Zhang Haiping, Zhao Qinpeng, He Baorong, Liu Jijun, Hao Dingjun, Guo Hua
Department of Orthopedics, Honghui Hospital of Xi'an Jiaotong University, Youyi east road 555#, Xi'an, Shanxi Province, China.
J Orthop Sci. 2015 Jul;20(4):689-94. doi: 10.1007/s00776-015-0723-7. Epub 2015 Apr 16.
Type C3 thoracic fracture is a severe spinal injury, but one that is clinically rare, and there are few reports pertaining to the treatment of this type of fracture. No consensus has been achieved on the proper timing of spine fracture fixation; therefore, we focused on evaluating the surgical effects using a posterior approach and determining the influence of surgical timing on surgical outcomes.
This was a retrospective cohort study of 36 cases of type C3 thoracic fracture in patients admitted to the hospital from April 2005 to October 2012, and who were divided into two groups according to the timing of surgery: early fixation (<72 h) and late fixation (>72 h). Surgical outcomes were analyzed based on surgery duration, intraoperative blood loss, intensive care unit and hospital stay, mortality rate, and complications.
There were 13 patients in the early fixation group and 23 patients in the late fixation group. Patients were treated with posterior decompression, intervertebral titanium mesh support, pedicle screw fixation, and fusion. All fractures involved a single segment: T7/T8 (8 patients), T9/T10 (11 patients), and T11/T12 (17 patients). All injuries were classified as American Spinal Injury Association (ASIA) grade A. Patients underwent periodic follow-up over a period of 12-30 months (average, 22.5 months). One patient developed ascending myelitis and died of respiratory failure 1 month after early fixation, and two patients died of pulmonary infection after late fixation procedures. Other patients achieved bone fusion without improvement in ASIA grade. No statistically significant difference in parameters was observed between groups.
Though type C3 thoracic fracture is one of the most severe spinal injuries, complete reduction and recovery of spinal stability can be achieved using a posterior approach. As clinical outcomes in this study were similar between early and late fixation procedures, early surgical intervention may not be helpful for improving neurologic recovery in type C3 thoracic fractures.
C3型胸椎骨折是一种严重的脊柱损伤，但临床上较为罕见，关于此类骨折治疗的报道较少。对于脊柱骨折固定的合适时机尚未达成共识；因此，我们着重评估采用后路手术的效果，并确定手术时机对手术结果的影响。
这是一项回顾性队列研究，纳入了2005年4月至2012年10月期间入院的36例C3型胸椎骨折患者，根据手术时机分为两组：早期固定（<72小时）和晚期固定（>72小时）。基于手术时间、术中出血量、重症监护病房和住院时间、死亡率及并发症等分析手术结果。
早期固定组有13例患者，晚期固定组有23例患者。患者接受了后路减压、椎间钛网支撑、椎弓根螺钉固定及融合术。所有骨折均累及单个节段：T7/T8（8例）、T9/T10（11例）和T11/T12（17例）。所有损伤均为美国脊髓损伤协会（ASIA）A级。患者接受了为期12 - 30个月（平均22.5个月）的定期随访。1例患者在早期固定后1个月发生上行性脊髓炎，死于呼吸衰竭，2例患者在晚期固定术后死于肺部感染。其他患者实现了骨融合，但ASIA分级无改善。两组之间在参数上未观察到统计学显著差异。
尽管C3型胸椎骨折是最严重的脊柱损伤之一，但采用后路手术可实现脊柱的完全复位和稳定性恢复。由于本研究中早期和晚期固定手术的临床结果相似，早期手术干预可能无助于改善C3型胸椎骨折患者的神经功能恢复。
