Clinical efficacy of posterior fixation and fusion for different types of thoracolumbar fractures

English Keywords:Posterior fixation and fusion  Thoracolumbar fracture  Denis type

English Abstract:

  【Abstract】 Objectives: To explore the different types of treatment of posterior fixation and fusion for thoracolumbar fracture classifications. Methods: 120 cases with thoracolumbar fractures receiving surgery from January 2010 to January 2015 were randomly divided into 2 groups, obsrervation group contained 60 cases treated with posterior fixation and fusion surgery, control group contained 60 cases treated with posterior fixed non-fusion treatment. The operation time, blood loss and postoperative evaluation of surgical incision drainage, the visual analogue scale(VAS), Roland-Morris dysfunction(RDQ) evaluation were used for evaluation, the clinical efficacy of different types of thoracolumbar fractures between two groups were compared. Results: Fusion rate in observation group was 87.9%, with the treatment efficiency of 93.3%; operation time, blood loss and incision drainage was 77.9±1.5min, 387.4±9.4ml, 115.8±6.4ml respectively. At preoperation, 1 day and 3 months after surgery, the VAS score was 7.9±1.0, 7.6±1.0 and 3.5±0.5 respectively; RDQ score was 21.8±1.8, 18.4±1.1 and 11.8±0.9 respectively. At control group, the total effective rate was 80.0%, the operation time, blood loss and incision drainage were 65.6±1.7min, 309.4±7.1ml, 103.2±6.3ml respectively. At preoperation, 1 day and 3 months after surgery, VAS score was 7.6±1.7, 7.2±1.1, 3.9±0.6 respectively; RDQ score was 22.1±1.7, 19.4±1.0 and 15.5±1.1 respectively. The treatment efficiency, operation time, blood loss and incision drainage, VAS score after 3 months, postoperative 1 day and 3 months RDQ score were statistically significant(P<0.05). Denis A, B, C and D type preoperative VAS scores were 8.1±0.9, 7.3±1.2, 7.8±0.9 and 7.9±0.8; postoperative 1 day VAS scores were 4.1±1.0, 7.6±1.1, 7.7±1.0 and 7.8±1.0; postoperative 3 months VAS scores were 3.5±0.8, 3.6±0.6, 3.7±0.5 and 3.8±0.5. The patients′ postoperative VAS scores decreased significantly(P<0.05), but postoperative 1 day VAS scores of B, C and D type patients were significantly higher than that in patients with A type(P<0.05). Denis A, B, C and D type preoperative RDQ scores were 17.8±1.9, 23.1±2.0, 23.4±2.1 and 22.8±1.9 respectively; postoperative 1 day RDQ scores were 12.4±1.1, 17.3±1.4, 18.3±1.8 and 18.9±1.5 respectively, postoperative 3 months RDQ scores were 11.9±1.9, 11.4±1.3, 11.5±1.9 and 12.4±1.9 respectively. RDQ scores of four types of patients decreased significantly(P<0.05), but postoperative 1 day RDQ scores of B, C and D type patients were significantly higher than that in patients with A type(P<0.05). Conclusions: The posterior fixation and fusion is superior than non-fusion, which can quickly relieve pain and improve spinal cord function for Denis A type fracture, and restore spinal stability for Denis B, C and D fracture.