Objective To retrospectively investigate the clinical characteristics of sternal insufficiency fractures(SIFs) of post-menopausal women.Methods Findings on the clinical presentation,associated diseases,and imaging of ...Objective To retrospectively investigate the clinical characteristics of sternal insufficiency fractures(SIFs) of post-menopausal women.Methods Findings on the clinical presentation,associated diseases,and imaging of SIFs in 17 postmenopausal women admitted to our hospital between February 1999 and January 2009 were reported.Results Twelve patients complained of severe pain in their anterior chest.Other symptoms included cough(5 cases),dyspnoea(3 cases),breathlessness(3 cases),and wheeze(2 cases).Four patients had no discomfort.The sternums of 11 cases were tender to palpation.Seventeen patients had osteoporosis.Other associated diseases were chronic obstructive pulmonary disease(7 cases),rheumatoid arthritis(3 cases),systemic lupus erythematosus(1 case),asthma(1 case),and thoracic vertebral fracture(13 cases).Nine patients had received glucocorticoid treatment.The fractures were located in the body of the sternum in 15 patients,in the manubrium in 1 patient,and in the manubriosternal junction in 1 patient.Displaced fracture was present in 13 cases.Lateral radiography of the sternum showed a fracture line in 14 patients.In the remaining 3 cases,other imaging examinations such as bone scan,computed tomography or magnetic resonance imaging demonstrated the presence of a fracture.Conclusions Osteoporosis,glucocorticoid therapy,chronic obstructive pulmonary disease,and rheumatoid arthritis might be risk factors for SIFs.SIFs should be considered in the differential diagnosis of chest pain.展开更多
Objective: The aim of this study was to identify the clinical features and prognostic factors associated with extremity osteosarcoma with pathologic fracture. Methods: The clinical records of 271 patients with extremi...Objective: The aim of this study was to identify the clinical features and prognostic factors associated with extremity osteosarcoma with pathologic fracture. Methods: The clinical records of 271 patients with extremity osteosarcomas were retrospectively reviewed. The data obtained covered the period from October 2003 to May 2012, and included sex, age, tumor site etc. The mean follow-up time was 25.2 months(ranged from 1 to 117). Chi-square method and Kaplan-Meier method were used to compare clinical differences and overall survival between patients with or without pathologic fracture, respectively. The univariate analysis was used to determine the prognostic factors related with survival rate by log-rank test. The multivariate analysis of prognosis was performed by COX proportional hazards regression model. Results: The proportions of patients having a tumor's diameter of 10 cm or more(P = 0.038), locating upper limbs(P = 0.004) and receiving amputation surgery(P = 0.02) were significantly higher with pathological fracture group than without pathological fracture group. The local recurrence rate(P = 0.000) was also significantly higher in the pathological fracture group. The median survival time of patients with or without pathological fracture was 16(95% confidence interval: 14.6–17.4) months and 22(95% confidence interval: 19.8–24.1) months(P = 0.002). The Log-rank univariate analysis indicated that the tumor size, Enneking's surgical staging, Karnofsky performance status(KPS) score, cycles of adjuvant chemotherapy, local recurrence and metastasis were significantly related to overall survival. Multivariate Cox regression analysis revealed KPS score, cycles of adjuvant chemotherapy and metastasis were independent prognostic factors(P < 0.05). Conclusion: Compared with the patients without pathological fracture, a higher proportion of patients receiving amputation surgery or having larger tumor size, humeral osteosarcoma or local recurrence was observed in patients with pathological fracture, and the prognosis of these patients was poor. The independent prognostic factors of extremity osteosarcoma with pathologic fracture were the KPS score, cycles of adjuvant chemotherapy and metastasis.展开更多
Objective： To compare the surgical results of two kinds of posterior approach for osteoporotic thoracolumbar Ktimmell＇s disease. Methods： Clinical and radiographic results of 1-segmental pedicle screw fixation com...Objective： To compare the surgical results of two kinds of posterior approach for osteoporotic thoracolumbar Ktimmell＇s disease. Methods： Clinical and radiographic results of 1-segmental pedicle screw fixation combined with vertebroplasty （Group A, n=12） or posterior shortening osteotomy （Group B, n=16） for osteoporotic thoracolumbar Kummell＇s disease were analyzed retrospectively. Japanese orthopedic association （JOA） and visual analogue scale （VAS） scores were used for clinical evaluation. Neurological status was judged by Frankel grades. X-ray was used to evaluate the radiographic results. Complications related to operation and devices were also