椎弓根螺钉置入骨折椎体治疗不稳定胸腰椎骨折的效果。

IF 1.4 Q3 EMERGENCY MEDICINE International Journal of Burns and Trauma Pub Date : 2022-08-15 eCollection Date: 2022-01-01
Aditya Vardhan Guduru, Ishwara Keerthi, Premjit Sujir, Manesh Kumar Jain, Praveen Sodavarapu
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引用次数: 0

摘要

背景:椎弓根螺钉置入椎体骨折水平已被证明可以改善不稳定胸腰椎和腰椎骨折的临床和影像学结果,尽管这需要进一步的证据。本研究旨在评估椎弓根螺钉置入对此类病例椎体骨折的影响。方法:一项前瞻性研究纳入了成年胸腰椎骨折患者,采用短节段后路内固定将椎弓根螺钉置入骨折椎体。术前、术后通过x线片和CT扫描测量前椎体高度损失、脊柱后凸角和椎管受损程度。术后随访1年神经系统状况。结果:本研究共纳入30例患者。5例患者(16.7%)为C级,3例患者(10%)为D级,22例患者(73.3%)为E级神经状态。术前平均后凸角(5.54)、椎体高度(39.67%)、椎管内陷(10.62)分别为5.54(5.35)、39.67%(8.04)、31.59%(10.62)。术后椎管减压显著,术后椎管损伤平均为5.53% (SD=7.70;结论:手术治疗不稳定胸腰椎骨折加中间螺钉短节段固定可明显恢复椎体高度和矫正后凸角度,无其他并发症。
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Effect of pedicle screw placement into the fractured vertebra in management of unstable thoracolumbar and lumbar fractures.

Background: Pedicle screw insertion at the level of the fractured vertebra has been shown to improve clinical and radiological outcomes in unstable thoracolumbar and lumbar fractures, albeit this requires further evidence. The study aims to evaluate the effect of pedicle screw placement on the fractured vertebra in such cases.

Methods: A prospective study included adult patients with thoracolumbar and lumbar fractures treated with short-segment posterior instrumentation with a pedicle screw into the fractured vertebra. Anterior vertebral body height loss, kyphotic angle and degree of spinal canal compromise were measured preoperatively and postoperatively in radiographs and CT scans. The neurological status was followed up for one year of the postoperative period.

Results: The study included a total of 30 patients. Five patients (16.7%) had grade C, three patients (10%) had grade D, and 22 patients (73.3%) had grade E neurological status. The mean (SD) preoperative kyphotic angle, vertebral body height and canal compromise were 5.54 (5.35), 39.67% (8.04), and 31.59% (10.62), respectively. Postoperatively there was a significant canal decompression, with a mean postoperative spinal canal compromise of 5.53% (SD=7.70; p-value <0.001). At the end of one year of follow-up, the radiological evaluation showed a correction of the kyphotic angle to 6.62 (SD=2.57; p-value <0.001), and the mean anterior vertebral body height was 70.38% (SD=11.25; p-value <0.001). At the end of one year, there was a significant overall neurological recovery with a final neurological status of grade D in 5 (16.7%) and grade E in 25 patients (83.3%). There was no significant association between canal decompression and neurology at the end of the one-year follow-up.

Conclusion: Unstable thoracolumbar and lumbar fractures surgically treated with short-segment fixation with an additional intermediate screw can achieve significant restoration of vertebral body height and correction of kyphotic angle without any added complications.

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