흉요추부 골절에서 척추경 나사못 고정술 후 발생한 금속부전시 Magerl 및 McCormack 하중담당 분류의 예측력 = Predictability of Magerl & McCormack’s Load Sharing Classification on the Metal Failure after Pedicle Screw Fixation in the Thoracolumbar Spine Fracture

다국어 초록 (Multilingual Abstract)

Study Design: A retrograde study of metal failures at thoracolumbar spinal fractures fixed using pedicle screws.
Objectives: The predictability and usefulness of the McCormack's classifications for metal failures was compared with Magerl’s
classifications.
Summary of Literature Review: The load sharing classification was introduced to predict metal failure after short-segmental
pedicle screw fixation by McCormack. However, its reliability is uncertain.
Materials and Methods: From July 2000 to July 2003, this study examined the plain radiographs and CT images of 31 out of
46 patients who underwent posterior stabilization using pedicle screws for thoracolumbar fractures and could be followed up at
least 1 year. Fractures were classified utilizing Denis’s, Magerl’s, and McCormack’s systems.
Results: As a result of analysis of relation between metal failure and classification system by Magerl or McCormack, there was
no significant difference in its distribution. There was no correlation between the fixation range and metal failures in type C3
fractures, but there was a correlation between short fixation and metal failures in rotational burst fractures in short fixation.
Conclusions: In order to prevent metal failures after fixing thoracolumbar spinal fractures by pedicle screws, the stability should
be evaluated using Magerl’s classification and McCormack’s total score. In addition, in cases of type C3 fractures according to
the Magerl’s classification, reconstructions should be carried out with a long segment fixation or anterior supporting bone
grafts, particularly when McCormack’s total score is greater than 7.

참고문헌 (Reference)

1 Huler RJ, "Thoracolumbar spine fracture. (in John W. Frmoyer ed. The adult spine-principles and practice" Lippincott-Raven 1473-, 1977

2 Denis F, "The three column spine and its significance in the classification of acute thoracolumbar spine injuries" 8 : 817-831, 1983

3 McCormack T, "The load sharing classification of spine fractures" 19 : 1741-1744, 1994

4 Dekutoski MB, "Spinal mobility and deformity after Harrington rod stabilization and limited arthrodesis of thoracolumbar fractures" 75 : 168-176, 1993

5 Denis F, "Spinal instability as defined by the three column spine concept in acute spinal trauma" 189 : 65-76, 1984

6 Guttmann L, "Spinal deformities in traumatic paraplegics and tetraplegics following surgical procedures" 7 : 38-58, 1969

7 Mikles MR, "Posterior instrumentation for thoracolumbar fractures" 12 : 424-435, 2004

8 Tezeren G, "Posterior fixation of thoracolumbar burst fracture: short-segment pedicle fixation versus longsegment instrumentation" 18 : 485-488, 2005

9 Carl AL, "Pedicle screw instrumentation for thoracolumbar burst fractures and fracture-dislocations" 17 : 317-324, 1992

10 Karlstrom G, "New principles for treating vertebral injuries. Increased stability gives advantages" 86 : 2739-2744, 1989

11 Aligizakis AC, "Gertzbein and load sharing classifications for unstable thoracolumbar fractures" 411 : 77-85, 2003

12 McLain RF, "Early failure of short segment pedicle instrumentation for thoracolumbar fractures" 75 : 162-167, 1993

13 Daniaux H, "Application of posterior plating and modifications in thoracolumbar spine injuries. Indication, techniques, and results" 16 : 125-133, 1991

14 Dick W, "A new device for internal fixation of thoracolumbar and lumbar spine fractures: the ‘fixateur interne’" 23 : 225-232, 1985

15 Magerl F, "A comprehensive classification of thoracic and lumbar spine injuries" 3 : 184-201, 1994

16 Fancy JP, "A comparative biomechanical study of spinal fixation using Cotrel-Dubousset instrumentation" 12 : 877-881, 1987