| Objective: To evaluate the healing and stability of thoracolumbar burst fracture in patients with thoracolumbar burst fracture of type A3 after posterior bone grafting and rod fixation.Methods: From January 2014 to January 2016,72 cases of A3 type TBF were clinically diagnosed in our hospital,including 49 males and 23 females,aged 18-69 years(mean 50.3 ±9.5)years,course of disease 2-15 days(mean 6.5 ±1.8)days;All the patients were treated with posterior bone grafting and rod system fixation.The Cobb's angle and height of the injured vertebrae were measured immediately before operation and immediately after operation to evaluate the recovery of vertebral body.Before the removal of internal fixation,anterior and lateral films were performed to measure the Cobb's angle,the height of the anterior and posterior edge of the injured vertebra,and to evaluate the fracture and healing of the injured vertebrae by CT+3D reconstruction.Incomplete healing measures the volume of the cavity,records the location of the cavity,observes the shape of the cavity,and counts the incidence of the cavity.One year after the removal of internal fixation,the Cobb's angle,anterior and posterior height of the injured vertebrae were measured on the positive and lateral films,and compared with those before the removal of the internal fixation,CT+3D reconstruction was performed to further evaluate the cavitation of incomplete healing of injured vertebrae,and thoracolumbar dynamic imaging was performed to evaluate the stability of injured vertebra.Results: The Cobb's angle of the injured vertebra was 19.91 ±6.53°,the height of the anterior edge of the injured vertebra was 21.06 ±5.54 mm,the height of the posterior edge of the injured vertebra was 33.85 ±3.85 mm,the Cobb's angle of the injured vertebra was 7.67 ±4.28°,the height of the anterior edge of the injured vertebra was 31.15 ±3.06 mm,the height of the posterior edge of the injured vertebra was 36.78 ±3.32 mm.The anterior and posterior edge height was significantly improved(P < 0.05).The Cobb's angle of the injured vertebra before internal fixation was 8.07 ±4.23°,the anterior height of the injured vertebra was 30.27 ±3.31 mm,the height of the posterior edge of the injured vertebra was 36.34 ±3.98 mm,the Cobb's angle of the injured vertebra and the height of the anterior and posterior edge of the injured vertebra had no significant change(P > 0.05).The results of CT examination were as follows: 16 cases of complete union of injured vertebra,0 cases of complete nonunion,51 cases of incomplete union.The main manifestations of incomplete healing were low density,irregular shape and different sizes of cavities in the injured vertebrae.The incidence of cavities was 76.11.The cavity was located on 1/3 of the injured vertebrae 10 cases,in the upper 1/3 and in the middle of 1/3 20 cases,in the upper and middle and lower 1/3 18 cases,1 case in the middle 1/3 and lower 1/3,2 cases in the middle 1/3,0 cases in the lower 1/3,0 cases in the upper 1/3 and in the lower 1/3;The minimum cavity was 804.37mm~3,the maximum was 2631.05mm~3,and the cavity size was 1504.37 ±329.87mm~3.The Cobb's angle of the injured vertebra was 9.43 ±4.72°,the anterior height of the injured vertebra was 29.99 ±3.55 mm,the height of the posterior edge of the injured vertebra was 35.98 ±3.66 mm.Compared with that before removal of internal fixation,the Cobb's angle and height of anterior and posterior edge of injured vertebrae had no significant change(P > 0.05).The cavity position had no change compared with that before removal,and the size of cavity was 1498.09 ±381.27mm~3.The radiologic evaluation standard of stability score of thoracolumbar vertebrae was referred to dynamic potential film.There were no secondary vertebral fractures and broken nails and rods in this study.Conclusion: The height of injured vertebrae was reconstructed and the deformity of posterior process was corrected after the treatment of type A 3 TBF with posterior bone grafting and rod fixation.The complete healing of the injured vertebrae showed that the density of each plane in the whole vertebral body was uniform,continuous,and there was no low density cavity.The incomplete healing was mainly manifested as the cavitation changes in the injured vertebrae,the size of the cavity was different,the shape was irregular,and the position was mostly in the upper part of the injured vertebra.The stability of injured vertebrae was not affected by incomplete bone healing. |
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