McLain Robert F
Lerner College of Medicine, Cleveland Clinic Spine Institute, and the Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Spine (Phila Pa 1976). 2006 May 15;31(11 Suppl):S70-9; discussion S104. doi: 10.1097/01.brs.0000218221.47230.dd.
Literature review.
Provide an overview of biomechanical strengths and weaknesses of long and short fixation constructs applied in thoracolumbar fractures, along with a discussion of specific indications for selecting an instrumentation construct for a given fracture.
Previous clinical and biomechanical studies have shown that segmental spinal instrumentation provides superior torsional, axial, and sagittal stability relative to nonsegmental systems. Multilevel fixation (long constructs) has proven reliable and effective in treating thoracic injuries, with or without anterior reconstruction. Short-segment pedicle instrumentation (short constructs) have proven effective in stabilizing thoracolumbar and lumbar fractures while limiting the disruption of lower lumbar motion segments. Loss of anterior column integrity leads to fixation failure when short constructs are not supplemented with further fixation or an anterior reconstruction.
Review of the applicable clinical and biomechanical literature.
Long constructs serve well in thoracic and thoracolumbar fractures, while short-segment fixation offers advantages in selected thoracolumbar and lumbar fractures. Anterior column integrity determines the risk of sagittal collapse and kyphosis at the thoracolumbar junction. Recognition of fundamental biomechanical principles is necessary to make either construct work reliably.
文献综述。
概述应用于胸腰椎骨折的长节段和短节段固定结构的生物力学优缺点，并讨论为特定骨折选择器械固定结构的具体适应症。
先前的临床和生物力学研究表明，相对于非节段性系统，节段性脊柱内固定器械提供了更好的扭转、轴向和矢状面稳定性。多级固定（长节段结构）已被证明在治疗胸椎损伤时可靠且有效，无论有无前路重建。短节段椎弓根内固定（短节段结构）已被证明在稳定胸腰椎和腰椎骨折的同时，能限制下腰椎运动节段的破坏。当短节段结构未辅以进一步固定或前路重建时，前柱完整性丧失会导致固定失败。
回顾适用的临床和生物力学文献。
长节段结构在胸椎和胸腰椎骨折中效果良好，而短节段固定在选定的胸腰椎和腰椎骨折中具有优势。前柱完整性决定了胸腰段交界处矢状面塌陷和后凸畸形的风险。认识基本的生物力学原理对于使任何一种结构可靠发挥作用都是必要的。
