Aligizakis Agisilaos C, Katonis Pavlos G, Sapkas George, Papagelopoulos Panayiotis J, Galanakis Ioannis, Hadjipavlou Alexander
Department of Orthopaedics, University of Crete Medical School, Heraklion, Greece.
Clin Orthop Relat Res. 2003 Jun(411):77-85. doi: 10.1097/01.blo.0000068187.83581.5d.
From 1996 to 1998, 30 consecutive patients with Level 1 thoracolumbar spinal injury were classified and treated according to the Gertzbein classification and the load sharing classification. A posterior short segment pedicle screw implant was used in 21 patients; anterior decompression with strut grafting and application of the Kaneda device was used in three patients; and six patients were treated with short posterior instrumentation and an anterior strut graft. The average followup was 32 months (range, 24-50 months). The clinical outcome was satisfactory in 22 of 30 patients. Five of nine patients had neurologic improvement. Radiographic imaging findings showed a slight loss of reduction, but the clinical outcome of the patients was not affected. No pseudarthrosis and no implant failures were recorded. The Gertzbein classification correlates the type of fracture with the degree of mechanical instability and neurologic lesion. The load sharing classification correlates fracture comminution and displacement with mechanical stability and implant failure. Patient selection is a fundamental component for a successful outcome. The best candidates for surgery are cooperative patients who require spinal mobility, patients who are able to tolerate a two-stage reconstruction, and patients in good general health.
1996年至1998年，根据Gertzbein分类法和载荷分担分类法，对30例连续的1级胸腰椎脊柱损伤患者进行了分类和治疗。21例患者采用后路短节段椎弓根螺钉植入术；3例患者采用前路减压支撑植骨并应用Kaneda器械；6例患者采用后路短节段内固定和前路支撑植骨治疗。平均随访32个月（范围24 - 50个月）。30例患者中有22例临床结果满意。9例患者中有5例神经功能得到改善。影像学检查结果显示复位有轻微丢失，但患者的临床结果未受影响。未记录到假关节形成和内固定失败情况。Gertzbein分类法将骨折类型与机械性不稳定程度和神经损伤相关联。载荷分担分类法将骨折粉碎和移位与机械稳定性和内固定失败相关联。患者选择是取得成功结果的基本要素。手术的最佳候选者是需要脊柱活动度的合作患者、能够耐受两阶段重建的患者以及全身健康状况良好的患者。
