Chinese Journal of Tissue Engineering Research ›› 2021, Vol. 25 ›› Issue (24): 3902-3907.doi: 10.12307/2021.100
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Wang Ziao, Song Wenhui, Liu Changwen
Received:
2020-10-12
Revised:
2020-10-14
Accepted:
2020-11-26
Online:
2021-08-28
Published:
2021-03-17
Contact:
Song Wenhui, MD, Chief physician, Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
About author:
Wang Ziao, Master candidate, Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
Supported by:
CLC Number:
Wang Ziao, Song Wenhui, Liu Changwen . Short-segment fixation of thoracolumbar burst fractures: method modification and strategies to reduce failure[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(24): 3902-3907.
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2.1 胸腰椎损伤分类 随着人们对脊柱生物力学和影像方法的认识不断提高,胸腰椎损伤的分类体系也越来越多。早先DENIS[16]提出“三柱理论”将胸腰椎损伤分为 A、B、C、D、E共5型。到20世纪90年代AO研究小组对胸腰段脊柱损伤进行了分类,损伤的严重程度包括影像学特点、预后评估、神经损伤情况,即A型(compression)、B型(tension band disruption)、C型 (displacement/translation)3型损伤,提出了脊柱前柱和后柱胸腰段脊柱损伤中关于稳定性和预后判定的重要意义。21世纪初期,美国脊柱创伤研究学组提出了一套胸腰段脊柱骨折新的分类系统——胸腰椎损伤严重评分(thoracolumbar injury severity score,TLISS),并在此基础上形成胸腰椎损伤分型及评分系统(thoracolumbar injury classification and scoring system,TLICS);2013年AO Spine提出了“新AO脊柱胸腰段损伤分类系统”,将影像学和神经系统的损伤有机地结合起来,突出了胸腰段脊柱的后方张力带和前方张力带在新分类中的地位和意义[17]。“新AO脊柱胸腰段损伤分类系统”将骨折类型分为A型(压缩性损伤)、B型(张力带损伤)、C型(前后结构损伤导致的骨折或脱位),并将A型骨折分为A0/A1/A2/A3/A4,B型骨折分为B1/B2/B3;依据神经损害的程度分为N0/N1/N2/N3/N4/NX;加上临床特有情形的修正M1和M2。人们普遍认为B型和C型损伤需要手术治疗,而 A0至 A2可以保守处理;而大多数争议主要存在于爆裂性骨折的治疗中,也就是 A3和A4损伤。 2.2 短节段固定的适应证 短节段固定通常用于不稳定的爆裂性骨折。多项研究表明,短节段固定在合适的病例中取得了良好的结果[9,12]。爆裂性骨折的稳定性问题一直是个棘手的问题,至今仍未完美解决。VACCARO等[18]引入了PLC或后方韧带复合体的概念来表明不稳定性,但是在确定后纵韧带的状态时,观察者之间的一致性较差,因此它不能作为爆裂性骨折不稳定性的唯一决定因素[19]。在爆裂性骨折中,椎体前部高度压缩≥50%、局部脊柱后凸≥20°或椎管侵 入≥50%被认为是不稳定的标志[20-22],另外神经损伤也被认为是不稳定脊椎畸形的一个独立预测因子,然而支持上述任何一项标准的有力证据都不足。除了放射学参数外,患者特有的因素如多处创伤、强直性脊柱炎、类风湿性关节炎、受伤部位皮肤覆盖情况等都可能进一步影响爆裂骨折手术治疗或保守治疗的决定[23]。保守治疗爆裂性骨折的研究很少涉及神经功能缺损的患者,而伴有神经功能缺损的爆裂性骨折则多采用外科手术方法处理[24];但神经损伤并不是短节段内固定的绝对指征。DAI等[25]的研究中保守治疗了127例爆裂性骨折患者,包括22例神经系统受损患者,所有患者均未出现神经系统损伤恶化,但是在他们的研究中并没有提到这部分患者选择保守治疗的原因。短节段固定也可用于非强直性脊柱的屈曲性/牵张损伤或B 型损伤[26-27],尽管有报道成功地使用短节段固定治疗胸腰椎体骨折脱位[28],高度不稳定的C型旋转和移位性胸腰椎损伤通常需要长节段固定来维持稳定。另一种短节段内固定可能不适用的情况是胸腰段脊柱强直性损伤,强直的脊柱有很长的杠杆力臂会增加植入骨界面的压力,同时骨质疏松症在强直性疾病患者中是非常普遍的,会进一步增加内固定失败的风险,一般此类损伤多采用长节段固定以减少置入失败的风险[29-30]。