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Objective: To explore the surgical treatment strategy of the vertebral "shell" after thoracolumbar fracture, and provide clinical reference for the intervention and treatment of "shell". Methods: Between June 2015 and January 2017, 53 patients with high risk of vertebral "shell" after thoracolumbar fracture surgery were enrolled in a prospective study according to the selection criteria. All patients were randomly divided into two groups according to the order of treatment, 27 cases in the treatment group were treated with short-segment fixation combined with vertebral reconstruction, 26 cases in the control group were treated with short-segment fixation. There was no significant difference in gender, age, injury cause, Denis classification, fracture segment, the degree of injured vertebra compression, bone mineral density, and American Spinal Cord Injury Association (ASIA) classification between the two groups ( P>0.05). The degree of injured vertebra compression, visual analogue scale (VAS) score, and Oswestry disability index (ODI) score at preoperation, immediate after operation, and last follow-up were calculated and compared between the two groups. The "shell" phenomenon and surgery complications were observed at the same time. Results: All patients were followed up 12-18 months with an average of 14.4 months. There were 5 cases of "shell" phenomenon in the treatment group and 4 cases of nonunion at last follow-up, 23 cases of "shell" phenomenon in the control group and 19 cases of nonunion at last follow-up; there was a significant difference between the two groups ( P0.05), but which was significantly higher in the control group than that in the treatment group at last follow-up ( P0.05). Conclusion: The treatment of thoracolumbar fracture with short-segment fixation combined with injured vertebral reconstruction can effectively prevent the "shell" phenomenon, which is conducive to maintaining the height of injured vertebral and improving the long-term function. The effectiveness is satisfactory.
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Objectives To evaluate the 3D printed navigation template used to assist axis pedicle lag-screw placement in the treatment of atypical Hangman's fracture(AHF).Methods From May 2015 to January 2017,12 patients with AHF were treated at Department of Orthopedics,The Fourth Peopled Hospital of Zigong.In their operation,the axis pedicle lag-screw placement was assisted by a 3D printed navigation template.They were 8 men and 4 women,aged from 27 to 53 years(average,45.6 years).There were 7 cases of type Ⅰ,4 cases type Ⅱ and one case of type HA according to the Levine-Edwards classification.There were 2 cases of grade D and 12 cases of grade E according to the assessment of America Spinal Injury Association(ASIA).Their preoperative and postoperative neck pain was evaluated by visual analogue scale(VAS);their preoperative and postoperative ranges of cervical motion were recorded and compared.To evaluate the postoperative safety of screws,the insertion point,position within the pedicle,axial angle and sagittal angle of the screws and maximum fracture displacement were compared between actual operation and simulative operation.Results A total of 12 guide plates were designed and printed;a total of 24 lag-screws were placed.All patients underwent surgery uneventfully.They were followed up for 12 to 20 months,with an average of 14.7 months.Two patients with ASIA grade D recovered to ASIA grade E at the last follow-up.All patients showed a significant improvement in neck pain.Their VAS score at 5 days after surgery(5.86±2.02) was significantly lower than their preoperative score(8.29±1.88)(P<0.05) and their VAS score at the last follow-up(1.73±0.87) was also significantly lower than that at 5 days after surgery(P<0.05).Their range of cervical motion at 6 months after surgery was significantly larger than that at 3 months after surgery(P<0.05);their range of cervical motion returned to normal roughly at the last follow-up,showing no significant difference from that at 6 months(P>0.05).Their postoperative X-ray and CT images showed that the dislocation was all corrected.The last follow-up showed no obvious vertebral instability,screw breakage or loosening.Postoperative CT showed that the 24 screws had been located completely in the pedicle(grade 0),indicating that the screw placement was 100% accurate.The postoperative deviation at insertion point(0.70±0.78 mm),deviation within the pedicle(1.3±0.82 mm),axial angle(8.26°±0.88°) and sagittal angle(22.62°±0.86°) of the screws showed no significant differences from the preoperative simulative data(P>0.05).There was a significant difference in the maximum fracture displacement between the preoperative data(3.94±0.38 mm) and the postoperative data(2.21±0.39 mm)(P<0.05).Conclusion The 3D printed navigation template can be used to better assist axis pedicle lag-screw placement in the treatment of AHF,because it ensures safe screw placement,leading to good reduction and fixation and precise match with the preoperative plan.
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Objective To explore the clinical efficacy of 3D printing technique in assisting sacroiliac screwing in combination with front ring nail-rod system for treatment of unstable pelvic fractures.Methods From July 2015 to June 2017,3D printing technique was used to assist the sacroiliac screwing in combination with front ring nail-rod system for 16 patients with unstable pelvic fracture at Orthopaedic Center,The Fourth People's Hospital of Zigong.They were 9 males and 7 females,aged from 19 to 60 years (average,39.8 years).By the Tile classification,5 cases were type B1,6 type B2,3 type B3 and 2 type C.Their operation duration,bleeding,fluoroscopy frequency,incision length,postoperative fracture reduction,success rate of sacroiliac screwing,accuracy of sacroiliac screwing,perioperative complications,weight-bearing exercise time,fracture healing time and the Majeed scores at the last follow-up were documented.Results All the 3D models and navigation templates were successfully designed and printed.Surgery succeeded in all the patients.Follow-ups ranged from 6 to 18 months,averaging 13.3 months.The bleeding ranged from 100 to 250 mL,averaging 162.4 mL;the operation duration ranged from 60 to 120 min,averaging 73.2 min;the intra-operative fluoroscopy frequency ranged from 13 to 31 times,averaging 17.4 times;the incision length ranged from 16 to 32 cm,averaging 21.1 cm.All the incisions healed by the first intention and all the fractures obtained osseous union after 90 to 120 d (average,102.3 d).No significant complications like neurovascular injury or pulmonary embolism happened.The weight-bearing exercise time ranged from 25 to 40 d,averaging 31.5 d.According to the Matta imaging scores,the reduction was rated as excellent in 12 cases and good in 4.Altogether 28 screws were inserted with a success rate of 100％.Compared with the preoperative simulated screwing,the actual screwing angle deviated postoperatively by 0.12° ± 0.32°,the X axis by 0.36 ± 1.24 mm,the Y axis by 0.36 ± 1.24 mm and the Z axis by 0.22 ± 1.26 mm,showing no statistically significant difference between the actual 3D deviations and the test value of 0 (P ＞ 0.05).Conclusion In the treatment of unstable pelvic fractures,3D printing technique can be used in preoperative preparation of the connecting rod in the front ring nail-rod system to assist the sacroiliac screwing,significantly shortening the operation duration,reducing bleeding,ensuring safe and accurate screwing,and facilitating functional recovery.
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Objective: To analyze the imaging characteristics of vertebral "shell" phenomenon of thoracolumbar fractures after posterior reduction and to explore the relationship between vertebral "shell" and fracture healing.