TREATMENT OF THORACOLUMBAR BURST FRACTURES BY POSTERIOR LAMINOTOMY DECOMPRESSION AND BONE GRAFTING VIA INJURED VERTEBRAE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHENTaiyong , LONGLingli , CAOGuangru , CAIYuqiang ,  LIAOWenbo

Department of Spinal Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003, P. R. China;

Corresponding?author：

LIAOWenbo, Email: wenbo900@sina.com

Keywords：

Thoracolumbar burst fracture; Spinal cord decompression; Bone grafting via injured vertebrae; Internal fixation

DOI：

10.7507/1002-1892.20140268

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To study the effectiveness of posterior laminotomy decompression and bone grafting via the injured vertebrae for treatment of thoracolumbar burst fractures. Methods Between November 2010 and November 2012, 58 patients with thoracolumbar burst fractures were treated by posterior fixation combined with posterior laminotomy decompression and intervertebral bone graft in the injured vertebrae. There were 40 males and 18 females with a mean age of 48 years (range, 25-58 years). According to Denis classification, 58 cases had burst fractures (Denis type B); based on neurological classification of spinal cord injury by American Spinal Injury Association (ASIA) classifications, 5 cases were rated as grade A, 18 cases as grade B, 20 cases as grade C, 14 cases as grade D, and 1 case as grade E. Based on thoracolumbar burst fractures CT classifications there were 5 cases of type A, 20 cases of type B1, 10 cases of type B2, and 23 cases of type C. The time between injury and operation was 10 hours to 9 days (mean, 7.2 days). The CT was taken to measure the space occupying of vertebral canal. The X-ray film was taken to measure the relative height of fractured vertebrae for evaluating the vertebral height restoration, Cobb angle for evaluating the correction of kyphosis, and ASIA classification was conducted to evaluate the function recovery of the spinal cord. Results The operations were performed successfully, and incisions healed primarily. All the patients were followed up 12-18 months (mean, 15 months). CT showed good bone graft healing except partial absorption of vertebral body grafted bone; no loosening or breakage of screws and rods occurred. The stenosis rates of fractured vertebral canale were 47.56%±14.61% at preoperation and 1.26%±0.62% at 1 year after operation, showing significant difference (t=24.46, P=0.00). The Cobb angles were (16.98±3.67)° at preoperation, (3.42±1.45)° at 1 week after operation, (3.82±1.60)° at 1 year after operation, and (4.84±1.70)° at 3 months after removal of internal fixation, showing significant differences between at pre-and post-operation (P < 0.05). The relative heights of fractured vertebrae were 57.10%±6.52% at preoperation, 96.26%±1.94% at 1 week after operation, 96.11%±1.97% at 1 year after operation, and 96.03%±1.96% at 3 months after removal of internal fixation, showing significant differences between at pre-and post-operation (P < 0.05). At 1 year after operation, the neural function was improved 1-3 grades in 56 cases. Based on ASIA classifications, 1 case was rated as grade A, 4 cases as grade B, 10 cases as grade C, 23 cases as grade D, and 20 cases as grade E. Conclusion Treatment of thoracic and lumbar vertebrae burst fractures by posterior laminotomy decompression and bone grafting via the injured vertebrae has satisfactory effectiveness, which can reconstruct vertebral body shape and height with spinal cord decompression and good vertebral healing. It is a kind of effective solution for thoracolumbar burst fracture.

Citation： CHENTaiyong, LONGLingli, CAOGuangru, CAIYuqiang, LIAOWenbo. TREATMENT OF THORACOLUMBAR BURST FRACTURES BY POSTERIOR LAMINOTOMY DECOMPRESSION AND BONE GRAFTING VIA INJURED VERTEBRAE. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(10): 1236-1240. doi: 10.7507/1002-1892.20140268 Copy

