Application of fenestration rammer in thoracolumbar burst fracture_West China Medical Journal

Authors：

 ZENG Jun , LIN Xu , WANG Xiangyu , YUAN Dechao , TAN Lun

Section I, Department of Orthopedics, Zigong Fourth People’s Hospital, Zigong, Sichuan 643000, P. R. China;

Corresponding?author：

ZENG Jun, Email: dynamic2006@sohu.com

Keywords：

Thoracolumbar burst fracture; finite fenestration; decompression; spinal occupying bone mass; rammer

DOI：

10.7507/1002-0179.202108070

Video：

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Objective To observe and evaluate the clinical effect of the new fenestration rammer in the treatment of thoracolumbar burst fracture by posterior internal fixation and reduction of lamina with finite fenestration decompression. Methods Patients with thoracolumbar burst fractures admitted to Zigong Fourth People’s Hospital between September 2017 and January 2020 were retrospectively selected. The patients were divided into observation group and control group according to different surgical methods. The observation group used a new tamping device with finite fenestration rammer of unilateral lamina to reduce the spinal occupying bone mass, and the control group used conventional instruments for reduction of intraspinal fracture masses. The operation time, intraoperative blood loss, CT measurement of sagittal diameter ratio of spinal canal and the number of cases of postoperative vertebral empty shell phenomenon were recorded in the two groups, and Frankel grading evaluation of spinal nerve function was conducted. Results A total of 67 patients were included. There were 33 cases in the observation group and 34 cases in the control group. The patients in both groups were followed up for 12 to 16 months, with an average of (14.45±2.25) months. The improvement rate of Frankel rating in each group was 100%. In the control group and the observation group, except for the sagittal diameter ratio of spinal canal before operation (P=0.616), the operation time [(150.44±26.47) vs. (120.91±20.86) min], the intraoperative blood loss [(244.41±42.97) vs. (183.33±34.56) mL], the sagittal diameter ratio of spinal canal one week after operation [(92.50±2.32)% vs. (93.72±2.40)%], the sagittal diameter ratio of spinal canal at the last follow-up [(91.50±2.96)% vs. (93.17±3.27)%] and the occurrence of empty shell phenomenon (13 vs. 5 cases) were statistically significant (P<0.05). The intragroup comparison showed that the sagittal diameter ratio of spinal canal was improved one week after operation and at the last follow-up compared with that before operation (P<0.05), there was no significant difference in the sagittal diameter ratio of spinal canal between one week after operation and the last follow-up (P>0.05). Conclusions The new fenestration rammer can effectively reduce the spinal occupying bone mass in thoracolumbar burst fracture, effectively restore the volume of the spinal canal, achieve the purpose of decompression, effectively prevent the formation of vertebral shell, maximize the retention of the stable structure of the posterior column, and avoid iatrogenic nerve injury. It is safe and effective.

Citation： ZENG Jun, LIN Xu, WANG Xiangyu, YUAN Dechao, TAN Lun. Application of fenestration rammer in thoracolumbar burst fracture. West China Medical Journal, 2022, 37(9): 1328-1333. doi: 10.7507/1002-0179.202108070 Copy

1.	江偉偉, 裴蕾, 王勝云, 等. 胸腰椎爆裂性骨折: 從致傷因素看臨床癥狀. 第二軍醫大學學報, 2019, 40(8): 909-913.
2.	Spiegl UJ, Josten C, Devitt BM, et al. Incomplete burst fractures of the thoracolumbar spine: a review of literature. Eur Spine J, 2017, 26(12): 3187-3198.
3.	閻崇楠, 王歡, 崔少千, 等. 后路前凸彎棒預加壓復位固定技術治療胸腰段不穩定性爆裂骨折. 中華骨科雜志, 2020, 40(15): 988-995.
4.	Aono H, Ishii K, Tobimatsu H, et al. Temporary short-segment pedicle screw fixation for thoracolumbar burst fractures: comparative study with or without vertebroplasty. Spine J, 2017, 17(8): 1113-1119.
5.	陳志達, 吳進, 林斌, 等. 后路傷椎短節段固定治療嚴重不穩的胸腰椎爆裂性骨折. 中國修復重建外科雜志, 2018, 32(1): 59-63.
6.	Liu JH, Pang ZB, Xu WB, et al. Comparison of pedicle fixation by the Wiltse approach and the conventional posterior open approach for thoracolumbar fractures, using MRI, histological analyses of the multifidus muscle. Eur Spine J, 2017, 26(5): 1506-1514.
7.	Street JT, Andrew Glennie R, et al. A comparisin of the Wiltse versus midline approache in degenerative conditions of the lumbar spine. J Neurosurg Spine, 2016, 25(3): 332-338.
8.	馮明星, 肖杰, 龍浩, 等. 肌間隙有限暴露結合椎板間減壓治療胸腰椎爆裂性骨折. 脊柱外科雜志, 2018, 16(6): 363-367.
9.	Piccone L, Cipolloni V, Nasto LA, et al. Reprint of: thoracolumbar burst fractures associated with incomplete neurological deficit in patients under the age of 40: is the posterior approach enough? Surgical treatment and results in a case series of 10 patients with a minimum follow-up of 2 years. Injury, 2020, 51(Suppl 3): S45-S49.
10.	Aono H, Ishii K, Takenaka S, et al. Risk factors for a kyphosis recurrence after short-segment temporary posterior fixation for thoracolumbar burst fractures. J Clin Neurosci, 2019, 66: 138-143.
11.	胡海剛, 林旭, 譚倫, 等. 胸腰椎骨折后路復位術后椎體“空殼”現象的影像學研究. 中國修復重建外科雜志, 2017, 31(8): 976-981.
12.	郭克淼, 李晶. 胸腰椎爆裂骨折后路手術后椎體內空隙高度的 CT 影像測量及其臨床意義. 醫學臨床研究, 2017, 34(4): 658-663.
13.	胡海剛, 譚倫, 林旭, 等. 胸腰椎骨折復位術后椎體“空殼現象”的相關因素分析. 中國脊柱脊髓雜志, 2017, 27(3): 242-247.
14.	馬曉東, 馬曉松, 孫宏橋, 等. 椎弓根釘內固定聯合椎體內植骨治療胸腰椎爆裂性骨折的臨床分析. 頸腰痛雜志, 2019, 40(4): 533-535.
15.	曹杰, 于海洋, 梁成民, 等. 后路椎弓根釘棒復位內固定+經傷椎椎弓根植骨治療胸腰椎骨折. 中華骨與關節外科雜志, 2016, 9(5): 381-385.

