Ko Sangbong, Jung Sukhan, Song Sukkyoon, Kim Jun-Young, Kwon Jaibum
Daegu Catholic University Medical Center, Daegu, South Korea.
Medicine (Baltimore). 2020 Apr;99(16):e19780. doi: 10.1097/MD.0000000000019780.
Segmental fusion is not necessarily needed in treatment of thoracolumbar unstable burst fracture requiring surgery. Our objective was to report the results of follow-up for at least 10 years in patients with thoracolumbar unstable burst fracture requiring surgery in which fractured segment was healed following temporary posterior instrumentation without fusion, and in whom implants were subsequently removed.Retrospective Cohort Study.Nineteen patients in whom union of fractured vertebra was observed following surgery and in whom implants were removed within an average 12.2 months, and who could be followed up for at least 10 years, were enrolled.At the last follow-up, we evaluated the segmental motions, anterior body height ratio, progress of further kyphotic deformity, Oswestry Disability Index, Rolland Morris Disability Questionnaire and Short Form 36.Results: The follow-up period after implant removal surgery was 151 months on average. The local kyphotic angle was 26.89 ± 6.08 degrees at the time of injury and 10.11 ± 2.22 degrees at the last follow-up. The anterior body height ratio was 0.54 ± 0.16 at the time of injury and 0.89 ± 0.05 at the last follow-up. Thus, the fractured vertebra was significantly reduced after surgery and maintained till last follow-up. The segmental motion was 9.84 ± 3.03, Oswestry Disability Index was 7.95 ± 7.38, Rolland Morris Disability Questionnaire was 2.17 ± 2.67, short form 36 Physical Component Score was 77.50 ± 16.61, and short form 36 Mental Component Score was 79.21 ± 13.32 at last follow-up.We conducted at least 10-year follow-up and found that temporary posterior instrumentation without fusion should be considered one of the useful alternative treatments for thoracolumbar unstable burst fracture in place of the traditional posterior instrumentation and fusion.
对于需要手术治疗的胸腰椎不稳定爆裂骨折，不一定需要节段性融合。我们的目的是报告对需要手术治疗的胸腰椎不稳定爆裂骨折患者进行至少10年随访的结果，这些患者在临时后路内固定但未融合的情况下骨折节段愈合，随后取出了植入物。
回顾性队列研究。纳入了19例患者，这些患者术后观察到骨折椎体愈合，平均在12.2个月内取出植入物，并且能够进行至少10年的随访。
在最后一次随访时，我们评估了节段运动、椎体前缘高度比值、后凸畸形进一步进展情况、Oswestry功能障碍指数、罗兰·莫里斯功能障碍问卷和简明健康状况调查36项量表。
植入物取出手术后的平均随访期为151个月。受伤时局部后凸角为26.89±6.08度，最后一次随访时为10.11±2.22度。受伤时椎体前缘高度比值为0.54±0.16，最后一次随访时为0.89±0.05。因此，骨折椎体在术后明显复位并维持至最后一次随访。最后一次随访时节段运动为9.84±3.03，Oswestry功能障碍指数为7.95±7.38，罗兰·莫里斯功能障碍问卷为2.17±2.67，简明健康状况调查36项量表身体成分评分为77.50±16.61，精神成分评分为79.21±13.32。
我们进行了至少10年的随访，发现临时后路非融合内固定应被视为胸腰椎不稳定爆裂骨折的一种有效的替代治疗方法，可替代传统的后路内固定融合术。
