Comparison of clinical effect of thoracolumbar vertebral fracture treated with pedicle screw fixation via posterior percutaneous way and paraspinal muscle approach

TU Hong-bo; LIU Feng; ZHAO Jian-hua

doi:10.3969/j.issn.1009-4237.2018.04.005

Abstract：Objective To compare the effect of pedicle screw fixation in the treatment of thoracolumbar frac -tures via the posterior percuteneous way and paraspinal muscle approach.Methods Between Jan.2014 and Jan. 2016,79 patients with thoracolumbar fracture were treated in our hospital,including 47 males and 32 females.The av-erage age was 46 years(range 17-65).There were 59 cases injured from high falling and 20 cases from car accident injury.All the patients underwent surgery 2-9 days after injury.According to the newly revised AO thoracolumbar in-jury classification system,47 cases were A1 type,7 cases were A2 type,14 cases were A3 type,and 11 cases were A4 type.Load-sharing score was 3-6(4.5 ±1.1)points.35 patients(44.3%)underwent reduction and internal fixa-tion with pedicle screw via the percutaneous approach and 44 patients(55.7%)underwent the operation via the pa-raspinal muscle approach.Length of incision,operation duration,blood loss,number of intraoperative fluoroscopy,re-covery of vertebral height and postoperative Oswestry Disability Index(ODI)were compared between the two groups af-ter surgery.Results The mean follow-up period was 18 months(range 12-30 months).Compared with the paraspi-nal muscle group,the percutaneous group had the shorter incision length and less pain on the first postoperative day. The percutaneous group had more fluoroscopy(P<0.05).There was no significant difference in operation duration, intraoperative blood loss,postoperative ODI between the two groups(P>0.05).Compared with preoperative,the an-terior height and sagittal Cobb angle of the two groups were significantly corrected(P<0.05).The height of the ante-rior margin and sagittal Cobb angle of the two groups at the last follow-up were compared with that immediately after surgery,showing that the difference was not statistically significant(P>0.05).Conclusion Minimally invasive per-cutaneous pedicle screw fixation via posterior percutaneous way and paraspinal muscle approach for treatment of single -segment thoracolumbar fractures have the same clinical effects.And the paraspinal muscle approach can achieve mini-mally invasive treatment with the use of traditional open surgical instruments.Meanwhile,it allows doctors to learn to master the relevant technology faster,and reduces the risk of iatrogenic radiation for intraoperative medical staff and patients.It is proposed to be the initial choice.