Luo Zhi-Wen, Liao Wei-Jie, Sun Bo-Lin, Wu Jia-Bao, Zhang Ning, Zhang Yu, Huang Shan-Hu, Liu Zhi-Li, Zhang Zhi-Hong, Liu Jia-Ming
Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China.
Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China.
Front Surg. 2023 Jan 11;9:1039100. doi: 10.3389/fsurg.2022.1039100. eCollection 2022.
Thoracolumbar fracture is one of the most common fractures of spine. And short-segment posterior fixation including the fractured vertebra (SSPFI) is usually used for the surgical treatment of it. However, the outcomes of SSPFI for different types of thoracolumbar fractures are not clear, and whether it is necessary to perform transpedicular bone grafting is still controversial. This study was conducted to determine the clinical efficacy of SSPFI for the treatment of different types of single-level thoracolumbar fracture, and make clear what kind of fractures need transpedicular bone grafting during the surgery.
Patients with single-level thoracolumbar fracture undergoing SSPFI surgery between January 2013 and June 2020 were included in this study. The operative duration, intraoperative blood loss, anterior vertebral height ratio (AVHR) and anterior vertebral height compressive ratio (AVHC) of the fractured vertebra, local kyphotic Cobb angle (LKA), vertebral wedge angle (VWA) and correction loss during follow up period were recorded. Outcomes between unilateral and bilateral pedicle screw fixation for fractured vertebra, between SSPFI with and without transpedicular bone grafting (TBG), and among different compressive degrees of fractured vertebrae were compared, respectively.
A total of 161 patients were included in this study. All the patients were followed up, and the mean follow-upped duration was 25.2 ± 3.1 months (6-52 months). At the final follow-up, the AVHR was greater, and the LKA and VWA were smaller in patients with bilateral fixation (6-screw fixation) than those with unilateral fixation (5-screw fixation) of AO type A3/A4 fractures (< 0.001). The correction loss of AVHR, LKA and VWA in fractured vertebra were significantly great when preoperative AVHC was >50% (< 0.05). For patients with AVHC >50%, the correction loss in patients with TBG were less than those without TBG at the final follow-up (< 0.05).
SSPFI using bilateral fixation was more effective than unilateral fixation in maintaining the fractured vertebral height for AO type A3/A4 fractures. For patients with AVHC >50%, the loss of correction was more obvious and it can be decreased by transpedicular bone grafting.
胸腰椎骨折是脊柱最常见的骨折之一。短节段后路固定术包括骨折椎体（SSPFI）通常用于其手术治疗。然而，SSPFI治疗不同类型胸腰椎骨折的疗效尚不清楚，且手术中是否有必要进行经椎弓根植骨仍存在争议。本研究旨在确定SSPFI治疗不同类型单节段胸腰椎骨折的临床疗效，并明确何种骨折在手术中需要经椎弓根植骨。
纳入2013年1月至2020年6月期间接受SSPFI手术的单节段胸腰椎骨折患者。记录手术时间、术中出血量、骨折椎体的前椎体高度比（AVHR）和前椎体高度压缩比（AVHC）、局部后凸Cobb角（LKA）、椎体楔角（VWA）以及随访期间的矫正丢失情况。分别比较骨折椎体单侧与双侧椎弓根螺钉固定、有与无经椎弓根植骨（TBG）的SSPFI以及不同压缩程度骨折椎体之间的结果。
本研究共纳入161例患者。所有患者均获随访，平均随访时间为25.2±3.1个月（6 - 52个月）。在末次随访时，AO A3/A4型骨折双侧固定（6枚螺钉固定）患者的AVHR更大，LKA和VWA更小，与单侧固定（5枚螺钉固定）患者相比差异有统计学意义（<0.001）。当术前AVHC>50%时，骨折椎体的AVHR、LKA和VWA矫正丢失显著更大（<0.05）。对于AVHC>50%的患者，末次随访时行TBG患者的矫正丢失小于未行TBG患者（<0.05）。
对于AO A3/A4型骨折，采用双侧固定的SSPFI在维持骨折椎体高度方面比单侧固定更有效。对于AVHC>50%的患者，矫正丢失更明显，经椎弓根植骨可减少这种丢失。
