| Objective:To retrospectively analyze and compare the clinical results of treating single vertebral fractures of the thoracolumbar spine by unilateral and bilateral nailing through the percutaneous posterior approach to the injured spine.To provide a reference for the choice of surgical modality in the clinical treatment of thoracolumbar fractures.Methods:A retrospective study was conducted to collect the treatment data of112 patients who underwent short-segment combined with percutaneous screw internal fixation at the level of the injured spine in the Department of Spine Surgery,Affiliated Hospital of Yangzhou University from September 2016 to September 2021.Based on the different number of nail placements,the case data were divided into bilateral nail placement group of the injured spine(group A)and unilateral nail placement group of the injured spine(group B),and the final number of included cases was 90,46 in group A and 44 in group B.Follow-up data were collected and analysed for each patient:imaging data included preoperative and postoperative Vertebral Wedge Angle(VWA),Local kyphosis Angle(LKA),and anterior vertebral body height ratio(AHV),Clinical efficacy measures included Visual Analogue Scale(VAS)and Oswestry Disability Index(ODI).Differences in clinical efficacy between the two surgical approaches were compared using statistical methods.Results:A total of 90 patients were included in this study,of whom 46 were male and 44 were female.46 cases were included in group A(6 nails),of whom 24 were male and 22 were female,with a male to female sex ratio of 12:11 and a mean age of49.9(±11.05)years.44 cases were included in group B(5 nails),of whom 22 were male and 22 were female,with a sex composition ratio of 11:11.The average age of the patients was 54.33(±12.02 years).The duration of the disease(time from diagnosis to surgery)was less than 7 days,with only one patient having a duration of 14 days due to the severity of the symptoms.A comparison between the two groups showed a P value>0.05 for gender,age and duration of illness,with no statistical difference between the two groups.One patient with infection was observed in group A.The infection was located in the left incision of the injured vertebrae and reached deep into the musculature,and was eventually discharged from hospital through debridement and flap grafting.Patients were injured in 58 cases of falls,18 cases of traffic accidents and14 cases of falls from height,with falls accounting for 64%of the cases.In group A(6nails)there were 30 cases of falls,8 cases of traffic accidents and 8 cases of falls from height,and in group B(5 nails)there were 28 cases of falls,10 cases of traffic accidents and 6 cases of falls from height,after processing by Pearson’s chi-squared test,χ~22=1.16,P=0.766,(P>0.05),there was no significant difference between the two in terms of injury mechanism.The proportion of cases with Tlics≥4 in this study was 86.7%and 12 patients scored less than 3 points,P=0.711(>0.05).The fracture segments of the patients in both groups:16 cases of L1 fracture,12 cases of L2fracture,5 cases of L3 fracture,1 case of L4 fracture,1 case of L5 fracture,1 case of T11 fracture and 10 cases of T12 fracture in group A,and 21 cases of L1 fracture,8cases of L2 fracture,2 cases of L3 fracture,2 cases of L4 fracture,1 case of T8 fracture,2 cases of T11 fracture and 8 cases of T12 fracture in group B.Among the three types of imaging data at follow-up,the P-value for postoperative VWA was 0.048(<0.05),and the P-value for the rest of the inter-group comparisons was greater than 0.05;the P-value for operative time between the two groups was 0.002(<0.05),which showed that the operative time in group B was significantly shorter than that in group A,and both were statistically significant.The mean operative time for both groups was 90minutes,with 100(85-125)minutes for group A and 85(80-100)minutes for group B.The data for this group did not conform to a normal distribution,so the statistical method took the form of a non-parametric test with a P-value=0.002(<0.05),resulting in the rejection of the original hypothesis that there was variability in operative time between the two groups and that group B had a shorter operative time;the two groups’correlation scores(VAS and ODI)are shown in Table 3,with no statistically significant differences in VAS scores and ODI indices between the two groups over the course of the disease.Comparing longitudinally the changes in scores at different times within the groups,the VAS scores at one week postoperatively were3.76±1.04 and 3.75±1.04 in both groups respectively,with significant pain relief,and the ODI index at the final follow-up was 13.5±2.9(%),both suggesting a good clinical prognosis.Conclusion:Unilateral and bilateral nails are comparable in imaging results and efficacy,and unilateral nailing is more recommended in terms of operation time and treatment cost. |
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