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Objective:To discuss the curative effect between direct decompression and indirect decompression plus lumbo-iliac fixation for treatment of Denis type II sacrum fracture combined with sacral foraminal bone space-occupying lesion and sacral nerve injury.Methods:A retrospective case-control study was performed on clinical data of 47 patients with Denis type II sacrum fracture combined with sacral foraminal bone space-occupying lesion and sacral nerve injury admitted to Honghui Hospital Affiliated to Xi'an Jiaotong University School of Medicine from March 2012 to March 2017. All patients underwent lumbo-iliac internal fixation. The operation time ranged from 3 to 14 days after injury, with an average of 6 days. In direct decompression group ( n=26), the sacral foramina mass was removed during the operation and direct decompression was performed. There were 16 males and 10 females, with age of (36.2±8.4)years. In indirect decompression group ( n=21), indirect decompression through traction and distraction was performed. There were 11 males and 10 females, with the age of (38.7±9.8)years. Operation time, intraoperative blood loss, bone union, Mears imaging evaluation, Gibbons score, and Majeed function score were compared between the two groups. Postoperative complications were observed as well. Results:All patients were followed up for 1233 months, with an average of 16.7 months. The operation time and intraoperative blood loss in direct decompression group were (112.3±26.3)minutes and (512.1±29.4)ml, which had no significant differences in comparison with that in indirect decompression group [(129.3±25.1)minutes and (529.7±22.1)ml] ( P>0.05). Bone union was observed in all patients. According to the Mears imaging evaluation, the direct decompression group had anatomical reduction in 17 patients, and satisfactory reduction in 9, and the indirect decompression group had anatomical reduction in 15 patients and satisfactory reduction in 6 ( P>0.05). At the last follow-up, Gibbons score in direct decompression group was lower than that in the indirect decompression group [(1.2±0.3)points vs. (2.2±0.5)points] ( P<0.01); Majeed function score in direct decompression group was higher than that in indirect decompression group [(87.3±11.4)points vs. (68.5±16.7)points] ( P<0.01). In direct decompression group, 1 patient had deep wound infection, while in indirect decompression group, 1 patient had pressure sore due to the protrusion of the tail of the iliac screws on the skin. Conclusion:For Denis type II sacrum fracture combined with sacral foraminal bone space-occupying lesion and sacral nerve injury, direct decompression with lumbo-iliac fixation can obtain better neural functional recovery and functional recovery of life compared with the indirect decompression.
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Vertebral body augmentation for spine-related diseases has the advantages of minimally invasive surgery,obvious postoperative pain relief,and quick postoperative recovery compared with open surgery.It can quickly reconstruct spinal stability,relieve pain,and improve patients' quality of life.Intraoperative injection of bone cement into the diseased vertebral body carries the risk of bone cement leakage during the process.Knowing well the complications is helpful to the timely clinical treatment so as to avoid delays,and understanding the risk factors can facilitate targeted measures to prevent leakage during surgery.Therefore,to understand the consequences of bone cement leakage,leakage incidence rate,related risks factors and preventative measures is conducive to clinical treatment and surgery safety.The authors discuss the complications and risk factors related to bone cement leakage after vertebral body augmentation,in order to deepen the understanding of bone cement leakage,provide reference for clinical work,and improve the safety of surgery.
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Sacral fractures are usually caused by high-energy violence,often complicated with injury to the lumbosacral plexus.In severe cases,they may cause instability of the posterior pelvic ring or of the lumbosacral junction.Their classifications commonly used in clinic are Denis,Tile,Isler and refined Denis type Ⅲ ones proposed by Roy-Camille and Gibbons.Recently,classifications of the lumbosacral lesions and scoring systems of the injury severity have often been used clinically.At present,internal instrumentation of sacral fractures is developing along the direction of high efficiency,safety and minimal invasion,but different methods of internal fixation have their own indications which should be strictly followed.This review summarizes the classifications of sacral fractures and their treatment advances.
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Objective To investigate the correlation factors for surgical outcome of sacral decompression and lumbopelvic fixation in H-shaped sacral fracture and the methods to prevent and treat the complications.Methods From January 2008 to January 2016,45 patients with H-shaped sacral fracture treated by sacral decompression and lumbopelvic fixation were respectively analyzed,including 29 men and 16 women,mean age 41.2 (range,24-53 years),mean follow-up time 52.6 months (range,16-93 months).The surgical outcome was evaluated by pelvic outcome score,and correlation factors were analyzed.We analyzed whether each factor was in correlation with pelvic outcome score.Then we integrated the statistically significant indicators into Logistic regression equation to determine the related factors.Postoperative complications were all recorded.Results The average operation time was 161.2 min (range,100-220 min),average blood loss was 491.6 ml (range,370-1 000 ml),injury-surgery interval was 7.2 d (range,1-23 d).In terms of pelvic outcome score,31 (68.9％) patients had satisfactory result and 14 (31.3％) patients had unsatisfactory result.Univariate x2 analysis suggested that cauda equina injury,Roy-Camille classification,L5S1 facet injury,fracture line,kyphotic angle,injury-surgery interval,decompression approach and inserting sacral screws were correlated with pelvic outcome score,but gender,age,injury mechanism and L5 pedicle fracture had no relation with pelvic outcome score.The multivariate Logistic regression analysis showed that cauda equina injury,Roy-Camille classification,fracture line,kyphotic angle,injury-surgery interval,decompression approach and inserting sacral screws were closely related to pelvic outcome score,but L5S1 facet injury was excluded.2 patients required early surgical procedures with proper antibiotics for deep wound infection;3 patients complained pain related to hardware prominence and the pain subsided after removal of implants;1 patient got unilateral rod breakage at 3-6 months and achieved bony fusion after nine months of observation.Conclusion Sacral decompression and lumbopelvic fixation is effective in neurological recovery and early ambulation in treating H-shaped sacral fracture.Better surgical outcome is related to timely surgery,preoperative or intraoperative bone traction,sacral screws insertion,incomplete cauda equina injury,Roy-Camille type Ⅱ,fracture line penetrating S2 and kyphotic angle less than 40°.
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Objective To develop a gas chromatography-mass spectrometric method(GC/MS) for simultaneous determination of environmental estrogens including 4-nonylphenol,bishphenol A,diethylstilbestrol and 17?-ethinylestradiol and endogenic estrogens including 17?-estradiol,17?-estradiol,estriol and estrone in mutton. Methods Mutton samples were extracted using a mixture of acetonitrile-ethyl acetate(3∶2,V/V) and cleaned up by florisil cartridge. Derived with pentafluoropropionic anhydride(PFPA) ,the derivatives were determined by GC-MS. Results The linear range of determination was 0.2-5.0 ?g/kg. The intraday relative standard deviations of the peak area were 1.25%—5.85% and the detection limits ranged from 0.024 to 1.40 ?g/kg,and the rates of recovery ranged from 71.5%—111.0% except for 17?-ethinylestradiol( 55.4%) . Conclusion This method is simple,rapid,accurate and applicable to the determination of trace environmental estrogens in mutton