L1爆裂骨折程度及圆锥位置及神经损伤程度相关性分析.doc

L1爆裂骨折程度及圆锥位置及神经损伤程度相关性分析 　 作者：杨明亮，李建军，唐和虎 【摘要】 [目的]分析L1爆裂骨折严重程度、圆锥位置与神经损伤程度的相关性。[方法]回顾性分析L1爆裂骨折合并神经损伤病例的临床资料。采集反应骨折程度的影像指标包括:L1椎前高压缩率、后高压缩率、椎管中矢径比值、弓根间距比值、椎管面积比值及圆锥位置高低。神经损伤程度采用ASIA标准评估。分析采集指标与神经损伤程度相关性。[结果]本组病例27例，平均L1椎前高压缩率0.63、后高压缩率0.91、椎管中矢径比值0.69、 弓根间距比值1.14、椎管面积比值0.83。圆锥位置在L1中横截面或以上11例(高位分组)，以下16例(低位分组)。L1椎管面积比值在≥0.5及lt;0.5水平的两组间，神经损伤程度存在显著差异(P=0.049)。高位圆锥组与低位圆锥组间神经损伤程度存在显著差异(P=0.046)。[结论]在本研究设定的分组水平，L1爆裂骨折时椎管面积比值lt;0.5，神经损伤发生率及程度明显增加。低位圆锥组神经损伤比高位组严重。 【关键词】 L1爆裂骨折; 圆锥; 椎管狭窄; 神经损伤; 相关性 　　Abstract：[Objective]To assess whether the canal compromise and the location of conus medullaris determine neurological deficit in burst fracture of the first lumbar vertebra (L1).[Method]Twentyseven consecutive patients with L1 burst fracture were collected in the study.The compressive ratios of anterior and posterior heights of fractured vertebral bodies,the remains to the estimated ones of the original vertebral bodies were measured on the radiogram,the extent of spinal canal compromise was assessed by computed tomography,and the location of conus medullaris was determined by the MRI examination.The neurological status was evaluated according to the standard neurological classification of spinal cord injury (ASIA).[Result]The compressive ratio of the anterior height was 0.63,the posterior height was 0.91,the stenotic ratio of the canal midsagital diameter was 0.69,the stenotic ratio of the distance between pedicles was 1.14,and the stenotic ratio of canal area was 0.83.The group having the stenotic ratio of canal area below 0.5 was at significant risk of neurologic involvement than the control [above (or equal to) 0.5(P=0.049)],and the group with lower conus medullaris had more serious neurological deficit than the upper ones (P=0.046).[Conclusion]There is a significant difference of neurological deficit between the groups with the spinal canal stenosis level of more than 50% and less 50%,and the group with lower conus medullaris had more serious neurological deficit than