The Clinical Study Of Anterior Decompression Bone Graft Fusion Fixation For Thoracolumbar Burst Fracture

Objective: Through spinal orthopedics of Ningxia Medical University General Hospitalin2005.10~2010.10treated by anterior decompression, bone graft, internal fixation fortreatment of thoracolumbar burst fracture patients, To discuss the operation efficacy andindication of anterior decompression and fixation for the Treatment of instable thoracolumbarburst fractures (TLBF).Methods: A retrospective survey of2005.10~2010.10our Hospital were treated byanterior decompression, bone graft, internal fixation for thoracolumbar burst fractures in51cases, follow-up in36patients, in whom Tran thoracic approach in9cases, after extra pleuralretroperitoneal approach in20cases, via retroperitoneal approach in7cases.For those patientswith medical records and imaging data were collected. By radiographic evaluation of thevertebral injury types, injury of the vertebral anterior vertebral body height restoration, Cobbangle, the changes of the graft and bone graft fusion;observation of the spinal location byspiral CT data; neural functions were assessed using the ASIA classification, low back painusing a visual analogue pain scale(VAS) assessmentResults: This group of36patients followed up for a mean of36.4months (9~67months), postoperative hospital stay averaged9days (6~21days), total hospital stayaveraged16days (9~33days).All patients tolerated operation, operation time averaged260±78min, intraoperative blood loss averaged820±113ml.1patients with postoperativeincision infection,1cases of delayed pneumothorax,2cases of postoperative abdominaldistention, and in1cases, right calf deep vein thrombosis, cured.33patients were injured when combined with nerve injury (92%), After surgery does not appear aggravated cases ofneurological symptoms.Preoperative vertebral height of the front angle and Cobb were(41.8%士9.3%)(23.5°士8.6°), postoperative respectively (95.3%士1.8%)(2.3°士1.5°);statistical comparisons revealed vertebral height of the front and Cobb postoperative andpreoperative P<0.05; follow-up vertebral height of the front and Cobb angle are lost, but theloss rate is smaller; preoperative spinal space-occupying rate58.2%士11.6%, postoperative,follow-up were3.1±4.0%、2.9±4.3%, preoperative and postoperative P<0.05, postoperativeand follow-up P>0.05; preoperative VAS score5.3士1.5,0.5士0.4follow-up, P<0.05.Duringthe follow-up period did not find any cases of patients with internal fixation loosening orfracture, there is only partial vertebral anterior vertebral body height and angle Cobb loss, butthe loss rate is low, all patients got good bone fusion.Conclusion: The anterior approach for thoracolumbar fractures may be preferred inpatients with incomplete neurologic deficit from burst fractures without substantial posteriorelement injury. Excellent visualization of the anterior durra mater allows safe decompressionand leads to some degree of neurologic recovery in most patients. Reconstruction generallyincludes the use of iliac crest strut graft, cages, or allograft. Supplementation with internalfixation can improve biomechanical stability and may lead to improved fusion rates andreductions in ultimate kyphosis. But the operation trauma, complex operation.