Postoperative efficacy comparison among three fixation methods in the treatment of thoracolumbar fracture

English Keywords:Thoracolumbar fractures  Short-segmental fixation  Intermediate screws

English Abstract:

  【Abstract】 Objectives: To compare the efficacy among single traditional transpedicular screw fixation, combined with vertebroplasty and combined with fractured vertebral transpedicular screws in treatment of thoracolumbar fracture. Methods: From January 2010 to October 2014, 87 consecutive patients with thoracolumbar single segment fractures were reviewed in this study, cases included 30 patients in group A(single transpedicular screw fixation), 25 patients in group B(combined with vertebroplasty) and 32 patients in group C(combined with fractured vertebral transpedicular screw fixation). The operative duration, blood loss were recorded. Changes in the anterior vertebral height ratio(AVH), local kyphosis angle(LKA) were measured preoperatively, postoperatively and at final follow-up. The vertebral defect degrees and sites in latest CT imaging and modified Oswestry disability index (ODI) in Chinese for each patient were recorded. Results: All the patients were followed up for an average of 15.5±2.3 months(13-21 months). The operative duration in group B was significantly longer than that in group A and group C(P<0.05). There was no difference in blood loss among the 3 groups, neither the anterior vertebral height ratio nor the local kyphosis angle was noted preoperatively and postoperatively(P>0.05). The AVH, LKA and ODI in group B and group C were higher than that in group A at final follow up(P<0.05), but there was no significant difference between group C and group B(P>0.05). The CT scans showed the bone defects mainly existed in one-third of the vertebral body in sagittal section and the central anterior edge. The degrees of bone defects in group A, B and group C were (18.6±7.3)％, (11.8±4.3)％, (8.4±2.1)％ respectively(P<0.01). 3 cases were noted fixation failure in group A, while there was no failure in group B or C. Conclusions: Our study indicates that fixation combined with vertebroplasty or fractured vertebral transpedicle screws provides better effect in vertebral height restoration and less complication incidence than single traditional transpedicular screw fixation. But the former seems to be safer and easier and can decrease the degree of bone defect effectively. It is a better choice for thoracolumbar spine fracture.