Objective:To evaluate the clinical effect of kyphoplasty in the treatment of multiple osteoporotic vertebral fractures in the elderly.Methods:The duration of the study was selected from January 2018 to December 2020,a...Objective:To evaluate the clinical effect of kyphoplasty in the treatment of multiple osteoporotic vertebral fractures in the elderly.Methods:The duration of the study was selected from January 2018 to December 2020,and 38 patients with multiple osteoporotic spinal fractures were selected for study evaluation.All patients were treated with kyphoplasty.The clinical indicators of the two groups were compared and analyzed.Results:The total effective rate was 94.7%and the complication rate was 5.3%.The height of midline,anterior and posterior vertebral body,Cobb angle,VAS score,ODI score and ADL score of 38 patients before and after treatment were compared,which were significantly better than those before treatment(P<0.05).Conclusion:The clinical effect of kyphoplasty in the treatment of elderly patients with multiple osteoporosis is significant,which can be promoted in all levels of medical institutions.展开更多
Objective:To analyze the effect of protection motivation theory on the quality of life of patients with spinal fracture.Methods:From August 2019 to September 2020,72 patients with spinal fracture were selected and ran...Objective:To analyze the effect of protection motivation theory on the quality of life of patients with spinal fracture.Methods:From August 2019 to September 2020,72 patients with spinal fracture were selected and randomly divided into two groups.The routine nursing group was the routine nursing group,and the combined nursing with the theory of protective motivation was the dynamic nursing group.Results:The hospitalization time,detumescence time,healing time and muscle strength recovery time of group A were shorter than those of group B(P<0.05).The VAS score and Barthel index score of the dynamic group were better than those of the conventional group(P<0.05);The score of SF-36 in the group A was higher than that in the group B(P<0.05).Conclusions:The application of protection motivation theory in the nursing of patients with spinal fracture can shorten the healing time of fracture,promote the recovery of muscle strength,relieve the pain of fracture,and then improve the ability of daily life and quality of life of patients.展开更多
Purpose:To identify risk factors for developing pressure ulcers(PUs)in the acute care period of traumatic spinal fracture patients with or without spinal cord injuries(SCIs).Methods:Data were collected prospectively i...Purpose:To identify risk factors for developing pressure ulcers(PUs)in the acute care period of traumatic spinal fracture patients with or without spinal cord injuries(SCIs).Methods:Data were collected prospectively in participating the National Spinal column/Cord Injury Registry of Iran(NSCIR-IR)from individuals with traumatic spinal fractures with or without SCIs,in-clusive of the hospital stay from admission to discharge.Trained nursing staff examined the patients for the presence of PUs every 8 h during their hospital stay.The presence and grade of PUs were assessed according to the European Pressure Ulcer Advisory Panel classification.In addition to PU,following data were also extracted from the NSCIR-IR datasets during the period of 2015-2021:age,sex,Glasgow coma scale score at admission,having SCIs,marital status,surgery for a spinal fracture,American Spinal Injury Association impairment scale(AIS),urinary incontinence,level of education,admitted center,length of stay in the intensive care unit(ICU),hypertension,respiratory diseases,consumption of ciga-rettes,diabetes mellitus and length of stay in the hospital.Logistic regression models were used to es-timate the unadjusted and adjusted odds ratio(OR)with 95%confidence intervals(CI).Results:Altogether 2785 participants with traumatic spinal fractures were included.Among them,87(3.1%)developed PU during their hospital stay and 392(14.1%)had SCIs.In the SCI population,63(16.1%)developed PU during hospital stay.Univariate logistic regression for the whole sample showed that marital status,having SCIs,urinary incontinence,level of education,treating center,number of days in the ICU,age,and Glasgow coma scale score were significant predictors for PUs.However,further analysis by multiple logistic regression only revealed the significant risk factors to be the treating center,marital status,having SCIs,and the number of days in the ICU.For the subgroup of individuals with SCIs,marital status,AIS,urinary incontinence,level of education,the treating center,the number of days in the ICU and the number of days in the hospital were significant predictors for PUs by univariate analysis.After adjustment in the multivariate model,the treating center,marital status(singles vs.marrieds,OR=3.06,95%CI:1.55-6.03,p=0.001),and number of days in the ICU(OR=1.06,95%Cl:1.04-1.09,p<0.001)maintained significance.Conclusions:These data confirm that individuals with traumatic spinal fractures and SCIs,especially single young patients who suffer from urinary incontinence,grades A-D by AIS,prolonged ICU stay,and more extended hospitalization are at increased risk for PUs;as a result strategies to minimize PU development need further refinement.展开更多
