Finoco Mikael, Dejean Charles, Giber David, Bastard Claire, Ferrero Emmanuelle, Dubory Arnaud, Khalifé Marc
Orthopaedic Surgery Unit, Hôpital Européen Georges Pompidou, APHP, 20 rue Leblanc, 75015, Paris, France.
Université de Paris, Paris, France.
Int Orthop. 2023 May;47(5):1295-1302. doi: 10.1007/s00264-023-05734-9. Epub 2023 Feb 28.
The aim of this study was to compare two percutaneous pedicle fixations for the treatment of thoracolumbar fractures: one associating a jack kyphoplasty (SpineCut) and the other using intermediate screws (Trident).
All adult patients treated for single-level Magerl/AO type A thoracolumbar traumatic fractures in four orthopaedic departments, with SpineCut or Trident, with a one year minimum follow-up, were retrospectively included. Neurological disorders and osteoporotic fractures were not included. The following data were collected: age, sex, Magerl/AO type, type of surgery, and complications. Radiological parameters were analyzed on pre-operative CT scan, and on standing X-rays before discharge, at three months and one year post-operative: vertebral wedge angle (VWA), regional kyphosis angle (RKA), and traumatic regional angulation (TRA: difference between RKA and physiological values for each vertebra).
Eighty patients were included, with 42 patients in SpineCut group and 38 in Trident group. Mean age was 41 ± 15.7 years. TRA correction did not differ between the groups: respectively 11.2 ± 8.1° in SpineCut versus 10.2 ± 9.1° in Trident group (p = 0.52). TRA loss of correction between early post-operative and three months was statistically higher in Trident group: -4 ± 5.1° versus -1.5 ± 3.8° (p = 0.03). After 3 months, TRA correction loss was comparable between the groups. Multivariate analysis demonstrated that pre-operative VWA was the only factor significantly associated with early TRA correction loss (p = 0.01). VWA correction and loss of correction did not differ significantly between the groups. No complications were observed.
Percutaneous pedicle fixations of traumatic thoracolumbar fractures associating jack kyphoplasty and intermediate screws are both safe and efficient techniques.
本研究旨在比较两种用于治疗胸腰椎骨折的经皮椎弓根固定术：一种结合了球囊后凸成形术（SpineCut），另一种使用中间螺钉（Trident）。
回顾性纳入在四个骨科科室接受单节段Magerl/AO A型胸腰椎创伤性骨折治疗的所有成年患者，采用SpineCut或Trident进行治疗，且至少随访一年。不包括神经功能障碍和骨质疏松性骨折。收集以下数据：年龄、性别、Magerl/AO类型、手术类型和并发症。在术前CT扫描以及出院前、术后三个月和一年的站立位X线片上分析放射学参数：椎体楔角（VWA）、节段后凸角（RKA）和创伤节段成角（TRA：每个椎体的RKA与生理值之间的差值）。
共纳入80例患者，SpineCut组42例，Trident组38例。平均年龄为41±15.7岁。两组间TRA矫正无差异：SpineCut组为11.2±8.1°，Trident组为10.2±9.1°（p = 0.52）。Trident组术后早期至三个月TRA矫正丢失在统计学上更高：-4±5.1° 对比 -1.5±3.8°（p = 0.03）。三个月后，两组间TRA矫正丢失相当。多因素分析表明术前VWA是与早期TRA矫正丢失显著相关的唯一因素（p = 0.01）。两组间VWA矫正及矫正丢失无显著差异。未观察到并发症。
结合球囊后凸成形术和中间螺钉的创伤性胸腰椎骨折经皮椎弓根固定术均是安全有效的技术。
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