The Effect Of Simple Internal Pedicle Screw Fixation On Thoracolumbar Vertebrae Burst Fracture Patients With Fracture Block Into The Spinal Canal

Objective: To explore the effect of simple internal fixation on thoracolumbar vertebrae burst fracture patients with fracture block into the spinal canal 30%-50%without neurological symptoms.Methods: A total of 72 patients underwent simple approach pedicle screw fixation with fracture block into the spinal canal without neurological symptoms were collected.Finish the relevant examinations before operation,like X-ray,CT,MRI,and so on.X-ray demonstrated the vertebral compression change,CT showed fracture block into the spinal canal and MRI showed the continuous presence of posterior longitudinal ligament.All the patients were divided into control group(occupation rate of spinal canal of 0%-29%,n=40)and observation group(occupation rate of spinal canal of 30%-50%,n=32)according to the occupation rate of fracture block into the spinal canal before operation.The indexes of both groups including kyphotic Cobb angle of the injured vertebra,vertebral compression rate,occupation rate of spinal canal,VAS score,ASIA(American Spinal Injury Association)grading were recorded before operation,immediately after the operation,and 1 month,3 months,6 months and 1 year after operation through follow-up.Meanwhile,the operation effect of both two groups was compared,and the effect of simple internal fixation in the treatment of 30%-50% occupation rate of the fracture block into spinal canal.Results: All patients were followed up for 1 year.All the 72 patients had no neurological symptoms,no loosening or breakage of internal fixation.In the A group,the spinal canal occupation rate was restored from 13.82±4.43% preoperatively to 4.53±1.38%,the vertebral body compression rate was restored from 17.37±4.25%preoperatively to 8.29±3.16%,and the kyphotic Cobb angle recovered from 12.17±2.43°to 6.39±1.57°.While in the B group,the spinal canal occupation rate was restored from38.48±5.82% preoperatively to 5.18±1.64%,the vertebral body compression rate was restored from 45.55±11.96%preoperatively to 9.05±3.67% and the kyphotic Cobb angle recovered from 22.71±5.35°to 7.29±2.42°.There was no significant difference between the two groups in kyphotic Cobb angle of the injured vertebra,vertebral compression rate,occupation rate of spinal canal and VAS score before operation,immediately after the operation,and 1 month,3 months,6 months and 1 year after operation compared by the T Test.The morphology of the spinal canal was improved immediately after the operation in both groups and no obvious vertebral canal remodeling was seen during follow-up.After January when the control group 44.68% compared with postoperative vertebral height loss and kyphotic Cobb angle,vertebral height lost an average of 2.22%,the average kyphosis angle increased 1.28 degree,after January 46.75% the observation group compared with postoperative vertebral height loss and kyphotic Cobb is increased,the vertebral height lost an average of 3.14% after.The average angle increased 1.09 degree.All patients were followed up for 1 year after operation.Neither the height of vertebral body continued to lose nor the kyphosis angle continued to increase.CT of one case confirmed the vacuum sign 1 year after the operation.One patient showed a shell-like change of the vertebral body with nonunion in the vertebral body.Six cases had incision margin necrosis and delayed healing.Conclusion: Simple internal fixation is so reliable in treatment of thoracolumbar vertebrae burst fracture patients with 30%-50% occupation rate of fracture block into the spinal canal without neurological symptoms that laminectomy was no need for decompression.The spinal canal occupation was improved after operation.Meanwhile,the vertebral height and kyphosis Cobb angle recovered well.In January,the height of vertebral body and the Cobb angle of the injured vertebra were increased in the 0%-29% group.