Comparative study of postural reduction and internal fixation versus laminectomy reduction and inter-nal fixation in the treatment ofthoracolumbar burst fractures

doi:10.3877/cma.j.issn.2096-0263.2024.06.003

Abstract

Abstract:

Objective

Laminectomy decompressionandpediclescrewinternal fixation is a commonly used technique for the treatment of spinal cord injuries caused by thoracolumbar burst fractures， but it has the disadvantage of high surgical trauma.Therefore，we evaluated the efficacy of postural reduction and internal fixation in the treatment of thoracolumbar burst fractures and compared the clinical efficacy of postural reduction internal fixation with laminectomy reduction internal fixation.

Methods

We retrospectively analysed 134 patients with thoracolumbar burst fractures who were surgically treated at the Orthopaedic Medical Centre of the Second Hospital of Jilin University between June 2016 to December 2020.All patients had an ASIA score of C or D.According to the operationmethods， patients were divided into two groups，A and B.Group A（n=66 patients）:treated with postural repositioning decompression and internal fixation；Group B（n=68 patients）: treated with laminectomy decompression and internal fixation. General condition， operative time，in traoperative blood loss，anterior height of injured vertebrae，sagittal Cobb angle，ASIA score，VAS score， ODI score and surgical complications were compared between the two groups.

Results

The average follow-up time of the 134 patients was 29.5±5.3 months， of which 24.4-34.5 months in group A and 24.2-34.8 months in group B.There were 37 males and 29 females in group A with an average age of 42.21±23.93 years and 38 males and 30 females in group B with an average age of 46.80±27.47 years.There was no statistical difference in the general condition of the patients in the two groups（P＞0.05）.At the preoperative and 2-year postoperative follow-up， the percentage height loss of the anterior margin of the injured vertebrae in group A and group B was ［（50.00±11.26）% vs. （46.26±14.50）%， P＞0.05］，［（13.74±3.33）% vs. （18.19±1.78）%，P＜0.05］，the Cobb angle was［（37.65±2.26）°vs.（37.13±1.59）°，P＞0.05］，［（12.38±1.25）°vs.（15.76±1.45）°，P＜0.05］，and the operation time was［（51.36±5.65）min vs.（74.81±9.29）min，P＜0.001］，intraoperative blood loss was ［（56.80±13.97） mL vs. （188.38±61.15） mL， P＜0.001］， and the results of the VAS score for back pain at 3 days postoperatively were ［（5.44±0.50） vs. （6.49±0.50）， P＜0.05］. When comparing the two groups， there was no statistically significant difference in ASIA score， VAS score for lower limb pain and ODI score at preoperative，3 days postoperative，1 year postoperative and 2 years postoperative follow-up（P＞0.05）. However， all these scores were significantly improved after surgery compared to the preoperative when compared within the two groups（P＜0.05）.

Conclusions

Both postural reduction internal fixation and laminectomy reduction internal fixation are safe and effective procedures for the treatment of thoracolumbar burst fractures. However， for patients with thoracolumbar burst fractures with ASIA scores of C and D， postural reduction internal fixation has the advantages of less surgical trauma， shorter operative time， and less back painin the early postoperative period.

Key words: Thoracolumbarburst fracture, Spinal cord injury, Decompression, Internal fixation

Tong Yu, Jianhang Jiao, Weibo Jiang, Zhonghan Wang, Yang Wang, Xuhui Wu, MinFei Wu. Comparative study of postural reduction and internal fixation versus laminectomy reduction and inter-nal fixation in the treatment ofthoracolumbar burst fractures[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2024, 10(06): 331-339.

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Figures/Tables 10

组别	男：女（百分比）	年龄（岁， $\bar{x}$ ±s）	体重（kg， $\bar{x}$ ±s）	骨折情况（例）				椎管受压容积（%， $\bar{x}$ ±s）	脊柱不稳（例）
组别	男：女（百分比）	年龄（岁， $\bar{x}$ ±s）	体重（kg， $\bar{x}$ ±s）	T₁₁骨折	T₁₂骨折	L₁骨折	L₂骨折	椎管受压容积（%， $\bar{x}$ ±s）	3级	4级
A组	56%：44%	42.21±23.93	70.50±12.08	11	20	26	9	16.58±13.16	36	30
B组	56%：44%	46.80±27.47	72.51±11.86	14	19	25	10	17.64±12.31	35	33
P值	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05
组别	BMI指数（kg/m²， $\bar{x}$ ±s）	神经功能状态（例）		肌力（例）		合并症（例）			受伤至到达医院时间（h， $\bar{x}$ ±s）
组别	BMI指数（kg/m²， $\bar{x}$ ±s）	ASIA评分（C级）	ASIA评分（D级）	3级	4级	肺挫伤	骨盆骨折	四肢骨折	受伤至到达医院时间（h， $\bar{x}$ ±s）
A组	22.09±4.48	22	44	22	44	3	2	2	15.38±7.98
B组	22.66±3.36	37	31	37	31	1	0	4	14.68±8.35
P值	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05

