Effect of percutaneous pedicle screw fixation on the reduction of thoraculumbar burst fractures with posterosuperior fracture fragment_West China Medical Journal

Authors：

YAN Ting ,  WU Chao , LIN Xu , ZENG Jun , ZHONG Zeli , TAN Lun

Section I, Department of Orthopaedics, the Fourth People’s Hospital of Zigong, Zigong, Sichuan 643000, P. R. China;

Corresponding?author：

WU Chao, Email: flightiness@163.com

Keywords：

Percutaneous pedical screw fixation; Thoracolumbar burst fracures; Occupancy rate of spinal canal

DOI：

10.7507/1002-0179.202108054

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the effectiveness of percutaneous pedicle screw fixation on the indirect reduction of posterosuperior fracture fragment in the thoraculumbar burst fractures. Methods Patients with thoracolumbar fractures treated in the Fourth People’s Hospital of Zigong from September 2017 to September 2019 were collected retrospectively. All patients were treated with percutaneous pedicle screw fixation. The main observation indexes before operation, 3 days after operation and 1 year after operation were compared, including the height ratio of the anterior margin of fractured vertebra, the inversion angle of posterosuperior fracture fragment, the fragment displacement, the occupancy rate of spinal canal, the Cobb angle of kyphosisat, Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Results A total of 38 patients were included. All patients were followed up for more than 1 year. During the follow-up period, there were no complications such as nerve injury, incision infection, internal fixation loosening or fracture. The operation time was (91.7±10.4) min, the amount of intraoperative bleeding was (94.3±19.5) mL, and the length of surgical incision was (9.3±1.8) cm. The height ratio of the anterior margin of fractured vertebra, the inversion angle of posterosuperior fracture fragment, the fragment displacement, the occupancy rate of spinal canal, the Cobb angle of kyphosisat 3 days after operation were significantly improved compared with those before operation (P<0.05); the height ratio of the anterior margin of fractured vertebra, the occupancy rate of spinal canal, and the Cobb angle of kyphosisat 1 year after operation were also significantly improved compared with those before operation (P<0.05); the height ratio of the anterior margin of fractured vertebra and the occupancy rate of spinal canalat 1 year after operation were significantly improved than those 3 days after operation (P<0.05), but the Cobb angle of kyphosis 1 year after operation was significantly lost than that 3 days after operation (P<0.05). The VAS score and ODI index 3 days and 1 year after operation were significantly improved compared with those before operation (P<0.05), and the VAS score and ODI index 1 year after operation were improved compared with those 3 days after operation (P<0.05). Conclusion The percutaneous pedicle screw fixation can effectively reduce the retropulsed bone fragment indirectly and restore the Cobb angle of kyphosis of the thoraculumbar burst fractures without neurological deficit, and at the same time reduce the operation time and surgical trauma.

Citation： YAN Ting, WU Chao, LIN Xu, ZENG Jun, ZHONG Zeli, TAN Lun. Effect of percutaneous pedicle screw fixation on the reduction of thoraculumbar burst fractures with posterosuperior fracture fragment. West China Medical Journal, 2021, 36(10): 1355-1360. doi: 10.7507/1002-0179.202108054 Copy

