Application Research Of Postural And Manual Reduction Combined With Percutaneous Pedicle Screw Fixation In The Treatment Of Single Segment Thoracolumbar Fracture Without Neurological Symptoms

ObjectiveTo compare the clinical effect of postural and manual reduction combined with percutaneous pedicle screw fixation and open reduction with internal fixation in the treatment of single segment thoracolumbar fracture without neurological symptoms.MethodsFrom January 2017 to February 2019 in the orthopedics ward of Affiliated Hospital of Chifeng University,83 cases of thoracolumbar fractures with single segment and no neurological symptoms were analyzed retrospectively.43 cases in the observation group were treated with postural and manual reduction combined with percutaneous pedicle screw fixation,and 40 cases in the control group were treated with open reduction and internal fixation.The operation duration,intraoperative blood loss volume,intraoperative X-ray exposure times,the time of first getting out of bed after operation,postoperative hospital stay and other indicators between the observation group and the control group were compared using t-test with independent samples.The assessment of the painvisual analogue score(VAS)to all patients were conducted before operation,3days after operation,3 months after operation,6 months after operation and 12 months after operation to compare the pain changes of the two groups at different time points using analysis of variance with repeated measurements.Before operation,3 months after operation and 12 months after operation,the recovery and loss of Cobb angle and the height of anterior vertebral border were evaluated through measuring by X-ray.Then independent sample t-test was used to compare data between the two groups.The Cobb angle and the height of anterior vertebral border in the group were compared with those in the same group by paired sample t-test.The complications and hospitalization expenses of the two groups were also compared.ResultsAll the patients were followed up effectively.After comparison between the two groups,the intraoperative blood loss volume,operation duration,the time of first getting out of bed after operation and postoperative hospital stay in the observation group were significantly less than those in the control group(P<0.05);the times of X-ray exposure in the observation group was significantly more than that in the control group,and the difference between the two groups was statistically significant(P<0.05).The VAS score of the two groups decreased with the passage of time.The VAS score of 3 days after operation,3months after operation,6 months after operation in the observation group was significantly lower than that of the control group(P<0.05),and the VAS score of the two groups at different time points was significantly lower than that of before operation in the same group(P<0.05).Compared with preoperative data of the same groups,the postoperative Cobb angle in the two groups decreased significantly,and the height of anterior vertebral border increased significantly(P<0.05).However,there was no significant difference between the two groupsin the recovery and loss of Cobb angle,the recovery and loss of the height of anterior vertebral border(P>0.05).There was significant difference between the two groups in postoperative complications(P<0.05).There was no significant difference between the two groups in hospitalization expenses(P>0.05).Conclusions1.Both kinds of operation can effectively treat the single segment of thoracolumbar fractures without neurological symptoms.There is no significant difference in the correction of Cobb angle and the height of anterior vertebral border.2.Postural and manual reduction combined with percutaneous pedicle screw fixation has less structural damage,and has obvious advantages in many aspects such as the blood loss volume,operation duration,the time of first getting out of bed after operation,postoperative hospital stay and pain control.The X-ray exposure times can be effectively controlled with the help of a new type of body surface pedicle positioner.