| (1)Research significanceIn recent years,with the rapid economic development,high incidence of traffic accidents and high-energy trauma,spinal fractures have become common orthopedic injuries.Bone fractures are common in the spine injury,occuring in the thoracolumbar.Thoracolumbar spine fractures account for spine fracture about 50%to 70%,which burst fracture accounted for spinal trauma of 10%to 20%.17%of thoracolumbar fractures patients often have spinal cord injury,while can cause permanent damage in nerve function and significant fluctuations in serum inflammatory markers and,causing a great burden to the patient's life,work and society.The choice of non-surgical treatment and surgical treatment with thoracolumbar burst fracture is currently no uniform standards,which mainly based upon the severity of the injury,including spinal oppression,kyphosis,and nerve damage.The purpose of surgery is complete decompression of the nerve tissue and providing a possiblely favorable environment for its recovery,stability and reconstruction to the spine.The stability of the reconstruction of thoracolumbar fractures conduce to nursing care,early fuctional exercise and and reducing complications.Surgical treatment may also be effective in preventing the occurrence of delayed kyphosis,so as to promote the recovery of neurological function in patients with incomplete neurological injury.The standard fusion operation is posterolateral intertransverse bone grafting fusion of the operation,which is widely used.Its' main advantage is that it can rebuild a good lumbar stability,effectively maintain the height of the vertebral body and reduce the incidence of complications such as the kyphosis,broken nails and broken rods.However,there are shortcomings such as a complicated operation,bone volume,revealeding a wide range.It need to take a large number of autologous bone,so the bone area after surgery may appear complications such as pain and paresthesia;Irn addition,because of the soft tissue between the transverse process and more distance,exposxare and bone grafting are very difficult.And it will require a lot of local bone pieces and wide release.What's more,from the mechanical point of view,intertransverse bone grafting fusion of the operation is difficult to achieve bone fusion purposes.Facet is a effective part of the posterior bone graft.From the anatomical point of view,the only joint of thoracic and lumbar intervertebral joint is lumbar facet joints,which plays an important role in the stability of the spine,and can bear 30%of the spine load,while it is involved in all directions of joint activities.By grafting bone between facet joint,if we can achieve bony fusion between the facet joint,it can restrict the activities of the small joints in all directions,even to the integration of the entire spine.The facet joint bone grafting fusion lead to less trauma and require less bone without iliac bone graft unit,avoiding the complications of iliac bone graft that may arise.lt also has other advantages such as local revealeding conveniently,no need to make a wide range of peeling,simple operation,without special equipment The disadvantage is less immediate stability.Aggressive surgery,and it can prevent further ischemia and necrosis of the bone marrow to create certain conditions for early bone-step recovery.Clinically,intertransverse bone grafting fusion is recognized the fusion surgery,which is currently the most widely used procedureAlthough it can achieve good results,it have shortcomings such as complex operation,bone volume,revealing a wide range and so on.Facet joint fusion surgery is rarely applied in clinical,But during clinical work,we observed that was simple siurgical procedure,less trauma,and can also achieve better fusion rate.(2)ObejectiveThis topic plans to compare the clinical efficacy between the facet joint bone grafting fusion and intertransverse bone grafting fusion.Thus it can provide a scientific basis to select the method for thoracolumbar burst fractire,so as to minimize the suffering of patients and to achieve the most best effect.(3)Method<1>Resarch objectBaseline information:The subject selected 45 Cases in Huizhou Central People's Hospital for treatment of patients with thoracolumbar burst fractures from September 2012 to March 2015.Surgical approach to the facet joint bone grafting fusion 23 cases of the experimental group,surgical ntertransverse bone grafting fusion for the 22 cases in the control group,and they were compared.In experimental group,there were 10 males and 13 females,whose age ranged 21 years to 60 years.In the control one,11 males and 11 females,age ranged 20 to 58 years old.There was no statistically significant difference in their Baseline informationClassification criteria:1.According to the diagnostic criteria of practical orthopedics ? patients had a clear history of trauma;? patients with thoracic back pain,deformity,limited mobility;?X films showed vertebral compression fractures,vertebral fracture line through centra;CT displayed;vertebral bone split to the surrounding,burst column bone broke into the spinal canal.;2 Single vertebral burst fracture without neurological dysfunction;3 Inclusion criteria:? meet the diagnostic criteria;?fractures fresh fractures,male or female;?20-60 years,Injury time?5d;?patient informed consent to treatment;?complete follow-up data of patients.Exclusion criteria:(1)does not meet the inclusion criteria;(2)met the inclusion criteria,but there are the following cases:? patients with severe heart,liver disease,diabetes,osteoporosis,autoimmune diseases,mental illness;? obvious focus of infection;? osteoporosis or pathological fracture<2>Outcome measuresNtra operative and Per operative conditions:Operative time,blood loss and the amount of bone graft.,and the The VAS before and 3d after operation between the 2 groups were compared.Imaging indicators:Patients were examined Lumbar lateral radiograph preoperatively and 1,6 months after surgery,and got the Thoracic and lumbar spine CT 12 months after surgery.The Leading edge,central and trailing edge height loss rate,Cobb angle,The rate of bone fusion,the rate of correction and long lost rate of the Injured vertebrae in 2 groups were comparedpostoperative follow-up:Have or don't have broken nails,broken rods,instability,kyphosis secondary and other complications<3>Statistical AnalysisApplicate SPSS 13.0 statistical software for data collected for statistical analysis.Measurement data were expressed in term of meanąstandard deviation(SD),paired t test was used to compare the use of the group,and independent samples t test was used in the comparison between groups.Count data between groups were compared using ?2 test.Significance level a=0.05.(4)ResultsTwo groups were successfully completed the surgery.Take the statistics of two groups about the situation during the surgery and Postoperative rehabilitation<1>Ntra operative and Per operative conditions:the experimental group owned a less Operative time,blood loss and the amount of bone graft.and the The VAS 3d after operation than the control group.(P<0.05)<2>Imaging indicators:Patients were examined Lumbar lateral radiograph preoperatively and 1,6 months after surgery,and got the Thoracic and lxmibar spine CT 12 months after surgery.The Leading edge,central and trailing edge height loss rate,Cobb angle,The rate of bone fusion,the rate of correction and long lost rate of the Injured vertebrae in 2 groups were comparedThe Leading edge,central and trailing edge height loss rate,Cobb angle,The rate of bone fusion,the rate of correction and long lost rate of the Injured vertebrae in 2 groups preoperatively and 1,6,12 months after surgery had statistically significant difference,except the Leading edge and central height loss rate 1 month after the surgery.<3>The postoperative complication rate case1-2 months after surgery,there were 2 cases in experimental group occured on a failure of intermal fixation.but the difference of the postoperative complication rate betwwen the experimental and control group was statistically significant(X2=2.002,P=0.157,P>0.05)(5)ConclusionsThe clihical effects of two groups were similar,but the method of facet joint fusion was more significant in the treatment of throacolumbar burst fracture associated with spinal cord injury,because it has less operational time,operational bleeding,the amount of graft bone and vas score.Therefore,the facet joint bone grafting fusion treatment of thoracolumbar burst fractures in the clinical process was with great promotional value. |
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