Thoracic spine fracture is a common orthopedic injury that is usually caused by external forces acting directly on or transmitted to the thoracic spine through other parts of the spine.Thoracic spine fractures can be ...Thoracic spine fracture is a common orthopedic injury that is usually caused by external forces acting directly on or transmitted to the thoracic spine through other parts of the spine.Thoracic spine fractures can be divided into two types:stable and unstable.An unstable fracture means that the relationship between the vertebral bodies is no longer stable,which may cause serious consequences such as spinal compression,nerve root compression,or spinal cord injury.Surgical treatment is often needed for patients with unstable fractures,nerve root compression,or spinal cord injury to restore stability and function to the thoracic spine.The probability of complications after thoracolumbar fracture surgery is high,which affects the outcome of surgical treatment.To improve postoperative rehabilitation outcomes,this article analyzed the value of nursing care based on the enhanced recovery after surgery(ERAS)concept for patients undergoing thoracolumbar fracture surgery.展开更多
BACKGROUND The combined anterior/posterior approach appears to be capable of reconstructing spinal stability,correcting thoracolumbar deformity,and promoting neural recovery in severe thoracolumbar fracture dislocatio...BACKGROUND The combined anterior/posterior approach appears to be capable of reconstructing spinal stability,correcting thoracolumbar deformity,and promoting neural recovery in severe thoracolumbar fracture dislocation.However,this type of operation requires changing the body position during the procedure,resulting in a lengthy operation time.As a universal surgical robot,TINAVI robot has achieved good surgical results in clinical surgery.But to our knowledge,no reports describing TINAVI robot-assisted single lateral position anteroposterior surgery for thoracolumbar fracture dislocation.CASE SUMMARY We describe a case of a 16-year-old female patient with severe thoracolumbar fracture and dislocation underwent surgery assisted by the TINAVI robot.A onestage combined anterior and posterior operation was performed on a severe thoracolumbar fracture dislocation using the TINAVI robot,and the operation was completed in right lateral position.CONCLUSION The TINAVI robot-assisted one-stage anterior and posterior surgery in right lateral position for severe thoracolumbar fracture and dislocation is both safe and effective.展开更多
Thoracolumbar fractures are usually treated by open posterior pedicle screw fixation.However,this procedure involves massive paraspinal muscle stripping,inflicting surgical trauma,and prolonged X-ray exposure.In this ...Thoracolumbar fractures are usually treated by open posterior pedicle screw fixation.However,this procedure involves massive paraspinal muscle stripping,inflicting surgical trauma,and prolonged X-ray exposure.In this study,we observed 127 patients with single-segment injury thoracolumbar fractures.Thirty-six patients were treated by the modified Wiltse’s paraspinal approach with minimally invasive channel system,while 91 patients were treated via traditional posterior approach.Operation time,intraoperative blood loss,intraoperative fluoroscopy frequency,screw placement accuracy,visual analogue scale score,and Cobb’s angle of two groups were compared.The X-ray exposure times were notably reduced(4.2±1.6) in the new approach group(P<0.05).The pedicle screw placement accuracy and Cobb’s angle after surgery were similar in the two groups.We conclude that modified Wiltse’s paraspinal approach w ith spinal minimally invasive channel system surgery can significantly reduce the X-ray exposure times and is an alternative therapy for the thoracolumbar fracture.展开更多
Objective:To evaluate the clinical effect of posterior internal fixation and fusion in the treatment of thoracolumbar fractures.Methods:36 patients with thoracolumbar fractures from January 2018 to December 2020 were ...Objective:To evaluate the clinical effect of posterior internal fixation and fusion in the treatment of thoracolumbar fractures.Methods:36 patients with thoracolumbar fractures from January 2018 to December 2020 were selected and divided into study group and control group according to the random number table model.The control group was treated with anterior internal fixation,while the study group was treated with posterior internal fixation and fusion.The indexes of the two groups were compared and analyzed.Results:Compared with the operation related indexes of the two groups,the study group had more advantages(P<0.05);The postoperative kyphosis Cobb angle,height of anterior and posterior vertebral body,wedge index of the two groups were better than those before operation(P<0.05),and there was no significant difference between the two groups(P>0.05);There was no significant difference between the two groups(P>0.05).Conclusion:The clinical effect of posterior internal fixation and fusion in the treatment of thoracolumbar fractures is significant,and the body damage is slight,which is worthy of comprehensive promotion.展开更多
BACKGROUND Thoracolumbar fractures are generally combined with spinal cord injury to varying degrees,which may cause deterioration of the patients’condition and increase the difficulty of clinical treatment.At presen...BACKGROUND Thoracolumbar fractures are generally combined with spinal cord injury to varying degrees,which may cause deterioration of the patients’condition and increase the difficulty of clinical treatment.At present,anterior or combined anterior-posterior surgery is preferred for severe thoracolumbar fractures.AIM To investigate the effectiveness and postoperative rehabilitation of one-stage combined anterior-posterior surgery for severe thoracolumbar fractures with spinal cord injury.METHODS One-hundred-and-twenty patients who received surgery for severe thoracolumbar fractures with spinal cord injury at our hospital from February 2018 to February 2020 were randomly enrolled.They were randomly divided into group 1(one-stage combined anterior-posterior surgery,n=60)and group 2(onestage anterior-approach surgery,n=60).Treatment efficacy was compared between the two groups.RESULTS Blood loss was greater and the operation time was longer in group 1 than in group 2,and the differences were statistically significant(P<0.05).Incision length,intraoperative X-rays,and length of hospital stay were not significantly different between the two groups(P>0.05).Preoperative function of the affected vertebrae was not significantly different between the two groups(P>0.05).In each group,the patients showed significant improvement after surgery.The anterior vertebral height ratio and the posterior vertebral height ratio in group 1 after surgery were significantly higher than those in group 2.The Cobb angle after surgery was significantly lower in group 1 than in group 2(P<0.05).The canal-occupying ratio of the affected vertebrae was not significantly different between the two groups(P>0.05).Before surgery,there was no significant difference in the quality of life scores between the two groups(P>0.05).The above indicators were significantly improved after surgery compared with before surgery in each group.In addition,these indicators were markedly better in group 1 than in group 2 after surgery(P<0.05 for each).CONCLUSION One-stage combined anterior-posterior surgery effectively improves the function of the affected vertebrae and the life quality of patients with severe thoracolumbar fractures and spinal cord injury.This surgical approach is worthy of popularization in clinical use.展开更多
