EFFECTIVENESS EVALUATION OF PERCUTANEOUS MONOAXIAL SCREW COMBINED WITH INJURED VERTEBRAE POLYAXIAL PEDICAL SCREW FIXATION FOR TREATMENT OF THORACOLUMBAR FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZHANGWenzhi , QIUDaquan , LIXu , DUANLiqun , ZHANGFeng , TANGKang

No. 2 Department of Orthopaedics, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei Anhui, 230001, P. R. China;

Corresponding?author：

ZHANGWenzhi, Email: zwzfp@163.com

Keywords：

Thoracolumbar fracture; Pedicle screw; Internal fixation; Percutaneous monoaxial screw; Polyaxial pedical screw

DOI：

10.7507/1002-1892.20160115

Video：

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Objective To explore the effectiveness percutaneous monoaxial screw combined with polyaxial pedical screw for treating thoracolumbar fracture by comparing with simple polyaxial pedicle screw fixation. Methods Between January 2012 and June 2014, 56 cases of thoracolumbar fractures were treated by percutaneous pedicle screw fixation, the clinical data were retrospectively analyzed. Of 56 cases, 30 were treated with percutaneous monoaxial screw combined with percutaneous polyaxial pedical screw fixation (group A), 26 patients with only percutaneous polyaxial pedicle screw fixation (group B). There was no significant difference in gender, age, body mass index, injury causes, time from injury to admission, involved segments, fracture type, and preoperative American Spinal Injury Association (ASIA) stage, visual analogue scale (VAS), the anterior height of the injured vertebrae, Cobb angle, and sagittal index between 2 groups (P>0.05). The operation time, intraoperative blood loss, and complications were recorded and compared between the 2 groups. The VAS score was used to evaluate the improvement of the pain. The sagittal kyphosis Cobb angle, the anterior height of the injured vertebrae, sagittal index, and the average correction (difference between 3 days after oeration and preoperation) and loss degrees (difference between last follow-up and 3 days after operation) were measured on the X-ray films at preoperation, 3 days after operation, and last follow-up. Results Incision healing at stage I was obtained, no related complications occurred. The operation time and intraoperative blood loss showed no significant difference between 2 groups (P>0.05). The patients were followed up 20-42 months (mean, 32 months) in group A and 21-44 months (mean, 30 months) in group B. VAS score of group A was significantly lower than that of group B at 3 days after operation (t=-2.277, P=0.027), but no significant difference was found at last follow-up (t=-0.289, P=0.774). X-ray examination showed good position of internal fixation, with no broken nails or exit of nail. There were significant differences in the anterior height of the injured vertebrae, Cobb angle, and sagittal index between at preoperation and at 3 days and last follow-up, and between at 3 days and last follow-up in 2 groups (P<0.05). The anterior height of the injured vertebrae, Cobb angle, and sagittal index of group A were significantly better than those of group B at 3 days and last follow-up (P<0.05), and correction degree were significantly higher than those of group B (P<0.05), but loss degree was not significant between 2 groups (P>0.05). Conclusion Percutaneous monoaxial screw combined with polyaxial pedicle screw fixation is better than simply polyaxial pedicle screw in effects of treating thoracolumbar fracture under the premise of strictly holding indications.

Citation： ZHANGWenzhi, QIUDaquan, LIXu, DUANLiqun, ZHANGFeng, TANGKang. EFFECTIVENESS EVALUATION OF PERCUTANEOUS MONOAXIAL SCREW COMBINED WITH INJURED VERTEBRAE POLYAXIAL PEDICAL SCREW FIXATION FOR TREATMENT OF THORACOLUMBAR FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(5): 569-574. doi: 10.7507/1002-1892.20160115 Copy

