BALLOON VERTEBROPLASTY COMBINED WITH SHORT-SEGMENT PEDICLE SCREW INSTRUMENTATION FOR TREATMENT OF THORACOLUMBAR BURST FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 JIAQiyu , HULianying , YUYu , WANGLin , GUOWangen

Department of Orthopedics, the Second People's Hospital of Hefei, Hefei Anhui, 230011, P. R. China;

Corresponding author：

JIAQiyu, Email: huliany8007@sina.com

Keywords：

Thoracolumbar burst fracture; Pedicle screw; Vertebroplasty; Balloon; Calcium sulfate cement

DOI：

10.7507/1002-1892.20150159

Video：

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Objective To investigate the short-term effectiveness of balloon vertebroplasty combined with short-segment pedicle screw instrumentation for the treatment of thoracolumbar burst fractures. Methods Between June 2011 and December 2013, 22 patients with thoracolumbar burst fractures were included. There were 14 males and 8 females, aged 20-60 years (mean, 42.5 years). The fracture segments included T₁₁ in 1 case, T₁₂ in 4 cases, L₁ in 10 cases, L₂ in 6 cases, and L₃ in 1 case. According to AO classification system, there were 13 cases of type A and 9 cases of type B. Spinal cord injury was classified as grade C in 2 cases, grade D in 3 cases, and grade E in 17 cases according to Frankel scale. The time from injury to operation was 3-10 days (mean, 5.5 days). All patients underwent posterior reduction and fixation via the injured vertebra, transpedicular balloon reduction of the endplate and calcium sulfate cement (CSC) injection. The ratio of anterior vertebral height, the ratio of central vertebral height, the sagittal Cobb angle, the restoration of nervous function, and internal fixation failure were analyzed. Results Primary healing of incision was obtained in the others except 2 cases of poor healing, which was cured after dressing change or debridement. All the patients were followed up 9-40 months (mean, 15 months). CSC leakage occurred in 2 cases. Absorption of CSC was observed at 8 weeks after operation with complete absorption time of 12-16 weeks (mean, 13.2 weeks). The mean fracture healing time was 18.5 weeks (range, 16-20 weeks). The ratio of anterior vertebral height, ratio of central vertebral height, and sagittal Cobb angle were significantly improved at 1 week and 3 months after operation and last follow-up when compared with preoperative values (P<0.01), but no significant difference was found among 3 time points after operation (P>0.01). There was no internal fixation failure or Cobb angle loss more than 10°. Frankel scale was improved with no deterioration of neurologic function injury. Conclusion Balloon vertebroplasty combined with short-segment pedicle screw instrumentation is simple and safe for the treatment of thoracolumbar burst fractures, and it can improve the quality of reduction, restore vertebral mechanical performance effectively, and prevent the loss of correction and internal fixation failure.

Citation： JIAQiyu, HULianying, YUYu, WANGLin, GUOWangen. BALLOON VERTEBROPLASTY COMBINED WITH SHORT-SEGMENT PEDICLE SCREW INSTRUMENTATION FOR TREATMENT OF THORACOLUMBAR BURST FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(6): 741-745. doi: 10.7507/1002-1892.20150159 Copy

1.	Knop C, Fabian HF, Bastian L, et al. Late results of thoracolumbar fractures after posterior instrumentation and transpedicular bone grafting. Spine (Phila Pa 1976), 2001, 26(1):88-99.
2.	Alanay A, Acaroglu E, Yazici M, et al. Short-segment pedicle instrumentation of thoracolumbar burse fractures:does transpedicular intracorporeal grafting prevent early failure? Spine (Phila Pa 1976), 2001, 26(2):213-217.
3.	徐宝山, 唐天驷, 杨惠林, 等. 经后路短节段椎弓根内固定治疗胸腰椎爆裂型骨折的远期疗效. 中华骨科杂志, 2002, 22(11):641-647.
4.	Altay M, Ozkurt B, Aktekin CN, et al. Treatment of unstable thoracolumbar junction burse fractures with short or long segment posterior fixation in magerl type a fractures. Eur Spine J, 2007, 16(8):1145-1155.
5.	Verlaan JJ, Diekerhof CH, Buskens E, et al. Surgical treatment of traumatic fractures of the thoracic and lumbar spine:a systematic review of the literature on techniques, complications, and outcome. Spine (Phila Pa 1976), 2004, 29(7):803-814.
6.	张英泽, 李宝俊, 张奇, 等. 胸腰椎骨折椎弓根内固定术后失败原因探讨. 中华骨科杂志, 2009, 29(1):7-11.
7.	Oner FC, van der Rijt RR, Ramos LM, et al. Changs in the disc space after fractures of thoracolumbar. J Bone Joint Surg (Br), 1998, 80(5):833-839.
8.	Verlaan JJ, Dhert WJ, Verbout AJ, et al. Balloon vertebroplasty in combination with pedical screw instrumentation:a novel technique to treat thoracic and lumbar burst fractures. Spine (Phila Pa 1976), 2005, 30(3):E73-E79.
9.	Daniaux H. Transpedicular repositioning and spongioplasty in fractures of the vertebral bodies of the lower thoracic and lumbar spine. Unfallchirurg, 1986, 89(5):197-213.
10.	马信龙. 胸腰椎骨折的外科治疗研究进展. 中华创伤杂志, 2013, 29(6):489-492.
11.	Grabowski G, Cornett CA. Bone graft and bone graft substitutes in spine surgery:current concepts and controversies. J Am Acad Orthop Surg, 2013, 21(1):51-60.
12.	Yeom JS, Kim WJ, Choy WS, et al. Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures. J Bone Joint Surg (Br), 2003, 85(2):83-89.
13.	Mahar A, Kim C, Wedemeyer M, et al. Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine (Phila Pa 1976), 2007, 32(14):1503-1507.
14.	贾其余, 王林, 俞宇, 等. 经伤椎与跨伤椎后路短节段内固定治疗胸腰椎爆裂性骨折的对比研究. 中国骨与关节损伤杂志, 2014, 29(9):869-871.
15.	朱云荣, 叶晓健, 余将民, 等. 短节段经伤椎椎弓根螺钉治疗胸腰段骨折. 中华创伤杂志, 2010, 26(3):221-224.
16.	曾至立, 程黎明, 高生, 等. 短节段椎弓根螺钉固定结合椎体增强术治疗胸腰椎爆裂性骨折. 中华骨科杂志, 2011, 31(9):927-931.
17.	Zhu X, Chen X, Chen C, et al. Evaluation of calcium phosphate and calcium sulfate as injectable bone cements in sheep vertebrae. J Spinnal Disord Tech, 2012, 25(6):333-337.
18.	星杰, 吴小涛, 张绍东, 等. 硫酸钙骨水泥降解成骨性能的实验研究. 中华创伤骨科杂志, 2007, 9(8):717-719.

