ObjectiveTo explore the safety and preliminary effectiveness of transintervertebral release, bone impaction grafting, and posterior column compressed-closing in the treatment of osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis.MethodsThe clinical data of 21 elderly patients with osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis were retrospectively analyzed between March 2016 and November 2017. There were 1 male and 20 females, aged 55-75 years, with an average of 64.8 years. The disease duration was 8-24 months, with an average of 13.1 months. The bone density T value ranged from ?3.4 to ?2.1, with an average of ?2.3. Lesion segments: T11 in 2 cases, T12 in 6 cases, L1 in 8 cases, L2 in 1 case, T11, 12 in 1 case, T12, L1 in 2 cases, and T12, L2 in 1 case. Preoperative neurological function was classified according to the American Spinal Injury Association (ASIA): 5 cases of grade D and 16 cases of grade E. All patients underwent transintervertebral release, bone impaction grafting, and posterior column compressed-closing. The effectiveness was evaluated by visual analogue scale (VAS) score and Oswestry dysfunction index (ODI) score before operation, at 3 months after operation, and at last follow-up. The neurological function was assessed by ASIA at last follow-up. Local kyphosis Cobb angle (LKCA), thoracic kyphosis (TK), lumbar lordosis (LL), and sagittal vertebral axis (SVA) were measured on the X-ray films of the full-length lateral spine of the patient before operation, at 1 week after operation, and at last follow-up.ResultsNo complication such as fracture of internal fixator or nerve injury occurred. LKCA, TK, and SVA were significantly improved at 1 week after operation and at last follow-up (P<0.05). There was no significant difference between at 1 week after operation and at last follow-up (P>0.05). There was no significant difference in LL before and after operation (F=3.013, P=0.057). The VAS and ODI scores were significantly improved at 3 months after operation and at last follow-up, and further improved at last follow-up when compared with the scores at 3 months after operation, showing significant differences between time points (P<0.05). Five patients with ASIA grade D neurological function recovered to grade E at 6 months after operation.ConclusionTransintervertebral release, bone impaction grafting, and posterior column compressed-closing for treating osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis has definite effectiveness, strong orthopaedic ability, and minimal trauma, which can effectively restore the sagittal balance of the spine, alleviate pain, and improve the patients’ quality of life.
Objective To evaluate the effect of self-designed antirotation reduction internal fixator(ARRIF) on treating different spine segment fracture.Methods From August 1999 to March 2003, 76 patients(48 males and 28 females, aged from 22 to 59 with an average of 34.1) with thoracolumbar fracture were operatively treated by ARRIF. The follow-up period ranged from 6 to 21 months(15 months in average). Classification according to injury segment: flexion compression racture 27 cases, burst fracture 42 cases, flexion distraction injury 3 cases, flexion revolving type fracture dislocation 2 cases, shear force type dislocation 2 cases. Classification according Frankel’s grade:A grade 16 cases, B grade 15 cases, C grade 27 cases, D grade 10 cases, E grade 8 cases.Operation duration, volume of bleeding, incidence postoperation complication and effect of reduction fixation were observed. Results The operation duration of ARRIF was 1.2 h in average, and there was about 200 ml volume of bleeding during operation. The nerve function showed one Frankel’s grade improvement after operation were as follows:A grade 8 cases(50%), B grade 11 cases (73.3%), C grade20 cases(74.1%), D grade 3 cases (30%); 2 Frankel’s E cases have no nerve function changes.The nerve function damage have no aggravation in all the patients,the postoperation Cobb’s angle was averagely corrected 22°. The horizontal displacement of dislocation vertebrae was averagely corrected 28% in sagittal plane, the statistical analysis had significant variance(Plt;0.01).ARRIF had no complications of the breakage of screws and rods. Conclusion ARRIF proves to be a valid internal fixator in reducing and fixing different thoracic lumbar segment spine fracture.
