Effect of percutaneous pedicle screw fixation on the reduction of thoraculumbar burst fractures with posterosuperior fracture fragment_West China Medical Journal

Authors：

YAN Ting ,  WU Chao , LIN Xu , ZENG Jun , ZHONG Zeli , TAN Lun

Section I, Department of Orthopaedics, the Fourth People’s Hospital of Zigong, Zigong, Sichuan 643000, P. R. China;

Corresponding author：

WU Chao, Email: flightiness@163.com

Keywords：

Percutaneous pedical screw fixation; Thoracolumbar burst fracures; Occupancy rate of spinal canal

DOI：

10.7507/1002-0179.202108054

Video：

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Objective To explore the effectiveness of percutaneous pedicle screw fixation on the indirect reduction of posterosuperior fracture fragment in the thoraculumbar burst fractures. Methods Patients with thoracolumbar fractures treated in the Fourth People’s Hospital of Zigong from September 2017 to September 2019 were collected retrospectively. All patients were treated with percutaneous pedicle screw fixation. The main observation indexes before operation, 3 days after operation and 1 year after operation were compared, including the height ratio of the anterior margin of fractured vertebra, the inversion angle of posterosuperior fracture fragment, the fragment displacement, the occupancy rate of spinal canal, the Cobb angle of kyphosisat, Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Results A total of 38 patients were included. All patients were followed up for more than 1 year. During the follow-up period, there were no complications such as nerve injury, incision infection, internal fixation loosening or fracture. The operation time was (91.7±10.4) min, the amount of intraoperative bleeding was (94.3±19.5) mL, and the length of surgical incision was (9.3±1.8) cm. The height ratio of the anterior margin of fractured vertebra, the inversion angle of posterosuperior fracture fragment, the fragment displacement, the occupancy rate of spinal canal, the Cobb angle of kyphosisat 3 days after operation were significantly improved compared with those before operation (P<0.05); the height ratio of the anterior margin of fractured vertebra, the occupancy rate of spinal canal, and the Cobb angle of kyphosisat 1 year after operation were also significantly improved compared with those before operation (P<0.05); the height ratio of the anterior margin of fractured vertebra and the occupancy rate of spinal canalat 1 year after operation were significantly improved than those 3 days after operation (P<0.05), but the Cobb angle of kyphosis 1 year after operation was significantly lost than that 3 days after operation (P<0.05). The VAS score and ODI index 3 days and 1 year after operation were significantly improved compared with those before operation (P<0.05), and the VAS score and ODI index 1 year after operation were improved compared with those 3 days after operation (P<0.05). Conclusion The percutaneous pedicle screw fixation can effectively reduce the retropulsed bone fragment indirectly and restore the Cobb angle of kyphosis of the thoraculumbar burst fractures without neurological deficit, and at the same time reduce the operation time and surgical trauma.

Citation： YAN Ting, WU Chao, LIN Xu, ZENG Jun, ZHONG Zeli, TAN Lun. Effect of percutaneous pedicle screw fixation on the reduction of thoraculumbar burst fractures with posterosuperior fracture fragment. West China Medical Journal, 2021, 36(10): 1355-1360. doi: 10.7507/1002-0179.202108054 Copy

