Impact of Pedicle Screw Length on Treatment Outcomes in Short-Segment Fixation Incorporating the Fractured Vertebra for Elderly Thoracolumbar Fractures

LI Peng; CUI Junzhi

doi:10.3639/j.issn.2095-3097.2025.06.018

Abstract：Objective To analyze the safety and effectiveness of using different types of vertebral fixation with screws for the treatment of thoracolumbar vertebral fractures in elderly patients.Method A prospective randomized controlled study design was adopted.A total of 92 elderly patients with thoracolumbar fractures admitted to Ankang People's Hospital from March 2019 to February 2023 were included.They were divided into a short screw group comprising 48 cases using 30-35 mm screws and a long screw group comprising 44 cases using 40-45 mm screws by the random number table method.The perioper-ative conditions of the two groups(operation time,incision length,intraoperative blood loss,radiation exposure time,postoper-ative drainage volume,hospital stay),and functional indicators(walking time,full weight-bearing time,VAS score at 3 months and 1 year after the operation,ODI score,ASIA neurological function rating),imaging indicators(the ratio of the anterior height of the injured vertebrae,the loss rate of the anterior height of the injured vertebrae,and the kyphosis Cobb Angle of the injured vertebrae),and adverse reactions were compared.Results There was no statistically significant difference in perioperative indicators between the short screw placement group and the long screw placement group(P>0.05).The walking time and full weight-bearing time of patients in the short screw placement group were both shorter than those in the long screw placement group(P<0.05).At 3 months and 1 year after the operation,the improvement in ASIA rating,VAS score and ODI score,etc.in the short screw group was better than that in the long screw group(P<0.05).The improvement in imaging indicators such as the anterior height ratio of the injured vertebrae,the loss rate of the anterior height of the injured vertebrae,and the kyphotic Cobb Angle of the injured vertebrae in the short screw placement group was better than that in the long screw placement group(P<0.05).The incidence of adverse reactions in the short screw placement group was 6.25%,which was lower than that in the long screw placement group(11.36%).However,there was no statistically significant difference between the two groups(P>0.05).Conclusion In the treatment of thoracolumbar fractures in the elderly with vertebral screw placement,short screws can effec-tively promote the recovery of spinal function,improve the imaging manifestations of fracture healing,and possess relatively high safety.It is recommended to give priority to their use in clinical practice.