Clinical Outcome Of Compared With Two Operation Methods In The Treatment Of Thoracolumbar Fracture And Dislocation

Objective: To compare the clinical efficacy of posterior pedicle screw fixation through Wiltse paraspinal approach with posterior traditional open pedicle screw fixation in the treatment of thoracolumbar fracture and dislocation.Methods: Forty patients with thoracolumbar fracture and dislocation were treated by surgery and were studied retrospectively between January 2013 and January 2016,The patients(25 males and 15 females)were from 18 years to 60 years.Because of the different surgical approaches,They were admitted to our hospital were divided into Mis-open group and open group.Posterior spinal decompression,rest,allograft cancellous bone particles mixed with autogenous bone graft method,the spinal vertebral interbody and posterolateral fusion,long segments of pedicle screw fixation through Wiltse paraspinal approach in the treatment of twenty patients(Mis-open group).The patients(12 males and 8 females)were from 21 years to 60 years.American spinal ingury association(ASIA)nerve function classification:A grade 14 cases,B grade 5 cases,C grade 1 case.And another twenty patients were treated Posterior spinal decompression,rest,allograft cancellous bone particles mixed with autogenous bone graft method,the spinal vertebral interbody and posterolateral fusion,long segments of traditional open pedicle screw fixation(Open group).The patients(13 males and 7 females)were from 18 years to 58 years.ASIA nerve function classification:A grade 14 cases,B grade 2 cases,C grade 3 cases,D grade 1 case.1.The Operation time,Intraoperative blood loss and the Postoperative drainage volume were recorded by using a timer,a negative pressure suction device and a negative pressure drainage ball respectively,and the curative effect of the two groups was evaluated.The visual analogue scale(VAS)were evaluated for postoperative incision pain.3.The sagittal diameter of vertebral canal was measured by vernier caliper,The patency rate of vertebral canal before and after operation in two groups was calculated,The two groups wereevaluated for decompression of the spinal canal.4.Using vernier calipers,protractor in vertebral lateral radiographs were measured on preoperative and postoperative anterior vertebral height percentage,Cobb angle,kyphosis correction was assessed in two groups.5.ASIA for neurological function assessment.6.All patients were followed-up from9 to 33 months,The Mis-open group was followed up(19.3± 5.6)months,The Open group was followed up(22.5± 4.9)months,and there was no statistical difference(P>0.05).Results: 1.Compared with Open group,the operation time was(240.5±38.3)min vs.(258.5±43.7)min,the intraoperative blood loss was(525.0±168.2)ml vs.(770.0±269.2)ml,the postoperative drainage was(190.1±78.9)ml vs.(281.7±122.3)ml,the visual analog score of 24 hours after operation and final follow-up incision pain was(6.4±1.0 、 1.6±0.5)vs.(7.8±0.7 、 2.2±0.4),Spinal canal patency at final follow-up(85.3±3.7)% vs.(85.8±1.8)%.Percentage of postoperative injury of vertebral height recovery(88.5±2.7)% vs.(88.8±1.3)%.Cobb angle(4.7±1.2)° vs.(5.3±1.5)°.ASIA nerve function classification of the groups at final follow-up: Mis-open group included A grade 7cases,B grade 5 cases,C grade 6 cases,D grade 1 case,E grade 1 case.Open group included A grade 6 cases,B grade 6 cases,C grade 5 cases,D grade 2 cases,E grade 1 case.2.Compared with the operation time and there was no statistical difference(P>0.05).Compared with Spinal canal patency and percentage of postoperative injury of vertebral height recovery at final follow-up and there was no statistical difference(P>0.05).3.The intraoperative blood loss,postoperative drainage volume,postoperative VAS score of Mis-open group were significantly lower than the Open group with statistical significance(P<0.05).4.Preoperative spinal canal patency and percentage of injury of vertebral height and Cobb angle of one group were significantly higher than the final follow-up with statistical significance(P<0.05).5.Compared with preoperative two groups neurological function assessment and there was no statistical difference(Z =-0.42,P=0.68).Compared with two groups neurological function assessment at final follow-up and there was no statistical difference(Z=-1.51,P=0.13).Postoperative ASIA nerve function classification of Mis-open group were lower than the preoperative with statisticalsignificance(Z =-2.89,P =0.004).Postoperative ASIA nerve function classification of Open group were lower than the preoperative with statistical significance(Z =-2.63,P =0.009).Conclusions: Posterior pedicle screw fixation through Wiltse paraspinal approach in the treatment of thoracolumbar fracture and dislocation can effectively restore the height of vertebral body height and spinal canal patency,But also can reduce the surgical injury,operation time,intraoperative bleeding,postoperative drainage,postoperative back pain.So,It was a worthful operation for dealing thoracolumbar fracture and dislocation.