Bernhard Wilhelm Ullrich, Merle Ottich, Aaron Lawson McLean, Thomas Mendel, Gunther Olaf Hofmann, Philipp Schenk
{"title":"[胸腰椎骨折手术治疗后局部脊柱轮廓:复位技术和骨质量的影响]。","authors":"Bernhard Wilhelm Ullrich, Merle Ottich, Aaron Lawson McLean, Thomas Mendel, Gunther Olaf Hofmann, Philipp Schenk","doi":"10.1007/s00113-021-01013-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The goal of surgery for spinal injuries is fracture reduction, fixation and stable healing in a physiological position. Several open and minimally invasive surgical techniques are available.</p><p><strong>Objective: </strong>The extent of open reduction and the fixation potential achieved by the AOSpine (AT) and Kluger (KT) techniques were compared. The influence of fracture morphology, age, sex, and bone quality on fracture reduction and secure fixation was investigated.</p><p><strong>Material and methods: </strong>In this monocentric retrospective cohort study data of patients with traumatic thoracolumbar and lumbar fractures treated by AT or KT were analyzed. The bisegmental kyphotic angle (bGDW) of each injured spinal segment was determined. Normal bGDW values were extrapolated from the literature. The change of bGDW over time was analyzed under consideration of the bone quality in Hounsfield units (HU), injury severity according to the AOSpine classification, gender and age of patients.</p><p><strong>Results: </strong>A total of 151 data sets were evaluated. The AT and KT methods achieved a similar extent of reduction (AT 10 ± 6°, KT 11 ± 8°; p = 0.786). In follow-up a mean reduction loss of -5 ± 4° was seen. The technique had no influence on this (p = 0.998). The fracture morphology just managed to achieve a significant influence (p = 0.043). Low HU correlated significantly but weakly with lower extent of reduction (r = 0.241, p < 0.003) and greater reduction loss (r = 0.272, p < 0.001). In the age group 50-65 years 21% of men and 43% of women had bone quality of < 110 HU. Age and HU were significantly correlated (r = -0.701, p < 0.001).</p><p><strong>Conclusion: </strong>The AT and KT are equivalent in terms of reduction and secure fixation properties. The high proportion of male and female patients with HU < 110 in the age group under 65 years and the influence on reduction and secure fixation emphasize the need for preoperative bone densitometry.</p>","PeriodicalId":49397,"journal":{"name":"Unfallchirurg","volume":"125 4","pages":"295-304"},"PeriodicalIF":0.0000,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00113-021-01013-7","citationCount":"0","resultStr":"{\"title\":\"[Local spinal profile following operative treatment of thoracolumbar and lumbar fractures : Impact of reduction technique and bone quality].\",\"authors\":\"Bernhard Wilhelm Ullrich, Merle Ottich, Aaron Lawson McLean, Thomas Mendel, Gunther Olaf Hofmann, Philipp Schenk\",\"doi\":\"10.1007/s00113-021-01013-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The goal of surgery for spinal injuries is fracture reduction, fixation and stable healing in a physiological position. Several open and minimally invasive surgical techniques are available.</p><p><strong>Objective: </strong>The extent of open reduction and the fixation potential achieved by the AOSpine (AT) and Kluger (KT) techniques were compared. The influence of fracture morphology, age, sex, and bone quality on fracture reduction and secure fixation was investigated.</p><p><strong>Material and methods: </strong>In this monocentric retrospective cohort study data of patients with traumatic thoracolumbar and lumbar fractures treated by AT or KT were analyzed. The bisegmental kyphotic angle (bGDW) of each injured spinal segment was determined. Normal bGDW values were extrapolated from the literature. The change of bGDW over time was analyzed under consideration of the bone quality in Hounsfield units (HU), injury severity according to the AOSpine classification, gender and age of patients.</p><p><strong>Results: </strong>A total of 151 data sets were evaluated. The AT and KT methods achieved a similar extent of reduction (AT 10 ± 6°, KT 11 ± 8°; p = 0.786). In follow-up a mean reduction loss of -5 ± 4° was seen. The technique had no influence on this (p = 0.998). The fracture morphology just managed to achieve a significant influence (p = 0.043). Low HU correlated significantly but weakly with lower extent of reduction (r = 0.241, p < 0.003) and greater reduction loss (r = 0.272, p < 0.001). In the age group 50-65 years 21% of men and 43% of women had bone quality of < 110 HU. Age and HU were significantly correlated (r = -0.701, p < 0.001).</p><p><strong>Conclusion: </strong>The AT and KT are equivalent in terms of reduction and secure fixation properties. The high proportion of male and female patients with HU < 110 in the age group under 65 years and the influence on reduction and secure fixation emphasize the need for preoperative bone densitometry.</p>\",\"PeriodicalId\":49397,\"journal\":{\"name\":\"Unfallchirurg\",\"volume\":\"125 4\",\"pages\":\"295-304\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1007/s00113-021-01013-7\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Unfallchirurg\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00113-021-01013-7\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2021/6/10 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Unfallchirurg","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00113-021-01013-7","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2021/6/10 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
[Local spinal profile following operative treatment of thoracolumbar and lumbar fractures : Impact of reduction technique and bone quality].
Background: The goal of surgery for spinal injuries is fracture reduction, fixation and stable healing in a physiological position. Several open and minimally invasive surgical techniques are available.
Objective: The extent of open reduction and the fixation potential achieved by the AOSpine (AT) and Kluger (KT) techniques were compared. The influence of fracture morphology, age, sex, and bone quality on fracture reduction and secure fixation was investigated.
Material and methods: In this monocentric retrospective cohort study data of patients with traumatic thoracolumbar and lumbar fractures treated by AT or KT were analyzed. The bisegmental kyphotic angle (bGDW) of each injured spinal segment was determined. Normal bGDW values were extrapolated from the literature. The change of bGDW over time was analyzed under consideration of the bone quality in Hounsfield units (HU), injury severity according to the AOSpine classification, gender and age of patients.
Results: A total of 151 data sets were evaluated. The AT and KT methods achieved a similar extent of reduction (AT 10 ± 6°, KT 11 ± 8°; p = 0.786). In follow-up a mean reduction loss of -5 ± 4° was seen. The technique had no influence on this (p = 0.998). The fracture morphology just managed to achieve a significant influence (p = 0.043). Low HU correlated significantly but weakly with lower extent of reduction (r = 0.241, p < 0.003) and greater reduction loss (r = 0.272, p < 0.001). In the age group 50-65 years 21% of men and 43% of women had bone quality of < 110 HU. Age and HU were significantly correlated (r = -0.701, p < 0.001).
Conclusion: The AT and KT are equivalent in terms of reduction and secure fixation properties. The high proportion of male and female patients with HU < 110 in the age group under 65 years and the influence on reduction and secure fixation emphasize the need for preoperative bone densitometry.
期刊介绍：
Der Unfallchirurg is an internationally recognised publication organ. The journal deals with all aspects of accident surgery and reconstruction surgery and serves the continuing medical education of surgeons and accident surgeons with own practices and those working in hospitals.
Practically-oriented works provide an overview on selected topics and offer the reader a summary of current findings from all fields of accident surgery. Besides the imparting of relevant background knowledge, the focus is on the assessment of scientific findings under consideration of practical experience. The reader is given concrete recommendations for his/her practical work.
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