TRANSPEDICULAR INSTRUMENTATION AND SHORT-SEGMENT FUSION OF THORACOLUMBAR FRACTURES - A PROSPECTIVE-STUDY USING A SINGLE INSTRUMENTATION SYSTEM
TRANSPEDICULAR INSTRUMENTATION AND SHORT-SEGMENT FUSION OF THORACOLUMBAR FRACTURES - A PROSPECTIVE-STUDY USING A SINGLE INSTRUMENTATION SYSTEM
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DOI：
10.1097/00005131-199509060-00007
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发表时间：
1995-01-01
影响因子：
2.3
通讯作者：
MANSFIELD, FL
中科院分区：
文献类型：
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作者：
KRAMER, DL;RODGERS, WB;MANSFIELD, FL
11 名患者采用双侧短节段椎弓根内固定术，使用后节段固定器（Ace Medical Co.，洛杉矶，加利福尼亚州，美国）结构，结合使用自体髂嵴骨移植的后外侧融合来治疗胸腰椎骨折。所有患者均接受了至少 2 年（平均 33 个月）的临床、放射学和功能评估。在此期间，11 名患者中有 4 名 (36.3%) 发生尾部螺钉断裂或脱离。随访期间，后凸角度平均增加12.9度。器械失败的患者（22 度）矫正损失比器械未失败的患者（7.7 度）更大。其中 5 名患者 (45.5%) 后凸角度逐渐增大 10 度或以上。随访时，与手术时达到的身高相比，所有 11 名患者的前椎体高度平均减少了 14%。其中 6 名患者 (54.5%) 的前身高度降低了 10% 或更多。尽管内固定失败率较高，后凸角度进行性增大，前椎体高度进行性下降，但患者术后Frankel分级并未恶化。与这种结构相关的高硬件故障率和术后骨折复位的重大损失表明，后路短节段椎弓根螺钉内固定与后节固定器不足以确保这一小群患者胸腰椎骨折的稳定。术后骨折复位的维持是令人满意的功能结果的最一致的预测因素。
Eleven patients were prospectively treated with bilateral short-segment transpedicular instrumentation using the Posterior Segment Fixator (Ace Medical Co., Los Angeles, CA, U.S.A.) construct combined with posterolateral fusion using autogenous iliac crest bone graft for the treatment of thoracolumbar vertebral fractures. All patients were evaluated clinically, radiographically, and functionally for a minimum of 2 years (mean 33 months). Four of the 11 patients (36.3%) had breakage or disengagement of the caudad screws during this interval. During the follow-up period, the angle of kyphosis increased an average of 12.9 degrees. The loss of correction was greater in those patients in whom the instrumentation failed (22 degrees) than in those patients in whom it did not (7.7 degrees). Five of the patients (45.5%) had a progressive increase in the angle of kyphosis of 10 degrees or more. At follow-up, the average loss of anterior vertebral body height for all 11 patients was 14% when compared with the body height that had been attained at surgery. Six of these patients (54.5%) had 10% or more loss of anterior body height. Despite the high incidence of failure of the instrumentation, progressive increase in the angle of kyphosis, and progressive loss of anterior vertebral body height, there was no worsening in the patients' Frankel grade postoperatively. The high rate of hardware failure and major postoperative loss of fracture reduction associated with this construct suggest that posterior short-segment pedicle-screw instrumentation with the Posterior Segment Fixator was not adequate to ensure stabilization of thoracolumbar fractures in this small group of patients. Maintenance of post operative fracture reduction was the most consistent predictor of satisfactory functional outcome.