Research Of Treatment Of Ankylosing Spondylitis Combined With Thoracolumbar Fracture By Posterior Long Segment Percutaneous Screw Internal Fixation Based On The TCM Theory Of "Paying Equal Attention To Both Bones And Soft Tissues"

Objective:To explore and compare the clinical efficacy of ankylosing spondylitis combined with thoracolumbar fracture under the guidance of TCM theory of "paying equal attention to both bones and soft tissues".The occurrence,development,diagnosis,treatment,prognosis and characteristics of surgical treatment of lumbar spine fractures are discussed to provide a reference for the selection of clinical treatment methods in the future.Methods:According to the inclusion criteria 42 patients with ankylosing spondylitis combined with thoracolumbar spine fractures who were treated in orthopedics in our hospital from November 2014 to January 2019 were selected;they were divided into two groups according to the different surgical methods,of which 22 patients were treated after long segment was treated with percutaneous nailing and internal fixation percutaneous group),and 20 patients underwent posterior approach with open reduction and internal fixation(incision group).During observation and treatment,during follow-up,due to inadequate teatment cycles,incomplete data,and non-compliance with regular follow-up,a total of 37 patients with ankylosing spondylitis complicated with thoracolumbar fractures were included in the study,including 19 in the percutaneous group,16 in males,3 females,aged 29 to 84 years;18 patients in the incision group,13 males,5 females,aged 35 to 86;the surgical materials of the two groups used the spinal fixation system provided by Shandong Kangsheng Medical Devices Corporation.Record the operation time,intraoperative blood loss,postoperative bed time,and number of fluoroscopy,and calculate the pedicle screw misplacement rate by intraoperative C-arm fluoroscopy(the screw has not been inserted through the pedicle).VAS and ODI scores were assessed by telephone,or outpatient follow-up at 1,3 and 6 months.The fracture healing line and spinal cord injury were evaluated by CT and MRI.Results:1.Judgment of curative effect:(1)The modified Macnab curative effect grading method was used to evaluate the overall postoperative effect.Both groups were satisfied with the curative effect of the operation,and there was no significant difference(P>0.05).(2)Two groups of patients were compared within the group.In terms of VAS score,ODI score and Cobb angle of injured kyphosis,there was a significant improvement in 1 month after treatment compared with before surgery,and the difference was statistically significant(P<0.05);On the VAS score and ODI score,the differences were statistically significant at 3 and 6 months after treatment compared with 1 month after treatment(P<0.05).(3)The comparison between the two groups was statistically significant in terms of operation time,intraoperative blood loss,postoperative bed time,number of fluoroscopy,and length of hospital stay(P<0.05);The VAS score,ODI score,and Cobb angle of the injured kyphosis were compared at 1,3 and 6 months,,and the differences were not statistically significant(P>0.05).2.Safety indicators:Postoperative incisions in both groups were healed in grade A.Two patients in the incision group experienced drug allergic reactions during treatment,and recovered after 1 day of active treatment such as oxygen inhalation,desensitization,and rest.There were no complications such as pulmonary embolism and deep vein thrombosis ofthe lower extremities.Conclusions:1.Percutaneous nail fixation for ankylosing spondylitis combined with thoracolumbar fractures has shorter operation time,less trauma,and less invasive surgery than incision and internal fixation in terms of operation time,intraoperative blood loss,and postoperative bed time.The advantages of less bleeding and quicker postoperative recovery,and the short-term and long-term effects after treatment are similar to the incision method.It is definitely effective in improving the pain of patients,correcting kyphosis of the spine,improving the quality of life,reducing the complications of long-term bed rest of fractures,and bringing the good news to some elderly patients.However,the spinal fixation system is more expensive,especially percutaneous screws,which are more expensive than ordinary screws,and because of the special nature of ankylosing spondylitis fractures,long-segment fixation is required,so the patient has a large financial burden and has different acceptance levels.Therefore,it is relatively difficult to carry out the technology.However,in the long run the internal fixation method of percutaneous nails will gradually be widely used in clinical practice,which has good economic and social benefits.2.Under the guidance of the theory of "paying equal attention to both bones and soft tissues" in Chinese medicine,pay attention to the coordination between muscles and bones,and treat ankylosing spondylitis combined with thoracolumbar fractures through minimally invasive small incision and nail placement,reducing the damage of muscles and tissues by open large incision,Pay attention to the protection of tendons,maintain the overall internal balance of muscles,bones,blood vessels,and nerves,and pay more attention to the integrity and stability of the spine,with significant curative effects.