1.	?聶鋒鋒, 張英華, 黃壽國, 等. 經皮微創椎弓根螺釘內固定與開放手術治療胸腰椎骨折:Cobb's角與椎體前緣高度恢復的比較. 中國組織工程研究, 2014, 18(44):7094-7099.
2.	付柏林, 李海波, 車崢, 等. 經皮微創與開放手術治療胸腰椎骨折的療效對比觀察. 瀘州醫學院學報, 2015, 38(1):74-76.
3.	田中, 鄧忠良. 經皮穿刺與傳統開放椎弓根螺釘內固定術治療胸腰椎骨折的Meta分析. 重慶醫學, 2015, 44(6):810-812.
4.	王洪偉, 李長青, 周躍, 等. 附加傷椎固定的微創經皮椎弓根螺釘 (Sextant)治療胸腰椎骨折. 中華創傷骨科雜志, 2010, 12(2):126-130.
5.	劉軍, 項良碧, 陳語, 等. 經皮微創椎弓根螺釘技術治療胸腰椎骨折12例. 中華創傷雜志, 2011, 27(9):782-784.
6.	張文志, 尚希福, 段麗群, 等. 微創經皮與傳統開放椎弓根螺釘內固定治療胸腰椎骨折的臨床對比研究. 中國骨與關節外科, 2012, 5(2):106-111.
7.	明江華, 鄭慧鋒, 趙奇, 等. Sextant經皮椎弓根釘棒微創系統治療胸腰椎骨折:隨訪評價. 中國組織工程研究, 2013, 17(48):8343-8348.
8.	唐康, 張文志, 段麗群, 等. 微創經皮椎弓根螺釘聯合傷椎置釘治療胸腰段脊椎骨折. 臨床骨科雜志, 2014, 17(3):253-257.
9.	汪群, 隋福革, 汪麗靜, 等. 經皮椎弓根釘棒置入結合椎體成形治療胸腰椎壓縮性骨折. 中國組織工程研究, 2014, 18(17):2716-2721.
10.	王春, 陳少堅. 經皮長U形空心椎弓根釘系統治療胸腰椎骨折的生物力學研究. 中華創傷骨科雜志, 2012, 14(7):595-598.
11.	Gelb D, Ludwig S, Karp JE, et al. Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation. J Spinal Disord Tech, 2010, 23(5):293-301.
12.	Ni WF, Huang YX, Chi YL, et al. Pereutaneous pedicle screw fixation for neurologic intact thoracolumbar burst fractures. J Spinal Disord Tech, 2010, 23(8):530-537.
13.	Shepard MF, Davies MR, Abayan A, et al. Effects of polyaxial pedicle screws on lumbar construct rigidity. J Spinal Disord Tech, 2002, 15(3):233-236.
14.	高浩然, 趙海恩, 錢澍, 等. 經皮螺釘置入固定結合關節突植骨修復胸腰椎骨折:建立傷椎長久穩定性. 中國組織工程研究, 2015, 19(17):2688-2693.
15.	王許可, 李長青, 王洪偉, 等. 聯合單向及萬向椎弓根螺釘經傷椎經皮內固定治療胸腰椎骨折. 中華創傷雜志, 2013, 29(5):431-437.
16.	王洪偉, 周躍, 李長青, 等. 經皮椎弓根螺釘內固定治療胸腰椎骨折的生物力學及臨床研究. 中華骨科雜志, 2011, 31(9):932-937.

1. ?聶鋒鋒, 張英華, 黃壽國, 等. 經皮微創椎弓根螺釘內固定與開放手術治療胸腰椎骨折:Cobb's角與椎體前緣高度恢復的比較. 中國組織工程研究, 2014, 18(44):7094-7099.
2. 付柏林, 李海波, 車崢, 等. 經皮微創與開放手術治療胸腰椎骨折的療效對比觀察. 瀘州醫學院學報, 2015, 38(1):74-76.
3. 田中, 鄧忠良. 經皮穿刺與傳統開放椎弓根螺釘內固定術治療胸腰椎骨折的Meta分析. 重慶醫學, 2015, 44(6):810-812.
4. 王洪偉, 李長青, 周躍, 等. 附加傷椎固定的微創經皮椎弓根螺釘 (Sextant)治療胸腰椎骨折. 中華創傷骨科雜志, 2010, 12(2):126-130.
5. 劉軍, 項良碧, 陳語, 等. 經皮微創椎弓根螺釘技術治療胸腰椎骨折12例. 中華創傷雜志, 2011, 27(9):782-784.
6. 張文志, 尚希福, 段麗群, 等. 微創經皮與傳統開放椎弓根螺釘內固定治療胸腰椎骨折的臨床對比研究. 中國骨與關節外科, 2012, 5(2):106-111.
7. 明江華, 鄭慧鋒, 趙奇, 等. Sextant經皮椎弓根釘棒微創系統治療胸腰椎骨折:隨訪評價. 中國組織工程研究, 2013, 17(48):8343-8348.
8. 唐康, 張文志, 段麗群, 等. 微創經皮椎弓根螺釘聯合傷椎置釘治療胸腰段脊椎骨折. 臨床骨科雜志, 2014, 17(3):253-257.
9. 汪群, 隋福革, 汪麗靜, 等. 經皮椎弓根釘棒置入結合椎體成形治療胸腰椎壓縮性骨折. 中國組織工程研究, 2014, 18(17):2716-2721.
10. 王春, 陳少堅. 經皮長U形空心椎弓根釘系統治療胸腰椎骨折的生物力學研究. 中華創傷骨科雜志, 2012, 14(7):595-598.
11. Gelb D, Ludwig S, Karp JE, et al. Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation. J Spinal Disord Tech, 2010, 23(5):293-301.
12. Ni WF, Huang YX, Chi YL, et al. Pereutaneous pedicle screw fixation for neurologic intact thoracolumbar burst fractures. J Spinal Disord Tech, 2010, 23(8):530-537.
13. Shepard MF, Davies MR, Abayan A, et al. Effects of polyaxial pedicle screws on lumbar construct rigidity. J Spinal Disord Tech, 2002, 15(3):233-236.
14. 高浩然, 趙海恩, 錢澍, 等. 經皮螺釘置入固定結合關節突植骨修復胸腰椎骨折:建立傷椎長久穩定性. 中國組織工程研究, 2015, 19(17):2688-2693.
15. 王許可, 李長青, 王洪偉, 等. 聯合單向及萬向椎弓根螺釘經傷椎經皮內固定治療胸腰椎骨折. 中華創傷雜志, 2013, 29(5):431-437.
16. 王洪偉, 周躍, 李長青, 等. 經皮椎弓根螺釘內固定治療胸腰椎骨折的生物力學及臨床研究. 中華骨科雜志, 2011, 31(9):932-937.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS EVALUATION OF PERCUTANEOUS MONOAXIAL SCREW COMBINED WITH INJURED VERTEBRAE POLYAXIAL PEDICAL SCREW FIXATION FOR TREATMENT OF THORACOLUMBAR FRACTURES

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