目的 探讨经伤椎椎弓根螺钉内固定治疗胸腰椎骨折的临床疗效。 方法 2008年5月－2010年12月，选择38例胸腰椎骨折患者，采用椎弓根螺钉固定伤椎及相邻上下椎体。其中男28例，女10例；年龄21～65岁，平均36.5岁。骨折部位：胸8 1例，胸9 2例，胸10 4例，胸11 8例，胸12 7例，腰1 10例，腰2 4例，腰3 2例。受伤至手术时间3～7 d，平均4.5 d。对患者手术前后椎体高度、矢状面后凸Cobb角、神经功能Frankel分级变化等指标进行测量并随访。 结果 术后患者切口均Ⅰ期愈合。38例获随访12～18个月，平均15个月。骨折均获得骨性融合，无钉棒断裂、无死亡或神经损伤加重患者。术后神经功能Frankel分级较术前有明显改善（P＜0.05）。术后X线片复查示伤椎高度恢复达90%以上，外形正常；CT复查示椎管内有效矢状径恢复满意，椎管前方无明显骨性压迫，伤椎椎体骨愈合良好。术后1、12个月时伤椎前、后缘高度及后凸Cobb角均较术前显著改善（P＜0.05）；术后12个月随访椎体高度无丢失。 结论 经伤椎椎弓根钉复位、减压、内固定治疗胸腰椎骨折具有创伤小、固定节段少、脊柱稳定性好、能有效矫正及预防脊柱后凸畸形等优点。
Objective To discuss the effectiveness of posterior short-segment fixation including the fractured vertebra for severe unstable thoracolumbar fractures using pedicle screw fixation. Methods Between May 2008 and July 2013, 52 patients of severe unstable thoracolumbar fractures were treated through posterior short-segment fixation including the fractured vertebra using pedicle screw fixation. There were 33 males and 19 females with an age of 21-56 years (mean, 37.9 years). The causes of thoracolumbar burst fractures included fall from height in 32 cases, traffic accidents in 16 cases, and others in 4 cases. The load sharing classification (LSC) score was 7-9 (mean, 7.85). The levels involved included T11 in 4 cases, T12 in 19 cases, L1 in 25 cases, and L2 in 4 cases. According to Frankel classification, there were 2 cases of grade A, 4 cases of grade B, 8 cases of grade C, 11 cases of grade D, and 27 cases of grade E. The rate of spinal canal occupying was 24.2%-76.7% (mean, 47.1%). The time from injury to operation was 3-5 days (mean, 3.6 days). The effectiveness was assessed by the changes of injured vertebral Cobb angle, anterior vertebral height, and the Frankel grading at pre- and post-operation. Results The operation time was 85-127 minutes (mean, 106.5 minutes). The intraoperative blood loss was 90-155 mL (mean, 137.6 mL). All the incision healed at first intension. Forty-seven patients were followed up 19-27 months (mean, 23.2 months), and no incision infection, screw loosening, or other internal fixation failures was found during follow-up. The injured vertebral Cobb angle and anterior vertebral height at immediate after operation or at last follow-up were significantly improved when compared with preoperative values (P<0.001). There was a loss of injured vertebral Cobb angle and anterior vertebral height at last follow-up, but no significant difference was found between at immediate after operation and at last follow-up (P>0.05). The Frankel grade improved by 0-2 grades at last follow-up, showing significant difference when compared with preoperative grades (Z=15.980, P=0.003). Conclusion Posterior short-segment fixation including the fractured vertebra for severe unstable thoracolumbar fractures (LSC≥7) using pedicle screw fixation can correct the kyphosis deformity, restore vertebral body height, and aviod the need of anterior reconstruction.
