Dr Abdullah Al Mamun Choudhury, Medical Officer, National Institute of Traumatology & Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh; E-mail:
Mymensingh Med J. 2021 Apr;30(2):485-492.
Stabilization procedures for the treatment of thoracolumbar burst fractures remain controversial. Traditional stabilization procedures include short and long segment stabilization. Nowadays short-segment including fracture vertebrae stabilization is one of the modalities of treatment. This study aimed to analyze the radiological and functional outcome of the Short-segment fixation with the inclusion of the fracture level (SSFIFL) for the treatment of unstable thoracolumbar fractures. In this prospective study, 40 cases of thoracolumbar burst fractures with incomplete spinal cord injury were operated by SSFIFL from Jan 2016 to Jan 2019 in NITOR, Dhaka, Bangladesh. The mean follow-up period was 18 months. Pre-operative and post-operative radiological parameters were the kyphotic angle, kyphotic deformation, Beck index, and clinical parameters include ASIA impairment scale, Visual Analogue Scale (VAS), and Oswestry Disability Index (ODI). Mean age was 32.30±11.85 years, among whom 80% (32) were male in this study. Fall from height (85%) was the main cause and occurs mostly in day labors (45%). Most common skeletal level was L1 (52.5%) followed by L2 (32.5%). Most cases operated between 10-15 days with mean duration of 119.58±19.93 minutes and mean blood loss of 350.38±31.26ml. The pre-operative kyphotic angle was 22.75±4.53° and 9.13±3.04° at final follow-up with correction loss of 5.15±2.54° (p<0.05). Most of the patients were in ASIA-C grade (57.5%) pre-operatively and ASIA-E (67.5%) at final follow-up after surgery (p=0.001). ODI improved from 67.20±12.90 to 25.08±11.36 and VAS form 60.25±8.91 to 21.50±8.33 (p<0.05). Main complication was superficial infection (5 cases) followed by bent rod and CSF leakage in 2 cases each. Good radiological and clinical outcome can be achieved by inclusion of fracture level in a short-segment fixation for unstable thoracolumbar fractures. Finally, this technique may allow us to save two or more segments of vertebral motion.
胸腰椎爆裂骨折的治疗稳定程序仍存在争议。传统的稳定程序包括短节段和长节段稳定。如今，包括骨折节段的短节段稳定是治疗方法之一。本研究旨在分析短节段固定（SSFIFL）治疗不稳定胸腰椎骨折的影像学和功能结果。在这项前瞻性研究中，40 例不完全性脊髓损伤的胸腰椎爆裂骨折患者于 2016 年 1 月至 2019 年 1 月在孟加拉国达卡的 NITOR 接受 SSFIFL 手术。平均随访时间为 18 个月。术前和术后影像学参数包括后凸角、后凸畸形、贝克指数，临床参数包括 ASIA 损伤量表、视觉模拟量表（VAS）和 Oswestry 残疾指数（ODI）。平均年龄为 32.30±11.85 岁，其中 80%（32 例）为男性。高处坠落（85%）是主要原因，多发生在日工（45%）。最常见的骨骼水平是 L1（52.5%），其次是 L2（32.5%）。大多数病例在 10-15 天内进行手术，平均手术时间为 119.58±19.93 分钟，平均失血量为 350.38±31.26ml。术前后凸角为 22.75±4.53°和 9.13±3.04°，末次随访时校正丢失 5.15±2.54°（p<0.05）。术前大多数患者为 ASIA-C 级（57.5%），术后为 ASIA-E 级（67.5%）（p=0.001）。ODI 从 67.20±12.90 改善至 25.08±11.36，VAS 从 60.25±8.91 改善至 21.50±8.33（p<0.05）。主要并发症为浅表感染（5 例），其次为弯曲棒和脑脊液漏各 2 例。不稳定胸腰椎骨折采用骨折节段短节段固定可获得良好的影像学和临床效果。最后，这种技术可能使我们能够节省两个或更多节段的椎体运动。
