Comparison of minimally invasive pedicle screw placement in thoracic-lumbar fractures with extracorporeal individualized guide plate combined with fluoroscopy and computer navigation system

English Keywords:Thoracic-lumbar  Internal fixation of fracture  Minimally invasive surgery  3D printing technology

English Abstract:

  【Abstract】 Objectives: To explore the feasibility and clinical effect of minimally invasive pedicle screw placement in the treatment of thoracic-lumbar fracture with the help of extracorporeal individualized guide plate combined with fluoroscopy. Methods: From February 2014 to April 2015, 53 cases of thoracic-lumbar fracture admitted to our hospital were retrospectively analyzed. Among them, extracorporeal individual guide plate combined with fluoroscopy were applied in 22 cases to assist minimally invasive pedicle screw insert(observation group), computer navigation system aided minimally invasive pedicle screw placement were allpied in 31 cases(control group). Blood loss, operation time, number of intra-operative X-ray exposures, incision length, anatomical location of screw and pedicle cortex, success rate of first puncture and sagittal screw insertion angle were recorded. The inclined angle deviation of postoperative screw and preoperative simulated screw were measured and calculated. All above parameters were statistically analyzed. Results: All patients were operated successfully. A total of 318 pedicle screws was implanted, including 132 in the observation group and 186 in the control group. No significant vascular or nerve injury happened. The average follow-up was 12.7±3.4 months in all patients. Bleeding of observation group and control group was 53.2±7.6ml and 56.0±9.9ml respectively, and the number of intra-operative X-ray exposures was 11.1±2.7 and 9.8±3.0 respectively, without statistical difference(P＞0.05). The operation time in the observation group and the control group was 69.9±12.5min and 108.8±25.9min respectively, the incision length was 9.2±1.8cm and 12.5±3.8cm respectively, with statistically significant differences(P＜0.05). In the observation group and control group, the relation between screw and pedicle cortex was 124 and 154 respectively in grade I, the success rate of the first puncture was 90.1% and 81.7% respectively, with statistically significant differences(P＜0.05). Sagittal screw insertion Angle was 2.6±2.1° and 2.6±1.9° respectively, without statistically significant differences. In the observation group, there was no significant difference in the Angle between the postoperative nailing and preoperative simulated nailing. Conclusions: Compared with computer navigation system, the extracorporeal individualized guide plate combined with fluoroscopy aided minimally invasive pedicle screw placement can reduce the operation time and obtain the accurate nail placement without significantly increasing fluoroscopy.