R A (2005)

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1 4, , 3 1 J Sp inal Surg, February 2005, Vol 3, No 1,,,,,, , 23,14 61,36. 7 : T 11 1 T L 1 33 L 2 12, L 1, 2 1L 2, 3 1 : 10, 58 : Z2PLATE43, PROF ILE19, ALPS6 : Frankel ASIA, ( Cobb ) (3 ), , 1. 25, ASIA CT MR I,,, ;;;;; ; R A (2005) An ter ior decom pression and bone graft w ith titan ic pla te f ixa tion for thoracolum bar fractures w ith sp ina l cord in ju2 r ies ZHOU Q iang, XU J ianzhong, TAN Zujian, et al. D epartm ent of O rthopaedics, Southw est Hospital, the Third M ilitary M edical U niversity, Chongqing , China Abstract O bjective To investigate the clinical effect of anterior decomp ression and bone graft with titanic p late fixation on thoracolumbar fractures with sp inal cord injuries. M ethods Sixty2eight cases of thoracolumbar fractures with sp inal cord injuries were treated by anterior decomp ression and structural bone graft with titanic p late fixation from M arch 1999 to May There were 45 males and 23 females aged from 14 to 61 years with an average of years. The fractures were located at T 11 in 1 case, T 12 in 20, L 1 in 33, L 2 in 12, L 1, 2 in 1 and L 2, 3 in 1. The states of p reoperative neurological function were comp lete parap legia in 10 cases and incomp lete parap legia in 58. The fixators were titanic Z2PLATE in 43 cases, PROF ILE in 19 and ALPS in 6. The materials for bone graft were auto2ilium in 45 cases and titanic mesh filled with auto2bone fragments in 23. The recovery of neurological function was evaluated according to Frankel grades and ASIA scores. The correction on the angle of sp inal deform ity( Cobb angle ), the area of decomp ression, the position of bone mass or titanic mesh and bone fusion were all exam ined by images. Results A ll of the 68 cases had successful operations. Sixty2five cases were followed up for months( mean months ). The postoperative neurological function was recovered partly or comp letely in 61 cases and imp roved by Frankel grades on average. The postoperative ASIA scores in all cases rised evidently. The CT scans and MR I scans showed that the comp ression of sp ine cord was comp letely relieved. Both ilium and titanic mesh did not loose and shift. Three sorts of titanic p late did not loose, shift and rup ture. The sp inal deform ities were well corrected without correction loss and imp lant failure at follow2up. The sp inal fusion was excellent in all follow2up cases. Conclusion Anterior decomp res2 sion surgery can make the comp ression of sp inal cord to be comp letely and safely relieved for thoracolumbar fractures with sp i2 nal cord injuries, and be used for the recovery of postoperative neurological function. The titanic p late fixation and structural bone graft can recover the stability of injuried sp ine with excellent bony fusion. Key words thoracic vertebrae; lumbar vertebrae; sp inal fractures; sp inal cord injuries; internal fixators; sp inal fusion J Sp inal Surg, 2005, 3 (1) : :( ),,,, : ,

2 , , 3 1 J Sp inal Surg, February 2005, Vol 3, No 1 5, [ 1 ],, [ 2 4 ], , T 11 L 2 MR I CT, 68, 45, 23,14 61, : 43, 18,7 X MR I ( ) CT :66,T 11 1 T L 1 33 L 2 12, 2, L 1, 2 L 2, 3 : 10, 58 ; 16,38, 14 ; Frankel, A 10, B 8, C 14, D 36 12,2,5,4, 1, 1 : Z - PLATE43, PROF ILE 19, ALPS6 : 45 23, ( ) : 1 14 d 55,5 7 d 37 ; d, 5 ;30 d 8, ,( ),,,,,3 /4, ; ;,, m l, 9, 7, d 5 7 d, h3 d,5 7 d dx, X MR I CT x gx s, SPSS10. 0 t, P < P < , , ,1, 19, 4, Frankel: (1) ASIA : ( ), ( ), ( ), ( ) ; ( ), ( ) ; ASIA ( P < 0. 01) :52, 30, 14, 8 XCobb 2, ( P < 0. 01), 94. 3%, 235,

6, 2005 2, 3 1 J Sp inal Surg, February 2005, Vol 3, No 1 ( P > 0. 05) X (2), ( P < 0. 01),82. 7% ; ( P > 0. 05), 2 4. 5 7. 8, 12 MR I, (1, 2) 1Frankel Tab.

