Zhang Haiping, Li Tao, Sun Honghui, Zhang Jun, Hao Dingjun
Department of Spine Surgery, Honghui Hospital of Xi'an Jiaotong University Health Science Center Xi'an, China.
Department of Trauma Surgery, Honghui Hospital of Xi'an Jiaotong University Health Science Center Xi'an, China.
Am J Transl Res. 2022 Sep 15;14(9):6323-6331. eCollection 2022.
This study aimed to analyze the reasons for failed thoracolumbar fracture treated with posterior surgical approaches and to discuss the revision strategies for the surgical treatment.
We retrospectively studied the patients that received failed thoracolumbar fracture (T11-L2) treatment with posterior approach and underwent revision surgery in our spine department from March 2010 to December 2020.
A total of 31 patients were included in this study. There were 4 (12.9%) cases of A3, 2 (6.5%) cases of B1, 5 (16.1%) cases of B2, 7 (22.6%) cases of B3, and 13 (41.9%) cases of C, according to the AO classification for thoracolumbar injuries. For load sharing classification, 26 (83.9%) cases ≥7, and 5 (16.1%) cases < 7. Regarding to the reasons for surgery failure, 26 cases (83.9%) were due to fracture of the internal fixation (pedicle screw or connecting rod) and kyphosis, 3 cases (9.7%) were due to misplacement of the posterior pedicle screw, 1 case (3.2%) was due to incomplete posterior decompression, and 1 case (3.2%) was due to scoliosis after the removal of the internal fixation. The revision surgery methods included: 2 cases (6.5%) with anterior approach, 17 cases (54.8%) with posterior approach, and 12 cases (38.7%) with posterior and anterior approach. All the patients were followed-up for 12-24 months after the revision surgery, and successful bony fusion with no internal fixation failure was observed. The kyphosis angle improved significantly after the revision surgery in 26 patients at the last follow-up, and the final correction rate was 91.8%. Frankel grading system, visual analog scale (VAS), Oswestry Disability Index (ODI) showed significant improvement at the last follow-up.
Types B and C of thoracolumbar fracture, load sharing classification ≥7, and the posterior approach could lead to a high failure rate. Fracture of the internal fixation was the main reason for surgery failure. Performing the posterior approach is inappropriate for every thoracolumbar fracture. Reasonable revision surgery can achieve good results for posterior surgery failure in most cases.
本研究旨在分析采用后路手术治疗胸腰椎骨折失败的原因，并探讨手术治疗的翻修策略。
我们回顾性研究了2010年3月至2020年12月在我院脊柱科接受后路手术治疗胸腰椎骨折（T11-L2）失败并接受翻修手术的患者。
本研究共纳入31例患者。根据胸腰椎损伤的AO分类，A3型4例（12.9%），B1型2例（6.5%），B2型5例（16.1%），B3型7例（22.6%），C型13例（41.9%）。载荷分担分类中，≥7分者26例（83.9%），＜7分者5例（16.1%）。关于手术失败的原因，26例（83.9%）是由于内固定（椎弓根螺钉或连接杆）断裂和后凸畸形，3例（9.7%）是由于后路椎弓根螺钉置入位置不当，1例（3.2%）是由于后路减压不彻底，1例（3.2%）是由于内固定取出后脊柱侧弯。翻修手术方法包括：前路2例（6.5%），后路17例（54.8%），前后联合入路12例（38.7%）。所有患者翻修手术后随访12-24个月，观察到骨融合成功，无内固定失败。末次随访时，26例患者翻修手术后后凸角明显改善，最终矫正率为91.8%。Frankel分级系统、视觉模拟评分法（VAS）、Oswestry功能障碍指数（ODI）在末次随访时均有显著改善。
胸腰椎骨折的B型和C型、载荷分担分类≥7以及后路手术可能导致较高的失败率。内固定断裂是手术失败的主要原因。并非所有胸腰椎骨折都适合采用后路手术。合理的翻修手术在大多数情况下可使后路手术失败取得良好效果。
