Surgical treatment strategy for the “shell” phenomenon after thoracolumbar fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HU Haigang ,  LIN Xu , TAN Lun , WU Chao , ZHONG Zeli , ZENG Jun , DENG Jiayan

SectionⅠDepartment of Orthopaedics, the Fourth People’s Hospital of Zigong City, Zigong Sichuan, 643000, P.R.China;

Corresponding?author：

LIN Xu, Email: med_linxu@163.com

Keywords：

Thoracolumbar fracture; " shell” phenomenon; injured vertebral reconstruction; posterior approach

DOI：

10.7507/1002-1892.201806085

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To explore the surgical treatment strategy of the vertebral " shell” after thoracolumbar fracture, and provide clinical reference for the intervention and treatment of " shell”.Methods Between June 2015 and January 2017, 53 patients with high risk of vertebral " shell” after thoracolumbar fracture surgery were enrolled in a prospective study according to the selection criteria. All patients were randomly divided into two groups according to the order of treatment, 27 cases in the treatment group were treated with short-segment fixation combined with vertebral reconstruction, 26 cases in the control group were treated with short-segment fixation. There was no significant difference in gender, age, injury cause, Denis classification, fracture segment, the degree of injured vertebra compression, bone mineral density, and American Spinal Cord Injury Association (ASIA) classification between the two groups (P>0.05). The degree of injured vertebra compression, visual analogue scale (VAS) score, and Oswestry disability index (ODI) score at preoperation, immediate after operation, and last follow-up were calculated and compared between the two groups. The " shell” phenomenon and surgery complications were observed at the same time.Results All patients were followed up 12-18 months with an average of 14.4 months. There were 5 cases of " shell” phenomenon in the treatment group and 4 cases of nonunion at last follow-up, 23 cases of " shell” phenomenon in the control group and 19 cases of nonunion at last follow-up; there was a significant difference between the two groups (P<0.05). In the treatment group, 1 case had incision fat liquefaction and 4 cases had bone cement leakage; in the control group, 2 cases had screw loosening and 1 case had unilateral connecting rod rupture; there was no significant difference in the incidence of complications between the two groups (χ²=0.504, P=0.478). The degree of injured vertebra compression, VAS score, and ODI score were significantly improved in both groups at immediate after operation and last follow-up (P<0.05). There was no significant difference in the degree of injured vertebra compression between the two groups at immediate after operation (P>0.05), but which was significantly higher in the control group than that in the treatment group at last follow-up (P<0.05). Except that the ODI score of the control group was significantly higher than that of the treatment group at last follow-up (P<0.05), there was no significant difference in VAS score and ODI score between the two groups at the other time points (P>0.05).Conclusion The treatment of thoracolumbar fracture with short-segment fixation combined with injured vertebral reconstruction can effectively prevent the " shell” phenomenon, which is conducive to maintaining the height of injured vertebral and improving the long-term function. The effectiveness is satisfactory.

Citation： HU Haigang, LIN Xu, TAN Lun, WU Chao, ZHONG Zeli, ZENG Jun, DENG Jiayan. Surgical treatment strategy for the “shell” phenomenon after thoracolumbar fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(1): 49-55. doi: 10.7507/1002-1892.201806085 Copy

