Application of the theory of equal emphasis on muscle and bone in percutaneous vertebroplasty of lumbar osteoporotic compression fracture / 中国骨伤

OBJECTIVE@#To explore the clinical efficacy of percutaneous vertebroplasty(PVP) combined with nerve block in the treatment of lumbar osteoporotic vertebral compression fractures under the guidance of traditional chinese medicine "theory of equal emphasis on muscle and bone".@*METHODS@#Total of 115 patients with lumbar osteoporotic vertebral compression fractures were treated by percutaneous vertebroplasty from January 2015 to March 2022, including 51 males and 64 females, aged 25 to 86 (60.5±15.9) years. Among them, 48 cases were treated with PVP operation combined with erector spinae block and joint block of the injured vertebral articular eminence (intervention group), and 67 cases were treated with conventional PVP operation (control group). The visual analogue scale(VAS) and Oswestry disability index(ODI) before operation, 3 days, 1 month and 6 months after operation between two groups were evaluated. The operation time, number of punctures and intraoperative bleeding between two groups were compared.@*RESULTS@#The VAS and ODI scores of both groups improved significantly after operation compared with those before operation(P<0.05). Moreover, the VAS and ODI scores of 3 days and 1 month after operation of the intervention group improved more significantly than that of the control group(P<0.05). The difference of VAS and ODI scores before operation and 6 months after operation between two groups had no statistical significances(P>0.05). There was no statistically significant difference in the number of punctures and intraoperative bleeding between the two groups (P>0.05).@*CONCLUSION@#Based on the theory of "equal emphasis on muscles and bones", PVP combined with nerve block can effectively relieve paravertebral soft tissue spasm and other "muscle injuries", which can significantly improve short-term postoperative low back pain and lumbar spine mobility compared to conventional PVP treatment, and accelerate postoperative recovery, resulting in satisfactory clinical outcomes.

Morphometric Assessment of Pedicles of Indian Adult Lumbar Vertebrae: A Cross Sectional Study

Introduction: Lumbar vertebral column is exposed to various kinds of stress during locomotion. In erect posture weight transmitted through posterior part including pedicles. This causes deformities of this region as the age advances in many individuals. Proper correction of deformity is challenging. There have been advances in spinal fusion procedures and interspinous implantation of devices including pedicle screws. Use of unsuitable dimensions of screw may cause problem of destruction of pedicle. Correct metricular data of pedicle is necessary for choice of appropriate screw size. Aims and Objectives: 1) To measure the various dimensions in Indian adult human lumbar vertebral pedicles. 2) To prepare data of lumbar pedicles useful in various surgical procedures. Material and Methods: A Cross-sectional study was done on 45 dry, fully ossified human lumbar vertebral sets. The bones were grouped into typical (L1 to L4) and atypical (L5) lumbar vertebrae. The dimensions measured included pedicle length, height, thickness, axial length, transverse and sagittal angles. ‘Digital Vernier Caliper’ and Protractor were used. The data was analyzed statistically. Results: The mean length, height and thickness of typical vertebral pedicles increases gradually. In atypical (L5), pedicle thickness suddenly increases. The transverse angle of pedicle elevated gradually from L1 to L4 but at L5, it abruptly increased. Conclusions: The study reported significant differences in several dimensions of pedicles of typical as well as atypical lumbar vertebrae. These differences should be considered by neurosurgeons.

Mechanical stability of the fracture at the junction of lumbar vertebral body and pedicle after implantation with different diameters of pedicle screws / 中国组织工程研究

