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首页> 外文期刊>Neurosurgery >Treatment of thoracolumbar burst fractures with polymethyl methacrylate vertebroplasty and short-segment pedicle screw fixation.
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Treatment of thoracolumbar burst fractures with polymethyl methacrylate vertebroplasty and short-segment pedicle screw fixation.

机译：聚甲基丙烯酸甲酯椎体成形术和短节段椎弓根螺钉固定治疗胸腰椎爆裂骨折。

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OBJECTIVES: We aimed to evaluate the efficacy of reinforcing short-segment pedicle screw fixation with polymethyl methacrylate (PMMA) vertebroplasty in patients with thoracolumbar burst fractures. METHODS: We enrolled 70 patients with thoracolumbar burst fractures for treatment with short-segment pedicle screw fixation. Fractures in Group A (n = 20) were reinforced with PMMA vertebroplasty during surgery. Group B patients (n = 50) were not treated with PMMA vertebroplasty. Kyphotic deformity, anterior vertebral height, instrument failure rates, and neurological function outcomes were compared between the two groups. RESULTS: Kyphosis correction was achieved in Group A (PMMA vertebroplasty) and Group B (Group A, 6.4 degrees; Group B, 5.4 degrees). At the end of the follow-up period, kyphosis correction was maintained in Group A but lost in Group B (Group A, 0.33-degree loss; Group B, 6.20-degree loss) (P = 0.0001). After surgery, greater anterior vertebral height was achieved in Group A than in Group B (Group A, 12.9%; Group B, 2.3%) (P < 0.001). During follow-up, anterior vertebral height was maintained only in Group A (Group A, 0.13 +/- 4.06%; Group B, -6.17 +/- 1.21%) (P < 0.001). Patients in both Groups A and B demonstrated good postoperative Denis Pain Scale grades (P1 and P2), but Group A had better results than Group B in terms of the control of severe and constant pain (P4 and P5) (P < 0.001). The Frankel Performance Scale scores increased by nearly 1 in both Groups A and B. Group B was subdivided into Group B1 and B2. Group B1 consisted of patients who experienced instrument failure, including screw pullout, breakage, disconnection, and dislodgement (n = 11). Group B2 comprised patients from Group B who did not experience instrument failure (n = 39). There were no instrument failures among patients in Group A. Preoperative kyphotic deformity was greater in Group B1 (23.5 +/- 7.9 degrees) than in Group B2 (16.8 +/- 8.40 degrees), P < 0.05. Severe and constant pain (P4 and P5) was noted in 36% of Group B1 patients (P < 0.001), and three of these patients required removal of their implants. CONCLUSION: Reinforcement of short-segment pedicle fixation with PMMA vertebroplasty for the treatment of patients with thoracolumbar burst fracture may achieve and maintain kyphosis correction, and it may also increase and maintain anterior vertebral height. Good Denis Pain Scale grades and improvement in Frankel Performance Scale scores were found in patients without instrument failure (Groups A and B2). Patients with greater preoperative kyphotic deformity had a higher risk of instrument failure if they did not undergo reinforcement with vertebroplasty. PMMA vertebroplasty offers immediate spinal stability in patients with thoracolumbar burst fractures, decreases the instrument failure rate, and provides better postoperative pain control than without vertebroplasty.
机译：目的：我们旨在评估在胸腰椎爆裂性骨折患者中使用聚甲基丙烯酸甲酯（PMMA）椎体成形术加强短节段椎弓根螺钉固定的疗效。方法：我们招募了70例胸腰椎爆裂性骨折的患者，以短节段椎弓根螺钉固定治疗。 A组骨折（n = 20）在手术过程中用PMMA椎体成形术加固。 B组患者（n = 50）未接受PMMA椎体成形术治疗。比较了两组的脊柱后凸畸形，前椎高，器械衰竭率和神经功能预后。结果：A组（PMMA椎体成形术）和B组（A组为6.4度; B组为5.4度）实现了后凸矫正。在随访期结束时，A组保持了驼背矫正，而B组则丢失了（A组为0.33度; B组为6.20度）（P = 0.0001）。手术后，A组比B组有更大的前椎高度（A组为12.9％; B组为2.3％）（P <0.001）。在随访过程中，仅在A组中保持前椎高度（A组为0.13 +/- 4.06％; B组为-6.17 +/- 1.21％）（P <0.001）。 A组和B组的患者均显示出良好的术后丹尼斯疼痛评分等级（P1和P2），但就控制严重和持续疼痛（P4和P5）而言，A组的效果优于B组（P <0.001）。 A组和B组的Frankel绩效量表得分均提高了近1。B组又分为B1组和B2组。 B1组由那些经历过仪器故障的患者组成，包括螺钉拔出，断裂，断开和移位（n = 11）。 B2组包括B组未发生仪器故障的患者（n = 39）。 A组患者中没有仪器故障。B1组（23.5 +/- 7.9度）比B2组（16.8 +/- 8.40度）术前后凸畸形更大，P <0.05。 B1组36％的患者出现严重且持续的疼痛（P4和P5）（P <0.001），其中三名患者需要摘除植入物。结论：PMMA椎体成形术加强短节段椎弓根内固定治疗胸腰椎爆裂性骨折可能达到并维持后凸矫正，也可能增加并保持前椎高度。在没有仪器故障的患者中（A组和B2组）发现良好的Denis疼痛量表评分和Frankel Performance量表评分得到改善。术前后凸畸形较大的患者如果不进行椎体成形术强化，则发生器械失败的风险较高。与没有椎体成形术相比，PMMA椎体成形术可为胸腰椎爆裂性骨折的患者提供即时的脊柱稳定性，降低器械失败率，并提供更好的术后疼痛控制。

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