The Clinical Research Of Percutaneous Pedicle Fixation To Treat Thoracolumbar Fractures

Objective: This topic screened 12 cases of thoracolumbar fractures patients since June 2012-June 2014 who were treated by percutaneous pedicle in our hospital, and compared with the same period treated 15 cases by open reduction and internal fixation. By observing this aspects(1) the bleeding of operation, Perioperative parameter: operation time, speeding of hospitalization; 2)postoperative imaging index: anterior vertebra height and Cobb,s angle between per and post operation;(3)pian of postoperation(VAS scores) after half a year,and so on to evaluate the surgical method, providing a reference for a way to improve clinical treatment of thoracolumbar fractures surgery, and exploring the issues related to the treatment of thoracolumbar fractures.Methods: 27 cases of thoracolumbar fractures patients in the subjects were all treated in Hebei Medical University Third Hospital period from June 2012- June 2014, all patients were fresh closed fractures and no obvious neurological symptoms. Fractures category : simple wedge compression fracture in 20 cases, blowout fracture in 5 cases and Chance fracture in 2. The percutaneous pedicle fixation group of 12 patients were treated by minimally invasive surgery with fixation of percutaneous pedicle, include simple wedge compression fracture in 9 cases,blowout fracture in 2 cases and Chance fracture in 1; The open reduction and internal fixation group of 15 patients were treated by spinal posterior open reduction and internal fixation, include simple wedge compression fracture in 11 cases,blowout fracture in 3 cases and Chance fracture in 1.Surgical methods: ①The percutaneous pedicle fixation group: Patients in prone position,An assistant filed patients lower limbs to clinch a deal with the ground about 45 °, traction over backwards,another aide in the patient’s head, hands from armpits do against tractionat the same time,Surgery patients who pressed vertebral spinous process, until the surgeon feels vertebra spinous process with the other vertebral spinous process at the same level.Type C arm fluoroscopy visible after reset is satisfied,local infiltration anesthesia after the injury vertebral upper and lower vertebral body positioning,next to the vertebral body at 4cm to open a small hole about 2cm, fluoroscopy-guided needle puncture to the pedicle anchor points, namely "C" type arm anteroposterior projection under the "eyes" of the center of the outer edge. through the puncture needle positioning one by one through the incision catheter dilator,after using countersink drill grinding bone, with hollow tapping expand nails,then screwed into the hollow needle puncture through the pedicle screw positioning.Then the same method to the other three hollow nail pedicle screw in turn into the injured vertebra adjacent vertebral pedicle,Under the C arm fluoroscopy to confirm the location of the pedicle screw are in good condition.with a special rod will penetrate corresponding length corresponding pedicle screw fixation rod joints up and down the tunnel incision deep muscle, then Stretched the injured vertebra,C-arm fluoroscopy Stretched see good results after restoration of vertebral height, kyphosis Cobb, s corner restored, then fixed,at last,rinse the wound sutured The open reduction and internal ②fixation group : Patients in prone position,After anesthesia satisfaction,the traditional approach, injured vertebral centered about 10 cm after a long midline incision.In turn, cut the skin, subcutaneous tissue and the deep fascia,then Stripped down both sides of the adjacent vertebral and vertebral paraspinal muscles, revealing the adjacent sides of the upper and lower vertebrae facet and transverse, according to the injury of the vertebral fracture location choosing appropriate into points and dip Angle, then followed by screwing four pedicle screw, install two pre-bent connecting rod, fixed after Stretched.then See vertebral height and kyphosis satisfaction at C-arm fluoroscopy Cobb, s corner after restoration, wash the wound sutured.All patients were followed up after surgery, observed and recorded :(1) Perioperative parameter:the bleeding of operation,operation time,speeding of hospitalization.;(2)postoperative imaging index: anterior vertebra height and Cobb,s angle between per and post operation;(3)pian of postoperation(VAS scores) after half a year,and so on. Applicating statisticl software SPSS13.0 to statistical analysis, Measurement data were presented as mean ± standard deviation(± s), said the two groups were compared using the t test, and P <0.05 was considered statistically significant, as there are significant differences P <0.05 note, comparing the advantages and disadvantages of the two surgical methods.Results: All subjects were followed up for 6 to 18 months, an average of 12 months. During follow-up, the incision of all patients were all first division healed; The percutaneous pedicle fixation group and the open reduction and internal fixation group were all reached clinical healing.No difference between the two groups of patients with operation time,however, blood loss, hospital stay and postoperative pain scores six months(VAS) percutaneous pedicle screw fixation group was significantly lower than ORIF group;There are significant differences between the two groups of patients before surgery and postoperative radiographic indicators such as vertebral height and kyphosis Cobb, s angle index contrast,but after comparing two groups of patients radiographic index was no significant difference.Conclusion: Percutaneous pedicle fixation of thoracolumbar fracture small incision, less trauma, reducing the soft tissue damage and less bleeding, shorter hospital stay, a safe and effective surgical method.