Fracturas vertebrales causadas por reductores de velocidad o "lomos de burro" / Spinal fractures caused by speed bumps

Objetivo: Presentar una serie de casos de fracturas vertebrales en pasajeros de autobús asociadas al pasaje por reductores de velocidad. Materiales y métodos: Se realizó un estudio descriptivo y retrospectivo de una serie de casos de lesiones vertebrales torácicas y lumbosacras sufridas por pasajeros a causa del impacto del vehículo con reductores de velocidad. Se incluyó a pacientes tratados en dos instituciones, entre el 1 de enero de 2012 y el 1 de enero de 2023. Resultados: Se registraron 23 pacientes con lesiones vertebrales de la columna toraco-lumbosacra, 14 mujeres (60,9%) y 9 hombres (39,1%), promedio de la edad 43 años (DE ± 12; rango 25-62). Casi todos eran pasajeros (n = 22; 95,7%) que viajaban sentados en la última fila del autobús (n = 20; 86,5%). Un solo caso correspondía a un conductor del vehículo. Se documentaron 29 lesiones vertebrales, 28 fracturas toracolumbares (de T10 a L2; 96,6%) y una fractura de coxis (3,4%). La vértebra más comprometida fue L1 (n = 16; 55%). Las fracturas más graves (A3/A4) se asociaron con tratamiento quirúrgico (p = 0,007) y una mayor mediana de días de internación (p = 0,005). Conclusiones: Las lesiones vertebrales asociadas al impacto vehicular con reductores de velocidad son fracturas causadas por un mecanismo de compresión axial, más frecuentes en pasajeros ubicados en la última fila de asientos del autobús. Comprometen predominantemente la charnela toracolumbar y la vértebra fracturada con más frecuencia es L1 y exclusivamente uno de los platillos vertebrales. Nivel de Evidencia: IV

Objective: To present a case series of spinal fractures in bus passengers caused by passing over speed bumps. materials and methods: A descriptive and retrospective study of a case series of thoracic and lumbosacral spinal injuries suffered by passengers as a result of vehicle impacts with speed bumps was conducted. Patients treated at two institutions from January 1, 2012 to January 1, 2023 were included. Results: 23 patients with vertebral injuries of the thoracolumbosacral spine were recorded: 14 women (60.9%) and 9 men (39.1%), average age 43 years (SD±12; range=25-62). Almost all of the patients were passengers (n=22, 95.7%) sitting in the last row of seats on the bus (n=20, 86.5%). A single case was documented involving the vehicle's driver. 29 spinal injuries were recorded, 28 thoracolumbar fractures (from T10 to L2; 96.6%) and 1 coccyx fracture (3.4%). The most frequently involved vertebra was L1 (n=16; 55%). The most severe fractures (A3/A4) were associated with surgical treatment (p=0.007) and a longer median hospital stay (p=0.005). Conclusions: Spinal injuries during vehicular impact with speed bumps are caused by an axial compression mechanism, with greater involvement of passengers who are located in the last row of seats. They primarily affect the thoracolumbar joint, with the L1 vertebra and exclusively one of the vertebral endplates being fractured most frequently. Level of Evidence: IV

Retrospective clinical study of hip replacement in the treatment of traumatic arthritis secondary to acetabular fracture / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of total hip replacement (THA) in the treatment of traumatic arthritis secondary to acetabular fracture.@*METHODS@#From October 2019 to June 2022, 15 patients with secondary traumatic arthritis of acetabulum fracture were treated with THA. There were 8 males and 7 females, aged from 40 to 76 years old with an average of (59.20±9.46) years old. Prosthesis loosening, dislocation of hip joint, range of motion of hip joint, nerve injury and other conditions were recorded before and after surgery. Harris score, visual analogue scale (VAS) and imaging were used to evaluate hip joint function and surgical effect.@*RESULTS@#Follow-up time ranged 6 to 39 months with an average of (18.33±9.27) months. All the 15 patients successfully completed the operation, no nerve and blood vessel injury during the operation, postoperative wound healing was stageⅠ, no infection, one case of acetabular side prosthesis loosening at half a year after operation, and recovered well after revision surgery, one case of hip dislocation was cured after open reduction treatment, no adverse consequences. Harris score at the last postoperative follow-up was (88.60±4.01) points, compared with the preoperative (47.20±11.77) points, the difference was statistically significant (P<0.05), and VAS at the lateat postoperative follow-up was 1 (1) points, compared with the preoperative 8 (2) points, the difference was statistically significant (P<0.05). At the last follow-up, the pain symptoms were relieved or disappeared, and the joint function was satisfactory. The imaging data of the latest follow-up showed joint was well pseudoradiated, no abnormal ossification occurred, and the prosthesis was not loose.@*CONCLUSION@#THA is effective in the treatment of traumatic arthritis secondary to acetabular fracture and can effectively improve the quality of life of patients. Preoperative comprehensive evaluation and bone defect evaluation of patients, and intraoperative management of acetabulum, femur, internal fixation and bone defect are key factors for the success of surgery.

