Farooque Kamran, Sharma Vijay, Kar Santanu
Department of Orthopaedics, Jai Prakash Narayan Apex Trauma Centre, AIIMS, 110029, NEW DELHI, India.
J Orthop. 2022 Mar 18;31:33-39. doi: 10.1016/j.jor.2022.03.003. eCollection 2022 May-Jun.
Retrospective cohort study.
Traumatic fracture dislocation of the spine injury is essentially a three column injury that optimally needs surgical intervention to decompress, stabilize and fuse the spinal column. This study evaluate the outcome of posterior and posterolateral decompression, instrumentation and 360° fusion achieved with help of locally harvested autologus morcellized grafts in traumatic fracture dislocation of thoracolumbar spine.
53 patients were included in this retrospective study. Patients aged 16-55 years, single level fracture dislocation of thoraco-lumbar spine (D5-L5) were included. Patients with multiple level fractures, coexisting degenerative diseases of spine,pathological fractures, patients presenting more than three weeks after initial trauma, patients with concomitant severe head injury that necessitated emergency surgery for the same were excluded from the study. Patients underwent posterior and posterolateral decompression, posterior instrumentation and interbody as well as posterolateral fusion with use of morcellized bone from resected posterior elements. Follow up data at immediate post operative period, 12 months and yearly thereafter up to minimum 7 years was obtained from previous record.
There were 46 males and 7 females. Mean age was 31.15 ± 9.64 yrs. Mean follow up period was 7.4 yrs (range 7-10 yrs). Thoracolumbar dislocation was most frequently noted at thoraco lumbar junction (T10-L2). Thirty six patients had complete neurological deficit (ASIA A) and sixteen had incomplete neurology. At one year follow up, osseous fusion was noted in 48 (90.56%) patients and 5 patients (9.44%) had fibrous union which was determined on CT scan. Immediete post operative, one year and 7 year kyphosis angle was calculated and change in kyphosis angle was not statistically significant. There was no implant failure till last follow up.
Morcellized locally harvested autologus grafts are sufficient to achieve 360° spinal fusion in fracture dislocation of thoracolumbar spine.
回顾性队列研究。
脊柱创伤性骨折脱位本质上是一种三柱损伤，最佳治疗方法是通过手术进行减压、稳定和融合脊柱。本研究评估在胸腰椎创伤性骨折脱位中，借助局部采集的自体碎骨移植实现后路及后外侧减压、器械固定和360°融合的效果。
本回顾性研究纳入53例患者。纳入年龄在16 - 55岁、胸腰椎单节段骨折脱位（D5 - L5）的患者。排除多节段骨折、并存脊柱退行性疾病、病理性骨折、初次创伤后超过三周就诊的患者、伴有严重颅脑损伤且需急诊手术的患者。患者接受后路及后外侧减压、后路器械固定、椎间融合以及使用切除的后部结构的碎骨进行后外侧融合。从既往记录中获取术后即刻、12个月及之后每年直至至少7年的随访数据。
男性46例，女性7例。平均年龄为31.15 ± 9.64岁。平均随访期为7.4年（范围7 - 10年）。胸腰椎脱位最常发生在胸腰段交界处（T10 - L2）。36例患者有完全性神经功能缺损（美国脊髓损伤协会A级），16例有不完全性神经功能障碍。在1年随访时，48例（90.56%）患者出现骨融合，5例（9.44%）患者通过CT扫描确定为纤维性融合。计算术后即刻、1年和7年的后凸角，后凸角的变化无统计学意义。直至最后随访时无植入物失败情况。
局部采集的自体碎骨移植足以在胸腰椎骨折脱位中实现360°脊柱融合。
