Therapeutic influence of using intermediate screws or not in short segment navigated percutaneous pedicular screws fixation for thoracolumbar compression fracture / 中华创伤杂志

ABSTRACT

Objective To investigate the therapeutic influence of short segment fixation with navigated percutaneous pedicle screws in the treatment of thoracolumbar compression fracture and whether use of pedicle screw fixation affects the treatment efficacy.Methods A retrospective case control study was conducted on the clinical data of 38 patients with thoracolumbar compression fracture admitted between January 2014 and October 2016.There were 27 males and 11 females,with an average age of 35.9 years (range,21-59 years).There were 14 cases with injured segment at T12,14 cases at L1,and 10 cases at L2,all of which were classified as Type A according to AO typing.The patients were divided into screw group (n =22) and non-screw group (n =16).The pedicle screws were placed into the upper and lower adjacent segments of the fracture vertebra or the fracture vertebra by percutaneous fluoroscopyguided navigation.The operation time,intraoperative blood loss,Visual analogue scale (VAS) before and after operation,anterior vertebral body height,Cobb angle,and complications in two groups were recorded.Results All patients were followed up for 12-30 months,average 15.2 months.No significant differences were found between the screw group and the non-screw group with respect to operation time [(44.7 ±12.6)minutes vs.(39.3 ±11.9)minutes] and blood loss [(56.8 ±13)ml vs.(48.4 ± 11.0)ml](P ＞0.05).In the screw group,preoperative VAS was (6.7 ± 1.5) points,and VAS at postoperative 1 week,six months and 1 year were (2.3 ± 0.9) points,(1.1 ± 0.3) points and (0.9 ± 0.5) points,respectively (P ＜ 0.01).In the non-screw group,preoperative VAS was (6.1 ± 1.7) points,and VAS at postoperative 1 week,six months and 1 year were (2.1 ± 0.8) points,(1.2-± 0.6) points and (1.0-±0.6) points,respectively (P ＜0.01).No significant difference was found on VAS between the two groups (P ＞ 0.05).In the screw group,anterior vertebral body height was (59.5 ±-1 3.6) ％ preoperatively,and anterior vertebral body height at postoperative 1 week,six months and 1 year was (90.6±7.7)％,(89.3 ±8.3)％ and (88.4 ±7.9)％ (P＜0.01).In the non-screw group,preoperative anterior vertebral body height was (60.1 ± 12.5)％,and anterior vertebral body height at postoperative 1 week,six months and 1 year was (89.3 ±8.9)％,(88.4 ±9.1)％ and (86.5 ±8.7)％ (P ＜0.01).No significant difference was found on anterior vertebral body height between the two groups (P＞0.05).In the screw group,preoperative Cobb angle was (15.6 ±4.1)°,and Cobb angle at postoperative 1 week,six months and 1 year was (3.0 ±1.8)°,(5.0 ±1.9) ° and (5.9 ±1.8)°,respectively (P ＜ 0.01).In the non-screw group,preoperative Cobb angle was (16.2 ± 5.1) °,and Cobb angle at postoperative 1 week,six months and 1 year was (3.1 ±1.4)°,(5.2 ±2.3)° and (5.6 ± 2.1) °,respectively (P ＜ 0.01).No significant difference was found on Cobb angle between the two groups (P ＞ 0.05).No spinal cord injuries because of pedicle screws were observed after operation in both groups.Conclusions For thoracolumbar compression fracture,short segment fixation with navigated percutaneous pedicle screws has the advantages of shorter operation time,less bleeding,better postoperative pain relief,and fewer complications.In addition,the postoperative VAS,anterior vertebral body height and sagittal Cobb angle are improved significantly.However,use of pedicle screw fixation in fracture vertebra does not have significant influence on the treatment efficacy.