Objective： To investigate prospectively the effectiveness ofkyphoplasty with SKY bone expander system in treatment of compression fracture of thoracic/ lumbar vertebrae and correction of the deformity. Methods： Twe...Objective： To investigate prospectively the effectiveness ofkyphoplasty with SKY bone expander system in treatment of compression fracture of thoracic/ lumbar vertebrae and correction of the deformity. Methods： Twenty-five patients with thoracic/lumbar vertebral osteoporotic compression fracture were admitted to our hospital between March 2007 and March 2008, and treated by kyphoplasty with SKY bone expander system. Patient＇s pain status was rated with Visual Analogue Scale （VAS） score system 1 day before and 1 hour, 48 hours, 6 months, 12 months after surgery. In addition, Rolland-Mor- ris and Oswestry disability questionnaires （RDQ and ODI） were used for survey 1 day before and 1, 6, 12 months after surgery. Pre- and post-operative vertebral heights and Cobb＇s angles were measured based on the X-ray films and statistically analyzed. Results： There were 27 fractured vertebrae in these 25 patients. After SKY kyphoplasty, the Cobb＇s angles （9.8°±9.76°） were significantly reduced compared with preoperative angles （17.18°±9.35°, P〈0.05）, and the average improve- ment rate was 39%. Patients＇ pain VAS scores were also greatly improved after operation （P〈0.05）. Moreover, postoperative RDQ and ODI scores were significantly smaller than preoperative values （P〈0.05）. Conclusions： Kyphoplasty with SKY bone expander system provides an effective method for treating thoracic/ lumbar vertebral osteoporotic compression fracture, with the advantages of small surgical wound and short duration. It can effectively recover the anterior and medial heights of fractured vertebrae （33% and 50%, respectively）, reduce the Cobb＇s angle, quickly alleviate pain and improve patients＇ quality of life in a relatively short time period.展开更多
Objective:To investigate the relationship between morphological abnormalities and spinal cord deficit in thoracolumbar burst fractures. Methods: Seventy-eight patients with thoracolumbar burst fractures were retrospec...Objective:To investigate the relationship between morphological abnormalities and spinal cord deficit in thoracolumbar burst fractures. Methods: Seventy-eight patients with thoracolumbar burst fractures were retrospectively reviewed to calculate the stenotic ratio of spinal canal based on the midsagittal diameters and the hyphosis angle according to Cobb. The ASIA scoring of motor function of lower extremities was recorded . Results: The differences (P > 0.05) of the stenotic ratio of spinal canal and the kyphosis angle were not significant between patients without neurological deficit, with incomplete and complete lesions. No significant correlation(P > 0.05) between the stenotic ratio of spinal canal and the kyphosis angle, and ASIA scoring was noted. Conclusion:The severity of spinal cord injuries in thoracolumbar burst fractures is not predicted according to the percentage of canal stenosis or the degree of kyphesis induced by thoracolumbar burst fractures.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
Objective： To prospectively evaluate the feasibility, safety and efficacy of the percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using ...Objective： To prospectively evaluate the feasibility, safety and efficacy of the percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system in the retrospective non-randomized case-control study. Methods： Atotal of 38 consecutive non-randomized patients with type A thoracolumbar fractures, which had been stabilized posteriorly from December 2006 to March 2009, were examined retrospectively more than 9 months after surgery. Twenty-one patients had been treated conventionally with open pedicle screw fixation （OPSF） and 17 patients received minimally invasive treatment with Sextant percutaneous pedicle screw fixation （SPPSF）. As a method of evaluation, the incision size, the intraoperation and post- operative volume of blood loss, operation time, postoperative hospital stay, blood transfusion, the radiological assessment of the sagittal Cobb＇s angle, vertebral body angle and vertebral body height were recorded and compared. Results： All patients were followed up for 8-24 months （average 11.6 months）. There were significant differences in the incision size, surgical blood loss, surgical draining Joss, operation time, hospital stay after operation, blood transfusion, the proportion of antalgic supplement and postoperative incisional VAS between the two groups （P〈0.05）. Mean preoperative kyphotic deformity was 16.0° and improved by 9.3° after surgery in OPSF group, but 15.2° and 10.3° respectively in SPPSF group. Mean preoperative angle of the fractured vertebral body was 15.9°and improved by 7.9° after surgery in OPSF group, but 14.9° and 6.6° respectively in SPPSF group. Mean anterior vertebral body height （% of normal） was 67.3% before surgery and 95.8% after surgery, but 69.1% and 90.1% respectively in SPPSF group. Mean posterior vertebral body height （% of normal） was 93.3% before surgery and 99.5% after surgery, but 88.9% and 93.3% respectively in SPPSF group. Among the patients whose 9-month follow-up films were available, 3.0° ofkyphosis correction was lost in OPSF group, but 3.2° in SPPSF group. And 1.0°of the angle of the fractured vertebral body correction was lost in OPSF group, but 1.5°in SPPSF group. Then 3.0% of the anterior vertebral body height correction was lost in OPSF group, but 2.2% in SPPSF group. And 3.0% of the posterior vertebral body height correction was lost in OPSF group, but 2.5% in SPPSF group. The sagittal Cobb＇s angle, vertebral body angle and anterior height of the fractured vertebra were all significantly different in each group before and after operation （P〈0.05）. There were no significant differences in the postoperative sagittal Cobb＇s angle, vertebral body angle and the improvement of the vertebral body height and the kyphotic deformity correction between OPSF and SPPSF groups （P〉0.05）, but there was significant difference in the postoperative anterior height of the fractured vertebra between the two groups （P〈0.05）. Conclusion： The percutaneous pedicle screw fixation through the pedicle of fractured vertebra using Sextant system is a good minimally-invasive surgical therapeutic choice for patients with type A thoracolumbar fracture except for that the SPPSF has a little insufficiency in resuming the anterior height of the fractured vertebra compared with OPSF.展开更多
