The Treatment Of Thoracolumbar Fractures With Semi-vertebral Fusion

Objective: Spine fractures are very common. The average annual incidence of spinal fracture is 63.6 per 100,000.And the thoracolumbar is at the position which is the junction of the two physiological bending (T11-L2) and the place of stress concentration,so thoracolumbar fracture is the most frequently[1]. For the fractures associated with nerve injury or instability ones, the first choice is surgical treatment to rebuild the stability of the spine, relieve spinal cord compression[2]. Surgical methods include anterior, posterior and combined anterior-posterior approaches. vertebral fusion is often applied. The traditional vertebral fusion is to mix the disease one with the upper and lower vertebrae to restore stability, the cost is making the loss of function of this whole spinal segment. The semi-vertebral fusion pass through strict preoperative surgical planning, strictly control surgical indications, by preserving a functional segment, to minimize the loss of spinal function. The aim of this article is to investigate the surgical indication,surgical methods and clinical effect.Methods: 17 cases with thoracolumbar fractures received the semi-vertebral fusion that had been admitted to our hospital from January 2007 to July 2010 were retrospectively reviewed. All of them were examined by AP radiography view,CT and MRI. According to imaging data, 17 patients were severe fracture or dislocation, all three columns were injured. For Denis type, 1 case was compression fracture,7 cases of burst fractures, seat belt injury in 5 cases, 4 cases of fracture and dislocation.CT showed traumatic spinal canal stenosis, spinal cord injury or the anterior-posterior compression of the dural sac, the sick vertebrae with the upper or inferior endplate integrity. MRI showed all the patients had the signal of bleeding or edema in the spinal cord,and the posterior ligament had damaged signal. ASIA grade is that A 2 patients, B grade 3, C 8 cases, D grade 3, E 1 case.Results: All of them were followed up, with an average of 15.2 months,the longest is 24 months,and the shortest is 8 months.For the efficacy evaluation of the spine fractures'treatment,the major clinical application is radiographic evaluation and neurological assessment(AISA).The postoperative review of 17 cases were obtained bony fusion.the internal fixation is not breakage or loosening. 2 cases of preoperative patients with complete spinal cord injury did not improve after the operation,only to see that the neurological level went down a little. While the incomplete nerve injury ones'recovery of nerve function is Not less than 1 grade (ASIA grade).Conclusion: Semi-vertebral fusion in the treatment of thoracolumbar unstable fracture can preserve spinal segment as much as possible.Through the early functional exercise, it can lead to satisfactory clinical efficacy.