Comparison between posterior short-segment pedicle screw fixation combined with vertebroplasty or injured vertebral transpedicular fixation in treating osteoporotic thoracolumbar burst fracture / 中华创伤杂志

ABSTRACT

Objective To investigate the clinical efficacy of posterior short-segment pedicle screw fixation combined with vertebroplasty or injured vertebral transpedicular fixation in the treatment of osteoporotic thoracolumbar Magerl type A3 fractures.Methods A retrospective case control study was conducted on 39 patients with acute traumatic osteoporotic thoracolumbar burst fractures admitted from May 2007 to May 2016.There were 17 males and 22 females,aged 52-85 years (mean 61.3 years).All patients had single segment thoracolumbar fracture(T11-L2),with bone mineral density T value ＜-2.5 SD and the Frankel grade D or E.According to operation method,the patients were divided into Group A (n =22) which adopted short segment pedicle screw fixation combined with vertebroplasty and Group B (n =17) which adopted pedicle screw fixation combined with injured vertebra transpedicular fixation.The operation time and blood loss were compared between the two groups.VAS and Frankel grade were used to evaluate the patients' pain and the recovery of neurological function.The height recovery and Cobb angle of fracture vertebra were measured according to X-ray.Complications at follow ups were observed.Results All patients underwent the operations successfully with good healing.The mean follow-up time was 23.5 months (range,12-40 months).The operation time was (61.7 ± 6.7)minutes in Group A and (48.1 ± 7.5) minutes in Group B (P ＜ 0.05).The blood loss was (347.7 ± 44.9) ml in Group A and (288.3 ±41.6)ml in Group B (P ＜ 0.05).Postoperative VAS score and VAS at the final follow-up in both groups were significantly improved compared with those before operation (P ＜ 0.05),with no significant difference between the two groups.Four cases in Group A and two cases in Group B with Frankel grade D were classified as grade E.After operation,the recovery rate of injured vertebral Cobb angle and anterior height were significantly improved in both groups (P ＜ 0.05).The recovery rate of Cobb angle and anterior height at the last follow up was lower than that after surgery,but with no statistical difference (P ＞ 0.05),and no significant differences were found between the two groups either (P ＞ 0.05).The screws were removed from four patients in Group A and two patients in Group B.No complications or failure of internal fixation was found during follow-up.Conclusion Posterior shortsegment pedicle screw fixation combined with vertebroplasty or injured vertebra transpedicular fixation are both helpful to the height recovery of vertebral osteoporotic fractures and reduce kyphosis with similar efficacy,while the former has the advantages of shorter operation time and less bleeding.