The evaluation of posterior ligament complex injury as well as the analysis of its effects in thoracic-lumbar fractures / 中华外科杂志

<p><b>OBJECTIVES</b>To evaluate and analyze the role of posterior ligament complex (PLC) in determining therapeutic principle for traumatic thoracic-lumbar fracture.</p><p><b>METHODS</b>From August 2005 to May 2008, 60 patients (38 male, 22 female) who suffered from the traumatic thoracic-lumbar fracture were carried out posterior operations. According to the Magerl traumatic thoracic-lumbar fracture classification system, these cases were classified to subtype A, B and C. The average age was 34 years (21 - 65 years). Magnetic resonance imaging (MRI) scan, which including both T1/T2 weight and fat-stir sequence, as well as the MRI negative film reading technique were used to evaluate the state of PLC. Furthermore, related physical or neurological examinations (such as severe skin bruising and sinking, broadening spinous process gap and tenderness, spinal cord or nerve root injury) and another X-ray or CT reconstruction films were taken to evaluate the the state of PLC synthetically. Above-mentioned results were compared with the final exploration results during operation and some parameters were analyzed.</p><p><b>RESULTS</b>The sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), misdiagnosis rate and rate of missed diagnosis of these sixty patients were 85.3%, 80.8%, 83.3%, 85.3%, 80.8%, 19.2%, 14.7% respectively. After 13 cases of thoracic-lumbar fracture-dislocation were eliminated, the sensitivity, specificity, accuracy, PPV, NPV, misdiagnosis rate and rate of missed diagnosis of remaining 47 cases were 81.0%, 80.8%, 80.9%, 77.3%, 84.0%, 19.2%, 19.0% respectively. There were 5 cases with MRI negative results before operation but positive results during operation. Contrarily, 5 cases with MRI positive results before operation but negative results during operation occurred.</p><p><b>CONCLUSIONS</b>MRI is a main means for evaluating the state of PLC. Although the MRI fat-stir sequence as well as the MRI negative film reading technique are adopted, the state of PLC can not be estimated exactly before operation (especially for those unfracture dislocation cases). In order to estimate the state of PLC exactly, the related local physical examination and image technology as well as the location of the abnormal image signal in MRI film and time of injury must be analyzed synthetically.</p>

Therapeutic strategy for traumatic instability of subaxial cervical spine / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>A simple, safe and effective therapeutic strategy for traumatic instability of the subaxial cervical spine, as well as its prognostic assessment, is still controversial.</p><p><b>METHODS</b>The therapeutic options for 83 patients of traumatic instability of the subaxial cervical spine, whose average age was 35 years, were determined, according to the Allen-Ferguson classification, general health and concomitant traumatic conditions, neurological function, position of compression materials, concomitant traumatic disc herniation/damage, concomitant locked-facet dislocation, the involved numbers and position, and the patients' economic conditions. An anterior, posterior or combination approach was used to decompress and reconstruct the cervical spine. No operations with an anterior-posterior-anterior approach were performed.</p><p><b>RESULTS</b>The average follow-up was three years and nine months. Distraction-flexion and compression-flexion were the most frequent injury subtypes. There were 46, 28 and 9 cases of anterior, posterior and combination operations, respectively. The average score of the Japanese Orthopaedics Association, visual analog scale and American Spinal Cord Injury Association (ASIA) motor index improved from 11.2, 7.8 and 53.5, respectively, before operation, to 15.3, 2.6 and 67.8, respectively, at final follow-up. For incomplete spinal cord injury (SCI), the average ASIA neurological function scale was improved by 1-2 levels. Patients with complete SCI had no neurological recovery, but recovery of nerve root function occurred to different extents. After surgery, radiological parameters improved to different extents. Fusion was achieved in all patients and 12 developed complications.</p><p><b>CONCLUSIONS</b>The best surgical strategy should be determined by the type of subaxial cervical injury, patients' general health, local pathological anatomy and neurological function.</p>

The retrospective analysis of surgical treatment for traumatic instability of sub-axial cervical spine / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate and analyze a therapeutic principle and strategy to treat the traumatic instability of sub-axial cervical spine as well as the prognosis assessment.</p><p><b>METHODS</b>According to the Allen-Fergurson's classification, 83 patients who suffered from the traumatic instability of sub-axial cervical spine were performed operations depending on the patients's general health, the local pathological anatomy and neurological function, including both the decompression and reconstruction maneuvers through anterior, posterior or combined approach.</p><p><b>RESULTS</b>The average follow-up was 3 years and 9 months. The distraction-flexion and compression-flexion were the most frequent injury subtypes. There were 46, 28 and 9 operations through anterior, posterior or combined approach respectively. No operation through anterior-posterior-anterior approach occurred. The average scores of JOA, VAS and ASIA motor index improved from 11.2, 7.8 and 53.5 before operation, to 15.3, 2.6 and 67.8 at the final follow-up, respectively. After operation, there were different extent improvements of average radiologic parameter. Fusion was achieved in all patients and 12 complications occurred.</p><p><b>CONCLUSIONS</b>According to both the patients's general health and the local pathological anatomy, individual therapeutic designing should be determined to treat the traumatic instability of sub-axial cervical spine.</p>