The Treatment Of Thoracolumbar Vertebral Bursting Fractures By The Method Of Posterior Decompression Applied In The Affected Vertabra Via Unipedicular Pedicle Medial Wall By Cutting Vertebral Canal

Objective To explore the clinical effect of the treatment ofthoracolumbar vertebral bursting fractures by the method of posteriordecompression applied in the affected vertabra via unipedicular medial wall bycutting vertebral canal. Methods From June2010to October2011, twenty-onecases of thoracolumbar vertebral bursting fractures were treated by the methodof posterior decompression applied in the affected vertabra via unipedicularmadial wall by cutting vertebral canal. The group of patients satisfied thefollowing conditions:(1) bursting fracture corresponded with Denisclassification (2) vertebral fracture only (3) the average time from injury tooperation was more than two weeks (4) when OR<0.5, or with free flip offracture block (5) unfold reduction of6nails and2bars, and vertebral canal’sindirect decompression fails. Exclusion criterion:(1) T11-L2facture dislocation(2) Chance fracture (3) old fracture with kyphosis or paresis (4) severe paralysis（FrankelA degrade）. There were16male cases and5female cases, from26to68, average age47.7. Reason of injury: traffic accident3cases, injury by falling15cases, crush injury3cases.The area of injury: T124cases, L111cases, L26cases. Neurological function was evaluated with the criteria of Frankle andrecorded operation time and bleeding during operation. Neurological status atpreoperative，3days postoperative were reviews by Frankel scoring system，comparing the front height of injured vertebral through DR and CT. The spinal reconstruction and decompression of fracture were evaluated by adjacentvertebral Cobb angle and spinal canal encroachment rate. Results Operationtime:90-130minutes, average time:108minutes. The amount of bleeding inoperation:155ml-350ml, average amount219ml. There were no cases ofbilateral pedicle fractures. The anterior spinal canal bone block compressionwas also lighter in relatively complete side of pedicle, that is screw placement.The lateral of decompression was the severer side of injury, however, there wasno developmental deformity in screw placement and situation which wasdifficult to place screw because of minor diameter. All the patients came backto visit the hospital, average time14.5months (3months to24months). Therewas no fragment displacement through observation of all cases. The frontheight of injuried vertebral recovered from preoperative average58.8%to97.1%. Adjacent vertebral Cobb angle preoperative average29.6°to4.8; spinalcanal encroachment rate41.2%to3.3%. There existed significant differentcompared with preoperative（P<0.05）. Adjacent vertebral Cobb angle andspinal canal encroachment rate showed no significant difference comparing thelast visit with3days postoperative(P>0.05). The neurological function ofvast majority of patients have different degrees of recovery postoperative, theimprovement rate was95.24%. Among them2cases of Frankel B recovered toGrade C,1case without recovery. One ninth returned from Frankel C to D; eightpatients to E;the remaining patients have reached E grade.Eight cases recoveredmore than one level, which was44.44%among cases of restoration. There wasno complication like postoperative incision infection,leakage of cerebrospinalor deep venous thrombosis among all cases.Patients were examined with DRafter operation,unseen looseness andfracture.Conclusion:1The following aresuitable for the treatment of thoracolumbar vertebral bursting fractures by themethod of posterior decompression applied in the affected vertabra viaunipedicular madial wall by cutting vertebral canal:(1) bursting fracture corresponds with Denis classification (2) vertebral fracture only (3) the averagetime of injury to operation was more than two weeks (4) when OR<0.5, or withfree flip of fracture block (5) unfold reduction of6nails and2bars, andvertebral canal’s indirect decompression fails.There was at least one relativelycomplete side with good bone density.2The method was reliable and effective,which was able to relieve compressive spinal cord injury, improve bloodprovision and recovery of neurological function.3It not only effectivelyrecovered the height of injuried verterbral and physiologial curve, but alsoreconstructed the stability of spinal cord and prevented loss of vertebral bodyheight and the failure of internal fixation.