Clinical Efficacy Analysis Of Percutaneous Short Segment Fixation With Versus Without Screw Placement In Injury Vertebra In The Treatment Of Thoracolumbar Burst Fractures

Objective:The short segment pedicle screw technique has been widely used for the treatment of thoracolumbar burst fractures,but the placement of with versus without screw placement in injury vertebra is still controversial.The purpose of this study was to compare the application and clinical efficacy of two different percutaneous short-segment pedicle screw internal fixation techniques,with versus without screw placement in injury vertebra,in the treatment of thoracolumbar burst fractures.Methods:Fifty-nine patients with thoracolumbar burst fractures admitted to our hospital from January 2017 to December 2019 were divided into the PSSPF group(percutaneous short-segment pedicle screw fixation,n=29)and the PPSSF group(Percutaneous pedicle screws combined with screw fixation,n=30).According to the AO fracture system classification,all patients had fracture types of thoracolumbar burst fractures without neurological impairment.Patients were evaluated according to their age,sex,cause of injury,fracture segment,and LSC score.The two groups of patients were compared in terms of operative time,bleeding volume(intraoperative blood loss + postoperative bleeding),hospital days,perioperative complications,postoperative height correction rate of the injured spine and postoperative Cobb angle correction rate,corrected height loss rate of the injured spine at 12 months after surgery and correction loss rate at 12 months after surgery,The Oswestry Disability Index(ODI)and VAS scores preoperatively and postoperatively at 1 week,3 months and 1 year.Postoperatively,all patients were followed up for fracture healing and any cases of internal fixation failure,and the collected data were statistically analyzed.Results:There were no statistically significant differences between the two groups in terms of gender(P=0.926),age(P=0.701),time since injury until surgery(P=0.318),cause of injury(P=0.979),fracture segment(P=0.875)and LSC score(P=0.586)(P>0.05).There were no statistically significant differences between the two groups in terms of mean operative time(P=0.494),mean bleeding(P=0.381),length of hospital stay(P=0.082),and postoperative complications(P=0.241)(P>0.05).Postoperative height correction rate of the injured spine(P=0.756)and postoperative Cobb angle correction rate(P=0.921)were not statistically significant in the two groups of patients(P>0.05).The corrected height loss rate of the injured spine at 12 months after surgery(P<0.001)and the rate of loss of Cobb angle correction of the injured spine at 12 months(P<0.001)were statistically significant compared between the two groups of patients(P<0.05).ODI scores : no statistical significance(P>0.05)in the 2 groups compared to preoperatively(P=0.756),1 week(P=0.630),3 months(P=0.862)and 1 year(P=0.214)postoperatively.VAS scores: no statistical significance(P>0.05)in the 2 groups compared to preoperatively(P=0.727),1 week(P=0.316),3 months(P=0.905)and 1year(P=0.239)postoperatively.The ODI and VAS scores were statistically significantly lower at 1 week,3 months,and 1 year postoperatively compared to preoperatively within the 2 groups(P <0.05).Conclusion:Percutaneous short-segment pedicle screw internal fixation for thoracolumbar burst fractures is clinically effective with and without screw placement in injury vertebra,but screw placement in injury vertebra is better than without screw placement in injury vertebra in restoring postoperative vertebral height,reducing postoperative loss of vertebral height,and maintaining correction.Meanwhile,the percutaneous short segment fixation technique has the advantages of less trauma,less bleeding,less damage to the paravertebral muscles and faster recovery,which is a surgical method worth promoting for the treatment of thoracolumbar burst fractures.