Girardo Massimo, Massè Alessandro, Risitano Salvatore, Fusini Federico
Spine Surgery Unit, Orthopaedic and Trauma Centre, Azienda Ospedaliera Città della Salute e della Scienza, Turin, Italy.
Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Azienda Ospedaliera Città della Salute e della Scienza, University of Turin, Turin, Italy.
Asian Spine J. 2021 Aug;15(4):424-430. doi: 10.31616/asj.2020.0033. Epub 2020 Oct 19.
Retrospective comparative study.
This study aimed to compare clinical and radiological data and rate of mechanical complications in elderly patients treated with short segment (SSS) or long segment stabilization (LSS) for thoracolumbar junction osteoporotic vertebral fractures (OVFs).
A fervent debate is now focused on the treatment of OVF using SSS or LSS. High rate of complications is associated with pedicle screw fixation because of poor bone quality.
Patients over 65 years old with a T-score of <-2.5, affected by (T10-L2) vertebral fracture treated with LSS or SSS pedicle screw fixation, with at least 24 months of follow-up were evaluated. All patients were analyzed with conventional X-ray to evaluate bisegmental kyphotic angle (BKA) and clinically with Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and rate of mechanical complications at 2, 6, 12, and 24 months. Data were expressed as mean±standard deviation. Student t-test was used to compare clinical scores between populations. Mann-Whitney U-test was used to analyze clinical and radiological variable, whereas Fisher's exact test was used to identify differences in the rate of complications between groups.
A total of 37 patients met the inclusion criteria. Mean follow-up was 33.97±9.26 months. For both groups, ODI and VAS significantly decreased over time with good results (p<0.00001). At the final follow-up, no significant differences were found in terms of ODI and VAS. There was no difference in correction of BKA between groups; however, a significant difference was found in LSS group between pre- and postoperative BKA (p=0.046), whereas no difference was found in SSS group. A significant difference in the rate of mechanical complications was found between groups (p=0.011).
Both treatments showed good clinical and radiological results; however, LSS group showed better BKA correction and lower mechanical complications than SSS group.
回顾性对比研究。
本研究旨在比较接受短节段（SSS）或长节段固定（LSS）治疗胸腰段骨质疏松性椎体骨折（OVF）的老年患者的临床和影像学数据以及机械并发症发生率。
目前，关于使用SSS或LSS治疗OVF存在激烈争论。由于骨质质量差，椎弓根螺钉固定的并发症发生率较高。
对年龄超过65岁、T值＜-2.5、患有（T10-L2）椎体骨折且接受LSS或SSS椎弓根螺钉固定治疗并至少随访24个月的患者进行评估。所有患者均接受常规X线检查以评估双节段后凸角（BKA），并在临床方面使用视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）以及在2、6、12和24个月时评估机械并发症发生率。数据以均值±标准差表示。采用学生t检验比较不同人群之间的临床评分。采用曼-惠特尼U检验分析临床和影像学变量，而采用费舍尔精确检验确定组间并发症发生率的差异。
共有37例患者符合纳入标准。平均随访时间为33.97±9.26个月。两组的ODI和VAS均随时间显著下降，效果良好（p＜0.00001）。在末次随访时，ODI和VAS方面未发现显著差异。两组之间在BKA矫正方面无差异；然而，LSS组术前和术后BKA之间存在显著差异（p = 0.046），而SSS组未发现差异。组间在机械并发症发生率方面存在显著差异（p = 0.011）。
两种治疗方法均显示出良好的临床和影像学结果；然而，LSS组在BKA矫正方面优于SSS组，且机械并发症发生率更低。
