Comparison of Therapeutic Effects between Percutaneous and Open Intramuscular Pedicle Screw Non Fusion Fixation for the Treatment of A3/A4 Type Thoracolumbar Fractures without Neurological Dysfunction
LIN Kai-feng, ZHONG Zhen-ye, CHEN Jin-shui, et al
Department of Orthopedics, The 900th Hospital of Joint Logistics Support Force , Fuzhou Fujian 350025
Abstract 【Objective】 To explore the clinical efficacy of percutaneous and open intramuscular pedicle screw non fusion fixation in the treatment of A3/A4 type thoracolumbar fractures without neurological dysfunction. 【Methods】 A prospective Cohort study design was used to select 46 patients with A3/A4 thoracolumbar fractures without neurological dysfunction who were admitted to The 900th Hospital of Joint Logistics Support Force from January 2018 to December 2020. The patients were randomly and alternately included in the transmuscular space screwfixation (PPSF) group and the open transmuscular space pedicle screwfixation(OPSF) group. The Cobb angle before and after surgery,corrected loss,blood loss,surgical time,and cumulative radiation time after 12 months were compared between two groups.【Results】 There was no statistically significant difference in Cobb angle before and after surgery and correction loss after 12 months between the OPSF group and the PPSF group (P>0.05). Compared with the OPSF group,the PPSF group had shorter surgical time,less perioperative blood loss,and higher average cumulative radiation time,with statistically significant differences (P<0.05). 【Conclusion】 The efficacy of percutaneous and open intramuscular pedicle screw fixation in the treatment of A3/A4 type thoracolumbar fractures without neurological dysfunction is equivalent,but pedicle screw fixation has shorter surgical time,less blood loss,and higher average cumulative radiation time.
LIN Kai-feng,ZHONG Zhen-ye,CHEN Jin-shui, et al. Comparison of Therapeutic Effects between Percutaneous and Open Intramuscular Pedicle Screw Non Fusion Fixation for the Treatment of A3/A4 Type Thoracolumbar Fractures without Neurological Dysfunction[J]. JOURNAL OF CLINICAL RESEARCH, 2023, 40(6): 805-807.
[1] HU R,MUSTARD C A,BURNS C. Epidemiology of incident spinal fracture in a complete population[J].Spine (Phila Pa 1976),1996,21(4):492-499. [2] AZIMI P,MOHAMMADI H R,AZHARI S,et al. The AOSpine thoracolumbar spine injury classification system:A reliability and agreement study[J].Asian J Neurosurg,2015,10(4):282-285. [3] DAULEAC C,BEURIAT P A,DI ROCCO F,et al. Surgical management of pediatric spine trauma:12 years of experience[J].World Neurosurg,2019,126:e1494-e1502. [4] HAMILTON K,JOSIAH D T,TIERNEY M,et al. Surgical practice in traumatic spinal fracture treatment with regard to the subaxial cervical injury classification and severity and the thoracolumbar injury classification and severity systems:a review of 58 patients at the university of wisconsin[J].World Neurosurg,2019,127:e101-e107. [5] WANG H,ZHOU Y,LI C,et al. Comparison of open versus percutaneous pedicle screw fixation using the sextant system in the treatment of traumatic thoracolumbar fractures[J].Clin Spine Surg,2017,30(3):E239-E246. [6] PHAN K,RAO P J,MOBBS R J. Percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures:Systematic review and meta-analysis of comparative studies[J]. Clin Neurol Neurosurg,2015,135:85-92. [7] KUMAR A,AUJLA R,LEE C. The management of thoracolumbar burst fractures:a prospective study between conservative management,traditional open spinal surgery and minimally interventional spinal surgery[J].Springerplus,2015,4:204. [8] KIM D Y,LEE S H,CHUNG S K,et al. Comparison of multifidus muscle atrophy and trunk extension muscle strength:percutaneous versus open pedicle screw fixation[J].Spine (Phila Pa 1976),2005,30(1):123-129. [9] WILD M H,GLEES M,PLIESCHNEGGER C,et al. Five-year follow-up examination after purely minimally invasive posterior stabilization of thoracolumbar fractures:a comparison of minimally invasive percutaneously and conventionally open treated patients[J].Arch Orthop Trauma Surg,2007,127(5):335-343. [10] LEE J K,JANG J W,KIM T W,et al. Percutaneous short-segment pedicle screw placement without fusion in the treatment of thoracolumbar burst fractures:is it effective? comparative study with open short-segment pedicle screw fixation with posterolateral fusion[J].Acta Neurochir (Wien),2013,155(12):2305-2312. [11] KREINEST M,RILLIG J,GRÜTZNER P A,et al. Analysis of complications and perioperative data after open or percutaneous dorsal instrumentation following traumatic spinal fracture of the thoracic and lumbar spine:a retrospective cohort study including 491 patients[J].Eur Spine J,2017,26(5):1535-1540. [12] DINIZ J M,BOTELHO R V. Is fusion necessary for thoracolumbar burst fracture treated with spinal fixation? A systematic review and meta-analysis[J].J Neurosurg Spine,2017,27(5):584-592. [13] VANEK P,BRADAC O,KONOPKOVA R,et al. Treatment of thoracolumbar trauma by short-segment percutaneous transpedicular screw instrumentation:prospective comparative study with a minimum 2-year follow-up[J].J Neurosurg Spine,2014,20(2):150-156.
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