Design and clinical application of a new extracorporeal reduction device for percutaneous pedicle screw fixation in treatment of thoracolumbar fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZOU Wei , XIAO Jie , LONG Hao , HE Hui , WU Chen , FENG Mingxing , ZHOU Changjun

Department of Spine Surgery, the Fourth People’s Hospital of Guiyang, Guiyang Guizhou, 550002, P.R.China;

Corresponding?author：

ZOU Wei, Email: zw8765019@163.com

Keywords：

Thoracolumbar fracture; minimally invasive technique; fracture reduction; internal fixation; new reduction device

DOI：

10.7507/1002-1892.201608117

Video：

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Objective To design a new extracorporeal reduction device for percutaneous pedicle screw fixation of thoracolumbar fractures (short for “new reduction device”), and to evaluate its effectiveness. Methods According to the mechanism of thoracolumbar fractures and biomechanics characteristic of reduction, a new reduction device was designed and used in a combination with long U-shaped hollow pedicle screw system. Between January 2014 and January 2016, 36 patients (group A) with single segment thoracolumbar fracture without neurological complications underwent percutaneous pedicle screw fixation, and the clinical data were compared with those of another 39 patients (group B) with thoracolumbar fracture underwent traditional open pedicle screw fixation. There was no significant difference in gender, age, cause of injury, classification of fractures, segments of fractures, injury to operation interval, height percentage of injury vertebrae, and kyphotic angle between 2 groups (P>0.05). The 2 groups were compared in terms of operation time, length of incision, intraoperative blood loss, drainage volume, visual analogue scale (VAS) at postoperative 24 hours, fluoroscopy frequency, ambulation time, height percentage of injury vertebrae, kyphotic angle and correction. Results Group A was significantly better than group B in the operation time, length of incision, intraoperative blood loss, drainage volume, VAS score at postoperative 24 hours, and ambulation time (P<0.05). However, fluoroscopy frequency of group B was significantly less than that of group A (P<0.05). All patients were followed up 11.2 months on average (range, 7-15 months). There was no intraoperative and postoperative complications of iatrogenic nerve injury, infection, breakage of internal fixation. Mild pulling-out of pedicle screws occurred in 1 case of group A during operation. The kyphotic angle and height percentage of the fractured vertebral body were significantly improved at 3 days after operation when compared with preoperative ones (P<0.05), but no significant difference was found between 2 groups at 3 days after operation (P>0.05). Conclusion Minimally invasive extracorporeal reduction device for percutaneous pedicle screw fixation is an effective and safe treatment of thoracic vertebrae and lumbar vertebrae fractures, because of little trauma, less bleeding, and quicker recovery.

Citation： ZOUWei, XIAOJie, LONGHao, HEHui, WUChen, FENGMingxing, ZHOUChangjun. Design and clinical application of a new extracorporeal reduction device for percutaneous pedicle screw fixation in treatment of thoracolumbar fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(1): 66-72. doi: 10.7507/1002-1892.201608117 Copy

