Short-term effectiveness of percutaneous pedicle screw fixation combined with intravertebral allograft by different methods for thoracolumbar fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DING Qirui , FAN Jin ,  REN Yongxin , YIN Guoyong

Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing Jiangsu, 210000, P.R.China;

Corresponding?author：

REN Yongxin, Email: renyongxinjsph@126.com

Keywords：

Thoracolumbar fracture; intravertebral allograft; Jack dilator; bone graft funnel

DOI：

10.7507/1002-1892.202103212

Video：

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Objective To investigate the short-term effectiveness of percutaneous pedicle fixation combined with intravertebral allograft by different methods for thoracolumbar fractures. Methods The clinical data of 94 patients with single segment thoracolumbar fracture who underwent percutaneous pedicle fixation combined with intravertebral allograft by different methods between October 2018 and October 2019 were retrospectively analyzed. According to the different methods of intravertebral allograft, they were divided into group A (bone grafting by Jack dilator, 40 cases) and group B (bone grafting by funnel, 54 cases). There was no significant difference between the two groups (P>0.05) in the gender, age, body mass index, cause of injury, injured segment, Wolter index, time from injury to operation, and preoperative visual analogue scale (VAS) score, injured vertebral height ratio, and Cobb angle. The operation time, fluoroscopy frequency, allograft volume, and complications were recorded and compared between the two groups. VAS score of low back pain was used to evaluate the remission of clinical symptoms before operation, at 3 days, 3 months, 12 months after operation, and at last follow-up. The injured vertebral height ratio and Cobb angle were measured before operation, at 3 days, 3 months, and 12 months after operation. Results The operation time, fluoroscopy frequency, and allograft volume in group A were significantly higher than those in group B (P<0.05). No complication occurred after operation, such as loosening or fracture of internal fixation. And bone grafting in the injured vertebrae healed at last follow-up. The VAS score, injured vertebral height ratio, and Cobb angle at each postoperative time point significantly improved when compared with preoperative ones (P<0.05); compared with 3 days postoperatively, the VAS score improved further after 3 months, but the injured vertebral height ratio decreased and the Cobb angle increased, and the differences were significant (P<0.05). There was no significant difference in the VAS scores of low back pain between the two groups at each time point after operation (P>0.05); the injured vertebrae height ratio in group A was significantly higher than that in group B, and the Cobb angle was significantly lower than that in group B, all showing significant differences (P<0.05). Conclusion The intravertebral allograft via Jack dilator can restore the height and decrease the Cobb angle of the injured vertebrae, but accompanied with higher fluoroscopy frequency and longer operation time when compared with funnel bone grafting. For patients with single level thoracolumbar fractures, intravertebral allograft via Jack dilator is recommended.

Citation： DING Qirui, FAN Jin, REN Yongxin, YIN Guoyong. Short-term effectiveness of percutaneous pedicle screw fixation combined with intravertebral allograft by different methods for thoracolumbar fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(10): 1311-1317. doi: 10.7507/1002-1892.202103212 Copy

