Comparison of strengthened transvertebral pedicle screw internal fixation and internal fixation plus percutaneous vertebroplasty in the treatment of thoracolumbar vertebral fractures

doi:10.3969/j.issn.2095-4344.0232

Abstract

Abstract:

BACKGROUND: Four screws plus two bars internal fixation combined with percutaneous vertebroplasty and strengthened pedicle screw internal fixation (five or six screws) are commonly surgical procedures for thoracolumbar burst or compression fractures.

OBJECTIVE: To compare clinical efficacy between strengthened transvertebral pedicle screw internal fixation and internal fixation plus percutaneous vertebroplasty in treatment of single thoracolumbar vertebral fractures, and to optimize operation scheme.

METHODS: Totally 76 patients with thoracolumbar vertebral fracture treated from July 2013 to December 2015 were respectively studied, who were divided into A (39 cases) and B (37 cases) groups according to different surgeries. Group A received strengthened transvertebral pedicle screw internal fixation scheme; group B received conventional internal fixation plus percutaneous vertebroplasty scheme. Operation indexes, variations on anterior and posterior vertebral height, kyphosis correction, pain degree and postoperative complications were compared between the two groups.

RESULTS AND CONCLUSION: (1) All patients were operated successfully. Intraoperative blood loss, time of out-of-bed activity postoperatively and hospital stay were significantly different between the two groups (P > 0.05). Operation time was significantly longer in the group A than in group B (P < 0.05). (2) Postoperative vertebral height, spinal curvature and pain degree were reduced to different degrees in both groups. Since 3 months after operation, no obvious vertebral height loss appeared in both groups. At postoperative 7 days, 1, 3 and 12 months, vertebral height compression rate, height recovery rate, posterior convex angle, kyphosis correction rate and Visual Analogue Scale were not significantly different between the two groups (P > 0.05). (3) Bone cement leakage occurred in two cases (5%) in group B, but it did not leak into spinal canal. During follow-up, there were no internal fixation failure or nerve injury cases in both groups. In group B, one case (3%) developed adjacent vertebral fracture. There was no adjacent vertebral fracture in group A. (4) These findings confirmed that strengthened transvertebral pedicle screw internal fixation and conventional internal fixation plus percutaneous vertebroplasty had similar efficacies in treatment of thoracolumbar single vertebral fracture, and the former had no risk of bone cement leakage and had less influence on adjacent vertebra.

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: Spinal Fractures, Kyphoplasty, Internal Fixators, Tissue Engineering

CLC Number:

R318

Zhang Cai-yi, Zuo Cai-hong, Tao Zhong-liang, Zhang Qing, Wang Shao-gang, Wang Sheng, Dai Lian-sheng. Comparison of strengthened transvertebral pedicle screw internal fixation and internal fixation plus percutaneous vertebroplasty in the treatment of thoracolumbar vertebral fractures[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(23): 3640-3646.

Figures/Tables 4

2.2 手术相关指标比较 2组术中出血量、术后开始下床活动时间及住院时间差异均无显著性意义(P > 0.05)，A组手术时间显著长于B组(P < 0.05)，见表2。 2.3 术后疗效比较 2组患者椎体高度、脊柱生理弯曲、疼痛程度均不同程度恢复或减轻；自术后3个月始，2组伤椎椎体高度无明显丢失；2组术后7 d、1个月、3个月、12个月伤椎高度压缩率、高度恢复率、椎体后凸角、后凸矫正率、目测类比评分差异均无显著性意义(P > 0.05)，见表3。 2.4 典型病例典型病例1：男，62岁，L2椎体压缩性骨折，术前目测类比评分9分，椎体高度压缩率58.4%，椎体后凸角22°；术后7 d目测类比评分3分，高度压缩率11.1%，高度恢复率73.7%，后凸角14°，后凸矫正率80.6%；术后3个月目测类比评分2分，高度恢复率71.9%，后凸矫正率78.8%；术后12个月目测类比评分1分，高度恢复率71.3%，后凸矫正率78.1%，见图7。典型病例2：女，56岁，L1椎体爆裂性骨折，术前目测类比评分8分，椎体高度压缩率41.3%，椎体后凸角20°；术后7 d目测类比评分2分，高度压缩率8.5%，高度恢复率78.5%，后凸角11°，后凸矫正率83.3%；术后3个月目测类比评分1分，高度恢复率75.3%，后凸矫正率81.0%；术后12个月目测类比评分0分，高度恢复率74.5%，后凸矫正率81.0%，见图8。 2.5 并发症比较术后2组切口均一期愈合。B组术后CT检查有2例(5%)出现少量骨水泥漏至椎体外缘，1例漏向椎体左前方，1例漏入椎间盘，未发现漏入椎管病例。随访期间2组均未出现钉棒松动、断裂及脱落现象，也未出现神经根损伤及迟发性神经功能障碍病例。B组术后有1例(3%)发生邻近椎体骨折，后经PVP治疗，疼痛解除，A组未出现临近椎体骨折病例。 "

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