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Objective To investigate the risk factors affecting Sandwich vertebral re-fracture after vertebral augmentation surgery for osteoporotic spine Sandwich fractures.Methods A retrospective case control study was conducted on the clinical data of 90 patients with osteoporotic spine Sandwich fractures treated with vertebral augmentation surgery from January 2004 to December 2015.There were 26 males and 64 females,aged (69.9 ± 7.4) years.The patients were divided into fracture group (n =15) and non fracture group (n =75) according to the incidence of re-fracture after operation during follow-up.Gender,age,height,weight,bone mineral density,cumulative number of cemented vertebrae,location of the Sandwich vertebrae in the thoracolumbar segment,the preoperative kyphosis angle of the Sandwich fracture segment,surgical approach,cement injection approach (unilateral or bilateral),cement injection volume,cement leakage between the Sandwich intervertebral spaces,the postoperative kyphosis angle of the Sandwich fracture segment,and follow-up duration were used as independent variables.Chi-square test and multivariate logistic regression analysis were used to analyze the risk factors of vertebral Sandwich fracture.Results There were 97 Sandwich vertebrae in 90 patients,and 226 fractured vertebrae were treated with initial intensive treatment.The mean follow-up was 18.1 months.There were no significant differences in gender,age,height,weight,cumulative number of cemented vertebrae,whether the Sandwich vertebrae was located at the thoracolumbar segment,the preoperative kyphosis angle of the Sandwich fracture segment,the cement injection approach (unilateral or bilateral),the volume of cement injection,and the cement leakage between the Sandwich intervertebral spaces (P ＞ 0.05).There were significant differences in bone mineral density,surgical approach,and postoperative kyphosis angle of the Sandwich fracture segment between the two groups (P ＜ 0.05).Further logistic regression analysis showed that bone mineral density ≤ 3.5 SD and segmental kyphosis (≥ 10°) were risk factors for Sandwich fracture (P ＜ 0.05).Conclusions The low bone mineral density (T value ≤-3.5 SD) and postoperative kyphotic angle (≥ 10°) are risk factors for re-fracture of Sandwich vertebrae.Vertebroplasty itself does not increase the risk of recurrent vertebral fractures.
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Objective To evaluate the clinical application of early total care (ETC) for polytrauma patients combined with thoracolumbar fractures.Methods A retrospective case control study was conducted to analyze the clinical data of 137 polytrauma patients combined with thoracolumbar fractures admitted to the First Affiliated Hospital of Soochow University and the Third People's Hospital of Zhang,jiagang from January 2012 to October 2015.There were 90 males and 47 females,aged 26-69 years,with an average age of 48.2 years.The patients were divided into ETC group (n =59) and TMC group (n =78).In the ETC group,physicians from different departments evaluated the patients and developed individualized therapeutic regimens to allow the patients to undergo surgery at early stage after injury.The TMC group preferentially stabilized the patient's condition or transferred the patients to specialist treatment,and then the surgery was performed electively after the condition of the patient was stable.The ISS of the ETC group was (22.15 ± 9.28)points,and that of the TMC group was (23.37 ± 10.74) points.All patients underwent conventional posterior pedicle screw internal fixation.For patients with burst fracture and nerve injury,posterior spinal canal decompression was performed.The thoracolumbar injury classification and severity score (TLICS),spinal load sharing classification (LSC),preoperative and postoperative Glasgow coma score (GCS),Frankel classification,hospitalization time and postoperative complications were compared between the two groups.Results The TLICS scores of ETC group were significantly lower than those of TMC group (P ＜ 0.05) while the LSC scores showed no significant differences between the two groups (P ＞ 0.05).ETC group had shorter hospitalization time [(11.8 ± 3.7)days ∶ (17.5 ±4.5)days] and lower pressure ulcer incidence [(5％ ∶ 21％)] than the TMC group (P ＜ 0.05 or 0.01),but the former had significantly higher wound infection rate [(17％ ∶ 15％)] (P ＜ 0.05).There was no significant difference in pulmonary infection and deep venous thrombosis incidence between the two groups (P ＞ 0.05).No significant differences were found in the preoperative GCS scores between the two group (P ＞ 0.05) while the postoperative GCS scores of TMC group were higher than those of ETC group (P ＜ 0.01).Postoperative GCS scores in both groups were significantly higher than their preoperative GCS (P ＜ 0.05).The results of postoperative Frankel classification in the ETC group were as follows:Grade A in one patient,Grade B in one,Grade C in three,Grade D in four and Grade E in two patients,with an improvement rate of 82％.The results of postoperative Frankel classification in the TMC group were as follows:Grade A in three patients,Grade B in three,Grade C in three,Grade D in four and Grade E in four,with an improvement rate of 65％.Conclusions For polytrauma patients combined with thoracolumbar fractures,ETC can shorten hospitalization time,reduce the pressure ulcer incidence,and better facilitate the recovery of nerve function,yet with higher wound infection risk compared with TMC.TMC was preferred subjectively for patients with unstable thoracolumbar fractures and high TLICS.
