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

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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.	顧琪珊,周禮,譚均,等.經椎弓根硬膜前方減壓傷椎植骨短節段內固定治療胸腰椎爆裂骨折.中國修復重建外科雜志,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.	梁濤,劉浩,豐干鈞,等.胸腰椎爆裂骨折前路單節段與雙節段固定的生物力學比較.生物醫學工程學雜志,2011,28(3):491-496.
7.	陳藝,白波,孫輝,等.短節段椎弓根釘固定術的生物力學研究.中華創傷雜志,2010,26(1):39-43.
8.	王培民,馬勇,范競.釘棒系統結合經椎體內與后外側植骨治療胸腰椎骨折.江蘇醫藥,2010,36(7):769-771.
9.	譚家昌,徐鴻育,楊有猛,等.傷椎置釘與跨節段椎弓根螺釘內固定術治療胸腰椎骨折的比較研究.中國矯形外科雜志,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.	印飛,張紹東,吳小濤,等.影響Denis B型胸腰椎爆裂骨折內固定術后療效的相關因素分析.中國矯形外科雜志,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.	姜世濤,丁亮華,張洛舟,等.椎體內置入支柱塊聯合椎弓根螺釘固定治療胸腰椎爆裂骨折.中國脊柱脊髓雜志,2012,22(5):470-471.
14.	陶笙,王惠先,梁雨田,等.胸腰椎骨折內固定手術失敗原因分析.中華創傷骨科雜志,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.	印飛,張紹東,吳小濤,等.短節段椎弓根螺釘復位固定傷椎內植骨治療Denis B型胸腰椎骨折的影像學觀察.中國脊柱脊髓雜志,2013,23(4):341-346.
17.	歷強,賀西京,王斌,等.胸腰椎骨折內固定術后椎弓根螺釘斷裂的原因分析及對策.中國脊柱脊髓雜志,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. 顧琪珊,周禮,譚均,等.經椎弓根硬膜前方減壓傷椎植骨短節段內固定治療胸腰椎爆裂骨折.中國修復重建外科雜志,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. 梁濤,劉浩,豐干鈞,等.胸腰椎爆裂骨折前路單節段與雙節段固定的生物力學比較.生物醫學工程學雜志,2011,28(3):491-496.
7. 陳藝,白波,孫輝,等.短節段椎弓根釘固定術的生物力學研究.中華創傷雜志,2010,26(1):39-43.
8. 王培民,馬勇,范競.釘棒系統結合經椎體內與后外側植骨治療胸腰椎骨折.江蘇醫藥,2010,36(7):769-771.
9. 譚家昌,徐鴻育,楊有猛,等.傷椎置釘與跨節段椎弓根螺釘內固定術治療胸腰椎骨折的比較研究.中國矯形外科雜志,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. 印飛,張紹東,吳小濤,等.影響Denis B型胸腰椎爆裂骨折內固定術后療效的相關因素分析.中國矯形外科雜志,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. 姜世濤,丁亮華,張洛舟,等.椎體內置入支柱塊聯合椎弓根螺釘固定治療胸腰椎爆裂骨折.中國脊柱脊髓雜志,2012,22(5):470-471.
14. 陶笙,王惠先,梁雨田,等.胸腰椎骨折內固定手術失敗原因分析.中華創傷骨科雜志,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. 印飛,張紹東,吳小濤,等.短節段椎弓根螺釘復位固定傷椎內植骨治療Denis B型胸腰椎骨折的影像學觀察.中國脊柱脊髓雜志,2013,23(4):341-346.
17. 歷強,賀西京,王斌,等.胸腰椎骨折內固定術后椎弓根螺釘斷裂的原因分析及對策.中國脊柱脊髓雜志,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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