Percutaneous pedicle screw fixation combined with calcium sulfate cement for single-level thoracolumbar fracture: a 3-month follow-up

doi:10.3969/j.issn.2095-4344.2017.23.010

Abstract

Abstract:

BACKGROUND: Percutaneous pedicle screw fixation has been applied in the treatment of thoracolumbar fracture, and has achieved satisfactory clinical efficacy. Injectable calcium sulfate holds good biocompatibility, degradability and fast curing.

OBJECTIVE: To explore the clinical efficacy of percutaneous pedicle screw fixation combined with calcium sulfate cement for single-level thoracolumbar fracture.

METHODS: Clinical data of 40 patients with single-level thoracolumbar fracture without nerve injury were analyzed retrospectively. All fractured vertebrae were compressed more than 30% and at least one pedicle was complete. All patients were treated with percutaneous pedicle screw fixation combined with calcium sulfate cement. The Visual Analog Scale and Oswestry Disability Index scores were recorded at baseline, 3 months postoperatively and last follow-up; the height of the fractured vertebra body and sagittal Cobb angle were measured on X-ray; the patient’s satisfaction and healing rate were recorded.

RESULTS AND CONCLUSION: (1) The Oswestry Disability Index at 3 months postoperatively and last follow-up was 16.3% and 4.4%, respectively. Compared with baseline, the Cobb angle and Visual Analog Scale scores were significantly reduced, and height of the fractured vertebra body was significantly increased after surgery (P < 0.01). (3) The healing rate at last follow-up was 95%, nonunion was not found, and the patients’ satisfaction reached 95%. (4) The loss of vertebral height and Cobb angle was found at last follow-up compared with 3 months postoperatively, but had no significant difference (P > 0.05). (5) These results indicate that percutaneous pedicle screw fixation combined with calcium sulfate cement is safe and reliable for single-level thoraclumbar fracture, which not only restores the vertebral height and relieves pain, but also has satisfactory long-term curative efficacy and high healing rate.

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, Bone Nails, Fracture Healing, Tissue Engineering

CLC Number:

R318

Zhan Fang-biao, Cheng Jun, Feng Shi-long, Xie Li-zhong, Li Bo, Zhang You, Chen Lin. Percutaneous pedicle screw fixation combined with calcium sulfate cement for single-level thoracolumbar fracture: a 3-month follow-up [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(23): 3664-3669.

Figures/Tables 1

2.1 参与者数量分析按意向性处理，纳入患者共40例，随访过程中无脱落，均进入结果分析。试验流程图见图1。 2.2 围手术期指标观察结果本组40例患者均获得随访，随访时间14-24个月。手术时间115-150 min，平均 133 min；术中出血量50-85 mL，平均63 mL；住院时间 9-17 d，平均12. 8 d；术后2-4 d(平均3.2 d)可在胸腰骶支具保护下离床活动。术后腰椎CT扫描发现3枚椎弓根螺钉误入椎管，但无脊髓或马尾神经损伤等并发症；无切口感染，切口积血，内固定断裂、松动、硫酸钙渗入椎管等术后并发症；术后遗留腰背部轻度疼痛2例。ODI术后3个月、术后末次随访分别为16.3%，4.4%。 2.3 临床指标观察结果与术前相比，术后3个月随访时，本组患者的伤椎局部后凸Cobb角及疼痛目测类比评分均减小，伤椎前缘高度百分比增加，差异有显著性意义(P < 0.01)；末次随访患者骨折愈合率为95%，2例患者末次随访时骨折未愈合，患者对手术主观满意度的优良率为95%。与术后3个月比较，末次随访患者胸腰椎局部矢状位Cobb角、伤椎前缘高度均有丢失，但差异无显著性意义(P > 0.05)，见表1。 2.4 典型病例分析男性患者，45岁，因交通事故伤6 h入院。L2椎体爆裂骨折A3. 1型，影像学资料见L2椎体前缘明显压缩，椎管内可见骨折块占位。采用经皮椎弓根螺钉置入内固定结合硫酸钙人工骨治疗，术后患者椎体高度基本恢复。影像学资料见图2-5。 2.5 不良事件本组40例患者中有3例术后腰椎CT扫描发现螺钉误入椎管，但术后围手术期、术后3个月及术后末次随访均未发现明显神经症状。所有患者术后均无切口感染，切口积血等并发症。术后2例患者遗留腰背部轻度疼痛，2例患者末次随访时骨折未愈合。所有患者随访期间未出现螺钉松动、断裂。 2.6 可能影响结果的因素本研究40例患者手术并非由同一手术医生完成，因此术中出血量、手术时间及椎弓根螺钉置入准确率可能有人为偏倚。本组研究量少，为回顾性研究，患者对手术满意率可能受其他非手术因素的影响(如随访时患者心理状态、患者对医生、护士以及治疗的满意度等)。"

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