IMPROVED METHOD OF TREATING THORACOLUMBAR BURST FRACTURE BY POSTERIOR PEDICLEFIXATION AND GRAFTING THROUGH INJURED VERTEBRAE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Tongxiang , XIAO Rui , GUAN Qing , WANG Miao , DONG Changchao.

Department of Orthopedics, First People’s Hospital of Yibin, Yibin Sichuan, 644000, P.R.China.;

Corresponding author：

Keywords：

Thoracolumbar burst fracture, Bone grafting, Posterior internal fixation

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Objective To discuss the improved method and effectiveness of posterior pedicle-screw fixation combined with restoring and grafting through the injured vertebrae for treating thoracolumbar burst fracture. Methods Between March 2008 and September 2010, 21 patients with thoracolumbar burst fracture were treated by posterior pedicle-screw fixation
combined with restoring and grafting through the injured vertebrae. Of 21 cases, 15 were male and 6 were female with an age range of 20-61 years (mean, 38.4 years). Affected segments included T12 in 5 cases, L1 in 7 cases, L2 in 5 cases, and T12-L1 in 4 cases. According to Frankel classification for neurological function, 2 cases were rated as grade A, 4 cases as grade B, 6 cases as grade C, 5 cases as grade D, and 4 cases as grade E; based on Denis classification, all 21 cases were burst fractures, including 7 cases of type A, 11 cases of type B, and 3 cases of type C. The X-ray film was taken to measure the relative height of fractured vertebrae and Cobb’s angle, and the function of the spinal cord was evaluated at preoperation, postoperation, and last followup. Results All the incisions healed primarily. The 21 patients were followed up 12-30 months (mean, 26 months). No loosening or breakage of screws and rods occurred. X-ray films showed good bone heal ing with the heal ing time from 12 to 23 months (mean, 16 months). The Cobb’s angles at 1 week and 1 year postoperatively were (3.4 ± 2.4)° and (5.2 ± 3.2)° respectively, showing significant differences when compared with preoperative angle (22.1 ± 1.2)° (P lt; 0.05), while no significant difference between 1 week and 1 year after operation (P gt; 0.05). The anterior height of injured vertebrae recovered from (14.6 ± 2.1) mm (40.2% ± 1.5% of the normal) at preoperation to (36.0 ± 2.0) mm (95.3% ± 1.3% of the normal) at 1 week, and to (35.0 ± 2.4) mm (94.4% ± 2.5% of the normal) at 1 year; significant differences were found between preoperation and postoperation (P lt; 0.05), while no significant difference between 1 week and 1 year after operation (P gt; 0.05). At 1 year after operation, the Frankel neurological function grade was improved in varying degrees, showing significant difference when compared with preoperative grade (χ2=11.140, P=0.025). Conclusion Improved method of posterior pedicle-screw fixation combined with restoring and grafting through the injured vertebrae in treatment of thoracolumbar burst fracture can reconstruct
the anterior and middle column stabil ity and prevent loss of Cobb’s angle and height of vertebrae.

Citation： LI Tongxiang,XIAO Rui,GUAN Qing,WANG Miao,DONG Changchao.. IMPROVED METHOD OF TREATING THORACOLUMBAR BURST FRACTURE BY POSTERIOR PEDICLEFIXATION AND GRAFTING THROUGH INJURED VERTEBRAE. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(5): 546-549. doi: Copy