ObjectiveTo evaluate the effectiveness of percutaneous monoplanar screw internal fixation via injured vertebrae for treatment of thoracolumbar fracture.MethodsBetween May 2015 and August 2017, 38 cases of thoracolumbar fractures without neurological symptom were treated with percutaneous monoplanar screw internal fixation via injured vertebrae. There were 22 males and 16 females, aged 25-52 years (mean, 32.5 years). There were 23 cases of AO type A3 and 15 cases of AO type A4. The injured vertebrae located at T11 in 4 cases, T12 in 9 cases, L1 in 11 cases, L2 in 10 cases, L3 in 3 cases, and L4 in 1 case. The mean interval between injury and operation was 4.5 days (range, 3-7 days). The pre- and post-operative degrees of lumbodorsal pain were estimated by the visual analogue scale (VAS) score. The X-ray film, CT three-dimensional reconstruction, and MRI were performed, and the ratio of anterior vertebral body height and sagittal Cobb angle were measured to assess the kyphosis of the fractured area.ResultsAll operations in 38 patients successfully completed without complications such as dural sac, nerve root, or vascular injury. The operation time was (56.2±3.7) minutes and the intraoperative blood loss was (42.3±3.5) mL. All incisions healed by first intention without redness, swelling, or exudation. All patients were followed up 17-33 months, with an average of 21.5 months. The VAS score at each time point after operation significantly improved when compared with that before operation (P<0.05), and significantly improved at 3 months and last follow-up when compared with that at 1 week (P<0.05); there was no significant difference between 3 months and last follow-up (P>0.05). There was no internal fixator loosening, breakage, or delayed kyphosis in all patients. The ratio of anterior vertebral body height and sagittal Cobb angle significantly improved postoperatively (P<0.05), and no significant difference was found between the different time points after operation (P>0.05).ConclusionPercutaneous monoplanar screw internal fixation via injured vertebrae is an easy approach to treat thoracolumbar fracture without neurological symptom, which can effectively restore vertebral body height and correct kyphosis, and avoid long-term segmental kyphosis.
ObjectiveTo investigate the effectiveness of sagittal top compression reduction technique in the treatment of thoracolumbar vertebral fractures. Methods A retrospective analysis was conducted on the clinical data of 59 patients with thoracolumbar vertebral fractures who met the selection criteria and were admitted between November 2018 and January 2022. Among them, 34 patients were treated with sagittal top compression reduction technique (top pressure group), and 25 patients were treated with traditional reduction technique (traditional group). There was no significant difference in baseline data between the two groups (P>0.05), including gender, age, fracture segment, cause of injury, AO classification of thoracolumbar vertebral fractures, thoracolumbar injury classification and severity (TLICS) score, American Spinal Injury Association (ASIA) grading, surgical approach, preoperative vertebral body index, height ratio of the anterior margin of injured vertebra, injured vertebra angle, segmental kyphosis angle, visual analogue scale (VAS) score, and Oswestry disability index (ODI). The operation time, intraoperative blood loss, and incidence of complications between the two groups were recorded and compared. After operation, VAS score and ODI were used to evaluate effectiveness, and X-ray and CT examinations were performed to measure imaging indicators such as vertebral body index, height ratio of the anterior margin of injured vertebra, injured vertebra angle, and segmental kyphosis angle. ResultsThere was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). No complication such as dural sac, nerve root, or vascular injury was found during operation, and all incisions healed by first intention. Patients in both groups were followed up 6-48 months, with an average of 20.6 months. No loosening, breakage, or failure of internal fixation occurred during follow-up. The imaging indicators, VAS score, and ODI of the two groups significantly improved at 1 week and last follow-up when compared to preoperative ones (P<0.05). At last follow-up, the VAS score and ODI further significantly improved when compared to 1 week after operation (P<0.05). At 1 week after operation and last follow-up, the vertebral body index, segmental kyphosis angle, injured vertebra angle, and ODI in the top pressure group were significantly better than those in the traditional group (P<0.05). There was no significant difference in VAS score and height ratio of the anterior margin of injured vertebra between the two groups at 1 week after operation (P>0.05), but the two indicators in the top pressure group were significantly better than those in the traditional group at last follow-up (P<0.05). Conclusion The treatment of thoracolumbar vertebral fractures with sagittal top compression reduction technique can significantly improve the quality of vertebral reduction, and is superior to traditional reduction techniques in relieving pain and improving spinal function.
