Early treatment of 29 cases of thoracolumbar burst fractures with early new pedicle screw fixation and selective decompression Xu Buwei, Wang Jian (Department of Orthopaedics, Jianhu County People's Hospital, Jianhu 224700, China) Spinal Fracture; Internal Fixation Pedicle screw thoracolumbar burst fracture due to its special anatomical location, often combined with spinal conus, nerve root and cauda equina injury. If it is not treated properly, it will inevitably have serious consequences. The author used the early new pedicle screw (AF) system to treat 29 such fractures and achieved good results. The report is as follows.
1 Clinical data of 29 cases of thoracolumbar burst fractures, 16 males and 13 females, aged 2057 years, mean 41 years old. Injured vertebral body: 1212 cases of chest, 14 cases of lumbar i, 22 cases of lumbar, and 111 cases of thoracic. The degree of spinal canal involvement was determined by Worlter index: index 1 was 16 cases, index 2 was 11 cases, and index 3 was 2 cases. Frankie spinal cord injury grade 2 grade B, 6 grade C, 17 grade D, 4 grade E.
Treatment All patients were treated with dexamethasone 10 mg beforehand to add 20E mannitol 250ml, dehydrated 2 times a day, 2472h stable after surgery.
During the operation, the prone position was taken, continuous epidural anesthesia was performed, and the posterior median incision was performed with AF internal fixation. For patients with rorlter index of 2 or more, intraoperative spinal canal angiography was performed. If the optic nerve was found in front of the spinal canal, decompression of the laminectomy was performed. The nerve stripper was retracted from the sides to the front to reduce the bone mass. The conventional skin tube drainage was 2448 hours, anti-infective and hormone therapy for 5 days, bed rest for 3 months, and rehabilitation training in bed.
2 Results The postoperative neurological function of the patients had a leaping recovery, and then entered a slow recovery process. X-ray examination showed that the thoracic and lumbar spine physiology, the fracture vertebral body and the intervertebral height were completely recovered, and the vertebral body was recovered. The line is smooth. After 6 months and 2 years of follow-up, the neurological function was graded according to Frankie and statistically improved. The improvement rate was 96.2E. Except for 1 case of obesity and vertebral loss of 1/4, no other height loss was observed. No loose screws or broken nails were seen.
Operation method and main points The patient is in a supine position, a posterior median incision, and the articular process laminae of the injured vertebrae and the upper and lower vertebral bodies are routinely exposed. The vertical extension line of the superior articular process of the upper vertebrae of the fixed vertebrae and the horizontal line intersection of the transverse process of the transverse process are advanced. Nail point, with the C-arm X-ray side position parallel to the end plate, positive position cohesion 10.15. Into four thick Kirschner wires, reaming, tapping, probe probe around the bone hole solid and screw into the vertebral arch The root screw, the angle bolt and the positive and negative threaded sleeve are sleeved into the tail of the screw, screwed into the spherical nut, and the vertebral body is fan-shaped open to restore the physiological loneliness of the thoracolumbar region. With the tension of the posterior longitudinal ligament, the inferior border bone is indirectly Get reset.
Decompression case selection and methods for preoperative computer tomography (CT) examination, showing bone compression in the spinal canal, Worlter index 2 and 2, Frankie grade C or less, internal fixation after routine intraoperative spinal canal Contrast, if the bone is almost completely restored, the dural sac is not compressed, and no exploration is performed. Otherwise, the upper 2/3 of the injured vertebral lamina and the lower 1/2 of the upper lamina are removed, and the lamina and the isthmus are kept as continuous as possible. Sex. Exploring the spinal canal, using a nerve stripper to carefully bypass the dural sac to detect the presence of fracture compression. If there is, push the bone block forward and reset to maximize the recovery of the posterior margin of the vertebral body without increasing the spinal cord. And the round vertebrae nerve injury.
The timing of surgery The choice of spinal cord and cauda equina nerve injury can be divided into primary and secondary, the former is caused by injury immediately, it is difficult to avoid, while the latter is further damaged by continuous compression, hematoma, edema, ischemia and other functions, This part of the injury can be relieved and avoided by surgery or drugs. Torg et al. found that the recovery of reversible injury depends in part on the duration of nerve deformation, that is, the time from bone spinal canal injury to reduction. This is the theoretical basis for the current reconstruction of spinal stabilization surgery, suggesting surgery. The sooner the better, but because the early patients often have spinal shock, and there may be a combined injury, the risk of surgery is large, the author believes that 2472h is appropriate.
The problem of this operation is severe fractured fracture. After the posterior reduction and internal fixation, the anterior middle part of the injured vertebra often has large bone defects, which makes the fracture healing difficult. The strength of the injured vertebra is insufficient. The height of the vertebral body is easy to be different after dismantling and fixation. The ground is lost, so the author advocates that the pedicle internal fixation can be taken out for at least 2 years. In addition, for severe burst fractures, especially CT shows that the posterior margin of the vertebral body is turned over, it is estimated that the posterior longitudinal ligament is broken and the bone block enters the dural sac. In the case of surgery, when the surgical reduction is extended, not only can the bone block be indirectly reset, but the dural sac is tightly bent and squeezed on the irregular bone block, which may aggravate the spinal cone or cauda equina injury. Such patients will be limited in posterior surgery, and it is best to change the anterior approach.
Jia Lianshun, Li Jiashun. Spinal trauma surgery. Shanghai: Shanghai Far East Publishing
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