Orthopaedics department, Northern academic Hospital, Mediterranean University, Chemin des Bourrely, 13915 Marseille, France.
Orthop Traumatol Surg Res. 2011 Sep;97(5):527-32. doi: 10.1016/j.otsr.2011.03.020. Epub 2011 Jul 16.
A number of techniques have been described in the management of thoracolumbar spinal fractures, testimony to the absence of consensus on their treatment. For the past few years, minimally invasive techniques have been developed to limit surgery-related iatrogenic injury. The objective of this study was to report the results of percutaneous management of these lesions and the technical progress made based on our experience.
Twenty-nine patients presenting an A3 fracture, with a mean age of 51 years, were included in this study. All had a balloon kyphoplasty and percutaneous osteosynthesis. Of the first 22 cases, kyphoplasty was the initial procedure performed associated with reduction maneuvers using distraction. Assessment was clinical (neurological status and pain intensity) and radiological (implant positioning, cement leakage, restoration of local kyphosis and any loss of correction).
In the overall series, the mean local kyphosis correction was 11° with a 2° angle loss at the last follow-up. Pain assessment showed significant improvement, decreasing from 6/10 to 1/10 on discharge. The mean hospital stay lasted 4 days. On the follow-up radiological exams, no cases of extrapedicular screw migration were noted; in two cases, lateral cement leakage was found. The results were equivalent in terms of correction no matter which procedure was performed first, although for the second part of the series the technology was available to bend the spinal fixation rod to the desired curve.
The results of this study support the growing interest in minimally invasive techniques in the management of spinal injuries with no neurological deficit. In addition, the evolving material makes it possible to come close to conventional techniques, including reduction maneuvers, while limiting muscle injury by using a purely percutaneous approach. Rigorous patient selection is necessary and the time to learn the procedure must be taken into account. Studies with a longer follow-up are required to confirm the stability of the correction over time.
Level IV. Retrospective observational study.
在胸腰椎脊柱骨折的治疗中，已经描述了许多技术，这表明对其治疗方法尚无共识。在过去的几年中，已经开发出微创技术来限制与手术相关的医源性损伤。本研究的目的是报告经皮治疗这些病变的结果以及根据我们的经验取得的技术进展。
本研究共纳入 29 例 A3 型骨折患者，平均年龄为 51 岁。所有患者均接受球囊后凸成形术和经皮骨固定术。在最初的 22 例中，球囊后凸成形术是最初进行的手术，并结合牵开复位进行了复位操作。评估包括临床（神经状态和疼痛强度）和放射学（植入物位置，骨水泥渗漏，局部后凸的恢复以及任何矫正丢失）。
在整个系列中，平均局部后凸矫正为 11°，最后随访时角度丢失 2°。疼痛评估显示明显改善，从出院时的 6/10 降至 1/10。平均住院时间为 4 天。在随访的影像学检查中，未发现椎弓根螺钉迁移的病例；在 2 例中发现了侧方骨水泥渗漏。无论先进行哪种程序，矫正效果都相当，尽管对于第二部分病例，该技术可以将脊柱固定棒弯曲到所需的曲线。
这项研究的结果支持在管理无神经功能缺损的脊柱损伤时对微创技术的日益关注。此外，不断发展的材料使得可以接近常规技术，包括复位操作，同时通过纯经皮入路限制肌肉损伤。需要进行严格的患者选择，并需要考虑学习手术的时间。需要进行随访时间更长的研究以确认矫正的稳定性随时间的推移。
IV 级。回顾性观察研究。
