Comparison of percutaneous and open pedicle screw system in the treatment of multilevel thoracolumbar fractures: the accuracy of screw placement

doi:10.3969/j.issn.2095-4344.0116

Abstract

Abstract:

BACKGROUND: Multilevel thoracolumbar fractures are mainly treated with percutaneous pedicle screw and open pedicle screw system, but the treatment effect of different systems and the accuracy rate of screw placement are controversial, resulting in the lack of uniform standards for choosing the treatment method.

OBJECTIVE: To evaluate the effect of percutaneous pedicle screw and open pedicle screw system in the treatment of multilevel thoracolumbar fractures and to evaluate the accuracy of the screw placement.

METHODS: Totally 90 patients with multilevel thoracolumbar fractures were divided into open pedicle screw group (n=43 cases) and percutaneous pedicle screw group (n=47) according to different surgical methods. Open pedicle screw group was treated with open pedicle screw treatment, and percutaneous pedicle screw group was treated with percutaneous pedicle screw. Comprehensive effects were analyzed by comparing perioperative indicators (operation time, postoperative drainage volume, and incision length) imaging index (anterior vertebral height percentage, posterior vertebral height percentage, sagittal Cobb angle), postoperative complications, and pedicle screw accuracy.

RESULTS AND CONCLUSION: (1) The amount of bleeding, postoperative drainage volume, and incision length were less (shorter) in the percutaneous pedicle screw group compared with the open pedicle screw group (P < 0.05). However, operation time and the number of undergoing fluoroscopy were longer (more) in the percutaneous pedicle screw group than in the open pedicle screw group (P < 0.05). (2) Anterior vertebral height percentage and posterior vertebral height percentage were higher in the percutaneous pedicle screw group than in the open pedicle screw group (P < 0.05). Sagittal Cobb angle was smaller in the percutaneous pedicle screw group than in the open pedicle screw group (P < 0.05). (3) At 2 months after surgery, the complication rate was significantly lower in the percutaneous pedicle screw group (4%) than in the open pedicle screw group (14%) (P < 0.05). (4) The accuracy rate of pedicle screw was significantly higher in the percutaneous pedicle screw group (92.1%; 279 screws) than in the open pedicle screw group (77.0%; 257 screws) (P < 0.05). (5) Results indicated that percutaneous pedicle screw fixation is characterized by less trauma and rapid recovery in the treatment of multilevel thoracolumbar fractures. It is helpful for the reduction of the injured vertebra, the maintenance of vertebral height; the safety and the accuracy of screw placement are high.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Bone Nails, Thoracic Vertebrae, Lumbar Vertebrae, Fractures, Bone, Internal Fixators, Tissue Engineering

CLC Number:

R318

Luo Peng-gang, Jin Da-di, Wu Zeng-zhi, Ling Hua-jun, Lin Wei-wen, Zhong Si-long. Comparison of percutaneous and open pedicle screw system in the treatment of multilevel thoracolumbar fractures: the accuracy of screw placement [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(7): 1050-1055.

Figures/Tables 2

2.1 参与者数量分析按意向性处理，纳入多节段胸腰椎骨折患者90例，分为2组，全部进入结果分析，中途无脱落，试验流程图见图1。 2.2 基线资料比较两组基线资料比较差异无显著性意义(P > 0.05)，具有可比性，见表1。 2.3 围术期指标比较经皮椎弓根螺钉组术中出血量、术后引流量、手术切口长度均少(短)于开放椎弓根螺钉组(P < 0.05)，但手术时间、术中透视次数均长(多)于开放椎弓根螺钉组(P < 0.05)，见表2。 2.4 影像学指标比较 2组术前伤椎前缘高度百分比、伤椎后缘高度百分比、矢状位Cobb角比较差异无显著性意义(P > 0.05)。经皮椎弓根螺钉组术后2个月伤椎前缘高度百分比、伤椎后缘高度百分比均大于开放椎弓根螺钉组(P < 0.05)，但经皮椎弓根螺钉组术后2个月矢状位Cobb角小于开放椎弓根螺钉组(P < 0.05)，见表3。 2.5 术后2个月并发症发生率比较经皮椎弓根螺钉组术后2个月并发症发生率为4%，与开放椎弓根螺钉组14%比较，差异有显著性意义(P < 0.05)，见表4。 2.6 围术期置钉准确率比较经皮椎弓根螺钉组共置入279枚螺钉，置钉准确率为92.1%，高于开放椎弓根螺钉组共置入257枚螺钉，置钉准确率77.0%。经皮椎弓根螺钉组置钉准确率高于开放椎弓根螺钉组，差异有显著性意义 (P < 0.05)，见表5。 2.7 典型病例病例1：女，45岁，由于车祸引起多节段胸腰椎骨折(T12，L1骨折)，患者行经皮椎弓根螺钉治疗，术前及术后2个月对患者行X射线检查，患者恢复良好。手术前后的X射线片见图2。病例2：男，40岁，车祸伤致多节段胸腰椎骨折，患者行开放椎弓根螺钉系统固定治疗，术前及术后2个月对患者行X射线检查，患者恢复良好。术前三维重建图片及术后的X射线片见图3。"

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