Research Of The Short-segment Internal Fixation With Or Without Fracture Level

Objective: To compare the clinical efficacy of the short-segment pedicle screw fixation with or without fractured vertebral screws in the treatment of thoracolumbar fractures both in short-term and long-term postoperatively. Meta-analysis method is applied to do comprehensive evaluation of the short-segment pedicle screw fixation with or without fractured vertebral screws in treating thoracolumbar fractures, provide a reference for clinical surgery choice and further research.Methods: This research is divided into two parts, the first part is the retrospective analysis of 53 cases from January 2010 to March 2010 in Tianjin First Central Hospital orthopedic department who was of eligible patients with thoracolumbar fractures, then divided the cases into include the injured vertebra group(Including group 21 cases) and cross the vertebral injury group( crossing group 32 cases). Truthfully record the data and do statistical analysis on the two groups` patients' basic situation: the average operation time, preoperative clinical data and the volume of bleeding in the surgery, sagittal Cobb Angle, vertebral fracture franterior margin compression ratio, neurologic recovery(Frankel classification) and VAS score. The second part of this study systematically researched the main database retrieval system both at home and abroad. Read the literature and evaluate the quality, extracting data, meta-analysis evaluating the clinical efficacy of the treatment of thoracolumbar fractures in short-segment pedicle screws fixation including the fractured level and cross the fractured vertebra.Results: The first part: 53 patients received more than 12 months of follow-up, an average follow-up of 18.4(12 to 24 months). There are no statistical significance(P > 0.05) in the two groups in gender, age, damage section, preoperative neurologic Frankel scores, the mean operation time, mean intraoperative blood loss; significantly difference was found in two groups of cases in the fracture degree of postoperative spinal vertebral compression and sagittal Cobb angle, the including group was found superior to the crossing group in the degree of loss across vertebral injury group the last time follow-up, the injured vertebral group in vertebral compression degree and the degree of sagittal Cobb Angle correction, the difference was statistically significant(P < 0.05). The second part: finally 11 articles were included in the analysis, including 3 randomized controlled trial(RCT), eight observational studies, a total of 626 cases, including group 316 cases, crossing group 310 cases. Three RCTs papers were of high quality, 1 in 8 observational studies was of low quality, the rest were of high quality. Meta-analysis results showed that: there are no significant statistical differences(P > 0.05) between the including vertebral group and crossing vertebral group of internal fixation in preoperative Cobb Angle, preoperative franterior margin compression degree; The difference was statistically significant(P< 0.05) in kyphotic Cobb Angle in after spinal surgery and postoperative follow-up between the two groups, the including vertebral group was superior to the crossing vertebral group; the differences in the franterior edge of the injured vertebra compression ratio were also statistically significant(P < 0.05) in 2 weeks after surgery, postoperative follow-up of 1 year, the injured vertebral internal fixation is superior to the cross vertebral group; Long-term follow-up of internal fixation failure rate, there is statistically significant difference between the two group, the including group was less than the crossing group.Conclusion: 1. The posterior short-segment pedicle fixation in the injured vertebral for the treatment of thoracolumbar fractures reduced the segments of spinal internal fixation, avoided the adjacent vertebral degeneration which was a serious complication in the treatment.2. The posterior short-segment pedicle fixation in the injured vertebral for the treatment of thoracolumbar fractures can be directly reconstruct the normal vertebral body height of the injured vertebra, correct the kyphosis angle of the spine. And reduce the long-term complications such as the follow-up Cobb Angle correction and the franterior highly compressed degree.3. The posterior short segment by the injured vertebral pedicle fixation compared with cross injured vertebral pedicle screw fixation can significantly reduce the failure rate of internal fixation occurred, is currently one of the ideal operation method for the treatment of thoracolumbar fractures.