Therapeutic effect and prognosis of PKP in patients with diabetes mellitus complicated with osteoporotic thoracolumbar compression fractures / 中华内分泌外科杂志

Objective:To investigate the therapeutic effect and prognosis of percutaneous balloon kyphoplasty (PKP) for diabetic patients with osteoporotic thoracolumbar compression fractures.Methods:A total of 105 patients with diabetes mellitus complicated with osteoporotic thoracolumbar compression fractures who received diagnosis and treatment in our hospital from May. 2017 to Feb. 2020, who were followed up to Mar. 2022 were selected as the research subjects, and all were treated with PKP. Time, intraoperative blood loss, hospital stay, incidence of secondary vertebral fracture, anterior height of injured vertebral body, Sagittal kyphosis Cobb angle, VAS score, and ODI index were investigated. The patients were divided into good prognosis group ( n=82) and poor prognosis group ( n=23) according to the presence or absence of secondary vertebral fractures during the follow-up period. Binary Logistic regression model was used to analyze the risk factors affecting the prognosis. Results:After PKP treatment, the efficiency of all 105 patients was 87.62% and the incidence of secondary vertebral fracture was 21.90%. The operative time was (83.52±16.85) min, the intraoperative blood loss was (32.11±1.52) ml, and the length of hospital stay was (10.62±1.65) d. The height of the anterior edge of the injured vertebra was (24.62±5.16) mm and (24.67±5.03) mm at the last follow-up and 3 months after surgery, respectively, higher than that before surgery ( t=15.21, 15.63, P=0.000). The Cobb angle of sagittal kyphosis was (10.03±1.27) ° and (10.10±1.25) °, respectively, and the VAS score was (3.11±0.52) and (1.00±0.11) points, respectively, 3 months after surgery and at the last follow-up. The ODI indexes were (11.25±2.85) % and (5.32±1.01) %, respectively, lower than those before surgery ( t3 months after surgery=28.84, 18.17, 29.21, tlast follow-up=25.68, 27.49, 42.78, P=0.000). There were significant differences in age, BMD, bone cement leakage, bone cement distribution and use of anti-osteoporosis drugs between the good prognosis group and the poor prognosis group ( t=4.03, 5.22, χ2=12.50, 22.694, 26.22, P=0.000). Logistic regression analysis showed that age ( OR=1.309, 95%CI=1.134-1.511, P=0.000), BMD ( OR=126.660, 95%CI=13.376-1199.376, P=0.000), bone cement leakage ( OR=4.698, 95%CI=1.306-16.902, P=0.018), dense distribution of bone cement ( OR=9.697, 95%CI=2.679-34.869, P=0.001), no use of anti-osteoporosis drugs ( OR=7.586, 95%CI=2.197-26.193, P=0.001) was an independent risk factor for the prognosis of patients with diabetes complicated with osteoporotic thoracolumbar compression fracture. Conclusion:PKP has a high rate of excellence in the treatment of diabetes mellitus complicated with osteoporotic thoracolumbar compression fractures, but factors such as age, BMD, bone cement leakage, bone cement dense distribution, and no postoperative use of anti-osteoporotic drugs will increase risks of secondary fractures, which in turn affects their prognosis.

Effect of morphological changes in the sagittal plane of vertebrae and discs on degenerative kyphodeformity / 中国骨伤

OBJECTIVE@#To explore the effects of morphological changes such as vertebral wedge deformation and disc degeneration (collapse) on adult thoracolumbar/lumbar degenerative kyphosis(TL/LDK) deformity.@*METHODS@#A retrospective analysis of 32 patients with spinal TL/LDK deformity admitted from August 2015 to December 2020, including 8 males and 24 females, aged 48 to 75(60.3±12.4) years old. On the long-cassette standing upright lateral radiographs, the coronal Cobb angle, sagittal thoracic lumbar/lumbar kyphosis angle(KA) of spine were measured, and the height and wedge parameters of apex vertebral(AV) and two vertebrae(AV-1, AV-2, AV+1, AV+2) above and below AV and the intervertebrae and the intervertebral disc(AV-1D, AV-2D, AV+1D, AV+2D) were evaluated, involving anterior vertebral body height(AVH), posterior vertebral body height(PVH), vertebral wedge angle(VWA), ratio of vertebral wedging(RVW), anterior disc height(ADH), posterior disc height(PDH), disc wedge angle(DWA), ratio of disc wedging(RDW), and DWA/KA.@*RESULTS@#The average angle of kyphosis was (44.2±19.1)°. A significant decrease in anterior height of vertebral was observed compared to the posterior height of vertebral(P<0.005). There was no significant difference in anterior and posterior height of discs. The vertebral wedging ratio/contribution ratio:AV-2(14.98±10.95)%/(14.21±8.08)%, AV-1(21.08±12.39)%/(18.09±7.38)%, AV(26.94±11.94)%/(25.52±8.64)%, AV+1(24.19±8.42)%/(20.82±8.69)%, AV+2(20.56±7.80)%/(15.60±9.71)%, total contribution(94.23±22.25)%, the disc wedging ratio/contribution ratio:AV-2D(2.88±2.57)%/(5.27±4.11)%, AV-1D(1.98±1.41)%/(2.29±2.16)%, AV+1D(-5.54±3.75)%/(-0.57±0.46)%, AV+2D(-8.27±4.62)%/(-1.22±1.11)%, total contribution (5.77±4.79)%. And the contribution rate of AV was significantly higher than that of adjacent vertebral(P<0.05).@*CONCLUSION@#The vertebral body and intervertebral disc shape both have influence on thoracolumbar kyphosis. However, the contribution of vertebral morphometry to the angle of TL/LDK deformity is relatively more important than the disc. The contribution of the wedge change of the AV to the TL/LDK deformity is particularly significant.

