经伤椎置入椎弓根螺钉内固定修复胸腰椎骨折的可行性评价

背景：传统修复单椎体胸腰椎骨折常采用跨伤椎4钉固定,由于存在“平行四边形效应”及“悬挂效应”,容易发生内固定失败,复位高度及矫正角度丢失等并发症,而经伤椎椎弓根钉内固定,可避免或减少上述并发症发生。 目的：探讨经伤椎椎弓根螺钉置入内固定修复单椎体胸腰椎骨折的可行性。 方法：回顾性分析兰州大学第一医院骨科2013年1月至2014年6月收治的单节段胸腰椎骨折患者23例,损伤节段为T11-L2,平均年龄47.8岁,所有患者均在受伤后10 d内接受后路伤椎椎弓根螺钉和相邻上下椎椎弓根螺钉6枚螺钉内固定治疗,观察修复效果,包括术后短期并发症、椎体前缘高度比值及后凸Cobb角,以及脊髓神经功能损伤恢复情况。 d内接受后路伤椎椎弓根螺钉和相邻上下椎椎弓根螺钉6枚螺钉内固定治疗,观察修复效果,包括术后短期并发症、椎体前缘高度比值及后凸Cobb角,以及脊髓神经功能损伤恢复情况。 结果与结论：23例患者随访4-15个月,所有病例治疗后短期内(4-15个月)均未出现严重并发症,末次随访未出现钉棒断裂及内固定松动等情况。治疗后及末次随访所测得椎体前缘高度比值及后凸Cobb角均较治疗前明显改善,差异有显著性意义(P < 0.05),两项指标末次随访与治疗后相比稍有反弹,但差异无显著性意义(P > 0.05)。末次随访时大部分患者脊髓神经功能有所恢复。提示经伤椎椎弓根螺钉置入内固定修复单节段胸腰椎骨折,能够有效恢复伤椎高度及矫正后凸畸形,并能保持矫正效果,钉棒断裂发生率低,优势明显。 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

微创与开放方案置入椎弓根螺钉内固定修复胸腰椎骨折

背景：近年来微创技术理念越来越受到重视,一些新的微创方法被运用到脊柱骨折治疗中,对旧的开放式手术治疗方法提出了挑战。 目的：对比观察常规后路开放经伤椎椎弓根螺钉内固定、微创内固定方式(利用Quadrant通道内固定和经皮Sextant内固定)治疗单节段无神经症状胸腰椎骨折的临床疗效。 方法：纳入2012年1月至2013年1月于柳州市工人医院脊柱外科住院并接受内固定修复治疗的94例单节段无神经症状胸腰椎骨折患者,根据患者病情及意愿分为开放内固定组、Quadrant通道内固定组及经皮Sextant内固定组,观察并比较各组患者的围手术期参数、临床疗效及影像学检查指标。 结果与结论：Quadrant通道内固定组、经皮Sextant内固定组在术中出血量、手术切口长度、住院时间方面均优于常规后路开放内固定组(P < 0.05)。94例患者均获得随访,随访时间为6个月,无脱钉、断钉及神经损伤现象。3组伤椎内固定后椎体前缘高度、Cobbs角、矢状位指数与内固定前相比较均有明显改善(P < 0.05),但3组之间比较差异无显著性意义(P > 0.05)。两微创组内固定后目测类比评分、Oswestry功能障碍指数均优于常规开放内固定组(P < 0.05)。提示与传统的开放内固定相比,微创(经皮Sextant内固定及利用Quadrant通道内固定)治疗胸腰椎骨折不仅能取得与之相当的影像学效果,而且具有创伤小、出血少、恢复快、安全性高的优点,有更好的临床疗效。在严格掌握手术适应证情况下,微创方法是治疗无神经损伤胸腰椎骨折的理想选择。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

钴合金椎弓根螺钉植入修复脊柱结核重度后凸畸形：自身对照临床试验方案

BACKGROUND: There is evidence that internal fixation through an anterior or posterior approach for treatment of severe kyphotic deformity in spinal tuberculosis exhibits good curative effects. However, few prospective, long-term follow-up case control studies are reported.     

