The mechanism of thoracolumbar burst fracture may be related to the basivertebral foramen
The mechanism of thoracolumbar burst fracture may be related to the basivertebral foramen
复制标题
胸腰椎爆裂性骨折的机制可能与基椎孔有关
DOI：
10.1016/j.spinee.2017.08.237
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发表时间：
2018-03-01
期刊：
影响因子：
4.5
通讯作者：
Zhao, Fengdong
中科院分区：
文献类型：
--
作者：
Zhang, Xuyang;Li, Shengyun;Zhao, Fengdong
背景：位于椎体中后壁的椎基底静脉孔（BF）可能导致局部薄弱，并促使胸腰椎爆裂骨折（TLBF）中形成后移骨块（RBF）。我们假设TLBF的发病机制与BF有关。
目的：本研究旨在阐明TLBF中RBF与BF之间的关系，并通过生物力学实验和显微计算机断层扫描（显微CT）解释结果。
研究设计：对尸体脊柱进行了涉及临床放射学、显微CT和生物力学实验的综合研究。
患者样本：从256名报告胸腰椎受伤的患者中选取了162名连续的被诊断为伴有RBF的TLBF患者作为样本。
观察指标：与BF相关的RBF的尺寸和位置是观察指标。
材料和方法：利用计算机断层扫描重建影像测量162名患者中RBF的尺寸和位置（RBF及椎体的长度、高度、宽度）。此外，对10具尸体脊柱进行了显微CT扫描。将每个椎体分为三层（上、中、下），每层又进一步分为九个区域（R1 - R9）。通过显微CT扫描计算微结构参数，包括骨体积分数（BV/TV）、连接性（Conn.D）、骨小梁数量（Tb.N）、骨小梁厚度（Tb.Th）和骨矿物质密度（BMD）。分析区域和层之间的差异。在尸体脊柱上模拟爆裂骨折以探究骨折线位置并检验RBF与BF之间的关系。
结果：后移骨块的宽度通常是椎体宽度的三分之一，而RBF的长度和高度大约是相应椎体尺寸的一半。在椎体中与BF相邻且受爆裂骨折影响最大的中央和上部区域，骨小梁质量的测量值通常最低。在模拟的TLBF中，骨折线穿过BF的顶点或上表面。
结论：椎体中最脆弱的区域位于BF内或BF正上方。特别是中央的MR2区域有骨折和RBF形成的风险。（C）2017爱思唯尔公司。保留所有权利。
BACKGROUND CONTEXT: The basivertebral foramen (BF), located in the middle posterior wall of the vertebral body, may induce local weakness and contribute to the formation of a retropulsed bone fragment (RBF) in thoracolumbar burst fracture (TLBF). We hypothesize that the mechanism of TLBF is related to the BF.PURPOSE: This study aimed to clarify the relationship between RBFs and the BF in TLBFs, and to explain the results using biomechanical experiments and micro-computed tomography (micro-CT).STUDY DESIGN: A comprehensive research involving clinical radiology, micro-CT, and biomechanical experiments on cadaveric spines was carried out.PATIENT SAMPLE: A total of 162 consecutive patients diagnosed with TLBF with RBFs, drawn from 256 patients who had reported accidents or injuries to their thoracolumbar spine, comprised the patient sample.OUTCOME MEASURES: Dimensions and location of the RBFs in relation to the BF were the outcome measures.MATERIALS AND METHODS: Computed tomography reconstruction imaging was used to measure the dimensions and location of RBFs in 162 patients (length, height, width of RBF and vertebral body). Furthermore, micro-CT scans were obtained of 10 cadaveric spines. Each vertebral body was divided into three layers (superior, middle, and inferior), and each layer was divided further into nine regions (R1-R9). Microarchitecture parameters were calculated from micro-CT scans, including bone volume fraction (BV/TV), connectivity (Conn.D), trabecular number (Tb.N), trabecular thickness (Tb.Th), and bone mineral density (BMD). Differences were analyzed between regions and layers. Burst fractures were simulated on cadaveric spines to explore the fracture line location and test the relationship between RBFs and BF.RESULTS: Retropulsed bone fragment width was usually one-third of the width of the vertebral body, whereas RBF length and height were approximately half of the corresponding vertebral body dimensions. Measures of trabecular bone quality were generally lowest in those central and superior regions of the vertebral body which are adjacent to the BF and which are most affected by burst fracture. In simulated TLBFs, the fracture line went across the vertex or upper surface of the BF.CONCLUSIONS: The most vulnerable regions in the vertebral body lie within or just superior to the BF. The central MR2 region in particular is at risk of fracture and RBF formation. (C) 2017 Elsevier Inc. All rights reserved.