Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China.
Graduate School, Xi'an Medical University, Xi'an, China.
Orthop Surg. 2023 Sep;15(9):2363-2372. doi: 10.1111/os.13816. Epub 2023 Jul 31.
Multi-segmental thoracolumbar fracture (MSF) generally refers to fractures occurring in two or more segments of the thoracolumbar spine. With the development of minimally invasive concept, there is little research on its application in the field of MSF. The purpose of this study is to compare two minimally invasive surgical techniques and determine which one is more suitable for treating patients with neurologically intact MSF.
We retrospectively analyzed the clinical data of 49 MSF patients with intact nerves who were admitted from January 2017 to February 2019. Among them, 25 cases underwent percutaneous pedicle screw fixation (PPSF), and 24 cases underwent Wiltse approach pedicle screw fixation (WAPSF). The operation time, number of fixed segments, blood loss, length of incision, postoperative ambulation time, accuracy of pedicle screw placement, facet joint violation (FJV), number of C-arm exposures, as well as pre- and postoperative visual analogue scale (VAS), Oswestry disability index (ODI), local Cobb's angle (LCA), and percentage of anterior vertebral body height (PAVBH) were recorded for both groups. Paired sample t-test was used for intra-group comparison before and after surgery while independent sample t-test was used for inter-group comparison.
The differences in the number of fixed segments, intraoperative bleeding, postoperative bed time, accuracy rate of pedicle screw placement, VAS, and ODI between the two groups were not statistically significant (p > 0.05). However, the operative time and total surgical incision length were significantly shorter in the WAPSF group than in the PPSF group (p < 0.05), and the FJV was significantly higher in the PPSF group than in the WAPSF group (p < 0.05). Also, the PPSF group received more intraoperative fluoroscopy (p < 0.05). The result of LCA and PAVBH in the WAPSF group were significantly better than in the PPSF group (p < 0.05).
Both PPSF and WAPSF were found to be safe and effective in the treatment of MSF without neurological deficits through our study. However, considering radiation exposure, FJV, vertebral height restoration, correction of kyphosis, and learning curve, WAPSF may be a better choice for neurologically intact MSF.
多节段胸腰椎骨折（MSF）一般指发生在胸腰椎两个或两个以上节段的骨折。随着微创理念的发展，其在 MSF 领域的应用研究甚少。本研究旨在比较两种微创外科技术，并确定哪种技术更适合治疗神经完整的 MSF 患者。
我们回顾性分析了 2017 年 1 月至 2019 年 2 月期间收治的 49 例神经完整的 MSF 患者的临床资料。其中，25 例行经皮椎弓根螺钉固定术（PPSF），24 例行 Wiltse 入路椎弓根螺钉固定术（WAPSF）。记录两组患者的手术时间、固定节段数、出血量、切口长度、术后下床时间、椎弓根螺钉置钉准确率、关节突关节侵犯（FJV）、C 臂透视次数、术前及术后视觉模拟评分（VAS）、Oswestry 功能障碍指数（ODI）、局部 Cobb 角（LCA）、椎体前缘高度百分比（PAVBH）。采用配对样本 t 检验比较两组患者手术前后的差异，采用独立样本 t 检验比较两组间的差异。
两组患者固定节段数、术中出血量、术后卧床时间、椎弓根螺钉置钉准确率、VAS 评分、ODI 评分比较差异无统计学意义（p>0.05）。但 WAPSF 组手术时间和总手术切口长度明显短于 PPSF 组（p<0.05），FJV 发生率明显高于 PPSF 组（p<0.05）。此外，PPSF 组术中透视次数较多（p<0.05）。WAPSF 组的 LCA 和 PAVBH 结果明显优于 PPSF 组（p<0.05）。
本研究表明，对于无神经损伤的 MSF，经皮椎弓根螺钉固定术和 Wiltse 入路椎弓根螺钉固定术均安全有效。然而，考虑到辐射暴露、FJV、椎体高度恢复、后凸畸形矫正和学习曲线，Wiltse 入路椎弓根螺钉固定术可能是治疗神经完整 MSF 的更好选择。
