Uzumcugil Onat, Dogan Ahmet, Yetis Mehmet, Yalcinkaya Merter, Caniklioglu Mustafa
S B Istanbul Education and Research Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey.
Kobe J Med Sci. 2010 Sep 28;56(2):E67-78.
The aim of this retrospective clinical study was to evaluate and compare the results of the technique so called 'two above one below approach' with intermediate screws at the fracture site with long-segment posterior fusion in the surgical treatment of thoracolumbar burst fractures. For this purpose neurologically intact 27 patients having isolated one level thoracolumbar burst fracture underwent posterior instrumentation and fusion in our clinic via 'two above-one below approach' with intermediate screws at the fracture site. A control group consisting of 15 patients having one level thoracolumbar burst fracture treated with long segment posterior spinal fusion in our institute was formed. At the preoperative, postoperative and final follow up period, anterior body height loss, local kyphosis and sagittal index values of both groups were noted. At the final follow up Visual Analogue Pain Scale and Oswestry disability scores were noted. Retrospective data from both groups underwent statistical analysis. In both groups anterior body height loss, local kyphosis and sagittal index measurements improved at the final follow-up, but there was no significance between two groups in terms of radiological and clinical follow-up data. The loss of correction in local kyphosis of short-segment group in the interval between postoperative and follow-up period was also significant. No implant failure was noted. As a conclusion 'two above one below approach' with intermediate screws at the fracture site is associated with loss of correction radiographically, but favorable clinical outcomes in the presence of any implant failure can be achieved in the treatment of thoracolumbar burst fractures.
这项回顾性临床研究的目的是评估和比较在胸腰椎爆裂骨折的手术治疗中，使用骨折部位中间螺钉的所谓“两上一下法”与长节段后路融合术的效果。为此，27例神经功能完好的孤立性单节段胸腰椎爆裂骨折患者在我们诊所通过骨折部位中间螺钉的“两上一下法”接受了后路内固定和融合术。形成了一个对照组，该组由15例在我们研究所接受长节段后路脊柱融合术治疗的单节段胸腰椎爆裂骨折患者组成。在术前、术后和最终随访期，记录两组患者的椎体前缘高度丢失、局部后凸和矢状指数值。在最终随访时，记录视觉模拟疼痛量表和奥斯维斯特功能障碍评分。对两组的回顾性数据进行统计分析。两组患者在最终随访时椎体前缘高度丢失、局部后凸和矢状指数测量值均有所改善，但在放射学和临床随访数据方面两组之间无显著差异。短节段组术后至随访期间局部后凸的矫正丢失也很显著。未发现内固定失败情况。结论是，骨折部位使用中间螺钉的“两上一下法”在影像学上与矫正丢失有关，但在胸腰椎爆裂骨折的治疗中，即使存在任何内固定失败，也可取得良好的临床效果。
