Anterior reversion after failures of posterior pedical screw instrumentation for thoracolumbar burst fracture combined with paraplegia / 中华创伤杂志

ABSTRACT

Objective To discuss basis and operative indications for anterior reversional indication after failures of posterior pedicel screw instrumentation for thorcolumbar burst fracture combined with paraplegia.Methods Clinical data of 21 cases who had failures of posterior pedical screw fixation because of thorcolumbar burst fracture combined with paraplegia were analyzed retrospectively from February 1999 to April 2005.All cases were operated by removing posterior screw device.Meanwhile,one stage anterior cord decompression,correction of kyphosis,fusion with self-ilium or Titanium cage with granule fractured vertebrate and internal fixation was carried out according to clinical symptom and image findings.Spinal cord function and correction of kyphosis were evaluated by Frankel score and Cob angle.Results All cases were operated successfully.After operation,there was rib nerve injury occurred in two cases,leakage of CSF in three and refractory thigh pain in two.The follow up ranging from three months to six years(average 2.2 years) showed good interfixation except for one case had breakage of screw four months after operation.Cob angle of kyphosis recovered from preoperative 16.4? to 5.2??0.3? at follow up.Of all,16 cases had partly recovery of spinal cord function according to Frankel score.(Conclusion)As for thoracolumbar burst fracture combined with paraplegia,anterior approach can attain direct decompression,satisfactory correction of kyphosis and stable fixation and is suitable for most cases.