Objective To investigate the latest research and the therapeutic development in the injuries to the spine and spinal cord. Methods Literature concerned was reviewed, combined with our own research and clinical experience, to summarize the trend of the researches and their clinical application in the treatment of the injured spine and spinal cord.Results Theposterior approach atlantoaxial stabilization technique changed the conventional wiring technique into the transarticular screw fixation to the plate and pedicle or the lateral mass screw fixation technique. Theclinical application of the transoralpharyngeal atlantoaxial reduction plate fixation technique showed a good effect on the reduction of atlantoaxial dislocation. However, there were no unified criteria for selection of the surgical approach, fixation level, and fusion mode in the treatment of thoracolumbar spinalfractures. Under optimal conditions, both the anterior and the posterior approaches could achieve good clinical effects on decompression and spinal reconstruction. The single level fixation technique showed some advantages in treating certaintypes of thoracolumbar spinal fractures when compared with the traditional cross-sectional fixation. The endoscopy-assistant and image-guiding spinal intervention techniques were evolved in China during these years. In the treatment of the obstinate painful osteoporotic vertebral compressive fracture, percutaneous vertebroplasty and kyphoplasty achieved good results in the pain relief and spinal reconstruction. Numerous basic and clinical researches have given us a further understanding of the medical protection of acute spinal cord injury, and biological treatments have given us new ideas on neural reparation and regeneration. Cell transplantation and gene therapy have become the most promising treatment strategies in this field.Conclusion With the rapid development of spine surgery, the repair and reconstruction ofthe injured spine and spinal cord made a great stride in the recent years.
Objective To explore the feasibility and accuracy of ultrasound volume navigation (UVN) combined with X-ray fluoroscopy-guided percutaneous pedicle screw implantation through a prospective randomized controlled study. Methods Patients with thoracic and lumbar vertebral fractures scheduled for percutaneous pedicle screw fixation between January 2022 and January 2023 were enrolled. Among them, 60 patients met the selection criteria and were included in the study. There were 28 males and 32 females, with an average age of 49.5 years (range, 29-60 years). The cause of injury included 20 cases of traffic accidents, 21 cases of falls, 17 cases of slips, and 2 cases of heavy object impact. The interval from injury to hospital admission ranged from 1 to 5 days (mean, 1.57 days). The fracture located at T12 in 15 cases, L1 in 20 cases, L2 in 19 cases, and L3 in 6 cases. The study used each patient as their own control, randomly guiding pedicle screw implantation using UVN combined with X-ray fluoroscopy on one side of the vertebral body and the adjacent segment (trial group), while the other side was implanted under X-ray fluoroscopy (control group). A total of 4 screws and 2 rods were implanted in each patient. The implantation time and fluoroscopy frequency during implantation of each screw, angle deviation and distance deviation between actual and preoperative planned trajectory by imaging examination, and the occurrence of zygapophysial joint invasion were recorded. Results In terms of screw implantation time, fluoroscopy frequency, angle deviation, distance deviation, and incidence of zygapophysial joint invasion, the trial group showed superior results compared to the control group, and the differences were significant (P<0.05). Conclusion UVN combined with X-ray fluoroscopy-guided percutaneous pedicle screw implantation can yreduce screw implantation time, adjust dynamically, reduce operational difficulty, and reduce radiation damage.
Thoracolumbar fractures are common injuries. Accurate diagnosis and classification are of great significance for guiding treatment. Although there are many classification systems, they have not been universally accepted and used to guide clinical practice. Denis classification, load sharing classification, Magerl/AO classification, and Thoracolumbar Injury Classification and Severity Score have a great clinical influence, but they also have some shortcomings. Recently, some new classifications of thoracolumbar fractures have been proposed, and some of them have been updated and revised, which makes it easy to cause confusion, and puts forward new requirements on how to grasp and apply these classification systems. This article reviews the main and commonly used classification systems of thoracolumbar fractures, discusses the main viewpoints, advantages and disadvantages of each classification system, and looks ahead to the future research direction.
