Modi Hitesh N, Chung Kook Jin, Seo Il Woo, Yoon Hoi Soo, Hwang Ji Hyo, Kim Hong Kyun, Noh Kyu Cheol, Yoo Jung Han
Department of Orthopedics, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea.
J Orthop Surg Res. 2009 Jul 27;4:28. doi: 10.1186/1749-799X-4-28.
Treatment of unstable thoracolumbar fractures is controversial regarding short or long segment pedicle screw fixation. Although long level fixation is better, it can decrease one motion segment distally, thus increasing load to lower discs.
We retrospectively analyzed 31 unstable thoracolumbar fractures with partial or intact neurology. All patients were operated with posterior approach using pedicle screws fixed two levels above and one level below the fracture vertebra. No laminectomy, discectomy or decompression procedure was done. Posterior fusion was achieved in all. Post operative and at final follow-up radiological evaluation was done by measuring the correction and maintenance of kyphotic angle at thoracolumbar junction. Complications were also reported including implant failure.
Average follow-up was 34 months. All patients had full recovery at final follow-up. Average kyphosis was improved from 26.7 degrees to 4.1 degrees postoperatively and to 6.3 degrees at final follow-up. And mean pain scale was improved from 7.5 to 3.9 postoperatively and to 1.6 at final follow-up, All patients resumed their activity within six months. Only 4 (12%) complications were noted including only one hardware failure.
Two levels above and one level below pedicle screw fixation in unstable thoracolumbar burst fracture is useful to prevent progressive kyphosis and preserves one motion segment distally.
对于不稳定型胸腰椎骨折的治疗，短节段或长节段椎弓根螺钉固定存在争议。尽管长节段固定更好，但它会减少远端一个运动节段，从而增加下椎间盘的负荷。
我们回顾性分析了31例伴有部分神经功能或神经功能完整的不稳定型胸腰椎骨折患者。所有患者均采用后路手术，使用椎弓根螺钉在骨折椎体上方两个节段和下方一个节段进行固定。未进行椎板切除术、椎间盘切除术或减压手术。所有患者均实现了后外侧融合。通过测量胸腰段交界处后凸角的矫正和维持情况进行术后及最终随访的影像学评估。还报告了包括植入物失败在内的并发症。
平均随访34个月。所有患者在最终随访时均完全康复。术后平均后凸角从26.7度改善至4.1度，最终随访时为6.3度。平均疼痛评分术后从7.5改善至3.9，最终随访时为1.6。所有患者均在6个月内恢复活动。仅记录到4例（12%）并发症，其中仅1例硬件故障。
在不稳定型胸腰椎爆裂骨折中，在骨折椎体上方两个节段和下方一个节段进行椎弓根螺钉固定，有助于预防后凸畸形进展，并保留远端一个运动节段。