作者认为在爆裂性骨折中,椎体前部高度压缩≥50%、局部脊柱后凸≥20°或椎管侵入≥50%以及伴有神经损伤是短节段固定的适应证,对于C型损伤以及继发于强直性脊柱疾病的胸腰段损伤适当延长固定节段更为妥善。 2.3 后路短节段固定的椎体复位与椎管内骨块清除 在短节段内固定中,骨折复位可以通过姿势复位、预成形杆和悬臂矫正相结合来实现[5,31]。椎弓根螺钉固定可以牵引脊柱的所有三柱,牵引应根据损伤的终板仔细进行,过度撑开会导致后柱撑开的差异增加,加重后凸角,并加重螺钉-骨界面的应力,因此还必须特别注意伴随的脊柱前凸及矢状位平衡重建[31]。经伤椎置钉可以有效提高短节段器械的有效性,骨折椎体中的螺钉能够以略微增加的垂直角度置入形成一个推动点,增加向前的力量,并在安装预弯棒时提供一个前驱力来实现更好的骨折复位效果[12];后路高效地间接撑开复位使得纤维环和后纵韧带紧张牵拉,间接地减少了椎管内骨块,促进椎管内骨块的回纳吸收,从而有助于实现椎管占位的有效清除[31-32]。以此实现的间接复位有助于改善局部后凸畸形,恢复椎体高度并减少椎管占位。 2.4 短节段固定的效果 已发表的研究表明,短节段器械固定后可立即矫正后凸角,角度范围为6.2°-21.4°[33];椎体前缘高度为50%-100%,椎体楔角也得到改善[34-35]。SJOSTROM等[36]的研究表明,间接复位爆裂性骨折后,平均椎管占位从40%(8%-70%)降至20% (7%-62%)。GERTZBEIN等[37]指出初始椎管占位为54%,术后剩余占位改善为40%;当初始占位为34%-66%且在伤后4 d内完成手术,则椎管内骨块清除效果最好。在怀疑纤维环破裂或存在“翻转骨块”的情况下,间接复位技术可能无法有效实现爆裂骨折的椎管清除[38]。临床研究报道了非常好的临床结果,平均目测类比评分通常小于2分,Oswestry功能障碍指数小于20%,其他功能评分和恢复工作能力有显著改善[39]。 2.5 后外侧融合短节段固定 后外侧融合与短节段器械的结合使用值得怀疑,它与改善临床结局无关,也不能防止后凸畸形再发或内固定失败;此外,它还伴随着较长的手术时间、术中出血增加和置入部位的发病率[9,40-44]。后外侧融合不能为脊柱提供足够的强度来抵抗主要的前轴向负荷,从而导致脊柱后凸的再发[34]。在一些研究中,融合组的结果较差可能是由于使用棘突作为移植物,这降低了后柱的张力带效应,导致后凸畸形的再发。在这些研究中,融合组和非融合组的临床参数和健康相关生活质量均明显改善。研究还显示,在接受或不接受融合治疗的患者中,其临床和放射学参数的结果相似[9,40,44-45]。 2.6 短节段固定失败 有报道指出,使用短节段器械时置入失败的发生率为9%-54%,平均校正损失范围为0.3°-15.4°[33]。MCLAIN等[7]首次在19例胸腰椎体骨折患者中描述了短节段器械的失败,其中11例经短节段修复治疗;这11例患者中有5例(45%)因螺钉弯曲或断裂而导致失败,而所有失败均在最初的6个月内发生。MCCORMAC等[8]分析了短节段仪器故障的案例,他们认为严重椎体粉碎是固定失败的原因,并提出了一种负荷分担分类(load sharing classification,LSC)来量化椎体粉碎并预测后路固定的失败,对骨折的3个独立特征进行了分级,即在矢状位CT重建中所见的椎体粉碎的数量、在轴位CT中所见的骨折碎片穿过骨折部位的位置,以及通过比较术前和术后侧位X射线平片测量矫正后凸畸形的程度;这些因素被细分为3个等级的严重程度,对应评分1-3分。在他们的系列研究中,所有10例置入失败患者的LSC得分都超过7分,其中5例患者的LSC得分达到上限9分。DAI等[25]发现在保守治疗的爆裂性骨折中,LSC评分更能预测晚期后凸畸形。ALTAY等[33]观察到短节段固定的放射学结果取决于骨折部位、骨折类型和骨折的LSC评分,在短节段固定治疗评分较高的L1椎体骨折中观察到更多的矫正损失。相反,SCHOLL等[46]回顾了22例胸腰椎体骨折患者的资料,指出LSC不能预测短节段器械的失败,LSC评分在临床中的应用仍有争议。 除椎体粉碎外,椎间盘完整性也被认为是脊柱后凸再发的重要因素。在取出内固定的研究中,即使椎体高度维持较好,椎间盘塌陷也会导致后凸畸形的进展[34]。椎间盘塌陷的机制仍存在争议,包括终板的血管破裂、后路固定的应力屏蔽效应和椎间盘突出到终板的中央凹陷[34-35]。固定失败的原因还包括植入物或结构设计不佳,例如螺钉头和轴之间接合处的直径较小、杆的原位弯曲、对后部结构的损坏以及过度撑开给螺钉造成过强压力等[5,7,9,40]。 2.7 应对短节段固定失败的策略 应对短期内固定失败的策略主要集中在前方加强或增强后方结构的生物力学强度。 2.7.1 增强后路短节段结构强度 增加后部结构生物力学强度的策略包括使用交联键、在螺钉水平处增加辅助的钩固定以及在伤椎中使用椎弓根螺钉进行附加固定[12],研究已证实伤椎置钉对于维持矢状线和减少植入物失败率非常有效。DICK等[13]首次报道了使用伤椎螺钉固定来增加短节段结构的生物力学强度;在尸体模型中,他们发现了经伤椎固定相对于交叉连接后路结构刚度和屈曲刚度分别增加了160%和84%。