The thoracolumbar junction is the junction of the thoracic and lumbar spine and is subjected to high biomechanical stress.With the rapid development of the society,the morbidity of thoracolumbar spine increases every ...The thoracolumbar junction is the junction of the thoracic and lumbar spine and is subjected to high biomechanical stress.With the rapid development of the society,the morbidity of thoracolumbar spine increases every year.Thoracolumbar fracture may affect the stability of the spine and even result in paralysis via the compression of the spinal cord.As a result of advancements in modern medicine,the theoretical and practical aspects concerning thoracolumbar fracture have made great progress.However,due to the complexity of thoracolumbar fracture,controversy still exists in the treatment strategies and methods for thoracolumbar fractures.In order to provide reference for clinical practice,the research progress in the treatment of thoracolumbar fracture is reviewed in this paper.展开更多
Objective To assess the outcomes of navigationguided posterior fixation plus transpedicular vertebroplasty for thoracolumbar fractures.Methods From June,2005 through March,2009,30 patients with thoracolumbar fracture
Objective To explore the effects of the anterior internal fixation systems on the post-operative lateral angulation in treatment of thoracolumbar fractures.Methods A retrospective study was done to analyze the 172 pat...Objective To explore the effects of the anterior internal fixation systems on the post-operative lateral angulation in treatment of thoracolumbar fractures.Methods A retrospective study was done to analyze the 172 patients who had展开更多
This study aimed to introduce a novel mini-open pedicle screw fixation technique via Wiltse approach,and compared it with the traditional posterior open method.A total of 72 cases of single-segment thoracolumbar fract...This study aimed to introduce a novel mini-open pedicle screw fixation technique via Wiltse approach,and compared it with the traditional posterior open method.A total of 72 cases of single-segment thoracolumbar fractures without neurologic injury underwent pedicle screw fixation via two different approaches.Among them,37 patients were treated using posterior open surgery,and 35 patients received mini-open operation via Wiltse approach.Crew placement accuracy rate,operative time,blood loss,postoperative drainage,postoperative hospitalization time,radiation exposure time,postoperative improvement in R value,Cobb's angle and visual analog scale(VAS)scores of the two methods were compared.There were no significant differences in the accuracy rate of pedicle screw placement,radiation exposure and postoperative R value and Cobb's angle improvement between the two groups.However,the mini-open method had obvious advantages over the conventional open method in operative time,blood loss,postoperative drainage,postoperative hospitalization time,and postoperative improvement in VAS.The mini-open pedicle screw technique could be applied in treatment of single-segment thoracolumbar fracture without neurologic injury and had advantages of less tissue trauma,short operative and rehabilitative time on the premise of guaranteed accuracy rate and no increased radiation exposure.展开更多
Objective:To study the clinical effect of minimally invasive single-segment reduction and internal fixation in patients with thoracolumbar fractures.Methods:From June 2013 to June 2014,100 patients with thoracolumbar ...Objective:To study the clinical effect of minimally invasive single-segment reduction and internal fixation in patients with thoracolumbar fractures.Methods:From June 2013 to June 2014,100 patients with thoracolumbar fractures were selected as the subjects and they were randomly divided into observation group(50 cases)and control group(50 cases).The patients in the observation group were treated with minimally invasive singlesegment reduction and internal fixation.The patients in the control group were treated with short segmental fixation.The clinical effects of the two groups were compared.Results:There was no significant difference in the compression rate and Cobb angle between the two groups before and after operation(P>0.05).For all patients who were followed up for the last time,the Cobb angle was significantly lower in the observation group than in the control group(P<0.05).The social function,affective function and physical pain score of the observation group were significantly better than the control group(P<0.05).The amount of bleeding in the observation group was(250.4±41.0)ml,which was significantly lower than that in the control group(267.5±32.8)ml.The time required for the operation was(90.2±35.4)min,which was significantly lower than that of the control group(104.5±22.6)min(P<0.05).After treatment,the prognosis was 70.00%and the excellent and good rate was 98.00%,which was significantly higher than that of the control group(46.00%)and 78.00%(P<0.05).Conclusion:Thoracolumbar fractures in patients with dilated channel minimally invasive single-segment reduction and internal fixation treatment can effectively repair the patient's vertebral height and Cobb angle and the degree of correction after surgery was significantly better,safer and worthy of clinical recommended use.展开更多
Objective:To evaluate the clinical effect of AF instrument in treating thoracolumbar fracture and to summarize the lesson of operation''''''''s fault.Methods:Fifty-four cases with thora...Objective:To evaluate the clinical effect of AF instrument in treating thoracolumbar fracture and to summarize the lesson of operation''''''''s fault.Methods:Fifty-four cases with thoracolumbar fracture were reviewed.Preoperative and postoperative of all patients,X-ray pictures,CT,MR and ASIA classification were studied and evaluated contrastively.Results:The main Cobb''''''''s angle of all 47 cases that had been followed up was corrected from 24.5° preoperatively to 5.5° post-operatively.Anterior height of compressed vertebral bodies restored from 53% preoperatively to 91% postoperatively.According to ASIA classification,the injury of nerves progressed 1-3 grade.The complications appeared in about 19.1%.Conclusion:AF instrument can achieve anatomical reduction and stable interior fixation.It is one of the best devices for the treatment of thoracolumbar fracture.To improve the operators.surgical technique is the key in decreasing the complications.展开更多
