Comparison Of The Treatment To Thoracolumbar Fracture With Unilateral And Bilateral Injured Vertebra Transpedicular Fixation

Objective To compare the efficacy of using unilateral and bilateral injured vertebra transpedicular fixation to treat the thoracolumbar fractures,provide certain reference for the clinical treatment.Methods From August 2017 to December 2020,36 patients with thoracolumbar fractures treated with posterior short-segment throughinjured-vertebra transpedicular fixation in the Third Affiliated Hospital of Anhui Medical University(Hefei First People’s Hospital)were selected as the research objects.Before the surgery,all the patients must undergo physical examination and imaging examination to identify the level of the injured vertebra,to assess the type of vertebral fracture and the integrity of the posterior ligament complex,and to confirm that the bilateral pedicle of the injured vertebra was intact,the spinal canal occupied was no more than 1 / 3 and had no symptoms of nerve injury.All the fractures were fresh within two weeks.All cases were divided into the unilateral injured vertebra transpedicular fixation group(group A)and bilateral injured vertebra transpedicular fixation group(group B)according to the screw placement of the injured vertebra.Between two groups,analyzed the operation time,blood loss,the injured vertebral height ratio of preoperative,postoperative 1 week,postoperative 1 year and kyphotic Cobb angle of preoperative,postoperative 1 week,postoperative 1 year.Results All the patients were followed up.There were no complications such as incision infection,internal fixation loosening and breakage.Comparison of operative parameters:In the unilateral injured vertebra transpedicular fixation group,the operation time was(94.55±8.09)min and the amount of intraoperative bleeding was(298.18±16.51)ml.In the bilateral injured vertebra transpedicular fixation group,the operation time was(97.71 ± 4.84)min and the amount of intraoperative bleeding was(308.57±17.91)ml.There was no significant difference in the operation time and the amount of intraoperative bleeding between the two groups(p > 0.05).Comparison of imaging parameters:(1)In the unilateral injured vertebra transpedicular fixation group,the injured vertebral height ratio was(49.31 ± 3.89)% before operation,improved to(94.95 ± 1.44)% after 1 week of postoperation,(92.77±1.39)% after 1 year of postoperation.The difference of the injured vertebral height ratio between preoperation and postoperative 1 week and between preoperation and postoperative 1 year was statistically significant(p <0.05).There was no significant difference between postoperative 1 year and postoperative 1 week(p > 0.05).In the bilateral injured vertebra transpedicular fixation group,the injured vertebral height ratio was(50.19±4.01)% before operation,improved to(94.49±0.10)% after 1 week of postoperation,(93.32±1.27)% after 1year of postoperation.The difference of the injured vertebral height ratio between preoperation and postoperative 1 week and between preoperation and postoperative1 year was statistically significant(p < 0.05).There was no significant difference between postoperative 1 year and postoperative 1 week(p > 0.05).Between the two groups,there was no significant difference in the ratio of injured vertebral height before operation,1 week after operation and 1 year after operation(p > 0.05).(2)In the unilateral injured vertebra transpedicular fixation group,kyphotic Cobb angle was(21.39±1.38)° before operation,improved to(3.15±0.74)° after 1week of postoperation,(3.55 ± 0.73)° after 1 year of postoperation.The difference of kyphotic Cobb angle between preoperation and postoperative 1 week and between preoperation and postoperative 1 year was statistically significant(p < 0.05).There was no significant difference between postoperative 1 year and postoperative 1 week(p > 0.05).In the bilateral injured vertebra transpedicular fixation group,the kyphotic Cobb angle was(21.56±1.41)° before operation,improved to(2.86±0.57)° after 1 week of postoperation,(3.14±0.60)°after1 year of postoperation.The difference of the kyphotic Cobb angle between preoperation and postoperative 1 week and between preoperation and postoperative1 year was statistically significant(p < 0.05).There was no significant difference between postoperative 1 year and postoperative 1 week(p > 0.05).Between the two groups,there was no significant difference in the kyphotic Cobb angle before operation,1 week after operation and 1 year after operation(p > 0.05).Conclusion The technique of unilateral or bilateral injured vertebral transpedicular fixation can effectively treat the thoracolumbar vertebral fractures.there were no significance differences in the clinical efficacy between two groups.