BACKGROUND:Since introduction of the pedicle screw-rod system, short-segment pedicle screw fixation has been widely adopted for thoracolumbar burst fractures (TLBF). Recently, the percutaneous pedicle screw fixation (PPSF) systems have been introduced in spinal surgery; and it has become a popularly used method for the treatment of degenerative spinal disease. However, there are few clinical reports concerning the efficacy of PPSF without fusion in treatment of TLBF. The purpose of this study was to determine the efficacy and safety of short-segment PPSF without fusion in comparison to open short-segment pedicle screw fixation with bony fusion in treatment of TLBF. METHODS:This study included 59 patients, who underwent either percutaneous (n = 32) or open (n = 27) short-segment pedicle screw fixation for stabilization of TLBF between December 2003 and October 2009. Radiographs were obtained before surgery, immediately after surgery, and at the final follow-up for assessment of the restoration of the spinal column. For radiologic parameters, Cobb angle, vertebral wedge angle, and vertebral body compression ratio were assessed on a lateral thoracolumbar radiograph. For patient's pain and functional assessment, the visual analogue scale (VAS), the Frankel grading system, and Low Back Outcome Score (LBOS) were measured. Operation time, and the amount of intraoperative bleeding loss were also evaluated. FINDINGS:In both groups, regional kyphosis (Cobb angle) showed significant improvement immediately after surgery, which was maintained until the last follow up, compared with preoperative regional kyphosis. Postoperative correction loss showed no significant difference between the two groups at the final follow-up. In the percutaneous surgery group, there were significant declines of intraoperative blood loss, and operation time compared with the open surgery group. Clinical results showed that the percutaneous surgery group had a lower VAS score and a better LBOS at three months and six months after surgery; however, the outcomes were similar in the last follow-up. CONCLUSIONS:Both open and percutaneous short-segment pedicle fixation were safe and effective for treatment of TLBF. Although both groups showed favorable clinical and radiologic outcomes at the final follow-up, PPSF without bone graft provided earlier pain relief and functional improvement, compared with open TPSF with posterolateral bony fusion. Despite several shortcomings in this study, the result suggests that ongoing use of PPSF is recommended for the treatment of TLBF.

译文

背景:自椎弓根钉杆系统引入以来,短节段椎弓根钉固定已被广泛用于胸腰椎爆裂骨折(TLBF)。最近,在脊柱外科手术中已经引入了经皮椎弓根螺钉固定(PPSF)系统。它已成为治疗退行性脊柱疾病的一种流行方法。但是,很少有关于不融合的PPSF治疗TLBF疗效的临床报道。这项研究的目的是确定与开放短节段椎弓根螺钉固定加骨融合术治疗TLBF相比,不进行融合的短节段PPSF的疗效和安全性。
方法:本研究包括59例患者,他们于2003年12月至2009年10月间接受了经皮短段(n = 32)或开放(n = 27)短节段椎弓根螺钉固定以稳定TLBF。 ,并在最后的随访中评估脊柱的恢复情况。对于放射学参数,在胸腰椎X线片上评估Cobb角,椎体楔角和椎体压缩比。对于患者的疼痛和功能评估,测量了视觉模拟量表(VAS),弗兰克尔(Frankel)评分系统和低腰成果评分(LBOS)。还评估了手术时间和术中出血量。
结果:与术前区域性后凸畸形相比,两组患者术后均立即发现区域性后凸畸形(Cobb角),并一直持续到最后一次随访。在最后一次随访中,两组的术后矫正损失无明显差异。与开放手术组相比,经皮手术组的术中失血量和手术时间明显减少。临床结果表明,经皮手术组在术后三个月和六个月时,VAS评分较低,LBOS较好。然而,最后一次随访的结果相似。
结论:开放式和经皮短节段椎弓根固定术治疗TLBF是安全有效的。尽管两组在最后的随访中均显示出良好的临床和放射学结果,但与开放式TPSF与后外侧骨融合术相比,无骨移植的PPSF可以更早地缓解疼痛和改善功能。尽管这项研究存在一些缺陷,但结果表明建议继续使用PPSF来治疗TLBF。

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