Objective To analyze the influence of segmental pedicle screws versus hybrid instrumentation on the correction results in adolescent idiopathic scoliosis patients undergoing posterior selective thoracic fusion. Metho...Objective To analyze the influence of segmental pedicle screws versus hybrid instrumentation on the correction results in adolescent idiopathic scoliosis patients undergoing posterior selective thoracic fusion. Methods By reviewing the medical records and roentgenograms of adolescent idiopathic scoliosis patients who underwent selective thoracic fusion from February 2000 to January 2007 in our hospital, the patients were divided into 2 groups according to different instrumentation fashions： Group A was hook-screw-rod （hybrid） internal fixation type, Group B was screw-rod （all pedicle screws） internal fixation type, and the screws were used in every segment on the concave side of the thoracic curve. The parameters of the scoliosis were measured and the correction results were analyzed. Results Totally, 48 patients （7 males, 41 females） were included, with an average age of 14.4 years old and a mean follow-up time of 12.3 months. Thirty and 18 patients were assigned to group A and group B, respectively. The mean preoperative coronal Cobb angles of the thoracic curve were 48.8° and 47.4°, respectively. After surgery, they were corrected to 13.7° and 6.8°, respectively. At final follow-up, they were 17.0° and 9.5°, with an average correction rate of 64.6% and 79.0%, respectively, and the correction rate of group B was significantly higher than that of group A （P=0.003）. The mean preoperative coronal Cobb angles of the lumbar curve were 32.6° and 35.2°, respectively. After surgery, they were corrected to 8.6° and 8.3°, respectively. At final follow-up, they were 10.3° and 11.1°, with an average correction rate of 66.8% and 69.9%, respectively, and the correction rate of group B was significantly higher than that of group A （P=0.003）. The correction loss of the thoracic curve and lumbar curve in the 2 groups were 3.1° and 1.8°, 2.4° and 2.4°, respectively. No significant difference was noted （both P〉0.05）. The decompensation rate at final follow-up in these 2 groups were 4% （1/25） and 7.1% （1/14） respectively, with no significant difference （P〉0.05）.展开更多
To evaluate the results of the TRAFIX instrumentation in correcting s coliosis. Methods. Since October 1997, 47 patients with scoliosis received spinal fixation with the TRAFIX instrumentation at the Peking Union Medi...To evaluate the results of the TRAFIX instrumentation in correcting s coliosis. Methods. Since October 1997, 47 patients with scoliosis received spinal fixation with the TRAFIX instrumentation at the Peking Union Medical College Hospital. T he average age was 14.3 years (range 10 to 38 years). There were 27 idiopathic c ases, 16 congenital cases, 2 cases with Marfan syndrome and 2 with neurofibromat osis. Twelve of the 47 patients underwent anterior release, while 4 patients rec eived the revision approach. The average follow up time was 26 months (13～38 m onths). Results. The measurements of primary coronal deformity before and after surgery were 74°(50°～115°) and 38.7° (11°～95°), respectively. The average curve correction was 54%. The average number of fused segments was 12.5 (7～17) verte brae. The distance between the center of apex and the C7 plumb line was 56.8 mm before surgery (25～107mm) and 31 mm after surgery (10～87mm). Conclusion. The TRAFIX instrumentation provides three dimensional correction wi th refinement, convenience and reliable fixation.展开更多
AIM: To investigate inpatient length of stay(LOS), complication rates, and readmission rates for sacral fracture patients based on operative approach.METHODS: All patients who presented to a large tertiary care center...AIM: To investigate inpatient length of stay(LOS), complication rates, and readmission rates for sacral fracture patients based on operative approach.METHODS: All patients who presented to a large tertiary care center with isolated sacral fractures in an 11-year period were included in a retrospective chart review. Operative approach(open reduction internal fixation vs percutaneous) was noted, as well as age, gender, race, and American Society of Anesthesiologists' score. Complications included infection, nonunion and malunion, deep venous thrombosis, and hardware problems; 90-d readmissions were broken down into infection, surgical revision of the sacral fracture, and medical complications. LOS was collected for the initial admission and readmission visits if applicable. Fisher's exact and non-parametric t-tests(Mann-Whitney U tests) were employed to compare LOS, complications, and readmissions between open and percutaneous approaches.RESULTS: Ninety-four