1.	McLain RF, Burkus JK, Benson DR.Segment instrumentation for thoracic and thoracolumbar fractures:prospective analysis of construct survival and five-year follow-up.Spine J, 2001, 1(5):310-323.
2.	陳善明, 陳琦, 劉學軍.經椎弓根植骨釘棒固定治療胸腰椎骨折.中國修復重建外科雜志, 2010, 24(2):245-246.
3.	敖俊, 辛志軍, 陳方, 等.兩種植骨法對胸腰椎爆裂骨折復位后骨缺損空隙殘存率及壓縮剛度的影響.中國修復重建外科雜志, 2013, 27(8):974-979.
4.	李利, 史亞民, 王華東, 等.胸腰椎爆裂骨折椎管內骨折塊CT分型及對后路減壓方式的意義.創傷外科雜志, 2006, 8(3):215-217.
5.	李欽亮, 劉藝, 儲照明, 等.經傷椎椎弓根椎體內植骨并植釘治療胸腰椎骨折.中國修復重建外科雜志, 2011, 25(8):956-959.
6.	宋躍明, 劉立岷, 龔全, 等.前路減壓固定植骨融合治療胸腰椎骨折合并脊髓損傷.中華創傷雜志, 2006, 22(1):20-23.
7.	楊曦, 宋躍明, 劉浩, 等.前路減壓n-HA/PA66支撐植骨內固定治療胸腰椎爆裂骨折的近期臨床效果.中國脊柱脊髓雜志, 2011, 21(11):885-889.
8.	楊雯棟, 王清, 蘭永樹, 等.前路減壓椎間支撐體周圍植骨治療胸腰椎骨折的療效觀察.中國脊柱脊髓雜志, 2013, 23(8):724-729.
9.	關驊.關注胸腰脊柱脊髓損傷的臨床研究.中國脊柱脊髓雜志, 2010, 20(9):705-706.
10.	成茂華, 鄭祖根, 張彩元, 等.胸腰段骨折椎管內骨折塊與脊髓損傷的關系.中國脊柱脊髓雜志, 2001, 11(5):275-277.
11.	周炳華, 江正康, 黃俊芳, 等.胸腰段爆裂骨折椎管狹窄程度與脊髓損傷關系的研究.臨床研究, 2007, 7(7):37-38.
12.	Karaikovi? EE, Pacheco HO.Treatment options for thoracolumbar spine fractures.Bosn J Basic Med Sci, 2005, 5(2):20-26.
13.	王偉, 尹宗生, 張輝, 等.椎管減壓在胸腰段骨折后路手術中的療效評價.中國修復重建外科雜志, 2011, 25(1):84-86.
14.	張貴林, 榮國威, 丁占云, 等.脊柱胸腰段骨折術后椎弓根螺釘斷裂及彎曲松動的原因分析.中華骨科雜志, 2000, 20(8):470-472.
15.	陳之青, 謝金兔, 顧曉民, 等.后路椎弓根釘結合椎體成形治療胸腰椎爆裂骨折.中國骨傷, 2010, 23(2):102-106.
16.	Marco RA, Kushwaha VP.Thoracolumbar burst fractures treated with posterior decompression and pedicle screw instrumentation supplemented with balloon-assisted vertebroplasty and calcium phosphate reconstruction.J Bone Joint Surg (Am), 2009, 91(1):20-28.
17.	賀新寧, 歐曄靈, 付軍初, 等.經皮椎體內植骨支撐成形術治療中青年胸腰椎骨折.中華創傷骨科雜志, 2010, 12(4):393-395.
18.	朱敏, 葉春萬, 甘業春, 等.計算骨喪失量經椎弓根打壓植骨治療胸腰椎壓縮性骨折.中華創傷骨科雜志, 2008, 10(6):592-593.
19.	Vaccaro AR, Lehman RA, Hurlbert RJ, et al.A new classification of thoracolumbar injuries:the importance of injury morphology, the integriy of the posterior ligamentous complex, and neurolcgic status.Spine (Phila Pa 1976), 2005, 30(20):2325-2333.
20.	Pappou IP, Papadopoulos EC, Swanson AN, et al.Osteoporotic vertebral fractures and collapse with intrahertebral vacuum sign (kummel's disease).Orthopedics, 2008, 31(1):61-66.
21.	Degreif J, Wenda K, Runkel M, et al.Rotational stability of the thoracolumbar spine after interlaminar ultrasound window, hemilaminectomy and laminectomy.A comparative experimental study.Unfallchirurg, 1994, 97(5):250-255.
22.	阮狄克, 呂維加, 費正奇, 等.節段開窗髓核摘除對腰椎穩定性的影響.中華骨科雜志, 1999, 19(5):269-271.
23.	胡龍駒, 馮新民, 陳鵬濤, 等.后路椎板開窗減壓加對側椎板植骨融合治療胸腰椎爆裂性骨折伴不全癱.中國矯形外科雜志, 2012, 20(22):2039-2042.
24.	Wood KB, Bohn D, Mehbod A.Anterior versus posterior treatment of stable thoracolumbar burst fractures without neurologic deficit:a prospective, randomized study.J Spinal Disord Tech, 2005, 18 Suppl:S15-23.

