Sahai Nikhil, Faloon Michael J, Dunn Conor J, Issa Kimona, Sinha Kumar, Hwang Ki Soo, Emami Arash
Orthopedics. 2018 Nov 1;41(6):e802-e806. doi: 10.3928/01477447-20180912-05. Epub 2018 Sep 18.
Clinical care of patients with unstable thoracolumbar vertebral body fractures may be challenging, especially in the setting of polytrauma patients who require other acute intervention. Compared with the traditional open approach, percutaneous short-segment fixation constructs place less surgical burden on patients regarding operative time and blood loss. Between 2008 and 2012, 32 patients with a mean age of 49 years (range, 19-80 years) underwent percutaneous short-segment fixation at the authors' institution and had a minimum of 6 months of complete clinical and radiographic follow-up. Load-sharing classification scores were determined. Outcomes evaluated included anterior body height, posterior body height, local kyphosis, regional kyphosis, thoracolumbar junctional kyphosis, mean operative time, and total blood loss. Standard binomial and categorical comparative analyses were performed. All load-sharing classification scores were 7 or less, and 11 of the 32 patients were polytrauma patients requiring surgery. No difference was seen between preoperative and late measurements of anterior body height, posterior body height, local kyphosis, regional kyphosis, or thoracolumbar junctional kyphosis. There were no complications, revisions, or anterior corpectomies. Only 2 patients (6%) underwent elective removal of hardware at 1 year. Mean operative time was 43 minutes (range, 33-56 minutes), and mean estimated blood loss was less than 50 mL. Percutaneous short-segment fixation prevented loss of vertebral body height and progression of kyphosis in the treatment of unstable thoracolumbar fractures with load-sharing classification scores of 7 or less. This study shows that these fractures with a load-sharing classification score of 6 and 7 may be stabilized using fewer screws than traditional methods in some patients and allow polytrauma patients to undergo other acute treatment. [Orthopedics. 2018; 41(6):e802-e806.].
不稳定型胸腰椎椎体骨折患者的临床护理可能具有挑战性，尤其是在需要其他紧急干预的多发伤患者中。与传统的开放手术方法相比，经皮短节段固定结构在手术时间和失血量方面给患者带来的手术负担较小。2008年至2012年期间，32例平均年龄49岁（范围19 - 80岁）的患者在作者所在机构接受了经皮短节段固定，并进行了至少6个月的完整临床和影像学随访。确定了载荷分担分类评分。评估的结果包括椎体前缘高度、椎体后缘高度、局部后凸、区域后凸、胸腰段交界性后凸、平均手术时间和总失血量。进行了标准二项式和分类比较分析。所有载荷分担分类评分均为7或更低，32例患者中有11例为需要手术的多发伤患者。椎体前缘高度、椎体后缘高度、局部后凸、区域后凸或胸腰段交界性后凸的术前和后期测量值之间未见差异。没有并发症、翻修手术或前路椎体次全切除术。仅2例患者（6%）在1年后接受了内固定物的择期取出。平均手术时间为43分钟（范围33 - 56分钟），平均估计失血量少于50 mL。在治疗载荷分担分类评分7或更低的不稳定胸腰椎骨折时，经皮短节段固定可防止椎体高度丢失和后凸进展。本研究表明，对于一些载荷分担分类评分为6和7的骨折患者，与传统方法相比，使用较少的螺钉即可实现骨折稳定，并允许多发伤患者接受其他紧急治疗。[《骨科》。2018；41(6):e802 - e806。]
