Clinical Effect Of Posterior Limited Decompression And 13 Mm Titanium Mesh Implantation In The Treatment Of Severe Thoracolumbar Burst Fractures

Objective: To evaluate the radiological results and ASIA classification of spinal cord nerve function in patients with thoracolumbar burst fracture before and after operation and 1 year follow-up,and to explore the clinical efficacy of localized decompression of injured vertebral canal and implantation of 13 mm titanium alloy mesh through posterior spinal approach in the treatment of severe thoracolumbar burst fractures(TLBF).Methods: From 2015 to 2019,15 patients with thoracolumbar burst fracture who underwent posterior spinal canal limited decompression and 13 mm titanium mesh implantation in Shaoxing Hospital of China Medical University were selected by inclusion and exclusion criteria.A total of 15 patients with thoracolumbar burst fracture were included in this study,and the case data of patients admitted to hospital,after operation and followed up for 1 year were analyzed retrospectively.Cobb angle measurement,spinal canal occupation degree measurement,anterior edge height measurement of injured vertebral body and ASIA classification of spinal nerve injury degree are all independently measured by three senior physicians without interference from each other,and the results are averaged.If there is obvious deviation in the data,please ask the three senior physicians to review.SPSS statistical software was used to analyze the collected data,and Wilcoxon rank sum test was carried out during the research of independent samples.Counting data were tested by X2.The data were tested and analyzed by Stata/SE15.1 software,and expressed in the form of mean standard deviation.The independent samples were tested by T test,and the P value was lower than 0.05.In this case,the difference was statistically significant.Results: Fifteen patients with TLBF were selected for study,and they were followed up for one year after the first stage operation.Operation time: 208.4±21.41 min,with an average operation time of 3.47 hours.Intraoperative blood loss: 900.0±359.17ml;Postoperative negative pressure drainage: 360.53 ±121.61ml;Hospitalization days:25.73 4.07 days.The postoperative follow-up time was no less than 12 months.The height of the anterior edge of the injured vertebra was not lost after measurement.The physiological curvature of the spine was OK,and bone graft fusion was OK.No screw,titanium rod or titanium mesh internal fixation device was displaced or broken during the follow-up.The nervous system function was evaluated by American Spinal Injury Association(ASIA)at the time of 1 year follow-up.Compared with the evaluation results at admission,2 TLBF patients recovered from A to D in ASIA.1case of grade b TLBF recovered to grade c,3 cases recovered to grade d and 2 cases recovered to grade e..1 case of grade c TLBF was still grade c,2 cases recovered to grade d and 2 cases recovered to grade e..In 2 cases of grade d TLBF,1 case did not change,and 1 case recovered to grade e.One case of thoracolumbar burst fracture was operated again more than one year after operation,and four pedicle screws were taken out,thus freeing the mobility of two vertebral bodies.One case of thoracolumbar burst fracture was evaluated one year after operation,and all the internal fixation devices were removed.The postoperative recovery was better,and no corresponding surgical complications occurred.The Cobb angle of 15 patients with TLBF was measured to be 7.07 1.38 after operation,and the Cobb angle was measured to be 6 ～ 9 after one year’s follow-up.Some physiological radians of spine were lost but not obvious.The percentage of vertebral anterior edge height was 7.531.71% after measurement and 7.0 1.41% after one year follow-up.The measurement data after operation and one year follow-up were significantly improved compared with those before operation.After statistical analysis,α=0.05 was finally selected as the test standard,and the difference was statistically significant(P<0.05).Conclusion: Limited decompression and 13 mm titanium mesh implantation for the treatment of thoracolumbar burst fractures can achieve the purpose of one-stage decompression and spinal reconstruction.Because of the small diameter,it is easier to place the 13 mm titanium mesh,which can effectively reduce the spinal canal decompression and bleeding,shorten the operation time,and achieve satisfactory results.