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A.K.Abduhalikov, A.Turahanov, F.Tashlanov

Forecasting treatment effectiveness of uncomplicated fractures of vertebral body at thoracolumbar division and its consequences

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Authors analyse results of treatment of 124 patients with compression fracture of bodies lowerthoracal and lumbar vertebras . 2 groups according to an initial corner kiphotic deformations (CKD) vertebral a segment are selected. Patients with less 20? CKD have made 61,3% , 20? and more 38,7%. All patients are carried out conservative and operative treatment. The remote results appeared less favorable to patients with CKD 20? and more, treated conservatively.

Conclusion, that at posttraumatic hernias of intervertebral disks it is needing microsurgical diskechtomy with foraminotomy squeezed rotlet.

Key words :

treatment effectiveness, fractures of vertebral body

The fractures of a backbone belong to heavy traumas of a loco motor apparatus [1]. The degree of heaviness, first of all, is determined by the destruction degree of two basic backbone elements: vertebral body, intervertebral disks and their combinations [3, 4]. In the case of failure or weakening of two main subsystems of backbone system, arises dysfunction: of support, movement, spinal cord protection and its roots. Therefore treatment of backbone fractures should be adequate in accordance with degree of obtained damages and correspond to principles of skeleton bone fracture treatment in general: reconstruction of wholeness, damaged segments functions and work capacity of suffered one in possible short terms [7, 8].

Conservative treatment methods by single-moment repositioning of broken vertebral body and spinal fixation by corset, and also backbone unloading by extending on ramp in functional treatment method and backbones staged reclination in combined method are widespread at present time [9].

The amount of unsatisfactory results remain quite high and fluctuate on average from 10% to 57%, even though conservative treatment methods constantly being improved.

According to majority traumotologists opinion, main reason lie in that, method doesnt provide reliable immobilization and unloading of backbones damaged segment for whole period of reparative regeneration in fractured vertebral body, which lasts during 8-10 months.

Level of physical invalidity remain high after conservative treatment and constitute 54% up to 82%..

Considerably have improved results of fractured vertebral body treatment operative methods as rear internal fixation of spine. Treatment methods like rear spondylosis with wire; rear internal fixation of spine with lavsan tape; spine fixation with couple-clamper and spring; metallic plates and Harringtons clampers did not loose its followers up to present days.

Spine stabilization method on the basis of transpedicular fixation is actively being introduced on modern stage [2, 5, 6]. Clinical observations have confirmed also high and strong performance characteristics of clampers from composite material on the basis of carbon.

Individualization of medical measures is regulated by certain kind or form of trauma, where diagnostics has become possible after introduction of magnetic - resonance tomography (MRT) in daily practice [10].

Materials and methods of research.

We have analyzed treatment results of 124 patients with compressive fractures of low-thoracic and lumbar spine, who were in specialized wards vertebrology Center and Andijan branch of RSCUMC.

While distributing patients in accordance of their sex and age, we noticed that, the biggest group constitutes patient at the age of 20 to 40 year, which is 51,6% from whole patients participating in treatment. Information on social background became as follows: workers-50,8%; clerks-26%; pensioners-16,9%; students and schoolboys-5,7%. Basically, traumas occurred in everyday life, work injuries detected with 7,1 % of patients. Fallings from height detected - at 29,8 %; fallings on buttocks - 24,2 %; auto accidents - 9,7 %; alcoholic intoxications - 12,9 %; transport run over - 8,1 %; traumas during fight - 4,0%. Damage structure of separate spines as follows: Th10 vertebral body fracture - 5,9 %; Th11 - 10,3 %; Th12 - 28,6 %; L1 - 34,6 %; L2 vertebra - 13,2%. First day 41,1 % suffered patients visited, during 7 days - 8,1 % arrived; during 1 month - 13,7 %, during 6 months - 12,9%.

For objective certainty of rontgenological symptoms evaluation rentgenometric research is conducted. MRT researches on sagittal tomography evaluated topography spinal canal, condition of intervertebral disk consequence of trauma and connections. From 47 patients, whom the given research was conducted, in 63 % of cases the damage of intervertebral disks in the damaged segment was determined.

According to initial kiphotic deformation angle (KDA) of spinal segment, 2 main groups were highlighted. At the same time, we based on rentgenometric, MRT and orthopedic evaluations of their potential stability. Patients with less then 200 KDA constituted - 61,3%, patients with 200 KDA and more - 38,7%.

49 people in 1 group received conservative treatment, and 27 - operative. Conservative treatment included methods of gradual or single-moment reclination of spine with laying up plaster corset or patients carried backboards. Patient were prescribed with medical physical culture, physiotherapy procedures and chondro-protective preparation Struktum - for improving metabolism and structure of damaged intervertebral disk. Preparation is prescribed on 500 mg 2 times per day during 1 month.

