Thoracolumbar burst fracture, a common condition in clinic, often leads to severe spinal instability and neurologic deficit. In most cases, the compression that caused by backward protrusion of the fracture fragments ...Thoracolumbar burst fracture, a common condition in clinic, often leads to severe spinal instability and neurologic deficit. In most cases, the compression that caused by backward protrusion of the fracture fragments to the spinal cord, makes complete decompression difficult through a posterior approach. Here, we reviewed the clinical records of 22 patients with thoracolumbar burst fracture treated by anterior corpectomy, decompression of the spinal cord, and implantation of titanium mesh cage.展开更多
Background Short-segment U-shaped pedicle screw fixation has been widely used to treat thoracolumbar burst fracture.Some studies have reported the disadvantages of traditional U-shaped pedicle screw,which included a r...Background Short-segment U-shaped pedicle screw fixation has been widely used to treat thoracolumbar burst fracture.Some studies have reported the disadvantages of traditional U-shaped pedicle screw,which included a relatively high rate of adjacent segment degeneration and screw failure,including screw pullout and breakage.The purpose of this study was to assess the efficacy of open reduction and fixation using KumaFix fixation system in treatment of thoracolumbar burst fractures.Methods From June 2011 to June 2012,45 consecutive patients with thoracolumbar burst fractures were enrolled.They were randomly assigned to treatment with KumaFix （the treatment group,n=23） or traditional U-shaped pedicle screw （the control group,n=22）.The patients were followed up postoperatively and were assessed with regard to radiologic and clinical outcomes.Radiologic outcomes were assessed mainly on the basis of Cobb angle and vertebral wedge angle.Clinical outcomes were evaluated mainly with use of Visual Analog Scale （VAS） for pain and the Oswestry Disability Index （ODI） Questionnaire.Results All patients were followed up from 9 to 22 months.There were no significant differences between the two groups with regard to preoperative indices.The operation time in the treatment group was significantly lower than that in the control group.Preoperative Cobb angles and vertebral wedge angles in two groups were significantly decreased after surgery,and these have been well maintained at the last follow-up with mild correction losses.The results of clinical outcome showed lower VAS and ODI scores in two groups compared with those preoperative,and the treatment group had greater improvement on the ODI compared with the control group at the last follow-up.Conclusions Compared with traditional U-shaped pedicle screw,KumaFix fixation system can achieve gradual,controlled reduction,provide enough space for bone implantation,and avoid acceleration of adjacent segment degeneration.It is an effective and reliable technique to treat thoracolumbar burst fractures.展开更多
Background Thoracolumbar burst fracture is a common clinical injury, and the fracture mechanism is still controversial. The aim of this research was to study the formation of intracanal fracture fragments in thoracolu...Background Thoracolumbar burst fracture is a common clinical injury, and the fracture mechanism is still controversial. The aim of this research was to study the formation of intracanal fracture fragments in thoracolumbar burst fractures and to provide information for the prevention of thoracolumbar bursts fractures and reduction of damage to the nervous system. Methods A nonlinear three-dimensional finite element model of T11-L3 segments was established, and the injury processes of thoracolumbar bursts were simulated. The intact finite element model and the finite element model after the superior articular were impacted by 100 J of energy in different directions. The distribution and variation of stress in the superior posterior region of the L1 vertebral body were analyzed. Abaqus 6.9 explicit dynamic solver was used as finite element software in calculations. Results A three-dimensional nonlinear finite element model of the thoracolumbar spine was created. In the intact model, stress was concentrated in the superior posterior region of the L1 vertebral body. The stress peak was a maximum for the extension impact load and a minimum for the flexion impact load. The stress peak and contact force in the facet joint had close correlation with time. The stress peak disappeared after excision of the superior articular process. Conclusions The three-dimensional nonlinear finite element model was suitable for dynamic analysis. The contact force in the facet joint, which can be transferred to the superior posterior vertebral body, may explain the spinal canal fragment in thoracolumbar burst fractures.展开更多