Acute traumatic spinal cord injury is often a lifechanging and devastating event with considerable mortality and morbidity.Over half a million people suffer from traumatic spinal cord injury annually with the majority...Acute traumatic spinal cord injury is often a lifechanging and devastating event with considerable mortality and morbidity.Over half a million people suffer from traumatic spinal cord injury annually with the majority resulting from road traffic accidents or falls.The Individual,societal and economic costs are enormous.Initial recognition and treatment of acute traumatic spinal cord injury are crucial to limit secondary injury to the spinal cord and to provide patients with the best chance of some functional recovery.This article is an overview of the management of the acute traumatic spinal cord injury patient presenting to the emergency department.We review the initial assessment,criteria for imaging and clearing the spine,and evaluate the literature to determine the optimum timing of surgery and the role of non-surgical treatment in patients presenting with acute spinal cord injury.展开更多
Osteoporotic vertebral compression fracture(OVCF)has become a major public health issue that becomes more pressing with increasing global aging.Percutaneous kyphoplasty(PKP)is an effective treatment for OVCF.Robot-ass...Osteoporotic vertebral compression fracture(OVCF)has become a major public health issue that becomes more pressing with increasing global aging.Percutaneous kyphoplasty(PKP)is an effective treatment for OVCF.Robot-assisted PKP has been utilized in recent years to improve accuracy and reduce complications.However,the effectiveness of robot-assisted PKP in the treatment of multi-segmental OVCF has yet to be proved.This study was designed to compare the efficacy of robot-assisted and conventional fluoroscopy-assisted multi-segmental PKP.A total of 30 cases with multi-segmental OVCF between April 2019 and April 2021 were included in this study.Fifteen cases were assigned to the robot-assisted PKP group(robot group)and 15 cases to the conventional fluoroscopy-assisted PKP group(conventional fluoroscopy group).The number of fluoroscopic exposures,fluoroscopic dose,operation time,cement leakage rate,visual analog scale(VAS)score,vertebral kyphosis angle(VKA),and height of fractured vertebral body(HFV)were compared between the 2 groups.The number of fluoroscopic exposures,fluoroscopic doses,and cement leakage rates in the robot group were lower than in the conventional fluoroscopy group(P<0.05)while the operative time in the robot group was longer than in the conventional fluoroscopy group(P<0.05).VAS score and VKA were decreased and HFV was increased after surgery in both groups(P<0.05).Therefore,robot-assisted PKP for the treatment of multi-segmental OVCF can reduce the number of fluoroscopic exposures,fluoroscopic doses,and cement leakage compared to conventional treatment.As such,robot-assisted PKP has good application prospects and is potentially more effective in the treatment of multi-segmental OVCF.展开更多
Study Design: Retrospective, diagnostic study. Objective: To verify if the interspinous distance is able to predict the risk for kyphotic collapse in thoracolumbar burst fractures treated conservatively without neurol...Study Design: Retrospective, diagnostic study. Objective: To verify if the interspinous distance is able to predict the risk for kyphotic collapse in thoracolumbar burst fractures treated conservatively without neurological deficit. Summary of Background Data: In patients with thoracolumbar burst fractures, the association between the amount of comminution, by using load-sharing classification (LSC), and kyphotic collapse is presented in the literature. However, LSC does not include the interspinous distance as an indirect sign to suggest biomechanical instability due to posterior ligamentous disruption in these patients in order to predict kyphotic collapse. Methods: We added the interspinous distance to the load-sharing classification (MLSC) in 50 consecutive patients with thoracolumbar burst fractures (according to Denis criteria) treated conservatively. Results: The LSC score was correlated to kyphotic collapse in the patients treated with TLSO (r = 0.312, p = 0.027;Spearman test;A = 0.668). The MLSC was similarly correlated to kyphotic collapse among TLSO-treated patients (r = 0.295, p = 0.038;Spearman test;A = 0.652). Conclusions: The interspinous distance did not contribute to the identification of worse radiographic outcomes, represented by the kyphotic collapse. This may suggest that the amount of comminution pointed out by the LSC is enough and more important than the interspinous opening in order to predict kyphotic collapse in thoracolumbar burst fractures. Possibly, the interspinous distance is much too heterogenous and multifactorial to be useful, since it reflects vertebral body height, preinjury anatomy, as well as posterior element disruption.展开更多
