Treatment of 89 cases of thoracolumbar instability fracture with pedicle screw and Hastelloy bar. Shenyang Municipal Orthopedic Hospital (110044) Guo Yong Li Shuping Wang Jingxu Zhou Zhongqi Our hospital 1990~1999 application of Hastelloy stick, Dicks nail, Socnn internal fixation Treatment of unstable thoracolumbar fractures in 89 cases, the results are satisfactory, the report is as follows.
1 Clinical data 1.1 General information In 89 cases, 72 males and 17 females. 19 cases of age.
1.2 Types of fractures According to the classification of Demis fractures, there were 37 cases of fracture dislocation and 52 cases of burst. According to Frankel classification, there were 15 cases of grade, 8 cases of grade B, 26 cases of grade C, 19 cases of grade D, and 11 cases of grade E.
1.3 Surgical methods In this group of 89 patients, Dick nail 46 cases, angle Didc15 cases, Harrington rod 23 cases, of which 56 cases have neurological symptoms of total laminectomy, lateral anterior decompression, no neurological symptoms, spinal canal Only less than 30% of the pedicle screw fixation was seen in the fusion. The double-segment injury and severe lateral dislocation were performed with Harrington rod internal fixation. The Harrington rod mainly selected short segments and the Harrington rod was bent. In the physiological curvature, the two vertebral bodies of the diseased vertebrae or the upper or two vertebral bodies are hooked to minimize the effect of internal fixation on the spinal activity.
1.4 Follow-up results All patients were followed up for 6 months to 8 years with an average of 4 years with good deformity correction and varying degrees of neurological recovery.
1.4.1 Malformation correction This group was surgically fixed, and the deformity was corrected to different degrees. Among them, double segmental injury and severe lateral and anterior dislocation of Hastelloy rods were better than pedicle screws. Cobbs angle with bone graft fusion was used. Less lost.
1.42 Restoration of neurological function In this group, 6 cases were not recovered except for the complete sputum, and the rest had different degrees of recovery. There was no significant difference in the recovery of nerve function between Hastelloy and pedicle screws.
1.5 of the 89 cases of complication, 4 cases of Hastelloy sticks were not fixed outside and premature activity caused the upper hook to fall off. 1 case of premature weight-bearing support caused proximal fracture, 66 cases of pedicle screw had 1 case of cone positioning error, 1 case of intervertebral space, 4 pieces of broken nail, 4 cases of loose screw and 2 cases of infection.
2 Discussion According to the Denis classification, the unstable thoracic and lumbar spine fractures of the spine have more than two columns of damage. Compression is the basic load force that causes spinal fracture. The axial distraction force is the main force of fracture reduction. The action point of the Hastelloy stick is in the posterior column, which has an indirect expansion effect on the anterior and middle columns. The action principle of the Hart's rod is based on the axial distraction force, so that the fracture dislocation is re-aligned under the tension of the ligament, the intervertebral disc and the posterolateral structure of the vertebral body (including the pedicle), thereby restoring the volume of the spinal canal and avoiding prolonged bed rest. However, the operation of pedicle screw fixation is complicated. When the screw is inserted, it is easy to locate incorrectly. It is inserted into the intervertebral space or spinal canal. In order to prevent intraoperative complications, the C-arm X-ray machine is used in the operation. The operation is careful to prevent it. In the later stage, the screw was broken and loosened. The operation was performed with a relatively thick screw of about 6.0 mm. The fixation was performed at the same time. The patient was removed from the bed and protected with a brace. In the past 4 years, almost no screw fracture occurred after the operation. At the same time, the postoperative spinal stabilization of the patients with bone fusion was effective, and the Cobbs angle loss after internal fixation was effectively prevented. It was further proved that the maintenance of the correction force was not only in the internal fixator itself, but also in the good bone graft fusion.
At present, there is still controversy about whether the unstable fracture without neurological symptoms is fixed. In this group of treatment, vertebral screw fixation for unstable fractures without neurological symptoms can restore and maintain normal alignment early, effectively prevent spinal injury into spinal deformity, facilitate nursing and prevent complications, and can be early Under the protection of the brace.
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