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.

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.

Choice of osteotomy methods for old thoracolumbar osteoporotic fracture with kyphosis / 中国骨伤

OBJECTIVE@#To investigate the clinical outcome of single or double-segment pedicle subtraction osteotomy (PSO) for the treatment of old thoracolumbar osteoporotic compression fractures with kyphosis.@*METHODS@#The clinical data of 26 patients with old thoracolumbar osteoporotic compression fractures with kyphosis who underwent surgery from January 2015 to June 2017 were retrospectively analyzed. There were 12 males and 14 females, aged from 58 to 72 years old with an average of 65.6 years. The time interval from fracture to surgery was (8.2±1.5) years. According to different surgical methods, the patients were divided into single-segment PSO group (group A) and double-segment PSO group(groupB). The perioperative data, preoperative and postoperative imaging data and postoperative complications were recorded, and the Oswestry Disability Index (ODI) and visual analogue scale (VAS) were used before and after surgery to evaluate the clinical effect.@*RESULTS@#All patients were followed up for 6-24 months with an average of 14.5 months. There was a statistically significant difference in operation time and intraoperative blood loss between the two groups (0.05). The postoperative correction angle of the single segment PSO group was (33.3± 9.4) ° with the correction rate of 85.3% and the double segment PSO group was (41.0±13.5) ° with the correction rate of 92.7%, and there was statistical significance between two groups (0.05). One case of cone injury occurred in the single-segment PSO group and recovered after treatment. There were no complications of spinal cord injury in the double segment group. Loose screws occurred during surgery in three patients in the single-segment PSO group and one patient in the double-segment PSO group (<0.05). All 4 patients were re inserted with screws after using bone cement to reinforce the nail pathway. There were no complications such as anterior spinal vascular and nerve damage or osteotomy unfusion.@*CONCLUSION@#Both single-segment PSO and double-segment PSO can achieve good orthopedic and clinical effects in the treatment of old thoracolumbar osteoporotic fractures with kyphosis. For patients with correction angles greater than 40° , the double-segment PSO provides a better correction angle and is safer, but it is with longer operation time and more intraoperative bleeding.

Fijación transpedicular percutánea versus técnica abierta en pacientes con fracturas toracolumbares tipo A / Percutaneous versus open technique transpedicular fixation in patients with thoracolumbares type A fractures

Resumen: Introducción: Las técnicas de fijación transpedicular percutánea son una herramienta emergente en el tratamiento del trauma espinal, sin embargo, su uso no es totalmente aceptado. Objetivo: Comparar resultados en pacientes con fractura vertebral traumática que fueron tratados con cirugía de fijación transpedicular percutánea versus fijación transpedicular abierta. Material y métodos: De Enero a Diciembre de 2016, 15 pacientes con fractura vertebral traumática fueron divididos aleatoriamente en dos grupos: el grupo A fue de seis pacientes tratados con fijación transpedicular percutánea y el grupo B fue de seis pacientes tratados con fijación transpedicular con técnica abierta; tres pacientes fueron eliminados. Se evaluó el sangrado transoperatorio, el dolor postoperatorio con la escala visual análoga a las 24 horas y a las dos semanas del postoperatorio; también se evaluó el índice de discapacidad de dolor lumbar Oswestry a seis semanas, además de tres, seis, 12 y 24 meses del postoperatorio. Resultado: El seguimiento fue de 24 meses. Se reportaron diferencias estadísticamente significativas en el sangrado transoperatorio (p 2.43E-05), EVA al primer día (p < 0.0003), EVA a las dos semanas (p = 0.01); también en el cuestionario de discapacidad de dolor lumbar Oswestry a las seis semanas (p = 0.0007), tres meses (p = 0.005), seis meses (p = 0.005), 12 meses (p = 0.01) y 24 meses (p = 0.004). No se observaron diferencias significativas con respecto al tiempo operatorio (p = 0.12). Discusión: En nuestro trabajo encontramos que el sangrado transoperatorio, dolor postoperatorio y discapacidad funcional son significativamente menores en el grupo de fijación transpedicular percutánea.

