【摘要】 [目的]探讨A型(AO分型)胸腰椎骨折的患者,应用术前MRI中椎间盘组织的影像学特点评估患者预后疗效的可行性,为A型胸腰椎骨折临床治疗提供理论依据。[方法]分析2008年1月~2012年6月收治的90例胸腰椎骨折患者术前的MRI资料,按照椎间盘损伤的影像学特点分为3组(A、B、C组),每组30例,所有患者均采用传统短节段椎弓根钉固定结合伤椎置钉并椎体内植骨进行治疗,分别测量术后2周、术后1年、内固定取出半年的疼痛评分(VAS)、Cobb角及伤椎前高率,并做统计学分析。[结果]术后平均随访19.3个月(15~23个月),无断钉、断棒及内固定松动发生,所有伤口均Ⅰ期愈合,未出现其他并发症。术后1年时,C组患者的Cobb角与A、B组比较差异有统计学意义(P<0.01),内固定取出半年时,C组患者的三项检查指标[疼痛评分(VAS)、Cobb角、伤椎前高率]与A、B组比较差异均有统计学意义(P<0.01)。[结论]MRI检查是判断椎间盘损伤的重要手段,通过本项研究,作者认为术前MRI表现符合C组的患者,无论前路还是后路手术,切除受损的椎间盘组织同时行牢固的植骨融合内固定是手术的重要目的之一。更多还原

【Abstract】 [Objective]To investigate the feasibility of application of preoperative MRI intervertebral disc tissue imaging assessment prognosis effect in type A thoracolumbar fractures,in order to provide theory basis. [Method]From January 2008 to June 2012,90 consecutive patients suffered from type A thoracolumbar fracture were examined by MRI. According to the imaging characteristics of intervertebral disc injury were divided into 3 groups( group A,group B and group C),30 cases of each group.All patients were treated by short- segment pedicle screw fixation combined with bone graft of vertebral body via pedicle. In three time point( 2 weeks after operation,1 year after operation and six months after surgery to remove the internal fixation),these patients were evaluated with X- ray for anterior heights of the injured vertebra( AHIV) and Cobb angle and visual analog scale( VAS). [Result]All patients were followed up for 19. 3 months( range 15- 23 months). All the factures were reduced and the internal fixation was not loosened or broken. There was no lost correction or other complications. One year after operation,Cobb angle in group C showed significant difference( P < 0. 01). Six months after surgery to remove the internal fixation,the average height,Cobb angle and VAS in group C showed significant difference( P < 0. 01). [Conclusion]MRI is the important means to judge the damage of the intervertebral disc,through this research. We think that MRI before operation with the patients in the group C,both anterior or posterior approach operation,resection of the damaged disc tissue and solid bone fusion and internal fixation are important objective of operation.更多还原