Analysis of the clinical effect of percutaneous pedicle screw fixation combined with transpedicular bone grafting in the treatment of thoracolumbar fracture / 中国骨伤

OBJECTIVE@#To investigate the clinical efficacy of percutaneous screw fixation combined with minimally invasive transpedicular bone grafting and non-bone grafting in the treatment of thoracolumbar fractures.@*METHODS@#From Janury 2021 to June 2022, 40 patients with thoracolumbar fracture were divided into the experimental group and the control group. There were 26 patients in the experimental group, including 21 males and 5 females with an aberage age of (47.3±12.3) years old, who underwent percutaneous pedicle screw fixation combined with transpedicular autogenous bone grafting. In the control group, 14 patients received percutaneous pedicle screw fixation only. including 7 makes and 7 females with an average age of (50.2±11.2) years old. The operative time, intraoperative blood loss, anterior height ratio of injured vertebrae, Cobb angle, visual analogue score (VAS), MacNab scores, loosening or broken of the implants. were compared and analyzed.@*RESULTS@#There was no significant difference in operation time, intraoperative blood loss, VAS and anterior height ratio of injured vertebrae between the two groups. Compared with the preoperative results, VAS and anterior height ratio of injured vertebrae were improved statistically(P<0.05). For Cobb angle of injured vertebra, there was no significant difference between the two groups before surgery (P=0.766). While at 1 week, 3 months and 12 months after surgery, there were statistically differences between the two groups (P values were 0.042, 0.007 and 0.039, respectively). The Cobb angle of injured vertebrae one year after operation was statistically decreased in both groups compared with that before surgery (P<0.001). One year after surgery, the excellent and good rate of Macnab scores was 96.15% in the experimental group and 92.86% in the control group, and there was no statistical differences between the two groups (P=0.648). There was one patient in the control group suffering superficial wound infection on the third day, which was cured by dressing change and anti-infection treatment. There were no postoperative screw loosening and broken in both groups.@*CONCLUSION@#The two surgical methods have the advantages of less trauma, less pain and quicker recovery, which can restore the height of the injured vertebra, reconstruct the spinal sequence and reduce the fracture of the vertebral body. Transpedicular autogenous bone grafting can increase the stability of the fractured vertebra and maintain the height of the vertebra better after surgery, thus reducing the possibility of complications such as kyphosis, screw loosening and broken.

Effect of modified Wiltse approach pedicle screw internal fixation combined with transpedicular bone grafting on the vertebral body and complications of senile osteoporotic vertebral compression fractures / 中华内分泌外科杂志

Objective:To investigate the effects of internal fixation with pedicle screw via modified Wiltse approach combined with transpedicular bone grafting on the vertebral body and complications of senile osteoporotic vertebral compression fractures (OVCF) .Methods:Ninety-four elderly patients with osteoporotic vertebral compression fractures who were admitted to Hangzhou Fuyang Traditional Chinese Medicine Orthopedics Hospital from Oct. 2018 to Oct. 2019 were selected as the research objects. The patients were divided into control group and observation group according to the random ball touch method. For 47 cases, the control group underwent posterior short-segment reduction and internal fixation combined with transpedicular bone grafting, and the observation group underwent modified Wiltse approach pedicle internal fixation combined with transpedicular bone grafting. The two groups were observed and compared in terms of surgery related indicators, the condition of the injured vertebrae, the recovery of the vertebral body, the length of hospitalization and fracture healing time, and the incidence of complications.Results:In comparison of the operation-related indexes between the two groups, the intraoperative blood loss, 3d postoperative visual analogue scale (VAS) score and operation time of the observation group were significantly lower, than those of the control group ( P<0.05) . In comparison of the condition of the injured vertebrae between the two groups, there was no significant difference in the ratio of the loss rate of the injured vertebrae Cobb angle, vertebral body sagittal plane index, and vertebral body height between the two groups before operation ( P>0.05) . The loss rates of Cobb angle and vertebral body height of the injured vertebrae in the two groups were lower than that before operation at 3 days after operation, and the sagittal index of the vertebral body was higher than before operation at 1 year after operation ( P<0.05) . The loss rate of Cobb angle and vertebral body height of the injured vertebral body in the observation group was significantly lower than that of the control group at 3 days postoperatively, and the vertebral body sagittal plane index was significantly higher than that of the control group at 1 year postoperatively ( P<0.05) . Comparing the recovery of injured vertebrae between the two groups, there was no statistically significant difference between the preoperative oswestry disability index (ODI) scores of the two groups ( P>0.05) , the improvement rate of Cobb angle and the recovery rate of vertebral body height in the observation group, ODI scores at 3 months after operation were significantly higher than those of the control group ( P<0.05) . The hospitalization time and fracture healing time of the observation group were significantly lower than those of the control group ( P<0.05) . The total incidence of complications in the observation group (4.26%) was significantly lower than the total incidence of complications in the control group (19.15%) ( P<0.05) . Conclusion:The combined use of internal fixation with pedicle screw via modified Wiltse approach combined with transpedicular bone grafting in treatment of elderly OVCF can reduce the amount of intraoperative blood loss, shorten the operation time and hospital stay and fracture healing time, improve the Cobb angle of the injured vertebra, promote the recovery of the height and function of the injured vertebra, and reduce the incidence of complications.