Back-forward bending CT in simulated surgical position to evaluate the remaining real angle and flexibility of thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture / 中国修复重建外科杂志

OBJECTIVE@#To introduce a scout view scanning technique of back-forward bending CT (BFB-CT) in simulated surgical position for evaluating the remaining real angle and flexibility of thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture.@*METHODS@#A total of 28 patients with thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture who met the selection criteria between June 2018 and December 2021 were included in the study. There were 6 males and 22 females with an average age of 69.5 years (range, 56-92 years). The injured vertebra were located at T 10-L 2, including 11 cases of single thoracic fracture, 11 cases of single lumbar fracture, and 6 cases of multiple thoracolumbar fractures. The disease duration ranged from 3 weeks to 36 months, with a median of 5 months. All patients received examinations of BFB-CT and standing lateral full-spine X-ray (SLFSX). The thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), local kyphosis of injured vertebra (LKIV), lumbar lordosis (LL), and the sagittal vertical axis (SVA) were measured. Referring to the calculation method of scoliosis flexibility, the kyphosis flexibility of thoracic, thoracolumbar, and injured vertebra were calculated respectively. The sagittal parameters measured by the two methods were compared, and the correlation of the parameters measured by the two methods was analyzed by Pearson correlation.@*RESULTS@#Except LL ( P>0.05), TK, TLK, LKIV, and SVA measured by BFB-CT were significantly lower than those measured by SLFSX ( P<0.05). The flexibilities of thoracic, thoracolumbar, and injured vertebra were 34.1%±18.8%, 36.2%±13.8%, and 39.3%±18.6%, respectively. Correlation analysis showed that the sagittal parameters measured by the two methods were positively correlated ( P<0.001), and the correlation coefficients of TK, TLK, LKIV, and SVA were 0.900, 0.730, 0.700, and 0.680, respectively.@*CONCLUSION@#Thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture shows an excellent flexibility and BFB-CT in simulated surgical position can obtain the remaining real angle which need to be corrected surgically.

Spinal Stenosis and Thoracolumbar Kyphosis in Achondroplasia / 罕见病研究

Achondroplasia (ACH) is a rare autosomal-dominant genetic disease resulting from a mutation in the fibroblast growth factor receptor-3 (FGFR3) gene. It is characterized by asymmetric short stature. Spinal stenosis and thoracolumbar kyphosis (TLK) are common findings in ACH patients. Severe TLK can exacerbate spinal stenosis, leading to neurological complications. This paper provides a brief review of the pathophysiological mechanisms, clinical characteristics, and treatments for spinal stenosis and TLK in ACH patients. Recently, three new drugs targeting FGFR3; vosoritide, recifercept, and infigratinib, have completed or are undergoing clinical trials. They have shown promising preliminary results in preventing spinal stenosis and TLK.

Risk factors for residual pain after percutaneous kyphoplasty for osteoporotic vertebral fractures / 中华创伤骨科杂志

Objective:To analyze the risk factors for residual pain after percutaneous kyphoplasty (PKP) for osteoporotic vertebral fractures (OVF).Methods:Retrospectively analyzed were the patients with OVC who had been treated at Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University by single level PKP from January 2020 to December 2021. They were 40 men and 181 women, with an age of (69.6±8.2) years. By the pain score of visual analogue scale (VAS) on the postoperative day 3, they were assigned into 2 groups: a residual pain group (VAS≥4) and a control group (VAS<4). The general demographics, radiographic and surgical related data of the 2 groups were analyzed by single factor analysis, including their gender, age, bone mineral density, body mass index, glucocorticoid usage, follow-up time, duration of symptoms, fracture location, severity of fracture compression, intravertebral cleft, middle column involvement, thoracolumbar fascia injury, anesthesia method, puncture method, volume of bone cement injected, cement-endplates contact, pattern of cement distribution, cement leakage, vertebral height restoration, preoperative cobb angle and correction of cobb angle. The P<0.1 factors screened were further analyzed by the multivariate logistic regression to determine the final variables. Results:In the present study, 19 patients were assigned into the residual pain group and 202 patients the control group. The univariate analysis showed that body mass index ( P=0.059), intravertebral cleft ( P=0.049) and thoracolumbar fascia injury ( P< 0.001) increased the risk for residual pain. The multivariate logistic regression analysis showed that thora-columbar fascia injury was an independent risk factor for residual pain ( OR=6.127, 95% CI: 2.240 to 16.755, P<0.001). Conclusion:Thoracolumbar fascia injury is an independent risk factor for residual pain after PKP for OVF.

Effect of different pressure balloon dilation combined with prying reduction and bone graft fixation in the treatment of thoracolumbar fractures and the risk factors of postoperative re-fracture / 中国综合临床

