Clinical Effects Of Pedicle Screws Fixation In Thoracolumbar Fracture: Report Of 74 Cases

Objective: To analyze the clinical effects of pedicle screws fixation in the treatment of thoracolumbar fracture.Methods:Seventy-four cases of thoracolumbar fracture patients were treated with fixation by pedicle screws system from March 2011 to September 2014. Among them, twenty-eight patients had spinal cord injury, accounted for 37.8%,four cases associated with thoracic injuries(5.4%), two cases with abdominal injuries(2.7%), two cases with pelvic bone fractures(2.7%), twenty-one cases with limbs fracture(28.4%).For patients with spinal cord injury, neural nutrition and dehydration should be given preoperatively, surgery for decompression of the spinal canal should be done as soon as possible. The patients with life threatening complications should be treated urgently, such as rupture of liver or spleen and hemopneumothorax, etc. When patients were recovered from risk,operation on thoracolumbar fractures should be done as soon as possible. All patients should be regularly followed up more than one year and a half after operation, until pedicle screws were removed. Each patients should be assessed by the anterior vertebral compression ratio, the sagittal Cobb angle,and ASIA(American Spinal Injury Association) impairment scales.Results:(1) The anterior vertebral compression ratios and Cobb angles of seventy-four cases were different significantly after operations by paired t test. Operation could restore the vertebral body height and correct spine kyphosis effectively(p<0.05).(2)The anterior vertebral compression ratios and Cobb angles were consecutively followed up until pedicle screws were removed,and the vertebral compression ratios were not different obviously by one way repeated analysis of variance(P>0.05). The sagittal vertebral Cobb angles were different overall by one way repeated analysis of variance(P<0.05), but the Cobb angles were not different before pedicle screws removed by paired t test(P>>0.009). The Cobb angles after pedicle screws removed were also different obviously from that before pedicle screws fixation.(3) ASIA impairment scales of the patients with neural lesion before operations were significantly different from that one year after operations by rank sum test(P<0.05), which meant pedicle screws fixation were beneficial to the recovery of neural function.Conclusion: Posterior pedicle screws fixation could restore the vertebral body height and correct kyphosis effectively. Pedicle screws system could provide a strong support for broken vertebral bodys before bones union, and prevent the loss of vertebral body height and kyphotic deformity. For patients with nerve damage, indirect reduction and pedicle screws fixation could relieve spinal cord compression, keep spine stable, and were beneficial to the recovery of neural function, which allowed early functional exercises after operation.