Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz Neurosciences Research Center, PO Box 71455-166, Shiraz, Iran.
Eur Spine J. 2010 Oct;19(10):1651-6. doi: 10.1007/s00586-010-1449-z. Epub 2010 May 21.
Short segment posterior fixation is the preferred method for stabilizing thoracolumbar fractures. In case of significant disruption of the anterior column, the simple short segment construct does not ensure adequate stability. In this study, we tried to evaluate the effect of inclusion of the fractured vertebra in short segment fixation of thoracolumbar fractures. In a prospective randomized study, eighty patients with thoracolumbar fractures treated just with posterior pedicular fixation were randomized into two groups receiving either the one level above and one level below excluding the fracture level (bridging group), or including the fracture level (including group). Different clinical and radiological parameters were recorded and followed. A sum of 80 patients (42 patients in group 1 and 38 patients in group 2) were enrolled in the study. The patients in both the groups showed similar clinical outcome. There was a high rate of instrumentation failure in the "bridging" group. The "bridging" group showed a mean worsening (29%) in kyphosis, whereas the "including" group improved significantly by a mean of 6%. The significant effect of the "including" technique on the reduction of kyphotic deformity was most prominent in type C fractures. In conclusion, inclusion of the fracture level into the construct offers a better kyphosis correction, in addition to fewer instrument failures, without additional complications, and with a comparable-if not better-clinical and functional outcome. We recommend insertion of screws into pedicles of the fractured thoracolumbar vertebra when considering a short segment posterior fixation, especially in Magerl type C fractures.
短节段后路固定是稳定胸腰椎骨折的首选方法。在严重破坏前柱的情况下,单纯的短节段结构并不能保证足够的稳定性。在本研究中,我们试图评估在胸腰椎骨折的短节段固定中加入骨折椎体的效果。在一项前瞻性随机研究中,80 例仅接受后路椎弓根固定治疗的胸腰椎骨折患者被随机分为两组,一组接受不包括骨折节段的上下各一节椎弓根固定(桥接组),另一组接受包括骨折节段的椎弓根固定(包括组)。记录并随访了不同的临床和影像学参数。共有 80 例患者(桥接组 42 例,包括组 38 例)入组本研究。两组患者的临床结果相似。桥接组内固定失败率较高。桥接组的后凸畸形平均加重(29%),而包括组的后凸畸形平均改善(6%)。在 C 型骨折中,包括技术对减少后凸畸形的显著效果最为明显。总之,将骨折节段纳入固定结构可提供更好的后凸矫正,同时减少内固定失败,且无额外并发症,并具有可比(如果不是更好)的临床和功能结果。我们建议在考虑短节段后路固定时,尤其是在 Magerl 型 C 型骨折中,将螺钉插入胸腰椎骨折的椎弓根内。