A Preliminary Clinical Study About The Influence Of Sternocostal Complex Injury To The Stability Of Thoracic Vertebral Fracture

Objective: To evaluate the influence of Sternocostal Complex injuries to the stability of thoracic vertebral fractures by clinical series study, and provide the basis for adding Sternocostal Complex injuries as a component into the TLICS thoracic fracture scoring system. According to the scoring system to explore the effect of clinical application.Methods: 189 patients hospitalized for thoracic vertebral fracture were recruited from January 2002 to December 2008 in a retrospective manner. Patients were screened according to inclusion and exclusion criteria, and relative clinical data collected. These patients were divided into four groups according to the degree of Sternocostal Complex injuries, there were 84 patients in Simple thoracic vertebral fracture group (T group), 46 in thoracic vertebral fracture with one side rib fracture group (T+OR group), 40 in thoracic vertebral fracture with bilateral rib fracture group(T+BR group) and 19 in thoracic and sternum fracture with bilateral ribs group(T+BRS group). And the general information, injury mechanism, combined chest injuries, Hanley and Eskay classification, TLICS rating, Cob'angle, cross-sectional area of the intraspinal bone fragments(S1), Sagittal area of the fractured vertebral body(S2) and Frankel scores were compared. A total of 89 patients consisting of 27 in T group, 19 in T+OR group, 28 in T+BR group and 15 in T+BRS group were managed with thoracic spinal instrumentation, and the surgical methods, complications, Frankel scores before and after the operation were compared between the groups.Results: In T+BR group and T+BRS group, chest complications are common and the incidence of fracture dislocation and burst fracture-dislocation were high (>50%). The operated patients with Cob angle of thoracic fractures≥20°were accounted for 47.5% and 57.9% respectively, ones with cross-sectional area of intraspinal bone fragments≥1/3 cross-sectional area of the spinal canal were accounted for 55.0% and 68.4% respectively, and ones with reduction of more than 50% of the sagittal area of the fractured vertebral body were accounted for 42.5% and 52.6% respectively in these two groups, which resulted in poor stability. In T+BR group and T+BRS group the average TLICS score were 5.0±2.0 points and 5.3±1.8 points respectively, significantly higher than the 3.5±1.9 points in T group and 3.8±2.0 points in T +OR group (p <0.05 ), which indicated that thoracic vertebral fracture injury was more severe and the poor stability in the former groups. The operated patients with 4 points in the TLICS score, The cure rate of T+BRS group was 75.0% ,which was higher than 8.3% in T group(p<0.01). There usually was a posterior long segmental fixation in T+BR group and T+BRS group. The rate of postoperative complications in the T+BRS group was 46.7%, which was obviously higher than T group(p<0.01). There was statistical difference between T+BRS group and T group in Frankel scores before and after the operation(p<0.05).Conclusion:1,Sternocostal complex injure can influence the stability of the thoracic vertebral fractures,2,It is necessary to take the rib and sternum injure into consideration for the evaluation of thoracic vertebral fractures with TLICS score .