Objective. To investigate the unique characteristics and treatment of thoracic spine fractures. Methods. Seventy seven patients with thoracic spine fractures were retrospectively reviewed. Of these, there were 37 comp...Objective. To investigate the unique characteristics and treatment of thoracic spine fractures. Methods. Seventy seven patients with thoracic spine fractures were retrospectively reviewed. Of these, there were 37 compression fractures, 34 fracture dislocations, 3 burst fractures and 3 burst dislocations. Twenty six patients had a complete lesion of the spinal cord, 14 sustained a neurologically incomplete injury, and 37 were neurologically intact. Fifty three patients were treated nonoperatively and 24 treated operatively. Results. All patients were followed up for 2～15 years. None of the 26 patients with a complete lesion recovered any significant function. Of 37 neurologically intact patients, 13 had local pain although all of them remained normal function. Two of 14 patients with incomplete paraplegia returned to normal, 7 recovered some function and 5 did not recovered. Conclusions. Because of the unique anatomy and biomechanics of the thoracic spine, the classification commonly applied to thoracolumbar fractures is not suitable for thoracic fractures. Fusion and instrumentation are indicated when the fractures are unstable, while patients with incomplete lesion of the spinal cord may be the candidates for supplemented decompression.展开更多
OBJECTIVE: To investigate the mechanism associated with thoracolumbar burst fractures. METHODS: Stress distribution of the spine in the upright, flexion and extension positions was analyzed using a three-dimensional f...OBJECTIVE: To investigate the mechanism associated with thoracolumbar burst fractures. METHODS: Stress distribution of the spine in the upright, flexion and extension positions was analyzed using a three-dimensional finite element model of the spinal motion segment. RESULTS: Stress concentration was noted at the pedicle and posterosuperior part of the vertebral body near the pedicle. CONCLUSION: Stress concentration of the spine may be implicated in the biomechanical mechanism underlying thoracolumbar burst fractures.展开更多
Objective： To explore the epidemiology, clinical presentation, radiology and surgical treatment outcome in Chinese patients with myelopathy caused by contiguous multilevel ossification of ligamentum flavum. Methods....Objective： To explore the epidemiology, clinical presentation, radiology and surgical treatment outcome in Chinese patients with myelopathy caused by contiguous multilevel ossification of ligamentum flavum. Methods. Medical notes and imaging data of 18 Chinese patients （14 males and 4 females, aged 43-72 years, mean： 57 years ） with myelopathy caused by contiguous multilevel ossification of ligamentum flavum were studied retrospectively in this article. The diagnosis was based on clinical examination, X-ray films, computerized tomography （CT） and magnetic resonance imaging （MRI） scanning results and pathological results. Sixteen patients were treated by laminectomy and two by laminoplasty, The average follow-up duration was 34 months （range, 28-49 months ）. The outcome was evaluated by Japanese Orthopaedics Association （JOA） Score. Results： The average time for occurring clinical symptoms was 7.5 months （range, 2 days-16 months）. All the 18 cases presented with clinical evidences of chronic and progressive thoracic spinal cord compression, which included bilateral leg weakness, spastic gait, numbness in lower limbs, paresthesia in terminal and perineum, and urinary incontinence. Neurological examination revealed severe spastic paraparesis, absence of abdominal reflexes, and reduction of the sensory function below the compression level. The mean JOA score before operation was 3. 6 （range, 0-6 ）. MRI and CT scans of the thoracic spine confirmed the presence of contiguous multilevel ossification of the ligamentum flavum. The mean recovery rate after surgery in terms of JOA score was 66.3 % （ range, 33.3 %- 100% ）, with a mean final JOA score of 8. 3. Thoracic decompression laminectomy or laminoplasty could result in a good postoperative outcome. Conclusions ： Contiguous multilevel ossification of the ligamentum flavum is not a common cause of myelopathy in Chinese population and should be treated as early as possible. MRI and CT scan examinations may diagnose the presence of thoracic ossification of ligamentum flavum （OLF）. Posterior decompression, especially with en bloc dissection of the laminae, can obtain satisfactory results.展开更多