1. McLain RF, Burkus JK, Benson DR.Segment instrumentation for thoracic and thoracolumbar fractures:prospective analysis of construct survival and five-year follow-up.Spine J, 2001, 1(5):310-323.
2. 陳善明, 陳琦, 劉學軍.經椎弓根植骨釘棒固定治療胸腰椎骨折.中國修復重建外科雜志, 2010, 24(2):245-246.
3. 敖俊, 辛志軍, 陳方, 等.兩種植骨法對胸腰椎爆裂骨折復位后骨缺損空隙殘存率及壓縮剛度的影響.中國修復重建外科雜志, 2013, 27(8):974-979.
4. 李利, 史亞民, 王華東, 等.胸腰椎爆裂骨折椎管內骨折塊CT分型及對后路減壓方式的意義.創傷外科雜志, 2006, 8(3):215-217.
5. 李欽亮, 劉藝, 儲照明, 等.經傷椎椎弓根椎體內植骨并植釘治療胸腰椎骨折.中國修復重建外科雜志, 2011, 25(8):956-959.
6. 宋躍明, 劉立岷, 龔全, 等.前路減壓固定植骨融合治療胸腰椎骨折合并脊髓損傷.中華創傷雜志, 2006, 22(1):20-23.
7. 楊曦, 宋躍明, 劉浩, 等.前路減壓n-HA/PA66支撐植骨內固定治療胸腰椎爆裂骨折的近期臨床效果.中國脊柱脊髓雜志, 2011, 21(11):885-889.
8. 楊雯棟, 王清, 蘭永樹, 等.前路減壓椎間支撐體周圍植骨治療胸腰椎骨折的療效觀察.中國脊柱脊髓雜志, 2013, 23(8):724-729.
9. 關驊.關注胸腰脊柱脊髓損傷的臨床研究.中國脊柱脊髓雜志, 2010, 20(9):705-706.
10. 成茂華, 鄭祖根, 張彩元, 等.胸腰段骨折椎管內骨折塊與脊髓損傷的關系.中國脊柱脊髓雜志, 2001, 11(5):275-277.
11. 周炳華, 江正康, 黃俊芳, 等.胸腰段爆裂骨折椎管狹窄程度與脊髓損傷關系的研究.臨床研究, 2007, 7(7):37-38.
12. Karaikovi? EE, Pacheco HO.Treatment options for thoracolumbar spine fractures.Bosn J Basic Med Sci, 2005, 5(2):20-26.
13. 王偉, 尹宗生, 張輝, 等.椎管減壓在胸腰段骨折后路手術中的療效評價.中國修復重建外科雜志, 2011, 25(1):84-86.
14. 張貴林, 榮國威, 丁占云, 等.脊柱胸腰段骨折術后椎弓根螺釘斷裂及彎曲松動的原因分析.中華骨科雜志, 2000, 20(8):470-472.
15. 陳之青, 謝金兔, 顧曉民, 等.后路椎弓根釘結合椎體成形治療胸腰椎爆裂骨折.中國骨傷, 2010, 23(2):102-106.
16. Marco RA, Kushwaha VP.Thoracolumbar burst fractures treated with posterior decompression and pedicle screw instrumentation supplemented with balloon-assisted vertebroplasty and calcium phosphate reconstruction.J Bone Joint Surg (Am), 2009, 91(1):20-28.
17. 賀新寧, 歐曄靈, 付軍初, 等.經皮椎體內植骨支撐成形術治療中青年胸腰椎骨折.中華創傷骨科雜志, 2010, 12(4):393-395.
18. 朱敏, 葉春萬, 甘業春, 等.計算骨喪失量經椎弓根打壓植骨治療胸腰椎壓縮性骨折.中華創傷骨科雜志, 2008, 10(6):592-593.
19. Vaccaro AR, Lehman RA, Hurlbert RJ, et al.A new classification of thoracolumbar injuries:the importance of injury morphology, the integriy of the posterior ligamentous complex, and neurolcgic status.Spine (Phila Pa 1976), 2005, 30(20):2325-2333.
20. Pappou IP, Papadopoulos EC, Swanson AN, et al.Osteoporotic vertebral fractures and collapse with intrahertebral vacuum sign (kummel's disease).Orthopedics, 2008, 31(1):61-66.
21. Degreif J, Wenda K, Runkel M, et al.Rotational stability of the thoracolumbar spine after interlaminar ultrasound window, hemilaminectomy and laminectomy.A comparative experimental study.Unfallchirurg, 1994, 97(5):250-255.
22. 阮狄克, 呂維加, 費正奇, 等.節段開窗髓核摘除對腰椎穩定性的影響.中華骨科雜志, 1999, 19(5):269-271.
23. 胡龍駒, 馮新民, 陳鵬濤, 等.后路椎板開窗減壓加對側椎板植骨融合治療胸腰椎爆裂性骨折伴不全癱.中國矯形外科雜志, 2012, 20(22):2039-2042.
24. Wood KB, Bohn D, Mehbod A.Anterior versus posterior treatment of stable thoracolumbar burst fractures without neurologic deficit:a prospective, randomized study.J Spinal Disord Tech, 2005, 18 Suppl:S15-23.

Chinese Journal of Reparative and Reconstructive Surgery

TREATMENT OF THORACOLUMBAR BURST FRACTURES BY POSTERIOR LAMINOTOMY DECOMPRESSION AND BONE GRAFTING VIA INJURED VERTEBRAE

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content