Service de chirurgie orthopédique pédiatrique, université Paris VII, hôpital Robert-Debré, AP-HP, 75019 Paris, France; Service de chirurgie orthopédique, université Paris V, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75908 Paris cedex 15, France.
Service de chirurgie orthopédique pédiatrique, hôpital Purpan, 31300 Toulouse, France.
Orthop Traumatol Surg Res. 2020 Feb;106(1):173-178. doi: 10.1016/j.otsr.2019.08.021. Epub 2019 Nov 20.
Spinal fractures are rare in children, in whom they contribute only 2% to 5% of all traumatic spinal injuries. The management of burst fractures is well standardised in adults but remains controversial in paediatric patients, due to specific growth-related considerations. The objective of this study was to assess the clinical and radiographic outcomes of surgical management in a multicentre cohort of paediatric patients with burst fractures, in order to devise an optimal therapeutic strategy.
A therapeutic strategy for burst fractures in children and adolescents can be devised based on data from a patient cohort and on previously published information.
Patients younger than 18 years who were managed surgically for one or more burst fractures (Magerl A3) were included in this retrospective multicentre study. Clinical, radiographic, and surgical data were collected before surgery, within 3 months after surgery, and 2 years after surgery. The primary surgical approach was posterior in all patients. Computed tomography (CT) was performed post-operatively to assess the extent of anterior bone loss in order to determine whether anterior fusion was required. The 26 included patients had a mean age of 15±1 years. The thoraco-lumbar spine was involved in 15 (57%) patients. Surgery consisted in correction by instrumentation and posterior fusion only in 14 patients and in posterior correction with anterior fusion in 12 patients. In 10 (38%) patients, the instrumentation extended one vertebra above and one vertebra below the fractured vertebra.
Significant correction of the vertebral kyphosis was achieved (17°±11° before vs. 4°±2° after surgery, p=0.001). Anterior and posterior vertebral heights were significantly increased (15±3mm vs. 20±3mm, p=0.01 and 23±4mm vs. 26±4mm, p=0.04, respectively).
The decision to perform surgery rests on the degree of kyphosis and presence of instability. Anterior bone grafting can be added if the instrumentation is short or a bone defect persists after posterior correction. Correction of the local kyphosis is important to prevent sagittal malalignment with its adverse functional consequences in adulthood. Neural decompression must be performed in patients with neurological deficits.
IV.
脊柱骨折在儿童中较为罕见，仅占所有创伤性脊柱损伤的 2%至 5%。成人爆裂骨折的治疗已经得到了很好的标准化，但由于与生长相关的特殊考虑，在儿科患者中仍然存在争议。本研究的目的是评估多中心儿科爆裂骨折患者的手术治疗的临床和影像学结果，以便制定最佳的治疗策略。
可以根据患者队列的数据和以前发表的信息为儿童和青少年的爆裂骨折制定治疗策略。
本回顾性多中心研究纳入了接受手术治疗的 1 个或多个爆裂骨折（Magerl A3）的年龄小于 18 岁的患者。收集了术前、术后 3 个月和术后 2 年的临床、影像学和手术数据。所有患者的主要手术入路均为后路。术后行 CT 检查以评估前路骨丢失程度，以确定是否需要前路融合。26 例纳入患者的平均年龄为 15±1 岁。胸腰椎受累 15 例（57%）。14 例患者仅行器械矫正和后路融合，12 例患者行后路矫正加前路融合。10 例（38%）患者的器械延伸至骨折椎体上下各一椎体。
脊柱后凸畸形得到显著矫正（术前 17°±11°，术后 4°±2°，p=0.001）。前路和后路椎体高度均显著增加（分别为 15±3mm 比 20±3mm，p=0.01 和 23±4mm 比 26±4mm，p=0.04）。
手术的决策取决于后凸畸形的程度和是否存在不稳定。如果器械较短或后路矫正后仍存在骨缺损，则可加行前路植骨。矫正局部后凸畸形对于防止矢状面失平衡及其成年后不良功能后果很重要。对于有神经功能缺损的患者，必须进行神经减压。
IV。
