Occult thoracolumbar flexion-distraction fractures combined with compression of anterior and central columns / 中华创伤杂志

ABSTRACT

Objective To study a case series of thoracolumbar flexion-distraction fractures combined with compression of anterior and central columns to analyze the causes of its occult symptoms and explore the injury mechanism,imaging diagnosis and operative reduction of the fractures.Methods A retrospective study was carried out on data of 39 patients with thoracolumbar flexion-distraction fractures admitted into our hospital from May 2003 to December 2006.Of all,there were 17 patients with compression of anterior and central columns.The diagnostic value of imaging examinations such as X-ray,CT and MRI was evaluated.All patients were treated with posterior operation,in which simple distraction of the anterior and central columns was followed by compression and reduction of the posterior column from the rear axial direction.The clinical efficacy and safety of operation were assessed.Results The patients with compression of anterior and central columns accounted for 43.6% of all thoracolumbar flexion-distraction fractures.Before operation,six patients were misdiagnosed as simple compression fracture.Various kinds of imaging examinations detected the bone injury and/or ligaments complex injury of the posterior column at different degrees.The positive results on X-ray,CT,spiral CT multi-planar reconstruction (MPR)and MRI were in 8,7,11 and 17 patients respectively.After simple posterior distraction in 17 patients,there occurred over distraction in eight patients who were cured with posterior recompression plus reduction.Conclusions The posterior column injury of thoracolumbar flexion-distraction fractures combined with compression of anterior and central columns is relatively occult and easy to be misdiagnosed as simple compression fracture,when MPR CT and MRI are helpful for diagnosis.The operation with twostep reduction of axial distraction followed by compression can attain satisfactory and safe results.