1.	Kocis J, Kelbl M, Kocis T, et al. Percutaneous versus open pedicle screw fixation for treatment of type A thoracolumbar fractures. Eur J Trauma Emerg Surg, 2020, 46(1): 147-152.
2.	Perna A, Santagada DA, Bocchi MB, et al. Early loss of angular kyphosis correction in patients with thoracolumbar vertebral burst (A3-A4) fractures who underwent percutaneous pedicle screws fixation. J Orthop, 2021, 24: 77-81.
3.	胡海剛, 譚倫, 林旭, 等. 胸腰椎骨折復位術后椎體“空殼現象”的相關因素分析. 中國脊柱脊髓雜志, 2017, 27(3): 242-247.
4.	劉小鵬, 顏春銘, 郭偉華, 等. 經傷椎椎弓根植骨聯合椎弓根釘內固定系統治療胸腰椎爆裂性骨折. 脊柱外科雜志, 2018, 16(6): 340-343, 348.
5.	韓雪昆, 任永信, 張慰. 經皮傷椎置釘植骨治療胸腰椎骨折療效觀察. 南京醫科大學學報 (自然科學版), 2020, 40(1): 115-118.
6.	付忠泉, 禤天航, 霍智銘, 等. 胸腰椎爆裂性骨折后路手術中三種不同植骨方式的療效比較. 中華創傷骨科雜志, 2019, 21(7): 623-627.
7.	莊蘇陽. 糾正胸腰椎骨折椎體高度丟失的研究. 南京: 東南大學, 2019.
8.	周煒, 凡進, 沈毅敏, 等. 改良Jack椎體擴張器治療218例骨質疏松性椎體壓縮性骨折的療效分析. 南京醫科大學學報 (自然科學版), 2014, 34(11): 1564-1567.
9.	凡進, 余利鵬, 丁其瑞, 等. 椎體擴張器植骨結合微創置釘治療胸腰椎骨折的早期臨床療效. 中華創傷雜志, 2017, 33(12): 1087-1093.
10.	Magerl F, Aebi M, Gertzbein SD, et al. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J, 1994, 3(4): 184-201.
11.	Wolter D. Classification and prognosis of spinal injuries. Langenbecks Arch Chir, 1988, Suppl 2: 237-243.
12.	Rosenthal BD, Boody BS, Jenkins TJ, et al. Thoracolumbar burst fractures. Clin Spine Surg, 2018, 31(4): 143-151.
13.	耿明皓, 孫建華, 李晶, 等. 胸腰椎骨折復位內固定術后傷椎發生骨缺損的相關危險因素分析. 中國脊柱脊髓雜志, 2020, 30(5): 410-416.
14.	Butt MF, Farooq M, Mir B, et al. Management of unstable thoracolumbar spinal injuries by posterior short segment spinal fixation. Int Orthop, 2007, 31(2): 259-264.
15.	陶春生, 孫培鋒, 趙金柱, 等. 改良Wiltse入路經傷椎椎弓根植骨內固定術治療胸腰椎爆裂性骨折. 脊柱外科雜志, 2021, 19(1): 34-37.
16.	焦永杰, 張潔, 蒙鑫, 等. 釘棒復位椎體內植骨在胸腰椎骨折椎體形態恢復中的應用. 臨床骨科雜志, 2021, 24(2): 170-173.
17.	魏桂財, 李超雄, 林向全, 等. 傷椎置釘聯合經椎弓根植骨在胸腰椎骨折椎弓根釘內固定術中的應用. 中國骨與關節損傷雜志, 2018, 33(11): 1170-1171.
18.	季文軍, 敖俊, 廖文波, 等. 經傷椎椎弓根椎體內植骨置釘短節段固定治療胸腰椎骨折. 中國矯形外科雜志, 2018, 26(4): 304-309.
19.	梁興斌, 李榮. 后路經傷椎椎弓根椎體內植骨治療腰椎骨折的療效分析. 中華骨與關節外科雜志, 2017, 10(5): 368-371.
20.	程彬, 趙敏, 史柏娜, 等. 經皮椎弓根釘內固定聯合球囊輔助復位椎體內植骨治療胸腰椎骨折. 臨床骨科雜志, 2020, 23(4): 483-486.
21.	毛良浩, 李大鵬, 江攀, 等. 后路椎弓根釘固定聯合植骨治療A3型胸腰段骨折. 中國矯形外科雜志, 2020, 28(16): 1518-1520.

