Briem D, Rueger J M, Linhart W
Klinik und Poliklinik für Chirurgie, Abteilung für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg.
Unfallchirurg. 2003 Mar;106(3):195-203. doi: 10.1007/s00113-002-0508-2.
It is widely believed that combined dorso-ventral stabilization provides superior mechanic stability in the operative treatment of thoracolumbar spine fractures. Currently there are no data available reflecting the fusion rates in trauma patients following the combined procedure. Aim of this investigation was to study the fusion rates following dorso-ventral stabilization of thoracolumbar spine fractures and the rates of local complications at the donor site.
In order to assess fusion and complication rates 30 patients with unstable fractures of the thoracolumbar spine were selected from a consecutive series and investigated in a prospective study. After posterior stabilization with a fixateur interne (USS, Synthes) anterior arthrodesis was performed subsequently by autogenous iliac bone grafting in combination with an osteosynthesis (MACS,Aesculap;VentroFix, Synthes). The osseous integration of the autogenous transplants was measured by CT-scan 12+/-2.4 months after surgery.
The evaluation of the radiographic and CT data revealed a fusion rate of 77% (23/30) one year after surgery. These findings were accompanied by minor complications at the donor site in 37% (11/30).
Our experiences with autogenous spine grafting gave evidence that a reliable osseus integration can not be expected in all of the cases. Furthermore one has to consider a high rate of local complications. Therefore alternative procedures such as the use of cages will be of increasing influence in the surgical treatment of thoracolumbar spine fractures.
人们普遍认为，在胸腰椎骨折的手术治疗中，背腹联合稳定术能提供更好的力学稳定性。目前尚无数据反映联合手术后创伤患者的融合率。本研究的目的是探讨胸腰椎骨折背腹联合稳定术后的融合率及供区局部并发症的发生率。
为了评估融合率和并发症发生率，从一系列连续病例中选取30例胸腰椎不稳定骨折患者进行前瞻性研究。先用内固定器（USS，Synthes）进行后路稳定，随后通过自体髂骨移植结合接骨术（MACS，Aesculap；VentroFix，Synthes）进行前路融合。术后12±2.4个月通过CT扫描测量自体移植骨的骨融合情况。
影像学和CT数据评估显示，术后一年融合率为77%（23/30）。这些结果伴随着37%（11/30）的供区轻微并发症。
我们自体脊柱移植的经验表明，并非所有病例都能期望获得可靠的骨融合。此外，必须考虑到较高的局部并发症发生率。因此，诸如使用椎间融合器等替代手术在胸腰椎骨折的手术治疗中将发挥越来越大的作用。
