Piazzolla Andrea, Solarino Giuseppe, Bizzoca Davide, Parato Claudia, Monteleone Gaetano, Dicuonzo Franca, Moretti Biagio
Orthopaedic, Trauma and Spine Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, AOU Policlinico Consorziale, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70100, Bari, Italy.
Eur Spine J. 2018 Jun;27(Suppl 2):182-189. doi: 10.1007/s00586-018-5602-4. Epub 2018 Apr 20.
To investigate if bone substitutes are strictly necessary to restore the vertebral body height and improve the clinical outcome, in patients with thoracolumbar or lumbar AO type A post-traumatic vertebral fractures, managed with balloon kyphoplasty combined with posterior screw and rod system.
105 patients with post-traumatic thoracolumbar spine fracture were recruited. At baseline, the patients underwent a CT and an MRI of the spine. Clinical evaluation was performed, using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI), at baseline, 48 h after surgery, at 3-month follow-up (FU), 6-month FU, 48 h after the instrumentation removal and at 24-month FU. At each FU, VK, regional kyphosis (RK), central wall (MH/PH) and anterior wall (AH/PH) heights were assessed on lateral spine X-rays. At 6-month FU, a CT scan of the spine was performed to investigate the fracture healing. The posterior instrumentation was removed 7 months after surgery (range 6-10 months).
A significant reduction of mean VAS (p < 0.05) and ODI (p < 0.05) was observed after surgery; no impairment of these scores was observed after the instrumentation removal. A significant correction of VK, RK, AH/PH and MH/PH was recorded after surgery; no significant changes of these values were noticed at subsequent FU. After the instrumentation removal, only an RK impairment was recorded, but it was not significant.
PMMA or bone substitutes are not necessary to keep the reduction of the endplate obtained with the balloon tamp, when BK is performed in the association with posterior percutaneous pedicle screws instrumentation. These slides can be retrieved under Electronic Supplementary Material.
探讨在采用球囊后凸成形术联合后路螺钉棒系统治疗的胸腰段或腰椎AO A型创伤后椎体骨折患者中，骨替代物对于恢复椎体高度及改善临床疗效是否为严格必需的。
招募105例创伤后胸腰椎骨折患者。基线时，患者接受脊柱CT和MRI检查。在基线、术后48小时、3个月随访、6个月随访、取出内固定装置后48小时及24个月随访时，使用视觉模拟量表（VAS）和奥斯威斯功能障碍指数（ODI）进行临床评估。在每次随访时，通过脊柱侧位X线片评估椎体后凸（VK）、节段后凸（RK）、中央壁（MH/PH）和前壁（AH/PH）高度。在6个月随访时，进行脊柱CT扫描以调查骨折愈合情况。术后7个月（范围6 - 10个月）取出后路内固定装置。
术后观察到平均VAS（p < 0.05）和ODI（p < 0.05）显著降低；取出内固定装置后这些评分未观察到损害。术后记录到VK、RK、AH/PH和MH/PH有显著矫正；在随后的随访中这些值未观察到显著变化。取出内固定装置后，仅记录到RK有损害，但不显著。
当球囊后凸成形术与后路经皮椎弓根螺钉内固定联合进行时，聚甲基丙烯酸甲酯（PMMA）或骨替代物对于维持球囊填塞获得的终板复位并非必需。这些幻灯片可在电子补充材料中获取。
