Objective To investigate the effect of bone grafting and pedicle screw internal fixation on the recovery of central vertebral height after thoracolumbar fracture and its clinical observation. Methods From January 2012 to December 2019, 89 patients with single-segment thoracolumbar fracture were admitted to our hospital, all of whom had single vertebral fracture T11~L2 (AO type A). Patients were divided into 3 groups according to different treatment methods: a trans-injured vertebra fixation and bone grafting group (n=15), a trans-injured vertebra fixation group (n=58), and a cross injury vertebral fixation group (n=16). The anterior vertebral body height (Ha), central vertebral body height (Hm), posterior vertebral body height (Hp) and kyphosis Cobb Angle of the injured vertebra were measured. The Ha loss rate, Hm loss rate and kyphosis Cobb Angle loss rate were statistically compared and analyzed in the last follow-up, and the recovery of vertebral height and kyphosis Angle after treatment was observed. Results The Ha compression rate, Hm compression rate and Cobb Angle of 89 patients after operation and at the last follow-up were significantly improved compared with those before operation, with significant differences (P<0.05). However, in the last follow-up, Hm loss rate (7.73±5.26) % in the trans-injured vertebra fixation and bone grafting group and Hm loss rate (11.71±11.15) % in the trans-injured vertebra fixation group were both lower than that in the cross injury vertebral fixation group (19.81±8.50) %, with significant significance (P<0.05). Hm loss rate in the trans-injured vertebra fixation and bone grafting group was lower than that in the simple injured vertebra fixation group, and there was similar statistical difference between them (P=0.052). Conclusions Percutaneous pedicle screw fixation in the treatment of thoracolumbar fractures can promote the recovery of the anterior and central height of the fractured vertebra, and the injured vertebral bone graft pedicle screw internal fixation in combination with vertebral body bone graft is more effective to prevent the loss of the central height of the injured vertebra
Key words
Thoracolumbar fracture; /
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Fracture type; /
Central height of vertebral body; /
Screw placement for injured vertebra; /
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Bone graft through vertebral arch
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References
[1] Wood KB, Li W, Lebl DR, et al. Management of thoracolumbar spine fractures[J]. Spine J, 2014,14(1):145-164. DOI: 10.1016/j.spinee. 2012.10.041.
[2] 李晓冬, 王素伟, 阴洪, 等.经皮椎弓根螺钉固定治疗胸腰段A3型骨折的临床观察[J].中国临床解剖学杂志, 2016, 34(4):444-449. DOI:10.13418/j.issn.1001-165x.2016.04.018.
[3] 李佳, 欧云生, 权正学, 等.经伤椎椎弓根植骨联合伤椎椎弓根螺钉固定治疗胸腰段骨折[J].中国临床解剖学杂志, 2011, 29(3):356-360. DOI:10.13418/j.issn.1001-165x.2011.03.035.
[4] Hitchon PW, He W, Viljoen S, et al. Predictors of outcome in the non-operative management of thoracolumbar and lumbar burst fractures[J]. Br J Neurosurg,2014,28(5):653-7. DOI: 10.3109/02688697.2013. 872226.
[5] Xiong CJ, Huang BW, Wei TJ, et al. Effect of the short-segment in⁃ ternal fixation with intermediate inclined-angle polyaxial screw at the fractured vertebra on the treatment of denis type b thoracolum⁃ bar fracture [J]. J Orthop Surg Res, 2020, 15 (1) : 182. DOI: 10.1186/s13018-020-01686-7.
[6] 李驰, 徐华梓, 王向阳, 等. 经皮与开放椎弓根螺钉内固定治疗胸腰椎骨折对椎旁肌影响的比较[J]. 中华外科杂志, 2007, 45(14):972-975. DOI: 10.3760/j.issn:0529-5815.2007.14.012.
[7] Toyone T,Tanaka T,Kato D, et al. The treatment of acute thoracolumbar burst fractures with transpedicular intracorporeal hydroxyapatite grafting following indirect reduction and pedicle screw fixation：a prospective study[J]. Spine(Phila Pa 1976) , 2006,31 (7): E208-E214.DOI: 10.1097/01.brs.0000208161.74286.ad.
[8] 朱立帆, 曾金才, 朱晓东, 等. 胸腰椎骨折三种不同内固定 方式的疗效比较[J]. 中国脊柱脊髓杂志, 2016, 26(10): 893- 898. DOI: 10.3969/j.issn.1004-406X.2016.10.05.
[9] 肖斌, 李健, 蔡厚洪, 等. 跨骨折椎体固定联合单侧伤椎植 钉治疗胸腰椎爆裂骨折的生物力学研究[J]. 中国修复重建外科杂志, 2016, 30(5): 580-584. DOI: CNKI:SUN:ZXCW.0.2016-05-017.
[10]Kokkonen SM, Kurunlahti M, Vanharanta H, et al. Endplate degeneration observed on magnetic resonance imaging of the lumbar spine: correlation with pain provocation and disc changes observed on computed tomography diskography[J]. Spine (Phila Pa 1976), 2002, 27(20):2274-2278. DOI: 10.1097/00007632-200210150-00017.
[11]Huang B, Liu J, Zhao F, et al. Damage to the human lumbar cartilage endplate and its clinical implications[J]. J Anat, 2021, 238(2):338-348. DOI: 10.1111/joa.13321.
[12]Su Y, Ren D, Wang P, et al. Effect of endplate reduction on endplate healing morphology and intervertebral disc degeneration in patients with thoracolumbar vertebral fracture[J]. Eur Spine J, 2023,32(1):55-67. DOI: 10.1007/s00586-022-07215-w.
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