Sasso Rick C, Best Natalie M, Reilly Thomas M, McGuire Robert A
Indiana Spine Group, Indianapolis, Indiana 46260, USA.
J Spinal Disord Tech. 2005 Feb;18 Suppl:S7-14. doi: 10.1097/01.bsd.0000137157.82806.68.
The optimal treatment of "unstable" thoracolumbar injuries remains controversial. Studies have shown the advantages of direct anterior decompression of thoracolumbar injuries along with supplemental posterior instrumentation as a combined or staged procedure. Others have also shown success in decompression as a single-stage anterior procedure, largely limited to two-column (anterior and middle) injuries. A retrospective review of all available clinical and radiographic data was used to classify unstable three-column thoracolumbar fractures according to the Association for the Study of Internal Fixation (AO) classification system. This was conducted to evaluate the efficacy of stand-alone anterior decompression and reconstruction of unstable three-column thoracolumbar injuries, utilizing current-generation anterior spinal instrumentation.
Between 1992 and 1998, 40 patients underwent anterior decompression and two-segment anteriorly instrumented reconstruction for three-column thoracolumbar fractures. Retrospective review of all available clinical and radiographic data was used to classify these unstable injuries according to the AO classification system, evaluating for neurologic changes, spinal canal compromise, preoperative and postoperative segmental angulation, and arthrodesis rate.
According to the AO classification system, there were 24 (60%) type B1.2, 10 (25%) type B2.3, 5 (12.5%) type C1.3, and 1 (2.5%) type C2.1 three-column injuries. Preoperative canal compromise averaged 68.5% and vertebral height loss averaged 44.5%. There were no cases of neurologic deterioration, and 30 (91%) patients with incomplete neurologic deficits improved by at least one modified Frankel grade. Mean preoperative segmental kyphosis of 22.7 degrees was improved to an early mean of 7.4 degrees (P < 0.0001). At latest follow-up, angulation had increased by an average 2.1 degrees but maintained significant improvement from preoperative measurements (P < 0.0001). There was one early construct failure due to technical error. Thirty-seven of the remaining patients (95%) went on to apparently stable arthrodesis.
Current types of anterior spinal instrumentation and reconstruction techniques can allow some types of unstable three-column thoracolumbar injuries to be treated in an anterior stand-alone fashion. This allows direct anterior decompression of neural elements, improvement in segmental angulation, and acceptable rates of arthrodesis without the need for supplemental posterior instrumentation.
“不稳定型”胸腰椎损伤的最佳治疗方法仍存在争议。研究表明，胸腰椎损伤直接前路减压并辅以后路内固定作为联合或分期手术具有优势。也有研究表明，一期前路减压手术取得了成功，不过主要限于两柱（前柱和中柱）损伤。本研究通过回顾所有可用的临床和影像学数据，根据内固定研究协会（AO）分类系统对不稳定的三柱胸腰椎骨折进行分类。目的是评估使用当代前路脊柱内固定器械单独进行前路减压和重建不稳定三柱胸腰椎损伤的疗效。
1992年至1998年间，40例患者接受了前路减压和两节段前路器械辅助重建治疗三柱胸腰椎骨折。通过回顾所有可用的临床和影像学数据，根据AO分类系统对这些不稳定损伤进行分类，评估神经功能变化、椎管狭窄情况、术前和术后节段性成角以及融合率。
根据AO分类系统，有24例（60%）为B1.2型，10例（25%）为B2.3型，5例（12.5%）为C1.3型，1例（2.5%）为C2.1型三柱损伤。术前椎管狭窄平均为68.5%，椎体高度丢失平均为44.5%。没有神经功能恶化的病例，30例（91%）不完全神经功能缺损患者至少改善了一个改良Frankel分级。术前平均节段后凸22.7度改善至早期平均7.4度（P < 0.0001）。在最近一次随访时，成角平均增加了2.1度，但与术前测量相比仍有显著改善（P < 0.0001）。有1例因技术失误导致早期内固定失败。其余37例患者（95%）最终实现了明显稳定的融合。
目前的前路脊柱内固定器械和重建技术能够使某些类型的不稳定三柱胸腰椎损伤采用单独前路手术治疗。这可以直接对神经结构进行前路减压，改善节段性成角，获得可接受的融合率，而无需辅助后路内固定。
