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
Pedicle screw instrumentation has been used to stabilize the thoracolumbar spine for several decades. Although pedicle screws were originally placed via a freehand technique, there has been a movement in favor of pedi...Pedicle screw instrumentation has been used to stabilize the thoracolumbar spine for several decades. Although pedicle screws were originally placed via a freehand technique, there has been a movement in favor of pedicle screw placement with the aid of imaging. Such assistive techniques include fluoroscopy guidance and stereotactic navigation. Imaging has the benefit of increased visualization of a pedicle's trajectory, but can result in increased morbidity associated with radiation exposure, increased time expenditure, and possible workflow interruption. Many institutions have reported high accuracies with each of these three core techniques. However, due to differing definitions of accuracy and varying radiographic analyses, it is extremely difficult to compare studies side-by-side to determine which techniques are superior. From the literature, it can be concluded that pedicles of vertebrae within the mid-thoracic spine and vertebrae that have altered morphology due to scoliosis or other deformities are the most difficult to cannulate. Thus, spine surgeons would benefit the most from using assistive technologies in these circumstances. All other pedicles in thethoracolumbar spine should theoretically be cannulated with ease via a free-hand technique, given appropriate training and experience. Despite these global recommendations, appropriate techniques must be chosen at the surgeon's discretion. Such determinations should be based on the surgeon's experience and the specific pathology that will be treated.展开更多
Objective To investigate diagnosis and treatment characters of cervical spondylotic myelopathy combined with thoracic spinal stenosis, and to analysis effective pathway of spinal function recovery. Methods We took res...Objective To investigate diagnosis and treatment characters of cervical spondylotic myelopathy combined with thoracic spinal stenosis, and to analysis effective pathway of spinal function recovery. Methods We took respective analysis on diagnosis, treatment and recovery results of 12 cases, whose symptoms, signs and MR were explicit. Results Follow ups times were from 9 months to 5 years and 8 months. Nerve function of 8 cases recovered completely or nearly completely; that of 2 cases improved apparently and that of 2 cases improved slightly. Conclusion Detailed disease history collection, particular body examination and MR reading are very important to early diagnosis of cervical spondylotic myelopathy combined with thoracic spinal stenosis. Early operation combined with cervical and thoracic spinal canal decompression at same time or at different stages is the single effective method to patients’ function recovery.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
Objective Comparing different medication pro ject of continuous epidural analgesia for the patient after lumbar verte bra opera-tion,to decrease the complications and promote analgesia effects.Methods150cases with AS...Objective Comparing different medication pro ject of continuous epidural analgesia for the patient after lumbar verte bra opera-tion,to decrease the complications and promote analgesia effects.Methods150cases with ASAⅠ～Ⅱgrade,lumbar intervertebral disc e x-tirpation and /or vertebral canal decompression,were divided into 5gro ups.A group:0.0625%bupivacaine;B group:0.125%bupiva-caine;C group:0.0625%bupivacaine and 1mg morphine;D group:0.125%bupivacaine and 1mg morphine;E group:n o analgesia.Record the occurrence of RR,MAP,HR,VAS score and side effects.Results The analgesia effects of all groups were satisfying,but the oc-currence of urine retention increased in B,C,D group,and the occurrence of nausea and vomit increased obviou sly in C,D group.Conclusions The continuous epidural analgesia w ith simple 0.0625%for patients afte r lumbar vertebral operation is best.展开更多
Objective: To compare the influence of normal and degenerative discs on stress distribution of the thoracolumbar vertebrae under destructive load, explore the biomechanical background and clinical meaning and provide ...Objective: To compare the influence of normal and degenerative discs on stress distribution of the thoracolumbar vertebrae under destructive load, explore the biomechanical background and clinical meaning and provide theoretical basis for clinical diagnosis and treatment. Methods: A mechanical model of thoracolumbar motion segment of normal and degenerative discs was built with a three dimensional finite element method and three stresses of vertical compression, compressive flexion and distractive flexion were comparatively analyzed. Results: With vertical compression and compressive flexion loads, the thoracolumbar motion segment of the normal disc showed that the central part of the upper and lower end plates of the vertebrae and the central part of the trabecular bone adjacent to the end plate were loaded with the most intensive stresses, meanwhile, the postero lateral part of the annulus fibrosus was concentrated with stresses. Degenerative disc showed that the stress distribution of the trabecular bone was relatively averaged, the stresses of the central part adjacent to the end plate were low, while at the same time, the stresses of the peripheral part were elevated relatively. With distraction flexion load, the stresses of the cortex bone, trabecular bone, end plate and annulus fibrosus of the thoracolumbar vertebrae of degenerative discs were low, meanwhile, the stresses of the posterior structure of the vertebral body were relatively elevated compared with that of normal discs. Conclusions: There is difference in influence between normal and degenerative discs on the stress distribution of the thoracolumbar vertebrae with destructive load. The transferring way of load is changed after disc degeneration.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.