Abstract: Introduction: Percutaneous transpedicular fixation techniques are an emerging tool in the treatment of spinal trauma, however, their use is not fully accepted. Objective: Compare results in patients with traumatic vertebral fracture, treated with percutaneous transpedicular fixation surgery versus open transpedicular fixation. Material and methods: From January to December 2016, 15 patients with traumatic vertebral fracture were randomly divided into 2 groups, group A were six treated with percutaneous transpedicular fixation, group B were treated with open technique transpedicular fixation, three patients were eliminated. Transoperative bleeding, postoperative pain with the 24-hour and two-week postoperative visual scale, the six-week Oswestry lumbar pain disability index, and three, six, 12 and 24 months of postoperative control were evaluated. Results: The follow-up was 24 months. Statistically significant differences in transoperative bleeding (p 2.43E-05), EVA on the first day (p < 0.0003), EVA at two weeks (p = 0.01) were reported in the Oswestry lumbar pain disability questionnaire at six weeks (p = 0.0007), three months (p = 0.005), six months (p = 0.005), 12 months (p = 0.01) and 24 months (p = 0.004), no significant differences were observed with respect to operating time (p = 0.12). Discussion: In our work we find that transoperative bleeding, postoperative pain and functional disability are significantly minor in the percutaneous transpedicular fixation group.

Anterior versus posterior decompression for the treatment of thoracolumbar fractures with spinal cord injury:a Meta-analysis / 中国骨伤

OBJECTIVE@#To systematically evaluate the efficacy and safety of anterior decompression and posterior decompression in the treatment of thoracolumbar fractures with spinal cord injury, so as to provide a good scientific basis for more effective treatment of thoracolumbar fractures with spinal cord injury.@*METHODS@#A clinical data about comparative study of anterior decompression and posterior decompression in the treatment of thoracolumbar fractures with spinal cord injury was searched and collected. The databases of Pubmed, Embase, Cochrane Library, CNKI, CBM, Wanfang Medical Network were searched by computer. Artificially collected journals included Spine, European Spine Journal, The Journal of Bone and Joint Surgery. Two spine surgeons independently screened the literature according to established inclusion and exclusion criteria and assessed the quality of the included studies. Meta-analysis was performed on the data using Review Manager 5.3 software, the indicators included operative time, intraoperative blood loss, postoperative tactile score, postoperative motor score, postoperative vertebral height, hospitalization time, neurological function recovery, efficiency of treatment, postoperative complications.@*RESULTS@#Fifteen randomized controlled trials (RCTs) were enrolled in a total of 1 360 patients, including 680 anterior decompression and 680 posterior decompression. The results of Meta-analysis showed that the anterior decompression group had longer operation time [MD=80.09, 95% CI(36.83, 123.34), P=0.000 3], more intraoperative blood loss [MD=225.21, 95%CI(171.07, 279.35), <0.000 01], longer hospitalization time [MD=2.31, 95% CI(0.32, 4.31), P=0.02]. And the postoperative tactile score [MD=13.39, 95% CI(9.86, 16.92), <0.000 01], postoperative motor score [MD=13.15, 95% CI(7.02, 19.29), <0.000 1], vertebral height [MD=1.36, 95% CI(0.79, 1.92), <0.000 01] in anterior decompression were higher than that in posterior decompression. There was no statistically significant differences in the efficacy of treatment [OR=1.14, 95% CI(0.56, 2.31), P=0.72], neurological recovery [OR=0.87, 95% CI(0.57, 1.33), P=0.52] between two groups.@*CONCLUSIONS@#Compared with posterior decompression, the anterior decompression has the advantages of longer operating time, more intraoperative blood loss, longer hospitalization time, higher postoperative tactile score, higher postoperative motor score, and higher injury vertebral height, But there was no significant difference in the treatment efficiency and nerve function recovery between two groups.

Analysis of the clinical effects of different pedicle screw fixation methods for the treatment of thoracolumbar fractures / 中国骨伤

