Эффективность и безопасность короткой транспедикулярной фиксации при неосложненных взрывных переломах нижнегрудного и поясничного отделов позвоночника: метаанализ исследований, опубликованных за последние 20 лет

Цель исследования. Систематизированный обзор и метаанализ исследований, посвященных хирургическому лечению больных с неосложненными взрывными переломами нижнегрудного и поясничного отделов позвоночника, определение эффективности и безопасности применения короткой транспедикулярной фиксации (ТПФ) у пациентов данной группы.

Материал и методы. В исследование отобраны статьи по следующим критериям: дата публикации с 01.01.2004 г. по 31.12.2023 г.; наличие полнотекстовой версии статьи на английском или русском языках; тип перелома А3 или А4 по классификации AOSpine либо взрывные переломы типов А, В или С по классификации Denis, либо прямое указание автора на наличие у пациентов взрывного перелома без его классификации; отсутствие травмы спинного мозга или его корешков на момент поступления пациента в стационар; ТПФ с вовлечением по одному смежному со сломанным позвонком сегменту в каудальном и краниальном направлениях; ТПФ без спондилодеза; возраст пациентов старше 18 лет; описание результатов лечения или развившихся осложнений; средний катамнез для выборки пациентов не менее 12 мес.

Результаты. Установлено, что оптимальным методом хирургического лечения взрывных переломов нижнегрудного и поясничного отделов позвоночника без неврологического дефицита является стандартная короткая ТПФ без применения дополнительного спондилодеза. Необходимо отметить, что у этих пациентов не было выявлено значимого влияния дополнительных винтов в сломанном позвонке при короткой ТПФ как на интраоперационные показатели, так и на отдаленные результаты лечения.

Заключение. Короткая ТПФ без дополнительного спондилодеза и ламинэктомии может быть эффективным и безопасным методом хирургического лечения взрывных переломов нижнегрудного и поясничного отделов позвоночника без неврологического дефицита. Ее применение позволяет добиться регресса кифотической деформации в отдаленном периоде травмы не менее чем на 5,9° и восстановления высоты передних отделов сломанного позвонка на 24 %.

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