Objective:To investigate the effect of different pressure balloon dilation combined with prying reduction and bone graft fixation in the treatment of thoracolumbar fractures and the risk factors of postoperative re-fracture.Methods:One hundred cases of thoracolumbar fracture patients admitted to Cangzhou Integrated Traditional Chinese and Western Medicine Hospital in Hebei Province from March 2019 to June 2021 were selected. Prospective randomized controlled study method was used and random number table method was used to divide them into three groups: incomplete expansion group (33 cases), moderate expansion group (33 cases) and complete expansion group (34 cases). All the 3 groups were treated with balloon dilation combined with prying reduction and bone graft fixation. The pressure of balloon dilation in incomplete dilation group, moderate dilation group and complete dilation group was 100 psi, 150 psi and no more than 200 psi respectively, and the volume of balloon dilation was 0.5∶1, 1∶1 and 1.5∶1 respectively. The operation time, intraoperative bleeding volume, postoperative drainage volume, vertebral anterior margin recovery rate and hospital stay, as well as local Cobb angle, visual analog scale (VAS) and Oswestry disability index (ODI) scores before and after operation were compared among the three groups. According to the follow-up of whether there is re-fracture after surgery, the clinical data of the re-fracture group and the non re-fracture group were compared, and the risk factors of the re-fracture after surgery were analyzed. The measurement data with normal distribution was expressed as: independent sample t-test was used for comparison between two groups, one-way ANOVA or repeated measurement ANOVA was used for comparison between three groups, and SNK-q test was used for comparison between two groups. Counting data were expressed in cases or cases (%), and compared between groups by χ 2 Inspection. Logistic regression was used to analyze the risk factors of refracture after thoracolumbar fracture. Results:There was no significant difference in operation time, intraoperative blood loss and postoperative drainage volume among the three groups ( P=0.096, 0.328 and 0.344, respectively). The recovery rate of vertebral anterior edge height in moderate expansion group was higher than that in incomplete expansion group and complete expansion group ((84.15±4.21)% vs (70.18±7.44)%, (75.94±6.56)%), and the hospitalization time was shorter than that in incomplete expansion group and complete expansion group ((10.38±2.35) d vs (15.18±3.44), (14.59±2.48) d) (all P<0.001). Before treatment, there was no significant difference in Cobb angle, VAS and ODI scores among the three groups (all P>0.05). After treatment, the Cobb angle, VAS and ODI scores of patients in the three groups were lower than those before treatment, and the moderate expansion group were lower than those in the incomplete expansion group and the complete expansion group ((14.08±2.15) ° vs (16.48±4.85) °, (15.06±3.45) °, (1.81±0.53)% vs (2.25±0.41), (2.31±0.42), (18.16±2.18)% vs (20.48±4.85), (20.01±4.45) points) (all P<0.001). 100 patients were followed up until the fracture was healed. They were divided into re-fracture group (15 cases) and non re-fracture group (85 cases) according to whether there was re-fracture after operation. The results of multifactor logistic regression analysis showed that body mass index and bone mineral density were protective factors for patients with thoracolumbar fracture after operation (odds ratio was 0.66 and 0.15 respectively, 95% confidence interval: 0.51~0.86, 0.05~0.42, P values were 0.006 and <0.001 respectively), The old wedge-shaped change of the vertebral body and the abnormal structure of the lumbar spine are the risk factors for postoperative re-fracture (odds ratio 4.22 and 6.36, 95% confidence interval 1.14-15.56 and 1.43-28.21, respectively, P values were 0.027 and 0.015). Conclusions:In the treatment of thoracolumbar fracture with prying reduction and bone grafting fixation, the effect of balloon expansion pressure of 150 psi is better. Body mass index (BMI) and bone mineral density (BMD) were protective factors for postoperative re-fracture of patients with thoracolumbar fracture. Old wedge-shaped change of vertebral body and abnormal lumbar structure are risk factors for postoperative re-fracture.

Anatomical study of the latissimus dorsi muscle flap / Estudio anatómico del colgajo del músculo latísimo del dorso

SUMMARY: The latissimus dorsi is a broad muscle that originates from the inferior thoracic spinous processes, thoracolumbar fascia, iliac crest, and inferior ribs. It inserts on the inferior aspect of the intertubercular groove of the humerus through a thin tendon. The study was conducted on 10 cadavers (7 male and 3 female). These specimens were dissected and examined to study the gross anatomical characteristics of the latissimus dorsi muscle. The dimensions of the latissimus dorsi muscle and its surface area were measured in all the cadavers. The branching pattern of the thoracodorsal vessels was recorded. The pedicle length and caliper were measured using Vernier calipers. On the 20 dissected sides, the thoracodorsal artery was found to be one of the terminal branches of the subscapular artery that originates in the axillary region. In 19 (95 %) cases, the thoracodorsal artery terminated in a bifurcation, giving off a medial and a lateral branch. The average size of the elevated flap of the latissimus dorsi muscle was 18 cm x 36 cm. The average pedicle length was 9.5 cm (range: 5 cm-14 cm), and the average diameter at its origin was 2.5 mm (range: 1.5 mm-3.5 mm). The average diameter of the vena comitans was 3.3 mm. The current study focuses on the anatomical features of the latissimus dorsi muscle and its blood supply to increase the success rate of operations in clinical practice.

RESUMEN: El músculo latísimo del dorso se origina en los procesos espinosos de las vértebras torácicas inferiores, la fascia toracolumbar, la cresta ilíaca y las costillas inferiores y se inserta en el surco intertubercular del húmero a través de un delgado tendón. El estudio se realizó en 10 cadáveres (7 mujeres y 3 hombres). Estos especímenes fueron disecados y examinados para estudiar las características anatómicas macroscópicas del músculo latísimo del dorso. En todos los cadáveres se midieron las dimensiones del músculo y su superficie. Se registró el patrón de ramificación de los vasos toracodorsales. La longitud del pedículo y el calibre se midieron con paquímetro Vernier. En los veinte lados disecados, se encontró que la arteria toracodorsal era una de las ramas terminales de la arteria subescapular que se originaba en la región axilar. En 19 (95 %) casos, la arteria toracodorsal terminaba bifurcándose en dos ramas, una rama medial y otra lateral. El tamaño promedio del colgajo elevado del músculo latísimo del dorso era de 18 cm x 36 cm. La longitud promedio del pedículo era de 9,5 cm (rango: 5 cm-14 cm), y el diámetro promedio en su origen era de 2,5 mm (rango: 1,5 mm-3,5 mm). El diámetro medio de la vena comitans era de 3,3 mm. El estudio actual se centra en las características anatómicas del músculo latísimo del dorso y su irrigación para aumentar la tasa de éxito de las operaciones en la práctica clínica.

