Sural Sumit, Goyal Arpit, Garg Rahul, Singh Ashwani, Kashyap Abhishek, Arora Sumit
Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, 110002, India.
SKOP Centre, B-516, Kamla Nagar, Agra, UP, India.
J Orthop. 2023 Jan 28;37:15-21. doi: 10.1016/j.jor.2023.01.010. eCollection 2023 Mar.
Various operative procedures have been described for the treatment of traumatic paraplegia caused by unstable thoracolumbar fractures. We prospectively evaluated interbody fusion (IBF) with SS-PSF in these cases with regard to clinico-radiological outcome with the objectives: (1) Does IBF and short segment pedicle screw fixation (SS-PSF) prevent progression of kyphotic angle after surgery? (2) Can this procedure be safely performed in the setting of acute trauma?.
Sixteen patients suffering from traumatic paraplegia caused by acute unstable thoracolumbar fractures were enrolled prospectively and underwent IBF with SS-PSF. They were evaluated for magnitude of shortening in spine, progression of kyphotic angle, and neurological improvement by American spinal injury association scale (ASIA).
Out of total sixteen, 14 patients were ASIA grade A and 2 were grade C, at the time of presentation. Thirteen out of these 14 remained grade A and one improved to B. Both the patients who had grade C involvement at the time of presentation improved to grade D at one-year follow-up. The mean blood loss was 750 ml (range; 650 ml-1150 ml). Mean kyphotic angle decreased from 20.6° (range; 13° to 37°) preoperatively to 6.2° (range; 3° to 10°) at postoperative day 2 (p = 0.002). Its mean value after 6 months was 6.5° (range; 3° to 11°). The procedure resulted in mean spinal column shortening of 18 mm (range; 16 mm-22 mm) in the spinal column. All the patients achieved bony union by a mean duration of 3.9 months (range; 3 months-6 months).
IBF with SS-PSF has the shortest possible instrumented construct for thoracolumbar junction fusion done by posterior approach. The interbody fusion for unstable thoracolumbar junction fractures prevents the progression of kyphotic angle post-operatively.
Level 4.
针对不稳定型胸腰椎骨折所致创伤性截瘫，已有多种手术方法被描述。我们前瞻性地评估了在这些病例中采用椎间融合术（IBF）联合短节段椎弓根螺钉固定术（SS-PSF）的临床影像学结果，目标如下：（1）椎间融合术和短节段椎弓根螺钉固定术能否防止术后后凸角进展？（2）该手术在急性创伤情况下能否安全实施？
前瞻性纳入16例由急性不稳定型胸腰椎骨折导致创伤性截瘫的患者，并对其实施椎间融合术联合短节段椎弓根螺钉固定术。通过测量脊柱缩短程度、后凸角进展情况以及采用美国脊髓损伤协会（ASIA）分级评估神经功能改善情况对患者进行评估。
在总共16例患者中，就诊时14例为ASIA A级，2例为C级。这14例中的13例仍为A级，1例改善为B级。就诊时为C级的2例患者在1年随访时均改善为D级。平均失血量为750毫升（范围：650毫升至1150毫升）。平均后凸角从术前的20.6°（范围：13°至37°）降至术后第2天的6.2°（范围：3°至10°）（p = 0.002）。6个月后的平均值为6.5°（范围：3°至11°）。该手术导致脊柱平均缩短18毫米（范围：16毫米至22毫米）。所有患者平均在3.9个月（范围：3个月至6个月）实现骨融合。
椎间融合术联合短节段椎弓根螺钉固定术是后路进行胸腰椎节段融合时所需固定节段最短的术式。不稳定型胸腰椎节段骨折的椎间融合术可防止术后后凸角进展。
4级。
