Objective To investigate the cl inical characteristics and methods of diagnosis and treatment of multiple level thoracolumbar spinal fractures. Methods From March 2002 to March 2006, 17 patients with 35 thoracolumbar spinal fractures were treated, 13 males and 4 females, aged 21-52 years old (36.4 on average), among whom there were 10 cases of traffic accident injury and 7 of high fall ing injury. One fracture was located at T2, 1 at T3, 1 at T10, 4 at T11, 6 at T12, 5 at L1, 3 at L2, 7 at L3, 5 at L4, and 2 at L15, with a total of 35 segments including 26 segments with unstable fractures and 9 segments with stable compression fractures. According to the Frankel grade, there was 1 case of grade A, 1 of grade B, 2 of grade C, 5 of grade D and 8 of grade E. The preoperative height of the anterior border of the vertebral body was (20.8 ± 3.8) mm and the preoperative kyphosis angle was (16.2 ± 3.4)°. All the unstable fractures were performed operation. Sixteen injured vertebras were treated with long-segment pedicle screw internal fixation; 8 were treated with short-segment pedicle screw internal fixation, and 2 were treated with anterior fusion and fixation. Five injured vertebras with stable compression fractures were not treated and 4 were treated with pedicle screw implantation. Results The operation time was 1.8-4.2 hours and the amount of blood loss was 300-900 mL. The incisions obtained heal ing by first intention after the operation. All 17 patients were followed up for 13-41 months (18 months on average), and radiological evaluation showed no failure of the internal fixation. After the operation, the Frankel scale assessment showed that 1 patient of grade A improved to grade B, 1 of grade B improved to grade C, 1 of grade C improved to grade D, 1 of grade C improved to grade E, 5 of grade D improved to grade E, and 8 of grade E had no improvement. At the final postoperative follow-up, the height of the anterior border of the vertebral body was (31.9 ± 3.2) mm and the kyphosis angle was (6.8 ± 3.7)°, which were significantly different from those of preoperation (P lt; 0.01). Conclusion The treatment of multiple level thoracolumbar spinal fractures should be individual ized according to the patients’ actual conditions in order to obtain decompression and stabil ity of spines.
Objective To study the clinical effects of the artificial vertebral body of the biomimetic nanohydroxyapatite/polyamide 66 (nHA/PA66) compositefor the structural reconstruction and the height restoring of the vertebral body in the thoracolumbar fractures by the anterior surgical procedures. Methods From December 2003 to January 2006, 42 patients with thoracolumbar fractures received the anterior surgical procedures to decompress and reconstruct the spinal vertebral structure with the artificial vertebral body of the nHA/PA66 composite. Among the patients, there were 28 males and 14 females, aged 1767 years, averaged 43.6 years. The thoracolumbar fractures developed at T12 in 5 patients, at L1 in 17, at L2 in 14, and at L3 in 6. The height of the anterior border of thevertebral body amounted to 29%-47% of the vertebral body height, averaged 40.6%.The Cobb angle on the sagittal plane was 2138° averaged 27.6°. According tothe Frankel grading scale, the injuries to the nerves were as the following: Grade A in 7 patients, Grade B in 19, Grade C in 8, Grade D in 6, and Grade E in 2. Results All the 42 patients were followed up for 625 months. Among the patients, 36 were reconstructed almost based on the normal anatomic structure, and 6 were well reconstructed. The mean height of the anterior border of the vertebralbody was 40.6% of the vertebral body height before operation but 91.7% after operation. And the reconstructed height of the vertebra was maintained. The mean Cobb angle on the sagittal plane was 27.6°before operation but 13.4° after operation. All the patients had a recovery of the neurological function that had a 1grade or 2grade improvement except 7 patients who were still in Grade A and 2 patients who were in Grade D. The implant was fused 35 months after operation. No infection, nail break, bar/plate break or loosening of the internal fixation occurred. Conclusion The artificial vertebral body of the biomimetic nHA/PA66 composite can effectively restore the height and the structure of the vertebra, can be fused with the vertebral body to reconstruct the spinal structural stability effectively, and can be extensively used in the clinical practice.
Objective To evaluate the effect of self-designed antirotation reduction internal fixator(ARRIF) on treating different spine segment fracture.Methods From August 1999 to March 2003, 76 patients(48 males and 28 females, aged from 22 to 59 with an average of 34.1) with thoracolumbar fracture were operatively treated by ARRIF. The follow-up period ranged from 6 to 21 months(15 months in average). Classification according to injury segment: flexion compression racture 27 cases, burst fracture 42 cases, flexion distraction injury 3 cases, flexion revolving type fracture dislocation 2 cases, shear force type dislocation 2 cases. Classification according Frankel’s grade:A grade 16 cases, B grade 15 cases, C grade 27 cases, D grade 10 cases, E grade 8 cases.Operation duration, volume of bleeding, incidence postoperation complication and effect of reduction fixation were observed. Results The operation duration of ARRIF was 1.2 h in average, and there was about 200 ml volume of bleeding during operation. The nerve function showed one Frankel’s grade improvement after operation were as follows:A grade 8 cases(50%), B grade 11 cases (73.3%), C grade20 cases(74.1%), D grade 3 cases (30%); 2 Frankel’s E cases have no nerve function changes.The nerve function damage have no aggravation in all the patients,the postoperation Cobb’s angle was averagely corrected 22°. The horizontal displacement of dislocation vertebrae was averagely corrected 28% in sagittal plane, the statistical analysis had significant variance(Plt;0.01).ARRIF had no complications of the breakage of screws and rods. Conclusion ARRIF proves to be a valid internal fixator in reducing and fixing different thoracic lumbar segment spine fracture.
