Vertebral decompression and implant fixation for thoracolumbar burst fractures：posterior approach is safer in follow-up
10.3969/j.issn.2095-4344.2015.22.017
- VernacularTitle:椎体减压植入物内固定修复胸腰椎爆裂性骨折：随访验证后路途径更安全
- Author:
Jinlong JIA
;
Qingguo YANG
;
Yinshun ZHANG
;
Wei LI
;
Guangyi LIU
- Publication Type:Journal Article
- From:
Chinese Journal of Tissue Engineering Research
2015;(22):3531-3537
- CountryChina
- Language:Chinese
-
Abstract:
BACKGROUND:Previously, serious thoracolumbar burst fractures with spinal cord injury were mainly treated by anterior surgery. The superiority of conventional posterior repair lies in strong reduction and fixation effects. However, it is difficult to fuly decompression. The anterior and central cylinders of the injured vertebra cannot receive good reconstruction. Loss of correction and internal fixation failure always appear. It remains controversial which repair method is more ideal. OBJECTIVE:To comparatively analyze the effect of posterior and anterior approaches with subtotal vertebrectomy, decompression, reconstruction of spine, and internal fixation for patients with thoracolumbar burst fractures. METHODS: The data of 42 patients with thoracolumbar burst fracture treated by anterior and posterior approaches with subtotal vertebrectomy, decompression, and reconstruction of spine from May 2006 to December 2012 was retrospectively analyzed. They were divided into two groups according to the surgical procedures: anterior approach group (n=23) and posterior approach group (n=19). They were folowed up for at least 24 months. Repair results and imaging results were compared in patients of both groups. RESULTS AND CONCLUSION:None patients in the two groups affected fixator loosing or breakage, and obtained good bone fusion. The intraoperative blood loss was more and operative time was longer in the anterior approach group than in the posterior approach group, showing significant difference (P < 0.05). The pulmonary function was significantly better in the posterior approach group than in the anterior approach group (P < 0.05). Visual Analog Scale score, Japanese Orthopaedic Association score for back pain and Frankel classification were significantly improved during final folow-up compared with pre-treatment in both groups, but no significant difference was found between groups (P > 0.05). No significant difference in the anterior vertebral height and kyphosis Cobb angle was detected before treatment, at 1 week after treatment and during final folow-up (P > 0.05). The incidence of postoperative complications was significantly higher in the anterior approach group than in the posterior approach group (P < 0.05). These findings confirm that subtotal vertebrectomy through anterior approach and posterior approach can effectively repair thoracolumbar burst fractures. However, the complications of posterior approach are less, and posterior approach has few impacts on the pulmonary function, is safe, and has good biocompatibility with the host.
