Clinical Results Of Treating Thoracolumbar Fracture: Combined Traditional Chinese Medicine With Surgical Stablization Via Paraspinal Approach

Objective To introduce the clinical value of treating thoracolumbar fracture via paraspinal approach combine traditional chinese medicine and compare with the preliminary clinical outcomes of the treatment of thorscolumbar spinal fracture with traditional internal posterior transpedicular fixation by midline approach.Methods From 2008.6 to 2010.6, the thoracolumbar fractures cases, which were in the 175 PLA hospital, according to strict inclusion criteria and collecting complete data:Including 36 males and 28 females with an average age of 41.3 years (range,22～56 years). Involvement was at L1 in 31, L2 in 4, and T12 in 29 fractures. However, as to AO fracture classification, the study comprised 33 in A1 and 31 in A2 with posterior column intact. The mean preoperative ratio of the height of the anterior border was 55.2%, kyphosis degree was 18.6°. The patients were divided randomly into two groups, Group A included 35 patients treated by tradition approach four screws short-segment posterior fixation and fracture vertebral transpedicular hydroxyapatite grafting, and Group B included 29 patients treated by paraspinal approach four screws short-segment posterior fixation and fracture vertebral transpedicular hydroxyapatite grafting. Incision suture removal 10～12 days after surgery, started to herbal fumigation. Group A and B were respectively divided randomly into two groups, Group A1 treated without herbal fumigation, Group A2 treated with herbal fumigation. Group B1 treated without herbal fumigation, Group B2 treated with herbal fumigation. Retrospective study such as by telephone and outpatient follow-up was applied. Mean follow-up time was over two years. Outcome measures:Operative time, Blood loss, Postoperative drainage, CK, Percentage of vertebral compression, kyphosis degree, VAS Rating, Oswestry Rating, the preoperative and postoperative cross-sectional area of multifidus muscle measured by MRI. The data was managed by the SPSS 13.0 software.Result The consumed time of operation, correction rate of the Cobb angle and postoperative analgesic injection time in the paraspinal approach group and the midline approach group made no significant difference(P>0.05), but the results confirmed that Group B had obvious advantage over Group A in blood loss, postoperative pain score and Oswestry dysfunction score, and the difference was of statistical significance (P<0.05). The preoperative and ten months postoperative cross-section area of multifidus muscle checked by MRI in the midline approach group seriously atrophied as to Group B The cure rate in Group A2 is higher than Group A2, Group B2 higher than Group B1, and the diffierence was of statistical significance (P<0.05)Conclusions Firstly, the paraspinal approach is an easy way for treating of thoracolumbar vertebral fracture, minimizes the soft tissue injury in operation and decreases complications after operation. Secondly, reinforcement with fracture level transpedicular hydroxyapatite grafting can help to provide better kyphosis correction, which could prevent the development of kyphosis in long-term. Thirdly, herbal fumigation can activat blood and relieve pain, promote functional recovery of patients. Traditional Chinese Medicine combine with surgical stabilization is an effective treatment.