These tools will no longer be maintained as of December 31, 2024. Archived website can be found here. PubMed4Hh GitHub repository can be found here. Contact NLM Customer Service if you have questions.


Pubmed for Handhelds

PUBMED FOR HANDHELDS

Search MEDLINE/PubMed

  • Title: [Effectiveness of injured vertebra fixation with inclined-long pedicle screws combined with interbody fusion for thoracolumbar fracture dislocation with disc injury].
    Author: Han Y, Ma J, Huang L, Su L, Lei C, Jiang J, Kang H.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2024 Apr 15; 38(4):466-473. PubMed ID: 38632068.
    Abstract:
    OBJECTIVE: To investigate the effectiveness of injured vertebra fixation with inclined-long pedicle screws combined with interbody fusion for thoracolumbar fracture dislocation with disc injury. METHODS: Between January 2017 and June 2022, 28 patients with thoracolumbar fracture dislocation with disc injury were underwent posterior depression, the injured vertebra fixation with inclined-long pedicle screws, and interbody fusion. There were 22 males and 6 females, with a mean age of 41.4 years (range, 22-58 years). The causes of injury included falling from height in 18 cases, traffic accident in 5 cases, and bruise in 5 cases. Fracture segment included 1 case of T 11, 7 cases of T 12, 9 cases of L 1, and 11 cases of L 2. According to the American Spinal Injury Association (ASIA) scale, the spinal injuries were graded as grade A in 4 cases, grade B in 2 cases, grade C in 11 cases, and grade D in 11 cases. Preoperative spinal canal encroachment ratio was 17.7%-75.3% (mean, 44.0%); the thoracolumbar injury classification and severity score (TLICS) ranged from 9 to 10 (mean, 9.9). Seventeen patients were associated with other injuries. The time from injury to operation ranged from 1 to 4 days (mean, 2.3 days). The perioperative indicators (operation time, intraoperative blood loss, and the occurrence of complications), clinical evaluation indicators [visual analogue scale (VAS) score and Oswestry Disability Index (ODI)], radiologic evaluation indicators [anterior vertebral height ratio (AVHR), kyphosis Cobb angle (KCA), intervertebral space height (ISH), vertebral wedge angle (VWA), displacement angle (DA), and percent fracture dislocation displacement (PFDD)], neurological function, and interbody fusion were recorded. RESULTS: The operation time was 110-159 minutes (mean, 130.2 minutes). The intraoperative blood loss was 200-510 mL (mean, 354.3 mL). All incisions healed by first intention, and no surgical complications such as wound infection or hematoma occurred. All patients were followed up 12-15 months (mean, 12.7 months). The chest and lumbar pain significantly relieved, VAS scores and ODI after operation were significantly lower than those before operation, and further decreased with the extension of postoperative time, with significant differences ( P<0.05). At last follow-up, the ASIA classification of neurological function of the patients was grade A in 3 cases, grade B in 1 case, grade C in 1 case, grade D in 10 cases, and grade E in 13 cases, which was significantly different from preoperative one ( Z=-4.772, P<0.001). Imaging review showed that AVHR, KCA, ISH, VWA, DA, and PFDD significantly improved at 1 week, 3 months and last follow-up ( P<0.05). There was no significant difference between different time points after operation ( P>0.05). At last follow-up, according to the modified Brantigan score, all patients achieved good intervertebral bone fusion, including 22 complete fusion and 6 good intervertebral fusion with a few clear lines. No complications such as internal fixation failure or kyphosis occurred during follow-up. CONCLUSION: The injured vertebra fixation with inclined-long pedicle screws combined with interbody fusion is an effective treatment for thoracolumbar fracture dislocation with disc injury, which can correct the fracture dislocation, release the nerve compression, restore the injured vertebral height, and reconstruct spinal stabilization. 目的: 探讨伤椎斜向长椎弓根钉固定联合椎体间融合治疗合并椎间盘损伤的胸腰椎骨折脱位的临床疗效。. 方法: 2017年1月—2022年6月，采用后路减压、伤椎斜向长椎弓根钉固定联合椎体间融合治疗28例合并椎间盘损伤的胸腰椎骨折脱位患者。其中，男22例，女6例；年龄 22～58 岁，平均41.4岁。致伤原因：高处坠落伤18例，交通事故伤5例，重物砸伤5例。骨折节段：T 11 1例，T 12 7例，L 1 9例，L 2 11例。神经功能美国脊髓损伤协会（ASIA）分级：A级4例，B级2例，C级11 例，D级11 例。术前椎管内占位率为17.7%～75.3%，平均44.0%；胸腰椎损伤分类和严重程度评分（TLICS）为9～10分，平均9.9分。17例存在合并损伤。受伤至手术时间1～4 d，平均2.3 d。记录围术期相关指标（手术时间、术中出血量、手术并发症）、临床疗效评价指标 ［疼痛视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）］、影像学评价指标 ［伤椎前缘高度比（anterior vertebral height ratio，AVHR）、局部Cobb角（kyphosis Cobb angle，KCA）、椎间隙高度（intervertebral space height，ISH）、伤椎楔形角（vertebral wedge angle，VWA）、伤椎位移角（displacement angle，DA）和伤椎移位百分比（percent fracture dislocation displacement，PFDD）］，以及神经功能、椎体间融合情况。. 结果: 手术时间110～159 min，平均130.2 min；术中出血量200～510 mL，平均354.3 mL。术后切口均Ⅰ期愈合，无切口感染、血肿等手术并发症发生。28例患者均获随访，随访时间12～15个月，平均12.7个月。术后患者胸腰部疼痛均明显缓解，VAS评分及ODI均较术前降低，术后随时间延长亦进一步下降，差异均有统计学意义（ P<0.05）。末次随访时，患者神经功能ASIA分级为A级3例、B级1例、C级1例、D级10例、E级13例，与术前比较差异有统计学意义（ Z=−4.772， P<0.001）。影像学复查示，术后1周、3个月及末次随访时AVHR、KCA、ISH、VWA、DA和PFDD均较术前改善（ P<0.05），术后各时间点间差异均无统计学意义（ P>0.05）。末次随访时，根据改良Brantigan评分，28例均获得良好椎间骨性融合，其中完全融合22例，椎间融合良好、但存在少许透亮线6例。随访期间无内固定失败、后凸畸形等并发症发生。. 结论: 采用伤椎斜向长椎弓根钉固定联合椎体间融合治疗合并椎间盘损伤的胸腰椎骨折脱位，可以有效矫正骨折脱位、解除神经压迫、恢复伤椎高度、重建脊柱稳定。.
    [Abstract] [Full Text] [Related] [New Search]