Imaging study of “shell” phenomenon of thoracolumbar fractures after posterior reduction_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HU Haigang ,  LIN Xu , TAN Lun , WU Chao , ZHONG Zeli , ZENG Jun , DENG Jiayan

No.1 Department of Orthopedics, Zigong Fourth People’s Hospital, Zigong Sichuan, 643000, P.R.China;

Corresponding author：

LIN Xu, Email: med_linxu@163.com

Keywords：

Thoracolumbar fracture; " shell” phenomenon; internal fixation; imaging characteristic

DOI：

10.7507/1002-1892.201611009

Video：

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Objective To analyze the imaging characteristics of vertebral " shell” phenomenon of thoracolumbar fractures after posterior reduction and to explore the relationship between vertebral " shell” and fracture healing. Methods Between January 2013 and December 2015, the clinical data of 116 patients with thoracolumbar fractures treated with posterior pedicle screw-rod system reduction and internal fixation were analyzed retrospectively. There were 72 males and 44 females, aged 22-66 years (mean, 43 years). Injury causes were traffic accident in 24 cases, falling from height in 54 cases, bruise in 38 cases. Fracture segment located at T₁₁ in 5 cases, T₁₂ in 38 cases, L₁ in 52 cases, L₂ in 21 cases. There were 51 cases of compressive fracture and 65 cases of burst fracture. The sagittal Cobb angle ranged from 8 to 27°, with an average of 15°. Degree of preoperative spinal compression ranged from 20% to 75%, with an average of 44%. Bone density measurement showed that normal bone mass in 30 cases, bone loss in 40 cases, osteoporosis in 41 cases, and severe osteoporosis in 5 cases. The number, pathological characteristics, and imaging regularity of the vertebral " shell” phenomenon were observed and analyzed by logistic regression. Results All patients were followed up 11-18 months with an average of 13 months. A total of 72 cases of vertebral " shell” phenomenon mainly located in the vertebral anterior column and the end plate near the weak area (54/72, 75.0%). Most of them were in the irregular shape (50/72, 69.5%). The vertebral fracture line was related to the shape of the vertebral body and the displacement of the vertebral body after reduction. The outcome of the " shell” can be divided into disappeared type, reduced type, and collapse type, the volume of vertebral " shell” and its outcome were the risk factors for vertebral fracture healing. Conclusion The incidence of vertebral " shell” and nonuion of thoracolumbar fractures after posterior reduction are high. The main influencing factors are vertebral " shell” outcome and size.

Citation： HU Haigang, LIN Xu, TAN Lun, WU Chao, ZHONG Zeli, ZENG Jun, DENG Jiayan. Imaging study of “shell” phenomenon of thoracolumbar fractures after posterior reduction. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(8): 976-981. doi: 10.7507/1002-1892.201611009 Copy

1.	叶晶华, 王剑锋, 顾豪杰, 等. 对不同年龄段胸腰椎骨折复位后" 空壳”现象的处理. 吉林医学, 2016, 37(4): 808-810.
2.	印飞, 张绍东, 吴小涛, 等. 短节段椎弓根螺钉复位固定伤椎内植骨治疗 Denis B 型胸腰椎骨折的影像学观察. 中国脊柱脊髓杂志, 2013, 23(4): 341-346.
3.	敖俊, 辛志军, 陈方, 等. 两种植骨法对胸腰椎爆裂骨折复位后骨缺损空隙残存率及压缩刚度的影响. 中国修复重建外科杂志, 2013, 27(8): 974-979.
4.	刘团江, 郝定均, 王晓东, 等. 胸腰段骨折椎弓根钉复位固定术后骨缺损的 CT 研究. 中国矫形外科杂志, 2003, 11(10): 706-707.
5.	桂忠山, 徐晓峰. 椎弓根螺钉置入修复胸腰椎骨折: 影响椎体高度恢复的相关因素分析. 中国组织工程研究, 2015, 19(39): 6315-6320.
6.	安毅, 李晶, 刘兰泽, 等. 胸腰椎骨折经椎弓根椎体内植骨术后伤椎愈合情况的对比. 中国骨与关节损伤杂志, 2015, 30(5): 460-463.
7.	沈军, 邹天明, 缪烨, 等. 决定胸腰椎骨折椎体内植骨组织爬行替代的因素. 中国组织工程研究, 2013, 17(53): 9113-9118.
8.	胡海刚, 谭伦, 林旭, 等. 经伤椎椎弓根植骨置钉后路复位内固定术治疗胸腰椎骨折. 中国脊柱脊髓杂志, 2011, 21(8): 663-668.
9.	辛志军. 不同植骨方法对胸腰椎爆裂骨折内固定后生物力学影响的实验研究. 遵义: 遵义医学院, 2012.
10.	谭伦, 吴超, 罗晓中, 等. 以椎板边缘对腰椎椎弓根螺钉进钉点的个体化定位. 中国矫形外科杂志, 2008, 16(3): 207-210.
11.	杜桂迎, 余卫, 林强, 等. WHO 双能 X 线吸收仪骨质疏松症诊断标准及其相关问题. 中华骨质疏松和骨矿盐疾病杂志, 2016, 9(3): 330-338.
12.	Phillips FM, Ho E, Campbell-Hupp M, et al. Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures. Spine, 2003, 28(19): 2265-2267.
13.	钱冰, 郝定均, 郑永宏, 等. 两种术式治疗不稳定型 Kümmell 病的疗效比较. 中国修复重建外科杂志, 2017, 32(2): 185-190.
14.	姜猛. 胸腰椎骨折去除内固定后" 蛋壳样椎体”与椎体矫正度丢失关系的有限元分析. 石家庄: 河北医科大学, 2014.
15.	刘列华, 赵斌, 周强. 伤椎椎体内强化治疗胸腰椎骨折的现状. 局解手术学杂志, 2016, 25(1): 62-65.
16.	丁明, 孙东升, 韩国华, 等. 胸腰段椎体区域性骨密度分析及其临床研究. 中国骨与关节损伤杂志, 2010, 25(3): 237-238.
17.	Biedermann L. Biomecaiancia of pedicle fixation as related to implant design. Munich: American-European Meeting on pedicle fixation of the Spine and Other Advanced Techniques, 1994.
18.	崔冠宇, 田伟, 刘波, 等. 椎体强化后椎弓根螺钉内固定术治疗骨质疏松性胸腰椎爆裂骨折. 中华创伤骨科杂志, 2015, 17(6): 502-508.

