Wang Hongwei, Zhou Yue, Li Changqing, Liu Jun, Xiang Liangbi
*Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, Liaoning †Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing, China.
Clin Spine Surg. 2017 Apr;30(3):E239-E246. doi: 10.1097/BSD.0000000000000135.
We retrospectively reviewed 100 patients who were posterior stabilized without graft fusion. Using the Sextant system, 22 patients underwent minimally invasive short-segment 4-pedicle screw fixation (MIF4) and 39 patients underwent minimally invasive short-segment combined with intermediate screws fixation, that is, 6-pedicle screw fixation (MIF6). The conventional open posterior short-segment 4-pedicle screw fixation (OPF4) technique was used in 39 patients.
To evaluate the feasibility, safety, and efficacy of percutaneous pedicle screw fixation using the Sextant system in the treatment of traumatic thoracolumbar fractures compared with the conventional open posterior short-segment pedicle screw fixation technique.
To the best of our knowledge, the clinical and radiographic outcomes of MIF4, MIF6 with polyaxial pedicle screws, and OPF4 with monoaxial pedicle screws have not been compared in the treatment of thoracolumbar fractures.
Visual analogue scores (VAS), Oswestry disability index (ODI) scores, clinical outcomes including surgical blood loss, operation time, and postoperative hospital stay, sagittal Cobb angle, vertebral body angle, and anterior height of the fractured vertebrae were compared among the 3 groups.
Significant postoperative improvements, relative to baseline, were observed in the VAS and ODI scores (P<0.05 each). There were no significant differences between the MIF4 and MIF6 groups in clinical outcomes, including surgical blood loss, operation time, postoperative hospital stay, VAS, and ODI scores (P>0.05 each). However, there were significant differences between both MIF groups and the OPF group (P<0.05 each). Significant improvements were observed in the sagittal Cobb angle, vertebral body angle, and anterior height of the fractured vertebrae (P<0.05 each). During follow-up, however, the correction loss of the sagittal Cobb angle was smallest in the MIF6 group (P<0.05).
Minimally invasive posterior stabilization using the Sextant system resulted in reduced injury compared with the open surgery, during both the internal fixation surgery and the implant removal surgery. Percutaneous screw fixation through the pedicle of the fractured vertebra is superior to the conventional OPF4 technique in correcting kyphotic deformities, and can be performed without any extra procedures.
我们回顾性分析了100例行后路稳定术但未行植骨融合的患者。使用Sextant系统，22例患者接受了微创短节段4枚椎弓根螺钉固定术（MIF4），39例患者接受了微创短节段联合中间螺钉固定术，即6枚椎弓根螺钉固定术（MIF6）。39例患者采用传统的开放后路短节段4枚椎弓根螺钉固定术（OPF4）。
与传统的开放后路短节段椎弓根螺钉固定技术相比，评估使用Sextant系统经皮椎弓根螺钉固定术治疗胸腰椎创伤性骨折的可行性、安全性和有效性。
据我们所知，在胸腰椎骨折治疗中，尚未对MIF4、多轴椎弓根螺钉的MIF6以及单轴椎弓根螺钉的OPF4的临床和影像学结果进行比较。
比较3组患者的视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）评分、包括手术失血、手术时间和术后住院时间在内的临床结果、矢状面Cobb角、椎体角度以及骨折椎体的前缘高度。
与基线相比，VAS和ODI评分术后均有显著改善（均P<0.05）。MIF4组和MIF6组在临床结果方面，包括手术失血、手术时间、术后住院时间、VAS和ODI评分，均无显著差异（均P>0.05）。然而，两个MIF组与OPF组之间均存在显著差异（均P<0.05）。骨折椎体的矢状面Cobb角、椎体角度和前缘高度均有显著改善（均P<0.05）。然而，在随访期间，MIF6组矢状面Cobb角的矫正丢失最小（P<0.05）。
与开放手术相比，使用Sextant系统进行微创后路稳定术在内固定手术和取出内植物手术期间均能减少损伤。经骨折椎体椎弓根的经皮螺钉固定术在矫正后凸畸形方面优于传统的OPF4技术，且无需任何额外操作即可完成。
