Operation In Treatment Of Thoracolumbar Spine Fractures:Evolution Of Fusions Sytle

Background and PurposeThoracolumbar vertebral fracture is a common clinical injury. It can be divided into four types on the basis of the shape of vertebral fracture, that is, the compressive fracture, the burst fracture, the seat belt fracture and the dislocation fracture. Thoracolumbar burst fracture is the most common clinical type. It occurs as the result of a compressive load, often with varying degrees of flexion, which causes part of the posterior vertebral body to be displaced backwards into the spinal canal with possible neural damage, and these complications cause severe psychosomatic trauma and economic burden to the patients and their families. Pedicle screw fixation has been widely used to treat thoracolumbar vertebral fractures, but many surgeons in basic hospitals don’t do bone-grafting and fusion or use the wrong method because of economic factors in patients and lack of qualifications for spinal bone graft fusion technique in doctors, which can cause the internal holders loosening or rupturing even neurological deterioration. We retrospectively analyze thoracolumbar vertebral fracture patients treated with pedicle screw fixation and different bone graft fusion methods in our hospital during2006and2009to investigate the usage tendency of bone graft fusion in basic hospitals and analyze its curative effects for the burst fracture patients, thus provide measures on how to make a clinical decision for clinicians. Materials and Methods1.Research Subjects:Select241surgical patients with thoracolumbar vertebral fracture from the153Central Hospital of Chinese People’s Liberation Army in Zhengzhou during2006and2009. Enroll patients with fresh fracture and surgical treatment for the first time. Eliminate the thoracolumbar vertebral fracture cases with obvious osteoporosis, contraindication. MRI scans demonstrate that posterior ligament complex were complete. The scores of the spine by Load-Sharing scoring system were3to6, which ensure the subjects were suitable for posterior surgery alone.2.Grouping Methods:Patients were divided into four groups by the year of admission:2006group,2007group,2008group and2009group.And each group was divided into two subgroups according to surgical choice of internal fixation:posterolateral fusion group (groupA) and posterolateral merged with interbody fusion group (groupB). Analyze the tendency of different bone graft fusion methods, compare the hours of operation, amount of bleeding, the cobb angle and the loss ratio of correction after last follow-up in the burst thoracolumbar vertebral fracture patients treated with pedicle screw fixation and posterolateral fusion (with or without interbody fusion) in2009,and evaluate the clinical efficacy by the ameliorated Oswestry disability index.3.Statistical Processing:Analyze the data with SPSS15.0, measurement data using T tests, effect analysis using Wilcoxon rank sum test.ResultsThe posterolateral fusion is common in basic hospitals, and the interbody fusion cases are increasing gradually in recent years, especially in the burst thoracolumbar vertebral fracture patients, the percentage reaching to50.79%in2009from the initial20.83%.There were no statistical differences in the postoperative quality of life between different methods. The data of the burst thoracolumbar vertebral fracture patients in2009demonstrated that the hours of operation and the amount of bleeding were significantly different between group A and group B, but the cobb angle, the loss ratio of correction and the oswestry disability index (ODI) were lower in group B, indicating better clinical efficacy.ConclusionThe posterolateral fusion has been a conventional method in the thoracolumbar vertebral fusion, and the interbody fusion has been accepted gradually by many basic hospitals. Posterolateral fusion merged with interbody grafting, which corresponds with the principle of biomechanics, can help reconstruct the spinal stability, especially for the burst thoracolumbar vertebral fracture patients. Therefore, patients treated with posterolateral merged with interbody fusion will lead a better life.