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Órgano Oficial del Colegio Medico de Ortopedia en Jalisco y de la Sociedad Uruguaya de Columna Vertebral (SUCVE)

2011, Number 1

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COLUMNA 2011; 1 (1)

Instrumentación de la vértebra fracturada.
Una opción válida de tratamiento en fracturas de la unión tóraco-lumbar

Ocampo RRI

Language: Spanish
References: 21
Page: 3-9
PDF size: 169.69 Kb.


ABSTRACT

Objective: Compare the short Instrumentation in traumatic not pathological fractures toraco-lumbar; union method against the instrumentation of vertebra fractured with full pedicle. Methods: In the period covered between January 2008 to July 2010 reviewed 22 cases divided into 2 groups: 8 (36.40%) with screw in the vertebra fractured with full pedicle associated with transpedicular grafting and posterolateral. 14 (63.60%) treated without screw in the fractured vertebra, associated with transpedicular graft. Included: vertebral fracture in the toraco-lumbar (T11 - L4). 16 patients (72.7%) were male and 6 (27.3%) female, average age was 37.27 d.s. 10.5 years. Results: The probability of fusion (pain ‹ 6 months, absence of neurologic injury without progressive deformity): 2.75 more times with autologous graft that combined with heterologous with an IC 95% = 0. 15-93. 1.91 more times if it implements vertebra fractured with an IC 95% = 0.12 - 58.54. Probability in neurologic improvement (2 or more levels of Frankel follow-up): 30 more times if you corrected the diameter of the spinal canal in less than 30% of invasion (% DC +) with an IC 95% = 1.54 - 1358. 7.5 most times if you corrected the transverse diameter of the spinal canal in less than 15% of invasion (% DT +) with an IC 95% = 0.36 - 258.58. 2.17 more times if successfully corrected kyphosis regional to ‹ 5° post surgery as (CBC + Cr1) with a 95% CI = 0. 17 - 28.35. 1.29 more times if successfully corrected vertebral kyphosis at ‹ 5° post surgery as (CBC + HP) with a CI = 0.14 - 12.19. With screw in the vertebra fractured there is 1.91 times more likely to fix the spinal canal in less than 15% of invasion with an IC = 0.12 - transverse diameter 38.54. 1.17 more probability of correcting the CR1 with an IC 95% = 0.06 - 39.62. 12.6 times more likely to fix the CV with an IC 95% = 0.95 - 366.02. 1.67 times more likely to have a proper function functionality (ambulation without limitation or assistance of a second person for minimum activities, fusion) with an IC 95% = 0.17 - 18.04. Discussion: When correcting the diameter of the spinal canal, we have 30 times more probability in neurologic improvement, 7.5 more times if we increase the spinal transverse diameter, achieving 1.91 more often implemented the fractured vertebra, achieving at the same time 12 times more likely to successfully correct surgical pre radiographic kyphosis at less than 5 degrees. There was no difference between decompression laminectomy or hemilaminectomía on neurological development, functionality, and fusion. The instrumentation of vertebra fractured is an option in not pathological toracolumbar union fractures with full pedicle more high rate of fusion, neurologic improvement, functionality and radiographic satisfactory correction.


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