Objective： The main treatment method used for thoracolumbar fractures is open reduction and in- ternal fixation. Commonly there are three surgical approaches： anterior, posterior and paraspinal. We attempt to compar...Objective： The main treatment method used for thoracolumbar fractures is open reduction and in- ternal fixation. Commonly there are three surgical approaches： anterior, posterior and paraspinal. We attempt to compare the three approaches based on our clinical data analysis. Methods： A group of 94 patients with Denis type A or B thoracolumbar burst fracture between March 2008 and September 2010 were recruited in this study. These patients were treated by anterior-, posterioror paraspinal-approach reduction with or without decompression. The fracture was fixed with titanium mesh and Z-plate via anterior approach （24 patients）, screw and rod system via posterior approach （38 patients） or paraspinal approach （32 patients）. Clinical evaluations included operation duration, blood loss, inci- sion length, preoperative and postoperative Oswestry disability index （ODI）. Results： The average operation duration （94.1 min±13.7 rain）, blood loss （86.7 ml-20.0 ml）, length of incision （9.3 mm± 0.7 mm） and postoperative ODI （6±0.5） were significantly lower （P〈0.05） in paraspinal approach group than in traditional posterior approach group （operation duration 94.1 min±13.7 min, blood loss 143.3 ml±28.3 ml, length of incision 15.4 cm±2.1 cm and ODI 12±0.7） and anterior approach group （operation duration 176.3 min±20.7 min, blood loss 255.1 ml±38.4 mt, length of incision 18.6 cm±2.4 cm and ODI 13±2.4）. There was not statistical difference in terms of Cobb angle on radiographs among the three approaches. Conclusion： The anterior approach surgery is conve- nient for resection of the vertebrae and reconstruction of vertebral height, but it is more complicated and traumatic. Hence it is mostly used for severe Denis type B fracture. The posterior approach is commonly applied to most thoracolumbar fractures and has fewer complications compared with the anterior approach, but it has some shortcomings as well. The paraspinal approach has great advantages compared with the other two approaches. It is in accordance with the concept of minimally invasive surgery and can replace most posterior approach operations.展开更多
Objective： To define the preoperative and intraoperative variables which may affect the immediate postoperative outcome in surgically managed patients with unstable pelvic fractures. Methods： This study was perform...Objective： To define the preoperative and intraoperative variables which may affect the immediate postoperative outcome in surgically managed patients with unstable pelvic fractures. Methods： This study was performed prospectively from January 2009 to June 2011 on 36 consecutive patients admitted to the trauma ward of Postgraduate Institute of Medical Education and Research, Chandigarh, with unstable pelvic injuries. Results： In the present study of 36 patients, 29 were managed surgically. Surgical duration was 2 hours in pa- tients operated on within 1 week and 3.4 hours in those operated on after 1 week. The blood loss was 550 ml when surgery was done after a week, but when done within a week it was 350 ml. The average blood loss through Pfanenstial approach was 360 ml, through posterior approach was 408 ml and through combined approach was 660 ml which was significantly high. Conclusion： Anterior approach to the pelvis would cause significantly more amount of blood loss than poste- rior approach and extemal fixation. Surgical approaches do not have any influence on the surgical duration or the infec- tion rate. The blood loss significantly increases when the surgical time is more than 1 h. The infection rate is not influ- enced by the duration of surgery. Presence or absence of associated injuries to the head, chest or abdomen is the main determinants of patient＇s survival and it greatly influ- ences the duration of hospital stay.展开更多
基金This research was supported by the National Natural Science Foundation of China （No.30772209）.
文摘Objective： The main treatment method used for thoracolumbar fractures is open reduction and in- ternal fixation. Commonly there are three surgical approaches： anterior, posterior and paraspinal. We attempt to compare the three approaches based on our clinical data analysis. Methods： A group of 94 patients with Denis type A or B thoracolumbar burst fracture between March 2008 and September 2010 were recruited in this study. These patients were treated by anterior-, posterioror paraspinal-approach reduction with or without decompression. The fracture was fixed with titanium mesh and Z-plate via anterior approach （24 patients）, screw and rod system via posterior approach （38 patients） or paraspinal approach （32 patients）. Clinical evaluations included operation duration, blood loss, inci- sion length, preoperative and postoperative Oswestry disability index （ODI）. Results： The average operation duration （94.1 min±13.7 rain）, blood loss （86.7 ml-20.0 ml）, length of incision （9.3 mm± 0.7 mm） and postoperative ODI （6±0.5） were significantly lower （P〈0.05） in paraspinal approach group than in traditional posterior approach group （operation duration 94.1 min±13.7 min, blood loss 143.3 ml±28.3 ml, length of incision 15.4 cm±2.1 cm and ODI 12±0.7） and anterior approach group （operation duration 176.3 min±20.7 min, blood loss 255.1 ml±38.4 mt, length of incision 18.6 cm±2.4 cm and ODI 13±2.4）. There was not statistical difference in terms of Cobb angle on radiographs among the three approaches. Conclusion： The anterior approach surgery is conve- nient for resection of the vertebrae and reconstruction of vertebral height, but it is more complicated and traumatic. Hence it is mostly used for severe Denis type B fracture. The posterior approach is commonly applied to most thoracolumbar fractures and has fewer complications compared with the anterior approach, but it has some shortcomings as well. The paraspinal approach has great advantages compared with the other two approaches. It is in accordance with the concept of minimally invasive surgery and can replace most posterior approach operations.
文摘Objective： To define the preoperative and intraoperative variables which may affect the immediate postoperative outcome in surgically managed patients with unstable pelvic fractures. Methods： This study was performed prospectively from January 2009 to June 2011 on 36 consecutive patients admitted to the trauma ward of Postgraduate Institute of Medical Education and Research, Chandigarh, with unstable pelvic injuries. Results： In the present study of 36 patients, 29 were managed surgically. Surgical duration was 2 hours in pa- tients operated on within 1 week and 3.4 hours in those operated on after 1 week. The blood loss was 550 ml when surgery was done after a week, but when done within a week it was 350 ml. The average blood loss through Pfanenstial approach was 360 ml, through posterior approach was 408 ml and through combined approach was 660 ml which was significantly high. Conclusion： Anterior approach to the pelvis would cause significantly more amount of blood loss than poste- rior approach and extemal fixation. Surgical approaches do not have any influence on the surgical duration or the infec- tion rate. The blood loss significantly increases when the surgical time is more than 1 h. The infection rate is not influ- enced by the duration of surgery. Presence or absence of associated injuries to the head, chest or abdomen is the main determinants of patient＇s survival and it greatly influ- ences the duration of hospital stay.
