Kumar Sinha Shivendra, Verma Vishal, Regmi Anil, Venkata Sudhakar P, Goyal Nikhil, Shekhar Sethy Siddharth, Jain Aakash, Verma Aman, Kandwal Pankaj, Sarkar Bhaskar
Department of Orthopedics, AIIMS, Rishikesh, Uttarakhand, 249203, India.
Department of Trauma Surgery, AIIMS, Rishikesh, Uttarakhand, 249203, India.
J Clin Orthop Trauma. 2024 Oct 18;58:102564. doi: 10.1016/j.jcot.2024.102564. eCollection 2024 Nov.
Prospective Comparative Study.
This study aims to study the outcome of thoracolumbar burst fractures by comparison of 3 different posterior constructs groups of patients treated by the posterior approach.
University level Tertiary care Centre of Northern India.
Single centre study conducted from September 2020 to April 2022, the study included patients aged 18-50 years with burst fractures in the thoracolumbar region, TLICS score ≥4, and injury surgery duration <3 weeks. Sixty patients were divided into three groups: Group I (short segment with index screw(s) in the fractured vertebrae), Group II (short segment with interbody cage fusion), and Group III (long segment without index screw or interbody cage). Clinical and radiological assessments were performed over a 6-month follow-up period. Outcome measures included the Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI), American Spinal Injury Association (ASIA) impairment scale, and radiological parameters.
Among 60 patients, 38 were male, and 22 were female, with a mean age of 33.37 ± 12.26 years. The most common injury mechanisms were falls from heights (85 %). Group I had the lowest estimated blood loss (395 ± 36.20 ml) and shortest surgery duration (140 ± 26.56 min), while Group III had the highest blood loss (744.25 ± 113.69 ml) and longest surgery duration (203.50 ± 23.40 min). No statistically significant differences were observed in kyphosis correction, canal clearance, or fusion status among the groups. Neurological and functional outcomes improved across all groups, with no significant intergroup differences.
All three posterior instrumentation constructs provided effective management of thoracolumbar burst fractures, demonstrating high rates of fusion, significant kyphosis correction, and minimal loss of alignment. Despite variations in surgical parameters such as estimated blood loss and surgery duration, the clinical and radiological outcomes were comparable.
III.
前瞻性比较研究。
本研究旨在通过比较经后路治疗的3种不同后路固定结构组患者的情况，来研究胸腰椎爆裂骨折的治疗结果。
印度北部大学三级护理中心。
2020年9月至2022年4月进行的单中心研究，研究纳入年龄在18 - 50岁、胸腰椎区域发生爆裂骨折、TLICS评分≥4且受伤至手术时间<3周的患者。60例患者分为三组：第一组（骨折椎体置入索引螺钉的短节段固定）、第二组（椎间融合器融合的短节段固定）和第三组（无索引螺钉或椎间融合器的长节段固定）。在6个月的随访期内进行临床和影像学评估。观察指标包括疼痛视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）、美国脊髓损伤协会（ASIA）损伤分级以及影像学参数。
60例患者中，男性38例，女性22例，平均年龄33.37 ± 12.26岁。最常见的损伤机制是高处坠落（85%）。第一组估计失血量最低（395 ± 36.20 ml），手术时间最短（140 ± 26.56分钟），而第三组失血量最高（744.25 ± 113.69 ml），手术时间最长（203.50 ± 23.40分钟）。各组在后凸畸形矫正、椎管减压或融合状态方面未观察到统计学显著差异。所有组的神经和功能结果均有改善，组间无显著差异。
所有三种后路内固定结构均能有效治疗胸腰椎爆裂骨折，融合率高，后凸畸形矫正显著，对线丢失最小。尽管在估计失血量和手术时间等手术参数上存在差异，但临床和影像学结果具有可比性。
III级。