经皮椎弓根螺钉内固定修复单节段胸腰椎骨折：活动度改善12个月随访

BACKGROUND: Studies have shown that percutaneous pedicle screw internal fixation in repair of single segment of thoracolumbar fracture can overcome quadrilateral effect, get better biomechanical properties, meanwhile, it also can provide three-point fixation, reduce suspension effect, and reduce the formation of kyphosis. OBJECTIVE: To investigate the clinical efficacy and incidence of complications of the percutaneous pedicle screw internal fixation for treatment of single segment thoracolumbar fractures. METHODS: Totally 36 patients with single segment thoracolumbar fractures treated by percutaneous pedicle screw internal fixation were enrolled. A total of 36 vertebral bodies were treated: T11=5, T12=8, L1=17, L2=6. The visual analog scale scores before treatment and at 3, 6 and 12 months after treatment, the Oswestry disability indexes before treatment, at the first week and at the 12th month after treatment, the Cobb angle before treatment, the first day and at the 12th month after treatment were compared and observed. The incidence of complications was recorded. RESULTS AND CONCLUSION: The visual analog scale scores at 3, 6 and 12 months after treatment was significantly lower than those before treatment (P < 0.001). The Oswestry disability indexes before treatment, at the first week and at the 12th month after treatment were significantly lower those that before treatment (P < 0.001).The Cobb angle before treatment, at the first day and at the 12th month after treatment was significantly smaller than that before treatment (P < 0.001). Only three (8%) patients had complications, including pedicle screw penetrating pedicle into the spinal canal, pedicle screws loosing and the infection in puncture site. These results suggest that percutaneous pedicle screw internal fixation for treatment of single segment thoracolumbar fractures can correct kyphosis, improve the thoracolumbar motion, quickly relieve patient’s back pain, and the incidence of complications is low.       

微创经皮与传统开放椎弓根螺钉置入固定胸腰椎骨折的文献荟萃

BACKGROUND: Open reduction pedicle screw fixation for thoracolumbar fracture could obtain satisfactory effects, and has been extensively used. However, it has potential risk during and after repair. Minimally invasive percutaneous pedicle screw technique minimizes the trauma and complications of soft tissue. It remains poorly understood which is better minimally invasive percutaneous or conventional open pedicle screw fixation for the repair of thoracolumbar fracture. OBJECTIVE: To perform quality evaluation and meta-analysis on curative effect and postoperative complications of minimally invasive percutaneous and conventional open pedicle screw fixation in the treatment of thoracolumbar fractures. METHODS: A detailed search of several electronic databases, including Cochrane Library, PubMed, WanFang, CNKI, VIP and CBM, was undertaken. Simultaneously, Chinese Journal of Orthopaedics, Chinese Journal of Orthopaedic Trauma, and Chinese Journal of Trauma were checked by hand to identify controlled trials regarding minimally invasive percutaneous and conventional open pedicle screw fixation in the treatment of thoracolumbar fractures published from inception to 2015, and the references of the included studies were checked. According to inclusion and exclusion criteria, references were screened, data were extracted and quality was evaluated by four investigators independently. Meta-analysis was conducted using RevMan 5.2 software. The quality of references of the included controlled trials was assessed with CONSORT statement and some surgery clinical evaluation indexes. RESULTS AND CONCLUSION: We included 28 studies, including 25 randomized controlled trials/quasi-randomized controlled trials and 3 retrospective comparative studies, with 1 285 patients. Meta-analysis results demonstrated that compared with the conventional open pedicle screw, minimally invasive percutaneous pedicle screw fixation could significantly reduce operation time, blood loss, hospital stays, postoperative complication rate and height loss (P < 0.05). No significant difference in postoperative pain grade was detected between them (P > 0.05). These results indicate that minimally invasive percutaneous pedicle screw fixation for thoracolumbar fracture was safe and reliable, had small trauma, less blood loss, rapid recovery, short hospital stay, and less postoperative complications. Nevertheless, methods and results of most studies are not detailed enough. We suggested reporting randomized controlled trials according to related standards in order to improve the report quality and authenticity of randomized controlled trials.       

