| Objective:To further compare and analyze the advantages and disadvantages of two different surgical methods(anterior approach and posterior approach)for thoracolumbar fractures with nerve injury.Methods: Retrospective collection of patients with thoracolumbar fractures complicated with nerve injury admitted to the Department of Orthopedic Spine in Affiliated Hospital of Yan ’an University from September 2014 to September 2019.According to the inclusion and exclusion criteria,62 patients were selected,including 48 males and 14 females,aged 21-62 years.They were divided into a group and b group.31 patients in group a were treated by anterior approach and 31 patients in group b were treated by posterior approach.there were 72 injured segments,including 8 cases of T12 segment injury,18 cases of L1,26 cases of L2,16 cases of L3 and 5 cases of L4.There were 34 cases of fall injury,15 cases of collision injury in traffic accident and 13 cases of crushing injury with heavy objects.According to the American Spinal Infusion Association(ASIA),there were 10 cases of Grade B(including 6 cases in Group A and 4cases in Group B),45 cases of Grade C(including 21 cases in Group A and 24 cases in Group B)and 7 cases of Grade D(including 4 cases in Group A and 3 cases in Group B)Two groups of patients were treated with different surgical methods.The operation time,intraoperative blood loss,JOA(Japanese Orthopaedic Association Scores)before and one month after operation,the percentage of vertebral canal sagittal diameter occupied by CT scan before and after operation,preoperative and postoperative Cobb angle,preoperative and postoperative height between the upper and lower vertebral bodies of the injured vertebral body,and the patients were followed up for 16 ～ 22 months(average about 19months).The comparison was made by comprehensive analysis of two kinds of operation data and recovery of nerve function in ASIA after operation.Results: All patients successfully completed the operation,and the operation time was(214.52±24.34)min in Group A and(175.16±25.28)min in Group B.The difference between them was statistically significant(P < 0.05).The amount of intraoperative blood loss in group A was(893.87±211.36)ml,while that in group B was(341.61±127.67)ml,and the difference was statistically significant(p < 0.05).The JOA scores of group a were(10.91±3.37)and(16.74±3.07)before operation and 1 month after operation respectively,while those of group b were(10.71±3.47)and(14.83±2.95)before operation and 1 month after operation respectively.There was no significant difference in preoperative JOA score between group A and group B(P > 0.05),but there was significant difference in JOA score one month after operation between the two groups.In group A,the percentage of vertebral canal fractures occupying sagittal diameter was(38.29±13.36)% before operation and(2.42±0.92)% after operation,while in group B,the percentage of vertebral canal fractures occupying sagittal diameter was(34.81±10.84)% before operation and(8.94±2.77)% after operation,respectively There was no significant difference between the two groups in the percentage of vertebral canal fracture occupying sagittal diameter in preoperative CT scan(P > 0.05),but there was significant difference between them in postoperative CT scan(P< 0.05).Cobb angles before and after operation were(21.23±2.25)°and(3.09±0.93)°in group A,and(21.16±2.31)°and(3.45±0.99)°in group B.There was no significant difference between the two groups before and after operation.The preoperative height between the upper and lower vertebral bodies of the injured vertebra in group A was(38.52±2.80)mm and(55.03±2.18)mm,and the preoperative height between the upper and lower vertebral bodies of the injured vertebra in group B was(37.61±2.65)mm and(50.74±2.29)mm.There was no significant difference between them before operation(P >0.05)There was no significant difference in ASIA nerve function between group A and group B before operation(P > 0.05),but there was significant difference in ASIA nerve function between group A and group B after operation after 16-22 months follow-up respectively(P < 0.05).Conclusion:1.Anterior and posterior approaches have certain significance in the treatment of thoracolumbar fractures complicated with nerve injury,and have strong orthopedic ability and decompression effect,and have certain curative effect on the recovery of patients’ nerve function.2.The posterior approach is simple and has the advantages of short operative time,less trauma,and less operative complications.However,it is not as good as the anterior approach for the recovery of the spinal canal volume and the height correction between the upper and lower vertebrae of the injured vertebra.The curative effect of nerve recovery after follow-up is not better than that of anterior approach.3.The anterior approach is difficult,with long operation time,large blood loss and more complications than the posterior approach.However,the anterior approach has sufficient decompression and strong spinal orthopedic repair ability,and has certain advantages over the posterior approach in the recovery of nerve function after operation.4.The selection of anterior and posterior approaches should be combined with clinical practice when referring to the scoring rules of the guidelines.Although anterior approach has certain advantages in nerve recovery,patients with complete nerve injury should be treated by posterior approach on the premise of reducing trauma and clinical complications. |
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