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
BACKGROUND Fractures of the axis are commonly seen in spinal injuries. Upper cervical fractures are usually managed conservatively. However, the complications due to long-term external immobilization cannot be ignored...BACKGROUND Fractures of the axis are commonly seen in spinal injuries. Upper cervical fractures are usually managed conservatively. However, the complications due to long-term external immobilization cannot be ignored. The traditional open surgery has the disadvantages of too much blood loss and soft tissue injury. The aim of our paper is to introduce a minimally invasive surgical treatment for multiple axis fractures.CASE SUMMARY We report a 40-year-old Chinese male who had severe neck pain and difficult neck movement after falling from 3 meters. X-ray and computed tomography(CT) scan revealed an axis injury consisting of an odontoid Type Ⅲ fracture associated with a Hangman fracture categorized as a Levine-Edwards Type Ⅰ fracture. The patient underwent anterior odontoid screw fixation and posterior percutaneous screw fixation using intraoperative O-arm navigation. Neck pain was markedly improved after surgery. X-rays and CT scan reconstructions of 3-mo follow-up showed good stability and fusion. The range of cervical motion was well preserved.CONCLUSION Anterior odontoid screw fixation and posterior direct C2 percutaneous pedicle screw fixation with the aid of O-arm navigation and neurophysiological monitoring can be an interesting alternative option for complicated multiple axis fractures.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
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
目的探讨关节镜辅助复位内固定(arthroscopically-assisted reduction and internal fixation,ARIF)结合加速康复外科(enhanced recovery after surgery,ERAS)理念与开放复位内固定(open reduction and internal fixation,ORIF)治疗胫...目的探讨关节镜辅助复位内固定(arthroscopically-assisted reduction and internal fixation,ARIF)结合加速康复外科(enhanced recovery after surgery,ERAS)理念与开放复位内固定(open reduction and internal fixation,ORIF)治疗胫骨平台后外侧骨折的临床疗效差异。方法回顾性选择2020年1月至2022年11月徐州市中心医院骨科胫骨平台后外侧骨折患者70例,根据治疗方法分为ARIF组(结合ERAS,n=32)和ORIF组(未结合ERAS,n=38)。所有患者住院后均通过影像学检查评估骨折类型,比较两组患者的手术时间、住院时间,采用视觉模拟量表(visual analogue scale,VAS)评估患者术后早期疼痛,美国特种外科医院(hospital for special surgery,HSS)评分评估患者术后3个月膝关节功能,比较两组患者术后6个月双侧大腿周径差值。结果ARIF组患者的手术时间显著短于ORIF组[(67.84±9.89)min vs(85.16±9.18)min,P<0.001],住院时间显著短于ORIF组[(7.13±1.41)d vs(8.74±1.84)d,P<0.001]。术后第3天,ARIF组的VAS评分显著低于ORIF组[(4.00±1.44)分vs(5.39±1.24)分,P<0.001]。术后3个月,ARIF组患者的膝关节功能显著优于ORIF组,术后6个月髌骨上10 cm大腿周径差值显著小于ORIF组(P<0.001)。结论与ORIF相比,接受ARIF结合ERAS治疗胫骨平台后外侧骨折的患者术后恢复更快、住院时间更短、临床疗效更确切。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BACKGROUND Fractures of the axis are commonly seen in spinal injuries. Upper cervical fractures are usually managed conservatively. However, the complications due to long-term external immobilization cannot be ignored. The traditional open surgery has the disadvantages of too much blood loss and soft tissue injury. The aim of our paper is to introduce a minimally invasive surgical treatment for multiple axis fractures.CASE SUMMARY We report a 40-year-old Chinese male who had severe neck pain and difficult neck movement after falling from 3 meters. X-ray and computed tomography(CT) scan revealed an axis injury consisting of an odontoid Type Ⅲ fracture associated with a Hangman fracture categorized as a Levine-Edwards Type Ⅰ fracture. The patient underwent anterior odontoid screw fixation and posterior percutaneous screw fixation using intraoperative O-arm navigation. Neck pain was markedly improved after surgery. X-rays and CT scan reconstructions of 3-mo follow-up showed good stability and fusion. The range of cervical motion was well preserved.CONCLUSION Anterior odontoid screw fixation and posterior direct C2 percutaneous pedicle screw fixation with the aid of O-arm navigation and neurophysiological monitoring can be an interesting alternative option for complicated multiple axis fractures.
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.
文摘目的探讨关节镜辅助复位内固定(arthroscopically-assisted reduction and internal fixation,ARIF)结合加速康复外科(enhanced recovery after surgery,ERAS)理念与开放复位内固定(open reduction and internal fixation,ORIF)治疗胫骨平台后外侧骨折的临床疗效差异。方法回顾性选择2020年1月至2022年11月徐州市中心医院骨科胫骨平台后外侧骨折患者70例,根据治疗方法分为ARIF组(结合ERAS,n=32)和ORIF组(未结合ERAS,n=38)。所有患者住院后均通过影像学检查评估骨折类型,比较两组患者的手术时间、住院时间,采用视觉模拟量表(visual analogue scale,VAS)评估患者术后早期疼痛,美国特种外科医院(hospital for special surgery,HSS)评分评估患者术后3个月膝关节功能,比较两组患者术后6个月双侧大腿周径差值。结果ARIF组患者的手术时间显著短于ORIF组[(67.84±9.89)min vs(85.16±9.18)min,P<0.001],住院时间显著短于ORIF组[(7.13±1.41)d vs(8.74±1.84)d,P<0.001]。术后第3天,ARIF组的VAS评分显著低于ORIF组[(4.00±1.44)分vs(5.39±1.24)分,P<0.001]。术后3个月,ARIF组患者的膝关节功能显著优于ORIF组,术后6个月髌骨上10 cm大腿周径差值显著小于ORIF组(P<0.001)。结论与ORIF相比,接受ARIF结合ERAS治疗胫骨平台后外侧骨折的患者术后恢复更快、住院时间更短、临床疗效更确切。