经保守治疗的稳定型胸腰椎骨折后凸畸形进行性加重相关原因分析被引量：5

Analysis the Causes of Progression Kyphotic Deformity in Conservatively Treated Stable Thoracolumbar Fractures

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摘要目的:探讨经保守治疗的稳定型胸腰椎骨折后凸畸形进行性加重与MRI影像学相关特征的关系。方法:回顾性研究经保守治疗的稳定型胸腰椎骨折患者,通过受伤时MRI来判断骨折椎前纵韧带(AL)、后纵韧带(PL)、上下终板及上下位椎间盘的损伤情况,通过X光片来测量受伤当时及最后随访时的骨折节段的后凸角、楔形角及椎体压缩比例,最后统计分析畸形加重的程度与MRI上相关结构损伤情况的相关性。结果:通过研究发现上终板的损伤和严重的骨水肿是引起后凸进行性加重、骨折椎体继续楔形变及椎体前柱压缩比例加大的重要因素。而当前纵韧带和骨折椎上椎间盘损伤时,仅后凸角呈进行性加大;但后纵韧带损伤、下终板的撕裂及下位椎间盘损伤与后凸畸形加重并没有明显的相关性。经研究发现引起后凸角加大超过5°的危险因素是前纵韧带损伤、上终板的撕裂、上位椎间盘的损伤及骨水肿范围超过椎体的1/3,同前纵韧带、上终板和上位椎间盘未损伤及骨水肿范围未超过椎体的1/3的病例相比,这些危险因素分别是引起后凸加重的约14.1、3.7、6.8和10.4倍。结论:前纵韧带损伤、骨折椎上终板及上位椎间盘损伤、严重的骨水肿是影响后凸畸形进行性加重的关键因素。 Objective： To investigate the relation between the progression of kyphotic deformity and magnetic resonance imaging （ MRI ） findings in conservatively treated stable thoracolumbar fractures.Method ： Retrospective study of patients with stable thoracolumbar fractures were treated with conservatively, MRI was used to determine the injury of anterior longitudinal ligament （ AL ）, posterior longitudinal ligament （ PL ）, superior and inferior endplate and superior and inferior intervertebral discs.The injured at that time and the last follow-up of the fracture segment kyphosis, wedge angle and the proportion of vertebral compression were measured by X ray.Finally, statistical analysis was made on the correlation between the severity of deformity and the damage of MRI.Result： The presence of superior endplate disruption and a higher level of bone edema were found to cause the progressions of kyphotic angle （ KA ）, wedge angle （ WA ）, and anterior vertebral compression （ AVC ） rate.When AL or superior disc injury was observed, only KA increased meaningfully, but PL injury, inferior endplate disruption, and inferior disc injury showed no notable correlation with kyphotic deformity progression.The risk factors found to be associated with an increase of KA to 〉5° were AL injury, superior endplate disruption, superior disc injury, and a bone edema level of over 1/3 were 14.1, 3.7, 6.8, and 10.4-fold compared with the not more than 1/3.Conclusion： AL injury, superior endplate and disc injury, and a high level of bone edema were critical actors that determine kyphotic deformity progression.