This is an expert consensus on the evaluation and treatment of thoracolumbar spinal injury, estab- lished from February 2009 to July 2010. The expert consensus consists mainly of six parts with a total of 54 recommend...This is an expert consensus on the evaluation and treatment of thoracolumbar spinal injury, estab- lished from February 2009 to July 2010. The expert consensus consists mainly of six parts with a total of 54 recommendations including the overview （one item）; pre-hospital care （one item）; evaluation and diagnosis （13 items）; treatment （23 items）; prevention and treatment of major com- plications （12 items）; and rehabilitation （four items）. This is the first time that Chinese experts have published a consensus on spine and spinal cord injury. The expert consensus was established based on Delphi methods, literature analysis, and clinical experiences. Each recommendation is supported by and was interpreted using multi-level evidences. The level of agreement with the rec- ommendation among the panel members was assessed as either low, moderate, or strong. Each panel member was asked to indicate his or her level of agreement on a 5-point scale, with ＂1＂ cor- respondJng to neutrality and ＂5＂ representJng maxJmum agreement. Scores were aggregated across the panel members and an arithmetic mean was calculated. This mean score was then translated into low, moderate, or strong. After all of the votes were collected and calculated, the results showed no low-level recommendations, 10 moderate-level recommendations, and 44 strong-level recom- mendations. An expert consensus was reached and was recognized by Chinese spine surgeons. Wide-scale adoption of these recommendations is urgent in the management of acute thora- columbar spine and spinal cord injury in a broader attempt to create a standard evaluation and treatment strategy for acute thoracolumbar spine and spinal cord injury in China.展开更多
<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> Thoracolumbar spine fr...<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> Thoracolumbar spine fracture-dislocations are very unstable and usually secondary to high energy trauma. Due to disruption of the entire vertebrae columns, the absence of neurological deficit is exceptional. </span><b><span style="font-family:Verdana;">Aim: </span></b><span style="font-family:Verdana;">The purpose of this work is to report our experience in the management of this entity in a context of limited resources and to make a review of the literature. </span><b><span style="font-family:Verdana;">Case presentation: </span></b><span style="font-family:Verdana;">A 30-year-old man was admitted with a severe low back pain after a traffic accident. Neurological functions were intact after examination. Radiological assessments revealed a complete L3-L4 fracture-dislocation.</span></span><span style="font-family:""><span style="font-family:Verdana;"> The patient underwent an open posterior reduction and internal long segment fixation. The post-operative was marked by a surgical site infection treated with surgical debridement and targeted antibiotic therapy. The neurological functions were preserved. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Fracture-dislocations of the thoracolumbar spine</span><span style="color:red;"> </span></span><span style="font-family:Verdana;">are</span><span style="font-family:Verdana;"> caused by high energy trauma and are remarkably unstable lesions. When they are associated with intact neurorological functions, reduction and stabilization of these fractures are a challenge.展开更多
