Chou Po-Hsin, Ma Hsiao-Li, Wang Shih-Tien, Liu Chien-Lin, Chang Ming-Chau, Yu Wing-Kwong
School of Medicine, National Yang-Ming University, Taipei, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan, Republic of China. E-mail address for S.-T. Wang:
Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Taipei, 112, Taiwan, Republic of China.
J Bone Joint Surg Am. 2014 Oct 15;96(20):1724-31. doi: 10.2106/JBJS.M.01486.
The surgical results of treating thoracolumbar and lumbar burst fractures were reported to be comparable between patients with and without fusion in an intermediate-term follow-up. To our knowledge, no prior report has compared the results of fusion and non-fusion with long-term follow-up.
This study was designed to provide long-term evaluation of patients with a burst fracture of the thoracolumbar and lumbar spine treated with short-segment fixation who were randomly assigned to a fusion or non-fusion group. Patients older than sixty years of age at the time of injury and those who were lost to follow-up were excluded. Functional outcomes were evaluated using the Greenough Low-Back Outcome Score and the visual analog scale for back pain. Radiographic outcomes were focused on the vertebral body height of the injured vertebra, the kyphotic angle, and the regional segmental motion.
Twenty-two patients were enrolled in the non-fusion group, and twenty-four patients were enrolled in the fusion group. The average follow-up period was 134 months (range, 121 to 161 months). The average preoperative kyphotic angle was 16.4° for the non-fusion group and 19.5° for the fusion group. The average postoperative kyphotic angle was 1.5° for the non-fusion group and 4.0° for the fusion group. At the time of the latest follow-up, the average kyphotic angle was 13.8° for the non-fusion group and 14.7° for the fusion group. The average kyphotic angle between the two groups was similar at all follow-up times. A progressive decrease of the kyphotic angle was significant (p < 0.05) with time, regardless of fusion. The radiographic outcomes were similar between these two groups at all follow-up times, as were functional outcomes. More patients in the non-fusion group underwent additional surgery to remove implants. Regional segmental motion was preserved in the non-fusion group, with a mean motion (and standard deviation) of 4.2° ± 1.9°.
The long-term results of short segmental fixation with and without fusion for burst fractures of the thoracolumbar and lumbar spine were comparable. Regional segmental motion could be preserved without fusion, and bone graft donor site complications could be eliminated.
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
据报道，在中期随访中，胸腰椎爆裂骨折患者行融合手术与未行融合手术的手术结果相当。据我们所知，此前尚无关于融合与非融合治疗长期随访结果比较的报道。
本研究旨在对接受短节段固定治疗的胸腰椎爆裂骨折患者进行长期评估，这些患者被随机分为融合组和非融合组。排除受伤时年龄超过60岁的患者以及失访患者。使用Greenough下腰痛结局评分和背痛视觉模拟量表评估功能结局。影像学结局重点关注受伤椎体的椎体高度、后凸角和节段运动。
非融合组纳入22例患者，融合组纳入24例患者。平均随访期为134个月（范围121至161个月）。非融合组术前平均后凸角为16.4°，融合组为19.5°。非融合组术后平均后凸角为1.5°，融合组为4.0°。在最近一次随访时，非融合组平均后凸角为13.8°，融合组为14.7°。两组在所有随访时间的平均后凸角相似。无论是否融合，后凸角随时间均有显著的逐渐减小（p<0.05）。两组在所有随访时间的影像学结局相似，功能结局也相似。非融合组更多患者接受了取出内固定物的二次手术。非融合组节段运动得以保留，平均运动度（及标准差）为4.2°±1.9°。
胸腰椎爆裂骨折短节段固定融合与非融合治疗的长期结果相当。不融合可保留节段运动，且可消除骨移植供区并发症。
治疗性II级。有关证据水平的完整描述，请参阅作者须知。
