Torakolomber patlama kırıklarında ameliyat sonrası deformite için kestirimci faktörler: İstatistiksel yaklaşım

Yıl 2015, , 133 - 138, 22.05.2015

Stelian Anghel Marius Petrisor Corneliu Florin Buicu Denes Marton Tiberiu Bataga

https://doi.org/10.3944/AOTT.2015.14.0274

Öz

Amaç: Bu çalışmanın amacı istatistiksel analiz kullanarak patlama kırıklarının cerrahi tedavisinin son neticesinin ne derece operasyon şekli, kırık seviyesi ve birincil deformite şiddetine bağlı olduğunu değerlendirmekti.

Çalışma planı: Yalın ve çoklu doğrusal regresyon modelleri kullanılarak tek-omur-seviyeli torasik ve lombar omur kırıkları olan 287 hastanın verileri analiz edildi. Bağımlı değişken son takipteki (ST) kifotik açıydı ve kestirimci değişkenler ise operasyon şekli (anteriyor yaklaşım [AY], posteriyor kısa-segment fiksasyon [PKSF] ve posteriyor tek-segment fiksasyon [PTF]), kırık seviyesi (T11–L1, L2–L3 ve L4–L5) ve ameliyat öncesi kifotik açıydı. Modeller, ya bütün örnekleme ya da operasyon şekli alt gruplarına uygulandı.

Bulgular: Son takip kifotik açı varyasyonunda kırık seviyesi, yalın doğrusal regresyon analiz modellerinde AY ve PTF alt gruplarında sırasıyla %32’si ve %18’inin nedenini açıkladı. Son takip kifotik açıda varyasyonunda kırık seviyesi, aynı alt grupların çoklu doğrusal regresyon modellerinde %40’a kadarını açıkladı. Kestirimci değişken olarak cerrahi tedavi, PKSF ile tespit edilen hastaların AY ile tespit edilen hastalara oranla operasyon sonrası 8.51° daha şiddetli kifotik açı geliştirdiklerini belirtti. Ancak, model son takipteki kifotik açı varyasyonunun yalnızca %2’sine açıklama getirdi. Bağımsız değişken olarak ameliyat öncesi kifotik açının temel alındığı her alt gruba uygulanan yalın doğrusal regresyonlar değişkenin son takipteki kifotik açının %15’ini (PKSF alt grubu), %17’sini (AY alt grubu) ve %34’ünü (PTF alt grubu) açıkladığını ortaya koydu.

Çıkarımlar: Geçerli bütün regresyon modelleri fazla açıklayıcı değillerdi ve göz önünde bulundurulan bu faktörler dışında başka faktörlerinde dâhil olduğunu ileri sürdü.

Anahtar Kelimeler

Post-travmatik kifotik deformite; torakolomber patlama kırığı.

Predictive factors for postoperative deformity in thoracolumbar burst fractures: a statistical approach

Öz

Objective: To assess, using statistical analysis, if and to what extent the final outcome of surgical treatment for burst fractures depends on operation type, fracture level and initial deformity severity.

Methods: A database of 287 patients with single-vertebral-level thoracic and lumbar spine fractures analysed using simple and multiple linear regression analyses models. The dependent variable was last follow-up (LFU) kyphotic angle and the predictor variables were operation type [anterior approach (AA), posterior short-segment fixation (PSSF) and posterior monosegmental fixation (PMF)], fracture level (T11–L1, L2–L3 and L4–L5) and preoperative kyphotic angle. The models were applied on either the whole sample or on the operation type subgroups.

Results: In simple linear regression analysis models, fracture level accounted for 32% and 18% of the variation in LFU kyphotic angle in the AA and PMF subgroups, respectively. In the multiple linear regression models for the same subgroups, up to 40% of the variation in LFU kyphotic angle was accounted for by fracture level. Surgical treatment, as predictor variable, indicated that patients reated by PSSF developed a post-surgical kyphotic angle 8.51° more severe than those treated by AA. However, the model accounted for only 2% of the variation in LFU kyphotic angle. Simple linear regressions performed on each subgroup with preoperative kyphotic angle as the independent variable revealed that the variable accounted for 15% (PSSF subgroup), 17% (AA subgroup) and 34% (PMF subgroup) of the variation in LFU kyphotic angle.

Conclusion: All valid regression models displayed modest explanatory power, suggesting that factors other than those taken into consideration are involved.