OBJECTIVE@#To discuss the clinical effects of the different pedicle screw fixation methods for the treatment of thoracolumbar fractures.@*METHODS@#The clinical data of 55 patients with single thoracolumbar fractures treated between January 2013 and December 2016 were retrospectively analyzed. There were 32 males and 23 females, aged from 20 to 55 years with an average of 35.6 years old. All the fractures were located on a single segment, 8 cases of T₁₁, 18 cases of T₁₂, 19 cases of L₁, 10 cases of L₂. According to the classification of AO, 10 cases were type A1, 17 cases were type A2, 18 cases were type A3, 7 cases were type B2, 2 cases were type B3, 1 case was type C1. The patients were divided into three groups according to the different fixation methods, among them, 20 cases treated by traditional short-segment 4 pedicle screws fixation were control group, 22 cases treated by intermediate bilateral pedicle screws fixation (6 pedicle screws fixation) were bilateral group, 13 cases treated by intermediate unilateral pedicle screw fixation (5 pedicle screws fixation) were unilateral group. The three groups were compared by operation time, intraoperative blood loss, hospitalization cost, VAS and ODI scores, the correction of the fractured vertebrae height and kyphosis angle postoperatively and the losing rate of the fractured vertebrae height and kyphosis angle at the final follow-up and so on.@*RESULTS@#All the patients were followed up from 12 to 20 months with an average of 15.2 months. No complications such as loosening of internal fixation and breakage were found after operation. There was no significant difference in operation time and intraoperative blood loss among three groups(>0.05). In terms of hospitalization cost, the control group[(20 932.4±298.3)yuan] was significantly lower than the unilateral group[(22 428.2±321.5)yuan] and the bilateral group [(23 630.5±310.5)yuan] (0.05). And there was no significant difference in the correction of the injuried vertebrae height and kyphosis angle immediately after operation among three groups(>0.05). However, for the losing rate of the injuried vertebrae height at the final follow-up, the unilateral group[(6.3±2.1)%] and bilateral group [(5.6±2.8)%] were significantly better than the control group[(9.2±1.8)%] (0.05).@*CONCLUSIONS@#All the three different pedicle screw fixation methods are suitable for the treatment of thoracolumbar fractures and the short-term clinical effects are consistent. Compared with traditional short-segment 4 pedicle screws fixation, intermediate bilateral or unilateral pedicle screw fixation were more effective in maintaining the height of the injuried vertebrae and preventing the occurrence of kyphosis. The intermediate unilateral pedicle screw fixation was comparable to that of bilateral fixation at clinical outcomes, but the unilateral fixed hospitalization cost was lower, which was worthy of clinical promotion.

Surgical treatment for thoracolumbar fractures of the spine / 医学研究生学报

With the development of transportation and industry，car accidents，falling accidents and firearm injuries have be⁃come the main causes of spinal fractures and spinal cord injuries. The thoracolumbar spine is the joint of thoracic kyphosis and lumbarlordosis after human bipedalism. From the perspective of biomechanics，it belongs to the weakest area of the spine and is prone to trau⁃matic fractures. A review from the literatures suggests that thoracolumbar fractures account for 40% of all spinal fractures. In recent years，with the development of biomechanics，biomaterials and digital medicine of the spine，new ideas，techniques and materials have been used for surgical treatment of spinal fractures.“Reconstruction stabilization and early rehabilitation”has become the princi⁃ple of treatment for spine surgeons to treat spinal thoracolumbar fractures. Regardless of patients with severe spinal cord injury or ad⁃vanced osteoporosis，perioperative evaluation，preoperative planning，and intraoperative injury control operation should be made，and surgical treatment should be the first choice for early rehabilitation and social return. New technologies and viewpoints such as digitalspine surgery，biomaterials，biomechanics and spinal surgery robots are gradually applied in the clinic. While applying these technolo⁃ gies，there are also many hot issues that deserve our attention. Not only the surgeries for thoracolumbar fractures，but also the surgical indications and expected effects have been rapidly developed and improved.

Correlation between intervertebral disc injury and postoperative kyphosis after percutaneous kyphoplasty for osteoporotic thoracolumbar fracture / 中华创伤骨科杂志

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.

Outcome Evaluation of Patients with Burst Thoracolumbar Fractures: A Case Series

Objective The aim of the present study was to evaluate the outcome of short segment instrumentation in patients affected by burst thoracolumbar fractures. Methods A total of 19 patients with unstable burst fractures of the thoracolumbar spine were eligible for short segment instrumentation. Their functional outcome (by using the Oswestry and Denis scales) and back pain (using the visual analog scale) were evaluated after 12 months. Results Themean age of the patients was 30.7 years old, andmost of them weremale (n » 15). The mean hospital stay was 4.6 days. The mean standard deviation (SD) of the pain score according to the visual analog scale was 1.63 1.25 after 12 months of surgery, and there were no patients classified with grades 4 or 5 on the Denis work scale. The average Oswestry disability index (ODI) was 17% during the follow-ups. Conclusions The outcome of the studied patients, including the clinical pain and the functional outcome of postsurgical patients, suggested that the short-segment instrumentation could be an appropriate method for patients with unstable thoracolumbar junction fractures. However, a long-term follow-up is recommended.

