Fractura vertebral tipo estallido de la unión tóraco-lumba. Estudio radiológico comparativo de los resultados del tratamiento quirúrgico mediante montajes posteriores cortos con y sin instrumentación de la vértebra fracturada.

Identificador:  TDX:625

Handle: https://hdl.handle.net/20.500.11797/TDX625

Autores:  González Pedrouzo, José Eduardo

Resumen:
At the present time the treatment of the burst type vertebral fracture of the thoraco-lumbar union continues being controverted. Within operative treatment, the most frequent and accepted it is the short posterior transpedicular assembling with or without instrumentation of the fractured vertebra. In the bibliography we did not find any study that compares both methods of treatment. Our hypothesis of work is to evaluate with as from both methods the best radiological results are obtained. For this reason, we evaluated: the correction and the stability of the anterior column; the correction of the deformity and the restoration of the alignment in the sagital plane and failure rate of the vertebral assembly. We analysed of retrospective form two groups of patients, that they fulfil the 15 established criteria of inclusion in the study. The group A is the patients with instrumentation of the fractured vertebra. And group B is the patients without instrumentation of the fractured vertebra. The data and the iconography of 43 clinical histories are gathered and analyzed by an only observer. Of all patients we gather of preoperative form, postoperative and whem fulfilling minimum the year of evolution, the simple x-rays in the antero-posterior and lateral plane. All x-rays are digitized by means of the scanner marks: Epson GT-12000, by means of driver Epson Twain Pro-32 (version 1.01) . By means of the use of the computer science program Micrografx Picture Publisher 8.0, the different images are processed to improve the quality of the same ones. AutoCAD 2000 in Spanish computer science program is used in order to determine a series of angles and adimensionals measures, that they allow us to make the measurement of different angles and to apply the method of the proportions to make the different radiological measurements. All the data and radiological measurements are stored in a table of data designed for the study according to the computer science program Microsoft Access 2000. A descriptive statistical analysis is made, a univariable analysis and a univariable analysis of repeated measures (MANOVA). The statistical level of accepted meaning is of p  0,05.We made different radiological measurements in simple radiology in the sagital plane (regional cifosis type 1, type 2, type 3, type 4, type 5, type 6, vertebral cifosis, sagital index, traumatic regional angulation, angle of the posterior wall, percentage of compression of anterior vertebral height, percentage of compression of posterior vertebral height, quotient of anterior vertebral height / posterior vertebral height of the fractured vertebra, quotient of anterior vertebral unit height / posterior vertebral unit height) and in the antero-posterior plane (lateral vertebral angulation, percentage of interpedicular widening). All measurements are repeated in each patient by the three periods of the study.As relevant conclusions we emphasized: 1) the patients with instrumentation of the fractured vertebra present a better postoperative radiological result than the patients without instrumentation of the vertebra fractured in the regional cifosis: CR2, CR4, CR5, CR6, IS ,ART and in the quotient AUVA/AUVP; 2) the patients with instrumentation of the fractured vertebra present a better evolution radiological result than the patients without instrumentation of the vertebra fractured in the regional cifosis: CR1, CR2, CR3, CR4, CR5, CR6, IS, ART, APP, in the CV and in the quotient AUVA/AUVP; 3) the patients with instrumentation of the fractured vertebra present a better initial correction, smaller loss of correction and maintains in the evolution the previous height of the vertebral body, better than in the patients without instrumentation of the fractured vertebra (according to the values of CV, percentage of the AVA and the quotient AVA/AVP); 4) the patients with instrumentation of the fractured vertebra have a better radiological evolution than the patients without instrumentation of the vertebra fractured in most of the analyzed radiological measurements, according to the analysis of the variance (MANOVA); 5) the patients with instrumentation of the fractured vertebra present a failure rate of practically null the vertebral assembly in comparison to the patients without instrumentation of the fractured vertebra.