Combination of transpedicle screw fixation and lordorizing screw fixation via percutaneous Wiltse paraspinal approach for the treatment of thoracolumbar spine fracture without nerve injury
Weng Xian1, 2, Wang Genlin1, Zhang Ge1, Zhang Yazhong1, Zheng Peiyan1, Jiang Weimin1, Yang Huilin1
1 Department of Orthopaedics, the First Affiliated Hospital, Soochow University, Suzhou 215000, China;
2 Department of Orthopaedics, Changshu Fifth People's Hospital, Changshu 215500, China
Abstract：Objective To investigate the effectiveness of percutaneous and multi-fissure intermuscular approach combined with injured vertebral screw fixation for the treatment of thoracolumbar fracture without nerve injury. Methods Retrospective analysis was conducted on the data of 52 patients with thoracolumbar fracture who were treated with percutaneous approach and multi-fissure intervertebral approach in the First Affiliated Hospital of Soochow University from January 2015 to January 2018. The patients were categorized in group A, which consisted of 25 individuals including 19 males and 6 females aged 35-67 (49.84±9.11) years who received the multi-fissure intervertebral approach, and group B, which comprised 27 individuals including 20 males and 7 females aged 21-66 (48.44±11.02) years who received the percutaneous approach. General data including bleeding volume, operation time, postoperative use of analgesic drug, postoperative grounding time and hospital stay, and visual analog score (VAS) of low back pain were obtained at different time points before and after surgery. Anterior height of vertebra and Cobb angle were compared before and 12 months after surgery. Results Both groups successfully completed the operation and were followed up for 12 months. No significant difference on general data was observed between the two groups (all P values＞0.05). The operative time and postoperative grounding time in group A were shorter than those in group B [120 (90,136) min vs. 144 (110, 220) min, 2 (1, 3) days vs. 4(2, 5) days, respectively], and the difference was statistically significant (all P values＜0.05). The number of patients using analgesic drug in group B was higher than that in group A (15 vs. 2), and the difference was statistically significant (P ＜ 0.05). No significant difference in the amount of surgical bleeding and length of postoperative hospitalization was found between the two groups (all P values＞0.05). The VAS scores of both groups were significantly improved after operation compared with those before operation, and the difference was statistically significant (all P values＜0.01). No significant difference was observed between two groups before and 12 months after surgery (all P values＞0.05); however, the VAS score in group A was better 3 days after surgery, and the difference was statistically significant (P＜0.05). In both groups, the anterior height of the injured vertebra and Cobb angles of the sagittal plane were significantly restored immediately after surgery and after 12 months compared with those before operation, and the difference was statistically significant (all P values＜0.05). However, no significant difference was found between both groups (all P values＞0.05). Conclusions Percutaneous and multi-fissure approach combined with vertebral screw placement have good effects on the treatment of single-segment thoracolumbar vertebral fractures without nerve injury. No significant difference was observed in the improvement of fracture deformity and long-term low back pain. Compared with the multi-fissure muscle approach, the percutaneous approach has longer operation time, more serious short-term low back pain, and delayed postoperative grounding time and thus has no significant advantages.
翁献, 王根林, 章戈, 张亚中, 郑培炎, 姜为民, 杨惠林. 多裂肌间隙入路与经皮入路联合伤椎置钉治疗无神经损伤的胸腰段椎体骨折的对比研究[J]. 中华解剖与临床杂志, 2020, 25(6): 662-667.
Weng Xian, Wang Genlin, Zhang Ge, Zhang Yazhong, Zheng Peiyan, Jiang Weimin, Yang Huilin. Combination of transpedicle screw fixation and lordorizing screw fixation via percutaneous Wiltse paraspinal approach for the treatment of thoracolumbar spine fracture without nerve injury. Chinese Journal of Anatomy and Clinics, 2020, 25(6): 662-667.
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2020, Vol. 25 
