Department of Orthopedics, Xijing Hospital, Air Force Medical University of PLA, No. 169 West Changle Road, Shaanxi Province, 710032, Xi'an, China.
BMC Musculoskelet Disord. 2022 Apr 30;23(1):407. doi: 10.1186/s12891-022-05360-3.
This study aimed to compare the clinical outcomes and effect on instrument-related facet joints between fixed-axis pedicle screw (FAPS) and monoplanar pedicle screw (MPPS).
816 pedicle screws of 204 patients with thoracolumbar vertebral fractures (TLVF) who underwent internal fixation surgery were analyzed in this retrospective study. All patients were divided into two groups (FAPS and MPPS). Preoperative, immediate postoperative, and 12-18-months postoperative CT and X-ray, and clinical data, including demographics, preoperative and immediate postoperative Visual Analogue Scale (VAS), blood loss (BL), operation time (OT) and hospital stay time (HST), were collected. Facet joint violation and degeneration grade were evaluated by CT according to Babu's criteria and Weishaupt's criteria respectively, and preoperative, immediate postoperative and 12-18-months postoperative anterior body compression index (ABCI) were measured by X-ray.
Postoperative VAS of two groups was lower than preoperative VAS (p < 0.05). BL, OT, and HST were less in MPPS than FAPS, and the difference was statistically significant in BL and HST (p < 0.05) but no in OT (p > 0.05). Immediate postoperative and 12-18-months postoperative ABCI were significantly higher than preoperative (p < 0.05), and the difference of ABCI between immediate postoperative and 12-18-months postoperative were not significant in two groups (p > 0.05). Total violation rate (VR) was about 1.35% (11/816) and FAPS had a lower VR than MPPS, but no significant (p > 0.05). Weishaupt's criteria revealed that average class (AC) was 0.69 in FAPS and 0.67 in MPPS, and the distribution of degenerated facet joints in two groups did not differ preoperatively (p > 0.05). In 12-18 months postoperatively, AC was significantly higher in FAPS than in MPPS, and the distribution of degenerated facet joints in two groups was significantly different (p < 0.05). The comparison of cranial to caudal joints in two groups revealed that cranial joints had more severe degeneration than caudal joints.
The findings suggested that both MPPS and FAPS were effective for patients with TLVF, but MPPS by percutaneous may be a better choice to avoid adjacent segment degeneration, especially the surgery-involved facet joints degeneration.
本研究旨在比较固定轴椎弓根螺钉（FAPS）和单平面椎弓根螺钉（MPPS）在临床结果和与器械相关的关节突关节方面的效果。
回顾性分析了 204 例胸腰椎骨折（TLVF）患者的 816 枚椎弓根螺钉内固定手术。所有患者均分为两组（FAPS 和 MPPS）。收集术前、术后即刻和 12-18 个月的 CT 和 X 线以及临床资料，包括人口统计学资料、术前和术后即刻视觉模拟量表（VAS）评分、失血量（BL）、手术时间（OT）和住院时间（HST）。根据 Babu 标准和 Weishaupt 标准分别通过 CT 评估关节突关节侵犯和退变程度，通过 X 线测量术前、术后即刻和 12-18 个月的前体压缩指数（ABCI）。
两组患者术后 VAS 均低于术前 VAS（p<0.05）。MPPS 的 BL、OT 和 HST 均少于 FAPS，BL 和 HST 差异有统计学意义（p<0.05），OT 差异无统计学意义（p>0.05）。术后即刻和 12-18 个月的 ABCI 均显著高于术前（p<0.05），但两组术后即刻和 12-18 个月的 ABCI 差异无统计学意义（p>0.05）。总侵犯率（VR）约为 1.35%（11/816），FAPS 的 VR 低于 MPPS，但差异无统计学意义（p>0.05）。Weishaupt 标准显示 FAPS 平均等级（AC）为 0.69，MPPS 为 0.67，两组术前关节突关节退变分布无差异（p>0.05）。术后 12-18 个月，FAPS 的 AC 明显高于 MPPS，两组关节突关节退变分布差异有统计学意义（p<0.05）。两组头侧到尾侧关节的比较显示，头侧关节比尾侧关节退变更严重。
研究结果表明，MPPS 和 FAPS 对 TLVF 患者均有效，但经皮 MPPS 可能是避免邻近节段退变的更好选择，尤其是手术相关的关节突关节退变。
