Imaging evaluation of traumatic thoracolumbar spine injuries: Radiological review

Spine fractures account for a large portion of musculoskeletal injuries worldwide. A classification of spine fractures is necessary in order to develop a common language for treatment indications and outcomes. Several classification systems have been developed based on injury anatomy or mechanisms of action, but they have demonstrated poor reliability, have yielded little prognostic information, and have not been widely used. For this reason, the Arbeitsgemeinschaftfür Osteosynthesefragen(AO) committee has classified thorocolumbar spine injuries based on the pathomorphological criteria into3 types(A: Compression; B: Distraction; C: Axial torque and rotational deformity). Each of these types is further divided into 3 groups and 3 subgroups reflecting progressive scale of morphological damage and the degree of instability. Because of its highly detailed sub classifications, the AO system has shown limited interobserver variability. It is similar to its predecessors in that it does not incorporate the patient's neurologic status.The need for a reliable, reproducible, clinically relevant, prognostic classification system with an optimal balance of ease of use and detail of injury description contributed to the development of a new classification system, the thoracolumbar injury classification and severity score(TLICS). The TLICS defines injury based on three clinical characteristics: injury morphology, integrity of the posterior ligamentous complex, and neurologic status of the patient. The severity score offers prognostic information and is helpful in decision making about surgical vs nonsurgical management.

Thoracolumbar Spine Fracture-Dislocation without Neurological Deficit: A Case Report and Review of the Literature

Background: Thoracolumbar spine fracture-dislocations are very unstable and usually secondary to high energy trauma. Due to disruption of the entire vertebrae columns, the absence of neurological deficit is exceptional. Aim: The purpose of this work is to report our experience in the management of this entity in a context of limited resources and to make a review of the literature. Case presentation: A 30-year-old man was admitted with a severe low back pain after a traffic accident. Neurological functions were intact after examination. Radiological assessments revealed a complete L3-L4 fracture-dislocation. The patient underwent an open posterior reduction and internal long segment fixation. The post-operative was marked by a surgical site infection treated with surgical debridement and targeted antibiotic therapy. The neurological functions were preserved. Conclusion: Fracture-dislocations of the thoracolumbar spine are caused by high energy trauma and are remarkably unstable lesions. When they are associated with intact neurorological functions, reduction and stabilization of these fractures are a challenge.

经皮椎体成形术治疗老年胸腰椎骨折对患者手术创伤程度及脊柱功能的影响

目的探讨经皮椎体成形术(Percutaneous Vertebroplasty,PVP)治疗老年胸腰椎骨折对患者手术创伤程度、脊柱功能的影响。方法方便选取2022年2月-2023年2月东台市中医院骨伤科收治的84例老年胸腰椎骨折患者为研究对象,以随机数生成器将患者分成两组,各42例。其中切开组应用切开复位内固定治疗;观察组应用PVP术式治疗。对比两组手术创伤程度(出血量、切口长度、住院时间),脊柱功能(椎体前缘高度、后凸Cobb角),Oswestry功能障碍指数(Oswestry Dability Index,ODI),数字模拟评分法(Numeric Rating Scale,NRS),Barthel指数评分(Barthel Index,BI),世界卫生组织生活质量量表(WHO Quality of Life,WHOQOL)。结果观察组出血量、切口长度、住院时间分别为(52.11±13.83)mL、(4.58±1.26)cm、(10.59±2.48)d,切开组对应指标分别为(116.79±15.98)mL、(11.86±2.95)cm、(13.75±2.64)d,观察组指标水平均优于切开组,差异有统计学意义(t=19.835、14.708、5.654,P均<0.05)。术前两组椎体前缘高度、后凸Cobb角对比,差异无统计学意义(P均>0.05);术后两组椎体前缘高度增加,后凸Cobb角减小,差异无统计学意义(P均>0.05)。观察组患者的ODI、NRS、BI以及WHOQOL评分均优于切开组,差异有统计学意义(P均<0.05)。结论PVP术式在治疗老年胸腰椎骨折患者中表现出令人满意的效果,能够控制手术创伤,促进脊柱功能恢复,并且有助于降低术后脊柱功能障碍、疼痛水平,能够使患者获得更全面的自主生活能力和更高的生活质量。

微创脊柱创伤手术治疗脊柱胸腰椎段骨折的效果分析

目的探讨在脊柱胸腰椎段骨折患者的治疗中采取微创脊柱创伤手术的效果。方法回顾性选取2022年6月—2024年2月单县中心医院骨科收治的70例脊柱胸腰椎段骨折患者的临床资料,按照手术方式不同分为两组,各35例。对照组采取传统开放手术,研究组采取微创脊柱创伤手术。对比两组手术指标、脊柱功能相关指标、腰椎功能评分及腰椎功能障碍指数、并发症发生率。结果研究组切口长度、术中出血量、手术时间、术后引流量、住院时间均少于对照组,差异有统计学意义(P均<0.05)。研究组伤椎前高压缩比高于对照组,Cobb角低于对照组,差异有统计学意义(P均<0.05)。研究组腰椎功能障碍指数低于对照组,日本骨科协会评估量表评分高于对照组,差异有统计学意义(P均<0.05)。研究组并发症发生率为5.71%(2/35),低于对照组的25.71%(9/35),差异有统计学意义(χ^(2)=5.285,P<0.05)。结论对脊柱胸腰椎段骨折患者采取微创脊柱创伤手术可减少并发症发生率,减轻患者因疾病与手术带来的疼痛感,加快患者术后腰椎功能的恢复,缩短治疗时间。

