The treatment of thoracolumbar burst fracture by using vertebroplasty combined with the fixation of injured vertebra

English Keywords:Thoracolumbar burst fracture  Calcium sulfate cement  Vertebroplasty  Fixation of fractured vertebra

English Abstract:

  【Abstract】 Objective：To explore the clinical treatment results for thoracolumbar burst fracture by using vertebroplasty with calcium sulfate cement combined with the fixation of injured vertebra.Method：From January 2005 to December 2008，91 patients with thoracolumbar burst fracture were divided into three groups：group A，32 patients underwent three-level fixation including fractured vertebra using vertebroplasty with injectable calcium sulfate；group B，29 patients were fixed three-level verbebra including injured vertebra；group C，30 cases underwent short-segment fixation combined with injectable calcium sulfate vertebroplasty.The least follow-up time was 13 months.Radiographic parameters and clinical outcomes were compared among 3 groups.Result：The 3 groups were similar in age，sex，fracture levels and preoperative neurologic status distribution.All patients with neurologic deficits were improved at the final follow-up.Operation time and blood loss in group B（83.5±15.6min，226.4±28.5ml） were less than group A（93.5±13.4min，243.4±30.4ml） and group C（90.4±13.3min，237.4±25.5ml）（P<0.05）.The ratio of anterior vertebral height（48.6%±8.1%，47.3%±8.6%，47.9%±7.7%） and the Cobb angle（28.6°±4.2°，28.8°±5.7°，29.8°±4.5°） had no statistical significance preoperatively（P>0.05），but which in group A（96.2%±3.2%，5.2°±1.2°） and group B（96.8%±3.5%，5.3°±1.1°） were better than group C（94.8%±4.3%，6.3°±1.8°） postoperatively.At the last follow-up，the ratio of anterior vertebral height and the Cobb angle in group A（97.1%±2.6%，5.7°±2.6°） were better than group B（93.7%±3.7%，6.8°±3.1°） and group C（94.2%±3.3%，29.8°±4.5°）（P<0.05）.The loss of ratio of anterior vertebral height and Cobb angle in the group A（2.1%±0.1%，1.2°±0.8°） and group C（2.3%±0.1%，1.4°±0.5°） were less than group B（5.1%±0.2%，3.7°±1.6°） at the follow-up，and the difference was statistical significance（P<0.05）.The VAS score had no statistical significance among the 3 groups at the final follow-up（P>0.05）.There was 1 case of broken screws in group B and 1 case of implant failure in group C，while there was no implant failure in group A.Conclusion：The surgery of fixation of fractured vertebra with calcium sulfate cement vertebroplasty is a safe and effective method for the treatment of thoracolumbar burst fracture.It can restore the vertebral mechanical strength，achieve and maintain kyphosis correction，decrease the instrument failure rate and loss of vertebral height.