Objective To evaluate the effectiveness of using pedical screw at the fracture level, intervertebral distraction, and Cage insertion by posterior approach to treat thoracolumbar kyphosis caused by old fracture. Methods Between June 2008 and June 2010, 15 cases of thoracolumbar kyphosis caused by old fracture were treated with pedical screw at the fracture level, intervertebral distraction, and Cage insertion by posterior approach. There were 9 males and 6 females with a mean age of 54.6 years (range, 39-65 years). The disease duration was 5 months to 3 years with an average of 1.5 years. Fractured segments included T11 in 1 case, T12 in 4 cases, L1 in 5 cases, and L2 in 5 cases. Ten patients had nerve symptom, according to American Spinal Injury Association (ASIA) grading, 3 cases were classified as grade B, 4 cases as grade C, and 3 cases as grade D, of which 3 cases had sexual and sphincter dysfunction. At preoperation, the Cobb angle was (47.4 ± 10.2)°; the Oswestry disability index (ODI) score was 67.9% ± 6.9%; and the visual analogue scale (VSA) was 8.6 ± 1.4. Results The wounds obtained primary healing. The mean follow-up time was 28 months (range, 13-60 months). X-ray films showed intervertebral bone fusion was obtained within 6-11 months (mean, 10.2 months). No fixation loosening or breaking occurred during follow-up. Kyphosis was corrected, and lumbar back pain was relieved. At 1 year after operation, Cobb angle was significantly corrected to (13.3 ± 7.7)° (t=72.80, P=0.00); ODI score was significantly improved to 25.2% ± 4.6% (t=48.04, P=0.00); VAS score was significantly decreased to 2.3 ± 0.6 (t=26.52, P=0.00). According to ASIA grading in 10 patients with spinal cord injury, the spinal cord function was improved by 1 grade in 8 cases (3 cases from grade B to C, 3 cases from grade C to D, and 2 cases from grade D to E); 3 patients with sexual and sphincter dysfunction recovered in different degrees. Conclusion Using pedical screw at the fracture level, intervertebral distraction, and Cage insertion by posterior approach is an effective method to treat thoracolumbar kyphosis caused by old fracture.
Objective To compare the effectiveness of percutaneous short-segment injured vertebra pedicle screw fixation combined with bone grafting versus percutaneous short-segment injured vertebra pedicle screw fixation alone for the treatment of thoracolumbar fractures. Methods The clinical data of 54 patients with single-level thoracolumbar fractures who met the selection criteria between January 2023 and February 2024 were retrospectively analysed. Based on whether bone grafting was performed on the injured vertebra, the patients were divided into a control group (28 cases, percutaneous short-segment injured vertebra pedicle screw fixation alone) and a study group (26 cases, percutaneous short-segment injured vertebra pedicle screw fixation combined with bone grafting using a self-made minimally invasive bone grafting funnel). No significant differences were observed between the two groups (P>0.05) in baseline characteristics, including age, gender, surgical segment, cause of injury, AO classification, and preoperative anterior-vertebral height compression ratio, mid-vertebral height compression ratio, Cobb angle, visual analogue scale (VAS) score, and Oswestry Disability Index (ODI). The operation time, intraoperative blood loss, fracture healing status, time to implant removal, and complications were recorded and compared between the two groups. Treatment efficacy was assessed using anterior-vertebral height compression ratio, mid-vertebral height compression ratio, Cobb angle, VAS scores, and ODI measurements taken preoperatively, at 1 week postoperatively, and at last follow-up. ResultsAll patients in both groups successfully underwent surgery. The operation time and intraoperative blood loss in the control group were significantly less than those in the study group (P<0.05). No significant difference was observed in the follow-up periods between the study group [(14.46±2.00) months] and control group [(14.36±1.83) months] (P>0.05). The fracture healing time of the study group was significantly shorter than that of the