Clinical research of percutaneous monoplanar screw internal fixation via injured vertebrae for thoracolumbar fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 KANG Hui , XU Feng , XIONG Chengjie , XI Jintao , WU Boyu

Department of Orthopaedics, Central Theater Command General Hospital of PLA, Wuhan Hubei, 430070, P.R.China;

Corresponding author：

KANG Hui, Email: kanghuicss@163.com

Keywords：

Thoracolumbar fracture; monoplanar screw; injured vertebra; percutaneous

DOI：

10.7507/1002-1892.201904140

Video：

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Objective To evaluate the effectiveness of percutaneous monoplanar screw internal fixation via injured vertebrae for treatment of thoracolumbar fracture.Methods Between May 2015 and August 2017, 38 cases of thoracolumbar fractures without neurological symptom were treated with percutaneous monoplanar screw internal fixation via injured vertebrae. There were 22 males and 16 females, aged 25-52 years (mean, 32.5 years). There were 23 cases of AO type A3 and 15 cases of AO type A4. The injured vertebrae located at T₁₁ in 4 cases, T₁₂ in 9 cases, L₁ in 11 cases, L₂ in 10 cases, L₃ in 3 cases, and L₄ in 1 case. The mean interval between injury and operation was 4.5 days (range, 3-7 days). The pre- and post-operative degrees of lumbodorsal pain were estimated by the visual analogue scale (VAS) score. The X-ray film, CT three-dimensional reconstruction, and MRI were performed, and the ratio of anterior vertebral body height and sagittal Cobb angle were measured to assess the kyphosis of the fractured area.Results All operations in 38 patients successfully completed without complications such as dural sac, nerve root, or vascular injury. The operation time was (56.2±3.7) minutes and the intraoperative blood loss was (42.3±3.5) mL. All incisions healed by first intention without redness, swelling, or exudation. All patients were followed up 17-33 months, with an average of 21.5 months. The VAS score at each time point after operation significantly improved when compared with that before operation (P<0.05), and significantly improved at 3 months and last follow-up when compared with that at 1 week (P<0.05); there was no significant difference between 3 months and last follow-up (P>0.05). There was no internal fixator loosening, breakage, or delayed kyphosis in all patients. The ratio of anterior vertebral body height and sagittal Cobb angle significantly improved postoperatively (P<0.05), and no significant difference was found between the different time points after operation (P>0.05).Conclusion Percutaneous monoplanar screw internal fixation via injured vertebrae is an easy approach to treat thoracolumbar fracture without neurological symptom, which can effectively restore vertebral body height and correct kyphosis, and avoid long-term segmental kyphosis.

Citation： KANG Hui, XU Feng, XIONG Chengjie, XI Jintao, WU Boyu. Clinical research of percutaneous monoplanar screw internal fixation via injured vertebrae for thoracolumbar fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(3): 308-312. doi: 10.7507/1002-1892.201904140 Copy

