Efficacy and safety of posterior small incision decompression combined with percutaneous pedicle screw fixation in the treatment of thoracolumbar fractures with neurological impairment

LUO Jun; SUN Jing-fu; WANG Hu; WU Ren-tao; LIU Xiao-peng; WEI Si-qi

doi:10.3969/j.issn.1009-4237.2018.06.011

Abstract：Objective To investigate the clinical efficacy and safety of posterior median incision decom-pression combined with percutaneous pedicle screw fixation for the treatment of thoracolumbar fractures with neuro -logical impairment,and to accumulate evidence -based experience for the good care for these special groups .Meth-ods Seventy -six patients with thoracolumbar fractures with neurological impairment , who were admitted to the Department of Orthopedics , Houjie Hospital of Dongguan City , Guangdong Medical University and Guangming People's Hospital from Sep.2014 to Dec.2016, were selected according to the random number table method.The subjects were divided into open surgery group (posterior decompression) and minimally invasive surgery group (pos-terior median incision decompression combined with percutaneous pedicle screw fixation ),with 38 cases in each group.The muscle exfoliation length ,operation time,intraoperative blood loss ,postoperative day 2 drainage,postop-erative visual analog pain score (VAS),and postoperative analgesic drug use were recorded in both groups.Both groups of patients were followed up for at least 6 months to assess the outcome of their outcomes ,including bony u-nion,fixation loosening,fixation fracture,and neurological function recovery.Results The length of muscle strip-ping in the minimally invasive surgery group was shorter than that in the open surgery group .The intraoperative blood loss and postoperative drainage were less than those in the open surgery group .The postoperative visual analog pain score was lower than that in the open surgery group ,and the postoperative analgesic drug use ratio was lower.In the open surgery group,the difference was statistically significant (P＜0.05); there was no significant difference in the operation time between the two groups (P＜0.05).There was no significant difference in the rate of bony heal-ing between the two groups (P＞0.05).The percentage of loosening ,fixation breakage and neurological recovery in the minimally invasive surgery group was better than that in the open surgery group.The difference was statistically significant (P＜0.05).Conclusion For patients with thoracolumbar fractures with impaired nerve function ,the treatment of posterior median and small incision decompression combined with percutaneous pedicle screw fixation can improve the curative effect and safety ,and it is worthy of further promotion and application.