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描述影响胸腰段脊柱不同类型骨折,以及指导脊柱骨折治疗的不同分类及关键影响因素。目前脊柱骨折分类以Denis三柱模型为基石,包括压缩性骨折、爆裂性骨折、屈曲牵张骨折和骨折伴脱位。骨折分类系统包括胸腰椎损伤分类和严重程度评分(Thoracolumbar Injury Classification and Severity Score,TLICS)系统和AO脊柱胸腰椎损伤分类和严重程度评分(AOSpine-TLICS)。正确分类需要定量成像方法,采用多个测量指标来评定其属于不同TLICS或AOSpine-TLICS类型。如果TLICS评分>4或者AOSpine-TLICS评分>5,则患者需要手术治疗。本文重点描述X线片、CT及MRI影像表现和测量参数,包括爆裂性骨折患者中椎体楔形变成角和压缩性骨折椎体高度丢失百分比、椎弓根间距和腰椎管狭窄程度以及一些严重骨折(如屈曲牵张骨折、骨折伴脱位)患者的椎体位移和棘突间距增加。通过图解和影像案例展现这些影像学特征和相关参数。
Describe the different types of fractures that affect thoracolumbar spine and the different categories and key influencing factors that guide the treatment of spinal fractures. Currently, the classification of spinal fractures is based on the Denis three-column model, including compression fractures, burst fractures, flexion-distraction fractures and fractures with dislocation. The fracture classification system includes the Thoracolumbar Injury Classification and Severity Score (TLICS) system and the AO Spine Thoracolumbar Injury Classification and Severity Score (AOSpine-TLICS). Correct classification requires a quantitative imaging method that uses multiple measures to assess that they belong to different TLICS or AOSpine-TLICS types. Patients require surgery if TLICS score> 4 or AOSpine-TLICS score> 5. This article focuses on X-ray, CT and MRI imaging findings and measurement parameters, including the percentage of vertebral body vertebral body wedge-shaped deformation and vertebral height loss in patients with burst fractures, the degree of pedicle spacing and lumbar spinal stenosis, and some serious Fractures (such as flexion and extension fractures, fractures with dislocation) in patients with vertebral body displacement and spinous process spacing increased. These imaging features and related parameters are presented through graphic and imaging examples.