considered. Results： The follow-up period was 12-54 months （average 29 months）. Pre- and post-operative VAS were 9.3 and 3.2 in Group A, 8.9 and 2.5 in Group B, respectively. The mean JOA score at the final follow-up was significantly higher than that of pre-operation （t=-5.306, P〈0.001）. There was no significant difference between Groups A and B （t=0.618,P〉0.05）. The kyphosis were corrected from preoperative 33.9°（A）/ 37.3°（B） to postoperative 10.3°（A）/6.5°（B）, and 15.3° （A）/13.7°（B） at the final follow-up. There was a significant difference between the two groups at the final follow-up. Frankel grade was improved from grade C preoperatively to postoperatively grade D or E in 7 cases of Group A and 5 cases of Group B, from grade D to E in 5 cases of Group A and 11 cases of Group B. The mean improvement was 1.6 and 1.7 grades for Groups A and B, respectively. There were no serious complications related to internal fixation. Conclusions： The similar clinical results can be obtained by the two kinds of posterior surgical methods for osteoporotic Kummell＇s disease. Posterior spinal shortening is a better choice for patients with serious kyphosis combined with neurological deficit than the other.展开更多
Objective： To explore the treatment methods and outcome of posterior wall fractures of the acetabulum. Methods： The data of 31 patients （25 males and 6 females, aged 19-59 years, mean： 40.5 years） with posterior ...Objective： To explore the treatment methods and outcome of posterior wall fractures of the acetabulum. Methods： The data of 31 patients （25 males and 6 females, aged 19-59 years, mean： 40.5 years） with posterior wall fractures of the acetabulum hospitalized in our department from 2002 to 2006 were analyzed retrospectively in this study. The types of fractures, number of fragments, combined dislocations, and sciatic nerve function were documented before admission. All the fractures were treated with open reduction and internal fixation. Based on the fracture type and site, either screws alone or reconstructive plates were used. The patients were immobilized for an average of 12 weeks before partial weight bearing was permitted. After follow-up for 12-70 months （43.6 months on average）, modified Merle d＇Aubigne score was adopted to evaluate the outcomes of the operations. Results： The percentages of the excellent, good, fair and poor results were 48.4%, 41.9%, 6.5%, and 3.3%, respectively, with a good to excellent rate of 90.2%. Idiopathic sciatic nerve injury occurred in only one case. Conclusions： The sciatic nerve should be routinely exposed and protected during the surgery. The type of fixation should be based on the fracture type and site. Prolonged immobilization may be helpful in improving the final outcomes.展开更多
Objective： To explore the safety and effect of the technique of reconstructing anterior and middle columns by posterior approach in treating lumbar burst fractures. Methods： From July 2005 to January 2007, 22 cases ...Objective： To explore the safety and effect of the technique of reconstructing anterior and middle columns by posterior approach in treating lumbar burst fractures. Methods： From July 2005 to January 2007, 22 cases （18 males and 4 females, aged 28-57 years, 42.7 years on average） of lumbar burst fractures were treated with surgical procedures in our hospital. Based on the routine posterior approach, one of the transverse processes of the injured vertebra was incised to get access to the lateral side of the injured vetebral body. After all the displaced fracture fragments were cleared away and the spinal canal was decompressed, the titanium mesh packed with autografts was implanted from the lateral side to reconstruct the anterior and middle columns. The adjacent above and below segments of the vetebral body were fixed with transpedicular screws. The operation time, intraoperative blood loss, vertebral height, degree of kyphotic deformity and comprised spinal canal were documented. Results： The average operation time was 3.5 hours （ranging 2.8-5.8 hours） and the average blood loss was 820 ml （ranging 650-2 100 ml）. All the cases were followed up for 17.2 months on average （ ranging 12-28 months）. The height of the injured vetebral body was restored from 24 % （12%- 45%） preoperatively to 96% （95%-99%） postoperatively （P〈0.05）. The natural spinal curvatures and spinal canal were restored. Three cases were involved in transient iatrogenic nerve root injury and 1 case was involved in the loosening of the connected rod of the pedicle screw system 3 months postoperatively. Conclusions： The technique of implanting the titanium mesh by posterior approach is effective and safe enough to reconstruct the anterior and middle columns in treating lumbar burst fractures.展开更多