经伤椎置钉单节段椎弓根钉治疗胸腰段骨折

目的探讨经伤椎置钉单节段椎弓根钉治疗胸腰椎骨折的适应症及临床疗效。方法 2008年7月至2010年7月,对14例胸腰椎骨折采用后路单节段伤椎椎弓根螺钉内固定、经伤椎植骨融合。经过5～29(平均16.8)个月随访,随访内容有术前后VAS疼痛评分、神经功能ASIA评分、术前、术后随访时椎体的高度、伤椎的后凸畸形,内固定物的状况。结果所有患者均得到随访,术后VAS疼痛分级平均0-1分,其中0分8人,1分6人,无需服药治疗。神经功能均恢复至正常;X线检查术后椎体高度恢复满意,术后伤椎高度恢复了96%,随访椎体高度丢失0.4mm,丢失率为1.4%。无内固定物断裂、松动、脱出,所有病例均获得骨性融合,无假关节形成。结论选择好适应证,后路单节段伤椎内固定是治疗胸腰段骨折的有效方法之一。

单节段椎弓根螺钉固定治疗胸腰椎骨折的临床观察

目的:探讨经伤椎置钉单节段椎弓根螺钉固定结合后外侧植骨治疗胸腰椎骨折的临床疗效。方法:2009年1月至2010年12月,对l4例胸腰椎骨折采用后路经伤椎置钉单节段椎弓根螺钉固定结合后外侧植骨融合治疗,比较手术前后伤椎椎体前缘高度及Gardner角变化,并观察椎体复位丢失及内固定物情况。结果:平均手术时间83min(52~125min),出血量120mL(50~350mL),无医源性神经损伤;术后所有病例均获得随访,平均随访16.8个月(12~24个月),术后伤椎椎体前缘高度及Gardner角较术前均明显改善,未见内固定松动、断裂、脱出,所有病例均获得骨性融合。结论:单节段椎弓根螺钉固定治疗胸腰椎骨折手术创伤小,临床疗效令人满意,但需严格掌握手术适应证及手术技巧。

胸腰椎外伤后脊髓损伤CT平扫的局限性

目的探讨CT平扫诊断胸腰椎外伤后脊髓损伤的局限性。方法收集近7a来48例胸腰椎外伤的CT平扫结果、X线片结果及临床资料,并进行对比分析。结果48例胸腰椎外伤病人中椎体骨折73个,单发59个,多发14个,其中CT示碎骨入椎管内的有25处,血肿1处,附件骨折36处,X线片漏报附件骨折16处(44%)。瘫痪病人11例,均经手术治疗,术中发现椎管内碎骨15处,血肿2处,脊髓挫伤或断裂10处。结论CT平扫对椎体、附件骨折、椎管形态改变和碎骨片移位及明显的椎管内血肿的诊断,优于X线平片,但是对脊髓损伤的显示有局限性,建议胸腰椎外伤后瘫痪病人做脊髓造影(CTM)或磁共振成像(MRI)。

静脉滴注氨甲环酸对脊柱经皮椎弓根螺钉手术失血量的影响及安全性

目的:探究静脉滴注氨甲环酸对脊柱经皮椎弓根螺钉手术失血量的影响及安全性。方法:选择2018年9月—2021年4月到本院接受治疗的88例胸腰段脊柱创伤患者作为研究对象,根据随机1∶1抽签原则将患者分为氨甲环酸组与对照组,各44例。两组均行脊柱经皮椎弓根螺钉手术治疗,氨甲环酸组在术前与术中给予静脉滴注氨甲环酸,对照组输注等剂量的生理盐水,比较两组出血与输血情况、并发症发生情况、疼痛程度及脊柱功能。结果:氨甲环酸组术中失血量、术中自体输血量、术中异体输血量、术后24h引流量少于对照组(P<0.05);氨甲环酸组并发症发生率为4.5%,低于对照组的25.0%(P<0.05);氨甲环酸组术后1d、3d、7d疼痛视觉模拟量表(VAS)评分低于对照组(P<0.05);氨甲环酸组术后7 d椎体前缘高度高于对照组,Cobb’s角低于对照组(P<0.05)。结论:在脊柱经皮椎弓根螺钉手术中静脉滴注氨甲环酸能改善患者的脊柱功能,缓解疼痛,减少术中失血量与输血量,还可减少并发症的发生概率。

后路内固定融合术对胸腰段脊柱骨折患者椎体参数与创伤应激状态的影响研究

目的:探究后路内固定融合术对胸腰段脊柱骨折患者椎体参数与创伤应激状态的影响。方法:选取2016年11月～2017年11月我院收治的60例胸腰段脊柱骨折患者为研究对象,将其依据治疗方式的不同分为对照组(前路内固定融合术组)30例和观察组(后路内固定融合术组)30例。比较两组手术前后的椎体参数与血清促肾上腺皮质激素(ACTH)、皮质醇(Cor)及肿瘤坏死因子α(TNF-α)水平的变化。结果:术后1个月及6个月,两组的Cobb角均较术前减小,椎体前、后缘高度均较术前增加,且观察组Cobb角均低于对照组,而椎体前、后缘高度均高于对照组。术后1周,两组血清ACTH、Cor水平升高,观察组以上指标明显低于对照组(P<0.05),观察组TNF-α水平较术前明显下降,而对照组较术前显著升高,两组比较差异有统计学意义(P<0.05)。术后2周,观察组的血清ACTH、Cor、TNF-α水平均明显低于对照组,且低于术前水平(P<0.05)。结论:后路内固定融合术对胸腰段脊柱骨折患者椎体参数与创伤应激状态的影响相对更好。