MAHAR等[14]认为这种节段性结构增加了结构的轴向扭转刚度,并在屈伸活动时保护了前柱。在尸体生物力学模型中,BARTANUSZ等[15]发现短节段骨折螺钉固定配合伤椎置钉固定在生物力学上等同于前后联合结构。 2.7.2 经伤椎内固定的临床疗效观察 临床研究也证实了短节段内固定的有效性[5,12,26,47]。在对72例胸腰椎爆裂性骨折伴不稳定爆裂性骨折的研究中,GUVEN等[48]观察到经伤椎固定组脊柱后凸矫正失败率降低。GELB等[5]认为在骨折椎体内置入椎弓根螺钉可以防止矫正丢失,无伤椎置钉组与伤椎置钉组相比有57% 的脊柱后凸矫正丢失 > 10°。FARROKHI等[26]在80例胸腰椎体骨折患者中比较了经伤椎固定组和未经伤椎固定组的差异,发现未经伤椎固定组患者出现了更高的固定失败率,且脊柱后凸的平均恶化率为29%;而伤椎固定组的平均恶化率为6%。伤椎固定对于减少后凸畸形和保持矢状面的稳定在 Magerl C 型骨折中最为明显。KOSE等[49]担心骨折碎片会分散,在骨折椎体中使用了1个更薄、更短的螺钉,术后平均矢状面指数从19.6°(12°-28°)被修正为-1.8°(-5°-3°),最终随访时平均矢状面指数为2.4°(0°-8°);在他们的病例中,未出现因为矫正失败或内固定失败而需要翻修的病例。LSC对结果无影响,KANNA等[12]回顾了32例 LSC评分> 7分的爆裂性骨折患者,采用伤椎固定治疗,无假体置入失败,平均脊柱后凸矫正缺失1°-2°,即使在LSC评分>7分的损伤情况下,也不需要前路固定。在一项60例患者的对比研究中,DOBRAN等[50]得出结论,对于胸腰段不稳定爆裂性骨折,经伤椎短节段固定与长节段固定在矫正脊柱后凸和维持矢状面平衡方面同样有效;在最终随访时,短节段固定组节段后凸角为(15.97±5.62)°,长节段固定组节段后凸角为(17.76±11.22)°。 2.7.3 伤椎固定禁忌证 椎弓根壁破碎是伤椎水平固定的禁忌证,如果一侧断裂,建议仅在另一侧使用椎弓根螺钉[12,14],已证明单侧椎弓根螺钉替代双侧螺钉的插入具有相同的临床和放射学结果。SUN等[51]研究表明,对于LSC评分>7分的胸腰椎爆裂性骨折,采用经伤椎单侧或双侧椎弓根螺钉置钉内固定治疗,平均随访18.3个月,两组矫正椎体楔形角、局部后凸角和椎体前缘高度无明显差异。 2.8 前柱支撑固定 根据前面的讨论,可以很直观地看到前柱支撑可解决植入物失败和再发性后凸畸形的问题。复位固定前柱的策略有3种方法:①经椎弓根途径撑开;②前路入路和重建;③全部通过后路入路进行前柱重建。 2.8.1 经椎弓根途径撑开 除短节段椎弓根螺钉固定外,自体颗粒骨椎体内移植、椎体成形术和羟基磷灰石、硫酸钙或磷酸钙球囊辅助终板复位椎体后凸成形术也通过椎弓根途径完成[52-53]。尽管有报道说使用羟基磷灰石、硫酸钙和磷酸钙取得了良好的效果[53],但骨水泥渗漏、骨折碎片移位、放射性暴露、人工合成移植物/骨水泥的额外成本和长期疗效等问题仍有待解决。 2.8.2 前路入路和重建 直接脊髓减压和完全后凸矫正的潜力是前路手术的主要优点。联合后路入路可提供最佳的即刻和长期后凸矫正[1,21];但是前路手术相对困难,在多发性创伤的情况下可能不切实际。此外椎管损伤的程度可能与神经功能障碍没有太大关系,前路椎管清理并非是必须的[9, 12,35];突出的骨折碎片可能会进一步重塑,从而消除了对椎管清理的需求。SJOSTROM等[36]观察到,在后路内固定治疗的爆裂性骨折中,1年内椎管侵占平均减少到2%,而术前为38% (范围为10%-70%)。前路的选择可能会受到外科医生的选择、成功治疗的定义以及所受培训和区域差异的影响[54]。 前柱支撑可以使后路内固定保持较短的节段,特别是在腰椎,保存活动节段非常重要。在匹配良好的一组腰椎骨折患者中,KORVOSSIS等[55]比较了经伤椎短节段固定和前后路联合入路,他们的结论是短节段经椎弓根固定对创伤后畸形具有显著的短期矫正作用并且有更好的即时临床效果。然而与前后路联合手术相比,在4年的最终评估中,它并不能维持已完成的后凸矫正,他们不建议单独使用后路短节段椎弓根螺钉固定治疗这种严重程度的骨折。 2.8.3 全部通过后路入路进行前柱重建 前路重建的全后路/外侧入路手术牺牲了重要的后路稳定结构且需要多节段固定,不推荐短节段固定[2]。 2.9 后路短节段固定术的改良 以相邻椎体为固定锚点的短节段固定已进一步改进为单节段固定或同节段短节段固 定[56-58],这种固定方式最初是由GOETZEN等[57]所描述,除了固定骨折的椎体外,还包括在相邻的1个椎体中固定,旨在节省运动节段并可能限制植入物的故障,同时减少手术时间和失血量[56-59],这种固定方法适用于非强直性脊椎的单纯韧带损伤,但在爆裂性骨折中应谨慎使用。有限元分析已经证明,与短节段固定相比,单节段固定在所有负荷条件下,骨折椎体的位移都会增加[60]。粉碎程度较高的骨折,上、下终板受累以及椎弓根皮质断裂的骨折均不适合此类固 定[21,55-59]。 随着微创理念的发展进步,微创经皮椎弓根螺钉内固定逐步应用于脊柱骨折治疗之中,尤其是短节段微创经皮椎弓根螺钉内固定在术后早期可使骨折达到良好复位及固定,有助于患者恢复。多项研究表明,经皮短节段固定较开放手术拥有创伤更小、出血更少、患者术后恢复更快的优势,并且与开放手术有着相似的治疗效果[6,61-63]。 "