Dislocation of the scapula between the ribs and into the thoracic cage is a very rare event.Scapulothoracic dissociation though has been reported,usually occurs after a severe injury and is often associated with other...Dislocation of the scapula between the ribs and into the thoracic cage is a very rare event.Scapulothoracic dissociation though has been reported,usually occurs after a severe injury and is often associated with other serious injuries like brachial plexus or chest injury,etc.Ainscow has described a rare type that may occur due to slight violence with a pre-existing condition.Cases of isolated scapular dislocation after minor trauma have not been reported frequently in the literature.It is a distinct clinical entity and needs to be differentiated from other similar conditions.Here,we present a case of painless scapular dislocation associated with trivial trauma followed by spontaneous reduction in a l0 years old girl.The patient had a recurrence of the dislocation before presenting to us.But she did not have any pre-existing condition for scapular dislocation.展开更多
Since the late 20th century owing to the improvement of spinal surgery techniques, the diagnosis and treatment of thoracolumbar fracture have been perfected more and more. Although the advent of modern spinal surgery ...Since the late 20th century owing to the improvement of spinal surgery techniques, the diagnosis and treatment of thoracolumbar fracture have been perfected more and more. Although the advent of modern spinal surgery in China was late, we have gained some advanced achievements owing to various international communications benefited from the open policy. Therefore, it is essential to evaluate the current status and perspective of diagnosis and treatment of thoracolumbar fracture. There are several issues we would like to discuss here.展开更多
Objective： The association of scapular fractures with other life-threatening injuries including blunt thoracic aortic injury is widely recognized. Few studies have investigated this presumed association. In this stud...Objective： The association of scapular fractures with other life-threatening injuries including blunt thoracic aortic injury is widely recognized. Few studies have investigated this presumed association. In this study, we investigated the incidence of significant associated injuries with scapular fracture and their outcomes. Methods： A retrospective study was conducted from 2005 to 2009 in a level I trauma center in Thailand. All blunt trauma patients were identified. Patients＇ demographics, injury mechanism, associated injuries, Injury Severity Score （ISS）, and survival outcomes were recorded. The manage- ment of associated injuries with scapular fracture was reviewed, and the risk factors for mortality were identified. Results： Among the 7 345 trauma patients admitted, scapular fractures occurred in 84 cases （1.1%）. The mean age was （37.98±15.21） years. Motorcycle crash was the most frequent mechanism of injury, occurring in 51 cases （60.7%）.Seventyour patients （88.1%） suffering from scapular fractures had associated injuries： 5 （6.0%） had significant chest injuries, but none of them had blunt thoracic aortic injury. Two patients （2.4%） with scapular fractures died. Factors determining the likelihood of mortality were： （1） ISS〉25 （LR=8.5, P〈0.05）; （2） significant associated chest injury （AIS〉3, LR=5.3, P〈0.05） and （3） significant associated abdominal injury （AIS〉3, LR=5.3, P〈0.05）. Conclusion： A blunt scapular fracture may not accompany a blunt thoracic aortic injury but it is strongly related to other injuries like chest injury, extremity injury, head injury, etc. If a scapular fracture is found with a high ISS score, high chest or abdomen AIS score, the patient would have a high risk of mortality.展开更多
文摘Objective. To investigate the unique characteristics and treatment of thoracic spine fractures. Methods. Seventy seven patients with thoracic spine fractures were retrospectively reviewed. Of these, there were 37 compression fractures, 34 fracture dislocations, 3 burst fractures and 3 burst dislocations. Twenty six patients had a complete lesion of the spinal cord, 14 sustained a neurologically incomplete injury, and 37 were neurologically intact. Fifty three patients were treated nonoperatively and 24 treated operatively. Results. All patients were followed up for 2～15 years. None of the 26 patients with a complete lesion recovered any significant function. Of 37 neurologically intact patients, 13 had local pain although all of them remained normal function. Two of 14 patients with incomplete paraplegia returned to normal, 7 recovered some function and 5 did not recovered. Conclusions. Because of the unique anatomy and biomechanics of the thoracic spine, the classification commonly applied to thoracolumbar fractures is not suitable for thoracic fractures. Fusion and instrumentation are indicated when the fractures are unstable, while patients with incomplete lesion of the spinal cord may be the candidates for supplemented decompression.
基金supported by the National Natural Science Foundation of China(No3880785)
文摘OBJECTIVE: To investigate the mechanism associated with thoracolumbar burst fractures. METHODS: Stress distribution of the spine in the upright, flexion and extension positions was analyzed using a three-dimensional finite element model of the spinal motion segment. RESULTS: Stress concentration was noted at the pedicle and posterosuperior part of the vertebral body near the pedicle. CONCLUSION: Stress concentration of the spine may be implicated in the biomechanical mechanism underlying thoracolumbar burst fractures.