Objective:To study the vertebral body structure as well as the whole body and nerve injury after treatment of thoracolumbar fractures through paraspinal muscle approach and traditional approach.Methods:A total of 74 p...Objective:To study the vertebral body structure as well as the whole body and nerve injury after treatment of thoracolumbar fractures through paraspinal muscle approach and traditional approach.Methods:A total of 74 patients with thoracolumbar fractures who received surgical treatment in our hospital between September 2013 and October 2015 were selected and randomly divided into the paraspinal approach group and the median approach group who received the internal fixation surgery through paraspinal muscle approach and the internal fixation surgery through traditional median approach respectively. Before surgery as well as 3 months, 6 months after surgery, Cobb Angle was detected;before surgery as well as 1 d and 3 d after surgery, serum levels of creatase, stress hormones and nerve injury molecules were determined.Results:3 months, 6 months after surgery, the Cobb Angle of paraspinal approach group and median approach group were significantly lower than those before surgery and the Cobb Angle were not significantly different between the two groups of patients;serum LDH, CK, Myo, NE, E, Cor and Ins levels of both groups 1 d and 3 d after surgery were significantly higher than those before surgery and the serum LDH, CK, Myo, NE, E, Cor and Ins levels of paraspinal approach group were significantly lower than those of median approach group, serum NSE, S100B and GFAP levels of both groups 1 d and 3 d after surgery were significantly lower than those before surgery and serum NSE, S100B and GFAP levels of paraspinal approach group were significantly lower than those of median approach group. Conclusion: The vertebral body stability are equivalent after treatment of thoracolumbar fractures through paraspinal muscle approach and traditional approach, and the trauma extent of paraspinal muscle approach is less.展开更多
Objective: To study the muscle injury, inflammatory response and bone metabolism after paravertebral muscle space and minimally invasive percutaneous approach surgeries for thoracolumbar fracture. Methods: A total of ...Objective: To study the muscle injury, inflammatory response and bone metabolism after paravertebral muscle space and minimally invasive percutaneous approach surgeries for thoracolumbar fracture. Methods: A total of 92 patients with thoracolumbar fractures who were treated in Baoji Central Hospital between May 2015 and January 2017 were selected and randomly divided into paravertebral group and minimally invasive percutaneous group who accepted pedicle screw fixation under different approaches. Before operation as well as 1 d and 3 d after operation, serum was collected to determine the contents of creatase, inflammatory reaction molecules and bone metabolism indexes. Results: Serum Myo, CK, LDH, TNF-α, MCP-1, HMGB-1, CRP, IL-1β, OC, OPG, PICP and PINP levels of both groups 1 d and 3 d after operation were significantly higher than those before operation while TRACP5b, RANKL, CTX and NTX levels were significantly lower than those before operation, and serum Myo, CK, LDH, TNF-α, MCP-1, HMGB-1, CRP, IL-1β, TRACP5b, RANKL, CTX and NTX levels of paravertebral group 1 d and 3 d after operation were significantly lower than those of minimally invasive percutaneous group while OC, OPG, PICP and PINP levels were significantly higher than those of minimally invasive percutaneous group. Conclusion:Paravertebral muscle space surgery for thoracolumbar fracture is more effective than minimally invasive percutaneous surgery in reducing muscle injury and inflammatory response, and improving bone metabolism.展开更多
Radial borehole fracturing that combines radial boreholes with hydraulic fracturing is anticipated to improve the output of tight oil and gas reservoirs.This paper aims to investigate fracture propagation and pressure...Radial borehole fracturing that combines radial boreholes with hydraulic fracturing is anticipated to improve the output of tight oil and gas reservoirs.This paper aims to investigate fracture propagation and pressure characteristics of radial borehole fracturing in multiple layers.A series of laboratory experiments with artificial rock samples(395 mm×395 mm×395 mm)was conducted using a true triaxial fracturing device.Three crucial factors corresponding to the vertical distance of adjacent radial borehole layers(vertical distance),the azimuth and diameter of the radial borehole are examined.Experimental results show that radial borehole fracturing in multiple layers generates diverse fracture geometries.Four types of fractures are identified based on the connectivity between hydraulic fractures and radial boreholes.The vertical distance significantly influences fracture propagation perpendicular to the radial borehole axis.An increase in the vertical distance impedes fracture connection across multiple radial borehole layers and reduces the fracture propagation distance along the radial borehole axis.The azimuth also influences fracture propagation along the radial borehole axis.Increasing the azimuth reduces the guiding ability of radial boreholes,which makes the fracture quickly curve to the maximum horizontal stress direction.The breakdown pressure correlates with diverse fracture geometries observed.When the fractures connect multi-layer radial boreholes,increasing the vertical distance decreases the breakdown pressure.Decreasing the azimuth and increasing the diameter also decrease the breakdown pressure.The extrusion force exists between the adjacent fractures generated in radial boreholes in multiple rows,which plays a crucial role in enhancing the guiding ability of radial boreholes and results in higher breakdown pressure.The research provides valuable theoretical insights for the field application of radial borehole fracturing technology in tight oil and gas reservoirs.展开更多
Acetabular fractures in the geriatric population are typically low-energy fractures resulting from a fall from standing height.Compromised bone quality in the elderly,as well as this population’s concomitant medical ...Acetabular fractures in the geriatric population are typically low-energy fractures resulting from a fall from standing height.Compromised bone quality in the elderly,as well as this population’s concomitant medical comorbidities,render the management of such fractures challenging and controversial.Non-operative management remains the mainstay of treatment,although such a choice is associated with numerous and serious complications related to both the hip joint as well as the general condition of the patient.On the other hand,operatively treating acetabular fractures(e.g.,with osteosynthesis or total hip arthroplasty)is gaining popularity.Osteosynthesis can be performed with open reduction and internal fixation or with minimally invasive techniques.Total hip arthroplasty could be performed either in the acute phase combined with osteosynthesis or as a delayed procedure after a period of non-operative management or after failed osteosynthesis of the acetabulum.Regardless of the implemented treatment,orthogeriatric co-management is considered extremely crucial,and it is currently one of the pillars of a successful outcome after an acetabular fracture.展开更多
BACKGROUND Distal humerus elbow fractures are one of the most common traumatic fractures seen in pediatric patients and present as three main types:Supracondylar(SC),lateral condyle(LC),and medial epicondyle(ME)fractu...BACKGROUND Distal humerus elbow fractures are one of the most common traumatic fractures seen in pediatric patients and present as three main types:Supracondylar(SC),lateral condyle(LC),and medial epicondyle(ME)fractures.AIM To evaluate the epidemiology of pediatric distal humerus fractures(SC,LC,and ME)from an American insurance claims database.METHODS A retrospective review was performed on patients 17 years and younger with the ICD 9 and 10 codes for SC,LC and ME fractures based on the IBM Truven MarketScan®Commercial and IBM Truven MarketScan Medicare Supplemental databases.Patients from 2015 to 2020 were queried for treatments,patient age,sex,length of hospitalization,and comorbidities.RESULTS A total of 1133 SC,154 LC,and 124 ME fractures were identified.SC fractures had the highest percentage of operation at 83%,followed by LC(78%)and ME fractures(41%).Male patients were,on average,older than female patients for both SC and ME fractures.CONCLUSION In the insurance claims databases used,SC fractures were the most reported,followed by LC fractures,and finally ME fractures.Age was identified to be a factor for how a pediatric distal humerus fractures,with patients with SC and LC fractures being younger than those with ME fractures.The peak age per injury per sex was similar to reported historic central tendencies,despite reported trends for younger physiologic development.展开更多
