The Clinical Efficacy Comparison Of The Procedure Beyond The Broken Vertebrae And Unilateral Or Bilateral Posterior Pedicle Screw Fixation Via The Broken Vertebra For The Treatment Of Thoracolumbar Fractures

Objective: To explore the clinical efficacy of the procedure beyond the broken vertebrae and unilateral or bilateral posterior pedicle screw fixation via the broken vertebra for thoracolumbar fractures.Method: In this study,93 patients with single thoracolumbar vertebral fractures underwent posterior pedicle screw beyond(30 cases,bilateral pedicle integrity,4 sets of screws),unilateral fixation via(35 cases,unilateral pedicle integrity in 14 and bilateral pedicle integrity in 21,5 sets of screws),and bilateral fixation via(28 cases,bilateral pedicle integrity,6 sets of screws)the broken vertebra respectively.Observe and analysis pre-and postoperative neurological function classification,the height of vertebral,Cobb's angle and the failure rate of fixation by q-test and partitions of ?2 method.Result: At the mean followed-up of 13.5±5.1 months(range from 6 to 24 months),no one got increasing damage on nerve function and the Frankel score improved 0-2 grades for patients with preoperative neurological deficits.In 4 sets of screws group,6 patients appeared nail broken(1 cases),and screws loosen and exit(5 cases),and no recurrence of vertebral deformity appeared in all cases.All patients could be a well recovery on the height of vertebral and the Cobb's angle(P<0.05).There were significant differences between 4 sets of screws group and 5 or 6 sets of screws groups on the followed areas –the recovery rate of the vertebral height(76.4±8.1% vs 89.3±5.9% vs 89.7±5.7%,respectively)and the loss rate(15.2±4.4% vs 7.5±2.8% vs 7.4±2.6%,respectively),the correct of Cobb's angle(16.23±2.51°vs 18.36±2.29°vs 18.93±2.15°,respectively)and the lost(4.17±2.32°vs 2.33±1.38°vs 2.15±1.43°,respectively),the recovery of the nerve function and the failure of internal fixation(P<0.05).However,it was hard to find the significant difference between 5 and 6 sets of screws groups(P>0.05).Conclusion:(1)Three different kinds methods are all effective to improve the height of vertebral and the Cobb's angle.(2)Compared with posterior pedicle screw beyond the broken vertebra,the other two kinds of methods play a better role on the treatment of thoracolumbar fractures.They show better results on maintain the height of broken vertebra,correct Cobb's angle and reduce the loss,improve the function of nerve,and reduce the internal fixation failure.(3)The operative effect of the unilateral or bilateral posterior pedicle screw fixation via the broken vertebra is similar,but the former is not only suitable for patients with unilateral pedicle integrity,but also for the bilateral,it has wider clinical indications than the latter.