Khan Kashif Mahmood, Bhatti Anisuddin, Khan Muhammad Arif
Department of Orthopaedics and Trauma Surgery, Jinnah Postgraduate Medical Centre, Karachi.
J Coll Physicians Surg Pak. 2012 Dec;22(12):778-82.
To determine the effectiveness of posterior spinal fixation in maintaining the stability of spine and to determine mortality in 6 months after posterior spinal fixation.
Quasi experimental study.
Department of Orthopaedics, Jinnah Postgraduate Medical Centre, Karachi and Department of Orthopaedics, Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar, from April 2006 to April 2009.
Fifty patients with unstable thoracolumbar spinal fractures from T7 - L4 were included. All the patients were operated by posterior approach using pedicle screws and rods. Effectiveness of the fixation was measured at 6 months postoperatively in terms of relief of pain and improvement in mobility using Oswestry disability index, range of motion of spine using Schobar Test/sign, reduction in deformity by measuring Cobb angle, local kyphosis angle (LKA), thoracolumbar angle, anterior and posterior vertebral heights (AVH and PVH respectively), evidence of union was made using plain radiographs and by computer assisted measurement using " OSIRIS " software. The data was then analyzed using SPSS software version 13 and presented in the form of tables and charts.
Twenty-eight patients were operated within first week. In 38 patients, 4 screws were used and in 12 patients, 8 screws were used with 2 rods. Pain and disability showed improvement, with mean 71.98% score pre-operatively to 44.96% mean at last visit (p = 0.001). Mean range of motion increased 0.5 - 2 cms postoperatively in all directions (p = 0.001). Mean kyphosis angle, Cobb angle and thoracolumbar angle improved postoperatively. Anterior and posterior vertebral body heights increased postoperatively with resultant decrease in anterior vertebral body compression. Ninety six percent patients showed signs of postoperative union on last visit and only 3 people died of unrelated causes till last visit.
Posterior spinal fixation with pedicle screws and rods is an effective surgical technique in maintaining stability of spine by improvement in pain and mobility, range of motion of spine, correction of deformity and bone union.
确定后路脊柱固定术在维持脊柱稳定性方面的有效性，并确定后路脊柱固定术后6个月内的死亡率。
准实验研究。
2006年4月至2009年4月，卡拉奇真纳研究生医学中心骨科及白沙瓦哈亚塔巴德医学综合大楼研究生医学研究所骨科。
纳入50例T7 - L4不稳定胸腰椎骨折患者。所有患者均采用后路椎弓根螺钉和棒进行手术。术后6个月通过Oswestry功能障碍指数评估疼痛缓解和活动能力改善情况，采用Schobar试验/体征评估脊柱活动范围，测量Cobb角、局部后凸角（LKA）、胸腰角、椎体前后高度（分别为AVH和PVH）评估畸形矫正情况，通过X线平片及使用“OSIRIS”软件的计算机辅助测量判断骨愈合情况。然后使用SPSS 13.0软件对数据进行分析，并以表格和图表形式呈现。
28例患者在第一周内接受手术。38例患者使用4枚螺钉，12例患者使用8枚螺钉及2根棒。疼痛和功能障碍有所改善，术前平均评分为71.98%，末次随访时平均为44.96%（p = 0.001）。术后各方向平均活动范围增加0.5 - 2厘米（p = 0.001）。术后平均后凸角、Cobb角和胸腰角均有所改善。椎体前后高度术后增加，椎体前缘压缩程度降低。96%的患者在末次随访时显示有术后骨愈合迹象，直至末次随访仅有3人死于无关原因。
椎弓根螺钉和棒的后路脊柱固定术是一种有效的手术技术，可通过改善疼痛和活动能力、脊柱活动范围、矫正畸形及促进骨愈合来维持脊柱稳定性。
