Evaluation the curative effect of pedicle technique with spinous process and vertebral plate rim positioning based height of injured vertebra and Cobb angle on thoracolumbar fractures
Objective To explore the effect of pedicle technique with spinous process and vertebral plate rim positioning based on height of injured vertebra and Cobb angle in patients with thoracolumbar fractures.Methods From September 2017 to September 2020,a total of 116 patients with thoracolumbar fractures were enrolled,which included 61 males and 55 fe-males,aged 38-71 years old with mean age of 48.59 years old.The fracture segments were L,in 37 cases,L2 in 23,L11 in 21 and L12 in 35.According to digital table method,all of them were divided into observation group(n=58)and control group(n=58).Both 2 groups were treated with pedicle screw technique.In control group,the pediclescrew was located on intersec tion of vertical line rim of superior articular process and transverse bisector(Magerl method),and observation group were given pedicle screws with spinous process and vertebral lamina rim positioning.The Oswestry Disability Index(ODI),sagittal Cobb angle of injured vertebrae,anterior vertebral height compression rate,bone metabolism,bone healing,inflammatory re-sponse,swelling and pain were compared between 2 groups.Results There was no significant difference in ODI before opera-tion,1-week and 1-year after operation between 2 groups(P＞0.05).There was no significant difference in sagittal Cobb angle of injured vertebrae before and 1 week after operation between 2 groups(P＞0.05).The sagittal Cobb angle of injured vertebrae in observation group was lower than that in control group[(9.8±2.9)° vs(13.5±3.0)°.P＜0.05]one year after operation.There was no significant difference in compression rate of anterior vertebral height of injured vertebrae before and 1-week after operation between 2 groups(P＞0.05).The height compression rate of anterior vertebral height of injured vertebrae in control group was higher than that in observation group[(14.2±3.4)％ vs(8.6±2.2)％.P＜0.05]one year after operation.The serum alkaline phosphatase(ALP),propeptide carboxy-terminal procollagen(PICP)type Ⅰ procollagen and bone gla protein(BGP)in observation group were higher than those in control group[(219.23±6.34)μg/L vs(182.54±5.17)μg/L,(112.72±2.18)μg/L vs(93.67± 2.69)μg/L,(7.52±0.36)μg/L vs(4.21±0.14)μg/L.P＜0.05].The levels of soluble intercellular adhesion molecule-1(sLCAM-1)and insulin-like growth factor-1(IGF-1)in observation group were higher than those in control group[(107.58±4.25)μg/L vs(92.12±4.19)μg/L,(296.57±8.04)μg/L vs(237.28±7.82)μg/L.P＜0.05].The levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and interleukin-1(IL-1)in observation group were lower than those in control group[(1.20±0.27)μg/L vs(1.52±0.51)μg/L,(1.06±0.14)μg/L vs(1.35±0.28)μg/L,(0.98±0.27)μg/L vs(1.19±0.42)μg/L.P＜0.05].On the 1st day,5th day,10th day,15th day and 20th day,the swelling degree and pain score of 2 groups decreased gradually.The swelling degree of observation group was higher than that of control group on the first day[(3.88±0.54)scores vs(3.31±0.43)scores.P＜0.05],while the pain score and swelling degree of control group were higher than those of observation group at other time points.Conclusion It is demonstrated that spinous process and vertebral plate rim positioning in treatment of thoracolumbar fractures could reduce height of injured vertebrae and Cobb angle,improve bone metabolism,reduce inflammation,swelling and pain,and promote bone healing,which with significant clinical efficacy.
height of injured vertebrabone metabolismCobb angleposition of spinous process and lamina rimpedicle techniquethoracolumbar fracture
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