Benek Huseyin Berk, Akcay Emrah, Yilmaz Hakan, Yurt Alaattin
Health Sciences University, Izmir Bozyaka Education and Research Hospital, Department of Neurosurgery, Izmir, Turkey.
Turk Neurosurg. 2021;31(6):973-979. doi: 10.5137/1019-5149.JTN.34860-21.3.
To compare the efficiency of distraction and ligamentotaxis in posterior spinal instrumentation of thoracolumbar retropulsed fractures according to the grade of spinal canal compression and fracture levels.
This study retrospectively reviewed 56 patients diagnosed with thoracolumbar fractures and significant fracture fragments retropulsed into the spinal canal who only underwent posterior instrumentation with distraction and ligamentotaxis, and compared groups according to the grade of spinal canal compression and fracture levels. The pre-and postoperative clinical outcomes were evaluated using Oswestry Disability Index and visual analog scale scores, and neuroimaging studies showed percentage of the spinal canal compression and fractured vertebral unit height.
A total of 34 male (60.7%), and 22 female (39.3%) patients with a mean age of 46.25 years was enrolled in study. The percentage of spinal cord compression reduced significantly from 40.2% preoperatively to 26.8% postoperatively (+13.4%). The vertebral unit height increased significantly from 25.20 ± 3.2 mm to 31.85 ± 2.6 mm (+6.65 ± 2.7). The absolute spinal canal compression reduction was higher for grade II fractures (1/3 to 2/3 compression) (+13.3%) than for grade I fractures (up to 1/3) (+7.9%). Greater widening was observed at L1?L2 level (+16.2%) than at T11?T12 level (+10.2%). Statistically significant differences were found between the two groups according to the grade of canal compression and fracture levels in the mean preand postoperative spinal canal compression reduction.
Indirect decompression techniques reduce retropulsed fragments, effectively improve the degree of spinal canal compression, and ensure safe laminectomy. The efficiency of distraction and ligamentotaxis after posterior spinal instrumentation correlated with the preoperative percentage of spinal canal compression and higher spinal canal area for fractures with a high preoperative stenosis.
根据椎管受压程度和骨折节段，比较撑开复位与韧带整复在胸腰段椎体后凸骨折后路脊柱内固定术中的效果。
本研究回顾性分析了56例诊断为胸腰段骨折且有明显骨折块突入椎管的患者，这些患者仅接受了撑开复位与韧带整复的后路内固定术，并根据椎管受压程度和骨折节段进行分组。术前和术后的临床结果采用Oswestry功能障碍指数和视觉模拟评分进行评估，神经影像学检查显示椎管受压百分比和骨折椎体高度。
本研究共纳入34例男性患者（60.7%）和22例女性患者（39.3%），平均年龄46.25岁。脊髓受压百分比从术前的40.2%显著降至术后的26.8%（增加13.4%）。椎体高度从25.20±3.2mm显著增加至31.85±2.6mm（增加6.65±2.7）。II级骨折（1/3至2/3受压）的椎管绝对减压率（13.3%）高于I级骨折（最多1/3受压）（7.9%）。L1-L2节段的增宽幅度（16.2%）大于T11-T12节段（10.2%）。根据椎管受压程度和骨折节段，两组在术前和术后平均椎管减压率方面存在统计学显著差异。
间接减压技术可减少后凸骨折块，有效改善椎管受压程度，并确保安全的椎板切除术。后路脊柱内固定术后撑开复位与韧带整复的效果与术前椎管受压百分比相关，术前狭窄程度较高的骨折其椎管面积更大。
