Department of Orthopaedics and Trauma Surgery, University Hospital Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
Department of Orthopaedics, Trauma- and Hand Surgery, Klinikum Darmstadt, Darmstadt, Germany.
Arch Orthop Trauma Surg. 2024 Jan;144(1):239-250. doi: 10.1007/s00402-023-05082-8. Epub 2023 Oct 15.
Thoracolumbar spine fractures often require surgical treatment as they are associated with spinal instability. Optimal operative techniques and treatment are discussed controversially. Aim of our prospective cohort study was to investigate the sagittal alignment after reduction, the secondary loss of reduction and the subjective outcome as well as the causal correlation of these parameters after minimally invasive stabilization of thoracic and lumbar fractures with polyaxial pedicle screws.
In a single-center study, a total of 78 patients with an average age of 61 ± 17 years who suffered a fracture of the thoracic or lumbar spine were included and subjected to a clinical and radiological follow-up examination after 8.5 ± 8 months. The kyphotic deformity was measured by determining the vertebral body angle, the mono- and bi-segmental wedge angle at three time points. The patients' subjective outcome was evaluated by the VAS spine score.
After surgical therapy, a significant reduction of the traumatic kyphotic deformity was shown with an improvement of all angles (vertebral body angle: 3.2° ± 4.4°, mono- and bi-segmental wedge angle: 3.1° ± 5.6°, 2.0° ± 6.3°). After follow-up, a significant loss of sagittal alignment was observed for all measured parameters with a loss of correction. However, no correlation between the loss of reduction and the subjective outcome regarding the VAS spine scale could be detected.
The minimally invasive dorsal stabilization of thoracic and lumbar spine fractures with polyaxial pedicle screws achieved a satisfactory reduction of the fracture-induced kyphotic deformity immediately postoperatively with a floss of reduction in the further course. However, maybe the main goal of this surgical procedure should be the prevention of a complete collapse of the vertebral body instead of a long-lasting restoration of anatomic sagittal alignment.
II.
胸腰椎骨折常需要手术治疗，因为它们与脊柱不稳定有关。最佳手术技术和治疗方法存在争议。我们前瞻性队列研究的目的是研究胸腰椎骨折多轴向椎弓根螺钉微创固定后复位后的矢状位排列、复位的继发性丢失以及主观结果，并探讨这些参数之间的因果关系。
在一项单中心研究中，共纳入了 78 名平均年龄为 61±17 岁的胸腰椎骨折患者，在 8.5±8 个月后进行临床和放射学随访检查。通过确定椎体角度、单节段和双节段楔形角度，测量后凸畸形。通过 VAS 脊柱评分评估患者的主观结果。
手术治疗后，创伤性后凸畸形明显减轻，所有角度均得到改善（椎体角度：3.2°±4.4°，单节段和双节段楔形角度：3.1°±5.6°，2.0°±6.3°）。随访时，所有测量参数的矢状面排列均明显丢失，矫正丢失。然而，在 VAS 脊柱量表的主观结果方面，没有发现丢失与丢失之间的相关性。
多轴向椎弓根螺钉微创治疗胸腰椎骨折可立即获得满意的骨折后后凸畸形复位，但在进一步治疗过程中复位会丢失。然而，这种手术方法的主要目标可能是预防椎体完全塌陷，而不是长期恢复解剖矢状面排列。
II 级。
