The anatomic study on the function of crura of diaphragm in the surgical reduction of upper lumbar burst fracture
LIU Duan, DU Xin-Ru, KONG Xiang-Yu
Chinese Journal of Clinical Anatomy ›› 2014, Vol. 32 ›› Issue (4) : 400-404.
The anatomic study on the function of crura of diaphragm in the surgical reduction of upper lumbar burst fracture
Objective To investigate the anatomical mechanism and function of crura of diaphragm during the reduction process in the fracture of L1~3 spinal vertebrae. Methods (1) 24 corpses were dissected to show diaphragm crura in front of L1~3 vertebrae. The origin and end of the two diaphragmatic crurae, the count of the vertebrae level covered by the diaphragm crura, the length, width and thickness in different level of the individual the diaphragm crus, and the length in a crus fused to the anterior longitudinal ligament were measured; (2) Four intact corpses were chosen to imitate the process of vertebral fracture and reduction. All specimens were managed to be operated from the posterior, using intermediate screws through the fractured vertebrae in short segment pedicular fixation. In the course of operation, the changes of vertebrae each step with X-ray were record. Results The overall length of right crus is (12.1±1.8) cm, with (7.0±1.1)cm fused with the anterior ligament, and the muscular length of the right crus is (6.4±1.4) cm, the tendon length is (5.6±1.1) cm; the overall length of left crus is (9.6±1.5) cm, with (5.3±1.1) cm fused with the anterior ligament, and the muscular length of right crus is (4.9±1.0) cm, the tendon length is (4.8±1.3) cm. The width and thickness of crura changes in different level. when the length and width, thickness of diaphragm crurae in the left and right sides were compared, there was significant difference, with the right crus being stronger than the left one. And there were significant differences between every step and the previous one. Conclusions (1) Strong diaphragm crura attached to the thoracolumbar vertebrae anteriorly, together with the longitudinal ligament forms “soft-tissue-splint”, which is helpful to reduce the bony fragments. (2) Every operational step makes some kind of reduction. the prone position is of the most significant importance in achieving the greatest reduction.
Lumbar burst fracture / Diaphragm crus / Immediate fixation through the fractured vertebra
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