Clinical Analysis Of Thoracolumbar Fractures With Upper Endplate Injury Treated By Short Segment Screw Placement Through Injured Vertebra

Objective:To explore and analyze the curative effect of single-level thoracolumbar fractures with upper endplate injury treated by pedicle screw reduction through injured vertebra and across injured vertebra,and then help clinicians to select the way of screw placement for patients with thoracolumbar fractures.Methods:A total of 45 patients diagnosed with single thoracolumbar fracture with upper endplate injury in our hospital from October 2016 to October 2018 were selected and their clinical data were retrospectively analyzed.The patients were randomly divided into experimental group(n = 25)treated with pedicle screw reduction through injured vertebra and control group(n = 20)treated with pedicle screw reduction across injured vertebra according to the method of screw placement.The age,gender,cause of trauma,injured vertebral segment,fracture classification,time from injury to operation and other general data of the two groups were statistically analyzed,and the difference had no statistical significance(P > 0.05).The general data of the two groups were comparable,and the statistical analysis of postoperative indicators could be performed.The operation time,intraoperative blood loss,postoperative drainage volume and postoperative hospital stay were compared between the two groups.The VAS score,ODI score,Cobb angle of injured vertebra and height ratio of anterior edge of injured vertebra were measured before operation,1 week after operation,3 months after operation,1 year after operation and during follow-up of fixation(all patients had hardware removed 12-15 months after surgery).The loss of Cobb angle of injured vertebra and height ratio of anterior edge of injured vertebra were calculated during follow-up.The healing of upper endplate injury was analyzed by reexamination of CT image data during follow-up of internal fixation.Results after statistical analysis,the goal of comparing the clinical efficacy of pedicle screw reduction through injured vertebra and across injured vertebra in the treatment of single-level thoracolumbar fractures with upper endplate injury was obtained.Results:All patients with thoracolumbar fractures included in the study achieved satisfactory reduction by both screw placement methods.The differences in the operation time and intraoperative blood loss between the two groups had statistical significance(P < 0.05);the differences in the preoperative VAS score,ODI score,Cobb angle of injured vertebra,height ratio of anterior edge of injured vertebra,postoperative drainage volume and postoperative hospital stay had no statistical significance(P > 0.05).There was no significant difference in VAS score,ODI score,Cobb angle of injured vertebra and height ratio of anterior edge of injured vertebra at 1 week and 3 months after operation(P > 0.05).There were significant differences in VAS score,ODI score,Cobb angle and height ratio of anterior edge of injured vertebra between 1 year after operation and follow-up after internal fixation(P < 0.05).In terms of healing of upper endplate injury,14 cases in the experimental group healed well,with a healing rate of 56.0%,while only 7 cases in the control group healed well,with a healing rate of 35.0%.During follow-up,there was no internal fixation fracture in the experimental group and 2 cases in the control group.Conclusion:1.Compared with pedicle screw reduction across injured vertebra,pedicle screw reduction through injured vertebra had no difference in the short-term effect of postoperative recovery of anterior height ratio of injured vertebra and Cobb angle of injured vertebra;2.Compared with pedicle screw reduction across injured vertebra,pedicle screw reduction through injured vertebra is more effective in maintaining vertebral body height and Cobb angle after surgery;3.Compared with pedicle screw reduction across injured vertebra,pedicle screw reduction through injured vertebra can significantly improve postoperative low back pain and function in patients at a later stage;4.Compared with pedicle screw reduction across injured vertebra,pedicle screw reduction through injured vertebra is more effective in the healing of postoperative upper endplate injury in patients.