| Objectives Most of thoracolumbar burst fractures are high-energy injuries caused by vertically compressed violence to the spine in accidents such as accidents,falls,Fractures mostly affect the middle column,so the posterior wall of the vertebral body is mostly bursty and incomplete.If the bursting of the bone in the posterior wall of the vertebral body protrudes into the spinal canal,it may cause oppression of the spinal cord or cauda equina,causing corresponding damage.Severe persons may even cause embarrassment.In addition,because the vast majority of thoracolumbar burst fractures are unstable fractures,the principle of treatment is mainly to restore the ideal height of the vertebral body and the normal sequence of the spine,to rebuild the stability of the spine,and to promote the patient’s early ambulation activity for functional exercise.Therefore,for the treatment of thoracolumbar burst fractures,surgical treatment is generally advocated in clinical practice.Among them,posterior surgery has a wide range of clinical applications because of its advantages such as less trauma,relatively simple surgical operation,and definite curative effect.However,it is easy for the posterior surgery to rely solely on the reduction of the instrument to cause stress concentration,leading to broken nails,back screws,loosening of internal fixation,and postoperative low back pain.The purpose of this study was to explore the clinical efficacy of Chinese medicine manipulation combined with posterior pedicle screw fixation and open reduction internal fixation in the treatment of thoracolumbar burst fractures.The purpose of this study is to inherit and develop the traditional Chinese traditional methods of reduction and modern surgery.Methods combined to provide a new clinically feasible treatment for thoracolumbar burst fractures.Methods A retrospective analysis of 58 cases of thoracolumbar burst fractures treated by Department of Orthopaedic Surgery of the Third People’s Hospital of Hubei Province and the Inpatient Department of Orthopaedics Department of Hubei Provincial Hospital between January 2014 and June 2017.Among them,29 patients in group A(observation group)were treated with Chinese medicine manipulation combined with posterior pedicle screw fixation and open reduction and internal fixation.29 patients in group B(control group)were treated with posterior pedicle screw fixation.Reset internal fixation surgery,no Chinese manipulation reset.The height ratio of anterior and posterior borders of the injured vertebral body before and after the treatment,the Cobb angle of the injured vertebrae,the occupancy rate of the injured vertebral canal,VAS score,surgical blood loss,operation time,postoperative time,clinical curative effect,etc.were compared between the two groups before and after treatment.Observe the postoperative complications and their incidence.Results1.Changes in the height of the injured vertebral front:In group A(observation group)and group B(control group),the ratio of anterior height of injured vertebral body before surgery was(49.94±5.24)%and(49.98±3.75)%,respectively,and there was no statistical difference between the two groups(t=0.032,P>0.05).In group A(observation group),the height ratio of traumatic anterior vertebral body at 1 week after operation was(96.06±1.89)%,which was significantly different from that before surgery(t=40.504,P<0.05),The ratio of the height of the anterior vertebral body after injury was(95.08±2.66)%in the last review after discharge,and there was no statistical difference compared with the first week after operation(t=1.904,P>0.05);In group B(control group),the ratio of the anterior height of injured vertebral body was(94.14±1.93)%at 1 week postoperatively,which was statistically different from that before surgery(t=52.943,P<0.05),and the last review after discharge.The height ratio of the vertebral anterior edge of the injured vertebral body was(92.99±2.80)%,which was not statistically different from that after one week(t=1.903,P>0.05);There was a statistically significant difference in the anterior height ratio of the traumatic vertebral body between the two groups at 1 week after surgery(t=3.843,P<0.05),and the recovery of the anterior edge of the injured vertebrae in group A(observation group)was better than that in group B(control group).2.Changes in height of posterior edge of injury:In group A(observation group)and group B(control group),the height ratio of posterior edge of injured vertebral body before treatment was(52.50±7.90)%and(54.06±8.21)%,respectively,and there was no statistical difference between the two groups(t=0.738,P>0.05).In group A(observation group),the height ratio of posterior edge of injured vertebral body was(98.07±1.64)%at 1 week postoperatively,which was statistically different from that before operation(t=29.425,P<0.05),and the last review after discharge was performed.The height ratio of posterior edge of injured vertebral body was(97.08±3.04)%,which was not statistically different from that at 1 week after operation(t=1.862,P>0.05);In group B(control group),the height ratio of posterior edge of injured vertebral body was(96.99±2.17)at 1 week postoperatively,which was statistically different from that before operation(t=27.401,P<0.05),and the last reexamination injury after discharge.The height ratio of the posterior edge of the vertebral body was(95.82±3.24),which was not statistically different from that at 1 week postoperatively(t=2.018,P>0.05);the height ratio of the posterior edge of the injured vertebral body at 1 week after surgery was compared in both groups.There was a statistical difference(t=2.149,P<0.05),and the recovery of the posterior edge of injury in group A(observation group)was better than that in group