Purpose: This study aims to investigate the predictive value of blood calcium in the prognosis of traumatic fracture. Methods: A retrospective experimental design was employed, 112 cases (52 non-fracture and 60 trauma...Purpose: This study aims to investigate the predictive value of blood calcium in the prognosis of traumatic fracture. Methods: A retrospective experimental design was employed, 112 cases (52 non-fracture and 60 traumatic fracture) were randomly selected. The type of fracture complies with WHO-recommended (2019) diagnostic criteria for osteoporosis combined with fracture. The blood pressure (BP) was measured by OMRON’s HEM-7136 model electronic blood pressure monitor. Blood calcium (Ca<sup>2+</sup>), and blood phosphorus (P) values were measured using Colorimetric Roche kits on a Roche/Hitachi fully automated biochemical analyzer. Data collection and analysis followed. Results: Higher levels of age, systolic and diastolic blood pressures were found in the traumatic fracture group compared to the control group, whereas weight, height, and blood phosphorus did not differ significantly (P adjusting for age, systolic blood pressure, diastolic blood pressure, and blood phosphorus, binary logistic regression analysis revealed that blood calcium was a protective factor against traumatic fracture (β = -26.85, OR = 0.00, 95% CI = 0.00 -0.02, P = 0.022). Conclusion: The findings suggest that high and low blood calcium levels may serve as useful indicators in predicting the prognosis of fractures resulting from trauma.展开更多
Stability analysis of underground constructions requires a model study of rock masses’ long-term performance. Creep tests under different stress conditions was conducted on intact granite and granite samples fracture...Stability analysis of underground constructions requires a model study of rock masses’ long-term performance. Creep tests under different stress conditions was conducted on intact granite and granite samples fractured at 30° and 45° angles. The experimental results indicate that the steady creep strain rates of intact and fractured rock present an exponential increase trend with the increase of stress level. A nonlinear creep model is developed based on the experimental results, in which the initial damage caused by fracture together with the damage caused by constant load have been taken into consideration. The fitting analysis results indicated that the model proposed is more accurate at identifying the full creep regions in fractured granite, especially the accelerated stage of creep deformation. The least-square fit error of the proposed creep model is significantly lower than that of Nishihara model by almost an order of magnitude. An analysis of the effects of elastic modulus, viscosity coefficient, and damage factors on fractured rock strain rate and creep strain is conducted. If no consideration is given to the effects of the damage, the proposed nonlinear creep model can degenerate into to the classical Nishihara model.展开更多
Horizontal well-stimulation is the key to unconventional resource exploration and development.The development mode of the well plant helps increase the stimulated reservoir volume.Nevertheless,fracture interference be...Horizontal well-stimulation is the key to unconventional resource exploration and development.The development mode of the well plant helps increase the stimulated reservoir volume.Nevertheless,fracture interference between wells reduces the fracturing effect.Here,a 2D hydro-mechanical coupling model describing hydraulic fracture(HF)propagation is established with the extended finite element method,and the effects of several factors on HF propagation during multiple wells fracturing are analyzed.The results show that with an increase in elastic modulus,horizontal principal stress difference and injection fluid displacement,the total fracture area and the reservoir stimulation efficiency are both improved in all three fracturing technologies.After a comparison of the three technologies,the method of improved zipper fracturing is proposed,which avoids mutual interference between HFs,and the reservoir stimulation effect is improved significantly.The study provides guidance for optimizing the fracturing technology of multiple horizontal wells.展开更多
Introduction: Forearm fractures involving both the radius and ulna, present distinctive challenges in orthopedic trauma management. This case report explores the complexities of a rare case of bilateral fractures, emp...Introduction: Forearm fractures involving both the radius and ulna, present distinctive challenges in orthopedic trauma management. This case report explores the complexities of a rare case of bilateral fractures, emphasizing the importance of a comprehensive approach for optimal outcomes. Case Presentation: This report presents the case of a 40-year-old motorcyclist who was involved in a road accident and arrived at the emergency department shortly after the incident. Clinical examination revealed closed fractures in both forearms with mild swelling and severe tenderness. Fortunately, no neurovascular issues or compartment syndrome were detected. The patient was administered intravenous fluids and effective pain relief. Forearm splints were applied and the arms were elevated using pillows. Radiographs showed fractures in the right distal radius and ulna, as well as the left mid-shaft radius and ulna. Under general anesthesia, open reduction and internal fixation were per-formed using plates and screws for all four fractures. Postoperatively, the patient’s arms were immobilized and elevated, with gradual recovery during follow-up appointments over six months, eventually achieving full function without complaints. Conclusion: This article highlights the possibility, although infrequent, of bilateral shaft fractures of the ulna and radius. With thorough clinical assessment and radiological investigation, such fractures can be well-defined. The required definitive treatment, which usually involves open reduction and internal fixation, can be performed.展开更多
文摘Thoracic spine fracture is a common orthopedic injury that is usually caused by external forces acting directly on or transmitted to the thoracic spine through other parts of the spine.Thoracic spine fractures can be divided into two types:stable and unstable.An unstable fracture means that the relationship between the vertebral bodies is no longer stable,which may cause serious consequences such as spinal compression,nerve root compression,or spinal cord injury.Surgical treatment is often needed for patients with unstable fractures,nerve root compression,or spinal cord injury to restore stability and function to the thoracic spine.The probability of complications after thoracolumbar fracture surgery is high,which affects the outcome of surgical treatment.To improve postoperative rehabilitation outcomes,this article analyzed the value of nursing care based on the enhanced recovery after surgery(ERAS)concept for patients undergoing thoracolumbar fracture surgery.
