Long-arm uniaxial screws through Wistle approach versus AF system through conventional approach in the treatment of thoracic and lumbar compressive fractures

doi:10.3969/j.issn.2095-4344.0374

Abstract

Abstract:

BACKGROUND: With the improvement of the concept of treatment, the reduction of iatrogenic injury has gradually been paid much attention. At present, the AF system is gradually withdrawing from the market. The surgical treatment of thoracic and lumbar spine fractures requires new internal fixations and operative approach.

OBJECTIVE: To evaluate the treatment outcomes of long-arm uniaxial screws through Wistle approach versus AF system through the conventional approach for thoracic and lumbar compressive fractures.

METHODS: From March 2011 to December 2016, 55 patients with thoracic and lumbar spine fractures treated with long-arm uniaxial screws through Wistle approach were served as Wistle approach, and 85 cases treated with AF system through the conventional approach from January 2006 to January 2011 were served as control group. The operation time, intraoperative blood loss, postoperative drainage, preoperative and postoperative Visual Analogue Scale scores, vertebral height correction rate, and Oswestry Disability Index scores at 3 months postoperatively were compared by independent-samples t test.

RESULTS AND CONCLUSION: (1) There was none of nail/rod broken in each group. (2) The Wistle approach group was significantly advantageous in the operation time, intraoperative blood loss, postoperative drainage and Visual Analogue Scale scores at 1 and 3 days postoperatively compared with the control group (P < 0.05). The preoperative Visual Analogue Scale scores, vertebral height correction rate, and Oswestry Disability Index scores at 3 months postoperatively did not differ significantly between two groups. (3) Compared with the AF system through the conventional approach, long-arm uniaxial screws through Wistle approach can retain the posterior ligament complex, is an effective and minimally invasive treatment and can reduce the iatrogenic injury, which is an appropriate repair method for the patients with simple thoracic and lumbar fractures without neurologic symptoms.

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: Thoracic Vertebrae, Lumbar Vertebrae, Spinal Fractures, Surgical Procedure, Minimally Invasive, Tissue Engineering

CLC Number:

R318

Han Li-qiang, Jiang Han, Wang Shu-sen, Li Xiao-dong, Zheng Jin-xin. Long-arm uniaxial screws through Wistle approach versus AF system through conventional approach in the treatment of thoracic and lumbar compressive fractures [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(31): 4949-4954.

Figures/Tables 2

References

[1] Bakhsheshian J, Dahdaleh NS, Fakurnejad S, et al. Evidence-based management of traumatic thoracolumbar burst fractures: a systematic review of nono perative management. Neurosurg Focus. 2014;37(1): E1.

[2] 肖延河,陈峰. 经椎弓根伤椎内植骨AF内固定治疗胸腰椎骨折[J].实用医学杂志,2011,23(18):2009-2010.

[3] Nakasuji M,Sub SH,Nomura M,et al.Hypotension from spinalanesthesia in patients aged greater than 80 years is due to a decrease in systemic vascular resistance.J Clin Anesth. 2012;24(3): 201-206.

[4] Jindal N,Sankhala SS,Bachhal V.The role of fusion in the management of burst fractures of the thomcolumbar spine treated by short segment pedicle screw fixation:A prospective randomised trial. J Bone Joint Surg Br. 2012;94(8):1101-1106.

[5] Fan S,Hu Z,Zhao F,et al. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. Eur Spine J. 2010; 19(2):316-324.

[6] Hoh DJ,Wang MY, Ritland SI. Anatomic features of the paramedian muscle-splitting approaches to the lumbar spine. Neurosurgery. 2010; 66(3 Suppl): 13-25.

[7] 胡志军,范顺武,赵兴. 微创后路腰椎椎体间融合术椎旁软组织解剖与评估[J]. 国际骨科学杂志, 2007,28(5):295-297.

[8] 张强,纪玉清,胡樵,等. 胸腰段骨折后路微创器械设计及临床应用[J]. 中华创伤骨科杂志,2010,12(7):605-608.

[9] Wiltse LL, Bateman JG, Hutchinson RH, et al. The paraspinal sacrospinalis-splitting approach to the lumbar spine. J Bone Joint Surg Am. 1968;50(5):919-926.

[10] Wiltse LL, Spencer CW. New uses and refinements of the paraspinal pproach to the lumbar spine. Spine (Phila Pa 1976). 1988;13(6):696-706.

[11] 梁亮科,杨宇,李磊,等. Wistle间隙准微创入路治疗单节段无神经损伤胸腰椎骨折的临床研究[J].实用医学杂志, 2014,26(8):1276-1278.

[12] Yuksel MO, Gurbuz MS, Is M, et al. Is the Thoracolumbar Injury Classification and Severity Score (TLICS) Superior to the AO Thoracolumbar Injury Classification System for Guiding the Surgical Management of Unstable Thoracolumbar Burst Fractures without Neurological Deficit? Turk Neurosurg. 2018;28(1):94-98.

[13] Mohamadi A, Googanian A, Ahmadi A, et al. Comparison of surgical or nonsurgical treatment outcomes in patients with thoracolumbar fracture with Score 4 of TLICS: A randomized, single-blind, and single-central clinical trial. Medicine (Baltimore). 2018;97(6):e9842.

[14] 范磊,陈琦,于晨,等. 微创加长臂椎弓根钉系统治疗胸腰椎压缩骨折的疗效分析[J].中国骨与关节损伤杂志,2015,30(1):85-86.

[15] 姜睿,王润森,程晓雷,等. 椎旁肌间隙入路在胸腰椎手术中的临床应用[J]. 吉林大学学报(医学版),2010,36(5):975-978.

[16] 许建柱,全仁夫,谢尚举,等. 前后联合入路治疗严重不稳定下腰椎爆裂骨折[J]. 中华创伤杂志,2017,33(4):305-309.