Service de Chirurgie du Rachis, Fédération de Médecine Translationnelle (FMTS), Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 1, Place de l'Hôpital, B.P. 426, 67091, Strasbourg Cedex, France.
Service de Santé Publique, Fédération de Médecine Translationnelle (FMTS), Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.
Eur Spine J. 2019 May;28(5):1121-1129. doi: 10.1007/s00586-017-5173-9. Epub 2017 Jun 9.
This retrospective study determined the rate of osteoarthritis and spontaneous facet joint fusion and analyzed risk factors related to patient characteristics, fracture type or surgical technique on pre- and postoperative CT after percutaneous instrumentation in thoracolumbar fractures.
1050 facet joints adjacent to screws in 148 patients (15-85 years) with thoracolumbar fractures were analyzed with an average time between CTs of 12.3 months. Screw diameters, lengths and cement augmentation were recorded. Facet joint violation by screw trajectory and by insertion depth was classified in three grades. Pre- and postoperative osteoarthritis was graded as absent, minor or severe and postoperative facet joint fusion as absent, partial or complete.
The facet violation rate was moderate in 15.4% and severe in 0.6% according to screw trajectory, and 11.0 and 0.6%, respectively, according to insertion depth. Osteoarthritis was preoperatively rated moderate in 9.6% and severe in 1.2%. A progression was evidenced in 79 facet joints (7.5%). Screw cement augmentation was the main predictive factor (p < 0.0001). Partial fusion was evidenced in 2.6% and complete fusion in 1% of facet joints. Risk factors were: BMI (p = 0.0002), age (p = 0.0013), preoperative osteoarthritis (p = 0.0005), time between 2 CTs (p = 0.0001), B-type fractures (p = 0.0005), concomitant anterior fusion (p = 0.0034).
Occurrence or worsening of osteoarthritis was mainly observed in elderly patients with cement-augmented screws and spontaneous facet fusion in elderly patients with high BMI and preoperative osteoarthritis, or in anteriorly fused B-type injuries. Thus, percutaneous instrumentation can safely be removed after fracture consolidation in younger patients while preserving facet joints.
本回顾性研究旨在确定胸腰椎骨折经皮内固定术后骨关节炎和自发性关节突关节融合的发生率，并分析与患者特征、骨折类型或手术技术相关的危险因素在术前和术后 CT 上的螺钉毗邻关节突关节。
分析了 148 例（15-85 岁）胸腰椎骨折患者的 1050 个关节突关节，两次 CT 检查的平均时间为 12.3 个月。记录螺钉直径、长度和骨水泥强化情况。根据螺钉轨迹和插入深度将关节突关节侵犯分为三级。术前和术后骨关节炎分为无、轻度和重度，术后关节突关节融合分为无、部分和完全。
根据螺钉轨迹，关节突关节侵犯率为中度 15.4%，重度 0.6%；根据插入深度，分别为中度 11.0%和重度 0.6%。术前骨关节炎中度 9.6%，重度 1.2%。79 个关节突关节（7.5%）出现进展。螺钉骨水泥强化是主要的预测因素（p<0.0001）。2.6%的关节突关节出现部分融合，1%的关节突关节出现完全融合。危险因素为：BMI（p=0.0002）、年龄（p=0.0013）、术前骨关节炎（p=0.0005）、两次 CT 检查时间间隔（p=0.0001）、B 型骨折（p=0.0005）、同期前路融合（p=0.0034）。
在接受骨水泥强化螺钉治疗的老年患者中，主要观察到骨关节炎的发生或加重，在 BMI 较高和术前骨关节炎的老年患者，或在前路融合的 B 型损伤中，观察到自发性关节突关节融合。因此，在年轻患者骨折愈合后，可安全地去除经皮内固定装置，同时保留关节突关节。
