Classification And Surgical Treatment Of Overlapping Displaced Fracture And Complete Dislocation Of Thoracolumbar Spine

Objectives:This paper presents a classification method for overlapping displaced fracture and complete dislocation of thoracolumbar spine.To explore the relationship between this classification and the cause of injury and injury mechanism;use the classification to indicate the degree of injury and prognosis;use the classification to guide the choice of surgical plan,analyze the curative effect of surgical treatment,and evaluate the clinical application value of the classification method.Methods:A retrospective analysis was made of 11 cases of overlapping displaced fracture and complete dislocation of thoracolumbar spine in our hospital from January 2004 to March 2018.By collecting the causes of injury,imaging findings,spinal nerve function,surgical treatment and efficacy,combined with injury and other data,a classification method for overlapping displaced fracture and complete dislocation of thoracolumbar spine was proposed:according to overlapping dislocation The direction can be divided into:front overlap type,rear overlap type,and side overlap type.According to the number of vertebral injuries,it can be divided into type ?(single vertebral injury),type ?(multiple vertebral injury).According to the degree of vertebral injury,type ? injury is divided into two subtypes:IA type(vertebral body)Light damage),type IB(heavy body damage).The classification method was used to guide the selection of surgical procedures:all patients were treated with open reduction,long segment fixation,spinal canal decompression,and bone graft fusion.Type ? lesions are few,all of them are treated with simple posterior approach;IA type vertebral body injury is light,no vertebral body resection and interbody fusion,only for posterolateral bone graft fusion;IB type vertebral body injury is heavy,need Vertebroplasty and interbody fusion.Type ? injury segment length,simple posterior approach surgery,increase the anterior incision when the difficulty is difficult,combined with the anterior and posterior approach;type ? injury segment is long,need to remove multiple damaged vertebral bodies and intervertebral disc,intervertebral bone graft Fusion with the posterolateral bone graft.Statistical operation time,bleeding volume;vertebral body height ratio,overlap length,degree of slippage before after surgery;ASIA classification of neurological function before and after surgery;surgical complications,internal fixation and bone graft fusion,surgical treatment The efficacy of the evaluation was evaluated.Results:All 11 patients were followed up for an average of(16 ± 8.5)months.After surgical treatment,11 patients had satisfactory correction of spinal overlap deformity,spondylolisthesis,and vertebral compression.In terms of surgical trauma:type ? surgery was short,intraoperative blood loss was small,and the difference between the two types was statistically significant;in terms of neurological recovery,there was no difference between type ? and type ?.There was no difference between type ? and type ? in terms of surgical complications,internal fixation/bone graft fusion.Conclusions:This study proposes the diagnostic criteria for overlapping displaced fracture and complete dislocation of thoracolumbar spine:severe thoracolumbar fracture and dislocation caused by high energy injury,the upper vertebral body completely loses the support and connection of the lower vertebral body,and overlapping deformities appear between adjacent vertebral bodies.The classification method is proposed:according to the direction of overlapping dislocation,it is divided into pre-overlapping type,post-overlapping type and lateral overlapping type;according to the number and degree of vertebral injury,it is divided into type I and type ?,of which type ? is divided into IA,IB two subtypes.The proposed diagnostic criteria and classification methods can improve and refine the existing classification of thoracolumbar fracture and dislocation injuries,distinguish different types of damage causes and mechanisms,and provide more accurate clinical work and scientific research exchanges.Classification criteria for diagnosis;use of classification to indicate the extent of injury and prognosis;use of classification to guide the choice of surgical options,can obtain satisfactory therapeutic results.