Comparison Of Three Different Surgical Methods For Thoracolumbar Fractures

Research objectiveThe operation time,blood loss,postoperative drainage,incision length,postoperative complications and 12 months follow-up of patients with thoracolumbar fracture were compared among three groups: unilateral pedicle screw placement through injured cone,unilateral pedicle screw placement through injured cone plus contralateral bone grafting and six-screw reduction and internal fixation of three vertebral bodies including injured cone.The results were observed,including: VAS(visual analogue score),ASIA functional score before and after surgery,and radiological-based studies,including radiometric measurement of vertebral wedge angle(VWA),anterior vertebral height(AVH),and spinal canal invasion rate to compare the clinical efficacy of the three surgical methods.ResultsSixty patients with thoracolumbar fractures(AO classification including A,B,C,see the attached figure)were randomly divided into three groups.Group A was treated with unilateral pedicle screw fixation through the injured cone;Group B was treated with unilateral pedicle screw fixation plus contralateral bone grafting through the injured cone;Group C was treated with six-screw internal fixation including the injured vertebrae.Sixty patients with thoracolumbar fractures(AO classification including A,B,C,see the attached figure)were randomly divided into three groups.Group A: 20 cases;group B: 20 cases;group C: 20 cases.All patients were operated in prone position under general anesthesia with tracheal intubation within 2 weeks after injury.According to different groups,open reduction and pedicle screw fixation were performed by different internal fixation methods.The posterior ligament complex was preserved as far as possible during the operation.The operation process included reduction and screw fixation.Whether decompression was performed in the spinal canal or not depending on the situation.No interbody fusion was performed.The injured spinous process and the primary supraspinous and interspinous ligaments were sutured and repaired.Patients were treated with routine antibiotics to prevent infection,relieve nerve root edema and neurotrophic drugs.About 10 of the patients were walking under the protection of lumbar support.Sixty patients were followed up for at least one year.The average follow-up time was 18 months.The perioperative indexes of the three groups were compared: length of operation,blood loss,length of incision,incidence of complications,VAS score,ASIA function score before and after operation,height of anterior edge of injured vertebra,wedge angle(VWA),spinal canal invasion rate.Spinal cord injury rate and other indicators.SPSS 22.0 computer software was used for analysis.Data(+s)was used to express measurement data.T test was used for measurement data and rank sum test was used for counting data(Frankel classification).Conclusion1.For thoracolumbar fractures,good clinical results can be achieved by unilateral pedicle screw fixation through the injured cone,unilateral pedicle screw fixation through the injured cone plus contralateral bone grafting and reduction and internal fixation with three vertebral bodies and six nails including the injured cone.2.From the imaging indicators,unilateral pedicle screw placement plus contralateral bone grafting through the injured cone is superior to unilateral pedicle screw placement through the injured cone and six-screw reduction and internal fixation including the injured cone.3.In the short term,the effect of unilateral pedicle screw fixation and six-screw reduction and internal fixation of three vertebrae including fracture vertebrae is better than that of unilateral pedicle screw fixation and contralateral pedicle screw fixation of fracture vertebrae;in the long run,the overall effect of unilateral pedicle screw fixation and contralateral pedicle screw fixation of fracture vertebrae is better than that of unilateral pedicle screw fixation of fracture vertebrae.Fixation,reduction and internal fixation with three vertebral bodies and six nails,including fractured vertebral bodies...