Abstract：【Objective】To investigate the significance of the degree of vertebral height loss and the degree of recovery of vertebral body height after operation and the clinical significance by measuring the size of the gap left by the bone defect in the thoracolumbar spine burst fracture before and after operation in CT images.【Methods】A retrospective review was made based on imaging material of forty patients who accepted posterior restoration and instrumentation through pedicle-screw implant technique because of thoracic or lumbar spine burst fracture. The preoperative and postoperative computed tomography (CT) scans were performed for each case, mid-sagittal or para-mid-sagittal scans were selected to measure the preoperative minimal residual vertebral body height (Pre-VBH), postoperative maximal vertebral body height restoration ( Po-VBH) and the maximal vertical gap-height (GH) within the restored vertebral body; the relationship between GH and Pre-VBH, Po-VBH was analyzed. At the same time, 15 cases of internal fixation fracture caused by nonunion of vertebral fracture were analyzed retrospectively in order to explore the critical value of the percentage of vertebral compression, because of the too large gap in the vertebral body resulting in fracture nonunion.【Results】 Preoperative minimal residual vertebral body height (Pre-VBH) ranged from 20.8% to 60%, averaged 48.2%; postoperative maximal vertebral body height restoration (Po-VBH) was 71.5%~127.3%, averaged 93.3%; difference between Po-VBH and Pre-VBH was 21.4%~79.1%, averaged 45.7%; the maximal vertical gap-height (GH) within the restored vertebral body was 19.3%~76.7%, averaged 45.3%. Statistical analysis demonstrated there was no significant difference between the value of Po-VBH minus Pre-VBH and the value of GH. The value of gap-height in restored vertebral body measured and calculated in 15 failed cases of bone nonunion ranged from 44.5% to 67.5%. 【Conclusion】 Accompanying the restoration of compressed vertebral body height, there is always vertical gap left within the fractured vertebral body, the height of vertical gap is nearly equal to postoperative maximal vertebral body height restoration (Po-VBH) minus Preoperative minimal residual vertebral body height (Pre-VBH),which can facilitate us to formulate a formula: postoperative gap height (GH)≌(Po-VBH)- (Pre-VBH). If the value of the gap-height within restored vertebral body is 44.5% more than the height of vertebral body after fracture reduction, bone nonunion may be an inevitable result for thoracic or lumbar burst fracture.
郭克淼;李晶;. 胸腰椎爆裂骨折后路手术后椎体内空隙高度的CT影像测量及其临床意义[J]. 医学临床研究, 2017, 34(4): 658-663.
GUO Ke-miao, LI Jing. CT Image Measurement and its Clinical Significance of Vertebral Height in Patients with Thoracolumbar Burst Fracture. JOURNAL OF CLINICAL RESEARCH, 2017, 34(4): 658-663.
[1] McLain RF, Sparling E, Benson DR. Early failure of short-segment pedicle instrumentation of thoracolumbar fractures. A preliminary report[J].J Bone Joint Surg Am,1993, 75(2):162-167. [2] Alanay A, Acarolu E, Yazici M,et al.Short-segment pedicle instrumentation of thoracolumbar burst fractures: does transpedicular intracorporeal grafting prevent early failure[J].Spine,2001, 26(2):213-217. [3] Knop C, Bastian L, Lange U, et al.Complications in surgical treatment of thoracolumbar injuries[J].Eur Spine J,2002,11(3):214-226. [4] Ebelke DK, Asher MA, Neff JR,et al.Survivorship analysis of VSP spine instrumentation in the treatment of thoracolumbar and lumbar burst fractures[J].Spine,1991,16 (suppl 8): 428-492. [5] Verlaan JJ, van Helden WH, Oner FC, et al.Balloon vertebroplasty with calcium phosphate cement augmentation for direct restoration of traumatic thoracolumbar vertebral fractures[J].Spine,2002,27(5):543-548. [6] Knop C, Fabian HF, Bastian L, et al. Late results of thoracolumbar fractures after posterior instrumentation and transpedicular bone grafting[J].Spine,2001,26(1):88-99. [7] Tagil M, Johnsson R, Stromqvist B, et al. Incomplete incorporation of morselized and impacted autologous bone graft: a histological study in 4 intracorporally grafted lumbar fractures[J].Acta Orthop Scand,1999,70(6):555-558. [8] Kaneda K, Abumi K, Fujiya M.Burst fractures with neurologic deficits of the thoracolumbar-lumbar spine: results of anterior decompression and stabilization with anterior instrumentation[J].Spine,1984,9(8):788-795. [9] Hitchon PW, Torner JC, Haddad SF, et al .Management options in thoracolumbar burst fractures[J].Surg Neurol,1998,49(6):619-627. [10] Kaneda K, Taneichi H, Abumi K, et al. Anterior decompression and stabilization with the Kaneda device for thoracolumbar burst fractures associated with neurological deficits[J].J Bone Joint Surg Am,1997,79(1):69-83.
2017, Vol. 34 