Percutaneous pedicle screw fixation combined with limited-open decompression technique for thoracolumbar fractures with neurologic deficit / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical effects of percutaneous pedicle screw fixation combined with limited open decompression technique for the treatment of thoracolumbar fractures with neurologic deficit.</p><p><b>METHODS</b>The clinical data of 76 patients with thoracolumbar fractures with neurologic deficit underwent percutaneous pedicle screw fixation combined with limited open decompression technique from June 2010 to June 2014 were retrospectively analyzed. There were 45 males and 31 femals, aged from 17 to 56 years with an average of 32.5 years old. According to the classification of Denis, 33 cases were type A, 26 cases were type B, 17 cases were type C. According to the criterion of American Spinal Injury Association(ASIA), 13 cases were grade A, 9 cases were grade B, 21 cases were grade C, 33 cases were grade D. The operative time, intraoperative blood loss, postoperative internal fixation lossening and breakage were recorded. The informations of the Cobb angle, the anterior height of injured vertebra, canal stenosis were observed before operation, 3 days after operation, and the final follow-up. The improvement of neurologic function were analyzed at final follow-up.</p><p><b>RESULTS</b>All the patients were followed up from 13 to 47 months with an average of 32.1 months. The mean operative time was 159 min (136 to 218 min) and the intraoperative blood loss was 225 ml(150 to 360 ml). The anterior height of injured vertebra was increased from (52.0±5.9)% before operation to (87.2±1.8)% at 3 days after operation, and (86.1±1.5)% at final follow-up (=45.27,=0.000); the Cobb angle was decreased from (29.7±8.2)° before operation to (5.7±2.9)° at 3 days after operation, and (5.9±3.6)° at final follow-up (=34.62,=0.000); the canal stenosis was decreased from (37.5±7.2)% before operation to (12.3±3.3)% at 3 days after operation, and (11.9±3.1)% at final follow-up(=37.02,=0.000); there was no significant differences between postoperative 3 days and the final follow-up about the above parametres(>0.05). According to ASIA criterion, the spinal cord function was classified as grade A in 13 cases, grade B in 0 cases, grade C in 10 cases, grade D in 21 cases and grade E in 32 cases at final follow-up. Internal fixation lossening and breakage occurred in 2 cases.</p><p><b>CONCLUSIONS</b>Percutaneous pedicle screw fixation combined with limited open decompression technique can obtain satisfactory clinical effect for patients with thoracolumbar fractures with neurologic deficit, and have a good recovery of nerve function can be observed.</p>

Effects of different types of bone cement augmentation of pedicle screws on prognosis of osteoporotic thoraco-lumbar fractures in elderly patients / 局解手术学杂志

Objective To compare the effects of different types of bone cement augmentation of pedicle screws on the prognosis of osteo -porotic thoracolumbar fractures in elderly patients.Methods From August 2013 to November 2016,184 elderly patients with osteoporotic thoracolumbar fractures in our hospital were selected as the research object,all the patients were randomly divided into observation group and control group,94 cases in each group.Two groups were treated with pedicle screw fixation,the control group received conventional pedicle screw combined with PMMA bone cement augmentation,and the observation group were treated by cannulated pedicle screws combined with PMMA bone cement augmentation,the prognosis of the two groups were recorded.Results All patients were successfully completed the oper-ation without serious complications occurred.There was no significant difference in operation time,intraoperative blood loss,the amount of sin-gle vertebral bone cement,hospitalization time between the two groups(P>0.05).The postoperative 1 month incidence rate of cerebrospinal fluid leakage,bone cement leakage,wound infection,loosening of internal fixation was 4.3% in the observation group,which was lower than 21.3%in the control group,the difference was significant(P<0.05).The postoperative 1 month of vertebral height in the observation group and the control group were respectively(4.53 ±1.11)mm and(5.09 ±1.42)mm that were lower than the preoperative(6.41 ±1.39)mm and(6.38 ±1.31)mm(P<0.05),meanwhile the vertebral height at postoperative 1 month of the observation group was lower than that of the control group,the differences were significant(P<0.05).There were 0 case of Frankle grade A,0 case of grade B,10 cases of grade C, 18 cases of grade D,66 cases of grade E in the observation group at postoperative 1 month,and there were 6 cases,14 cases,20 cases,20 ca-ses and 34 cases of corresponding Frankle grade in the control group,the observation group was significantly better than the control group,the differences were significant(P<0.05).Conclusion The application of cannulated pedicle screw combined with PMMA bone cement in the osteoporotic thoracolumbar fractures does not increase the difficulty of operation,and it can reduce the complications and reduce vertebral height,which is conducive to the recovery of nerve function.

