Caruso Gaetano, Lombardi Enrica, Andreotti Mattia, Lorusso Vincenzo, Gildone Alessandro, Padovani Sara, Massari Leo
Department of Biomedical and Specialty Surgical Sciences, Azienda Ospedaliero-Universitaria di Ferrara - Arcispedale Sant'Anna, University of Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Italy.
Orthopaedic and Traumatology Department, Azienda Ospedaliero-Universitaria di Ferrara - Arcispedale Sant'Anna, University of Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Italy.
Eur J Orthop Surg Traumatol. 2018 Jul;28(5):849-858. doi: 10.1007/s00590-018-2122-1. Epub 2018 Jan 22.
To assess and compare the efficacy of two minimally invasive techniques (percutaneous pedicle screw with intermediate screw vs. percutaneous pedicle screw with kyphoplasty) for spinal fracture fixation by comparing the segmental kyphosis and vertebral kyphosis angles after trauma before surgery, after surgery, and at 4-month and 12-month follow-up.
Data from 49 patients without neurological deficit treated by either percutaneous pedicle screw with intermediate screw or percutaneous pedicle screw with kyphoplasty were retrospectively analysed. The segmental kyphosis and vertebral kyphosis angles over time were calculated and correlated with the type of procedure, AO classification, lumbar or thoracic site and the age and sex of the patients.
After surgery, both techniques were found to be efficacious means of bringing about a significant correction of the segmental kyphosis angle (p = 0.002) and a just significant correction of the vertebral kyphosis angle (p = 0.06), although less effectively in thoracic fractures (p = 0.004). At follow-up, the vertebral kyphosis angle was stable in both groups, while there was a significant loss of segmental kyphosis angle stability in the percutaneous pedicle screw with kyphoplasty group at 1 year (p = 0.004); fractured thoracic vertebrae maintained a greater vertebral kyphosis angle (p = 0.06) and segmental kyphosis angle (p < 0.001), than the lumbar.
At 1 year after surgery, the use of intermediate screws in fractured vertebrae seemed to maintain a more efficacious correction with respect to kyphoplasty, although thoracic fracture sites appear to be associated with greater post-traumatic segmental kyphosis and lesser stability in the long term after both percutaneous surgical techniques.
通过比较手术前、手术后以及4个月和12个月随访时的节段后凸角和椎体后凸角，评估和比较两种微创技术（经皮椎弓根螺钉联合中间螺钉与经皮椎弓根螺钉联合椎体后凸成形术）治疗脊柱骨折固定的疗效。
回顾性分析49例接受经皮椎弓根螺钉联合中间螺钉或经皮椎弓根螺钉联合椎体后凸成形术治疗且无神经功能缺损患者的数据。计算不同时间的节段后凸角和椎体后凸角，并与手术方式、AO分类、腰椎或胸椎部位以及患者年龄和性别进行相关性分析。
手术后，两种技术均被发现是有效手段，可显著矫正节段后凸角（p = 0.002），并对椎体后凸角进行近乎显著的矫正（p = 0.06），尽管对胸椎骨折的矫正效果较差（p = 0.004）。随访时，两组椎体后凸角均稳定，而经皮椎弓根螺钉联合椎体后凸成形术组在1年时节段后凸角稳定性显著丧失（p = 0.004）；与腰椎相比，骨折胸椎维持了更大的椎体后凸角（p = 0.06）和节段后凸角（p < 0.001）。
术后1年，在骨折椎体中使用中间螺钉相对于椎体后凸成形术似乎能维持更有效的矫正，尽管两种经皮手术技术治疗后，胸椎骨折部位长期来看创伤后节段后凸更大且稳定性较差。