Spine fractures account for a large portion of musculoskeletal injuries worldwide. A classification of spine fractures is necessary in order to develop a common language for treatment indications and outcomes. Several...Spine fractures account for a large portion of musculoskeletal injuries worldwide. A classification of spine fractures is necessary in order to develop a common language for treatment indications and outcomes. Several classification systems have been developed based on injury anatomy or mechanisms of action, but they have demonstrated poor reliability, have yielded little prognostic information, and have not been widely used. For this reason, the Arbeitsgemeinschaftfür Osteosynthesefragen(AO) committee has classified thorocolumbar spine injuries based on the pathomorphological criteria into3 types(A: Compression; B: Distraction; C: Axial torque and rotational deformity). Each of these types is further divided into 3 groups and 3 subgroups reflecting progressive scale of morphological damage and the degree of instability. Because of its highly detailed sub classifications, the AO system has shown limited interobserver variability. It is similar to its predecessors in that it does not incorporate the patient's neurologic status.The need for a reliable, reproducible, clinically relevant, prognostic classification system with an optimal balance of ease of use and detail of injury description contributed to the development of a new classification system, the thoracolumbar injury classification and severity score(TLICS). The TLICS defines injury based on three clinical characteristics: injury morphology, integrity of the posterior ligamentous complex, and neurologic status of the patient. The severity score offers prognostic information and is helpful in decision making about surgical vs nonsurgical management.展开更多
Between 1990 and 1996, 15 patients with thoracolumbar spine fracture complicated by simple conusmedullaris injury were admitted. All patients were Injured by falling from height (mean, o meters). Clinical symp-toms in...Between 1990 and 1996, 15 patients with thoracolumbar spine fracture complicated by simple conusmedullaris injury were admitted. All patients were Injured by falling from height (mean, o meters). Clinical symp-toms indicated hypoesthesia or anesthesia of S3-5 sensory region,dysporia and urinary dysfunction. but normal sensation and motion of the bilateral lower extremities. Waston-Jones classified the spinal cord and nerve root injury following thoracolumbar spine fracture into three types. According to our observations, it should be classfied into five types: 1) concussion of the conus medullaris; 2) simple incomplete injury of the conus medullaris; 3) simplecomplete injury of the conus medullaris; 4) spinal cord transection and partial nerve root injury; 5) spinal cordtransection and entire nerve root injury.展开更多
Background: Long segment transpedicular screw fixation in thoracolumbar spine injury has gained popularity in the last decades as it provides immediate stability, prevents further risk of complications and allows earl...Background: Long segment transpedicular screw fixation in thoracolumbar spine injury has gained popularity in the last decades as it provides immediate stability, prevents further risk of complications and allows early mobilization of patient. Objectives: Evaluation of clinical and functional outcome after long segment transpedicular screw fixation in unstable thoracolumbar spine injury with incomplete neurological deficit patients. Methods: This quasi experimental study was conducted at Dhaka Medical College and Hospital (DMCH), Dhaka, Bangladesh from January 2016 to December 2017. A total of twenty four (24) patients with traumatic unstable fracture of the thoracolumbar spine with incomplete neurological deficit underwent long segment transpedicular screw fixation were included in this study. Clinical and radiologic outcomes were assessed pre-operatively and post-operatively. Results: A total of 24 patients aged between 20 - 60 years of both sexes (Male-21, Female-03) were included in this study. Their mean (±SD) age was 33.12 (±8.57) years. Most of them were farmer [09 (37.5%)] and day labour [08 (33.33%)]. Motor vehicle accidents were the most common [16 (66.67%)] cause of injury and then fall from height [08 (33.33%)]. The most common level of injury involved was L1-10 (41.67%) patients, followed by L2-07 (29.17%), T12-05 (20.83%) and T11-02 (8.33%) of the study patients. Burst fracture was the commonest [22 (91.67%)] type of fracture followed by Chance fracture [02 (8.33%)]. Pre-operative mean (±SD) Cobb angle, Kyphotic deformation of vertebral body, Beck index and vertebral compression deformity were 21.83 ± 4.5 degrees, 22.09 ± 4.40 degrees, 0.78 ± 2.65 and 0.18 ± 0.93 mm respectively, after procedure which were significantly (p Conclusions: Long segment transpedicular screw fixation is an effective method of treatment in patients having thoracolumbar spine injury with incomplete neurological deficit.展开更多
