The Clinical Study Of Vertebral Body Graft Via Spinal Canal For Treatment Of Thoracolumbar Burst Fracture

Objective:To investigate the advantage and practicability of vertebral body graft via spinal canalfor treatment of thoracolumbar burst fracture through observing clinical efficacy andcomparative analysis. Provide a theoretical basis for the clinical work.Methods:70cases of patients with thoracolumbar burst fracture in our hospital who acceptedposterior operation treatment from January2012to February2014were selected. Allpatients were treated with posterior operation and divided into3groups according to thedifferent ways of graft.Group A(n=25):Posterior decompression、open reduction andpedicle screws system fixation, vertebral body graft through spinal canal. GroupB(n=23):Posterior decompression、open reduction and pedicle screws system fixation,bone graft through pedicle.Group C(n=22):Posterior decompression、 open reduction andpedicle screws system fixation, non-bone graft. The operative time、estimate blood lossand bone volume were recorded. Some index included height of the injured vertebralbody、Cobb angle、postoperative bone density、bone area、recovery of neurological functionand postoperative lumbago during the time of preoperative、postoperative and follow-upwere recorded and evaluated. The results of above3groups will be compared with eachother base on statistical methods. Chi-square test and One-way ANOVA were used for thecomparable analysis of age、sex、Spinal segment and Frankel grade. The other indexeswere analyzed and compared with ANOVA. Results:1、The operative time of Group A(bone graft through spinal canal)was163.24±18.33min,Group B(bone graft through pedicle)was173.87±14.65min, GroupC(non-bone graft)was141.05±19.85min.the time of the Group B was longer than Group A,Group C had took the shortest time. estimate blood loss of Group A was543.20±60.40ml;compared with Group B(533.91±83),the difference between them was notstatistically significant (P>0.05);compared with Group C (407.27±60.80ml),the differencebetween them was statistically significant(P<0.05).2、Bone graft volume of Group A was11.72±2.05g, Group B(9.91±2.15g),what inthe Group A was more than Group B, the difference between them was statisticallysignificant(P<0.05).3、The anterior height of the injured vertebral body of Group A：preoperative(48.64±5.15%),postoperative(95.76±2.71%),last follow-up(94.64±2.43%), the loosedheight was2.73±1.17%; the cobb angle： preoperative (21.65±1.97°),postoperative(5.48±0.68°),last follow-up (7.04±0.52°), the loosed angle was1.57±0.58°.the loosedheight of Group B was more than Group A, Group C was the most one in the three groups.the difference during the three group was statistically significant (P<0.05). the loosed angleof Group B was more than Group A, Group C had loosed the most angle in the threegroups.the difference during the three group was statistically significant(P<0.05)4、 The defect void survival-rate of Group A was15.95±2.95%,GroupB(22.02±3.73%),Group C(42.01±4.40%).Group C was more than the other groups, GroupA was the least. Bone area of Group A was42.09±5.51%. Group B (28.82±5.05%), bonearea of Group A was bigger than Group B.the difference during the three groups wasstatistically significant (P<0.05).5、 Excellent rate of Group A neurological function:preoperative52%,postoperative76%.the difference of the recovery of neurological function andpost-operative lumbago during three groups was not statistically significant (P>0.05).Conclusions:1、The operation of bone graft through spinal canal was easy、visualized、timesavingand less hurt. The bone pieces were convenient to prepare. The fixator and pedicle have asmall influence on the operational process.2、More bone piece could be filled evenly and widely in the injured vertebral bodythrough enlarging the bone graft space by poking. In the same way, the reduction of the fracture will be more easily. the Cobb angle、vertebral height、postoperative lumbago andlumbago will be recovered in the same way.3、Because of the operative limitations, The bone graft through spinal canal was moresuitable for the lumbar burst fracture.