Effect of bracing post-operatively on the patients with type A thoracolumbar fracture

English Keywords:Thoracolumbar fracture  Orthosis  Time of bracing

English Abstract:

  【Abstract】 Objectives: To discuss the effect of bracing time on the outcome in the post-operative patients who have type A thoracolumbar fracture. Methods: A retrospective analysis was performed on sixty-six patients with single-level type A thoracolumbar fracture from January 2008 to December 2012. Schanz pedicle screws were used in all patients and all of them wore thoracolumbosacral orthosis(TLSO) from 1 day after operation. These patients were divided into two groups according to time of bracing: 32 patients wearing TLSO for less than 1 month after operation were classified as group A, while the other 34 patients wearing TLSO for more than 1 month were classified as group B. The pre-operative Cobb angle was 22.1°±4.9° in group A and 21.9°±5.4° in group B, compression ratio of vertebrae before operation was (31.8±6.8)% in group A and (32.6±6.5)% in group B. There was no statistical difference with respect to the age, gender, fracture segment, pre-operative Cobb angle or pre-operative compression ratio of vertebrae(P≥0.05). The Cobb angles immediately after operation and at 1 year after operation were measured. One year after operation, all patients were asked to finish a series of evaluation, which included visual analogue scale(VAS), JOA score, Oswestry disability index(ODI) and general life quality. Results: No post-operative complications were noted in both groups. The Cobb angle immediately after operation was 7.2°±2.9° in both group A and group B. The Cobb angle at 1 year after operation was 8.1°±2.8° in group A and 8.4°±3.2° in group B, with the loss rate of Cobb angle of (14.4±20.2)% in group A and (19.6±23.5)% in group B. There was no statistical difference between 2 groups(P≥0.05). The compression ratio of vertebrae immediately after operation was (15.3±3.7)% in group A and (15.8%±3.9)% in group B. The compression ratio of vertebrae at 1 year after operation was (16.8±4.0)% in group A and (17.1%±3.8)% in group B. There was no statistical difference between group A and B(P≥0.05). The VAS score at 1 year after operation was 1.03±0.56 in group A and 1.18±0.68 in group B. The ODI at 1 year after operation was (9.9±3.3)% in group A and (11.3±3.4)% in group B. There was no statistical difference between group A and B(P≥0.05). The score of general life quality at 1 year after operation was 2.6±0.5 in group A and 2.1±0.7 in group B, and there was statistical difference between group A and B(P＜0.05). The JOA score at 1 year after operation was 25.3±1.2 in group A and 24.4±1.5 in group B, and there was statistical difference between group A and B(P＜0.05). The bony union was noted in 29 cases of group A(90.6%) and 31 cases in group B(91.2%) at 3 months after operation, there was no statistical difference between 2 groups(P≥0.05). All fractures healed at 1 year after operation and there was no instrument failure. Conclusions: For the post-operative patients with single segmental type A thoracolumbar fracture, long time(more than 1 month) and short time(less than 1 month) brace wearing show no difference on the outcome, but short time brace wearing has higher life quality score and JOA score.