patients with isolated sacral fractures were identified: 31(30.4%) who underwentopen reduction and internal fixation(ORIF) vs 63(67.0%) who underwent percutaneous fixation. There was a significant difference in LOS based on operative approach: 9.1 d for ORIF patients vs 6.1 d for percutaneous patients(P = 0.043), amounting to a difference in cost of $13590. Ten patients in the study developed complications, with no significant difference in complication rates or reasons for complications between the two groups(19.4% for ORIF patients vs 6.3% for percutaneous patients). Eight patients were readmitted, with no significant difference in readmission rates or reasons for readmission between the two groups(9.5% percutaneous vs 6.5% ORIF).CONCLUSION: There is a significant difference in LOS based on operative approach for sacral fracture patients. Given similar complications and readmission rates, we recommend a percutaneous approach.展开更多
BACKGROUND Despite recent meta-analyses of randomized controlled trials(RCTs),there remains no consensus regarding the preferred surgical treatment for humeral shaft fractures.The fragility index(FI)is an emerging too...BACKGROUND Despite recent meta-analyses of randomized controlled trials(RCTs),there remains no consensus regarding the preferred surgical treatment for humeral shaft fractures.The fragility index(FI)is an emerging tool used to evaluate the robustness of RCTs by quantifying the number of participants in a study group that would need to switch outcomes in order to reverse the study conclusions.AIM To investigate the fragility index of randomized control trials assessing outcomes of operative fixation in proximal humerus fractures.METHODS We completed a systematic review of RCTs evaluating the surgical treatment of humeral shaft fractures.Inclusion criteria included:articles published in English;patients randomized and allotted in 1:1 ratio to 2 parallel arms;and dichotomous outcome variables.The FI was calculated for total complications,each complication individually,and secondary surgeries using the Fisher exact test,as previously published.RESULTS Fifteen RCTs were included in the analysis comparing open reduction plate osteosynthesis with dynamic compression plate or locking compression plate,intramedullary nail,and minimally invasive plate osteosynthesis.The median FI was 0 for all parameters analyzed.Regarding individual outcomes,the FI was 0 for 81/91(89%)of outcomes.The FI exceeded the number lost to follow up in only 2/91(2%)outcomes.CONCLUSION The FI shows that data from RCTs regarding operative treatment of humeral shaft fractures are fragile and does not demonstrate superiority of any particular surgical technique.展开更多
目的:分析胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的危险因素,并建立风险预测模型。方法:以2017年3月至2020年3月,在郑州市骨科医院接受椎弓根螺钉内固定术或椎弓根螺钉内固定术联合仿生骨柱植骨术治疗的患者为研究对象,根据术后...目的:分析胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的危险因素,并建立风险预测模型。方法:以2017年3月至2020年3月,在郑州市骨科医院接受椎弓根螺钉内固定术或椎弓根螺钉内固定术联合仿生骨柱植骨术治疗的患者为研究对象,根据术后2年内是否并发脊柱后凸畸形分为2组。收集2组患者性别、年龄、体质量指数、是否合并内科疾病、骨折节段、骨折原因等一般资料和是否合并椎间盘损伤、骨折爆裂程度、胸腰椎AO脊柱损伤评分(thoracolumbar AO Spine injury score,TLAOSIS)等损伤情况评价指标,以及手术入路、固定节段长短等手术情况。测量术前影像学参数,在术前X线侧位片上测量椎体楔形角、骨折节段Cobb角和椎体前缘高度(计算椎体前缘高度比值),在术前X线正位片上测量上位椎间盘角和下位椎间盘角。比较2组患者的一般资料、损伤情况评价指标、手术情况和影像学参数,进行单因素分析。根据单因素分析结果,采用Logistic回归分析胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的危险因素。依据危险因素分析结果建立胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的风险预测列线图模型,并对模型进行评价。结果:共纳入176例患者,并发畸形组30例,未并发畸形组146例。单因素分析结果显示,2组患者合并椎间盘损伤情况、骨折爆裂程度、TLAOSIS,以及术前椎体前缘高度比值、骨折节段Cobb角、上位椎间盘角、下位椎间盘角的组间差异,均有统计学意义。Logistic回归分析结果显示,合并椎间盘损伤、TLAOSIS>8分、完全爆裂骨折、术前椎体前缘高度比值<50%、术前上位椎间盘角≤3.5°是胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的危险因素[OR=2.965,95%CI(1.682,4.534),P=0.003;OR=2.707,95%CI(1.364,4.216),P=0.009;OR=1.921,95%CI(0.716,3.357),P=0.022;OR=2.221,95%CI(0.986,3.627),P=0.013;OR=3.654,95%CI(1.867,4.853),P=0.000]。列线图模型预测结果显示,上述5个因素对应的胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的风险预测值分别为44.0分、42.5分、33.0分、39.0分、51.5分,并发脊柱后凸畸形的概率为0.10~0.56。受试者操作特征曲线分析结果显示,该模型预测胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的曲线下面积为0.921(P=0.000),灵敏度为78.43%,特异度为85.52%;模型验证C-index值为0.823,校正曲线和标准曲线拟合度较好,模型校准度良好。决策曲线分析结果显示,根据该模型对胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的风险进行预测,可获得较好的净收益,阈值概率为0.02~0.95。结论:合并椎间盘损伤、TLAOSIS>8分、完全爆裂骨折、术前椎体前缘高度比值<50%、术前上位椎间盘角≤3.5°均为胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的危险因素;基于这些因素构建的风险预测列线图模型,对于胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形具有一定的预测价值。展开更多