1.	劉列華, 趙斌, 周強. 傷椎椎體內強化治療胸腰椎骨折的現狀. 局解手術學雜志, 2016, 25(1): 62-65.
2.	郭克淼, 李晶. 胸腰椎爆裂骨折后路手術后椎體內空隙高度的CT影像測量及其臨床意義. 醫學臨床研究, 2017, 34(4): 658-663.
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.	胡海剛, 譚倫, 林旭, 等. 胸腰椎骨折復位術后椎體" 空殼現象”的相關因素分析. 中國脊柱脊髓雜志, 2017, 27(3): 242-247.
5.	胡海剛, 林旭, 譚倫, 等. 胸腰椎骨折后路復位術后椎體" 空殼”現象的影像學研究. 中國修復重建外科雜志, 2017, 31(8): 976-981.
6.	譚倫, 吳超, 羅小中, 等. 以椎板邊緣對腰椎椎弓根螺釘進釘點的個體化定位. 中國矯形外科雜志, 2008, 16(3): 207-210.
7.	葉晶華, 王劍鋒, 顧豪杰, 等. 對不同年齡段胸腰椎骨折復位后" 空殼”現象的處理. 吉林醫學, 2016, 37(4): 808-810.
8.	姜猛. 胸腰椎骨折去除內固定后" 蛋殼樣椎體”與椎體矯正度丟失關系的有限元分析. 石家莊: 河北醫科大學, 2014.
9.	Kopperdahl DL, Morgan EF, Keaveny TM. Quantitative computed tomography estimates of the mechanical properties of human vertebral trabecular bone. J Orthop Res, 2002, 20(4): 801-805.
10.	王翔, 瞿東濱, 蔡毅, 等. 胸腰椎骨折內固定術后傷椎椎體中央高度恢復的影像學研究及臨床意義. 中國脊柱脊髓雜志, 2016, 26(12): 1087-1092.
11.	朱勁松, 楊民, 徐祝軍, 等. 后路經椎弓根螺釘內固定治療胸腰椎骨折治療失敗原因分析. 中華創傷骨科雜志, 2016, 18(3): 253-256.
12.	Aono H, Tobimatsu H, Ariga K, et al. Surgical outcomes of temporary short-segment instrumentation without augmentation for thoracolumbar burst fractures. Injury, 2016, 47(6): 1337-1344.
13.	Kao FC, Hsieh MK, Yu CW, et al. Additional vertebral augmentation with posterior instrumentation for unstable thoracolumbar burst fractures. Injury, 2017, 48(8): 1806-1812.
14.	李國慶, 馬維虎, 孫韶華, 等. 體位復位結合釘棒系統及經皮椎體后凸成形術治療骨質疏松性胸腰段爆裂骨折. 中華創傷雜志, 2017, 33(3): 230-234.
15.	胡海剛, 譚倫, 林旭, 等. 經傷椎椎弓根植骨置釘后路復位內固定術治療胸腰椎骨折. 中國脊柱脊髓雜志, 2011, 21(8): 663-668.
16.	印飛, 孫振中, 殷渠東, 等. 短節段椎弓根釘固定聯合重組人BMP-2和同種異體骨植骨治療胸腰椎爆裂骨折. 中國修復重建外科雜志, 2017, 31(9): 1080-1085.
17.	張君哲, 朱康. 經椎弓根椎體內植骨對胸腰椎骨折復位術后防止矯正度丟失的作用研究. 臨床和實驗醫學雜志, 2017, 16(6): 575-577.
18.	林玉江, 楊利民, 楊健. 經皮穿刺加壓植入骨棒骨粉椎體成形治療胸腰椎體壓縮性骨折:恢復傷椎結構完整性和穩定性. 中國組織工程研究, 2017, 21(23): 3670-3675.
19.	李益明, 夏計劃, 姜效韋, 等. 經椎弓根植骨聯合椎弓根釘內固定治療胸腰段椎體爆裂骨折的療效分析. 中國骨與關節損傷雜志, 2017, 32(7): 734-736.
20.	周江軍. 相鄰節段骨水泥強化椎弓根螺釘固定聯合傷椎植骨置釘治療重度骨質疏松性胸腰椎骨折. 中國脊柱脊髓雜志, 2016, 26(7): 662-664.

