Tsai Ping-Jui, Hsieh Ming-Kai, Fan Kuo-Feng, Chen Lih-Huei, Yu Chia-Wei, Lai Po-Liang, Niu Chi-Chien, Tsai Tsung-Ting, Chen Wen-Jer
Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
BMC Musculoskelet Disord. 2017 Sep 11;18(1):393. doi: 10.1186/s12891-017-1753-4.
Burst fracture is a common thoracolumbar injury that is treated using posterior pedicle instrumentation and fusion combined with transpedicular intracorporeal grafting after reduction. In this study, we compared the outcome of these two techniques by using radiologic imaging and functional outcome.
Sixty-one patients with acute thoracolumbar burst fracture were operated with kyphoplasty (n = 31) or vertebroplasty (n = 30) and retrospectively reviewed in our institution between 2011 and 2014. All 61 patients underwent surgery within 5 days after admission to the hospital and then followed-up for 12 to 24 months after surgery.
Significant improvement was found in the anterior vertebral height (92 ± 8.9% in the kyphoplasty group, 85.6 ± 7.2% in the vertebroplasty group, p < 0.01) at 1 month post-operatively and (89 ± 7.9% in the kyphoplasty group, 78 ± 6.9% in the vertebroplasty group, p < 0.01) at the 24-month follow-up. Significant improvement was also observed in the kyphotic angle (1.2 ± 0.5° in the kyphoplasty group, 10.5 ± 1.2° in the vertebroplasty group, p < 0.01) at 1 month post-operatively and (5.4 ± 1.2° in the kyphoplasty group, 11.5 ± 8.5° in the vertebroplasty group, p < 0.01) at the 24-month follow-up. Both operations led to significant improvement of the patients' pain and the Oswestry disability index (p < 0.01). Cement leakage was noted in 29% of patients after kyphoplasty and 77% of patients after vertebroplasty (p < 0.01). Only one implant failure (3.3%), which required further surgical intervention, was reported in the vertebroplasty group.
Reduction with additional balloon at the fractured site is better than indirect reduction only by posterior instrumentation. The better reduction of kyphotic angle and the lower cement leakage rate in the kyphoplasty group indicate that additional balloon kyphoplasty is safe and effective for acute thoracolumbar burst fracture.
爆裂骨折是一种常见的胸腰椎损伤，治疗方法为复位后采用后路椎弓根内固定及融合术并结合经椎弓根体内植骨。在本研究中，我们通过影像学检查和功能结果比较了这两种技术的疗效。
2011年至2014年期间，我们对61例急性胸腰椎爆裂骨折患者分别采用椎体后凸成形术（n = 31）或椎体成形术（n = 30）进行手术，并进行回顾性分析。所有61例患者均在入院后5天内接受手术，术后随访12至24个月。
术后1个月时，椎体前缘高度有显著改善（椎体后凸成形术组为92 ± 8.9%，椎体成形术组为85.6 ± 7.2%，p < 0.01），24个月随访时（椎体后凸成形术组为89 ± 7.9%，椎体成形术组为78 ± 6.9%，p < 0.01）。术后1个月时，后凸角也有显著改善（椎体后凸成形术组为1.2 ± 0.5°，椎体成形术组为10.5 ± 1.2°，p < 0.01），24个月随访时（椎体后凸成形术组为5.4 ± 1.2°，椎体成形术组为11.5 ± 8.5°，p < 0.01）。两种手术均使患者疼痛和奥斯维斯特残疾指数有显著改善（p < 0.01）。椎体后凸成形术后29%的患者出现骨水泥渗漏，椎体成形术后77%的患者出现骨水泥渗漏（p < 0.01）。椎体成形术组仅报告1例植入物失败（3.3%），需要进一步手术干预。
在骨折部位附加球囊进行复位优于仅通过后路器械进行间接复位。椎体后凸成形术组后凸角复位更好且骨水泥渗漏率更低，表明附加球囊椎体后凸成形术治疗急性胸腰椎爆裂骨折安全有效。