1.	Cahueque M, Cobar A, Zuñiga C, et al. Management of burst fractures in the thoracolumbar spine. J Orthop, 2016, 13(4): 278-281.
2.	Briem D, Behechtnejad A, Ouchmaev A, et al. Pain regulation and health-related quality of life after thoracolumbar fractures of the spine. Eur Spine J, 2007, 16(11): 1925-1933.
3.	Guerra J Jr, Garfin SR, Resnick D. Vertebral burst fractures: CT analysis of the retropulsed fragment. Radiology, 1984, 153(3): 769-772.
4.	Mumford J, Weinstein JN, Spratt KF, et al. Thoracolumbar burst fractures. The clinical efficacy and outcome of nonoperative management. Spine (Phila Pa 1976), 1993, 18(8): 955-970.
5.	Crutcher JP Jr, Anderson PA, King HA, et al. Indirect spinal canal decompression in patients with thoracolumbar burst fractures treated by posterior distraction rods. J Spinal Disord, 1991, 4(1): 39-48.
6.	Mohanty SP, Bhat SN, Ishwara-Keerthi C. The effect of posterior instrumentation of the spine on canal dimensions and neurological recovery in thoracolumbar and lumbar burst fractures. Musculoskelet Surg, 2011, 95(2): 101-106.
7.	李洪伟, 李鹤, 赵鹏飞. 后路经皮置钉与开放置钉行椎弓根钉内固定手术治疗脊椎骨折的疗效及组织创伤应激反应比较. 颈腰痛杂志, 2021, 42(2): 232-235.
8.	祝乃强, 侯静怡, 马桂云, 等. 经皮椎弓根螺钉内固定治疗胸腰椎骨折. 中国矫形外科杂志, 2019, 27(18): 1663-1668.
9.	关骅, 陈学明. 脊髓损伤ASIA神经功能分类标准(2000年修订). 中国脊柱脊髓杂志, 2001, 11(3): 164.
10.	Heller GZ, Manuguerra M, Chow R. How to analyze the visual analogue scale: myths, truths and clinical relevance. Scand J Pain, 2016, 13: 67-75.
11.	Fairbank JC, Pynsent PB. The oswestry disability index. Spine (Phila Pa 1976), 2000, 25(22): 2940-2952.
12.	陈意磊, 张旭阳, 邱小明, 等. 伤椎椎体后上缘骨块对胸腰椎爆裂骨折手术入路的影响. 中华创伤杂志, 2017, 33(11): 998-1004.
13.	阎崇楠, 王欢, 崔少千, 等. 后路前凸弯棒预加压复位固定技术治疗胸腰段不稳定性爆裂骨折. 中华骨科杂志, 2020, 40(15): 988-995.
14.	Hongo M, Abe E, Shimada Y, et al. Surface strain distribution on thoracic and lumbar vertebrae under axial compression. The role in burst fractures. Spine (Phila Pa 1976), 1999, 24(12): 1197-1202.
15.	Zhao FD, Pollintine P, Hole BD, et al. Vertebral fractures usually affect the cranial endplate because it is thinner and supported by less-dense trabecular bone. Bone, 2009, 44(2): 372-379.
16.	张旭阳, 李生鋆, 虞天明, 等. 胸腰椎爆裂性骨折椎体后上缘骨折块与椎基静脉孔的相关性. 中华骨科杂志, 2017, 37(19): 1223-1230.
17.	Aebi M. Classification of thoracolumbar fractures and dislocations. Eur Spine J, 2010(Suppl 1): S2-S7.
18.	Wang XB, Lü GH, Li J, et al. Posterior distraction and instrumentation cannot always reduce displaced and rotated posterosuperior fracture fragments in thoracolumbar burst fracture. Clin Spine Surg, 2017, 30(3): E317-E322.
19.	Peng Y, Zhang L, Shi T, et al. Relationship between fracture-relevant parameters of thoracolumbar burst fractures and the reduction of intra-canal fracture fragment. J Orthop Surg Res, 2015(10): 131.
20.	杨彬, 王德成, 陈学谦, 等. 经皮微创置钉和开放椎弓根螺钉内固定术治疗无神经损伤胸腰椎骨折的疗效分析. 颈腰痛杂志, 2019, 40(6): 841-843.
21.	周忠贤. 微创经皮椎弓根螺钉内固定术治疗无脊髓神经损伤型胸腰段骨折的疗效分析. 南宁: 广西医科大学, 2019.
22.	覃海飚, 钟远鸣, 张家立, 等. 经皮微创椎弓根螺钉内固定治疗无神经症状的胸腰椎爆裂骨折45例. 广西医学, 2016, 38(10): 1437-1439.
23.	赵红卫, 刘扬, 张思胜, 等. 经皮椎弓根螺钉内固定治疗胸腰椎爆裂性骨折. 上海医学, 2012, 35(7): 605-608, 前插1.
24.	王敏, 马文泽, 李文成, 等. 胸腰椎压缩骨折后路内固定术后复位丢失的临床研究. 实用骨科杂志, 2019, 25(7): 635-639.
25.	王珣, 陈远明, 黄中飞, 等. 经伤椎置钉内固定治疗胸腰椎骨折的研究进展. 广西医学, 2018, 40(3): 322-325.
26.	祝乃强, 侯静怡, 陈宾, 等. 折弯连接棒联合伤椎置钉杠杆复位经皮椎弓根钉内固定治疗胸腰椎骨折的疗效观察. 中国骨与关节损伤杂志, 2020, 35(1): 1-5.

