The treatment of thoracolumbar fractures with posterior transpedicular instrumentation of bone graft and vertebral pedicle screw in fractured vertebra

English Keywords:Thoracolumbar fractures  Injured vertebral fixation  Bone graft in injured vertebra

English Abstract:

  【Abstract】 Objective：To assess the efficacy and safety of the method in treatment of thoracolumbar fractures with posterior instrumentation of bone graft and vertebral pedicle screw in fractured vertebra.Method：75 cases of single segmental thoracolumbar fracture between June 2007 and September 2009 were treated by posterior reduction and internal fixation，30 cases with bone graft and vertebral pedicle screw in fractured vertebra（group A），45 cases with routine fixation strided over fractured vertebra（group B）.The adjacent vertebral Cobb angle and the anterior height of injured vertebra in lateral radiograph were measured before and after surgery，then the vertebral compression ratio was calculated.The sagittal diameter of injured vertebral spinal canal encroachment on the CT scan was measured before and after surgery，and the occupation ratio was calculated.The operation time and blood loss were recorded，the surgical complications were observed，and the scores of low back pain with Denis′Grading System were got.Result：The anterior high vertebral compression ratio in group A was 59.8% and 92.9%，before and after surgery respectively.In group B，it was 57.3% and 87.1% respectively.The adjacent vertebral average Cobb angle turned from 20.2° preoperatively to 8.5° postoperatively and maintained 10.3° at final follow-up in group A.In group B，it turned from 22.7° preoperatively to 12.3° postoperatively and maintained 16.7° at final follow-up.The spinal canal encroachment ratio turned from 37.1% to 21.9% in group A and turned from 34.8% to 18.3% in group B. The average amount of blood loss in group A was 256ml，with the operation time of 107min；the pain assessment for P1 was in 25 cases，P2 in 5 cases；and there was 1 case of cerebrospinal fluid leakage.The average amount of blood loss in group B was 236ml，with the operation time of 87min；the pain assessment for P1 was in 35 cases，P2 in 8 cases，and P3 in 2 cases；and there was 1 case of screw breakage and 2 cases of loosening of internal fixation.There was a significant difference between two groups in operation time，vertebral compression ratio and Cobb angle（P＜0.05）.The above data showed no significant difference within group A（P＞0.05），but showed statistically significant difference within group B（P＜0.05）.However，there was no significant difference in spinal canal encroachment ratio，surgical bleeding amount，the complications and pain scores between two groups（P＞0.05）.Conclusion：In the treatment of thoracolumbar fractures with posterior reduction and internal fixation，the method of bone graft and vertebral pedicle screw in fractured vertebra obtained better kyphosis correction，reconstructed vertebral body height and maintained the correction effect.It also reduced the incidence of internal fixation hardware failure.This method did not increase the amount of bleeding，the incidence of infection，nerve damage and other complications.It was safe and effective.