胸腰椎爆裂骨折术后椎管内骨块吸收回纳的相关因素分析

Relationship between clinical factors and the absorption of the bone fragment in thoracolumbar burst fractures after surgery

中文关键词:  胸腰椎爆裂骨折  椎管重塑  复位率  再吸收率

英文关键词:Thoracolumbar burst fractures  Spontaneous spinal remodeling  Reduction rate  Resorption rate

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管内骨块吸收回纳与临床因素之间的关系。方法：本研究共纳入2016年1月～2017年10月收治的61例无脊髓神经损伤症状的胸腰椎爆裂骨折患者。所有患者均拍摄术前、术后3d内与术后6个月时的CT+三维重建影像，通过影像资料计算其各时期的椎管内骨块体积。复位率定义为术后即刻较术前椎管内骨块体积的变化与术前椎管内骨块的体积之比；将术后6个月较术后骨块体积的变化与术后椎管内骨块体积之比称为再吸收率。可能影响椎管内骨块吸收回纳的因素包括：年龄、性别、骨折节段、术后椎体前缘压缩比率的恢复、术中置钉方式的不同、Cobb角的恢复率。通过多元回归分析研究复位率、再吸收率与上述相关因素之间的关系。结果：术后椎管内占位骨块的复位率及再吸收率与年龄、性别、骨折节段、术中置钉方式的不同、Cobb角恢复率无相关性（P＞0.05）。椎体前缘压缩比率的恢复与术后椎管内占位骨块的复位率（t=3.552）、再吸收率（t=2.262）均有明显相关性（P＜0.05）。术后椎体前缘压缩率较术前每恢复1%，复位率会提高0.429%，再吸收率会提高0.284%。结论：在进行后路撑开复位、间接减压的手术中，椎体前缘压缩比率的恢复与术后椎管内占位骨块的吸收回纳、椎管重塑均有明显相关性。在进行撑开复位过程中应注意对于椎体前缘压缩比率的恢复，有利于骨块复位及椎管重塑。

英文摘要:

  【Abstract】 Objectives: To analyze the relationship between clinical factors and the absorption of the bone fragment after posterior distraction and indirect decompression of thoracolumbar burst fractures. Methods: 61 patients without spinal cord nerve damage after thoracolumbar burst fractures were included. 3D-computed tomography scan was performed on these patients before surgery, within a week after surgery, and at 6 months after surgery. The volume of the bone fragment was calculated by 3D-CT images. The ratio of the volume of bone fragments at 3 days after operation to those before the operation was called reduction rate. The ratio of the volume of bone fragments at 6 months after operation to those immediately after the operation was called reabsorption rate. Factors potentially affecting the postoperative degree of reduction and spontaneous spinal remodeling, including age, sex, location, degree of change of anterior vertebral compression ratio, different implantations of the pedicle screws, and recovery rate of Cobb angle were analyzed. Multiple regression analyses were conducted on these factors to analyze the extent of their influences on the reduction and resorption rates. Results: The reduction rate and resorption rate had no correlation with age, sex, location, different implantations of the pedicle screws, recovery rate of Cobb angle(P＞0.05). The recovery rate of the anterior compression was significantly related(P＜0.05) to the reduction rate(t=3.552) and the resorption rate(t=2.262) after surgery. When 1% of the anterior compression rate had been restored, 0.429% of the reduction rate increased, 0.284% of the resorption rate increased. Conclusions: During posterior distraction and indirect decompression, the recovery rate of the anterior compression is significantly related to the bone fragment absorption and spontaneous canal remodeling. Therefore, more attention must be paid to the distraction technique during the operation so as to get better recovery of the anterior compression.