Early results after vertebral body stenting for fractures of the anterior column of the thoracolumbar spine
Early results after vertebral body stenting for fractures of the anterior column of the thoracolumbar spine
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DOI：
10.1016/j.injury.2011.04.006
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发表时间：
2011-10-01
影响因子：
2.5
通讯作者：
John, Joby
中科院分区：
文献类型：
--
作者：
Klezl, Zdenek;Majeed, Haroon;John, Joby
前言：椎体成形术和球囊后凸成形术已被证明能改善症状性脊椎骨折患者的疼痛和功能结果。虽然球囊后凸成形术似乎更容易恢复椎体高度和后凸，但很明显，一旦球囊放气，球囊所实现的一些矫正就会丢失。椎体支架就是为了消除这种现象而发展起来的。据我们所知，这是第一次在临床环境中描述这项技术的研究。材料和方法：17例患者，20个椎体骨折。骨折类型均为A1.3或A3.1型(不完全爆裂型)。定期前瞻性记录疼痛(视觉模拟评分-VAS)、功能(OSwestry残疾指数-ODI)和椎体畸形(椎体角度-VA)信息。按年龄分为骨质疏松组(7例)和创伤组(10例，年龄<60岁)。结果：本组病例中男6例，女11例，平均年龄58.1岁(31~88岁)。平均随访12个月。术前疼痛评分骨质疏松组平均8.9分，创伤组平均9.7分。骨质疏松组术后6周、6个月、12个月的平均VAS分别为4.8、4.0、2.5，而创伤性骨折组术后6周、6个月、12个月的平均VAS分别为2.7、2.2、1.6。骨质疏松组平均ODI为41.7%(14-58%)，创伤组为20.4%(6-33%)。骨质疏松组术前椎体角度平均为9.7度，术后为5.2度，平均矫正4.5度。创伤性组术前视力为13度，术后为5.7度，平均矫正7.3度。结论：在骨质疏松性和创伤性骨折的治疗中，椎体支架植入术在疼痛、功能和脊柱后凸矫正方面取得了令人满意的改善。脊柱前柱，特别是碎裂的上终板，只要插入准确，支架就能很好地重建。随着后路椎弓根内固定的增加，这项技术的适应症可能会更广泛，适用于一些具有类似椎体损伤的B型和C型骨折。(C)2011爱思唯尔有限公司。保留所有权利。
Introduction: Vertebroplasty and balloon kyphoplasty have shown to improve pain and functional outcome in cases with symptomatic vertebral fractures. Although restoration of the vertebral body height and kyphosis seemed to be easier with balloon kyphoplasty, it became clear that some of the correction achieved by the balloon is lost once it was deflated. Vertebral body stent was developed to eliminate this phenomenon. To our knowledge this is the first study in describing this technique in clinical settings.Materials and methods: Seventeen patients with 20 fractured vertebral bodies were included. All fractures were Type A1.3 or A3.1 (incomplete burst). Information about pain (visual analogue scale-VAS) and function (Oswestry disability index-ODI) and vertebral body deformity (vertebral angle-VA) was recorded in a prospective way at regular intervals. Patients were classified into osteoporotic group (7 patients) and traumatic groups (10 patients, younger than 60 years).Results: There were 6 male and 11 female patients with mean age of 58.1 years (31-88 years). Mean follow up was 12 months. The preoperative pain level showed a mean VAS score of 8.9 in osteoporotic group and 9.7 in traumatic group. Postoperatively, in osteoporotic group, mean VAS was 4.8 at 6 weeks, 4.0 at 6 months and 2.5 at 12 months compared with traumatic fracture group where it was 2.7 at 6 weeks, 2.2 at 6 months and 1.6 at 12 months. Mean ODI in osteoporotic group was 41.7% (14-58%) and in traumatic group it was 20.4% (6-33%). Mean vertebral body angle prior to surgery in osteoporotic group was 9.7 whilst postoperatively it was 5.2 degrees; so the mean correction achieved was 4.5 degrees. In traumatic group preoperative VA was 13 degrees whilst postoperatively it was 5.7 degrees; therefore the mean correction achieved was 7.3 degrees. None of the patients lost reduction at their last follow up.Conclusion: Vertebral body stenting leads to satisfactory improvement in pain, function and kyphosis correction in the treatment of osteoporotic and traumatic fractures. Anterior spinal column, especially the fragmented superior endplate is nicely reconstructed by the stent provided it is inserted accurately. With addition of posterior transpedicular instrumentation, indications for this technique may be wider covering some Type B and C fractures with similar vertebral body damage. (C) 2011 Elsevier Ltd. All rights reserved.