The thoracolumbar spine,due to its large range of motion and relatively fragile anatomical structure,is prone to traumatic fractures and has become one of the common types of fractures in clinical practice.Thoracic an...The thoracolumbar spine,due to its large range of motion and relatively fragile anatomical structure,is prone to traumatic fractures and has become one of the common types of fractures in clinical practice.Thoracic and lumbar fractures may lead to spinal instability,spinal stenosis,etc.,and early restoration of vertebral height and sequence is necessary.Although the technique of transpedicular screw internal fixation for traumatic vertebrae is effective in the short term,in the long run,there may be adverse situations such as fixation breakage and loosening,leading to loss of vertebral height and kyphosis deformity.The technique of internal fixation of injured vertebrae with screws is considered to minimize postoperative complications and is worthy of promotion and use.With the advancement of medical technology,imaging,and biomechanics,the treatment methods for thoracolumbar spinal fractures are becoming increasingly diverse.展开更多
背景:脊柱骨折最高发部位是胸腰段,其症状为后背部疼痛、后凸畸形、活动受限,或伴脊髓神经损伤引发下肢疼痛、麻木甚至截瘫等并发症。有限元法是一种数字化的计算机建模技术,能真实模拟实物模型并进行受力分析。目的:综述有限元法在脊...背景:脊柱骨折最高发部位是胸腰段,其症状为后背部疼痛、后凸畸形、活动受限,或伴脊髓神经损伤引发下肢疼痛、麻木甚至截瘫等并发症。有限元法是一种数字化的计算机建模技术,能真实模拟实物模型并进行受力分析。目的:综述有限元法在脊柱胸腰段骨折中的应用。方法:在中英文文献数据库PubMed、Web of Science、中国知网中检索2024年3月之前发表的有限元分析法在脊柱胸腰段骨折中应用的相关文献,中英文检索词为“有限元分析法(finite element analysis methods)”“生物力学(biomechanical phenomena)”“应力分析(stress analysis)”“胸腰椎骨折(thoracolumbar fractures)”“脊柱骨折(spinal fractures)”,最终纳入55篇文献。结果与结论:①通过有限元法对不同病因(骨质疏松性、创伤性、病理性)导致的胸腰椎骨折进行探索,有利于对各种类型胸腰椎骨折的生物力学特征有更加深刻的认识,完善对胸腰椎骨折的个性化和精细化治疗;②单一样本或数量较少样本的有限元分析具有偶然性,未来的有限元分析需要更大的样本数量来减少样本偶然性带来的误差;③仅骨骼的刚性结构不能满足实物的完整性所具有的生物力学工况,未来的有限元模型需要尽可能纳入实物的所有结构(例如肌肉、韧带等软组织);④有限元法在骨质疏松性和创伤性胸腰椎骨折方面的研究较多,未来需要进行更加深入的研究;病理性胸腰椎骨折领域的研究较少,未来研究范围较广。展开更多
Paraplegic gait orthosis has been shown to help paraplegic patients stand and walk, although this method cannot be individualized for patients with different spinal cord injuries and functional recovery of the lower e...Paraplegic gait orthosis has been shown to help paraplegic patients stand and walk, although this method cannot be individualized for patients with different spinal cord injuries and functional recovery of the lower extremities. There is, however, a great need to develop individualized paraplegic orthosis to improve overall quality of life for paraplegic patients. In the present study, 36 spinal cord（below T4） injury patients were equally and randomly divided into control and observation groups. The control group received systematic rehabilitation training, including maintenance of joint range of motion, residual muscle strength training, standing training, balance training, and functional electrical stimulation. The observation group received an individualized paraplegic locomotion brace and functional training according to the various spinal cord injury levels and muscle strength based on comprehensive systematic rehabilitation training. After 3 months of rehabilitation training, the observation group achieved therapeutic locomotion in 8 cases, family-based locomotion in 7 cases, and community-based locomotion in 3 cases. However, locomotion was not achieved in any of the control group patients. These findings suggest that individualized paraplegic braces significantly improve activity of daily living and locomotion in patients with thoracolumbar spinal cord injury.展开更多