Inverse arch roof breaking technique combined with pedicle screw and bone graft in the treatment of thoracolumbar burst fractures / 中国组织工程研究

BACKGROUND: The morbidity rate of thoracolumbar burst fracture is high; however, the simple posterior distraction and reduction technique has poor patient satisfaction on maintaining vertebral height and reducing complications. Therefore, we attempt to explore a better therapeutic regimen. OBJECTIVE: To assess the efficacy of inverse arch roof breaking technique combined with pedicle screw and bone graft in treatment of thoracolumbar burst fractures. METHODS: This was a retrospective study of 78 patients with thoracolumbar burst fractures. All the patients suffered from fresh closed fractures, and all of them were operated by posterior approach. The time from injury to surgery ranged from 4 to 14 days, with an average of 7.8 days. They were randomly assigned to two groups. The 38 cases in the simple distraction group were treated with simple vertebra pedicle screw-rod system distraction and reduction fixation. The 40 cases in the inverse arch roof breaking and bone graft group were treated with inverse arch roof breaking technique combined with pedicle screw and bone graft in fractured vertebra. All patients signed the informed consent. The study was approved by the Hospital Ethics Committee. Operation time, intraoperative blood loss, fracture healing time, anterior height ratio of injured vertebrae, Cobb angle, visual analogue score, Barthel Index and postoperative complications were measured between the two groups. RESULTS AND CONCLUSION: (1) The follow-up period for all patients was 10-22 months. (2) Operation time and intraoperative blood loss were better in the simple distraction group than in the inverse arch roof breaking and bone graft group (P < 0.01). (3) The ratio of anterior height of injured vertebra and Cobb angle were significantly different between the two groups (P < 0.01). Above indexes were better in the inverse arch roof breaking and bone graft group than in the simple distraction group. (4) There were significant differences in fracture healing time and life activity function (Barthel index) between the two groups (P < 0.01), and above indexes were better in the inverse arch roof breaking and bone graft group than in the simple distraction group. (5) No deep infection was found in both groups. There were no complications such as internal fixation failure and excessive loss of vertebral height in arch roof breaking and bone graft group. In the simple distraction group, there were 3 cases of screw pull-out because of failed internal fixation, 2 cases of titanium rod breakage, and 10 cases of obvious vertebral height loss. (6) These findings suggest that compared with simple distraction and reduction fixation, inverse arch roof breaking technique combined with pedicle screw and bone graft can provide bony support to compression center of fractured vertebra. The efficacy was identified in reconstructing the height of anterior and middle columns. This method has the advantages of high mechanical strength, strong vertebral height maintenance, high bone healing rate and few complications, which will be the ideal choice in the treatment of thoracolumbar burst fracture.