Park Sub-Ri, Na Hwa-Yeop, Kim Jung-Mook, Eun Dong-Chan, Son Eui-Young
Department of Orthopedic Surgery, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea.
Clin Orthop Surg. 2016 Mar;8(1):71-7. doi: 10.4055/cios.2016.8.1.71. Epub 2016 Feb 13.
The development of pedicle screw-based posterior spinal instrumentation is recognized as one of the major surgical treatment methods for thoracolumbar burst fractures. However, the appropriate level in posterior segment instrumentation is still a point of debate. To assesses the long-term results of two-level and three-level posterior fixations of thoracolumbar burst fractures that have load-sharing scores of 7 and 8 points.
From January 1998 to May 2009, we retrospectively analyzed clinical and radiologic outcomes of 45 patients with thoracolumbar burst fractures of 7 and 8 points in load-sharing classification who were operated on using two-level posterior fixation (one segment above and one segment below: 28 patients, group I) or three-level posterior fixation (two segments above and one segment below: 17 patients, group II). Clinical results included the grade of the fracture using the Frankel classification, and the visual analog score was used to evaluate pain before surgery, immediately after surgery, and during follow-up period. We also evaluated pain and work status at the final follow-up using the Denis pain scale.
In all cases, non-union or loosening of implants was not observed. There were two screw breakages in two-level posterior fixation group, but bony union was obtained at the final follow-up. There were no significant differences in loss of anterior vertebral body height, correction loss, or change in adjacent discs. Also, in clinical evaluation, there was no significant difference in the neurological deficit of any patient during the follow-up period.
In our study, two-level posterior fixation could be used successfully in selected cases of thoracolumbar burst fractures of 7 and 8 points in the load-sharing classification.
基于椎弓根螺钉的后路脊柱内固定技术的发展被认为是胸腰椎爆裂骨折的主要手术治疗方法之一。然而，后路节段性内固定的合适节段仍存在争议。本研究旨在评估载荷分享评分7分和8分的胸腰椎爆裂骨折采用两级和三级后路固定的长期疗效。
1998年1月至2009年5月，我们回顾性分析了45例载荷分享分级为7分和8分的胸腰椎爆裂骨折患者的临床和影像学结果，这些患者接受了两级后路固定（损伤节段上下各一个节段：28例，I组）或三级后路固定（损伤节段上方两个节段和下方一个节段：17例，II组）手术。临床结果包括采用Frankel分级评估骨折情况，采用视觉模拟评分评估术前、术后即刻及随访期间的疼痛情况。我们还使用Denis疼痛量表在末次随访时评估疼痛和工作状态。
所有病例均未观察到内固定物不愈合或松动。两级后路固定组有2例螺钉断裂，但在末次随访时获得了骨愈合。椎体前缘高度丢失、矫正丢失或相邻椎间盘变化方面无显著差异。此外，在临床评估中，随访期间任何患者的神经功能缺损均无显著差异。
在我们的研究中，两级后路固定可成功应用于载荷分享分级为7分和8分的部分胸腰椎爆裂骨折病例。