文摘BACKGROUND The combined anterior/posterior approach appears to be capable of reconstructing spinal stability,correcting thoracolumbar deformity,and promoting neural recovery in severe thoracolumbar fracture dislocation.However,this type of operation requires changing the body position during the procedure,resulting in a lengthy operation time.As a universal surgical robot,TINAVI robot has achieved good surgical results in clinical surgery.But to our knowledge,no reports describing TINAVI robot-assisted single lateral position anteroposterior surgery for thoracolumbar fracture dislocation.CASE SUMMARY We describe a case of a 16-year-old female patient with severe thoracolumbar fracture and dislocation underwent surgery assisted by the TINAVI robot.A onestage combined anterior and posterior operation was performed on a severe thoracolumbar fracture dislocation using the TINAVI robot,and the operation was completed in right lateral position.CONCLUSION The TINAVI robot-assisted one-stage anterior and posterior surgery in right lateral position for severe thoracolumbar fracture and dislocation is both safe and effective.
基金financially supported by the National Natural Science Foundation of China(Grant No.81672152 and No.81871773)the Jiangsu Natural Science Foundation(Grant No.BE2018132)。
文摘Thoracolumbar fractures are usually treated by open posterior pedicle screw fixation.However,this procedure involves massive paraspinal muscle stripping,inflicting surgical trauma,and prolonged X-ray exposure.In this study,we observed 127 patients with single-segment injury thoracolumbar fractures.Thirty-six patients were treated by the modified Wiltse’s paraspinal approach with minimally invasive channel system,while 91 patients were treated via traditional posterior approach.Operation time,intraoperative blood loss,intraoperative fluoroscopy frequency,screw placement accuracy,visual analogue scale score,and Cobb’s angle of two groups were compared.The X-ray exposure times were notably reduced(4.2±1.6) in the new approach group(P<0.05).The pedicle screw placement accuracy and Cobb’s angle after surgery were similar in the two groups.We conclude that modified Wiltse’s paraspinal approach w ith spinal minimally invasive channel system surgery can significantly reduce the X-ray exposure times and is an alternative therapy for the thoracolumbar fracture.
文摘Objective:To evaluate the clinical effect of posterior internal fixation and fusion in the treatment of thoracolumbar fractures.Methods:36 patients with thoracolumbar fractures from January 2018 to December 2020 were selected and divided into study group and control group according to the random number table model.The control group was treated with anterior internal fixation,while the study group was treated with posterior internal fixation and fusion.The indexes of the two groups were compared and analyzed.Results:Compared with the operation related indexes of the two groups,the study group had more advantages(P<0.05);The postoperative kyphosis Cobb angle,height of anterior and posterior vertebral body,wedge index of the two groups were better than those before operation(P<0.05),and there was no significant difference between the two groups(P>0.05);There was no significant difference between the two groups(P>0.05).Conclusion:The clinical effect of posterior internal fixation and fusion in the treatment of thoracolumbar fractures is significant,and the body damage is slight,which is worthy of comprehensive promotion.
文摘BACKGROUND Thoracolumbar fractures are generally combined with spinal cord injury to varying degrees,which may cause deterioration of the patients’condition and increase the difficulty of clinical treatment.At present,anterior or combined anterior-posterior surgery is preferred for severe thoracolumbar fractures.AIM To investigate the effectiveness and postoperative rehabilitation of one-stage combined anterior-posterior surgery for severe thoracolumbar fractures with spinal cord injury.METHODS One-hundred-and-twenty patients who received surgery for severe thoracolumbar fractures with spinal cord injury at our hospital from February 2018 to February 2020 were randomly enrolled.They were randomly divided into group 1(one-stage combined anterior-posterior surgery,n=60)and group 2(onestage anterior-approach surgery,n=60).Treatment efficacy was compared between the two groups.RESULTS Blood loss was greater and the operation time was longer in group 1 than in group 2,and the differences were statistically significant(P<0.05).Incision length,intraoperative X-rays,and length of hospital stay were not significantly different between the two groups(P>0.05).Preoperative function of the affected vertebrae was not significantly different between the two groups(P>0.05).In each group,the patients showed significant improvement after surgery.The anterior vertebral height ratio and the posterior vertebral height ratio in group 1 after surgery were significantly higher than those in group 2.The Cobb angle after surgery was significantly lower in group 1 than in group 2(P<0.05).The canal-occupying ratio of the affected vertebrae was not significantly different between the two groups(P>0.05).Before surgery,there was no significant difference in the quality of life scores between the two groups(P>0.05).The above indicators were significantly improved after surgery compared with before surgery in each group.In addition,these indicators were markedly better in group 1 than in group 2 after surgery(P<0.05 for each).CONCLUSION One-stage combined anterior-posterior surgery effectively improves the function of the affected vertebrae and the life quality of patients with severe thoracolumbar fractures and spinal cord injury.This surgical approach is worthy of popularization in clinical use.