Clinical study of modified suspension reduction method combined with percutaneous vertebroplasty in the treatment of thoracolumbar osteoporotic compression fracture / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of modified suspension reduction method combined with percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar compression fractures.@*METHODS@#From February 2020 to October 2021, 92 patients with thoracolumbar osteoporotic compression fracture were treated by percutaneous vertebroplasty. According to different treatment methods, they were divided into the observation group and the control group. The observation group was treated with modified suspension reduction and then percutaneous vertebroplasty, while the control group was treated with percutaneous vertebroplasty alone. The observation group (47 cases), including 20 males and 27 females, the age ranged from 59 to 76 years old with an average of (69.74±4.50) years old, fractured vertebral bodies:T10(2 cases), T11(7 cases), T12(19 cases), L1(14 cases), L2(5 cases);the control group(45 cases), including 21 males and 24 females, the age ranged from 61 to 78 years old with an average of (71.02±3.58) years old, fractured vertebral bodies:T10(3 cases), T11(8 cases), T12(17 cases), L1(12 cases), L2(5 cases);The leakage of bone cement were observed, the visual analogue scale (VAS), Oswestry lumbar dysfunction index (ODI), anterior vertebrae height (AVH), Cobb angle of kyphosis and the amount of bone cement injected before and after operation were recorded and compared between the two groups.@*RESULTS@#All patients were followed up, ranged from 6 to10 with an average of (8.45±1.73) months. Two patients ocurred bone cement leakage in observation group and 3 patients in control group. AVH of observation group increased (P<0.05) and Cobb angle of injured vertebrae decreased (P<0.05). Cobb angle of injured vertebrae and AVH of the control group were not significantly changed (P>0.05). Cobb angle of injured vertebrae of the observation group was lower than that of control group (P<0.05) and AVH was higher than that of the control group (P<0.05). In the observation group, VAS before operation and 1 week, 3 and 6 months after operation respectively were(7.32±1.05) scores, (3.56±1.18) scores, (1.83±0.67) scores, (1.27±0.34) scores, and ODI were(40.12±14.69) scores, (23.76±10.19) scores, (20.15±6.39) scores, (13.45±3.46) scores. In the control group, VAS before operation and 1 week, 3 and 6 months after operation respectively were(7.11±5.26) scores, (3.82±0.68) scores, (1.94±0.88) scores, (1.36±0.52) scores, and ODI were(41.38±10.23) scores, (25.13±14.22) scores , (20.61±5.82) scores, (14.55±5.27) scores . The scores of VAS and ODI after operation were lower than those before operation (P<0.05), but there was no significant difference between the two groups (P<0.05).@*CONCLUSION@#Modified suspension reduction method combined with PVP surgery for osteoporotic thoracolumbar compression fractures has achieved good clinical results, which can effectively relieve lumbar back pain, restore vertebral height, correct kyphosis, improve lumbar function and patients' quality of life.

Application value of bone cement containing rhbFGF and RHBMP-2 in PKP treatment of osteoporotic lumbar compression fracture / 中国骨伤

OBJECTIVE@#To investigate the effect of bone cement containing recombinant human basic fibroblast growth factor (rhbFGF) and recombinant human bone morphogenetic protein-2 (rhBMP-2) in percutaneous kyphoplasty(PKP)treatment of osteoporotic vertebral compression fracture(OVCF).@*METHODS@#A total of 103 OVCF patients who underwent PKP from January 2018 to January 2021 were retrospectively analyzed, including 40 males and 63 females, aged from 61 to 78 years old with an average of (65.72±3.29) years old. The injury mechanism included slipping 33 patients, falling 42 patients, and lifting injury 28 patients. The patients were divided into three groups according to the filling of bone cement. Calcium phosphate consisted of 34 patients, aged(65.1±3.3) years old, 14 males and 20 females, who were filled with calcium phosphate bone cement. rhBMP-2 consisted of 34 patients, aged (64.8±3.2) years old, 12 males and 22 females, who were filled with bone cement containing rhBMP-2. And rhbFGF+rhBMP-2 consisted of 35 patients, aged (65.1±3.6) years old, 14 males and 21 females, who were filled with bone cement containing rhbFGF and rhBMP-2. Oswestry disability index (ODI), bone mineral density, anterior edge loss height, anterior edge compression rate of injured vertebra, visual analog scale (VAS) of pain, and the incidence of refracture were compared between groups.@*RESULTS@#All patients were followed for 12 months. Postoperative ODI and VAS score of the three groups decreased (P<0.001), while bone mineral density increased (P<0.001), anterior edge loss height, anterior edge compression rate of injured vertebra decreased first and then slowly increased (P<0.001). ODI and VAS of group calcium phosphate after 1 months, 6 months, 12 months were lower than that of rhBMP-2 and group rhbFGF+rhBMP-2(P<0.05), bone mineral density after 6 months, 12 months was higher than that of rhBMP-2 and group calcium phosphate(P<0.05), and anterior edge loss height, anterior edge compression rate of injured vertebra of group rhbFGF+rhBMP-2 after 6 months and 12 months were lower than that of group rhBMP-2 and group calcium phosphate(P<0.05). There was no statistical difference in the incidence of re-fracture among the three groups (P>0.05).@*CONCLUSION@#Bone cement containing rhbFGF and rhBMP-2 could more effectively increase bone mineral density in patients with OVCF, obtain satisfactory clinical and radiological effects after operation, and significantly improve clinical symptoms.

