Sextant system fixation for the repair of lumbar fracture: ratio of anterior to posterior border height of the injured vertebra and kyphosis Cobb angle

doi:10.3969/j.issn.2095-4344.2015.04.010

Abstract

Abstract:

BACKGROUND: Posterior lumbar pedicle screw fixation has been a common method to treat vertebral compression fractures. Traditional surgical incision of pedicle screw fixation commonly produces many local muscle tissue damages. Lumbar fixation by minimally invasive method is a big progress in minimally invasive spine surgery.

OBJECTIVE: To investigate the therapeutic results of Sextant system with percutaneous pedicle screw fixation for the treatment of lumbar fracture, and to compare the changes in visual analog scale, the ratio of anterior to posterior border height of the injured vertebra, and kyphosis Cobb angle before and after fixation.

METHODS: Data of 58 cases of vertebral compression fractures were retrospectively analyzed. All cases were treated by the senior associate chief physician (second author) at the Department of Orthopedics, the First People’s Hospital of Chengdu from January 2008 to December 2013. They received Sextant system with percutaneous pedicle screw fixation. Intraoperative blood loss, the changes in visual analog scale, the ratio of anterior to posterior border height of the injured vertebra, and kyphosis Cobb angle before and after fixation were observed.

RESULTS AND CONCLUSION: The average blood loss during the surgery was 40 mL, with an average post-surgery drainage of 80 mL. Postoperative lumbar back pain was significantly reduced (P < 0.01). After 2 weeks of lying in bed, they could do early functional rehabilitation exercises. The ratio of anterior to posterior border height of the injured vertebra, and kyphosis Cobb angle were significantly improved after fixation (P < 0.05). There was no screw loosening or breakage. These data suggested that the Sextant system with percutaneous pedicle screw fixation for vertebral compression fractures can better restore the anterior border height and correct kyphosis. Moreover, blood loss is less. Pain became mild after fixation, which is convenient to early functional exercises after the surgery.

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

全文链接：

Key words: Lumbar Vertebrae, Fractures, Bone, Internal Fixators, Surgical Procedures, Minimally Invasive, Pain Measurement

CLC Number:

R318

Liu Cheng-jun, Gu Zu-chao, Zhang Yu. Sextant system fixation for the repair of lumbar fracture: ratio of anterior to posterior border height of the injured vertebra and kyphosis Cobb angle [J]. Chinese Journal of Tissue Engineering Research, 2015, 19(4): 548-553.

Figures/Tables 2

2.1 参与者数量分析分析2008年1月至2013年12月收治的330例腰椎骨折行内固定治疗的患者中58例创伤所致单一腰椎压缩性骨折患者的资料，术前椎管无明显狭窄及占位，无脊髓神经损伤症状，Frankel分级为E级，既往无相应节段腰椎创伤及手术病史，均于术中行经后路腰椎Sextant系统内固定。按意向性处理，58例患者全部进入结果分析并得到完整的随访。 2.2 患者基线资料见表1。 2.3 治疗结果 58例经后路腰椎Sextant系统内固定患者的平均手术时间为60 min，术中平均出血量为40 mL，术后平均引流量为80 mL，所有病例术中、术后未出现输血者。术后复查腰椎正侧位X射线平片示，所有患者内固定后均无椎弓根螺钉置入椎间隙，无椎弓根螺钉过度撑开现象，无椎弓根螺钉穿破椎体前、后外侧壁。 2.4 内固定前后患者目测类比评分及伤椎前后缘高度比、后凸Cobb角变化内固定后患者疼痛明显减轻，仅7例患者内固定后24 h内口服非类固醇镇痛药物，内固定前后目测类比评分比较差异有显著性意义(P < 0.01)；伤椎前后缘高度比以及后凸Cobb角在内固定前后比较差异有显著性意义(P < 0.05，表2)。内固定后3-6个月门诊随访，采用改良Macnab疗效评定标准进行评估，优28例，良22例，可8例，优良率为86%。 2.5 典型病例男性患者，44岁，建筑工人，高坠伤致L2椎体压缩性骨折。图1A可见，患处椎体受压变扁，密度增高，呈现出前窄后宽的楔型改变，脊柱稳定性下降，椎体前后缘高度比为0.68，后凸Cobb角为29°。图1B所示为患者内固定后第3天复查X射线片，可见患处椎体前后缘高度比以及后凸Cobb角较内固定前得到积极的矫正，椎体前后缘高度比为0.91，后凸Cobb角为6°。 2.6 不良事件本组所有患者内固定后均未出现神经根刺激症状，手术切口全部一期愈合，未出现切口感染、下肢深静脉血栓形成现象，未出现椎弓根松动、脱落及断裂。"

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