ABSTRACT
As a common type of fracture in cervical, atlas fracture is frequently unstable due to its special anatomical structure. In a previous treatment, external fixation was likely to bring low bony union rate and long-term neck pain, while occipito-cervical fusion and atlantoaxial fusion sacrifice range of motion in cervical spine. Reduction and single section fixation of atlas by anterior lateral mass screws through the transoral approach were reported by some scholars, and the retrospective study demonstrated the high healing rate, reservation of cervical ROM and less bleeding. But it also has high risks of cervical spinal cord and vertebral artery damage, as well as the post-operation infection. Moreover, the indication and fixation strength require further evidences. As a result, this surgical option provides a new way for spinal surgeons to deal with unstable atlas fractures.
ABSTRACT
Objective To investigate the methods and clinical outcome of the operative treatment of thoracolumbar fractures with pedicle screw single segment fixation and the approach through paravertebral muscles.Methods One hundred and twenty patients were selected as our subjects,who were suffered from thoracolumbar fracture without neurological deficit and underwent surgical treatment in the Central Hospital of Zibo from Jan.2009 to Dec.2010.All cases were randomly divided into mini-invasion group and control group.Patients in mini-invasion group were received the single segment fixation of the spatium intermusculare of longissimus muscle and multifidus,and in control group were received the traditional approach with short segment fixation group.The muscle gap approach along the longest muscle and multifidus muscle gap enters,preserving the integrity of the paraspinal muscles.Results The operation periods of mini-invasion group and control group were (53.8 ± 12.3) min and (88.5 ± 18.5) min (t =1.731,P ＜ 0.05),the intraoperative bleeding volume were (95.7 ±21.5) ml and (280.3 ±83.1) ml(t =2.414,P ＜0.05),the postoperative drainage volume were (20.4±8.2) ml and (132.9 ±50.3) ml(t =2.068,P ＜0.05) and inpatient time were (13.8 ±2.2)d and (20.4 ±5.5)d(t =1.853,P ＜0.05).However,there was no significant difference in terms of fracture healing time,visual analogue scale,Oswestry disability index and radiology(P ＞0.05).All cases had union of fractures and no reduction loss and fixation failure occurred.Condusion The treatment of pedicle screw single segment fixation and the approach through paravertebral muscles on thoracolumbar fracture is proved to be an effective method with minimally invasive,less bleeding volume,simple procedure and fast recovery method.