Short-segment pedicle instrumentation of thoracolumbar burst fractures - Does transpedicular intracorporeal grafting prevent early failure?
Short-segment pedicle instrumentation of thoracolumbar burst fractures - Does transpedicular intracorporeal grafting prevent early failure?
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DOI：
10.1097/00007632-200101150-00017
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发表时间：
2001-01-15
期刊：
影响因子：
3
通讯作者：
Surat, A
中科院分区：
文献类型：
--
作者：
Alanay, A;Acaroglu, E;Surat, A
研究设计.一项前瞻性随机研究，比较胸腰椎爆裂性骨折的两种治疗方法：短节段内固定加经椎弓根植骨和相同手术不加经椎弓根植骨。评价经椎弓根植骨在预防胸腰椎爆裂性骨折短节段固定失败中的作用。短节段椎弓根内固定治疗胸腰椎骨折由于缺乏前路支撑而早期失败。已经提供了额外的经椎弓根移植作为防止这种失败的替代方法。然而，经椎弓根植骨的结果仍存在争议。本研究纳入了20例胸腰椎爆裂性骨折患者。入选标准为T11-L3椎体骨折，无神经损害。采用简单随机方法将患者分为两组。第1组采用短节段内固定加经椎弓根植骨（TPG）治疗（n = 10），第2组采用短节段内固定加经椎弓根植骨（NTPG）治疗（n = 10）。临床（Likert的问卷）和放射学（矢状指数，前体高度压缩的百分比，和局部后凸）outcomes.Results，两组在年龄，随访时间，畸形和骨折的严重程度相似。两组术后和随访时的矢状指数、前体高度压缩百分比和局部后凸畸形的平均矫正丢失无显著差异。失败率，定义为局部后凸和/或螺钉断裂增加10度或更多，也没有显著差异（TPG = 50%，NTPG = 40%。P = 0.99）。胸腰椎爆裂性骨折的短节段经椎弓根内固定失败率高，不能通过额外的经椎弓根内植骨来降低。
Study Design. A prospective, randomized study comparing two treatment methods for thoracolumbar burst fractures: short-segment instrumentation with transpedicular grafting and the same procedure without transpedicular grafting.Objective. To evaluate the efficacy of transpedicular grafting in preventing failure of short-segment fixation for the treatment of thoracolumbar burst fractures.Summary of Background Data. Short-segment pedicle instrumentation for thoracolumbar but-st fractures is known to fail early because of the absence of anterior support. Additional transpedicular grafting has been offered as an alternative to prevent this failure. However, there is controversy about the results of transpedicular grafting.Methods. Twenty patients with thoracolumbar burst fractures were included in the study. The inclusion criterion was the presence of fractures through the T11-L3 vertebrae without neurologic compromise. The patients were randomized by a simple method into two groups. Group 1 patients were treated using short-segment instrumentation with transpedicular grafting (TPG) (n = 10], and Group 2 patients were treated by short-segment fixation atone (NTPG) (n = 10). Clinical (Likert's questionnaire) and radiologic (sagittal index, percentage of anterior body height compression, and local kyphosis) outcomes were analyzed.Results, The two groups were similar in age, follow-up period, and severity of the deformity and fracture. The postoperative and follow-up sagittal index, percentage of anterior body height compression, and average correction loss in local kyphosis in both groups were not significantly different. The failure rate, defined as an increase of 10 degrees or more in local kyphosis and/or screw breakage, was also not significantly different (TPG = 50%, NTPG = 40%. P = 0.99).Conclusions. Short-segment transpedicular instrumentation of thoracolumbar burst fractures is associated with a high rate of failure that cannot be decreased by additional transpedicular intracorporeal grafting.