[1] SASSO RC, RENKENS K, HANSON D, et al. Unstable thoracolumbar burst fractures: anterior-only versus short-segment posterior fixation. J Spinal Disord Tech. 2006;19(4):242-248. [2] HAIYUN Y, RUI G, SHUCAI D, et al. Three-column reconstruction through single posterior approach for the treatment of unstable thoracolumbar fracture. Spine (Phila Pa 1976). 2010;35(8):E295-302. [3] 余文超, 袁文. 对胸腰段骨折治疗策略的若干思考[J]. 中国骨伤, 2018,31(8):689-691. [4] MCAFEE PC, BOHLMAN HH, YUAN HA. Anterior decompression of traumatic thoracolumbar fractures with incomplete neurological deficit using a retroperitoneal approach. J Bone Joint Surg Am. 1985;67(1):89-104. [5] GELB D, LUDWIG S, KARP JE, et al. Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation. J Spinal Disord Tech. 2010;23(5):293-301. [6] 顾勇杰,赵刘军,于亮,等.后路短节段伤椎经皮椎弓根螺钉内固定治疗A3型和A4型胸腰段骨折[J].中国脊柱脊髓杂志,2016, 26(5):395-400. [7] MCLAIN RF, SPARLING E, BENSON DR. Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. A preliminary report. J Bone Joint Surg Am. 1993;75(2):162-167. [8] MCCORMACK T, KARAIKOVIC E, GAINES RW. The load sharing classification of spine fractures. Spine (Phila Pa 1976). 1994;19(15):1741-1744. [9] JINDAL N, SANKHALA SS, BACHHAL V. The role of fusion in the management of burst fractures of the thoracolumbar spine treated by short segment pedicle screw fixation: a prospective randomised trial. J Bone Joint Surg Br. 2012;94(8):1101-1106. [10] 孙祥耀,张希诺,海涌.后路短节段内固定治疗胸腰段骨折取出内固定后再发后凸的危险因素分析[J].中国骨与关节杂志,2017,6(9): 702-708. [11] LAZARO BC, DENIZ FE, BRASILIENSE LB, et al. Biomechanics of thoracic short versus long fixation after 3-column injury. J Neurosurg Spine. 2011;14(2):226-234. [12] KANNA RM, SHETTY AP, RAJASEKARAN S. Posterior fixation including the fractured vertebra for severe unstable thoracolumbar fractures. Spine J. 2015;15(2):256-264. [13] DICK JC, JONES MP, ZDEBLICK TA, et al. A biomechanical comparison evaluating the use of intermediate screws and cross-linkage in lumbar pedicle fixation. J Spinal Disord. 1994;7(5):402-407. [14] MAHAR A, KIM C, WEDEMEYER M, et al. Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine (Phila Pa 1976). 