摘要
目的评估胸腰段骨折椎体邻近椎间盘中短期的变化,总结其在MRI上的影像学特点,并对其临床意义进行探讨。方法收集山西医科大学第二医院2020年5月至2021年5月共25例胸腰段骨折患者资料,其中男19例,女6例;年龄29~56岁,平均(41.08±7.10)岁。其中T_(12)骨折3例,L_(1)骨折14例,L_(2)骨折8例。记录术前和内固定取出(内固定物平均在10个月时取出)前1周内的MRI资料,观察与骨折椎体相邻的50个椎间盘在T_(2)WI上的形态学特征及信号变化,总结其特点,并比较术后及内固定取出后疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)。结果术前T_(2)WI提示信号正常的21个椎间盘中,86%(18/21)的椎间盘在取出内固定时显示正常信号;术前T_(2)WI提示信号增加的19个椎间盘中,42%(8/19)的椎间盘信号强度在取出内固定时恢复正常,16%(3/19)的椎间盘提示高信号,26%(5/19)的椎间盘提示低信号,16%(3/19)的椎间盘出现信号丢失;术前T_(2)WI信号降低的10个椎间盘中,仅有1个椎间盘在取出内固定时恢复正常。在19个形态完整的椎间盘(Ⅰ类)中,共有79%(15/19)的椎间盘保留了其结构完整性;在29个有轻微缺陷的椎间盘(Ⅱ类)中,有7%(2/29)的椎间盘在取出内固定时形态恢复至Ⅰ类,62%(18/29)的椎间盘保持不变,31%的椎间盘结构出现恶化(Ⅲ类)。术后VAS、ODI与取出内固定后VAS、ODI比较,差异均有统计学意义(P<0.05)。结论部分胸腰段骨折患者会合并椎间盘的损伤,临床上可将MRI上椎间盘信号和形态的改变作为选择治疗方式的重要参考因素之一;若是椎间盘信号和形态完整或轻度改变时,可行单纯后路撑开复位内固定术;若在椎间盘信号改变的基础上出现较为严重的形态学改变,这类患者在取出内固定后VAS及ODI评分显示更差,远期可能会出现后凸畸形等并发症,故应酌情考虑行融合手术。
Objective To evaluate the mid and short term changes of vertebral disc adjacent to thoracolumbar burst fracture and summarize its imaging characteristics and clinical significance on MRI.Methods The MRI data of 25 patients with thoracolumbar fracture in the Second Hospital of Shanxi Medical University from May 2020 to May 2021 were collected,including 19 males and 6 females.The age ranged from 29 to 56 years,with an average of(41.08±7.10)years.There were 3 T fractures,14 L fractures and 8 L fractures.MRI data were recorded before surgery and one week before internal fixation removal(internal fixation was removed at an average of 10 months).Morphological characteristics and signal changes of 50 intervertebral discs adjacent to the fractured vertebral body were observed on T_(2)WI,and their characteristics were summarized.Visual analogue scale(VAS)and The Oswestry disability index(ODI)were compared after surgery and removal of internal fixation.Results 86%of the 21 discs with normal signal on T_(2)WI prior to reduction showed normal signal when the implants were removed.Of the 19 discs with increased signal intensity on T_(2)WI prior to treatment,42%returned to normal at the time of removal,16%had high signal intensity,26%had decreased signal intensity,and 16%had disc signal loss.Of the 10 discs with decreased signal on T_(2)WI before reduction,only 1 disc returned to normal.In 19 intact interverte bral disc(CategoryⅠ),a total of 79%of the intervertebral disc kept its structural integrity.In 29 slightly damaged intervertebral disc(CategoryⅡ),7%of the intervertebral discs recovered to the category 1,when internal fixation was removed.62%of the intervertebral disc remains the same,and 31%of the intervertebral disc structure deteriorated(CategoryⅢ).There were statistically significant differences in VAS and ODI after surgery compared with those after internal fixation(P<0.05).Conclusion Some patients with thoracolumbar fracture will have intervertebral disc injury.Clinically,the changes of intervertebral disc signal and shape on MRI is one of the important reference factors in the selection of treatment.If the signal and shape of the disc are intact or slightly changed,simple posterior distraction reduction and internal fixation is feasible.If serious morphological changes occur on the basis of changes in intervertebral disc signals,the VAS and ODI scores of such patients will be worse after the removal of internal fixation,and complications such as kyphosis may occur in the long term.Therefore,fusion surgery should be considered as appropriate.
作者
王佳佳
宋文慧
梁凯恒
鲍凯
Wang Jiajia;Song Wenhui;Liang Kaiheng;Bao Kai(Shanxi Medical University,Taiyuan 030000,China;Department of Orthopaedics,The 2nd Hospital of Shanxi Medical University,Taiyuan 030001,China)
出处
《实用骨科杂志》
2022年第6期481-486,共6页
Journal of Practical Orthopaedics
基金
山西省应用基础研究项目(201801D121324)。
关键词
胸腰段骨折
椎间盘损伤
影像学特点
融合治疗
thoracolumbar fracture
intervertebral disc
imaging features
fusion treatment