Purpose:There is a common opinion that spinal fractures usually reflect the substantial impact of injuries and therefore may be used as a marker of significant associated injuries,specifically for intra-abdominal inju...Purpose:There is a common opinion that spinal fractures usually reflect the substantial impact of injuries and therefore may be used as a marker of significant associated injuries,specifically for intra-abdominal injury(IAI).The impact of concomitant spinal cord injury(SCI)with the risk of associated IAI has not been well clarified.The aim of this study was to evaluate the incidence and severity of IAIs in patients suffering from spinal fractures with or without SCI.Methods:A retrospective cohort study using the Israeli National Trauma Registry was conducted.Patients with thoracic,lumbar and thoracolumbar fractures resulting from blunt mechanisms of injury from January 1,1997 to December 31,2018 were examined,comparing the incidence,severity and mortality of IAIs in patients with or without SCI.The collected variables included age,gender,mechanism of injury,incidence and severity of the concomitant IAIs and pelvic fractures,abbreviated injury scale,injury severity score,and mortality.Statistical analysis was performed using GraphPad InStat?Version 3.10,with Chi-square test for independence and two sided Fisher’s exact probability test.Results:Review of the Israeli National Trauma Database revealed a total of 16,878 patients with spinal fractures.Combined thoracic and lumbar fractures were observed in 1272 patients(7.5%),isolated thoracic fractures in 4967 patients(29.4%)and isolated lumbar fractures in 10,639 patients(63.0%).The incidence of concomitant SCI was found in 4.95%(63/1272),7.65%(380/4967)and 2.50%(266/10639)of these patients,respectively.The overall mortality was 2.5%,proving higher among isolated thoracic fracture patient than among isolated lumbar fracture counterparts(11.3%vs.4.6%,p<0.001).Isolated thoracic fractures with SCI were significantly more likely to die than non-SCI counterparts(8.2%vs.3.1%,p<0.001).There were no differences in the incidence of IAIs between patients with or without SCI following thoracolumbar fractures overall or in isolated thoracic fractures;although isolated lumbar fractures patients with SCI were more likely to have renal(3.4%vs.1.6%,p=0.02)or bowel injuries(2.3%vs.1.0%,p=0.04)than the non-SCI counterparts.Conclusion:SCI in the setting of thoracolumbar fracture does not appear to be a marker for associated IAI.However,in a subset of isolated lumbar fractures,SCI patient is associated with increased risks for renal and bowel injury.展开更多
Spinal fracture is a serious problem impairing life quality,associating with low back pain and many other chronic diseases.Among all the spinal fractures,the rate of thoracolumbar fractures is the highest and accounts...Spinal fracture is a serious problem impairing life quality,associating with low back pain and many other chronic diseases.Among all the spinal fractures,the rate of thoracolumbar fractures is the highest and accounts for approximately 90%.Although surgical treatment is an effective approach,it is still unclear which treatment method performs the best.The aim of the present study was to investigate the biomechanical performance of three spinal implants for treating the thoracolumbar wedge-shaped burst fractures using the finite element(FE)method.FE model of the T12/L1/L2 spinal segment was created from CT images and the thoracolumbar wedge-shaped burst fractures were created by removing some elements in the anterior part of L1.The FE models of the traditional system,the universal spine system(USS)and the cortical bone trajectory(CBT)system were created and their biomechanical performances were evaluated.The results revealed that among the three fixation systems,the highest von-Mises stress occurred in the CBT system.Under all the loading scenarios except for the lateral bending,the maximal von-Mises stress was higher when the USS system rather than the traditional system was applied.The average displacement around the fracture site was the highest in the CBT system.Except for the lateral bending,the average displacement around the fracture site was higher when the USS system rather than the traditional system was applied.For all the fixation approaches,the highest von-Mises stress always occurred at the screw junctions.The present study provided important data for the treatment of thoracolumbar wedge-shaped burst fractures.For example,the traditional spinal system is preferentially selected for the thoracolumbar wedgeshaped burst fracture of L1.展开更多