文摘The thoracolumbar junction is the junction of the thoracic and lumbar spine and is subjected to high biomechanical stress.With the rapid development of the society,the morbidity of thoracolumbar spine increases every year.Thoracolumbar fracture may affect the stability of the spine and even result in paralysis via the compression of the spinal cord.As a result of advancements in modern medicine,the theoretical and practical aspects concerning thoracolumbar fracture have made great progress.However,due to the complexity of thoracolumbar fracture,controversy still exists in the treatment strategies and methods for thoracolumbar fractures.In order to provide reference for clinical practice,the research progress in the treatment of thoracolumbar fracture is reviewed in this paper.
文摘Objective To assess the outcomes of navigationguided posterior fixation plus transpedicular vertebroplasty for thoracolumbar fractures.Methods From June,2005 through March,2009,30 patients with thoracolumbar fracture
文摘Objective To explore the effects of the anterior internal fixation systems on the post-operative lateral angulation in treatment of thoracolumbar fractures.Methods A retrospective study was done to analyze the 172 patients who had
基金supported by the National Natural Science Foundation of China(Grant No.30973058, 81171694,and 81371968)the Program for Development of Innovative Research Team in the First Affiliated Hospital of NJMU(No.IRT-015)A Project Funded by the Priority Academic Program Development of Jiangsu Higher Education Institutions
文摘This study aimed to introduce a novel mini-open pedicle screw fixation technique via Wiltse approach,and compared it with the traditional posterior open method.A total of 72 cases of single-segment thoracolumbar fractures without neurologic injury underwent pedicle screw fixation via two different approaches.Among them,37 patients were treated using posterior open surgery,and 35 patients received mini-open operation via Wiltse approach.Crew placement accuracy rate,operative time,blood loss,postoperative drainage,postoperative hospitalization time,radiation exposure time,postoperative improvement in R value,Cobb's angle and visual analog scale(VAS)scores of the two methods were compared.There were no significant differences in the accuracy rate of pedicle screw placement,radiation exposure and postoperative R value and Cobb's angle improvement between the two groups.However,the mini-open method had obvious advantages over the conventional open method in operative time,blood loss,postoperative drainage,postoperative hospitalization time,and postoperative improvement in VAS.The mini-open pedicle screw technique could be applied in treatment of single-segment thoracolumbar fracture without neurologic injury and had advantages of less tissue trauma,short operative and rehabilitative time on the premise of guaranteed accuracy rate and no increased radiation exposure.
文摘Objective:To study the clinical effect of minimally invasive single-segment reduction and internal fixation in patients with thoracolumbar fractures.Methods:From June 2013 to June 2014,100 patients with thoracolumbar fractures were selected as the subjects and they were randomly divided into observation group(50 cases)and control group(50 cases).The patients in the observation group were treated with minimally invasive singlesegment reduction and internal fixation.The patients in the control group were treated with short segmental fixation.The clinical effects of the two groups were compared.Results:There was no significant difference in the compression rate and Cobb angle between the two groups before and after operation(P>0.05).For all patients who were followed up for the last time,the Cobb angle was significantly lower in the observation group than in the control group(P<0.05).The social function,affective function and physical pain score of the observation group were significantly better than the control group(P<0.05).The amount of bleeding in the observation group was(250.4±41.0)ml,which was significantly lower than that in the control group(267.5±32.8)ml.The time required for the operation was(90.2±35.4)min,which was significantly lower than that of the control group(104.5±22.6)min(P<0.05).After treatment,the prognosis was 70.00%and the excellent and good rate was 98.00%,which was significantly higher than that of the control group(46.00%)and 78.00%(P<0.05).Conclusion:Thoracolumbar fractures in patients with dilated channel minimally invasive single-segment reduction and internal fixation treatment can effectively repair the patient's vertebral height and Cobb angle and the degree of correction after surgery was significantly better,safer and worthy of clinical recommended use.
文摘Objective:To evaluate the clinical effect of AF instrument in treating thoracolumbar fracture and to summarize the lesson of operation''''''''s fault.Methods:Fifty-four cases with thoracolumbar fracture were reviewed.Preoperative and postoperative of all patients,X-ray pictures,CT,MR and ASIA classification were studied and evaluated contrastively.Results:The main Cobb''''''''s angle of all 47 cases that had been followed up was corrected from 24.5° preoperatively to 5.5° post-operatively.Anterior height of compressed vertebral bodies restored from 53% preoperatively to 91% postoperatively.According to ASIA classification,the injury of nerves progressed 1-3 grade.The complications appeared in about 19.1%.Conclusion:AF instrument can achieve anatomical reduction and stable interior fixation.It is one of the best devices for the treatment of thoracolumbar fracture.To improve the operators.surgical technique is the key in decreasing the complications.