1. Cahueque M, Cobar A, Zuñiga C, et al. Management of burst fractures in the thoracolumbar spine. J Orthop, 2016, 13(4): 278-281.
2. Briem D, Behechtnejad A, Ouchmaev A, et al. Pain regulation and health-related quality of life after thoracolumbar fractures of the spine. Eur Spine J, 2007, 16(11): 1925-1933.
3. Guerra J Jr, Garfin SR, Resnick D. Vertebral burst fractures: CT analysis of the retropulsed fragment. Radiology, 1984, 153(3): 769-772.
4. Mumford J, Weinstein JN, Spratt KF, et al. Thoracolumbar burst fractures. The clinical efficacy and outcome of nonoperative management. Spine (Phila Pa 1976), 1993, 18(8): 955-970.
5. Crutcher JP Jr, Anderson PA, King HA, et al. Indirect spinal canal decompression in patients with thoracolumbar burst fractures treated by posterior distraction rods. J Spinal Disord, 1991, 4(1): 39-48.
6. Mohanty SP, Bhat SN, Ishwara-Keerthi C. The effect of posterior instrumentation of the spine on canal dimensions and neurological recovery in thoracolumbar and lumbar burst fractures. Musculoskelet Surg, 2011, 95(2): 101-106.
7. 李洪伟, 李鹤, 赵鹏飞. 后路经皮置钉与开放置钉行椎弓根钉内固定手术治疗脊椎骨折的疗效及组织创伤应激反应比较. 颈腰痛杂志, 2021, 42(2): 232-235.
8. 祝乃强, 侯静怡, 马桂云, 等. 经皮椎弓根螺钉内固定治疗胸腰椎骨折. 中国矫形外科杂志, 2019, 27(18): 1663-1668.
9. 关骅, 陈学明. 脊髓损伤ASIA神经功能分类标准(2000年修订). 中国脊柱脊髓杂志, 2001, 11(3): 164.
10. Heller GZ, Manuguerra M, Chow R. How to analyze the visual analogue scale: myths, truths and clinical relevance. Scand J Pain, 2016, 13: 67-75.
11. Fairbank JC, Pynsent PB. The oswestry disability index. Spine (Phila Pa 1976), 2000, 25(22): 2940-2952.
12. 陈意磊, 张旭阳, 邱小明, 等. 伤椎椎体后上缘骨块对胸腰椎爆裂骨折手术入路的影响. 中华创伤杂志, 2017, 33(11): 998-1004.
13. 阎崇楠, 王欢, 崔少千, 等. 后路前凸弯棒预加压复位固定技术治疗胸腰段不稳定性爆裂骨折. 中华骨科杂志, 2020, 40(15): 988-995.
14. Hongo M, Abe E, Shimada Y, et al. Surface strain distribution on thoracic and lumbar vertebrae under axial compression. The role in burst fractures. Spine (Phila Pa 1976), 1999, 24(12): 1197-1202.
15. Zhao FD, Pollintine P, Hole BD, et al. Vertebral fractures usually affect the cranial endplate because it is thinner and supported by less-dense trabecular bone. Bone, 2009, 44(2): 372-379.
16. 张旭阳, 李生鋆, 虞天明, 等. 胸腰椎爆裂性骨折椎体后上缘骨折块与椎基静脉孔的相关性. 中华骨科杂志, 2017, 37(19): 1223-1230.
17. Aebi M. Classification of thoracolumbar fractures and dislocations. Eur Spine J, 2010(Suppl 1): S2-S7.
18. Wang XB, Lü GH, Li J, et al. Posterior distraction and instrumentation cannot always reduce displaced and rotated posterosuperior fracture fragments in thoracolumbar burst fracture. Clin Spine Surg, 2017, 30(3): E317-E322.
19. Peng Y, Zhang L, Shi T, et al. Relationship between fracture-relevant parameters of thoracolumbar burst fractures and the reduction of intra-canal fracture fragment. J Orthop Surg Res, 2015(10): 131.
20. 杨彬, 王德成, 陈学谦, 等. 经皮微创置钉和开放椎弓根螺钉内固定术治疗无神经损伤胸腰椎骨折的疗效分析. 颈腰痛杂志, 2019, 40(6): 841-843.
21. 周忠贤. 微创经皮椎弓根螺钉内固定术治疗无脊髓神经损伤型胸腰段骨折的疗效分析. 南宁: 广西医科大学, 2019.
22. 覃海飚, 钟远鸣, 张家立, 等. 经皮微创椎弓根螺钉内固定治疗无神经症状的胸腰椎爆裂骨折45例. 广西医学, 2016, 38(10): 1437-1439.
23. 赵红卫, 刘扬, 张思胜, 等. 经皮椎弓根螺钉内固定治疗胸腰椎爆裂性骨折. 上海医学, 2012, 35(7): 605-608, 前插1.
24. 王敏, 马文泽, 李文成, 等. 胸腰椎压缩骨折后路内固定术后复位丢失的临床研究. 实用骨科杂志, 2019, 25(7): 635-639.
25. 王珣, 陈远明, 黄中飞, 等. 经伤椎置钉内固定治疗胸腰椎骨折的研究进展. 广西医学, 2018, 40(3): 322-325.
26. 祝乃强, 侯静怡, 陈宾, 等. 折弯连接棒联合伤椎置钉杠杆复位经皮椎弓根钉内固定治疗胸腰椎骨折的疗效观察. 中国骨与关节损伤杂志, 2020, 35(1): 1-5.

West China Medical Journal

Effect of percutaneous pedicle screw fixation on the reduction of thoraculumbar burst fractures with posterosuperior fracture fragment

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