Bone fusion, correction and functional recovery after three approaches of implant fixation for lumbar burst fractures

doi:10.3969/j.issn.2095-4344.2014.22.010

Abstract

Abstract:

BACKGROUND: Currently, the treatment methods of lumbar burst fractures include anterior spinal approach, posterior spinal approach, and anterior combined with posterior approach. However, it is still controversial which the best approach is for lumbar burst fracture and what are their indications.

OBJECTIVE: To assess clinical outcomes of surgical treatments through anterior, posterior approaches, and anterior combined with posterior approach for lumbar vertebrae burst fractures.

METHODS: A total of 79 patients with lumbar burst fractures were treated by operation. Different approaches were selected according to conditions of injury: posterior approach (57 patients), anterior approach (12 patients), and anterior combined with posterior approach (10 patients). ASIA was used to assess the recovery of neurological function before and after treatment. Cobb angle, correction loss of Cobb angle, bone fusion rate, failure rate of internal fixation, operative time and intraoperative bleeding loss were observed before and after treatment.
RESULTS AND CONCLUSION: All 79 patients were followed up for at least 19 months. Except no changes in the 5 complete paralysis cases, the ASIA classification of postoperative nerve function in 63 incomplete paralysis cases was improved by 1 grade or more. ASIA grade and the Cobb angle were obviously improved after operation, showing significant differences between preoperation and last follow-up (P < 0.05). The Cobb angle correction loss in patients with posterior approach was significantly larger than those with anterior approach and anterior combined with posterior approach (P < 0.05). Operative time and blood loss were significantly less in posterior approach compared with anterior approach and anterior combined with posterior approach (P < 0.05). Five cases with posterior approach suffered from screw breakage. There were no significant differences in the rate of bone fusion and postoperative neurological function recovery in three approaches (P > 0.05). Results suggested that the three surgical approaches can effectively treat lumbar burst fractures, and can achieve satisfactory clinical outcomes. Posterior approach easily affected fixation breakage and postoperative correlation loss. Anterior approach and anterior combined with posterior approach obtained less correlation loss. The surgeons should choose the surgical approach according to the characteristics of patients, and aim to achieve the best clinical outcomes.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: lumbar vertebrae, fractures, bone, internal fixators

CLC Number:

R318

Huang Xiao-nan, Zhang Yong. Bone fusion, correction and functional recovery after three approaches of implant fixation for lumbar burst fractures[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(22): 3498-3503.

Figures/Tables 4

2.3 脊柱后路短节段置入植入物内固定治疗后ASIA分级及植骨融合时间 57例后路治疗中，51例不全瘫患者治疗后ASIA分级均较治疗前提高1级或1级以上。如25例B级中，6例恢复至C级，19例恢复至D级；13例C级中9例恢复至E级，4例恢复至D级；13例D级均恢复至E级。治疗后随访X射线片及CT发现椎管减压彻底，植骨块完全融合，平均融合时间为(3.5±1.5)个月(3-5个月)(图1)。其中有5例患者在治疗后6个月随访时发现断钉，但骨折已愈合，未引起不良并发症；3例患者末次随访时，Cobb角增加。平均治疗时间为(145.2±35.4) min(80-190 min)；平均出血量为(613±23) mL(500-1 500 mL)。 2.4 脊柱前路椎体置入植入物内固定治疗ASIA分级及植骨融合时间 12例前路治疗患者均为不全瘫，治疗后ASIA分级均较治疗前提高1级或1级以上。如7例B级中，2例恢复至C级，4例恢复至D级，1例恢复至E级；5例C级中4例恢复至E级，1例恢复至D级。治疗后随访X射线片及CT发现椎管减压彻底，植骨块完全融合，平均融合时间为(3.5±1.5)个月(3-5个月)，末次随访时Cobb角较治疗后即刻无明显改变(图2)；无内固定失败。平均手术时间为(178.5±64.7) min(125-245 min)；平均出血量为(950±130) mL(790-1 500 mL)。 2.5 脊柱前后联合置入植入物内固定治疗ASIA分级及植骨融合时间 10例前后联合治疗患者均为不全瘫，治疗后ASIA分级均较术前提高1级或1级以上。如5例B级中，2例恢复至C级，2例恢复至D级，1例恢复至E级；5例C级中4例恢复至E级，1例恢复至D级。治疗后随访X射线片及CT发现椎管减压彻底，植骨块完全融合，平均融合时间为(3.8±1.5)个月(3-6个月)，末次随访时Cobb角较治疗后即刻无明显改变(图3)；无内固定失败。平均手术时间为(245.8±78.5) min(225-345 min)；平均出血量为(960±135) mL(785-1 400 mL)。 2.6 三种方法神经功能恢复结果及手术时间和术中出血量 3种治疗后神经恢复与治疗前比较，均有明显恢复，3种方法之间比较，神经恢复差异无显著性意义。前路或前后联合方法相比后路，治疗创伤较大，表现为操作时间较长，出血量较多，其中前后联合治疗创伤最大(表2，3)。 2.7 不良反应所有患者均顺利完成手术，切口均Ⅰ期愈合，治疗后无神经症状加重，无感染等并发症发生。后路治疗有5例患者在治疗后6个月随访时发现断钉，但骨折已愈合，未引起不良并发症。"

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