control group (P<0.05). One patient in the study group was found to have bilateral titanium rod breakage by X-ray reexamination at 8 months after operation, and there was no subsequent vertebral height collapse occurred, and the internal fixator was removed following complete fracture healing. The other patients had no complications such as spinal cord injury, internal fixator loosening and breakage. There was no significant difference in the removal time of internal fixation between the two groups (P<0.05). The anterior-vertebral height compression ratio, mid-vertebral height compression ratio, Cobb angle, VAS score, and ODI significantly improved in both groups at 1 week after operation and at last follow-up (P<0.05). Among them, the Cobb angle, VAS score, and ODI further improved at last follow-up when compared with at 1 week after operation, while anterior-vertebral height compression ratio and mid-vertebral height compression ratio slightly increased when compared with 1 week after operation, and the differences were significant (P<0.05). There was no significant difference between the two groups in Cobb angle at last follow-up, VAS score and ODI at 1 week after operation (P>0.05), while the other indicators in the study group were significantly better than those in the control group at all time points (P<0.05).Conclusion Compared to percutaneous short-segment injured vertebra pedicle screw fixation alone, the technique combined with intravertebral bone grafting can shorten fracture healing time, effectively restore and maintain vertebral body height, correct kyphotic deformity, and improve clinical outcomes for patients with thoracolumbar fractures.
ObjectiveTo evaluate the long-term effect of unilateral versus bilateral screw placement on thoracolumbar single vertebral fracture by means of meta-analysis.MethodsThe data of China National Knowledge Infrastructure, Wangfang Database, SinoMed, VIP Database for Chinese Technical Periodicals, PubMed, Elsevier Science Direct, EBSCO, Web of Science, and Springer Link were searched by computer, and the literatures related to effect comparison between unilateral and bilateral pedicle screw fixation in thoracolumbar single vertebral fracture were collected, including domestic and foreign published journal literatures and grey literatures such as academic conference reports and dissertations. The retrieval time was from their inception to August 17, 2019. After literature screening, quality evaluation, and data extraction, Stata 12.0 and RevMan 5.0 softwares were used for data analysis.ResultsA total of 12 articles were included, including 7 in English and 5 in Chinese, with a total of 848 patients (424 in the unilateral pediclescrew fixation group and 424 in the bilateral pedicle screw fixation group). The results of meta-analysis showed that: there was no significant difference in any of the main outcome indicators between the two groups, including the ratio of anterior height of fractured vertebra [mean difference (MD)= −0.16%, 95% confidence interval (CI) (−1.20%, 0.88%), P=0.76], postoperative follow-up Cobb angle [MD=−0.17°, 95%CI (−0.50, 0.15)°, P=0.29], postoperative follow-up Visual Analogue Scale score [MD=−0.06, 95%CI (−0.16, 0.04), P=0.24], postoperative follow-up Oswestry Disability Index score [MD=−0.28, 95%CI (−0.66, 0.11), P=0.15], and incidence of complications [relative risk=0.81, 95%CI (0.57, 1.15), P=0.23], but two secondary outcome indicators namely operation time [MD=−33.26 minutes, 95%CI (−51.72, −14.80) minutes, P=0.000 4] in the unilateral pedicle screw fixation group were smaller than those in the bilateral pedicle screw fixation group, whlie there were no statistically significant difference in postoperative length of hospital stay [MD=−1.59 days, 95%CI (−4.53, 1.36) days, P=0.29] and intraoperative blood loss [MD=−74.09 mL, 95%CI (−155.96, 7.77) mL, P=0.08] between the two groups.ConclusionUnilateral and bilateral screw placement of thoracolumbar single vertebral fracture has the same long-term effect, and unilateral screw placement can reduce the number of screw implantation, and shorter operation time, which is more in line with the actual clinical needs.
