与强直性脊柱疾病相关的 B 型和 C 型胸腰椎骨折的孤立后方稳定术:临床和放射学结果的单中心经验。

IF 1.8 Q2 ORTHOPEDICS SICOT-J Pub Date : 2024-01-01 Epub Date: 2024-08-09 DOI:10.1051/sicotj/2024022
Benoit Sulpis, Thomas Neri, Antonio Klasan, Xavier Castel, François Vassal, Marie Charlotte Tetard
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引用次数: 0

摘要

导言:强直性脊柱疾病(ASD)骨折的并发症和死亡率都很高。在对这些骨折进行后方稳定时,往往会部分复位,导致前方持续存在明显的裂隙。我们的目的是从临床和放射学结果、并发症和死亡率的角度,评估在不直接减少前方裂隙的情况下,对老年 ASD 患者进行孤立后方稳定的安全性和有效性:这项回顾性研究共纳入46例ASD患者,平均年龄79.3岁,他们都因胸腰椎骨折接受了开放式或经皮的孤立后路稳定术。平均随访 21.7 个月,最少随访 6 个月。对手术前后的自主性(Parker评分)和放射学结果(前凸角度)进行了分析:结果:自主性在最后一次随访时得以保持,帕克评分无明显差异。巩固率为 94.6%。没有植入失败的记录。尽管没有进行前路手术,但在6个月时,前倾角度明显减少了2.6°(p = 0.02)。开放手术后的手术并发症发生率为10.9%(n = 5),其中6.5%为感染。经皮手术未出现手术并发症。内科并发症发生率为67.4%(n = 31),其中开放手术组为88.2%,而经皮手术组为55.2%。开腹手术的并发症风险是经皮手术的五倍(P = 0.049)。九名患者在随访期间死亡(19.6%):结论:在治疗老年 ASD 患者胸腰椎骨折的过程中,孤立后路稳定术是一种安全的技术,可促进患者自主性的保留和放射学上的骨愈合,并发症和死亡率也在可接受的范围内。脊柱负重时,持续存在的前方间隙会部分缩小,似乎不需要前方手术,从而减少了并发症。经皮手术应是减少手术并发症的首选技术。
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Isolated posterior stabilization in type B and C thoracolumbar fractures associated with ankylosing spine disorders: A single center experience with clinical and radiological outcomes.

Introduction: Fractures in ankylosing spine disorders (ASD) are associated with high complication and mortality rates. During the posterior stabilization of these fractures, reduction is often partial, resulting in the persistence of a significant anterior diastasis. Our objective was to evaluate the safety and efficiency of isolated posterior stabilization in elderly ASD patients, without direct reduction of the anterior diastasis, in terms of clinical and radiological outcomes, complications, and mortality.

Methods: This retrospective study included 46 patients, mean age 79.3 years, with ASD, who underwent isolated posterior stabilization, open or percutaneous, for thoracolumbar fractures. The average follow-up was 21.7 months, with a minimum follow-up of 6 months. Autonomy (Parker score) and radiological results (lordotic angulation) were analyzed pre-and post-operatively.

Results: Autonomy was maintained at the last follow-up, with no significant difference in Parker's score. The consolidation rate was 94.6%. No implant failure was recorded. Despite the absence of an anterior procedure, lordotic angulation was significantly reduced by 2.6° at 6 months (p = 0.02). The rate of surgical complications following open surgeries was 10.9% (n = 5), of which 6.5% were infections. No surgical complications were reported in percutaneous surgeries. The rate of medical complications was 67.4% (n = 31), with a rate of 88.2% in the open surgery group, compared to 55.2% in the percutaneous surgery group. An open approach was associated with a five-fold higher risk of complications (p = 0.049). Nine patients died during follow-up (19.6%).

Conclusions: Isolated posterior stabilization in the treatment of thoracolumbar spine fractures in elderly ASD patients is a safe technique promoting autonomy preservation, and high radiological bony healing with acceptable complication and mortality rates. The persistent anterior gap is partially reduced when the spine is loaded and does not seem to require an anterior procedure, thus decreasing complications. Percutaneous surgery should be the technique of choice to reduce surgical complications.

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来源期刊
SICOT-J
SICOT-J ORTHOPEDICS-
CiteScore
3.20
自引率
12.50%
发文量
44
审稿时长
14 weeks
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