Mohammed Riaz, Carrasco Roberto, Verma Rajat, Siddique Irfan, Mohammad Saeed, Elmalky Mahmoud
Salford Royal NHS Foundation Trust, Salford, United Kingdom.
Division of Population Health, Health Sciences Research and Primary Care, University of Manchester, Manchester, United Kingdom.
Global Spine J. 2023 Jan;13(1):53-59. doi: 10.1177/2192568221991106. Epub 2021 Feb 3.
Retrospective comparative study.
To compare radiological and functional outcomes of patients with fixation constructs utilizing pedicle screw stabilization at the fracture level (FL group) versus patients with non-fracture level (NFL group) fixation in single level fractures of the thoracolumbar junction (T11-L1).
53 patients of whom fracture level screw was used in 34 (FL group) were compared to 19 patients in NFL group. Radiological parameters analyzed were sagittal index, bi-segmental kyphosis (Cobb) angle and degree of vertebral height restoration. Prospectively collected patient reported functional outcomes and post-operative complications were also studied. Stepwise regression analysis adjusted by age, gender and functional scores was performed to account for the small numbers and unequal sizes of the groups.
Back pain score was significantly lower in the FL group ( < 0.025). Core Outcome Measures Index scores and leg pain scores, though low in the FL group, were not statistically significant. The regression analysis showed that the inclusion of the fracture-level screw was independently associated with a greater change in sagittal index and vertebral height restoration post-operatively. Sagittal index was maintained through to final follow up as well. The bi-segmental Cobb's angle correction was not associated with fracture-level screw construct. There was no significant difference between the groups for revision surgery, deep infection, implant failure or length of hospital stay.
The inclusion of the fracture-level pedicle screws in the fixation construct significantly improves the immediate and final measured radiological parameters, with improved functional scores in single level unstable vertebral fractures of the thoracolumbar junction.
回顾性对比研究。
比较胸腰段交界处（T11-L1）单节段骨折患者中，在骨折节段使用椎弓根螺钉固定的患者（骨折节段组）与非骨折节段固定的患者（非骨折节段组）的影像学和功能结果。
将53例患者进行比较，其中34例使用骨折节段螺钉（骨折节段组），19例为非骨折节段组。分析的影像学参数包括矢状面指数、双节段后凸（Cobb）角和椎体高度恢复程度。还前瞻性收集了患者报告的功能结果和术后并发症。进行了按年龄、性别和功能评分调整的逐步回归分析，以考虑两组样本量小和大小不等的情况。
骨折节段组的背痛评分显著更低（<0.025）。尽管骨折节段组的核心结局指标指数评分和腿痛评分较低，但无统计学意义。回归分析表明，使用骨折节段螺钉独立与术后矢状面指数和椎体高度恢复的更大变化相关。矢状面指数直至最终随访时也得以维持。双节段Cobb角矫正与骨折节段螺钉固定结构无关。两组在翻修手术、深部感染、植入物失败或住院时间方面无显著差异。
在固定结构中使用骨折节段椎弓根螺钉可显著改善即时和最终测量的影像学参数，并改善胸腰段交界处单节段不稳定椎体骨折的功能评分。
