[Transpedicular bone graft for the treatment of thoracolumbar vertebral fractures through Wiltse approach].

OBJECTIVE

To explore methods and therapeutic effects of transpedicular bone graft in treating thoracolumbar fractures through Wiltse approach.

METHODS

From March 2009 to February 2012,56 patients with thoracolumbar fractures were treated by transpedicular bone graft through Wiltse approach. Among them, there were 36 males and 20 females, ranging in age from 14 to 55 years old (mean, 41 years old). The time from injury to operation from 2 to 15 d (mean,3 d). Twenty-five cases were caused by falling down, 7 cases were caused by slipping, 20 cases were caused by car accident and 4 cases were caused by crush trauma. MRI was performed before operation to exclude pathological fracture. The distance between multifidus muscle and longissimus to midcourt line was measured. Self-made trocar was applied in operation. According to AO classification,there were 33 cases with type A1 compression fracture,5 cases with type A2 cleavage fracture and 18 cases with type A3 burst fracture. Sixteen cases of the 56 cases combined with spinal cord injury. Based on Frankel neurologic grading system, preoperative neurological function was grade B in 5 cases, grade C in 2 cases, gade D in 9 cases. Preoperative Denis gading were P5. Frankel and lumbago Denis clssification were used to evaluate neurological function and lumbago. The imaging data before, after operation and the latest follow-up were used to evaluate correction vision.

RESULTS

All patients were followed up over 24 months. At the time of the latest follow-up, Frankel B were 3 cases, Frankel C were 2 cases, Frankel D were 4 cases and Frankel E were 7 cases. According to lumbago Denis clssification, P1 (painlessness) were 32 cases, P2 ( slight pain without treatment) were 18 cases, P3 ( moderate pain and taking medicine occasionally) were 6 cases. The anterior vertebral height improved from preoperative (13.38 +/- 4.72)mm to postoperative (22.18 +/- 1.44)mm. The Cobb's angle decreased from preoperative (28.39 +/- 2.64) degrees to (10.07 +/- 3.05) degrees. There were no nails broken, rod broken, internal fixation lossen and vertebral body recompression.

CONCLUSION

Transpedicular bone graft for thoracolumbar fractures through Wiltse approach can reduce intraoperative blood loss and postoperative complications, and aviod "eggshell" vertebral body. Mastering revealed way, drafting detailed preoperative plan and eariler exercise is the key to the success of treatment.