Percutaneous pedicle screw internal fixation combined with pedicle screw implanting in injured vertebra body for treating single segment of thoracolumbar fracture

doi:10.3969/j.issn.2095-4344.2016.53.015

Abstract

Abstract:

BACKGROUND: Studies have shown that percutaneous pedicle screw internal fixation for treatment of thoracolumbar fracture has got good clinical results, but for the injured vertebra body, whether pedicle screw should be implanted in injured vertebra body and unilateral or bilateral implanting screw is still controversial.

OBJECTIVE: To investigate the clinical efficacy of the percutaneous pedicle screw internal fixation combined with pedicle screw implanting in injured vertebra body for treatment of single segment of thoracolumbar fracture.

METHODS: Totally 21 patients with single segment thoracolumbar fractures were treated by the percutaneous pedicle screw internal fixation combined with pedicle screw implanting in injured vertebra body, including 16 males and 5 females. There were T₁₁ in 2 cases, T₁₂ in 4 cases, L₁ in 13 cases, and L₂ in 2 cases. The Visual Analog Scale scores (VAS), the Japanese Orthopaedic Association (JOA) disability scores and Cobb’s angle were recorded preoperatively and postoperatively. In addition, complications were also recorded.

RESULTS AND CONCLUSION: (1) The VAS scores at 1 week and 3, 6 and 12 months after treatment were significantly lower than those before surgery (P < 0.001). In addition, VAS scores were lower at 1 week than that at postoperative 3, 6, 12 months (P < 0.001). No significant difference in VAS scores was detected at postoperative 3, 6, 12 months. (2) Lumbar function: JOA scores were significantly higher at postoperative 1 week and 12 months than those before treatment (P < 0.001), and the postoperative JOA scores were significantly higher at 12 months than at postoperative 1 week (P < 0.001). (3) Cobb’s angle was significantly smaller at 1 week and 12 months after surgery than that before treatment (P < 0.001). No significant difference in Cobb’s angle was detectable at 1 week and 12 months after surgery. (4) No complications were found. (5) These results suggest that the percutaneous pedicle screw internal fixation combined with pedicle screw implanting in injured vertebra body for single segment of thoracolumbar fracture can correct kyphosis, improve the thoracolumbar motion, quickly relieve patient’s back pain, and is very safe.

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: Spine, Internal Fixators, Tissue Engineering

CLC Number:

R318

Li Rui-long, Zhang Qiang, Yang Liu-zhu, Luo Jin, Huang Wen, Feng Liang-en, Su Mou, Liang Da-di . Percutaneous pedicle screw internal fixation combined with pedicle screw implanting in injured vertebra body for treating single segment of thoracolumbar fracture[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(53): 8004-8009.

Figures/Tables 1

2.1 参与者数量分析按意向性分析处理，21例患者均完成治疗后12个月随访，进入结果分析。 2.2 螺钉置入情况共有21例单节段胸腰椎骨折患者被纳入研究，其中男16例，女5例，年龄(42.5±8.48)岁；共有21个椎体骨折，涉及T11 2例、T12 4例、L1 13例、L2 2例；共置入105枚椎弓根螺钉，其中伤椎置入的万向椎弓根螺钉为21枚。 2.3 试验流程图见图1。 2.4 治疗前后目测类比评分变化治疗前目测类比评分最高，说明患者腰背部疼痛最为剧烈；行经皮椎弓根螺钉内固定并伤椎置钉治疗后，患者腰背部疼痛较治疗前明显减轻，治疗后1周、3个月、6个月及12个月目测类比评分均明显低于治疗前(t1=22.07，P1 < 0.001；t3=26.30，P3 < 0.001；t6=31.78，P6 < 0.001；t12=30.36，P12 < 0.001)；治疗后1周目测类比评分高于治疗后3，6，12个月(t1，3=18.86，P1，3 < 0.001；t1，6=10.95，P1，6 < 0.001；t1，12=13.35，P1，12<0.001)，这说明治疗后1周腰背部疼痛改善尚未达到最好；治疗后3，6，12个月目测类比评分比较差异无显著性意义(P > 0.05)，见图2，这说明治疗后腰背部疼痛缓解可以长期维持。 2.5 治疗前后JOA评分变化治疗后不同时间点的JOA评分明显高于治疗前(t1周=-20.2，P1 < 0.001；t12个月= -30.56，P12个月<0.001)；治疗后1周JOA评分低于治疗后12个月(P12 < 0.001)，见图3，这说明治疗后1周患者的腰椎功能改善尚未达到最好，治疗后随时间的推移患者的腰椎功能逐渐改善。 2.6 治疗前后Cobb角变化治疗后1周、12个月Cobb角明显低于治疗前(t1=12.90，P1 < 0.001；t12=11.97，P12 < 0.001)，治疗后1周Cobb角与治疗12个月比较差异无显著性意义(t=-2.06，P=0.053)，见图4，这说明经皮椎弓根螺钉内固定并伤椎置钉可快速矫正胸腰椎后凸畸形，且可以长时间维持腰椎的稳定性。 2.7 并发症试验中，术中及术后未出现并发症。 2.8 典型病例 45岁男性患者，因车祸致L1椎体压缩性骨折，治疗前目测类比评分为9，治疗前前JOA评分为10分，治疗前Cobb角为5°，行经皮椎弓根螺钉内固定并单侧伤椎置钉治疗，治疗后12个月目测类比评分为1，腰背疼痛较前明显减轻；治疗后12个月JOA评分为27分，治疗后12个月Cobb角为2°。患者治疗前后影像学图片见图5。"

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