Anterior stabilization of spine column in the staged surgical treatment of patients with fractures of thoracic and lumbar vertebrae with low bone mineral density

封面

如何引用文章

全文:

详细

Aim. To determine the clinical effectiveness of anterior stabilization in the surgical treatment of patients with traumatic injuries of the thoracic and lumbar spine with reduced bone mineral density.

Materials and methods. The study included 238 patients with thoracic and lumbar vertebral fractures with reduced bone mineral density (BMD). The age of patients is from 48 to 85 years. There are following types of fractures according to F. Magerl (1992): A1.2, A1.3, B1.2, B2.3. BMD of the vertebrae was decreased (T-score from –1.5 to –3.5).

Results. All patients underwent short segment transpedicular fixation (TPF) with four-screw systems. In group 1 were included 68 patients who underwent TPF without cemented augmentation of screws. Group 2 included 170 patients who underwent TPF reinforced with a cement. Both groups were divided into 2 subgroups. Subgroup 1.1 included patients, which were operated on in two stages. The first stage is TPF. The second stage is the anterior stabilization. Subgroup 1.2 included patients who underwent only TPF. Patients in group 2 were divided into two subgroups in a similar way. The results and complications according to clinical and spondylometric criteria were studied. Correlation analysis was performed between surgical technique, surgical tactics and the treatment results in the four selected subgroups. The observation period is at least 2 years.

Conclusion. 1. When using TPF with cement augmentation for the treatment of patients with fractures of the thoracic and lumbar spine with reduced BMD, the anterior stabilization of injured spinal motion segment as a second stage of surgical treatment does not provide clinical advantages compared to the use of only TPF with cement augmentation. 2. In case of cementless TPF in patients with reduced BMD, anterior stabilization of the injured spinal motion segment is necessary. Only when anterior stabilization is performed, the stability of fixation is ensured. It is sufficient to preserve the anatomical relationships restored during the operation and functional adaptation of patients in the long-term period after surgery.

作者简介

Asker Afaunov

Federal State Budgetary Institution of Higher Education “Kuban State Medical University” of the Ministry of Health of the Russian Federation

编辑信件的主要联系方式.
Email: afaunovkr@mail.ru
ORCID iD: 0000-0001-7976-860X

professor, MD, PhD

俄罗斯联邦, Krasnodar

Igor Basankin

State Budgetary Healthcare Institution “Research Institute — Regional Clinical Hospital No. 1 named after Professor S.V. Ochapovsky”

Email: basankin@rambler.ru
ORCID iD: 0000-0003-3549-0794

MD, PhD

俄罗斯联邦, Krasnodar

Karapet Takhmazyan

State Budgetary Healthcare Institution “Research Institute — Regional Clinical Hospital No. 1 named after Professor S.V. Ochapovsky”

Email: dr.karpo@gmail.com
ORCID iD: 0000-0002-4496-2709

Traumatologist-orthopedist, neurosurgeon. Physician of Neurosurgery department No. 3

俄罗斯联邦, Krasnodar

Abram Giulzatyan

State Budgetary Healthcare Institution “Research Institute — Regional Clinical Hospital No. 1 named after Professor S.V. Ochapovsky”

Email: abramgulz@gmail.com
ORCID iD: 0000-0003-1260-4007

MD

俄罗斯联邦, Krasnodar

Mikhail Mukhanov

Federal State Budgetary Institution of Higher Education “Kuban State Medical University” of the Ministry of Health of the Russian Federation

Email: pputinn@yandex.ru
ORCID iD: 0000-0002-9061-6014

MD

俄罗斯联邦, Krasnodar

Nikita Chaikin

State Budgetary Healthcare Institution “Stavropol Regional Clinical Hospital”

