Abstract：【Objective】To investigate the clinical efficacy of the minimally invasive pedicle screw fixation for the treatment of unstable thoracolumbar fractures. 【Methods】Thirty-seven patients of unstable thoracolumbar fracture without neurological symptoms from January 2011 to October 2012 were seen in the Departments of Orthopedics of the First and Second Hospitals of Xi'an Jiaotong University. There were 24 males and 13 females, aged 19 to 69 years (mean 31.8 ± 8.5 years). All cases were treated with minimally invasive percutaneous pedicle screw fixation techniques. The operation time, blood loss, vertebral height before and after surgery, Cobb's angle changes, and postoperative complications were collected and statistical analysis was conducted. 【Results】The operation time was 1.1 (0.75 ~ 1.5) h, the bleeding volume was 20~100 (40.5±10) mL, and the follow-up time was 10~36 (19.8±5.6) months. There were significant differences in VAS scores four weeks and one year after operation compared to that on one day before operation (P<0.05), showing a significant reduction in pain. The percentage of vertebral body height and Cobb's angle were significantly higher than those before treatment, and the difference was statistically significant (P<0.05). The percentage of vertebral height and Cobb's angle before treatment and after treatment were significantly different (P<0.05). However, there were no statistical difference between these values one month and twelve months after surgery (P>0.05). Intraoperative complications accounted for three cases (8.1%), caused by improper pedicle screw placement resulting in piercing the outer wall, while there were no rupture of the dura mater and vascular injury patients. However, follow-up showed fracture healed without much deformity and height loss. The twelve-month follow-up had two patients with a total of three loose pedicle screws. There were two cases (5.4%) of ruptured pedicle screw; one case was seen six months after operation and another case was seen twelve months after operation. Only one case (2.7%) showed pedicle screw withdrawal twenty-four months after operation.【Conclusion】Minimally invasive percutaneous pedicle screw technology can minimize the damage on stability of the disease, not only to achieve the purpose of stabilizing the spine, but also to reduce intraoperative trauma. Under the premise of strict control of surgical indications, it can be widely used as a basic technology.
[1] 李长青,罗刚,周跃,等.新型微创经皮椎弓根螺钉内固定治疗胸腰椎骨折[J].中华创伤杂志,2009, 25(6):522-525. [2] Ringel F,Stoffel M,Staer C,et al.Minimally invasive transmuscular pedicle screw fixation of the thoracic and lumbar spine[J].Neurosurgery,2006,59(4):361-366. [3] Park Y,Ha JW.Comparison of one level posterior lumbar interbody fusion performed with a minimally invasive approach:a traditional open approach [J].Spine,2007,32(5):537-543. [4] Fisher CG, DiPaola CP, Ryken TC, et al.A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the spine oncology study group[J].Spine,2010 ,35(22):E1221-E1229. [5] Masala S,Taglieri A,Chiaravalloti A,et al. Thoraco-lumbar traumatic vertebral fractures augmentation by osteo-conductive and osteo-inductive bone substitute containing strontium-hydroxyapatite: our experience[J].Neuroradiology,2014,56(6): 459-466. [6] 严广斌.视觉模拟评分法[J].中华关节外科杂志(电子版),2014,8(2):559-560. [7] Ni WF, Huang YX, Chi YL, et al. Percutaneous pedicle screw fixation for neurologic intact thoracolumbar burst fractures[J].J Spinal Disord Tech,2010,23(8): 530-537. [8] 余建民, 全必春, 孟志新. 经皮穿刺椎体成形术治疗老年骨质疏松性椎体压缩性骨折[J].医学临床研究,2016,11(23):1798-1799. [9] 王洪伟. 经皮椎弓根螺钉内固定治疗胸腰椎骨折的生物力学及临床研究[J].中华骨科杂志,2011,31(9):932-937. [10] 黄其杉.经皮与开放椎弓根螺钉固定治疗胸腰椎骨折的比较研究[J].中华外科杂志,2008,46(2):112-114. [11] Court C,Vincent C.Percutaneous fixation of thoracolumbar fractures:current concepts[J].Orthop Traumatol Surg Res,2012,98(8):900-909. [12] Wimmer C.Percutaneous fusion technique on the thoraeolumbar spine with the Expedium LIS[J].Oper Orthop Traumatol,2008,20(6):511-524. [13] Nowitzke AM.Assessment of the learning curve for lumbar microendoscopic discectomy[J].J Neurosurg,2005,56(4):755-762.
2017, Vol. 34 
