Relationship between fracture-relevant parameters of thoracolumbar burst fractures and the reduction of intra-canal frac
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RESEARCH ARTICLE
Open Access
Relationship between fracture-relevant parameters of thoracolumbar burst fractures and the reduction of intra-canal fracture fragment Ye Peng†, Licheng Zhang†, Tao Shi, Houchen Lv, Lihai Zhang* and Peifu Tang*
Abstract Objective: Posterior longitudinal ligament reduction (PLLR) has been widely used for treatment of thoracolumbar burst fractures. However, there are no systemic studies assessing the influence of position parameters of intra-canal fracture fragment (IFF) itself on outcome of reduction. The aim of this study was to analyze the relationship between position parameters of IFF and the reduction efficacy of PLLR. Methods: Sixty-two patients (average age, 36.9 years) with single thoracolumbar burst fractures and intact posterior longitudinal ligaments were recruited. Patients were divided into reduced and unreduced groups based on IFF reduction situations by PLLR. Preoperative and intraoperative computed tomography (CT) were used to evaluate reduction and location parameters of IFF, such as position, width, height, inversion, and horizontal angle, ratio of width of IFF to the transverse diameter of vertebral canal (R1), and ratio of height of IFF to height of injured vertebrae (R2) before and after PLLR. Results: There were significant differences in width (P < 0.001), height (P = 0.0141; R1, P < 0.001), and R2 (P = 0.0045) between the two groups. When width of IFF was more than 75 % of transverse diameter of vertebral canal and height of IFF was more than 47 % of height of injured vertebrae, the IFF could not be reduced by PLLR. Conclusions: In patients with thoracolumbar burst fractures, IFF in apterium of the posterior longitudinal ligament cannot be reduced by PLLR. For thoracolumbar burst fractures that cover the posterior longitudinal ligament, the width and height of IFF are important parameters that influence reduction quality. Keywords: Single thoracolumbar burst fracture, Posterior longitudinal ligament, Fracture reduction, Intra-canal fracture fragment
Introduction Each year, 13.3–45.9 of every 1,000,000 people suffer from spinal trauma. Ninety percent of fractures occur in the thoracolumbar spine, and thoracolumbar burst fractures account for 20 % of these. Among patients with thoracolumbar burst fractures, 50−60 % also experience neurologic deficit [1–6]. The major causes of spinal fractures are traffic accidents (43 %), falling from a significant height (25 %), and a violent incident (16.5 %) [7]. The spinal cord suffers both primary and secondary damage after acute spinal cord injury. However, it is * Correspondence: [email protected]; [email protected] † Equal contributors Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, People’s Republic of China
difficult to avoid primary damage since it usually occurs very rapidly. Therefore, current therapeutic strategies for spinal cord injury (SCI) primarily focus on reducing the severity of secondary damage. Secondary mechanisms of injury encompass an array of perturbance
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