Factores influyentes en el desarrollo de competencias en Ortopedia y Traumatología durante el internado médico / Influential Factors in The Development of Competencies in Orthopedics and Traumatology During the Medical Internship

RESUMEN Introducción: Actualmente la salud es concebida como un derecho fundamental y para garantizarlo se debe propender por una adecuada formación de los profesionales de la salud. El internado rotatorio es la última etapa y la más importante del pregrado en Medicina. Objetivo: Explorar los factores desde la perspectiva de estudiantes y docentes, que influyen en el desarrollo de competencias en la rotación de Ortopedia y Traumatología durante el internado médico. Métodos: Estudio cualitativo con enfoque en teoría fundamentada. Para la recolección de datos se realizó un cuestionario semiestructurado a una muestra aleatoria de 14 participantes, 7 estudiantes y 7 docentes, que cumplían los criterios de inclusión. El análisis se basó en la codificación y categorización de los datos que posteriormente fueron sometidos a un proceso de triangulación para lograr la teorización final. Resultados: Los factores que favorecen el desarrollo de competencias están relacionados con la motivación intrínseca del estudiante, la flexibilidad y disponibilidad de recursos académicos, las características del programa de la rotación y el ambiente de práctica. Se identificaron como factores limitantes aquellos asociados a una formación deficiente en ciencias básicas médicas, la priorización del componente asistencial sobre el académico, la disponibilidad limitada de espacios y recursos de aprendizaje y los métodos de enseñanza tradicionales. Conclusiones: Es de vital importancia la identificación de los factores que favorecen y limitan el desarrollo de las competencias de los estudiantes de medicina en su última etapa de formación en ortopedia.

ABSTRACT Introduction: Few areas of orthopedic surgery have had such important technical changes in recent decades as in corrective spinal surgery. Fundamental changes have come with the new spinal instrumentation systems, which have been substantially modified and improved to facilitate three-dimensional correction of the deformity and provide secure spinal fixation, correction and stability. Objective: To evaluate the results achieved with the spinal instrumentation systems used in the correction of thoracolumbar kyphosis due to ankylosing spondylitis. Methods: A descriptive, retrospective and longitudinal study was carried out on 16 patients with thoracolumbar kyphosis due to ankylosing spondylitis operated on with the pedicle subtraction osteotomy technique and instrumented with Luque-type pedicle and sublaminar systems, in the Orthopedics service at Hermanos Ameijeiras Surgical Clinical Hospital, from March 2001 to March 2021. Results: All the patients were male, white skin color and average age of 39 years. More than 80% correction was achieved in the sagittal profile and an average of 34.3° per osteotomy, without major neurological complications. Good functional results were obtained, with high degree of patient satisfaction and improvement in their quality of life. Conclusions: The use of both spinal instrumentation systems is effective in maintaining the correction of thoracolumbar kyphosis due to ankylosing spondylitis.

Sistemas de instrumentación espinal en la corrección de la cifosis toracolumbar por espondilitisanquilopoyética / Spinal Instrumentation Systems in The Correction of Thoracolumbar Kyphosis Due to AnkylosingSpondylitis

Introducción: En pocas áreas de la cirugía ortopédica se han producido cambios técnicos tan importantes en las últimas décadas como en la cirugía correctora espinal. Los cambios fundamentales han sobrevenido con los nuevos sistemas de instrumentación espinal, que se han modificado y mejorado sustancialmente para facilitar la corrección tridimensional de la deformidad y aportar fijación segura de la columna, corrección y estabilidad. Objetivo: Evaluar los resultados alcanzados con los sistemas de instrumentación espinal utilizados en la corrección de la cifosis toracolumbar por espondilitis anquilopoyética. Método: Se realizó un estudio tipo descriptivo, retrospectivo y longitudinal a 16 pacientes con cifosis toracolumbar por espondilitis anquilopoyética intervenidos con la técnica de osteotomía de sustracción pedicular e instrumentados con sistemas pediculares y sublaminar tipo Luque, en el servicio de Ortopedia del Hospital Clínico Quirúrgico Hermanos Ameijeiras, durante el período comprendido entre marzo de 2001 y marzo de 2021. Resultados: La totalidad de los pacientes correspondieron al sexo masculino, color de la piel blanca y edad promedio de 39 años. Se logró más del 80 por ciento de corrección en el perfil sagital y un promedio de 34,3° por osteotomía, sin complicaciones neurológicas mayores. Se obtuvo un buen resultado funcional, con un alto grado de satisfacción de los pacientes y mejora de su calidad de vida. Conclusiones: La utilización de ambos sistemas instrumentación espinal es eficaz para mantener la corrección de la cifosis toracolumbar por espondilitis anquilopoyética(AU)

Introduction: Few areas of orthopedic surgery have had such important technical changes in recent decades as in corrective spinal surgery. Fundamental changes have come with the new spinal instrumentation systems, which have been substantially modified and improved to facilitate three-dimensional correction of the deformity and provide secure spinal fixation, correction and stability. Objective: To evaluate the results achieved with the spinal instrumentation systems used in the correction of thoracolumbar kyphosis due to ankylosing spondylitis. Methods: A descriptive, retrospective and longitudinal study was carried out on 16 patients with thoracolumbar kyphosis due to ankylosing spondylitis operated on with the pedicle subtraction osteotomy technique and instrumented with Luque-type pedicle and sublaminar systems, in the Orthopedics service at Hermanos Ameijeiras Surgical Clinical Hospital, from March 2001 to March 2021. Results: All the patients were male, white skin color and average age of 39 years. More than 80 percent correction was achieved in the sagittal profile and an average of 34.3° per osteotomy, without major neurological complications. Good functional results were obtained, with high degree of patient satisfaction and improvement in their quality of life. Conclusions: The use of both spinal instrumentation systems is effective in maintaining the correction of thoracolumbar kyphosis due to ankylosing spondylitis(AU)

