Efficacy and safety of posterior pedicle screw internal fixation in combination with transpedicular bone grafting for treating thoracolumbar fractures in elderly patients / 中华老年医学杂志

ABSTRACT

Objective To investigate the efficacy and safety of posterior pedicle screw internal fixation as add-on to transpedicular bone grafting in the treatment of thoracolumbar fractures in elderly patients.Methods The 86 elderly patients with thoracolumbar fracture admitted to our hospital were enrolled in the retrospective study.All patients were divided into a control group(n=40)receiving posterior short-segment pedicle fixation,and a study group(n=46)undergoing transpedicular bone grafting as add-on to posterior short-segment pedicle fixation.The recovery of lumbar function and neurological function were compared between the two groups.Results The Cobb angle of the injured vertebrae was significantly decreased in two groups at one week after operation,and then increased slightly with time-lapse(Ftime =86.34,P＜0.05).The whole Cobb angle of injured vertebrae was lower in the study group than in the control group(F =7.68,P＜0.05).The Cobb angle reduction of injured vertebrae was more in the study group than in the control group (Ftime× groups =4.19,P ＜0.05).The height of the anterior and posterior edges of injured vertebrae was significantly increased in two groups at 1 week after operation,and then decreased slightly with time-lapse(Ftime =75.87 and 66.92,P ＜0.05).The overall level of anterior and posterior edges height of injured vertebrae was higher in the study group than in the control group(Fgroup =9.75 and 6.76,P＜0.05).The increased height of anterior and posterior edges of injured vertebrae was higher in the study group than in the control group(Ftime× groups =7.59 and 5.21,P＜0.05).The bone fusion rate was higher in the study group than in control group (97.8 ％ vs.82.5 ％,P ＜ 0.05).The failure rate of internal fixation was lower in the study group than in the control group (2.2 ％ vs.17.5％,x2 =5.96,P ＜ 0.05).The recovery of neurological function was better in the study group than in the control group(Z =2.12,P ＜0.05).The Oswestry disability index(ODI)in two groups was decreased with time-lapse(Ftime =85.49,P＜0.05).The overall ODI level was lower in the study group than in the control group(Fgroup =47.28,P＜0.05).The decrement of ODI index was larger in the study group than in the control group(Ftime× groups =8.97,P ＜ 0.05).Conclusions Posterior pedicle screw internal fixation in combination with transpedicular bone grafting are safe and effective in the treatment of thoracolumbar fractures in the elderly,which can improve the stability of vertebral compression,and promote the recovery of neurological function and lumbar function.