Clinical Application Of Mini-open Anterolateral Approach In Treated Thoracolumbar A3/A4 Type Fracture With Nerve Injury

BACKGROUND CONTEXT: Spinal fracture is not uncommon in daily life,injury mechanism mostly due to direct or indirect effects of external force,but also there may be caused by osteoporosis,bone tuberculosis,bone tumor and the metastatic tumor pathological changes,eliminate pathological change caused by fracture,caused by the external force of the spine fracture occurred in the thoracolumbar region(T11-L2).Because,1.thoracolumbar segment in thoracic in position at the junction of the lumbar,thoracic activity range is small,the large range of lumbar,thoracic and stress concentration;2.The lumbar lordosis,physiology of thoracic kyphosis,thoracolumbar is another physiological curvature conversion;3.Thoracic facet joint and lumbar articular facet orientation different in thoracolumbar transitional.The treatment principle of spinal burst fracture: nerve decompression in order to facilitate the recovery of nerve injury,anterior and / or posterior reduction and fixation,bone graft fusion and reconstruction of spinal stability by sequence.In the treatment of spinal fractures in conventional anterior and posterior open incision has been able to fully decompression and reconstruction of spinal stability,but conventional open spinal surgery with blood loss,postoperative muscle pain,high risk of infection and extensive muscle stripping lead to muscle denervation and ultimately lead to the limitations of the muscle tissue scarring.Therefore,the satisfaction of patients for operation is reduced.With the deepening of the concept of minimally invasive and minimally invasive surgery of the spine is also becoming popular.Mini-open anterolateral approach in the treatment of thoracolumbar fracture,relieve the responsible lesion of nerve compression,reconstruction of spinal stability and restore the spinal normal sequence,has been able to achieve with conventional lateral anterior open surgery effect,less bleeding during the operation,small trauma,postoperative analgesic drug application less,less hospitalization time,quick recovery,in clinic for treatment of thoracolumbar vertebral injuries(injury of anterior column and posterior structure without injury)has obvious advantages.Thoracolumbar A3/A4 fractures is no posterior ligament injury of vertebral burst fracture or burst part,at the same time with or without nerve injury;nerve injury in patients with thoracolumbar A3/A4 fractures(AO type),nerve compression from the anterior dura sac,posterior structure without injury,using small incision anterior lateral approach decompression and fusion with more obvious advantages: direct decompression of nerve completely,small interference;anterior column support bone fusion more;anterolateral approach to avoid the disadvantages of posterior column structure without destroying the original after injury;small incision and lateral anterior approach greatly reduces the disadvantages of traditional anterior surgery major trauma.We use small incision anterolateral approach for treatment of nerve injury associated with thoracolumbar fracture A3/A4 in clinic,and achieved good results.OBJECTIVE: In order to confirm in thoracolumbar mini-open anterolateral surgery in reconstruction of thoracolumbar burst fracture of the anterior spinal column stability safety and effectiveness.Through the use of the technology for the treatment of thoracolumbar fracture patients were followed up for success,and prospectively collected relevant data.And through a retrospective analysis of all the results,we summarized the clinical experience of minimally invasive surgery on the front of the thoracic and lumbar spine.METHODS: We collected in our hospital for traumatic thoracolumbar fractures since 2013.For the thoracolumbar anterolateral mini-open corpectomy surgery in 12 patients.According to the preoperative and postoperative 1 week,1 month,6 months,1 years,2 years or longer,the change of evaluation of patients with postoperative Cobb angle.The intraoperative blood loss,surgical time and complications were collected data.Analysis of Cobb angle measurement of paired sample t-test was carried out at the same time,ASIA classification for spinal cord injury before and after the operation.RESULTS: 12 patients were successfully completed the operation.Without the complications of pneumothorax and so on during operation.The patients were discharged smoothly.We summarize the intraoperative bleeding was 250 ~ 450 ml,average was 339 ml.The operation time ranged from 120 to 180 min,average was 148 min.In the postoperative follow-up,the patients were followed up for more than 4 months,the 1 patients were followed up for 35 months,the average follow-up time of more than 12 months.During follow-up,we performed ASIA level of 12 patients were assessed.The level of 12 patients were promoted.6 cases recovered to grade D,1 cases of grade C recovered to grade E,and 5 patients with grade D recovered to E grade.During the follow-up period,there was no obvious loss of vertebral height and no movement of the artificial vertebral body.Through statistical software,paired t-test result preoperative Cobb angle is 27.9 degrees.After the last follow-up Cobb angle mean to 4.8 degrees,the average correct 23.0 degrees,the test results t=27.754,P < 0.01,postoperative recovery well and was statistically significant.No adverse complications such as exacerbation of symptoms occurred in the long-term follow-up.CONCLUSION: Mini-open anterolateral surgery in the treatment of thoracolumbar vertebrae fractures(type A3 / A4)has obvious advantages in operative time,bleeding volume and complications incidence and Cobb angle recovery.In the reconstruction of thoracolumbar three column stability is safe and effective.