Improved unilateral puncture PVP based on 3D printing technology for the treatment of osteoporotic vertebral compression fracture / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of unilateral percutaneous vertebroplasty (PVP) combined with 3D printing technology for the treatment of thoracolumbar osteoporotic compression fracture.@*METHODS@#A total of 77 patients with thoracolumbar osteoporotic compression fractures from October 2020 to April 2022 were included in the study, all of which were vertebral body compression fractures caused by trauma. According to different treatment methods, they were divided into experimental group and control group. Thirty-two patients used 3D printing technology to improve unilateral transpedicle puncture vertebroplasty in the experimental group, there were 5 males and 27 females, aged from 63 to 91 years old with an average of (77.59±8.75) years old. Forty-five patients were treated with traditional bilateral pedicle puncture vertebroplasty, including 7 males and 38 females, aged from 60 to 88 years old with an average of(74.89±7.37) years old. Operation time, intraoperative C-arm X-ray times, anesthetic dosage, bone cement injection amount, bone cement diffusion good and good rate, complications, vertebral height, kyphotic angle (Cobb angle), visual analogue scale(VAS), Oswestry disability index (ODI) and other indicators were recorded before and after surgery, and statistically analyzed.@*RESULTS@#All patients were followed up for 6 to 23 months, with preoperative imaging studies, confirmed for thoracolumbar osteoporosis compression fractures, two groups of patients with postoperative complications, no special two groups of patients' age, gender, body mass index (BMI), time were injured, the injured vertebral distribution had no statistical difference(P>0.05), comparable data. Two groups of patients with bone cement injection, bone cement dispersion rate, preoperative and postoperative vertebral body height, protruding after spine angle(Cobb angle), VAS, ODI had no statistical difference(P>0.05). The operative time, intraoperative fluoroscopy times and anesthetic dosage were statistically different between the two groups(P<0.05). Compared with the traditional bilateral puncture group, the modified unilateral puncture group combined with 3D printing technology had shorter operation time, fewer intraoperative fluoroscopy times and less anesthetic dosage. The height of anterior vertebral edge, kyphosis angle (Cobb angle), VAS score and ODI of the affected vertebrae were statistically different between two groups at each time point after surgery(P<0.05).@*CONCLUSION@#In the treatment of thoracolumbar osteoporotic compression fractures, 3D printing technology is used to improve unilateral puncture PVP, which is convenient and simple, less trauma, short operation time, fewer fluoroscopy times, satisfactory distribution of bone cement, vertebral height recovery and kyphotic Angle correction, and good functional improvement.

O-arm navigation versus C-arm navigation for guiding percutaneous long sacroiliac screws placement in treatment of Denis type Ⅱ sacral fractures / 中国修复重建外科杂志

OBJECTIVE@#To compare the effectiveness of O-arm navigation and C-arm navigation for guiding percutaneous long sacroiliac screws in treatment of Denis type Ⅱ sacral fractures.@*METHODS@#A retrospective study was conducted on clinical data of the 46 patients with Denis type Ⅱ sacral fractures between April 2021 and October 2022. Among them, 19 patients underwent O-arm navigation assisted percutaneous long sacroiliac screw fixation (O-arm navigation group), and 27 patients underwent C-arm navigation assisted percutaneous long sacroiliac screw fixation (C-arm navigation group). There was no significant difference in gender, age, causes of injuries, Tile classification of pelvic fractures, combined injury, the interval from injury to operation between the two groups ( P>0.05). The intraoperative preparation time, the placement time of each screw, the fluoroscopy time of each screw during placement, screw position accuracy, the quality of fracture reduction, and fracture healing time were recorded and compared, postoperative complications were observed. Pelvic function was evaluated by Majeed score at last follow-up.@*RESULTS@#All operations were completed successfully, and all incisions healed by first intention. Compared to the C-arm navigation group, the O-arm navigation group had shorter intraoperative preparation time, placement time of each screw, and fluoroscopy time, with significant differences ( P<0.05). There was no significant difference in screw position accuracy and the quality of fracture reduction ( P>0.05). There was no nerve or vascular injury during screw placed in the two groups. All patients in both groups were followed up, with the follow-up time of 6-21 months (mean, 12.0 months). Imaging re-examination showed that both groups achieved bony healing, and there was no significant difference in fracture healing time between the two groups ( P>0.05). During follow-up, there was no postoperative complications, such as screw loosening and breaking or loss of fracture reduction. At last follow-up, there was no significant difference in pelvic function between the two groups ( P>0.05).@*CONCLUSION@#Compared with the C-arm navigation, the O-arm navigation assisted percutaneous long sacroiliac screws for the treatment of Denis typeⅡsacral fractures can significantly shorten the intraoperative preparation time, screw placement time, and fluoroscopy time, improve the accuracy of screw placement, and obtain clearer navigation images.

Morbilidad de las fracturas vertebrales osteoporóticas durante el aislamiento social en la pandemia COVID-19 / Osteoporotic vertebral fractures morbidity during social isolation on COVID-19 pandemic

Introducción: la pandemia por COVID-19 afectó negativamente los sistemas de salud. Las fracturas vertebrales osteoporóticas y el aislamiento social se relacionan con mayor morbimortalidad. Objetivos: caracterizar la morbilidad de las fracturas vertebrales osteoporóticas y evaluar una posible relación entre morbilidad y nivel de aislamiento social se-cundario al estado de pandemia. Material y métodos: estudio observacional, analítico y transversal. Resultados: se incluyeron en el estudio 45 adultos. La fractura fue mayorita-riamente lumbar con una evolución superior de 3 meses. El 35% presentaba seguimiento, el 48% había recibido tratamiento para osteoporosis y el 48% presentaba fracturas previas documentadas. El 46% refirió falta de accesibilidad al sistema. Se evaluó el aisla-miento social con la escala sociofamiliar de Gijón, que evidenció una situación buena en el 75% y un deterioro social intermedio/severo en el 24%. El Índice de Oswestry mostró una discapacidad mínima/moderada en el 66% y severa o mayor en el 33%. Se evaluó el dolor por la Escala análoga visual (VAS) y se obtuvo un VAS mayor de 5 en el 57%. Al comparar el grupo de situación sociofamiliar buena con el de deterioro social intermedio/severo se observó una diferencia en multipli-cidad de fracturas (p 0,030), hipovitaminosis D (p 0,045) y falta de accesibilidad (p 0,029). En discapacidad y dolor no hubo diferencias. Conclusión: el grupo con mayor aislamiento presentó una enfermedad más severa en términos de multiplicidad de fracturas e hipovitaminosis D; esto podría indicar una asociación entre aislamiento social secundario al estado de pandemia y morbilidad por las fracturas vertebrales. (AU)

