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首页> 外文期刊>Spine >Anterior-only stabilization using plating with bone structural autograft versus titanium mesh cages for two- or three-column thoracolumbar burst fractures: a prospective randomized study.
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Anterior-only stabilization using plating with bone structural autograft versus titanium mesh cages for two- or three-column thoracolumbar burst fractures: a prospective randomized study.

机译：仅前路稳定术使用自体植骨与钛网笼进行钢板固定，用于两栏或三栏胸腰椎爆裂性骨折：一项前瞻性随机研究。

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STUDY DESIGN: A randomized, controlled follow-up study to review patients with acute thoracolumbar burst fractures treated by anterior instrumentation and reconstruction. OBJECTIVE: The objective of this study was to evaluate the results of anterior instrumentation in the treatment of thoracolumbar burst fractures and to determine whether anterior-only approach would be sufficient for highly unstable burst fractures. In this prospective follow-up study, we also compared the results of anterior reconstruction with structural grafting and with titanium mesh cage in a randomized fashion. SUMMARY OF BACKGROUND DATA: Anterior decompression and reconstruction supplemented with instrumentation is generally believed to be superior to fixation with posterior pedicle screw instrumentation for a highly unstable burst fracture, but the indications and methods for anterior approach has not been fully documented. METHODS: A total of 65 patients undergoing anterior plating for a thoracolumbar burst fracture with a load-sharing score of 7 or more between 2000 and 2003 were included this study. They were randomized to receive iliac crest autograft (group A, n = 32) or titanium mesh cages (group B, n = 33). The patients were similar in the distribution of 3-column injuries (n = 8 in group A vs. n = 9 in group B). During the minimum 4-year (range, 4-7 years) follow-up period, all patients were prospectively evaluated for clinical and radiologic outcomes. The Frankel scale, the ASIA motor score, and the Short Form 36 were used for clinical evaluation, whereas the fusion status and the loss of kyphosis correction for the local kyphosis angle were examined for radiologic outcome. RESULTS: All patients in this study achieved solid fusion, with significant neurologic improvement and no significant correction loss as defined by loss of kyphosis correction. The clinical and radiologic results were not significantly different (P > 0.05) at all time points between the 2 groups A and B. Twenty-six of 32 patients in group A still complained of donor site pain to some degree at the final follow-up. No significant impact of 3-column injuries (P > 0.05) were identified on the results for all comparisons. CONCLUSION: Anterior-only instrumentation and reconstruction with structural autograft or titanium mesh cages is sufficient for surgical treatment of thoracolumbar burst fractures with a load-sharing score of > or = 7 and even with 3-column injuries.
机译：研究设计：一项随机对照随访研究，回顾了通过前路器械和重建术治疗的急性胸腰椎爆裂骨折的患者。目的：本研究的目的是评估前路器械治疗胸腰椎爆裂骨折的效果，并确定仅采用前入路是否足以解决高度不稳定的爆裂骨折。在这项前瞻性随访研究中，我们还以随机方式比较了采用结构移植和钛网笼进行前路重建的结果。背景资料概述：对于高度不稳定的爆裂性骨折，一般认为前路减压和重建再加上器械可比后路椎弓根螺钉器械固定更好，但是前路手术的适应症和方法尚未完全记录。方法：2000年至2003年间，共65例因胸腰椎爆裂性骨折而接受前面板负荷分担评分为7或更高的患者被纳入本研究。他们被随机接受receive自体移植（A组，n = 32）或钛网笼（B组，n = 33）。患者的三柱损伤分布相似（A组为n = 8，B组为n = 9）。在最少的4年（4-7年范围）随访期内，对所有患者的临床和影像学结果进行前瞻性评估。临床评估使用Frankel量表，ASIA运动评分和简短表格36，而放射学结果检查了融合状态和局部后凸角的后凸矫正损失。结果：本研究中的所有患者均实现了牢固融合，神经功能得到了显着改善，并且没有由驼背矫正损失定义的显着矫正损失。 A组和B组在所有时间点的临床和影像学结果均无显着差异（P> 0.05）。A组的32名患者中有26名在最后的随访中仍抱怨有供体部位疼痛。所有比较的结果均未发现三栏损伤的显着影响（P> 0.05）。结论：仅使用前路器械和自体结构或钛网笼进行再造就足以手术治疗胸腰椎爆裂骨折，分担分值≥7或什至是3柱损伤。

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