合并椎板骨折的L_2-L_5爆裂性骨折伴硬膜及马尾神经卡压  

Dural tear and cauda equina entrapment in the burst fractures of the second through fifth lumbar vertebrae with the laminar fractures

作　　者：张银顺[1] 张建湘[1] 华兴一[1] 汤健[1] 杨庆国[1] 申才良[1] 江曙[1] 周剑[1] 

机构地区：[1]安徽医科大学第一附属医院骨科三病区,安徽合肥230022

出　　处：《颈腰痛杂志》2009年第4期313-316,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨合并椎板骨折的L2-L5爆裂性骨折中硬脊膜撕裂及马尾神经卡压的创伤机制、发生率,以及哪些临床和影像学表现有助于术前判断硬脊膜撕裂和马尾神经卡压。方法对36例行手术治疗的合并椎板骨折的L2-L5爆裂性骨折进行回顾性分析。结果36例中,16例(44.4%)并发硬脊膜撕裂,有硬脊膜撕裂的患者神经损伤程度明显重于无硬脊膜撕裂的患者,前者伤椎椎弓根间距增宽率明显高于后者。结论对于椎板骨折,尤其是裂缝骨折的患者,术前很难通过影像学表现明确判断是否有硬脊膜撕裂及马尾神经卡压。因此只要怀疑有硬脊膜撕裂,应首先选择后路手术方案,任何复位操作宜在椎管减压之后进行。Objective To determine the incidence and mechanism of dural tears in burst fractures of the second through fifth lumbar vertebrae with lamina fractures and to find out if any specific clinical and radiographic factors are predictive of dural tears and cauda equina entrapment. Methods 36 patients who had burst fractures of the second through fifth lumbar vertebrae with lamina fractures treated operatively were retrospectively reviewed. Results Dural tears were detected in 16 （44.4%） of the 36 patients. There were a obviously association between a dural tear and neurologic deficit. Percentage increase of interpedicular distance was significantly higher（P〈0.01） in cases with dural tears than that were in cases without dural tears. Conclusion It is difficult to detect dural tear and nerve root entrapment in greenstick lamina fracture before surgery. Therefore, if there is any suspicion of such an occurrence,it should be the rule to begin with posterior approach and use the open book technique to expose the dura safely before reduction maneuver.

关 键 词：爆裂性骨折 椎板骨折 硬脊膜撕裂 马尾神经 

分 类 号：R683.2[医药卫生—骨科学]