1. 劉列華, 趙斌, 周強. 傷椎椎體內強化治療胸腰椎骨折的現狀. 局解手術學雜志, 2016, 25(1): 62-65.
2. 郭克淼, 李晶. 胸腰椎爆裂骨折后路手術后椎體內空隙高度的CT影像測量及其臨床意義. 醫學臨床研究, 2017, 34(4): 658-663.
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. 胡海剛, 譚倫, 林旭, 等. 胸腰椎骨折復位術后椎體" 空殼現象”的相關因素分析. 中國脊柱脊髓雜志, 2017, 27(3): 242-247.
5. 胡海剛, 林旭, 譚倫, 等. 胸腰椎骨折后路復位術后椎體" 空殼”現象的影像學研究. 中國修復重建外科雜志, 2017, 31(8): 976-981.
6. 譚倫, 吳超, 羅小中, 等. 以椎板邊緣對腰椎椎弓根螺釘進釘點的個體化定位. 中國矯形外科雜志, 2008, 16(3): 207-210.
7. 葉晶華, 王劍鋒, 顧豪杰, 等. 對不同年齡段胸腰椎骨折復位后" 空殼”現象的處理. 吉林醫學, 2016, 37(4): 808-810.
8. 姜猛. 胸腰椎骨折去除內固定后" 蛋殼樣椎體”與椎體矯正度丟失關系的有限元分析. 石家莊: 河北醫科大學, 2014.
9. Kopperdahl DL, Morgan EF, Keaveny TM. Quantitative computed tomography estimates of the mechanical properties of human vertebral trabecular bone. J Orthop Res, 2002, 20(4): 801-805.
10. 王翔, 瞿東濱, 蔡毅, 等. 胸腰椎骨折內固定術后傷椎椎體中央高度恢復的影像學研究及臨床意義. 中國脊柱脊髓雜志, 2016, 26(12): 1087-1092.
11. 朱勁松, 楊民, 徐祝軍, 等. 后路經椎弓根螺釘內固定治療胸腰椎骨折治療失敗原因分析. 中華創傷骨科雜志, 2016, 18(3): 253-256.
12. Aono H, Tobimatsu H, Ariga K, et al. Surgical outcomes of temporary short-segment instrumentation without augmentation for thoracolumbar burst fractures. Injury, 2016, 47(6): 1337-1344.
13. Kao FC, Hsieh MK, Yu CW, et al. Additional vertebral augmentation with posterior instrumentation for unstable thoracolumbar burst fractures. Injury, 2017, 48(8): 1806-1812.
14. 李國慶, 馬維虎, 孫韶華, 等. 體位復位結合釘棒系統及經皮椎體后凸成形術治療骨質疏松性胸腰段爆裂骨折. 中華創傷雜志, 2017, 33(3): 230-234.
15. 胡海剛, 譚倫, 林旭, 等. 經傷椎椎弓根植骨置釘后路復位內固定術治療胸腰椎骨折. 中國脊柱脊髓雜志, 2011, 21(8): 663-668.
16. 印飛, 孫振中, 殷渠東, 等. 短節段椎弓根釘固定聯合重組人BMP-2和同種異體骨植骨治療胸腰椎爆裂骨折. 中國修復重建外科雜志, 2017, 31(9): 1080-1085.
17. 張君哲, 朱康. 經椎弓根椎體內植骨對胸腰椎骨折復位術后防止矯正度丟失的作用研究. 臨床和實驗醫學雜志, 2017, 16(6): 575-577.
18. 林玉江, 楊利民, 楊健. 經皮穿刺加壓植入骨棒骨粉椎體成形治療胸腰椎體壓縮性骨折:恢復傷椎結構完整性和穩定性. 中國組織工程研究, 2017, 21(23): 3670-3675.
19. 李益明, 夏計劃, 姜效韋, 等. 經椎弓根植骨聯合椎弓根釘內固定治療胸腰段椎體爆裂骨折的療效分析. 中國骨與關節損傷雜志, 2017, 32(7): 734-736.
20. 周江軍. 相鄰節段骨水泥強化椎弓根螺釘固定聯合傷椎植骨置釘治療重度骨質疏松性胸腰椎骨折. 中國脊柱脊髓雜志, 2016, 26(7): 662-664.

Chinese Journal of Reparative and Reconstructive Surgery

Surgical treatment strategy for the “shell” phenomenon after thoracolumbar fracture

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