Lange Uta, Edeling Sebastian, Knop Christian, Bastian Leonard, Oeser Michael, Krettek Christian, Blauth Michael
Trauma Department, Hannover Medical School, Hannover, Germany.
Eur Spine J. 2007 Feb;16(2):161-72. doi: 10.1007/s00586-005-0015-6. Epub 2006 May 13.
In the operative treatment of spinal injuries, the reconstruction of the anterior column of the thoracolumbar spine is still controversial. We conducted a prospective clinical study to investigate the clinical and radiological outcome of 50 patients treated with a vertebral body replacement of adjustable height (Synex). Fifty consecutive patients were evaluated during in-patient treatment and at 12 and 20 months post-operatively in clinical notes and radiographs. 38/50 patients were operated for traumatic fractures. Out of 50 patients 45 attended the follow-up clinic 1 year post-operatively and 39 of these patients were examined after 20 months. Twenty-five patients returned to pre-injury activities within 1 year. This number increased to 29/39 patients at 20 months. Seventy-three percent of the patients returned to their job. After 1 year 25/45 patients complained of little or no back pain and 6 months later six patients were limited in their back function. At 1 year only three patients complained of surgical site pain which was improved at their final follow-up at 20 months. Individual satisfaction was determined using a score on a visual analog scale containing 19 questions on back pain, and functional limitation of the spine that has to be filled in by the patients at three different points of time. The score decreased from 87/100 pre-operatively to 65/100 at 1 year follow-up (P<0.001). The average permanent correction of the injured vertebra was 16.8 degrees (88%) including 2.3 degrees (12%) loss of correction at 12 months after operation. Bony integration was obtained in 83%. Early and intermediate outcome with the Synex vertebral replacement device for reconstruction of the anterior column appears promising. The loss of correction or reduction was only minimal. On the basis of our results we recommend the Synex implant as an alternative for the fixation and stabilisation of thoracolumbar fractures. However, long-term results and a clinically random control study are still required.
在脊柱损伤的手术治疗中，胸腰椎前柱的重建仍存在争议。我们进行了一项前瞻性临床研究，以调查50例接受可调高度椎体置换（Synex）治疗的患者的临床和影像学结果。在住院治疗期间以及术后12个月和20个月时，通过临床记录和X线片对连续的50例患者进行了评估。50例患者中有38例因创伤性骨折接受手术。50例患者中有45例在术后1年到随访门诊就诊，其中39例患者在20个月后接受了检查。25例患者在1年内恢复到受伤前的活动水平。到20个月时，这一数字增加到29/39例患者。73%的患者恢复了工作。术后1年，25/45例患者抱怨背部疼痛轻微或无疼痛，6个月后有6例患者的背部功能受限。术后1年只有3例患者抱怨手术部位疼痛，在20个月的最终随访时有所改善。使用包含19个关于背痛和脊柱功能受限问题的视觉模拟量表评分来确定个体满意度，患者需在三个不同时间点填写该量表。评分从术前的87/100降至术后1年随访时的65/100（P<0.001）。受伤椎体的平均永久矫正角度为16.8度（88%），术后12个月矫正丢失2.3度（12%）。83%实现了骨融合。使用Synex椎体置换装置重建前柱的早期和中期结果似乎很有前景。矫正丢失或复位仅为最小程度。根据我们的结果，我们推荐Synex植入物作为胸腰椎骨折固定和稳定的一种替代方法。然而，仍需要长期结果和临床随机对照研究。
