Posterior Fixation With Pedicle Screw System Plus Transpedicular Grafting In The Treatment Of Thoracolumbar Fracture

Objective:Posterior pedicle screws system has a long history in clinically therapeutic of thoracolumbar fractures, however, with the follow-up survey to the postoperative patients simply with vertebral pedicle screw by the height of the injury vertebral, recovery will constantly loss as the time goes on, and the injury vertebrae are poorly healed. Therefore, this study of thoracolumbar fractures in patients treated with posterior fixation with pedicle screw system, at the same time added transpedical grafting, has made a comparison with patients purely used posterior vertebral pedicle screw instrumentation. To evaluate the clinical curative effect of posterior fixation with pedicle screw system plus transpedicular grafting in the treatment of thoracolumbar fracture through the follow-up of postoperative patients.Methods: Retrospectively analyze diagnosed patients with thoracolumbar fractures, who visit the first hospital spinal surgery of Jilin University from February 2009 to February 2011. In cases of screening comply with conditions of 32 cases. Sixteen patients were treated with posterior fixation with pedicle screw system, at the same time added transpedical grafting which was composed of allogeneic bone grafts in the injury vertebra, to organize bone grafting group. and the other 16 cases were treated purely with posterior fixation with pedicle screw system, to compose the control group. Observe comparison of anterior body compression,Cobb's angles correction and fracture healing between the two groups cases of preoperative, postoperative and follow-up, Using statistical methods to process the observation results statistically.Results: All of the patients have been followed up, bone grafting group have a follow-up time 2 ~ 14 months, 8.37 months on average, and the control group's follow-up time is 2 ~ 14 months, averaging 7 months. Mean anterior body compression of both groups: bone grafting group: mean anterior body compression preoperative: 58.25%(58.25±8.52); mean anterior body compression postoperative: 102.22%(102.22±4.10); mean anterior body compression terminal follow-up: 100.70%(100.70±3.51), compared with postoperative has no obvious loss(t=2.045, P=0.059>0.05), with no statistical significance. The control group: mean anterior body compression preoperative: 66.42%(66.42±10.98); mean anterior body compression postoperative: 100.17%(100.17±4.81); mean anterior body compression terminal follow-up: 95.53%(95.53±3.68), compared with postoperative has no obvious loss(t=6.545,P=0.00<0.05), with statistical significance. Cobb's angles correction: bone grafting group: mean Cobb's angles preoperative: 21.22o(21.22±5.80); mean Cobb 's angles postoperative: 7.64o(7.64±2.32); mean Cobb 's angles terminal follow-up: 7.90o(7.90±2.56), compared with postoperative average angles has no obvious loss(t=-2.003,P=0.064>0.05), with no statistical significance. The control group: mean Cobb's angles preoperative: 20.38o(20.38±5.09); mean Cobb 's angles postoperative: 8.72o(8.72±3.81); mean Cobb 's angles terminal follow-up: 10.01o(10.01±4.48), compared with postoperative average angles has obvious loss(t=-4.138,P=0.001<0.05), with statistical significance. Fracture healing: 11 cases of bone grafting group did CT scanning at the end of a follow-up session, all show injury within the vertebras had grafts fusion in good condition, no empty formation. 7 cases of the control group did CT scanning at the end of a follow-up session, and 4 cases of vertebras had cavitas in formation.Conclusion: Posterior fixation with pedicle screw system plus transpedicular grafting is an effective method in the treatment of thoracolumbar fracture, which can make fracture with satisfactory restoration, stable spinal mechanical properties effectively, at the same time in recovering of vertebral body height, Fracture healing and grafts fusion are in good condition.