Hakalo Jerzy, Wroński Jerzy
Orthopedic Deprtment of Polokwane/Mankweng Hospital Complex, MEDUNSA Polokwane Campus (RSA), Konarskiego 16, 66-200 Swiebodzin.
Neurol Neurochir Pol. 2006 Mar-Apr;40(2):134-9.
Complications of transpedicular stabilizations of thoraco-lumbar burst fractures are presented on the basis of literature review and own experiences. Unstable thoraco-lumbar burst fractures create the most difficult biomechanical conditions for a stabilizer. A literature review was done to estimate the effectiveness of vertebral body height restoration and its maintenance, the effectiveness of transpedicular grafting, the fusion rate and the implant-related complications rate. Transpedicular stabilization systems demonstrate a marked stiffness in all directions which is greater than in the case of other posterior stabilization systems. During the postero-lateral spondylodesis the transpedicular stabilizer is gradually unburdened but it is still loaded even after the completion of the bone fusion. A support of the anterior spinal column markedly diminishes the loads of the stabilizer and improves the segmental stability. Long-term follow-up studies of transpedicularly stabilized burst fractures reveal a deterioration of primarily good corrections. In some cases the correction returns to the level from before the operation in spite of transpedicular bone grafting. The implant-related complications rate (screw or rod breakages and a loss of interconnections) reaches up to 28 % of cases. In order to improve the anterior column stability and limit late kyphotization, as well as avoid implant-related complications, some authors additionally recommend performing a posterior interbody fusion (PLIF) or an anterior corpectomy with stabilization. Posterior transpedicular stabilization of thoraco-lumbar burst fractures does not provide a complete stabilization of the anterior spinal column, which results in a recurrence of spine kyphotization and implant-related complications. In selected cases, the application of an additional anterior column support markedly relieves the transpedicular fixator and reduces the pseudoarthrosis rate, late kyphotization and implant-related complications simultaneously.
基于文献综述和自身经验，介绍了胸腰椎爆裂骨折经椎弓根固定的并发症。不稳定的胸腰椎爆裂骨折给内固定装置带来了最困难的生物力学条件。进行文献综述以评估椎体高度恢复及其维持的有效性、经椎弓根植骨的有效性、融合率和植入物相关并发症发生率。经椎弓根固定系统在各个方向上均表现出明显的刚度，大于其他后路固定系统。在后外侧脊柱融合术中，经椎弓根固定器逐渐卸载，但即使在骨融合完成后仍有负荷。前路脊柱支撑可显著减轻固定器的负荷并提高节段稳定性。对经椎弓根固定的爆裂骨折进行长期随访研究发现，最初良好的矫正效果会恶化。在某些情况下，尽管进行了经椎弓根植骨，矫正仍会回到手术前的水平。植入物相关并发症发生率（螺钉或棒断裂以及连接丧失）高达28%。为了提高前路稳定性并限制后期后凸畸形，以及避免植入物相关并发症，一些作者还建议进行后路椎间融合术（PLIF）或前路椎体次全切除并固定。胸腰椎爆裂骨折的后路经椎弓根固定不能完全稳定前路脊柱，这会导致脊柱后凸畸形复发和植入物相关并发症。在特定情况下，额外的前路支撑应用可显著减轻经椎弓根固定器的负荷，同时降低假关节形成率、后期后凸畸形和植入物相关并发症。
