A COMPARATIVE STUDY ON TREATMENT OF THORACOLUMBAR FRACTURE WITH INJURED VERTEBRA PEDICLE INSTRUMENTATION AND CROSS SEGMENT PEDICLE INSTRUMENTATION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YINFei ¹ ,  SUNZhenzhong ¹ , YINQudong ¹ , LIUJun ¹ , GUSanjun ¹ , ZHANGShaodong ²

1. Department of Orthopaedics, No. 9 People's Hospital of Wuxi, Wuxi Jiangsu, 214000, P. R. China;
2. Department of Orthopaedics, Zhongda Hospital Affiliated to Southeast University;

Corresponding author：

SUNZhenzhong, Email: szzwuxi@163.com

Keywords：

Thoracolumbar burst fracture; Pedicle screw; Bone grafting and pedicle screw implanting in injured vertebra

DOI：

10.7507/1002-1892.20140049

Video：

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Objective To compare the effective of short-segment pedicle instrumentation with bone grafting and pedicle screw implanting in injured vertebra and cross segment pedicle instrumentation with bone grafting in injured vertebra for treating thoracolumbar fractures. Methods A prospective randomized controlled study was performed in 40 patients with thoracolumbar fracture who were in accordance with the inclusive criteria between June 2010 and June 2012. Of 40 patients, 20 received treatment with short-segment pedicle screw instrumentation with bone grafting and pedicle screw implanting in injured vertebra in group A, and 20 received treatment with cross segment pedicle instrumentation with bone grafting in injured vertebra in group B. There was no significant difference in gender, age, affected segment, disease duration, Frankel grade, Cobb angle, compression rate of anterior verterbral height, visual analogue scale (VAS) score, and Japanese Orthopaedic Association (JOA) score between 2 groups before operation (P>0.05). The operation time, blood loss, Cobb angle, compression rate of anterior vertebral height, loss of disc space height, Frankel grade, VAS and JOA scores were compared between 2 groups. Results There was no significant difference in the operation time and blood loss between 2 groups (P>0.05). Primary healing of incision was obtained in all patients, and no early complication of infection or lower limb vein thrombus occurred. Forty patients were followed up 12-16 months (mean, 14.8 months). No breaking or displacement of internal fixation was observed. The improvement of Frankel grading score was 0.52±0.72 in group A and 0.47±0.63 in group B, showing no significant difference (t=0.188, P=0.853) at 12 months after operation. The Cobb angle, compression rate of anterior verterbral height, and VAS score at 1 week and 12 months, and JOA score at 12 months were significantly improved when compared with preoperative ones in 2 groups (P<0.05). No significant difference was found in Cobb angle, disc space height, VAS score, and JOA score between 2 groups at each time point (P>0.05), but the compression rate of anterior verterbral height in group A was significantly lower than that in group B (P<0.05). The loss of disc space height next to the internal fixation or the injured vertebra was observed in 2 groups at 12 months, but showing no significant difference (P>0.05). Conclusion Compared with cross segment pedicle instrumentation, short-segment pedicle screw instrumentation with bone grafting and pedicle screw implanting in injured vertebra can recover and maintain the affected vertebra height in treating thoracolumbar fractures, but it could not effectively prevent degeneration of adjacent segments and the loss of kyphosis correction degree.

Citation： YINFei, SUNZhenzhong, YINQudong, LIUJun, GUSanjun, ZHANGShaodong. A COMPARATIVE STUDY ON TREATMENT OF THORACOLUMBAR FRACTURE WITH INJURED VERTEBRA PEDICLE INSTRUMENTATION AND CROSS SEGMENT PEDICLE INSTRUMENTATION. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(2): 227-232. doi: 10.7507/1002-1892.20140049 Copy

