One stage posterior pedicle screw fixation combined with transpedicle intervertebrae titanic mesh autograft for type C thoracolumbar fractures / 中华创伤杂志

ABSTRACT

Objective To evaluate the therapeutic effeet of one stage posterior pedicle screw fixation combined with transpedicle intervertebrae titanic mesh autograft versus traditional posterior and anterior approach surgery in the treatment of severe thoracolumbar fractures.Methods A retrospective case-control study was done on 40 cases of type C thoracolumbar fractures admitted from January 2012 to December 2015.There were 28 males and 12 females,with age range of 20-48 years (mean,30.6 years).The fractures were located at T11 in 4 cases,at T12 in 16,at L1 in 14,and at L2 in 6.All cases were divided into two groups (with 20 cases per group) according to treatment method difference.The cases in posterior group had one stage posterior pedicle screw fixation combined with transpedicle intervertebrae titanic mesh autograft,and the others in posterior and anterior group were treated by traditional posterior and anterior approach surgery.The operation duration,volume of blood loss,hospital stay,kyphosis correction rate,visual analogue scale (VAS) and Oswestry disability index (ODI) were compared between the two groups.Results All patients were followed up for 10-46 months (mean,28.6 months).In posterior group,the average operation time was 154 minutes,the average blood loss was 564 ml,the postoperative suction drainage was 180.5 ml,the time period between surgery and recovery of walking ability was 5.9 days,and the hospital stay was 10.6 days.While in posterior and anterior group,the average operation time was 248.5 minutes,with the average blood loss of 960.8 ml,the postoperative suction drainage of 359.2 ml,the time duration between surgery and recovery of walking ability of 8.4 days,and the hospital stay of 14.5 days (P ＜ 0.05).At one week and six months postoperatively,the height ratio of anterior edge,Cobb angle,VAS and ODI in both groups were improved compared to the preoperative status (P ＜ 0.05).But there was no significant difference of these indicators between two groups (P ＞ 0.05) except for lumbar back pain one week after operation (P ＞ 0.05).Conclusions Through single pathway of posterior approach,one stage posterior pedicle screw fixation combined with transpedicle intervertebrae titanic mesh autograft can complete reduction of fractured vertebral body,spinal cord decompression,and anterior-middle column stability reconstruction.Compared with traditional combined posterior and anterior approach surgery,this technique has many advantages including simpler manipulation,less invasion,shorter rehabilitation time and equal bony fusion and hence is an ideal option for type C thoracolumbar fractures.