Anahtar Kelimeler

Post-traumatic kyphotic deformity, thoracolumbar, burst fracture

Kaynakça

• Verlaan JJ, Diekerhof CH, Buskens E, van der Tweel I, Verbout AJ, Dhert WJ, et al. Surgical treatment of trau- matic fractures of the thoracic and lumbar spine: a system- atic review of the literature on techniques, complications, and outcome. Spine (Phila Pa 1976) 2004;29:803–14.
• Shen WJ, Liu TJ, Shen YS. Nonoperative treatment ver- sus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit. Spine (Phila Pa 1976)
• Dai LY, Jiang SD, Wang XY, Jiang LS. A review of the management of thoracolumbar burst fractures. Surg Neu- rol 2007;67:221–31.
• Buchowski JM, Kuhns CA, Bridwell KH, Lenke LG. Sur- gical management of posttraumatic thoracolumbar kypho- sis. Spine J 2008;8:666–77.
• Vaccaro AR, Silber JS. Post-traumatic spinal deformity. Spine (Phila Pa 1976) 2001;26(24 Suppl):111–8.
• Aebi M, Etter C, Kehl T, Thalgott J. Stabilization of the lower thoracic and lumbar spine with the internal spinal skeletal fixation system. Indications, techniques, and first results of treatment. Spine (Phila Pa 1976) 1987;12:544– 51.
• Prolo DJ, Oklund SA, Butcher M. Toward uniformity in evaluating results of lumber spine operations: a paradigm supplied to PLIF. Spine 1986;11:601–6.
• Parker JW, Lane JR, Karaikovic EE, Gaines RW. Success- ful short-segment instrumentation and fusion for thora- columbar spine fractures: a consecutive 41/2-year series. Spine (Phila Pa 1976) 2000;25:1157–70.
• Wang XY, Dai LY, Xu HZ, Chi YL. Kyphosis recurrence after posterior short-segment fixation in thoracolumbar burst fractures. J Neurosurg Spine 2008;8:246–54.
• Benson DR, Burkus JK, Montesano PX, Sutherland TB, McLain RF. Unstable thoracolumbar and lumbar burst fractures treated with the AO fixateur interne. J Spinal Disord 1992;5:335–43.
• Wood K, Buttermann G, Mehbod A, Garvey T, Jhanjee R, Sechriest V. Operative compared with nonoperative treat- ment of a thoracolumbar burst fracture without neurologi- cal deficit. A prospective, randomized study. J Bone Joint Surg Am 2003;85-A(5):773–81.
• Shi R, Liu H, Zhao X, Liu X, Gong Q, Li T, et al. Anterior single segmental decompression and fixation for Denis B type thoracolumbar burst fracture with neurological de- ficiency: thirty-four cases with average twenty-six month follow-up. Spine (Phila Pa 1976) 2011;36:598–605.
• Xu JG, Zeng BF, Zhou W, Kong WQ, Fu YS, Zhao BZ, et al. Anterior Z-plate and titanic mesh fixation for acute burst thoracolumbar fracture. Spine (Phila Pa 1976) 2011;36:498–504.
• Shono Y, McAfee PC, Cunningham BW. Experimental study of thoracolumbar burst fractures. A radiographic and biomechanical analysis of anterior and posterior instru- mentation systems. Spine (Phila Pa 1976) 1994;19:1711– 22.
• Schultheiss M, Hartwig E, Kinzl L, Claes L, Wilke HJ. Thoracolumbar fracture stabilization: comparative bio- mechanical evaluation of a new video-assisted implantable system. Eur Spine J 2004;13:93–100.
• Kallemeier PM, Beaubien BP, Buttermann GR, Polga DJ, Wood KB. In vitro analysis of anterior and posterior fixa- tion in an experimental unstable burst fracture model. J Spinal Disord Tech 2008;21:216–24.
• Flamme CH, Hurschler C, Heymann C, von der Heide N. Comparative biomechanical testing of anterior and posterior stabilization procedures. Spine (Phila Pa 1976) 2005;30:352–62.
• Eichholz KM, Hitchon PW, From A, Rubenbauer P, Na- kamura S, Lim TH, et al. Biomechanical testing of ante- rior and posterior thoracolumbar instrumentation in the cadaveric spine. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine 2004;1:116–21.
• Wood KB, Bohn D, Mehbod A. Anterior versus posterior treatment of stable thoracolumbar burst fractures without neurologic deficit: a prospective, randomized study. J Spi- nal Disord Tech 2005;18 Suppl:15–23.
