Clinical Analysis Of Percutaneous Fixation Combined Monoaxial With Polyaxial Pedicle Screws In The Treatment Of Thoracolumbar Fractures

Objective: Short-term clinical analysis of percutaneous fixation combined monoaxial and polyaxial pedicle screws in the treatment of thoracolumbar fractures.Methods: A retrospective analysis was made of 65 patients with thoracolumbar single-segment fracture and without neurological impairment who were admitted to the orthopaedic department of the Fourth Affiliated Hospital of China Medical University from September 2016 to June 2018.All patients received minimally invasive pedicle screw fixation and were divided into observation group and control group.The observation group consisted of 31 cases,treated with 2 monoaxial pedicle screws into the superior fractured vertebre,and 4 polyaxial pedicle screws into the fractured and the inferior vertebre.In the control group,34 cases were fixed with 6 polyaxial pedicle screws.The perioperative parameters(operative time,intraoperative blood loss,hospitalization time,etc.)(SCA),Vertebral Body Angle(VBA),and Sagittal Index(Sagittal Index),SI)changes were used to assess the ability to correct spinal deformity and maintain correctiveness with different pedicle screw fixation;Application of Visual Analogue Scale(VAS)and Oswestry dysfunction index Oswestry Disability Index,ODI)were compared the surgical outcomes.Results:(1)There was no significant difference in gender,age,Body Mass Index(BMI),fracture segment and classification,operation time,intraoperative blood loss,hospital stay and follow-up time between the two groups(P > 0.05).(2)The correction of AVBH,SCA,VBA and SI in the observation group were 30.3%±9.4%,10.3°±5.6°,12.4°±5.7°and 14.5°±7.4°,respectively.and the control group were 22.8%±11.6%,7.1°±5.6°,7.6°±5.3°and 9.6°±6.5°,respectively.There was a significant difference between the two groups(P< 0.05);(3)The correction loss of AVBH,SCA,VBA and SI in the observation group: 3.1%±2.0%,2.1°±1.9°,3.1°±1.8°and 2.2°±1.5°,respectively,statistically significant with the control group(6.8%±4.1%,3.3°±2.3°,4.7°±3.0°and 4.1°±2.4°,respectively)(P<0.05).(4)There was no significant difference in the VAS and ODI scores between the two groups(P>0.05).(5)There was one internal fixation loosening case(1 monoaxial pedicle screw)in the observation group and one internal fixation breaking case(2 polyaxial pedicle screws)in the control group,and there was no significant difference in postoperative complications between the two groups.(P > 0.05)Conclusions: Combination of monoaxial and polyaxial pedicle screw internal fixation and all application of polyaxial pedicle screw internal fixation for the treatment of thoracolumbar spine fracture can significantly improve clinical symptoms and promote functional rehabilitation,but the former has better correction of deformity and maintenance of orthopedic outcomes.