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| Investigation of the Effect of Minimally Invasive Arch Nailing Technique Access Selection on Vertebral Fractures in the Thoracolumbar Segment |
| XU Wenshuo, CHEN Shentiao, GUAN Yan, et al |
| Department of Orthopedics, Chengde Central Hospital, Chengde Hebei 067000 |
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Abstract 【Objective】To explore the efficacy of percutaneous and trans-paraspinal muscle space approaches for pedicle screw fixation in the treatment of thoracolumbar vertebral fractures and their impact on surgical traumatic stress.【Methods】A total of 124 patients with thoracolumbar vertebral fractures treated in our hospital from January 2019 to October 2022 were selected and randomly divided into the paraspinal muscle group (treated pedicle screw fixation via paraspinal muscle space approach) and the percutaneous group (treated pedicle screw fixation via percutaneous approach), with 62 cases in each group. The surgical indicators, visual analogue scale (VAS) scores, traumatic factors [cortisol (Cor), interleukin-8 (IL-8), C-reactive protein (CRP)], radiological imaging indicators (kyphotic Cobb angle and sagittal vertebral index), functional recovery parameters [Oswestry Disability Index (ODI) and Barthel Index (BI)], and complication rates were compared between the two groups.【Results】The operation time of the percutaneous group was longer than that of the paraspinal muscle group, and the number of fluoroscopies was more than that of the paraspinal muscle group. The incision length, intraoperative blood loss, and hospital stay of the percutaneous group were better than those of the paraspinal muscle group (P<0.05). The vertebral body reduction rate was 100.00% in both groups one week after surgery. At 3 days and 1 week after surgery, the VAS score of the percutaneous group was lower than that of the paraspinal muscle group (P<0.05), and the levels of serum Cor, IL-8, and CRP were lower than those of the paraspinal muscle group (P<0.05). At 3 days, 3 months, and 1 year after surgery, there was no significant difference in the sagittal vertebral index and kyphotic Cobb angle between the two groups (P>0.05). At 1 month after surgery, the ODI of the percutaneous group was lower than that of the paraspinal muscle group (P<0.05), and the BI was higher than that of the paraspinal muscle group (P<0.05). At 1 year after surgery, there was no significant difference in both ODI and BI between the two groups (P>0.05). The total complication rate of the percutaneous group was 9.68%, which was not significantly different from 14.52% of the paraspinal muscle group (P>0.05).【Conclusion】Both percutaneous and paraspinal muscle space approaches for pedicle screw fixation in the treatment of thoracolumbar vertebral fractures are effective, safe, and reliable. However, the former has less trauma, higher surgical precision, and greater difficulty, with longer operation time and more fluoroscopy. The operator requires rich experience in open surgery and minimally invasive surgery. The latter has simpler surgical operation, but longer incision and relatively slower early postoperative recovery.
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Received: 05 February 2025
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2025, Vol. 42 
