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Han Y, Ma J, Zhang G, Huang L, Kang H. Percutaneous monoplanar screws versus hybrid fixed axial and polyaxial screws in intermediate screw fixation for traumatic thoracolumbar burst fractures: a case-control study. J Orthop Surg Res 2024; 19:85. [PMID: 38254136 PMCID: PMC10801944 DOI: 10.1186/s13018-024-04547-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND To compare the clinical and radiological outcomes of monoplanar screws (MSs) versus hybrid fixed axial and polyaxial screws (HSs) in percutaneous short-segment intermediate screw fixation (PSISF) for traumatic thoracolumbar burst fractures (TTBFs) in patients without neurologic impairment. METHODS A consecutive series of 100 patients with single-segment TTBFs and no neurologic impairment who underwent PSISF with 6 monoplanar screws (MS group) or correct were retrospectively enrolled. The demographic data, radiologic evaluation indicators, perioperative indicators and clinical assessment indicators were analysed between the MS group and HS group. RESULTS The demographic data and perioperative indicators were not significantly different in the two groups (P > 0.05). The postoperative anterior vertebral height ratio (AVHR), kyphosis Cobb angle (KCA), vertebral wedge angle (VWA) and spinal canal encroachment rate (SCER) were significantly improved in both groups (*P < 0.05). The MS group obtained better correction than the HS group in terms of improvement in the AVHR, KCA and VWA after surgery (*P < 0.05). At the last follow-up, the MS group had less correction loss of AVHR, KCA and VWA (*P < 0.05). The MS group presented greater improvement in the SCER at the last follow-up (*P < 0.05). The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) score of all patients were significantly better postoperatively than those preoperatively (*P < 0.05), and the scores collected at each follow-up visit did not differ significantly between the two groups (P > 0.05). In the MS group, no internal fixation failure was observed during the follow-up period, but, in the HS group, two cases of internal fixation failure were observed at the last follow-up (one case of rod loosening and one case of screw breakage). CONCLUSIONS Both MSs and HSs fixation are effective treatments for TTBFs and have comparable clinical outcomes. In contrast, MSs fixation can improve the correction effect, better improve the SCER, and further reduce correction loss as well as reduce the incidence of instrumentation failure. Therefore, MSs fixation might be a better option for treating TTBFs in patients without neurological deficits.
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Affiliation(s)
- Yaozheng Han
- Medical College, Wuhan University of Science and Technology, Wuhan, 430065, Hubei, China
| | - Jun Ma
- Department of Orthopaedic, General Hospital of Central Theater Command, Wuhan, 430070, Hubei, China
| | - Guoquan Zhang
- Medical College, Hubei University of Medicine, Shiyan, 442000, Hubei, China
| | - Liangliang Huang
- Department of Orthopaedic, General Hospital of Central Theater Command, Wuhan, 430070, Hubei, China.
| | - Hui Kang
- Department of Orthopaedic, General Hospital of Central Theater Command, Wuhan, 430070, Hubei, China.
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Ye B, Ye Z, Yan M, Huang P, Tu Z, Wang Z, Luo Z, Hu X. Effection of monoplanar pedicle screw on facet joint degeneration in thoracolumbar vertebral fractures. BMC Musculoskelet Disord 2022; 23:407. [PMID: 35490240 PMCID: PMC9055697 DOI: 10.1186/s12891-022-05360-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background This study aimed to compare the clinical outcomes and effect on instrument-related facet joints between fixed-axis pedicle screw (FAPS) and monoplanar pedicle screw (MPPS). Methods 816 pedicle screws of 204 patients with thoracolumbar vertebral fractures (TLVF) who underwent internal fixation surgery were analyzed in this retrospective study. All patients were divided into two groups (FAPS and MPPS). Preoperative, immediate postoperative, and 12–18-months postoperative CT and X-ray, and clinical data, including demographics, preoperative and immediate postoperative Visual Analogue Scale (VAS), blood loss (BL), operation time (OT) and hospital stay time (HST), were collected. Facet joint violation and degeneration grade were evaluated by CT according to Babu’s criteria and Weishaupt’s criteria respectively, and preoperative, immediate postoperative and 12–18-months postoperative anterior body compression index (ABCI) were measured by X-ray. Results Postoperative VAS of two groups was lower than preoperative VAS (p < 0.05). BL, OT, and HST were less in MPPS than FAPS, and the difference was statistically significant in BL and HST (p < 0.05) but no in OT (p > 0.05). Immediate postoperative and 12–18-months postoperative ABCI were significantly higher than preoperative (p < 0.05), and the difference of ABCI between immediate postoperative and 12–18-months postoperative were not significant in two groups (p > 0.05). Total violation rate (VR) was about 1.35% (11/816) and FAPS had a lower VR than MPPS, but no significant (p > 0.05). Weishaupt’s criteria revealed that average class (AC) was 0.69 in FAPS and 0.67 in MPPS, and the distribution of degenerated facet joints in two groups did not differ preoperatively (p > 0.05). In 12–18 months postoperatively, AC was significantly higher in FAPS than in MPPS, and the distribution of degenerated facet joints in two groups was significantly different (p < 0.05). The comparison of cranial to caudal joints in two groups revealed that cranial joints had more severe degeneration than caudal joints. Conclusions The findings suggested that both MPPS and FAPS were effective for patients with TLVF, but MPPS by percutaneous may be a better choice to avoid adjacent segment degeneration, especially the surgery-involved facet joints degeneration.
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Affiliation(s)
- Bin Ye
- Department of Orthopedics, Xijing Hospital, Air Force Medical University of PLA, No. 169 West Changle Road, Shaanxi Province, 710032, Xi'an, China
| | - Zhengxu Ye
- Department of Orthopedics, Xijing Hospital, Air Force Medical University of PLA, No. 169 West Changle Road, Shaanxi Province, 710032, Xi'an, China
| | - Ming Yan
- Department of Orthopedics, Xijing Hospital, Air Force Medical University of PLA, No. 169 West Changle Road, Shaanxi Province, 710032, Xi'an, China
| | - Peipei Huang
- Department of Orthopedics, Xijing Hospital, Air Force Medical University of PLA, No. 169 West Changle Road, Shaanxi Province, 710032, Xi'an, China
| | - Zhipeng Tu
- Department of Orthopedics, Xijing Hospital, Air Force Medical University of PLA, No. 169 West Changle Road, Shaanxi Province, 710032, Xi'an, China
| | - Zhe Wang
- Department of Orthopedics, Xijing Hospital, Air Force Medical University of PLA, No. 169 West Changle Road, Shaanxi Province, 710032, Xi'an, China
| | - Zhuojing Luo
- Department of Orthopedics, Xijing Hospital, Air Force Medical University of PLA, No. 169 West Changle Road, Shaanxi Province, 710032, Xi'an, China.
| | - Xueyu Hu
- Department of Orthopedics, Xijing Hospital, Air Force Medical University of PLA, No. 169 West Changle Road, Shaanxi Province, 710032, Xi'an, China.
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