Introduction: the COVID-19 pandemic had a negative impact on healthcare systems. Osteoporotic vertebral fractures and social isolation have a significant morbidity in our setting. Objectives: to characterize the morbidity of osteoporotic vertebral fractures and evaluate a potential relationship between morbidity and the level of social isolation secondary to the pandemic. Material and methods: observational, analytical and cross-sectional study. Results: forty-five adults were included. Fractures were mostly lumbar with a history of over 3 months. Thirty-five percent (35%) had been followed-up, 48% had been treated for osteoporosis and 48% had previous documented fractures. Forty-six percent (46%) reported lack of accessibility to healthcare. Social isolation was measured using Gijón ́s social-familial evaluation scale, which showed a good situation in 75% of cases and an intermediate/severe social deterioration in 24%. According to the Oswestry index, disability was minimal/moderate in 66% of cases and severe or worse in 33%. Pain was assessed using the Visual Analogue Scale (VAS), with a score greater than 5 recorded in 57% of patients. When comparing the group with a good social-familial situation vs. the group with intermediate/severe social deterioration, differences were found in multiplicity of fractures (p 0.030), hypovitaminosis D (p 0.045) and lack of accessibility (p 0.029). No differences were found in disability and pain. Conclusion: the group with higher levels of isolation exhibited more severe disease in terms of multiplicity of fractures and hypovitaminosis D, which might suggest an association between social isolation secondary to the pandemic and morbidity due to vertebral fractures. (AU)

Comparison Between Surgical and Conservative Treatment for AOSpine Type A3 and A4 Thoracolumbar Fractures without Neurological Deficit: Prospective Observational Cohort Study / Comparação entre tratamento cirúrgico e conservador para fraturas toracolombares AOSpine tipo A3 e A4 sem déficit neurológico: Estudo de coorte prospectivo observacional

Abstract Objective To compare the clinical results between conservative (CS) and surgical treatment (CXS) of A3 and A4 fractures without neurological deficit. Methods Prospective observational study of patients with thoracolumbar fractures type A3 and A4. These patients were separated between the surgical and conservative groups, and evaluated sequentially through the numeric rating scale (NRS), Roland-Morris disability questionnaire (RMDQ), EuroQol-5D (EQ-5D) quality of life questionnaire, and Denis work scale (DWS) up to 2.5 years of follow-up. Results Both groups showed significant improvement, with no statistical difference in pain questionnaires (NRS: CXS 2.4 ± 2.6; CS 3.5 ± 2.6; p> 0.05), functionality (RMDQ: CS 7 ± 6.4; CXS 5.5 ± 5.2; p> 0.05), quality of life (EQ-5D), and return to work (DWS). Conclusion Both treatments are viable options with equivalent clinical results. There is a tendency toward better results in the surgical treatment of A4 fractures.

Resumo Objetivo Comparar os resultados clínicos entre os tratamentos conservador (CS) e cirúrgico (CXS) das fraturas A3 e A4 sem déficit neurológico. Métodos Estudo prospectivo observacional de paciente com fraturas toracolombares tipo A3 e A4. Esses pacientes foram separados entre os grupos cirúrgico e conservador e avaliados sequencialmente através da escala numérica de dor (NRS), do questionário de incapacidade de Roland-Morris (RMDQ), do EuroQol-5D (EQ-5D) e da escala de trabalho de Denis (DWS) até 2,5 anos de acompanhamento. Resultados Ambos os grupos apresentaram melhora significante, sem diferença estatística nos questionários de dor (NRS: CXS 2,4 ± 2,6; CS 3,5 ± 2,6; p> 0,05), funcionalidade (RMDQ: CS 7 ± 6,4; CXS 5,5 ± 5,2; p> 0,05), qualidade de vida (EQ-5D) e retorno ao trabalho (DWS). Conclusão Ambos os tratamentos são opções viáveis e com resultados clínicos equivalentes. Há uma tendência a melhores resultados no tratamento cirúrgico das fraturas A4.

Spinal Cord Alignment in Patients with Thoracolumbar Burst Fracture / Alinhamento espinopélvico em pacientes com fratura toracolombar explosão

Abstract Objective To evaluate the spinopelvic alignment in patients with thoracolumbar burst fracture (TBF) without neurological deficit treated nonsurgically and surgically in a tertiary reference trauma hospital. Method Retrospective cross-sectional study of patients with single level, type A3 and A4 AOSpine TBF only of the thoracolumbar region. Analysis of clinical data, low back pain (visual analogue scale [VAS]), Denis Pain Scale, quality of life (SF-36), sagittal (TC, TLC, LL, SVA) and spinopelvic (IP, PV, SI, PI-LL) radiographic parameters of patients treated surgically and nonsurgically. Results A total of 50 individuals with an average age of 50 years old with a mean follow-up of 109 months (minimum of 19 and maximum of 306 months) were evaluated. There was a significant difference between treatments for the Denis Work Scale (p= 0.046) in favor of nonsurgical treatment. There was no significant difference between the treatments for lower back pain VAS and Denis Pain Scale (p= 0.468 and p= 0.623). There was no significant difference between treatments in any of the domains evaluated with the SF-36 (p> 0.05). Radiographic parameters were not different between the analyzed groups; however, all radiographic parameters showed significant difference between the population considered asymptomatic, except for pelvic incidence (p< 0.005). Conclusions The spinopelvic alignment was normal in patients with TBF without neurological deficit treated nonsurgically and surgically after a minimum follow-up of 19 months. However, they presented a higher mean pelvic version and discrepancy between lumbar lordosis and pelvic incidence when compared with the reference values of the Brazilian population.

