Zou Wei, Xiao Jie, Long Hao, He Hui, Wu Chen, Feng Mingxing, Zhou Changjun
Department of Spine Surgery, the Fourth People's Hospital of Guiyang, Guiyang Guizhou, 550002,
Department of Spine Surgery, the Fourth People's Hospital of Guiyang, Guiyang Guizhou, 550002, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Jan 15;31(1):66-72. doi: 10.7507/1002-1892.201608117.
To design a new extracorporeal reduction device for percutaneous pedicle screw fixation of thoracolumbar fractures (short for "new reduction device"), and to evaluate its effectiveness.
According to the mechanism of thoracolumbar fractures and biomechanics characteristic of reduction, a new reduction device was designed and used in a combination with long U-shaped hollow pedicle screw system. Between January 2014 and January 2016, 36 patients (group A) with single segment thoracolumbar fracture without neurological complications underwent percutaneous pedicle screw fixation, and the clinical data were compared with those of another 39 patients (group B) with thoracolumbar fracture underwent traditional open pedicle screw fixation. There was no significant difference in gender, age, cause of injury, classification of fractures, segments of fractures, injury to operation interval, height percentage of injury vertebrae, and kyphotic angle between 2 groups ( >0.05). The 2 groups were compared in terms of operation time, length of incision, intraoperative blood loss, drainage volume, visual analogue scale (VAS) at postoperative 24 hours, fluoroscopy frequency, ambulation time, height percentage of injury vertebrae, kyphotic angle and correction.
Group A was significantly better than group B in the operation time, length of incision, intraoperative blood loss, drainage volume, VAS score at postoperative 24 hours, and ambulation time ( <0.05). However, fluoroscopy frequency of group B was significantly less than that of group A ( <0.05). All patients were followed up 11.2 months on average (range, 7-15 months). There was no intraoperative and postoperative complications of iatrogenic nerve injury, infection, breakage of internal fixation. Mild pulling-out of pedicle screws occurred in 1 case of group A during operation. The kyphotic angle and height percentage of the fractured vertebral body were significantly improved at 3 days after operation when compared with preoperative ones ( <0.05), but no significant difference was found between 2 groups at 3 days after operation ( >0.05).
Minimally invasive extracorporeal reduction device for percutaneous pedicle screw fixation is an effective and safe treatment of thoracic vertebrae and lumbar vertebrae fractures, because of little trauma, less bleeding, and quicker recovery.
设计一种用于胸腰椎骨折经皮椎弓根螺钉固定的新型体外复位装置（简称“新型复位装置”），并评估其有效性。
根据胸腰椎骨折的机制及复位的生物力学特性，设计一种新型复位装置，并与长U形空心椎弓根螺钉系统联合使用。2014年1月至2016年1月，36例无神经并发症的单节段胸腰椎骨折患者（A组）接受经皮椎弓根螺钉固定，将其临床资料与另外39例行传统开放椎弓根螺钉固定的胸腰椎骨折患者（B组）进行比较。两组在性别、年龄、损伤原因、骨折分类、骨折节段、受伤至手术间隔时间、伤椎高度百分比及后凸角方面差异均无统计学意义（P>0.05）。比较两组的手术时间、切口长度、术中出血量、引流量、术后24小时视觉模拟评分（VAS）、透视次数、下床活动时间、伤椎高度百分比、后凸角及矫正情况。
A组在手术时间、切口长度、术中出血量、引流量、术后24小时VAS评分及下床活动时间方面均明显优于B组（P<0.05）。然而，B组的透视次数明显少于A组（P<0.05）。所有患者平均随访11.2个月（范围7 - 15个月）。术中及术后均未发生医源性神经损伤、感染、内固定断裂等并发症。A组1例患者术中出现轻度椎弓根螺钉拔出。术后3天骨折椎体的后凸角和高度百分比与术前相比明显改善（P<0.05），但术后3天两组间差异无统计学意义（P>0.05）。
经皮椎弓根螺钉固定微创体外复位装置治疗胸腰椎骨折有效且安全，具有创伤小、出血少、恢复快等优点。
