Efficacy Analysis Of Intra-vertebral Bone Grafting In The Treatment Of Denis Type B Thoracolumbar Burst Fracture

Objective:To investigate the clinical efficacy of intra-vertebral bone grafting in the treatment of Denis type B thoracolumbar burst fractures.Methods:A total of 46 patients with thoracolumbar burst fracture who were admitted to our hospital from January 2018 to April 2020 and finally selected posterior pedicle screw fixation are involved.All patients underwent posterior pedicle screw fixation with their perioperative conditions and postoperative efficacy analyed retrospectively.Patients were divided into two groups according to the operation they received.Among the 46 patients,25 patients received the intra-vertebral bone grafting combined with posterior pedicle screw fixation and 21 patients received simple posterior pedicle screw fixation without bone grafting.The observation indicators are as follows:(1)General data as age,gender,surgical segment and preoperative bed time;(2)Operation time,intraoperative blood loss of patients,postoperative drainage and postoperative complications;(3)Pain score,ODI index assessment at postoperative and one month,6 months,12 months after operation;ASIA neural function classification at postoperative and 12 months after operation.Meanwhile,VAS score is used to evaluate the pain score,ODI index is used to evaluate the clinical efficacy,and the recovery of neurological function is evaluated by ASIA neural function classification.Each assessment was conducted by two investigators to ensure the accuracy of the assessment;(4)The anterior edge height ratio of the injured vertebra,the posterior edge height ratio of the injured vertebra and the Cobb angle were obtained before operation,and one month,6 months,12 months after surgery by thoracolumbar lateral radiographs.Results:(1)There is insignificant difference in general data between the two groups(P>0.05);(2)In the terms of operative time,intraoperative blood loss and postoperative drainage,the bone grafting group is more than the non-graft group(P<0.05).Delayed wound healing occurred in one patient in the bone grafting group and loosened internal fixation occurred in one patient in the non-graft group.(3)There is no significant difference in VAS scores and ODI index between the two groups before surgery and one month,6 months after operation(P>0.05);Meanwhile,the ODI index between the two groups before operation and one month,6 months after operation shows no difference.However,the ODI index of 12 months after operation of bone grafting group patients is lower than the patients without bone grafting group(P<0.05);Meanwhile,the VAS scores between the two groups show no difference(P>0.05).There is no significant difference in the distribution of ASIA neurological function before operation and 12 months after operation between the two groups(P>0.05).(4)There is no significant difference between two groups in the anterior and posterior edge height ratio of the injured vertebra,and the Cobb angle before operation,one month after surgery,6 months after surgery(P>0.05).At 12 months after operation,there is significant difference between two groups in the anterior edge height ratio and the posterior edge height ratio of the injured vertebra and the Cobb angle(P<0.05).Conclusion:Both two operation methods could have a better analgesic effect in patients with thoracolumbar burst fracture.Although with slightly larger trauma,the vertebral body bone grafting in the treatment of single section of thoracolumbar burst fracture strengthened the stability of the spine in the column,reduced long-term postoperative anterior trailing edge height of the protruding after spine angle losing again,improved the long-term quality of life in patients.In general,vertebrae bone grafting is a surgical method with good clinical effect and worth promoting.