方法:这是一项回顾性队列研究。
目的:本研究旨在比较微创手术(MIS)和开放手术(OS)在手术治疗的胸腰椎骨折中对整体矢状面对准(GSA)的影响。
背景:外伤性胸腰椎骨折(TLF)的最佳治疗方法仍存在争议。具有多轴螺钉的MIS技术和具有Schanz螺钉的OS技术都获得了广泛的使用。尚未报道每种技术对全局矢状面对齐的影响。
方法:从2014年到2021年,22例创伤性TLF患者使用开放的经椎弓根Schanz螺钉棒构建体进行了开放的后路稳定,并与15例使用多轴经皮椎弓根螺钉棒构建体进行了微创手术的患者进行了比较。在术前仰卧CT扫描和立即停止站立X射线以及最终随访全脊柱站立X射线上测得的报告放射学参数包括骨盆入射(PI),骨盆倾斜(PT),腰椎前凸(LL),术前节段性脊柱后凸(术前-K),术后即刻节段性脊柱后凸(postop-Ki),最终术后节段性脊柱后凸(post-Kf),矢状-垂直-轴(SVA),和脊柱-骶骨角(SSA)。
结果:OS组平均年龄为42.5岁;5例患者为AOB型,17例患者有AOA型(A3和A4)骨折。平均随访16.8个月。平均放射学参数为:PI=54.9°,PI-LL=3°,PT=17.6°,preop-K=16.2°,postop-Ki=8.7°,finalpostop-Kf=14.3°,SVA=4.58厘米,和SSA=101.8°。MIS组平均年龄为43.4岁;5例患者为AOB型,10例AOA型骨折。平均随访25个月。平均放射学参数如下:PI=51°,PI-LL=8°,PT=18°,preop-K=18.4°,postop-Ki=11.6°,postop-Kf=14.3°,SVA=6.4cm,SSA=106°。
结论:固定技术没有显著影响局部后凸和整体脊柱对准参数的最终矫正。
METHODS: This is a retrospective comparative cohort study.
OBJECTIVE: This study aims to compare the effects of minimally invasive surgery (MIS) and open surgery (OS) on global sagittal alignment (GSA) in surgically managed thoracolumbar fractures.
BACKGROUND: The optimal treatment of traumatic thoracolumbar fractures (TLF) remains controversial. Both MIS techniques with polyaxial screws and OS techniques with Schanz screws have gained widespread use. The effect of each technique on the global sagittal alignment has not been reported.
METHODS: From 2014 to 2021, 22 patients with traumatic TLF underwent open posterior stabilization using an open transpedicular Schanz screw-rod construct and were compared to 15 patients who underwent minimally invasive surgery using a polyaxial percutaneous pedicle screw-rod construct. The reported radiological parameters measured on preoperative supine CT scan and immediate postop standing X-ray and on final follow-up whole spine standing X-rays included pelvic incidence (PI), pelvic tilt (PT), lumbar
lordosis (LL), preoperative segmental kyphosis (Preop-K), immediate post-operative segmental kyphosis (postop-Ki), final post-operative segmental kyphosis (postop-Kf), sagittal-vertica-axis (SVA), and spino-sacral angle (SSA).
RESULTS: The average age of the OS group was 42.5 years; 5 patients had AO type B, and 17 patients had AO type A (A3 and A4) fractures. The average follow-up was 16.8 months. The average radiological parameters were: PI = 54.9°, PI-LL = 3°, PT = 17.6°, preop-K = 16.2°, postop-Ki = 8.7°, final postop-Kf = 14.3°, SVA = 4.58 cm, and SSA = 101.8°. The average age of the MIS group was 43.4 years; 5 patients had AO type B, and 10 patients had AO type A fractures. The average follow-up was 25 months. The average radiological parameters were as follows: PI = 51°, PI-LL = 8°, PT = 18°, preop-K = 18.4°, postop-Ki = 11.6°, postop-Kf = 14.3°, SVA = 6.4 cm, SSA = 106°.
CONCLUSIONS: The fixation technique did not significantly affect the final correction of the local kyphosis and global spine alignment parameters.