Background Among the various treatments of neurologically involved unstable thoracolumbar burst fractures,the combination of anterior and posterior instrumentation provides the most stable reconstruction.However,the u...Background Among the various treatments of neurologically involved unstable thoracolumbar burst fractures,the combination of anterior and posterior instrumentation provides the most stable reconstruction.However,the use of both approaches on a trauma patient may increase the morbidity.This study is a retrospective matched cohort study to evaluate the advantages of a single stage posterior approach for spinal canal decompression in combination with circumferential reconstruction by comparing the clinical and radiographic results.Methods From March 2005 to September 2009,patients with matched type spinal fracture,ages at surgery,and involved levels in our institute underwent either a single stage posterior approach （group one,n=12） or traditional combined approach （group two,n=14） for spinal canal decompression and circumferential reconstruction were reviewed.Pre-and post-operative X-ray films were reviewed and changes in Cobb angle of thoracolumbar spine were documented.Intra-operative,post-operative,and general complications were registered.Results The mean follow-up was （27.7±9.6） months （range,14 to 56 months） in group one and （29.2±7.4） months （range,20 to 60 months） in group two （P 〉0.05）.The mean operation time was 214 minutes （range,186-327 minutes） in group one and 284 minutes （range,219-423 minutes） in group two （P 〈0.05）.The average volume of intraoperative blood loss was 1856 ml （range,1250-3480 ml） in group one and 2453 ml （range,1600-3680 ml） in group two （P 〈0.05）.There was no statistical difference between the groups one and two in average vertebral body height loss at the injured level and the average Cobb angle in sagittal plane before and immediately after surgery.Postoperatively,there was an epidural hematoma in one patient in group one and two patients in group two.Bony union after stabilization was obtained in all patients,without loosening or breakage of screws.Loss of correction （5°） was seen in 1 patient in group one at the 6th month owing to the subsidence of the Titanium mesh cages into the vertebra.In group two,totally four patients suffered respiratory-related complication,including pneumonia in two,severe atelectasis in one and pleural effusions in one.Importantly,there were no intraoperative or postoperative deaths in any group.All patients with incomplete neurologic deficits improved at least 1 Frankel grade.Conclusion Single-stage posterior vertebra resection in combination with circumferential reconstruction is a new option to manage severe thoracolumbar burst fractures.展开更多
文摘Thoracolumbar burst fracture, a common condition in clinic, often leads to severe spinal instability and neurologic deficit. In most cases, the compression that caused by backward protrusion of the fracture fragments to the spinal cord, makes complete decompression difficult through a posterior approach. Here, we reviewed the clinical records of 22 patients with thoracolumbar burst fracture treated by anterior corpectomy, decompression of the spinal cord, and implantation of titanium mesh cage.
基金This research was supported by a grant from the Natural Science Foundation of Shaanxi Province （No.2011JM4019）.
文摘Background Short-segment U-shaped pedicle screw fixation has been widely used to treat thoracolumbar burst fracture.Some studies have reported the disadvantages of traditional U-shaped pedicle screw,which included a relatively high rate of adjacent segment degeneration and screw failure,including screw pullout and breakage.The purpose of this study was to assess the efficacy of open reduction and fixation using KumaFix fixation system in treatment of thoracolumbar burst fractures.Methods From June 2011 to June 2012,45 consecutive patients with thoracolumbar burst fractures were enrolled.They were randomly assigned to treatment with KumaFix （the treatment group,n=23） or traditional U-shaped pedicle screw （the control group,n=22）.The patients were followed up postoperatively and were assessed with regard to radiologic and clinical outcomes.Radiologic outcomes were assessed mainly on the basis of Cobb angle and vertebral wedge angle.Clinical outcomes were evaluated mainly with use of Visual Analog Scale （VAS） for pain and the Oswestry Disability Index （ODI） Questionnaire.Results All patients were followed up from 9 to 22 months.There were no significant differences between the two groups with regard to preoperative indices.The operation time in the treatment group was significantly lower than that in the control group.Preoperative Cobb angles and vertebral wedge angles in two groups were significantly decreased after surgery,and these have been well maintained at the last follow-up with mild correction losses.The results of clinical outcome showed lower VAS and ODI scores in two groups compared with those preoperative,and the treatment group had greater improvement on the ODI compared with the control group at the last follow-up.Conclusions Compared with traditional U-shaped pedicle screw,KumaFix fixation system can achieve gradual,controlled reduction,provide enough space for bone implantation,and avoid acceleration of adjacent segment degeneration.It is an effective and reliable technique to treat thoracolumbar burst fractures.
