经微创方法行椎弓根下减压及胸腰椎Magerl型不完全爆裂骨折椎体重建术
Subpedicle decompression and vertebral reconstruction for thoracolumbar Magerl incomplete burst fractures via a minimally invasive method.
作者信息
Li Kung-Chia, Yu Shang-Won, Li Allen, Hsieh Ching-Hsiang, Liao Ting-Hua, Chen Ju-Hung, Wu Shu-Jung, Lu Chih-Shen
机构信息
*Department of Orthopaedic Surgery, Chiayi Yang-Ming Hospital, Chiayi, Taiwan, ROC †Institute and Faculty of Physical Therapy, National Yang-Ming University, Taipei, Taiwan, ROC ‡Department of Orthopaedic Surgery, E-Da Hospital, Kaohsiung City, Taiwan, ROC §School of Medicine, University of Pittsburgh, Pittsburgh, PA; and ¶Department of Neurosurgery, Chiayi Yang-Ming Hospital, Chiayi, Taiwan, ROC.
出版信息
Spine (Phila Pa 1976). 2014 Mar 1;39(5):433-42. doi: 10.1097/BRS.0000000000000186.
STUDY DESIGN
Retrospective.
OBJECTIVE
To evaluate the clinical and radiographical results.
SUMMARY OF BACKGROUND DATA
The evolution of posterior approach for burst fractures was from long-segment to short-segment and then to monosegmental fixation. Decompression of the spinal cord is performed by anterior or posterior approaches. The technique attempts to decompress the spinal cord by a paramedian subpedicle approach, and simultaneous vertebral reconstruction with pile-up titanium spacers (subpedicle decompression and body augmentation [SpBA]) was developed.
METHODS
Eighty patients with symptomatic single thoracolumbar Magerl incomplete burst fractures were included. After manual reduction, transpedicle body augmentation and shortsegment fixation (TpBA group) were performed in 38 patients and SpBA in 42 cases. The mean follow-up was 52.6 ± 18.7 (TpBA) and 42.1 ± 7.8 (SpBA) months, and the age was 57.9 ± 7.2 and 59.1 ± 8.3 years. Clinical and radiographical outcomes were analyzed.
RESULTS
The operation time was 66 ± 11 (TpBA) versus 34.5 ± 5.5 (SpBA) minutes. The initial anterior vertebral correction was 46.8 ± 12.2% (TpBA) versus 53.2 ± 15.0% (SpBA) (P = 0.03) and the final correction was 44.0 ± 10.8% versus 51.5 ± 15.3% (P = 0.01). Initial corrections of the lateral Cobb angle were 22.3° ± 2.6° versus 22.8° ± 2.7° and the final corrections were 19.1° ± 3.4° versus 20.5° ± 2.9°. The VAS score was 7.7 ± 1.2 versus 7.9 ± 1.2 preoperatively and 2.2 ± 0.7 versus 1.8 ± 0.6 (P = 0.02) at the final visit. Seventy-five patients maintained or recovered to Frankel grade E. Three patients in the TpBA group and 2 in the SpBA group improved from grade C to D. Technical complications included 1 root overstretch in the SpBA group and one incomplete decompression in the TpBA group.
CONCLUSION
SpBA is a safe and fast technique to treat Magerl incomplete burst fractures and leads to good clinical results.
LEVEL OF EVIDENCE
N/A.
研究设计
回顾性研究。
目的
评估临床和影像学结果。
背景资料总结
爆裂骨折后路手术方式的演变经历了从长节段固定到短节段固定，再到单节段固定。脊髓减压可通过前路或后路进行。该技术尝试通过椎弓根旁正中入路进行脊髓减压，并同时采用堆积钛间隔器进行椎体重建（椎弓根旁减压及椎体增强术[SpBA]）。
方法
纳入80例有症状的单节段胸腰段Magerl不完全性爆裂骨折患者。手法复位后，38例患者行椎弓根椎体增强术及短节段固定（TpBA组），42例患者行SpBA手术。平均随访时间TpBA组为52.6±18.7个月，SpBA组为42.1±7.8个月，年龄分别为57.9±7.2岁和59.1±8.3岁。分析临床和影像学结果。
结果
手术时间TpBA组为66±11分钟，SpBA组为34.5±5.5分钟。初始椎体前缘矫正率TpBA组为46.8±12.2%，SpBA组为53.2±15.0%（P = 0.03），最终矫正率分别为44.0±10.8%和51.5±15.3%（P = 0.01）。初始侧方Cobb角矫正度数分别为22.3°±2.6°和22.8°±2.7°，最终矫正度数分别为19.1°±3.4°和20.5°±2.
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