基金Supported by Gordon and Marilyn Macklin Foundation
文摘Pedicle screw instrumentation has been used to stabilize the thoracolumbar spine for several decades. Although pedicle screws were originally placed via a freehand technique, there has been a movement in favor of pedicle screw placement with the aid of imaging. Such assistive techniques include fluoroscopy guidance and stereotactic navigation. Imaging has the benefit of increased visualization of a pedicle's trajectory, but can result in increased morbidity associated with radiation exposure, increased time expenditure, and possible workflow interruption. Many institutions have reported high accuracies with each of these three core techniques. However, due to differing definitions of accuracy and varying radiographic analyses, it is extremely difficult to compare studies side-by-side to determine which techniques are superior. From the literature, it can be concluded that pedicles of vertebrae within the mid-thoracic spine and vertebrae that have altered morphology due to scoliosis or other deformities are the most difficult to cannulate. Thus, spine surgeons would benefit the most from using assistive technologies in these circumstances. All other pedicles in thethoracolumbar spine should theoretically be cannulated with ease via a free-hand technique, given appropriate training and experience. Despite these global recommendations, appropriate techniques must be chosen at the surgeon's discretion. Such determinations should be based on the surgeon's experience and the specific pathology that will be treated.
文摘Objective To investigate diagnosis and treatment characters of cervical spondylotic myelopathy combined with thoracic spinal stenosis, and to analysis effective pathway of spinal function recovery. Methods We took respective analysis on diagnosis, treatment and recovery results of 12 cases, whose symptoms, signs and MR were explicit. Results Follow ups times were from 9 months to 5 years and 8 months. Nerve function of 8 cases recovered completely or nearly completely; that of 2 cases improved apparently and that of 2 cases improved slightly. Conclusion Detailed disease history collection, particular body examination and MR reading are very important to early diagnosis of cervical spondylotic myelopathy combined with thoracic spinal stenosis. Early operation combined with cervical and thoracic spinal canal decompression at same time or at different stages is the single effective method to patients’ function recovery.
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Objective Comparing different medication pro ject of continuous epidural analgesia for the patient after lumbar verte bra opera-tion,to decrease the complications and promote analgesia effects.Methods150cases with ASAⅠ～Ⅱgrade,lumbar intervertebral disc e x-tirpation and /or vertebral canal decompression,were divided into 5gro ups.A group:0.0625%bupivacaine;B group:0.125%bupiva-caine;C group:0.0625%bupivacaine and 1mg morphine;D group:0.125%bupivacaine and 1mg morphine;E group:n o analgesia.Record the occurrence of RR,MAP,HR,VAS score and side effects.Results The analgesia effects of all groups were satisfying,but the oc-currence of urine retention increased in B,C,D group,and the occurrence of nausea and vomit increased obviou sly in C,D group.Conclusions The continuous epidural analgesia w ith simple 0.0625%for patients afte r lumbar vertebral operation is best.
文摘Objective: To compare the influence of normal and degenerative discs on stress distribution of the thoracolumbar vertebrae under destructive load, explore the biomechanical background and clinical meaning and provide theoretical basis for clinical diagnosis and treatment. Methods: A mechanical model of thoracolumbar motion segment of normal and degenerative discs was built with a three dimensional finite element method and three stresses of vertical compression, compressive flexion and distractive flexion were comparatively analyzed. Results: With vertical compression and compressive flexion loads, the thoracolumbar motion segment of the normal disc showed that the central part of the upper and lower end plates of the vertebrae and the central part of the trabecular bone adjacent to the end plate were loaded with the most intensive stresses, meanwhile, the postero lateral part of the annulus fibrosus was concentrated with stresses. Degenerative disc showed that the stress distribution of the trabecular bone was relatively averaged, the stresses of the central part adjacent to the end plate were low, while at the same time, the stresses of the peripheral part were elevated relatively. With distraction flexion load, the stresses of the cortex bone, trabecular bone, end plate and annulus fibrosus of the thoracolumbar vertebrae of degenerative discs were low, meanwhile, the stresses of the posterior structure of the vertebral body were relatively elevated compared with that of normal discs. Conclusions: There is difference in influence between normal and degenerative discs on the stress distribution of the thoracolumbar vertebrae with destructive load. The transferring way of load is changed after disc degeneration.
