Department of Spinal Surgery, Huangpu Division of First Affiliated Hospital, Sun-Yat Sen University, Guangzhou, Guangdong, People's Republic of China.
Spine (Phila Pa 1976). 2010 Jul 1;35(15):E714-20. doi: 10.1097/BRS.0b013e3181d7ad1d.
A prospective clinical trial was conducted.
To compare the clinical and radiologic late results of monosegmental transpedicular fixation versus short-segment pedicle instrumentation (SSPI) in management of thoracolumbar burst fractures and evaluate the efficacy of monosegmental transpedicular fixation.
SSPI (1 level above and 1 below the fracture level) are accepted by many surgeons as an accepted technique for the treatment of thoracolumbar burst fractures. To preserve more motion segments, some authors have advocated monosegmental pedicle instrumentation (MSPI). The recent developments showed that MSPI yielded good clinical results; however, there were no report about comparison of clinical outcome between monosegmental and biosegmental transpedicular fixation in management of thoracolumbar burst fractures.
Eighty-five patients with thoracolumbar burst fractures fulfilling the inclusion criteria were included in the study. The patients were randomized by a simple method into 2 groups. Group 1 were treated with monosegmental transpedicular fixation (n = 47), and group 2 were treated with biosegmental transpedicular fixation (n = 38). Clinical (Low Back Outcome Score and Oswestry Disability Index) and radiologic (load-sharing classification index, sagittal index, and percentage of anterior body height compression) outcomes were analyzed.
The 2 groups were similar in age, follow-up period, and severity of the deformity and fracture. The postoperative and follow-up sagittal index, local kyphosis, percentage of anterior body height compression, and average correction loss in local kyphosis in both groups were not significantly different. The failure rate between the 2 surgical approaches was also not significantly different (group 1 = 6.38% and group 2 = 5.26%). Oswestry Disability Index improved in both groups by >25 points in a similar amount (P = 0.23). The average follow-up Low Back Outcome Score was 74.9 and 60.2 for group 1 and group 2, respectively (P = 0.033).
In conclusion, radiologic parameters demonstrated that both MSPI and SSPI are the effective and reliable operative techniques for selected thoracolumbar burst fractures. MSPI shortened the operative time and decreased the amount of blood loss significantly and, thus, offered better clinical results. Nevertheless, long-term studies are supposed to be performed to support the outcomes.
进行了一项前瞻性临床试验。
比较单节段经皮椎弓根固定与短节段椎弓根内固定（SSPI）治疗胸腰椎爆裂骨折的临床和影像学晚期结果，并评估单节段经皮椎弓根固定的疗效。
SSPI（骨折水平上下各 1 个节段）被许多外科医生认为是治疗胸腰椎爆裂骨折的一种公认技术。为了保留更多的运动节段，一些作者提倡单节段椎弓根内固定（MSPI）。最近的研究表明，MSPI 取得了良好的临床效果；然而，关于单节段和双节段经皮椎弓根固定治疗胸腰椎爆裂骨折的临床结果比较尚无报道。
符合纳入标准的 85 例胸腰椎爆裂骨折患者纳入本研究。患者采用简单方法随机分为 2 组。组 1 采用单节段经皮椎弓根固定（n=47），组 2 采用双节段经皮椎弓根固定（n=38）。分析临床（下腰痛结果评分和 Oswestry 残疾指数）和影像学（载荷分担分级指数、矢状指数和前部椎体高度压缩百分比）结果。
2 组在年龄、随访时间、畸形和骨折严重程度方面相似。两组术后和随访时的矢状指数、局部后凸角、前部椎体高度压缩百分比和局部后凸角平均矫正丢失均无显著差异。两种手术方法的失败率也无显著差异（组 1=6.38%，组 2=5.26%）。两组的 Oswestry 残疾指数均有改善，且改善程度相似（P=0.23）。组 1 和组 2 的平均随访下腰痛结果评分分别为 74.9 和 60.2（P=0.033）。
综上所述，影像学参数表明，MSPI 和 SSPI 都是治疗胸腰椎爆裂骨折的有效可靠手术技术。MSPI 显著缩短了手术时间，减少了出血量，从而获得了更好的临床效果。然而，应该进行长期研究来支持这些结果。