Email: ch.nik92@yandex.ru
ORCID iD: 0000-0003-4297-6653

Neurosurgeon

俄罗斯联邦, Stavropol

参考

  1. Мельниченко Г.А., Белая Ж.Е., Рожинская Л.Я., и др. Федеральные клинические рекомендации по диагностике, лечению и профилактике остеопороза. Проблемы эндокринологии. 2017;63(6):392-426. [Melnichenko GA, Belaya ZhE, Rozhinskaya LYa, et al. Russian federal clinical guidelines on the diagnostics, treatment, and prevention of osteoporosis. Problemy endokrinologii. 2017;63(6):392-426. (In Russ.)] https://doi.org/10.14341/probl2017636392-426.
  2. Лесняк О.М. Аудит состояния проблемы остеопороза в странах Восточной Европы и Центральной Азии 2010. Остеопороз и остеопатии. 2011;14(2):3-6. [Lesnyak OM. Audit of the state of osteoporosis in the countries of Eastern Europe and Central Asia 2010. Osteoporoz i osteopatii. 2011;14(2):3-6. (In Russ.)] https://doi.org/10.14341/osteo201123-6.
  3. European Prospective Osteoporosis Study (EPOS) Group; Felsenberg D, Silman AJ, Lunt M, et al. Incidence of vertebral fracture in Europe: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res. 2002;17(4):716-24. https://doi.org/10.1359/jbmr.2002.17.4.716.
  4. Dreimann M, Hempfing A, Stangenberg M, et al. Posterior vertebral column resection with 360-degree osteosynthesis in osteoporotic kyphotic deformity and spinal cord compression. Neurosurg Rev. 2018;41(1):221-8. https://doi.org/10.1007/s10143-017-0840-1.
  5. Iqbal MM. Osteoporosis: epidemiology, diagnosis, and treatment. South Med J. 2000;93(1):2-18. https://doi.org/10.1097/00007611-200093010-00002.
  6. Афаунов А.А., Басанкин И.В., Мишагин А.В., и др. Ревизионные операции в хирургическом лечении повреждений грудного и поясничного отделов позвоночника. Хирургия позвоночника. 2015;(4):8-16. [Afaunov AA, Basankin IV, Mishagin AV, et al. Revision procedures in the surgical treatment of thoracic and lumbar spine injuries. Khirurgiya pozvonochnika. 2015;(4):8-16. (In Russ.)] https://doi.org/ 10.14531/ss2015.4.8-16.
  7. Рахматиллаев Ш.Н., Рерих В.В., Садовой М.А. Особенности лечения переломов тел позвонков на фоне остеопороза. Хирургия позвоночника. 2006;(2):43-7. [Rakhmatillaev ShN, Rerikh VV, Sadovoy MA. Treatment of osteoporotic vertebral fractures. Hirurgiya pozvonochnika. 2006;(2):43-47. (In Russ.)] https://doi.org/10.14531/ss2006.2.43-47.
  8. Басанкин И.В., Тахмазян К.К., Афаунов А.А., и др. Способ профилактики переломов смежных позвонков при транспедикулярной фиксации на фоне остеопороза. Хирургия позвоночника. 2016;13(3):8-14. [Basankin IV, Takhmazyan KK, Afaunov AA, et al. Method for preventing fractures of adjacent vertebrae during transpedicular fixation in osteoporosis. Khirurgiya pozvonocnika. 2016;13(3):8-14. (In Russ.)] https://doi.org/10.14531/ss2016.3.8-14.
  9. Nguyen HV, Ludwig S, Gelb D. Osteoporotic vertebral burst fractures with neurologic compromise. J Spin Disorders Techniques. 2003;16(1):10-9. https://doi.org/10.1097/00024720-200302000-00003.
  10. Борисов А.К. Оперативное лечение переломов грудного и поясничного отделов позвоночника с применением траспедикулярной фиксации: Дис. … канд. мед. наук. М.; 2001. [Borisov AK. Operativnoe lechenie perelomov grudnogo i poyasnichnogo otdelov pozvonochnika s primeneniem traspedikulyarnoi fiksatsii. [dissertation abstract] Moscow; 2001. (In Russ.)]