文摘Objective:To study the vertebral body structure as well as the whole body and nerve injury after treatment of thoracolumbar fractures through paraspinal muscle approach and traditional approach.Methods:A total of 74 patients with thoracolumbar fractures who received surgical treatment in our hospital between September 2013 and October 2015 were selected and randomly divided into the paraspinal approach group and the median approach group who received the internal fixation surgery through paraspinal muscle approach and the internal fixation surgery through traditional median approach respectively. Before surgery as well as 3 months, 6 months after surgery, Cobb Angle was detected;before surgery as well as 1 d and 3 d after surgery, serum levels of creatase, stress hormones and nerve injury molecules were determined.Results:3 months, 6 months after surgery, the Cobb Angle of paraspinal approach group and median approach group were significantly lower than those before surgery and the Cobb Angle were not significantly different between the two groups of patients;serum LDH, CK, Myo, NE, E, Cor and Ins levels of both groups 1 d and 3 d after surgery were significantly higher than those before surgery and the serum LDH, CK, Myo, NE, E, Cor and Ins levels of paraspinal approach group were significantly lower than those of median approach group, serum NSE, S100B and GFAP levels of both groups 1 d and 3 d after surgery were significantly lower than those before surgery and serum NSE, S100B and GFAP levels of paraspinal approach group were significantly lower than those of median approach group. Conclusion: The vertebral body stability are equivalent after treatment of thoracolumbar fractures through paraspinal muscle approach and traditional approach, and the trauma extent of paraspinal muscle approach is less.
文摘Objective: To study the muscle injury, inflammatory response and bone metabolism after paravertebral muscle space and minimally invasive percutaneous approach surgeries for thoracolumbar fracture. Methods: A total of 92 patients with thoracolumbar fractures who were treated in Baoji Central Hospital between May 2015 and January 2017 were selected and randomly divided into paravertebral group and minimally invasive percutaneous group who accepted pedicle screw fixation under different approaches. Before operation as well as 1 d and 3 d after operation, serum was collected to determine the contents of creatase, inflammatory reaction molecules and bone metabolism indexes. Results: Serum Myo, CK, LDH, TNF-α, MCP-1, HMGB-1, CRP, IL-1β, OC, OPG, PICP and PINP levels of both groups 1 d and 3 d after operation were significantly higher than those before operation while TRACP5b, RANKL, CTX and NTX levels were significantly lower than those before operation, and serum Myo, CK, LDH, TNF-α, MCP-1, HMGB-1, CRP, IL-1β, TRACP5b, RANKL, CTX and NTX levels of paravertebral group 1 d and 3 d after operation were significantly lower than those of minimally invasive percutaneous group while OC, OPG, PICP and PINP levels were significantly higher than those of minimally invasive percutaneous group. Conclusion:Paravertebral muscle space surgery for thoracolumbar fracture is more effective than minimally invasive percutaneous surgery in reducing muscle injury and inflammatory response, and improving bone metabolism.
基金The authors gratefully acknowledge the financial support received from the Strategic Cooperation Technology Projects of CNPC and CUPB(No.ZLZX2020-01)the National Key Scientific Research Instrument Research Project of NSFC(No.51827804).
文摘Radial borehole fracturing that combines radial boreholes with hydraulic fracturing is anticipated to improve the output of tight oil and gas reservoirs.This paper aims to investigate fracture propagation and pressure characteristics of radial borehole fracturing in multiple layers.A series of laboratory experiments with artificial rock samples(395 mm×395 mm×395 mm)was conducted using a true triaxial fracturing device.Three crucial factors corresponding to the vertical distance of adjacent radial borehole layers(vertical distance),the azimuth and diameter of the radial borehole are examined.Experimental results show that radial borehole fracturing in multiple layers generates diverse fracture geometries.Four types of fractures are identified based on the connectivity between hydraulic fractures and radial boreholes.The vertical distance significantly influences fracture propagation perpendicular to the radial borehole axis.An increase in the vertical distance impedes fracture connection across multiple radial borehole layers and reduces the fracture propagation distance along the radial borehole axis.The azimuth also influences fracture propagation along the radial borehole axis.Increasing the azimuth reduces the guiding ability of radial boreholes,which makes the fracture quickly curve to the maximum horizontal stress direction.The breakdown pressure correlates with diverse fracture geometries observed.When the fractures connect multi-layer radial boreholes,increasing the vertical distance decreases the breakdown pressure.Decreasing the azimuth and increasing the diameter also decrease the breakdown pressure.The extrusion force exists between the adjacent fractures generated in radial boreholes in multiple rows,which plays a crucial role in enhancing the guiding ability of radial boreholes and results in higher breakdown pressure.The research provides valuable theoretical insights for the field application of radial borehole fracturing technology in tight oil and gas reservoirs.
文摘Acetabular fractures in the geriatric population are typically low-energy fractures resulting from a fall from standing height.Compromised bone quality in the elderly,as well as this population’s concomitant medical comorbidities,render the management of such fractures challenging and controversial.Non-operative management remains the mainstay of treatment,although such a choice is associated with numerous and serious complications related to both the hip joint as well as the general condition of the patient.On the other hand,operatively treating acetabular fractures(e.g.,with osteosynthesis or total hip arthroplasty)is gaining popularity.Osteosynthesis can be performed with open reduction and internal fixation or with minimally invasive techniques.Total hip arthroplasty could be performed either in the acute phase combined with osteosynthesis or as a delayed procedure after a period of non-operative management or after failed osteosynthesis of the acetabulum.Regardless of the implemented treatment,orthogeriatric co-management is considered extremely crucial,and it is currently one of the pillars of a successful outcome after an acetabular fracture.
