Departments of Neurosurgery, University of Iowa, Iowa City, IA 52245, USA.
Neurosurg Focus. 2013 Aug;35(2):E2. doi: 10.3171/2013.6.FOCUS13176.
Flexion-distraction injuries occur due to distractive forces causing disruption of the posterior and middle spinal columns. These fractures classically consist of a fracture line through the posterior bony elements; involvement of the posterior ligamentous complex is, however, common. Surgical treatment is often required for these unstable injuries to avoid neurological deterioration and posttraumatic kyphosis, and the surgery traditionally consists of an open posterior approach with instrumented fusion. Percutaneous pedicle screw fixation for these injuries, with the goal of minimal tissue disruption and preservation of normal anatomy while achieving adequate stabilization, has recently been reported in the literature, but to date, a direct comparative study comparing open and percutaneous fixation has not been reported. The authors report their experience treating these fractures with both techniques and review the available literature.
Patients with flexion-distraction injury who were treated between May 2003 and March 2013 were prospectively followed. American Spinal Injury Association scores and degree of kyphotic angulation were recorded at admission, discharge, and follow-up. Data regarding intraoperative blood loss and operative time were obtained from a chart review. Patients treated with open versus minimally invasive procedures were compared.
The authors identified 39 patients who suffered flexion-distraction injuries and were treated at their institution during the specified period; one of these patients declined surgery. All had injury to the posterior ligamentous complex. Open surgical procedures with pedicle screw fixation and posterolateral fusion were performed in 27 patients, while 11 patients underwent minimally invasive pedicle screw placement. Overall, there was improvement in kyphotic angulation at the time of discharge as well as most recent follow-up in both the open surgery and minimally invasive surgery (MIS) groups. The authors found no significant difference in American Spinal Injury Association score or the degree of kyphotic angulation between the MIS and open surgery groups. There was a trend toward shorter operative time for the MIS group, and patients who underwent minimally invasive procedures had significantly less blood loss.
Minimally invasive percutaneous pedicle screw fixation appears to have similar efficacy in the treatment of flexion-distraction injuries and it allows for reduced blood loss and tissue damage compared with open surgical techniques. Therefore it should be considered as an option for the treatment of this type of injury.
屈伸分离伤是由于分离力导致后柱和中柱破坏而引起的。这些骨折经典地包括穿过后骨元素的骨折线；然而，后韧带复合体的受累是常见的。为了避免神经恶化和创伤后后凸，这些不稳定的损伤通常需要手术治疗，传统的手术方法是通过开放式后路入路进行器械融合。最近文献中报道了经皮椎弓根螺钉固定这些损伤的方法，目的是在实现充分稳定的同时，尽量减少组织破坏和保持正常解剖结构，但迄今为止，还没有直接比较开放和经皮固定的对照研究。作者报告了他们使用这两种技术治疗这些骨折的经验，并回顾了现有的文献。
前瞻性随访 2003 年 5 月至 2013 年 3 月期间接受治疗的屈伸分离伤患者。在入院、出院和随访时记录美国脊髓损伤协会（American Spinal Injury Association，ASIA）评分和后凸角度。从病历回顾中获得术中失血量和手术时间的数据。比较了接受开放手术与微创手术的患者。
作者确定了在指定期间在他们的机构接受治疗的 39 例屈伸分离伤患者；其中 1 例患者拒绝手术。所有患者均有后韧带复合体损伤。27 例患者接受了后路椎弓根螺钉固定和后外侧融合的开放性手术，11 例患者接受了微创椎弓根螺钉固定。总体而言，无论是开放手术组还是微创组（minimally invasive surgery，MIS），在出院时以及最近的随访中，后凸角度都有所改善。作者发现 MIS 组和开放手术组之间的 ASIA 评分或后凸角度没有显著差异。MIS 组的手术时间有缩短的趋势，接受微创手术的患者失血量明显减少。
微创经皮椎弓根螺钉固定在治疗屈伸分离伤方面似乎具有相似的疗效，与开放手术技术相比，它可以减少失血和组织损伤。因此，它应该被视为治疗这种类型损伤的一种选择。
