| Objective:To observe and analyze the clinical results of the treatment of thoracolumbar fractures without decompression of vertebral canal through the approach of the paravertebral muscle space(I.E.the medial polyfissure muscle and the lateral longest muscle)combined with the internal fixation of the vertebral body.Methods:The data of 70 patients with thoracolumbar fracture who were randomly selected from the second affiliated Hospital of Shandong first Medical University from November 2016 to January 2018 were analyzed.The 70 patients with thoracolumbar vertebral fractures were randomly divided into a vertebral nail group(group A,25 cases in total)and a traditional posterior median approach combined vertebral nail group(group B,a total of 22 cases)and the spinal clearance approach crossed the injured vertebral nail group(group C,a total of 23cases)according to the treatment method used: Group A: 25 patients(15 males,10 females).The mean age was(41.61±8.25)years.Group B: 22 patients(13 males and 9 females).The mean age was(42.12±7.64)years.Group C: 23 patients(15 males and 8 females).The mean age was(40.34±8.14)years.In group A and group B,group A and group C,there were no significant differences in sex,age,type of injury,and vertebra contours between groups A and B,as well as in group C and group A.There was significant difference(P>0.05).The postoperative bleeding volume,postoperative drainage volume,creatine kinase level on the1 st and 3rd day after operation,the VAS score of pain sensation before and after operation,and the days of postoperative lower ground activity were analyzed and compared retrospectively between group A and group B,group A and group C,and the postoperative bleeding volume,postoperative drainage volume,creatine kinase level on day 1 and day 3after operation.The difference of postoperative hospitali-zation days,the percentage of anterior edge height of injured vertebrae,and the Cobb’s angle of sagittal position before and after operation.All surgical treatments(including surgery)in the three groups were performed by the same professional group of physicians.From half an hour before operation to 24 hours after operation,the first generation cephalosporin intravenous infusion was used in the three groups to prevent the incision infection.The amount and character of drainage were recorded after operation.The drainage tube was usually removed 1-2 days after operation(lower than 40 m L/day),and the drainage tube could be fixed at the lower end of the bed assisted by external fixation in the thoracolumbar vertebrae on the 3rd day after operation,and the drainage tube was lower than that on the second day after operation.Pain can be tolerated step by step underground bed standing,walking activities,appropriate early and other functional exercises.Results:All patients were followed up for an average of 21 months,with the shortest follow-up of 14 months and the longest follow-up of 28 months.In group B,the operative time,intraoperative bleeding volume,postoperative drainage volume,creatine kinase on the first day after operation,creatine kinase on the 3rd day after operation,activity time on the ground after operation,and days in hospital after operation were significantly higher in group B than those in group A.The difference was statistically significant between C group and A group,operation time,intraoperative bleeding volume,postoperative drainage volume,creatine kinase on the first day after operation,creatine kinase on the 3rd day after operation,and time of lower ground activity after the operation,and there was no significant difference between the two groups(P<0.05).There was no significant difference in postoperative hospitalization days(P>0.05).VAS score: the indexes after operation in each group were significantly better than those before operation,3 days after operation and 1 month after operation,group A was better than group B in the same period of time after operation,the difference was statistically significant(P<0.05).There was no significant difference between the two groups at the last follow-up(P>0.05).There was no significant difference between group A and group C at 3 days,1 month and the last follow-up(P>0.05).There were significant differences in the percentage of anterior edge height and sagittal Cobb’s angle between groups before and after operation(P < 0.01).The percentage of anterior edge height and sagittal Cobb angle were significantly different between group A and group B before and after operation.There was no significant difference in the percentage of anterior edge height and sagittal Cobb angle between A group and C group before and after operation.However,there were significant differences in the percentage of anterior edge height and sagittal Cobb angle in the last follow-up.There were no complications such as incision infection,vertebral space infection,spinal cord nerve injury and cerebrospinal fluid leakage after operation in all the three groups.The screw rod system was removed about 1 year after operation,and no pedicle screw and connecting rod were found.In group C,the pedicle screw loosened in 1 case,and the screw was slightly removed.Conclusion:1.The treatment of thoracolumbar fractures without nerve decompression by pedicle fixation via paravertebral intermuscular space(medial polyfissure muscle and lateral longest muscle)has less damage to paravertebral muscles,less bleeding during operation,less drainage and less pain after operation,and no nerve decompression is needed in the treatment of thoracolumbar fractures,and the injury to paravertebral muscles is less,less bleeding,less postoperative drainage,and less pain.Patients recovered quickly after operation,significantly reducing the occurrence of lumbar failure syndrome.2.Unilateral or bilateral fixation of the fractured vertebral body can more effectively reduce the vertebral fracture and restore and maintain the height of the vertebral body,which relieves the problem of stress concentration of the pedicle screw.It also reduces the failure of internal fixation and the loss of long-term correction angle.To sum up,it is safe to treat thoracolumbar fractures without decompression of vertebral canal by means of transpedicular screw fixation combined with transpedicular screw fixation through the approach of paravertebral intermuscular space,which is superior to traditional posterior median approach in the treatment of thoracolumbar fractures,and it is a safe and effective method for the treatment of thoracolumbar fractures without decompression of vertebral canal.Effective and less invasive treatment. |
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