| Objective To investigate the clinical effect of posterior long-segment pedicle screw instrumentation for thoracia and lumbar burst fracture with neurological deficit.Methods Retrospective analysis of 18 patients with thoracolumbar burst fractures who were reoperated in Affiliated Zhongshan Hospital of Dalian University from 2011 to 2018,including 11 males and 7 females,aged from 22 to 63 years,with an average of 42.5 years old.According to AOspine classification: 4 cases of A3 type,6 cases of A4 type,5 cases of B type,and 3 cases of C type.There were 13 cases of falling injuries in high places and 5 cases of car accidents.11 cases of single vertebral fracture: 1 case of T3,3 cases of T12,4 cases of L1,2 cases of L2,1 case of L3,7 cases of multiple vertebral fractures: 1 case of T5~T6,1 case of T11~T12,3 cases of T12~L1,2 cases of L1 to L2.According to thoracolumbar AOSpine injury score(TLAOSIS),the average score was 7.8,ranging from 7 to 10.The neurological function was graded according to the American Spine Injury Association(ASIA).There were 5 grades in grade A,7 in grade B,4 in grade C,and 2 in grade D.All 18 patients underwent posterior long-segment pedicle screw fixation with more than 2 or more vertebral bodies in the injured vertebrae.(Patients with complete nerve injury underwent spinal canal decompression during surgery).The operation time,intraoperative blood loss and postoperative complications,neurological recovery,and visual analogue scale(VAS)were recorded.The following indexes were measured before operation,1 week after operation and 1 year after operation: the height of the anterior edge of the injured vertebra,the height of the anterior edge of the upper and lower vertebrae,the median diameter of the injured vertebral canal and the median diameter of the upper and lower vertebral canals.The recovery of neurological function(ASIA grade)and visual analogue scale(VAS)of pain before and 1 year after operation were recorded.The following indicators were counted before operation,1 week after operation and 1 year after operation: the change of the height ratio of the anterior edge of the injured vertebra and the compression ratio of the median disfigurement diameter of the injured vertebral canal.Results All surgery underwent successfully.The operation time was from 3 to 6(3.7±0.4)hours,and the intraoperative blood loss was from 500 to 1100(760±150)ml.All the patients heal well.All patients were followed up for follow-up time.12 to 24 months,an average of 16.5 months.All the injured vertebrae healed,and no postoperative complications such as instrumentation loosening or breaking occurred during the follow-up period.Among the 18 patients with neurological impairment,except that 4 of the 5 patients with grade A were still grade A after surgery,13 of in the 18 at least 1 level improvement in neurological function.postoperative ASIA grade There were 4 cases of grade A,1 case of grade B,6 cases of grade C,2 cases of grade D,and 5 cases of grade E.The VAS score was significantly improved at 1 year after surgery compared with preoperative.The height ratio of the anterior edge of the injured vertebrae and the diameter of the spinal canal were significantly improved 1 week after operation(p <0.05).There was no significant change in the ratio of the height of the anterior border of the injured vertebrae and the compression ratio of the median diameter of the spinal canal at 1 year follow-up and 1 week after operation(p>0.05).Conclusion Posterior long-segment pedicle screw instrumentation is safe and effective in the treatment of severe thoracia and lumbar burst fractures with neurological deficit. |
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