Objective To investigate the effect of the sequence of intermediate instrumentation with long screws and distraction-reduction on mild to moderate thoracolumbar fractures treated by posterior open and short-segmental fixation. MethodsThe clinical data of 68 patients with mild to moderate thoracolumbar burst fractures who met the selection criteria between January 2016 and June 2019 were retrospectively analyzed. The patients were divided into group ISDRF (intermediate screws then distraction-reduction fixation, 32 cases) and group DRISF (distraction-reduction then intermediate screws fixation, 36 cases) according to the different operation methods. There was no significant difference between the two groups in age, gender, body mass index, fracture segment, cause of injury, and preoperative load-sharing classification score, thoracolumbar injury classification and severity score, vertebral canal occupational rate, back pain visual analogue scale (VAS) score, anterior height of fractured vertebra, and Cobb angle (P>0.05). The operation time, intraoperative blood loss, complications, and fracture healing time were recorded and compared between the two groups. The vertebral canal occupational rate, anterior height of fractured vertebra, kyphosis Cobb angle, and back pain VAS score before and after operation were used to evaluate the effectiveness. Results There was no significant difference in intraoperative blood loss and operation time between the two groups (P>0.05). No vascular or spinal nerve injury and deep infections or skin infections occurred in both groups. At 1 week after operation, the vertebral canal occupational rate in the two groups was significantly improved when compared with that before operation (P<0.05), no significant difference was found in the difference of vertebral canal occupational rate before and after operation and improvement between the two groups (P>0.05). The patients in both groups were followed up 18-24 months, with an average of 22.3 months. All vertebral fractures reached bone union at 6 months postoperatively. At last follow-up, there was no internal fixation failures such as broken screws, broken rods or loose screws, but there were 2 cases of mild back pain in the ISDRF group. The intra-group comparison showed that the back pain VAS score, the anterior height of fractured vertebra, and the Cobb angle of the two groups were significantly improved at each time point postoperatively (P<0.05); the VAS scores at 12 months postoperatively and last follow-up were also improved when compared with that at 1 week postoperatively (P<0.05). At last follow-up, the anterior height of fractured vertebra in the ISDRF group was significantly lost when compared with that at 1 week and 12 months postoperatively (P<0.05), the Cobb angle had a significant loss when compared with that at 1 week postoperatively (P<0.05); the anterior height of fractured vertebra and Cobb angle in DRISF group were not significantly lost when compared with that at 1 week and 12 months postoperatively (P>0.05). The comparison between groups showed that there was no significant difference in the remission rate of VAS score between the two groups at 1 week postoperatively (P>0.05), the recovery value of the anterior height of fractured vertebra in ISDRF group was significantly higher than that in DRISF group (P<0.05), the loss rate at last follow-up was also significantly higher (P<0.05); the correction rate of Cobb angle in ISDRF group was significantly higher than that in DRISF group at 1 week postoperatively (P<0.05), but there was no significant difference in the loss rate of Cobb angle between the two groups at last follow-up (P>0.05). ConclusionIn the treatment of mild to moderate thoracolumbar burst fractures with posterior short-segment fixation, the instrumentation of long screws in the injured vertebrae does not affect the reduction of the fracture fragments in the spinal canal. DRISF can better maintain the restored anterior height of the fractured vertebra and reduce the loss of kyphosis Cobb angle during the follow-up, indicating a better long-term effectiveness.
