Cerny Jan, Soukup Jan, Loukotova Lucie, Zrzavecky Marek, Novotny Tomas
Department of Orthopaedics, Faculty of Health Studies, Jan Evangelista Purkyne University in Usti nad Labem and Masaryk Hospital, 401 13 Usti nad Labem, Czech Republic.
Department of Orthopaedic Surgery, Faculty of Medicine in Hradec Kralove, Charles University, 500 03 Hradec Kralove, Czech Republic.
J Clin Med. 2025 Jul 3;14(13):4700. doi: 10.3390/jcm14134700.
The objective was to evaluate and compare the efficacy of direct fragment impaction, indirect reduction through ligamentotaxis, and the combination of both techniques in burst fractures of the thoracolumbar (TL) spine. The fractures were categorized using the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification and assessed via standard computed tomography (CT) scans for spinal canal area (SCA) and mid-sagittal diameter (MSD). The Frankel classification was used to assess neurological deficits. Only single vertebrae AO types A3 and A4 thoracic or lumbar fractures were included. All patients received bisegmental posterior stabilization, one of the reduction techniques, and, if neurological deficits were present, a spinal decompression. Mean preoperative (µSCApre/µMSDpre), postoperative (µSCApost/µMSDpost) and difference (∆SCA/∆MSD) in radiographic values were obtained and analyzed using the Mumford formula. The significance of the reduction from preoperative stenosis was assessed using a t-test, while the effectiveness of the reduction techniques was compared using the Kruskal-Wallis test and Dunn's post hoc test. The manuscript was focused primarily on radiographic outcomes; therefore, aside from the neurostatus, no other clinical parameters were statistically analyzed. Thirteen patients (38.2%) received stand-alone indirect reduction, 13 patients (38.2%) underwent direct reduction, and a combined reduction was used in eight patients (23.6%). All methods resulted in a statistically significant reduction in spinal canal stenosis ( < 0.05), with a minimal mean ∆SCA of 19%. Patients in the direct reduction group had significantly higher µSCApre values compared to those in the indirect reduction group ( = 0.02). All of the tested reduction techniques provided a significant reduction in spinal canal stenosis. Patients who underwent mere direct reduction had significantly higher preoperative spinal canal stenosis compared to the indirect reduction group.
目的是评估和比较直接碎骨块嵌压、通过韧带整复进行间接复位以及这两种技术联合应用于胸腰椎（TL）爆裂骨折的疗效。骨折采用德国骨科内固定协会（AO）分类法进行分类，并通过标准计算机断层扫描（CT）评估椎管面积（SCA）和矢状径（MSD）。采用Frankel分类法评估神经功能缺损情况。仅纳入单节段AO A3和A4型胸椎或腰椎骨折。所有患者均接受双节段后路固定、一种复位技术，若存在神经功能缺损则进行脊髓减压。使用Mumford公式获得并分析影像学值的术前均值（µSCApre/µMSDpre）、术后均值（µSCApost/µMSDpost）及差值（∆SCA/∆MSD）。采用t检验评估术前狭窄复位的显著性，采用Kruskal-Wallis检验和Dunn事后检验比较复位技术的有效性。该论文主要关注影像学结果；因此，除神经状态外，未对其他临床参数进行统计学分析。13例患者（38.2%）接受单纯间接复位，13例患者（38.2%）接受直接复位，8例患者（23.6%）采用联合复位。所有方法均使椎管狭窄得到统计学显著改善（<0.05），平均最小∆SCA为19%。与间接复位组相比，直接复位组患者的µSCApre值显著更高（=0.02）。所有测试的复位技术均使椎管狭窄得到显著改善。单纯接受直接复位的患者术前椎管狭窄程度显著高于间接复位组。