经伤椎椎弓根螺钉置入内固定修复胸腰椎骨折：远期效果及生物力学分析

BACKGROUND: Pedicle screw fixation is a common repair method for thoracolumbar fractures. Of them, pedicle screw placement into the injured vertebra is an important method. However, the long-term effects and the related biomechanical properties deserve further analysis. OBJECTIVE: To analyze the long-term effect and biomechanical characteristics of the internal fixation of thoracolumbar fractures by pedicle screw implantation.  METHODS: A retrospective analysis was performed in 126 cases of thoracolumbar fractures. The patients were treated with pedicle screw implantation and the treatment was followed up regularly. Ten specimens of fresh calf chest and lumbar spines were obtained. Five specimens served as an experimental group to prepare models of anterior middle column fractures, and these specimens received pedicle screw fixation into the injured vertebra. The other five specimens served as the control group, and did not receive any treatment. In the two groups, along the sagittal axis, axial compression displacement, anterior flexion displacement, posterior extension displacement, torsion angle and pull-out strength were measured and recorded.  RESULTS AND CONCLUSION: (1) Clinical trial results: 126 patients were followed up for 10-36 months. Compared with pre-treatment, compression ratio of the injured vertebra, the height of intervertebral space, vertebral slip distance, visual analogue score and Cobb angle were significantly improved at 1 month after treatment and during final follow-up (all P < 0.05). No significant difference in above indexed was detected between 1 month and final follow-up (all P > 0.05). At the end of follow-up, Frankel spinal cord injury grade was significantly improved (Z=-4.127, P < 0.05). After operation, three patients suffered from pulmonary infection, four patients affected urinary tract infection, and one patient experienced delayed wound healing. (2) Biomechanical results: axial compression displacement, anterior flexion displacement, posterior extension displacement, torsion angle and pull-out strength were smaller in the experimental group than in the control group (all P > 0.05). (3) Above findings showed that pedicle screw fixation into the injured vertebra for thoracolumbar fractures obtained good long-term effects, and had good biomechanical properties.     

经伤椎置钉与跨节段椎弓根螺钉置入固定修复胸腰椎骨折的Meta分析

背景：临床上胸腰椎骨折越来越多,但对于胸腰椎骨折固定方式存在较多争论,对于采用经伤椎置钉椎弓根螺钉固定还是传统跨节段椎弓根螺钉固定存在不同观点,尚缺乏循证医学支持。 目的：对经伤椎置钉与跨节段椎弓根螺钉固定治疗胸腰椎骨折固定后效果效果的评价。 方法：按照Cochrane系统评价的方法,检索下列数据库：美国国立医学图书馆数据库、中国知网、万方数数据库,维普数据库并手工检索等方法收集会议文献,检索时间为2005年至2015年3月。收集所有随机对照试验,采用Cochrane协作网提供的软件Revman 4.2进行Meta分析。 结果与结论：通过筛选,总共纳入14个临床对照试验共个956例患者。Meta分析结果显示,伤椎置钉组较跨节段组治疗胸腰椎骨折固定后Cobb角度改善明显(OR=-2.72,95%CI：-3.08至-2.35,P < 0.01)。经伤椎置钉组较跨节段组椎体高度矫正率较高(OR=7.45,95%CI：6.94-7.97,P < 0.01)。经伤椎置钉组较跨节段组相比较内固定失败率较低(OR=0.12,95%CI：0.05-0.27,P < 0.01)。结果证实,经伤椎置钉与跨节段椎弓根螺钉固定治疗胸腰椎骨折相比较固定后Cobb角度改善明显,固定后椎体高度纠正明显以及引起内固定失败率等并发症更少,固定效果较好。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程      

经皮椎弓根螺钉内固定并伤椎单侧置钉修复单节段胸腰椎骨折

BACKGROUND: Studies have shown that percutaneous pedicle screw internal fixation for treatment of thoracolumbar fracture has got good clinical results, but for the injured vertebra body, whether pedicle screw should be implanted in injured vertebra body and unilateral or bilateral implanting screw is still controversial.     

经皮微创椎弓根螺钉内固定治疗无神经症状单节段胸腰椎骨折的临床疗效及安全性研究

目的:分析经皮微创椎弓根螺钉内固定治疗无神经症状单节段胸腰椎骨折的临床效果.方法:回顾性分析2018年7月～2020年7月本院治疗的81例无神经症状的单节段胸腰椎骨折患者临床资料,按照治疗方法的差异将其分为研究组(n=43,经皮微创椎弓根螺钉内固定)和对照组(n=38,切开复位椎弓根螺钉内固定).对比两组手术指标、椎体恢复情况及术后并发症.结果:研究组手术切口长度、手术时间、下床活动时间及住院时间短于对照组,且术中出血量及伤口引流量更少(P<0.05);术后两组患者伤椎前缘高度及椎间隙高度较前升高,Cobb氏角较前降低,且研究组患者上述指标改善程度更高(P<0.05);研究组并发症总发生率明显低于对照组(6.99％vs 23.68％,P<0.05).结论:对无神经症状单节段胸腰椎骨折患者予以经皮微创椎弓根螺钉内固定术治疗可显著减轻手术创伤,促进椎体恢复,缩短恢复时间,且安全性更高.     

