| Objective: To explore the effect of self-made Y-shaped fracture reduction device assisted with small fenestration of unilateral lamina space in the treatment of thoracolumbar burst fracture.Methods: 1.Design of Y-shaped fracture reduction device: 30 patients with thoracolumbar burst fracture from January 2015 to December 2017 in our hospital were collected and designed according to the parameters of intraspinal fracture block measured on the CT sagittal plane,and a 3D printing model of thoracolumbar burst fracture was established to evaluate the effect of Y-shaped fracture reduction device on the model.2.Clinical experimental study: From January 2016 to December 2017,a retrospective analysis was made on 20 cases of patients with fracture mass protruding into the spinal canal through traditional reduction method in our hospital and they were set as the control group;From January 2018 to December 2019,20 patients with self-designed Y-shaped fracture block inserted into the spinal canal through reduction were set as the experimental group.All patients underwent posterior unilateral laminectomy with small fenestration and direct decompression and internal fixation.The rate of spinal stenosis(SSR),Cobb angle and Anterior compression ratio of injured vertebrae(ACRIV)in the experimental group were statistically analyzed before and after the operation.The preoperative and postoperative statistical credits were made according to the operation time,intraoperative bleeding volume,SSR,Cobb angle,ACRIV and ASIA neurological function classification of the two groups Analysis.Results: Most of the fracture fragments protruding into the spinal canal are triangular in shape in thoracolumbar burst fracture,the vertex angle of the fracture block is about 90 °and the retroversion angle of the fracture block is about 30 ° in sagittal position,the length of the cortical surface of the fracture block is longer than that of the cross-section,which is generally twice the length of the fracture section,the fracture fragments are mainly divided into three sizes: cortical surface is about 6 mm in length and 3 mm in cross section;thecortical surface is about 8 mm in length and 4 mm in cross section;the cortical surface is about 10 mm in length and the cross section is about 5 mm in length,the application on 3D printing model showed that the reduction effect of Y-shaped fracture block reduction device was good.40 patients were followed up for 3~24 months,with an average of 14.2months.There were no complications such as injury of blood vessels and nerves,serious postoperative infection and internal fixation fracture or loosening in the two groups.The SSR,Cobb angle and ACRIV in the experimental group were significantly improved compared with those in the immediate and the last follow-up(P < 0.05).The difference was statistically significant(P < 0.05).Compared with the last follow-up,there was no statistical difference in the height of the Cobb angle and the ACRIV academic difference(P > 0.05);There was significant difference between the experimental group and the control group in the operation time and bleeding volume(P < 0.05),The experimental group is less than the control group;There was no significant difference in SSR,Cobb angle and ACRIV between the two groups before and immediately after operation compared with the last follow-up(P > 0.05),There was no significant difference in neurological function between the two groups before and after the last follow-up(P >0.05).Conclusion: The Y-shaped fracture block reduction device can match with the fracture block,and can significantly reduce the operation time and intraoperative blood loss.It has a certain clinical practical value. |
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