Effect of modified Wiltse approach pedicle screw internal fixation combined with transpedicular bone grafting on the vertebral body and complications of senile osteoporotic vertebral compression fractures / 中华内分泌外科杂志

ABSTRACT

Objective:To investigate the effects of internal fixation with pedicle screw via modified Wiltse approach combined with transpedicular bone grafting on the vertebral body and complications of senile osteoporotic vertebral compression fractures (OVCF) .Methods:Ninety-four elderly patients with osteoporotic vertebral compression fractures who were admitted to Hangzhou Fuyang Traditional Chinese Medicine Orthopedics Hospital from Oct. 2018 to Oct. 2019 were selected as the research objects. The patients were divided into control group and observation group according to the random ball touch method. For 47 cases, the control group underwent posterior short-segment reduction and internal fixation combined with transpedicular bone grafting, and the observation group underwent modified Wiltse approach pedicle internal fixation combined with transpedicular bone grafting. The two groups were observed and compared in terms of surgery related indicators, the condition of the injured vertebrae, the recovery of the vertebral body, the length of hospitalization and fracture healing time, and the incidence of complications.Results:In comparison of the operation-related indexes between the two groups, the intraoperative blood loss, 3d postoperative visual analogue scale (VAS) score and operation time of the observation group were significantly lower, than those of the control group ( P<0.05) . In comparison of the condition of the injured vertebrae between the two groups, there was no significant difference in the ratio of the loss rate of the injured vertebrae Cobb angle, vertebral body sagittal plane index, and vertebral body height between the two groups before operation ( P>0.05) . The loss rates of Cobb angle and vertebral body height of the injured vertebrae in the two groups were lower than that before operation at 3 days after operation, and the sagittal index of the vertebral body was higher than before operation at 1 year after operation ( P<0.05) . The loss rate of Cobb angle and vertebral body height of the injured vertebral body in the observation group was significantly lower than that of the control group at 3 days postoperatively, and the vertebral body sagittal plane index was significantly higher than that of the control group at 1 year postoperatively ( P<0.05) . Comparing the recovery of injured vertebrae between the two groups, there was no statistically significant difference between the preoperative oswestry disability index (ODI) scores of the two groups ( P>0.05) , the improvement rate of Cobb angle and the recovery rate of vertebral body height in the observation group, ODI scores at 3 months after operation were significantly higher than those of the control group ( P<0.05) . The hospitalization time and fracture healing time of the observation group were significantly lower than those of the control group ( P<0.05) . The total incidence of complications in the observation group (4.26%) was significantly lower than the total incidence of complications in the control group (19.15%) ( P<0.05) . Conclusion:The combined use of internal fixation with pedicle screw via modified Wiltse approach combined with transpedicular bone grafting in treatment of elderly OVCF can reduce the amount of intraoperative blood loss, shorten the operation time and hospital stay and fracture healing time, improve the Cobb angle of the injured vertebra, promote the recovery of the height and function of the injured vertebra, and reduce the incidence of complications.