Vertebral fixation with minimally invasive HXN pedicle screw system for thoracolumbar fractures

doi:10.3969/j.issn.2095-4344.2017.35.007

Abstract

Abstract:

BACKGROUND: Open reduction and internal fixation have been used to treat thoracolumbar fractures, which possesses good efficacy, but causes large trauma and many complications. Minimally invasive treatment like Wiltse operative approach and Sextant, Zina system also has many defects such as large incision, insufficient fixed strength, limited orthopedic forces.

OBJECTIVE: To access the effect of vertebral fixation with HXN pedicle screw system in the treatment of thoracolumbar fractures.

METHODS: Totally 68 cases of thoracolumbar fractures admitted in the Department of Orthopedics, the First Affiliated Hospital of Xinxiang Medical University from October 2014 to December 2016 were randomly divided into two groups: the patients in group A received minimally invasive pedicle screw fixation with HXN system and those in group B were subjected to open reduction and internal fixation. The perioperative indexes (blood loss), Visual Analogue Scale scores, Oswestry Disability Index, anterior vertebral height, and Cobb angle were detected to compare the curative efficacy between two groups.

RESULTS AND CONCLUSION: (1) All patients were followed up for 3-24 months. (2) There were no significant differences in the operation time, intraoperative fluoroscopy times between two groups (P > 0.05), and the blood loss in the group B was significantly more than that in the group A (P < 0.05). (3) The preoperative Visual Analogue Scale and Oswestry Disability Index scores showed no significant differences between two groups (P > 0.05), and the postoperative and last follow-up scores were significantly decreased (P < 0.05), but the group A had lower scores than those in the group B (P < 0.05). (4) The anterior vertebral height and Cobb angle were significantly improved postoperatively (P < 0.05); at the last follow-up, both indexes had no obvious loss and showed no significant difference between two groups (P > 0.05). (5) The incision healed well in the group A, while there were two cases of incision infection in the group B. No screw loosening, displacement or rupture occurred during follow-up. (6) These results suggest that the minimally invasive HXN pedicle screw system for thoracolumbar fracture not only has the advantages of fewer traumas, less blood loss, low incidence of incision infection, pain relief, but also is safe and easy to operate, which obtains good fixation stability and can achieve the same curative effect with the open 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

Key words:

Surgical, Minimally Invasive, Thoracic Vertebrae, Lumbar Vertebrae, Fractures, Bone, Internal Fixators, Tissue Engineering

CLC Number:

R318

Wang Jing-yu, Dong Yu-zhen, An Yong-bo, Cui Ming-xing, Li Qing-jiang. Vertebral fixation with minimally invasive HXN pedicle screw system for thoracolumbar fractures[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(35): 5616-5621.

Figures/Tables 2

2.2 两组患者一般资料比较微创组与对照组患者治疗前在年龄、性别、病程、骨折节段方面差异无显著性意义(P > 0.05)，具有可比性，见表1。 2.3 手术时间、透视次数、术中失血量等情况比较 2组患者手术均顺利完成，其中2组手术时间、透视次数相比，经检验差异无显著性意义(P > 0.05)；术中平均失血量微创组显著小于对照组(P < 0.05)，见表2。 2.4 两组目测类比评分及ODI比较 2组术前目测类比评分差异无显著性意义(P > 0.05)，术后及末次随访时目测类比评分均较术前明显降低(P < 0.05)，但微创组低于对照组(P < 0.05)；2组术前ODI差异无显著性意义(P > 0.05)，术后及末次随访时ODI均较术前明显改善(P < 0.05)，但微创组低于对照组(P < 0.05)，见表3。均说明微创组术后腰椎残余痛轻。 2.5 两组伤椎前缘高度、Cobb 角比较 2组术前、术后、末次随访时伤椎前缘高度、Cobb 角差异均无显著性意义(P > 0.05)；末次随访与术后相比2组伤椎前缘高度、Cobb 角无明显丢失(P > 0.05)，见表4。说明微创组与对照组在矫形方面疗效相当。 2.6 不良事件微创组术后切口均愈合良好；对照组出现2例切口感染迹象，考虑可能与创口大、暴露时间长、脂肪液化有关，经积极抗感染治疗及加强换药后愈合。随访期间2组均未见内固定松动、移位及断裂的情况发生。说明微创组创伤小、切开感染率低，但两者术后内固定稳定性均较好。 2.7 典型病例典型病例1：患者男，35岁，“高处坠落致腰背部疼痛2 h”为主诉入院，入院后行胸腰椎X射线片示L1椎体骨折，CT示椎体后缘骨块突入椎管1/3，双侧椎弓根完整，全麻下行微创椎弓根钉固定手术，术后6个月复查胸腰椎正侧位片示伤椎高度维持良好，内植物无松动、断裂。相关图片见图2。典型病例2：患者男，40岁，以“外伤致腰背部疼痛半天余”主诉入院，入院后胸腰椎X射线片显示L1椎体骨折，CT示椎体后缘骨块突入椎管1/4，双侧椎弓根无损伤，全麻下行切开复位椎弓根钉内固定术，术后12个月复查胸腰椎正侧位片示伤椎高度满意，内固定位置良好。相关图片见图3。"

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