The Clinical Research Of Curing The Ankylosing Spondylitis With Thoracolumbar Fractures By The Pedical Nail Bar System

Objective Objective to investigate the design and clinical effect of posterior long segment pedicle screw rod system internal fixation in the treatment of ankylosing spondylitis combined with thoracolumbar fractures.Methods From January 2015 to may 2020,19 patients with ankylosing spondylitis complicated with thoracolumbar spine fracture were retrospectively analyzed.All patients were treated with posterior long segment internal fixation system.In principle,the fractured vertebral body was fixed adjacent to 2-3 vertebrae.If there is osteoporosis(t value <-2.5)in preoperative examination,it is easy to lead to instability of screw placement.Bone cement should be used to strengthen pedicle screw fixation.MRI has the manifestation of spinal cord damage.If the segment is consistent with the clinical symptoms and physical examination,the spinal canal should be decompressed.The Cobb angle of kyphosis and the height of fractured vertebral body were observed before and after operation.The visual analogue scale(VAS)and disability index(ODI)of low back pain and leg pain were recorded and analyzed.At the last follow-up,the modified macnab criteria were used to evaluate the surgical effect.MRI,CT and X-ray of thoracolumbar vertebrae were regularly reviewed after operation,and the fracture healing was evaluated according to the fracture healing criteria.Record any complications related to the operation: cerebrospinal fluid leakage,nerve injury,wound nonunion or infection.Results All subjects were followed up completely.The Cobb angle of kyphosis recovered from 36.705 ± 12.061 ° to 14.289 ± 8.433 ° postoperatively.The average height of the anterior,central and posterior edges of the median sagittal plane were 26.993 ± 4.340 mm,26.558 ±3.248 mm and 29.457 ± 3.823 mm respectively before operation,and recovered to 29.492 ±2.872 mm,28.580 ± 2.548 mm and 30.240 ± 3.332 mm after operation.The mean VAS score was 8.32 ± 1.157 preoperatively,1.74 ± 1.046 postoperatively and 0.58 ± 0.607 postoperatively.The ODI index was 71.16 ± 16.375 preoperatively,36.63 ± 23.702 at 1 month and 16.21 ± 28.086 at 3 months postoperatively.3 months after operation,1 case of incomplete fracture healing was found,and the fracture healing rate was 90.91%.Six months after operation,the fracture healing rate was 100%,and the fracture vertebral body could be seen bony connection to achieve local stability reconstruction.The differences of Cobb angle,VAS score,ODI index of kyphosis deformity were statistically significant.Conclusion The application of pedicle screw rod internal fixation system in the treatment of ankylosing spondylitis complicated with thoracolumbar fractures restored the sequence of the upper and lower vertebrae,corrected the kyphosis caused by fracture,and restored the biomechanical stability of the spine.Obviously improve the fracture healing rate,effectively prevent secondary spinal cord injury.And bone cement reinforcement can effectively improve the fixation of pedicle screw,which can become the main method for the treatment of as combined with spinal fracture.