Department of Orthopedics Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kweishian, Taoyuan, Taiwan.
Spine (Phila Pa 1976). 2010 Jul 1;35(15):1482-8. doi: 10.1097/BRS.0b013e3181c176f8.
A retrospective clinical and radiographic study was performed.
To compare 2 grafting materials of anterior augmentation for thoracolumbar burst fractures: transpedicular cancellous bone (TPCB) grafting and transpedicular calcium sulfate grafting and to decide whether calcium sulfate cement can replace autogenous cancellous bone applied in anterior vertebral body augmentation after posterior short-segment instrumentation.
Additional TPCB grafting was developed as an alternative to prevent early implant failure. However, the results are inconsistent and donor-site complications are a major concern. Calcium sulfate has been offered as a bone substitute for treating patients with metaphysis fractures or bone defect, but the results of application in spinal surgeries are uncertain.
Fifty-one patients with a single-level thoracolumbar burst fracture for treatment with short-segment pedicle screw fixation were enrolled in the study. Fractures in group 1 patients were reinforced with TPCB (n = 31), and fractures in group 2 patients were augmented with transpedicular calcium sulfate cement (TPCSC; n = 20). All patients were followed-up at least 2 years after surgery. Radiographic parameters and clinical outcomes were compared between the 2 groups.
The 2 groups were similar in age, sex, fracture levels, preoperative neurologic status distribution, and the associated injuries. The TPCB group had a longer period of follow-up (52.7 +/- 4.9 vs. 28.6 +/- 3.5 months, P < 0.001). Blood loss and operation time were less in the TPCSC group (247.5 +/- 164.2 vs. 600.0 +/- 403.1 mL, P = 0.001 and 161.7 +/- 28.5 vs. 227.2 +/- 43.6 minutes, P < 0.001). Radiographic parameters and clinical outcomes were similar in both groups. The TPCSC group had no surgical complication, but the TPCB group revealed 2 cases with wound infection after surgery. The failure rate, defined as an increase of 10 degrees or more in loss of correction or implant failure, was also not significantly different (TPCB = 9.6% and TPCSC = 15%; P = 0.565). All patients with partial neurologic deficits initially improved at the final follow-up.
Additional TPCB grafting after posterior short-segment instrumentation remains a reliable surgical method for correcting and maintaining sagittal alignment and vertebral body height in thoracolumbar burst fractures. Calcium sulfate cement also proved to be an effective bone substitute used in spinal surgeries for patients with thoracolumbar burst fractures.
回顾性临床和影像学研究。
比较两种用于胸腰椎爆裂骨折前路增强的植骨材料：经椎弓根松质骨（TPCB）植骨和经椎弓根硫酸钙植骨，并决定硫酸钙水泥是否可以替代后路短节段内固定后用于前路椎体增强的自体松质骨。
作为预防早期植入物失败的替代方法，开发了额外的 TPCB 移植物。然而，结果不一致，供区并发症是一个主要问题。硫酸钙已被用作治疗干骺端骨折或骨缺损患者的骨替代物，但在脊柱手术中的应用结果尚不确定。
51 例单节段胸腰椎爆裂骨折患者行短节段椎弓根螺钉固定治疗，纳入本研究。第 1 组患者的骨折采用 TPCB（n = 31）增强，第 2 组患者的骨折采用经椎弓根硫酸钙水泥（TPCSC；n = 20）增强。所有患者术后至少随访 2 年。比较两组的影像学参数和临床结果。
两组患者的年龄、性别、骨折节段、术前神经状态分布和合并伤相似。TPCB 组的随访时间更长（52.7±4.9 比 28.6±3.5 个月，P<0.001）。TPCSC 组的出血量和手术时间更少（247.5±164.2 比 600.0±403.1 mL，P=0.001 和 161.7±28.5 比 227.2±43.6 分钟，P<0.001）。两组的影像学参数和临床结果相似。TPCSC 组无手术并发症，但 TPCB 组术后有 2 例发生伤口感染。失效率（定义为矫正丢失增加 10 度或以上或植入物失败）也无显著差异（TPCB = 9.6%和 TPCSC = 15%；P=0.565）。所有伴有部分神经功能缺损的患者在末次随访时均得到改善。
后路短节段内固定后附加 TPCB 植骨仍然是纠正和维持胸腰椎爆裂骨折矢状面和椎体高度的可靠手术方法。硫酸钙水泥也被证明是治疗胸腰椎爆裂骨折患者脊柱手术的有效骨替代物。