2007;32(14):1503-1507. [15] BARTANUSZ V, HARRIS J, MOLDAVSKY M, et al. Short Segment Spinal Instrumentation With Index Vertebra Pedicle Screw Placement for Pathologies Involving the Anterior and Middle Vertebral Column Is as Effective as Long Segment Stabilization With Cage Reconstruction: A Biomechanical Study. Spine (Phila Pa 1976). 2015;40(22):1729-1736. [16] DENIS F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976). 1983;8(8): 817-831. [17] VACCARO AR, ONER C, KEPLER CK, et al. AOSpine Spinal Cord Injury & Trauma Knowledge Forum. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976). 2013;38(23):2028-2037. [18] VACCARO AR, LEHMAN RA JR, HURLBERT RJ, et al. A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine (Phila Pa 1976). 2005;30(20):2325-2333. [19] SCHROEDER GD, KEPLER CK, KOERNER JD, et al. A Worldwide Analysis of the Reliability and Perceived Importance of an Injury to the Posterior Ligamentous Complex in AO Type A Fractures. Global Spine J. 2015;5(5):378-382. [20] MCLAIN RF. The biomechanics of long versus short fixation for thoracolumbar spine fractures. Spine (Phila Pa 1976). 2006;31(11 Suppl): S70-79; discussion S104. [21] RAJASEKARAN S, KANNA RM, SHETTY AP. Management of thoracolumbar spine trauma: An overview. Indian J Orthop. 2015;49(1):72-82. [22] VERHEYDEN AP, SPIEGL UJ, EKKERLEIN H, et al. Treatment of Fractures of the Thoracolumbar Spine: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J. 2018;8(2 Suppl):34S-45S. [23] SCHNAKE KJ, SCHROEDER GD, VACCARO AR, et al. AOSpine Classification Systems (Subaxial, Thoracolumbar). J Orthop Trauma. 2017;31 Suppl 4: S14-S23. [24] VACCARO AR, LIM MR, HURLBERT RJ, et al. Spine Trauma Study Group. Surgical decision making for unstable thoracolumbar spine injuries: results of a consensus panel review by the Spine Trauma Study Group. J Spinal Disord Tech. 2006;19(1):1-10. [25] DAI LY, JIANG LS, JIANG SD. Conservative treatment of thoracolumbar burst fractures: a long-term follow-up results with special reference to the load sharing classification. Spine (Phila Pa 1976). 2008;33(23):2536-2544. [26] FARROKHI MR, RAZMKON A, MAGHAMI Z, et al. Inclusion of the fracture level in short segment fixation of thoracolumbar fractures. Eur Spine J. 2010;19(10):1651-1656. [27] LIU YJ, CHANG MC, WANG ST, et al. Flexion-distraction injury of the thoracolumbar spine. Injury. 