| Objective:Short-segment transpedicular screw fixation is a common method for the treatment of thoracolumbar burst fractures(TBFs),but this technique has the following problems:Insufficient reduction;The formation of"cavity-like vertebral bodies"and lack of bone graft support.Therefore,the purpose of this study is to design a novel transpedicular reducer,which can reduce the injured vertebra through minimally invasive pedicle channels and after the reducer exits the injured vertebrae,bone grafts can be performed on the"cavity-like vertebrae".In addition,observe and evaluate the treatment of TBFs with the novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation.Methods:1.Development of a novel transpedicular reducer for vertebral fractures that can open and reduce injured vertebrae:(1)Measure the vertebral data of 32 patients with TBFs single vertebral body(T11～L2 segment),including the transverse and sagittal diameters of the narrowest part of the inner diameter of the pedicle,the mid-height of the injured vertebrae,the mid-height of the injured vertebrae after screw fixation,and the difference between the mid-height of the injured vertebra after the operation and the preoperative value.The main parameters are the transverse and sagittal diameters of the narrowest part of the inner diameter of the pedicle and the height difference before and after reduction of the injured vertebra.(2)Refer to the above-mentioned main parameters and adopt CAD software to design a kind of adjustability that can pass the narrowest part of the pedicle inner diameter in the closed state,and the expansion height is greater than the required height of the fractured vertebral body.The reducer also elaborates on the composition and principle of use of this novel transpedicular reducer.Combining the above information,entrust Baiyide Medical Device Company to process the products.2.From July 2018 to November 2020,70 cases of TBFs were included.Thirty-five patients were treated with the novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation(observation group),and 35 patients were treated with short-segment transpedicular screw fixation(control group).Before the operation,after reduction,and 3 days,3 months,and 12 months after the operation,the two groups were assessed,and compared with respect to the anterior and middle heights of the injured vertebrae,the ratios of the anterior and middle heights of the injured vertebral body to the respective heights of the adjacent uninjured vertebral bodies(AVBHr and MVBHr,respectively),and the Cobb angle of the patients.12 months after surgery,VAS score and quality of life GQOL-74 score were used to evaluate pain and quality of life,and CT to evaluate bone healing.Results:1.The transverse diameter of the narrowest part of the pedicle diameter at the T11～L2 segment is 6.58-7.48mm,with an average of 7.10mm,and the sagittal diameter is11.39-16.04 mm,with an average of 14.16mm.The height difference of the vertebral body before and after the reduction of burst fracture was 5.66±1.75 mm～6.04±1.97 mm.(2)The finished product of the new type of transpedicular reducer has a side length of 5.0mm in the closed state,a height of 13.0mm at the maximum expansion,and an expansion range of 8.0mm.2.The anterior heights of the observation group before operation,after reduction,3 days,3 months and 12 months after operation were respectively:20.56±3.74mm,29.53±2.53mm,29.88±2.52mm,28.36±1.93mm and 27.96±0.72mm.The middle heights were respectively:20.36±4.20mm,27.54±1.00mm,27.70±2.01mm,27.05±2.45mm and26.83±2.45mm.AVBHr were respectively:63.09±8.91%,97.22±7.38%,97.54±5.08%,96.46±3.87%and 94.89±4.21%.HVBHr were respectively:68.97±8.43%,97.34±4.85%,97.40±6.11%,96.05±5.21%and93.11±3.22%.Cobb angles were respectively:11.80±1.44°,2.46±1.00°,2.72±0.70°,3.03±0.65°and 4.34±0.56°.It can be seen that the parameters of the observation group in each time period after the operation were compared with the corresponding parameters before the operation,and they were all improved,and the difference was statistically significant(P<0.05).The anterior heights of the control group before operation,after reduction,3 days,3 months and 12 months after operation were20.70±4.57mm,28.32±3.18mm,28.5±5.09mm,27.03±1.43mm and 23.7±0.66mm,respectively.The middle heights were:19.36±3.06mm,26.43±2.03mm,26.56±4.56mm,24.12±3.23mm and 22.45±2.57mm.AVBHr were respectively:63.76±4.68%,93.31±2.75%,93.06±3.57%,85.64±3.23%and 82.77±4.97%.HVBHr were respectively:64.91±4.84%,89.15±3.57%,89.13±4.5%,77.95±5.67%and 74.8±3.68%.Cobb angles were respectively:11.84±1.78°,3.59±1.03°,3.65±0.69°,4.68±0.23°and 7.89±1.24°.It can be seen that the parameter values of the observation group at different time periods after surgery were better than the parameter values of the control group at the corresponding time(P<0.05).The VAS score of the observation group was lower than that of the control group at 12months after operation(P<0.05),but the difference in GQOL-74 scores between the two groups was not statistically significant(P>0.05).CT showed good bone healing in the observation group at 12 months postoperatively,and no obvious bone defects were found.Conclusion:1.The nnovel transpedicular reducer can be safely implanted through the pedicle channel and the injured vertebrae can be reset,providing uniform mechanical support and self-regulation of the reset height.After the reducer exits the injured vertebrae,bone grafts can be performed on the"cavity-like vertebrae,which meets the basic requirements of minimally invasive surgical treatment of TBFs.2.The novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation for TBFs has good clinical efficacy. |
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