目的 評價微創椎弓根釘內固定技術治療胸腰椎爆裂骨折的中期臨床療效。 方法 2002年9月－2007年9月，采用微創椎弓根釘內固定技術治療胸腰椎爆裂骨折30例。其中男16例，女14例;年齡18～65歲，平均39.8歲。骨折節段:胸11者3例， 胸12者13例， 腰1者12例， 腰者22例。所有骨折按AO分型，均為A3型。受傷至手術時間6 h～6 d，平均45 h。分析術后影像學指標、疼痛評分及功能障礙指數。 結果 患者均獲隨訪，隨訪時間3～9年，平均5.2年。術后各時間點傷椎前緣高度及后凸Cobb角均較術前明顯恢復（P＜0.01）。術后傷椎高度隨隨訪時間延長逐漸下降，后凸Cobb角逐漸增大。取出內固定物后、術后2年、末次隨訪時動力位X線片上骨折椎體前后相對滑移距離分別為（1.9 ± 0.3）、（2.1 ± 0.2）、（2.1 ± 0.3）mm，兩兩比較差異無統計學意義（P＞0.05）。術后1、2年及末次隨訪時疼痛視覺模擬評分分別為（2.5 ± 1.2）、（2.5 ± 1.1）、（2.4 ± 1.3）分，兩兩比較差異無統計學意義（P＞0.05）。末次隨訪時Denis腰痛分級：P1級13例，P2級12例，P3級5例。功能障礙指數為（11.4 ± 3.1）分，獲優23例、良5例、可2例。 結論 單純微創椎弓根釘內固定技術治療胸腰椎爆裂骨折中期臨床效果滿意，脊柱穩定性良好。Objective To mid-term efficacy of the technique of minimally invasive pedicle screw fixation on thoracolumbar burst fracture. Methods From September 2002 to September 2007, 30 patients were treated with minimally invasive pedicle screw fixation for thoracolumbar fracture. There were 16 males and 14 females with the mean age of 39.8 years (range,18-65 years). The injured level of was T11 in 3 cases, T12 in 13 cases, L1 in 12 cases, and L2 in 2 cases. The type of thoracolumbar fractures of all the patients was A3 according to AO classification. The during from injury to operation was 6 hours to 6 days with an average of 45 hours. The index of image and pain and disability index were evaluated after operation. Results All patients were followed up for 3 to 9 years with the mean of 5.2 years. Their average sliding distance after operation for removing internal fixation was (1.9 ± 0.3), and (2.1 ± 0.2) mm 2 years after the operation and (2.1 ± 0.3) mm at the latest follow-up. There was no significant difference (P＞0.05). Their average score was (2.51 ± 1.2) 1 year after the operation, was (2.42 ± 1.1) 2 year after the operation, and was (2.36 ± 1.3) at the latest follow-up (P＞0.05). According to Denis score system to evaluate index of lumbago, there was P1 in 13 cases, P2 in 12 cases, and P3 in 5 cases. The score of Oswestry Disability Index (ODI) was 11.4 ± 3.1 at the latest follow-up. Twenty-one cases gotexcellent therapeutic result, five cases got good and two were moderate. Conclusions Minimally invasive pedicle screw fixation for the treatment of thoracolumbar burst fracture provide satisfactory clinical results. The vertebral body and adjacent vertebral body have a good stability.
Thoracolumbar injury is a common injury in clinic. Accurate diagnosis and classification is of great significance for guiding treatment. Although there are many typing systems, no typing system has been widely accepted and used to guide clinical practice. Denis classification, spinal load classification, thoracolumbar injury classification system and severity score or thoracolumbar injury classification and severity score and AO classification have great influence in clinical practice, but they all have some shortcomings. In recent years, the classification of thoracolumbar injury has been updated, modified and supplemented constantly. When using these fracture types in clinical practice, different people often have some deviation. This paper reviews the widely used thoracolumbar injury classification system, discusses the main viewpoints, advantages and disadvantages of each classification system, and looks into the future research direction based on the current research progress.
