Unstable And Burst Fracture Of Thoracolumbar Vertebrae Treated By Pedicle Screw Instrumentation Plus Vertebral Body Bone Grafting

Objective:To investigate the clinical curative effect of posterior vertebral body bone grafting plus posterolateral fusion withβ-Tricalcium phospate (β-TCP) bone combined with pedicle screw fixation for unstable and burst thoracolumbar fractures in 13 cases, And to summarize the clinical experience of the treatment, in order to prevent the occurrence of complications.Methods:Between August 2003 and December 2008, Twenty-five patients cases of unstable and burst thoracolumbar fractures were analyzed retrospectively. All patients were cured by bone grafting plus pedicle screw fixation. Among them 16 were male and 9 female, age range was 36.9 years(19-60years). The injure segments were T11 5 cases, T125 cases, L1 7 cases, L28 cases. There were average 6 hours-14 days from injury to operation. Operation steps were reduction, decompression, pedicle screw fixation and bone fusion. The patients were divided into group A and group B, including 13 cases(group A) of posterior vertebral body bone grafting plus posterolateral fusion,12 cases(group B) of posterolateral fusion.25 cases were followed up for 15 to 24 months. The mean period of follow-up was 18.7 months. To evaluate spinal cord function, X-ray and CT before and after operation, meanwhile, observe the height of fractured vertebrae, the Cobb's angle, and the recovery of spinal cord function. Curative results were evaluated by the Frankel grade criteria.Results:The internal fixations were moved out after operation(from 12 to 24 months). In height and Cobb's angle of fractured vertebrae, there was no significant diference between 2 groups before operation, after surgery and one week before taking out the internal fixation (P>0.05), while there was a significant difference three months after taking out the internal fixation (P<0.05). There was a statistical significant difference in Frankel grade while the last follow-up(P<0.05). The nervus function of group A and group B were improved by average 1.7 and 1.0 grade.Conclusion:With less expensive,β-TCP bone is effective for clinical bone grafting, and may be a replacement of the autogenous iliac bone graft, at the same time it can shorten operation time and decrease the blood loss. Posterior vertebral body bone grafting plus posterolateral fusion withβ-TCP bone can increase the stability of the three column of spine, and obviously lower implant failure and correction loss, and kyphosis can be prevented. It can also provide and maintain vertebral stability early and long-term, which is superior to posterolateral fusion alone, so it is a stable and reliable method in treatment of unstable and burst thoracolumbar fractures. posterior vertebral body bone grafting plus posterolateral fusion withβ-TCP bone combined with pedicle screw fixation for unstable and burst thoracolumbar fractures is worth wide application in clinics.