STUDY DESIGN:Computed tomography aided evaluation of spinal decompression by ultrasound-guided spinal fracture repositioning, ligamentotaxis, and remodeling after thoracolumbar burst fractures. OBJECTIVES:To determine the necessity of spinal canal widening by ultrasound-guided fracture repositioning for fractures with and without neurologic deficit. SUMMARY OF BACKGROUND DATA:Ultrasound-guided spinal fracture repositioning is an alternative new approach. Reports have varied concerning ligamentotaxis and remodeling. METHODS:Computed tomography aided planimetry of the spinal canal (64 consecutive burst fractures) and neurologic evaluation by Frankel grades. RESULTS:Ultrasound-guided spinal fracture repositioning (n = 37) reduced the stenosis of the spinal canal area from 45% before surgery to 20% after surgery of the estimated original area. Fifteen patients had a primary neurologic deficit, which improved markedly in 11 cases after treatment. Patients with neurologic symptoms had a greater preoperative spinal stenosis than those without. No correlation was seen between the degree of pretreatment spinal stenosis, fracture type, and severity of the neurologic deficit. Ligamentotaxis (n = 27) reduced the stenosis from 30% before surgery to 18% after surgery and remodeling (n = 11) from 25% after surgery to 13% after metal removal. CONCLUSION:Ultrasound-guided fracture repositioning is an efficient method for spinal canal decompression of burst fractures with neurologic symptoms. The marked degree of widening of the spinal canal due to the effects of ligamentotaxis and remodeling may render the reposition of retropulsed fragments unnecessary in cases of fractures without a neurologic deficit.

译文

研究设计:计算机断层扫描技术可通过超声引导下的胸腰椎爆裂性骨折复位,韧带切开和重塑来评估脊柱减压。
目的:通过超声引导下的骨折再定位术来确定有无神经功能缺损的骨折是否需要加宽椎管。
背景数据摘要:超声引导下的脊柱骨折复位术是另一种新方法。关于韧带趋化和重塑的报道多种多样。
方法:计算机断层扫描辅助椎管平面测量(64例连续爆裂性骨折)并通过Frankel等级进行神经系统评估。
结果:超声引导下的脊柱骨折复位术(n = 37)将椎管面积的狭窄程度从手术前的45%降低到手术后估计的原始面积的20%。 15例有原发性神经功能缺损,治疗后11例明显改善。具有神经系统症状的患者比没有神经系统症状的患者具有更大的术前椎管狭窄。在治疗前的椎管狭窄程度,骨折类型和神经功能缺损的严重程度之间没有相关性。韧带切开术(n = 27)将狭窄从手术前的30%减少到手术后的18%,重塑(n = 11)从手术后的25%减少到金属去除后的13%。
结论:超声引导下骨折复位术是一种有效的方法,可用于治疗具有神经系统症状的爆裂性骨折的椎管减压术。由于韧带趋化和重塑的影响,椎管的明显增宽程度可能使无神经功能缺损的骨折患者无需重新放置后退段。

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