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[Modified posterior-anterior operation for treatment of serious lumbar fracture and dislocation]
Xing Zhao1, Shunwu Fan, Xiangqian Fang
1Department of Orthopaedics, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Zhejiang University, Hangzhou Zhejiang, 310016, PR China.
Objective:
To evaluate the clinical outcomes of modified posterior-anterior operation in the treatment of serious lumbar fracture and dislocation.
Methods:
From January 2002 to February 2006, 24 patients, 17 males and 7 females aged 22-69 years, underwent reduction of posterior spatium intermuscular approach combined with modified anterior operation. Nine cases were caused by falling and 15 by traffic accident, involving: L1 in 5 cases, L2 in 10 cases, L3 in 4 cases, L4 in 2 case, L1,2 in 1 case and L3,4 in 2 cases. According to the Frankel grade, there were 5 cases for grade A, 11 for grade B, 7 for grade C and 1 for grade D. The recovery of neurological function was evaluated. The imagology examination was applied to evaluate the condition of internal fixation and bone union. The Cobb' s angle was measured by X-ray film before operation, 3 days after operation and at the final follow-up, and the difference was estimated.
Results:
Nineteen patients were followed up for 8-52 months, 28.4 months on average. Among the 2 cases of grade A, one improved to C and the other had no improvement. Among the 9 cases of grade B, 5 improved to C, 2 improved to D, and other two had no improvement. Among the 7 cases of grade C, 5 improved to D and 2 improved to E. One case of grade D improved to E. The average Cobb' s angle was (-11.5 +/- 4.6) degrees preoperatively, (4.2 +/- 4.7) degrees 3 days after operation and (4.0 +/- 4.8) degrees at the final follow-up, indicating there was a significant difference between preoperation, 3 days after operation and the final follow-up (P < 0.001), but no significant difference between 3 days after operation and the final follow-up (P > 0.05). The position of internal fixation was good during follow-up. The complications such as disruption, loosening and collapse were not observed.
Conclusion:
Reduction of posterior spatium intermuscular approach combined with modified anterior operation in the treatment of serious lumbar fracture and dislocation could complete the reduction, decompression, grafting and internal fixation in one stage, and protect the paraspinal soft tissue and minimize the trauma caused by surgery. It has the merits of short time of operation, small amount of intraoperative hemorrhage, solid union of internal fixation and satisfactory clinical outcome.
