The Clinical Effect Analysis Of Single Segment Thoracolumbar Burst Fracture Which Combined The Replacement Spinal Fracture Reductor With Bone Grafting And Posterior Pedicle Screw System

objective: To investigate the clinical value effects on Posterior pedicle screw operation use the replacement Stapes-knife spinal fracture reductor and Bone grafting in treatment with Single Segment Thoracolumbar Burst Fracture.Methods : A retrospective study from March 2012 to June 2013,36 patients of Single Segment Thoracolumbar Burst Fracture were treated by Stapes-knife spinal fracture reductor and Bone grafting combined the Pedicle screw system in our hospital.There were 24 males and 12 females, aged from 22 to 50 years(average,36.8±9.5 years).Causes of injury: high falling 17 cases, traffic accident 12 cases, Weights bruises injury 7 cases.The area of Fracture occurred at T-11 in 6 cases,T-12 in 12 cases,L-1 in 10 cases,L-2 in 8 cases. According to the classification of Denis all cases were Thoracolumbar Burst Fractures.According to Frankel grading system,there were 4 case of grade A,8 cases of grade B,10 cases of grade C,and 14 cases of grade D,The Surgery time between Injury time:from 2 to 9 days(average,5.4 days). Surgical method:A posterior midline incision Was taken for this surgery.Centering on the injured vertebra body for incision, Exposed the injured vertebra and its upper and lower near vertebras as well ae the lamina,the articular process,the vertebra plate, the transverse process and pedicle screw entry points.Then pedicle screws were put into the upper and lower vertebra and a distraction reduction was tried to restore spinal alignment for temporary fixation.According to the situation half lamina windowing or lamina resection decompression were resected,The catheter was holded by nerve dissection carefully,A posterolateral working pathway was built from the Pedicle medial rim to the posterior longitudinal ligament.Then work through the posterolateral working pathway by using the replacement Stapes-knife spinal fracture reductor to crack down the injured vertebral into reset,strengthening the injured vertebral by bone grafting,terminate the placeholder in spinal canal,Then compressing the pedicle screws in Injured vertebral after a satisfactory fluoroscopy.Results: The operative time ranged from 130 to 180 minutes(average,150 minutes).The blood loss ranged from 210 to 700 ml(average,390±15.5ml).All patients were followed up.There was no complication during operation and follow-up.the final follow up showed that there was no internal fixation failure such as screws break and cages shift.Vertebral body fracture healing and highly satisfactory results.the front height of fractured vertebral ratio was restored from 55.42%±2.64% of the normal value preoperation to 92.16%±1.06%(P<0.01),the stable height of fractured vertebral ratio was restored from 33.94%±1.34% of the normal value preoperation to 89.10%±1.37%(P<0.01),and the Cobb’s angle on the sagittal plane was down from 25.95°±2.27°of the normal value preoperation to 3.26°±0.52°(P<0.01).Among the Follow-up period,The average loss respectively between the front height of fractured vertebral ratio,the front and behind height of fractured vertebral ratio,the stable height of fractured vertebral ratio,the Cobb’s angle on the sagittal plane,were only 2.87%,3.96%,2.65°.The improvement in Frankel grade at the last follow-up was observed in 36 cases, 30 cases at least improved 1 grade.No complications such as nerve damage and aggravating.To assess the pain and function of the back by the VAS score,ODI score,JOA score,all of these Evaluation system make improvement after operation.Use the FIM score and Barthel index to evaluate the activities of daily living, the last follow-up than preoperative have improved significantly.Conclusion The replacement Stapes-knife spinal fracture reductor and Bone grafting combined the Pedicle screw system treatment is an effective method for treating Single Segment Thoracolumbar Burst Fracture,which shows good results in restore vertebral height, protrusion deformity and rebuild spinal sequence.It can effectively did vertebral canal decompression ahead,relieve spinal cord compression,restore blood supply to recovery the neural and back function.However it still needs cases of accumulation and long-term follow-up.