Treatment of Multiple Thoracolumbar and Lumbar Spine Fractures: Comparison of Contiguous and Non-Contiguous Fractures in Non-Osteoporotic Patients / 대한척추외과학회지

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the outcomes of multiple thoracolumbar and lumbar fractures depending on whether the fractures were contiguous. SUMMARY OF THE LITERATURE REVIEW: The treatment of multiple spine fractures in patients without osteoporosis has rarely been reported. MATERIALS AND METHODS: From February 2004 to January 2016, 81 patients without osteoporosis who had acute thoracolumbar and lumbar fractures and underwent posterior fusion surgery were evaluated. Patients were divided into 2 groups (group A: contiguous, group B: non-contiguous). We investigated the causes of the injuries, the locations of the injuries within the spine, the range of fusion levels, and functional outcomes based on the patients' general characteristics. RESULTS: Group A comprised 37 patients and group B comprised 44 patients. In most patients, the fusion included 3 segments (group A: 12, group B: 14) or 4 segments (group A: 9, group B: 10). Group A scored 21.2 and group B scored 19.0 on the Korean Oswestry Disability Index. In both groups, longer fusion was associated with poorer clinical results. In the clinical evaluation of the fusion rate, there was no statistically significant difference between the 2 groups (p=0.446). CONCLUSIONS: In this study, patients with multiple vertebral fractures showed more fusion segments and poor clinical outcomes in contiguous fractures. In the patients with non-contiguous fractures, the clinical results were better when a minimal number of segments was fused. Therefore, the authors recommend conservative treatment to minimize the number of segments that are fused in non-contiguous multiple thoracolumbar and lumbar fractures when decompression is not necessary.

Therapeutic Effect of Posterior Decompression, Internal Fixation and Interlaminar Fusion for Severe Osteoporotic Vertebral Fractures and Collapse Complicated with Spinal Canal Encroachment / 广州中医药大学学报

Objective To evaluate the clinical effect of posterior decompression, internal fixation and interlaminar fusion for the treatment of severe osteoporotic vertebral fracture and collapse complicated with spinal canal encroachment. Methods A retrospective study was carried out in 27 cases of severe osteoporotic vertebral fractures complicated with spinal canal encroachment. The patients were treated with posterior decompression, internal fixation and interlaminar fusion during the period from January 1, 2009 to December 31, 2014. All patients were given vertebral pedicle screw fixation after pedicle augmentation with bone cement. The pain scores of visual analogue scale(VAS), Oswestry Disability Index(ODI), Cobb angle , thoracolumbar Cobb angle and the recovery of neurological function(estimated by Frankel grading system) of the patients were compared beforeoperation, one week after operation and at the end of follow-up. The incidences of internal fixation failure, adjacent vertebral fracture and bone cement leakage also were recorded. Results The patients were followed up for an average of 27 months. The spinal canal occupation rate caused by fracture fragment of posterior vertebral wall was 27.41%~63.85%, with an average of(43.24 ± 10.61)%. Postoperative VAS pain scores, ODI, Cobb angle and thoracolumbar Cobb angle were statistically different from those before operation (P 0.05). In respect of Frankel grading of neurological function at the end of the follow-up, 6 cases were in grade D and 19 cases were in grade E, but the differences were insignificant compared with those before operation (P > 0.05). None of the patients had surgical site infection, screw looseness or breakage, or rod breakage during the follow-up period. There were 8 patients with asymptomatic bone cement leakage after operation. Vertebral compression fractures recurred in 5 patients, of which 2 had adjacent vertebral fractures and 3 had non -adjacent segment. Conclusion The therapy of posterior decompression, internal fixation and interlaminar fusion is effective for the treatment of severe osteoporotic vertebral fracture and collapse complicated with spinal canal encroachment by obviously relieving pain, improving the physiological function of the spine and stabilizing the spine.

Association study on classification,injury score, kyphosis deformity and nerve function injury of thoracolumbar fracture / 重庆医学

Objective To investigate the association between the lumbar vertebral fracture damage degree with the fracture classification,injury score,kyphosis deformity and nerve function injury.Methods According to the damage degree of posterior lig ament complex(PLC),the patients were divided into the PLC intact group and PLC injury group.Its relationship with PLC injury was researched by evaluating the fracture classification,injury score and nerve function injury situation in the two groups.Results The LCS score and TLICS score in the PLC injury group were (7.1±0.8) points and (8.2±0.6) points,which were higher than (5.7±0.5) points and (4.6±0.7) points in the PLC intact group.The Denis score in the PLC injury group was more serious.The Cobb angle in the PLC injury group was 29°,and which in the PLC intact group was 19°.The proportion of nerve function insufficiency in the PLC injury group was 89％,while which in the PLC intact group was only 60 ％.Conclusion The thoracolumbar vertebral fracture is closely related with PLC.PLC damage degree is positively correlated with the fracture classification,injury score,kyphosis deformity and nerve function injury degree.

