Introduction

Spinal fractures with a split component present specific bone union problems (pseudarthrosis). The purpose of this study was to assess the rate of pseudarthrosis after stand-alone percutaneous kyphoplasties and analyze clinical and radiographic parameters that are predictive of its efficacy in thoracolumbar spine fractures with a split-type of injury.

Hypothesis

Stand-alone kyphoplasty results in satisfactory bone union of the treated vertebral body despite the diastasis of fracture fragments.

Materials and methods

A retrospective single-center study of 36 patients with posttraumatic monosegmental thoracolumbar vertebral fractures, that were classified as either Magerl A2 or A3.2, without any neurologic deficits. Patients were treated with percutaneous kyphoplasty and PMMA bone cement. The assessment included both clinical (visual analog pain scale [VAS] and Oswestry disability index) and radiographic (pseudarthrosis, fracture gap, disk incarceration, vertebral height and length, and vertebral and regional kyphosis) criteria.

Results

A total of 36 patients (mean age 58 years) were included, with a mean follow-up of 19.1 months. Five of these patients (14%) had a pseudarthrosis. The fracture gap was significantly greater in these patients than in those who had bone union preoperatively (+3.94 mm, p < 0.001) and at the last follow-up consultation (+9.3 mm, p < 0.001). There was an association between the incarceration of adjacent disks located above (p = 0.008) and below (p = 0.003) the fracture site and the pseudarthrosis. The mean VAS decreased significantly on the first postoperative day (p < 0.001) and remained lower than the initial assessment until the last follow-up (p < 0.001).

Discussion

Stabilization by stand-alone kyphoplasty produces good clinical and radiographic results for split fractures, provided that the extent of the fragment diastasis has been carefully assessed preoperatively to prevent the risk of pseudarthrosis.

Level of evidence

IV; retrospective.

中文翻译：

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近期胸腰椎劈裂骨折的独立后凸成形术：19 个月时对 36 名患者的系列回顾

介绍

具有分裂组件的脊柱骨折存在特定的骨愈合问题（假关节）。本研究的目的是评估独立经皮椎体后凸成形术后假关节的发生率，并分析可预测其在伴有分裂型损伤的胸腰椎骨折中疗效的临床和影像学参数。

假设

尽管骨折碎片已分离，但独立的椎体后凸成形术可使受治疗的椎体获得令人满意的骨愈合。

材料和方法

一项针对 36 名创伤后单节段胸腰椎骨折患者的回顾性单中心研究，这些患者被分类为 Magerl A2 或 A3.2，没有任何神经功能障碍。患者接受经皮椎体后凸成形术和 PMMA 骨水泥治疗。评估包括临床（视觉模拟疼痛量表 [VAS] 和 Oswestry 残疾指数）和影像学（假关节、骨折间隙、椎间盘嵌顿、椎体高度和长度，以及椎体和区域后凸畸形）标准。

结果

总共包括 36 名患者（平均年龄 58 岁），平均随访时间为 19.1 个 月。这些患者中有 5 名 (14%) 患有假关节。这些患者的骨折间隙明显大于术前骨愈合 (+3.94 mm， p  <  0.001) 和最后一次随访会诊 (+9.3 mm，p  <  0.001)的患者。位于骨折部位上方 ( p  =  0.008) 和下方 ( p  =  0.003) 的相邻椎间盘嵌顿与假关节之间存在关联。术后第一天平均 VAS 显着下降 ( p  < 0.001)，并且在最后一次随访之前一直低于初始评估 ( p  <  0.001)。

讨论

如果在术前仔细评估骨折块分离的程度以防止假关节形成的风险，通过独立的椎体后凸成形术进行稳定可对劈裂骨折产生良好的临床和影像学结果。

证据等级

四；回顾性的。