The First Hospital Affiliated to Suzhou University, Suzhou, Jiangsu 215006, China.
Eur Spine J. 2011 Mar;20(3):380-6. doi: 10.1007/s00586-010-1542-3. Epub 2010 Aug 8.
Indirect reduction and fixation is not a new method in the treatment of thoracolumbar burst fractures but the indications and efficacy are controversial. The current study was designed to evaluate the efficacy of indirect reduction without fusion. Sixty-four patients with single-level thoracolumbar burst fractures were identified and treated by this method. The outcome was analyzed by the Frankel method, radiographic measurements, and at the latest follow-up the Denis Pain Scale and Oswestry disability index (ODI) were used to assess back pain and functional outcome. The average follow-up period was 40.1 months. The anterior vertebral height (AVH) was corrected from 55.2 to 97.2% post-operatively and decreased to 88.9% after hardware removal. The posterior vertebral height (PVH) increased from 88.9 to 99.1% post-operatively and decreased slightly after implant removal to 93.7%. The average pre-operative canal compromise was 41.4%, which decreased to 13.7% at last follow-up. Except for three paraplegic patients, neurological status significantly improved or stayed normal in the study's remaining 61 patients. Fifty-two of sixty-four patients had excellent or good function. At latest follow-up the average ODI score was 16.7 and the Denis pain score improved in all patients but one. Indirect reduction and fixation can not only restore vertebral column structure but also, more importantly, patients' functional outcome.
经皮间接复位固定治疗胸腰椎爆裂骨折并不新鲜，但适应证和疗效存在争议。本研究旨在评估不融合间接复位的疗效。通过该方法治疗了 64 例单节段胸腰椎爆裂骨折患者。采用 Frankel 分级、影像学测量评估疗效，末次随访时采用 Denis 疼痛评分和 Oswestry 功能障碍指数（ODI）评估腰背疼痛和功能恢复情况。平均随访时间 40.1 个月。术后伤椎前缘高度（AVH）从 55.2%恢复至 97.2%，内固定取出后降至 88.9%。术后伤椎后缘高度（PVH）从 88.9%增加至 99.1%，内固定取出后略有下降至 93.7%。术前椎管侵占率平均为 41.4%，末次随访时降至 13.7%。除 3 例截瘫患者外，其余 61 例患者神经功能均显著改善或保持正常。64 例患者中 52 例功能恢复优良。末次随访时，ODI 平均评分为 16.7，所有患者除 1 例外均改善了疼痛情况。经皮间接复位固定不仅能恢复脊柱结构，还能显著改善患者的功能预后。