Unilateral short-segment pedicle screw fixation for treatment of thoracolumbar fractures / 局解手术学杂志

Objective To assess the operation results of unilateral and bilateral short-segment pedicle screw fixation combined with in-termediate screws in thoracolumbar fractures .Methods A total of 73 patients with thoracolumbar fracture were included in our study .Among the 73 patients, 48 cases were treated by bilateral short-segment pedicle screw fixation and the other 25 cases were treated by unilateral short-segment pedicle screw fixation,with a mean follow-up of 24.6 months.Surgical time,surgical blood loss,surgical draining loss,hospital stays, hospitalization cost,Cobb’s angle,kyphosis of the vertebral body ,anterior height of the fracture vertebral body ,VAS and ODI scores between the two groups were compared .Results There were significant differences in the surgical time and hospitalization cost between two groups (P0.05).Conclusion Unilateral short-segment pedicle screw fixation combined with intermediate screws can significantly correct the kyphosis and achieve the clinical effect of bilateral short -segment pedicle screw fixation technique .Meanwhile , the unilateral short-segment pedicle screw fixation technique can significantly reduce the surgical time and hospitalization cost ,which is an ef-fective method for thoracolumbar fracture .

Bisphosphonates promoting repair of injured vertebrae after thoracolumbar fracture internal fixation: A randomized controlled study / 第二军医大学学报

Objective To explore the anti-osteoporosis effect of bisphosphonates on repairing injured vertebrae after thoracolumbar fracture internal fixation through a randomized controlled study. Methods Eighty-four patients with thoracolumbar fracture treated by orthopaedic internal fixation in Department of Orthopaedics, Nanjing General Hospital from Jun. 2014 to Jun. 2015 were included, and the patients were divided into the bisphosphonate treatment group (n=42) and control group (n=42) by random number method. The patients in both groups were given the routine anti-osteoporosis drugs such as calcitriol and calcium carbonate D3 after surgery; in addition, the patients in the bisphosphonate treatment group were also given alendronate sodium D3 tablets (each containing alendronate sodium 70 mg, 1 tablet per week), while the control group received a placebo. The bone mineral density (BMD) in thoracolumbar vertebral injury area of patients in the two groups was measured and compared at 1 month, 3 months, 6 months and 1 year after surgery. Results The BMD values of patients in two groups were significantly decreased immediately after reset compared with preoperation, and then they were increased continuously in follow-up. There was no significant difference in BMD between the two groups at 1 month or 3 months after sursery (P>0.05), while the BMD in the bisphosphonate treatment group was significantly higher than that in the control group at 6 months and 1 year after surgery (P<0.05). Conclusion Bisphosphaonate drugs can accelerate the repair of vertebral osteoporosis after thoracolumbar fracture internal fixation, showing a good clinical application value.

Clinical Observation of Short-segment Percutaneous Pedicle Screw Non-fusion Fixation Plus Electro-acupuncture for Treatment of Single Thoracolumbar Fracture / 广州中医药大学学报

Objective To investigate the feasibility of short-segment percutaneous pedicle screw non-fusion fixation plus electro-acupuncture for the treatment of single thoracolumbar fracture.Methods Forty-three patients with single thoracolumbar fracture were treated with short-segment percutaneous pedicle screw fixation without fusion,and then were given electro-acupuncture on points such as Jiaji (EX-B2),Huantiao (GB30),and Zhibian (BL54) after the operation.Before and after operation and during the follow-up,X-ray images of the spine at positive position and lateral position were taken for the measurement of vertebral anterior and posterior diameter ratio and the vetebral kyphosis Cobb's angle.Lumbago visual analogue scale (VAS) scores and Oswestry scores for lumbago function disorder were used for the evaluation of clinical efficacy.Results (1) All of the 43 patients were followed-up,and the follow-up period lasted for 10-27 months.(2) After the operation and at the end of follow-up,vertebral anterior and posterior diameter ratio and Cobb's angle were much improved (P ＜ 0.01compared with those before the operation),and the two indexes at the end of follow-up were improved as compared with those after the operation (P ＜ 0.05).(3) One week after the operation and at the end of follow-up,VAS scores and Oswestry scores were obviously improved as compared with those before treatment (P ＜ 0.01),and the two kinds of scores at the end of follow-up were also improved as compared with those after the operation (P ＜0.01).Conclusion Short-segment percutaneous pedicle screw fixation without fusion plus electro-acupuncture at points such as Jiaji is effective for the treatment of single thoracolumbar fracture by relieving pain in the waist and back,which ensures the satisfactory effect of operation.