The operative treatment included rear internal fixation of spines damaged segment in the position orthopedic correction. At the same time clampers from a composite material Ostek was used, on the basis of carbon or metal slices CITO(Central Institute of Traumotology and Orthopedy) and HSRIOT(Harkov Scientific Research Institute of Orthopedy and Traumotology)

In the second group 30 patients were treated by a surgical method.

Results and their discussion.

The analysis of results has revealed direct connection between permanent deformation of spine after fracture and its functional disturbance in separate posttraumatic period in the form of pain, limitation of mobility, secondary compression of damaged spine and deepening of an axial deformation, right up to emerging neurological disorders, fast development of deforming spondylosis and osteochondrosis.17 patients were reoperated during posttraumatic periods because of posttraumatic hernias in intervertebral disks, where microsurgical diskechtomy with compremmed root foraminotomy was executed.

Average stay terms of patients in wards, with conservative treatment, has constituted 43 8 days. Patients, treated by surgical method, stayed 17 3 days.

Analyzing orthopedo-rentgenologic criteria, it is possible to mark, that satisfactory rentgenometric outcomes are obtained, both in conservative, and in surgical treatment. However, separate outcomes less favorable on patients with 200 and more CDA, treated by conservative method.

Taking into account above stated, we consider that:

  1. Volume of diagnostic researches in compressive fractures vertebral bodies of thoracic and lumbar localization should include execution of rentgenometric and MRT researches.
  2. CDA in 200 and more can be an important criterion for the indication to correcto - stabilizing operation with application of carbon clampers.
  3. Conservative treatment can be shown in fractures with less than 200 CDA with application of a preparation Struktum.
  4. In posttraumatic hernias of intervertebral disk microsurgical diskechtomy with foraminotomy of squeezed root is shown.
The literature
  1. Azizov M.J., Saliyev N.M. The condition and perspectives of traumatology-orthopedic science development in Uzbekistan. New technologies in traumatology and orthopedy. Mat. VI congresses of traumatologists-orthopedists of Uzbekistan. - Tashkent, 2003. -p.5-9.
  2. Shotursunov Sh.Sh., Ahrorov Sh.K., Nuraliyev H.A. A comparative evaluation of outcomes of surgical treatment of unstable damages thoracolumbar division of spine. New technologies in traumatology and orthopedy. Mat. VI congresses of traumatologists-orthopedists of Uzbekistan. - Tashkent, 2003. -p.391-2.
  3. Abe E; Sato K; Shimada Y; Mizutani Y; Chiba M; Okuyama K. Thoracolumbar burst fracture with horizontal fracture of the posterior column. - Spine, 1997 - 22 (1):83-7.
  4. Cigliano A; Scarano E; De Falco R; Profeta G. The postero-lateral approach in the treatment of post-traumatic canalar stenosis of the thoraco-lumbar spine.-J. Neurosurg Sci, 1997-41 (4):387-93.
  5. Domenicucci M; Preite R; Ramieri A; Ciappetta P; Delfini R; Romanini L. Thoracolumbar fractures without neurosurgical involvement: surgical or conservative treatment? -J. Neurosurg Sci, 1996-40 (1):1-10/
  6. Knop C: Blauth M: Beuhren V; Hax PM; Kinzl L; Mutschler W; Pommer A; Ulrich C; Wagner S; Weckbach A; Wentzensen A; Weorsdeorfer O.I.-Surgical treatment of injuries of the thoracolumbar transition. 1:Epidemiology - Unfallchirurg-1999-102 (12):924-35
  7. Parker JW, Jane JR, Kraikovic EE, Gaines RW. Successful shor-segment instrumentation and fusion for thoracolumbar spine fractures: a consecutive 4 -year study. Spine, 2000; 25:1175-70
  8. Muller U, Berlemann U, Sledge J, Schwarzenbach O. Treatment of thoracolumbar burst fractures without neurologic deficit by indirect reduction and posterior instrumentation: bisegmental stabilization with monosegmental fusion. Eur Spine J, 1999; 8:284-9
  9. Resch H; Rabl M; Klampfer H; Ritter E; Povacz P. Surgica vs. Conservative treatment of fractures of the thoracolumbar transition.- Unfallchirurg, 2000-03 (4):281-8/
  10. Yazici M; Atilla B; Tepe S; Calisir A. Spinal canal remodeling in burst fractures of the thoracolumbar spine: a computerized tomographic comparison between operative and nonoperative treatment.-J. Spinal Disord, 1996-9 (5):406-13


Contact author:

E-mail: verteb@mail.ru






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