ABSTRACT
Objective:To compare the clinical efficacy of robot-assisted percutaneous screw implantation and free-hand open screw implantation by Wiltse approach in the treatment of thoracolumbar fracture.Methods:A retrospective cohort study was performed to analyze the clinical data of 71 patients with thoracolumbar fracture admitted to Second Affiliated Hospital of Soochow University from May 2018 to May 2020. There were 52 males and 19 females, with age range of 22-54 years［(41.0±7.8)years］. Of all, 33 patients were treated with robot-assisted percutaneous screw implantation (Group A) and 38 patients were treated with free-hand open screw implantation by Wiltse approach (Group B). Following parameters were measured, including frequency of radiation exposure, operation time, intraoperative blood loss, length of hospital stay, incidence of complications, rate of fracture healing at 3 months and 6 months postoperatively, visual analogue scale (VAS) and Oswestry dysfunction index (ODI) at 3 days, 3 months, 6 months postoperatively and at the last follow-up, anterior vertebral body height ratio and sagittal Cobb angle preoperatively, at 3 days postoperatively and at the last follow-up, and rate of screw implantation of grade A and B and rate of facet joint violation at 3 days postoperatively.Results:All patients were followed up for 10-24 months［(15.2±4.4)months］. Frequency of radiation exposure and operation time showed no statistical differences between the two groups (both P>0.05). Intraoperative blood loss was 100(100, 135)ml in Group A, less than 160(120, 200)ml in Group B ( P<0.01). Length of hospital stay was 8(7, 11) days in Group A, shorter than 12(10, 16)days in Group B ( P<0.01). There were no complications such as infection, spinal nerve injury or cerebrospinal fluid leakage in both group. There were no significant differences between the two groups in the rate of fracture healing at 3 and 6 months postoperatively (all P>0.05). VAS and ODI in Group A was 3(2, 4)points and 21(18, 23)points at 3 days postoperatively, lower than 4 (3, 5)points and 27(20, 32)points in Group B ( P<0.05 or 0.01), and the two groups showed no significant differences in VAS and ODI at other time points (all P>0.05). There were no significant difference in the anterior vertebral body height ratio or sagittal Cobb angle between the two groups at 3 days postoperatively and at the last follow-up (all P>0.05). Rate of screw implantation of grade A and B was 96.5% (191/198) in Group A, higher than 90.4% (206/228) in Group B ( P<0.05). Rate of facet joint violation was 4.0%(8/198) in Group A, lower than 11.8% (27/228) in Group B ( P<0.01). Conclusion:For thoracolumbar fracture, robot-assisted percutaneous screw implantation is superior to free-hand open screw implantation by Wiltse approach in terms of less bleeding, shorter hospitalization, earlier pain alleviation, higher accuracy of screw implantation and lower risk of facet joint violation.
ABSTRACT
Objective:To evaluate the effect of zoledronic acid administration for osteoporotic vertebral compression fracture (OVCF) after treatment with percutaneous kyphoplasty (PKP).Methods:A retrospective case-control study was performed on 430 elderly patients with OVCF admitted to the Second Affiliated Hospital of Soochow University from January 2012 to December 2016. There were 31 males and 399 females, with age of 52-92 years[(72.8±8.3)years]. Fracture segments were at T 5-T 10 (82 vertebrae), T 11-L 2 (389 vertebrae) and L 3-L 5 (173 vertebrae). In zoledronic acid group ( n=178), patients were given zoledronic acid 3 days after PKP surgery. In basic treatment group ( n=252), patients were only given basic treatment after PKP surgery. Bone mineral density was measured before operation and one year after operation. Visual analogue scale (VAS) and Oswestry disability index (ODI) were assessed before operation, 3 days and one year after operation. Incidence rate of refracture, mortality and complication rate were recorded after operation. Results:All patients were followed up for 12-60 months (mean, 27 months). Before operation and at postoperative 1 year, the vertebral bone mineral density in zoledronic acid group was (-2.3±1.5)SD and (-1.2±2.3)SD ( P<0.05), and that in basic treatment group was (-2.2±1.2)SD and (-2.1±1.1)SD ( P>0.05). At postoperative 1 year, the bone mineral density in zoledronic acid group was significantly better than that in basic treatment group ( P<0.05). At preoperative 3 days, postoperative 3 days and postoperative 1 year, the VAS was (8.6±0.8)points, (2.8±0.8)points, (2.1±0.8)points in zoledronic acid group, and was (8.5±1.1)points, (2.9±0.9)points, (3.0±2.3)points in basal treatment group; ODI was 48.7±5.3, 24.0±2.9, 22.3±3.3 in zoledronic acid group, and was 48.3±6.1, 24.5±3.8, 27.6±4.0 respectively in basal treatment group. The VAS and ODI were significantly reduced in two groups at postoperative 3 days and 1 year compared to those before operation ( P<0.05). Moreover, the VAS and ODI in zoledronic acid group were significantly lower than those in basal treatment group at postoperative 1 year ( P<0.05). At postoperative 2 years, the incidence rate of refracture in zoledronic acid group was 10.1%(18/178), significantly lower than 16.7%(43/252) in basic treatment group ( P<0.05). Mortality rate in zoledronic acid group was 5.1%(9/178), and that in basic treatment group was 6.3%(16/252) ( P>0.05). No serious complications were observed in both groups such as nerve injury or pulmonary embolism. Conclusion:For OVCF patients, zoledronic acid given after PKP can improve the bone mineral density, reduce pain, fasten function recovery, and effectively decrease the refracture rate.
