Observational study on the treatment of ankylosing spondylitis with thoracolumbar fracture with posterior long segmental percutaneous fixation

English Keywords:Ankylosing spondylitis with thoracolumbar fracture  Posterior long segment fixation  Percutaneous fixation  Cut and fix  3D printing technology

English Abstract:

  【Abstract】 Objectives: To observe the clinical efficacy of posterior long segmental percutaneous fixation for the treatment of ankylosing spondylitis(AS) with thoracolumbar fractures. Methods: 50 patients with ankylosing spondylitis and thoracolumbar fractures were analyzed retrospectively from November 2014 to November 2018 in our hospital. Among them, 41 patients who completed 1 year follow-up were included in the study. According to the surgical method, 21 cases underwent posterior long segment percutaneous fixation(percutaneous group, 13 males and 8 females, aged 48-85 years, mean age 65.0±5.2 years). Twenty patients underwent open reduction and internal fixation by posterior approach (cut group, 12 males and 8 females, aged 35-76 years, mean age 52.0±4.7 years). The operation time, intraoperative blood loss and postoperative bedtime were recorded. The misplaced rate of pedicle screws was calculated by intraoperative C-arm fluoroscopy (screws not inserted through the pedicle). VAS scores were assessed by telephone or outpatient follow-up. Fracture healing was evaluated by CT and MRI on the fracture line and signal changes at 3 months, 6 months and 1 year after operation. Results: Both groups underwent successful operation. All the incisions reached grade A healing. All patients were cured. There were no such complications as pedicle screw placement, iatrogenic nerve injury, wound infection, pulmonary embolism and deep venous thrombosis of the lower extremity. The patients were followed up for 12 to 48 months, and the average follow-up was 28.4±2.3 months. All the fracture sites reached the clinical bone healing, and there was no loosening nail rod. The operation time of percutaneous group was 123.7±9.9min, the amount of bleeding was 375.6±30.8 ml, and the average activity was 2.3±0.4 days. The operation time of the cut group was 178.6±14.9 min, and the amount of bleeding was 580.5±27.7ml, with an average of 4.4±0.5 days. There was a statistically significant difference between the percutaneous group and the cut group in terms of operation time, intraoperative blood loss and postoperative bedtime(P<0.05). The percutaneous group had a VAS pain score of 2.3±0.4 points after 6 months, with kyphosis Cobb angle 8.7°±1.2° significantly improved compared with preoperative 7.6±0.2 points and 24.6°±4.6°. In the cut group, VAS pain score was 2.5±0.5 points and kyphosis Cobb was 9.8°±1.3° 6 months after operation, which significantly improved compared with 7.8±0.7 points and 25.7°±6.3° before operation, but there was no significant difference between the two groups (P>0.05). Conclusions: For posterior long segment percutaneous fixation, the required operation time is shorter, the trauma is less, the amount of bleeding is less, and the effect similar to the traditional incision method can be achieved in improving the pain and kyphosis of patient.