胸腰段爆裂骨折的影像异常与神经损伤的关系

目的观察分析胸腰段爆裂骨折患者神经损伤是否存在及严重程度与以下因素的关系：①就诊时CT表现的椎管内骨块占位程度；②后凸畸形程度，评价后路经椎弓根器械治疗对恢复以下临床指标的效果：①伤椎前缘、后缘高度；②后凸成角；③神经功能；④椎管骨块占位。方法本组为99例胸腰段爆裂骨折患者，其中男71例，女28例；年龄17—68岁，平均37岁；致伤原因高处坠落57例，车祸2，4例，砸伤12例，其它6例；非手术治疗2例，除1例行单纯后路椎板减压外，余96例均行后路手术经椎弓根镙钉器械治疗，手术时间为伤后6小时-24天，术中出血为50ml-2000ml。所有患者入院时均行术前CT扫描、术前正侧位x线片，其中有7例有术后CT，非手术治疗和单纯后路椎板减压患者无术后x线片。所有影像资料都包括伤椎及与之相邻的上下椎体。受伤部位T11为5例、T12为15例、L1为53例、L2为26例。脊髓功能的评估以入院时首次体检（非手术治疗）或术前最后一次体检（手术治疗）为准，尽可能排除脊髓震荡所致的短暂脊髓功能障碍，术后以出院前最后一次体检为准。按修改的ASIA分级法进行评分，其中A级13例，B级7例，c级13例，D级29例，E级14例，F级23例。结果神经损伤按修改后的ASIA分级，各功能级之间椎管占位程度和后凸成角均无显著差异（P〉0．05），术后伤椎前缘高度恢复至（91．4±10．0）％，后缘高度恢复至（96．7±4．4）％，Cobb角恢复至（-2．0±5．6）°，椎管内占位恢复至（14．6±13．8）％，神经功能评分降至（1．5±1．6），以上各项指标与术前比较差异有显著性（P〈0．05）。结论①胸腰段爆裂骨折神经损伤是否存在及严重程度与就诊时CT表现的椎管内骨块占位程度和后凸畸形程度均具有不一致性，对于胸腰椎爆裂性骨折的早期治疗选择，不仅要考虑?

Relationship between morphological abnormalities and spinal cord lesion in thoracolumbar burst fracture and therapeutic effect of operation

Objective To investigate the rehtionship between spinal cord deficit in thoracolumbar brust fractures and morphological abnormalities including stenesis of spinal canal and kyphosis angle; To evaluate the effective d transpediele screw system through posterior method in recover the height of the vertebrae,the kyphosis angle,nerver function and degree of stenosis.Methods Ninety- nine patients with thorcolumbar burst fractures were retrospectively reviewed, including 71 males,28females. The average age is 37. The causes include 57 fall,24 raod accident, 12 smash,6 others. We calculate the stenofie ratio of spinal canal based on the area,and measure the kyphosis angle according to Cobb,and record the modified ASIA scoring of motor function of lower extremities;Of these ninety-nine cases,ninety-six patients were undertaken operation through posterior method. We measured the vertebral anterior and pos- terior height, stenotic ratio of spinal canal,kyphosis angle,nerve function before and after operation. Results There was no signifi- cant difference （ P 〉 0.05） of the stenotic ratio of spinal canal and the kyphosis angle among the patients of different ASIA scales. After operation, the anterior height of the injuried vertebrae is （91.4± 10.0）%, the posterior height of the injuried vertebrae is （96.7± 4.4） %, Cobb＇ s angle is （ - 2.0±5.6）% stenotic ratio of spinal canal is （ 14.6 ± 13.8） %, the score of nerve function is （ 1.5 ± 1.6）, there is significant difference （ P 〈 0.05）of these data according to the ones before operation. Conclusion The severity of spinal cord injuries in thomcolumbar burst fractures in not predicted according to the percentage of spinal canal stenosis or the degree of kyphosis induced by thoracolumbar burst fiactures; Operation using tanspedicle screw systera through posterior method is effective in ameliorating the sequence of spine and the function of spinal cord. It can indirect reduce the retropuled fragment effectivdy.