组别	男：女（百分比）	年龄（岁， $\bar{x}$ ±s）	体重（kg， $\bar{x}$ ±s）	骨折情况（例）				椎管受压容积（%， $\bar{x}$ ±s）	脊柱不稳（例）
组别	男：女（百分比）	年龄（岁， $\bar{x}$ ±s）	体重（kg， $\bar{x}$ ±s）	T₁₁骨折	T₁₂骨折	L₁骨折	L₂骨折	椎管受压容积（%， $\bar{x}$ ±s）	3级	4级
A组	56%：44%	42.21±23.93	70.50±12.08	11	20	26	9	16.58±13.16	36	30
B组	56%：44%	46.80±27.47	72.51±11.86	14	19	25	10	17.64±12.31	35	33
P值	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05
组别	BMI指数（kg/m²， $\bar{x}$ ±s）	神经功能状态（例）		肌力（例）		合并症（例）			受伤至到达医院时间（h， $\bar{x}$ ±s）
组别	BMI指数（kg/m²， $\bar{x}$ ±s）	ASIA评分（C级）	ASIA评分（D级）	3级	4级	肺挫伤	骨盆骨折	四肢骨折	受伤至到达医院时间（h， $\bar{x}$ ±s）
A组	22.09±4.48	22	44	22	44	3	2	2	15.38±7.98
B组	22.66±3.36	37	31	37	31	1	0	4	14.68±8.35
P值	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05

组别	术前	术后3天	术后1年	术后2年	F值	P值
A组	50.00±11.26	12.89±3.12^*	13.50±2.74^{*^}	13.74±3.33^{*^&}	570.570	＜0.001^*
B组	46.26±14.50	17.18±1.78^*	18.16±2.01^{*^}	18.19±1.78^{*^&}	233.646	＜0.001^*
F值	1.633	-9.726	-11.195	-9.603
P值	0.106	＜0.001^*	＜0.001^*	＜0.001^*

组别	术前	术后3天	术后1年	术后2年	F值	P值
A组	37.65±2.26	12.27±1.38^*	12.52±1.23^{*^}	12.38±1.25^{*^&}	1532.785	＜0.001^*
B组	37.13±1.59	15.26±1.68^*	15.49±1.85^{*^}	15.76±1.45^{*^&}	758.036	＜0.001^*
F值	1.535	-11.257	-14.719	-18.602
P值	0.125	＜0.001^*	＜0.001^*	＜0.001^*

组别	术前	术后3天	术后1年	术后2年	F值	P值
A组	7.77 ± 1.05	4.97 ± 0.80^*	2.50 ± 0.50^*#	2.42 ± 0.56^*#&	731.89	＜0.001^*
B组	7.56 ± 1.04	5.04 ± 0.87^*	2.41 ± 0.50^*#	2.49 ± 0.56^*#&	679.150	＜0.001^*
F值	1.184	-0.514	1.022	-0.633
P值	0.239	0.608	0.309	0.528

组别	术前	术后3天	术后1 年	术后2年	F值	P值
A组	7.44 ± 0.99	5.44 ± 0.50^*	2.47 ± 0.50^*#	2.39 ± 0.61^*#&	855.949	＜0.001^*
B组	7.66 ± 0.97	6.49 ± 0.50^*	2.59 ± 0.50^*#	2.44 ± 0.53^*#&	1130.607	＜0.001^*
F值	-1.310	-12.062	-1.374	-0.482
P值	0.193	＜0.001^*	0.172	0.631

组别	术前	术后3天	术后1年	术后2年	F值	P值
A组	79.27 ± 6.32	57.73 ± 2.23^*	25.33 ± 3.26^*	25.00 ± 1.73^*&	1337.883	＜0.001^*
B组	80.41 ± 5.82	57.35 ± 4.43^*	25.22 ± 3.66^*	25.22 ± 1.35^*&	1639.715	＜0.001^*
t值	-1.086	0.245	0.188	-0.825
P值	0.280	0.807	0.851	0.411

组别	手术时间（分， $\bar{x}$ ±s ）	失血量（毫升， $\bar{x}$ ±s ）	手术并发症［（例数）%］
组别	手术时间（分， $\bar{x}$ ±s ）	失血量（毫升， $\bar{x}$ ±s ）	断钉	断棒	感染
A组	51.36 ± 5.65	56.80 ± 13.97	0（0）	0（0）	0（0）
B组	74.81 ± 9.29	188.38 ± 61.15	2（2.94）	1（1.47）	0（0）
t值	-10.087	-11.935	0.376	0.218	-0.736
P值	＜0.001^*	＜0.001^*	0.259	0.869	0.523

组别	手术时间（分， $\bar{x}$ ±s ）	失血量（毫升， $\bar{x}$ ±s ）	手术并发症［（例数）%］
组别	手术时间（分， $\bar{x}$ ±s ）	失血量（毫升， $\bar{x}$ ±s ）	断钉	断棒	感染
A组	51.36 ± 5.65	56.80 ± 13.97	0（0）	0（0）	0（0）
B组	74.81 ± 9.29	188.38 ± 61.15	2（2.94）	1（1.47）	0（0）
t值	-10.087	-11.935	0.376	0.218	-0.736
P值	＜0.001^*	＜0.001^*	0.259	0.869	0.523

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