Hwang Jin-Ho, Modi Hitesh N, Yang Jae-Hyuk, Kim Seong-Jun, Lee Suk-Ha
Division of Spine Surgery, Department of Orthopedics, Konkuk University Hospital, Seoul, South Korea.
Acta Orthop Belg. 2009 Dec;75(6):822-7.
In unstable thoracolumbar fractures T11-L2, exaggerated kyphosis at the end of treatment may predispose to late back pain and poor functional outcome. Short-segment (SS) (3 vertebrae) pedicle instrumentation has become a popular method of treatment. However the question to add a fusion or not is still under debate. The authors retrospectively evaluated the radiological and functional results in 74 patients who had undergone an SS pedicle screw fixation. They were divided into two groups: group 1 (39 patients) was the non-fusion group; group 2 (35 patients) was the fusion group. In the non-fusion group the mean preoperative, immediate postoperative and final kyphosis angles at the fracture site were respectively 20.8 degrees +/- 6.4, 8.2 degrees +/- 4.8, and 15.2 degrees +/- 6.0. In the fusion group the corresponding angles were 26.6 degrees +/- 4.1, 7.9 degrees +/- 2.1, and 8.4 degrees +/- 2.4, which demonstrated a distinctly better final result (p < 0.0001). In the non-fusion group the preoperative, immediate postoperative and final follow-up visual analog scores (VAS) for back pain were respectively 7.3 +/- 0.8, 3.9 +/- 0.8, and 3.4 +/- 0.9. In the fusion group the corresponding scores were 7.5 +/- 1.0, 3.9 +/- 1.1, and 1.6 +/- 0.7; the final result pleaded again in favour of fusion (p < 0.0001). Moreover, there were significantly more implant-related complications (screw loosening and breakage) in the non-fusion group (p < 0.0001). The authors conclude that fusion is advisable to obtain a better final outcome with respect to kyphosis and pain, and to avoid implant-related complications. However, at least one other study has led to the opposite conclusion: the issue remains controversial.
在不稳定的胸腰椎骨折（T11-L2）中，治疗结束时出现的脊柱后凸加重可能会导致后期背痛和功能预后不良。短节段（SS，3个椎体）椎弓根内固定术已成为一种流行的治疗方法。然而，是否进行融合仍存在争议。作者回顾性评估了74例行SS椎弓根螺钉固定患者的影像学和功能结果。他们被分为两组：第1组（39例患者）为非融合组；第2组（35例患者）为融合组。非融合组骨折部位术前、术后即刻和最终的脊柱后凸角度分别为20.8°±6.4°、8.2°±4.8°和15.2°±6.0°。融合组相应的角度分别为26.6°±4.1°、7.9°±2.1°和8.4°±2.4°，这表明融合组的最终结果明显更好（p<0.0001）。非融合组术前、术后即刻和最终随访时的背痛视觉模拟评分（VAS）分别为7.3±0.8、3.9±0.8和3.4±0.9。融合组相应的评分分别为7.5±1.0、3.9±1.1和1.6±0.7；最终结果再次表明融合更具优势（p<0.0001）。此外，非融合组中与植入物相关的并发症（螺钉松动和断裂）明显更多（p<0.0001）。作者得出结论，为了在脊柱后凸和疼痛方面获得更好的最终结果，并避免与植入物相关的并发症，融合术是可取的。然而，至少另一项研究得出了相反的结论：这个问题仍然存在争议。
