The Effect Analysis Of Transforaminal Lumbar Interbody Fusion (TLIF) In The Treatment Of Thoracolumbar Burst Fractures With Endplate Collapse

Objective:The purpose of this study was to compare the clinical effects of posterior pedicle screw fixation and TLIF in the treatment of thoracolumbar burst fractures with endplate collapse.Methods:46 patients with thoracolumbar burst fracture who met the inclusion criteria from July 2016 to February 2018 were randomly divided into two groups.In the fusion group,22 patients underwent TLIF,and in the non fusion group,24 patients underwent posterior pedicle screw fixation.The general information,operation time,intraoperative bleeding volume,postoperative drainage volume,X-ray,CT,MRI,VAS score,Asia grade,anterior height ratio,Cobb angle,Molinari fusion grade and complications of all patients were included in this study.Statistical analysis was made on the operation time,intraoperative bleeding volume,postoperative drainage volume,Asia classification before operation and one year after internal fixation removal,VAS score before operation,one week after operation,six months after operation,before internal fixation removal and one year after internal fixation removal,anterior height ratio of the injured vertebra,convex Cobb angle of the injured vertebra.Results:There was no significant difference between the fusion group and the non fusion group in the mean age,gender,cause of injury,injury segment,height ratio of anterior edge of injured vertebra,Cobb angle of injured vertebra,VAS score,Asia grade,time of internal fixation(P>0.05).Comparison among groups:There were statistically significant differences between the two groups at 1 week,6 months,before and 1 year after the removal of the internal fixation and the VAS score,the height ratio of the anterior edge of the injured vertebra and the Cobb angle of the kyphosis of the injured vertebra(P<0.05).Intra group comparison:The operation time,intraoperative bleeding volume and postoperative drainage volume in the fusion group were higher than those in the non fusion group,and there was statistical significance between the two groups(P<0.05).There was no significant difference in VAS score,anterior height ratio and Cobb angle between the fusion group and the non fusion group at 1 week,6 months and before the removal of the internal fixation(P>0.05),but there was significant difference between the two groups at 1 year after the removal of the internal fixation(P<0.05).The degree of loss of correction and back pain in the fusion group was smaller than that in the non fusion group.One year after the removal of internal fixation,the Asia scores of fusion group and non fusion group were significantly improved(P<0.05),and there was no significant difference between the two groups(P>0.05).The imaging data of all cases showed that the internal fixation was in good position without loosening or fracture.Except for one case of severe kyphosis and back pain after internal fixation and removal in the non fusion group,there were no adverse events in the perioperative and postoperative follow-up.Conclusion:TLIF treatment of thoracolumbar burst fracture with endplate collapse can effectively prevent the loss of correction after internal fixation and reduce the long-term back pain of patients.It is a safe and effective operation,which is worthy of further promotion in clinical practice.