ABSTRACT
Objective To investigate the clinical effect of pedicle screw internal fixation with different surgical approach in the treatment of thoracolumbar vertebral fractures. Methods Fifty?three cases with thoracolumbar vertebral fracture without nerve injury were selected as our subjects,who were hospitalized in the Central Hospital of Chaoyang from January 2008 to December 2013. They were randomly divided into observation group(27 cases) and control group(26 cases). The patients in the observation group were treated with pedicle screw internal fixation with Wiltse paraspinal approach and the patients in the control group were treated with pedicle screw internal fixation with traditional posterior open approach. The duration of operation,intraoperative blood loss,volume of drainage and length of hospital stay of all patients were recorded and the ratio of anterior vertebral body height to normal height before and after operation was compared between the two groups. Visual analog scores( VAS) for pain severity and Cobb’ s angle of the vertebrae was compared between the two groups 1 year after operation. Results The duration of operation and length of hospital stay of patients in both groups had no statistically significant differences ( P>0. 05 ) . The intraoperative blood loss and volume of drainage in observation group were less than that in control group respectively((146. 3±25. 1) ml vs. (240. 2±28. 7) ml, (73.1±15.3) ml vs. (150.5±20.1) ml;P=0.034,0.023).The ratio of anterior vertebral body height to normal height 1 week after operation was higher than that before operation in the observation group ( ( 93. 1 ±5.1)% vs. (70.3±8.6)%,P=0.048) and in the control group((93.0±6.0)% vs. (71.8±9.8)%,P=0. 049),the difference between two group had no statistically significant(P>0. 05). The Cobb′s angle of the vertebrae 1 year after operation was less than that before operation in the observation group((10. 10±4. 00)° vs. (19. 10±7. 81)°,P=0. 045) and in the control group ((9. 97±3. 78)° vs. (18. 87±6. 90)°,P=0. 045),the difference between two group had no statistically significant(P>0. 05). The VAS for pain severity 1 year after operation was less than that before operation in the observation group(1. 1±0. 5 vs. 6. 0±0. 9,P=0. 023) and in the control group ( 1. 7 ± 0. 6 vs. 5. 9 ± 0. 7, P= 0. 038 ) , the difference between two group had statistically significant( P=0. 046) . Conclusion Pedicle screw internal fixation with Wiltse paraspinal approach in the treatment of thoracolumbar vertebral fractures without nerve injury has advantages with traditional posterior open approach in less trauma, less bleeding, rapid recovery and reduces the incidence of postoperative lumbar pain. The treatment has a good clinical effect and is worthy of clinical application.
ABSTRACT
Objective To observe effect of Rho kinase inhibitor combined with hyperbaric oxygen on the recovery of neurological function after spinal cord injury in patients with thoracolumbar fractures.Methods A total of 80 cases of thoracolumbar fractures combined with spinal cord injury patients as the research object, the packet by the standards of admission of single and double serial number, odd numbers were divided into control group, even number were divided into treatment group (40 cases in each group); two groups underwent surgical treatment, control group was given single usage fasudil treatment, treatment group was given hyperbaric oxygen therapy for auxiliary therapy on the basis of control group, Continuous treatment for two months.Compared neurological function scoring, grading, blood superoxide dismutase (SOD) , epithelial growth factor (EGF) , lipid peroxide (LPO) and adverse reactions pre-and post-treatment between two groups of patients.Results After treatment,total effective rate of treatment group (92.50%), ASIA sensory, movement scores were significantly higher than control group (75.00%)(P<0.05);Content of SOD and EGF of treatment group were significantly higher than control group(P<0.05);the adverse reaction rate (12.50%) was significantly lower than that of control group (32.50%)(P<0.05).Conclusion Rho kinase inhibitor combined with hyperbaric oxygen can significantly improve the degree of injury, neurological function and blood SOD, EGF, LPO content in patients with lumbar vertebral fractures combined with spinal cord injury, and the adverse reactions are few, has definite clinical effect.
ABSTRACT
Objective To observe the effect of electroacupuncture and body-weight supported treadmill training in the treatment of spinal cord injury (SCI) after fractures of the thoracolumbar segment of the spine.Methods Forty-three patients with SCI after fractures of the thoracolumbar segment of the spine were randomly divided into a treatment group (22 cases) and a control group (21 cases). The patients in the treatment group were treated with electroacupuncture and body-weight supported treadmill training, while those in the control group were treated mainly with drugs. Patients were scored with the American Spinal Injury Association (ASIA) assessment and the modified Barthel index (MBI) initially and after 6 months. Results The ASIA and MBI scores of all patients were significantly higher after 6 months than before treatment, but those in the treatment group were significantly higher than those in the control group. Excellent and good ratings were applied to 77% of the treatment group, while only 48% of the control group, a statistically significant difference. Conclusions Electroacupuncture and body-weight supported treadmill training can effectively improve ability in the activities of daily living, sensation and locomotor abilities after thoracolumbar vertebral fractures.