B(control group).3.Traumatic Cobb angle recovery before and after treatment:In group A(observation group)and group B(control group),the Cobb angles before surgery were(37.16±2.80)°and(37.24±2.69)°,respectively.There was no statistical difference between the two groups(t=0.124,P>0.05);In group A(observation group),the Cobb angle at the first postoperative week was(1.38±0.93)°,which was statistically different from that before surgery(t=67.235,P<0.05).The Cobb angle of the injured vertebral body was reviewed at the last post-discharge.It was(1.84±1.44)°,and there was no statistical difference compared with 1 week after operation(t=1.914,P>0.05);In group B(control group),the Cobb angle at the first postoperative week was(6.42±1.85)°,which was statistically different from that before surgery(t=45.148,P<0.05).The Cobb angle at the last review after discharge was(6.71±1.82)°compared with 1 week after operation,there was no statistical difference(t=2.038,P>0.05);There was a statistically significant difference in the Cobb angle of the injured vertebrae between the two groups at 1 week after surgery(t=13.122,P<0.05),and the recovery of the Cobb angle of the injured vertebrae was better in the A group(observation group)than in the B group(control group).4.Comparison of Occupation Rate of Traumatic Spinal Canal Before and After Treatment:In group A(observation group)and group B(control group),the prevalence of traumatic spinal canal occupancy was(16.17±6.90)%and(15.33±8.13)%,respectively.There was no statistical difference between the two groups(t=0.423,P>0.05);In group A(observation group),the occupancy rate of injured spinal canal was(1.53±1.32)%at 1 week postoperatively,which was statistically different from preoperative(t=12.276,P<0.05);group B(control group)The postoperative spinal vertebral occupancy rate was(1.43±1.16)%in the first week,which was statistically different from that before surgery(t=10.096,P=0.05);There was no significant difference in the occupancy rate of traumatic spinal canal between the two groups at 1 week after surgery(t=0.296,P=0.768>0.05).5.Comparison of VAS scores before and after treatment:The preoperative VAS scores in group A(observation group)and group B(control group)were(8.17±1.07)points and(8.03±1.15)points,and there was no statistical difference between the two groups(t=0.473,P>0.05).In group A(observation group),the VAS score was(2.07±1.16)points at 1 week postoperatively,which was significantly different from preoperative comparison(t=23.099,P<0.05).The final VAS score after discharge was(0.72±0.75).Scores were statistically different from those before surgery(t=31.579,P<0.05);In group B(control group),the VAS score was(2.21±1.18)points at 1 week postoperatively,which was significantly different from preoperative comparison(t=22.164,P<0.05).The final VAS score after discharge was(1.24±0.91).Scores were statistically different from those before surgery(t=26.650,P<0.05);There was no significant difference in VAS scores between the two groups at 1 week postoperatively(t=0.449,P>0.05),but the VAS score at the last review after discharge was statistically significant(t=2.357,P<0.05),and the observation group VAS The score is lower than the control group.6.Comparison of blood loss during surgery,time spent on surgery,and time after surgery:The intraoperative blood loss in group A(observation group)and group B(control group)were(105.62±55.23)ml and(146.14±43.01)ml,respectively,and there was a statistical difference between the two groups(t=3.117,P<0.05),and patients in group A(observation group)had less bleeding during surgery;The time of operation in group A(observation group)and group B(control group)was(63.28±16.36)min and(79.45±13.76)min,respectively.There was a statistical difference between the two groups(t=4.074,P<0.05),And in group A(observation group),the operation of patients is less time-consuming;The postoperative time of patients in group A(observation group)and group B(control group)was(33.03±7.15)days,(38.10±7.00)days,and there was a statistical difference between the two groups(t=2.728,P<0.05),and patients in group A(observation group)were able to go earlier and lower after surgery.7.Postoperative complications:The complication rates in patients in group A(observation group)and group B(control group)were3.45%and 27.59%,respectively.There was a statistically significant difference between the two groups(χ~2=4.735,P<0.05),and the two groups were compared to group A.(Observation group)The incidence of complications was even lower.8.Clinical follow-up review after out-patient discharge and outpatient review:The excellent and good rates of patients in group A(observation group)and group B(control group)were 96.55%and93.10%,respectively,and there was no statistical difference between the two groups(χ~2=0.358,P>0.05).Conclusion Chinese medicine manipulation combined with posterior pedicle screw fixation and open reduction and internal fixation for thoracolumbar burst fractures,compared with simple posterior pedicle screw fixation and reduction and internal fixation,to improve the anterior and posterior edges of the vertebral body The height,the injury vertebral Cobb angle,and the long-term postoperative VAS score had obvious advantages.The amount of blood loss during the operation was much lower.The time to walk after surgery was earlier.The bed rest time was relatively short.The incidence of complications such as long-term lower back pain was lower than that of posterior pedicle screw fixation and internal fixation,and the improvement of the position of the spinal canal is similar to that of posterior pedicle screw fixation and open reduction and internal fixation.The clinical curative effect is significant and it is worthy of clinical application. |
