Comparison Of Surgical Fixation And Nonsurgical Management In Thoracolumbar Fracture Patients Who Combined With Pulmonary Contusion

ObjectiveTo compare the clinical efficacy of surgical fixation and nonsurgical management in thoracolumbar fracture patients who combined with pulmonary contusion and to compare the different timing of surgery so as to discuss the experience of the management.Methods117 patients who were diagnosed thoracolumbar fracture with pulmonary contusion were chosen from our department and analyzed retrospectively,from July,2014 to June,2017.They were divided into surgical group and nonsurgical group according to the treatment method.The clinical dates,such ashospital length of stay,duration of antibiotic use,APACHEⅡscore,ISS score,hospitalization cost,oxygenation index at admission and discharge,preoperative and postoperative follow-up injury Cobb angle,Visual Analogue Scale(VAS)score on admission and postoperative follow-up,occurrence of pleural effusion,occurrence of pneumonia were collected from all the subjects.The surgical group was further divided into 2 groups according to the timing of surgery.Within 48 hours of operation was defined as early surgery,the remaining was defined as later one.The clinical dates,such ashospital length of stay,duration of antibiotic use,APACHEⅡscore,ISS score,hospitalization cost,surgery time,intraoperative bleeding,oxygenation index at admission and discharge,preoperative and postoperative follow-up injury Cobb angle,Visual Analogue Scale(VAS)score on admission and postoperative follow-up,occurrence of pleural effusion,occurrence of pneumonia,occurrence of wound infection were also collected.ResultsThe early therapeutic effect of traumatic thoracolumbar burst fractures in the surgical group is better than that of the nonsurgical group such as pain relief,early activity and kyphosis correction.The difference of therapeutic effect of traumatic thoracolumbar burst fractures in the surgical and nonsurgical groups decreased step by step,so the long-term functional outcome of them is similar.The early operation group compared with the late operation group,can reduce the incidence of complications of pneumonia(3/36VS11/36)and pleural effusion(2/36VS9/36),and promote the recovery of Cobb angle of the injured vertebra(6.9±1.5VS8.1±1.8),the remaining results also had no significant difference.ConclusionsThoracolumbar fractures with pulmonary contusion in patients with surgical treatment and conservative treatment can be used as a treatment option.Early selection of surgical treatment according to the patient’s specific condition can reduce the incidence of postoperative complications.