Efficacy of limited posterior laminotomy decompression and bone grafting combined with percutaneous pedicle screw internal fixation in the treatment of type C thoracolumbar fractures
Objective To compare the efficacy of limited posterior laminotomy decompression and bone grafting combined with percutaneous pedicle screw internal fixation and conventional posterior laminotomy decompression and bone grafting combined with pedicle screw internal fixation in the treatment of type C thoracolumbar fractures.Methods A retrospective cohort study was conducted to analyze the clinical data of 60 patients with type C thoracolumbar fractures who were admitted to Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University from January 2015 to December 2019,including 37 males and 23 females,aged 25-61 years[(46.5±9.8)years].Injured segments included T10-11 in 11 patients,T11-12 in 12,T12-L1 in 19,L1-2 in 9,and L2-3 in 9.American Spinal Injury Association(ASIA)impairment scale was grade A in 27 patients,grade B in 21,and grade C in 12.Thirty patients underwent limited posterior laminotomy decompression and bone grafting combined with percutaneous pedicle screw internal fixation(minimally invasive surgery group),and the other 30 patients underwent conventional posterior laminotomy decompression and bone grafting combined with pedicle screw internal fixation(conventional laminotomy group).The operation time and intraoperative blood loss were compared between the two groups.The sagittal Cobb angle,anterior edge height of the fractured vertebra,Visual Analogue Scale(VAS)and Oswestry Disability Index(ODI)before,at 1 week,6 months after surgery and at the last follow-up,the ASIA grading at the last follow-up,and the incidence of intraoperative and postoperative complications were compared between the two groups.Results All the patients were followed up for 35-46 months[(39.0± 3.4)months].In the minimally invasive surgery group,the operation time and the intraoperative blood loss were 150(120,210)minutes and 145(100,200)ml respectively,which were shorter or less than 210(210,240)minutes and 330(300,350)ml in the conventional laminotomy group(P＜0.01).There were no significant differences in the sagittal Cobb angle,anterior edge height of the fractured vertebra or ODI between the two groups before,at 1 week and 6 months after surgery and at the last follow-up(P＞0.05).The VAS scores of the minimally invasive surgery group were 3.0(2.0,4.0)points and 1.0(1.0,2.0)points at 1 week and 6 months after surgery,which were lower than those of the conventional laminotomy group[4.0(4.0,5.0)points and 2.0(1.0,2.0)points](P＜0.01).There were no significant differences in VAS or ASIA grading between the two groups before surgery and at the last follow-up(P＞0.05).The incidence of intraoperative and postoperative complications in the minimally invasive surgery group was 10.0％(3/30),which was lower than that in conventional laminotomy group[33.3％(10/30)](P＜0.05).Conclusion For type C thoracolumbar fractures,compared with conventional posterior laminotomy decompression and bone grafting combined with pedicle screw internal fixation,limited posterior laminotomy decompression and bone grafting combined with percutaneous pedicle screw internal fixation has the advantages of shorter operation time,less intraoperative blood loss,more obvious early postoperative pain relief and a lower complication rate.
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