Intra Pedicular Screw Fixation for Thoracolumbar Burst Fracture: Six-Year Experience

以包含斷裂節的後固定方式治療胸腰椎的爆裂性骨折

楊椒喬(Jaio-Chiao Yang) ； 林建邦(Chien-Pang Lin) ； 陳俊賢(Jun-Yeen Chan) ； 劉元凱(Yuan-Kai Liu) ； 柯紹華(Shao-Hwa Ko) ； 張志儒(Chih-Ju Chang) ； 張坤權(Kun-Chuan Chang) ； 劉康男(Kan-Nan Liu) ； 黃金山(Jing-Shan Huang)

《Formosan Journal of Surgery》 37卷4期 (2004/07) Pp. 149-153

https://doi.org/10.29833/FJS.200407.0001

摘要

胸、腰椎是脊椎外傷最易發生骨折之處，正確的診斷及了解外傷的機轉，對治療此類病患是極為重要的。外科手術治療包含有：前融合、後融合及合併手術。治療的目的是要維持骨折後脊椎的穩定及良好的神經功能。
針對十六位病患，皆具有單節爆裂性骨折，其範圍為T12-L5；平均追蹤時間為26.19個月（範圍為13到50個月），術前的前彎角度為21.25±9.92度（範圍為0到33度），術後的角度為11.81±10.51度（範圍為0到33度），平均矯正回9.44度。其中，沒有病患發生繼續前彎的情形，也沒有骨釘的斷裂。
因此，我們發現，以包含斷裂節的方式從事經椎弓的後固定，對此類病患有很好的治療效果，其可以避免產生更嚴重的脊椎前彎，得到更好的矯正的角度。相較於以往不包含斷裂節的固定方式，我們認為，包含斷裂節的固定能得到更好的臨床效果。

並列摘要

Pedicle screw fixation from posterior approach is one of the treatment options for thoracolumbar burst fracture. Traditionally, the pedicle screws are fixed above and below the fracture level, sparing the fracture level. The authors introduce a new technique of pedicle screw fixation involving the fracture level. This report presents our preliminary experience of pedicle screw fixation involving the fracture level in the treatment of thoracolumbar fracture and discusses the advantages.
Materials and Methods: We reviewed records of patients treated from 1995 to 2003 and found a total of 16 patients with a diagnosis of thoracolumbar burst fracture. We measured the preoperative and postoperative Cobb angle and its difference. Fracture sites ranged from T12 to L5. In the patient with spinal instability, surgery was undertaken in order to achieve stabilization and laminectomy was performed for decompression of nerve root. Instrumentation included the transpedicle screw to secure the rod and crosslink bar to prevent rotation injury. Transpedicle screw fixation was used for stabilization. All our patients received laminectomy for decompression at the fracture level.
Results: The mean age in patients with fixation involving the fracture level was 54.4 16.2. The mean follow-up period was 26.19 10.96 months (ranged from 13 to 50 months). Progression of kyphosis was considered if the difference between preoperative and postoperative kyphotic angle became positive. In patients fusion with the fracture level, the preoperative kyphotic angle was 21.25 9.92 degrees (ranged from 9 to 43 degrees); and the postoperative kyphotic angle was
11.81 10.51 degrees (ranged from 0 to 33 degrees). The corrected kyphotic angle was 9.44 4.44 degrees (ranged from 4 to 18 degrees). No kyphosis progression was noted in these 16 patients. There was no instrument failure found in our patients.
Conclusions: Our clinical experience reveals that pedicle screw instrumentation is a very effective procedure in the treatment of fractures of the thoracic and lumbar spine, with a high percentage of fusions and a low percentage of hardware failures. We also find that pedicle screw fixation involving the fracture level can result in nearly complete reduction of the kyphotic deformity and less progression of kyphosis.

並列關鍵字

thoracic spine ； lumbar spine ； burst fracture