2003;34(12):920-923. [28] CHOKSHI JJ, SHAH M. Outcomes of Including Fracture Level in Short- Segment Fixation for Th oracolumbar Fracture Dislocation. Asian Spine J. 2019;13(1):56-60. [29] REINHOLD M, KNOP C, KNEITZ C, et al. Spine Fractures in Ankylosing Diseases: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J. 2018; 8(2 Suppl):56S-68S. [30] LINDTNER RA, KAMMERLANDER C, GOETZEN M, et al. Fracture reduction by postoperative mobilisation for the treatment of hyperextension injuries of the thoracolumbar spine in patients with ankylosing spinal disorders. Arch Orthop Trauma Surg. 2017;137(4): 531-541. [31] WHANG PG, VACCARO AR. Thoracolumbar fracture: posterior instrumentation using distraction and ligamentotaxis reduction. J Am Acad Orthop Surg. 2007;15(11):695-701. [32] 吴文斌,宋文慧,赵卫东,等.胸腰椎爆裂骨折术后椎管内骨块吸收回纳的相关因素分析[J].中国脊柱脊髓杂志,2018,28(3):200-205. [33] ALTAY M, OZKURT B, AKTEKIN CN, et al. Treatment of unstable thoracolumbar junction burst fractures with short- or long-segment posterior fixation in magerl type a fractures. Eur Spine J. 2007;16(8): 1145-1155. [34] WANG XY, DAI LY, XU HZ, et al. Kyphosis recurrence after posterior short-segment fixation in thoracolumbar burst fractures. J Neurosurg Spine. 2008;8(3):246-254. [35] LAKSHMANAN P, JONES A, MEHTA J, et al. Recurrence of kyphosis and its functional implications after surgical stabilization of dorsolumbar unstable burst fractures. Spine J. 2009;9(12):1003-1009. [36] SJOSTROM L, KARLSTROM G, PECH P, et al. Indirect spinal canal decompression in burst fractures treated with pedicle screw instrumentation. Spine (Phila Pa 1976). 1996;21(1):113-123. [37] GERTZBEIN SD, CROWE PJ, FAZL M, et al. Canal clearance in burst fractures using the AO internal fixator. Spine (Phila Pa 1976). 1992; 17(5):558-560. [38] ARLET V, ORNDORFF DG, JAGANNATHAN J, et al. Reverse and pseudoreverse cortical sign in thoracolumbar burst fracture: radiologic description and distinction--a propos of three cases. Eur Spine J. 2009; 18(2):282-287. [39] SIEBENGA J, LEFERINK VJ, SEGERS MJ, et al. Treatment of traumatic thoracolumbar spine fractures: a multicenter prospective randomized study of operative versus nonsurgical treatment. Spine (Phila Pa 1976). 