| Objective:To investigate the clinical efficacy of using a comprehensive orthopedic indirect decompression technique with the support of intraoperative three-dimensional imaging technology versus the traditional total laminectomy direct decompression technique in the treatment of fresh thoracolumbar burst fractures with spinal cord injury;to observe the value of intraoperative three-dimensional imaging technology in the operation of thoracolumbar burst fractures with combined spinal cord injury.Methods:The clinical data of 70 patients with fresh thoracolumbar vertebral burst fractures with spinal nerve injury admitted to our medical group between 2015 and 2021 were retrospectively analyzed;28patients were male and 42 were female;age ranged from 48 to 72 years,with an average of 58.74 years.Distribution of responsible segments: 9 cases of T11,10 cases of T12,24 cases of L1,and 27 cases of L2.Pre-and postoperative X-ray and CT examinations were routinely performed in all cases.According to the different surgical methods,they were divided into indirect decompression group and direct decompression group.In the indirect decompression group,a comprehensive orthopaedic indirect decompression with an internal arch fixation system in the hyperextension position(medial eight nail placement,overbending rod technique,and axial spreading in the external eight)was adopted,and in the direct decompression group,a traditional direct decompression with total laminectomy was adopted.Patients in the indirect decompression group were scanned with intraoperative three-dimensional imaging technology to observe the fracture block reset in the spinal canal.In the indirect decompression group,there were 32 patients,12 males and 20 females,aged 48-71 years,with an average of 50.09±6.42 years,and the distribution of responsible segments: T11 4 cases,T12 5 cases,L1 11 cases,L2 12 cases;in the direct decompression group,there were 38 patients,16 males and 22 females,aged 49-72 years,with an average of 49.98±6.40 years,and the distribution of responsible segments: T11 5 cases,T12 5 cases,L1 13 cases.T12 5 cases,L113 cases,L2 15 cases.The clinical efficacy of the surgery was assessed according to the preoperative and postoperative ASIA spinal cord injury grading scales;the orthopedic effect of the surgery was assessed according to the measurements of the height compression ratio of the anterior margin of the injured spine and the posterior convexity angle of the injured spine region before,3 days after,3 months after,and 24 months after surgery;the orthopedic effect of the surgery was assessed according to the preoperative,3days after,3 months after,and 24 months after surgery The improvement of low back and leg pain was evaluated according to the Visual Analogue Score(VAS)before surgery,3 days after surgery,3 months after surgery,and 24 months after surgery.Statistical analysis was performed to assess the clinical outcomes of the two procedures in the treatment of fresh thoracolumbar burst fractures with spinal nerve symptoms.This study was approved by the ethics committee of our hospital,and all patients were informed and signed the informed consent form.Results:Intraoperative 3D imaging scans in the indirect decompression group showed complete or basic reduction of the fracture mass into the spinal canal in 27 cases(84.4%)and compression of the dura mater in 5 cases(15.6%)where the fracture mass still occupied the spinal canal.The operative time,intraoperative bleeding and hospital stay were statistically significant(P < 0.05)in the indirect decompression group and the direct decompression group,and the indirect decompression group was less than the direct decompression group.There were no intraoperative and postoperative complications,such as dural rupture,postoperative infection,epidural hematoma or rupture of the internal fixation device,in patients of both groups.There was no statistically significant difference between the two groups in terms of preoperative and postoperative neurological function according to the American Spinal Cord Injury Association(ASIA)classification(P > 0.05).The differences in the height of the anterior margin of the injured spine and the posterior convexity angle of the injured spine area between the two groups were not statistically significant at the third day and the third month after surgery,but the differences between the two groups at the 24 th month after surgery were statistically significant,and the indirect decompression group was better than the direct decompression group.The postoperative VAS scores of the lumbar region and the leg region decreased in both groups compared with the preoperative scores,and there was no statistically significant difference in the VAS scores of the lumbar region and the leg region between the two groups at the third day and the third month after surgery,but there was a statistically significant difference between the two groups at the 24 th month after surgery,and the indirect decompression group was superior to the direct decompression group.Conclusion:In patients with fresh thoracolumbar burst fractures with neurological symptoms,the comprehensive orthopedic indirect decompression with the arch root internal fixation system in the hyperextension position(medial eight nail placement,overbending rod technique,and external eight axial bracing)is effective in restoring the height of the anterior margin of the injured vertebral body and preventing distant loss of vertebral body height,and the clinical efficacy does not differ from that of the traditional direct decompression with total laminectomy,while,due to the preservation of the posterior ligamentous complex It is a better method for treating fresh thoracolumbar vertebral fractures because it can better prevent distant loss of vertebral height due to the preservation of the posterior ligamentous complex.The medical value of intraoperative 3D imaging technology is reflected in this procedure,which has a powerful guiding effect on decompression and fracture block repositioning,which improves the scientific and reliable treatment of fresh thoracolumbar burst fractures and has unique clinical application prospects. |
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