Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Xi'an, 710054, Shaanxi, China.
J Orthop Surg Res. 2018 Jul 11;13(1):174. doi: 10.1186/s13018-018-0880-4.
Over the past decade, the techniques for minimally invasive spinal stabilization have improved significantly. The multiaxial screw utilized in minimally invasive operations is limited in restoring fracture height, reconstructing the anterior vertebral column, and improving kyphosis. Therefore, the percutaneous, minimally invasive approach is not recommended for a thoracolumbar fracture with severe vertebral height loss. We report our novel, percutaneous, self-expanding, forceful reduction screw system to address this problem.
Thirty-eight patients experiencing thoracolumbar fracture, with a vertebral height loss more than 50%, were treated with the novel, percutaneous, self-expanding, forceful reduction screw between March 2014 and June 2015. The patients' charts and radiographs were reviewed. The vertebral body index (VBI), height of the anterior margin of fractured vertebra (HAMFV), vertebral body angle (VBA), bisegmental Cobb angle (BCA), and Oswestry disability index (ODI) scores were obtained before and after the operation, as well as during the 2-year follow-up. The scoring results were compared using t tests.
The operation was completed successfully in 38 patients. A total of 152 screws were placed. The average operation time was 90.7 ± 21.9 min, and the average intraoperative bleeding amount was 89.2 ± 31.9 ml. The patients were discharged at a mean of 3.2 ± 0.9 postoperative days, with a mean hospital stay of 4.8 ± 1.0 days. The VBI, HAMFV, VBA, and BCA scores were significantly improved after treatment with the novel screw system; there was a significant difference between pre- and postoperative parameters (p < 0.05). Although the decreases in all of the parameters were variable during the 2-year follow-up, there were no statistical differences between the postoperative imaging parameters and the last follow-up imaging parameters (p > 0.05). The ODI score at the last follow-up examination was 5.9 ± 2.7, which was significantly improved compared with the preoperative score of 44.6 ± 2.3 (p < 0.05).
We believe that the novel, percutaneous, self-expanding, forceful reduction screw system developed by us not only successfully expands the minimally invasive percutaneous surgery to the thoracolumbar fracture with severe vertebral height loss but also achieves significant vertebral height restoration and kyphosis correction.
在过去的十年中，微创脊柱稳定技术有了显著的进步。在微创手术中使用的多轴螺钉在恢复骨折高度、重建前柱和改善后凸方面受到限制。因此，不建议对严重椎体高度丢失的胸腰椎骨折采用经皮微创入路。我们报告了一种新的经皮微创、自膨胀、强力复位螺钉系统来解决这个问题。
2014 年 3 月至 2015 年 6 月，我们采用新型经皮微创、自膨胀、强力复位螺钉治疗 38 例胸腰椎骨折，椎体高度丢失超过 50%。回顾患者的病历和影像学资料。分别于术前、术后及 2 年随访时测量椎体体指数（VBI）、骨折椎体前缘高度（HAMFV）、椎体角度（VBA）、双节段 Cobb 角（BCA）和 Oswestry 功能障碍指数（ODI）评分。采用 t 检验比较评分结果。
38 例患者均成功完成手术，共置入 152 枚螺钉。手术平均时间为 90.7±21.9 分钟，术中平均出血量为 89.2±31.9ml。患者平均术后住院时间为 3.2±0.9 天，平均术后住院时间为 4.8±1.0 天。新型螺钉系统治疗后 VBI、HAMFV、VBA 和 BCA 评分显著提高，治疗前后参数差异有统计学意义（p<0.05）。虽然在 2 年随访期间，所有参数的下降均有差异，但术后影像学参数与末次随访影像学参数之间无统计学差异（p>0.05）。末次随访时 ODI 评分为 5.9±2.7，与术前 44.6±2.3 相比显著改善（p<0.05）。
我们认为，我们开发的新型经皮微创、自膨胀、强力复位螺钉系统不仅成功地将微创经皮手术扩展到严重椎体高度丢失的胸腰椎骨折，而且实现了显著的椎体高度恢复和后凸矫正。
