Treatment of thoracolumbar fracture by posterior reduction combined with H-shaped bone grafting and spinous process replantation for reconstruction of spinal structures
10.3760/cma.j.issn.1001-8050.2014.06.017
- VernacularTitle:后路复位结合“H”形植骨棘突回植重建椎管结构治疗胸腰椎骨折
- Author:
Qing YE
;
Wu HUANG
;
Yunsong HE
;
Mingshan NONG
;
Tiansen LIANG
;
Suzhen TAN
- Publication Type:Journal Article
- Keywords:
Spinal fractures;
Thoracic vertebrae;
Lumbar vertebrae;
Spinal canal
- From:
Chinese Journal of Trauma
2014;30(6):530-534
- CountryChina
- Language:Chinese
-
Abstract:
Objective To detect the clinical effect of posterior reduction combined with H-shaped bone grafting and spinous process replantation for reconstruction of spinal structures in treatment of thoracolumbar fracture.Methods Forty-three patients with thoracolumbar burst fracture treated surgically from February 2008 to June 2012 were reviewed retrospectively.There were 30 male and 13 female patients aged 23 to 55 years (mean,38 years).Fracture resulted from high falls in 21 patients,traffic accidents in 16 patients,and a crush by heavy objects in 6 patients.Denis system was used for classification of fracture and Frankel rating for assessing the degree of nerve damage and recovery.After posterior reduction combined with H-shaped bone grafting and spinous process replantation for all patients,visual analogue scale (VAS) was utilized to assess symptom improvement and Cobb' s angle and sagittal spinal canal diameter were measured to help assess the treatment outcome.Results Pain was apparently eased at a 24-month follow-up (range,12-46 months).Cobb' s angle improved from preoperative 43.56° to postoperative 8.23° (t =1.33,P ＜ 0.01).CT findings showed mean spinal canal stenosis rate was 56.3％ before surgery and that mean sagittal canal diameter of the injured spine was larger than that of adjacent segments at follow-up,with the mean ratio of 116.3％ (range,111.3％-120.3％).Rate of spinal canal stenosis was negative for all patients and posterior canal with bone grafts healed.Spinal cord injury improved at least one Frankel grade.Conclusion Posterior reduction combined with H-shaped bone grafting and spinous process replantation is worthy of clinical application,for the procedure can restore the fractured thoracolumbar spine and posterior canal structure,but also effectively avoid the iatrogenic spinal stenosis.
