Clinical Efficacy Of Transpedicular Intravertebral BCP Bone Grafting In The Treatment Of Thoracolumbar Burst Fractures

[Objective]In order to provide advice on the clinical treatment for single-segment thoracolumbar burst fracture.We compare differences among three surgical treatments of single-segment thoracolumbar burst fracture,including injured vertebral screw placement without internal fixation removement,injured vertebral screw placement with internal fixation removement,and removing internal fixation after screw placement in the injured vertebral combined with biphasic calcium phosphates（BCP）bone grafting.Those differences are about postoperative vertebral body height loss,loss of corrected kyphosis angle,and thoracolumbar back pain.[Methods]This study was conducted at the First Affiliated Hospital of Dali University,Yunnan province.From January 2018 to January 2022,patients with stage vertebral body thoracolumbar（T11-L2）burst fracture were selected as the research subjects.Under the different operation plans chosen,they were divided into 3 groups.A represented injured vertebral screw placement without internal fixation removement,B was on behalf of injured vertebral screw placement with internal fixation removement,and C represented removing internal fixation after screw placement in the injured vertebral combined with bidirectional calcium phosphate bone grafting.The age,gender,injury duration,fracture cause,fracture segment,operation duration,intraoperative blood loss,hospitalization duration,and follow-up duration of the three groups of patients were collected.We recorded the AHRIV,MHRIV,PHRIV,Cobb angle,VAS score,and other data of the three groups of patients before internal fixation implantation,1 week after internal fixation implantation,and the last follow-up after surgery.Then the changes of AHRIV,MHRIV,PHRIV,and Cobb angle in the postoperative improvement and last loss were calculated.SPSS25.0 was chosen to analyze the differences in the collected data of the three groups of patients,and to compare whether there were differences in the postoperative vertebral body height,loss of corrected kyphotic angle,and thoracic,lowback pain between different schemes.[Results]A total of 106 patients with single-segment thoracolumbar burst fracture who met the criteria were included in the study.The baseline data（age,gender,injury duration,fracture cause,fracture segment,operation duration,intraoperative blood loss,hospitalization duration,and follow-up duration）of the three groups of patients were not statistically significant（P>0.05）.There was no significant difference in AHRIV and MHRIV among the three groups before operation and one week after operation（P>0.05）,but there was a statistical difference in AHRIV and MHRIV at the last time（P<0.05）.Further,group B and group C had statistical difference（P<0.05）,and group A and group C had no statistical difference（P>0.05）.The postoperative improvement of AHRIV and MHRIV was not statistically significant in the three groups.While there was significant difference in the last loss of AHRIV and MHRIV among the three groups（P < 0.05）.Moreover,there were statistical differences between group A and group B,group B and group C（P<0.05）,there was no statistical difference between group A and group C（P>0.05）.There was no significant difference in PHRIV before surgery,one week after surgery,and the last time among the three groups（P>0.05）.Moreover,the postoperative improvement and last loss of PHRIV were also not statistically different among the three groups A,B,and C（P>0.05）.There was no statistical comparison of Cobb angle among the three groups before operation and one week after operation(（P>0.05）.But there was significant difference in Cobb angle at the last time（P<0.05）,among which,there was statistical difference between group A and group B,group B and group C（P <0.05）,there was no statistical difference between group A and group C（P>0.05）.The postoperative improvement of Cobb angle was not statistically significant in the three groups.While there was significant difference in the last loss of Cobb angle among the three groups（P< 0.01）.Moreover,there were statistical differences between group A and group B,group B and group C（P<0.01）,there was no statistical difference between group A and group C（P>0.05）.There was no statistical comparison of VAS scores among the three groups before operation and one week after operation(（P>0.05）.But there was significant difference in VAS scores at the last time（P<0.05）,among which,there was statistical difference between group A and group C,group B and group C（P <0.05）,there was no statistical difference between group A and group B（P>0.05）.[Conclusion]Ⅰ.Short-segment trauma vertebral screwing and intravertebral BCP bone grafting combined with trauma vertebral screwing can both achieve a satisfactory reduction in the treatment of thoracolumbar burst fractures while maintaining spinal stability.Ⅱ.BCP bone grafting in the injured vertebra combined with the removement of internal fixation for the injured vertebrae can reduce the loss of the height of the injured vertebra,the loss of the corrected angle,and relieve the pain of the lower back.The clinical effect is better than the other two groups without bone grafting.Ⅲ.For thoracolumbar burst fractures treated with vertebral screws and internal fixation,the internal fixation should be removed as soon as possible after the fracture has healed.