Clinical Observation Of Paravertebral Intermuscular Approach Combined With Injured Vertebral Bone Grafting And Nailing Internal Fixation In The Treatment Of Thoracolumbar Vertebral Fracture

Objective: To observe and analyze the application effect of paravertebral intermuscular approach combined with injured vertebral bone grafting and nailing internal fixation in the treatment of thoracolumbar vertebral fracture without spinal canal decompression.Methods: The medical records of 65 patients with thoracolumbar vertebral fractures from February 2015 to February 2016 in our hospital were retrospectively analyzed.The 65 thoracolumbar vertebral fracture patients were divided by different treatment measures into group A and group B.Group A was treated with posterior median approach.31 cases were treated by traditional posterior median approach with pedicle screw fixation,including 18 males and 13 females,aged between 28 to 58,with an average age of 41.61±8.36.According to the site of fracture,10 cases of T12,12 cases of L1 and 9 cases of L2 were included.Group B was treated with paravertebral intermuscular approach.34 cases(22 males and 12 females,aged between 28 to 56,with an average age of 40.82 ±7.83)were treated by paravertebral intermuscular approach combined with bone grafting and nail fixation of injured vertebrae.According to the fracture position,11 cases of T 12 fracture,15 cases of L 1 fracture,and 8 cases of L 2 fracture were included.Curative effects were compared between the two groups.The operative time,blood loss,post-operative drainage,length of hospital stay,postoperative pain sensation VAS score,vertebral collapse correction rate and Cobb’s angle were evaluated and analyzed.Results: The patients were followed up for 12-24 months with a mean follow-up of 19.2 months.In group A,the mean operative time was 93.87 ±12.89 minutes,the average intraoperative bleeding volume was 248.55 ±41.255 ml,the mean postoperative drainage volume was 166.58 ±14.859 ml,and the average hospital stay was 11.61±0.919 days.The VAS scores of 3 days,1 month and the last follow-up were 3.00 ± 0.730,1.71 ±0.643,0.638 ±0.109 respectively.The percentages of anterior height of injured vertebrae for the immediate follow-up and the last follow-up were 91.77 ±3.547% and 77.42 ±4.978% respectively.The Cobb angles of immediate and last follow-up were 3.52 ±1.313 and 8.74 ±1.932 respectively.In group B the mean operative time was 94.21 ±8.92 minutes,the average intraoperative bleeding volume was 113.53 ±19.36 ml,the average postoperative drainage volume was 93.03±11.03 ml,and the average hospital stay was 10.32 ±0.68 days.The VAS scores of 3 days,1 month and the last follow-up were 1.91 ±0.570,1.12 ±0.478 and 0.564 ±0.101,respectively.The percentages of anterior height of injured vertebrae for the immediate follow-up and the last follow-up were 92.29 ±2.419% and 3.62 ±1.181% respectively,and the Cobb angles of immediate and last follow-up were 3.62 ±1.181 and 6.03±1.678 respectively.There was no significant difference in average operation time between the two groups(P>0.05).But the hospitalization time,intraoperative bleeding volume and the postoperative drainage volume in group B were significantly decreased(P<0.05).There was no significant difference in the VAS scores between the 2 groups before operation(P>0.05),but there were significant differences in the VAS scores between group B and group A after operation for 3 days and 1 months(P<0.05),and group B had a significant advantage.The two groups had no significant difference in VAS score at the last follow-up(P>0.05).There was no significant difference in the percentage of anterior vertebral height and Cobb’s angle between the two groups before and after internal fixation(P>0.05).For both of the two groups,the percentage of anterior vertebral height and Cobb’s angle were significantly recovered after operation(P<0.05).But the percentage of anterior vertebral height and Cobb’s angle between the two groups at the last follow-up were significantly different(P< 0.05).Conclusion: Paravertebral intermuscular approach combined with injured vertebral bone grafting and nailing internal fixation in the treatment of thoracolumbar fracture has the following advantages: minimal invasion,less blood loss and the height satisfactory of fractured vertebra,and it is one of the ideal methods for the treatment of thoracolumbar vertebral fracture.