目的探讨骨质疏松性椎体压缩骨折(OVCF)合并胸腰筋膜损伤(TFI)患者在椎体强化术后的临床疗效。方法选取2022年11月至2023年8月川北医学院附属医院骨科收治的81例采用经皮椎体球囊后凸成形术(PKP)治疗的OVCF患者为研究对象,根据是否合并...目的探讨骨质疏松性椎体压缩骨折(OVCF)合并胸腰筋膜损伤(TFI)患者在椎体强化术后的临床疗效。方法选取2022年11月至2023年8月川北医学院附属医院骨科收治的81例采用经皮椎体球囊后凸成形术(PKP)治疗的OVCF患者为研究对象,根据是否合并TFI进行分组,将合并TFI的患者作为TFI组(n=36),未合并TFI患者作为NTFI组(n=45)。比较两组患者年龄、性别、住院时间、骨密度等一般资料;手术时间、术中出血量、伤椎节段(T10-L2、L3-I5)占比、单侧或双侧穿刺占比、骨水泥注射量等术中指标。分别采用视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评估患者腰部疼痛程度和腰椎功能改善情况。结果两组患者伤椎节段占比、手术时间、术中出血量、单或双侧穿刺占比比较,差异均无统计学意义(P>0.05)。两组患者术前、术后3 d VAS、ODI评分比较,差异均无统计学意义(P>0.05)。TFI组患者术后1、3个月VAS、ODI评分均高于NTFI组患者(P<0.05)。结论TFI组患者在采用PKP治疗后3个月内,腰椎疼痛缓解程度和腰椎功能改善情况均较NTFI组患者差,TFI可作为OVCF合并TFI患者在椎体强化术后临床疗效观察的有效指标。展开更多
基金supported by the Capital Medical Development Foundation of Beijing,No.2005-2016the Scientific and Technique Fund of the Chinese PLA during the Eleventh Five-Year Plan Period,No.06G028
文摘This is an expert consensus on the evaluation and treatment of thoracolumbar spinal injury, estab- lished from February 2009 to July 2010. The expert consensus consists mainly of six parts with a total of 54 recommendations including the overview （one item）; pre-hospital care （one item）; evaluation and diagnosis （13 items）; treatment （23 items）; prevention and treatment of major com- plications （12 items）; and rehabilitation （four items）. This is the first time that Chinese experts have published a consensus on spine and spinal cord injury. The expert consensus was established based on Delphi methods, literature analysis, and clinical experiences. Each recommendation is supported by and was interpreted using multi-level evidences. The level of agreement with the rec- ommendation among the panel members was assessed as either low, moderate, or strong. Each panel member was asked to indicate his or her level of agreement on a 5-point scale, with ＂1＂ cor- respondJng to neutrality and ＂5＂ representJng maxJmum agreement. Scores were aggregated across the panel members and an arithmetic mean was calculated. This mean score was then translated into low, moderate, or strong. After all of the votes were collected and calculated, the results showed no low-level recommendations, 10 moderate-level recommendations, and 44 strong-level recom- mendations. An expert consensus was reached and was recognized by Chinese spine surgeons. Wide-scale adoption of these recommendations is urgent in the management of acute thora- columbar spine and spinal cord injury in a broader attempt to create a standard evaluation and treatment strategy for acute thoracolumbar spine and spinal cord injury in China.
文摘<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> Thoracolumbar spine fracture-dislocations are very unstable and usually secondary to high energy trauma. Due to disruption of the entire vertebrae columns, the absence of neurological deficit is exceptional. </span><b><span style="font-family:Verdana;">Aim: </span></b><span style="font-family:Verdana;">The purpose of this work is to report our experience in the management of this entity in a context of limited resources and to make a review of the literature. </span><b><span style="font-family:Verdana;">Case presentation: </span></b><span style="font-family:Verdana;">A 30-year-old man was admitted with a severe low back pain after a traffic accident. Neurological functions were intact after examination. Radiological assessments revealed a complete L3-L4 fracture-dislocation.</span></span><span style="font-family:""><span style="font-family:Verdana;"> The patient underwent an open posterior reduction and internal long segment fixation. The post-operative was marked by a surgical site infection treated with surgical debridement and targeted antibiotic therapy. The neurological functions were preserved. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Fracture-dislocations of the thoracolumbar spine</span><span style="color:red;"> </span></span><span style="font-family:Verdana;">are</span><span style="font-family:Verdana;"> caused by high energy trauma and are remarkably unstable lesions. When they are associated with intact neurorological functions, reduction and stabilization of these fractures are a challenge.
