Kumar Vishnu, Palaniappan Pasupathy, Sharma Deep, Mounisamy Prabu, Samuel Gipson T, M Sharran
Orthopedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND.
Cureus. 2025 Aug 25;17(8):e90939. doi: 10.7759/cureus.90939. eCollection 2025 Aug.
Background Thoracolumbar spine fractures account for the majority of all spinal injuries and pose a significant challenge in trauma care. Fixation techniques have evolved over the decades, with pedicle screw fixation becoming the norm. However, the debate continues regarding the number of vertebral levels that should be included in the fixation construct for optimal outcomes in case of single-level injuries. While long-segment fixation provides robust stability, it sacrifices motion segments, potentially increasing stiffness and adjacent segment degeneration. Short-segment fixation (SSF), involving one vertebra above and below the fracture, reduces stiffness and implant cost. Mono-segmental fixation (MSF), a recently introduced concept, advocates instrumenting only the fractured vertebra and one adjacent vertebra either above or below. We believe that MSF could provide outcomes similar to SSF with fewer complications, shorter operative times, and reduced blood loss in specific fracture patterns. Hence, this study was designed as a single-center randomized controlled trial to test this hypothesis. Methodology Twenty-six patients were randomized into the two intervention groups: Group A (MSF, = 13, 50%) and Group B (SSF, = 13, 50%). After the intervention, the patients followed a standard postoperative care regimen and rehabilitation protocol. All patients underwent open surgery. Radiographs were obtained at regular intervals, and the outcome variables were recorded up to one year following surgery. Sagittal index (SI), anterior vertebral height loss (AVHL), Cobb's angle (CA), local kyphotic angle (LKA), and implant failure were the radiological outcome measures studied. The other parameters assessed were surgical blood loss, postoperative drain volume, surgical time, pain, and wound complications. Results The groups were comparable for mean age, gender distribution, AO fracture type, and mechanism of injury (> 0.05). The mean change between observations at one year and immediate postoperative radiographs in SI, AVHL, and CA were similar between the groups ( > 0.05). The mean change in LKA was higher in the MSF group ( = 0.018, 95% confidence interval (CI) 0.78, 7.70). While the MSF group demonstrated reduced intraoperative blood loss (= 0.055, 95% CI -64.89, -2.80) and surgical time ( = 0.039, 95% CI, -24.74, -0.64), both groups had similar drain volume ( = 0.443, 95% CI -41.24, -0.21) and pain Visual Analog Scale (VAS) scores throughout the follow-up period (> 0.05). Conclusions MSF could be an effective alternative to SSF in selected thoracolumbar fracture patterns with both pedicles and one end plate intact, offering similar radiological outcomes with reduced surgical morbidity.
胸腰椎骨折占所有脊柱损伤的大部分，给创伤护理带来了重大挑战。几十年来，固定技术不断发展，椎弓根螺钉固定已成为标准方法。然而，对于单节段损伤时为获得最佳疗效，固定结构应包含的椎体节段数量仍存在争议。虽然长节段固定提供了强大的稳定性，但它牺牲了运动节段，可能增加僵硬程度和相邻节段退变。短节段固定（SSF），包括骨折上下各一个椎体，可降低僵硬程度并降低植入成本。单节段固定（MSF）是最近提出的概念，主张仅固定骨折椎体及上方或下方的一个相邻椎体。我们认为，在特定骨折类型中，MSF可提供与SSF相似的疗效，且并发症更少、手术时间更短、失血更少。因此，本研究设计为单中心随机对照试验以验证这一假设。
26例患者被随机分为两个干预组：A组（MSF，n = 13，50%）和B组（SSF，n = 13，50%）。干预后，患者遵循标准的术后护理方案和康复协议。所有患者均接受开放手术。定期进行X线检查，并记录术后一年的结局变量。矢状指数（SI）、椎体前缘高度丢失（AVHL）、Cobb角（CA）、局部后凸角（LKA）和植入物失败是研究的影像学结局指标。评估的其他参数包括手术失血量、术后引流量、手术时间、疼痛和伤口并发症。
两组在平均年龄、性别分布、AO骨折类型和损伤机制方面具有可比性（P > 0.05）。两组在术后一年与术后即刻X线片观察指标之间的平均变化在SI、AVHL和CA方面相似（P > 0.05）。MSF组LKA的平均变化更高（P = 0.018，95%置信区间（CI）0.78，7.70）。虽然MSF组术中失血量减少（P = 0.055，95% CI -64.89，-2.80）且手术时间缩短（P = 0.039，95% CI -24.74，-0.64），但两组在整个随访期间的引流量（P = 0.443，95% CI -41.24，-0.21）和疼痛视觉模拟量表（VAS）评分相似（P > 0.05）。
在椎弓根和一个终板完整的选定胸腰椎骨折类型中，MSF可能是SSF的有效替代方法，可提供相似的影像学结局且手术并发症减少。
