Levent ÇELEBİ, Özgür DOĞAN, HASAN HİLMİ MURATLI, Mehmet Fırat YAĞMURLU, ALİ BİÇİMOĞLU

Torakolomber vertebranın patlama kırıklarında kısa segment posterior enstrümantasyonun etkinliği

Amaç: Torakolomber vertebra kırıklarının kısa segment posterior enstrümantasyonunun sonuçları değerlendirildi, radyografik ve fonksiyonel sonuçlar arasındaki ilişki incelendi ve düzeltme kaybına etki eden faktörler araştırıldı. Çalışma planı: Çalışmaya torakal veya lumbar vertebra patlama kırığı nedeniyle pedikül vidaları ile kısa segment posterior enstrümantasyon ve füzyon uygulanan 48 hasta (30 erkek, 18 kadın; ort. yaş 40±14; dağılım 18-67) alındı. En sık tutulum seviyesi 18 hastada L1 (%37.5), 11 hastada T12 (%22.9) idi. Frankel derecelendirmesine göre altı hastada tam, 14 hastada inkomplet nörolojik defisit vardı. Tüm hastalarda Cobb açıları ve bilgisayarlı tomografide kanal işgali ölçüldü. Fonksiyonel değerlendirmede Denis ağrı ve iş skalaları kullanıldı; bu skalalardan modifiye fonksiyonel sonuçlar (MFS) çıkarıldı. Ortalama takip süresi 21.7±9.1 ay (dağılım 12-48 ay) idi. Sonuçlar: Cobb açısındaki ortalama düzelme 18.2±8.6° (p

Anahtar Kelimeler:

Omurga kırıkları, Ağrı ölçümü, Torasik omurga, Sırt ağrısı, Kırık tespiti, intramedüller, Kifoz, Lumbar omurga, Tedavi sonucu

The effectiveness of short-segment posterior instrumentation of thoracolumbar burst fractures

Objectives: We evaluated the results of short-segment posterior instrumentation of thoracolumbar burst fractures and investigated correlations between radiographic and functional results as well as factors that affected correction losses. Methods: We reviewed 48 patients (30 males, 18 females; mean age 40±14 years; range 18 to 67 years) who underwent short-segment posterior instrumentation with pedicle screws and fusion. The most common involvement was at L1 in 18 patients (37.5%), followed by T12 in 11 patients (22.9%). According to the Frankel grading system, six patients had complete, 14 patients had incomplete neurologic deficits. The Cobb angles were measured, and canal remodeling was assessed by computed tomography. Modified functional results were derived using the Denis pain and work scales. The mean follow- up was 21.7±9.1 months (range 12 to 48 months). Results: The mean correction in the Cobb angle was 18.2±8.6° (p<0.01), the mean correction loss was 7.4±5.7° (p<0.01), and the mean canal remodeling was 51.3±9.3% (p<0.001). There was a significant correlation between Cobb angle correction and correction loss (r=0.38, p<0.01). An intraoperative correction of greater than 15° was significantly associated with a greater correction loss (p<0.05). Patients with a correction loss of more than 10° had a significantly poorer Denis pain score and modified functional result (p<0.05). Modified functional results were excellent in 16 patients (33.3%), good in 23 patients (47.9%), fair in seven patients (14.6%), and poor in two patients (4.2%). At final follow- ups, the Cobb angle was not correlated with functional results (p>0.05). All the patients having incomplete neurologic deficits improved by at least 1 Frankel grade. Conclusion: An intraoperative correction exceeding 15° is significantly associated with a greater correction loss, which in turn has a significantly adverse effect on functional results. Key words: Fracture fixation, internal; kyphosis/etiology; lumbar vertebrae/surgery/radiography; spinal canal/pathology; spinal fractures/ surgery; thoracic vertebrae/surgery/radiography.

Keywords:

Spinal Fractures, Pain Measurement, Thoracic Vertebrae, Back Pain, Fracture Fixation, Intramedullary, Kyphosis, Lumbar Vertebrae, Treatment Outcome,

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