Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099, Guizhou, China.
BMC Musculoskelet Disord. 2021 Jun 14;22(1):540. doi: 10.1186/s12891-021-04423-1.
Short-segment transpedicular screw fixation is a common method for the treatment of thoracolumbar burst fractures (TBFs),but this technique has many problems. Therefore,the purpose of this article is to observe and evaluate the clinical efficacy of a novel transpedicular reducer that we designed for fractured vertebral body reduction and bone grafting in the treatment of TBFs.
From July 2018 to November 2020, 70 cases of TBFs were included. Thirty-five patients were treated with the novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation (observation group), and 35 patients were treated with short-segment transpedicular screw fixation (control group). Before the operation, after reduction, and 3 days, 3 months,and 12 months after the operation, the two groups were assessed, and compared with respect to the anterior and middle heights of the injured vertebrae, the ratios of the anterior and middle heights of the injured vertebral body to the respective heights of the adjacent uninjured vertebral bodies (AVBHr and MVBHr, respectively), and the Cobb angle of the patients. We compared the pain VAS score and quality of life GQOL-74 score at the last follow-up. Finally,we evaluated the distribution of bone grafts and bone healing 12 months after the operation.
The anterior height, middle height, AVBHr, MVBHr, and Cobb angle of the injured vertebral body in the observation after reduction, and 3 days, 3 months and 12 months post-operatively were compared with those of the injured vertebral body before operation. All of these parameters were improved, and the difference was statistically significant (p < 0.05). These parameters in the observation group at the above time points were significantly better than thoes in the control group at the corresponding time points (p < 0.05). The VAS scores at the last follow-up were significantly better than those of the control group (p < 0.05), but the GQOL-74 score differences were not statistically significant (p > 0.05). The observation group showed no obvious defects on CT at 12 months after the operation, and the bone healing was good.
The novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation for TBFs has good clinical efficacy.
短节段经皮椎弓根螺钉固定是治疗胸腰椎爆裂性骨折（TBF）的常用方法，但该技术存在诸多问题。因此，本文旨在观察和评估我们设计的新型经皮椎弓根复位器在治疗 TBF 时对骨折椎体复位和植骨的临床疗效。
2018 年 7 月至 2020 年 11 月，纳入 70 例 TBF 患者。其中 35 例采用新型经皮椎弓根复位器复位植骨联合经皮椎弓根螺钉固定治疗（观察组），35 例采用短节段经皮椎弓根螺钉固定治疗（对照组）。术前、复位后及术后 3d、3 个月、12 个月，两组均进行评估，比较两组患者伤椎前缘及中部高度、伤椎前缘及中部高度与相邻未伤椎高度比值（AVBHr 和 MVBHr）、患者 Cobb 角。末次随访时比较两组患者疼痛视觉模拟评分（VAS）及生活质量 GQOL-74 评分。最后，评估术后 12 个月植骨分布及骨愈合情况。
观察组患者伤椎复位后及术后 3d、3 个月、12 个月时伤椎前缘及中部高度、AVBHr、MVBHr、Cobb 角与术前比较，均有改善，差异有统计学意义（p<0.05）；且上述各时间点观察组均优于对照组，差异有统计学意义（p<0.05）。末次随访时观察组患者 VAS 评分明显优于对照组，差异有统计学意义（p<0.05），但 GQOL-74 评分差异无统计学意义（p>0.05）。观察组术后 12 个月 CT 未见明显复位器缺损，植骨愈合良好。
新型经皮椎弓根复位器复位植骨联合经皮椎弓根螺钉固定治疗 TBF 临床疗效较好。
