Background: To investigate the curative effect of limited traumatic surgical strategy for thoracolumbar fracture-dislocation.
Methods : Twenty-two patients with thoracolumbar fracture-dislocation who were admitted to our department from May 2013 to January 2016 were 16 males and 6 females, aged 21-53 years. All patients were associated with varying degrees of spinal nerve injury. Twenty-two patients were randomly assigned to the percutaneous minimally invasive group (group A) and the intermuscular approach group (group B). Among them, 11 patients in group A underwent percutaneous minimally invasive pedicle screw fixation combined with small incision for spinal canal reduction. Pressure and interbody fusion: 11 patients in group B underwent transpedicular space fixation with pedicle screw fixation combined with partial decompression and bone graft fusion. The operation time and intraoperative blood loss were recorded in the two groups. Visual analog scale (VAS) was recorded at 3 days and terminal follow-up. The fracture healing and spinal cord invasion rate were evaluated by imaging examination before and after the final follow-up. The neurological recovery was assessed according to the ASIA grading criteria.
Result : There was a statistically significant difference between the two groups in the operation time and intraoperative blood loss (P<0.05). The VAS scores of the lumbar dorsal incision were compared between the two groups at the same time point, and the difference was statistically significant (P<0.05). Imaging examination showed that the fracture healed well and there was no internal fixation fracture. The rate of spinal canal invasion in the fracture and dislocation segments of the two groups was compared at the final follow-up, and the difference was statistically significant. Neurological recovery at the last follow-up (ASIA classification): 6 patients with grade A, 6 patients with grade B, 7 patients with grade C, 2 patients with grade D, and 1 patient with grade E, with significant improvement compared with preoperative.
Conclusion : Percutaneous minimally invasive pedicle screw fixation combined with small incision decompression of the spinal canal and interbody fusion can also achieve the effect of posterior open surgery, and the trauma is smaller, which is more conducive to postoperative rehabilitation and reduce surgical complications.