文摘Objective： To explore the epidemiology, clinical presentation, radiology and surgical treatment outcome in Chinese patients with myelopathy caused by contiguous multilevel ossification of ligamentum flavum. Methods. Medical notes and imaging data of 18 Chinese patients （14 males and 4 females, aged 43-72 years, mean： 57 years ） with myelopathy caused by contiguous multilevel ossification of ligamentum flavum were studied retrospectively in this article. The diagnosis was based on clinical examination, X-ray films, computerized tomography （CT） and magnetic resonance imaging （MRI） scanning results and pathological results. Sixteen patients were treated by laminectomy and two by laminoplasty, The average follow-up duration was 34 months （range, 28-49 months ）. The outcome was evaluated by Japanese Orthopaedics Association （JOA） Score. Results： The average time for occurring clinical symptoms was 7.5 months （range, 2 days-16 months）. All the 18 cases presented with clinical evidences of chronic and progressive thoracic spinal cord compression, which included bilateral leg weakness, spastic gait, numbness in lower limbs, paresthesia in terminal and perineum, and urinary incontinence. Neurological examination revealed severe spastic paraparesis, absence of abdominal reflexes, and reduction of the sensory function below the compression level. The mean JOA score before operation was 3. 6 （range, 0-6 ）. MRI and CT scans of the thoracic spine confirmed the presence of contiguous multilevel ossification of the ligamentum flavum. The mean recovery rate after surgery in terms of JOA score was 66.3 % （ range, 33.3 %- 100% ）, with a mean final JOA score of 8. 3. Thoracic decompression laminectomy or laminoplasty could result in a good postoperative outcome. Conclusions ： Contiguous multilevel ossification of the ligamentum flavum is not a common cause of myelopathy in Chinese population and should be treated as early as possible. MRI and CT scan examinations may diagnose the presence of thoracic ossification of ligamentum flavum （OLF）. Posterior decompression, especially with en bloc dissection of the laminae, can obtain satisfactory results.
文摘Dislocation of the scapula between the ribs and into the thoracic cage is a very rare event.Scapulothoracic dissociation though has been reported,usually occurs after a severe injury and is often associated with other serious injuries like brachial plexus or chest injury,etc.Ainscow has described a rare type that may occur due to slight violence with a pre-existing condition.Cases of isolated scapular dislocation after minor trauma have not been reported frequently in the literature.It is a distinct clinical entity and needs to be differentiated from other similar conditions.Here,we present a case of painless scapular dislocation associated with trivial trauma followed by spontaneous reduction in a l0 years old girl.The patient had a recurrence of the dislocation before presenting to us.But she did not have any pre-existing condition for scapular dislocation.
文摘Since the late 20th century owing to the improvement of spinal surgery techniques, the diagnosis and treatment of thoracolumbar fracture have been perfected more and more. Although the advent of modern spinal surgery in China was late, we have gained some advanced achievements owing to various international communications benefited from the open policy. Therefore, it is essential to evaluate the current status and perspective of diagnosis and treatment of thoracolumbar fracture. There are several issues we would like to discuss here.
文摘Objective： The association of scapular fractures with other life-threatening injuries including blunt thoracic aortic injury is widely recognized. Few studies have investigated this presumed association. In this study, we investigated the incidence of significant associated injuries with scapular fracture and their outcomes. Methods： A retrospective study was conducted from 2005 to 2009 in a level I trauma center in Thailand. All blunt trauma patients were identified. Patients＇ demographics, injury mechanism, associated injuries, Injury Severity Score （ISS）, and survival outcomes were recorded. The manage- ment of associated injuries with scapular fracture was reviewed, and the risk factors for mortality were identified. Results： Among the 7 345 trauma patients admitted, scapular fractures occurred in 84 cases （1.1%）. The mean age was （37.98±15.21） years. Motorcycle crash was the most frequent mechanism of injury, occurring in 51 cases （60.7%）.Seventyour patients （88.1%） suffering from scapular fractures had associated injuries： 5 （6.0%） had significant chest injuries, but none of them had blunt thoracic aortic injury. Two patients （2.4%） with scapular fractures died. Factors determining the likelihood of mortality were： （1） ISS〉25 （LR=8.5, P〈0.05）; （2） significant associated chest injury （AIS〉3, LR=5.3, P〈0.05） and （3） significant associated abdominal injury （AIS〉3, LR=5.3, P〈0.05）. Conclusion： A blunt scapular fracture may not accompany a blunt thoracic aortic injury but it is strongly related to other injuries like chest injury, extremity injury, head injury, etc. If a scapular fracture is found with a high ISS score, high chest or abdomen AIS score, the patient would have a high risk of mortality.
