Posterior Injured Vertebra Transpedicular Fixation In Management Of Thoracolumbar Fractures

Objective: This study expored the injured vertebra transpedicular fixation intreating the thoracolumbar fractures compared with the conventional Cross-fracturedvertebral transpedicular fixation in the advantage of the curative effect of postoperativeand follow-up.Method: The records of38consecutive patients with thoracolumbar fractures whounderwent the injured vertebra transpedicular fixation（18patients,Group A）or theconventional Cross-fractured vertebral transpedicular fixation（20patients,Group B）were reviewed from March2011to Octorber2012. There are10male and8female,aged（37.44±7.76）years averagely (range,22~51years) in Group A. In Group A,there are10～120h(range,26.7h) to go to the hospital after be injured which2cases inT11fracture,5cases in T12fracture,7cases in L1fracture,4cases in L2fracture. Thespinal cord function was classified by ASIA scale as grade B in2cases, grade C in1case, grade D in5cases, grade E in10case. There are15male and5female, aged（40.00±9.28）years averagely (range,22~53years) in Group B. In Group B, thereare8～144h(range,26.7h) to go to the hospital after be injured which1case in T11fracture,4cases in T12fracture,8cases in L1fracture,7cases in L2fracture. The spinalcord function was classified by ASIA scale as grade B in1case, grade C in1case,grade D in4cases, grade E in14cases. Operative time, blood loss, correct and loss ofthe fracture vertebra cobb angle (after the operation and the last follow-up visit), correctand loss of fracture vertebra height ratio(after the operation and the last follow-up visit),spinal cord function(ASIA grade), pain visual analogue scale(VAS)scores, complicationafter the operation were observed and compared between the2groups.Result: All of the38patients were completed the operations successfully. Therewere2patients whose fracture vertebra’s upper screws were loose in Group B，whichhad been taken off in1years after the operation. There was no difference in operative time, blood loss in both of the two groups(P＞0.05), there was also no difference inpostoperative correction of the fracture vertebra cobb angle (P＝0.389) and correctionof the fracture vertebra height ratio(P＝0.109). However, the last follow-up visit of thecorrection of the fracture vertebra cobb angle (P＝0.000)and the correction of thefracture vertebra(P＝0.021) and pain visual analogue scale(VAS)scores(P＝0.000) inthe Group A were significantly better than the Group B. There was no improvement inpreoperative and postoperative spinal cord function (ASIA classification) between thetwo groups.Conclusions: These findings indicate that, the injured vertebra transpedicularfixation in treating the thoracolumbar fractures has obvious advantages in the lastfollow-up visit of the correction of the fracture vertebra cobb angle and the correction ofthe fracture vertebra height ratio and pain visual analogue scale(VAS)scores comparedwith the conventional Cross-fractured vertebral transpedicular fixation.