| Objective: To compare the clinical effects of surgical and conservative treatment for thoracolumbar burst fracture(type A3)with TLICS score<4.Evaluate objectively the safety and validity of surgical treatment for thoracolumbar burst fractures with TLICS score<4,and to verify the guiding significance of TLICS system,and in order to provide a more accurate,safe and effective treatment for thoracolumbar burst fractures with TLICS score<4.Methods: From June 2017 to December 2018,60 patients of thoracolumbar burst fracture with TLICS scores less than 4 were treated with surgery and conservative treatment.including32 cases in the surgical group and 28 cases in the conservative group,39 males and 21females;aged 21 to 65 years;34 cases of traffic accident injury,5 drifting-down injury,2 heavy object injury and 19 fall damage.According to the TLICS system,the scores of 60 cases are all2points(burst fracture 2 points,neurological intact 0 points and PLC intact 0 points).The surgical cases were treated with posterior transpedicular screw internal fixation and bone grafting.The conservation groups has strict requirements for the patient’s bed rest time and our plastic surgeon rehabilitation exercise guidance.All patients underwent thoracolumbar X-ray,CT and MRI examinations before treatment,and regular thoracolumbar X-ray examinations after treatment.Vas scores,Odi Index,Cobb angle,anterior edge compression rate were measured before and after treatment,and the symptoms of delayed low back pain and nerve compression were counted.Results:All the patients were followed up after treatment.Follow-up time was 12-28 months,with an average of 20.2 months.In the surgical group,there was no injury of blood vessels,spinal cord and nerve root.Postoperative imaging showed that the pedicle screw position is good,the collapse return to normal basically,reduction of vertebral body is satisfactory,and no complications such as falling pneumonia,decubitus ulcer,lower limb thrombosis,internal fixation loosening and rupture occurred.In the conservative group,there was 1 case of delayed low back pain and lower limb nerve symptom,3 cases of lung infection.The complication rate was about 14.3%.After anti-infection,physical therapy and other symptomatic treatment,the infection symptoms were cured,back pain and lower limb neurological symptoms were not significantly improved.The clinical effects of surgical group was better than that of conservative group in getting out of bed,staying in hospital,improving Cobb angle and restoring the height of anterior edge of injured vertebra,and the differences were statistically significant(p<0.05).The Vas score and Odi index of the two groups were significantly improved compared with those before treatment,and the differences were statistically significant(p<0.05).After 1 month,the surgical group had more advantage than the conservative group in improving the VAS score and Odi index(p<0.05),but there was no significant difference at the last follow-up,the results were not statistically significant(p>0.05).Conclusion:(1)Surgical treatment of thoracolumbar burst fractures with TLICS score<4is better than conservative treatment in the aspects of initial pain relief,recovery of function and correction of deformity.(2)The results of surgical and conservative treatment were similar in the middle and late stage,but the operation was more advantageous in preventing the aggravation of Kyphosis and secondary nerve injury.(3)The partial revision and supplement contents of TLICS scoring system are verified.Both of them can be used in the treatment of thoracolumbar burst fracture with TLICS score<4,but the reasonable choice should be made according to the needs and actual conditions of the patients. |
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