ABSTRACT
Objective To investigate the correlation between intervertebral disc injury and postoperative kyphosis after percutaneous kyphoplasty (PKP) in patients with single-level osteoporotic thoracolumbar fracture.Methods The data of 63 patients were retrospectively analyzed who had been treated at Department of Orthopaedics,Puai Hospital for single-level osteoporotic thoracolumbar fractures from August 2012 to August 2015.They were all treated with posterior balloon dilatation PKP.According to the preoperative MRI data,they were divided into an observation group (29 patients with intervertebral disc injury) and a control group (34 patients without intervertebral disc injury).The wedged angles (WA) and cobb angles of the injured vertebrae were compared between the 2 groups at postoperative 1,6 and 12 months.The changes in WA and cobb angles were observed in the same group at postoperative 1,6 and 12 months.The cob angles in the patients with different Sander classifications of intervertebral disc injury in the observation group were observed at postoperative 1,6 and 12 months.The correlation between intervertebral disc injury and postoperative kyphosis after PKP was statistically analyzed.Results The 2 groups were comparable as there were no significant differences between them in preoperative general data (P ＞ 0.05).All the patients were followed up for an average of 19.3 months (from 12 to 30 months).The WAs at postoperative 1,6 and 12 months in the observation group (4.9° ± 2.5°,5.8° ± 2.4° and 6.2° ± 2.4°) were insignificantly larger than those in the control group (4.7° ± 2.4°,5.2° ± 2.4° and 5.8° ± 2.4°) (P ＞ 0.05).The cobb angles at postoperative 6 and 12 months in the observation group (14.4° ± 3.6° and 15.8° ± 3.5°) were significantly larger than those in the control group (10.1 ° ± 3.7° and 10.7° ± 3.8°) (P ＜ 0.05),and also significantly larger than that at postoperative one month in the same group (10.6° ± 3.2°) (P ＜ 0.05).The cobb angles at postoperative1,6 and 12 months in the control group showed a tendency of insignificant increase (P ＞ 0.05).At postoperative 1,6 and 12 months in the observation group,the cobb angles for patients with Sander types Ⅱ & Ⅲ were significantly larger than for patients with Sander type Ⅰ (P ＜ 0.05).Conclusion After PKP for patients with single-level osteoporotic thoracolumbar fracture,kyphosis of different severities may occur after operation;intervertebral disc injury is an important factor which aggravates postoperative kyphosis.
ABSTRACT
Objective To evaluate the effects of posterior decompression,subtotal vertebrectomy,intervertebral fusion and internal fixation through unilateral pedicle in the treatment of severe throracolumar fractures.Methods A retrospective study was conducted to evaluate the outcomes of 11 patients with severe thmracolumar fracture who had been treated with posterior decompression,subtotal vertebrectomy,intervertebral fusion and internal fixation through unilateral pedicle at our department from March 2009 to March 2012.They were 10 males and one female,aged from 20 to 42 years (mean,31.1 years).According to AO classification,there were 2 cases of type B1,3 cases of type B2 and 6 cases of type C2.The Gaines scores for anterior column stability were more than 6 in all.All the patients had neurological disorders.The fracture reduction,fusion of bone grafting and recovery of neurological function were followed up.Results Their operation time ranged from 200 to 300 minutes,averaging 243.2 minutes;the amount of bleeding ranged from 800 to 1,600 mL,averaging 1,023.3 mL.No deterioration of neurological symptoms or no new neurological symptoms were observed postoperatively.Cerebrospinal fluid leakage was found in 3 patients who healed spontaneously following extubation,compressive dressing and elevation of the bed end.All the patients were followed up for 12 to 30 months (average,18.3 months).A loosened screw cap was found in one patient after 6 months who had no discomfort and received no treatment.X-ray films showed satisfactory fracture reduction and fine bone grafting locations.No spinal canal stenosis was found by CT scans.It took 3 to 6 months (mean,4.3 months) for the bone grafts to get fused.No height loss of the injured vertebrae was no found at the last follow-ups.No functional recovery was found in the patients with complete spinal cord injury whose Frankle grade remained A.The spinal function recovered from Frankel grade B to grade D in one patient with incomplete spinal injury.Of the 8 patients with medullary cone injury,7 recovered Frankle grade E and one Frankle grade D.The symptoms were relieved in one patient with simple cauda equine injury.Conclusion Posterior decompression,subtotal vertebrectomy,intervertebral fusion and internal fixation through unilateral pedicle is an effective alternative for treatment of severe throracolumar fractures,because it can lead to satisfactory fracture reduction,thorough decompression of the spinal canal and good reconstruction of spinal stability.
ABSTRACT
Objective To discuss spinal fusion effect of lumbar intertransverse process in rabbits by using bone marrow stromal stem cells(MSCs)in conjunction with bone morphogenetic protein(BMP)and freeze-dried demineralized bone matrix(FDBM)as scaffold.Methods To separate and cultivate MSCs in vitro,with FDBM as scaffold,osteogenesis was induced by BMP.Sixty Japan white rabbits were randomly divided into three groups.Group A was MSCs+FDBM+BMP,group B was FDBM,group C was autogenous ilium cancellous bone(AIB).Lumbar intertransverse process was fused in lumbar five to six.Rabbits were killed at 8 weeks after operation.The general observation and imageology were used to assess the fusion condition.To estimate the implantation using DR image.Gray scale analysis of DR image caculated the osteogenic density and acreage.The CT scan and three-dimensional reconstruction was used to observe the fusion configuration of lumbar intertransverse process.Results The fusion mass character in group A and C was hard,the morphology was not regulation.The fusion mass was almost absorbed in group B beside little tissue approach transverse process.There were high density image between intertransverse processes,osteogenic density were nonuniform in group A and C.There were nonunion in group B.Consistent callus were existed between intertransverse process in group A and C.There were not consistent callus in group B.Group A was similar to group C in osteogenesis density and acreage.Group B was the worst.There were cartilage and newly born bone trabecular formation in group A and group C.Between transverse process were mainly fiber tissue in group B.Conclusion MSCs in conjunction with BMP and FDBM has the similar osteogenic capability to the AIB and better osteogenic capability than that of FDBM alone when spinal fusion of lumbar intertransverse process is performed in rabbits.