Analysis Of Therapeutic Effect Of Different Surgical Approaches For Thoracolumbar Vertebra Burst Fracture

Objective:To compare and analyze the curative effect of anterior operation and posterior operation in the treatment of thoracolumbar burst fracture((Thoracolumbar Vertebra Burst Fracture;TVBF),in order to provide reference basis for the selection of different surgical methods in the clinical treatment of thoracolumbar burst fracture.Methods:A total of 91 TVBF patients admitted to the Department of Spinal surgery of the affiliated Hospital of Yanbian University from January 2012 to December 2020 were analyzed retrospectively.According to the different surgical approaches,the patients were divided into two groups: anterior approach group(n = 31)and posterior approach group(n =60).Denis grading system and LSC score were used to classify and score the patients in the two groups.The general data,operation time and intraoperative blood loss of the patients in the anterior and posterior groups were compared and analyzed.The follow-up data were evaluated by ASIA neural function grading system,and the effects of the two operations on the recovery of neurological function were analyzed.The imaging data of anterior group and posterior group were analyzed before operation and 12 months after operation.The height ratio of injured vertebral body,Cobb angle of injured vertebral body,invasion rate of injured spinal canal and internal fixation were compared between the two time points.Results:1.There was no significant difference in sex ratio and age distribution between the anterior approach group and the posterior approach group(P > 0.05).The operation time in the anterior approach group(243.33 ±45.2723.79min)was significantly longer than that in the posterior approach group(130.59 ±min).The intraoperative blood loss in the anterior approach group(897.86 ± 98.35ml)was significantly higher than that in the posterior approach group(470.35 ±54.37ml).2.There was significant difference in ASIA grade before and 12 months after operation between the anterior approach group and the posterior approach group,but there was no significant difference between the two groups in each period(P> 0.05).3.There was no significant difference in the ratio of anterior vertebral height between the anterior approach group and the posterior approach group before operation and 12 months after operation(P > 0.05),but the ratio of anterior vertebral height at 12 months after operation in both groups was significantly lower than that before operation.the difference was statistically significant(P < 0.05).There was no significant difference in the Cobb angle of injured vertebrae between the anterior approach group and the posterior approach group before operation and 12 months after operation,but the Cobb angle of injured vertebrae in the two groups decreased significantly 12 months after operation,and the difference was statistically significant(P < 0.001).The invasion rate of injured spinal canal in the anterior approach group was significantly lower than that in the posterior approach group at 12 months after operation,and there was significant difference between the two time points(P <0.001).There was no significant difference between the two groups at 12 months after operation(P > 0.05).There was no significant difference between the two time points(P >0.05),and there was no significant difference between the two time points(P > 0.05).The proportion of injured spinal canal invasion in the anterior approach group was significantly lower than that in the posterior approach group at 12 months after operation(P < 0.05).There was no significant difference between the two time points.At 12 months after operation,the invasion rate of injured spinal canal in the anterior approach group was significantly lower than that in the posterior approach group,and there was significant difference between the two groups(P < 0.001).At 12 months after operation,there was no failure of internal fixation in the anterior group and the posterior group.In the posterior group,12 months after surgery,28 patients requested removal of internal fixations,and all the operations were successfully completed without adverse reactions.Conclusion:1.The clinical results of anterior and posterior surgical treatment of TVBF are satisfactory,and satisfactory results can be obtained in the correction of deformity and the recovery of neurological function.2.Anterior operation has clear field of vision and complete decompression,but it has disadvantages such as complex operation,high risk of operation,long operation time,large trauma,and large amount of intraoperative blood loss.3.Posterior operation is easy to operate,the surgical approach is safe and reliable,the operation time is short,the trauma is small,the intraoperative blood loss is less,but there is a risk of failure of the internal fixation instruments.