Resumo Objetivo Avaliar o alinhamento espinopélvico em pacientes com fratura toracolombar do tipo explosão (FTE) sem déficit neurológico tratados de forma não operatória e operatória em um hospital terciário de referência em trauma. Método Estudo transversal retrospectivo de pacientes com FTE apenas da região toracolombar, de nível único, do tipo A3 e A4 AOSpine. Análise de dados clínicos, dor lombar (escala visual analógica [EVA]), Escala de Denis, qualidade de vida (SF-36), parâmetros radiográficos sagitais (cifose torácica [CT], cifose toracolombar [CTL], lordose lombar [LL] e eixo vertical sagital [EVS]) e espinopélvicos (incidência pélvica [IP], versão pélvica [VP], inclinação sacral [IS] e a discrepância entre incidência pélvica e lordose lombar [IP-LL]) de pacientes tratados de forma operatória e não operatória. Resultados O presente estudo avaliou um total de 50 indivíduos com uma média de 50 anos de idade com acompanhamento médio de 109 meses (mínimo de 19 e máximo de 306 meses). Houve diferença significativa entre os tratamentos para Denis trabalho (p= 0,046) a favor do tratamento não operatório. Não houve diferença significativa entre os tratamentos para EVA dor lombar e Denis dor (p= 0,468 e p= 0,623). Não houve diferença significante entre os tratamentos em nenhum dos domínios avaliados do SF-36 (p> 0,05). Parâmetros radiográficos não se mostraram diferentes entre os grupos analisados; contudo, todos os parâmetros radiográficos mostraram diferença significante entre a população considerada assintomática, com exceção da incidência pélvica (p< 0,005). Conclusões O alinhamento espinopélvico foi normal em pacientes com FTE sem déficit neurológico tratados de forma não operatória e operatória, após acompanhamento mínimo de 19 meses. Entretanto, estes pacientes apresentaram maior média de versão pélvica e de discrepância entre lordose lombar e incidência pélvica quando comparados com os valores de referência da população brasileira.

Lesiones vertebrales postraumáticas / Post-traumatic vertebral injuries

Introducción: Las lesiones raquídeas son frecuentes en hombres adultos jóvenes. Reconocer la cinemática ayuda a disminuir la tasa de diagnósticos tardíos, principalmente si hay trastornos de la conciencia. Las fracturas vertebrales pueden ser únicas o múltiples, y asociarse con lesiones extravertebrales. Los objetivos de este estudio fueron analizar la distribución de la lesión según el mecanismo de producción, caracterizar el cuadro neurológico, evaluar el patrón de lesión y la asociación con lesiones extra-vertebrales, y analizar el tratamiento. materiales y métodos: Estudio multicéntrico, prospectivo de pacientes con lesiones vertebrales postrauma, que ingresaron entre el 1 de julio de 2018 y el 30 de junio de 2020. Se analizaron los siguientes parámetros: edad, sexo, cinemática, cuadro neurológico, sector afectado, patrón de lesión, lesiones extravertebrales asociadas. Resultados: Se evaluó a 281 pacientes (60% hombres) con 400 lesiones vertebrales y 118 extravertebrales que, en 62 casos, conformaban un cuadro de politraumatismo; 147 con trauma por caída de altura y 98, por accidente de tránsito. El cuadro neurológico más observado fue ASIA E (8 casos), no determinado al ingreso. El sector T2-L5 fue el más afectado, en su mayoría, por lesiones por compresión. Las lesiones extravertebrales más frecuentes fueron el trauma de cráneo y de tórax; hubo un caso de SCIWORA y un óbito temprano. Conclusiones: Los sectores raquídeos más afectados fueron: el toracolumbar, el torácico y el lumbar; las lesiones suelen deberse a caídas de altura y suelen ser únicas, sin cuadro neurológico. El tratamiento se decide según la estabilidad y el cuadro neurológico. Nivel de Evidencia: IV

Introduction: Spinal injuries are common among young adult men. Recognizing kinematics can help reduce the number of late diagnoses, especially if there are consciousness disorders. Vertebral fractures can be single or multiple, and they are often associated with extravertebral injuries. Objectives: To examine the distribution of the lesion based on the mechanism of production, to characterize the neurological condition, to evaluate the lesion pattern and its relationship with extravertebral lesions, and to analyze the treatment. materials and methods:This was a multicenter, prospective study of patients admitted with post-trauma vertebral injuries between July 1, 2018 and June 30, 2020. Age, gender, kinematics, neurological condition, affected sector, pattern of injury, and associated extravertebral injuries were all examined. Results: There were 281 patients (60% men) evaluated, with 400 vertebral and 118 extravertebral lesions. The causes were as follows: polytrauma in 62 cases, falls from great heights in 147 patients, and traffic accidents in 98. ASIA E was the most frequently observed neurological picture (8 cases), which was not determined at admission. The T2-L5 sector was the most affected, mostly by compression injuries. Head and chest trauma were the most common extravertebral injuries; there was one case of SCIWORA and one early death. Conclusions: The most commonly affected spinal sectors were thoracolumbar, thoracic, and lumbar; the injuries are typically caused by falls from great heights and, in general, are isolated, with no neurological injuries. The treatment is determined by the stability and neurological condition. Level of Evidence: IV