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2.	Assaker R. Minimal access spinal technologies: state-of-the-art, indications, and techniques. Joint Bone Spine, 2004, 71(6): 459-469.
3.	Lee ST, Chen JF. Closed reduction vertebroplastry for the treatment of osteoporosis vertebral compression fracture. J Neurosurg, 2004, 100(4 Suppl Spine): 392-396.
4.	Mathews HH, Long BH. Endoscopy assisted percutaneous anterior interbody fusion with subcutaneous suprafascial internal fixation: evolution of technique and surgical considerations. Orthop Int ED, 1995, 3(6): 496-500.
5.	Kim DY, Lee SH, Chung SK, et al. Comparison of multifidus muscle atrophy and trunk extension muscle strenhth: percutaneous versus open pedicle screw fixation. Spine (Phila Pa 1976), 2005, 30(1): 123-129.
6.	Palmisani M, Gasbarrini A, Brodano GB, et al. Minimally invasive percutaneous fixation in the treatment of thoracic and lumbar spine fractures. Eur Spine J, 2009, 18 Suppl 1: 71-74.
7.	Ni WF, Huang YX, Chi YL, et al. Percutaneous pedicle screw fixation for neurological intact thoracolumbar burst fractures. J Spinal Disord Tech, 2010, 23(8): 530-537.
8.	Blondel B, Fuentes S, Pech-Gourg G, et al. Percutaneous management of thoracolumbar burst fractures: Evolution of techniques and strategy. Orthop Traumatol Surg Res, 2011, 97(5): 527-532.
9.	Prokop A, L?hlein F, Chmielnicki M, et al. Minimally invasive percutaneous instrumentation for spine fractures. Unfallchirurg, 2009, 112(7): 621-624, 626-628.
10.	王洪偉, 李長青, 周躍, 等. 微創與傳統開放附加傷椎經椎弓根螺釘內固定手術治療胸腰椎骨折的療效比較. 中國脊柱脊髓雜志, 2010, 20(2): 112-116.
11.	李長青, 羅剛, 周躍, 等. 新型微創經皮椎弓根螺釘內固定治療胸腰椎骨折. 中華創傷雜志, 2009, 25(6): 522-525.
12.	Gelb D, Ludwig S, Karp JE, et al. Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation. J Spinal Disord Tech, 2010, 23(5): 293-301.
13.	Wang HW, Li CQ, Zhou Y, et al. Percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system: an analysis of 38 cases. Chin J Traumatol, 2010, 13(3): 137-145.
14.	王建, 周躍, 初同偉, 等. 經皮椎弓根螺釘固定治療無神經損傷胸腰椎骨折. 中華創傷雜志, 2009, 25(3): 223-226.
15.	王春, 陳少堅. 經皮長U形空心椎弓根釘系統治療胸腰椎骨折的生物力學研究. 中華創傷骨科雜志, 2012, 14(7): 595-598.
16.	周英杰, 王許可, 趙剛, 等. 經皮自旋轉撐開椎弓根螺釘系統治療胸腰椎骨折. 中華創傷雜志, 2015, 31(5): 412-417.
17.	劉繼軍, 王欣文, 郝定均, 等. 微創自撐開釘與開放椎弓根螺釘內固定治療胸腰椎骨折的療效比較. 中華創傷骨科雜, 2014, 16(3): 208-211.
18.	Adams MA, Hutton WC, Stott JR. The resistance to flexion of the lumbar intervertebral joint. Spine (Phila Pa 1976), 1980, 5(3): 245-253.
19.	Mahar A, Kim C, Wedemeyer M, et al. Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine (Phila Pa 1976), 2007, 32(14): 1503-1507.
20.	袁強, 田偉, 張貴林, 等. 骨折椎垂直應力螺釘在胸腰椎骨折中的應用. 中華骨科雜志, 2006, 26(4): 217-222.
21.	王洪偉, 周躍, 李長青, 等. 經皮椎弓根螺釘內固定治療胸腰椎骨折的生物力學及臨床研究. 中華骨科雜志, 2011, 31(9): 932-937.
22.	李方財, 陳其昕, 陳維善, 等. 經皮椎弓根螺釘內固定結合椎體內植骨治療胸腰椎骨折. 中華骨科雜志, 2011, 31(10): 1066-1071.