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Objective To investigate the perioperative effects of simultaneous fixation and staging fixation in polytrauma patients combined with spine injury and long bone fracture.Methods A retrospective case control study was conducted to analyze the clinical data of 41 severe polytrauma patients with unstable spine combined with long bone fracture admitted from June 2009 to June 2015.There were 30 males and 11 females,aged 21-66 years [(41.2 ± 12.2)years].The injured spinal segments included cervical vertebrae in 11 patients,thoracic vertebrae in 15,lumbar vertebrae in 23,sacrococcygeal vertebrae in two,as well as injuries at two or more different segments in 10 patients.The long bone fracture segments included humerus in six patients,radius and ulna in 14,femur in 15,tibia and fibula in 14,as well as injuries at two or more different segments in eight patients.The injury severity score (ISS) were all ≥ 15 points.According to the timing of operation,the patients were divided into the simultaneous operation group (20 patients) and the staging operation group (21 patients).In the simultaneous operation group,there were 16 males and four females,aged (43.1 ± 12.6)years,and internal or external fixations of spine and long bone were performed at stage Ⅰ.In the staging operation group,there were 14 males and seven females,aged (40.1 ± 11.9)years.Spine fixation surgery was performed first,and then surgery for long bone fracture was performed after the conditions were stabilized.Spinal surgery methods included anterior subtotal vertebral resection,bone graft plate internal fixation,posterior laminectomy and decompression,and lateral mass screw or pedicle screw internal fixation.Plate and interlocking nail were used for internal fixation of long bone fracture,and single arm bracket for external fixation.The preoperative hospitalization time,operation time,operative blood loss (intraoperative hemorrhage and postoperative drainage),postoperative complications,hospitalization time and Frankel score of spinal cord injury before and after operation were compared between the two groups.Results The preoperative hospital stay was (9.3 ± 6.7) days in the simultaneous operation group and (5.6 ± 5.0) days in the staging operation group (P ＞ 0.05).The simultaneous operation group had significantly longer operation time [(4.9 ± 2.0) hours] than the staging operation group [(3.2 ± 1.2) hours] (P ＜ 0.01),more operative blood loss [(1 322.6 ± 507.1) ml] than the staging operation group [(1 036.7 ± 233.9) ml] (P＜0.05),and shorter hospitalization stay [(22.8 ± 12.6)days] than the staging operation group [(33.0 ± 15.4) days] (P ＜ 0.05).The complication incidence of the simultaneous operation group [45％ (9/20)] was significantly lower than that of the staging operation group [86％ (18/21)] (P ＜ 0.01).No significant difference was found in Frankel score between the simultaneous operation group [(3.3 ±1.7)points] and the staging operation group [(3.1 ± 1.5)points] (P ＞0.05).Conclusion For polytrauma patients combined with spine injury and long bone fracture,simultaneous operation can reduce hospitalization time and complication incidence compared with staging operation.
