Percutaneous fixation assisted by O-arm-based navigation for thoracolumbar fractures without neurologic deficits / 中华创伤杂志

ABSTRACT

Objective To investigate the clinical efficacy of percutaneous fixation assisted by O-arm-based navigation for thoracolumbar fractures without neurologic deficits.Methods A retrospective case control study was conducted analyze the clinical data of 35 thoracolumbar fracture patients without neurologic deficits admitted to Henan Provincial People's Hospital from January 2018 10 December 2018.There were 26 males and 9 females,aged 17-51 years,with an average age of 30.4 years.The injured segments were distributed at T11 in 10 patients,T12 in 15,L1 in 11,and L2 in 4 patients.A total of 19 patients(22 vertebrae,98 pedicle screws)were treated with O-arm guided navigation assisted percutaneous internal fixation(Group A),and 16 patients(18 vertebrae,82 pedicle screws)were treated with C-arm guided percutaneous internal fixation(Group B).The operation time,accuracy rate of nail placement,complications,Cobb angle of fracture vertebral body,visual analogue score(VAS)and Japanese Orthopaedic Association(JOA)score were recorded and compared before operation,7 days after operation and at the last follow-up.Results The patients were followed up for 2-12 months [(7.2 ±2.9)months] in Group A and 3-13 months [(7.1±3.3)months] in Group B.The operation time was(70.5±11.2)minutes in Group A and(81.3±10.9)minutes in Group B(P＜0.01).A total of 93 screws were completely placed in the pedicle in Group A(accuracy rate of 95％),and 74 screws in Group B(accuracy rate of 90％)(P＜0.01).There were no complications such as infection,pulmonary embolism,spinal cord,nerve injury or lower extremity deep vein thrombosis in either group.The Cobb angle of the fractured vertebral body at day 7 after operation in Group A and Group B was(9.4±2.1)° and(10.4±2.5)° respectively,while the Cobb angle of the fractured vertebral body at the final follow-up in Group A and Group B was(9.7±2.3)°and(11.4±2.9)° respectively.The postoperative Cobb angle was significantly increased compared with the preoperative Cobb angle(P＜0.05),but there was no significant difference between the two groups(P＞0.05).The V AS at day 7 after operation was(2.3±1.1)points and(2.8±1.0)points in Group A and Group B,respectively,while the VAS at the final follow-up was(0.7±0.7)points and(0.8±0.7)points in Group A and Group B respectively.The postoperative VAS was significantly decreased compared with the preoperative VAS(P＜0.05),but there was no significant difference between the two groups(P ＞0.05).The JOA at day 7 after operation was(21.1±2.2)points and(21.8±2.5)points in Group A and Group B respectively,while the JOA at the final follow-up was(24.9±2.2)points and(23.8±1.9)points in Group A and Group B respectively.The postoperative JOA was significantly increased compared with the preoperative JOA(P＜0.05),but there was no significant difference between the two groups(P＞0.05).Conclusion For thoracolumbar fractures without neurologic deficits,percutaneous fixation assisted by O-arm-based navigation can shorten the operation time and deliver a higher accuracy rate in the placement of pedicle screws,in addition to the similar effects with percutaneous fixation assisted by C-arm in pain relief,function improvement and correction of fracture vertebral kyphosis.