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.	葉晶華, 王劍鋒, 顧豪杰, 等. 對不同年齡段胸腰椎骨折復位后" 空殼”現象的處理. 吉林醫學, 2016, 37(4): 808-810.
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4.	劉團江, 郝定均, 王曉東, 等. 胸腰段骨折椎弓根釘復位固定術后骨缺損的 CT 研究. 中國矯形外科雜志, 2003, 11(10): 706-707.
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8.	胡海剛, 譚倫, 林旭, 等. 經傷椎椎弓根植骨置釘后路復位內固定術治療胸腰椎骨折. 中國脊柱脊髓雜志, 2011, 21(8): 663-668.
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13.	錢冰, 郝定均, 鄭永宏, 等. 兩種術式治療不穩定型 Kümmell 病的療效比較. 中國修復重建外科雜志, 2017, 32(2): 185-190.
14.	姜猛. 胸腰椎骨折去除內固定后" 蛋殼樣椎體”與椎體矯正度丟失關系的有限元分析. 石家莊: 河北醫科大學, 2014.
15.	劉列華, 趙斌, 周強. 傷椎椎體內強化治療胸腰椎骨折的現狀. 局解手術學雜志, 2016, 25(1): 62-65.
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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, 田偉, 劉波, 等. 椎體強化后椎弓根螺釘內固定術治療骨質疏松性胸腰椎爆裂骨折. 中華創傷骨科雜志, 2015, 17(6): 502-508.

1. 葉晶華, 王劍鋒, 顧豪杰, 等. 對不同年齡段胸腰椎骨折復位后" 空殼”現象的處理. 吉林醫學, 2016, 37(4): 808-810.
2. 印飛, 張紹東, 吳小濤, 等. 短節段椎弓根螺釘復位固定傷椎內植骨治療 Denis B 型胸腰椎骨折的影像學觀察. 中國脊柱脊髓雜志, 2013, 23(4): 341-346.
3. 敖俊, 辛志軍, 陳方, 等. 兩種植骨法對胸腰椎爆裂骨折復位后骨缺損空隙殘存率及壓縮剛度的影響. 中國修復重建外科雜志, 2013, 27(8): 974-979.
4. 劉團江, 郝定均, 王曉東, 等. 胸腰段骨折椎弓根釘復位固定術后骨缺損的 CT 研究. 中國矯形外科雜志, 2003, 11(10): 706-707.
5. 桂忠山, 徐曉峰. 椎弓根螺釘置入修復胸腰椎骨折: 影響椎體高度恢復的相關因素分析. 中國組織工程研究, 2015, 19(39): 6315-6320.
6. 安毅, 李晶, 劉蘭澤, 等. 胸腰椎骨折經椎弓根椎體內植骨術后傷椎愈合情況的對比. 中國骨與關節損傷雜志, 2015, 30(5): 460-463.
7. 沈軍, 鄒天明, 繆燁, 等. 決定胸腰椎骨折椎體內植骨組織爬行替代的因素. 中國組織工程研究, 2013, 17(53): 9113-9118.
8. 胡海剛, 譚倫, 林旭, 等. 經傷椎椎弓根植骨置釘后路復位內固定術治療胸腰椎骨折. 中國脊柱脊髓雜志, 2011, 21(8): 663-668.
9. 辛志軍. 不同植骨方法對胸腰椎爆裂骨折內固定后生物力學影響的實驗研究. 遵義: 遵義醫學院, 2012.
10. 譚倫, 吳超, 羅曉中, 等. 以椎板邊緣對腰椎椎弓根螺釘進釘點的個體化定位. 中國矯形外科雜志, 2008, 16(3): 207-210.
11. 杜桂迎, 余衛, 林強, 等. WHO 雙能 X 線吸收儀骨質疏松癥診斷標準及其相關問題. 中華骨質疏松和骨礦鹽疾病雜志, 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. 錢冰, 郝定均, 鄭永宏, 等. 兩種術式治療不穩定型 Kümmell 病的療效比較. 中國修復重建外科雜志, 2017, 32(2): 185-190.
14. 姜猛. 胸腰椎骨折去除內固定后" 蛋殼樣椎體”與椎體矯正度丟失關系的有限元分析. 石家莊: 河北醫科大學, 2014.
15. 劉列華, 趙斌, 周強. 傷椎椎體內強化治療胸腰椎骨折的現狀. 局解手術學雜志, 2016, 25(1): 62-65.
16. 丁明, 孫東升, 韓國華, 等. 胸腰段椎體區域性骨密度分析及其臨床研究. 中國骨與關節損傷雜志, 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, 田偉, 劉波, 等. 椎體強化后椎弓根螺釘內固定術治療骨質疏松性胸腰椎爆裂骨折. 中華創傷骨科雜志, 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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