胸腰段脊柱骨折内固定:经伤椎与跨伤椎短节段经皮椎弓根螺钉内固定系统的应用
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摘要
背景:目前临床上对后路短节段经皮椎弓根螺钉治疗胸腰段骨折的随访数据有限,且是否应进行伤椎置钉尚存在一定的争议。目的:探究短节段经皮椎弓根螺钉内固定系统经伤椎置钉与跨伤椎固定修复胸腰段骨折的短期疗效。方法:纳入使用经皮椎弓根螺钉内固定的胸腰段骨折患者27例,随机将患者分为经伤椎置钉组和跨伤椎固定组。所有治疗均已取得患者知情同意,且得到医院伦理委员会批准。使用目测类比评分、Oswestry功能障碍指数评估临床症状的改善情况,使用骨折椎体前缘相对高度,矢状面后凸Cobb角度评估骨折椎体复位情况。结果与结论:(1)所有纳入随访的患者均顺利完成手术,经伤椎置钉组随访8-20个月,跨伤椎置钉组随访5-17个月,均未出现内固定断裂、伤椎高度丢失等并发症;(2)2组患者术后的目测类比评分及Oswestry功能障碍指数均较术前明显好转(P <0.05),组间对比差异无显著性意义(P> 0.05);(3)2组患者术后骨折椎体前缘相对高度及矢状面后凸Cobb角均较术前好转,差异有显著性意义(P <0.05),组间对比差异无显著性意义(P> 0.05);(4)提示随访期间使用短节段经皮椎弓根螺钉内固定系统修复胸腰段骨折能够取得满意疗效,而经伤椎置钉和跨节段固定并未表现出明显差异。
BACKGROUND: At present, the clinical follow-up data of posterior short-segment percutaneous pedicle screw for thoracolumbar fractures are limited, and there is still some controversy about whether the injured vertebra should be placed with screw. OBJECTIVE: To investigate the short-term effectiveness of short-segment percutaneous pedicle screw instrumentation for the treatment of thoracolumbar fractures. METHODS: Totally 27 patients, who suffered from thoracolumbar fractures and underwent short-segment percutaneous pedicle screw instrumentation, were retrospectively analyzed. These patients were divided into two groups: bilateral fracture level screw group and cross-fracture level instrumentation group. Informed consent was obtained from all patients. This study was approved by the Hospital Ethics Committee. Visual analogue scale score and Oswestry disability index were used to access clinical outcomes. Relative fracture-level vertebralbody height and Cobb angle were used to access the reduction situation of fractured vertebrae. RESULTS AND CONCLUSION:(1) All surgeries were completed successfully. Patients in the bilateral fracture level screw group were followed up for 8-20 months. Patients in the cross-fracture level instrumentation group were followed up for 5-17 months. No complications such as internal fixation fracture or reduction loss were observed.(2) Visual analogue scale score and Oswestry disability index were significantly improved after operation in both groups(P < 0.05). No significant difference was found between the two groups(P > 0.05).(3) Relative fracture-level vertebral body height and Cobb angle were improved after operation when compared to pre-operative data of both groups(P < 0.05). The difference between groups presented no statistically difference(P > 0.05).(4) During short-term follow-up, the short-term effectiveness of short-segment percutaneous pedicle screw instrumentation is proven to have satisfactory effect; no significant difference was observed between bilateral fracture level screw and cross-fracture level instrumentation.
BACKGROUND: At present, the clinical follow-up data of posterior short-segment percutaneous pedicle screw for thoracolumbar fractures are limited, and there is still some controversy about whether the injured vertebra should be placed with screw. OBJECTIVE: To investigate the short-term effectiveness of short-segment percutaneous pedicle screw instrumentation for the treatment of thoracolumbar fractures. METHODS: Totally 27 patients, who suffered from thoracolumbar fractures and underwent short-segment percutaneous pedicle screw instrumentation, were retrospectively analyzed. These patients were divided into two groups: bilateral fracture level screw group and cross-fracture level instrumentation group. Informed consent was obtained from all patients. This study was approved by the Hospital Ethics Committee. Visual analogue scale score and Oswestry disability index were used to access clinical outcomes. Relative fracture-level vertebralbody height and Cobb angle were used to access the reduction situation of fractured vertebrae. RESULTS AND CONCLUSION:(1) All surgeries were completed successfully. Patients in the bilateral fracture level screw group were followed up for 8-20 months. Patients in the cross-fracture level instrumentation group were followed up for 5-17 months. No complications such as internal fixation fracture or reduction loss were observed.(2) Visual analogue scale score and Oswestry disability index were significantly improved after operation in both groups(P < 0.05). No significant difference was found between the two groups(P > 0.05).(3) Relative fracture-level vertebral body height and Cobb angle were improved after operation when compared to pre-operative data of both groups(P < 0.05). The difference between groups presented no statistically difference(P > 0.05).(4) During short-term follow-up, the short-term effectiveness of short-segment percutaneous pedicle screw instrumentation is proven to have satisfactory effect; no significant difference was observed between bilateral fracture level screw and cross-fracture level instrumentation.
