Clinical Analysis Of Thoracolumbar Fracture Combine With Greenstick Laminar Fracture

Objective To analyze the clinical features of patients that diagnosed with thoracolumbar fractures accompanied with greenstick laminar fractures and discuss the relevant therapeutic strategies.Methods A retrospective study on patients who were diagnosed with greenstick lamina fractures in thoracolumbar fractures from January 2010 to December 2015 in department of Orthopaedics,the 175 th Hospital of PLA was conducted.The subjects were selected as:(1)non-osteoporotic,non-pathologic thoracolumbar fractures,(2)trauma occurred within 3 weeks,(3)greenstick lamina fractures was confirmed by CT.The relevant clinical indicators were statistically analyzed,including general data: gender,age,pathogeny,distribution of fractured vertebra,fracture classification,treatment;clinical symptoms: associated injuries,preoperative and postoperative ASIA,VAS and ODI;Imaging parameters:preoperative and postoperative Cobb angle,anterior height of the fractured vertebral body;Operation: intraoperative blood loss,surgical time,the incidence of dural tear and nerve root entrapment,postoperative complications.Results There were a total of 875 patients with acute thoracolumbar fractures from January 2010 to December 2015 were reviewed,and 169 patients combined with greenstick lamina fractures,including 95 males and 74 females,average age of 37.7 ± 9.1 years(17-63 ages).Fracture classification according to Denis were as follows: 153 cases of type B,16 cases of type D.The injured vertebral distribution were as follows: 31 cases in T11,33 cases in T12,37 cases in L1,28 cases in L2,40 cases in L3.Preoperative neurological function was evaluated using the ASIA scale:10 cases were grade A,25 were grade B,46 were grade C,54 were grade D,34 were grade E.Preoperative neurological function was evaluated using the ASIA scale: 10 cases were grade A,25 were grade B,46 were grade C,54 were grade D,and 34 were grade E.There were 47 patients(group A)treated by posterior decompression and pedicle screw internal fixation and 41 patients(group B)treated by posterior pedicle screw internal fixation in patients whose preoperative neurological function were grade D or grade E.The other 81 patients(group C)that ASIA grade were A,B and C were all treated by posterior decompression and pedicle screw internal fixation.Dural tears were found in 31 patients and nerve entrapment were found in 19 patients.The neurological function of most patients improved after operation.However,there were 4 patients' neurological function in group B deteriorated after surgery in who 1 patients went through a second operation,dural tear and cauda equina entrapment were found in second operation,the patient got urinary tract infection postoperatively and was cured by anti-infection;the other 3 patients were treated by conservative treatment,the neurological function of the 4 patients recovered to normal during follow-up.Three cases of incision swelling in all patients and cured by conservative treatment.Conclusion Greenstick laminar fractures occur in thoracolumbar burst fractures mostly and may result in dural tear and nerve entrapment,a operation of posterior open book laminectomy should be selected for paitients who were diagnosed with thoracolumbar fractures accompanied with greenstick laminar fractures,which can release the entrapped nerve and repaire dural,avoiding deterioration of neurological function postoperatively and a second exploratory operation.