Short segmental pedicle instrumentation via the paraspinal approach for the treatment of thoracolumbar fractures complicated with posterior ligamentous complex injury / 中华创伤骨科杂志

ABSTRACT

Objective To study the efficacy and safety of short segmental pedicle instrumentation via the paraspinal approach for the management of neurologically intact patients with thoracolumbar burst fracture and posterior ligamentous complex injury.Methods From October 2008 to June 2010,70 such patients were treated in our department.They were 44 males and 26 females,with an average age of 33.4 years (range,from 19 to 55 years).They were divided into 2 groups according to 2 different operative methods.In group A,35 patients were treated via the paraspinal approach while 35 patients in group B were treated via the traditional open approach.The 2 approaches were compared in terms of operation time,intraoperative bleeding,postoperative ambulant time,hospital stay,changes in local kyphosis angle (LKA) and vertebral body height (VBH) at preoperation,postoperation and the last follow-up,postoperative complications and accuracy of screw insertion.Results The time for follow-up ranged from 24 to 36 months (mean,29.3 months).The operation time,intraoperative bleeding,postoperative ambulant time and hospital stay in group B were significantly more than in group A(P ＜ 0.05).No implant failure occurred in either group.There was no significant difference in pedicle screw cut-out between the 2 groups [7 (5.0％) versus 6 (4.3％)] (P ＞0.05).The LKA and VBH increased significantly at postoperation and the last follow-up compared with the preoperation in both groups (P ＜ 0.05),but there was no significant difference between the postoperation and the last follow-up (P ＞ 0.05).There were no significant differences between the 2 groups regarding LKA and VBH at preoperation,postoperation and the last follow-up (P ＞ 0.05).Conclusion The paraspinal approach may result in a good and safe clinical outcome in the treatment of thoracolumbar burst fractures with posterior ligamentous complex injury,because it can maintain the fracture reduction effectively and minimize the iatrogenic injury to soft tissues.