A Analysis Of Results Of Short Segment Fixation Combined With Interbody Fusion And Posterolateral Fusion For Treating Thoracolumbar Vertebral Fracture

Objective:To compare the efficacy of the implantation of bone graft with interbody fusion and posterolateral fusion for treating thoracolumbar vertebral fracture by posterior pedicle screw fixationMethod:1.62 cases from June,2007 to Dec,2008 with thoracolumbar vertebral fractures, the single segment injury, no significant osteoporosis, were treated by posterior pedicle screw fixation. The cases were randomly divided into A, B groups. A group was treated with the implantation of bone graft with interbody fusion; B group were treated with posterolateral fusion. The two groups adopted standard surgical approach and method, the same postoperative treatment and functional exercise program respectively.2.evaluate with X-ray, ASIS classification and the JOA scores (Japanese Orthopaedic Association). Evaluation criteria:(1) evaluated by X-ray:including postoperative vertebral height correction, kyphoscoliosis Cobb'S angle rectification and the vertebral height and kyphoscoliosis Cobb'S angle at follow-up. (2) classified with American Spinal Injury Association (ASIS), because ASIS classification could indicate the recovery of neurological function. A grade-increase of ASIS indicated improvement. (3) scored with JOA scores, comparing the scores'improvement rate at pre-and post-treatment. The improving index (rate) could indicate the lumbar vertebral function. The evaluation standard of the improving rate of JOA score:more than 75% was excellent; 50%-74% was good; 25%-49% was middle; less than 25% was worse. 3.Statistical analysis:All data were analysed by SPSS 10.0 statistical software; statistical data were shown with mean±standard deviation measurement data with t test, grade data with rank-sum test; P<0.05 indicated the significant difference and statistically significant.Results:1. The restoration of vertebral height, the correction rate of Cobb angle and JOA score in two groups were no significant differences (P>0.05).2. The 6-months'fusion rate of A group cases was 94%; the 6-months' fusion rate of B group cases was 85%,2 cases'screw nails in which were broken after 3 months (P<0.05).3. The restoration rate of vertebral height and the Cobb angle correction loss rate at 9-months'follow-up of A group was significantly better than the B group (P<0.05).4. The neurological function improvement of two groups at 9-months' follow-up was similar (P>0.05), but the improving rate of JOA score of A group was significantly better than the B group (P<0.05)Conclusion:1. The vertebral height, the immediate effect of Cobb angle correction and the neurological function improvement were similar in two groups cases, who were treated by posterior pedicle screw fixation combined with the implantation of bone graft with interbody fusion and posterolateral fusion. However, interbody fusion can immediately increase the anti-pressure stability of front column of spine, reduce complications of internal fixation because of excessive stress, such as broken nails, broken rods.2. The effective fusion rate of the pedicle screw fixation combined with the implantation of bone graft with interbody fusion was significantly higher than the pedicle screw fixation combined with the posterolateral fusion.3. The pedicle screw fixation combined with the implantation of bone graft with interbody fusion was better than the pedicle screw fixation combined with the posterolateral fusion in long-term prevention loss of vertebral height and Cobb angle and symptoms improvement in the treatment of thoracolumbar fractures.