Medical College, Wuhan University of Science and Technology, Wuhan, 430065, Hubei, China.
Department of Orthopaedic, General Hospital of Central Theater Command, Wuhan, 430070, Hubei, China.
J Orthop Surg Res. 2024 Jan 22;19(1):85. doi: 10.1186/s13018-024-04547-9.
To compare the clinical and radiological outcomes of monoplanar screws (MSs) versus hybrid fixed axial and polyaxial screws (HSs) in percutaneous short-segment intermediate screw fixation (PSISF) for traumatic thoracolumbar burst fractures (TTBFs) in patients without neurologic impairment.
A consecutive series of 100 patients with single-segment TTBFs and no neurologic impairment who underwent PSISF with 6 monoplanar screws (MS group) or correct were retrospectively enrolled. The demographic data, radiologic evaluation indicators, perioperative indicators and clinical assessment indicators were analysed between the MS group and HS group.
The demographic data and perioperative indicators were not significantly different in the two groups (P > 0.05). The postoperative anterior vertebral height ratio (AVHR), kyphosis Cobb angle (KCA), vertebral wedge angle (VWA) and spinal canal encroachment rate (SCER) were significantly improved in both groups (*P < 0.05). The MS group obtained better correction than the HS group in terms of improvement in the AVHR, KCA and VWA after surgery (*P < 0.05). At the last follow-up, the MS group had less correction loss of AVHR, KCA and VWA (*P < 0.05). The MS group presented greater improvement in the SCER at the last follow-up (*P < 0.05). The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) score of all patients were significantly better postoperatively than those preoperatively (*P < 0.05), and the scores collected at each follow-up visit did not differ significantly between the two groups (P > 0.05). In the MS group, no internal fixation failure was observed during the follow-up period, but, in the HS group, two cases of internal fixation failure were observed at the last follow-up (one case of rod loosening and one case of screw breakage).
Both MSs and HSs fixation are effective treatments for TTBFs and have comparable clinical outcomes. In contrast, MSs fixation can improve the correction effect, better improve the SCER, and further reduce correction loss as well as reduce the incidence of instrumentation failure. Therefore, MSs fixation might be a better option for treating TTBFs in patients without neurological deficits.
比较单平面螺钉（MSs）与混合固定轴向和多轴向螺钉（HSs）在无神经损伤的创伤性胸腰椎爆裂骨折（TTBFs）经皮短节段中间螺钉固定（PSISF）中的临床和影像学结果。
回顾性连续纳入 100 例单节段 TTBF 且无神经损伤患者，分别采用 6 枚单平面螺钉（MS 组）或正确固定进行 PSISF。分析 MS 组和 HS 组的一般资料、影像学评估指标、围手术期指标和临床评估指标。
两组患者的一般资料和围手术期指标差异无统计学意义（P>0.05）。两组术后均有明显的前椎体高度比（AVHR）、后凸 Cobb 角（KCA）、椎体楔变角（VWA）和椎管侵占率（SCER）改善（均 P<0.05）。MS 组在术后 AVHR、KCA 和 VWA 的改善方面取得了比 HS 组更好的矫正效果（均 P<0.05）。末次随访时，MS 组 AVHR、KCA 和 VWA 的矫正丢失较少（均 P<0.05）。MS 组末次随访时 SCER 改善更明显（P<0.05）。所有患者术后的视觉模拟评分（VAS）和 Oswestry 功能障碍指数（ODI）评分均明显优于术前（均 P<0.05），且两组各随访点评分差异均无统计学意义（均 P>0.05）。MS 组随访期间未发生内固定失败，而 HS 组在末次随访时发生了 2 例内固定失败（1 例为棒松动，1 例为螺钉断裂）。
MSs 和 HSs 固定均为 TTBF 的有效治疗方法，临床效果相当。相比之下，MSs 固定可改善矫正效果，更好地改善 SCER，并进一步减少矫正丢失，降低器械失效发生率。因此，MSs 固定可能是治疗无神经损伤 TTBF 的更好选择。