文摘Objective To analyze the influence of segmental pedicle screws versus hybrid instrumentation on the correction results in adolescent idiopathic scoliosis patients undergoing posterior selective thoracic fusion. Methods By reviewing the medical records and roentgenograms of adolescent idiopathic scoliosis patients who underwent selective thoracic fusion from February 2000 to January 2007 in our hospital, the patients were divided into 2 groups according to different instrumentation fashions： Group A was hook-screw-rod （hybrid） internal fixation type, Group B was screw-rod （all pedicle screws） internal fixation type, and the screws were used in every segment on the concave side of the thoracic curve. The parameters of the scoliosis were measured and the correction results were analyzed. Results Totally, 48 patients （7 males, 41 females） were included, with an average age of 14.4 years old and a mean follow-up time of 12.3 months. Thirty and 18 patients were assigned to group A and group B, respectively. The mean preoperative coronal Cobb angles of the thoracic curve were 48.8° and 47.4°, respectively. After surgery, they were corrected to 13.7° and 6.8°, respectively. At final follow-up, they were 17.0° and 9.5°, with an average correction rate of 64.6% and 79.0%, respectively, and the correction rate of group B was significantly higher than that of group A （P=0.003）. The mean preoperative coronal Cobb angles of the lumbar curve were 32.6° and 35.2°, respectively. After surgery, they were corrected to 8.6° and 8.3°, respectively. At final follow-up, they were 10.3° and 11.1°, with an average correction rate of 66.8% and 69.9%, respectively, and the correction rate of group B was significantly higher than that of group A （P=0.003）. The correction loss of the thoracic curve and lumbar curve in the 2 groups were 3.1° and 1.8°, 2.4° and 2.4°, respectively. No significant difference was noted （both P〉0.05）. The decompensation rate at final follow-up in these 2 groups were 4% （1/25） and 7.1% （1/14） respectively, with no significant difference （P〉0.05）.
文摘To evaluate the results of the TRAFIX instrumentation in correcting s coliosis. Methods. Since October 1997, 47 patients with scoliosis received spinal fixation with the TRAFIX instrumentation at the Peking Union Medical College Hospital. T he average age was 14.3 years (range 10 to 38 years). There were 27 idiopathic c ases, 16 congenital cases, 2 cases with Marfan syndrome and 2 with neurofibromat osis. Twelve of the 47 patients underwent anterior release, while 4 patients rec eived the revision approach. The average follow up time was 26 months (13～38 m onths). Results. The measurements of primary coronal deformity before and after surgery were 74°(50°～115°) and 38.7° (11°～95°), respectively. The average curve correction was 54%. The average number of fused segments was 12.5 (7～17) verte brae. The distance between the center of apex and the C7 plumb line was 56.8 mm before surgery (25～107mm) and 31 mm after surgery (10～87mm). Conclusion. The TRAFIX instrumentation provides three dimensional correction wi th refinement, convenience and reliable fixation.
文摘AIM: To investigate inpatient length of stay(LOS), complication rates, and readmission rates for sacral fracture patients based on operative approach.METHODS: All patients who presented to a large tertiary care center with isolated sacral fractures in an 11-year period were included in a retrospective chart review. Operative approach(open reduction internal fixation vs percutaneous) was noted, as well as age, gender, race, and American Society of Anesthesiologists' score. Complications included infection, nonunion and malunion, deep venous thrombosis, and hardware problems; 90-d readmissions were broken down into infection, surgical revision of the sacral fracture, and medical complications. LOS was collected for the initial admission and readmission visits if applicable. Fisher's exact and non-parametric t-tests(Mann-Whitney U tests) were employed to compare LOS, complications, and readmissions between open and percutaneous approaches.RESULTS: Ninety-four patients with isolated sacral fractures were identified: 31(30.4%) who underwentopen reduction and internal fixation(ORIF) vs 63(67.0%) who underwent percutaneous fixation. There was a significant difference in LOS based on operative approach: 9.1 d for ORIF patients vs 6.1 d for percutaneous patients(P = 0.043), amounting to a difference in cost of $13590. Ten patients in the study developed complications, with no significant difference in complication rates or reasons for complications between the two groups(19.4% for ORIF patients vs 6.3% for percutaneous patients). Eight patients were readmitted, with no significant difference in readmission rates or reasons for readmission between the two groups(9.5% percutaneous vs 6.5% ORIF).CONCLUSION: There is a significant difference in LOS based on operative approach for sacral fracture patients. Given similar complications and readmission rates, we recommend a percutaneous approach.
