Jeong Won-Ju, Kim Joon-Woo, Seo Dong-Kyo, Lee Hyun-Joo, Kim Jun-Young, Yoon Jong-Pil, Min Woo-Kie
Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea.
Orthopedics. 2013 May;36(5):e567-74. doi: 10.3928/01477447-20130426-17.
The use of pedicle screws for short-segment implants has been known to be dangerous in patients who score a 7 or higher on McCormack's classification. The efficiency of ligamentotaxis of the posterior longitudinal ligament (PLL) and short-segment implants and fusion in relation to McCormack's classification has not been proven. The purpose of this study was to compare the clinical and radiological results of indirect decompression using PLL ligamentotaxis between patients with a high- (score of 7 or higher) or low-grade (score of 6 or less) fracture. Eighteen patients (19 levels) in the low-grade fracture group were compared with 23 patients (27 levels) in the high-grade fracture group. Clinical outcomes were measured using the Oswestry Disability Index (ODI) and visual analog scale (VAS) scores; radiologic measures were determined using the spinal canal area and mean sagittal diameter; and the complications were evaluated and compared. A significant improvement in each groups was found in the mean pre- and postoperative spinal canal area, mean sagittal diameter, Cobb's angle, and anterior vertebral height compression rate. A significant difference was found between the 2 groups in the mean pre- and postoperative spinal canal area, mean sagittal diameter, and anterior vertebral height compression rate. Moreover, the VAS and ODI scores continued to significantly improve at the last follow-up in each group. No difference was found in the prevalence of complications. Despite a high score, no significant difference was found in the clinical and radiological results and the complications. Therefore, indirect decompression using PLL ligamentotaxis was found to be a useful technique for patients who recieve a high McCormack's classification score.
对于 McCormack 分级为 7 分及以上的患者，使用椎弓根螺钉进行短节段植入被认为是危险的。后纵韧带（PLL）的韧带整复作用以及短节段植入物和融合与 McCormack 分级的关系尚未得到证实。本研究的目的是比较高分级（7 分及以上）或低分级（6 分及以下）骨折患者使用 PLL 韧带整复进行间接减压的临床和放射学结果。将低分级骨折组的 18 例患者（19 个节段）与高分级骨折组的 23 例患者（27 个节段）进行比较。使用奥斯威斯利功能障碍指数（ODI）和视觉模拟量表（VAS）评分来衡量临床结果；通过椎管面积和矢状径平均值来确定放射学测量结果；并对并发症进行评估和比较。发现每组患者术前和术后的平均椎管面积、矢状径平均值、Cobb 角和椎体前缘高度压缩率均有显著改善。两组患者术前和术后的平均椎管面积、矢状径平均值和椎体前缘高度压缩率存在显著差异。此外，每组患者在最后一次随访时 VAS 和 ODI 评分继续显著改善。并发症的发生率没有差异。尽管评分较高，但在临床和放射学结果以及并发症方面未发现显著差异。因此，对于 McCormack 分级得分较高的患者，使用 PLL 韧带整复进行间接减压被认为是一种有用的技术。
