Treatment of 32 cases thoracolumbar fractures in Wenchuan earthquake

Abstract

Objective To investigate an optimal treatment method for a large number of earthquake casualties on the basis of analysis of the characteristics of 32 patients with thoracolumbar fracture in 5.12 Wenchuan earthquake. Methods Of the 32 earthquake casualties with thoracolumbar fracture, 24 were treated by operation. Short-segment fixation with pedicle screw system was applied for 21 cases, 13 of which received laminectomy and posterolateral hone grafting additionally. Three cases were treated with percutaneous vertebroplasty, and 8 cases with expectant treatment. McAfee classification system was used for evaluation of spinal stability. Patients with neurological impairment were evaluated by ASIA (American Spinal Injury Association) system. Results Postoperative plain radiographs showed that the vertebral height and kyphosis were improved more or less in all the patients. The mean postoperative improvement was 1.3 ASIA grades in 7 patients who had had neurological impairments. No deterioration was fond in 25 patients with Grade E neurological status. One patient had delayed incision healing. Conclusions Operations may restore neurological function, rebuild stabilization of mechanically unstable spine and allow early mobilization to reduce complications in patients with unstable thoracolumbar fractures and impaired neurological function. Treatment methods must vary according to fracture level, soft tissue integrity, anterior column integrity, and skills of surgeons. Short-segment fixation with pedicle screws at the level of the fracture is a safe and effective method for earthquake thoracolumbar fractures. Key words: Thoracolumbar fracture; Treatment; Earthquake