Columna vertebral flotante y otras variantes de la asociación de múltiples fracturas vertebrales inestables simultáneas / Floating spine and other types of associated multiple simultaneous unstable spinal fractures

ntroducción: El objetivo de este estudio fue evaluar a una serie de pacientes con la asociación de múltiples fracturas vertebrales inestables (tipo B o C) simultáneas. Materiales y métodos: Estudio descriptivo de pacientes con trauma vertebromedular de alta energía y asociación de múltiples fracturas vertebrales inestables simultáneas entre enero de 2015 y enero de 2021. Se incluyó a pacientes con fracturas vertebrales múltiples tipo B (asociación de lesión ligamentaria) o tipo C (evidencia de subluxación/luxación). Se excluyó a pacientes con registros incompletos de historias clínicas, fracturas por osteoporosis o patológicas y seguimiento <3 meses. Resultados: Se constataron 5 pacientes (1 mujer y 4 hombres) con dos fracturas vertebrales inestables simultáneas, con 4 casos (80%) de fracturas no contiguas y 3 casos (60%) con 2 luxofracturas simultáneas no contiguas ("columna flotante"); 2 (40%) pacientes presentaron la asociación de una fractura tipo B con una tipo C. La mediana de la edad era de 35 años. Todos tenían traumatismos de alta energía con lesiones asociadas. Los pacientes fueron operados por vía posterior convencional, con reducción y artrodesis larga. Se constató la recuperación neurológica en 2 pacientes. Conclusión: Presentamos una serie de casos de múltiples fracturas vertebrales inestables (tipo B o C) y simultáneas por traumatismos de alta energía. Esta asociación de lesiones es poco frecuente y tiene una elevada morbilidad relacionada con el trauma vertebral, sistémico y neurológico. Nivel de Evidencia: IV

ntroduction: We intend to present a series of patients with associated multiple and simultaneous unstable spinal fractures (Type B or C). materials and methods: A descriptive analysis of patients with high-energy spinal cord injuries and associated multiple unstable and simultaneous spinal fractures from January 2015 to January 2021 was conducted. Patients with type B (ligament injury) and/or type C (subluxation/dislocation) multiple spinal fractures were included. Patients with incomplete medical records, osteoporotic or pathological fractures, or fewer than 3 months of follow-up were excluded. Results: We included 5 patients (1 woman and 4 men) with two simultaneous unstable spinal fractures, including 4 cases (80%) of non-contiguous fractures and 3 (60%) with two simultaneous non-contiguous fracture dislocations ("floating spine"); 2 (40%) cases had a type B fracture associated with a type C fracture. The median age was 35 years. High-energy trauma with associated injuries occurred in all cases. All patients were surgically treated with a conventional posterior approach, reduction, and long arthrodesis. In two patients, neurological recovery was confirmed. Conclusion: A case series of multiple simultaneous unstable spinal fractures (type B or C) caused by high-energy trauma is presented. This is a rare injury association with significant morbidity associated with spinal, systemic, and neurological trauma. Level of Evidence: IV

Trauma no accidental de columna toracolumbar en un niño de 10 meses / Non-accidental trauma to the thoracolumbar spine in a 10-month-old child

Presentamos el caso de un niño de 10 meses con fractura-subluxación inveterada de la columna toracolumbar, sin daño neurológico, a causa de un trauma no accidental por mecanismo desconocido. Para evaluar la estabilidad espinal se utilizó el sistema de clasificación de la gravedad de las lesiones toracolumbares de Vaccaro. Se realizó una osteosíntesis pedicular segmentaria. Se analizó y comparó el caso presentado con otros publicados. Se actualizaron los datos registrados por Unicef sobre violencia infantil en la República Argentina, no sin antes definir claramente el tema, el marco legal y realizar una sucinta reseña histórica. Nivel de Evidencia: IV

We present the case of a 10-month-old boy with a chronic thoracolumbar spine fracture-subluxation without neurological damage caused by an unknown mechanism of non-accidental trauma. To assess stability, we used the scoring system for thoracolumbar injuries according to Vaccaro et al. We performed a segmental pedicle osteosynthesis. We analyzed and compared our case with others in the available literature. We updated UNICEF data on child violence in Argentina, but not before clearly defining the subject, and the legal framework, and providing a brief historical review. Level of Evidence: IV

Evaluation of kyphosis measurement in thoracolumbar spine fractures / Avaliação da mensuração da cifose nas fraturas da coluna toracolombar / Evaluación de la medición de cifosis en fracturas de la columna toracolumbar

ABSTRACT Objectives: Evaluate the reliability and reproducibility of the kyphosis measurement in thoracolumbar spine traumatic fractures by different assessment methods in different types of fractures. Methods: Fifteen fractures of the thoracolumbar spine, previously classified into types A, B, and C according to Magerl's classification, were evaluated. The value of kyphosis was measured using five different methods: (1) Cobb angle; (2) Gardner's method; (3) back wall method; (4) angle of adjacent endplates; and (5) wedge angle. The measurements were performed by five independent observers and repeated five times with a minimum interval of two weeks between each evaluation. Results: Intraobserver reliability was excellent among the five observers, evidencing good reproducibility of the methods. The five methods used also showed great intraobserver reliability in the global analysis, with methods one and four being more consistent. Conclusion: Although there is no universal agreement on measuring kyphosis in thoracolumbar fractures, our study concluded that method 1 (Cobb angle) and method 4 (adjacent endplate angle) presented the best interobserver reliabilities. Furthermore, the use of digitized radiographs and a simple computer program allowed the performance of highly reliable and reproducible measurements by all methods, given the high intraobserver reliability. Level of Evidence II; Comparative study.