1.	Cahueque M, Cobar A, Zu?iga C, et al. Management of burst fractures in the thoracolumbar spine. J Orthop, 2016, 13(4): 278-281.
2.	Briem D, Behechtnejad A, Ouchmaev A, et al. Pain regulation and health-related quality of life after thoracolumbar fractures of the spine. Eur Spine J, 2007, 16(11): 1925-1933.
3.	Guerra J Jr, Garfin SR, Resnick D. Vertebral burst fractures: CT analysis of the retropulsed fragment. Radiology, 1984, 153(3): 769-772.
4.	Mumford J, Weinstein JN, Spratt KF, et al. Thoracolumbar burst fractures. The clinical efficacy and outcome of nonoperative management. Spine (Phila Pa 1976), 1993, 18(8): 955-970.
5.	Crutcher JP Jr, Anderson PA, King HA, et al. Indirect spinal canal decompression in patients with thoracolumbar burst fractures treated by posterior distraction rods. J Spinal Disord, 1991, 4(1): 39-48.
6.	Mohanty SP, Bhat SN, Ishwara-Keerthi C. The effect of posterior instrumentation of the spine on canal dimensions and neurological recovery in thoracolumbar and lumbar burst fractures. Musculoskelet Surg, 2011, 95(2): 101-106.
7.	李洪偉, 李鶴, 趙鵬飛. 后路經皮置釘與開放置釘行椎弓根釘內固定手術治療脊椎骨折的療效及組織創傷應激反應比較. 頸腰痛雜志, 2021, 42(2): 232-235.
8.	祝乃強, 侯靜怡, 馬桂云, 等. 經皮椎弓根螺釘內固定治療胸腰椎骨折. 中國矯形外科雜志, 2019, 27(18): 1663-1668.
9.	關驊, 陳學明. 脊髓損傷ASIA神經功能分類標準(2000年修訂). 中國脊柱脊髓雜志, 2001, 11(3): 164.
10.	Heller GZ, Manuguerra M, Chow R. How to analyze the visual analogue scale: myths, truths and clinical relevance. Scand J Pain, 2016, 13: 67-75.
11.	Fairbank JC, Pynsent PB. The oswestry disability index. Spine (Phila Pa 1976), 2000, 25(22): 2940-2952.
12.	陳意磊, 張旭陽, 邱小明, 等. 傷椎椎體后上緣骨塊對胸腰椎爆裂骨折手術入路的影響. 中華創傷雜志, 2017, 33(11): 998-1004.
13.	閻崇楠, 王歡, 崔少千, 等. 后路前凸彎棒預加壓復位固定技術治療胸腰段不穩定性爆裂骨折. 中華骨科雜志, 2020, 40(15): 988-995.
14.	Hongo M, Abe E, Shimada Y, et al. Surface strain distribution on thoracic and lumbar vertebrae under axial compression. The role in burst fractures. Spine (Phila Pa 1976), 1999, 24(12): 1197-1202.
15.	Zhao FD, Pollintine P, Hole BD, et al. Vertebral fractures usually affect the cranial endplate because it is thinner and supported by less-dense trabecular bone. Bone, 2009, 44(2): 372-379.
16.	張旭陽, 李生鋆, 虞天明, 等. 胸腰椎爆裂性骨折椎體后上緣骨折塊與椎基靜脈孔的相關性. 中華骨科雜志, 2017, 37(19): 1223-1230.
17.	Aebi M. Classification of thoracolumbar fractures and dislocations. Eur Spine J, 2010(Suppl 1): S2-S7.
18.	Wang XB, Lü GH, Li J, et al. Posterior distraction and instrumentation cannot always reduce displaced and rotated posterosuperior fracture fragments in thoracolumbar burst fracture. Clin Spine Surg, 2017, 30(3): E317-E322.
19.	Peng Y, Zhang L, Shi T, et al. Relationship between fracture-relevant parameters of thoracolumbar burst fractures and the reduction of intra-canal fracture fragment. J Orthop Surg Res, 2015(10): 131.
20.	楊彬, 王德成, 陳學謙, 等. 經皮微創置釘和開放椎弓根螺釘內固定術治療無神經損傷胸腰椎骨折的療效分析. 頸腰痛雜志, 2019, 40(6): 841-843.
21.	周忠賢. 微創經皮椎弓根螺釘內固定術治療無脊髓神經損傷型胸腰段骨折的療效分析. 南寧: 廣西醫科大學, 2019.
22.	覃海飚, 鐘遠鳴, 張家立, 等. 經皮微創椎弓根螺釘內固定治療無神經癥狀的胸腰椎爆裂骨折45例. 廣西醫學, 2016, 38(10): 1437-1439.
23.	趙紅衛, 劉揚, 張思勝, 等. 經皮椎弓根螺釘內固定治療胸腰椎爆裂性骨折. 上海醫學, 2012, 35(7): 605-608, 前插1.
24.	王敏, 馬文澤, 李文成, 等. 胸腰椎壓縮骨折后路內固定術后復位丟失的臨床研究. 實用骨科雜志, 2019, 25(7): 635-639.
25.	王珣, 陳遠明, 黃中飛, 等. 經傷椎置釘內固定治療胸腰椎骨折的研究進展. 廣西醫學, 2018, 40(3): 322-325.
26.	祝乃強, 侯靜怡, 陳賓, 等. 折彎連接棒聯合傷椎置釘杠桿復位經皮椎弓根釘內固定治療胸腰椎骨折的療效觀察. 中國骨與關節損傷雜志, 2020, 35(1): 1-5.

