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Objective:The included angle of the outermost edge of the pedicle and the front edge of the central line of T12, L1, and L12 in the axial projection was compared before surgery (the incidence angle of the pedicle was set as α). A horizontal line passing through point C was made to cross the inner edge of the pedicle in the axial projection and the intersection point was designated as point D. The distance between point C and point D was compared among T12, L1, and L2. The advantages and feasibility of the measurement of these parameters for guiding puncture and bone cement injection in L1 percutaneous vertebroplasty were investigated.Methods:The clinical data of 91 patients with L1 osteoporotic vertebral compression fracture who underwent percutaneous vertebroplasty in The First People's Hospital of Chu Zhou from January 2018 to November 2021 were retrospectively analyzed. Axial α and CD of the L1 vertebral body and its adjacent vertebral bodies were measured. The amount of bone cement injected during the surgery, bone cement leakage rate, and pre- and post-surgery Visual Analogue Scale score were determined.Results:The α and CD of L1 in the axial projection were (20.43 ± 1.61)° and (5.37 ± 1.08) mm, respectively. Bone cement leakage rates of unilateral and bilateral approaches of L1 vertebral body were 35% and 12%, respectively, and there was a significant difference between the two approaches ( χ2 = 6.08, P < 0.05). There was no significant difference in the amount of bone cement injected during the surgery between unilateral and bilateral approaches of L1 ( P > 0.05). There was no significant difference in pre- and post-surgery Visual Analogue Scale scores between unilateral and bilateral approaches of L1 ( P > 0.05). Conclusion:The α and CD of L1 in the axial projection are smaller than those of other adjacent vertebral bodies, which is of great significance for selecting a puncture path and reducing bone cement leakage.
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Objective To explore the effect of minimally invasive pedicle screw fixation for the treatment of thoracolumbar spine fracture.Methods Totally 80 patients with thoracolumbar spinal fracture accepted pedicle screw internal fixation in our hospital from January 2012 to December 2015 were selected as the observation object.According to the operation mode,they were equally divided into minimally invasive surgery group and open surgery group.The operation effect,quality of life and the incidence of complications of the two groups were compared.Results The operation time of the two groups had no significant difference.The amount of blood loss and postoperative drainage volume in minimally invasive surgery group were less than those in open surgery group(P ＜ 0.05).The anterior and posterior Cobb's angles of the two groups had no significant difference.The anterior and posterior Cobb's angles of the two groups both decreased 3 months after operation,and it decreased more significantly in the minimally invasive surgery group compared with the open surgery group with statistically significant difference(P ＜0.05).The VAS and ODI scores between the two groups had no significant difference before operation.And the scores of the two groups all decreased 3 months after operation,but the reduction in the minimally invasive surgery group was more significant (P ＜ 0.05).The incidence rate of complications of the two groups had no significant difference (P ＞ 0.05).The quality of life of the two groups had no difference before surgery,and it increased 3 months after the operation both in the two groups,and the minimally invasive surgery group increased more significantly (P ＜ 0.05).Conclusion The minimally invasive pedicle screw internal fixation for thoracolumbar spine fracture has a better therapeutic effect,which can significantly improve the patients clinical symptoms,signs,and their quality of life.
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Objective To explore the clinical effect of the atlanto-axial pedicle screw internal fixation to reconstruct upper cervical spine instability. Methods Using atlanto-axial pedicle screw and internal fixation system combined with autogenous iliac bone graft to treat 21 patients with upper cervical spine instability. Type Ⅱ odontoid process old fracture was 13 patients, odontoid process nonunion was 5 patients, injury of the transverse ligament was 3 patients. They were placed in 84 atlanto-axial pedicle screws, autogenous bones were placed in the posterior arch of atlas and axis to fusion, so that atlanto-axial complex got stabilized. Results The left lateral cortical bone of atlas vertebral pedicle was broken by screws in 2 patients, but the spinal cord and vertebral artery was intact. X-ray film showed the atlas and the fracture of dens of axis was completely replaced in all patients. The position of screw and vertebral artery or spinal cord was good in CT image. According to JOA score standard, 15 cases of all were excellent, 3 cases were good,2 cases were common,1 case was bad, and the rate of excellent and good was 85.71%(18/21).Seventeen cases were followed up for 12-26 (12.83 ± 4.23) months, all patients had acquired bone fusion and found no screw and plate fracture. Conclusions Atlanto-axial pedicle screw combined with screw-plate system fixation to treat upper cervical spine instability, can significantly enhance the biomechanical stability of the atlanto-axial interbody, bone grafting fusion rate is higher, the application value of the atlanto-axialfusion is higher.
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Objective To study the feasibility of percutaneous pedicle screw fixation in treatment of thoraco-lumbar fractures.Methods Twenty-two patients with thoraeo-lumbar fractures were treated with the posterior percutaneous or open pedicle screw fixation respectively.Operation time,the bleeding volume,the height of the anterior border,the cobb angles of seoliosis,the late loss of correction,and complications were compared.Results All patients were followed up for mean 19 months(13 to 22 months).In percutaneous group,the mean time of operation was 102 minutes,the anterior height of compressed vertebral bodies was restored from 52% to 95% of the normal height,and the Cobb angle was corrected from 16?to 6.3?,the mean late loss of correction was 13% in percutaneous group,and there were no significant differences between the two groups(P＞0.05).The mean bleeding volume in the percutaneous group and open group was 102 ml and 290 ml respectively,which showed significant difference(P＜0.05).Conclusion Posterior percutaneous pedicle screw fixation in treatment of thoracolumar fractures,which didn't need vertebral canal decompression,was a perfect and effective method.Compared with open method,it had such strongpoints as quicker recovery and less invasive.
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Objective:To explore the effects of the treatment by internal fixation operation through pedicle of vertebral arch for thoracolumbar vertebral fracture cases.Methods:48 cases sufering from thoracic or lumbar vertebral fracture accept the treatment by internal fixation operation through pedicle of vertebral arch and intervertebral body fusion.Total or partly resection of vertebral plate was performed while needed for decompression.The lasted 18～30 months or more.Results:All the injured vertebrae had get reposition of height and the Cobb angle get well without any serious complication.Follow-up shows that every patient has get solid fusion with good height and stability,and the Cobb angle stain well.Thirty-six of the 38 spinal injury patients have get Franke1 grade raise in different degree.There were 2 Franke1A grade spinal injury cases with no neuro-function amelioration,who both got late hospital admission.Conclusion:For thoracolumbar vertebral fracture,internal fixation operation through pedicle of vertebral arch and intervertebral body fusion provide reposition of the injured vertebra height and spinal stabilization,and the spinal nerves function will get improved,and the operation indication and opportunity must be assurance.