The clinical outcome of anterior-precurved rod and precompressive reduction and fixation technique for the treatment of unstable thoracolumbar burst fracture / 中华骨科杂志

ABSTRACT

Objective:To investigate the safety and effectiveness of anterior-curved rod and precompressive reduction and fixation from posterior approach for unstable burst fractures in thoracolumbar junction.Methods:From July 2017 to December 2019, according to the classification standard of AO Spine-Spine Trauma Classification System of 2019, 33 patients with type A3 thoracolumbar junction fractures with kyphosis angle > 20° and Asia Grade E were treated with anterior-curved rod and precompressive reduction and fixation from posterior approach. All the patients had single vertebral fractures. Three groups of screws were used to fix the injured vertebrae and the upper and lower vertebrae adjacent to the injured vertebrae, and the injured vertebrae were reduced. No bone graftor fusion was performed during the operation. The main outcome measures were the height of middle column of the injured vertebrae, the invaded cross-area of the injured vertebral canal, the encroachment rate of the injured vertebral canal, the Cobb angle of kyphosis, and visual analogue scale (VAS) and Oswestry disability index (ODI) before and after operation and at the last follow-up. All these data were analyzed statistically by t-test. Results:The operation was successfully performed in all 33 patients. 198 pedicle screws were implanted. The accuracy ofthe screws by CT evaluation was 98.8%. The average operation time was 89.8±20.4 min, and the average intraoperative blood loss was 170±53.7 ml. The height of the middle column was improved from 17.32±2.02 mm preoperatively to 21.41±3.68 mm postoperatively, and the invaded cross-area of the injured vertebral canal was improved from 101.3 ± 21.67mm2 before operation to 68.5±18.2 mm 2 after operation. The encroachment rate of the injured vertebral canal was improved from 47.66% ± 19.83% before operation to 19.61%±5.75% after operation; Cobb angle of kyphosis was improved from 26.33°±5.68° before operation to 3.13°±1.25° after operation; VAS score was improved from 6.42±1.25 before operation to 1.85±0.71 after operation, and 1.69±1.21 at the last follow-up; ODI was improved from 43.03%±3.46% before operation to 21.88%±4.22% after operation and 6.33%±2.31% at the last follow-up. There were statistically significant differences in the observative indexes after operation and at the last follow-up compared with those before the operation (P < 0.05). Conclusion:The technique of anterior-curved rod and precompressive reduction and fixation from posterior approach can safely and effectively reduce both the invading bone mass within the injured vertebral canal and the kyphosis angle.