A Retrospective Study Research Of Acute Thoracolumbar Burst Fracture With D-rod Anterior Instrument

Objective To compare the differences in radiographic and clinical outcomes when individuals with the D-rod,Kaneda or Z-plate anterior internal fixation combine with titanium mesh cages autogenous bone graft were treated with thoracolumbar burst fractures.Mathods A retrospective study a series of 95 patients with thoracolumbar burst fractures treated with anterior fixation combine with titanium mesh cages autogenous bone graft from August 2007 to June 2009. Clinical and radiographic evaluation was performed on all 95 patients.34 patients fixation with D-rod,31 patients fixation with Kaneda and 31 patients fixation with a Z-plate were carried out. Statistical analysis of preoperative information on the three groups were comparable. Assessment of the vertebral type of injury, vertebral compression height, Cobb's angle and The Load-Sharing Score through X-ray. Canal compromise and vertebral comminution were viewed on CT or MRI.Spinal cord function was fully assessed with the standard Frankel score and JOA score.The follow-up time was at least 3 month(3month-lyear).Results One patient occurred titanium cage displacement leading the vertebral deformity scoliosis on the third postoperative month. The other ninety-four patients were successful fixation and interbody fusion. No patient was lost to follow-up observation, and no patient required subsequent posterior fusion because of the instances of hardware failure or the secondary deformity. Sagittal alignment was improved from preoperative kyphosis of 19.89°±0.99°to postoperative 5.84°±0.53°, and to 8.26°±0.56°at final follow-up observation in D-rod group; The Kaneda group was improved from preoperative kyphosis of 18.73°±1.23°to postoperative 4.58°±0.97°, and to 7.78°±0.49°at final follow-up observation; The Z-plate group was improved from preoperative kyphosis of 19.46°±0.84°to postoperative 5.62°±0.84°, and to 9.44°±0.73°at final follow-up observation. The mean operation time of D-rod group was one hour and forty-seven minutes, the Kaneda group was two hours and nine minutes, the Z-plate group was one hour and fifty-six minutes. The mean blood loss was 1650 in D-rod group,2130ml in Kaneda group,1860ml in Z-plate group. All patients had received varying degrees of neurological improvement. The mean Frankel grade improved 1.06 degree in D-rod group,1.15 degree in Kaneda group, and 1.24 degree in Z-plate group. Other complication about four cases of abdominal distention, one case of delayed pneumothorax, one case of pulmonary embolism caused by deep vein thrombosis. No patient deaths occurred. Conclusions Anterior corpectomy, strut graft, and the D-rod anterior thoracolumbar instrument fixation is an effective treatment for thoracolumbar burst fractures. The device has the advantages of flexible, operational simplicity, low notch and solid fixation. It allows direct decompression of the spinal cord in the acute setting and was associated with a high rate of neurologic improvement, and a low complication rate.