文摘Spine fractures account for a large portion of musculoskeletal injuries worldwide. A classification of spine fractures is necessary in order to develop a common language for treatment indications and outcomes. Several classification systems have been developed based on injury anatomy or mechanisms of action, but they have demonstrated poor reliability, have yielded little prognostic information, and have not been widely used. For this reason, the Arbeitsgemeinschaftfür Osteosynthesefragen(AO) committee has classified thorocolumbar spine injuries based on the pathomorphological criteria into3 types(A: Compression; B: Distraction; C: Axial torque and rotational deformity). Each of these types is further divided into 3 groups and 3 subgroups reflecting progressive scale of morphological damage and the degree of instability. Because of its highly detailed sub classifications, the AO system has shown limited interobserver variability. It is similar to its predecessors in that it does not incorporate the patient's neurologic status.The need for a reliable, reproducible, clinically relevant, prognostic classification system with an optimal balance of ease of use and detail of injury description contributed to the development of a new classification system, the thoracolumbar injury classification and severity score(TLICS). The TLICS defines injury based on three clinical characteristics: injury morphology, integrity of the posterior ligamentous complex, and neurologic status of the patient. The severity score offers prognostic information and is helpful in decision making about surgical vs nonsurgical management.
文摘Between 1990 and 1996, 15 patients with thoracolumbar spine fracture complicated by simple conusmedullaris injury were admitted. All patients were Injured by falling from height (mean, o meters). Clinical symp-toms indicated hypoesthesia or anesthesia of S3-5 sensory region,dysporia and urinary dysfunction. but normal sensation and motion of the bilateral lower extremities. Waston-Jones classified the spinal cord and nerve root injury following thoracolumbar spine fracture into three types. According to our observations, it should be classfied into five types: 1) concussion of the conus medullaris; 2) simple incomplete injury of the conus medullaris; 3) simplecomplete injury of the conus medullaris; 4) spinal cord transection and partial nerve root injury; 5) spinal cordtransection and entire nerve root injury.
文摘Background: Long segment transpedicular screw fixation in thoracolumbar spine injury has gained popularity in the last decades as it provides immediate stability, prevents further risk of complications and allows early mobilization of patient. Objectives: Evaluation of clinical and functional outcome after long segment transpedicular screw fixation in unstable thoracolumbar spine injury with incomplete neurological deficit patients. Methods: This quasi experimental study was conducted at Dhaka Medical College and Hospital (DMCH), Dhaka, Bangladesh from January 2016 to December 2017. A total of twenty four (24) patients with traumatic unstable fracture of the thoracolumbar spine with incomplete neurological deficit underwent long segment transpedicular screw fixation were included in this study. Clinical and radiologic outcomes were assessed pre-operatively and post-operatively. Results: A total of 24 patients aged between 20 - 60 years of both sexes (Male-21, Female-03) were included in this study. Their mean (±SD) age was 33.12 (±8.57) years. Most of them were farmer [09 (37.5%)] and day labour [08 (33.33%)]. Motor vehicle accidents were the most common [16 (66.67%)] cause of injury and then fall from height [08 (33.33%)]. The most common level of injury involved was L1-10 (41.67%) patients, followed by L2-07 (29.17%), T12-05 (20.83%) and T11-02 (8.33%) of the study patients. Burst fracture was the commonest [22 (91.67%)] type of fracture followed by Chance fracture [02 (8.33%)]. Pre-operative mean (±SD) Cobb angle, Kyphotic deformation of vertebral body, Beck index and vertebral compression deformity were 21.83 ± 4.5 degrees, 22.09 ± 4.40 degrees, 0.78 ± 2.65 and 0.18 ± 0.93 mm respectively, after procedure which were significantly (p Conclusions: Long segment transpedicular screw fixation is an effective method of treatment in patients having thoracolumbar spine injury with incomplete neurological deficit.
文摘The thoracolumbar spine,due to its large range of motion and relatively fragile anatomical structure,is prone to traumatic fractures and has become one of the common types of fractures in clinical practice.Thoracic and lumbar fractures may lead to spinal instability,spinal stenosis,etc.,and early restoration of vertebral height and sequence is necessary.Although the technique of transpedicular screw internal fixation for traumatic vertebrae is effective in the short term,in the long run,there may be adverse situations such as fixation breakage and loosening,leading to loss of vertebral height and kyphosis deformity.The technique of internal fixation of injured vertebrae with screws is considered to minimize postoperative complications and is worthy of promotion and use.With the advancement of medical technology,imaging,and biomechanics,the treatment methods for thoracolumbar spinal fractures are becoming increasingly diverse.