1.	周蔚, 徐建广, 孔维清, 等. 后路内固定加经伤椎椎弓根植骨治疗胸腰椎骨折. 同济大学学报: 医学版, 2009, 30(3): 132-135.
2.	赵勤鹏, 郝定均, 贺宝荣, 等. 经伤椎置钉辅以经椎弓根椎体内植骨治疗胸腰段椎体爆裂骨折. 中国骨与关节损伤杂志, 2010, 25(11): 1004-1005.
3.	袁海涛, 张强, 陶笙, 等. 经伤椎椎弓根植骨联合后路椎弓根内固定治疗胸腰椎稳定型爆裂性骨折. 脊柱外科杂志, 2009, 7(1): 9-12.
4.	王广积, 林明狭, 沈宁江, 等. 椎弓根钉伤椎固定治疗胸腰椎爆裂性骨折疗效分析. 实用骨科杂志, 2009, 15(9): 690-691.
5.	邓仲元, 谭小青, 彭军, 等. 经伤椎椎弓根椎体内植骨内固定治疗胸腰椎爆裂性骨折. 中国脊柱脊髓杂志, 2010, 20(4): 351-352.
6.	李钦亮, 刘艺, 储照明, 等. 经伤椎椎弓根椎体内植骨并植钉治疗胸腰椎骨折. 中国修复重建外科杂志, 2011, 25(8): 956-959.
7.	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.
8.	Roy-Camille R, Saillant G, Mazel CH. Plating of thoracic, thoracolumbar, and lumbar injuries with pedicle screw plates. Orthop Clin North Am, 1986, 17(1): 147-159.
9.	叶启彬, 邱贵兴. 脊柱外科新手术. 北京: 中国协和医科大学出版社, 2001: 30-37.
10.	徐敏, 唐汉武, 黄承军, 等. 后路选择性减压融合内固定术治疗胸腰椎不稳定骨折. 中国骨与关节损伤杂志, 2009, 24(11): 1006-1007.
11.	贾水淼, 董胜利, 张凯, 等. 伤椎单侧椎弓根固定治疗胸腰椎骨折的临床探讨. 中国矫形外科杂志, 2008, 16(20): 1595-1596.
12.	Denis F, Armstrong GW, Searls K, et al. Acute thoracolumbar burst fractures in the absence of neurologic deficit: a comparison between operative and non operative treatment. Clin Orthop Relat Res, 1984, (189): 142-149.
13.	林家忠, 李亮, 王家欣, 等. 后路短节段固定治疗胸腰椎爆裂性骨折同时行植骨融合的系统评价. 循证医学, 2010, 10(4): 223-224.
14.	Wang MY, Kim OH, Kim KA. Correction of late traumatic thoracic and thoracolumbar hypnotic spinal deformities using posteriorly placed intervertebral distraction cages. Neurosurgery, 2008, 62(3 Suppl 1):.
15.	Korovessis P, Rapantis T, Petsinis G, et al. Direct reducation of thoracolumbar burst fractures by means of balloon kyphoplasty with calcium phosphate and stabilization with pedicle-screw instrumentation and fusion. Spine (Phila Pa 1976), 2008, 33(4): E100-108.
16.	Yuare R, Marré B, Urzua A, et al. Residual mobility of instrumented and non-fused segments in thoracolumbar spine fractures. Eur Spine J, 2006, 15(6): 864-875.
17.	Toyone T, Tanaka T, Kato D, et al. The treatment of acute thoracolumbar burst fractures with transpedicular intracorporeal hydroxyapatite grafting following indirect reduction and pedicle screw fixation: a prospective study. Spine (Phila Pa 1976), 2006, 31(7): E208-214.
18.	王华东, 史亚民, 侯树勋, 等. 经椎弓根植骨预防骨折后椎体塌陷的疗效观察. 脊柱外科杂志, 2009, 7(1): 18-20, 25.
19.	贺新宁, 欧晔灵, 付军初, 等. 经皮椎体内植骨支撑成形术治疗中青年胸腰椎骨折. 中华创伤骨科杂志, 2010, 12(4): 393-395.
20.	陈善明, 陈琦, 刘学军, 等. 经椎弓根植骨钉棒固定治疗胸腰椎骨折. 中国修复重建外科杂志, 2010, 24(2): 245-246.
21.	韩林, 顾前来. AF内固定联合经椎弓根注射硫酸钙增强治疗胸腰椎爆裂性骨折. 中国脊柱脊髓杂志, 2011, 21(6): 497-500.
22.	-171.