Objective： To discuss the pathological characteristics of cervical spinal fracture complicating ankylosing spondylitis （AS） and the effect of combined anterior and posterior operation. Methods： Eighteen AS patien...Objective： To discuss the pathological characteristics of cervical spinal fracture complicating ankylosing spondylitis （AS） and the effect of combined anterior and posterior operation. Methods： Eighteen AS patients with traumatic cervical fracture-dislocation were treated operatively from January 2000 to January 2006. The symptom duration of AS was 14.5 years on average. Three cases had undergone osteotomy in lumbar spine. There were 4 cases of Grade A, 3 cases of Grade B, 9 cases of Grade C and 2 cases of Grade D according to Frankel＇s score. There were 15 cases of Grade III dislocation and 3 cases of Grade II. All patients underwent surgical procedures by combined anterior and posterior approach. Results： There were 4 anterior-posterior procedures, 8 anterior-posterior-anterior procedures and 6 posterior-anterior procedures. Seven patients had one stage operation and 11 cases underwent two stage surgeries. There was certain extent of neurological improvement in 14 incomplete paraplegic patients, but no improvement in 4 complete paraplegic patients. The follow-up period was 21.2 months on average and the time for bone fusion was 3.6 months. There were 4 complications during operation and a longterm complication in follow-up. Conclusions： The study suggests that anterior combined with posterior approach makes the spine stable and relieves the pressure immediately. It is a reasonable surgical strategy for treatment of cervical spinal fracture-dislocation with AS.展开更多
Objective:To explore the efficacy and mechanism of warm needling moxibustion plus percutaneous kyphoplasty(PKP)for osteoporotic vertebral compression fracture(OVCF)due to kidney deficiency and blood stasis.Methods:A t...Objective:To explore the efficacy and mechanism of warm needling moxibustion plus percutaneous kyphoplasty(PKP)for osteoporotic vertebral compression fracture(OVCF)due to kidney deficiency and blood stasis.Methods:A total of 70 OVCF patients were randomized into a control group and an observation group,with 35 cases in each group.The control group was given PKP treatment,and the observation group was treated with warm needling moxibustion on the basis of the treatment in the control group.The visual analog scale(VAS)and Oswestry disability index(ODI)were scored and the Cobb angle of fractured vertebrae was measured before and after treatment.The re-fracture rate of the adjacent vertebrae was recorded at 1-year follow-up.The serum levels of transforming growth factor(TGF)-β1 and omentin-1 were measured before and after treatment.Results:After treatment,the VAS and ODI scores in both groups decreased(all P<0.05),and all the scores in the observation group were lower than those in the control group(both P<0.05).After treatment,the Cobb angle of fractured vertebrae in both groups decreased(both P<0.05),and the Cobb angle in the observation group was smaller than that in the control group(P<0.05).At 1-year follow-up,the re-fracture rate of the adjacent vertebrae in the observation group was lower than that in the control group(P<0.05).After treatment,the serum levels of TGF-β1 and omentin-1 in both groups increased significantly(all P<0.05),and the serum levels of TGF-β1 and omentin-1 in the observation group were higher than those in the control group(both P<0.05).Conclusion:The treatment of warm needling moxibustion plus PKP can relieve pain,improve dysfunction,promote healing of the injured vertebrae,and reduce the re-fracture rate of the adjacent vertebrae in patients with OVCF due to kidney deficiency and blood stasis,which may be related to the increase of serum TGF-β1 and omentin-1 levels.展开更多
文摘Objective To retrospectively investigate the clinical characteristics of sternal insufficiency fractures(SIFs) of post-menopausal women.Methods Findings on the clinical presentation,associated diseases,and imaging of SIFs in 17 postmenopausal women admitted to our hospital between February 1999 and January 2009 were reported.Results Twelve patients complained of severe pain in their anterior chest.Other symptoms included cough(5 cases),dyspnoea(3 cases),breathlessness(3 cases),and wheeze(2 cases).Four patients had no discomfort.The sternums of 11 cases were tender to palpation.Seventeen patients had osteoporosis.Other associated diseases were chronic obstructive pulmonary disease(7 cases),rheumatoid arthritis(3 cases),systemic lupus erythematosus(1 case),asthma(1 case),and thoracic vertebral fracture(13 cases).Nine patients had received glucocorticoid treatment.The fractures were located in the body of the sternum in 15 patients,in the manubrium in 1 patient,and in the manubriosternal junction in 1 patient.Displaced fracture was present in 13 cases.Lateral radiography of the sternum showed a fracture line in 14 patients.In the remaining 3 cases,other imaging examinations such as bone scan,computed tomography or magnetic resonance imaging demonstrated the presence of a fracture.Conclusions Osteoporosis,glucocorticoid therapy,chronic obstructive pulmonary disease,and rheumatoid arthritis might be risk factors for SIFs.SIFs should be considered in the differential diagnosis of chest pain.
