Spinal Department, First Affiliated Hospital of University of South China, Hengyang city, Hunan, China.
Spine (Phila Pa 1976). 2011 Apr 20;36(9):E606-11. doi: 10.1097/BRS.0b013e3181f92dac.
A technical report of thoracolumbar fractures managed by percutaneous external pedicular fixation and intracorporeal bone grafting.
To develop a new technique by combining simplified percutaneous external pedicular fixator with intracorporeal bone grafting to treat thoracolumbar fractures and assess its technical safety and clinical efficacy.
For surgical treatment of thoracolumbar fractures, the classical techniques are beneficial in decompression, restoration, fixation, and graft fusion, but they are also hugely invasive procedures. The earlier external spinal fixation procedures are good at indirect restoration, decompression, and elastic fixation of spinal fracture. However, they are limited by remains of a large external frame and inability of vertebral reconstruct. Therefore, the minimally invasive techniques combining simplified percutaneous external pedicular fixation and intracorporeal bone grafting might be a useful alternative.
There were 50 consecutive patients who had thoracolumbar fractures with or without associated incomplete neurologic deficit. They underwent percutaneous external pedicle fixation and intracorporeal bone grafting surgery within 7 days of admission, had their implants removed after 3 months, and were prospectively followed for at least 12 months. American Spine Injury Association grading, spinal canal encroachment, spinal Cobb angle, and vertebral body height were calculated before and after surgery to assess clinical outcome.
A minimum of 12-month follow-up was achieved in 50 patients. The average operative time was 90 minutes (range, 50-160 minutes). The mean bone graft volume was 4.8 cm (range, 3.2-10.6 cm). The intraoperative mean blood loss was 100 mL (range, 50-180 mL). Forty-two patients all had at least one American Spine Injury Association grade neurologic improvement on final follow-up observation; there were no surgery-related complications. The mean anterior height of vertebral body was 53.2% (range 25%-78%) before surgery, 93.6% (range 78%-104%) after surgery, and 94% (range 79%-103%) at final follow-up. The preoperative Cobb angle of the primary curve averaged 30.7° (range 8°-67°), and corrected to 4.5° (range 0°-12.0°) immediately after surgery, There were statistically significant (P < 0.01) among them before and after operation. There was no instrumentation failure or measurable loss of sagittal curve and vertebral height correction in any cases.
The new technique by combination of percutaneous external transpedicular fixation and transpedicular bone grafting is a feasible, safe, useful, efficient, and minimally invasive method to treat thoracolumbar fractures. It is a reasonable alternative method to other minimally invasive techniques of surgical management of the thoracolumbar fractures.
经皮椎弓根外固定与经皮椎体内植骨治疗胸腰椎骨折的技术报告。
通过结合简化的经皮椎弓根外固定器与经皮椎体内植骨术来治疗胸腰椎骨折，开发一种新技术，并评估其技术安全性和临床疗效。
对于胸腰椎骨折的手术治疗，经典技术在减压、复位、固定和植骨融合方面是有益的，但同时也是极具侵袭性的手术。早期的脊柱外固定术擅长于脊柱骨折的间接复位、减压和弹性固定。然而，它们受到大量外固定架残留和椎体重建能力的限制。因此，结合简化的经皮椎弓根外固定与经皮椎体内植骨的微创技术可能是一种有用的替代方法。
50 例连续的胸腰椎骨折患者，伴或不伴有不完全性神经功能障碍，在入院后 7 天内接受经皮椎弓根外固定和经皮椎体内植骨手术，术后 3 个月取出植入物，并进行至少 12 个月的前瞻性随访。在术前和术后评估临床结果时，采用美国脊柱损伤协会分级、椎管侵占、脊柱 Cobb 角和椎体高度进行计算。
50 例患者均获得至少 12 个月的随访。平均手术时间为 90 分钟（范围：50-160 分钟）。平均植骨体积为 4.8cm（范围：3.2-10.6cm）。术中平均失血量为 100ml（范围：50-180ml）。42 例患者在最终随访观察时均至少有 1 项美国脊柱损伤协会神经功能改善分级；无手术相关并发症。术前椎体前缘高度为 53.2%（范围：25%-78%），术后为 93.6%（范围：78%-104%），最终随访时为 94%（范围：79%-103%）。主要前凸曲线的术前 Cobb 角平均为 30.7°（范围：8°-67°），术后即刻矫正至 4.5°（范围：0°-12.0°），术后即刻与术前比较差异有统计学意义（P < 0.01）。在任何情况下，均未发生器械失效或矢状曲线和椎体高度矫正丢失。
经皮椎弓根外固定与经皮椎体内植骨相结合的新技术是一种可行、安全、有效、高效和微创的方法，可治疗胸腰椎骨折。这是治疗胸腰椎骨折的其他微创手术管理方法的合理替代方法。