2006;31(25):2881-2890. [40] SANDERSON PL, FRASER RD, HALL DJ, et al. Short segment fixation of thoracolumbar burst fractures without fusion. Eur Spine J. 1999;8(6): 495-500. [41] WANG ST, MA HL, LIU CL, et al. Is fusion necessary for surgically treated burst fractures of the thoracolumbar and lumbar spine: a prospective, randomized study. Spine (Phila Pa 1976). 2006;31(23):2646-2652; discussion 2653. [42] DAI LY, JIANG LS, JIANG SD. Posterior short-segment fixation with or without fusion for thoracolumbar burst fractures. a five to seven-year prospective randomized study. J Bone Joint Surg Am. 2009;91(5): 1033-1041. [43] 高峰,张智达,孙成群,等.不同融合方式对胸腰椎爆裂性骨折后路内固定手术疗效影响的临床研究[J].中国现代医生,2018,56(20): 95-98. [44] 庄林波,王立胜,王志勇.后外侧融合与否对无脊髓损伤的不稳定胸腰椎骨折的疗效影响[J].临床骨科杂志,2014,17(3):258-261+264. [45] 何磊,戎利民,董健文,等.后外侧融合与不融合在经伤椎固定治疗无脊髓损伤胸腰椎骨折中的疗效比较[J].中华创伤骨科杂志, 2013,15(6):499-504. [46] SCHOLL BM, THEISS SM, KIRKPATRICK JS. Short segment fixation of thoracolumbar burst fractures. Orthopedics. 2006;29(8):703-708. [47] SHEN WJ, LIU TJ, SHEN YS. Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit. Spine (Phila Pa 1976). 2001;26(9):1038-1045. [48] GUVEN O, KOCAOGLU B, BEZER M, et al. The use of screw at the fracture level in the treatment of thoracolumbar burst fractures. J Spinal Disord Tech. 2009;22(6):417-421. [49] KOSE KC, INANMAZ ME, ISIK C, et al. Short segment pedicle screw instrumentation with an index level screw and cantilevered hyperlordotic reduction in the treatment of type-A fractures of the thoracolumbar spine. Bone Joint J. 2014;96-B(4):541-547. [50] DOBRAN M, NASI D, BRUNOZZI D, et al. Treatment of unstable thoracolumbar junction fractures: short-segment pedicle fixation with inclusion of the fracture level versus long-segment instrumentation. Acta Neurochir (Wien). 2016;158(10):1883-1889. [51] SUN C, LIU X, TIAN J, et al. Comparison of unilateral versus bilateral pedicle screw fixation at the level of fracture using posterior short-segment pedicle instrumentation in the treatment of severe thoracolumbar burst fractures. Int J Surg. 2017;41:50-55. [52] ALANAY A, ACAROGLU E, YAZICI M, et al. Short-segment pedicle instrumentation of thoracolumbar burst fractures: does transpedicular intracorporeal grafting prevent early failure? Spine (Phila Pa 1976). 