Posterior Pedicle Screw Fixation Combined With Bone Graft To Treat Fractures Of Thoracolumbar

Objective:To evaluate the clinical results of the treatment of thoracolumbar fractures with posterior pedicle screw fixation and transpedicular intrabody grafting.Methods:Sixty-three cases of thoracohmbar fractures were treated surgically since January 2005 to July 2009.28 patients received posterior pedicle screw fixation combined with bone graft surgery, and 37 cases which with posterior pedicle screw fixation were used as control group.To evaluate the clinical results of the treatment of thoracolumbar fractures with posterior pedicle screw fixation and transpedicular intrabody grafting,the correction of height of injured vertebrae and angular kyphosis (Cobb angulation), the recovery of neurologic deficit, Frankel classification, and the complication of low back pain of the two groups were assessed before and after operation and during follow-up. The mean follow-up time was 17.3 months(8-34 months).Results:The height and Cobb angulation were similar between two groups before operation and no significant statistical diference(P>0.05). Through surgery, anterior vertebral height ratio of the group interbody bone grafting increased from 42.2% to 94.2%,Cobb angulation from 24.1°reduced to 6.5°,and anterior vertebral height ratio of the control group increased from 44.1% to 93.7%, Cobb angulation was 18.3°before surgery reduced to 7.5°. Compared with the preoperative vertebral body height, kyphosis correction of angular deformities, surgical results were satisfactory. Anterior vertebral height ratio was 92.1% and Cobb angulation was 7.6°of the observer group which were better than the control group(86.1%,12.1°) when eventually followed up(The mean was 17.3 months),difference between the two groups was statistically significant (P<0.05). The Interbody bone grafting group reduce low back pain better than the control group,VAS score were 6.7±1.5 and 5.9±1.3, and difference was statistically significant (P<0.05). Frankel classification were improved to some extent in both groups, but the difference between two groups was not significant (P> 0.05).The interbody bone grafting group in 13 cases have no changed in neurological function and improved 1 degree of 10 cases, improved 2degree of 4 cases, improved 3 degrees of 1 case.The control group have 17 no changed cases and 12 cases improved 1 degree,5 cases improved 2 degree,1 case improved 3 degrees.Conclusion:The results of treatment of thoracolumbar fracture with posterior pedicle screw fixation and transpedicular intrabody grafting are good. This procedure can prevent the loss of correction and decrease the complication of low back pain after operation.