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Objective To compare the clinical outcomes of long and short InterTan intramedullary nailing of senior intertrochanteric hip fracture in conjunction with early total care (ETC).Methods In this prospective study, records of 30 elder patients with intertrochanteric fracture hospitalized between January 2011 and September 2013 were included.Using the concept of ETC, the patients were treated with long (long-nail group, n =15) and short InterTan intramedullary nails (shortnail group, n =15) within 72 hours postinjury.The two groups were compared for operation time, intraoperative blood loss, fracture healing time, Harris hip score, time to pre-injury mobilization and hardware failure rate.Results Operation time was (77.25 ± 7.38) minutes in long-nail group versus (72.10 ± 6.90) minutes in short-nail group (P ＜ 0.01).Time to pre-injury mobilization was (7.45 ± 1.61) months in long-nail group versus (8.57 ± 2.18) months in short-nail group (P ＜ 0.05).There were no significant differences between long-and short-nail groups regarding the blood loss [(180.75 ± 38.26)ml vs (178.62 ± 34.79)ml], fracture healing time [(4.82 ± 1.12)months vs (4.76 ± 1.04) months], and Harris hip score [(83.75 ± 1.71) points vs (82.57 ± 2.18) points] (P ＞ 0.05).Conclusions Either long or short InterTan intramedullary nailing combined with ETC is effective in treatment of intertrochanteric hip fracture in the elderly.However patients treated with long nails return to pre-injury mobilization relatively earlier.Long InterTan intramedullary nail system is better for the patients combined with serious osteoporosis.
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Objective To study the clinical epidemiology of ossification of ligamentum flavum(OLF)and evaluate its characteristics of prevalence,morphology,and distribution in a common population.Some factors associated with its occurrence were analyzed by meta-analysis.Methods A total of 1736 southern Chinese volunteers were recruited by open invitation.T2 weighted MRI sequences of whole spine in all participants were obtained.OLF was identified as an area of low signal intensity located in the posterior part of the spinal canal,and subsequently confirmed by CT scan.The distribution of OLF was classified into three types:isolated type,continuous type and non-continuous type.The morphology of the lesion was classified into triangular,round and beak shapes based on the pattern of ossification on T2 weighted sagittal MRIs.Literatures about OLF were searched in Ovid Medline,PubMed,Embase and Chinese BioMedical Literature Database from January 1980 to January 2010.Results OLF was identified in 66 volunteers including 52 females and 14 males.According to the new classification of the study,there were 45 cases of single type (68.2%),11 cases of continuous type(16.7%)and 10 cases of non-continuous type(15.2%).In 92 OLF,there were 17 triangular shape(18.5%)and 75 rounded shape according to morphological classification.A literature review showed that there were only 4 reports related to the prevalence of OLF.Conclusion This study demonstrated that morbidity rate of OLF is about 3.8% in southern Chinese population.The incidence is related to age and gender.It is necessary to perform whole spine MRI examination to detect the multiple level and noncontinous type.
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Objective To evaluate the effects of nutritional status on wound healing after hip fracture in the elderly. Methods From July 2002 to December 2004, 127 patients with hip fracture who were older than 65 years were treated surgically in our department. Their preoperative nutritional status was reviewed. There were 69 males and 58 females, with an average age of 72.7 years (from 65 to 99 years). 60 cases had femoral neck fractures, and 67 cases had intertrochanteric fractures. The parameters indicative of nutritional status (serum albumin, serum transferrin and total lymphocyte count levels) at the time of admission were assessed, along with Rainey McDonald nutritional index and age. Suture removal was performed on postoperative day 14. Results Delayed wound healing complicated 31 of the 127 cases. The preoperative serum transferrin levels were significantly lower in patients who subsequently had delayed wound healing. Only preoperative serum transferrin levels( P