| Along with the fast development between traffic and building industry, the occurrence of the spinal vertebral fracture increases. Thoracolumbar vertebras have a bigger movable degree, and it is the turning point of thoracic vertebral and lumbar vertebral,so it is easy to casue thoracolumbar fracture,and that is a main reason of nerve hurt,but the treatment opportune and way of the choice affect prognosis directly. As the development with the biomechanics and internal fixation material,the treatment of thoracolumbar fracture internal fixation by a short segments accepting this kind of internal fixation.From 1995. 5 to 2004.3, 334 cases of thoracolumbar fracture patients in our department were collected, all were cured by pedicles screw a short segments. The review analyzes its clinical data, postoperative complications is 42 cases (15.1%), pedicles screw broken is 25 cases (9.0%), pedicles screw loosened is 9cases(3.2%),nervous stimulated symptom is 2 cases(0.7%),postoperative infected is 3 cases(1.1%),among them 1 case skin infected,inflammatory substance around screw is 2 cases, Internal fixators projection sense at dorsa is 3 cases(1.1%)。Neurological status improved at least 1 Frankel grade is 45.5%of the patients,37 cases burst fractures of the thoracolumbar vertebras fracture without any neurocomplications, no case appears the nervous symptoms complications, no cases appears lumbago, all can go in for the light physical labor.The internal fixation by pedicle the technique screws vertebral bodies,this kind of internal fixation by pedicle screw is good enough to guarantee to open ,compress and rotate between pedicle screw and longitudinal linked pole .It is advantageous not to break the back of vertebral ligaments ,provide 3D correction , the fixation is short, the internal fixation is stronger and the rate of vertebral healing is higher. The indirect decompression mechanism of the pedicle screw open the fracture vertebral and intervertebral discs ,strain posterior longitudinal ligament and intervertebral discs annulus tibrosus ,and push the bone pieces in the vertebral canal ahead to reduct, this process is Ligamentotaxis ,It is function depends on the completement of posterior longitudinal ligament and intervertebral discs annulus tibrosus. Thoracolumbar fractures with spinal injury, no matter complete paraplegia or incomplete paraplegia, need surgery therapy. Surgery therapy can acquire good reduction and reliable stability. It is advantageous for the nerve recovery and functional training. The decompression can relieve the exotic compression on the spinal cord. Earlier decompression can relieve the spinal injury, can make us know the reliable condition of spinal injury and provide reference for the prognosis. Earlier operation on patients with lumber bursting fractures without spinal injury can prevent later angulation deformity and processing nerve injury. Most of the scholars think thoracolumbar fractures need bone planting after internal fixation and interspinal bone planting is very important for severe thoracolumbar bursting fractures to prevent the failure of internal fixation, secondary angulation deformity of the spine and later nerve injury. We have observed that the severity degree of nerve injury doesn't coincide with the occupying degree of vertebral canal. The severity degree of nerve injury of the bursting fractures depends on the condition of the moment on which the injury occurred. The condition has good relation to the strength of the moment on which the injury occurred. The condition of the patients in the hospital and the later screenage data only response the condition after injury and not the injury moment. So most of the patients with complete nerve injury can't acquire nerve function recovery even given thorough vertebral canal decompression. The patients with incomplete nerve injury can acquire satisfactory indirect decompression by pedicle of vertebra fixation and reduction. Rehabilitation exercise af... |
PDF Full Text Request