Rispoli Rossella, Abousayed Mahmoud, Hamed Alaa A, Cappelletto Barbara
Unit of Spine and Spinal Cord Surgery, University Hospital of Udine, Udine, Italy -
Kasr Al Ainy Medical School, Department of Orthopedic Surgery, Cairo University, Giza, Egypt.
J Neurosurg Sci. 2024 Oct;68(5):567-573. doi: 10.23736/S0390-5616.22.05794-0. Epub 2022 Sep 16.
Long segment fixation has been frequently used to treat thoracolumbar burst fractures. In our study we want to compare the long and short segment with intermediate screw fixation of thoracolumbar junction burst fractures in relation to radiological and clinical outcomes.
We collected the data of 115 patients, with thoracolumbar junction (T11-L2) burst fracture A3 or A4, according to AO Classification. Patients were divided into two groups. Group A was treated by long segment fixation. Group B was treated by short segment fixation. At admission, after surgery, and at 12-month follow-up the patients were radiographically assessed for local kyphotic angle using the Cobb method. Patients were clinically evaluated with the Visual Analogue Scale (VAS) for back pain.
The mean difference of the preoperative, immediate postoperative, and 12-month follow-up Cobb angle was significant in both groups (P=0.018). The mean difference of the preoperative and immediate postoperative Cobb angle, Δ1, was significantly greater in group A than in group B (P=0.038), indicating that the Cobb angle correction immediately postoperative was better in patients with double level fixation. The mean difference of the immediate postoperative and 12-month follow-up Cobb angle, Δ2, was significantly greater in group A than in group B (P=0.007), indicating that the maintenance of local Cobb angle correction was better in patients with double level, long fixation. There was no difference in VAS values between group B (single) and group A (double) segment fixation immediately postoperatively (P=0.356) or after 12 months (P=0.147).
In A3 and A4 thoracolumbar junction fractures, long segment fixation can correct the local kyphosis Cobb angle and maintain the correction at 12-month follow-up better than short segment fixation with intermediate screws in the fractured vertebra. However, the radiological difference was not predictive of clinical results.
长节段固定常用于治疗胸腰椎爆裂骨折。在我们的研究中，我们希望比较长节段和短节段中间螺钉固定治疗胸腰段交界区爆裂骨折的影像学和临床结果。
我们收集了115例根据AO分类法诊断为胸腰段交界区（T11-L2）A3或A4型爆裂骨折患者的数据。患者分为两组。A组采用长节段固定治疗。B组采用短节段固定治疗。在入院时、术后及12个月随访时，采用Cobb法对患者进行影像学评估，测量局部后凸角。采用视觉模拟评分法（VAS）对患者的背痛进行临床评估。
两组患者术前、术后即刻及12个月随访时Cobb角的平均差异均有统计学意义（P=0.018）。A组术前与术后即刻Cobb角的平均差值Δ1显著大于B组（P=0.038），表明双节段固定患者术后即刻Cobb角矫正效果更好。A组术后即刻与12个月随访时Cobb角的平均差值Δ2显著大于B组（P=0.007），表明双节段长节段固定患者局部Cobb角矫正的维持效果更好。术后即刻（P=0.356）或12个月后（P=0.147），B组（单节段）和A组（双节段）固定的VAS值无差异。
在A3和A4型胸腰段交界区骨折中，与在骨折椎体中使用中间螺钉的短节段固定相比，长节段固定能更好地矫正局部后凸Cobb角，并在12个月随访时维持矫正效果。然而，影像学差异并不能预测临床结果。
