Objective:To study the clinical effect of minimally invasive single-segment reduction and internal fixation in patients with thoracolumbar fractures.Methods:From June 2013 to June 2014,100 patients with thoracolumbar ...Objective:To study the clinical effect of minimally invasive single-segment reduction and internal fixation in patients with thoracolumbar fractures.Methods:From June 2013 to June 2014,100 patients with thoracolumbar fractures were selected as the subjects and they were randomly divided into observation group(50 cases)and control group(50 cases).The patients in the observation group were treated with minimally invasive singlesegment reduction and internal fixation.The patients in the control group were treated with short segmental fixation.The clinical effects of the two groups were compared.Results:There was no significant difference in the compression rate and Cobb angle between the two groups before and after operation(P>0.05).For all patients who were followed up for the last time,the Cobb angle was significantly lower in the observation group than in the control group(P<0.05).The social function,affective function and physical pain score of the observation group were significantly better than the control group(P<0.05).The amount of bleeding in the observation group was(250.4±41.0)ml,which was significantly lower than that in the control group(267.5±32.8)ml.The time required for the operation was(90.2±35.4)min,which was significantly lower than that of the control group(104.5±22.6)min(P<0.05).After treatment,the prognosis was 70.00%and the excellent and good rate was 98.00%,which was significantly higher than that of the control group(46.00%)and 78.00%(P<0.05).Conclusion:Thoracolumbar fractures in patients with dilated channel minimally invasive single-segment reduction and internal fixation treatment can effectively repair the patient's vertebral height and Cobb angle and the degree of correction after surgery was significantly better,safer and worthy of clinical recommended use.展开更多
Study Design: Original article. Objective: Guidelines for deciding whether to perform open or percutaneous surgery in burst fractures. Summary of Background Data: The authors propose an algorithm for deciding whether ...Study Design: Original article. Objective: Guidelines for deciding whether to perform open or percutaneous surgery in burst fractures. Summary of Background Data: The authors propose an algorithm for deciding whether to perform open surgery or percutaneous surgery with short fixation in patients with fractures of the thoracolumbar junction and lumbar spine. Methods: Between July 2005 and July 2009, 72 patients underwent surgical stabilization by posterior route for fractures of the thoracolumbar junction and lumbar spine. In 44 the lesion involved the thoracolumbar junction, in 28 the lumbar spine (L2 in6 cases, L3 in15 cases, L5 in7 cases). The fractures were assessed morphologically according to Magerl’s classification (52 type A, 12 type B, 8 type C). All patients were analyzed according to the algorithm proposed, according to which patients must fulfil certain criteria: the fracture must be Magerl type A.3, it must involve one level, McCormack score must be 6 or less, invasion of the spinal canal must be 25% or less according to Hashimoto’s formula, Magnetic Resonance Imating (MRI) must confirm discoligamentous integrity. Neurologically, the patient must be ASIA E. 25 patients (17 thoracolumbar junction, 8 lumbar spine) fulfilled these criteria and were treated by percutaneous short fixation. Results: The average length of the surgical procedure was 80 minutes and the loss of blood 10 cc. All patients were dismissed without brace and were submitted to follow-upComputed Tomography CTscan 3 and 6 months after surgery. Follow-up ranged from 6 months to 4 years. In all cases CT scan confirmed fusion and there were no cases of rupture of the device. None of the patients presented neurological deficits. Conclusion: The algorithm described permits a proper selection of patients with thoracolumbar fractures who can be treated by percutaneous short fixation, thus avoiding the risks connected with failure of the stabilization system.展开更多