文摘BACKGROUND Despite recent meta-analyses of randomized controlled trials(RCTs),there remains no consensus regarding the preferred surgical treatment for humeral shaft fractures.The fragility index(FI)is an emerging tool used to evaluate the robustness of RCTs by quantifying the number of participants in a study group that would need to switch outcomes in order to reverse the study conclusions.AIM To investigate the fragility index of randomized control trials assessing outcomes of operative fixation in proximal humerus fractures.METHODS We completed a systematic review of RCTs evaluating the surgical treatment of humeral shaft fractures.Inclusion criteria included:articles published in English;patients randomized and allotted in 1:1 ratio to 2 parallel arms;and dichotomous outcome variables.The FI was calculated for total complications,each complication individually,and secondary surgeries using the Fisher exact test,as previously published.RESULTS Fifteen RCTs were included in the analysis comparing open reduction plate osteosynthesis with dynamic compression plate or locking compression plate,intramedullary nail,and minimally invasive plate osteosynthesis.The median FI was 0 for all parameters analyzed.Regarding individual outcomes,the FI was 0 for 81/91(89%)of outcomes.The FI exceeded the number lost to follow up in only 2/91(2%)outcomes.CONCLUSION The FI shows that data from RCTs regarding operative treatment of humeral shaft fractures are fragile and does not demonstrate superiority of any particular surgical technique.
文摘目的:分析胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的危险因素,并建立风险预测模型。方法:以2017年3月至2020年3月,在郑州市骨科医院接受椎弓根螺钉内固定术或椎弓根螺钉内固定术联合仿生骨柱植骨术治疗的患者为研究对象,根据术后2年内是否并发脊柱后凸畸形分为2组。收集2组患者性别、年龄、体质量指数、是否合并内科疾病、骨折节段、骨折原因等一般资料和是否合并椎间盘损伤、骨折爆裂程度、胸腰椎AO脊柱损伤评分(thoracolumbar AO Spine injury score,TLAOSIS)等损伤情况评价指标,以及手术入路、固定节段长短等手术情况。测量术前影像学参数,在术前X线侧位片上测量椎体楔形角、骨折节段Cobb角和椎体前缘高度(计算椎体前缘高度比值),在术前X线正位片上测量上位椎间盘角和下位椎间盘角。比较2组患者的一般资料、损伤情况评价指标、手术情况和影像学参数,进行单因素分析。根据单因素分析结果,采用Logistic回归分析胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的危险因素。依据危险因素分析结果建立胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的风险预测列线图模型,并对模型进行评价。结果:共纳入176例患者,并发畸形组30例,未并发畸形组146例。单因素分析结果显示,2组患者合并椎间盘损伤情况、骨折爆裂程度、TLAOSIS,以及术前椎体前缘高度比值、骨折节段Cobb角、上位椎间盘角、下位椎间盘角的组间差异,均有统计学意义。Logistic回归分析结果显示,合并椎间盘损伤、TLAOSIS>8分、完全爆裂骨折、术前椎体前缘高度比值<50%、术前上位椎间盘角≤3.5°是胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的危险因素[OR=2.965,95%CI(1.682,4.534),P=0.003;OR=2.707,95%CI(1.364,4.216),P=0.009;OR=1.921,95%CI(0.716,3.357),P=0.022;OR=2.221,95%CI(0.986,3.627),P=0.013;OR=3.654,95%CI(1.867,4.853),P=0.000]。列线图模型预测结果显示,上述5个因素对应的胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的风险预测值分别为44.0分、42.5分、33.0分、39.0分、51.5分,并发脊柱后凸畸形的概率为0.10~0.56。受试者操作特征曲线分析结果显示,该模型预测胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的曲线下面积为0.921(P=0.000),灵敏度为78.43%,特异度为85.52%;模型验证C-index值为0.823,校正曲线和标准曲线拟合度较好,模型校准度良好。决策曲线分析结果显示,根据该模型对胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的风险进行预测,可获得较好的净收益,阈值概率为0.02~0.95。结论:合并椎间盘损伤、TLAOSIS>8分、完全爆裂骨折、术前椎体前缘高度比值<50%、术前上位椎间盘角≤3.5°均为胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的危险因素;基于这些因素构建的风险预测列线图模型,对于胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形具有一定的预测价值。