Resumo: Objetivos: Avaliar a confiabilidade e reprodutibilidade da mensuração da cifose nas fraturas traumáticas da coluna toracolombar por diferentes métodos de avaliação nos diferentes tipos de fraturas. Métodos: Foram avaliadas 15 fraturas na coluna toracolombar previamente classificadas em tipo A, B e C de acordo com a classificação de Magerl. Em cada caso, foi medido o valor da cifose através de cinco diferentes métodos: (1) ângulo de Cobb; (2) método de Gardner; (3) método das paredes posteriores; (4) ângulo das placas terminais adjacentes; e (5) ângulo de cunha. As mensurações foram realizadas por cinco avaliadores independentes e repetidas cinco vezes com intervalo mínimo de duas semanas entre cada avaliação. Resultados: A confiabilidade intraobservador mostrou-se excelente entre os cinco avaliadores, evidenciando boa reprodutibilidade dos métodos. Os cinco métodos utilizados também apresentaram grande confiabilidade intraobservador na análise global, sendo mais consistentes o método 1 e o método 4. Conclusão: Apesar de não haver concordância universal em como medir a cifose nas fraturas toracolombares, nosso estudo concluiu que o método 1 (ângulo de Cobb) e o método 4 (ângulo das placas terminais adjacentes) apresentaram as melhores confiabilidades interobservadores. Além disso, o uso de radiografias digitalizadas e um programa computadorizado simples permitiram a realização de medidas altamente confiáveis e reprodutíveis por todos os métodos, visto pela elevada confiabilidade intraobservador. Nível de evidência II; Estudo Comparativo.

Resumen: Objetivos: Evaluar la fiabilidad y reproducibilidad de mensuración de cifosis en fracturas traumáticas de la columna toracolumbar por diferentes métodos de valoración en diferentes tipos de fracturas. Métodos: Se evaluaron quince fracturas de columna toracolumbar, previamente clasificadas en los tipos A, B y C según la clasificación de Magerl. En cada caso, el valor de la cifosis se midió utilizando cinco métodos diferentes: (1) ángulo de Cobb; (2) método de Gardner; (3) método de la pared posterior; (4) ángulo de placas de extremo adyacentes; y (5) ángulo de cuña. Las mediciones fueron realizadas por cinco evaluadores independientes y repetidas cinco veces con un intervalo mínimo de dos semanas entre cada evaluación. Resultados: La confiabilidad intraobservador fue excelente entre los cinco evaluadores, evidenciando una buena reproducibilidad de los métodos. Los cinco métodos utilizados también mostraron una gran fiabilidad intraobservador en el análisis global, siendo el método 1 y el método 4 más consistentes. Conclusión: Aunque no existe un acuerdo universal sobre cómo medir la cifosis en las fracturas toracolumbares, nuestro estudio concluyó que el método 1 (ángulo de Cobb) y el método 4 (ángulo de la placa terminal adyacente) presentaron las mejores confiabilidades entre observadores. Además, el uso de radiografías digitalizadas y un programa informático simple permitieron realizar mediciones altamente fiables y reproducibles por todos los métodos, dada la alta fiabilidad intraobservador. Nivel de evidencia II; Estudio Comparativo.

Pressure ulcers and acute risk factors in individuals with traumatic spinal fractures with or without spinal cord injuries: A prospective analysis of the National Spinal Column/Cord Injury Registry of Iran (NSCIR-IR) data / 中华创伤杂志(英文版)

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, inclusive 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 cigarettes, diabetes mellitus and length of stay in the hospital. Logistic regression models were used to estimate 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% CI: 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.

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

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

Herniation of intervertebral disc into thoracolumbar fracture vertebral body leads to malunion of fracture and decrease of intervertebral space height / 中国骨伤

OBJECTIVE@#To analyze the clinical characteristics of intervertebral disc tissue injury and herniation into the vertebral body in thoracolumbar fracture on fracture healing, vertebral bone defect volume and intervertebral space height.@*METHODS@#From April 2016 to April 2020, a total of 140 patients with thoracolumbar single vertebral fracture combined with upper intervertebral disc injury treated with pedicle screw rod system reduction and internal fixation in our hospital. There were 83 males and 57 females, aged from 19 to 58 years old, with an average age of (39.33±10.26) years old. All patients were followed up regularly 6 months, 12 months and 18 months after surgery. The patients with injured intervertebral disc tissue not herniated into the fractured vertebral body were the control group, and the patients with injured intervertebral disc and herniated into the fractured vertebral body were the observation group. By detecting the thoracolumbar AP and lateral X-ray films, CT and MRI of the thoracolumbar segment at different follow-up time, calculate the changes of the wedge angle of the fractured vertebral body, the sagittal kyphosis angle and the height of the superior adjacent intervertebral space, the changes of the fracture healing and bone defect volume after the reduction of the vertebral body, and the changes of the intervertebral disc degeneration grade. The prognosis was evaluated by visual analogue scale(VAS) and Oswestry disability index(ODI). Finally, the differences of the above results among different groups were comprehensively analyzed.@*RESULTS@#All the patients had normal wound healing without complications. A total of 87 patients received complete follow-up data, at least 18 months after internal fixation. Thoracolumbar AP and lateral X-ray films showed that 18 months after the reduction and internal fixation operation, the vertebral wedge angle, sagittal kyphosis angle and the height of the upper adjacent intervertebral space in the observation group were greater than those in the control group(P<0.05). CT scanning showed that the deformity of the fracture healed 12 months after the vertebral body reduction in the observation group and formed a "cavity" of bone defect connected with the intervertebral space, and its volume was significantly increased compared with that before (P<0.05). MRI scanning showed that the degeneration rate of injured intervertebral discs in the observation group was more serious than that in the control group 12 months after operation(P<0.05). However, there was no significant difference in VAS and ODI score at each time.@*CONCLUSION@#Herniation of injured intervertebral disc tissue hernias into the fractured vertebral body leads to increased bone resorption defect volume around the fracture and forms a malunion "cavity" connected with the intervertebral space. This may be the main reason for the change of vertebral wedge angle, the increase of sagittal kyphosis angle and the decrease of intervertebral space height after removal of internal fixation devices.