1. Cahueque M, Cobar A, Zu?iga C, et al. Management of burst fractures in the thoracolumbar spine. J Orthop, 2016, 13(4): 278-281.
2. Briem D, Behechtnejad A, Ouchmaev A, et al. Pain regulation and health-related quality of life after thoracolumbar fractures of the spine. Eur Spine J, 2007, 16(11): 1925-1933.
3. Guerra J Jr, Garfin SR, Resnick D. Vertebral burst fractures: CT analysis of the retropulsed fragment. Radiology, 1984, 153(3): 769-772.
4. Mumford J, Weinstein JN, Spratt KF, et al. Thoracolumbar burst fractures. The clinical efficacy and outcome of nonoperative management. Spine (Phila Pa 1976), 1993, 18(8): 955-970.
5. Crutcher JP Jr, Anderson PA, King HA, et al. Indirect spinal canal decompression in patients with thoracolumbar burst fractures treated by posterior distraction rods. J Spinal Disord, 1991, 4(1): 39-48.
6. Mohanty SP, Bhat SN, Ishwara-Keerthi C. The effect of posterior instrumentation of the spine on canal dimensions and neurological recovery in thoracolumbar and lumbar burst fractures. Musculoskelet Surg, 2011, 95(2): 101-106.
7. 李洪偉, 李鶴, 趙鵬飛. 后路經皮置釘與開放置釘行椎弓根釘內固定手術治療脊椎骨折的療效及組織創傷應激反應比較. 頸腰痛雜志, 2021, 42(2): 232-235.
8. 祝乃強, 侯靜怡, 馬桂云, 等. 經皮椎弓根螺釘內固定治療胸腰椎骨折. 中國矯形外科雜志, 2019, 27(18): 1663-1668.
9. 關驊, 陳學明. 脊髓損傷ASIA神經功能分類標準(2000年修訂). 中國脊柱脊髓雜志, 2001, 11(3): 164.
10. Heller GZ, Manuguerra M, Chow R. How to analyze the visual analogue scale: myths, truths and clinical relevance. Scand J Pain, 2016, 13: 67-75.
11. Fairbank JC, Pynsent PB. The oswestry disability index. Spine (Phila Pa 1976), 2000, 25(22): 2940-2952.
12. 陳意磊, 張旭陽, 邱小明, 等. 傷椎椎體后上緣骨塊對胸腰椎爆裂骨折手術入路的影響. 中華創傷雜志, 2017, 33(11): 998-1004.
13. 閻崇楠, 王歡, 崔少千, 等. 后路前凸彎棒預加壓復位固定技術治療胸腰段不穩定性爆裂骨折. 中華骨科雜志, 2020, 40(15): 988-995.
14. Hongo M, Abe E, Shimada Y, et al. Surface strain distribution on thoracic and lumbar vertebrae under axial compression. The role in burst fractures. Spine (Phila Pa 1976), 1999, 24(12): 1197-1202.
15. Zhao FD, Pollintine P, Hole BD, et al. Vertebral fractures usually affect the cranial endplate because it is thinner and supported by less-dense trabecular bone. Bone, 2009, 44(2): 372-379.
16. 張旭陽, 李生鋆, 虞天明, 等. 胸腰椎爆裂性骨折椎體后上緣骨折塊與椎基靜脈孔的相關性. 中華骨科雜志, 2017, 37(19): 1223-1230.
17. Aebi M. Classification of thoracolumbar fractures and dislocations. Eur Spine J, 2010(Suppl 1): S2-S7.
18. Wang XB, Lü GH, Li J, et al. Posterior distraction and instrumentation cannot always reduce displaced and rotated posterosuperior fracture fragments in thoracolumbar burst fracture. Clin Spine Surg, 2017, 30(3): E317-E322.
19. Peng Y, Zhang L, Shi T, et al. Relationship between fracture-relevant parameters of thoracolumbar burst fractures and the reduction of intra-canal fracture fragment. J Orthop Surg Res, 2015(10): 131.
20. 楊彬, 王德成, 陳學謙, 等. 經皮微創置釘和開放椎弓根螺釘內固定術治療無神經損傷胸腰椎骨折的療效分析. 頸腰痛雜志, 2019, 40(6): 841-843.
21. 周忠賢. 微創經皮椎弓根螺釘內固定術治療無脊髓神經損傷型胸腰段骨折的療效分析. 南寧: 廣西醫科大學, 2019.
22. 覃海飚, 鐘遠鳴, 張家立, 等. 經皮微創椎弓根螺釘內固定治療無神經癥狀的胸腰椎爆裂骨折45例. 廣西醫學, 2016, 38(10): 1437-1439.
23. 趙紅衛, 劉揚, 張思勝, 等. 經皮椎弓根螺釘內固定治療胸腰椎爆裂性骨折. 上海醫學, 2012, 35(7): 605-608, 前插1.
24. 王敏, 馬文澤, 李文成, 等. 胸腰椎壓縮骨折后路內固定術后復位丟失的臨床研究. 實用骨科雜志, 2019, 25(7): 635-639.
25. 王珣, 陳遠明, 黃中飛, 等. 經傷椎置釘內固定治療胸腰椎骨折的研究進展. 廣西醫學, 2018, 40(3): 322-325.
26. 祝乃強, 侯靜怡, 陳賓, 等. 折彎連接棒聯合傷椎置釘杠桿復位經皮椎弓根釘內固定治療胸腰椎骨折的療效觀察. 中國骨與關節損傷雜志, 2020, 35(1): 1-5.

West China Medical Journal

Effect of percutaneous pedicle screw fixation on the reduction of thoraculumbar burst fractures with posterosuperior fracture fragment

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content