Laghmouche Nadir, Prost Solène, Farah Kaissar, Graillon Thomas, Blondel Benjamin, Fuentes Stéphane
Unité de chirurgie du rachis, Université Aix-Marseille, CHU Timone, 264, rue Saint-Pierre, 13005 Marseille, France.
Unité de chirurgie du rachis, Université Aix-Marseille, CHU Timone, 264, rue Saint-Pierre, 13005 Marseille, France.
Orthop Traumatol Surg Res. 2019 Apr;105(2):347-350. doi: 10.1016/j.otsr.2018.09.023. Epub 2019 Feb 18.
Flexion-distraction fractures represent around 15% of all thoracolumbar fractures, with neurological deficit in 25% of cases. Optimal surgical strategy remains controversial. In neurologically intact patients, percutaneous fixation can offer quick stabilization with good deformity correction. If necessary, an additional minimally invasive anterior approach can complete the surgical strategy. We report results in a series of 28 thoracolumbar flexion-distraction fractures without neurologic deficit, treated using a minimally invasive approach.
A single-center retrospective study was conducted for the period 2008-2015. Patients over 16 years of age with a flexion-distraction fracture without neurologic deficit were included. Analysis was based on preoperative CT-scan and measurement of post-traumatic kyphotic deformity. Surgery comprised posterior percutaneous fixation, alone or associated to an anterior step in case of discal lesion on preoperative MRI or of severe vertebral comminution. Operative time, blood loss and postoperative complications were recorded. Residual segmental kyphosis and bone healing were evaluated on CT at 1 year.
Seventeen males and 11 females were included (mean age, 29.2 years). An anterior approach was performed in 11 cases (39%): 5 for B1 fractures due to severe comminution (corpectomy and expandable vertebral cage with bone and BMP-2) and 6 for B2 fractures due to discal involvement on MRI (discectomy and iliac graft fusion). Regional kyphosis was significantly reduced (17.3° vs. 5.7°; p<0.05) and bone healing was obtained in all cases. There were no cases of postoperative infection.
Patients with flexion-distraction fractures without neurologic deficit can be eligible for minimally invasive percutaneous posterior fixation, associated if necessary to a minimally invasive anterior approach. This technique provides excellent bone healing with low surgical trauma and bleeding.
IV.
屈曲-牵张性骨折约占所有胸腰椎骨折的15%，其中25%的病例存在神经功能缺损。最佳手术策略仍存在争议。在神经功能完整的患者中，经皮固定可实现快速稳定并良好地矫正畸形。如有必要，可采用额外的微创前路手术来完善手术策略。我们报告了一系列采用微创方法治疗的28例无神经功能缺损的胸腰椎屈曲-牵张性骨折的结果。
对2008年至2015年期间进行了一项单中心回顾性研究。纳入年龄超过16岁、患有无神经功能缺损的屈曲-牵张性骨折的患者。分析基于术前CT扫描和创伤后后凸畸形的测量。手术包括单纯后路经皮固定，或在术前MRI显示椎间盘病变或椎体严重粉碎的情况下联合前路手术。记录手术时间、失血量和术后并发症。在术后1年通过CT评估残留节段后凸畸形和骨愈合情况。
纳入17例男性和11例女性（平均年龄29.2岁）。11例（39%）患者进行了前路手术：5例因严重粉碎性骨折行B1型骨折手术（椎体次全切除并植入带骨和骨形态发生蛋白-2的可扩张椎间融合器），6例因MRI显示椎间盘受累行B2型骨折手术（椎间盘切除并髂骨植骨融合）。局部后凸畸形明显减轻（17.3°对5.7°；p<0.05），所有病例均实现骨愈合。无术后感染病例。
无神经功能缺损的屈曲-牵张性骨折患者适合采用微创经皮后路固定，必要时可联合微创前路手术。该技术可实现良好的骨愈合，手术创伤和出血量少。
IV级。
