Chinese PLA Medical School, Beijing, China.
Department of Orthopaedics, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.
Orthop Surg. 2024 Oct;16(10):2364-2371. doi: 10.1111/os.14127. Epub 2024 Jul 9.
OBJECTIVE: The revision procedure for failure of internal fixation after thoracolumbar fracture is controversial. Combined anterior and posterior surgery is associated with higher risk more intraoperative bleeding and tissue damage. The success rate of simple anterior surgery needs further confirmation, and posterior surgery lacks stability of internal fixation. This study evaluates the feasibility and surgical effect of multi-rod constructs in the revision of thoracolumbar fractures. METHODS: Eleven patients with thoracolumbar fractures who underwent previous construct failure and were treated with revision and internal fixation with the multi-rod technique from March 2017 to September 2018 were analyzed. The original internal fixation was removed and replaced in the medial insertion of satellite rods and bone graft. The average follow-up time was 15.97 months. The intraoperation blood loss, the time of the operation, activation and discharge and the rate of rod fracture were calculated. The sagittal Cobb angle before revision, after revision and at the last follow-up were compared. The clinical effect was evaluated by visual analogue scale (VAS) and Oswestry Disability Index questionnaire (ODI). RESULTS: The average operation time was 107 min, the intraoperative blood loss was 131.81 mL, the active time was 1.59 days, and the discharge time was 10.89 days. No rod fractured again during the follow-up period. The paired t-test was used to compare the Cobb angle, VAS score, and ODI before and after surgery. There was significant difference in the sagittal Cobb angle between the pre-revision and the posterior sagittal position (p = 0.000), and no significant difference was found between post-revision and last follow-up (p = 0.551). VAS and ODI were greatly improved at the last follow-up. CONCLUSION: The literature on revision of thoracolumbar fractures is insufficient and comprises varying opinions. This paper proposes a new treatment option. The application of the multi-rod constructs in the revision of thoracolumbar fractures is safe, simple, and effective and might provide guidance for future clinical work.
目的：胸腰椎骨折内固定失败后的翻修手术方法仍存在争议。前后联合手术风险更高，术中出血量和组织损伤更大。单纯前路手术的成功率有待进一步证实，后路手术内固定稳定性不足。本研究评估多棒重建在胸腰椎骨折翻修中的可行性和手术效果。
方法：2017 年 3 月至 2018 年 9 月，对 11 例胸腰椎骨折患者进行了多棒重建翻修手术，这些患者之前的内固定失败，需要进行翻修和内固定。取出原内固定，在卫星棒的内侧插入处进行重建和植骨。平均随访时间为 15.97 个月。计算术中出血量、手术时间、激活和出院时间以及棒断裂率。比较术前、术后和末次随访时的矢状面 Cobb 角。采用视觉模拟评分（VAS）和 Oswestry 功能障碍指数问卷（ODI）评估临床疗效。
结果：手术时间平均为 107 分钟，术中出血量为 131.81 毫升，主动活动时间为 1.59 天，出院时间为 10.89 天。随访期间无棒再次断裂。配对 t 检验比较手术前后 Cobb 角、VAS 评分和 ODI。术前与术后矢状面 Cobb 角比较，差异有统计学意义（p=0.000），术后与末次随访比较，差异无统计学意义（p=0.551）。末次随访时 VAS 和 ODI 均明显改善。
结论：胸腰椎骨折翻修的文献不足，意见不一。本文提出了一种新的治疗方案。多棒重建应用于胸腰椎骨折翻修是安全、简单、有效的，可为今后的临床工作提供指导。
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