Treatment of thoracolumbar vertebral fractures with percutaneous pedicle screw fixation

doi:10.3969/j.issn.2095-4344.2017.27.009

Abstract

Abstract:

BACKGROUND: Traditional open surgery will do great damage to the patients with thoracolumbar fractures, and easily induces local degeneration. In contrast, the novel method is minimally invasive, which contributes to the functional recovery of the spine.

OBJECTIVE: To discuss the essential procedures and precautions in the treatment of thoracolumbar fractures with percutaneous pedicle screw fixation.

METHODS: Twenty-seven cases of single-level thoracolumbar fractures without spinal neurological deficits treated with percutaneous pedicle screw fixation were selected. The operation time and intraoperative blood loss were observed. The Visual Analogue Scale scores during axial turning at baseline and 3 days postoperatively, and the Visual Analogue Scale scores of the operation region at 1 and 3 days postoperatively were detected, respectively.

RESULTS AND CONCLUSION: (1) Twenty-seven patients with 108 vertebrae underwent percutaneous pedicle screw fixation under the guidance of the needle, the puncture was smooth, 98 vertebrae was punctured successfully once, and 10 vertebrae were punctured successfully twice. (2) The Visual Analogue Scale scores during axial turning at 3 days postoperatively were significantly lower than those at baseline, and the scores of the operation region at 3 days postoperatively were significantly lower than those at 1 day postoperatively (P < 0.001). (3) The mean operation time was (109±18) minutes, and the mean intraoperative blood loss was (60±16) mL. (4) There were no nerve root injury and other complications. (5) Our results indicate that percutaneou pedicle screw fixation is a minimally invasive and safe method to treat the patients suffering single-level thoracolumbar fractures without spinal neurological deficits.

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, Internal Fixators, Bone Nails, Tissue Engineering

CLC Number:

R318

Ye Bin, Chen Ling-bin, Chen Wei, Yang Guo-yi, Chen Chao-bin, Zhou Li-li. Treatment of thoracolumbar vertebral fractures with percutaneous pedicle screw fixation [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(27): 4312-4317.

Figures/Tables 1

References

[1] 刘侃,吴闻文,郭继东,等.经Wiltse肌间隙入路内固定结合椎体内植骨治疗胸腰椎骨折的早期疗效观察[J].中国骨与关节外科, 2013, 6(4):349-354.

[2] 邓万祥,赵胡瑞,刘华,等.经伤椎置钉治疗胸腰椎骨折的临床研究[J].中国骨伤,2011,24(7):541-543.

[3] 焦伟,于海洋,梁成民,等.经椎旁肌间隙入路微创小切口在胸腰段骨折术后内固定取出术中的应用[J].临床骨科杂志,2011,14(2): 168-170.

[4] 曹贵君,孟纯阳,张卫红,等．经椎弓根钉内固定治疗合并后方韧带复合体损伤胸腰椎骨折早期疗效观察[J].中华创伤杂志,2015, 31( 4) :307-311．

[5] Denis F,Armstrong GW,Searls K et al：Acute thoracolumbar burst fractures in the absence of neurologic deficit．A comparison between operative and nonoperative treatment. Clin Orthop Relat Res.1984(189):142-149．

[6] 水小龙,徐华梓,池永龙,等.微创技术在不同类型胸腰段骨折中的应用[J].中华外科杂志,2011,49(12):1086-1090.

[7] 徐海栋,赵建宁,刘刚,等.椎旁肌间隙入路伤椎置钉技术治疗胸腰段骨折近期疗效观察[J].医学研究生学报,2015,28(1):45-48.

[8] Gazzeri R,Tamorri M,Galarza M,et al.Balloon—assisted endoscopic retroperitoneal gasless approach(BERG)for lumbar interbody fusion:is it a valid alternative to the laparoscopic approach? .Minim Invasive Neurosurg.2007;50(3):150-154.

