Lee Hyung-Rae, Kang Minseung, Park Jae Min, Yang Jae-Hyuk
Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul 02841, Republic of Korea.
College of Medicine, Korea University, Seoul 02841, Republic of Korea.
J Clin Med. 2025 Sep 10;14(18):6379. doi: 10.3390/jcm14186379.
Thoracolumbar burst fractures often require surgical stabilization. Although posterolateral fusion (PLF) has been traditionally used, percutaneous posterior fixation (PPF) without fusion has emerged as a less invasive alternative. However, comparative data specifically addressing PPF and PLF are limited. This study aimed to compare the radiological and perioperative outcomes of PPF and PLF for thoracolumbar burst fractures. This retrospective cohort study analyzed 61 patients with T11-L2 burst fractures (PPF, 28; PLF, 33). Radiological parameters included local and global sagittal alignment and vertebral height ratio. Fracture morphology was assessed using a structured grading system based on anterior height ratios. Perioperative variables were also assessed. Statistical significance was set at < 0.05. PPF demonstrated significant advantages in operative time (160.7 min vs. 205.8 min, < 0.01) and blood loss (165 cc vs. 317 cc, < 0.01), with a shorter hospitalization time. PPF achieved outcomes comparable to PLF in global alignment and anterior height restoration. The PLF group showed greater local kyphotic angle correction (-7.77° vs. -1.53°, = 0.01), whereas the PPF group showed significantly higher postoperative posterior height ratio ( = 0.02). Changes in morphological grades, assessed using the anterior height ratio-based grading system, showed similar patterns of improvement in both groups. All implant removals were performed due to patient-reported discomfort. PPF yielded radiological outcomes comparable to PLF in the treatment of thoracolumbar burst fractures. The use of a morphological grading system provided a structured descriptive tool to evaluate surgical impact, though its utility remains exploratory and requires further validation.
胸腰椎爆裂骨折通常需要手术稳定。虽然传统上使用后外侧融合术（PLF），但不融合的经皮后路固定术（PPF）已成为一种侵入性较小的替代方法。然而，专门针对PPF和PLF的比较数据有限。本研究旨在比较PPF和PLF治疗胸腰椎爆裂骨折的影像学和围手术期结果。这项回顾性队列研究分析了61例T11-L2爆裂骨折患者（PPF组28例；PLF组33例）。影像学参数包括局部和整体矢状位对线以及椎体高度比。使用基于前侧高度比的结构化分级系统评估骨折形态。还评估了围手术期变量。设定统计学显著性为<0.05。PPF在手术时间（160.7分钟对205.8分钟，<0.01）和失血量（165毫升对317毫升，<0.01）方面显示出显著优势，住院时间也更短。PPF在整体对线和前侧高度恢复方面取得了与PLF相当的结果。PLF组显示出更大的局部后凸角矫正（-7.77°对-1.53°，=0.01），而PPF组术后后侧高度比显著更高（=0.02）。使用基于前侧高度比的分级系统评估的形态学分级变化显示，两组的改善模式相似。所有植入物取出均因患者报告不适而进行。PPF在治疗胸腰椎爆裂骨折方面产生了与PLF相当的影像学结果。使用形态学分级系统提供了一种结构化的描述工具来评估手术影响，尽管其效用仍处于探索阶段，需要进一步验证。
