医学
后凸
失血
围手术期
外科
植入物失效
可视模拟标度
柯布角
射线照相术
神经外科
固定(群体遗传学)
透视
植入
人口
环境卫生
作者
Junxin Zhang,Hao Liu,Hui Liu,Angela Carley Chen,Fan He,Feng Zhou,Huilin Yang,Tao Liu
标识
DOI:10.1007/s00586-018-5822-7
摘要
To compare intermediate screws (IS) with kyphoplasty (KP) in posterior short-segment fixation (PSSF) for patients with single-level thoracolumbar burst fractures. Between 2010 and 2016, 1465 patients were retrospectively reviewed; 48 patients were enrolled with a minimal follow-up of 2 years. Perioperative and functional outcomes were compared. The regional Cobb angle (CA) was included in radiographic analysis. Implant failures or CA correction loss over 10° were regarded as surgical failures. Multiple linear regression was performed to investigate the risk factors of kyphosis recurrence. Fluoroscopic time (23.7 ± 3.6 vs. 79.3 ± 12.1 s, p < 0.001), operative time (109.6 ± 13.1 vs. 123.8 ± 19.0 min, p = 0.006) and blood loss (104.6 ± 34.9 vs. 129.1 ± 21.7 ml, p = 0.005) were all lower in the IS group. The KP group had lower Visual Analogue Scale scores (3.3 ± 0.9 vs. 2.7 ± 0.8, p = 0.028) and greater anterior body height (ABH) (30.3 ± 9.0 vs. 36.3 ± 11.0%, p = 0.044) after surgery, and less correction loss (5.6 ± 2.7 vs. 0.4 ± 1.2%, p < 0.001). Both groups had a CA correction loss of 4° with a 10% failure rate. The A3 Magerl subclassification, smaller preoperative ABH and smaller postoperative CA had positive correlations with CA correction loss. PSSF with KP provides better back pain relief, greater ABH reduction and less correction loss, while IS has the advantages of less operative time, fluoroscopic time and blood loss. Magerl subclassification of burst fracture is a potential predictor for recurrent kyphosis. Reducing fractured vertebral body height rather than segmental curvature may be more important in PSSF. Retrospective, non-randomized controlled study. These slides can be retrieved under Electronic Supplementary Material.
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