Comparison Of Clinical Efficacy Of Pedicle Screw Internal Fixation Combined With Transpedicular Bone Grafting Versus Non-bone Grafting For Thoracolumbar Fractures

Objective:To analyze and compare the clinical effect of pedicle screw internal fixation combined with transpedicular bone grafting versus non-bone grafting for thoracolumbar fractures.Methods:Through a retrospective study,103 cases who were diagnosed as single-segment thoracolumbar vertebral fractures(T11-L2)in the Department of Spine Center of the First Affiliated Hospital of Nanchang University from December 2012 to December2018 were selected and followed up effectively.They were divided into two groups according to whether or not the fractured vertebral body was bone-grafted through the pedicle in operation: 50 cases in the study group were given pedicle screw internal fixation in fractured vertebra combined with bone grafting through the pedicle;53cases in the control group were given simply pedicle screw internal fixation.Followed up for 12 to 36 months after operation.To collect and organize all clinical relevant data of the two groups of patients including gender,age,follow-up time,fracture segment,fracture classification.Observing and comparing operation time,intraoperative bleeding volumethe,the ratio of the height of the anterior edge of the injured vertebra and the kyphotic Cobb angle of the adjacent vertebrae of the injured vertebra before operation,after operation and at last follow-up.Analyzing the reduction of the ratio of the height of the anterior edge of the injured vertebra and the kyphotic Cobb angle of the adjacent vertebrae of the injured vertebra at last follow-up.Results:Compared with the control group,there was no significant difference in preoperative clinical general data between gender,age,follow-up time,injured segment,fracture classification in the study group(P> 0.05).The average operationtime and intraoperative bleeding volume of the study group were slightly higher than that of the control group,but the difference between them was not statistically significant(P> 0.05).The ratio of the anterior height of the injured vertebra and the kyphotic Cobb angle of the adjacent vertebrae of the injured vertebra in two groups after operation and last follow-up were significantly different from those before operation(P <0.05).There was no significant difference in the ratio of the anterior height of the injured vertebra and the kyphotic Cobb angle of the adjacent vertebrae of the injured vertebra between the two groups after operation and last follow-up(P>0.05).However,the loss of the ratio of the anterior height of the injured vertebra and the loss of the Cobb angle of the adjacent vertebrae of the injured vertebrae in the last follow-up of the A3 and B fractures in the control group were larger than that of the study group(P<0.05).Conclusion:Pedicle screw internal fixation combined with transpedicular pedicle bone grafting and non-bone grafting have the same effect on the immediate height recovery of thoracolumbar fractures and correcting the physiological curve of the spine;vertebral bone grafting can better reduce the loss of the ratio of the anterior height of the injured vertebra and the kyphotic Cobb angle of the adjacent vertebra of the injured vertebra at last follow-up,especially for type A3 and B fractures.