引文
[1]Khare S,Sharma V.Surgical outcome of posterior short segment trans-pedicle screw fixation for thoracolumbar fractures.J Orthop.2013;10(4)162-167.
[2]Rajasekaran S,Kanna RM,Shetty AP.Management of thoracolumbar spine trauma:An overview.Indian J Orthop.2015;49(1):72-82.
[3]王圣杰,夏天,柳超,等.经皮椎弓根螺钉棒无融合内固定治疗胸腰椎骨折[J].中国矫形外科杂志,2018,26(4):294-298.
[4]Reinhold M,Knop C,Beisse R,et al.Operative treatment of733 patients with acute thoracolumbar spinal injuries:comprehensive results from the second,prospective,internet-based multicenter study of the spine study group of the german association of trauma surgery.Eur Spine J.2010;19(10):1657-1676.
[5]Alander DH,Cui S.Percutaneous pedicle screw stabilization:surgical technique,fracture reduction,and review of current spine trauma applications.J Am Acad Orthop Surg.2018;26(7):231-240.
[6]Phan K,Rao PJ,Mobbs RJ.Percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures:Systematic review and meta-analysis of comparative studies.Clin Neurol Neurosurg.2015;135:85-92.
[7]Scheer JK,Bakhsheshian J,Fakurnejad S,et al.Evidence-based medicine of traumatic thoracolumbar burst fractures:a systematic review of operative management across 20 years.Global Spine J.2015;5(1):73-82.
[8]Gejo R,Matsui H,Kawaguchi Y,et al.Serial changes in trunk muscle performance after posterior lumbar surgery.Spine.1999;24(10):1023-1028.
[9]Magerl FP.Stabilization of the lower thoracic and lumbar spine with external skeletal fixation.Clin Orthop Relat Res.1984(189):125-141.
[10]Fogel GR,Reitman CA,Liu W,et al.Physical characteristics of polyaxial-headed pedicle screws and biomechanical comparison of load with their failure.Spine.2003;28(5):470-473.
[11]Fan S,Hu Z,Zhao F,et al.Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion:minimally invasive procedure versus conventional open approach.Eur Spine J.2010;19(2):316-324.
[12]Kim DY,Lee SH,Chung SK,et al.Comparison of multifidus muscle atrophy and trunk extension muscle strength:percutaneous versus open pedicle screw fixation.Spine.2005;30(1):123-129.
[13]Rodriguez-Vela J,Lobo-Escolar A,Joven-Aliaga E,et al.Perioperative and short-term advantages of mini-open approach for lumbar spinal fusion.Eur Spine J.2009;18(8):1194-1201.
[14]Schmidt OI,Strasser S,Kaufmann V,et al.Role of early minimal-invasive spine fixation in acute thoracic and lumbar spine trauma.Indian J Orthop.2007;41(4):374-380.
[15]Zhao Q,Zhang H,Hao D,et al.Complications of percutaneous pedicle screw fixation in treating thoracolumbar and lumbar fracture.Medicine(Baltimore).2018;97(29):e11560.
[16]Gayet LE,Pries P,Hamcha H,et al.Biomechanical study and digital modeling of traction resistance in posterior thoracic implants.Spine.2002;27(7):707-714.
[17]Liljenqvist U,Hackenberg L,Link T,et al.Pullout strength of pedicle screws versus pedicle and laminar hooks in the thoracic spine.Acta orthopaedica Belgica.2001;67(2):157-163.