1. Knop C, Fabian HF, Bastian L, et al. Late results of thoracolumbar fractures after posterior instrumentation and transpedicular bone grafting. Spine (Phila Pa 1976), 2001, 26(1):88-99.
2. Alanay A, Acaroglu E, Yazici M, et al. Short-segment pedicle instrumentation of thoracolumbar burse fractures:does transpedicular intracorporeal grafting prevent early failure? Spine (Phila Pa 1976), 2001, 26(2):213-217.
3. 徐宝山, 唐天驷, 杨惠林, 等. 经后路短节段椎弓根内固定治疗胸腰椎爆裂型骨折的远期疗效. 中华骨科杂志, 2002, 22(11):641-647.
4. Altay M, Ozkurt B, Aktekin CN, et al. Treatment of unstable thoracolumbar junction burse fractures with short or long segment posterior fixation in magerl type a fractures. Eur Spine J, 2007, 16(8):1145-1155.
5. Verlaan JJ, Diekerhof CH, Buskens E, et al. Surgical treatment of traumatic fractures of the thoracic and lumbar spine:a systematic review of the literature on techniques, complications, and outcome. Spine (Phila Pa 1976), 2004, 29(7):803-814.
6. 张英泽, 李宝俊, 张奇, 等. 胸腰椎骨折椎弓根内固定术后失败原因探讨. 中华骨科杂志, 2009, 29(1):7-11.
7. Oner FC, van der Rijt RR, Ramos LM, et al. Changs in the disc space after fractures of thoracolumbar. J Bone Joint Surg (Br), 1998, 80(5):833-839.
8. Verlaan JJ, Dhert WJ, Verbout AJ, et al. Balloon vertebroplasty in combination with pedical screw instrumentation:a novel technique to treat thoracic and lumbar burst fractures. Spine (Phila Pa 1976), 2005, 30(3):E73-E79.
9. Daniaux H. Transpedicular repositioning and spongioplasty in fractures of the vertebral bodies of the lower thoracic and lumbar spine. Unfallchirurg, 1986, 89(5):197-213.
10. 马信龙. 胸腰椎骨折的外科治疗研究进展. 中华创伤杂志, 2013, 29(6):489-492.
11. Grabowski G, Cornett CA. Bone graft and bone graft substitutes in spine surgery:current concepts and controversies. J Am Acad Orthop Surg, 2013, 21(1):51-60.
12. Yeom JS, Kim WJ, Choy WS, et al. Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures. J Bone Joint Surg (Br), 2003, 85(2):83-89.
13. Mahar A, Kim C, Wedemeyer M, et al. Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine (Phila Pa 1976), 2007, 32(14):1503-1507.
14. 贾其余, 王林, 俞宇, 等. 经伤椎与跨伤椎后路短节段内固定治疗胸腰椎爆裂性骨折的对比研究. 中国骨与关节损伤杂志, 2014, 29(9):869-871.
15. 朱云荣, 叶晓健, 余将民, 等. 短节段经伤椎椎弓根螺钉治疗胸腰段骨折. 中华创伤杂志, 2010, 26(3):221-224.
16. 曾至立, 程黎明, 高生, 等. 短节段椎弓根螺钉固定结合椎体增强术治疗胸腰椎爆裂性骨折. 中华骨科杂志, 2011, 31(9):927-931.
17. Zhu X, Chen X, Chen C, et al. Evaluation of calcium phosphate and calcium sulfate as injectable bone cements in sheep vertebrae. J Spinnal Disord Tech, 2012, 25(6):333-337.
18. 星杰, 吴小涛, 张绍东, 等. 硫酸钙骨水泥降解成骨性能的实验研究. 中华创伤骨科杂志, 2007, 9(8):717-719.

Chinese Journal of Reparative and Reconstructive Surgery

BALLOON VERTEBROPLASTY COMBINED WITH SHORT-SEGMENT PEDICLE SCREW INSTRUMENTATION FOR TREATMENT OF THORACOLUMBAR BURST FRACTURES

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