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Objective:To investigate the effect of enhanced recovery after surgery (ERAS) in percutaneous pedicle screw internal fixation treating thoracolumbar fracture patients.Methods:A retrospective case-control study was conducted to analyze the clinical data of 62 patients with thoracolumbar fracture treated by percutaneous pedicle screw internal fixation at Second Hospital of Soochow University from October 2018 to April 2019. There were 42 males and 20 females, aged 27-59 years (mean, 43.9 years). Fracture site included T 11 in 4 patients, T 12 in 28, L 1 in 23 and L 2 in 7, and AO type contained type A1 in 40 patients, type A2 in 3, and type A3 in 19. Thirty-one patients were treated with ERAS nursing mode (ERAS group), and other 31 patients with routine nursing mode (control group). The postoperative recovery time of intestinal function, first time of expelling flatus and dejection time, hospitalization time, preoperative and postoperative pain visual analogue scale (VAS), Kolcaba comfort scale (GCQ), Oswestry disability index (ODI), incidence of abdominal distension, incidence of urinary tract infection, first wake up dizziness, urinary retention, and wound healing were compared between the two groups. Results:Period of follow-up for all patients was 3-6 months (mean, 4.5 months). Postoperative recovery time of intestinal function, first time of expelling flatus and dejection time in ERAS group were (7.2±2.0)hours, (10.7±3.7)hours and (26.7±6.4)hours, respectively, which were significantly decreased compared to control group [(19.2±5.6)hours, (22.5±5.1)hours, (72.5±12.4)hours] ( P<0.05). Hospitalization time was (4.7±1.3)days in ERAS group, shorter than that in control group [(5.9±1.5)days]. There was no significant difference in VAS preoperatively between the two groups ( P>0.05). VAS in ERAS group was (3.6±1.5)points, (2.8±0.8)points, (1.7±0.6)points at postoperative 1, 3 and 7 days, lower than that in control group [(4.6±1.3)points, (4.0±1.3)points, (2.7±0.9)points] ( P<0.05). GCQ score in ERAS group was (72.0±6.5)points, (75.0±11.1)points, (88.4±5.1)points and (89.3±4.5)points at 2 hours before operation and 2 hours, 1 days and 3 days after operation, which were higher than that in control groups [(54.0±7.2)points, (59.5±6.3)points, (62.7±5.9)points, (76.0±5.7)points] ( P<0.05). ODI in ERAS group was 37.3±5.8, 28.9±6.3 and 23.1±2.7 at 3 days, 1 month and 3 months after operation, which was markedly decreased compared to control group (44.9±7.9, 33.9±8.7, 30.3±5.3) ( P<0.05). Moreover, the incidence of abdominal distension, urinary tract infection and first wake up dizziness in ERAS group was 7%, 5%, 3%, respectively, reduced from that in control group (26%, 35%, 16%) ( P<0.05). No significant difference was observed in urinary retention wound healing of the two groups, but there was no difference in wound healing ( P>0.05). Conclusion:For thoracolumbar fracture patients treated with percutaneous pedicle screw internal fixation, ERAS has advantages over traditional nursing in attenuating pain, shortening hospitalization time, reducing postoperative abdominal distension and urinary tract infection, and accelerating functional recovery.
ABSTRACT
Objective: To describe the applications and effects of electromagnetic navigation [EN] technology in distal locking for the treatment of long diaphyseal fracture [LDF] with interlocking intramedullary nailing [IIN]
Study Design: An interventional study
Place and Duration of Study: The Second Affiliated Hospital of Soochow University, China, from March 2013 to July 2014
Methodology: Patients who underwent IIN-LDF were selected. Twenty-four [50%] of whom were operated under EN guidance [group A] and the other 24 [50%] under conventional targeting guidance [group B]. The distal locking time and X-ray irradiation time of the two groups were compared
Results: Each group included 16 [33.3%] cases of femoral fracture and 8 [16.7%] cases of tibial fracture. The success rate of distal locking in group A was higher than that in group B [95.8% vs. 83.3%, p=0.045]. There were statistically significant differences in the distal locking time and X-ray irradiation time of femoral intramedullary nailing between the two groups [p=0.027 and p=0.001, respectively]. There were no statistically significant differences in the distal locking time and X-ray irradiation time of tibial intramedullary nailing between the two groups [p=0.347 and p=0.056, respectively]
Conclusion: EN-IN was advantageous as it enabled easy targeting, significantly reduced intraoperative fluoroscopy and operation time and small trauma and had other advantages when used for treating LDFs, especially femoral diaphyseal fractures