2001;26(2):213-217. [53] TOYONE T, OZAWA T, INADA K, et al. Short-segment fixation without fusion for thoracolumbar burst fractures with neurological deficit can preserve thoracolumbar motion without resulting in post-traumatic disc degeneration: a 10-year follow-up study. Spine (Phila Pa 1976). 2013;38(17):1482-1490. [54] PISHNAMAZ M, CURFS I, BALOSU S, et al Two-Nation Comparison of Classification and Treatment of Thoracolumbar Fractures: An Internet-Based Multicenter Study Among Spine Surgeons. Spine (Phila Pa 1976). 2015;40(22):1749-1756. [55] KOROVESSIS P, BAIKOUSIS A, ZACHARATOS S, et al. Combined anterior plus posterior stabilization versus posterior short-segment instrumentation and fusion for mid-lumbar (L2-L4) burst fractures. Spine (Phila Pa 1976). 2006;31(8):859-868. [56] DEFINO HL, SCARPARO P. Fractures of thoracolumbar spine: monosegmental fixation. Injury. 2005;36 Suppl 2:B90-97. [57] GOTZEN L, PUPLAT D, JUNGE A. Indications, technique and results of monosegmental dorsal spondylodesis in wedge compression fractures (grade II) of the thoracolumbar spine. Unfallchirurg. 1992;95(9):445-544. [58] LI X, MA Y, DONG J, et al. Retrospective analysis of treatment of thoracolumbar burst fracture using mono-segment pedicle instrumentation compared with short-segment pedicle instrumentation. Eur Spine J. 2012;21(10):2034-2042. [59] WEI FX, LIU SY, LIANG CX, et al. Transpedicular fixation in management of thoracolumbar burst fractures: monosegmental fixation versus short-segment instrumentation. Spine (Phila Pa 1976). 2010;35(15):E714-720. [60] LIU H, WANG H, LIU J, et al. Biomechanical comparison of posterior intermediate screw fixation techniques with hybrid monoaxial and polyaxial pedicle screws in the treatment of thoracolumbar burst fracture: a finite element study. J Orthop Surg Res. 2019;14(1):122. [61] 高飞,阿日奔吉日嘎拉,姜富祥,等.经皮与开放椎弓根钉棒系统复位内固定治疗中青年单节段胸腰椎压缩性骨折临床疗效比较[J].中华临床医师杂志(电子版),2016,10(23):3502-3506. [62] 程晓东,杨宁,俞宇,等.经皮短节段椎弓根钉内固定附加伤椎置钉治疗胸腰段脊柱骨折疗效观察[J].中国骨与关节损伤杂志,2018, 33(9):957-959. [63] 贾吉光,刘江涛,徐俊昌,等.后路短节段经皮经伤椎椎弓根螺钉内固定治疗单节段胸腰段骨折[J].骨科,2018,9(4):268-273. |
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