RESUMO
Re-fracture of the injured vertebrae is a serious complication after vertebral augmentation for osteoporotic thoracolumbar fractures (OTLF), manifested by recurrent lower back pain, limitation of spinal motion and increased retroflexion deformity. The clinical treatment of re-fracture of the injured vertebrae is difficult, and some patients even need spinal function reconstruction to stabilize the fractured vertebrae, which has a serious impact on their postoperative rehabilitation, quality of life and economic burdens. Re-fracture of the injured vertebrae after vertebral augmentation for OTLF is closely related to patient factors, bone cement factors and perioperative factors. To this end, the authors discuss the risk factors for re-fracture of the injured vertebrae after vertebral augmentation for OTLF and propose corresponding management methods to provide a reference for understanding the risk of re-fracture of the injured vertebrae and improving the clinical treatment.
RESUMO
BACKGROUND: The bone trabecula of the vertebral body cannot be fully recovered, and the mechanical stability of the sagittal position of the spinal column Is affected. The antl-bendlng force and the anti-torsion force of the short-segment fixation of fractured vertebra are obviously Increased. The bearing load of various activities such as flexion, extension, and rotation of the vertebral body is increased. The stability of the injured vertebra is better maintained, and favorable conditions are created for fracture healing. OBJECTIVE: To compare the early- and mid-term follow-up results of trans-injured and cross-injured vertebra pedicle screw fixation in the treatment of thoracolumbar fractures. METHODS: Eighty-eight patients with thoracolumbar vertebrae fracture treated in Affiliated Hospital of Qinghai University from April 2017 to April 2018 were divided into trans-injured vertebra group and cross-injured vertebra group according to the treatment plan. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Intraoperative blood loss, operation time, postoperative bed rest time, postoperative site infection, and subcutaneous hematoma were analyzed in both groups. Visual analogue scale score, Oswestry Disability Index, anterior edge height ratio and kyphosis Cobb angle were compared before surgery, 6 and 12 months after surgery between the two groups. RESULTS AND CONCLUSION: (1) The operation time was longer and intraoperative blood loss was higher in the trans-injured group than those in the cross-injured group, but the postoperative bed rest time was shorter in the trans-injured group than that in the cross-injured group (P 0.05). (3) At 6 and 12 months after surgery, visual analogue scale score and Oswestry Disability Index were lower in the trans-injured group than in the cross-injured group; anterior edge height ratio was larger in the trans-injured group than in the cross-injured group; kyphosis Cobb angle was smaller in the trans-injured group than in the cross-injured group (all P < 0.05). (4) Incidence of complications was higher in the cross-injured group (30%) than in the trans-injured group (7%) (P=0.001). (5) The treatment of thoracolumbar fracture with trans-injured pedicle screw can not only effectively restore and maintain the injured vertebral height and kyphosis Cobb angle, restore the physiological height and curvature of vertebral body, but also the incidence of postoperative complications is low, which can effectively improve the prognosis of patients and improve the quality of life of patients.
RESUMO
Objective To assess the clinical outcome of short segment fixation in combination of pedicle screw in injured vertebrae for thoracolumbar fractures. Methods Twenty-one cases of thoracolumbar fractures received short segment fixation combined with pedicle screw in injured vertebrae surgery. The protruding after angle correction and vertebral body height recovery situation were measured by X-ray film before and after surgery. Results All the patients were followed up for 6~20 months,achieved good reduction effect. The imaging measure-ment results found that before the operation Cobb’s angle was (26. 4 ± 7. 3),fracture fanterior flange height was (56. 1 ± 12. 5)%. Com-pared with after the operation and the end of follow-up of Cobb’ s and fracture fanterior flange height,the difference had statistical significance (P0. 05). Conclusion Short segment fixation in combination of pedicle screw in injured vertebrae can restore the height of vetebra,rectify protrusion deformity,which is an effective method for thoracolumbar fracture.
RESUMO
Objective Short-segment fixation is one of the most commonly used methods for the management of thoracolumbar vertebral fractures.In this study, we compared the clinical effects of short-segment fixation via and across the injured vertebrae in the treatment of thoracolumbar vertebral fractures . Methods We retrospectively analyzed 75 cases of thoracolumbar vertebral fractures treated by short-segment fixation, 39 via the injured vertebrae (group A) and 36 across the injured vertebrae (group B).We obtained the pre-and post-operative anterior vertebral body height ratio (AVBHr) and sagittal Cobb angle, operation time, and intraoperative blood loss, and compared them between the two groups of patients . Results Compared with the baseline, the AVBHr and the sagittal Cobb angle were significantly restored after surgery in both groups A ([56.32 ±12.53] vs [85.76 ±11.48]%and [20.41 ±5.73] vs [8.72 ±5.34]°, P0.05).The losses of the AVBHr and Cobb angle were (3.78 ±1.24)%and (2.25 ±1.06)°in group A, signifi-cantly lower than (6.69 ±2.52)% and (6.31 ±2.18)°in group B (P<0.05). Conclusion For thoracolumbar fractures, short-segment fixation either via or across the injured vertebrae can effective-ly improve the vertebral height and Cobb angle , but fixation via the injured vertebrae may achieve a better maintenance of correction .