Service de neurochirurgie Pr Dufour, Hôpital de la Timone, Université de la Mediterranée, 249 rue Saint Pierre, 13005 Marseille, France.
Eur Spine J. 2010 Aug;19(8):1281-7. doi: 10.1007/s00586-010-1444-4. Epub 2010 May 22.
The study design includes prospective evaluation of percutaneous osteosynthesis associated with cement kyphoplasty on 18 patients. The objective of the study is to assess the efficacy of a percutaneous method of treating burst vertebral fractures in patients without neurological deficits. Even if burst fractures are frequent, no therapeutic agreement is available at the moment. We report in this study the results at 2 years with a percutaneous approach for the treatment of burst fractures. 18 patients were included in this study. All the patients had burst vertebral fractures classified type A3 on the Magerl scale, between levels T9 and L2. The patients' mean age was 53 years (range 22-78 years) and the neurological examination was normal. A percutaneous approach was systematically used and a kyphoplasty was performed via the transpedicular pathway associated with percutaneous short-segment pedicle screw osteosynthesis. The patients' follow-up included CT scan analysis, measurement of vertebral height recovery and local kyphosis, and clinical pain assessments. With this surgical approach, the mean vertebral height was improved by 25% and a mean improvement of 11.28 degrees in the local kyphotic angle was obtained. 3 months after the operation, none of the patients were taking class II analgesics. The mean duration of their hospital stay was 4.5 days (range 3-7 days) and the mean follow-up period was 26 months (range 17-30 months). No significant changes in the results obtained were observed at the end of the follow-up period. Minimally invasive methods of treating burst vertebral fractures can be performed via the percutaneous pathway. This approach gives similar vertebral height recovery and kyphosis correction rates to those obtained with open surgery. It provides a short hospital stay, however, and might therefore constitute a useful alternative to open surgical methods.
研究设计包括对 18 例患者进行经皮骨内固定联合骨水泥后凸成形术的前瞻性评估。本研究的目的是评估一种治疗无神经功能缺损的爆裂性骨折的经皮方法的疗效。尽管爆裂性骨折很常见，但目前还没有治疗共识。我们在此研究中报告了经皮入路治疗爆裂性骨折的 2 年结果。18 例患者纳入本研究。所有患者均为 Magerl 分类 A3 型爆裂性骨折，骨折部位位于 T9 至 L2 之间。患者的平均年龄为 53 岁（22-78 岁），神经检查正常。系统采用经皮入路，通过经椎弓根途径行后凸成形术，并联合经皮短节段椎弓根螺钉内固定。患者的随访包括 CT 扫描分析、椎体高度恢复和局部后凸角测量以及临床疼痛评估。采用这种手术方法，椎体高度平均改善 25%，局部后凸角平均改善 11.28 度。术后 3 个月，无患者服用 II 类止痛药。患者的平均住院时间为 4.5 天（3-7 天），平均随访时间为 26 个月（17-30 个月）。随访结束时，未观察到结果有显著变化。经皮入路可以微创治疗爆裂性骨折。这种方法可以获得与开放手术相似的椎体高度恢复和后凸角矫正率。然而，它提供了较短的住院时间，因此可能是开放手术方法的有用替代方法。