[18]Regev GJ,Lee YP,Taylor WR,et al.Nerve injury to the posterior rami medial branch during the insertion of pedicle screws:comparison of mini-open versus percutaneous pedicle screw insertion techniques.Spine.2009;34(11):1239-1242.
[19]Koreckij T,Park DK,Fischgrund J.Minimally invasive spine surgery in the treatment of thoracolumbar and lumbar spine trauma.Neurosurg Focus.2014;37(1):E11.
[20]Liao JC,Fan KF,Keorochana G,et al.Transpedicular grafting after short-segment pedicle instrumentation for thoracolumbar burst fracture:calcium sulfate cement versus autogenous iliac bone graft.Spine.2010;35(15):1482-1488.
[21]Lehmann W,Ushmaev A,Ruecker A,et al.Comparison of open versus percutaneous pedicle screw insertion in a sheep model.Eur Spine J.2008;17(6):857-863.
[22]Hussain NS,Perez-Cruet MJ.Complication management with minimally invasive spine procedures.Neurosurg Focus.2011;31(4):E2.
[23]Lee KH,Yue WM,Yeo W,et al.Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion.Eur Spine J.2012;21(11):2265-2270.
[24]Anekstein Y,Brosh T,Mirovsky Y.Intermediate screws in short segment pedicular fixation for thoracic and lumbar fractures:a biomechanical study.J Spinal Disord Tech.2007;20(1):72-77.
[25]Baaj AA,Reyes PM,Yaqoobi AS,et al.Biomechanical advantage of the index-level pedicle screw in unstable thoracolumbar junction fractures.J Neurosurg Spine.2011;14(2):192-197.
[26]Gelb D,Ludwig S,Karp JE,et al.Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation.J Spinal Disord Tech.2010;23(5):293-301.
[27]Tian JW,Wang L,Xia T,et al.Posterior short-segmental fixation combined with intermediate screws vs conventional intersegmental fixation for monosegmental thoracolumbar fractures.Orthopedics.2011;34(8):e389-396.
[28]Raley DA,Mobbs RJ.Retrospective computed tomography scan analysis of percutaneously inserted pedicle screws for posterior transpedicular stabilization of the thoracic and lumbar spine:accuracy and complication rates.Spine.2012;37(12):1092-1100.
[29]Seng C,Tow BP,Siddiqui MA,et al.Surgically treated cervical myelopathy:a functional outcome comparison study between multilevel anterior cervical decompression fusion with instrumentation and posterior laminoplasty.Spine J.2013;13(7):723-731.
[30]Fitschen-Oestern S,Scheuerlein F,Weuster M,et al.Reduction and retention of thoracolumbar fractures by minimally invasive stabilisation versus open posterior instrumentation.Injury.2015;46 Suppl 4:S63-70.
[2]Rajasekaran S,Kanna RM,Shetty AP.Management of thoracolumbar spine trauma:An overview.Indian J Orthop.2015;49(1):72-82.
[3]王圣杰,夏天,柳超,等.经皮椎弓根螺钉棒无融合内固定治疗胸腰椎骨折[J].中国矫形外科杂志,2018,26(4):294-298.
[4]Reinhold M,Knop C,Beisse R,et al.Operative treatment of733 patients with acute thoracolumbar spinal injuries:comprehensive results from the second,prospective,internet-based multicenter study of the spine study group of the german association of trauma surgery.Eur Spine J.2010;19(10):1657-1676.
[5]Alander DH,Cui S.Percutaneous pedicle screw stabilization:surgical technique,fracture reduction,and review of current spine trauma applications.J Am Acad Orthop Surg.2018;26(7):231-240.
[6]Phan K,Rao PJ,Mobbs RJ.Percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures:Systematic review and meta-analysis of comparative studies.Clin Neurol Neurosurg.2015;135:85-92.
[7]Scheer JK,Bakhsheshian J,Fakurnejad S,et al.Evidence-based medicine of traumatic thoracolumbar burst fractures:a systematic review of operative management across 20 years.Global Spine J.2015;5(1):73-82.
[8]Gejo R,Matsui H,Kawaguchi Y,et al.Serial changes in trunk muscle performance after posterior lumbar surgery.Spine.1999;24(10):1023-1028.
[9]Magerl FP.Stabilization of the lower thoracic and lumbar spine with external skeletal fixation.Clin Orthop Relat Res.1984(189):125-141.
