Comparative study of pedicle screw internal fixation under different approaches for the treatment of asymptomatic thoracolumbar fractures
10.3760/cma.j.cn115455-20240903-00770
- VernacularTitle:不同入路下椎弓根钉内固定术治疗无神经症状胸腰椎骨折对比研究
- Author:
Hongsheng GUO
1
;
Qingshan LI
Author Information
1. 邯郸市中心医院脊柱外科，邯郸 056001
- Publication Type:Journal Article
- Keywords:
Spinal fractures;
Thoracic vertebrae;
Lumbar vertebrae;
Fracture fixation, internal;
Pain;
Wiltse′s approach
- From:
Chinese Journal of Postgraduates of Medicine
2025;48(5):392-397
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the clinical effects of pedicle screw internal fixation under different approaches for the treatment of asymptomatic thoracolumbar fractures.Methods:Retrospective analysis was conducted to collect data from 83 patients with asymptomatic thoracolumbar fractures treated with pedicle screw internal fixation at Handan Central Hospital from January 2023 to December 2023. Based on different surgical approaches, 40 patients who underwent regular percutaneous approach surgery were included in the conventional approach group, and 43 patients who underwent modified Wiltse approach surgery were included in the modified approach group. The perioperative indexes and postoperative complications of the two groups were statistically analyzed. The visual analogue score (VAS) was compared before operation, 1 month after operation and 3 months after operation. The anterior vertebral height, Cobb angle and fracture healing factors were compared before operation and 3 months after operation.Results:The surgical time, incision length and intraoperative fluoroscopy frequency of the modified approach group were all lower than those of the conventional approach group: (65.75 ± 7.16) min vs. (74.28 ± 6.85) min, (6.75 ± 0.42) cm vs. (9.58 ± 0.50) cm and (9.22 ± 1.24) times vs. (21.03 ± 2.45) times, with statistically significant differences ( P<0.05). The total incidence of postoperative complications in the modified approach group was 9.30% (4/43), while the total incidence of postoperative complications in the conventional approach group was 15.00% (6/40), with no statistically significant difference ( P>0.05). The VAS of the modified approach group was lower than that of the conventional approach group at 1 and 3 months after surgery: (3.05 ± 0.82) points vs. (3.86 ± 0.85) points and (1.62 ± 0.32) points vs. (2.24 ± 0.54) points, with statistically significant differences ( P<0.05). Three months after surgery, the height of the anterior vertebral edge, serum type Ⅰ procollagen N-terminal propeptide and platelet-derived growth factor in the modified approach group were significantly higher than those in the conventional approach group: (72.96 ± 9.27)% vs. (67.58 ± 9.02)%, (174.36 ± 16.75) μg/L vs. (146.24 ± 15.86) μg/L, (250.28 ± 14.62) U/L vs. (241.20 ± 12.75) U/L, the Cobb angle was lower than that of the conventional approach group: (10.15 ± 1.32)° vs. (12.20 ± 1.86)°, with statistically significant differences ( P<0.05). Conclusions:The modified Wiltse approach and percutaneous approach pedicle screw internal fixation are safe and effective in treating asymptomatic thoracolumbar fractures; but compared to the latter, the former has a shorter surgical time, fewer intraoperative fluoroscopy sessions, and less postoperative pain. It has better effects in improving the height of the anterior edge of the injured vertebra, Cobb angle recovery, and fracture healing factors.
