Effect Of Sagittal Vertebral Injuries In Posterior Reconstruction Operation For Thoracolumbar Fracture

Objective: To explore the relationsionsinp between different vertebral sagittal range ofthoracolumbar fracture and dinic effect of anterior and middle column reconstruction operation.Methods: From August2006to December2011，124patients suffered form thoracolumbarfracture and dislocation underment different kinds of surgrcal methods according to the rauge ofsagittal vertebral injury. simple upper endplate damage (fracture, dislocation), usingposterior anterior and middle column supporting bone graft operation treatment (group A1, n=21), posterolateral bone graft in the treatment of posterior operation (group B, n=20)；Upperend plate injury with vertebral sagittal injury <60%, using posterior anterior and middle columnsupporting bone graft operation treatment (group A2, n=23), posterolateral bone graft in thetreatment of posterior operation (group C, n=25)；Vertebral sagittal damage≥60%with upperand lower endplate damage, using posterior anterior and middle column supporting bone graftoperation treatment (group A3, n=16), anterior approach operation of bone graft in thetreatment of anterior column (D group, n=19). Soms operation indexes, For example:operation time、intraoperative blood loss、postoperative drainage were compared among A1, A2,A3group, oder early and middle stage clinical index between A group and B, C,D groups werecompared on. Include： gender, age, impaired segment, cause of injury, fracture type,preoperative cobb ’ s angle, pre-operation hospital days, sugical approach, operation time,intraoperative blood loos, blood transfusion, early complications, postoperative drainage,postoperative hospital days, the preoperative and postoperative3-10day Frankel grading,intervertebral disc injury and typing, follow-up Frankel grade, low back pain (ODI score),postoperative and follow-up cobb ’ s angle correction and follow-up of loss, The date wereanalyzed by different statistical methods to different tykes.Results:(1) Between A1, A2, A3group, the operation time, bleeding during operation andintraoperative and postoperative blood transfusion, postoperative drainage volume werestatistical differences;(2) For A1group and B group, there was not statistical different inoperation time,blood loss, postoperative drainage, postoperative drainage, neurological recovery, but the fllow-up cobb angle, vertebral height loss and implant complications have significantdifference;(3)For A2group and C group, there was not statistical different in operationtime,blood loss, postoperative drainage, postoperative drainage, neurological recovery, but thefllow-up cobb angle, vertebral height loss and implant complications have significant difference;(4) For A3group and D group, there was statistical different in operation time, blood loss,postoperative drainage, but the fllow-up cobb angle, vertebral height loss and implantcomplications not significant difference.Conclusion:1, Sagittal vertebral injury range can offece the severity of trauma in the surgicalmocess of one stege posterior anterior column reconstruction, the operation trauma graduallyincreased with the range of sagittal vertebral damage.2, For mild sagittal vertebral burst fracture, one stage posterior anterior column reconstructionoperation is simple, safe and effective.3,For severe sagittal vertebral burst fracture, excensive posterior decompression, reduction,anterior and middle column reconstruction may increase the operation trauma,and vascular,nerve injury risk, should be used prudently.