Chen Zhida, Wu Jin, Lin Bin, Wu Songsong, Zeng Wenrong
Department of Orthopaedics, the Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Fujian Zhangzhou, 363000, P.R.China.
Department of Orthopaedics, the Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Fujian Zhangzhou, 363000,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2018 Jan 15;32(1):59-63. doi: 10.7507/1002-1892.201708082.
To discuss the effectiveness of posterior short-segment fixation including the fractured vertebra for severe unstable thoracolumbar fractures using pedicle screw fixation.
Between May 2008 and July 2013, 52 patients of severe unstable thoracolumbar fractures were treated through posterior short-segment fixation including the fractured vertebra using pedicle screw fixation. There were 33 males and 19 females with an age of 21-56 years (mean, 37.9 years). The causes of thoracolumbar burst fractures included fall from height in 32 cases, traffic accidents in 16 cases, and others in 4 cases. The load sharing classification (LSC) score was 7-9 (mean, 7.85). The levels involved included T in 4 cases, T in 19 cases, L in 25 cases, and L in 4 cases. According to Frankel classification, there were 2 cases of grade A, 4 cases of grade B, 8 cases of grade C, 11 cases of grade D, and 27 cases of grade E. The rate of spinal canal occupying was 24.2%-76.7% (mean, 47.1%). The time from injury to operation was 3-5 days (mean, 3.6 days). The effectiveness was assessed by the changes of injured vertebral Cobb angle, anterior vertebral height, and the Frankel grading at pre- and post-operation.
The operation time was 85-127 minutes (mean, 106.5 minutes). The intraoperative blood loss was 90-155 mL (mean, 137.6 mL). All the incision healed at first intension. Forty-seven patients were followed up 19-27 months (mean, 23.2 months), and no incision infection, screw loosening, or other internal fixation failures was found during follow-up. The injured vertebral Cobb angle and anterior vertebral height at immediate after operation or at last follow-up were significantly improved when compared with preoperative values ( <0.001). There was a loss of injured vertebral Cobb angle and anterior vertebral height at last follow-up, but no significant difference was found between at immediate after operation and at last follow-up ( >0.05). The Frankel grade improved by 0-2 grades at last follow-up, showing significant difference when compared with preoperative grades ( =15.980, =0.003).
Posterior short-segment fixation including the fractured vertebra for severe unstable thoracolumbar fractures (LSC≥7) using pedicle screw fixation can correct the kyphosis deformity, restore vertebral body height, and aviod the need of anterior reconstruction.
探讨采用椎弓根螺钉固定的后路短节段固定术（包括骨折椎体）治疗严重不稳定型胸腰椎骨折的疗效。
2008年5月至2013年7月，对52例严重不稳定型胸腰椎骨折患者采用椎弓根螺钉固定术进行后路短节段固定（包括骨折椎体）治疗。其中男性33例，女性19例，年龄21 - 56岁（平均37.9岁）。胸腰椎爆裂骨折的原因包括高处坠落32例、交通事故16例、其他4例。载荷分担分类（LSC）评分7 - 9分（平均7.85分）。受累节段包括T10 4例、T11 19例、L1 25例、L2 4例。根据Frankel分级，A级2例，B级4例，C级8例，D级11例，E级27例。椎管占位率为24.2% - 76.7%（平均47.1%）。受伤至手术时间为3 - 5天（平均3.6天）。通过术前和术后伤椎Cobb角、椎体前缘高度及Frankel分级的变化评估疗效。
手术时间为85 - 127分钟（平均106.5分钟）。术中出血量为90 - 155毫升（平均137.6毫升）。所有切口均一期愈合。47例患者获得随访，随访时间19 - 27个月（平均23.2个月），随访期间未发现切口感染、螺钉松动或其他内固定失败情况。术后即刻或末次随访时伤椎Cobb角和椎体前缘高度与术前相比均显著改善（P <0.001）。末次随访时伤椎Cobb角和椎体前缘高度有所丢失，但术后即刻与末次随访时比较差异无统计学意义（P >0.05）。末次随访时Frankel分级提高0 - 2级，与术前分级相比差异有统计学意义（P =15.980，P =0.003）。
采用椎弓根螺钉固定的后路短节段固定术（包括骨折椎体）治疗严重不稳定型胸腰椎骨折（LSC≥7）可矫正后凸畸形，恢复椎体高度，避免前路重建的需要。