目的:總結汶川大地震期間合并有多發傷的脊柱骨折的臨床特點和治療經驗。方法:回顧分析汶川大地震期間四川大學華西醫院收治的281例脊柱骨折,其中223例合并有多發傷,分析其臨床特點和治療方式。結果:223例合并多發傷的脊柱骨折中單純椎體骨折138例,單純附件損傷37例,椎體+附件骨折48例;平均年齡43.45±14.05歲;椎體分布以下胸段和腰段為主,胸腰段占60%左右;致傷原因中砸傷占82.1%;脊柱手術治療35例,占需手術治療的27.8%;合并傷共267例次;嚴重并發癥127例次;合并脊髓或馬尾神經損傷101例,占45.3%,有15例在搬運中發生脊髓損傷。結論:汶川大地震發生在山區,地震烈度高,傷員多為復合傷,存在嚴重的并發癥,受累椎體多,治療的重點首先放在處理開放傷、感染、并發癥上,影響了脊柱骨折的治療;早期救援時正確施救才能有效防范繼發性脊髓損傷。
ObjectiveTo evaluate the feasibility and short-term effectiveness of bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach for osteoporotic vertebral compression fracture (OVCF) of lumbar.MethodsA retrospective analysis was made on the clinical data of 93 patients with OVCF of lumbar who met the selection criteria between January 2018 and June 2019. According to the different surgical methods, they were divided into group A (44 cases, treated with bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach) and group B [49 cases, treated with percutaneous kyphoplasty (PKP) via bilateral transpedicle approach]. There was no significant difference in gender, age, body mass index, T value of bone mineral density, injury cause, fractured level, time from injury to operation, comorbidities, and preoperative Cobb angle of injured vertebra, visual analogue scale (VAS) score, and Oswestry disability index (ODI) between the two groups (P>0.05). The operation time, intraoperative fluoroscopy times, bone cement injection amount, and incidence of bone cement leakage were recorded and compared between the two groups; Cobb angle of the injured vertebrae, VAS score, and ODI were measured before operation, at 2 days and 1 year after operation. The contralateral distribution ratio of bone cement was calculated according to the anteroposterior X-ray film at 2 days after operation.ResultsThe operation time and the intraoperative fluoroscopy times in group A were significantly less than those in group B (P<0.05). There was no bone cement adverse reactions, cardiac and cerebrovascular adverse events, and no complications such as puncture needles erroneously inserted into the spinal canal and nerve injuries occurred in the two groups. Bone cement leakage occurred in 6 cases and 8 cases in groups A and B, respectively, all of which were asymptomatic paravertebral or intervertebral leakage, and no intraspinal leakage occurred; the bone cement injection amount and incidence of bone cement leakage between the two groups showed no significant differences (P>0.05). The contralateral distribution ratio of bone cement in group A was significantly lower than that in group B (t=2.685, P=0.009). Patients in both groups were followed up 12-20 months, with an average of 15.3 months. The Cobb angle of the injured vertebrae, VAS score, and ODI in the two groups were significantly improved at 2 days after operation, however, the Cobb angle of the injured vertebra at 1 year after operation was significantly lost when compared with the 2 days after operation, the VAS score and ODI at 1 year after operation were significantly further improved when compared with the 2 days after operation, the differences were all significant (P<0.05). There was no significant difference in the Cobb angle of the injured vertebrae, VAS score, and ODI between the two groups at each time point after operation (P>0.05).ConclusionBilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach is comparable to bilateral PKP in short-term effectiveness with regard to fracture reduction, reduction maintenance, pain relief, and functional improvement. It has great advantages in reducing operation time and radiation exposure, although it is inferior in bone cement distribution.
Objective To study the clinical effects of the artificial vertebral body of the biomimetic nanohydroxyapatite/polyamide 66 (nHA/PA66) compositefor the structural reconstruction and the height restoring of the vertebral body in the thoracolumbar fractures by the anterior surgical procedures. Methods From December 2003 to January 2006, 42 patients with thoracolumbar fractures received the anterior surgical procedures to decompress and reconstruct the spinal vertebral structure with the artificial vertebral body of the nHA/PA66 composite. Among the patients, there were 28 males and 14 females, aged 1767 years, averaged 43.6 years. The thoracolumbar fractures developed at T12 in 5 patients, at L1 in 17, at L2 in 14, and at L3 in 6. The height of the anterior border of thevertebral body amounted to 29%-47% of the vertebral body height, averaged 40.6%.The Cobb angle on the sagittal plane was 2138° averaged 27.6°. According tothe Frankel grading scale, the injuries to the nerves were as the following: Grade A in 7 patients, Grade B in 19, Grade C in 8, Grade D in 6, and Grade E in 2. Results All the 42 patients were followed up for 625 months. Among the patients, 36 were reconstructed almost based on the normal anatomic structure, and 6 were well reconstructed. The mean height of the anterior border of the vertebralbody was 40.6% of the vertebral body height before operation but 91.7% after operation. And the reconstructed height of the vertebra was maintained. The mean Cobb angle on the sagittal plane was 27.6°before operation but 13.4° after operation. All the patients had a recovery of the neurological function that had a 1grade or 2grade improvement except 7 patients who were still in Grade A and 2 patients who were in Grade D. The implant was fused 35 months after operation. No infection, nail break, bar/plate break or loosening of the internal fixation occurred. Conclusion The artificial vertebral body of the biomimetic nHA/PA66 composite can effectively restore the height and the structure of the vertebra, can be fused with the vertebral body to reconstruct the spinal structural stability effectively, and can be extensively used in the clinical practice.