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AF treatment of thoracolumbar pedicle screw fracture with spinal cord injury experience

11 cases, 7 cases of fracture and dislocation; injury cases segment T5, T11 cases, L14 cases, L10 cases,[link widoczny dla zalogowanych], 4 cases; Incomplete paralysis in 24 cases, 10 cases of complete paraplegia. The average time from injury to surgery 1 / 2 ~ 8d, an average of 3.5d. Were followed up for an average of 1 year (6 to 2.6 months). 1.2 surgical anesthesia or epidural anesthesia strengthening of anesthesia, prone position, fractures of lumbar vertebrae aligned bridge. After the injured vertebrae as the center median incision in layers above and below the injured vertebra revealed a vertebral spinous process, lamina, articular process and transverse process, pedicle screw entrance point, the outer edge of the lumbar facet on the straight and transverse re- axis intersection. Close to the upper thoracic vertebrae under a facet, 3mm out from the joints near the midpoint of the needle point hole, about 20mm deep,[link widoczny dla zalogowanych], pull out the bone awl, bone hole by hand along human cancellous bone screw to the vertebral body wire tapping, the choice of 4.5mm appropriate length of pedicle screw placement. And then nailed into position radiograph understand the situation. Needed exploration line and spinal cord decompression, installation and connection rod, adjust the location with the way the operating table, reset the purposes of mechanical forces on the spine, but necessary distraction connecting rod, tighten the nut. Fixation in this group were only 11 cases, total laminectomy decompression and internal fixation in 17 cases, the whole spinal cord decompression laminectomy probe fixation in 6 cases. Results All patients were followed up for an average of 1.3 follow-up 1 year, measured by X-ray films before and after vertebral height, vertebral BecK index, Cobb angle and observe the position of pedicle screw fixation, and compare frankel indices before and after surgery vertebral compression and trailing edge angle of the posterior arch to change the outcome to determine efficacy. The average preoperative anterior vertebral compression 51 (30 ~ 75), after an average of 8 (0 ~ 23%), reduction rate of 84.3, the average preoperative posterior arch angle is 21 degrees (5 to 36 degrees), surgery after 8 degrees (3 to 14 degrees). 2 discussion of thoracolumbar fracture is usually due to a variety of complex stress, leading to axial compression, bending and rotation of the plane of one or more spinal instability. Treatment should be the elimination of all defects directly, but also as far as possible to restore and maintain its anatomical position to correct dislocation of the deformity, the vertical axis 29 * reset the line separation or compression, the sagittal plane extension reset to correct kyphosis , vertebral body height restoration of vertebral sequence, fracture block back position, thereby increasing the area of the spinal canal and neural foramen, for the recovery of neurological function to create the best conditions. AF pedicle fixation system and will have a strong grip of the pedicle screw, the pedicle screw into the vertebral body, the use of mechanical power or means to reset the spine. AF system from the perspective of positive and negative screw bolts, pros and cons of self-locking pedicle screw thread casing cross-nailing horizontal bar and the composition of the angle bolt sleeve connection at both ends, length by 60mm into lOOmm, with positive and negative angle screw bolts,[link widoczny dla zalogowanych], accurate and robust, expanding the threaded sleeve compression can only turn positive and negative, so a simple reset implantation, and distraction, while recovery in the physiological lordosis of the spine to achieve an effective reduction bone decompression,[link widoczny dla zalogowanych], due to bolt rotation angle tight rear nuts, bolts and the front fan-shaped opening restore physiological lordosis,[link widoczny dla zalogowanych], with the axial tension of the posterior longitudinal ligament distraction by some broken bones can move forward. AF system than other similar operations with a simplified, less invasive characteristics. However, the right pedicle screw positioning accuracy is the key to successful surgery, surgical exposure should be clear, sagittal plane angle of SSA, TSA be inclined cross-section have accurate, careful measurements before surgery and X-CT, in particular, to the line CT upper and lower pedicle tomography, master cross-section of people tilt angle and the length of set screws, the best monitored in the c-arm machine screws inserted, such as the conditions are not allowed to be inserted Kirschner film location. Thoracolumbar burst fracture and paraplegia patients, most of the spinal cord or nerve root compression from the spinal canal by the anterior wall of combat, the application restore vertebral height distraction AF system, relying on tension in the posterior longitudinal ligament, the convex into the vertebral bone chip reset However, some patients often can not completely reset the bone slices. May be short-segment posterior decompression laminectomy retain a small joint, forming the anterior wall look down the spinal canal, anterior canal restoration so complete and more reliable to go in addition to the spinal cord or nerve root compression caused by objects, thereby achieving the spinal canal The purpose of decompression, played a complete decompression. Forming anterior spinal surgery under direct vision, simple operation, small iatrogenic injury.