The analysis of spinal alignment for thoracolumbar dislocated fractures（type C）with posterior long-segment instrumentation
WANG Xiang, CAI Yi, ZHENG Ming-hui, QU Dong-bin
Chinese Journal of Clinical Anatomy ›› 2017, Vol. 35 ›› Issue (1) : 85-89.
The analysis of spinal alignment for thoracolumbar dislocated fractures（type C）with posterior long-segment instrumentation
Objective The purpose of the retrospective study is to analyzethe imbalance of the spinal sagittal and coronalalignmentfor thoracolumbar fracture-dislocations with posterior long-segment pedicle screws instrumentation. Methods 33 patients with thoracic or lumbar type C spinal injurieswere treated with long-segment fixation which contained four or more segments. The distance of the vertebrae moving forward or backward, Cobb angle and kyphotic angle were measured prior to and after surgery by radiography, and the spinal sagittal and coronal alignment was analyzed. 33 patients were divided into the group of balanced alignment (group A) and the group of imbalanced alignment (group B). Then we discussed influence of the number of pedicle screws placed on postoperative spinal alignment. Results Among all patients, there were 20 cases (60.6%) with balanced alignment, others (39.4%) with imbalanced alignment. The segments of instrumentation and the total number of pedicle screws showed no obvious difference between two groups (P>0.05). As far as the number of single vertebra screws was concerned, group A was 1.7±0.3 and group B was 1.3±0.4, which showed no significant difference (P＜0.05). Conclusions The imbalance of the spinal alignment often happened tothoracic or lumbar dislocated fractures with long-segment instrumentation. The segments of instrumentation, the number of screws, pedicular screw and so on play an important role in postoperative spinal alignment.
Thoracolumbar fracture / Dislocated / Alignment / Long-segment instrumentation / Number of pedicle screw
[1] Norton RP, Milne EL, Kaimrajh DN, et al. Biomechanical analysis of four- versus six-screw constructs for short-segment pedicle screw and rod instrumentation of unstable thoracolumbar fractures[J]. Spine J, 2014, 14(8):1734-1739.
[2] Scheer JK, Bakhsheshian J, Fakurnejad S, et al. Evidence-based medicine of traumatic thoracolumbar burst fractures: a systematic rReview of operative management across 20 years[J]. Global Spine J, 2014, 5(1):73-82.
[3] Xu B, Tang T, Yang H. Long-term results of thoracolumbar and lumbar burst fractures after short-segment pedicle instrumentation, with special reference to implant failure and correction loss[J]. Orthop Surg, 2009, 1(2):85-93.
[4] Wood KB, Li W, Lebl DS, et al. Management of thoracolumbar spine fractures[J]. Spine J, 2014, 14(1): 145-164.
[5] Hasegewa K, Kitahara K, Hara T, et al. Biomechanical evaluation of segmental instability in degenerative lumbar spondylolisthesis[J]. Eur Spine J, 2009,18(4): 465-470.
[6] Hitchon PW, He W, Viljoen S, et al. Predictors of outcome in the non-operative management of thoracolumbar and lumbar burst fractures[J]. Br J Neurosurg, 2014, 28(5): 653-657.
[7] Reinhold M, Knop C, Beisse R, et al. Operative treatment of 733 patients with acute thoracolumbar spinal injuries: comprehensive results from the second, prospective, internet-based multicenter study of the Spine Study Group of the German Association of Trauma Surgery[J]. Eur Spine J, 2010, 19(10): 1657-1676.
[8] Tezeren G, Kuru I. Posterior fixation of thoracolumbar burst fracture[J]. J Spinal Disord Tech, 2005, 18(6):485-488.
[9] Afzal S, Akbar S, Dhar SA. Short segment pedicle screw instrumentation and augmentation vertebroplasty in lumbar burst fractures: an experience[J]. Eur Spine J, 2008, 17(3):336-341.
[10] Park S, Na H, Kim J, et al. More than 5-year follow-up results of two-level and three-level posterior fixations of thoracolumbar burst fractures with load-sharing scores of seven and eight points[J]. Clin Orthop Surg, 2016, 8(1):71-77.
[11] 李晶，吕国华，王冰，等. 胸腰椎骨折脱位伤椎固定的可行性研究[J]. 中华骨科杂志, 2005, 25(5):2 93-296.
[12] 杨勇，邹琳，江建明，等. 胸腰椎二柱和三柱损伤短节段固定的稳定性比较[J]. 中国临床解剖学杂志, 2012, 30(2): 225-228.
[13] 杜心如，赵玲秀，石继川，等. 经伤椎椎弓根螺钉复位治疗胸腰椎爆裂骨折的临床解剖学研究[J]. 中国临床解剖学杂志, 2007, 25(3):239-242.
[14] Tan CE, Fok MW, Luk KD, et al. Insertional torque and pullout strength of pedicle screws with or without repositioning: a porcine study[J]. J Orthop Surg (Hong Kong), 2014, 22(2):224-227.
/
| 〈 |
|
〉 |