A sandwich vertebra is formed after multiple osteoporotic vertebral fractures treated by percutaneous vertebroplasty,which has a risk of developing new fractures.The purpose of our study was to(i)investigate the occur...A sandwich vertebra is formed after multiple osteoporotic vertebral fractures treated by percutaneous vertebroplasty,which has a risk of developing new fractures.The purpose of our study was to(i)investigate the occurrence of new fractures in sandwich vertebra after cement augmentation procedures and to(ii)evaluate the clinical outcomes after prophylactic vertebral reinforcement applied with resorbable bone cement.From June 2011 to 2014,we analysed 55 patients with at least one sandwich vertebrae and treated with percutaneous vertebroplasty.Eighteen patients were treated by prophylactic vertebroplasty with a resorbable bone cement to strengthen the sandwich vertebrae as the prevention group.The others were the non-prevention group.All patients were examined by spinal radiographs within 1 day,6 months,12 months,24 months and thereafter.The incidence of sandwich vertebra is 8.25%(55/667)in our study.Most sandwich vertebrae(69.01%,49/71)are distributed in the thoracic-lumbar junction.There are 24 sandwich vertebrae(18 patients)and 47 sandwich vertebrae(37 patients)in either prevention group or non-prevention group,respectively.No significant difference is found between age,sex,body mass index,bone mineral density,cement disk leakage,sandwich vertebrae distribution or Cobb angle in the two groups.In the follow-up,8 out of 37(21.6%)patients(with eight sandwich vertebrae)developed new fractures in non-prevention’group,whereas no new fractures were detected in the prevention group.Neither Cobb angle nor vertebral compression rate showed significant change in the prevention group during the follow-up.However,in the non-prevention group,we found that Cobb angle increased and vertebral height lost significantly(P<0.05).Prophylactic vertebroplasty procedure applied with resorbable bone cement could decrease the rate of new fractures of sandwich vertebrae.展开更多
Objective: To compare the biomechanical properties of bilateral puncture PVP and unilateral curved PVP. Methods: Twenty old sheep spine models were taken as research specimens in this experiment, which were randomly d...Objective: To compare the biomechanical properties of bilateral puncture PVP and unilateral curved PVP. Methods: Twenty old sheep spine models were taken as research specimens in this experiment, which were randomly divided into control group and experimental group, with 10 in each group. The specimens were made into a compressive spinal fracture model and treated with bone cement for vertebroplasty. In the control group, 1.5 ml of bone cement was injected into one side through bilateral puncture PVP. In the experimental group, a total of 3 ml of bone cement was injected through the unilateral curved PVP. The exudation of bone cement was observed and a CT examination was performed. Mechanical experiments were performed on the two groups of experimental specimens, and the compressive strength and stiffness of the two groups were counted and compared. Results: The initial height of the spine in the experimental group and the control group were(18.52 ±0.84) mm and(18.42±0.86) mm, respectively, and the difference was not statistically significant(P>0.05). After compression, the height of the vertebral bodies decreased significantly in both groups. With(10.36±2.33) mm in the experimental group and(10.51±2.41) mm in the control group, the difference was statistically significant(P<0.05) compared with that before compression, and there was no significant difference between the groups(P>0.05). After the PVP operation of the two groups, there was no bone cement exudation. The specimens in the control group had an ultimate compressive strength of(1752.52 ±55.21) N and a stiffness of(208.51 ±11.02) Nwm/m. The compressive strength and stiffness of the experimental group after PVP were:(3052.51±85.24) N,(235.25 ±10.35) Nwm/m. The difference was significant compared with the control group(P>0.05). Conclusion: The use of PVP in the treatment of spinal osteoporotic compression fractures can effectively increase the compression resistance of the spine while restoring the anatomical structure of the spine, so mechanical requirements are met, and the surgical method is safe. Implementation of bone cement injection using unilateral curvature of the spine can result in better spinal compression resistance,which has high promotion and application value.展开更多