BACKGROUND: Most scholars believe that the fracture of the lumbar spine and pedicle is stable, and transvertebral pedicle screw implantation can improve the stability of fractures. However, the diameter of the transvertebral pedicle screw, mechanical stability and safety of the vertebrae still remain controversial. OBJECTIVE: To analyze the effect of pedicle screws of different diameters and pedicle cortex on the mechanical stability of the fractured vertebrae and pedicle by three-dimensional finite element method. METHODS: Based on normal adult L2-L3 CT DICOM data, a mimics software was used to establish a model of the fracture at L2 vertebral body and the pedicle. At the same time, a three-dimensional model of L3 vertebra was created. The L2-L3 model was imported into 3-matic in stl format, and a model of pedicle screws with different diameters (diameter of 6.5 and 6.0 mm, and length of 45 mm) was established. The model was imported into ansys after the material attributes were assigned in the mimics software. A vertical load of 500 N was applied to the upper surface of the L2 vertebral body to simulate the biomechanical performance of a adult with standard body mass after implantation with transvertebral pedicle screw with different diameters under upright condition. RESULTS AND CONCLUSION: (1) After implantation with 6.0 mm screw, the equivalent load on the lower, upper, inner, and outer walls of the pedicle at the junction of the lumbar vertebra and the pedicle was (1.28±0.62), (0.95±0.18), (0.62±0.37), and (0.36±0.16) MPa, respectively. The difference was significant among groups (F=4.298, P < 0.05). (2) After implantation with 6.5 mm screw, the equivalent load on the lower, upper, inner, and outer walls of the pedicle at the junction of the lumbar vertebra and the pedicle was (1.82±0.76), (1.11±0.18), (0.93±0.38), and (0.43±0.14) MPa, respectively. The difference was significant among groups (F=7.034, P < 0.05). (3) The equivalent load on the lower, upper, inner, and outer walls of the 6.5 mm pedicle screw model was significantly higher than that on the 6.0 mm pedicle screw model (P < 0.05). (4) These results imply that the larger the pedicle screw is, the greater the load on the cortical bone at the junction of the lumbar vertebra and the pedicle is, and the stronger the holding force is. The load on the upper, lower, inner and outer walls of the pedicle is positively related to its cortical thickness. The cortical bone of the inferior wall is thickest, the equivalent load it bears is largest, and the cortical bone of the outer wall is thinnest, and it has the smallest equivalent load. The closer the pedicle screw is to the lower medial wall within the pedicle, the stronger the holding force and the better the stability. The closer it is to the upper and outer side walls, the smaller the gripping force and the worse the stability. However, the placement of nails on the upper and outer walls is safer than the placement of nails on the lower inner wall, and the pros and cons need to be weighed in accordance with the experience of the surgeon during placement.

Analysis on Mechanical Characteristics of Lin’s Lumbar Vertebral Manipulation by Lifting-Rotating and Oblique-Pulling / 医用生物力学

Objective To study the mechanical characteristics of lumbar vertebral manipulation by lifting-rotating and oblique-pulling using multi-film pressure measurement system. Methods Twenty-one male operators were divided into groups of experts, skilled operators and beginners. Everyone completed 7 actions of Lin’s lumbar manipulation continuously, and repeated 3 times. The graphs and data were collected and processed. Results The time-force curve by the experts had regularity. The average pre-load force was (147.25±26.04) N, duration was (0.98±0.20) s, the average minimum force was (79.22±9.50) N, the maximum impact force was (706.26±56.21) N, the flip time was (0.44±0.09) s, and flip speed was (1 666.33±411.91) N/s, the impulse was (310.95±56.67) N·s. The curve graphs and the index by the skilled operators were similar to those by the experts, but the average maximum impact force was (464.51±53.49) N, which was relatively smaller. The curve graphs by the beginners could be broadly divided into three categories. Class Ⅰ was chaotic and unregulated; Class Ⅱ only had impact force and did not have pre-load force, and the maximum impact force varied in size; Class Ⅲ had both impact force and pre-load force, but the forces were relatively small and stable. Conclusions The multi-film pressure measurement system can preferably display the mechanical characteristics of manipulation by lifting-rotating and oblique-pulling, which is an ideal testing tool for quantitative research on mechanical parameters of Lin’s lumbar vertebral manipulation. The experimental results provide a scientific basis for visualization, quantification and standardization of the manipulation.

Iatrogenic Lumbar Vertebral Fracture during Osteosynthesis for a Trochanteric Fracture of the Femur in Diffuse Idiopathic Skeletal Hyperostosis

Vertebral fractures occur with only slight trauma in patients with diffuse idiopathic skeletal hyperostosis (DISH). However, a lumbar vertebra fracture, due to an intraoperative body position has not been previously reported. An 87-year-old woman with kyphosis sustained a left trochanteric fracture of her femur. The patient was placed in a supine position during the operation. Postoperatively, the patient experienced severe right thigh pain. Magnetic resonance imaging revealed an L4 vertebral fracture. Computed tomography revealed ankylosis from the upper thoracic spine to the sacrum. While in a supine position under general anesthesia, the contact of the patient's lower back with operating table likely created a fulcrum at her lumbosacral spine acting as a long lever arm, bearing the mass of her upper body. We performed L1-S2 posterior stabilization. DISH patients with kyphosis placed in a supine position have an increased risk for lumbar vertebral fracture.

