Unidad de Columna, Servicio Cirugía Ortopédica, Hospital Clínico Universitario de Valladolid, Spain.
Unidad de Columna, Servicio Cirugía Ortopédica, Hospital Clínico Universitario de Valladolid, Spain; Hospital Clinico Universitario de Valladolid, Calle Ramón y Cajal, Spain.
Pain Physician. 2021 Aug;24(5):E631-E638.
There are controversies about the optimal management of AO subtype A3 burst fractures. The most common surgical treatment consists of posterior fixation with pedicle screw and rod augmentation. Nevertheless, a loss of correction in height restoration and kyphotic reduction has been observed.
The aim of this study was to assess long-term outcomes of a minimally invasive technique using a percutaneous intravertebral expandable titanium implant (PIETI).
This prospective, single center, pilot study was carried out on a consecutive case series of 44 patients with acute (< 2 weeks) traumatic thoracolumbar fractures AO type A3. The average follow-up was 5.6 years.
A single center in Castilla y Leon, SpainMETHODS: Clinical outcomes (pain intensity on visual analog scale [VAS], Oswestry Disability Index [ODI], analgesic consumption) and radiographic outcomes (anterior/mid/posterior vertebral body height, vertebral area, local kyphosis angle, traumatic regional angulation) were analyzed before surgery, at one month after surgery, and at the end of the follow-up period.
At one-month postsurgery, significant improvements in VAS score and ODI score were observed. PIETI achieved significant vertebral body height restoration with median height increases of 2.9 mm/4.3 mm/2.3 mm for anterior/middle/posterior parts, respectively. Significant correction of the local kyphotic angle and improvement of the traumatic regional angulation were accomplished. All these improvements were maintained throughout the follow-up period. The only complication reported was a case of cement leakage.
In our opinion, the main limitation of the study is the small number of patients. However, the sample is superior to that shown in other papers.
This study showed that using a PIETI in the treatment of fractures type A3 is a safe and effective method that allows marked clinical improvement, as well as anatomical vertebral body restoration. Unlike with other treatments, results were maintained over time, allowing a better long-term clinical and functional improvement. The rate of cement leakage was lower than other reports.
对于 AO 亚型 A3 型爆裂骨折的最佳治疗方法仍存在争议。最常见的手术治疗方法是后路椎弓根螺钉和棒系统固定。然而，已经观察到在高度恢复和后凸矫正方面存在丢失。
本研究旨在评估使用经皮可扩张钛植入物（PIETI）的微创技术的长期结果。
这是一项前瞻性、单中心、试点研究，纳入了 44 例急性（<2 周）创伤性胸腰椎骨折 AO 分型 A3 的连续病例系列。平均随访时间为 5.6 年。
西班牙卡斯蒂利亚-莱昂的一个单中心。
分析了手术前后（视觉模拟评分[VAS]疼痛强度、Oswestry 功能障碍指数[ODI]、镇痛药用量）和影像学结果（前/中/后椎体高度、椎体面积、局部后凸角、创伤性区域角度）。
术后 1 个月，VAS 评分和 ODI 评分均显著改善。PIETI 实现了显著的椎体高度恢复，前、中、后部分的平均椎体高度分别增加了 2.9mm、4.3mm 和 2.3mm。局部后凸角显著矫正，创伤性区域角度得到改善。所有这些改善在整个随访期间都得到了维持。唯一报告的并发症是一例水泥渗漏。
在我们看来，这项研究的主要局限性是患者数量较少。然而，与其他论文相比，该样本是优越的。
本研究表明，使用 PIETI 治疗 A3 型骨折是一种安全有效的方法，可显著改善临床症状，重建解剖学椎体。与其他治疗方法不同，结果随着时间的推移得以维持，从而获得更好的长期临床和功能改善。水泥渗漏率低于其他报告。
