胸腰椎爆裂骨折术后椎体“空壳”体积变化的相关因素分析

Relationship between clinical factors and the volume change of vertebral "shell" after thoracolumbar burst fractures after surgery

中文关键词:  胸腰椎爆裂骨折  “空壳”现象  再吸收率  相关因素

英文关键词:Thoracolumbar burst fractures  "Shell" phenomenon  Resorption rate  Influencing factor

中文摘要:

  【摘要】 目的：分析胸腰椎爆裂骨折后路撑开复位间接减压内固定术后椎体“空壳”体积变化与临床因素之间的关系。方法：本研究共纳入2016年1月～2018年1月我科收治的52例胸腰椎单节段爆裂骨折行后路撑开复位间接减压内固定术后出现“空壳”现象的患者。所有患者均拍摄术前、术后3d内及术后6个月时的CT-三维重建影像学资料，通过收集临床及影像学资料计算各时期的“空壳”体积。将术后6个月较术后即刻椎管内骨块体积的变化与术后即刻骨块体积之比称为再吸收率，将术后6个月较术后即刻椎体“空壳”体积的变化与术后即刻“空壳”体积之比称为体积变化率。可能影响椎体“空壳”体积变化率的因素包括：年龄、性别、骨折节段、骨折类型、术前椎体压缩率、术后椎管内骨块的再吸收率、术后椎体前缘高度的恢复率、Cobb角的恢复率。通过单因素和多因素分析研究体积变化率与上述相关因素之间的关系。结果：术后椎体“空壳”的体积变化率与年龄、性别、BMI、吸烟、骨折节段、骨折类型、Cobb角的恢复率、有无椎间盘损伤无相关性（P＞0.05）。单因素分析结果中显示患者术前椎体压缩率、术后椎管内骨块的再吸收率、术后椎体前缘高度的恢复率与术后椎体“空壳”的体积变化率均有明显相关性（P＜0.05），多因素分析中结果显示术前椎体压缩率（t=-2.47）、术后椎管内骨块的再吸收率（t=5.06）是影响术后椎体“空壳”体积变化率的主要因素，术前椎体压缩率对术后椎体“空壳”体积变化率有负向影响，术后椎管内骨块的再吸收率对术后椎体“空壳”体积变化率有正向影响（P＜0.05）。结论：胸腰椎爆裂骨折行后路撑开复位、间接减压内固定术后出现的椎体“空壳”体积变化受多种因素影响，其中术前椎体压缩率、术后椎管内骨块的再吸收率是其主要影响因素。

英文摘要:

  【Abstract】 Objectives: To analyze the relationship between the volume change of vertebral "shell" and clinical factors after posterior distraction and indirect decompression of thoracolumbar burst fractures. Methods: Totally 52 patients with thoracolumbar single-segment burst fractures undergoing open reduction and indirect decompression and internal fixation in our department from January 2016 to January 2018 were reviewed. CT- three dimentional reconstruction was performed on these patients before surgery, within 3 days after surgery, and at 6 months after surgery. The volume of vertebral "shell" was calculated by 3D-CT images. The ratio of the volume of bone fragments at 6 months after surgery to those immediately after the surgery was called resorption rate. The ratio of the volume change of vertebral "shell" at 6 months after surgery to that immediately after surgery was called the rate of volume change. Possible factors affecting the rate of volume change of vertebral "shell" included age, gender, location, fracture segment, fracture type, preoperative compression rate of vertebra, resorption rate, recovery rate of the anterior height of vertebral body after operation and recovery rate of Cobb angle. Single factor and multi-factor logistic analysis were used to study the correlation between these factors and the rate of volume change of vertebral "shell". Results: The rate of volume change of vertebral "shell" had no correlation with age, gender, BMI, smoking, intervertebral disc injury location, fracture type, recovery rate of Cobb angle(P>0.05). Single factor analysis showed that the rate of volume change of vertebral "shell" was significantly correlated with preoperative compression rate of vertebral body, resorption rate and recovery rate of the anterior height of vertebral body after operation(P<0.05). Multi-factor analysis showed that preoperative compression rate(t=-2.47) of vertebral body and resorption rate(t=5.06) were the main influencing factors of the rate of volume change of vertebral "shell". Preoperative compression rate of vertebral body had a negative influence on the rate of volume change of vertebral "shell" while the resorption rate had a positive effect on the rate of volume change of vertebral "shell"(P<0.05). Conclusions: The volume change of vertebral "shell" after thoracolumbar burst fracture with open reduction, indirect decompression and internal fixation is influenced by many factors. The preoperative compression rate of vertebral body and resorption rate are the main influencing factors.