The Clinical Study Of The Percutaneous Pedicle Screw Fixation In The Treatment Of Thoracolumbar Fractures Without Neurological Injury

Objective:To evaluate the clinical efficacy of UPASS- Ⅱpercutaneous pedicle screw fixation(UPPSF) in the treatment of thoracolumbar fractures without neurological injury.Methods:We Collected and retrospectively analyzed 32 patients with single segment thoracolumbar fractures without neurological injury, who had been treated with pedicle screw fixation at the Orthopedic Zone 1 of The First Affiliated Hospital of Fujian Medical University from June 2010 to June 2015. UPPSF group:17 patients had been treated with minimally invasive with UPPSF without the fixation of the fractured vertebra. COPSF group: 15 patients had been treated with conventionally open pedicle screw fixation(COPSF) without the fixation of the fractured vertebra. By comparing and analyzing, between the two groups of patients at the perioperative observation records(Operative time, Intraoperative blood loss, Postoperative drainage, Incision size, Postoperative hospital stay), the radiography results(Anterior vertebral height percentage(AVHP), Posterior vertebral height percentage(PVHP), Vertebral body angle(VBA), Sagittal Cobb’s angle(SCA)) and the postoperative complications, to evaluate the clinical efficacy of UPPSF in the treatment of thoracolumbar fractures without neurological injury. The problems encountered in the clinical application and the development trend of UPPSF were discussed and analysis.Results:1. The comparison of the two groups of patients at the age, the time from injury to surgery, the AVHP, PVHP, VBA, SCA, were no significant differences in preoperation(P ﹥ 0.05). The mean follow-up time of UPPSF group: 16.6±4.3months, the mean follow-up time of COPSF group: 18.5±5.0months,the difference of the mean follow-up time of the two groups was not statistically significant(P﹥0.05).2. There were significant differences in the Operative time, Intraoperative blood loss, Postoperative drainage, Incision size, Postoperative hospital stay between UPPSF group and COPSF group(P﹤0.01).3.Each group compared to itself between preoperation and postoperation, the AVHP, PVHP, VBA, SCA were all significantly different(P﹤0.01). The comparison of the two groups of patients at the AVHP, PVHP, VBA, SCA, were no significant differences in postoperation(P ﹥ 0.05). The comparison of the two groups of patients at the AVHP, PVHP, VBA, SCA, were also no significant differences in last follow-up(P﹥0.05).4. COPSF group had 2 patients incision swelling in postoperative, the incision healed by enhancing dressing. 1 patient of COPSF group occurred screw loosening, screw back. 1 patient of COPSF group had lower back stiff feeling, chronic pain.Conclusion:1. Compared with COPSF, UPPSF in the treatment of thoracolumbar fractures without neurological injury had a simple operation, safe and reliable, less trauma, less bleeding, quicker recovery and shorter postoperative hospital stay and so on.2. UPPSF reset injured vertebrae, maintained vertebral height, corrected SCA and VBA, which had reached the level of COPS, no difference in efficacy between the two groups in middle-term follow-up.3. UPPSF had less damage to paraspinal muscles, the posterior longitudinal ligament complex and so on. The spinal column had better coordination, balance, and power stability. Compared with COPSF, UPPSF had less complications, such as screw loosening, screw back, screw breakage, back stiff feeling, chronic pain and so on.