Azam Farooq, Shah Mewat
Department of Neurosurgery, Hayatabad Medical Complex, Peshawar.
J Pak Med Assoc. 2011 Oct;61(10):1005-8.
To assess the effectiveness of transpedicular screw fixation in neurological recovery and pain control in thoracolumbar junction injuries.
This audit was carried out in the Neurosurgery Department of Postgraduate Medical Institute, Hayatabad Medical Complex Peshawar from November 2008 to April 2010. Written informed consent was taken from all patients. Detail history, clinical examination, x-ray dorsolumbar spine (or CT scan dorsolumbar spine) and MRI dorsolumbar spine were done in all cases. Neurological status was assessed using the Frankel grading for spinal cord injury. Post traumatic unstable thoracolumbar junction fractures were included in this study. Open fractures, fractures with significant kyphotic deformity, fractures with anterior retropulsed fragments, multiple level fractures requiring long segment fixation, pedicles fractures and pathological fractures were excluded from study. The short-segment transpedicular fixation was performed in all patients. Effect of transpedicular screw fixation on pain relief was measured by improvement in Dennis pain scale. History of pain relief and neurological assessments of patients were done on each follow up visit. The data was analyzed in SPSS 16.0.
Transpedicular screw fixation was performed in 80 patients including 55 males and 25 females. Mean age was 35 +/- 6.75 years (range 15-61 years). The level of injuries were D11 = 6 (7%) cases, D12 = 13 (16%) cases, L1 = 40 (50%) cases, L2 = 15 (19%) cases, D12 & L1 = 6 (8%) cases. There were 43 (54%) Wedge fractures, 9 (11%) fracture subluxations, burst fracture in 14 (17%), translational injuries in 8 (10%) while distraction injuries in 6 (8%) cases. Pre operative neurological status according to Frankel grading was: grade A, 48 (60%) cases, grade B 12 (15%) cases, grade C 6 (7%) cases, grade D 4 (5%) cases and grade E 10 (13%) cases. Six months post operatively, there were 16 (20%) cases in grade A, grade B 34 (42.5%) cases, grade C 16 (20%) cases, grade D 4 (5%) cases and grade E 10 (12.5%) cases. Pain control was assessed by improvement in Dennis pain scale. Pre operatively there was no patient in P1, 4 (5%) patients in P2, 16 (20%) in P3, 24 (30%) in P4 and 36 (45%) in P5. Six months later there were 56 (70%) patients in P1,16 (20%) in P2, 4 (5%) in P3 and 4 (5%) patients in P4.There was no patient in P5.
Thoracolumbar junction injuries are common in young male patients. Transpedicular screw fixation is useful choice for achieving better neurological recovery and good pain control in traumatic thoracolumbar fractures.
评估经椎弓根螺钉固定术在胸腰段交界处损伤的神经功能恢复及疼痛控制方面的有效性。
本研究于2008年11月至2010年4月在白沙瓦哈亚塔巴德医疗中心研究生医学研究所神经外科进行。所有患者均签署书面知情同意书。对所有病例均进行详细病史采集、临床检查、胸腰椎X线（或胸腰椎CT扫描）及胸腰椎MRI检查。采用Frankel脊髓损伤分级评估神经功能状态。本研究纳入创伤性胸腰段交界处不稳定骨折。开放性骨折、伴有明显后凸畸形的骨折、伴有前方骨折块后移的骨折、需要长节段固定的多节段骨折、椎弓根骨折及病理性骨折排除在研究之外。所有患者均行短节段经椎弓根固定术。通过Dennis疼痛量表的改善情况来衡量经椎弓根螺钉固定术对疼痛缓解的效果。每次随访时均记录患者的疼痛缓解情况及神经功能评估结果。数据采用SPSS 16.0软件进行分析。
80例患者行椎弓根螺钉固定术，其中男性55例，女性25例。平均年龄35±6.75岁（范围15 - 61岁）。损伤节段为：D11共6例（7%），D12共13例（16%），L1共40例（50%），L2共15例（19%），D12和L1共6例（8%）。其中楔形骨折43例（54%），骨折脱位9例（11%），爆裂骨折14例（17%），平移性损伤8例（10%），牵张性损伤6例（8%）。术前根据Frankel分级，A级48例（60%），B级12例（15%），C级6例（7%），D级4例（5%），E级10例（13%）。术后6个月，A级16例（20%），B级34例（42.5%），C级16例（20%），D级4例（5%），E级10例（12.5%）。通过Dennis疼痛量表的改善情况评估疼痛控制效果。术前P1级无患者，P2级4例（5%），P3级16例（20%），P4级24例（30%），P5级36例（45%）。6个月后，P1级56例（70%），P2级16例（20%），P3级4例（5%），P4级4例（5%）。P5级无患者。
胸腰段交界处损伤在年轻男性患者中较为常见。经椎弓根螺钉固定术是创伤性胸腰椎骨折实现更好神经功能恢复及良好疼痛控制的有效选择。