BACKGROUND Older people are more likely to experience pelvic fractures than younger people.Multi-slice spiral computed tomography(CT)uses three-dimensional(3D)reconstruction technology to generate 3D images that can c...BACKGROUND Older people are more likely to experience pelvic fractures than younger people.Multi-slice spiral computed tomography(CT)uses three-dimensional(3D)reconstruction technology to generate 3D images that can clearly demonstrate the 3D space of fractures and detect fractures at a higher rate.AIM To investigate the clinical value of multi-slice spiral CT 3D reconstruction in the diagnosis of unstable pelvic fractures in the elderly as well as the effect of less invasive stabilization.METHODS A total of 86 patients with unstable pelvic fractures treated between March 2016 and March 2019 underwent femoral supracondylar bone traction before surgery.Pelvic radiography and multi-row spiral CT were performed successively once the patient’s vital signs and hemodynamic indices were stable.Secondary processing of the original data was performed to obtain 3D reconstruction images and determine the vertical displacement of the pelvis.After basic or complete reduction,minimally invasive internal fixation using hollow lag screws was performed.The detection rates of fracture location and classification by X-ray and CT reconstruction were compared.Patients were divided into two groups according to the presence or absence of preoperative 3D reconstruction to compare postoperative reduction,wound healing time,fracture healing time,hospitalization time,visual analog scale(VAS)score,poor internal fixation,and functional recovery.RESULTS The diagnostic coincidence rates of X-rays for pubic symphysis,ilium wing,sacroiliac periarticular,and sacral fractures were lower than those of CT reconstruction.The coincidence rate of CT reconstruction in the clinical classification of pelvic fractures was 100%,whereas 11 cases were misdiagnosed by X-ray;the total coincidence rate was 87.21%.The total excellent and good rates of postoperative reduction were significantly higher in the study group than in the control group(P<0.05).The wound healing,fracture healing,and hospitalization times were significantly shorter in the study group than in the control group(P<0.05).The VAS scores decreased in both groups postoperatively and were lower in the study group than in the control group(P<0.05).The total incidence of poor postoperative internal fixation was significantly lower in the study group than in the control group(P<0.05).The overall rate of postoperative functional recovery was significantly higher in the study group than in the control group(P<0.05).CONCLUSION Multi-slice spiral CT has high guiding significance for the diagnosis,classification,and treatment of unstable pelvic fractures in the elderly.Preoperative 3D reconstruction can effectively shorten the operation time and promote fracture healing,while minimally invasive internal fixation can effectively reduce pain and promote functional recovery of fracture sites,making it worthy of clinical application.展开更多
目的应用有限元分析法,探究以不同置钉角度三螺钉固定治疗SandersⅡB型跟骨骨折的生物力学稳定性.方法应用Mimics Medical 19.0软件建立跟骨三维模型,通过Geomagic Wrap软件及Sliodworks软件对跟骨三维模型进行切割及装配操作,建立Sand...目的应用有限元分析法,探究以不同置钉角度三螺钉固定治疗SandersⅡB型跟骨骨折的生物力学稳定性.方法应用Mimics Medical 19.0软件建立跟骨三维模型,通过Geomagic Wrap软件及Sliodworks软件对跟骨三维模型进行切割及装配操作,建立SandersⅡB型跟骨骨折及不同内固定模型:(1)1枚螺钉经跟骨结节内侧、外侧和跟骨外侧壁固定载距突,其余2枚螺钉经跟骨后方向跟骰关节方向固定(纵行方向交叉、水平方向平行),模型共计三组(A组、B组、C组);(2)1枚螺钉经跟骨结节内侧、外侧和跟骨外侧壁固定载距突,其余2枚螺钉经跟骨后方向跟骰关节方向固定(纵行方向交叉、水平方向交叉),模型共计三组(D组、E组、F组);(3)1枚螺钉经跟骨结节内侧、外侧和跟骨外侧壁固定载距突,1枚螺钉经跟骨后方固定跟骨外侧壁,最后1枚螺钉经跟骨后方固定跟骰关节(纵行方向平行、水平方向平行),模型共计三组(G组、H组、I组).运用Ansys 17.0软件对9组模型进行参数设定并进行有限元分析,分析跟骨整体骨块应力、螺钉应力、骨折块位移及螺钉形变情况.结果在相同条件加载下,内固定模型D组和E组在跟骨整体等效应力、螺钉受力等效应力、骨折块位移及螺钉形变方面均小于其他7组模型.结论1枚螺钉经跟骨结节内侧或外侧向固定载距突,另2枚螺钉经跟骨后方固定跟骰关节(纵行方向交叉、水平方向交叉)时,更符合跟骨生物力学特征,可为临床SandersⅡB型跟骨骨折螺钉内固定治疗提供参考.展开更多