文摘背景:脊柱骨折最高发部位是胸腰段,其症状为后背部疼痛、后凸畸形、活动受限,或伴脊髓神经损伤引发下肢疼痛、麻木甚至截瘫等并发症。有限元法是一种数字化的计算机建模技术,能真实模拟实物模型并进行受力分析。目的:综述有限元法在脊柱胸腰段骨折中的应用。方法:在中英文文献数据库PubMed、Web of Science、中国知网中检索2024年3月之前发表的有限元分析法在脊柱胸腰段骨折中应用的相关文献,中英文检索词为“有限元分析法(finite element analysis methods)”“生物力学(biomechanical phenomena)”“应力分析(stress analysis)”“胸腰椎骨折(thoracolumbar fractures)”“脊柱骨折(spinal fractures)”,最终纳入55篇文献。结果与结论:①通过有限元法对不同病因(骨质疏松性、创伤性、病理性)导致的胸腰椎骨折进行探索,有利于对各种类型胸腰椎骨折的生物力学特征有更加深刻的认识,完善对胸腰椎骨折的个性化和精细化治疗;②单一样本或数量较少样本的有限元分析具有偶然性,未来的有限元分析需要更大的样本数量来减少样本偶然性带来的误差;③仅骨骼的刚性结构不能满足实物的完整性所具有的生物力学工况,未来的有限元模型需要尽可能纳入实物的所有结构(例如肌肉、韧带等软组织);④有限元法在骨质疏松性和创伤性胸腰椎骨折方面的研究较多,未来需要进行更加深入的研究;病理性胸腰椎骨折领域的研究较少,未来研究范围较广。
文摘Paraplegic gait orthosis has been shown to help paraplegic patients stand and walk, although this method cannot be individualized for patients with different spinal cord injuries and functional recovery of the lower extremities. There is, however, a great need to develop individualized paraplegic orthosis to improve overall quality of life for paraplegic patients. In the present study, 36 spinal cord（below T4） injury patients were equally and randomly divided into control and observation groups. The control group received systematic rehabilitation training, including maintenance of joint range of motion, residual muscle strength training, standing training, balance training, and functional electrical stimulation. The observation group received an individualized paraplegic locomotion brace and functional training according to the various spinal cord injury levels and muscle strength based on comprehensive systematic rehabilitation training. After 3 months of rehabilitation training, the observation group achieved therapeutic locomotion in 8 cases, family-based locomotion in 7 cases, and community-based locomotion in 3 cases. However, locomotion was not achieved in any of the control group patients. These findings suggest that individualized paraplegic braces significantly improve activity of daily living and locomotion in patients with thoracolumbar spinal cord injury.
文摘目的探讨骨质疏松性椎体压缩骨折(OVCF)合并胸腰筋膜损伤(TFI)患者在椎体强化术后的临床疗效。方法选取2022年11月至2023年8月川北医学院附属医院骨科收治的81例采用经皮椎体球囊后凸成形术(PKP)治疗的OVCF患者为研究对象,根据是否合并TFI进行分组,将合并TFI的患者作为TFI组(n=36),未合并TFI患者作为NTFI组(n=45)。比较两组患者年龄、性别、住院时间、骨密度等一般资料;手术时间、术中出血量、伤椎节段(T10-L2、L3-I5)占比、单侧或双侧穿刺占比、骨水泥注射量等术中指标。分别采用视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评估患者腰部疼痛程度和腰椎功能改善情况。结果两组患者伤椎节段占比、手术时间、术中出血量、单或双侧穿刺占比比较,差异均无统计学意义(P>0.05)。两组患者术前、术后3 d VAS、ODI评分比较,差异均无统计学意义(P>0.05)。TFI组患者术后1、3个月VAS、ODI评分均高于NTFI组患者(P<0.05)。结论TFI组患者在采用PKP治疗后3个月内,腰椎疼痛缓解程度和腰椎功能改善情况均较NTFI组患者差,TFI可作为OVCF合并TFI患者在椎体强化术后临床疗效观察的有效指标。