文摘BACKGROUND Distal humerus elbow fractures are one of the most common traumatic fractures seen in pediatric patients and present as three main types:Supracondylar(SC),lateral condyle(LC),and medial epicondyle(ME)fractures.AIM To evaluate the epidemiology of pediatric distal humerus fractures(SC,LC,and ME)from an American insurance claims database.METHODS A retrospective review was performed on patients 17 years and younger with the ICD 9 and 10 codes for SC,LC and ME fractures based on the IBM Truven MarketScan®Commercial and IBM Truven MarketScan Medicare Supplemental databases.Patients from 2015 to 2020 were queried for treatments,patient age,sex,length of hospitalization,and comorbidities.RESULTS A total of 1133 SC,154 LC,and 124 ME fractures were identified.SC fractures had the highest percentage of operation at 83%,followed by LC(78%)and ME fractures(41%).Male patients were,on average,older than female patients for both SC and ME fractures.CONCLUSION In the insurance claims databases used,SC fractures were the most reported,followed by LC fractures,and finally ME fractures.Age was identified to be a factor for how a pediatric distal humerus fractures,with patients with SC and LC fractures being younger than those with ME fractures.The peak age per injury per sex was similar to reported historic central tendencies,despite reported trends for younger physiologic development.
文摘Purpose: This study aims to investigate the predictive value of blood calcium in the prognosis of traumatic fracture. Methods: A retrospective experimental design was employed, 112 cases (52 non-fracture and 60 traumatic fracture) were randomly selected. The type of fracture complies with WHO-recommended (2019) diagnostic criteria for osteoporosis combined with fracture. The blood pressure (BP) was measured by OMRON’s HEM-7136 model electronic blood pressure monitor. Blood calcium (Ca<sup>2+</sup>), and blood phosphorus (P) values were measured using Colorimetric Roche kits on a Roche/Hitachi fully automated biochemical analyzer. Data collection and analysis followed. Results: Higher levels of age, systolic and diastolic blood pressures were found in the traumatic fracture group compared to the control group, whereas weight, height, and blood phosphorus did not differ significantly (P adjusting for age, systolic blood pressure, diastolic blood pressure, and blood phosphorus, binary logistic regression analysis revealed that blood calcium was a protective factor against traumatic fracture (β = -26.85, OR = 0.00, 95% CI = 0.00 -0.02, P = 0.022). Conclusion: The findings suggest that high and low blood calcium levels may serve as useful indicators in predicting the prognosis of fractures resulting from trauma.
基金supported by the National Natural Science Foundation of China(No.42307258)the technological research projects in Sichuan Province(No.2022YFSY0007)the China Atomic Energy Authority(CAEA)through the Geological Disposal Program.
文摘Stability analysis of underground constructions requires a model study of rock masses’ long-term performance. Creep tests under different stress conditions was conducted on intact granite and granite samples fractured at 30° and 45° angles. The experimental results indicate that the steady creep strain rates of intact and fractured rock present an exponential increase trend with the increase of stress level. A nonlinear creep model is developed based on the experimental results, in which the initial damage caused by fracture together with the damage caused by constant load have been taken into consideration. The fitting analysis results indicated that the model proposed is more accurate at identifying the full creep regions in fractured granite, especially the accelerated stage of creep deformation. The least-square fit error of the proposed creep model is significantly lower than that of Nishihara model by almost an order of magnitude. An analysis of the effects of elastic modulus, viscosity coefficient, and damage factors on fractured rock strain rate and creep strain is conducted. If no consideration is given to the effects of the damage, the proposed nonlinear creep model can degenerate into to the classical Nishihara model.
基金funded by Shaanxi Natural Science Basic Research Program Project Study on Liquid Propellant High Energy Gas Fracturing Mechanism in Radial Well Based on Phase Field Method(No.2019JQ-824)NSFC Projects Evolution Mechanism and Effectiveness Evaluation of Fracture Network Produced by Volume Fracturing with Tighter Clusters in Continental Shale Oil Reservoir(No.52274040)+1 种基金Study on Thermal Secondary Pore Evolution and Salt Precipitation Regulation Mechanism in Fire Flooding Reservoirs Based on Multi-field Coupling of Thermal-Flow-Solid-Chemical(No.52274039)Xi’an Shiyou University Youth Scientific Research and Innovation Team Operation Funds in 2018 Flow Mechanism of Complex Reservoirs and High Efficiency Development and Oil Production Technology(No.115080020).
文摘Horizontal well-stimulation is the key to unconventional resource exploration and development.The development mode of the well plant helps increase the stimulated reservoir volume.Nevertheless,fracture interference between wells reduces the fracturing effect.Here,a 2D hydro-mechanical coupling model describing hydraulic fracture(HF)propagation is established with the extended finite element method,and the effects of several factors on HF propagation during multiple wells fracturing are analyzed.The results show that with an increase in elastic modulus,horizontal principal stress difference and injection fluid displacement,the total fracture area and the reservoir stimulation efficiency are both improved in all three fracturing technologies.After a comparison of the three technologies,the method of improved zipper fracturing is proposed,which avoids mutual interference between HFs,and the reservoir stimulation effect is improved significantly.The study provides guidance for optimizing the fracturing technology of multiple horizontal wells.
文摘Introduction: Forearm fractures involving both the radius and ulna, present distinctive challenges in orthopedic trauma management. This case report explores the complexities of a rare case of bilateral fractures, emphasizing the importance of a comprehensive approach for optimal outcomes. Case Presentation: This report presents the case of a 40-year-old motorcyclist who was involved in a road accident and arrived at the emergency department shortly after the incident. Clinical examination revealed closed fractures in both forearms with mild swelling and severe tenderness. Fortunately, no neurovascular issues or compartment syndrome were detected. The patient was administered intravenous fluids and effective pain relief. Forearm splints were applied and the arms were elevated using pillows. Radiographs showed fractures in the right distal radius and ulna, as well as the left mid-shaft radius and ulna. Under general anesthesia, open reduction and internal fixation were per-formed using plates and screws for all four fractures. Postoperatively, the patient’s arms were immobilized and elevated, with gradual recovery during follow-up appointments over six months, eventually achieving full function without complaints. Conclusion: This article highlights the possibility, although infrequent, of bilateral shaft fractures of the ulna and radius. With thorough clinical assessment and radiological investigation, such fractures can be well-defined. The required definitive treatment, which usually involves open reduction and internal fixation, can be performed.
