Thoracolumbar Burst Fracture Of The Posterior Decompression Different Comparative Analysis Of Clinical Efficacy

Backgrounds: The thoracolumbar spine locates between the thoracic spine whose activity is limited by the thorax and lumbar spine whose activity is larger so that the stress often concentrated here and cause injuries in this region. Burst fractures account for approximately 45% of all thoracolumbar fractures and 30%～60% of them cause a neurologic deficit. One characteristic of burst fracture is the bone fragment retropulsed into the spine canal. The thoracolumbar burst fracture hurt reason with traffic accident harm, sink into wound and exercise related wound etc. is lord, the companion has other parts of the skull, chest and belly department of hurt. Getting hurt the mechanism has crook, stretch, revolve and compress dint outside etc, but take reuniting outside dint as a lord much. The judgment which hurts stability is mainly depended on in clinical symptom and image to learn a check. In clinical work, the computed tomography imaging and plain radiography often tell significant signs after the patients are hospitalized due to the thoracolumbar burst fracture including significant spinal canal narrowing by characteristic retropulsed fragments, increased interpediculate distance and kyphosis angle. These signs are always considered as the necessity for operation, and that they exactly cause the nerve injury and affect its recovery. The 70's in 20 century applies pedicle fixation to cure the thoracolumbar fracture fixedly first, come from 30 years, the technique with pedicle fixation the in the last years develops quickly, had been applied in various spinal column paroxysm treatment extensively. Short stanza segment fixedly with 3D to replace the fixed system of long stanza-segment very quickly inside bolt. In the extensive clinical treatment process, there are debates for how to choose a various operation type orientation certificate. Nowadays, transpedicle screw system through posterior method is widely used for operation. It make the bone fragment reduced by the posterior longitudinal ligament and structures around it. The thoracolumbar burst fracture don't companion with the vertebral dish and The anterior and posterior longitudinal ligaments severity damaged, the surgical method of pedicle fixation indirect decompression is the principal choice for the early treatment of thoracolumbar burst fractures.Through the retrospective analysis 86 cases patients of thoracolumbar burst fractures from January 2000 to June 2007, to evaluate the effective of transpedicle screw system through posterior method in recover the height of the vertebrae, the kyphosis angle, nerver function,complications in medium and late phases, degree of stenosis and so on. On two different spinal posterior decompression for treatment of thoracolumbar burst fracture surgery on effect, with a view to guiding clinical application.Objective: This article is to compare the effects of two surgical methods for posterior decompression on the treatment of thoracolumbar burst fractures.Method: Through the retrospective analysis from January 2000 to June 2007, 86 cases of thoracolumbar burst fractures were divided into two groups by different decompression methods: direct decompression group,34 cases who had one-or-two-side laminas cut off and posterior transpedicular fixation;and indirect compression group,52 cases with sole posterior transpedicular fixation. There was a comparison between the two groups by statistical analysis. Two groups were both followed-up for 6 months to 36 months. The recovery of neurological function after operation was evaluated by ASIA evaluation standards;The complications in medium and late phases were evaluated according to that whether there were low back pain, numbness and asthenia;The living ability was evaluated by FIM.Results:1. The two groups both was have significant difference in recovered vertebral body high and vertebral tube capacity between the two groups with before surgical operation, but there was no significant difference between the two groups with after the two operations. 2. The direct decompression group and indirect decompression group was no significant difference between the two groups with the nerve function recovers in after the operation medium and late period.3. The incidence rate of complications in medium and late phases of the direct decompression group was higher than that of the indirect decompression group, and independent living ability after operation of the latter was better than the former.Conclusion:1. The thoracolumbar burst fracture don't companion with the vertebral dish and The anterior and posterior longitudinal ligaments severity damaged, going the pedicle fixation can attain dissection to reset fixedly.2. Adopted direct decompression in medium and late days after going the pedicle fixation with indirect decompression's recovering aspect in the nerve function can attain anticipant treatment result, and of 2 sets treatment result no significant difference.3. The incidence rate of complications ,what the spinal column is unsteady and it with the result that after the hair a series of complications such as spinal cord and horsetail nerve harm etc, in late phases of the direct decompression group was higher than that of the indirect decompression group.