Long-term efficacy and BMP-7/25- (OH) -D-3 levels of percutaneous kyphoplasty in the treatment of elderly osteoporotic thoracolumbar compression fractures / 中华内分泌外科杂志

Objective:To analyze the long-term efficacy of percutaneous kyphoplasty (PKP) assisted with vitamin D in the treatment of elderly thoracolumbar single vertebral osteoporotic vertebral compression fractures (OVCF) and its effect on transfected bone morphogenetic protein-Effects of 7 (BMP-7) /25-hydroxyvitamin D3 [ (25- (OH) -D3] levels.Methods:106 elderly patients with fresh OVCF of thoracic and lumbar vertebrae who were treated with PKP in Li Huili Hospital of Ningbo Medical Center from Jun. 2017 to Jun. 2021 were selected as the research object, and they were divided into two groups according to the random number table method (53 cases in each group) . Both groups were treated with PKP and received conventional anti-osteoporosis treatment and rehabilitation training. On this basis, patients in the treatment group were given vitamin D therapy. Before treatment and 1, 3, 6, and 12 months after treatment, the degree of pain improvement, Cobb angle improvement, bone mineral density, vertebral body compression rate, vertebral body function recovery and serum BMP-7, 25- (OH) -D3 level, and the cement leakage rate of all subjects within 1 year of follow-up was recorded.Results:Two patients in the observation group and 3 patients in the control group lost to follow-up. Comparing the results of before treatment and 12 months after treatment: the control group’s BMD increased from 0.585±0.042 to 0.755±0.0641; BMP-7 increased from 80.02±6.24 to 129.87±10.52;25- (OH) -D3 increased from 9.15±2.16 to 13.52±2.64;and the treatment group’s BMD increased from 0.576±0.039 to 0.868±0.079; BMP-7 increased from 78.36±6.20 to 153.41±12.70; 25- (OH) -D3 increased from 9.01±2.12 to 16.24±2.81; the treatment group had higher increase ( P<0.05) . Meanwhile the control group’s Cobb angle decreased from 13.54±1.81 to 8.05±1.05; vertebral body compression rate decreased from 28.41±3.47 to 19.86±2.29; ODI score decreased from 74.42±7.37 to 24.08±2.41; VAS score decreased from7.54±0.81 to 2.65±0.25,and the treatment group’s Cobb angle decreased from 13.70±1.89 to 7.42±0.97;vertebral body compression rate decreased from 28.97±3.62 to 18.86±2.02; ODI score decreased from75.78±7.43 to 21.39±2.08; VAS score decreased from7.70±0.891 to 2.32±0.20,while the treatment group decreased more ( P<0.05) . In addition, the vertebral refracture rate in the control group was 22.00% (11/50) , while the vertebral refracture rate in the treatment group was 5.88% (3/51) , and there was a significant difference between the groups ( χ 2=5.125, P=0.024) . Conclusion:PKP combined with vitamin D in the treatment of elderly thoracolumbar OVCF can significantly improve the levels of BMP-7 and 25- (OH) -D3, better restore bone mineral density, vertebral body function and correct kyphosis, with a more ideal long-term efficacy.

Construction of co-management care pathway and its application in elderly patients with thoracolumbar fractures / 中国实用护理杂志

Objective:To explore the application value of co-management care pathway in elderly patients with thoracolumbar fractures.Methods:Totally, 104 elderly patients with thoracolumbar fractures were selected in Pingxiang No.2 People′s Hospital from January 2018 to August 2019. They were assigned to experimental group ( n=52) and control group ( n=52) by random number table method. The control group was given routine care, the experimental group implemented the intervention scheme of co-management care pathway on the basis of routine nursing. The effects were assessed by Elderly Frailty Assessment Scale and Barthel Index, respectively at 3 and 6 months after discharge. Results:Finally, 47 cases were included in the experimental group and 50 cases in the control group.After 3 months of intervention, the scores of Barthel Index were (71.87 ± 8.86) points in the experimental group, higher than in the control group (66.22 ± 8.99) points, the difference was statistically significant ( t=3.12, P<0.05). The scores of physiological and psychological frailty dimensions were (5.28 ± 1.06) points and (1.10 ± 0.25) points in the experimental group, lower than in the control group (5.78 ± 1.36) points and (1.27 ± 0.37) points, the difference was statistically significant ( t=2.04, 2.09, both P<0.05). After 6 months of intervention, the scores of physiological, psychological, cognitive dimensions and frailty total scores were (4.59 ± 1.17), (1.21 ± 0.44), (0.54 ± 0.14) points and (7.49 ± 1.21) points in the experimental group, lower than in the control group (5.24 ± 1.79), (1.49 ± 0.32), (0.67 ± 0.21) points and (8.51 ± 1.89) points, the differences were statistically significant ( t values were 2.11-3.51, all P<0.05). Conclusions:Co-management care pathway can effectively reduce the degree of frailty in elderly patients with thoracolumbar fractures, and improve the patients′ activities of daily living.