文摘Objective： To investigate prospectively the effectiveness ofkyphoplasty with SKY bone expander system in treatment of compression fracture of thoracic/ lumbar vertebrae and correction of the deformity. Methods： Twenty-five patients with thoracic/lumbar vertebral osteoporotic compression fracture were admitted to our hospital between March 2007 and March 2008, and treated by kyphoplasty with SKY bone expander system. Patient＇s pain status was rated with Visual Analogue Scale （VAS） score system 1 day before and 1 hour, 48 hours, 6 months, 12 months after surgery. In addition, Rolland-Mor- ris and Oswestry disability questionnaires （RDQ and ODI） were used for survey 1 day before and 1, 6, 12 months after surgery. Pre- and post-operative vertebral heights and Cobb＇s angles were measured based on the X-ray films and statistically analyzed. Results： There were 27 fractured vertebrae in these 25 patients. After SKY kyphoplasty, the Cobb＇s angles （9.8°±9.76°） were significantly reduced compared with preoperative angles （17.18°±9.35°, P〈0.05）, and the average improve- ment rate was 39%. Patients＇ pain VAS scores were also greatly improved after operation （P〈0.05）. Moreover, postoperative RDQ and ODI scores were significantly smaller than preoperative values （P〈0.05）. Conclusions： Kyphoplasty with SKY bone expander system provides an effective method for treating thoracic/ lumbar vertebral osteoporotic compression fracture, with the advantages of small surgical wound and short duration. It can effectively recover the anterior and medial heights of fractured vertebrae （33% and 50%, respectively）, reduce the Cobb＇s angle, quickly alleviate pain and improve patients＇ quality of life in a relatively short time period.
文摘Objective:To investigate the relationship between morphological abnormalities and spinal cord deficit in thoracolumbar burst fractures. Methods: Seventy-eight patients with thoracolumbar burst fractures were retrospectively reviewed to calculate the stenotic ratio of spinal canal based on the midsagittal diameters and the hyphosis angle according to Cobb. The ASIA scoring of motor function of lower extremities was recorded . Results: The differences (P > 0.05) of the stenotic ratio of spinal canal and the kyphosis angle were not significant between patients without neurological deficit, with incomplete and complete lesions. No significant correlation(P > 0.05) between the stenotic ratio of spinal canal and the kyphosis angle, and ASIA scoring was noted. Conclusion:The severity of spinal cord injuries in thoracolumbar burst fractures is not predicted according to the percentage of canal stenosis or the degree of kyphesis induced by thoracolumbar burst fractures.
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。
文摘Objective： To prospectively evaluate the feasibility, safety and efficacy of the percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system in the retrospective non-randomized case-control study. Methods： Atotal of 38 consecutive non-randomized patients with type A thoracolumbar fractures, which had been stabilized posteriorly from December 2006 to March 2009, were examined retrospectively more than 9 months after surgery. Twenty-one patients had been treated conventionally with open pedicle screw fixation （OPSF） and 17 patients received minimally invasive treatment with Sextant percutaneous pedicle screw fixation （SPPSF）. As a method of evaluation, the incision size, the intraoperation and post- operative volume of blood loss, operation time, postoperative hospital stay, blood transfusion, the radiological assessment of the sagittal Cobb＇s angle, vertebral body angle and vertebral body height were recorded and compared. Results： All patients were followed up for 8-24 months （average 11.6 months）. There were significant differences in the incision size, surgical blood loss, surgical draining Joss, operation time, hospital stay after operation, blood transfusion, the proportion of antalgic supplement and postoperative incisional VAS between the two groups （P〈0.05）. Mean preoperative kyphotic deformity was 16.0° and improved by 9.3° after surgery in OPSF group, but 15.2° and 10.3° respectively in SPPSF group. Mean preoperative angle of the fractured vertebral body was 15.9°and improved by 7.9° after surgery in OPSF group, but 14.9° and 6.6° respectively in SPPSF group. Mean anterior vertebral body height （% of normal） was 67.3% before surgery and 95.8% after surgery, but 69.1% and 90.1% respectively in SPPSF group. Mean posterior vertebral body height （% of normal） was 93.3% before surgery and 99.5% after surgery, but 88.9% and 93.3% respectively in SPPSF group. Among the patients whose 9-month follow-up films were available, 3.0° ofkyphosis correction was lost in OPSF group, but 3.2° in SPPSF group. And 1.0°of the angle of the fractured vertebral body correction was lost in OPSF group, but 1.5°in SPPSF group. Then 3.0% of the anterior vertebral body height correction was lost in OPSF group, but 2.2% in SPPSF group. And 3.0% of the posterior vertebral body height correction was lost in OPSF group, but 2.5% in SPPSF group. The sagittal Cobb＇s angle, vertebral body angle and anterior height of the fractured vertebra were all significantly different in each group before and after operation （P〈0.05）. There were no significant differences in the postoperative sagittal Cobb＇s angle, vertebral body angle and the improvement of the vertebral body height and the kyphotic deformity correction between OPSF and SPPSF groups （P〉0.05）, but there was significant difference in the postoperative anterior height of the fractured vertebra between the two groups （P〈0.05）. Conclusion： The percutaneous pedicle screw fixation through the pedicle of fractured vertebra using Sextant system is a good minimally-invasive surgical therapeutic choice for patients with type A thoracolumbar fracture except for that the SPPSF has a little insufficiency in resuming the anterior height of the fractured vertebra compared with OPSF.