1. Kocis J, Kelbl M, Kocis T, et al. Percutaneous versus open pedicle screw fixation for treatment of type A thoracolumbar fractures. Eur J Trauma Emerg Surg, 2020, 46(1): 147-152.
2. Perna A, Santagada DA, Bocchi MB, et al. Early loss of angular kyphosis correction in patients with thoracolumbar vertebral burst (A3-A4) fractures who underwent percutaneous pedicle screws fixation. J Orthop, 2021, 24: 77-81.
3. 胡海剛, 譚倫, 林旭, 等. 胸腰椎骨折復位術后椎體“空殼現象”的相關因素分析. 中國脊柱脊髓雜志, 2017, 27(3): 242-247.
4. 劉小鵬, 顏春銘, 郭偉華, 等. 經傷椎椎弓根植骨聯合椎弓根釘內固定系統治療胸腰椎爆裂性骨折. 脊柱外科雜志, 2018, 16(6): 340-343, 348.
5. 韓雪昆, 任永信, 張慰. 經皮傷椎置釘植骨治療胸腰椎骨折療效觀察. 南京醫科大學學報 (自然科學版), 2020, 40(1): 115-118.
6. 付忠泉, 禤天航, 霍智銘, 等. 胸腰椎爆裂性骨折后路手術中三種不同植骨方式的療效比較. 中華創傷骨科雜志, 2019, 21(7): 623-627.
7. 莊蘇陽. 糾正胸腰椎骨折椎體高度丟失的研究. 南京: 東南大學, 2019.
8. 周煒, 凡進, 沈毅敏, 等. 改良Jack椎體擴張器治療218例骨質疏松性椎體壓縮性骨折的療效分析. 南京醫科大學學報 (自然科學版), 2014, 34(11): 1564-1567.
9. 凡進, 余利鵬, 丁其瑞, 等. 椎體擴張器植骨結合微創置釘治療胸腰椎骨折的早期臨床療效. 中華創傷雜志, 2017, 33(12): 1087-1093.
10. Magerl F, Aebi M, Gertzbein SD, et al. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J, 1994, 3(4): 184-201.
11. Wolter D. Classification and prognosis of spinal injuries. Langenbecks Arch Chir, 1988, Suppl 2: 237-243.
12. Rosenthal BD, Boody BS, Jenkins TJ, et al. Thoracolumbar burst fractures. Clin Spine Surg, 2018, 31(4): 143-151.
13. 耿明皓, 孫建華, 李晶, 等. 胸腰椎骨折復位內固定術后傷椎發生骨缺損的相關危險因素分析. 中國脊柱脊髓雜志, 2020, 30(5): 410-416.
14. Butt MF, Farooq M, Mir B, et al. Management of unstable thoracolumbar spinal injuries by posterior short segment spinal fixation. Int Orthop, 2007, 31(2): 259-264.
15. 陶春生, 孫培鋒, 趙金柱, 等. 改良Wiltse入路經傷椎椎弓根植骨內固定術治療胸腰椎爆裂性骨折. 脊柱外科雜志, 2021, 19(1): 34-37.
16. 焦永杰, 張潔, 蒙鑫, 等. 釘棒復位椎體內植骨在胸腰椎骨折椎體形態恢復中的應用. 臨床骨科雜志, 2021, 24(2): 170-173.
17. 魏桂財, 李超雄, 林向全, 等. 傷椎置釘聯合經椎弓根植骨在胸腰椎骨折椎弓根釘內固定術中的應用. 中國骨與關節損傷雜志, 2018, 33(11): 1170-1171.
18. 季文軍, 敖俊, 廖文波, 等. 經傷椎椎弓根椎體內植骨置釘短節段固定治療胸腰椎骨折. 中國矯形外科雜志, 2018, 26(4): 304-309.
19. 梁興斌, 李榮. 后路經傷椎椎弓根椎體內植骨治療腰椎骨折的療效分析. 中華骨與關節外科雜志, 2017, 10(5): 368-371.
20. 程彬, 趙敏, 史柏娜, 等. 經皮椎弓根釘內固定聯合球囊輔助復位椎體內植骨治療胸腰椎骨折. 臨床骨科雜志, 2020, 23(4): 483-486.
21. 毛良浩, 李大鵬, 江攀, 等. 后路椎弓根釘固定聯合植骨治療A3型胸腰段骨折. 中國矯形外科雜志, 2020, 28(16): 1518-1520.

Chinese Journal of Reparative and Reconstructive Surgery

Short-term effectiveness of percutaneous pedicle screw fixation combined with intravertebral allograft by different methods for thoracolumbar fractures

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