ObjectiveTo investigate the security of pedicle screw fixation in fractured vertebra in treatment of thoracolumbar fractures by comparing with routine fixation cross fractured vertebra. MethodsA total of 101 cases of single segmental thoracolumbar fracture were selected between June 2008 and June 2011. Of them, 56 cases underwent pedicle screw fixation in fractured vertebra (group A), and 45 cases received routine fixation cross fractured vertebra (group B). There was no significant difference in gender, age, causes of injury, fracture type, fracture segment, Frankel grading, time of injury to operation, and the preoperative anterior vertebral height compression ratio and the canal occupation rate between 2 groups (P>0.05). There were 34 cases of junction fracture of pedicle and vertebra (type I), 2 cases of pedicle waist fracture (type Ⅱ), and 20 cases of junction fracture of pedicle and lamina (type Ⅲ) in group A. The position of fractured vertebral pedicle screw was observed; the anterior vertebral height compression ratio, canal occupation rate, and surgical complications were compared between 2 groups. ResultsA total of 103 pedicle screws were placed in 54 patients of group A, except 2 patients of type Ⅱ fracture; 96 screws were placed in the bone cortex completely and 7 screws deviated. The operation time of group A was significantly longer than that of group B (t=4.339, P=0.000), but there was no significant difference in intraoperative blood loss between 2 groups (t=-0.089, P=0.929). All 101 patients were followed up 6-16 months (mean, 8.5 months). The patients of 2 groups achieved nerve functional recovery. Fixation-related complications occurred in 1 case of 2 groups respectively, showing no significant difference (P=1.000). At last follow-up, according to Denis lumbago classification, 51 cases were rated as P1 level and 5 cases as P2 level in group A; 35 cases were rated as P1 level, 8 cases as P2 level, and 2 cases as P3 level in group B; and there was no significant difference between 2 groups (Z=-1.836, P=0.066). There was no significant difference between 2 groups in canal occupation rate at immediate after operation and at last follow-up (P>0.05), and in the anterior vertebral height compression ratio at immediate after operation (P>0.05), but the anterior vertebral height compression ratio of group B was significantly higher that of group A at last follow-up (P<0.05). ConclusionSingle segmental thoracolumbar fracture treated by pedicle screw fixation in fractured vertebra through posterior approach is safe and feasible according to different pedicle fracture types to guide fixation.
ObjectiveTo systematically review the efficacy of at the fracture level (AFL) versus cross the fracture level (CFL) short-segment pedicle screw fixation for thoracolumbar fractures. MethodsWe electronically search PubMed, The Cochrane Library (Issue 8, 2015), EMbase, CBM, CNKI, VIP and WanFang data to collect randomized controlled trials (RCTs) of AFL versus CFL short segment pedicle screw fixation for thoracolumbar fractures from inception to Aug. 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed using RevMan 5.3 software. ResultsA total of 11 RCTs involving 730 patients were included. The results of meta-analysis indicated that: compared with the CFL group, the AFL group had more blood loss (MD=9.8, 95%CI 7.40 to 12.20), less implant failure rate (RR=0.19, 95%CI 0.07 to 0.48), lower long term postoperative VAS score of thoracolumbar pain (MD=-1.20, 95%CI -1.85 to -0.56), higher correction in short term postoperative kyphotic Cobb angle (MD=3.56, 95%CI 2.25 to 4.87), smaller value in long term postoperative kyphotic Cobb angle and its loss of correction (MD=-3.95, 95%CI -7.78 to -0.12; MD=-4.65, 95%CI -6.91 to -2.40), smaller degree of anterior vertebral height compression in short and long term postoperative (MD=-3.51, 95%CI -5.23 to -1.80; MD=-8.28, 95%CI -12.22 to -4.33), better result in long term postoperative anterior vertebral height and its loss of correction (MD=8.00, 95%CI 3.85 to 12.15; MD=-6.06, 95%CI -7.68 to -4.44). There were no significant differences between two groups regarding operation time, infectious complications and short term postoperative kyphotic Cobb angle (MD=0.11, 95%CI -5.36 to 5.57; RR=0.55, 95%CI 0.11 to 2.85; MD=-0.66, 95%CI -2.19 to 0.87). ConclusionCurrent evidence shows that AFL short-segment pedicle screw fixation for thoracolumbar fractures is superior to CFL fixation. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.