• Sasso RC, Renkens K, Hanson D, Reilly T, McGuire RA Jr, Best NM. Unstable thoracolumbar burst fractures: ante- rior-only versus short-segment posterior fixation. J Spinal Disord Tech 2006;19:242–8.
• White AA, Panjabi MM. Clinical biomechanics of the spine. 2nd ed. Philadelphia: J.B. Lippincott Company; 1990.
• Al-Khalifa FK, Adjei N, Yee AJ, Finkelstein JA. Patterns of collapse in thoracolumbar burst fractures. J Spinal Disord Tech 2005;18:410–2.
• McCormack T, Karaikovic E, Gaines RW. The load shar- ing classification of spine fractures. Spine (Phila Pa 1976) 1994;19:1741–4.
• Bailey CS, Urquhart JC, Dvorak MF, Nadeau M, Boyd MC, Thomas KC, et al. Orthosis versus no orthosis for the treatment of thoracolumbar burst fractures without neuro- logic injury: a multicenter prospective randomized equiva- lence trial. Spine J 2014;14:2557–64.
• Suzuki T, Abe E, Miyakoshi N, Murai H, Kobayashi T, Abe T, et al. Anterior Decompression and Shortening Re- construction with a Titanium Mesh Cage through a Pos- terior Approach Alone for the Treatment of Lumbar Burst Fractures. Asian Spine J 2012;6:123–30.
• Sasani M, Ozer AF. Single-stage posterior corpectomy and expandable cage placement for treatment of tho- racic or lumbar burst fractures. Spine (Phila Pa 1976) 2009;34:33–40.
• Haiyun Y, Rui G, Shucai D, Zhanhua J, Xiaolin Z, Xin L, et al. Three-column reconstruction through single poste- rior approach for the treatment of unstable thoracolumbar fracture. Spine (Phila Pa 1976) 2010;35:295–302.
• Defino HL, Canto FR. Low thoracic and lumbar burst fractures: radiographic and functional outcomes. Eur Spine J 2007;16:1934–43.
• Ko SB, Lee SW. Result of posterior instrumentation without fusion in the management of thoracolumbar and lumbar unstable burst fracture. J Spinal Disord Tech
• Parker JW, Lane JR, Karaikovic EE, Gaines RW. Success- ful short-segment instrumentation and fusion for thora- columbar spine fractures: a consecutive 41/2-year series. Spine (Phila Pa 1976) 2000;25:1157–70.
• Gelb D, Ludwig S, Karp JE, Chung EH, Werner C, Kim T, et al. Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation. J Spinal Disord Tech 2010;23:293–301.
• Toyone T, Tanaka T, Kato D, Kaneyama R, Otsuka M. The treatment of acute thoracolumbar burst fractures with transpedicular intracorporeal hydroxyapatite grafting fol- lowing indirect reduction and pedicle screw fixation: a pro- spective study. Spine (Phila Pa 1976) 2006;31:208–14.
• Defino HL, Scarparo P. Fractures of thoracolumbar spine: monosegmental fixation. Injury 2005;36 Suppl 2:90–7.
• Liu S, Li H, Liang C, Long H, Yu B, Chen B, et al. Mono- segmental transpedicular fixation for selected patients with thoracolumbar burst fractures. J Spinal Disord Tech 2009;22:38–44.
• Shi J, Mei X, Liu J, Jiang W, Moral MZ, Ebraheim NA, et al. The influence of correction loss in thoracolumbar fractures treated by posterior instrumentation: a minimum 7-year follow-up. J Clin Neurosci 2011;18:500–3.
• Sasso RC, Best NM, Reilly TM, McGuire RA Jr. Anterior- only stabilization of three-column thoracolumbar injuries. J Spinal Disord Tech 2005;18 Suppl:7–14.
• An HS, Lim TH, You JW, Hong JH, Eck J, McGrady L. Biomechanical evaluation of anterior thoracolumbar spinal instrumentation. Spine (Phila Pa 1976) 1995;20:1979– 83.
• Allain J. Anterior spine surgery in recent thoracolum- bar fractures: An update. Orthop Traumatol Surg Res 2011;97:541–54.
• McLain RF, Burkus JK, Benson DR. Segmental instru- mentation for thoracic and thoracolumbar fractures: pro- spective analysis of construct survival and five-year follow- up. Spine J 2001;1:310–23.
• Panjabi MM, Oxland TR, Kifune M, Arand M, Wen L, Chen A. Validity of the three-column theory of thoraco- lumbar fractures. A biomechanic investigation. Spine (Ph- ila Pa 1976) 1995;20:1122–7.
• Slosar PJ Jr, Patwardhan AG, Lorenz M, Havey R, Sartori M. Instability of the lumbar burst fracture and limitations of transpedicular instrumentation. Spine (Phila Pa 1976) 1995;20:1452–61.