Short segment pedicle screw fixation without bone fusion for the repair of thoracolumbar burst fracture: mid-term follow-up

doi:10.3969/j.issn.2095-4344.2014.44.007

Abstract

Abstract:

BACKGROUND: Many present studies have reported the early clinical therapeutic effects of short-segment non-fusion fixation for the repair of thoracolumbar burst fracture. The results are satisfactory. However, the mid- and long-term follow-up results of this scheme for treating thoracolumbar burst fracture are seldom reported.
OBJECTIVE: To evaluate the mid-term results of short segment pedicle screw fixation without bone fusion for unstable thoracolumbar burst fracture.
METHODS: Data of 12 patients with unstable thoracolumbar burst fractures undergoing short segment pedicle screw fixation without bone fusion were retrospectively analyzed. All patients experienced severe intraspinal occupying and neurological dysfunction, and all of them affected single segment thoracolumbar injuries. The surgical procedure included postural reduction for 2 days and screw fixations at one level above, one level below
and at the fractured level itself. The patients underwent removal of implants at 12 months after the initial operation. Imaging and clinical findings, including canal encroachment, percentage of vertebral body height loss, Cobb angle, American Spinal Injury Association motor score, Frankel grade and adjacent segment degenemtion, were evaluated.
RESULTS AND CONCLUSION: All patients were followed up for at least 5 years. Significant differences in canal encroachment, percentage of vertebral body height loss and Cobb angle were detectable between post-fixation and pre-fixation (P < 0.05). Evaluation results were significantly better after fixation than that before fixation, but no significant difference in evaluation results after fixation was detected (P > 0.05). After implantation and removal of fixator, none cases affected aggravated symptoms of neurological impairment. American Spinal Injury Association motor score was 34.2±6.3 before fixation, and 47.7±9.5 during the final follow-up, showing significant differences (t=-4.103, P=0.000). During the final follow-up, adjacent segments in damage levels did not suffer from degeneration in all patients. Neurological function showed the recovery of Frankel grades 1 or 2. These data indicated that a good mid-term result of short segment pedicle screw fixation without bone fusion for unstable thoracolumbar burst fracture with neurological deficit can be achieved. The improved saggital alignment was effectively constructed and maintained. Adjacent segment degeneration was not found at the injury level.

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: fractures, bone, thoracic vertebrae, lumbar vertebrae, internal fixators, follow-up studies

CLC Number:

R318

Ma Jing-xin, Wang Xiang-yan, Xu Guo-xing. Short segment pedicle screw fixation without bone fusion for the repair of thoracolumbar burst fracture: mid-term follow-up[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(44): 7088-7093.

Figures/Tables 3

2.1 参与者数量分析按意向性处理，纳入12例胸腰椎爆裂骨折患者，全部进入结果分析，无脱落。 2.2 随访分析本组病例的手术时间为75-118 min，平均95 min；术中失血量为200-335 mL，平均235 mL，所有病例术中均未输血。本组患者均获至少5年的内固定后随访，所有病例均在内固定后12个月时取出胸腰椎内固定物。根据加州大学洛杉矶分校分级标准，在末次随访时，所有患者的损伤水平相邻节段均未发生退变情况。 2.3 椎管内占位率经影像学测量发现，在椎管占位率评估方面(表1)，内固定后多次测量结果较之初次内固定前，差异均有显著性意义(P < 0.05)，内固定后多次的评估结果均显著优于内固定前，但内固定后多次评估结果之间差异无显著性意义(P > 0.05)。 2.4 伤椎高度在伤椎椎体高度丢失率评估方面(表1)，内固定后多次测量结果较之初次内固定前，差异均有显著性意义(P < 0.05)，内固定后多次的评估结果均显著优于内固定前。尽管在内固定取出后伤椎椎体高度出现丢失，但内固定取出后的多次评估结果与内固定后12个月内固定取出前相比，差异均无显著性意义(P > 0.05)。 2.5 Cobb角在Cobb角评估方面(表1)，内固定后多次测量结果较之初次内固定前，差异均有显著性意义(P < 0.05)，内固定后多次的评估结果均显著优于内固定前。尽管在内固定取出后Cobb角出现增大，但内固定取出后的多次评估结果与内固定后12个月内固定取出前相比，差异均无显著性意义(P > 0.05)。 2.6 临床疗效评估本组病例内固定前的ASIA运动神经评分为34.2±6.3，末次随访时为47.7±9.5，差异有显著性意义(t=-4.103，P=0.000)。内固定取出后，所有病例均未出现神经功能损害症状加重。根据Frankel分级标准，在末次随访时，内固定前3例B级患者中2例恢复至D级，1例恢复至C级；内固定前7例C级中6例恢复至D级，1例恢复至E级；内固定前2例D级患者均恢复至E级。 "

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