1.	王洪伟, 周跃, 李长青, 等. 经皮椎弓根螺钉内固定治疗胸腰椎骨折的生物力学及临床研究. 中华骨科杂志, 2011, 31(9): 932-937.
2.	杨标, 田素魁, 隗昱, 等. 经皮与开放椎弓根螺钉内固定治疗胸腰椎多节段骨折的比较. 中国矫形外科杂志, 2019, 27(4): 310-315.
3.	邹伟, 肖杰, 龙浩, 等. 腰椎骨折经皮椎弓根螺钉复位内固定体外撑开器的设计与临床应用研究. 中国修复重建外科杂志, 2017, 31(1): 66-72.
4.	王洪伟, 李长青, 周跃, 等. 附加伤椎固定的微创经皮椎弓根螺钉 (Sextant) 治疗胸腰椎骨折. 中华创伤骨科杂志, 2010, 12(2): 126-130.
5.	刘军, 项良碧, 陈语, 等. 经皮微创椎弓根螺钉技术治疗胸腰椎骨折 12 例. 中华创伤杂志, 2011, 27(9): 782-784.
6.	Fogel GR, Reitman CA, Liu W, et al. Physical characteristics of polyaxial-headed pedicle screws and biomechanical comparison of load with their failure. Spine (Phila Pa 1976), 2003, 28(5): 470-473.
7.	Reinhold M, Audigé L, Schnake KJ, et al. AO spine injury classification system: a revision proposal for the thoracic and lumbar spine. Eur Spine J, 2013, 22(10): 2184-2201.
8.	Dick JC, Jones MP, Zdeblick TA, et al. A biomechanical comparison evaluating the use of intermediate screws and cross-link-age in lumbar pedicle fixation. J Spinal Disord, 1994, 7(5): 402-407.
9.	Mahar A, Kim C, Wedemeyer M, et al. Short-segment fixation of Lumbar burst fractures using pedicle fixation at the level of the fracture. Spine (Phila Pa 1976), 2007, 32(14): 1503-1507.
10.	肖斌, 李健, 蔡厚洪, 等. 跨骨折椎体固定联合单侧伤椎植钉治疗胸腰椎爆裂骨折的生物力学研究. 中国修复重建外科杂志, 2016, 30(5): 580-584.
11.	王洪伟, 李长青, 周跃, 等. 伤椎置钉技术治疗胸腰椎骨折的生物力学及临床随访研究. 中国矫形外科杂志, 2011, 19(16): 1356-1360.
12.	沈昆, 王守国, 费昊东, 等. 伤椎置钉治疗单节段胸腰段椎体骨折的临床疗效. 中国矫形外科杂志, 2017, 25(22): 2016-2018.
13.	陈志达, 吴进, 林斌, 等. 后路伤椎短节段固定治疗严重不稳的胸腰椎爆裂性骨折. 中国修复重建外科杂志, 2018, 32(1): 59-63.
14.	邹伟, 肖杰, 龙浩, 等. 微创经皮椎弓根罗东内固定治疗胸腰椎骨折的置钉选择. 中国组织工程研究, 2017, 21(3): 356-361.
15.	吕胜江, 付丽娟, 李红梅. 椎弓根单向螺钉及万向螺钉置入内固定修复腰椎骨折的生物力学比较. 中国组织工程研究, 2016, 20(22): 3308-3314.
16.	Gelb D, Ludwig S, Karp JE, et al. Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation. J Spinal Disord Tech, 2010, 23(5): 293-301.
17.	Ni WF, Huang YX, Chi YL, et al. Percutaneous pedicle screw fixation for neurologic intact thoracolumbar burst fractures. J Spinal Disord Tech, 2010, 23(8): 530-537.
18.	何文野, 包肇华, 季一鸣, 等. 过伸牵引弹性按压联合经皮椎弓根螺钉内固定术治疗胸腰椎骨折临床观察. 山东医药, 2018, 58(44): 1-4.
19.	罗狄鑫, 金勋杰, 徐汪洋, 等. 胸腰椎骨折患者经伤椎置钉与跨节段椎弓根螺钉内固定治疗的临床效果比较. 中国矫形外科杂志, 2017, 25(14): 1320-1323.
20.	康辉, 徐峰, 兰生辉, 等. 伤椎斜向长螺钉置钉治疗 Denis B 型胸腰椎骨折. 中国矫形外科杂志, 2018, 26(20): 1825-1829.
21.	胡海刚, 谭伦. 不同椎弓根骨折类型行伤椎置钉的 CT 影像学观察. 中国骨与关节杂志, 2014, 3(1): 49-53.
22.	吴卫平, 孙业青, 李少华, 等. 胸腰椎椎弓根骨折分型及螺钉固定安全性研究. 同济大学学报 (医学版), 2010, 31(1): 89-93.
23.	陈德纯, 来津, 谭俊铭, 等. 伤椎椎弓根长螺钉在治疗胸腰椎骨折中的应用. 颈腰痛杂志, 2013, 34(1): 46-49.
24.	Korovessis P, Repantis T, Petsinis G, et al. Direct reduction of thoracolumbar burst fractures by means of balloon kyphoplasty with calcium phosphate and stabilization with pedicle-screw instrumentation and fusion. Spine (Phila Pa 1976), 2008, 33(4): E100-E108.

