흉요추부 굴곡 신연 손상의 방사선학적 특징과 임상 결과

Abstract

Purpose: Retrospective analysis of radiologic features and clinical results of flexion-distraction injury in thoracolumbar spine. This study reports radiologic features and clinical results of flexion-distraction injury that cause posterior ligament complex injury since it became an important factor that determines the treatment of thoracolumbar spine injury. Materials and Methods: The materials of the study were 37 patients hospitalized for flexion-distraction injury and injured by damage of seat belts in Chosun university hospital from January, 2003 to January, 2009. Their average age was 37 years (18-57 years). They consist of 28 males and 19 females. The causes of injuries were traffic accidents (21 cases), falling accidents (10 cases), force of falling objects (5 cases) and sports(1 case). Injured parts were T11(2 cases), T12(11 cases), L1(19 cases), L2(4 cases), and L3(1 case). All patients had simple radiography and CT scan done on thoracolumbar spine, and 32 cases had MRI scan done. Results: Among total 37 cases, 31 cases had posterior fusion, 3 cases one segment fusion, 20 cases two segmental fusion, and 8 cases three segmental fusion. Simple radiography showed wide interspinous distance(25 cases) and spinous process fracture((12 cases). CT scan showed dissolving pedicle sign(21 cases) and naked facet sign(14 cases). Sandwich sign was showed in all cases to which MRI scan was done. Flexion-distraction injury in thoracolumbar spine caused associated abdominal injury(18 cases), intestine injury(10 cases), spleen injury(6 cases), liver injury(4 cases), kidney injury(1 case). Neurologic deficit was found in 3 cases which showed Frankel grade D and recovered completely through one year follow-up. Conclusion: Abdominal injury is common even though neurologic deficit is not quite common in flexion-distraction injury in thoracolumbar spine. Therefore, spine surgeons should be aware of associated internal organ injury. In addition, MRI scan is required to check flexion-distraction injury.