Clinical effect of limited decompression under endoscope combined with percutaneous transpedicular screw fixation for treatment of degenerative lumbar spinal stenosis / 中国综合临床

Objective To investigate clinical effect of limited decompression under endoscope combined with percutaneous transpedicular screw fixation for treatment of degenerative lumbar spinal stenosis.Methods Thirty-four senile patients with lower lumbar spinal stenosis were selected as our subjects from February 2010 to August 2011,and were treated with limited decompression under endoscope combined with percutaneous transpedicular screw fixation through posterior approach.The VAS scores of all patients were collected at the four periods including pre-operation,leaving hospital,3 months after operation,and the last follow-up.The therapeutic effectiveness for the postoperative follow-up was expressed as excellent,good,ordinary,and poor according to Nakai standard.Results The VAS scores at pre-operation,leaving hospital,3 month after operation,and the last follow-up were (7.9 ± 1.6),(2.9 ± 1.4),(1.9 ± 1.9),(2.4 ± 1.5)respectively,and the difference was significant (F =13.524,P =0.036).But no significant differences of VAS scores at three sequential tests after operation were observed (P ＞ 0.05).In the last postoperative follow-up,32 cases were graded as excellent,1 cases for good and 1 case for ordinary,and the excellent rate reached to 97％.Conclusion The therapeutic effectiveness of lumbar spinal stenosis limited decompression under endoscope combined with percutaneous transpedicular screw fixation is reliable.Furthermore,no side effects on spine and back muscles are observed.

Analgesic effect of auto-moxibustion on lumbar vertebral osteoarthritis / 现代临床护理

Objective To investigate the analgesic effect of auto-moxibostion on lumbar vertebral osteoarthritis? Methods Sixty patients with lumbar vertebral osteoarthritis were randomized equally into the control group and observation group by a random digits table: the former group received routine nursing care and the latter was intervened with auto-moxibustion together with routine nursing care? The curative effects were appraised by short-form of McGill pain questionnaire? Result The curative effect in the observation group was significantly better than that of the control group(P < 0?05)? Conclusions The auto-moxibustion is effective for the analgesia of lumbar vertebral osteoarthritis? The right management of medication and detained medicine is helpful for the increased effect of auto-moxibustion?

Disruption of a Dacron Graft Caused by the Vertebral Body of the Lumbar Vertebrae after Reconstruction of the Thoracoabdominal Aortic Aneurysm / 日本心臓血管外科学会雑誌

We report an extremely rare case of early disruption of a woven Dacron graft by the mechanical force of the lumbar vertebral body after a thoracoabdominal aortic aneurysm repair. A 75-year-old man with thoracoabdominal aortic aneurysm of Crawford type III underwent replacement of the thoracoabdominal aorta using a Gelweave thoracoabdominal graft (Vascutek) and a Gelweave bifurcate graft (Vascutek). His postoperative course was uneventful and discharged on postoperative day 20. On the 22nd postoperative day, he was re-hospitalized with low back pain. Computed tomography scanning showed a massive hematoma around the region of the graft-to-graft anastomosis. He underwent an emergency operation. At laparotomy, the Gelweave thoracoabdominal graft had a 2-mm hole which had been caused by the mechanical force of lumbar vertebral body, which was not related to the anastomosis. The graft was repaired with a 4-0 polypropylene buttress suture and a new prosthesis graft was used to wrap around the disrupted graft.

Analysis of Factors Related to Neurological Deficit in Thoracolumbar Fractures

OBJECTIVE: The purpose of this study is to determine the factors that have effects on the neurological deficit in the patients with thoracolumbar fracture. METHODS: Forty-eight patients were included. Cause of injury, type of injury, time interval, combined injury, kyphotic angle, spinal canal compromise, sagittal diameter, the most narrow sagittal diameter, transverse diameter, the most narrow transverse diameter, and remained height of vertebra body were concerned as the factors. The patients with American Spinal Injury Association(ASIA) impairment scale grade A to D were considered as having neurology while others with ASIA grade E were considered to be without neurology. The patients with ASIA grade A were classified to paraplegia group and the patients with ASIA grade B to E were not thought to be paraplegia. Statistical analysis for these groups were performed. RESULTS: Spinal canal compromise (P<0.001) have correlation with neurological deficit. The most narrow sagittal diameter was smaller in the group with deficit than that in the group without deficit (P=0.004). Also, combined injury have correlation with neurology (P=0.028). Spinal canal compromise (P<0.001), sagittal diameter (P=0.032), the most narrow sagittal diameter (P=0.025), and Denis type (P<0.001) also have correlation with paraplegia. CONCLUSION: The factors of percentage of spinal canal compromise, the most narrow sagittal diameter, and combined injury are predictive of neurological deficit. The patients with paraplegia may be predicted by the factors such as type of injury, spinal canal compromise, sagittal diameter, the most narrow sagittal diameter, and Denis type.

