Chung W H, Ng W L, Chiu C K, Chan Cyw, Kwan M K
Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia.
Malays Orthop J. 2020 Nov;14(3):22-31. doi: 10.5704/MOJ.2011.005.
This was a retrospective study aimed to investigate the perioperative outcomes of long construct minimally invasive spinal stabilisation (MISt) using percutaneous pedicle screws (PPS) versus conventional open spinal surgery in the treatment of spinal fracture in ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH).
Twenty-one patients with AS and DISH who were surgically treated between 2009 and 2017 were recruited. Outcomes of interest included operative time, intra-operative blood loss, complications, duration of hospital stay and fracture union rate.
Mean age was 69.2 ± 9.9 years. Seven patients had AS and 14 patients had DISH. 17 patients sustained AO type B3 fracture and 4 patients had type B1 fracture. Spinal trauma among these patients mostly involved thoracic spine (61.9%), followed by lumbar (28.6%) and cervical spine (9.5%). MISt using PPS was performed in 14 patients (66.7%) whereas open surgery in 7 patients (33.3%). Mean number of instrumentation level was 7.9 ± 1.6. Mean operative time in MISt and open group was 179.3 ± 42.3 minutes and 253.6 ± 98.7 minutes, respectively (p=0.028). Mean intra-operative blood loss in MISt and open group was 185.7 ± 86.4ml and 885.7 ± 338.8ml, respectively (p<0.001). Complications and union rate were comparable between both groups.
MISt using PPS lowers the operative time and reduces intra-operative blood loss in vertebral fractures in ankylosed disorders. However, it does not reduce the perioperative complication rate due to the premorbid status of the patients. There was no significant difference in the union rate between MISt and open surgery.
这是一项回顾性研究，旨在调查使用经皮椎弓根螺钉（PPS）的长节段微创脊柱稳定术（MISt）与传统开放性脊柱手术治疗强直性脊柱炎（AS）和弥漫性特发性骨肥厚（DISH）脊柱骨折的围手术期结果。
招募了2009年至2017年间接受手术治疗的21例AS和DISH患者。感兴趣的结果包括手术时间、术中失血、并发症、住院时间和骨折愈合率。
平均年龄为69.2±9.9岁。7例患者患有AS，14例患者患有DISH。17例患者为AO B3型骨折，4例患者为B1型骨折。这些患者的脊柱创伤主要累及胸椎（61.9%），其次是腰椎（28.6%）和颈椎（9.5%）。14例患者（66.7%）采用PPS进行MISt，7例患者（33.3%）进行开放手术。平均固定节段数为7.9±1.6。MISt组和开放手术组的平均手术时间分别为179.3±42.3分钟和253.6±98.7分钟（p=0.028）。MISt组和开放手术组的平均术中失血量分别为185.7±86.4ml和885.7±338.8ml（p<0.001）。两组的并发症和愈合率相当。
使用PPS的MISt可缩短强直性疾病椎体骨折的手术时间并减少术中失血。然而，由于患者的病前状态，它并未降低围手术期并发症发生率。MISt与开放手术的愈合率无显著差异。