Risk factors for surgical site infection in patients with thoracolumbar fracture / 中国感染控制杂志

Objective To evaluate risk factors for surgical site infection(SSI) in patients with thoracolumbar fracture,and provide basis for making prevention and control measures.Methods Patients with thoracolumbar fractures operation in the department of spinal surgery of a hospital between January 2010 and March 2015 were monitored through information monitoring system,on-site visit,and telephone follow-up,incidence of SSI was investigated,risk factors were performed univariate analysis.Results A total of 326 patients undergoing thoracolumbar fracture operation were monitored,15(4.60％) had SSI.SSI were high in patients≥60 years old,underwent operation at nonlaminar air flow operation room,didn't receive antimicrobial prophylaxis 30 minutes prior to operation,preoperative hospital stay ＞3 days,operation duration ＞3 hours,as well as with diabetes mellitus and chronic respiratory disease (all P＜ 0.01).Conclusion Risk factors for SSI in patients undergoing thoracolumbar fractures operation were patients with older age,receive operation at non-laminar air flow operation room,didn't receive antimicrobial prophylaxis,long length of preoperative hospital stay and operation duration,as well as combined with diabetes mellitus and chronic respiratory disease,preventive measures should be taken to reduce the incidence of infection.

Thoracolumbar burst fractures, short x long fixation: a meta-analysis / Fraturas toracolombares do tipo explosão, fixação curta x longa: uma metanálise / Fracturas toracolumbares tipo explosión, fijación corta x larga: un meta-análisis

ABSTRACT The number of fixed segments in the surgical treatment of thoracolumbar burst fractures remains controversial. This study aims to compare the results of short and long fixation in thoracolumbar burst fractures through a meta-analysis of studies published recently. MEDLINE and Cochrane databases were used. Randomized controlled trials and non-randomized comparative studies (prospective and retrospective) were selected. Data were analyzed with the software Review Manager. There was no statistically significant difference in the Cobb angle of preoperative kyphosis. Long fixation showed lower average measurements postoperatively (MD = 1.41; CI = 0.73-2.08; p<0.0001) and in the last follow-up (MD = 3.98; CI = 3.22-4.75; p<0.00001). The short fixation showed the highest failure rates (RD = 4.03; CI = 1.33-12.16; p=0.01) and increased loss of height of the vertebral body (MD = 1.24; CI = 0.49-1.98; p=0.001), with shorter operative time (MD = -24.54; CI = -30.16 - -18.91; p<0.00001). There was no significant difference in blood loss and clinical outcomes. The high rates of kyphosis correction loss with short fixation and the lower correction rate in the immediate postoperative period were validated. There was no significant difference in the blood loss rates because arthrodesis was performed in a short segment in the analyzed studies. The short fixation was performed in a shorter operative time, as expected. No study has shown superior clinical outcomes. The short fixation had worse rates of kyphosis correction in the immediate postoperative period, and increased loss of correction in long-term follow-up, making the long fixation an effective option in the management of this type of fracture.

RESUMO A quantidade de segmentos fixados no tratamento cirúrgico das fraturas toracolombares tipo explosão continua controverso. Este estudo tem como objetivo comparar os resultados da fixação curta e da longa nas fraturas toracolombares do tipo explosão, por meio de uma metanálise dos estudos publicados recentemente. Foram utilizadas as bases de dados MEDLINE e COCHRANE. Foram selecionados estudos controlados randomizados e estudos comparativos não randomizados (prospectivos e retrospectivos). Os dados foram analisados com o software Review Manager. Não houve diferença estatisticamente significante na medida do ângulo de Cobb da cifose pré-operatória. A fixação longa apresentou medidas médias inferiores no pós-operatório (MD = 1,41; IC = 0,73-2,08; p < 0,0001) e no último seguimento (MD = 3,98; IC =3,22-4,75; p < 0,00001). A fixação curta apresentou taxas de falha maiores (RD = 4,03; IC = 1,33-12,16; p = 0,01) e maior perda de altura do corpo vertebral (MD = 1,24; IC = 0,49-1,98; p = 0,001), com menor tempo operatório (MD = -24,54; IC = -30,16 - -18,91; p < 0,00001). Não houve diferença estatisticamente significante na perda sanguínea e nos desfechos clínicos. As taxas elevadas de perda da correção da cifose na fixação curta e a menor taxa de correção no pós-operatório imediato foram validadas. Não houve diferença estatisticamente significante quanto às taxas de perda sanguínea, porque a artrodese foi realizada em um segmento curto nos trabalhos analisados. A fixação curta teve menor tempo operatório, como esperado. Nenhum estudo demonstrou superioridade dos resultados clínicos. A fixação curta apresentou taxas piores de correção da cifose no pós-operatório imediato e maior perda da correção no seguimento a longo prazo, fazendo da fixação longa uma opção efetiva no manejo deste tipo de fratura.

