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Title: [Posterior short-segment fixation including the fractured vertebra for severe unstable thoracolumbar fractures].
Author: Chen Z, Wu J, Lin B, Wu S, Zeng W.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2018 Jan 15; 32(1):59-63. PubMed ID: 29806367.
Abstract:
OBJECTIVE: To discuss the effectiveness of posterior short-segment fixation including the fractured vertebra for severe unstable thoracolumbar fractures using pedicle screw fixation. METHODS: Between May 2008 and July 2013, 52 patients of severe unstable thoracolumbar fractures were treated through posterior short-segment fixation including the fractured vertebra using pedicle screw fixation. There were 33 males and 19 females with an age of 21-56 years (mean, 37.9 years). The causes of thoracolumbar burst fractures included fall from height in 32 cases, traffic accidents in 16 cases, and others in 4 cases. The load sharing classification (LSC) score was 7-9 (mean, 7.85). The levels involved included T ₁₁ in 4 cases, T ₁₂ in 19 cases, L ₁ in 25 cases, and L ₂ in 4 cases. According to Frankel classification, there were 2 cases of grade A, 4 cases of grade B, 8 cases of grade C, 11 cases of grade D, and 27 cases of grade E. The rate of spinal canal occupying was 24.2%-76.7% (mean, 47.1%). The time from injury to operation was 3-5 days (mean, 3.6 days). The effectiveness was assessed by the changes of injured vertebral Cobb angle, anterior vertebral height, and the Frankel grading at pre- and post-operation. RESULTS: The operation time was 85-127 minutes (mean, 106.5 minutes). The intraoperative blood loss was 90-155 mL (mean, 137.6 mL). All the incision healed at first intension. Forty-seven patients were followed up 19-27 months (mean, 23.2 months), and no incision infection, screw loosening, or other internal fixation failures was found during follow-up. The injured vertebral Cobb angle and anterior vertebral height at immediate after operation or at last follow-up were significantly improved when compared with preoperative values ( P<0.001). There was a loss of injured vertebral Cobb angle and anterior vertebral height at last follow-up, but no significant difference was found between at immediate after operation and at last follow-up ( P>0.05). The Frankel grade improved by 0-2 grades at last follow-up, showing significant difference when compared with preoperative grades ( Z=15.980, P=0.003). CONCLUSION: Posterior short-segment fixation including the fractured vertebra for severe unstable thoracolumbar fractures (LSC≥7) using pedicle screw fixation can correct the kyphosis deformity, restore vertebral body height, and aviod the need of anterior reconstruction. 目的: 探讨经后路伤椎短节段椎弓根内固定治疗严重不稳的胸腰椎爆裂性骨折的临床疗效。. 方法: 2008 年 5 月—2013 年 7 月，采用后路伤椎短节段椎弓根内固定治疗 52 例严重不稳的胸腰椎爆裂性骨折。其中男 33 例，女 19 例；年龄 21～56 岁，平均 37.9 岁。致伤原因：高处坠落伤 32 例，交通事故伤 16 例，其他伤 4 例。载荷分享评分（load sharing classification，LSC）为 7～9 分，平均 7.85 分。累及节段：T ₁₁ 4 例，T ₁₂ 19 例，L ₁ 25 例，L ₂ 4 例。Frankel 分级：A 级 2 例，B 级 4 例，C 级 8 例，D 级 11 例，E 级 27 例。伤椎椎管占位 24.2%～76.7%，平均 47.1%。伤后至手术时间 3～5 d，平均 3.6 d。根据患者手术前后的伤椎 Cobb 角、伤椎前缘高度及 Frankel 分级变化评价临床疗效。. 结果: 手术时间为 85～127 min，平均 106.5 min；术中出血量为 90～155 mL，平均 137.6 mL。术后手术切口均Ⅰ期愈合。47 例患者获随访，随访时间 19～27 个月，平均 23.2 个月。随访期间均未出现切口感染、椎弓根钉松动和内固定物断裂等并发症。患者术后即刻及末次随访时的伤椎 Cobb 角及伤椎前缘高度均较术前显著改善（ P<0.001）；末次随访时较术后即刻有一定程度丢失，但比较差异无统计学意义（ P>0.05）。末次随访时 Frankel 分级均较术前提高 1～2 个等级，差异有统计学意义（ Z=15.980， P=0.003）。. 结论: 经后路伤椎短节段椎弓根内固定治疗严重不稳的胸腰椎爆裂性骨折（LSC≥7 分），能有效矫正后凸畸形、恢复椎体高度，并可避免前路的重建。.

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