[9] Shen FH,Samartzis D,Khanna AJ et al:Minimally invasive Techniques for Lumbar Interbody Fusions.Orthop Clin N Am. 2007;38：373-386

[10] 王洪伟,李长青,周跃,等.微创与传统开放附加伤椎经椎弓根螺钉内固定手术治疗胸腰椎骨折的疗效比较[J].中国脊柱脊髓杂志,2010, 20(2)112-116

[11] 庞正宝,庞帮镭,汤优民,等. Wiltse 入路治疗单节段胸腰椎骨折对多裂肌影响的研究[J] .中华骨科杂志,2016,36(2):72-80．

[12] 华俊,刘栋,徐又佳,等.经皮椎体后凸成形术近期疗效及再发骨折率与骨质疏松度的相关性[J].中华创伤杂志,2015,31(12): 1073-1076．

[13] 陈晓庆,陈向东,姜星杰,等.后路复位固定治疗严重胸腰椎骨折脱位[J]．中华创伤骨科杂志,2015,17( 3) : 265-267．

[14] Wang J,Zhou Y,Zhang ZF,et al.Radiological study on disc degeneration of thoracolumbar burst fractures treated by percutaneous pedicle screw fixation.Eur Spine J.2013: 22(3): 489-494.

[15] Barbagallo GM,Certo F,Visocchi M,et al.Multilevel mini-open TLIFs and percutaneous pedicle screw fixation：description of a simple technical nuance used to increase intraoperative safety and improve workflow. Tips and tricks and review of the literature. Neurosurg Rev.2015:38(2):343-354.

[16] 曹志军,黄世均,濮羽.胸腰椎骨折行经皮微创椎弓根钉棒内固定疗效分析[J].青海医药杂志,2015,45(7): 24-26.

[17] 张雪冬,史晓林,刘磊,等.微创椎弓根钉内固定治疗胸腰段脊柱骨折[J].临床手术学杂志,2017,26(3): 174-177.

[18] 孙树发,孙海燕,张引锋,等.30例椎旁肌间隙入路治疗胸腰段骨折临床体会[J].颈腰痛杂志,2013,34(4):317-319.

[19] 吴剑飞,谢德胜,龚进红,等.Wiltse肌间隙入路治疗57例胸腰段无神经损伤症状的单节段椎体骨折[J].临床军医杂志,2012,40(4): 867-868.

[20] 薛文,管晓鹂,刘姝娆,等.微创经皮与传统开放椎弓根螺钉固定治疗胸腰椎骨折的Meta分析[J].中华临床医师杂志:电子版,2015, 9(23):115-121．

[21] 王富贵,粪颜伟,陈伟,等. 经伤椎单侧置钉短节段内固定治疗胸腰椎骨折的效果[J]. 江苏医药,2014,40(13):1548-1550．

[22] 盛文辉,尚琦松,吴兵,等．短节段固定结合伤椎置钉、植骨治疗胸腰椎骨折的临床研究[J].中华临床医师杂志:电子版, 2013,7(3): 990-995．

[23] Kim DY, Lee SH,Chung S K,et al：Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation.Spine.2005; 30:123-129．

[24] 王毓幸,陈新军.最长肌多裂肌间隙入路治疗胸腰段骨折[J].实用医学杂志,2014,30(6):1008-1009.

[25] 祁磊,李牧,司海朋,等.应用翼状工作通道经椎旁肌间隙入路治疗胸腰椎骨折疗效分析[J]. 中华外科杂志,2015,53(4) : 294-299．

[26] 朱劲松,杨民,徐祝军,等.后路经椎弓根螺钉内固定治疗胸腰椎骨折治疗失败原因分析[J]．中华创伤骨科杂志2016,18(3) :253-256．

[27] 郭胜利,张远征,周定标,等.应用C1-2螺钉棒系统行后路复位、固定和融合治疗合并寰—枢推脱位的颅底凹陷症[J].中华神经外科疾病研究杂志,2014,13(5):412-415.

[28] 刘小勇,杨慧林,唐天驷,等.椎体后凸成形术棘突定位穿刺点与穿刺轨道的研究[J].中华骨科杂志,2005,25(18):462-466

[29] Dvrak M,MacDonuld S,Gurr KR,et al:Ananatomic,radiographic and biomechanical assessment of extropedicular screw fixation in the thoracic spine.Spine.1993;18(12): 1689-1694

[30] Phillips JH,Kling JR,Cohen MD,et al:The radiographic anatomy of the thoracic pedicle. Spine.1994;19(4):446-449

[31] 余铮,李振宇,张洪,等.腰椎弓根螺钉进钉点和一次置钉率的研究[J].中国医师杂志,2005,7(8): 1050-1052.