1. 王洪伟, 周跃, 李长青, 等. 经皮椎弓根螺钉内固定治疗胸腰椎骨折的生物力学及临床研究. 中华骨科杂志, 2011, 31(9): 932-937.
2. 杨标, 田素魁, 隗昱, 等. 经皮与开放椎弓根螺钉内固定治疗胸腰椎多节段骨折的比较. 中国矫形外科杂志, 2019, 27(4): 310-315.
3. 邹伟, 肖杰, 龙浩, 等. 腰椎骨折经皮椎弓根螺钉复位内固定体外撑开器的设计与临床应用研究. 中国修复重建外科杂志, 2017, 31(1): 66-72.
4. 王洪伟, 李长青, 周跃, 等. 附加伤椎固定的微创经皮椎弓根螺钉 (Sextant) 治疗胸腰椎骨折. 中华创伤骨科杂志, 2010, 12(2): 126-130.
5. 刘军, 项良碧, 陈语, 等. 经皮微创椎弓根螺钉技术治疗胸腰椎骨折 12 例. 中华创伤杂志, 2011, 27(9): 782-784.
6. Fogel GR, Reitman CA, Liu W, et al. Physical characteristics of polyaxial-headed pedicle screws and biomechanical comparison of load with their failure. Spine (Phila Pa 1976), 2003, 28(5): 470-473.
7. Reinhold M, Audigé L, Schnake KJ, et al. AO spine injury classification system: a revision proposal for the thoracic and lumbar spine. Eur Spine J, 2013, 22(10): 2184-2201.
8. Dick JC, Jones MP, Zdeblick TA, et al. A biomechanical comparison evaluating the use of intermediate screws and cross-link-age in lumbar pedicle fixation. J Spinal Disord, 1994, 7(5): 402-407.
9. Mahar A, Kim C, Wedemeyer M, et al. Short-segment fixation of Lumbar burst fractures using pedicle fixation at the level of the fracture. Spine (Phila Pa 1976), 2007, 32(14): 1503-1507.
10. 肖斌, 李健, 蔡厚洪, 等. 跨骨折椎体固定联合单侧伤椎植钉治疗胸腰椎爆裂骨折的生物力学研究. 中国修复重建外科杂志, 2016, 30(5): 580-584.
11. 王洪伟, 李长青, 周跃, 等. 伤椎置钉技术治疗胸腰椎骨折的生物力学及临床随访研究. 中国矫形外科杂志, 2011, 19(16): 1356-1360.
12. 沈昆, 王守国, 费昊东, 等. 伤椎置钉治疗单节段胸腰段椎体骨折的临床疗效. 中国矫形外科杂志, 2017, 25(22): 2016-2018.
13. 陈志达, 吴进, 林斌, 等. 后路伤椎短节段固定治疗严重不稳的胸腰椎爆裂性骨折. 中国修复重建外科杂志, 2018, 32(1): 59-63.
14. 邹伟, 肖杰, 龙浩, 等. 微创经皮椎弓根罗东内固定治疗胸腰椎骨折的置钉选择. 中国组织工程研究, 2017, 21(3): 356-361.
15. 吕胜江, 付丽娟, 李红梅. 椎弓根单向螺钉及万向螺钉置入内固定修复腰椎骨折的生物力学比较. 中国组织工程研究, 2016, 20(22): 3308-3314.
16. Gelb D, Ludwig S, Karp JE, et al. Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation. J Spinal Disord Tech, 2010, 23(5): 293-301.
17. Ni WF, Huang YX, Chi YL, et al. Percutaneous pedicle screw fixation for neurologic intact thoracolumbar burst fractures. J Spinal Disord Tech, 2010, 23(8): 530-537.
18. 何文野, 包肇华, 季一鸣, 等. 过伸牵引弹性按压联合经皮椎弓根螺钉内固定术治疗胸腰椎骨折临床观察. 山东医药, 2018, 58(44): 1-4.
19. 罗狄鑫, 金勋杰, 徐汪洋, 等. 胸腰椎骨折患者经伤椎置钉与跨节段椎弓根螺钉内固定治疗的临床效果比较. 中国矫形外科杂志, 2017, 25(14): 1320-1323.
20. 康辉, 徐峰, 兰生辉, 等. 伤椎斜向长螺钉置钉治疗 Denis B 型胸腰椎骨折. 中国矫形外科杂志, 2018, 26(20): 1825-1829.
21. 胡海刚, 谭伦. 不同椎弓根骨折类型行伤椎置钉的 CT 影像学观察. 中国骨与关节杂志, 2014, 3(1): 49-53.
22. 吴卫平, 孙业青, 李少华, 等. 胸腰椎椎弓根骨折分型及螺钉固定安全性研究. 同济大学学报 (医学版), 2010, 31(1): 89-93.
23. 陈德纯, 来津, 谭俊铭, 等. 伤椎椎弓根长螺钉在治疗胸腰椎骨折中的应用. 颈腰痛杂志, 2013, 34(1): 46-49.
24. Korovessis P, Repantis T, Petsinis G, et al. Direct reduction of thoracolumbar burst fractures by means of balloon kyphoplasty with calcium phosphate and stabilization with pedicle-screw instrumentation and fusion. Spine (Phila Pa 1976), 2008, 33(4): E100-E108.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical research of percutaneous monoplanar screw internal fixation via injured vertebrae for thoracolumbar fracture

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