| ObjectiveEvaluate the clinic effect and various influence factors of the treatment ofthe severe burst fractures of the thoracic and lumbar spine throughbone-transplanting and internal fixation by posterior decompression. Explore theindications of posterior approaches in reconstructing the stability of anterior andmiddle columns in order to appraise the superiority and prospects.MethodsFrom June2007to June2011, there were eighty-seven cases of the severeburst fractures of the thoracic and lumbar spine were treated in Taian CentralHospital. The cases were divided into four groups: Posterior decompression andinternal fixation through intraspinal bone-transplanting with functionreconstruction of spinal anterior and middle columns(Group A,24cases);Posterior decompression and internal fixation through Titanium Retebone-transplanting with function reconstruction of spinal anterior and middlecolumns(Group B,20cases); Anterior decompression and internal fixationthrough intraspinal bone-transplanting with function reconstruction of spinalanterior and middle columns(Group C,21cases); Anterior decompression andinternal fixation through Titanium Rete bone-transplanting with functionreconstruction of spinal anterior and middle columns(Group D,22cases). All ofthem will be analyzed by systematic statistics and followed up for12-48months.Investigate the outcomes such as the height ratio of vertebra anterior border tothe posterior also the spinal correction and follow-up loss rate, kyphosis angle and its spinal correction and follow-up loss rate, vertebral canal volume, neuralfunction grade of ASIA, intraoperative bleeding volume, operation time, JOAscore and VAS score and Denis degree of post operation, and changes of pre andpost-operative pulmonary function before and after operations. Meanwhile,evaluate the effect of the treatment of the severe burst fractures of the thoracicand lumbar spine through bone-transplanting and internal fixation by posteriordecompression.Results1.Intraoperative bleeding volume in the posterior approaches: Group A(527.50±141.40ml), Group B (879.25±118.74ml); Operation time: Group A(205.96±19.61min), Group B (252.80±20.34min). The statistics showedsignificant differences (p＜0.05) when compared with the anterior approaches(groups C and D).2. In the posterior approach-Group A: the preoperative heightof vertebra anterior and posterior border is (34.17±15.05﹪，48.92±4.27﹪), andis rectified to (93.00±2.03﹪，95.76±1.43﹪) respectively; The spinal correctionis (58.83±14.92﹪，46.84±4.51﹪) respectively; The follow-up loss rates are(6.36±2.89﹪，2.62±1.68﹪) respectively. Kyphosis angle is rectified from thepreoperative (20.69±5.80°) to the posterior (6.63±1.13°); The correction rate is(67.95±0.07﹪); The follow-up loss rate is (2.62±1.02°). Vertebral canal volumeis rectified from the preoperative (36.08±11.56﹪) to the posterior (95.79±1.27﹪); The improvement rate of the JOA score is (0.65±0.14﹪). In the posteriorapproach-Group B: the preoperative height of vertebra anterior and posteriorborder is (29.14±13.28﹪，48.22±5.44﹪), and is rectified to (92.19±2.20﹪，95.04±2.85﹪) respectively; The spinal correction is (63.05±12.63﹪，46.82±4.16﹪) respectively; The follow-up loss rates are (6.78±2.52﹪，2.08±0.86﹪) respectively. Kyphosis angle is rectified from the preoperative(22.36±5.44°) to the posterior (6.69±1.05°); The correction rate is (70.08±0.07﹪); The follow-up loss rate is (3.07±1.54°). Vertebral canal volume is rectifiedfrom the preoperative (37.59±13.92﹪) to the posterior (95.64±1.40﹪); Theimprovement rate of the JOA score is (0.63±0.16﹪). The neural function isimproved after operation, and the statistics showed no significant difference (P＞0.05) when compared with the anterior approaches (groups C and D).3. Incidence rates of the post operative Denis degree are8.33﹪in Group A and5.00﹪in Group B respectively. The VAS score is declined from （5.01±1.39）to （2.33±0.83）in Group A, and from （5.44±1.30）to （2.36±0.85）in GroupB. The statistics showed significant difference (P＜0.05) when compared withthe anterior approaches (Groups C and D) in the all of aspects including thepulmonary function.ConclusionComparing the bone-transplanting and internal fixation by posteriordecompression with that by anterior decompression, both of them have the equalclear reliability in renewing the vertebral bodies’ height and vertebral canalvolume, correcting the kyphotic deformity, improving neurological symptomsand reconstructing the stability of anterior and middle columns either after thesurgery or in the follow-up. However, the posterior approaches have greatsuperiority in the following aspects: bleeding and time consuming in operation,improvement of pain after surgery, intervention of the pre and post-operation,and the occurrence of complications. The two approaches of bone-transplantingand internal fixation by posterior decompression has achieved the same effect offull decompression and reconstruction and firm fixation with the anteriorapproaches by relatively concise operation, which are the perfect combination ofthe advantages of traditional anterior and posterior approaches, and are the verysafe, effective and reliable ways in treating severe burst fractures of the thoracicand lumbar spine and reconstructing the stability of anterior and middle columnsat present. |
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