Accurate rebuilding of sagittal plane radian measure for treatment of thoracolumbar vertebrate fracture: A comparative study / 第二军医大学学报

ABSTRACT

Objective To conduct a comparative study on the middle- and long-term efficacies of individualized titanium stick angular designs for treating thoracolumbar vertebrate fractures. Methods A total of 96 patients were divided into two groups,with 50 in the treatment group and 46 in the control group. The titanium stick in the treatment group was folded based on the numerical value which had been obtained by measuring and calculating the standard lateral projection of thoracolumbar vertebrate before the operation; the numerical value on sagittal plane was the sum of the average angle of its upper and subtus athletic segment, the angulation of subtus athletic segment and the angle of subtus vertebral body. The titanium stick in the control group was folded based on experience during the operation, with other treatments being the same. The patients were followed-up for at least 6 months, with an average of (18±5) months. All the patients received radiography examination pre- and post-operatively. And 42 patients received CT examination before and at the last follow-up; another 30 patients received MRI examination at last follow-up. Results At the final follow-up, the anterior, posterior vertebral heights were (1.06±0.46) mm and (0.42±0.26) mm for the treatment group and (2.37±0.86) mm (P<0.05) and (0.79±0.46) mm for the control group, respectively. The average loss of Cobb angle was (1.57±0.51)° in the treatment group and (2.49±0.89)° in the control group at final follow-up (P<0.05). The treatment group had 21 cases with fish tail and the control group had 25. The failure rate of internal fixation was 6% in the treatment group and 13% in the control group. The eggshell phenomenon on CT findings was found in 10 of the 22 patients in the treatment group and in 9 of the 20 cases in the control group at final follow-up. The neurological status was improved at least by 1 Frankel grade in the patients who had preoperative incomplete paraplegia. The scores of Oswestry Disability Questionnaire for the treatment group were 0 in 17 cases, 2 in 15 cases, 4 in 11 cases, 6 in 2 cases, 8 in 2 cases, 56 in 1 case,80 in 1 case, and 88 in 1 case; for the control group were 0 in 10 cases, 4 in 15 cases, 6 in 11 cases, 8 in 2 cases, 10 in 2 cases,18 in 2 cases, 50 in 2 cases, and 80 in 2 cases. There were significant differente between the two groups (34% vs 21.74%, P<0.05). Conclusion When transpedicle vertebral arch internal fixation system is used for treatment of thoracolumbar vertebrae fractures via posterior approach, individualized titanium stick angular design can accurately regain the physiologic curve of the fixed thoracolumbar segment,reducing operational time,loss of vertebral height correction, failure rate of internal fixation, incidence of backache, and degeneration of adjacent segment.