1. 叶晶华, 王剑锋, 顾豪杰, 等. 对不同年龄段胸腰椎骨折复位后" 空壳”现象的处理. 吉林医学, 2016, 37(4): 808-810.
2. 印飞, 张绍东, 吴小涛, 等. 短节段椎弓根螺钉复位固定伤椎内植骨治疗 Denis B 型胸腰椎骨折的影像学观察. 中国脊柱脊髓杂志, 2013, 23(4): 341-346.
3. 敖俊, 辛志军, 陈方, 等. 两种植骨法对胸腰椎爆裂骨折复位后骨缺损空隙残存率及压缩刚度的影响. 中国修复重建外科杂志, 2013, 27(8): 974-979.
4. 刘团江, 郝定均, 王晓东, 等. 胸腰段骨折椎弓根钉复位固定术后骨缺损的 CT 研究. 中国矫形外科杂志, 2003, 11(10): 706-707.
5. 桂忠山, 徐晓峰. 椎弓根螺钉置入修复胸腰椎骨折: 影响椎体高度恢复的相关因素分析. 中国组织工程研究, 2015, 19(39): 6315-6320.
6. 安毅, 李晶, 刘兰泽, 等. 胸腰椎骨折经椎弓根椎体内植骨术后伤椎愈合情况的对比. 中国骨与关节损伤杂志, 2015, 30(5): 460-463.
7. 沈军, 邹天明, 缪烨, 等. 决定胸腰椎骨折椎体内植骨组织爬行替代的因素. 中国组织工程研究, 2013, 17(53): 9113-9118.
8. 胡海刚, 谭伦, 林旭, 等. 经伤椎椎弓根植骨置钉后路复位内固定术治疗胸腰椎骨折. 中国脊柱脊髓杂志, 2011, 21(8): 663-668.
9. 辛志军. 不同植骨方法对胸腰椎爆裂骨折内固定后生物力学影响的实验研究. 遵义: 遵义医学院, 2012.
10. 谭伦, 吴超, 罗晓中, 等. 以椎板边缘对腰椎椎弓根螺钉进钉点的个体化定位. 中国矫形外科杂志, 2008, 16(3): 207-210.
11. 杜桂迎, 余卫, 林强, 等. WHO 双能 X 线吸收仪骨质疏松症诊断标准及其相关问题. 中华骨质疏松和骨矿盐疾病杂志, 2016, 9(3): 330-338.
12. Phillips FM, Ho E, Campbell-Hupp M, et al. Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures. Spine, 2003, 28(19): 2265-2267.
13. 钱冰, 郝定均, 郑永宏, 等. 两种术式治疗不稳定型 Kümmell 病的疗效比较. 中国修复重建外科杂志, 2017, 32(2): 185-190.
14. 姜猛. 胸腰椎骨折去除内固定后" 蛋壳样椎体”与椎体矫正度丢失关系的有限元分析. 石家庄: 河北医科大学, 2014.
15. 刘列华, 赵斌, 周强. 伤椎椎体内强化治疗胸腰椎骨折的现状. 局解手术学杂志, 2016, 25(1): 62-65.
16. 丁明, 孙东升, 韩国华, 等. 胸腰段椎体区域性骨密度分析及其临床研究. 中国骨与关节损伤杂志, 2010, 25(3): 237-238.
17. Biedermann L. Biomecaiancia of pedicle fixation as related to implant design. Munich: American-European Meeting on pedicle fixation of the Spine and Other Advanced Techniques, 1994.
18. 崔冠宇, 田伟, 刘波, 等. 椎体强化后椎弓根螺钉内固定术治疗骨质疏松性胸腰椎爆裂骨折. 中华创伤骨科杂志, 2015, 17(6): 502-508.

Chinese Journal of Reparative and Reconstructive Surgery

Imaging study of “shell” phenomenon of thoracolumbar fractures after posterior reduction

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