Department of Spine Surgery, First Affiliated Hospital of Dalian Medical University, Dalian 116011, People's Republic of China.
BMC Musculoskelet Disord. 2014 Feb 11;15:40. doi: 10.1186/1471-2474-15-40.
Currently, Posterior Short Segment Pedicle Screw Fixation is a popular procedure for treating unstable thoracolumbar/lumbar burst fracture. But progressive kyphosis and a high rate of hardware failure because of lack of the anterior column support remains a concern. The efficacy of different methods remains debatable and each technique has its advantages and disadvantages.
A consecutive series of 20 patients with isolated thoracolumbar/lumbar burst fractures were treated by posterior short segment pedicle screw fixation and transforaminal thoracolumbar/lumbar interbody fusion (TLIF) between January 2005 and December 2007. All patients were followed up for a minimum of 2 years. Demographic data, neurologic status, anterior vertebral body heights, segmental Cobb angle and treatment-related complications were evaluated.
The mean operative time was 167 minutes (range, 150-220). Blood loss was 450 ~ 1200 ml, an average of 820 ml. All patients recovered with solid fusion of the intervertebral bone graft, without main complications like misplacement of the pedicle screw, nerve or vessel lesion or hard ware failure. The post-operative radiographs demonstrated a good fracture reduction and it was well maintained until the bone graft fusion. Neurological recovery of one to three Frankel grade was seen in 14 patients with partial neurological deficit, three grades of improvement was seen in one patient, two grades of improvement was observed in 6 patients and one grade of improvement was found in 6 patients. All the 6 patients with no paraplegia on admission remained neurological intact, and in one patient with Frankel D on admission no improvement was observed.
Posterior short-segment pedicle fixation in conjunction with TLIF seems to be a feasible option in the management of selected thoracolumbar/lumbar burst fractures, thereby addressing all the three columns through a single approach with less trauma and good results.
目前，后路短节段椎弓根螺钉固定治疗不稳定胸腰椎/腰椎爆裂性骨折是一种较为流行的术式。但由于缺乏前柱支撑，后凸畸形和内固定失败的发生率较高仍然是一个关注点。不同方法的疗效仍存在争议，每种技术都有其优缺点。
回顾性分析 2005 年 1 月至 2007 年 12 月期间采用后路短节段椎弓根螺钉固定联合经椎间孔胸腰椎/腰椎体间融合术（TLIF）治疗的 20 例单纯胸腰椎/腰椎爆裂性骨折患者。所有患者均获得至少 2 年的随访。评估患者的一般资料、神经功能状态、伤椎前缘高度、节段 Cobb 角及治疗相关并发症。
手术时间平均为 167 分钟（范围 150-220 分钟）。术中出血量为 450-1200ml，平均 820ml。所有患者均获得植骨融合，无内固定物松动、神经或血管损伤等主要并发症。术后影像学检查显示骨折复位良好，直至植骨融合后仍保持良好。术后 14 例合并部分神经功能缺损患者中，1 例神经功能恢复 1-3 个 Frankel 分级，1 例恢复 3 个分级，6 例恢复 2 个分级，6 例恢复 1 个分级。入院时无截瘫的 6 例患者神经功能均保持完整，入院时 Frankel D 级的 1 例患者神经功能无改善。
后路短节段椎弓根螺钉固定联合 TLIF 治疗胸腰椎/腰椎爆裂性骨折是一种可行的选择，可通过单一入路治疗三柱骨折，创伤小，疗效好。
