Yang Peng, Chen Kangwu, Zhang Kai, Sun Jiajia, Yang Huilin, Mao Haiqing
Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, PR China.
J Orthop Translat. 2019 Dec 5;21:1-7. doi: 10.1016/j.jot.2019.11.002. eCollection 2020 Mar.
To compare the clinical and radiological outcomes of O-arm navigation assisted percutaneous pedicle fixation and open freehand pedicle fixation in treatment of AO type A3 thoracolumbar burst fractures (TBFs) without neurological deficit.
This retrospective study involved 72 patients with type A3 TBFs who underwent O-arm navigation assisted percutaneous pedicle fixation (MIS group) or open freehand posterior pedicle fixation (OPPF group) from September 2015 to December 2017. Demographic data and clinical characteristics were comparable between these two groups before surgery. Operating time, intraoperative blood loss, and the time of hospitalisation stay were analysed. Visual analog scale (VAS) scoring and Oswestry disability index (ODI) was assessed for each patient pre- and postoperatively. Radiographic follow-up was assessed by the Local kyphosis angle (LKA), Vertebral wedge angle (VWA), and Anterior body height (ABH). The accuracy of screw placement was examined by computed tomography.
The two groups were matched in terms of demographic and clinical features. Intraoperative blood loss was significantly less in the MIS group compared to the OPPF group ( < 0.05). The average time for hospitalisation stay in the MIS group was significantly shorter than OPPF group ( < 0.05). However, the operative time revealed no significant difference between two groups ( > 0.05). Meanwhile, the VAS score and ODI score in the MIS group were significantly lower than that in the OPPF group after surgery ( < 0.05). Radiographic assessments revealed no obvious difference between the 2 groups immediately after surgery or at the final follow-up ( > 0.05); The accuracy rate of pedicle screw position in the MIS group was higher than OPPF group (97.8% vs 78.5%, respectively; < 0.001). No deep wound infection, additional surgery, implant failure, or neurological complications were recorded in either group.
Percutaneous short-segment pedicle instrumentation assisted with O-arm navigation represents an effective and safe alternative for type A3 TBFs. It has several advantages compared with open approach, including less blood loss, shorter hospitalisation, less postoperative pain, higher accuracy of pedicle screw placement, and faster recovery period in treating TBFs. However, it requires a longer learning curve and long-term results have to be studied in other well-designed studies.
Percutaneous short-segment pedicle instrumentation assisted with O-arm navigation represents an effective and safe alternative for type A3 TBFs. The utilization of O-arm navigation and percutaneous pedicle screw fixation guaranteed the high accuracy of screw placement, protected staff from radiation exposure and offered benefits of minimal invasive technique.
比较O型臂导航辅助下经皮椎弓根固定与开放徒手椎弓根固定治疗无神经功能缺损的AO型A3胸腰椎爆裂骨折（TBF）的临床和影像学结果。
本回顾性研究纳入了2015年9月至2017年12月期间接受O型臂导航辅助下经皮椎弓根固定（微创组）或开放徒手后路椎弓根固定（OPPF组）的72例A3型TBF患者。两组患者术前的人口统计学数据和临床特征具有可比性。分析手术时间、术中出血量和住院时间。对每位患者术前和术后进行视觉模拟量表（VAS）评分和Oswestry功能障碍指数（ODI）评估。通过局部后凸角（LKA）、椎体楔角（VWA）和椎体前缘高度（ABH）进行影像学随访评估。通过计算机断层扫描检查螺钉置入的准确性。
两组在人口统计学和临床特征方面相匹配。与OPPF组相比，微创组术中出血量显著减少（<0.05）。微创组的平均住院时间明显短于OPPF组（<0.05）。然而，两组手术时间差异无统计学意义（>0.05）。同时，术后微创组的VAS评分和ODI评分均显著低于OPPF组（<0.05）。影像学评估显示，术后即刻或末次随访时两组之间无明显差异（>0.05）；微创组椎弓根螺钉置入准确率高于OPPF组（分别为９７.８％和７８.５％；<0.001）。两组均未记录到深部伤口感染、再次手术、内固定失败或神经并发症。
O型臂导航辅助下经皮短节段椎弓根内固定术是治疗A3型TBF的一种有效且安全的替代方法。与开放手术相比，它具有多个优点，包括出血量少、住院时间短、术后疼痛轻、椎弓根螺钉置入准确率高以及治疗TBF时恢复快。然而，它需要更长的学习曲线，长期结果有待在其他设计良好的研究中进行研究。
O型臂导航辅助下经皮短节段椎弓根内固定术是治疗A3型TBF的一种有效且安全的替代方法。O型臂导航和经皮椎弓根螺钉固定的应用保证了螺钉置入的高精度，保护工作人员免受辐射暴露，并提供了微创技术的优势。
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