基金This study was supported by grants from Key Support Project from Science and Technology Commission of Shanghai，the National Natural Science Foundation of China
文摘Background Thoracolumbar burst fracture is a common clinical injury, and the fracture mechanism is still controversial. The aim of this research was to study the formation of intracanal fracture fragments in thoracolumbar burst fractures and to provide information for the prevention of thoracolumbar bursts fractures and reduction of damage to the nervous system. Methods A nonlinear three-dimensional finite element model of T11-L3 segments was established, and the injury processes of thoracolumbar bursts were simulated. The intact finite element model and the finite element model after the superior articular were impacted by 100 J of energy in different directions. The distribution and variation of stress in the superior posterior region of the L1 vertebral body were analyzed. Abaqus 6.9 explicit dynamic solver was used as finite element software in calculations. Results A three-dimensional nonlinear finite element model of the thoracolumbar spine was created. In the intact model, stress was concentrated in the superior posterior region of the L1 vertebral body. The stress peak was a maximum for the extension impact load and a minimum for the flexion impact load. The stress peak and contact force in the facet joint had close correlation with time. The stress peak disappeared after excision of the superior articular process. Conclusions The three-dimensional nonlinear finite element model was suitable for dynamic analysis. The contact force in the facet joint, which can be transferred to the superior posterior vertebral body, may explain the spinal canal fragment in thoracolumbar burst fractures.
文摘Background Among the various treatments of neurologically involved unstable thoracolumbar burst fractures,the combination of anterior and posterior instrumentation provides the most stable reconstruction.However,the use of both approaches on a trauma patient may increase the morbidity.This study is a retrospective matched cohort study to evaluate the advantages of a single stage posterior approach for spinal canal decompression in combination with circumferential reconstruction by comparing the clinical and radiographic results.Methods From March 2005 to September 2009,patients with matched type spinal fracture,ages at surgery,and involved levels in our institute underwent either a single stage posterior approach （group one,n=12） or traditional combined approach （group two,n=14） for spinal canal decompression and circumferential reconstruction were reviewed.Pre-and post-operative X-ray films were reviewed and changes in Cobb angle of thoracolumbar spine were documented.Intra-operative,post-operative,and general complications were registered.Results The mean follow-up was （27.7±9.6） months （range,14 to 56 months） in group one and （29.2±7.4） months （range,20 to 60 months） in group two （P 〉0.05）.The mean operation time was 214 minutes （range,186-327 minutes） in group one and 284 minutes （range,219-423 minutes） in group two （P 〈0.05）.The average volume of intraoperative blood loss was 1856 ml （range,1250-3480 ml） in group one and 2453 ml （range,1600-3680 ml） in group two （P 〈0.05）.There was no statistical difference between the groups one and two in average vertebral body height loss at the injured level and the average Cobb angle in sagittal plane before and immediately after surgery.Postoperatively,there was an epidural hematoma in one patient in group one and two patients in group two.Bony union after stabilization was obtained in all patients,without loosening or breakage of screws.Loss of correction （5°） was seen in 1 patient in group one at the 6th month owing to the subsidence of the Titanium mesh cages into the vertebra.In group two,totally four patients suffered respiratory-related complication,including pneumonia in two,severe atelectasis in one and pleural effusions in one.Importantly,there were no intraoperative or postoperative deaths in any group.All patients with incomplete neurologic deficits improved at least 1 Frankel grade.Conclusion Single-stage posterior vertebra resection in combination with circumferential reconstruction is a new option to manage severe thoracolumbar burst fractures.
文摘目的探讨稳定型胸腰椎爆裂骨折(thoracolumbar burst fractures,TBF)非手术治疗的失败率和预测因素。方法选择2015年1月~2020年12月在该院接受非手术治疗的稳定型TBF患者资料进行回顾性分析,记录患者非手术治疗失败率。观察非手术治疗失败和非手术治疗成功患者的性别、年龄、体质量指数(body mass index,BMI)、个人史、伴随疾病、损伤原因、损伤椎体、疼痛视觉模拟评分(visual analogue scale,VAS)、椎体压缩率(vertebral body compression rate,VBCR)、椎体前缘高度压缩百分比(percentage anterior high compression,PAHC)、Cobb角、椎弓根间距(interpedicular distance,IPD)和椎管压缩程度,采用Logistic回归分析确定影响非手术治疗效果的独立因素。结果71例患者有21例非手术治疗失败,发生率29.58%。非手术治疗失败患者年龄、BMI、糖尿病、VBCR、PAHC、Cobb角、IPD、椎管压缩和VAS均高于非手术治疗成功患者(P<0.05)。多因素Logistic回归分析结果显示,年龄和IPD是影响非手术治疗效果的独立风险因素(P<0.05)。年龄预测非手术治疗失败的灵敏度、特异性、截断值和AUC分别为71.40%、86.00%、47岁、0.811,IPD预测非手术治疗失败的灵敏度、特异性、截断值和AUC分别为71.43%、88.00%、16.7%和0.771。结论年龄和IPD是影响稳定型TBF患者非手术治疗失败的风险因素,对预测手术失败具有一定临床价值。