短节段椎弓根螺钉置入内固定治疗胸腰椎骨折

背景：近年来短节段椎弓根螺钉内固定的使用范围不断扩大,使“脊柱载荷”评分系统的可靠性受到质疑,国内外已有报道肯定了短节段椎弓根螺钉内固定对各型胸腰椎骨折的治疗效果。 目的：观察短节段椎弓根螺钉置入内固定治疗胸腰椎骨折的临床效果。 方法：回顾性分析2007-05/2010-10解放军北京军区总医院骨科收治的胸腰椎骨折患者38例,均经后路短节段椎弓根螺钉内固定治疗。 结果与结论：38例患者均获得随访,随访时间10.3-28.9个月;末次随访平均相对后凸畸形Cobb角9.0°,平均矫正丢失6.3°。A、B、C型骨折末次随访平均矫正丢失分别为6.4°,5.7°,7.4°;脊柱载荷评分≤6分末次随访平均矫正丢失5.7°,脊柱载荷评分≥7分末次随访平均矫正丢失7.5°;胸腰段骨折(T11-L2)和下位腰椎骨折(L3-L5)末次随访平均矫正丢失分别为6.3°,6.5°。11例(30%)矫正丢失大于10°,平均11.5°(10.1°-16.3°),其中A型骨折组4例,B型组4例,C型组3例;脊柱载荷评分≤6分组5例,在脊柱载荷评分≥7分组6例;组间差异均无显著性意义。提示短节段椎弓根螺钉内固定能够有效地治疗胸腰椎骨折患者,不受限于AO骨折分型及脊柱载荷评分,对于治疗胸腰段骨折和下腰椎骨折,疗效基本一致。     

有限元法分析胸腰椎骨折椎弓根钉置入内固定的应力分布

BACKGROUND: Spinal surgery requires a relatively high accuracy. At present, the study of pedicle screw fixation is more focused on the safety and stability, but the premise is the safe and effective screw placement. Selection of the insertion point is the key to success.     

Sextant微创椎弓根螺钉内固定修复老年骨质疏松性脊柱骨折的生物相容性

BACKGROUND: Pedicle screw internal fixation is a commonly used method to treat osteoporotic fracture. Internal fixation can effectively reconstruct vertebral body height, restore physiological curvature, and maintain good spinal stability.     

Viper脊柱微创系统和椎弓根螺钉内固定修复胸腰椎压缩性骨折

BACKGROUND: Thoracolumbar spine as highly concentrated stress, often prone to vertebral fractures. With the further development of the biomechanics and anatomical structure of the spine, posterior open reduction and internal fixation with pedicle screw has been widely accepted by clinicians.     

RTS和SEXTANT经皮微创椎弓根螺钉置入修复不稳定胸腰椎骨折：椎体复位高度比较

BACKGROUND: In recent years, with the development of minimally invasive techniques, the application of percutaneous pedicle screw fixation techniques gradually become widespread, but in the percutaneous pedicle screw fixation for thoracolumbar fractures, due to lack of reduction apparatus or power defect, the reduction of the injured vertebra is poor. In order to improve this deficiency, we design a percutaneous pedicle screw system in order to achieve the desired effect of reduction.     

椎弓根置钉修复胸腰椎骨折合并脊髓损伤：选择性损伤节段及全部固定节段植骨融合的比较

BACKGROUND: Spinal canal decompression is needed in posterior pedicle screw fixation surgery for thoracolumbar burst fractures combine with spinal cord injury. The structure of posterior spine is often damaged. The posterolateral bone fusion in all fixed segment is still the main surgery. In order to further reduce fusion segment and maintain motor unit, it is necessary to perform selective segmental bone graft fusion during fixation and decompression.      

高黏度骨水泥治疗骨质疏松压缩性椎体骨折：前瞻性自身前后对照开放性临床试验方案

BACKGROUND: Traditional bone cement in the treatment of osteoporotic vertebral compression fracture easily induces heat dissipation effect, leakage, big difference in mechanical strength with the surrounding tissue, which greatly affects treatment effect of osteoporotic vertebral compression fracture. This prospective self-controlled open-label clinical trial is designed to analyze the effectiveness of a novel high viscosity bone cement for osteoporotic vertebral compression fractures.     

3D打印模块辅助腰椎弓根微创置钉：自身对照、开放性、2年随访临床试验方案

BACKGROUND: Minimally invasive pedicle screw fixation is an effective treatment for thoracolumbar diseases, but skilled operations are required during the internal fixation. If inaccurate implantation occurs, adverse reactions will appear postoperatively; for example, the implanted screw will fall off. 3D printing can manufacture a suitable implant for a patient, accurately simulate the repair process, and reduce the difficulty and complexity of the operation, aiming to produce an implant that is most suitable for repair surgery.     

椎弓根单向螺钉及万向螺钉置入内固定修复腰椎骨折的生物力学比较

BACKGROUND: Previous studies have performed three-dimensional finite element analysis on lumbar fracture fixation. However, a few studies concerned three-dimensional finite element analysis of lumbar spinal pedicle screw fixation.