The Comparison Of Thoracolumbar Burst Fracture Treated With Minimally Invasive And Traditionnal Open Pedicle Screw Fixation

Objective:In recent years, with the development of architectural andtransport, the incidence of thoracolumbar burst fracture has been increasing.there is still debate on choosing surgery approach to treat thoracolumbar burstfracture. Since Boucher fixed the lumbosacral joint successfully by longPedicle screw In1959, the technology of pedicle screw internaI fixation intreating thoracolumbar fracture have been extensively carried out in theworld.The posterior surgery of pedicle screw internaI fixation in treatingthoracolumbar fracture is the most commonly used method. The traditionalposterior surgery operation itself is simple, but has some shortcoming such asstripping the muscle organization widely, more Traumaand bleeding, longhospitalization period and it is too expensive.For that, posterior intermuscularapproach fixation in the treatment of thoracolumbar and lumbar burst fracturesrepresents a good alternative option,which can avoid Actions of violence andgross stretch and reduce tissue damage and muscle-split.The aim ofexperiment was to compare clinical outcome of the posterior intermuscularapproach versus traditionnal open pedicle screw fixation in the treatment ofthoracolumbar and lumbar brust fracture with neurological intact or minor.Methods:80patients with athoracolumbar and lumbar brust fracturewere treated since January2009until May2010.Patients were24females,46males; average age was38.3years (range from25to51).The interval betweeninjury and operation was3-7days (4.3days on average);Fracture section: T71cases，T116cases，T1220cases，L126cases，L216cases，L41cases;fallinginjury57cases, traffic accident injury15cases, the weight scarred6cases,other injury2case.35patient of them underwent minimally invasive posteriorintermuscular approach pedicle screw fixation,whith take the4pedicle rootas the center and cut4small incision of about1.5cm long vertical line,next,we cut the deep fascia and blunt separation of paravertebral musclesto reveal the needle point.Some obese patients can take the posterior midlineincision and cut the skin and subcutaneous, then blunt separation ofparavertebral.And the other35patient underwent traditionnal open pediclescrew fixation,which take the middle approach, in turn cut the skin,subcutaneous tissue, stripping of the paraspinal muscles to reveal the needlepoint.24hours after the operation,patients should go into functional exerciseswith hip flexion and knee extension movement against resistance Under theguidance of doctor.three weeks after the operation,they can get out of bedunder the protection of Brace. During hospitalization,we take a series ofmeasures to prevent Many complications such as using air bed and regularBody-turning to prevent bedsores.The patients have been banned from Heavyphysical work and frequently bent over.Patient follow-up ranged from12to16months (mean13.7months)andthe patients were assessed by clinical and radiographic evaluation such asoperation time,blood loss,the length of hospitalization and the Cobb angle.Thefuction were assessed by the Oswestry questionnaire.Result:180patients were followed up for12to16months, averaging13.7months,postoperative wound was primary healing. There were no seriouspostoperative complications such as aggravation of neurologic symptoms.There were significance difference（p＜0.05） in the length of hospitalizationand blood loss between the posterior intermuscular approach and traditionnalopen approach.（Table1）2There were no significance difference（p＞0.05） in the operation timebetween the posterior intermuscular approach and traditionnal openapproach.（Table1）3The anterior vertebral height recovery, Cobb angle correction ofpostoperative had significantly improved than that of the preoperation.There was statistical significance difference（p＜0.05）between them. There ware no statistical significance difference in anterior vertebral height recoveryand Cobb angle correction of postoperative between the posteriorintermuscular approach and traditionnal open approach.(p>0.05).（Table2、Table3）4There ware no statistical significance difference in the Oswestryquestionnaire between the posterior intermuscular approach and traditionnalopen approach(p>0.05).All the patient with neurologically intact(Frankel E)have been fully recovered.Conclusion:1Two kinds of operation method both could better reduct and fix the spinalfractures.2There was statistical significance difference in anterior vertebral heightrecovery and Cobb angle correction of postoperative between the posteriorintermuscular approach and traditionnal open approach.3The posterior intermuscular approach pedicle screw fixation in thetreatment of thoracolumbar and lumbar spine fractures with neurological intactor minor represents a good alternative option to conservative treatment withthe advantages of reliable clinical results..Clinical and functional results arebetter or comparable,time of recovery and hospitalization is much quicker, theblood loss of operation is less.