Traumatismo toracolumbar: fijación in situ vs descompresión y fijación en fracturas por estallido con compromiso neurológico / Thoracolumbar trauma: in situ fixation vs decompression and fixation in neurologically involved burst fractures

Resumen: Las fracturas por estallido toracolumbar son un gran desafío para los cirujanos de columna, es por ello que el objetivo de este estudio fue realizar una revisión sistemática analizando la literatura actual respecto a los diferentes factores a tener en cuenta en el manejo de las mismas. Material y métodos: Búsqueda sistemática en los sitios PubMed, Cochrane, MedlinePlus. «Thoracolumbar Burst Fractures¼ fueron las palabras claves. Se analizaron los títulos, resúmenes y texto completo a partir de dos observadores independientes. Resultados: Seis estudios han sido incluidos, cinco (83.33%) fueron de cohorte prospectivos y sólo uno (16.67%) retrospectivo. Hubo un total de 289 pacientes entre todas las muestras. La media de edad fue 38.48 años y la relación respecto al sexo fue masculino-femenino de 1.7:1. Conclusión: Las fracturas por estallido toracolumbar siguen siendo controversiales en su tratamiento con bibliografía publicada de bajo nivel de evidencia y sin establecer un consenso en el momento de la toma de decisiones con diferentes opciones según la experiencia y preferencia del cirujano. Sin embargo, la mayoría de los mismos se inclinan hacia el tratamiento con fijación posterior de segmento corto pero sin seguimiento a largo plazo. Respecto al déficit neurológico, la descompresión quirúrgica logró consenso entre todos los cirujanos.

Abstract: Thoracolumbar burst fractures are a great challenge for spine surgeons and that is why the aim of this study was to perform a systematic review analyzing the current literature regarding the different factors to take into account in their management. Material and methods: Systematic search in PubMed, Cochrane, MedlinePlus sites. «Thoracolumbar Burst Fractures¼ were the keywords. Titles, abstracts and full text were analyzed from two independent observers. Results: Six studies were included, five (83.33%) were prospective cohort studies and only one (16.67%) was retrospective. There were a total of 289 patients among all samples. The mean age was 38.48 years and the sex ratio was male to female of 1.7:1. Conclusion: Thoracolumbar burst fractures remain controversial in their treatment with published literature of low level of evidence and without establishing a consensus at the time of decision making with different options depending on the surgeon's experience and preference. However, most of them are inclined towards treatment with short segment posterior fixation but without long-term follow-up. Regarding neurological deficit, surgical decompression achieved consensus among all surgeons.

Suspension exercise training can improve walking and balance after thoracolumbar fracture and spinal cord injury / 中华物理医学与康复杂志

Objective:To explore the effect of suspension exercise training (SET) on the lumbar function and balance ability of patients with thoracolumbar fracture and spinal cord injury.Methods:Totally 64 patients with thoracolumbar fracture and spinalcord injury were randomly divided into a control group and an observation group, each of 32. Both groups received pedicle screw reduction with internal fixation and spinal dome decompression, followed by routine post-operative rehabilitation. In addition, the observation group performed double bridge and single leg suspension training and pelvic lift training. Everyone′s walking ability, spinal nerve functionality and balance were evaluated 3 days after the operation and 2 months after the training. Stride frequency, stride length and walking speed were observed. American Spinal Injury Association (ASIA) nerve function classifications were assigned. The trajectory length, trajectory included area and movement deviation of each subject′s center of gravity (CG) was recorded.Results:The average stride frequency, step length and walking speed of the observation group had all improved significantly after the intervention, and were significantly better than the control group′s averages at that point. This was also true of the proportion in ASIA neurological function grade D (65.63%), CG trajectory length and area, and the Romberg rate of deviation along the X-axis and Y-axis of the CG.Conclusion:SET training after pedicle screw reduction and internal fixation and spinal dome decompression can significantly improve the spinal nerve functioning of persons after a thoracolumbar fracture with incomplete spinal cord injury. It enhances their balance and walking ability. Such therapy is worthy of clinical promotion and application.

Single-cell RNA Sequencing Reveals Thoracolumbar Vertebra Heterogeneity and Rib-genesis in Pigs / 基因组蛋白质组与生物信息学报·英文版

Development of thoracolumbar vertebra (TLV) and rib primordium (RP) is a common evolutionary feature across vertebrates, although whole-organism analysis of the expression dynamics of TLV- and RP-related genes has been lacking. Here, we investigated the single-cell transcriptome landscape of thoracic vertebra (TV), lumbar vertebra (LV), and RP cells from a pig embryo at 27 days post-fertilization (dpf) and identified six cell types with distinct gene expression signatures. In-depth dissection of the gene expression dynamics and RNA velocity revealed a coupled process of osteogenesis and angiogenesis during TLV and RP development. Further analysis of cell type-specific and strand-specific expression uncovered the extremely high level of HOXA10 3'-UTR sequence specific to osteoblasts of LV cells, which may function as anti-HOXA10-antisense by counteracting the HOXA10-antisense effect to determine TLV transition. Thus, this work provides a valuable resource for understanding embryonic osteogenesis and angiogenesis underlying vertebrate TLV and RP development at the cell type-specific resolution, which serves as a comprehensive view on the transcriptional profile of animal embryo development.

Effect of compound bone peptide injection on osteoporotic fractures of thoracolumbar spine, bone density and bone metabolism / 药学实践杂志

Objective To evaluate the clinical value of compound bone peptide injection in patients with thoracolumbar osteoporotic fracture. Methods 96 patients admitted from January 2018 to January 2020 with thoracolumbar osteoporotic fracture were selected. The patients were randomly divided into group A (receiving calcine D with compound bone peptide injection) and group B (receiving calcine D treatment) with 48 patients in each group. TCM symptom scores, bone metabolism, degree of osteoporosis, bone density level, visual analogue scale (VAS) and lumbar spine disease treatment score (JOA) were compared between the two groups after treatment. Results After treatment, the TCM symptom score and JOA score in group A were higher than those in group B (P<0.05). The levels of bone alkaline phosphatase (BALP) and type I procollagen N-terminal propeptide (PIINP) in group A were significantly lower than those in group B (P<0.05). The grade 3 osteoporosis ratio in group A was lower than that in group B (P<0.05). The bone mineral density level in group A was higher than that in group B (P<0.05). The visual analogue scale (VAS) in group A was lower than that in group B (P<0.05). Conclusion The treatment of thoracolumbar osteoporotic fracture with compound bone peptide injection effectively improved the bone metabolism and bone mineral density, relieved pain and promoted the recovery of lumbar function.

