微创经皮椎弓根螺钉内固定治疗胸腰椎骨折的置钉选择

Screw placement selection of minimally invasive percutaneous pedicle screw fixation for thoracolumbar fractures

背景:单向椎弓根螺钉虽然在经皮椎弓根螺钉技术中有不利于安装的弱势,但其具有比万向椎弓根螺钉更佳的力学传导特性和稳定性,实践中如何选择和使用这2种螺钉,发挥各自优势,进一步提高疗效,已成为一个值得思考的课题。目的:比较单向与万向椎弓根螺钉不同置钉选择下,经皮椎弓根复位固定治疗胸腰椎骨折的临床疗效。方法:对46例无神经损伤症状的胸腰椎骨折患者采用微创经皮椎弓根螺钉复位内固定手术治疗,其中25例采用单向钉复位骨折固定(单向钉组),21例采用万向钉复位骨折固定(万向钉组)。比较内固定前后2组椎体前、后缘高度、伤椎后凸角、矫正率、丢失率等影像学指标,评价经皮单向钉和万向钉复位固定胸腰椎骨折的治疗效果。结果与结论:(1)2组在内固定时间、出血量、并发症以及住院时间等围术期资料差异无显著性意义(P>0.05),(2)2组内固定后伤椎前、后缘高度百分比、伤椎后凸角度与内固定前比较,差异均有显著性意义(P<0.05)。(3)内固定后单向螺钉组伤椎前缘高度百分比、伤椎后凸角度、矫正度优于万向螺钉组(P<0.05),末次随访时丢失率优于万向螺钉组(P<0.05),但内固定后伤椎后缘高度百分比差异无显著统计学差异(P>0.05);(4)结果说明,与万向钉复位固定比较,应用单向钉椎弓根螺钉经皮微创复位、固定治疗胸腰椎骨折,更具有满意的骨折撑开复位疗效,后期矫形丢失更少。

BACKGROUND： Monoaxial pedicle screws are not conducive to the installation during percutaneous pedicle screw technique, but it has better mechanical conductivity and stability than polyaxial pedicle screws. How toselect and use these two kinds of screws in the clinic to exert their advantages and to further elevate efficacy has become a subject worthy of reflection. OBJECTIVE： To compare the clinical efficacy of percutaneous pedicle screw placement for thoracolumbar fracture using monoaxial and polyaxial pedicle screws at different placement selections. METHODS： A total of 46 cases of thoracolumbar fracture without neurological symptoms underwent minimally invasive percutaneous pedicle screw fixation. 25 patients（monoaxial screw group） were treated with monoaxial pedicle screws and the other 21 ones（polyaxial screw group） with polyaxial pedicle screws. Kyphotic angle, correction rate, correction loss rate and height of injury vertebrae were compared before and after fixation in both groups. The therapeutic effects of monoaxial and polyaxial percutaneous pedicle screw fixation in the treatment of thoracolumbar fractures were evaluated. RESULTS AND CONCLUSION：（1） Fixation time, blood loss, complication and hospital stay were not significantly different in both groups（P〈0.05）.（2） Kyphotic angle and height of the fractured vertebra body were significantly different between the two groups（P〈0.05）.（3） The restoration of anterior height of injured vertebrae, kyphotic angle and correction rate were better in the monoaxial screw group than in the polyaxial screw group after treatment（P〈0.05）. The correction loss rate was significantly better in the monoaxial screw group than in the polyaxial screw group during last follow-up（P〈0.05）. However, there was no significant difference in the posterior height of injured vertebraeafter fixation（P〈0.05）.（4） These findings indicate that compared with the polyaxial percutaneous pedicle screw fixation, the monoaxial pedicle screw may be preferable in percutaneous pedicle screw fixation for thoracolumbar fractures, has more satisfactory fracture distraction reduction, and has less postoperative correction loss rate.