Ramieri Alessandro, Domenicucci Maurizio, Cellocco Paolo, Raco Antonino, Costanzo Giuseppe
Orthopaedic Service, The Don Gnocchi Foundation of Rome, Rome, Italy.
Eur Spine J. 2009 Jun;18 Suppl 1(Suppl 1):89-94. doi: 10.1007/s00586-009-0991-z. Epub 2009 Apr 24.
We report results in the surgical treatment of thoracolumbar flexion-distraction fractures, both associated or not with neurological impairment. Items in the present study include function, pain (back pain rating scale) and neurological recovery (Asia Score). A prospective series of 19 consecutive flexion-extension thoracolumbar injuries (T11-L2), occurred in young patients (20-33 years) due to motor vehicle crashes wearing the 3-point safety belts, includes 2 Chance and 17 seat-belt fractures, with different amount of vertebral dislocation and neurological impairment. Fractures have been evaluated according to the Magerl's classification. All patients were operated via posterior approach using hybrid instrumentation or short pedicular fixation to reduce dislocation and to obtain spinal fusion. Posterior decompression was performed in all patients with neurological deficit. Posterior instrumented arthodesis was performed by wide constructs that preferably include 2 levels above and below the dislocated vertebra. Most of them were instrumented using thoracic hooks and lumbar pedicular screws. One postoperative vascular complication was successfully treated by selective embolization. All neurological patients were submitted to a postoperative rehabilitation program. Posterior procedure allows proper reduction and realignment. In our experience, the use of laminar hooks one level above the dislocation seems to reduce the potential risk of neurological and /or vascular damage during the intraoperative maneuvers on the dislocated pedicles. At follow-up, fusion was achieved in all patients. The clinical condition was totally satisfactory due to the absence of significant pain, confirming mechanical stability of the implants. In terms of neurological outcomes, patients presenting as ASIA A-B or ASIA E, maintained their preoperative neurological condition. Surgical treatment, together with an early postoperative rehabilitation program, can be of paramount importance in neurological patients' quality of life.
我们报告了胸腰段屈曲-牵张性骨折手术治疗的结果，这些骨折伴有或不伴有神经损伤。本研究的项目包括功能、疼痛（背痛评分量表）和神经恢复情况（亚洲脊髓损伤评分）。一项前瞻性系列研究纳入了19例连续的胸腰段屈伸损伤（T11-L2）患者，这些患者均为20至33岁的年轻人，因机动车碰撞事故佩戴三点式安全带受伤，其中包括2例Chance骨折和17例安全带骨折，伴有不同程度的椎体脱位和神经损伤。骨折根据马格勒（Magerl）分类法进行评估。所有患者均采用后路手术，使用混合内固定或短节段椎弓根固定以复位脱位并实现脊柱融合。所有有神经功能缺损的患者均进行了后路减压。后路器械辅助关节融合术采用广泛的固定结构，最好包括脱位椎体上下各两个节段。大多数患者使用胸椎钩和腰椎椎弓根螺钉进行内固定。1例术后血管并发症通过选择性栓塞成功治疗。所有神经损伤患者均接受了术后康复计划。后路手术能够实现适当的复位和重新排列。根据我们的经验，在脱位上方一个节段使用椎板钩似乎可以降低在脱位椎弓根进行术中操作时神经和/或血管损伤的潜在风险。随访时，所有患者均实现了融合。由于无明显疼痛，临床状况完全令人满意，证实了植入物的机械稳定性。在神经功能结果方面，表现为亚洲脊髓损伤评分A-B级或E级的患者维持了术前的神经状况。手术治疗以及早期术后康复计划对于神经损伤患者的生活质量至关重要。