OBJECTIVE: To observe the clinical results in the anterior stabile operation of spinal fracture using red blood salvage. METHODS: Nineteen cases with spinal fracture were performed the anterior decompress operation. Blood cell salvage were used during operation. Other 20 cases were also reviewed as control group, who were received the same operation without blood cell salvage. RESULTS: In the 19 cases, average volume of autologous transfusion was 536 ml. Only two cases had homologous transfusion requirements. In the control group, all cases needed homologous transfusion (averaged 947 ml). CONCLUSION: In the anterior decompress operation, the intraoperative blood salvage is highly effective in reducing transfusion and also improves the security of operation
ObjectiveTo compare the clinical results of throacolumbar fractures treated through Wiltse paraspinal approach and conventional posterior approach. MethodsSeventy-six cases of single segmental thoracolumbar fractures (Type A) were treated by posterior reduction and pedicle screw instrumentation from January 2011 to January 2013. Thirty-five cases were treated through Wiltse paraspinal approach (group A), including 27 males and 8 females with an average age of 39.7 years. Forty-one cases were treated through conventional posterior approach (group B), including 30 males and 11 females with an average age of 41.6 years. The data including incision length, operation time, intraoperative blood loss, postoperative volume of drainage, the anterior vertebral height, Cobb angle and complications were compared between the two groups. ResultsAll operations were finished successfully. The incision length, operation time, intraoperative blood loss and postoperative volume of drainage were (8.3±1.9) cm, (74.0±21.9) min, (125.0 ±46.7) mL, and (51.0±42.6) mL respectively in group A, and (10.7±2.8) cm, (97.0±18.2) min, (245.0±56.1) mL, and (190.0±72.3) mL in group B respectively. There was significant difference between the two groups (P<0.05). The restoration of anterior vertebral height and the correction of Cobb angle were well maintained in both groups. The difference was statistically significant before and after treatment (P<0.05), but there was no significant difference between the two groups (P>0.05). There was no difference in the complication rate between the two groups (P>0.05). ConclusionCompared with conventional posterior approach, Wiltse paraspinal approach has the advantage of shorter operation time, less trauma and blood loss. It is a better option for the treatment of throacolumbar fractures.
Objective To explore the short-term therapeutic effect of mini-incision common vertebral pedicle screw internal fixation on thoracoclumbar fractures without neurological injury. Methods The data of 61 patients with thoracolumbar fractures without neurological injury treated with mini-incision common vertebral pedicle screw internal fixation (the mini-incision group, n=32) or percutaneous pedicle screw fixation (the percutaneous group, n=29) from February 2014 to January 2016 was retrospectively collected and analyzed. Total incision length, operation time, blood loss, fluoroscopy times, postoperative bed rest time, hospitalization costs, Visual Analogue Scale (VAS) score, Oswestry Disability Index (ODI), vertebral Cobb angle of correction, and accuracy rate of screw placement were compared between the two groups. Results All the patients were followed up for 6 to 24 months with a mean of 13.4 months. There were no complications such as incision infection and neurovascular injury except for 2 screws breakage in one patient in the percutaneous group. In the mini-incision group, the average total incision length was longer than that in the percutaneous group [(7.33±0.53) vs. (6.38±0.44) cm], while the average operation time was shorter than that in the percutaneous group [(62.66±4.75) vs. (72.93±5.09) minutes]; the differences were statistically significant (P<0.001). In the mini-incision group, the average frequency of fluoroscopy was fewer [(5.63±0.61)vs. (19.07±1.60) times] and the average hospitalization costs was lower [(23.3±1.5) thousand yuan vs. (39.5±1.6) thousand yuan] than those in the than that in the percutaneous group; the differences were statistically significant (P<0.001). No significant difference was found in blood loss, postoperative bed rest time, VAS score, ODI, vertebral Cobb angle of correction, and accuracy rate of screw placement between the two groups (P>0.05). Conclusions Mini-incision common vertebral pedicle screw internal fixation for thoracoclumbar fractures without neurological injury has the advantages of short operation time, less fluoroscopy times, low hospitalization costs and high fixation strength. It may obtain a good short-term effectiveness.
Thoracolumbar fractures are common injuries. Accurate diagnosis and classification are of great significance for guiding treatment. Although there are many classification systems, they have not been universally accepted and used to guide clinical practice. Denis classification, load sharing classification, Magerl/AO classification, and Thoracolumbar Injury Classification and Severity Score have a great clinical influence, but they also have some shortcomings. Recently, some new classifications of thoracolumbar fractures have been proposed, and some of them have been updated and revised, which makes it easy to cause confusion, and puts forward new requirements on how to grasp and apply these classification systems. This article reviews the main and commonly used classification systems of thoracolumbar fractures, discusses the main viewpoints, advantages and disadvantages of each classification system, and looks ahead to the future research direction.