Saget Mathieu, Teyssedou Simon, Prebet Remi, Vendeuvre Tanguy, Gayet Louis-Etienne, Pries Pierre
Service de Chirurgie Orthopédique et Traumatologie, CHU de Poitiers, 2 rue de la Milétrie, 86000 Poitiers, France.
J Spinal Disord Tech. 2014 Aug;27(6):E226-33. doi: 10.1097/BSD.0b013e31829a3785.
Prospective clinical and radiological study.
To evaluate the impact of stand-alone acrylic kyphoplasty in the treatment of recent traumatic fractures of the thoracolumbar spine in young patients.
The management of fractures of the thoracolumbar spine without neurological deficit remains controversial. For a long time clinicians could only chose between functional treatment, orthopedic treatment, and traditional surgery. The recent advent of minimally invasive surgical techniques is an interesting alternative.
Fifty-four patients with a mean age of 45.8±18.2 years and who had recently sustained a fracture of the thoracolumbar junction were enrolled into the study. Balloon kyphoplasty was performed using acrylic cement. Radiologic assessments (computed tomography scans) and clinical assessments (including Visual Analog Scale and Oswestry Disability Index scores) were used to determine kyphoplasty success and measure patient recovery over 2 years.
Kyphoplasty reduced mean vertebral kyphosis from 12.8±5.0 degrees at trauma to 8.2±5.1 degrees at 2-year follow-up. Mean vertebral kyphosis was corrected by -5.7±4.7 degrees (P=0.0001) at the point of first verticalization, with no significant change at the 2-year follow-up visit (+1.1±4.3 degrees, P=0.1058). Kyphoplasty significantly augmented the height of the 6 anterior and intermediate segments. Maximum mean augmentation of intermediate vertebral height after 6 months was (11.6%±15.5%, P<0.0001). Patients tolerated the procedure well and 56% of them returned to work 3 months after kyphoplasty.
Kyphoplasty is safe and effective in the correction of nonosteoporotic fractures of the thoracolumbar junction in young patients, and remains stable for at least 2 years postsurgery.
前瞻性临床与放射学研究。
评估单纯丙烯酸骨水泥椎体后凸成形术对年轻患者近期胸腰椎创伤性骨折的治疗效果。
无神经功能缺损的胸腰椎骨折的治疗仍存在争议。长期以来，临床医生只能在功能治疗、矫形治疗和传统手术之间做出选择。近年来微创外科技术的出现是一种有趣的替代方法。
54例平均年龄为45.8±18.2岁、近期发生胸腰段骨折的患者纳入本研究。使用丙烯酸骨水泥进行球囊椎体后凸成形术。通过放射学评估（计算机断层扫描）和临床评估（包括视觉模拟评分和Oswestry功能障碍指数评分）来确定椎体后凸成形术的成功率，并测量患者2年的恢复情况。
椎体后凸成形术使平均椎体后凸角从创伤时的12.8±5.0度降至2年随访时的8.2±5.1度。首次复位时平均椎体后凸角矫正了-5.7±4.7度（P = 0.0001），2年随访时无显著变化（+1.1±4.3度，P = 0.1058）。椎体后凸成形术显著增加了6个前侧和中间节段的高度。6个月后中间椎体高度的最大平均增加量为（11.6%±15.5%，P < 0.0001）。患者对该手术耐受性良好，56%的患者在椎体后凸成形术后3个月恢复工作。
椎体后凸成形术在矫正年轻患者胸腰段非骨质疏松性骨折方面安全有效，且术后至少2年保持稳定。
