Effect Analysis Of Treatment Of Thoracolumbar Burst Fractures By Safe Triangle Bone Graft

ObjectiveTo explore the efficacy and advantages of short-segment posterior internal fixation combined with bone grafting by trans-safe triangular approach in the treatment of thoracolumbar burst fracture,and to provide new ideas for clinical treatment of thoracolumbar burst fracture.MethodsThe inclusion and exclusion criteria were formulated as follows:1.The patients were younger than 65 years old and had a clear history of trauma.No osteoporosis was needed before operation(bone mineral density was detected before operation to exclude it).2.Thoracolumbar burst fracture(Dennis type was chosen as B type).3.The time from injury to operation was not more than 14 days.4.There were spinal cord,nerve injury or without spinal cord,spinal cord injury.Neurological injuries(nerve injuries were classified as grade C,D and E according to Frankel classification).5.All patients were treated with posterior short-segment open reduction and internal fixation.6.All patients were treated with autogenous bone or allogeneic bone or autogenous bone mixed bone graft.Exclusion criteria,1.Patients with serious complications such as heart,brain and lung,2.Fractures caused by osteoporosis,3.Fractures caused by bone tumors,4.Complete paraplegia patients(nerve injury excluded grade A and B according to Frankel classification).From June 2016 to September 2017,34 patients with thoracolumbar burst fracture were enrolled.They were treated with posterior open reduction and short-segment pedicle screw internal fixation combined with intravertebral bone grafting through safe triangle channel.The insertion points of pedicle screw were all positioned by crossing method.Among them,there were 23 males and 11 females.The range of age was 30-65 years old,And the average age was 50 years old.All patients' clinical and preoperative data(age,sex,fracture vertebral distribution,vertebral height,Cobb's angle,classification and preoperative VAS score),imaging parameters(anterior height of fracture vertebral body,Cobb's angle)and VAS score after operation and follow-up at all stages were sorted out.andthe advantages of intravertebral bone grafting in the treatment of thoracolumbar burst fracture were compared with traditional bone grafting.SPSS 11.5 was used for statistical analysis,ResultsAll 34 patients received bone healing without wound infection and nerve injury.The average height of anterior vertebral margin was increased form 15.7±1.6 millimeter preoperatively to 25.0±2.2 millimeter postoperatively(P<0.05).Cobb's angle was decreased form 15.3°±7.6 to-5.9°±3.9(P<0.05).All patients were followed up for 6-18 months with an average of 8.9 months.,no loss of anterior height and Cobb's angle were found in 3 months,6 months and 12 months after operation.3 months after operation,the average VAS score of low back pain was decreased form 6.7±0.8 preoperatively to 2.3±0.6 postoperatively(P<0.05).6 months after operation,the average VAS score was 1.2±0.5.During the follow-up period,no complications such as loosening and breakage of internal fixation were found.ConclusionFor thoracolumbar burst fracture patients,posterior instrumentation combined with intravertebral bone grafting via safe triangle approach was safe and reliable.It can be used for full bone grafting in the injured vertebrae and promote the healing of the injured vertebrae.