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흉요추부 및 요추부 방출성 골절에서 척추 후방주 손상에 대한 고찰
신병준,김상기,이병일,김연일,나수균,최창욱 대한척추외과학회 1997 대한척추외과학회지 Vol.4 No.1
Study Design : The authors analysed the posterior columm injuries in thoracolumbar and lumbar burst fractures. Objectives : To confirm the pattern of posterior columm injuries in burst fractures and to match these findings to the plain X-rays and CT findings to know the predictive factors. Summary of Background Data : In burst fractures, the anteiror and middle columm fail under compression load. The difference of stable fractures and unstable ones I whether the posterior columm is disrupetd or not. If the posterior columm fail, there is a tendency for posttraumatic kyphosis and progressive neural deficit due to instability. Many authors stress the importance of posterior columm injuries in the stability of spinal fractures. But, there is no data available to predict the posterior columm injuries preoperatively. Methods : In twenty-five thoracolumbar and lumbar burst fractures, posterior columm injuries, if any, were precisely documented on the fill-up protocols and drawings. Preoperative plain X-rays were reviewed to measure anterior and posterior body heights, Cobb's angles and wedge angles of the involved vertebrae. Axial CT scans were also reviewed to know the amount of canal encroachment, vertical split angle of lower body, amount of separation of clevage fracture in the lower portion of involved body. Vertical fracture of the lamina was not considered to be a posterior columm injury. All the X-ray and CT findings were compared with the operative findings. Results : There were four types of posterior columm injuries. Type I had no posterior columm injury at all(no injury ; 10 patients). Type Ⅱ had supraspinous and interspinous ligament disruptions(ligamentous injury ; 4 patients). Type Ⅲ had spinous process and/or facet fractures(bony injury ; 5 patients). Type Ⅳ had extensive posterior columm injuries including ligaments and bone(combined injury ; 6 patients). In this type, supraspinous, interspinous and ligamentum flavum were torn completely and facet and/or pars were fractured. Statistical analysis(Fisher's exact test) was done between the type Ⅰ(no injury group) and type Ⅱ, Ⅲ, Ⅳ(injury groups) to identify the risk factors. Posterior columm injuries were more common above L2 fractures(p<0.02), with more than 50% of body collapse anteriorly(p<0.05) and the wedge angle greater than 20。(P<0.01). Other variables were not predictive to know the posterior columm injury. Conclusion : Sixty percent of burst fractures had posterior columm injuries. It could occur without any evidence of rotation. Collapse of anterior body height(>50%) and increased wedge angle(>20。) and fracture level are good mechanical indicators for surgical treatment of burst fractures to prevent posttraumatic kyphosis.
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