文摘Objective:To evaluate the clinical effect of kyphoplasty in the treatment of multiple osteoporotic vertebral fractures in the elderly.Methods:The duration of the study was selected from January 2018 to December 2020,and 38 patients with multiple osteoporotic spinal fractures were selected for study evaluation.All patients were treated with kyphoplasty.The clinical indicators of the two groups were compared and analyzed.Results:The total effective rate was 94.7%and the complication rate was 5.3%.The height of midline,anterior and posterior vertebral body,Cobb angle,VAS score,ODI score and ADL score of 38 patients before and after treatment were compared,which were significantly better than those before treatment(P<0.05).Conclusion:The clinical effect of kyphoplasty in the treatment of elderly patients with multiple osteoporosis is significant,which can be promoted in all levels of medical institutions.
文摘Objective:To analyze the effect of protection motivation theory on the quality of life of patients with spinal fracture.Methods:From August 2019 to September 2020,72 patients with spinal fracture were selected and randomly divided into two groups.The routine nursing group was the routine nursing group,and the combined nursing with the theory of protective motivation was the dynamic nursing group.Results:The hospitalization time,detumescence time,healing time and muscle strength recovery time of group A were shorter than those of group B(P<0.05).The VAS score and Barthel index score of the dynamic group were better than those of the conventional group(P<0.05);The score of SF-36 in the group A was higher than that in the group B(P<0.05).Conclusions:The application of protection motivation theory in the nursing of patients with spinal fracture can shorten the healing time of fracture,promote the recovery of muscle strength,relieve the pain of fracture,and then improve the ability of daily life and quality of life of patients.
基金Sina Trauma and Surgery Research Center,Tehran University of Medical Sciences,Iran(grant number is 96-02-38-35120).
文摘Purpose:To identify risk factors for developing pressure ulcers(PUs)in the acute care period of traumatic spinal fracture patients with or without spinal cord injuries(SCIs).Methods:Data were collected prospectively in participating the National Spinal column/Cord Injury Registry of Iran(NSCIR-IR)from individuals with traumatic spinal fractures with or without SCIs,in-clusive of the hospital stay from admission to discharge.Trained nursing staff examined the patients for the presence of PUs every 8 h during their hospital stay.The presence and grade of PUs were assessed according to the European Pressure Ulcer Advisory Panel classification.In addition to PU,following data were also extracted from the NSCIR-IR datasets during the period of 2015-2021:age,sex,Glasgow coma scale score at admission,having SCIs,marital status,surgery for a spinal fracture,American Spinal Injury Association impairment scale(AIS),urinary incontinence,level of education,admitted center,length of stay in the intensive care unit(ICU),hypertension,respiratory diseases,consumption of ciga-rettes,diabetes mellitus and length of stay in the hospital.Logistic regression models were used to es-timate the unadjusted and adjusted odds ratio(OR)with 95%confidence intervals(CI).Results:Altogether 2785 participants with traumatic spinal fractures were included.Among them,87(3.1%)developed PU during their hospital stay and 392(14.1%)had SCIs.In the SCI population,63(16.1%)developed PU during hospital stay.Univariate logistic regression for the whole sample showed that marital status,having SCIs,urinary incontinence,level of education,treating center,number of days in the ICU,age,and Glasgow coma scale score were significant predictors for PUs.However,further analysis by multiple logistic regression only revealed the significant risk factors to be the treating center,marital status,having SCIs,and the number of days in the ICU.For the subgroup of individuals with SCIs,marital status,AIS,urinary incontinence,level of education,the treating center,the number of days in the ICU and the number of days in the hospital were significant predictors for PUs by univariate analysis.After adjustment in the multivariate model,the treating center,marital status(singles vs.marrieds,OR=3.06,95%CI:1.55-6.03,p=0.001),and number of days in the ICU(OR=1.06,95%Cl:1.04-1.09,p<0.001)maintained significance.Conclusions:These data confirm that individuals with traumatic spinal fractures and SCIs,especially single young patients who suffer from urinary incontinence,grades A-D by AIS,prolonged ICU stay,and more extended hospitalization are at increased risk for PUs;as a result strategies to minimize PU development need further refinement.
