胸腰椎压缩性骨折椎间盘形态学观察及临床意义-东南大学学报医学版

胸腰椎压缩性骨折椎间盘形态学观察及临床意义

单位：南京医科大学鼓楼临床医学院脊柱外科, 江苏南京 210008

分类号：R683.2

出版年·卷·期（页码）：2016·35·第二期（176-180）

摘要：

目的:观察胸腰椎非骨质疏松性压缩性骨折邻近椎间盘MR影像学特征,分析其与终板损伤和椎体骨折之间的相关性。方法:选择96例胸腰椎非骨质疏松性压缩性骨折患者为研究对象,其中男69例,女27例,年龄20~50岁,平均31.7岁。行MR检查判断患者伤椎上位椎间盘和终板的损伤程度,行CT检查判断伤椎骨折范围。测量术前胸腰椎侧位X线片骨折节段后凸Cobb角、椎间隙高度、伤椎楔变角和前缘高度,比较不同程度椎间盘损伤组影像学指标的差异性,分析终板损伤程度、椎体骨折范围与椎间盘损伤程度之间相关性。结果:96例患者中椎间盘损伤Ⅰ型20例,Ⅱ型29例,Ⅲ型30例,Ⅳ型17例;终板损伤Ⅰ型23例,Ⅱ型29例,Ⅲ型27例,Ⅳ型17例;椎体骨折Ⅰ度32例,Ⅱ度40例,Ⅲ度24例。终板损伤程度、椎体骨折范围与椎间盘损伤程度呈显著正相关(分别r=0.973、0.884,均P<0.01)。ANOVA结果显示:术前不同程度椎间盘损伤组的后凸Cobb角和伤椎楔变角差异均无统计学意义;而椎体前缘高度和椎间隙高度差异均有统计学意义(P<0.05)。在不同程度椎间盘损伤组中椎体前缘高度分别为Ⅰ型0.73±0.072、Ⅱ型0.65±0.084、Ⅲ型0.51±0.085、Ⅳ型0.36±0.061,SNK两两比较提示,各组间差异有统计学意义(P<0.05);椎间隙高度分别为Ⅰ型0.32±0.049、Ⅱ型0.28±0.057、Ⅲ型0.25±0.053、Ⅳ型0.24±0.041,SNK两两比较提示,椎间隙高度Ⅲ、Ⅳ型比Ⅰ型、Ⅱ型显著降低(P<0.05)。结论:在胸腰椎非骨质疏松性压缩性骨折中,终板损伤、椎体的骨折程度与伤椎上位椎间盘的损伤程度密切相关。

Objective:To observe the morphological characteristics of the intervertebral disc in thoracolumbar non-osteoporotic compression fractures and to analyze its correlation with endplate injury and vertebra fracture. Methods:Ninety-six patients with thoracolumbar non-osteoporotic compression compression fractures were retrospectively reviewed, including 69 males and 27 females, with the average age of 31.7(20-50) years old. MR were underwent to evaluate the injury degrees of the superior intervertebral discs and endplates. CT were performed to assess the severity of vertebrae fracture. Local kyphosis angle(LKA), disc height(DH), vertebral wedge angle(VWA) and anterior vertebral body height(AVH) were measured on preoperative X-ray images. The difference in radiographic indexes between type Ⅰ-Ⅳ disc injury groups were compared, and correlation of endplate injury, vertebral fracture and disc injury analyzed. Results:Among the 96 patients, 20 patients were type Ⅰ disc injury, 29 were typeⅡ, 30 were type Ⅲ and 17 were type Ⅳ. With regard to endplate injury, 23 patients were categorized to type Ⅰ, 29 patients were typeⅡ, 27 were type Ⅲ and 17 were type Ⅳ. With respect to vertebra fracture, 32 patients were ranked with degree Ⅰ, 40 were degree Ⅱ and 24 were degree Ⅲ. The degree of endplate injury, severity of vertebrae fracture were strongly correlated with the degrees of disc injury(r=0.973, r=0.884, respectively, P<0.01). ANOVA results revealed there were no significant difference in LKA and VWA between type Ⅰ-Ⅳ disc injury group but there were significant difference in AVH and DH(all P<0.05). The AVH in type Ⅰ-Ⅳ disc injury group were 0.73±0.072, 0.65±0.084, 0.51±0.085 and 0.36±0.061 respectively, with significant difference between each other among all types as demonstrated in SNK test. The DH in type Ⅰ-Ⅳ disc injury group were 0.32±0.049, 0.28±0.057, 0.25±0.053 and 0.24±0.041 respectively, with significantly lower DH in types Ⅲ and Ⅳ than types Ⅰ and Ⅱ. Conclusion:In thoracolumbar non-osteoporotic compression fracture, the degree of superior endplate injury and the severity of vertebrae fracture are highly correlated with injury of the superior intervertebral discs.

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