Postoperative outcome in thoracolumbar spinal tuberculosis: a retrospective study

Background: Spinal tuberculosis is the most common location of extra pulmonary tuberculosis. ATT alone may not be suitable in all situations, especially when treating patients with risk of instability, progression of neurologic deficit, and failure of medical treatment. Surgical intervention is a major treatment modality for symptom relief in spinal tuberculosis.Methods: The aim of this study was to assess the immediate post-operative outcome in surgically treated patients with dorsolumbar spine tuberculosis at Department of Neurosurgery Government Medical College, Thrissur. All operated patients of dorsolumbar spinal tuberculosis during 2014 September to 2019 august were included under study.Results: A total of 57 patients were included in the study. The mean age of the patient was 42.77 years. There were 40 males (70.2%) and 17 females (29.8%). 55 (96.5%) out of 57 patients were having sensory symptoms. 41 (71.9%) out of 57 patients were having motor symptoms. Bladder involvement 23 (40.4%) and bowel involvement 15 (26.3%) were also noted in the study. Sensory symptoms improvement in post-operative period was noted in 46 (80.7%). Motor symptoms improvement was observed in 23 (56.1%) out of 41. Bladder symptoms improved in 6 (26.1%) out of 23. There is improvement in clinical symptoms, neurological function immediately after surgery. Surgical patients have faster improvement and can be mobilized earlier. Improvement in sensory symptoms (96.5%), motor symptoms (56.1%) and bladder symptoms (26.1%) were noted in our study in the immediate post-operative period.Conclusions: There was significant immediate relief in symptoms and morbidity of patients undergoing surgical treatment for dorsolumbar spine tuberculosis.

Operative versus Non-Operative Management of Traumatic Thoracolumbar Injuries according to the AO Spine Thoracolumbar Spine Injury Classification System

Introduction The AOSpine Thoracolumbar Spine Injury Classification (AOSTSIC) system has been proposed to better characterize injury morphologies and improve the classification of thoracolumbar (TL) spine trauma. However, the indications for surgical treatment according to the AOSTSIC system are still debated. Additionally, the proposed Thoracolumbar AOSpine Injury Score (AOSIS) is quite complex, which may preclude its use in daily practice. The objective of this reviewis to discuss the AOSTSIC systemand its indications for initial nonoperative versus surgical management of acute TL spine trauma. Methods We analyzed the literature for each injury type (and subtype, when pertinent) according to the AOSTSIC system as well as their potential treatment options. Results Patients with AOSTSIC subtypes A0, A1, and A2 are neurologically intact in the vast majority of the cases and initially managed nonoperatively. The treatment of A3- and A4-subtype injuries (burst fractures) in neurologically-intact patients is still debated with great controversy, with initially nonoperative management being considered an option in select patients. Surgery is recommended when there are neurological deficits or failure of nonoperativemanagement,with the role of magnetic resonance findings in the Posterior Ligamentous Complex (PLC) evaluation still being considered controversial. Injuries classified as type B1 in neurologically-intact patients may be treated, initially, with nonoperative management, provided that there are no ligamentous injury and non-displacing fragments. Due to severe ligamentous injury, type-B and type-C injuries should be considered as unstable injuries that must be surgically treated, regardless of the neurological status of the patient. Conclusions Until further evidence, we provided an easy algorithm-based guide on the spinal trauma literature to help surgeons in the decision-making process for the treatment of TL spine injuries classified according to the new AOSTSIC system.

Correlation between the schanz screw insertion angle and the loss of kyphosis correction in thoracolumbar fractures / Correlação entre o ângulo de inserção do pino de schanz e a perda de correção da cifose em fraturas toracolombares / Correlación entre el ángulo de inserción del tornillo de schanz y la pérdida de corrección de la cifosis en fracturas toracolumbares

ABSTRACT Objective To compare the Schanz screw insertion angle and the loss of the regional kyphosis correction in thoracolumbar burst fractures following posterior short instrumentation surgery. Methods Patients with a thoracolumbar burst fracture between levels T11-L2 were divided into two groups (parallel and divergent) according to the angle formed between the Schanz screw and the vertebral plateau. Regional kyphosis was evaluated in preoperative, immediate postoperative and last follow-up radiographs. Results Of the 58 patients evaluated, 31 had a parallel assembly and 27 had a divergent assembly. When we analyzed the angle of kyphosis, no statistical difference was observed between the pre- and postoperative radiographs. However, a statistical difference in the last follow-up radiographs and in the final loss of the kyphosis correction was confirmed. Conclusion The insertion of Schanz screws with a divergent assembly presents better radiographic results with less loss of kyphosis correction angle when compared with the parallel assembly technique. Level of Evidence III; Retrospective cohort study.