文摘Acute traumatic spinal cord injury is often a lifechanging and devastating event with considerable mortality and morbidity.Over half a million people suffer from traumatic spinal cord injury annually with the majority resulting from road traffic accidents or falls.The Individual,societal and economic costs are enormous.Initial recognition and treatment of acute traumatic spinal cord injury are crucial to limit secondary injury to the spinal cord and to provide patients with the best chance of some functional recovery.This article is an overview of the management of the acute traumatic spinal cord injury patient presenting to the emergency department.We review the initial assessment,criteria for imaging and clearing the spine,and evaluate the literature to determine the optimum timing of surgery and the role of non-surgical treatment in patients presenting with acute spinal cord injury.
基金supported by the National Natural Science Foundation of China (Grants No. 81672152 and 81871773)Jiangsu Provincial Science and Technology Department Key R&D Program (Grant No. BE2018132)
文摘Osteoporotic vertebral compression fracture(OVCF)has become a major public health issue that becomes more pressing with increasing global aging.Percutaneous kyphoplasty(PKP)is an effective treatment for OVCF.Robot-assisted PKP has been utilized in recent years to improve accuracy and reduce complications.However,the effectiveness of robot-assisted PKP in the treatment of multi-segmental OVCF has yet to be proved.This study was designed to compare the efficacy of robot-assisted and conventional fluoroscopy-assisted multi-segmental PKP.A total of 30 cases with multi-segmental OVCF between April 2019 and April 2021 were included in this study.Fifteen cases were assigned to the robot-assisted PKP group(robot group)and 15 cases to the conventional fluoroscopy-assisted PKP group(conventional fluoroscopy group).The number of fluoroscopic exposures,fluoroscopic dose,operation time,cement leakage rate,visual analog scale(VAS)score,vertebral kyphosis angle(VKA),and height of fractured vertebral body(HFV)were compared between the 2 groups.The number of fluoroscopic exposures,fluoroscopic doses,and cement leakage rates in the robot group were lower than in the conventional fluoroscopy group(P<0.05)while the operative time in the robot group was longer than in the conventional fluoroscopy group(P<0.05).VAS score and VKA were decreased and HFV was increased after surgery in both groups(P<0.05).Therefore,robot-assisted PKP for the treatment of multi-segmental OVCF can reduce the number of fluoroscopic exposures,fluoroscopic doses,and cement leakage compared to conventional treatment.As such,robot-assisted PKP has good application prospects and is potentially more effective in the treatment of multi-segmental OVCF.
文摘Study Design: Retrospective, diagnostic study. Objective: To verify if the interspinous distance is able to predict the risk for kyphotic collapse in thoracolumbar burst fractures treated conservatively without neurological deficit. Summary of Background Data: In patients with thoracolumbar burst fractures, the association between the amount of comminution, by using load-sharing classification (LSC), and kyphotic collapse is presented in the literature. However, LSC does not include the interspinous distance as an indirect sign to suggest biomechanical instability due to posterior ligamentous disruption in these patients in order to predict kyphotic collapse. Methods: We added the interspinous distance to the load-sharing classification (MLSC) in 50 consecutive patients with thoracolumbar burst fractures (according to Denis criteria) treated conservatively. Results: The LSC score was correlated to kyphotic collapse in the patients treated with TLSO (r = 0.312, p = 0.027;Spearman test;A = 0.668). The MLSC was similarly correlated to kyphotic collapse among TLSO-treated patients (r = 0.295, p = 0.038;Spearman test;A = 0.652). Conclusions: The interspinous distance did not contribute to the identification of worse radiographic outcomes, represented by the kyphotic collapse. This may suggest that the amount of comminution pointed out by the LSC is enough and more important than the interspinous opening in order to predict kyphotic collapse in thoracolumbar burst fractures. Possibly, the interspinous distance is much too heterogenous and multifactorial to be useful, since it reflects vertebral body height, preinjury anatomy, as well as posterior element disruption.
