Fixation via vertebral pedicle in the treatment of unstable thoracolumbar fractures

YU Hong-jin; LIU Xing-guo; WANG Zhen-han; SONG Ming-hui

Abstract：Objective To investigate the clinical efficacy of the fixation via injured vertebra pedicle for treating unstable thoracolumbar fractures without nerve injury.Methods From Jul.2008 to Jun.2011,we treated 44 patients(28 males and 16 females aged from 22-57 years,average 36.8 years) with unstable thoracolumbar frac-tures without nerve injury.Manipulative reduction by ankle suspension method was employed under general anesthe-sia.Then screw fixation via vertebral pedicle with the posterior median approach(6 nails,2 rods,1 rank) was per-formed without bone graft fusion surgery.Bed exercise function was encouraged within 6 weeks after the operation. A brace of ambulation were worn within 3 months,and the internal fixation device was removed 10-12 months after operation.The operation time,bleeding volume,complications,Cobb’ s angle,anterior vertebral height ratio and VAS score were observed.Results A total of 44 patients received 10-16 months( average 12.4 months) of follow-up.The operation time was 50-105 minutes(average 70 minutes);intraoperative bleeding was 100-400mL(average 200mL);no nerve injury,wound infection or other complications occurred before or after operation;Cobb’ s angle was 26.3°±4.7°before operation,4.3°±1.4°after operation and 5.2°±1.2°after the removal of internal fixation;anterior vertebral body height ratio was 43.3% ± 14.7% before operation,97.3% ± 4.4% after operation and 96.3% ±3.4%after the removal of internal fixation;VAS pain score was 7.6 ±0.5 before operation and 1.2 ± 0.4 after the removal of internal fixation.Neither internal fixation loosening nor breakage was found in any patient. Conclusion Fixation via vertebral pedicle in the treatment of unstable thoracolumbar fractures without nerve injury can get a good effect,fix firmly,effectively correct the kyphosis, restore and maintain vertebral height.Spinal stabil-ity can be reconstructed after the healing of the injured vertebra without the need of bone graft fusion.Internal fixa-tion can be removed in a timely manner to avoid loosening or breakage.