基金Supported by a grant from the National Natural Science Foundation of China(No.81172548)
文摘Objective: The aim of this study was to identify the clinical features and prognostic factors associated with extremity osteosarcoma with pathologic fracture. Methods: The clinical records of 271 patients with extremity osteosarcomas were retrospectively reviewed. The data obtained covered the period from October 2003 to May 2012, and included sex, age, tumor site etc. The mean follow-up time was 25.2 months(ranged from 1 to 117). Chi-square method and Kaplan-Meier method were used to compare clinical differences and overall survival between patients with or without pathologic fracture, respectively. The univariate analysis was used to determine the prognostic factors related with survival rate by log-rank test. The multivariate analysis of prognosis was performed by COX proportional hazards regression model. Results: The proportions of patients having a tumor's diameter of 10 cm or more(P = 0.038), locating upper limbs(P = 0.004) and receiving amputation surgery(P = 0.02) were significantly higher with pathological fracture group than without pathological fracture group. The local recurrence rate(P = 0.000) was also significantly higher in the pathological fracture group. The median survival time of patients with or without pathological fracture was 16(95% confidence interval: 14.6–17.4) months and 22(95% confidence interval: 19.8–24.1) months(P = 0.002). The Log-rank univariate analysis indicated that the tumor size, Enneking's surgical staging, Karnofsky performance status(KPS) score, cycles of adjuvant chemotherapy, local recurrence and metastasis were significantly related to overall survival. Multivariate Cox regression analysis revealed KPS score, cycles of adjuvant chemotherapy and metastasis were independent prognostic factors(P < 0.05). Conclusion: Compared with the patients without pathological fracture, a higher proportion of patients receiving amputation surgery or having larger tumor size, humeral osteosarcoma or local recurrence was observed in patients with pathological fracture, and the prognosis of these patients was poor. The independent prognostic factors of extremity osteosarcoma with pathologic fracture were the KPS score, cycles of adjuvant chemotherapy and metastasis.
文摘Objective： To compare the surgical results of two kinds of posterior approach for osteoporotic thoracolumbar Ktimmell＇s disease. Methods： Clinical and radiographic results of 1-segmental pedicle screw fixation combined with vertebroplasty （Group A, n=12） or posterior shortening osteotomy （Group B, n=16） for osteoporotic thoracolumbar Kummell＇s disease were analyzed retrospectively. Japanese orthopedic association （JOA） and visual analogue scale （VAS） scores were used for clinical evaluation. Neurological status was judged by Frankel grades. X-ray was used to evaluate the radiographic results. Complications related to operation and devices were also considered. Results： The follow-up period was 12-54 months （average 29 months）. Pre- and post-operative VAS were 9.3 and 3.2 in Group A, 8.9 and 2.5 in Group B, respectively. The mean JOA score at the final follow-up was significantly higher than that of pre-operation （t=-5.306, P〈0.001）. There was no significant difference between Groups A and B （t=0.618,P〉0.05）. The kyphosis were corrected from preoperative 33.9°（A）/ 37.3°（B） to postoperative 10.3°（A）/6.5°（B）, and 15.3° （A）/13.7°（B） at the final follow-up. There was a significant difference between the two groups at the final follow-up. Frankel grade was improved from grade C preoperatively to postoperatively grade D or E in 7 cases of Group A and 5 cases of Group B, from grade D to E in 5 cases of Group A and 11 cases of Group B. The mean improvement was 1.6 and 1.7 grades for Groups A and B, respectively. There were no serious complications related to internal fixation. Conclusions： The similar clinical results can be obtained by the two kinds of posterior surgical methods for osteoporotic Kummell＇s disease. Posterior spinal shortening is a better choice for patients with serious kyphosis combined with neurological deficit than the other.
文摘Objective： To explore the treatment methods and outcome of posterior wall fractures of the acetabulum. Methods： The data of 31 patients （25 males and 6 females, aged 19-59 years, mean： 40.5 years） with posterior wall fractures of the acetabulum hospitalized in our department from 2002 to 2006 were analyzed retrospectively in this study. The types of fractures, number of fragments, combined dislocations, and sciatic nerve function were documented before admission. All the fractures were treated with open reduction and internal fixation. Based on the fracture type and site, either screws alone or reconstructive plates were used. The patients were immobilized for an average of 12 weeks before partial weight bearing was permitted. After follow-up for 12-70 months （43.6 months on average）, modified Merle d＇Aubigne score was adopted to evaluate the outcomes of the operations. Results： The percentages of the excellent, good, fair and poor results were 48.4%, 41.9%, 6.5%, and 3.3%, respectively, with a good to excellent rate of 90.2%. Idiopathic sciatic nerve injury occurred in only one case. Conclusions： The sciatic nerve should be routinely exposed and protected during the surgery. The type of fixation should be based on the fracture type and site. Prolonged immobilization may be helpful in improving the final outcomes.
