Effect of posterior indirect decompression plus intraoperative CT scan on thoracolumbar burst fractures with incomplete nerve injury
Objective To observe the clinical effect of posterior indirect decompression combined with intraoperative CT evaluation on thoracolumbar burst fractures with incomplete nerve injury,and to explore the role of intraoperative CT evaluation.Methods From May 2021 to May 2022,48 patients with thoracolumbar burst fractures with incomplete nerve injury underwent posterior indirect decompression and pedicle screw internal fixation in Henan Provincial People's Hospital.Intraoperative CT examination was performed to evaluate the fracture reduction.The patients were followed up till December 2023.Before,immediately after and 3 months after operation and at the latest follow-up,X-ray and CT were used to measure the Cobb's angle in sagittal position of injured vertebra,anterior margin height compression ratio and median sagittal diameter of the spinal canal.The nerve function was evaluated by Frankel grading before operation and at the latest follow-up.Fracture healing and complications were recorded.Results Immediately after operation,3 months after operation and at the latest follow-up,the Cobb's angle in sagittal position of injured vertebra[(5.68± 2.65)°,(5.33±2.44)°,(5.31±2.36)°]was smaller than that before operation[(25.12±4.08)°](P＜0.05),the anterior margin height compression ratio[(95.06±3.86)％,(93.81±3.33)％,(90.21±2.95)％]and median sagittal diameter[(92.46±4.09)％,(91.54±3.71)％,(90.81±3.60)％]were higher than those before operation[(38.90± 5.66)％,(38.13±3.59)％](P＜0.05),and there were no significant differences in the above indexes immediately after operation,3 months after operation and at the latest follow-up(P＞0.05).At the latest follow-up,in 23 patients with Frankel grade C,10 patients returned to grade D,10 to grade E,and 3 had no change;in 25 patients with grade D,21 returned to grade E and 4 showed no change.The rate of Frankel grade E was higher at the latest follow-up(64.6％)than that before operation(0)(x2=42.878,P＜0.001).Bone healing was achieved in all patients after operation,and no complications such as infection,delayed nerve function injury,loosening or rupture of internal fixation,or kyphosis occurred.No secondary decompression was required.Internal fixation was removed after fracture healing.Conclusion CT evaluation in posterior indirect decompression can reveal the reduction of bone mass in the spinal canal in time,improve the reduction accuracy,effectively improve the height of the injured vertebra and kyphosis,promote the recovery of nerve function,and reduce postoperative complications of patients with thoracolumbar burst fractures with incomplete nerve injury.
thoracolumbar burst fracturesincomplete nerve function injuryindirect decompressionintraoperative CT
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