A Comparative Study Of Clinical Effects Of Paravertebral Muscle Space Approach And Minimally Invasive Percutaneous Approach For Posterior Pedicle Screw Fixation In The Treatment Of Thoracolumbar Vertebral Fracture

BackgroundSpinal fracture is a common type of fracture.As the anatomical characteristics and mechanical characteristics determined that the thoracolumbar vertebral fracture is one of the highest parts of the incidence of spinal injury,which occurred in young men,the clinical manifestations of deformity,pain and rupture of posttraumatic thoracolumbar segment of the spinal cord,and often spread cause nerve damage.Surgical treatment is the main treatment for thoracolumbar fractures.Active surgical treatment is very important for spinal reconstruction,and can avoid complications and sequelae caused by conservative treatment.This study explored the effect of posterior pedicle screw fixation for thoracolumbar fractures.Posterior pedicle screw fixation surgery is widely used in the clinical treatment of thoracolumbar vertebral fracture,there are mainly 3 kinds of surgical approach,respectively conventional posterior open surgery method,road by paraspinal muscle pedicle screw fixation and minimally invasive percutaneous pedicle screw internal fixation.Although the traditional open surgery has been applied in clinical practice earlier,its technology is more mature,but its trauma,intraoperative destruction of ligaments and paraspinal muscles and other surrounding soft tissues have hindrance to early functional exercise of patients,so clinical application is gradually less.ObjectiveTo compare the effects of two posterior approaches,minimally invasive percutaneous and paraspinal approach,for the treatment of thoracolumbar fractures with pedicle screwfixation.Methods60 cases of thoracolumbar fracture with single segment,no nerve system injury,and without spinal canal decompression,admitted in our hospital from June 2014 to June 2015 were selected according to the approach,the paraspinal muscle group treated with pedicle screw internal fixation via paraspinal muscle space and the minimally invasive group treated with minimally invasive percutaneous pedicle screw fixation,respectively,and 30 patients in each group.The anterior vertebral height ratio,sagittal Cobb angle,surgical incision,operation time,number of fluoroscopy,intraoperative blood loss and ODI and VAS scores were compared between the two groups,and evaluate the effect of two kinds of internal fixation on nerve injury.Results1.Follow up of two groups of patients after operation.At the end of 3 days,3 months and 12 months after operation,vertebral sagittal index and Cobb angle of the two groups were significantly recovered compared with the preoperative data(P<0.05).2.the ODI and VAS scores were significantly lower than those before the operation,but the above indicators had no significant difference between the two groups(P>0.05).3.The surgical trauma and intraoperative blood loss of patients in the minimally invasive group were significantly lower than those of the paraspinal muscle approach group,while the operation time and fluoroscopy times were significantly higher than those of the paraspinal muscle approach group,and the differences were statistically significant(P<0.05).ConclusionsMinimally invasive percutaneous and paraspinal muscle approach pedicle screw fixation are both effective,safe and reliable.