| Objectives:To observe the intermediate stage and long-term results of nonoperative treatment versus posterior-instrumentation fixation using pedicle screws techniques of traumatic thoracolumbar burst fractures.Methods:102 patients who were suffered from traumatic thoracolumbar burst fractures were studied retrospectively from Jan.2002 to Otc.2007. After carefully bolting, following cases were excluded:(1) patients who had chronic low back pain or the history of operation located in the lumbar part (2) patients whose fractures were not located in T11-L2 (3) simple compression fracture (4) The type of fracture was type A or type B accord with AO classisfication system (5) patients who had osteoporosis apparatently (6) patients whose spinal canal were invaded >50% (7) patients who were found congenital spinal stenosis by CT scanning (8) patients who were uncooperative for affiliating with craniocerebral injuries (9) patients who were affiliated with medical disease or tumor (10) patients whose image information was semicomplete. At last 74 patients met the inclusion criteria were taken into account. Posterior-instrumentation fixation using pedicle screws techniques was ultilized normally in the operative group.Neurological deficits were not found in all patients. But the spinal canal invasion was found in all candidates by CT scanning. The patients were followed 2-7 years(average 4.2) and assessed by clinical and radiologic outcomes. The plain photographs and CT scans were analyzed at pre-operation, post-operation and the final follow-up. The local kyphosis angle was measured on the lateral plain photographs using the method recommended by Sang WL. The reduction of vertebrae,The local kyphosis angle, JOA scores and the recovery of spinal canal invasion were used to evaluate the results.The ultimate data were analyzed by SPSS 13.0 package of software. Results:No development of neurologic deficit occurred in all patients. Patients in the group A (n=40), the mean hospitallization was 12.3(5-56) days, the augmentation of local kyphosis angle was 3.6°(-3-9)°; the extent of spinal canal invasion decreased from (29.85±7.32)% to (10.60±5.58)%, the JOA scores increased from (7.23±1.53) to (26.28±1.28), the improvement rate of JOA scores was 87.5%, common complications such as decubital ulcer, deep phlebothrombosis and pulmonary infection were found in 4,6 and 2 patients. Patients in group B (n=34), the mean operating time was 125(90-160) minutes, the mean blood loss was 320 (150-750) ml, the decrease of local kyphosis angle was 13°(11-27)°, the extent of spinal canal invasion decreased from (28.09±7.59)% to (6.80±6.26)%, the JOA scores increased from (7.74±1.02) to (26.82±1.31),the improvement rate of JOA scores was 89.7%. common complications such as decubital ulcer, deep phlebothrombosis and pulmonary infection were found in 1,7 and 1 patients.21 of the operative patients had been removed of the internal fixation until the last follow-up. Two pedicle screws of AF were found broken, one located in the above pedicle,the other situated below both broke at the ventro-connection of the nail and the rod.Conclusions: (1) The early therapeutic effect of traumatic thoracolumbar burst fractures in the surgical group is better than that of the nonsurgical group such as pain relief, early activity and kyphosis correction (2) The difference of therapeutic effect of traumatic thoracolumbar burst fractures in the surgical and nonsurgical groups decreased step by step, so the long-term functional outcome of them is similar (3) Nonoperative treatment and posterior-instrumentation fixation are alternative method for traumatic thoracolumbar burst fractures. |
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