1. ?Rampersaud YR, Annand N, Dekutoski MB. Use of Minimally Invasive Surgical Techniques in the Management of Thoracolumbar Trauma: Current Concepts. Spine (Phila Pa 1976), 2006, 31(11 Suppl): S96-102, 104.
2. Assaker R. Minimal access spinal technologies: state-of-the-art, indications, and techniques. Joint Bone Spine, 2004, 71(6): 459-469.
3. Lee ST, Chen JF. Closed reduction vertebroplastry for the treatment of osteoporosis vertebral compression fracture. J Neurosurg, 2004, 100(4 Suppl Spine): 392-396.
4. Mathews HH, Long BH. Endoscopy assisted percutaneous anterior interbody fusion with subcutaneous suprafascial internal fixation: evolution of technique and surgical considerations. Orthop Int ED, 1995, 3(6): 496-500.
5. Kim DY, Lee SH, Chung SK, et al. Comparison of multifidus muscle atrophy and trunk extension muscle strenhth: percutaneous versus open pedicle screw fixation. Spine (Phila Pa 1976), 2005, 30(1): 123-129.
6. Palmisani M, Gasbarrini A, Brodano GB, et al. Minimally invasive percutaneous fixation in the treatment of thoracic and lumbar spine fractures. Eur Spine J, 2009, 18 Suppl 1: 71-74.
7. Ni WF, Huang YX, Chi YL, et al. Percutaneous pedicle screw fixation for neurological intact thoracolumbar burst fractures. J Spinal Disord Tech, 2010, 23(8): 530-537.
8. Blondel B, Fuentes S, Pech-Gourg G, et al. Percutaneous management of thoracolumbar burst fractures: Evolution of techniques and strategy. Orthop Traumatol Surg Res, 2011, 97(5): 527-532.
9. Prokop A, L?hlein F, Chmielnicki M, et al. Minimally invasive percutaneous instrumentation for spine fractures. Unfallchirurg, 2009, 112(7): 621-624, 626-628.
10. 王洪偉, 李長青, 周躍, 等. 微創與傳統開放附加傷椎經椎弓根螺釘內固定手術治療胸腰椎骨折的療效比較. 中國脊柱脊髓雜志, 2010, 20(2): 112-116.
11. 李長青, 羅剛, 周躍, 等. 新型微創經皮椎弓根螺釘內固定治療胸腰椎骨折. 中華創傷雜志, 2009, 25(6): 522-525.
12. Gelb D, Ludwig S, Karp JE, et al. Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation. J Spinal Disord Tech, 2010, 23(5): 293-301.
13. Wang HW, Li CQ, Zhou Y, et al. Percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system: an analysis of 38 cases. Chin J Traumatol, 2010, 13(3): 137-145.
14. 王建, 周躍, 初同偉, 等. 經皮椎弓根螺釘固定治療無神經損傷胸腰椎骨折. 中華創傷雜志, 2009, 25(3): 223-226.
15. 王春, 陳少堅. 經皮長U形空心椎弓根釘系統治療胸腰椎骨折的生物力學研究. 中華創傷骨科雜志, 2012, 14(7): 595-598.
16. 周英杰, 王許可, 趙剛, 等. 經皮自旋轉撐開椎弓根螺釘系統治療胸腰椎骨折. 中華創傷雜志, 2015, 31(5): 412-417.
17. 劉繼軍, 王欣文, 郝定均, 等. 微創自撐開釘與開放椎弓根螺釘內固定治療胸腰椎骨折的療效比較. 中華創傷骨科雜, 2014, 16(3): 208-211.
18. Adams MA, Hutton WC, Stott JR. The resistance to flexion of the lumbar intervertebral joint. Spine (Phila Pa 1976), 1980, 5(3): 245-253.
19. Mahar A, Kim C, Wedemeyer M, et al. Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine (Phila Pa 1976), 2007, 32(14): 1503-1507.
20. 袁強, 田偉, 張貴林, 等. 骨折椎垂直應力螺釘在胸腰椎骨折中的應用. 中華骨科雜志, 2006, 26(4): 217-222.
21. 王洪偉, 周躍, 李長青, 等. 經皮椎弓根螺釘內固定治療胸腰椎骨折的生物力學及臨床研究. 中華骨科雜志, 2011, 31(9): 932-937.
22. 李方財, 陳其昕, 陳維善, 等. 經皮椎弓根螺釘內固定結合椎體內植骨治療胸腰椎骨折. 中華骨科雜志, 2011, 31(10): 1066-1071.

Chinese Journal of Reparative and Reconstructive Surgery

Design and clinical application of a new extracorporeal reduction device for percutaneous pedicle screw fixation in treatment of thoracolumbar fractures

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