Jain Vaibhav, Champawat Vishal, Rajpoot Manish, Sarkar Abhishek, Verma Rahul, Parmar Vijendra, Saha Anagh
Department of Orthopaedics, Gandhi Medical College, Bhopal, Bhopal, IND.
Cureus. 2024 Dec 13;16(12):e75653. doi: 10.7759/cureus.75653. eCollection 2024 Dec.
Introduction Thoracolumbar fractures, particularly burst fractures, represent a significant health concern due to their prevalence and functional impact. This study evaluates the efficacy of short-segment posterior fixation with intermediate screw instrumentation in treating unstable thoracolumbar fractures. Methods A prospective study was conducted from July 2022 to December 2023, including 26 patients with traumatic thoracolumbar fractures. Surgical intervention was indicated for patients with a thoracolumbar injury classification and severity (TLICS) score >4. Functional outcomes were assessed using the visual analog scale (VAS), Oswestry Disability Index (ODI), and the American Spinal Injury Association (ASIA) grading system. Radiological outcomes, including the local kyphotic angle (LKA) and anterior vertebral body height ratio (AVBHR), were evaluated preoperatively, postoperatively, and at follow-ups. Results Significant improvements in functional and radiological parameters were observed over 24 weeks. The mean VAS score reduced from 7.50 ± 0.58 preoperatively to 1.42 ± 0.50 (p < 0.001), and the mean ODI improved from 42.23 ± 3.54 to 16.12 ± 3.09 (p < 0.001). Neurological improvements were seen in ASIA grades B-D, with no new deficits. Radiologically, the mean LKA improved from 19.73 ± 1.59° preoperatively to 8.46 ± 1.33° at 24 weeks (p < 0.001), and the AVBHR increased from 34.08 ± 2.25% to 86.64 ± 0.83% (p < 0.001). No implant failures were reported. Conclusion Short-segment fixation with intermediate screws provides effective stabilization and significant functional and radiological improvements in thoracolumbar fractures. It minimizes intraoperative morbidity and preserves motion segments, making it a viable alternative to long-segment fixation, particularly for non-complex fractures. Further randomized controlled trials are recommended to validate these findings.
引言 胸腰椎骨折，尤其是爆裂骨折，因其发病率和功能影响而成为重大的健康问题。本研究评估短节段后路中间螺钉内固定治疗不稳定胸腰椎骨折的疗效。方法 2022年7月至2023年12月进行了一项前瞻性研究，纳入26例创伤性胸腰椎骨折患者。胸腰椎损伤分类及严重程度（TLICS）评分>4的患者接受手术干预。使用视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）和美国脊髓损伤协会（ASIA）分级系统评估功能结局。术前、术后及随访时评估包括局部后凸角（LKA）和椎体前缘高度比值（AVBHR）在内的影像学结局。结果 在24周内观察到功能和影像学参数有显著改善。平均VAS评分从术前的7.50±0.58降至1.42±0.50（p<0.001），平均ODI从42.23±3.54改善至16.12±3.09（p<0.001）。ASIA B-D级患者神经功能有改善，无新的神经功能缺损。影像学方面，平均LKA从术前的19.73±1.59°改善至24周时的8.46±1.33°（p<0.001），AVBHR从34.08±2.25%增加至86.64±0.83%（p<0.001）。未报告植入物失败情况。结论 中间螺钉短节段固定可为胸腰椎骨折提供有效的稳定作用，并显著改善功能和影像学表现。它可将术中发病率降至最低，并保留运动节段，是长节段固定的可行替代方案，尤其适用于非复杂骨折。建议进一步进行随机对照试验以验证这些结果。
