Li Wen-Chao, Lin Hong-Heng, Liu Hong-Jiang, Wu Chun-Fei
The Third Affiliated Hospital of Guangzhou University of TCM, Guangzhou 518000, Guangdong, China.
Zhongguo Gu Shang. 2022 May 25;35(5):435-41. doi: 10.12200/j.issn.1003-0034.2022.05.006.
To explore the clinical efficacy of percutaneous pedicle screw short segment internal fixation with or without the intermediate screw in the treatment of Magerl A3 thoracolumbar fractures with low bone mineral density.
Patients with Magerl A3 thoracolumbar fracture underwent percutaneous pedicle screw short segment internal fixation from January 2017 to July 2020 were retrospectively analyzed, 93 cases met the diagnosis and inclusion criteria, 9 cases were excluded according to the exclusion criteria, and the remaining 84 cases obtained complete imaging follow-up data. There were 38 males and 46 females, the age ranged from 56 to 73 years old with an average of (64.78±7.12) years old, bone mineral density (BMD) ranged from 0.61 to 0.89 g/cm with an average of (0.73±0.14) g/cm, the follow-up time was 11 to 25 months with an average of (17.58±6.12) months. There were 45 cases in group A with intermediate screw and 39 cases in group B without intermediate screw. The operation time and intraoperative blood loss were recorded, Oswestry Disability Index (ODI) and visual analogue scale (VAS) were used for clinical evaluation. The Cobb angle, vertebral wedge angle (VWA) and anterior vertebral body height (AVBH) were measured by X-ray after the operation. The corrected loss of the above parameters was calculated.
There were 5 cases of screw loosening in 84 patients (2 cases in group A and 3 cases in group B, >0.05). There were significant differences in operation time and intraoperative blood loss between two groups(<0.01). Clinical effects of two groups were good, postoperative VAS and ODI after operation obviously improved, there was no significant difference between two groups during all follow-up periods (3 days, 1 month after operation and the final follow-up) (>0.05). Three days after the operation, the image evaluations (Cobb angle, VWA and AVBH) were significantly improved (<0.05), but significant reduction loss was observed in both groups at 1 month after the operation and at the final follow-up (<0.05). At the final follow-up, the loss of Cobb angle, VWA and AVBH in group A were (5.26±4.18) °, (4.63±3.80) ° and (9.54±8.71)%, respectively;group B was (6.01±4.34) °, (6.55±6.21) ° and (11.67± 9.95)%, respectively;however, there was no significant difference in reduction loss between the two groups(>0.05).
Although the curative effect of the patients is satisfactory, the stability of the patients can not be improved by increasing the middle injured vertebra screw placement, the two groups of percutaneous short segment internal fixation can not resist the reduction loss of Magerl-A3 thoracolumbar fracture with low bone mineral density. Because the injured vertebra screw increases the operation time and intraoperative blood loss, it is not significant to use the intermediate screw for the elderly Magerl A3 thoracolumbar fractures with low bone mineral density.
探讨经皮椎弓根螺钉短节段内固定加或不加中间螺钉治疗骨密度低的Magerl A3型胸腰椎骨折的临床疗效。
回顾性分析2017年1月至2020年7月行经皮椎弓根螺钉短节段内固定治疗的Magerl A3型胸腰椎骨折患者，93例符合诊断及纳入标准，9例根据排除标准排除，其余84例获得完整影像学随访资料。其中男性38例，女性46例，年龄56～73岁，平均（64.78±7.12）岁，骨密度（BMD）0.61～0.89g/cm，平均（0.73±0.14）g/cm，随访时间11～25个月，平均（17.58±6.12）个月。A组45例采用中间螺钉，B组39例未采用中间螺钉。记录手术时间及术中出血量，采用Oswestry功能障碍指数（ODI）和视觉模拟评分法（VAS）进行临床评估。术后通过X线测量Cobb角、椎体楔角（VWA）和椎体前缘高度（AVBH），计算上述参数的矫正丢失量。
84例患者中有5例螺钉松动（A组２例，B组3例，P＞0.05）。两组手术时间及术中出血量差异有统计学意义（P＜0.01）。两组临床效果良好，术后VAS及ODI明显改善，随访各期（术后3天、1个月及末次随访）两组间差异无统计学意义（P＞0.05）。术后3天影像学评估（Cobb角、VWA及AVBH）明显改善（P＜0.05），但术后1个月及末次随访时两组均出现明显矫正丢失（P＜0.05）。末次随访时，A组Cobb角、VWA及AVBH丢失量分别为（5.26±4.18）°、（4.63±3.80）°和（9.54±8.71）%；B组分别为（6.01±4.34）°、（6.55±6.21）°和（11.67±9.95）%；两组间矫正丢失量差异无统计学意义（P＞0.05）。
虽然患者疗效满意，但增加伤椎中间螺钉置入并不能提高患者的稳定性，两组经皮短节段内固定均不能抵抗骨密度低的Magerl - A3型胸腰椎骨折的矫正丢失。由于伤椎螺钉增加了手术时间及术中出血量，对于骨密度低的老年Magerl A3型胸腰椎骨折使用中间螺钉意义不大。