基金The study was approved by Gertner Institute IRB committee(protocol#5138-19,ethical approval number 20187640).
文摘Purpose:There is a common opinion that spinal fractures usually reflect the substantial impact of injuries and therefore may be used as a marker of significant associated injuries,specifically for intra-abdominal injury(IAI).The impact of concomitant spinal cord injury(SCI)with the risk of associated IAI has not been well clarified.The aim of this study was to evaluate the incidence and severity of IAIs in patients suffering from spinal fractures with or without SCI.Methods:A retrospective cohort study using the Israeli National Trauma Registry was conducted.Patients with thoracic,lumbar and thoracolumbar fractures resulting from blunt mechanisms of injury from January 1,1997 to December 31,2018 were examined,comparing the incidence,severity and mortality of IAIs in patients with or without SCI.The collected variables included age,gender,mechanism of injury,incidence and severity of the concomitant IAIs and pelvic fractures,abbreviated injury scale,injury severity score,and mortality.Statistical analysis was performed using GraphPad InStat?Version 3.10,with Chi-square test for independence and two sided Fisher’s exact probability test.Results:Review of the Israeli National Trauma Database revealed a total of 16,878 patients with spinal fractures.Combined thoracic and lumbar fractures were observed in 1272 patients(7.5%),isolated thoracic fractures in 4967 patients(29.4%)and isolated lumbar fractures in 10,639 patients(63.0%).The incidence of concomitant SCI was found in 4.95%(63/1272),7.65%(380/4967)and 2.50%(266/10639)of these patients,respectively.The overall mortality was 2.5%,proving higher among isolated thoracic fracture patient than among isolated lumbar fracture counterparts(11.3%vs.4.6%,p<0.001).Isolated thoracic fractures with SCI were significantly more likely to die than non-SCI counterparts(8.2%vs.3.1%,p<0.001).There were no differences in the incidence of IAIs between patients with or without SCI following thoracolumbar fractures overall or in isolated thoracic fractures;although isolated lumbar fractures patients with SCI were more likely to have renal(3.4%vs.1.6%,p=0.02)or bowel injuries(2.3%vs.1.0%,p=0.04)than the non-SCI counterparts.Conclusion:SCI in the setting of thoracolumbar fracture does not appear to be a marker for associated IAI.However,in a subset of isolated lumbar fractures,SCI patient is associated with increased risks for renal and bowel injury.
基金This study was supported by the National Natural Science Foundation of China(12072066)the DUT-BSU grant(ICR2103)the Chinese Fundamental Research Funds for the Central Universities(DUT21LK21).
文摘Spinal fracture is a serious problem impairing life quality,associating with low back pain and many other chronic diseases.Among all the spinal fractures,the rate of thoracolumbar fractures is the highest and accounts for approximately 90%.Although surgical treatment is an effective approach,it is still unclear which treatment method performs the best.The aim of the present study was to investigate the biomechanical performance of three spinal implants for treating the thoracolumbar wedge-shaped burst fractures using the finite element(FE)method.FE model of the T12/L1/L2 spinal segment was created from CT images and the thoracolumbar wedge-shaped burst fractures were created by removing some elements in the anterior part of L1.The FE models of the traditional system,the universal spine system(USS)and the cortical bone trajectory(CBT)system were created and their biomechanical performances were evaluated.The results revealed that among the three fixation systems,the highest von-Mises stress occurred in the CBT system.Under all the loading scenarios except for the lateral bending,the maximal von-Mises stress was higher when the USS system rather than the traditional system was applied.The average displacement around the fracture site was the highest in the CBT system.Except for the lateral bending,the average displacement around the fracture site was higher when the USS system rather than the traditional system was applied.For all the fixation approaches,the highest von-Mises stress always occurred at the screw junctions.The present study provided important data for the treatment of thoracolumbar wedge-shaped burst fractures.For example,the traditional spinal system is preferentially selected for the thoracolumbar wedgeshaped burst fracture of L1.
