Effect of percutaneous lordorizing screw fixation in correction of kyphosis in thoracolumbar fractures / 中华创伤杂志

ABSTRACT

Objective To investigate the effect of percutaneous lordorizing screws fixation for correcting kyphosis in thoracolumbar burst fractures and treatment strategies.Methods A retrospective case control study was designed to analyze data of 97 patients with single-level thoracolumbar burst fractures without neurological deficits undergone percutaneous lordorizing screw fixation from April 2010 to March 2015.According to the different surgical procedures,the patients were divided into Group A (percutaneous transpedicle fixation,n =47) and Group B (percutaneous transpedicle fixation combine lordorizing screw fixation,n =50).Each group was subdivided based on the preoperative segmental kyphosisGroup A consisted subgroups A1 (kyphosis angle≤ 10°,n =11),A2 (kyphosis angle between 10° and 20°,n =20) and A3 (kyphosis angle ≥ 20°,n =16),and Group B consisted of subgroups B1 (kyphosis angle ≤ 10°,n =16),B2 (kyphosis angle between 10° and 20°,n =16) and B3 (kyphosis angle ≥ 20°,n =18).Length of hospital stay,operation time,blood loss,visual analogue scale (VAS) and Oswestry disability index (ODI) were compared between groups.Segmental kyphosis angle and vertebral wedge angle were compared between subgroups before operation,after operation and at the final follow-up.Results All patients were followed-up for 12-37 months (mean,21.2 months).There were no significant differences between the two groups in aspects of length of hospital stay,blood loss,VAS and ODI (P ＞ 0.05).Operation time was (60.62 ± 9.59) min in Group A,significantly less than that in Group B [(74.78 ± 17.66) min] (P ＜ 0.05).No breakage or malfunction of fixation occurred.There were no significant differences between the two groups in preoperative segmental kyphosis angle (P ＞ 0.05),while the correction of segmental kyphosis angle in Group B was better than Group A at the final follow-up [(7.97 ± 5.09) ° vs.(3.76 ± 1.67) °] (P ＜ 0.05).At the final follow-up,the correction of segmental kyphosis angle was similar between Group A1 and Group B1 (P ＞ 0.05),but the correction in Group B2 was better than GroupA2 (P ＜0.05) and the correction in Group B3 better than Group A3 (P ＜ 0.05).Besides,the correction of vertebral wedge angle was similar between Group A1 and Group B1 (P ＞ 0.05),but the correction in Group B2 was better than Group A2(P ＜0.05) and the correction in Group B3 was better than Group A3 (P ＜ 0.05).Loss of segmental kyphosis angle and vertebral wedge angle in Group A were greater than these in Group B (P ＜ 0.05).Conclusions Combined use of lordorizing screw with percutaneous transvertebral fixation improves the correction of thoracolumbar kyphosis angle in single-level thoracolumbar burst fractures.When the preoperative segmental kyphosis over 20°,lordorizing screw fixation should be recommended so as to achieve better correction of kyphotic deformity.