文摘Objective:To study the clinical effect of minimally invasive single-segment reduction and internal fixation in patients with thoracolumbar fractures.Methods:From June 2013 to June 2014,100 patients with thoracolumbar fractures were selected as the subjects and they were randomly divided into observation group(50 cases)and control group(50 cases).The patients in the observation group were treated with minimally invasive singlesegment reduction and internal fixation.The patients in the control group were treated with short segmental fixation.The clinical effects of the two groups were compared.Results:There was no significant difference in the compression rate and Cobb angle between the two groups before and after operation(P>0.05).For all patients who were followed up for the last time,the Cobb angle was significantly lower in the observation group than in the control group(P<0.05).The social function,affective function and physical pain score of the observation group were significantly better than the control group(P<0.05).The amount of bleeding in the observation group was(250.4±41.0)ml,which was significantly lower than that in the control group(267.5±32.8)ml.The time required for the operation was(90.2±35.4)min,which was significantly lower than that of the control group(104.5±22.6)min(P<0.05).After treatment,the prognosis was 70.00%and the excellent and good rate was 98.00%,which was significantly higher than that of the control group(46.00%)and 78.00%(P<0.05).Conclusion:Thoracolumbar fractures in patients with dilated channel minimally invasive single-segment reduction and internal fixation treatment can effectively repair the patient's vertebral height and Cobb angle and the degree of correction after surgery was significantly better,safer and worthy of clinical recommended use.
文摘Study Design: Original article. Objective: Guidelines for deciding whether to perform open or percutaneous surgery in burst fractures. Summary of Background Data: The authors propose an algorithm for deciding whether to perform open surgery or percutaneous surgery with short fixation in patients with fractures of the thoracolumbar junction and lumbar spine. Methods: Between July 2005 and July 2009, 72 patients underwent surgical stabilization by posterior route for fractures of the thoracolumbar junction and lumbar spine. In 44 the lesion involved the thoracolumbar junction, in 28 the lumbar spine (L2 in6 cases, L3 in15 cases, L5 in7 cases). The fractures were assessed morphologically according to Magerl’s classification (52 type A, 12 type B, 8 type C). All patients were analyzed according to the algorithm proposed, according to which patients must fulfil certain criteria: the fracture must be Magerl type A.3, it must involve one level, McCormack score must be 6 or less, invasion of the spinal canal must be 25% or less according to Hashimoto’s formula, Magnetic Resonance Imating (MRI) must confirm discoligamentous integrity. Neurologically, the patient must be ASIA E. 25 patients (17 thoracolumbar junction, 8 lumbar spine) fulfilled these criteria and were treated by percutaneous short fixation. Results: The average length of the surgical procedure was 80 minutes and the loss of blood 10 cc. All patients were dismissed without brace and were submitted to follow-upComputed Tomography CTscan 3 and 6 months after surgery. Follow-up ranged from 6 months to 4 years. In all cases CT scan confirmed fusion and there were no cases of rupture of the device. None of the patients presented neurological deficits. Conclusion: The algorithm described permits a proper selection of patients with thoracolumbar fractures who can be treated by percutaneous short fixation, thus avoiding the risks connected with failure of the stabilization system.