[10]Fogel GR,Reitman CA,Liu W,et al.Physical characteristics of polyaxial-headed pedicle screws and biomechanical comparison of load with their failure.Spine.2003;28(5):470-473.
[11]Fan S,Hu Z,Zhao F,et al.Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion:minimally invasive procedure versus conventional open approach.Eur Spine J.2010;19(2):316-324.
[12]Kim DY,Lee SH,Chung SK,et al.Comparison of multifidus muscle atrophy and trunk extension muscle strength:percutaneous versus open pedicle screw fixation.Spine.2005;30(1):123-129.
[13]Rodriguez-Vela J,Lobo-Escolar A,Joven-Aliaga E,et al.Perioperative and short-term advantages of mini-open approach for lumbar spinal fusion.Eur Spine J.2009;18(8):1194-1201.
[14]Schmidt OI,Strasser S,Kaufmann V,et al.Role of early minimal-invasive spine fixation in acute thoracic and lumbar spine trauma.Indian J Orthop.2007;41(4):374-380.
[15]Zhao Q,Zhang H,Hao D,et al.Complications of percutaneous pedicle screw fixation in treating thoracolumbar and lumbar fracture.Medicine(Baltimore).2018;97(29):e11560.
[16]Gayet LE,Pries P,Hamcha H,et al.Biomechanical study and digital modeling of traction resistance in posterior thoracic implants.Spine.2002;27(7):707-714.
[17]Liljenqvist U,Hackenberg L,Link T,et al.Pullout strength of pedicle screws versus pedicle and laminar hooks in the thoracic spine.Acta orthopaedica Belgica.2001;67(2):157-163.
[18]Regev GJ,Lee YP,Taylor WR,et al.Nerve injury to the posterior rami medial branch during the insertion of pedicle screws:comparison of mini-open versus percutaneous pedicle screw insertion techniques.Spine.2009;34(11):1239-1242.
[19]Koreckij T,Park DK,Fischgrund J.Minimally invasive spine surgery in the treatment of thoracolumbar and lumbar spine trauma.Neurosurg Focus.2014;37(1):E11.
[20]Liao JC,Fan KF,Keorochana G,et al.Transpedicular grafting after short-segment pedicle instrumentation for thoracolumbar burst fracture:calcium sulfate cement versus autogenous iliac bone graft.Spine.2010;35(15):1482-1488.
[21]Lehmann W,Ushmaev A,Ruecker A,et al.Comparison of open versus percutaneous pedicle screw insertion in a sheep model.Eur Spine J.2008;17(6):857-863.
[22]Hussain NS,Perez-Cruet MJ.Complication management with minimally invasive spine procedures.Neurosurg Focus.2011;31(4):E2.
[23]Lee KH,Yue WM,Yeo W,et al.Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion.Eur Spine J.2012;21(11):2265-2270.
[24]Anekstein Y,Brosh T,Mirovsky Y.Intermediate screws in short segment pedicular fixation for thoracic and lumbar fractures:a biomechanical study.J Spinal Disord Tech.2007;20(1):72-77.
[25]Baaj AA,Reyes PM,Yaqoobi AS,et al.Biomechanical advantage of the index-level pedicle screw in unstable thoracolumbar junction fractures.J Neurosurg Spine.2011;14(2):192-197.
[26]Gelb D,Ludwig S,Karp JE,et al.Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation.J Spinal Disord Tech.2010;23(5):293-301.
[27]Tian JW,Wang L,Xia T,et al.Posterior short-segmental fixation combined with intermediate screws vs conventional intersegmental fixation for monosegmental thoracolumbar fractures.Orthopedics.2011;34(8):e389-396.
[28]Raley DA,Mobbs RJ.Retrospective computed tomography scan analysis of percutaneously inserted pedicle screws for posterior transpedicular stabilization of the thoracic and lumbar spine:accuracy and complication rates.Spine.2012;37(12):1092-1100.
[29]Seng C,Tow BP,Siddiqui MA,et al.Surgically treated cervical myelopathy:a functional outcome comparison study between multilevel anterior cervical decompression fusion with instrumentation and posterior laminoplasty.Spine J.2013;13(7):723-731.
[30]Fitschen-Oestern S,Scheuerlein F,Weuster M,et al.Reduction and retention of thoracolumbar fractures by minimally invasive stabilisation versus open posterior instrumentation.Injury.2015;46 Suppl 4:S63-70.