短节段与长节段后路椎弓根螺钉固定治疗胸腰椎爆裂性骨折:一项前瞻性比较研究

Ashutosh Kumar Singh, S. Bali, Subhajit Maji, K. Ahuja, Nagaraj Manju Moger, S. Mittal, B. Sarkar, P. Kandwal
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A total of 18 of the patients underwent Short-Segment Posterior Fixation (SSPF) (Group A); group A is further divided into three subgroups A1: short-segment only(n=10), A2: short-segment with index screw(n=4) and A3: short-segment with anterior column reconstruction(n=4) with cage, Whereas 14 patients had Long-Segment Posterior Fixation (LSPF) (Group B). Surgical (duration of surgery, blood loss, complication), Clinical (Oswestry questionnaire, spinal cord independent measuring scale), radiological (percentage of anterior body height compression, kyphosis correction loss, Mc Cormack classification) and Neurological (Frankel grading) outcomes were analyzed. Results:  The operative time Group A (159.85 min  22.5) was significantly shorter than Group B (198.7  31.5).  Blood loss was significantly less in Group A (478 ml   259.3) than Group B (865ml   275.7). 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引用次数: 4

摘要

背景:胸腰椎不稳定爆裂骨折(TLICS >4)的手术治疗仍存在争议。本研究旨在比较短节段与长节段后路固定治疗胸腰椎爆裂性骨折。本研究的目的是比较短节段后路固定(SSPF)与长节段后路固定(LSPF)治疗胸腰椎爆裂性骨折在外科、放射学、神经学和功能方面的疗效。对象与方法:在本前瞻性研究中,我们纳入32例胸腰椎爆裂性骨折AO型A3、A4 (T10-L2)患者,接受后路椎弓根螺钉固定治疗胸腰椎爆裂性骨折。18例患者行短节段后路固定(SSPF) (A组);A组又分为3个亚组:A1:仅短节段(n=10), A2:短节段带索引螺钉(n=4), A3:B组14例采用长节段后路固定(LSPF)。对手术(手术时间、出血量、并发症)、临床(Oswestry问卷、脊髓独立测量量表)、放射学(前体高度压缩百分比、后凸矫正损失、Mc Cormack分级)和神经学(Frankel分级)结果进行分析。结果:A组手术时间(159.85 min 22.5)明显短于B组(198.7 31.5)。出血量A组(478 ml 259.3)明显少于B组(865ml 275.7)。A组(A1亚组:10.7°6.2,A2亚组:7.1°7.4,A3亚组:6.1°5.2)随访6个月后凸矫正损失高于B组(6.2°6.3)。b组2例患者出现并发症(手术部位感染),两组在功能和神经预后改善方面无显著差异。随访6个月时,A组的SCIM和ODI评分分别为74.7 +-22.29、31.5+-13.73,B组分别为73.8+-26.07、26.7+-17.9。结论:短节段后路固定(SSPF)与长节段后路固定(LSPF)相比,可显著减少手术时间和出血量。短节段后路固定(SSPF)后凸矫正的损失可以通过指数螺钉或前柱重建来减少。
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Short Segment versus Long Segment Posterior Pedicle Screws Fixation for Treatment of Thoracolumbar Burst Fracture: A Comparative Prospective Study
Background: The surgical treatment of unstable burst fracture (TLICS >4) of the thoracolumbar vertebrae remain controversial. This study is aimed to compare the short segment versus long-segment posterior fixation for thoracolumbar burst fracture.The objective of the study is to study comparison of outcome of the Short-Segment Posterior Fixation (SSPF) versus Long-Segment Posterior Fixation (LSPF) for treatment of thoracolumbar burst fracture in term of surgical, radiological, neurological and functional outcome. Subjects & Methods: In this prospective study, we included 32 patients with Burst fracture AO type A3, A4 of Thoracolumbar spine (T10-L2), who underwent posterior pedicle screw fixation for Burst fracture Thoracolumbar spine. A total of 18 of the patients underwent Short-Segment Posterior Fixation (SSPF) (Group A); group A is further divided into three subgroups A1: short-segment only(n=10), A2: short-segment with index screw(n=4) and A3: short-segment with anterior column reconstruction(n=4) with cage, Whereas 14 patients had Long-Segment Posterior Fixation (LSPF) (Group B). Surgical (duration of surgery, blood loss, complication), Clinical (Oswestry questionnaire, spinal cord independent measuring scale), radiological (percentage of anterior body height compression, kyphosis correction loss, Mc Cormack classification) and Neurological (Frankel grading) outcomes were analyzed. Results:  The operative time Group A (159.85 min  22.5) was significantly shorter than Group B (198.7  31.5).  Blood loss was significantly less in Group A (478 ml   259.3) than Group B (865ml   275.7). Kyphosis Correction loss at 6th month follow up in Group A (subgroup A1: 10.7deg  6.2, subgroup A2: 7.1deg  7.4 and subgroup A3: Subgroup A3: 6.1deg  5.2) was higher than that of group B (6.2deg 6.3). Complication (surgical site infection) occurred in Two patients in group B. There was no significant difference in terms of improvement in functional and neurological outcomes among both groups. The functional outcomes as per the SCIM and ODI score at 6th month follow up in group A: 74.7 +-22.29, 31.5+-13.73 respectively, and group B: 73.8+-26.07, 26.7+-17.9, respectively. Conclusion: Short-Segment Posterior Fixation (SSPF) is a significantly decreased duration of surgery and blood loss compare with Long-Segment Posterior Fixation (LSPF). Loss of kyphosis correction in Short-Segment Posterior Fixation (SSPF) may be decreased with index screws or anterior column reconstruction.
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