Minimally Invasive Percutaneous Pedicle Screw Fixation In The Treatment Of Thoracolumbar Fractures Without Spinal Cord Nerve Injury

Objective To investigate the clinical effect of minimally invasive percutaneous pedicle screw fixation for thoracolumbar fractures without spinal cord nerve injury.Methods A retrospective analysis was performed on 73 patients admitted to the spine surgery department of nanning second people's hospital for thoracolumbar fracture(t11-l2)between August 2016 and August 2017,including 45 males and 28 females.The average age was 44.5 years(16 ~ 61years).Among them,38 were road traffic injuries.The time from injury to surgery was 1-8(mean 2.4)d.According to the latest AO thoracolumbar injury classification system,there were 5 cases of A1 type,9 cases of A2 type,36 cases of A3 type and 23 cases of A4 type.The load-sharing score is 4 to 7(average4.9).Minimally invasive percutaneous(percutaneous group,35 cases)and open(open group,38 cases)pedicle screws were used to fix the injured vertebrae.Incision length,operation time,blood loss,intraoperative fluoroscopy frequency,serum creatine kinase level change,postoperative pain score,vertebral height recovery,postoperative ODI score and other indicators were compared betweenthe two groups.Results The mean follow-up was 13 months(12 to 16 months).Compared with the open group,the percutaneous group had less blood loss [(70.3 10.7)ml vs.(103.0 12.1)ml],shorter operative time(87.8 10.2)min vs.(108.2 4.23)min),and less incision pain on the first day after surgery(VAS score 3.61 1.25 vs.5.841.36),while the open group had less intraoperative fluoroscopy [(7.1 0.5)vs.17.2 0.7)].The difference between the two groups was statistically significant(P< 0.05),while the difference between the two groups in incision length and postoperative ODI score was not statistically significant(P > 0.05).Compared with the preoperative results,both the anterior vertebral height and the sagittal Cobb Angle of the two groups were significantly corrected immediately after surgery,and the difference was statistically significant(P < 0.05).Compared with the postoperative results,the difference between the anterior vertebral height and the sagittal Cobb Angle of the two groups at the last follow-up was not statistically significant(P > 0.05).Conclusion At present,open and minimally invasive percutaneous pedicle screw fixation is available for thoracolumbar fractures.Open pedicle screw fixation can be thoroughly decompression,doctors learn to master relevant technology faster,but slightly long operation time,blood loss,postoperative pain relief,length of hospital stay,and minimally invasive percutaneous pedicle screw fixation for postoperative patients relieve pain,short operative time,intraoperative bleeding is little,but in medical staff and patients suffer iatrogenic radiation probability is bigger,high fees,but the spine surgery minimally invasive treatment into consideration,is worth to recommend.