埼玉医科大学雑誌 第43巻 第2号 (2017年3月) 155-161頁◇論文(図表を含む全文)は，PDFファイルとなっています．
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Tetsuya Torio1,2)*, Jun Kikkawa1,2), Fumihiro Kannari1,2), Keiko Suzuki1,2), Manabu Nemoto2), Hiromi Oda1)
Short segment pedicle screw fixation (non-segmental SSPSF) is an excellent technique to preserve segmental motion for thoracolumbar burst fractures (TLBFs). However, unacceptable failures, such as vertebral collapse and progression of kyphosis, have been reported. Therefore, to evaluate the effectiveness of SSPSF with additional pedicle screws in the fractured vertebra (segmental SSPSF) in maintaining fracture reduction, a clinical course for patients was followed until after implant removal.
This study included 11 patients in a non-segmental group (Group A) and 24 patients in a segmental group (Group B). The mean age was 48.7 years and 46.9 years, and mean follow-up duration was 36 months and 29.4 months.
The anterior vertebral height compression ratio (AVHC) at the time of injury (pre-operatively) in Group A and Group B was 41.67 % and 38.38 % (P=0.62). The local kyphosis angle (KA) was 14.55° and 14.04° (P=0.88). The immediate postoperative AVHC was 15.25 % and 10.88 %, respectively (P=0.08); and the KA was 1.18° and 1.42° (P=0.91). Satisfactory initial reduction was achieved in both groups. At the time of bone union, the AVHC was significantly different, 30.69 % and 13.61 %, respectively (P<0.05), and the KA was significantly different, 16° and 4.46°, respectively (P<0.05). After implant removal, the AVHC correction loss was only 3.5 % and 2.27 %, and the KA loss was only 4.5° and 3.46°.
Satisfactory initial reduction and kyphosis correction were achieved with SSPSF. However, reduction and kyphosis correction were not adequately maintained by non-segmental SSPSF, but they were effectively maintained by segmental SSPSF with additional pedicle screws in the fractured vertebra. In addition, implant removal is recommended to regain segmental motion.
J Saitama Medical University 2017; 43(2): 155-161