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.	王洪偉, 周躍, 李長青, 等. 經皮椎弓根螺釘內固定治療胸腰椎骨折的生物力學及臨床研究. 中華骨科雜志, 2011, 31(9): 932-937.
2.	楊標, 田素魁, 隗昱, 等. 經皮與開放椎弓根螺釘內固定治療胸腰椎多節段骨折的比較. 中國矯形外科雜志, 2019, 27(4): 310-315.
3.	鄒偉, 肖杰, 龍浩, 等. 腰椎骨折經皮椎弓根螺釘復位內固定體外撐開器的設計與臨床應用研究. 中國修復重建外科雜志, 2017, 31(1): 66-72.
4.	王洪偉, 李長青, 周躍, 等. 附加傷椎固定的微創經皮椎弓根螺釘 (Sextant) 治療胸腰椎骨折. 中華創傷骨科雜志, 2010, 12(2): 126-130.
5.	劉軍, 項良碧, 陳語, 等. 經皮微創椎弓根螺釘技術治療胸腰椎骨折 12 例. 中華創傷雜志, 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. 跨骨折椎體固定聯合單側傷椎植釘治療胸腰椎爆裂骨折的生物力學研究. 中國修復重建外科雜志, 2016, 30(5): 580-584.
11.	王洪偉, 李長青, 周躍, 等. 傷椎置釘技術治療胸腰椎骨折的生物力學及臨床隨訪研究. 中國矯形外科雜志, 2011, 19(16): 1356-1360.
12.	沈昆, 王守國, 費昊東, 等. 傷椎置釘治療單節段胸腰段椎體骨折的臨床療效. 中國矯形外科雜志, 2017, 25(22): 2016-2018.
13.	陳志達, 吳進, 林斌, 等. 后路傷椎短節段固定治療嚴重不穩的胸腰椎爆裂性骨折. 中國修復重建外科雜志, 2018, 32(1): 59-63.
14.	鄒偉, 肖杰, 龍浩, 等. 微創經皮椎弓根羅東內固定治療胸腰椎骨折的置釘選擇. 中國組織工程研究, 2017, 21(3): 356-361.
15.	呂勝江, 付麗娟, 李紅梅. 椎弓根單向螺釘及萬向螺釘置入內固定修復腰椎骨折的生物力學比較. 中國組織工程研究, 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, 包肇華, 季一鳴, 等. 過伸牽引彈性按壓聯合經皮椎弓根螺釘內固定術治療胸腰椎骨折臨床觀察. 山東醫藥, 2018, 58(44): 1-4.
19.	羅狄鑫, 金勛杰, 徐汪洋, 等. 胸腰椎骨折患者經傷椎置釘與跨節段椎弓根螺釘內固定治療的臨床效果比較. 中國矯形外科雜志, 2017, 25(14): 1320-1323.
20.	康輝, 徐峰, 蘭生輝, 等. 傷椎斜向長螺釘置釘治療 Denis B 型胸腰椎骨折. 中國矯形外科雜志, 2018, 26(20): 1825-1829.
21.	胡海剛, 譚倫. 不同椎弓根骨折類型行傷椎置釘的 CT 影像學觀察. 中國骨與關節雜志, 2014, 3(1): 49-53.
22.	吳衛平, 孫業青, 李少華, 等. 胸腰椎椎弓根骨折分型及螺釘固定安全性研究. 同濟大學學報 (醫學版), 2010, 31(1): 89-93.
23.	陳德純, 來津, 譚俊銘, 等. 傷椎椎弓根長螺釘在治療胸腰椎骨折中的應用. 頸腰痛雜志, 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. 王洪偉, 周躍, 李長青, 等. 經皮椎弓根螺釘內固定治療胸腰椎骨折的生物力學及臨床研究. 中華骨科雜志, 2011, 31(9): 932-937.
2. 楊標, 田素魁, 隗昱, 等. 經皮與開放椎弓根螺釘內固定治療胸腰椎多節段骨折的比較. 中國矯形外科雜志, 2019, 27(4): 310-315.
3. 鄒偉, 肖杰, 龍浩, 等. 腰椎骨折經皮椎弓根螺釘復位內固定體外撐開器的設計與臨床應用研究. 中國修復重建外科雜志, 2017, 31(1): 66-72.
4. 王洪偉, 李長青, 周躍, 等. 附加傷椎固定的微創經皮椎弓根螺釘 (Sextant) 治療胸腰椎骨折. 中華創傷骨科雜志, 2010, 12(2): 126-130.
5. 劉軍, 項良碧, 陳語, 等. 經皮微創椎弓根螺釘技術治療胸腰椎骨折 12 例. 中華創傷雜志, 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. 跨骨折椎體固定聯合單側傷椎植釘治療胸腰椎爆裂骨折的生物力學研究. 中國修復重建外科雜志, 2016, 30(5): 580-584.
11. 王洪偉, 李長青, 周躍, 等. 傷椎置釘技術治療胸腰椎骨折的生物力學及臨床隨訪研究. 中國矯形外科雜志, 2011, 19(16): 1356-1360.
12. 沈昆, 王守國, 費昊東, 等. 傷椎置釘治療單節段胸腰段椎體骨折的臨床療效. 中國矯形外科雜志, 2017, 25(22): 2016-2018.
13. 陳志達, 吳進, 林斌, 等. 后路傷椎短節段固定治療嚴重不穩的胸腰椎爆裂性骨折. 中國修復重建外科雜志, 2018, 32(1): 59-63.
14. 鄒偉, 肖杰, 龍浩, 等. 微創經皮椎弓根羅東內固定治療胸腰椎骨折的置釘選擇. 中國組織工程研究, 2017, 21(3): 356-361.
15. 呂勝江, 付麗娟, 李紅梅. 椎弓根單向螺釘及萬向螺釘置入內固定修復腰椎骨折的生物力學比較. 中國組織工程研究, 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, 包肇華, 季一鳴, 等. 過伸牽引彈性按壓聯合經皮椎弓根螺釘內固定術治療胸腰椎骨折臨床觀察. 山東醫藥, 2018, 58(44): 1-4.
19. 羅狄鑫, 金勛杰, 徐汪洋, 等. 胸腰椎骨折患者經傷椎置釘與跨節段椎弓根螺釘內固定治療的臨床效果比較. 中國矯形外科雜志, 2017, 25(14): 1320-1323.
20. 康輝, 徐峰, 蘭生輝, 等. 傷椎斜向長螺釘置釘治療 Denis B 型胸腰椎骨折. 中國矯形外科雜志, 2018, 26(20): 1825-1829.
21. 胡海剛, 譚倫. 不同椎弓根骨折類型行傷椎置釘的 CT 影像學觀察. 中國骨與關節雜志, 2014, 3(1): 49-53.
22. 吳衛平, 孫業青, 李少華, 等. 胸腰椎椎弓根骨折分型及螺釘固定安全性研究. 同濟大學學報 (醫學版), 2010, 31(1): 89-93.
23. 陳德純, 來津, 譚俊銘, 等. 傷椎椎弓根長螺釘在治療胸腰椎骨折中的應用. 頸腰痛雜志, 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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