RESUMO Objetivo Comparar o ângulo de inserção do pino de Schanz e os resultados da perda de correção da cifose regional nas fraturas toracolombares do tipo explosão após tratamento cirúrgico com instrumentação curta por via posterior. Métodos Os pacientes com fratura toracolombar do tipo explosão entre os níveis de T11-L2 foram divididos em dois grupos (paralelo e divergente) de acordo com o ângulo formado entre o pino de Schanz e o platô vertebral. Foi avaliada a cifose regional nas radiografias pré-operatória, pós-operatória imediata e do último acompanhamento. Resultados Dos 58 pacientes avaliados, 31 apresentaram uma montagem paralela e 27 uma montagem divergente. Ao analisarmos o ângulo da cifose, não se observou diferença estatística nas radiografias pré- e pós-operatória imediata. Porém, verificou-se uma diferença estatística nas radiografias do último acompanhamento e na perda final de correção da cifose. Conclusões A inserção do pino de Schanz com uma montagem divergente apresenta melhores resultados radiográficos com menor perda do ângulo de correção da cifose quando comparada com a técnica de montagem paralela. Nível de Evidência III; Estudo de coorte retrospectivo.

RESUMEN Objetivo Comparar el ángulo de inserción del tornillo de Schanz y los resultados de la pérdida de corrección de la cifosis regional en las fracturas toracolumbares del tipo explosión después del tratamiento quirúrgico con instrumentación corta por vía posterior. Métodos Los pacientes con fractura toracolumbar del tipo explosión entre los niveles de T11-L2 fueron divididos en dos grupos (paralelo y divergente) de acuerdo con el ángulo formado entre el tornillo de Schanz y la meseta vertebral. Fue evaluada la cifosis regional en las radiografías preoperatoria, posoperatoria inmediata y del último acompañamiento. Resultados De los 58 pacientes evaluados, 31 presentaron un montaje paralelo y 27 un montaje divergente. Al analizar el ángulo de la cifosis, no se observó diferencia estadística en las radiografías pre y postoperatoria inmediata. Sin embargo, se verificó una diferencia estadística en las radiografías del último acompañamiento y en la pérdida final de corrección de la cifosis. Conclusiones La inserción del tornillo de Schanz con un montaje divergente presenta mejores resultados radiográficos con menor pérdida del ángulo de corrección de la cifosis cuando comparada con la técnica de montaje paralelo. Nivel de Evidencia III; Estudio de cohorte retrospectivo.

Clinical management of dogs with presumptive diagnosis of thoracolumbar intervertebral disc disease: 164 cases (2006-2017) / Tratamento clínico de cães com diagnóstico presuntivo de doença do disco intervertebral toracolombar: 164 casos (2006-2017)

This study aimed to identify dogs with presumptive diagnosis of cervical intervertebral disc disease (IVDD) submitted to clinical management and to evaluate the outcomes. Data were obtained from the medical records of patients with neurological dysfunction assisted at a University Veterinary Hospital from 2006 to 2017. In addition to the patients' records, dog owners responded to a questionnaire on the success of therapy. Four hundred and thirteen neurological records were evaluated, and 164 met the inclusion criteria of the study. The most common breed was Dachshund, followed by mongrels. Classification of neurological dysfunction in the study sample was as follows: 15.9% with grade I, 25.6% with grade II, 26.8% with grade III, 8.5% with grade IV, and 23.2% with grade V. Outcome was satisfactory in 71.6% of the dogs and unsatisfactory in 28.4% of them. Recurrence was observed in 27.7% of those with satisfactory outcomes. The clinical treatment of dogs with thoracolumbar IVDD is satisfactory, particularly for animals with milder disease grades (I, II, and III). There is possibility of recurrence with conservative therapy and clinical signs may be more severe.(AU)

O objetivo desse estudo foi identificar cães com diagnóstico presuntivo de DDIV toracolombar submetidos ao tratamento clínico, a fim de avaliar a resposta à terapia instituída. Foram revisados os registros neurológicos de cães atendidos pelo Serviço de Neurologia e Neurocirurgia Veterinária no período de 2006 a 2017 de um Hospital Veterinário Universitário. Foi realizada coleta de dados a partir dos registros e por meio de um questionário respondido pelos tutores. Foram avaliadas 413 fichas neurológicas de cães e obtidas informações para inclusão no estudo em 164 delas. As raças mais frequentes foram dachshunds, seguido de cães sem raça definida. Quanto ao grau de disfunção neurológica foi definido como grau I para 15,9% dos cães, grau II para 25,6%, grau III para 26,8%, grau IV para 8,5% e grau V para 23,2%. A recuperação foi satisfatória em 71,6% dos cães e insatisfatória em 28,4%. Dos que se recuperaram satisfatoriamente, 27,7% tiveram recidivas. Com base nos resultados obtidos pode-se concluir que o tratamento clínico em repouso absoluto e administração de anti-inflamatórios e analgésicos opióides para cães com DDIV toracolombar é efetivo, principalmente para cães em graus mais leves da doença (grau I, II e III). Há possibilidade de recidiva com esse tipo de terapia cujos sinais clínicos poderão ser mais graves.(AU)

Modal Analysis of Thoracolumbar Osteoporotic Vertebral Bodies / 医用生物力学

Objective To explore the dynamic characteristics of the thoracolumbar osteoporotic vertebral bodies under free state. Methods Based on CT data from the thoracic and lumbar vertebral body of a healthy female volunteer, model materialization and intervertebral disc tissue reconstruction were realized by using the computerized processing software. The finite element models of normal thoracolumbar vertebral body and thoracolumbar osteoporotic vertebral body were established in ABAQUS 6.14 to perform modal analysis. Results Compared with the normal model, the osteoporosis model had a lower natural frequency and a lager amplitude. As the vibration frequency increased, the model vibration type changed from uniaxial and unidirectional motion to multiaxial and multidirectional motion, and the responsible vertebral body for the maximum amplitude moved down gradually. Conclusions Modal analysis can better analyze dynamic characteristics of the thoracolumbar osteoporotic vertebral body. Patients with osteoporosis should try to avoid the specific vibration environment, so as to decrease the risk of intervertebral disc tissue degeneration, strain of thoracolumbar soft tissues and lesion in posterior structures of the vertebral body.