Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery · 2018
[Posterior short-segment fixation including the fractured vertebra for severe unstable thoracolumbar fractures].
СтатьяНазвание и аннотация: Перевод в очереди
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Chen Zhida, Wu Jin, Lin Bin, Wu Songsong, Zeng Wenrong
Аннотация
OBJECTIVE: To discuss the effectiveness of posterior short-segment fixation including the fractured vertebra for severe unstable thoracolumbar fractures using pedicle screw fixation.
METHODS: Between May 2008 and July 2013, 52 patients of severe unstable thoracolumbar fractures were treated through posterior short-segment fixation including the fractured vertebra using pedicle screw fixation. There were 33 males and 19 females with an age of 21-56 years (mean, 37.9 years). The causes of thoracolumbar burst fractures included fall from height in 32 cases, traffic accidents in 16 cases, and others in 4 cases. The load sharing classification (LSC) score was 7-9 (mean, 7.85). The levels involved included T 11 in 4 cases, T 12 in 19 cases, L 1 in 25 cases, and L 2 in 4 cases. According to Frankel classification, there were 2 cases of grade A, 4 cases of grade B, 8 cases of grade C, 11 cases of grade D, and 27 cases of grade E. The rate of spinal canal occupying was 24.2%-76.7% (mean, 47.1%). The time from injury to operation was 3-5 days (mean, 3.6 days). The effectiveness was assessed by the changes of injured vertebral Cobb angle, anterior vertebral height, and the Frankel grading at pre- and post-operation.
RESULTS: The operation time was 85-127 minutes (mean, 106.5 minutes). The intraoperative blood loss was 90-155 mL (mean, 137.6 mL). All the incision healed at first intension. Forty-seven patients were followed up 19-27 months (mean, 23.2 months), and no incision infection, screw loosening, or other internal fixation failures was found during follow-up. The injured vertebral Cobb angle and anterior vertebral height at immediate after operation or at last follow-up were significantly improved when compared with preoperative values ( P<0.001). There was a loss of injured vertebral Cobb angle and anterior vertebral height at last follow-up, but no significant difference was found between at immediate after operation and at last follow-up ( P>0.05). The Frankel grade improved by 0-2 grades at last follow-up, showing significant difference when compared with preoperative grades ( Z=15.980, P=0.003).
CONCLUSION: Posterior short-segment fixation including the fractured vertebra for severe unstable thoracolumbar fractures (LSC≥7) using pedicle screw fixation can correct the kyphosis deformity, restore vertebral body height, and aviod the need of anterior reconstruction.
METHODS: Between May 2008 and July 2013, 52 patients of severe unstable thoracolumbar fractures were treated through posterior short-segment fixation including the fractured vertebra using pedicle screw fixation. There were 33 males and 19 females with an age of 21-56 years (mean, 37.9 years). The causes of thoracolumbar burst fractures included fall from height in 32 cases, traffic accidents in 16 cases, and others in 4 cases. The load sharing classification (LSC) score was 7-9 (mean, 7.85). The levels involved included T 11 in 4 cases, T 12 in 19 cases, L 1 in 25 cases, and L 2 in 4 cases. According to Frankel classification, there were 2 cases of grade A, 4 cases of grade B, 8 cases of grade C, 11 cases of grade D, and 27 cases of grade E. The rate of spinal canal occupying was 24.2%-76.7% (mean, 47.1%). The time from injury to operation was 3-5 days (mean, 3.6 days). The effectiveness was assessed by the changes of injured vertebral Cobb angle, anterior vertebral height, and the Frankel grading at pre- and post-operation.
RESULTS: The operation time was 85-127 minutes (mean, 106.5 minutes). The intraoperative blood loss was 90-155 mL (mean, 137.6 mL). All the incision healed at first intension. Forty-seven patients were followed up 19-27 months (mean, 23.2 months), and no incision infection, screw loosening, or other internal fixation failures was found during follow-up. The injured vertebral Cobb angle and anterior vertebral height at immediate after operation or at last follow-up were significantly improved when compared with preoperative values ( P<0.001). There was a loss of injured vertebral Cobb angle and anterior vertebral height at last follow-up, but no significant difference was found between at immediate after operation and at last follow-up ( P>0.05). The Frankel grade improved by 0-2 grades at last follow-up, showing significant difference when compared with preoperative grades ( Z=15.980, P=0.003).
CONCLUSION: Posterior short-segment fixation including the fractured vertebra for severe unstable thoracolumbar fractures (LSC≥7) using pedicle screw fixation can correct the kyphosis deformity, restore vertebral body height, and aviod the need of anterior reconstruction.