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Thoracolumbar Burst Fracture of the Posterior Decompression Different Comparative Analysis of Clinical Efficacy

Author: LeiJianPing
Tutor: LiJingNian
School: Dalian Medical University
Course: Surgery
Keywords: Thoracolumbar Burst fracture Surgical methods
CLC: R687.3
Type: Master's thesis
Year: 2008
Downloads: 148
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Abstract


BACKGROUND: The thoracolumbar transition zone of the thoracic and lumbar spine, this area is located in the thoracic lumbar and activity activity less easy to produce stress concentration and damage. Thoracolumbar burst fractures account for about 45% of thoracolumbar fractures, a burst fracture characteristics that form the threat placeholder in spinal bone, nerve function, spinal cord injury accounted for thoracolumbar burst fractures 30% to 60%. Thoracolumbar burst fracture injury causes a car accident injury, fall injury, sports-related injuries, mainly associated with head, chest and abdomen and other parts of the injury. The mechanism of injury flexion, extension, rotation, compression, external force, but more than a composite force. Damage stability judgment mainly relies on clinical symptoms and imaging studies. Clinical thoracolumbar burst fracture patients visit the image data is often clear or specific performance, including the the kyphotic angle X line, the posterior edge of the bone fragments and trailing edge line abnormalities on CT bone block broke into the spinal canal, the performance of these often as indications for surgical treatment, and that their presence lead to nerve damage or affect its recovery. 1970s Roy-Camille first application of pedicle screw fixation for thoracolumbar fractures, pedicle screw fixation technique developed rapidly in the past 30 years, has been widely used in the treatment of a variety of spinal disorders. Fixed-and three-dimensional fixed short segment pedicle screw fixation soon replace long segments of the fixed system. In a wide range of clinical course of treatment for thoracolumbar burst fracture choose from a variety of surgical indications and treatment is considerable controversy exists. Currently is considered full effect and has been widely applied treatment method is the application by the pedicle screw posterior surgical instruments, the axial distraction restore physiological curvature, by means of the posterior longitudinal ligament and surrounding structures indirect reduction bone. Severely damaged intervertebral disc and posterior longitudinal ligament of thoracolumbar burst fractures without associated the pedicle screw indirect decompression surgery is regarded as the main method of thoracolumbar burst fracture early surgery. Selectively analyzed retrospectively from January 2000 - June admitted thoracolumbar burst fractures, 86 cases of the pedicle screw device therapy after an evaluation of the effect of recovery following clinical indicators including injured vertebral height ratio , angular kyphosis, neurological, spinal bone placeholder and independent functional status assessment. Furthermore, the effect of two different posterior spinal decompression surgical treatment of thoracolumbar burst fractures research to guide the clinical application. Purpose: To study two different posterior spinal decompression treatment of thoracolumbar burst fracture surgery effect. Methods: by selectively analyzed retrospectively from January 2000 - June admitted thoracolumbar burst fracture 86 cases, according to their specific different surgical approach will be divided into two groups: direct decompression group, the removal of on one side or both sides of the lamina canal decompression and posterior pedicle screw system fixed 34 cases; indirect decompression group, simply pedicle screw system fixed 52 cases. The statistical analysis of the two sets of data are comparable, the two groups were obtained in June -36 month follow-up. Postoperative neurologic recovery assessment in accordance with the ASIA neurological function evaluation; late complications back pain, lower extremity radicular pain, numbness and weakness assessment; FIM standard assessment of the ability to live. Results: 1. Restore vertebral body height and spinal volume treatment results, the two groups before and after surgery compare the differences were highly significant (P lt; 0.01), while no significant difference between the two groups after operation ( P gt; 0.05). 2. Direct decompression group and late indirect decompression group (1-3 years) recovery of neurological function difference was not statistically significant significance (P gt; 0.05). 3. Direct decompression group and the late group (1-3 years) indirect decompression complications and the ability to live independently difference between the two groups was significant (P lt; 0.05). Conclusion: 1. Associated with severely damaged intervertebral disc and posterior longitudinal ligament of thoracolumbar burst fractures posterior pedicle screw fixation can achieve good reset. Posterior pedicle screw fixation in late, take direct decompression and the indirect decompression in the recovery of nerve function can achieve the desired therapeutic effect, and no significant difference in treatment effect between the two groups. Posterior pedicle screws directly decompression than indirect decompression comparison, direct decompression the late postoperative easily associated with spinal instability secondary spinal cord and cauda equina injury caused by a series of complications.

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CLC: > Medicine, health > Surgery > Orthopaedic Surgery ( movement system diseases,orthopedic surgery ) > Orthopedic surgery and surgery > Bone surgery
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