文摘BACKGROUND Older people are more likely to experience pelvic fractures than younger people.Multi-slice spiral computed tomography(CT)uses three-dimensional(3D)reconstruction technology to generate 3D images that can clearly demonstrate the 3D space of fractures and detect fractures at a higher rate.AIM To investigate the clinical value of multi-slice spiral CT 3D reconstruction in the diagnosis of unstable pelvic fractures in the elderly as well as the effect of less invasive stabilization.METHODS A total of 86 patients with unstable pelvic fractures treated between March 2016 and March 2019 underwent femoral supracondylar bone traction before surgery.Pelvic radiography and multi-row spiral CT were performed successively once the patient’s vital signs and hemodynamic indices were stable.Secondary processing of the original data was performed to obtain 3D reconstruction images and determine the vertical displacement of the pelvis.After basic or complete reduction,minimally invasive internal fixation using hollow lag screws was performed.The detection rates of fracture location and classification by X-ray and CT reconstruction were compared.Patients were divided into two groups according to the presence or absence of preoperative 3D reconstruction to compare postoperative reduction,wound healing time,fracture healing time,hospitalization time,visual analog scale(VAS)score,poor internal fixation,and functional recovery.RESULTS The diagnostic coincidence rates of X-rays for pubic symphysis,ilium wing,sacroiliac periarticular,and sacral fractures were lower than those of CT reconstruction.The coincidence rate of CT reconstruction in the clinical classification of pelvic fractures was 100%,whereas 11 cases were misdiagnosed by X-ray;the total coincidence rate was 87.21%.The total excellent and good rates of postoperative reduction were significantly higher in the study group than in the control group(P<0.05).The wound healing,fracture healing,and hospitalization times were significantly shorter in the study group than in the control group(P<0.05).The VAS scores decreased in both groups postoperatively and were lower in the study group than in the control group(P<0.05).The total incidence of poor postoperative internal fixation was significantly lower in the study group than in the control group(P<0.05).The overall rate of postoperative functional recovery was significantly higher in the study group than in the control group(P<0.05).CONCLUSION Multi-slice spiral CT has high guiding significance for the diagnosis,classification,and treatment of unstable pelvic fractures in the elderly.Preoperative 3D reconstruction can effectively shorten the operation time and promote fracture healing,while minimally invasive internal fixation can effectively reduce pain and promote functional recovery of fracture sites,making it worthy of clinical application.
文摘目的应用有限元分析法,探究以不同置钉角度三螺钉固定治疗SandersⅡB型跟骨骨折的生物力学稳定性.方法应用Mimics Medical 19.0软件建立跟骨三维模型,通过Geomagic Wrap软件及Sliodworks软件对跟骨三维模型进行切割及装配操作,建立SandersⅡB型跟骨骨折及不同内固定模型:(1)1枚螺钉经跟骨结节内侧、外侧和跟骨外侧壁固定载距突,其余2枚螺钉经跟骨后方向跟骰关节方向固定(纵行方向交叉、水平方向平行),模型共计三组(A组、B组、C组);(2)1枚螺钉经跟骨结节内侧、外侧和跟骨外侧壁固定载距突,其余2枚螺钉经跟骨后方向跟骰关节方向固定(纵行方向交叉、水平方向交叉),模型共计三组(D组、E组、F组);(3)1枚螺钉经跟骨结节内侧、外侧和跟骨外侧壁固定载距突,1枚螺钉经跟骨后方固定跟骨外侧壁,最后1枚螺钉经跟骨后方固定跟骰关节(纵行方向平行、水平方向平行),模型共计三组(G组、H组、I组).运用Ansys 17.0软件对9组模型进行参数设定并进行有限元分析,分析跟骨整体骨块应力、螺钉应力、骨折块位移及螺钉形变情况.结果在相同条件加载下,内固定模型D组和E组在跟骨整体等效应力、螺钉受力等效应力、骨折块位移及螺钉形变方面均小于其他7组模型.结论1枚螺钉经跟骨结节内侧或外侧向固定载距突,另2枚螺钉经跟骨后方固定跟骰关节(纵行方向交叉、水平方向交叉)时,更符合跟骨生物力学特征,可为临床SandersⅡB型跟骨骨折螺钉内固定治疗提供参考.