Clinical assessment of one-level posterior lumbar interbody fusion performed with microendoscopic approach / 中华显微外科杂志

Objective To evaluate the clinical outcome of one-level posterior lumbar interbody fusion (PLIF) performed with microendoscopic approach.Methods A consecutive series of 56 patients who under went one-level PLIF procedure(24 cases performed with microendoseopic approach and 32 cases with tradition- al open approach)were studied from January 2005 to May 2006.The following data were compared between 2 groups with 12 to 27 months follow-up:estimated blood loss,postoperative drainage,transfusion needs,surgi- cal time,length of hospital stay,postoperative back pain by visual analogue scale,complications,and the clinical and radiographic results.Results The microendoscopic approach was found to have a significantly less blood loss,less postoperative drainage,less needs of transfusion,less postoperative back pain,shorter re- covery time and shorter length of hospital stay.However,the microendoscopic approach needed significantly longer surgical time.There was no significant difference between 2 groups in the aspects of the complications and the clinical and radiographic results.Conclusion The one-level PLIF performed with microendoscopic approach minimize estimated blood loss,length of hospital stay,postoperative back pain.It also shows the ex- cellent surgical efficacy of the microendoscopic approach for suitable patients.

Diagnosis and treatment of the posterior margin separation of lumbar vertebral epiphysis / 中国矫形外科杂志

[Objective]To study the pathogenesis,clinical manifestation and surgical treatment of the posterior margin separation of lumbar vertebral epiphysis.[Method]Sixteen patients suffering from the posterior margin separation of lumbar vertebral epiphysis were followed up.The clinical manifestation and radiologic examination were analyzed and results of surgical treatment were evaluated.[Result]The patients were usually young and manifested with the sign and symptom of lumbar disc herniation and/or lumbar stenosis.CT was helpful for the accurate diagnosis of this disease.The different surgical measures were taken for the treatment according to the type and range of protrusion.[Conclusion]The posterior margin separation of lumbar vertebral epiphysis were divided into three types:end plate separation and moving into posterior margin,Schmorl node and avulsion fracture.The good results can be obtained with surgery.

Rehabilitation exercises for preventing recurrence of lumbar vertebral disc hernia

A monitoring of 150 cases of stabilized lumbar disc herniation showed that in the group of subjects who dit not practise physical exercises, the recurrent rate was rather high, 34% within 6 months, 44% in 12 months, while in subjects practized the exercises, these indices were 4% and 6% respectively. Moreover in these practized subjects, the severity of recurrent condition was mild with the syndrome of lumbar spinal column and rarely lumbar radicle. Heavy works such as military works, agriculture and industrial works were still the cause of recurrence of lumbar disc herniation.

The technique of discography and the injection of medicaments for treating lumbar vertebral disc hernination which has no response enough to internal combining therapy

40 patients with lumbar disc herniation, aged 17-68 years old, including 27 males and 13 females, were treated by combined internal procedure within a week by Vioxx, Methycobalt and Hydrocortisone infected into the disc once a day within 15 day. The syndrome of radicular painful was improved well and rather well in 65-85% of patients. However, for a less number of motion disturbance, surgery was recommended.

Note on the image of photo contrast root sheath in comparing with the diagnosis after operation of hernia of lumbar vertebral disk

200 patients aged 18-67 including 109 males, 91 females were diagnosed definitely as lumbar disk prolapsas by saccoradiculography and treated surgically in the Hospital N0103 from Nov 1999 to Nov 2003. Saccoradiculography give accurate results, without complication and consistent with post operative diagnosis. The tecnique can be used at provincial level, in lacking of MRI

Treatment of Compression Fracture of Thoracic/Lumbar Vertebral Body with SKY Expander Vertebroplasty and KYPHON Vertebroplasty / 广州中医药大学学报

[Objective] To investigate the effect of SKY expander vertebroplasty and KYPHON vertebroplasty for compression fracture of thoracic/lumbar vertebral body. [Methods] Twenty-one patients (group A) with compression fracture in 27 thoracic/lumbar vertebral bodies were enrolled to this study. Among them, 17 fractured vertebral bodies from 15 patients received SKY expander vertebroplasty and another 10 fractured vertebral bodies from 6 patients received KYPHON vertebroplasty. Thirty-three patients (group B) with compression fracture in 35 thoracic/lumbar vertebral bodies receiving conservative treatment during the same period served as the control. After treatment, the therapeutic effect and result of X-ray image were compared in the two groups. [Results] A follow-up ranging from 1 month to 11 months showed that pain in the loin and back, decrease of vertebral height, complications of leaking of bone cement, and bed sore (which occurred in group B) were not found in the patients receiving vertebroplasty. [Conclusion] SKY expander vertebroplasty and KYPHON vertebroplasty are effective and safe for compression fracture of thoracic/lumbar vertebral body, which can relieve the back and loin pain as soon as possible, reconstruct the vertebral body, decrease the occurrence of complications and promote the rehabilitation, and have a better effect than conservative treatment. For the two kinds of vertebroplasty, SKY expander vertebroplasty is economic and indicated for single vertebral fracture and old fracture, and KYPHON vertebroplasty is indicated for multiple vertebral fracture, severe fracture, and vertebral body fracture with end-plate broken.