RESUMEN El número de segmentos fijados en el tratamiento quirúrgico de las fracturas toracolumbares tipo explosión sigue siendo controvertido. Este estudio tiene como objetivo comparar los resultados de fijación corta y larga en las fracturas toracolumbares tipo explosión, a través de un meta-análisis de estudios publicados recientemente. Se utilizaron las bases de datos MEDLINE y COCHRANE. Se seleccionaron los ensayos controlados aleatorios y estudios comparativos no aleatorios (prospectivos y retrospectivos). Los datos fueron analizados con el software Review Manager. No hubo diferencia estadísticamente significativa en cuanto a la medida del ángulo de Cobb de la cifosis preoperatoria. Lar fijación larga mostró mediciones promedio más bajas en el postoperatorio (MD = 1,41, IC = 0,73-2,08; p < 0,0001) y en el último seguimiento (MD = 3,98, IC = 3,22-4,75; p < 0,00001). La fijación corta mostró las tasas de fracaso más altas (RD = 4,03, IC = 1,33-12,16; p = 0,01) y una pérdida mayor de la altura del cuerpo vertebral (MD = 1,24, IC = 0,49-1,98; p = 0,001), con un menor tiempo operatorio (MD = -24,54; IC = -30,16 - -18.91; p < 0,00001). No hubo diferencia significativa en la pérdida de sangre y los resultados clínicos. Se validaron las altas tasas de pérdida de corrección de la cifosis con la fijación corta y la menor tasa de corrección en el postoperatorio inmediato. No hubo diferencia significativa en las tasas de pérdida de sangre porque la artrodesis se realizó en un segmento corto en los estudios analizados. La fijación corta tuvo menor tiempo operatorio, como se esperaba. Ningún estudio ha demostrado resultados clínicos superiores. La fijación corta tuvo peores tasas de corrección de la cifosis en el postoperatorio inmediato y mayor pérdida de corrección en el seguimiento a largo plazo, por lo que la fijación larga es una opción efectiva en el manejo de este tipo de fracturas.

Comparison of biomechanical properties by different posterior fixation methods with or without crosslink for fixing thoracolumbar fractures / 医用生物力学

Objective To compare the biomechanical differences in 3 posterior fixation methods with or without crosslink for treatment of thoracolumbar fractures, so as to find the optimal posterior fixation methods. Methods On the basis of the validated finite element model of T12-L2 segments to simulate L1 vertebra burst fracture, the superior 1/2 cortical bone of T12 segment was removed and the superior 1/2 cancellous bone was assigned with the material damage property of cancellous bone. Then 6 thoracolumbar fracture models by intermediate unilateral pedicle screw fixation without or with crosslink (Model A1, A2), traditional short-segment pedicle screw fixation without or with crosslink (Model B1, B2), intermediate bilateral pedicle screw fixation without or with crosslink (Model C1,C2) were established, respectively. The range of motion (ROM) as well as the maximum Von Mises stress of the pedicle screw and rod for 6 models under various physiological loading conditions were compared. Results The ROM under flexion-extension and lateral bending in Model A and Model C was obviously smaller than that of Model B. Under flexion-extension, no significant difference was found in ROM between Model A and Model C; under lateral bending, the ROM of Model C was smaller than that of Model A. The stress was concentrated in the root of upper screw and the rob located between upper screw and intermediate screw; the maximum stress of upper screw in Model C was smaller than that in Model A and Model B. The crosslink could increase the stability of all fixation groups under axial rotation stress condition, and decrease the maximum stress on upper screw and rod under axial rotation stress condition, but no significant difference was found under flexion-extension and lateral bending. Conclusions Additional pedicle screws at the level of fracture vertebra can achieve the better biochemical stability. The additional crosslink not only increases the torsional rigidity, but also decreases the maximum torsional stress of the screw and rod, which is a better choice as the treatment of thoracolumbar fractures.