Comparison of clinical efficacy of unilateral and bilateral short segment transpedicular fixation in treating thoracolumbar fractures combined with unilateral pedicle fractures / 中华创伤杂志

ABSTRACT

Objective To compare the clinical efficacy of unilateral and bilateral short segment fixation in treating thoracolumbar fractures combined with unilateral pedicle fractures.Methods A retrospective case control study was conducted on the clinical data of 43 patients with thoracolumbar fractures with unilateral pedicle fractures admitted from January 2012 to December 2016.There were 24 males and 19 females,with a mean age of 48 years (range,19-68 years).Fractured segments included T10 in 1 patient,T11 in 6,T12 in 11,L1 in 19,and L2 in 6.According to the fixation method,the patients were divided into unilateral transpedicular fixation group (unilateral group,15 patients) and bilateral transpedicular fixation group (bilateral group,28 patients).All patients were treated with fixation via injured vertebrae combined with short segment fixation.The operation time,intraoperative blood loss,X-ray frequency,fracture healing time,intemal fixation removal time,preoperative and postoperative anterior vertebral height ratio,sagittal Cobb angle recovery,spinal canal invasion rate,visual analogue score (VAS),Oswestry dysfunction index (ODI),Frankel classification of spinal cord injury,incidence of screw deviation,and spinal lateral angulation were compared between the two groups.Results All patients were followed up for 12-26 months,with an average of 18.5 months.The operation time in unilateral group and bilateral group were (82.3 ± 14.7) minutes and (120.9 ± 12.8) minutes,respectively.The intraoperative blood loss was (186.1 ± 20.4)ml in unilateral group and (231.2 ± 39.6) ml in bilateral group.The number of fluoroscopy was (6.6 ± 1.2) times in unilateral group and (13.3 ± 2.0) times in bilateral group respectively.The incidence of screw deviation was 13％ (2/15) in unilateral group and 46％ (26/56) in bilateral group (P ＜ 0.05).There were no significant differences between the two groups in anterior vertebral height ratio,sagittal Cobb angle,spinal canal invasion rate,VAS,ODI,Frankel grade and spinal lateral angulation (P ＞ 0.05).Conclusions For thoracolumbar fractures combined with unilateral pedicle fractures,unilateral and bilateral transpedicular short segment fixation has similar reduction and fixation effects.Unilateral transpedicular short segment fixation has the advantages of shorter operation time,less bleeding,fewer fluoroscopy times,and lower screw deviation rate.