脊柱后结构在胸腰段脊髓神经损伤及爆裂骨折分类中的作用

目的观察脊柱后结构在脊髓神经组织损伤中的作用,为脊髓神经损伤程度评估和预测脊髓神经功能恢复的可能性及进一步完善分类提供依据。方法实验采用高速准静态轴向加载法复制脊椎爆裂型骨折模型,检测椎管内压力变化及脊柱后结构损伤程度。对127例胸腰椎爆裂骨折合并截瘫患者的脊髓神经损伤程度及脊髓神经功能恢复情况与后结构损伤的相关性进行回顾性研究。结果实验证实后柱有损伤者椎管内压力变化峰值较小,无损伤者峰值较大。55例后结构损伤患者中伴脊髓神经损伤38例(69.09%),其中24例(63.16%)神经功能得到恢复,而72例无后结构损伤者有52例(72.22%)合并脊髓神经损伤,其中20例(38.46%)有神经功能改善。两组之间差异有显著性,提示无后结构损伤患者脊髓神经损伤和功能缺失的程度更重。结论无后结构损伤时脊髓神经损伤和功能缺失的程度明显高于有后结构损伤者,脊柱后结构的完整与否对脊髓神经损伤程度起着重要作用,可作为伤情评估、功能恢复预测和完善Denis分类的有效尺度。

The role of the posterior elements of the spine in the classification of thoraco-lumbar burst fractures and spinal cord injuries

Objective To observe the role of the posterior e lements of the spine in the spinal cord injuries and to provide the basic evidence for proper evaluation of the se verity of spinal cord injuries and th e possibilities of functional recove ry.Methods Experimental study:The experiment al model of spinal burst fracture was established in the thoraco-lumbar column section which subjected high velocity vertical loadi ng in static pattern.The pressure changes in the vertebral canal and the severity of posterior elements of the spin e were observed,and then their relationship was studied.Clinical Study:The data were obtained from 127consecutive cases of thoraco-lumbar burst fracture associated with paraplegia.The relationship between t he severity of spinal cord injury,functional recovery and the posterior elements injuries was studied retrosp ec-tively.Results The experimental study showed that g reat pressure changes appeared in th e vertebral spec-imens without posterior elements in juries.On the contrary,the peak value of pressure was low in cases with posterior elements injuries.Clini cal results:Of 38cases(69.09%)with spinal cord injuries in 55patie nts without posterior elements injurie s,functional recovery was found in 24cases(63.16%).In another group,of 52cases(72.22%)with spinal cord injuries in 72patie nts with posterior elements injurie s,functional recovery was found in 20cases(38.46%).The statistic difference between t he two groups indicated that the severity of spinal cord injuries in t he patients without posterior eleme nts injuries was more severe than that with posterior elements injuries.Conclusion The spinal posterior elements play a n important role in spinal cord injuries.The severity of posterior elements injuries can be used as a sca le in the evaluation of the severity o f spinal cord injuries,functional re covery and improvement of Denis classification.