Objective To discuss the improved method and effectiveness of posterior pedicle-screw fixation combined with restoring and grafting through the injured vertebrae for treating thoracolumbar burst fracture. Methods Between March 2008 and September 2010, 21 patients with thoracolumbar burst fracture were treated by posterior pedicle-screw fixationcombined with restoring and grafting through the injured vertebrae. Of 21 cases, 15 were male and 6 were female with an age range of 20-61 years (mean, 38.4 years). Affected segments included T12 in 5 cases, L1 in 7 cases, L2 in 5 cases, and T12-L1 in 4 cases. According to Frankel classification for neurological function, 2 cases were rated as grade A, 4 cases as grade B, 6 cases as grade C, 5 cases as grade D, and 4 cases as grade E; based on Denis classification, all 21 cases were burst fractures, including 7 cases of type A, 11 cases of type B, and 3 cases of type C. The X-ray film was taken to measure the relative height of fractured vertebrae and Cobb’s angle, and the function of the spinal cord was evaluated at preoperation, postoperation, and last followup. Results All the incisions healed primarily. The 21 patients were followed up 12-30 months (mean, 26 months). No loosening or breakage of screws and rods occurred. X-ray films showed good bone heal ing with the heal ing time from 12 to 23 months (mean, 16 months). The Cobb’s angles at 1 week and 1 year postoperatively were (3.4 ± 2.4)° and (5.2 ± 3.2)° respectively, showing significant differences when compared with preoperative angle (22.1 ± 1.2)° (P lt; 0.05), while no significant difference between 1 week and 1 year after operation (P gt; 0.05). The anterior height of injured vertebrae recovered from (14.6 ± 2.1) mm (40.2% ± 1.5% of the normal) at preoperation to (36.0 ± 2.0) mm (95.3% ± 1.3% of the normal) at 1 week, and to (35.0 ± 2.4) mm (94.4% ± 2.5% of the normal) at 1 year; significant differences were found between preoperation and postoperation (P lt; 0.05), while no significant difference between 1 week and 1 year after operation (P gt; 0.05). At 1 year after operation, the Frankel neurological function grade was improved in varying degrees, showing significant difference when compared with preoperative grade (χ2=11.140, P=0.025). Conclusion Improved method of posterior pedicle-screw fixation combined with restoring and grafting through the injured vertebrae in treatment of thoracolumbar burst fracture can reconstructthe anterior and middle column stabil ity and prevent loss of Cobb’s angle and height of vertebrae.
To compare the effectiveness of the operations in treatment of thoracolumber spine fracture and dislocation with spinal cord injury in different periods. Methods Between June 2003 and June 2008, 80 cases of thoracolumber spine fracture and dislocation with spinal cord injury were treated. There were 52 males and 28 females with an average age of 37.6 years (range, 28-49 years). According to different operative time, they were divided into 2 groups by randomized controlled study: group A (n=39, operation was performed within 24 hours) and group B (n=41, operation was performed at 3-7 days). In group A, there were 23 cases of degree I-II (group A1), 16 cases of degree III-V (group A2) according to Meyerding standard, including 17 cases of grade A, 7 cases of grade B, 9 cases of grade C, and 6 cases of grade D according to Frankel scoring system. In group B, there were 21 cases of degree I-II (group B1) and 20 cases of degree III-V (group B2), including 20 cases of grade A, 7 cases of grade B, 11 cases of grade C, and 3 cases of grade D. All cases were treated with posterior spinal cord decompression and reduction, with internal fixation by pedicle screw-rod system and transforamen lumbar interbody fusion. Results The blood loss was (407.4 ± 24.3) mL in group A1 and (397.4 ± 8.2) mL in group B1, showing no significant difference (t=1.804, P=0.078); the blood loss was (1 046.9 ± 128.6) mL in group A2 and (494.4 ± 97.7) mL in group B2, showing significant difference (t=14.660, P=0.000). All 80 patients were followed up 2 years to 2 years and 6 months (mean, 2 years and 3 months) with satisfactory results in spinal cord decompression and reduction, and bony fusion was achieved at 12 months. There was no significant difference in the vertebral canal volume, vertebral height, and Cobb angle at both pre- and postoperation between 2 groups (P gt; 0.05). No loosening or breakage of screws and rods occurred. At 12 months after operation, the cure rates were 47.83% (11/23) in group A1 and 19.05% (4/21) in group B1, showing significant difference (χ2=4.046, P=0.044); the cure rates were 12.50% (2/16) in group A2 and 10.00% (2/20) in group B2, showing no significant difference (χ2=0.056, P=0.813). There was no significant difference (χ2=0.024, P=0.878) in the cure rates in the patients at grades A and B before operation between group A (12.50%, 3/24) and group B (11.11%, 3/27); but there was significant difference (χ2=5.992, P=0.014) in the cure rates in the patients at grades C and D before operation between group A (66.67%, 10/15) and group B (21.43%, 3/14). Conclusion Emergency operation of posterior pedicle screw-rod system for treatment of thoracolumber spine fracture and dislocation with spinal cord injury can provide good reduction, rigid fixation, and high fusion rate, so it is asafe and effective treatment method.
ObjectiveTo evaluate the clinical significance of individualized reference model of sagittal curves and navigation templates of pedicle screw by three-dimensional printing technique for thoracolumbar fracture with dislocation. MethodsBetween February 2011 and November 2013, 42 patients with thoracolumbar fracture and dislocation undergoing pedicle screw fixation were divided into 2 groups:traditional pedicle screw internal fixation by fluoroscopy assistant was used in 24 cases (control group), and individualized reference model of sagittal curves and navigation templates of pedicle screw were used in 18 cases (trial group). There was no significant difference in gender, age, injury causes, segment, degree of dislocation, and Frankel classification between 2 groups (P>0.05). The operation time, intraoperative blood loss, perspective times, and dislocation rate, sagittal angle recovery rate at different time were compared. The success rate of pedicle screw insertion, sagittal screw angle, and Frankel classification were compared. The angle between sagittal screws, difference of screw entry point at horizontal position, and difference of screw inclined angle were compared. ResultsThe operating time, intraoperative blood loss, and perspective times in trial group were significantly lower than those in control groups (P<0.05). All the patients were followed up 12-40 months (mean, 22 months). The dislocation rate at immediate after operation and last follow-up were significantly improved when compared with preoperative value in 2 groups (P<0.05). At immediate after operation and last follow-up, the dislocation rate and sagittal angle recover rate in trial group were significantly better than those in control group (P<0.05). There were significant differences in the one-time success rate, final success rate of pedicle screw insertion, and saggital screw angle between 2 groups (χ2=9.38, P=0.00; χ2=10.95, P=0.00; χ2=13.43, P=0.00). The angle between sagittal screws, difference of screw entry point at horizontal position, and difference of screw inclined angle in trail group were significantly less than those in control group (P<0.05). There was significant difference in the Frankel classification between 2 groups at last follow-up (Z=-1.99, P=0.04). ConclusionThe application of individualized reference model of sagittal curves and navigation templates of pedicle screw by three-dimensional printing technique for thoracolumbar fracture with dislocation has the advantages of shorter operation time, less intraoperative blood loss, better recovery of thoracolumbar dislocation, and better Frankel classification.