文摘Objective： To explore the safety and effect of the technique of reconstructing anterior and middle columns by posterior approach in treating lumbar burst fractures. Methods： From July 2005 to January 2007, 22 cases （18 males and 4 females, aged 28-57 years, 42.7 years on average） of lumbar burst fractures were treated with surgical procedures in our hospital. Based on the routine posterior approach, one of the transverse processes of the injured vertebra was incised to get access to the lateral side of the injured vetebral body. After all the displaced fracture fragments were cleared away and the spinal canal was decompressed, the titanium mesh packed with autografts was implanted from the lateral side to reconstruct the anterior and middle columns. The adjacent above and below segments of the vetebral body were fixed with transpedicular screws. The operation time, intraoperative blood loss, vertebral height, degree of kyphotic deformity and comprised spinal canal were documented. Results： The average operation time was 3.5 hours （ranging 2.8-5.8 hours） and the average blood loss was 820 ml （ranging 650-2 100 ml）. All the cases were followed up for 17.2 months on average （ ranging 12-28 months）. The height of the injured vetebral body was restored from 24 % （12%- 45%） preoperatively to 96% （95%-99%） postoperatively （P〈0.05）. The natural spinal curvatures and spinal canal were restored. Three cases were involved in transient iatrogenic nerve root injury and 1 case was involved in the loosening of the connected rod of the pedicle screw system 3 months postoperatively. Conclusions： The technique of implanting the titanium mesh by posterior approach is effective and safe enough to reconstruct the anterior and middle columns in treating lumbar burst fractures.
文摘Objective： To discuss the pathological characteristics of cervical spinal fracture complicating ankylosing spondylitis （AS） and the effect of combined anterior and posterior operation. Methods： Eighteen AS patients with traumatic cervical fracture-dislocation were treated operatively from January 2000 to January 2006. The symptom duration of AS was 14.5 years on average. Three cases had undergone osteotomy in lumbar spine. There were 4 cases of Grade A, 3 cases of Grade B, 9 cases of Grade C and 2 cases of Grade D according to Frankel＇s score. There were 15 cases of Grade III dislocation and 3 cases of Grade II. All patients underwent surgical procedures by combined anterior and posterior approach. Results： There were 4 anterior-posterior procedures, 8 anterior-posterior-anterior procedures and 6 posterior-anterior procedures. Seven patients had one stage operation and 11 cases underwent two stage surgeries. There was certain extent of neurological improvement in 14 incomplete paraplegic patients, but no improvement in 4 complete paraplegic patients. The follow-up period was 21.2 months on average and the time for bone fusion was 3.6 months. There were 4 complications during operation and a longterm complication in follow-up. Conclusions： The study suggests that anterior combined with posterior approach makes the spine stable and relieves the pressure immediately. It is a reasonable surgical strategy for treatment of cervical spinal fracture-dislocation with AS.
文摘Objective:To explore the efficacy and mechanism of warm needling moxibustion plus percutaneous kyphoplasty(PKP)for osteoporotic vertebral compression fracture(OVCF)due to kidney deficiency and blood stasis.Methods:A total of 70 OVCF patients were randomized into a control group and an observation group,with 35 cases in each group.The control group was given PKP treatment,and the observation group was treated with warm needling moxibustion on the basis of the treatment in the control group.The visual analog scale(VAS)and Oswestry disability index(ODI)were scored and the Cobb angle of fractured vertebrae was measured before and after treatment.The re-fracture rate of the adjacent vertebrae was recorded at 1-year follow-up.The serum levels of transforming growth factor(TGF)-β1 and omentin-1 were measured before and after treatment.Results:After treatment,the VAS and ODI scores in both groups decreased(all P<0.05),and all the scores in the observation group were lower than those in the control group(both P<0.05).After treatment,the Cobb angle of fractured vertebrae in both groups decreased(both P<0.05),and the Cobb angle in the observation group was smaller than that in the control group(P<0.05).At 1-year follow-up,the re-fracture rate of the adjacent vertebrae in the observation group was lower than that in the control group(P<0.05).After treatment,the serum levels of TGF-β1 and omentin-1 in both groups increased significantly(all P<0.05),and the serum levels of TGF-β1 and omentin-1 in the observation group were higher than those in the control group(both P<0.05).Conclusion:The treatment of warm needling moxibustion plus PKP can relieve pain,improve dysfunction,promote healing of the injured vertebrae,and reduce the re-fracture rate of the adjacent vertebrae in patients with OVCF due to kidney deficiency and blood stasis,which may be related to the increase of serum TGF-β1 and omentin-1 levels.