1.	He D,Wu L,Chi Y,et al.Facet joint plus interspinous process graft fusion to prevent postoperative late correction loss in thoracolumbar fractures with disc damage:Finite element analysis and small clinical trials.Clin Biomech (Bristol,Avon),2011,26(3):229-237.
2.	顾琪珊,周礼,谭均,等.经椎弓根硬膜前方减压伤椎植骨短节段内固定治疗胸腰椎爆裂骨折.中国修复重建外科杂志,2008,22(12):1522-1523.
3.	Shen WJ,Liu TJ,Shen YS.Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit.Spine (Phila Pa 1976),2001,26(9):1038-1045.
4.	Hakalo J,Wroński J.Complications of a transpedicular stabilization of thoraco-lumbar burst fractures.Neurol Neurochir Pol,2006,40(2):134-139.
5.	Potter BK,Lehman RA,Kuklo TR.Anatomy and biomechanics of thoracic pedicle screw instrumentation.Curr Opinin Orthop,2004,15(3):133-144.
6.	梁涛,刘浩,丰干钧,等.胸腰椎爆裂骨折前路单节段与双节段固定的生物力学比较.生物医学工程学杂志,2011,28(3):491-496.
7.	陈艺,白波,孙辉,等.短节段椎弓根钉固定术的生物力学研究.中华创伤杂志,2010,26(1):39-43.
8.	王培民,马勇,范竞.钉棒系统结合经椎体内与后外侧植骨治疗胸腰椎骨折.江苏医药,2010,36(7):769-771.
9.	谭家昌,徐鸿育,杨有猛,等.伤椎置钉与跨节段椎弓根螺钉内固定术治疗胸腰椎骨折的比较研究.中国矫形外科杂志,2009,17(14):1094-1096.
10.	Eno JJ,Chen JL,Mitsunaga MM.Short same-segment fixation of thoracolumbar burst fractures.Hawaii J Med Public Health,2012,71(1):19-22.
11.	印飞,张绍东,吴小涛,等.影响Denis B型胸腰椎爆裂骨折内固定术后疗效的相关因素分析.中国矫形外科杂志,2013,21(12):1177-1180.
12.	Lin D,Guo L,Ding Z,et al.Modified surgery for acute thoracolumbar fractures:a prospective report.Eur Orthop Traumatol,2011,2(1-2):33-39.
13.	姜世涛,丁亮华,张洛舟,等.椎体内置入支柱块联合椎弓根螺钉固定治疗胸腰椎爆裂骨折.中国脊柱脊髓杂志,2012,22(5):470-471.
14.	陶笙,王惠先,梁雨田,等.胸腰椎骨折内固定手术失败原因分析.中华创伤骨科杂志,2006,8(8):740-743.
15.	Shi J,Mei X,Liu J,et al.The influence of correction loss in thoracolumbar fractures treated by posterior instrumentation:a minimum 7-year follow-up.J Clin Neurosci,2011,18(4):500-503.
16.	印飞,张绍东,吴小涛,等.短节段椎弓根螺钉复位固定伤椎内植骨治疗Denis B型胸腰椎骨折的影像学观察.中国脊柱脊髓杂志,2013,23(4):341-346.
17.	历强,贺西京,王斌,等.胸腰椎骨折内固定术后椎弓根螺钉断裂的原因分析及对策.中国脊柱脊髓杂志,2007,17(6):430-432.

1. He D,Wu L,Chi Y,et al.Facet joint plus interspinous process graft fusion to prevent postoperative late correction loss in thoracolumbar fractures with disc damage:Finite element analysis and small clinical trials.Clin Biomech (Bristol,Avon),2011,26(3):229-237.
2. 顾琪珊,周礼,谭均,等.经椎弓根硬膜前方减压伤椎植骨短节段内固定治疗胸腰椎爆裂骨折.中国修复重建外科杂志,2008,22(12):1522-1523.
3. Shen WJ,Liu TJ,Shen YS.Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit.Spine (Phila Pa 1976),2001,26(9):1038-1045.
4. Hakalo J,Wroński J.Complications of a transpedicular stabilization of thoraco-lumbar burst fractures.Neurol Neurochir Pol,2006,40(2):134-139.
5. Potter BK,Lehman RA,Kuklo TR.Anatomy and biomechanics of thoracic pedicle screw instrumentation.Curr Opinin Orthop,2004,15(3):133-144.
6. 梁涛,刘浩,丰干钧,等.胸腰椎爆裂骨折前路单节段与双节段固定的生物力学比较.生物医学工程学杂志,2011,28(3):491-496.
7. 陈艺,白波,孙辉,等.短节段椎弓根钉固定术的生物力学研究.中华创伤杂志,2010,26(1):39-43.
8. 王培民,马勇,范竞.钉棒系统结合经椎体内与后外侧植骨治疗胸腰椎骨折.江苏医药,2010,36(7):769-771.
9. 谭家昌,徐鸿育,杨有猛,等.伤椎置钉与跨节段椎弓根螺钉内固定术治疗胸腰椎骨折的比较研究.中国矫形外科杂志,2009,17(14):1094-1096.
10. Eno JJ,Chen JL,Mitsunaga MM.Short same-segment fixation of thoracolumbar burst fractures.Hawaii J Med Public Health,2012,71(1):19-22.
11. 印飞,张绍东,吴小涛,等.影响Denis B型胸腰椎爆裂骨折内固定术后疗效的相关因素分析.中国矫形外科杂志,2013,21(12):1177-1180.
12. Lin D,Guo L,Ding Z,et al.Modified surgery for acute thoracolumbar fractures:a prospective report.Eur Orthop Traumatol,2011,2(1-2):33-39.
13. 姜世涛,丁亮华,张洛舟,等.椎体内置入支柱块联合椎弓根螺钉固定治疗胸腰椎爆裂骨折.中国脊柱脊髓杂志,2012,22(5):470-471.
14. 陶笙,王惠先,梁雨田,等.胸腰椎骨折内固定手术失败原因分析.中华创伤骨科杂志,2006,8(8):740-743.
15. Shi J,Mei X,Liu J,et al.The influence of correction loss in thoracolumbar fractures treated by posterior instrumentation:a minimum 7-year follow-up.J Clin Neurosci,2011,18(4):500-503.
16. 印飞,张绍东,吴小涛,等.短节段椎弓根螺钉复位固定伤椎内植骨治疗Denis B型胸腰椎骨折的影像学观察.中国脊柱脊髓杂志,2013,23(4):341-346.
17. 历强,贺西京,王斌,等.胸腰椎骨折内固定术后椎弓根螺钉断裂的原因分析及对策.中国脊柱脊髓杂志,2007,17(6):430-432.

Chinese Journal of Reparative and Reconstructive Surgery

A COMPARATIVE STUDY ON TREATMENT OF THORACOLUMBAR FRACTURE WITH INJURED VERTEBRA PEDICLE INSTRUMENTATION AND CROSS SEGMENT PEDICLE INSTRUMENTATION

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