1. 江偉偉, 裴蕾, 王勝云, 等. 胸腰椎爆裂性骨折: 從致傷因素看臨床癥狀. 第二軍醫大學學報, 2019, 40(8): 909-913.
2. Spiegl UJ, Josten C, Devitt BM, et al. Incomplete burst fractures of the thoracolumbar spine: a review of literature. Eur Spine J, 2017, 26(12): 3187-3198.
3. 閻崇楠, 王歡, 崔少千, 等. 后路前凸彎棒預加壓復位固定技術治療胸腰段不穩定性爆裂骨折. 中華骨科雜志, 2020, 40(15): 988-995.
4. Aono H, Ishii K, Tobimatsu H, et al. Temporary short-segment pedicle screw fixation for thoracolumbar burst fractures: comparative study with or without vertebroplasty. Spine J, 2017, 17(8): 1113-1119.
5. 陳志達, 吳進, 林斌, 等. 后路傷椎短節段固定治療嚴重不穩的胸腰椎爆裂性骨折. 中國修復重建外科雜志, 2018, 32(1): 59-63.
6. Liu JH, Pang ZB, Xu WB, et al. Comparison of pedicle fixation by the Wiltse approach and the conventional posterior open approach for thoracolumbar fractures, using MRI, histological analyses of the multifidus muscle. Eur Spine J, 2017, 26(5): 1506-1514.
7. Street JT, Andrew Glennie R, et al. A comparisin of the Wiltse versus midline approache in degenerative conditions of the lumbar spine. J Neurosurg Spine, 2016, 25(3): 332-338.
8. 馮明星, 肖杰, 龍浩, 等. 肌間隙有限暴露結合椎板間減壓治療胸腰椎爆裂性骨折. 脊柱外科雜志, 2018, 16(6): 363-367.
9. Piccone L, Cipolloni V, Nasto LA, et al. Reprint of: thoracolumbar burst fractures associated with incomplete neurological deficit in patients under the age of 40: is the posterior approach enough? Surgical treatment and results in a case series of 10 patients with a minimum follow-up of 2 years. Injury, 2020, 51(Suppl 3): S45-S49.
10. Aono H, Ishii K, Takenaka S, et al. Risk factors for a kyphosis recurrence after short-segment temporary posterior fixation for thoracolumbar burst fractures. J Clin Neurosci, 2019, 66: 138-143.
11. 胡海剛, 林旭, 譚倫, 等. 胸腰椎骨折后路復位術后椎體“空殼”現象的影像學研究. 中國修復重建外科雜志, 2017, 31(8): 976-981.
12. 郭克淼, 李晶. 胸腰椎爆裂骨折后路手術后椎體內空隙高度的 CT 影像測量及其臨床意義. 醫學臨床研究, 2017, 34(4): 658-663.
13. 胡海剛, 譚倫, 林旭, 等. 胸腰椎骨折復位術后椎體“空殼現象”的相關因素分析. 中國脊柱脊髓雜志, 2017, 27(3): 242-247.
14. 馬曉東, 馬曉松, 孫宏橋, 等. 椎弓根釘內固定聯合椎體內植骨治療胸腰椎爆裂性骨折的臨床分析. 頸腰痛雜志, 2019, 40(4): 533-535.
15. 曹杰, 于海洋, 梁成民, 等. 后路椎弓根釘棒復位內固定+經傷椎椎弓根植骨治療胸腰椎骨折. 中華骨與關節外科雜志, 2016, 9(5): 381-385.

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