3 6, , 3 1 J Sp inal Surg, February 2005, Vol 3, No 1 ( P > 0. 05) X (2), ( P < 0. 01),82. 7% ; ( P > 0. 05), , 12 MR I, (1, 2) 1Frankel Tab. 1 Preoperative and postoperative Frankel grades Preoperative grades n Postoperative grades A B C D E A B C D Total Cobb s Tab. 2 Preoperative and postoperative Cobb s angle of kyphosis and scoliosis Cobb s ( ) Cobb s angle of kyphosis Cobb s ( ) Cobb s angle of scoliosis Pre2op Post2op A t follow2up :, P < 0. 01;, P > Note: sp reoperative results, P < 0. 01; s the follow2up results, P > , 12, 2 6,,, 1 a, b X MR I L 1 c, d X MR I 2 a MR I L 2 L 3 b, c, d X MR I F ig. 1 a, b Preoperative lateral X2ray and MR I scan showed the comp ression of sp inal cord for L 1 fracture c, d Postoperative lateral X2ray and MR I scan showed the kyphosis was corrected and the comp ression of sp inal cord was relieved F ig. 2 a Preoperative MR I scan showed the comp ression of sp inal cord for L 2 and L 3 fractures b, c, d Postoperative positive and lateral X2rays and MR I scan showed the position of titanic mesh and the comp res2 sion of sp inal cord was relieved

4 , , 3 1 J Sp inal Surg, February 2005, Vol 3, No 1 7 3, [ 3 ],,,,, [ 1, 5 ],,,,, [ 4, 6 ],, [ 7 ],,,, :,,,,,,, [ 1, 5, 8 10 ], 68 Z - PLATE PROF ILE ALPS, X,, 10, 1, 3D ; 8 B, 1, 2D ; 14 C, 7, 6D ; 33 D,,, MR I, 50%,,,,, :,,,,,,,, ;,,:,,,,, 23,, [ 1 ] Gertzbein SD. Scoliosis Research Society. Multicenter sp ine frac2 ture study. Sp ine, 1992, 17: [ 2 ] Ghanayem AJ, Zbeblick TA. Anterior instrumentation in the man2 agement of throracolumbar burst fractures. Clin O rthop, 1997, (335) :

5 8, , 3 1 J Sp inal Surg, February 2005, Vol 3, No 1 [ 3 ] Parker JW, Lane JR, Karaikovic EE, et al. Successful short - segment instrumentation and fusion for thoracolumbar spine frac2 ture: a consecutive 41 /2 - year series. Spine, 2000, 25: [ 4 ],,,.., 2004, 24: [ 5 ] Gertzbein SD, Growe DJ, FaziM, et al. Canal clearance in burst fractures using the AO internal fixateur. Sp ine, 1992, 17: [ 6 ] M ler U, Berlemann U, Sledge J, et al. Treatment of thoracolum2 bar burst fractures without neurologic deficit by indirect reduction and posterior instrumentation: bisegmental stabilization with mono2 segmental fusion. Eur Spine, 1999, 8: [ 7 ] Steinmann JC, Herkowitz HN. Pseudarthrosis of the sp ine. Clin O rthop, 1992, (284) : [ 8 ] Zdeblick TA, Shirado O, McAfee PC, et al. Anterior sp inal fixa2 tion after corpectomy: a study in dogs. J Bone Joint Surg, 1991, 73A: [ 9 ] H itchon PW, Goel VK, Rogge T, et al. B iomechanical studies on two anterior thoracolumbar implants in cadaveric sp ines. Spine, 1999, 24: [ 10 ] Zdeblick TA, W arden KE, Zou D, et al. Anterior sp inal fix2 ators: a biomechanical in - vitro study. Sp ine, 1993, 18: (: ) ( ) : , : 00 23: 00, : 00 23: 00, 600 ;1000, : 1 ( ),,, 2: : 321 : : : E - mail: scoliosis2002@ sina. com www. sosscoliosis. com www. scoliosis2china. com

KumaFix fixation for thoracolumbar burst fractures: a prospective study on selective consecutive patients

$KumaFix fixation for thoracolumbar burst fractures: a prospective study on selective consecutive patients$ Xi an Hong Hui Hospital Xi an, Shaanxi, China KumaFix fixation for thoracolumbar burst fractures: a prospective study on selective consecutive patients Dingjun Hao, Baorong He, Liang Yan Hong Hui Hospital,