| Objective 1.To make a model of the thoracolumbar segment of the spinal column in pigs,measure the biomechanical differences between different Numbers and different directions of injured vertebral screw placement,and determine the best stable fixation method of injured vertebral screw placement.2.Collect long-term follow-up of thoracolumbar fracture patients with different fixation methods in clinical practice,compare the differences in the efficacy of several surgical methods,and determine the best fixation method for long-term stability.3.Through the comparison of clinical curative effect,the curative effect of dachengqi decoction on thoracolumbar fracture and postoperative abdominal distension and defecation difficulty of patients with fracture was determined.Methods 1.Three-dimensional motion test of the spine: the obtained fresh samples of the thoracic and lumbar vertebrae were removed from the excess soft tissue,sealed and bagged separately,and stored in a low-temperature refrigerator at a temperature of-20 c.In this temperature environment,the structure of soft tissue such as ligament muscle and bone and joint would not be damaged.Before the experiment,the specimen was placed in a natural environment to thaw in advance until the bone and soft tissue of the specimen recovered.Any specimen processing,the specimen tissue to remove excess,maintain the spine itself strength retention of soft tissue,with polymethyl methacrylate material will swine spinal vertebral embedding on both ends of the specimen,both ends of the vertebral bodies with completely the embedding of the abovementioned materials,bearing formation,then,will be 1vertebral body fracture vertebra system,pork loin in the anterior column and column are injury,make to experiment model specimens.Make seven pigs spine specimen,respectively complete group(group A),L1 fracture group(group B),the short segment across the injured vertebra fixed group(group C),short segmental injury parallel unilateral vertebral endplate fixation group(group D),short segmental injury vertebral unilateral oblique line fixation group(group E),short segmental injury vertebral bilateral parallel end plate fixation group(group F),short segmental injury vertebral bilateral oblique line fixed group(group G)A total of7 seven of the state.The seven models were tested in six directions,each time a force of 10 Nm was applied to the spine specimen.The whole process was monitored and analyzed by a professional system,and then the data results were analyzed to obtain the range of motion of each group of specimens in each direction.Stiffness test: group A,group B,group C,group D and group E conduct compression test on an electronic universal tester to calculate their stiffness.Screw pull-out force experiment: three fresh specimens were molded and fixed into group C,group D,group E,group F and group G,a total of five groups.The overall screw pull-out force test was conducted on the electronic universal testing machine,and the pull-out force was calculated.2.Data of 124 patients with thoracolumbar burst fractures admitted to the department of orthopedics of the central theater general hospital of the Chinese people's liberation army from January 2016 to January 2018 were retrospectively analyzed.Short segmental injury parallel unilateral vertebral endplate fixation group(group B): 27 cases,15 cases were male,female 12 cases,short segmental injury vertebral unilateral oblique fixation group(group C): 24 cases,16 cases of male,female 9 cases,short segmental injury vertebral bilateral parallel end plate fixation group(group D): 19 cases,12 cases male,female 7 cases,short segmental injury vertebral bilateral oblique fixation group(group E): 25 cases of male 16 cases,9 cases of female.No special treatment was given in all four groups.Outcome measures: clinical evaluation: visual analogue scale(VAS)score of pain before surgery,1 day after surgery and1 year after surgery,Oswestry disability index(ODI)at 1 day and1 year after surgery were recorded.Imaging evaluation: the correction rate and loss rate of vertebral anterior margin height,as well as the correction rate and loss rate of convex Cobb Angle before surgery,3 days after surgery and 1 year after surgery were measured in 5 groups respectively.The above indicators were used for comparative analysis of the curative effect of the five groups of fixation methods.3.42 patients were divided into two groups.Control group: patients were given oral symptomatic treatment of commonly used western medicine.Observation group: on the basis of observation group,dachengqi decoction was used for flavored treatment,and the results of the two groups were compared.Results 1.(1)in experiment 1:(1)the range of motion in all directions of group B was significantly higher than that of group A,indicating that spinal stability was significantly reduced after fracture,with significant differences between the two groups(P<0.05).(2)compared with the vertebral screw fixation group with several different methods,the range of motion in the six directions was significantly larger in group C,indicating that vertebral fixation could significantly improve the stability of the spine compared with the trans-vertebral fixation group,with statistically significant differences(P<0.05).(3)compared with group C,the activity degree of group D was lower in all directions(P<0.05).The experimental results showed that the spinal movement in all directions in group D was less than that in group C(P<0.05).Compared with group C,the range of motion in each direction of the spine was significantly smaller,with statistical significance(P<0.05).Compared with group C,the range of motion in each direction of the spine was significantly reduced in group E(P<0.05).(5)compared with group D,the degree of spinal motion was significantly lower in group E(P<0.05).Compared with group E,group G showed significantly lower spinal motion(P<0.05).Compared with group F,group E had significantly lower spinal motion(P<0.05).(2)experiment 2: the compression stiffness test is the maximum strength that the test model can bear,which is quite destructive.The number of specimens in this test is small,which fails to meet the standard of statistical requirements.Among all the fixed groups,the test results of group B showed the lowest stiffness,and the results of each group were compared as C(3)experiment 3:this experiment is a destructive experiment with a small number of specimens,which fails to meet the statistical requirements.In group C,the overall pedicle screw extractive force of internal fixation was the least,and in all groups,the anti-extractive force was the largest in group G.2.The results showed that there was no significant difference between each group in preoperative and postoperative vertebral body anterior margin height percentage and cobb Angle(P>0.05);pairwise comparison between group A and the other four groups 1 year after surgery showed statistical difference(P<0.05);pairwise comparison between group B,C,D and E showed no statistical significance(P>0.05).3.The time of the three indicators in the observation group was significantly less than that in the control group when the two groups were compared in the indicators of first exhaust,first defecation and constipation disappearance.The total effective rate of treatment in the observation group was 91.3%,significantly higher than that in the control group(78.9%)(P < 0.05).Conclusion 1.The short segment bilateral oblique fixation group was the best choice for the biomechanical stability of all fixation methods.2.In clinical application,the effect of vertebral screw fixation is better than that of trans-vertebral screw fixation.However,compared with other fixation methods,the short-segment trans-vertebral bilateral oblique fixation group has more advantages in long-term efficacy.3.Dachengqi decoction (dachengqi decoction),a traditional Chinese medicine prescription,is effective in treating thoracolumbar fracture and postoperative symptoms such as abdominal distension and difficulty in defecating. |
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