Treatment of spinal canal occupying thoracolumbar burst fractures by unilateral fenestration posterior wall reduction and decompression with a self-made rammer
Objective To investigate the safety and effectiveness of unilateral fenestration posterior wall re-duction and decompression with a self-made rammer in the treatment of spinal canal occupying thoracolumbar burst fractures(TLBF).Methods From Dec.2016 to Dec.2018,67 patients with TLBF admitted to Chongqing Ortho-paedics Hospital of Traditional Chinese Medicine or the Fourth People's Hospital of Zigong,Sichuan Province were enrolled in this prospective study.There were 48 males and 19 females aged 19-63(mean 41.1)years.Patients were divided into test group(n=33)and control group(n=34)according to the decompression methods.For the test group,patients were treated by posterior midline approach unilateral fenestration posterior wall reduction and de-compression,and subsequent consolidation with a self-made rammer;while for the control group,patients were trea-ted with posterior midline approach total laminectomy decompression reduction and internal fixation & fusion.In the test group,there were 23 males and 10 females aged 22-63(mean 40.9)years,with 13 road traffic injuries,18 falls from height and 2 others.Frankel's grading system showed 13 cases in grade C,12 in grade D and 8 in grade E.In the control group,there were 25 males and 9 females aged 19-59(mean 41.2)years,with 12 road traffic injuries,19 falls from height and 3 others.Frankel's grading system showed 12 cases in grade C,13 in grade D and 9 in grade E.The two groups were comparable in terms of injury severity(compression ratio and Cobb angle of the injured ver-tebrae,sagittal diameter ratio of the spinal canal and spinal nerve function by the Frankel's grading system before operation).The operation time,intraoperative blood loss,compression ratio and Cobb angle of the injured vertebrae and sagittal diameter ratio of the spinal canal at 1 week after operation and last follow-up,internal fixation-related complications,as well as the spinal nerve function by the Frankel's grading system at last follow-up were recorded and compared between the two groups.Results For the test group,the compression ratio and Cobb angle of the in-jured vertebrae,and the sagittal diameter ratio of the spinal canal was 51.8％±10.1％,20.7°±2.8° and 43.4％±9.5％before operation respectively,which was greatly improved or reduced at postoperative 1 week(90.0％±3.4％,3.4°±1.5°,91.8％±2.9％)and last follow-up(88.8％±3.5％,3.8°±1.8°,93.3％±4.7％,all P＜0.05 compared with that before operation).The control group showed similar results:the compression ratio and Cobb angle of the injured vertebrae,and the sagittal diameter ratio of the spinal canal was 51.4％±9.3％,21.7°±3.6° and 43.2％±8.6％before operation respectively,which was greatly improved or reduced at postoperative 1 week(88.8％±3.0％,3.9°±1.8°,91.5％±2.7％)and last follow-up(87.4％±3.4％,4.0°±2.0°,92.6％±4.2％,all P＜0.05 compared with that before operation).The spinal nerve function by Frankel's grading system was also greatly improved both in the test group(25 grade E,5 grade D and 3 grade C vs.8 grade E,12 grade D and 13 grade C)and the control group(25 grade E,5 grade D and 4 grade C vs.9 grade E,13 grade D and 12 grade C,both P＜0.05).Comparison between the two groups revealed no significant difference in terms of operation time,compression ratio or Cobb angle of the injured vertebrae,sagittal diameter ratio of the spinal canal,or spinal nerve function by Frankel's grading sys-tem at each time point(all P＞0.05),except for much less intraoperative blood loss in the test group(mL,163.3± 44.6 vs.229.4±53.0,P＜0.001).Conclusion For the treatment of TLBF,both unilateral fenestration posterior wall reduction and decompression with a self-made rammer and the traditional total laminectomy can achieve good and comparable therapeutic effects in terms of compression ratio and Cobb angle of the injured vertebrae,sagittal di-ameter ratio of the spinal canal and spinal nerve function,but the former has much less intraoperative blood loss.
万方数据
维普
