Treatment Of Thoracolumbar Burst Fracture By Posterior 270 Degree Spinal Canal Decompression And Double Titanium Mesh 270 Degree Reconstruction

Objective: To explore the feasibility and efficacy of one-stage posterior 270 degree spinal canal decompression and double titanium mesh270 degree reconstruction for thoracolumbar burst fractures.Methods: The clinical data of 35 patients from 2014-6 months to2017-10 months were retrospectively analyzed.There were 21 males and14 females,aged 23-67 years(47.3±12.3 years).Cause of injury: 16 cases of traffic accident,falling from height in 8 cases,11 cases were injured by objects.Segments: 9 cases of T11,15 cases of T12,3 cases of L1,3 cases of L4 and 5 cases of L5.ASIA grading: Grade a 6 cases,B grade 16 cases,C grade 8 cases,D grade 5 cases.The preoperative Cobb angle was 20.3±5.5 degrees,the height loss of the anterior vertebral body was 41.5±16.4%,the area in the spinal canal was 75.9 ± 7.4%,and the surgical treatment was 2~7d(average 4 d).All patients were treated by 270 degree spinal canal decompression and 270 degree reconstruction with doubletitanium mesh.The operative time and bleeding volume were recorded.The Cobb angle,height of vertebral body and recovery of neurological function before and after operation were compared.Result: All patients completed the operation in one phase,the operation time was 1.5~2.5h(1.9±0.3h),the amount of bleeding in the operation was 400~1200mL(707±225ml),the follow-up time was 6~36(8.7±5.2)months,and the recovery of nerve function: except 3 class A patients had no obvious improvement,the improvement of the residual disease per capita was obvious.Postoperative cerebrospinal fluid leakage occurred in 2 cases and wound infection in 2 cases.After operation and late follow-up,the Cobb angle of injured vertebrae was 6.1±1.8 degrees and6.5±1.9 degrees,and the anterior height lose of the vertebral body was 6.6± 1.6% and 7.4 ± 1.5% respectively.Compared with preoperative(P <0.05).During follow-up,CT showed complete decompression of spinal canal,no aggravation of lumbosacral pain,no screw loosening and breakage,no displacement and subsidence of titanium mesh.Conclusion: the 270 degree reconstruction of the spinal canal through a single posterior approach of 270 degree spinal canal decompression and reconstruction of the three column of the spinal canal through a single approach can reduce the difficulty of the operation of the titanium mesh,reduce the occurrence of nerve root and dura traction injury during operation.,increase the contact area of the fusion interface,and reduce theincidence of the subsidence of the titanium mesh.It is a good surgical method for thoracolumbar burst fractures.