  11. Афаунов А.А., Басанкин И.В., Тахмазян К.К. Анализ результатов применения транспедикулярной фиксации с цементной имплантацией винтов при лечении повреждений грудного и поясничного отделов позвоночника на фоне остеопороза. В сб.: Перспективы развития вертебрологии: инновационные технологии в лечении повреждений и заболеваний позвоночника и спинного мозга: Материалы IV съезда Межрегиональной общественной организации «Ассоциация хирургов-вертебрологов» с международным участием. M.; 2013. С. 10-16. [Afaunov AA, Basankin IV, Takhmazyan KK. Analysis of the results of the use of transpedicular fixation with cement implantation of screws in the treatment of injuries to the thoracic and lumbar spine against the background of osteoporosis. In: Perspektivy razvitiya vertebrologii: innovatsionnye tekhnologii v lechenii povrezhdeniy i zabolevaniy pozvonochnika i spinnogo mozga: Proceedings of IV Congress with international participation of Interregional Public Organization “Association of Surgeons-Vertebrologists”. Moscow; 2013. P. 10-16. (In Russ.)]
  12. Shota T, Yoshihiro M, Noboru H, Takeshi F. Major surgical treatment of osteoporotic vertebral fractures in the elderly: a comparison of anterior spinal fusion, anterior-posterior combined surgery and posterior closing wedge osteotomy. Asian Spine J. 2014;8(3):322-30. https://doi.org/10.4184/asj.2014.8.3.322.
  13. Kashii M, Yamazaki R, Yamashita T, et al. Surgical treatment for osteoporotic vertebral collapse with neurological deficits: retrospective comparative study of three procedures—anterior surgery versus posterior spinal shorting osteotomy versus posterior spinal fusion using vertebroplasty. Eur Spine J. 2013;22(7):1633-42. https://doi.org/10.1007/s00586-013-2759-8.
  14. Charlson ME, Pompei P, Ales KL, McKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987;40(5):373-83. https://doi.org/10.1016/0021-9681(87)90171-8.
  15. Cook SD, Salkeld SL, Stanley T, et al. Biome- chanical study of pedicle screw fixation in severely osteoporotic bone. Spine J. 2004;4(4):402-8. https://doi.org/10.1016/j.spinee.2003.11.010.
  16. El Saman A, Meier S, Sander A, et al. Reduced loosening rate and loss of correction following posterior stabilization with or without PMMA augmentation of pedicle screws in vertebral fractures in the elderly. Eur J Trauma Emerg Surg. 2013;39(5): 455-60. https://doi.org/10.1007/s00068-013-0310-6.
  17. Яриков А.В., Денисов А.А., Масевнин С.В., и др. Остео-пороз в практике вертебролога. Врач. 2020;(3):11-8. [Yarikov AV, Denisov AA, Masevnin SV, et al. Osteoporosis in the practice of a vertebrologist. Vrach. 2020;(3):11-8. (In Russ.)] https://doi.org/10.29296/25877305-2020-03-02.
  18. Bullmann V, Liljenqvist UR, Rodl R, Schulte TL. Pedicle screw augmentation from a biomechanical perspective. Orthopade. 2010;39(7):673-8. (In German). https://doi.org/10.1007/s00132-010-1602-8.
  19. Sawakami K, Yamazaki A, Ishikawa S, et al. Polymethylmethacrylate augmentation of pedicle screws increases the initial fixation in osteoporotic spine patients. J Spinal Disord Tech. 2012;25(2):E28-35. http://dx.doi.org/10.1097/bsd.0b013e318228bbed.
  20. Seo JH, Ju CI, Kim SW, et al. Clinical efficacy of bone cement augmented screw fixation for the severe osteoporotic spine. Korean J Spine. 2012;9(2):79-84. http://dx.doi.org/10.14245/kjs.2012.9.2.79.

补充文件

附件文件
动作
1. JATS XML
下载

版权所有 © Eco-Vector, 2020



##common.cookie##