Posterior lumbar interbody fusion and internal fixation for complete thoracolumbar fracture and dislocation / 中华骨科杂志

ABSTRACT

Objective To investigate the clinical features,safety and clinical efficacy of the posterior decompression and interbody fusion with internal fixation for complete thoracolumbar fracture and dislocation.Methods The clinical data of 23 patients with complete thoracolumbar fracture and dislocation treated by posterior decompression and interbody fusion with pedicle screw fixation from August 2011 to October 2014 were retrospectively analyzed.There were 18 males and 15 females,aging from 20 to 50 years old with an average age of 38.2±0.3 years.There were 8 cases of T10,11 vertebral dislocation,8 of T11,12 vertebral dislocation,3 of T12L1 vertebral dislocation,and 4 of L1.2 vertebral dislocation.All the patients had different degrees of multiple rib fractures and pneumothorax complications.Preoperative spinal cord nerve function was evaluated according to the American Spinal Injury Association of spinal cord function (ASIA).There were 10 cases of ASIA grade A and 13 cases of grade B.Operation time,intraoperative blood loss,clinical outcome,imaging X-ray and CT examination,segmental kyphosis angle and bone graft fusion were recorded.Results All the patients were followed up for 13 to 26 months,average 20.2±4.3 months.The operation time ranged from 150 to 260 min with the average time of 180.3± 14.8 min;intraoperative blood loss was 800-1 500 ml with the average of 950.2±98.1 ml.Preoperative sagittal Cobb angle was-13.5° ±6.3° (range,-20.1° to 2.3°);postoperative sagittal Cobb angle was 1.43°±6.4° (range,-7.6° to 3.5°);at the latest follow-up,sagittal Cobb angle was 1.6°±6.3° (range,-8.1° to 10.3°);the dislocation reduced from preoperative 100％ to postoperative 0-15％ (10％±6％).After operation,the ASIA grade of 2 cases improved from A to B,and 5 cases improved from B to C.All of the patients had bone fusion after operation,no false joint or nonunion occurred,no loosening or breakage of internal fixation occurred.Conclusion There are high risks and difficulty of surgery for those who with thoracolumbar fracture dislocation and severe injuries of spine and spinal cord combined with multiple injuries.Proper treatment of preoperative complications is the premise of good curative effect;reliable fusion and long segment internal fixation is the key of operation.Single posterior decompression and reduction with interbody fusion and internal fixation is less invasive and could achieve satisfactory clinical efficacy.