文摘A sandwich vertebra is formed after multiple osteoporotic vertebral fractures treated by percutaneous vertebroplasty,which has a risk of developing new fractures.The purpose of our study was to(i)investigate the occurrence of new fractures in sandwich vertebra after cement augmentation procedures and to(ii)evaluate the clinical outcomes after prophylactic vertebral reinforcement applied with resorbable bone cement.From June 2011 to 2014,we analysed 55 patients with at least one sandwich vertebrae and treated with percutaneous vertebroplasty.Eighteen patients were treated by prophylactic vertebroplasty with a resorbable bone cement to strengthen the sandwich vertebrae as the prevention group.The others were the non-prevention group.All patients were examined by spinal radiographs within 1 day,6 months,12 months,24 months and thereafter.The incidence of sandwich vertebra is 8.25%(55/667)in our study.Most sandwich vertebrae(69.01%,49/71)are distributed in the thoracic-lumbar junction.There are 24 sandwich vertebrae(18 patients)and 47 sandwich vertebrae(37 patients)in either prevention group or non-prevention group,respectively.No significant difference is found between age,sex,body mass index,bone mineral density,cement disk leakage,sandwich vertebrae distribution or Cobb angle in the two groups.In the follow-up,8 out of 37(21.6%)patients(with eight sandwich vertebrae)developed new fractures in non-prevention’group,whereas no new fractures were detected in the prevention group.Neither Cobb angle nor vertebral compression rate showed significant change in the prevention group during the follow-up.However,in the non-prevention group,we found that Cobb angle increased and vertebral height lost significantly(P<0.05).Prophylactic vertebroplasty procedure applied with resorbable bone cement could decrease the rate of new fractures of sandwich vertebrae.
文摘Objective: To compare the biomechanical properties of bilateral puncture PVP and unilateral curved PVP. Methods: Twenty old sheep spine models were taken as research specimens in this experiment, which were randomly divided into control group and experimental group, with 10 in each group. The specimens were made into a compressive spinal fracture model and treated with bone cement for vertebroplasty. In the control group, 1.5 ml of bone cement was injected into one side through bilateral puncture PVP. In the experimental group, a total of 3 ml of bone cement was injected through the unilateral curved PVP. The exudation of bone cement was observed and a CT examination was performed. Mechanical experiments were performed on the two groups of experimental specimens, and the compressive strength and stiffness of the two groups were counted and compared. Results: The initial height of the spine in the experimental group and the control group were(18.52 ±0.84) mm and(18.42±0.86) mm, respectively, and the difference was not statistically significant(P>0.05). After compression, the height of the vertebral bodies decreased significantly in both groups. With(10.36±2.33) mm in the experimental group and(10.51±2.41) mm in the control group, the difference was statistically significant(P<0.05) compared with that before compression, and there was no significant difference between the groups(P>0.05). After the PVP operation of the two groups, there was no bone cement exudation. The specimens in the control group had an ultimate compressive strength of(1752.52 ±55.21) N and a stiffness of(208.51 ±11.02) Nwm/m. The compressive strength and stiffness of the experimental group after PVP were:(3052.51±85.24) N,(235.25 ±10.35) Nwm/m. The difference was significant compared with the control group(P>0.05). Conclusion: The use of PVP in the treatment of spinal osteoporotic compression fractures can effectively increase the compression resistance of the spine while restoring the anatomical structure of the spine, so mechanical requirements are met, and the surgical method is safe. Implementation of bone cement injection using unilateral curvature of the spine can result in better spinal compression resistance,which has high promotion and application value.