1. 周蔚, 徐建广, 孔维清, 等. 后路内固定加经伤椎椎弓根植骨治疗胸腰椎骨折. 同济大学学报: 医学版, 2009, 30(3): 132-135.
2. 赵勤鹏, 郝定均, 贺宝荣, 等. 经伤椎置钉辅以经椎弓根椎体内植骨治疗胸腰段椎体爆裂骨折. 中国骨与关节损伤杂志, 2010, 25(11): 1004-1005.
3. 袁海涛, 张强, 陶笙, 等. 经伤椎椎弓根植骨联合后路椎弓根内固定治疗胸腰椎稳定型爆裂性骨折. 脊柱外科杂志, 2009, 7(1): 9-12.
4. 王广积, 林明狭, 沈宁江, 等. 椎弓根钉伤椎固定治疗胸腰椎爆裂性骨折疗效分析. 实用骨科杂志, 2009, 15(9): 690-691.
5. 邓仲元, 谭小青, 彭军, 等. 经伤椎椎弓根椎体内植骨内固定治疗胸腰椎爆裂性骨折. 中国脊柱脊髓杂志, 2010, 20(4): 351-352.
6. 李钦亮, 刘艺, 储照明, 等. 经伤椎椎弓根椎体内植骨并植钉治疗胸腰椎骨折. 中国修复重建外科杂志, 2011, 25(8): 956-959.
7. 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.
8. Roy-Camille R, Saillant G, Mazel CH. Plating of thoracic, thoracolumbar, and lumbar injuries with pedicle screw plates. Orthop Clin North Am, 1986, 17(1): 147-159.
9. 叶启彬, 邱贵兴. 脊柱外科新手术. 北京: 中国协和医科大学出版社, 2001: 30-37.
10. 徐敏, 唐汉武, 黄承军, 等. 后路选择性减压融合内固定术治疗胸腰椎不稳定骨折. 中国骨与关节损伤杂志, 2009, 24(11): 1006-1007.
11. 贾水淼, 董胜利, 张凯, 等. 伤椎单侧椎弓根固定治疗胸腰椎骨折的临床探讨. 中国矫形外科杂志, 2008, 16(20): 1595-1596.
12. Denis F, Armstrong GW, Searls K, et al. Acute thoracolumbar burst fractures in the absence of neurologic deficit: a comparison between operative and non operative treatment. Clin Orthop Relat Res, 1984, (189): 142-149.
13. 林家忠, 李亮, 王家欣, 等. 后路短节段固定治疗胸腰椎爆裂性骨折同时行植骨融合的系统评价. 循证医学, 2010, 10(4): 223-224.
14. Wang MY, Kim OH, Kim KA. Correction of late traumatic thoracic and thoracolumbar hypnotic spinal deformities using posteriorly placed intervertebral distraction cages. Neurosurgery, 2008, 62(3 Suppl 1):.
15. Korovessis P, Rapantis T, Petsinis G, et al. Direct reducation of thoracolumbar burst fractures by means of balloon kyphoplasty with calcium phosphate and stabilization with pedicle-screw instrumentation and fusion. Spine (Phila Pa 1976), 2008, 33(4): E100-108.
16. Yuare R, Marré B, Urzua A, et al. Residual mobility of instrumented and non-fused segments in thoracolumbar spine fractures. Eur Spine J, 2006, 15(6): 864-875.
17. Toyone T, Tanaka T, Kato D, et al. The treatment of acute thoracolumbar burst fractures with transpedicular intracorporeal hydroxyapatite grafting following indirect reduction and pedicle screw fixation: a prospective study. Spine (Phila Pa 1976), 2006, 31(7): E208-214.
18. 王华东, 史亚民, 侯树勋, 等. 经椎弓根植骨预防骨折后椎体塌陷的疗效观察. 脊柱外科杂志, 2009, 7(1): 18-20, 25.
19. 贺新宁, 欧晔灵, 付军初, 等. 经皮椎体内植骨支撑成形术治疗中青年胸腰椎骨折. 中华创伤骨科杂志, 2010, 12(4): 393-395.
20. 陈善明, 陈琦, 刘学军, 等. 经椎弓根植骨钉棒固定治疗胸腰椎骨折. 中国修复重建外科杂志, 2010, 24(2): 245-246.
21. 韩林, 顾前来. AF内固定联合经椎弓根注射硫酸钙增强治疗胸腰椎爆裂性骨折. 中国脊柱脊髓杂志, 2011, 21(6): 497-500.
22. -171.

Chinese Journal of Reparative and Reconstructive Surgery

IMPROVED METHOD OF TREATING THORACOLUMBAR BURST FRACTURE BY POSTERIOR PEDICLEFIXATION AND GRAFTING THROUGH INJURED VERTEBRAE

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