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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.
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Objective To evaluate the influencing factors of recurrence of fracture after percutaneous vertebral augmentation.Methods From January 2007 to December 2013,256 cases patients with percutaneous vertebral augmentation in treatment of osteoporotic vertebral compression fractures in the Central Hospital of Chaoyang were retrospectively reviewed.After operation,the patients were divided into recurrent fracture group (59 cases) and no recurrence group (197 cases) according to whether postoperative recurrence of vertebral fracture.The age,sex,body mass index (BMI),bone mineral density,operation mode,bone cement injection volume,the existence of bone cement leakage and vertebral body height recovery rate were compared between the two groups respectively.Multi factor Logistic regression analysis was performed to analyze the correlation between the factors and the recurrence of vertebral body fractures.Results The age((75.9±4.6) years old vs.(69.9±5.0) years old),BMI((23.5±0.6) kg/m2 vs.(25.4±0.7) kg/m2),bone mineral density((-3.67±0.68)vs.(-2.75 ±0.98)),the existence of bone cement leakage rate(22.0％ vs.5.1％) and vertebral body height recovery rate ((24.1±2.9) ％ vs.(14.9±3.0)％) between recurrent fracture group and no recurrence group had statistically significant differences (P=0.046,0.047,0.046,0.026,0.023).Multi factor Logistic regression analysis showed that age,BMI were not related to postoperative recurrence of fracture(P=0.140,0.137),and bone density,bone cement leakage and vertebral body height recovery rate were related to recurrence of fracture (P=0.018,0.000,0.000).Conclusion Low bone mineral density,existence of bone cement leakage and high body height recovery rate are the risk factors of recurrence of fracture after percutaneous vertebral augmentation.
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Objective:To evaluate the clinical effect of posterior cervical pedicle screw fixation operation for cervical spondylotic myelopathy.Methods: From Mar 2014 to Sep 2015, 55 patients with cervical spondylotic myelopathy treated with posterior cervical pedicle screw fixation operation were involved. Cervical curvature in the cervical three dimensional CT by the Harrison’ s cervical curvature measuring method was measured, and JOA scores, NDI scores and VAS scores before and after operation and the last follow-up were evaluated. Results:A total of 55 patients with cervical spondylotic myelopathy obtained good operation effect and the cervical curvature and neural function were improved.The cervical curvature, JOA score, NDI scores, and VAS scores were significantly better than that before operation (P < 0.05) . Last follow-up results showed that there was statistical significance on JOA score, NDI score, and VAS score compared with that after operation (P<0.05), but not on cervical curvature (P>0.05) . Conclusion:The neurological function and cervical curvature of the cervical spondylotic myelopathy can be improved through posterior cervical pedicle screw fixation operation.