Comparative Study Of The Clinical Effects Of Thoracolumbar Fractures In The Posterior Fixation With Or Without Fractured Vertebral

Objective:This paper was aimed to evaluate the clinical effect of two kinds of treatment methods for the thoracolumbar spine fracture in the posterior fixation with or without fractured vertebral.Method:70 patients with single segment thoracolumbar spine(T11-L2)fractures from October 2015 to December 2016 in Affiliated Hospital of Yan án University were collected,including 43 males and 27 females,aged 21-49 year old.All patients according to AO spinal fractures were type A fractures,and neurological function by Frankel grading were E grade.According to the order of admission to sort,and then random number table divided into 2 groups.Across fracture vertebra group was 35 cases,21 males and 14 females.The average age was(36.5 ± 12.3)years old.Cause of fracture was high fall injury in 15 cases,falls in 13 cases,traffic accidents in 7 cases.Fractured vertebral segments were T11 vertebral body in 6 cases,T12 vertebral body in 13 cases,L1 vertebral body in 11 cases,L2 vertebral body in 5 cases.This group was treated in the posterior short segment fixation by 4 screws-2 rods-3 vertebrae.Trans-fracture vertebral group was 35 cases,22 males and 13 females.The average age was(38.1 ± 10.2)years old.Cause of fracture was high fall injury in 14 cases,falls in 15 cases,traffic accidents in 6 cases.Fractured vertebral segments were T11 vertebral body in 6 cases,T12 vertebral body in 11 cases,L1 vertebral body in 12 cases,L2 vertebral body in 6 cases.This group was treated in the posterior short segment fixation by 6 screws-2 rods-3 vertebrae.These were recorded respectively,including the operative time,intraoperative blood loss,intraoperative fluoroscopy times,as well the anterior vertebral height ratio(AVH%)and the Cobb angle of the fractured vertebral body,the visual analogue scale(VAS)scores and the Oswestry disability index(ODI)scores at preoperative,postoperative 1 week and 12 months,of the 2 groups.Result:(1)There were no statistically significant differences between the 2 groups in gender,age,cause of fracture and fractured vertebral body segments(p>0.05).(2)There were no significant differences between the 2 groups in the operation time,intraoperative blood loss,and intraoperative fluoroscopy times(p>0.05).(3)The AVH%,Cobb angle,VAS score and ODI score of the two groups at the postoperative 1 week were significantly different from those before operation(p <0.05),but no significant difference was found between the two groups(p> 0.05).(4)The AVH% and Cobb angle at the postoperative 12 months of the across fracture vertebra group were significantly different from those at the postoperative 1 week(p <0.05).There was no significant difference in the AVH% and Cobb angle between the postoperative 12 months and the postoperative 1 week in the trans-fracture vertebral group(p> 0.05).The VAS score and ODI score of the two groups at the postoperative 12 months were significantly different from those at the postoperative 1 week respectively(p <0.05).There was statistically significant difference in AVH% and Cobb angle at the postoperative 12 months between the two groups respectively(p<0.05);while there was no significant difference in VAS score and ODI score between the two groups at the postoperative 12 months(p> 0.05).Conclusion:(1)When it comes to the treatment of single segment thoracolumbar spine fracture,the two fixation ways with or without fractured vertebral could both satisfactorily reset the fracture vertebral body and achieve a similar immediate fixation effect.(2)With time going by,there will be a certain degree of correction loss in the fixation with or without fractured vertebral.However,the fixation with fractured vertebral was more advantageous in maintaining postoperative fixation effect and reducing correction loss.