Posterior cervical pedicle screw rod short-segment internal fixation for the treatment of atlantoaxial fracture and dislocation / 中国骨伤

OBJECTIVE@#To investigate the clinical efficacy of posterior cervical pedicle screw short-segment internal fixation for the treatment of atlantoaxial fracture and dislocation.@*METHODS@#The clinical data of 60 patients with atlantoaxial vertebral fracture and dislocation underwent surgery between January 2015 and January 2018 were retrospectively analyzed. The patients were divided into study group and control group according to different surgical methods. There were 30 patients in study group, including 13 males and 17 females, with an average age of (39.32±2.85) years old, were underwent short-segment internal fixation with posterior cervical pedicle screws. There were 30 patients in control group, including 12 males and 18 females, with an average age of (39.57±2.90) years old, were underwent posterior lamina clip internal fixation of the atlas. The operation time, intraoperative blood loss, postoperative ambulation time, hospitalization time and complications between two groups were recorded and compared. The pain visual analogue scale(VAS), Japanese Orthopedic Association(JOA) score of neurological function, and fusion status were evaluated between two groups.@*RESULTS@#All patients were followed up for at least 12 months. The study group was better than control group in operation time, intraoperative blood loss, postoperative off-bed activity time, and hospital stay (P=0.000). One case of respiratory tract injury occurred in study group. In control group, 2 cases occurred incision infection, 3 cases occurred respiratory tract injury, and 3 cases occurred adjacent segmental joint degeneration. The incidence of complications in study group was lower than that in control group (χ2=4.705, P=0.030). At 1, 3, 7 days after operation, VAS of study group was lower than that of control group(P=0.000). At 1, 3 months after operation, JOA score of study group was higher than that of control group(P=0.000). At 12 months after operation, all the patients in the study group achieved bony fusion. In control group, there were 3 cases of poor bony fusion and 3 cases of internal fixation fracture, the incidence rate was 20.00%(6/30). The difference between two groups was statistically significant (χ2=4.629, P=0.031).@*CONCLUSION@#Posterior cervical short-segment pedicle screw fixation for atlantoaxial fracture and dislocation has the advantages of less trauma, shorter operation time, fewer complications, and less pain, and can promote the recovery of nerve function as soon as possible.

Treatment of stage Ⅱ-Ⅲ Kümmell disease with robot-assisted bone cement-augmented pedicle screw fixation / 中国骨伤

OBJECTIVE@#To evaluate the early clinical efficacy of robot-assisted percutaneous short-segment bone cement-augmented pedicle screw fixation in the treatment of stageⅡ-Ⅲ Kümmell disease.@*METHODS@#The clinical data of 20 patients with stageⅡ-Ⅲ Kümmell's disease who underwent robot-assisted percutaneous bone cement-augmented pedicle screw fixation between June 2017 and January 2021 were retrospectively analyzed. There were 4 males and 16 females, aged from 60 to 81 years old with an average age of (69.1±8.3) years. There were 9 cases of stageⅡand 11 cases of stage Ⅲ, all of which were single vertebral lesions, including 3 cases of T11, 5 cases of T12, 8 cases of L1, 3 cases of L2, and 1 case of L3. These patients did not exhibit symptoms of spinal cord injury. The operation time, intraoperative blood loss, and complications were recorded. The position of pedicle screws and the filling and leakage of bone cement in gaps were observed using postoperative CT 2D reconstruction. The data of the visual analogue scale (VAS), Oswestry disability index (ODI), kyphosis Cobb angle, wedge angle of the diseased vertebra, and anterior and posterior vertebral height on lateral radiographs were statistically analyzed preoperatively, 1 week postoperatively, and at the final follow-up.@*RESULTS@#Twenty patients were followed up for 10 to 26 months, with an average follow-up of (16.0±5.1) months. All operations were successfully completed. The surgical duration ranged from 98 to 160 minutes, with an average of (122±24) minutes. The intraoperative blood loss ranged from 25 to 95 ml, with an average of (45±20) ml. There were no intraoperative vascular nerve injuries. A total of 120 screws were inserted in this group, including 111 screws at grade A and 9 screws at grade B according to the Gertzbein and Robbins scales. Postoperative CT indicated that the bone cement was well-filled in the diseased vertebra, and cement leakage occurred in 4 cases. Preoperative VAS and ODI were (6.05±0.18) points and (71.10±5.37)%, respectively, (2.05±0.14) points and (18.57±2.77)% at 1 week after operation, and (1.35±0.11) points and (15.71±2.12) % at final follow-up. There were significant differences between postoperative 1 week and preoperative, and between final follow-up and postoperative 1 week(P<0.01). Anterior and posterior vertebral height, kyphosis Cobb angle, and wedge angle of the diseased vertebra were(45.07±1.06)%, (82.02±2.11)%, (19.49±0.77) °, and (17.56±0.94) ° preoperatively, respectively, (77.00±0.99)%, (83.04±2.02)%, (7.34±0.56) °, and (6.15±0.52) ° at 1 week postoperatively, and (75.13±0.86)%, (82.39±0.45)%, (8.38±0.63) °, and (7.09±0.59) ° at the final follow-up.@*CONCLUSION@#Robot-assisted percutaneous short-segment bone cement-augmented pedicle screw fixation demonstrates satisfactory short-term efficacy in treating stageⅡ-Ⅲ Kümmell's disease as an effective minimally invasive alternative. However, longer operation times and strict patient selection criteria are necessary, and long-term follow-up is required to determine its lasting effectiveness.

Percutaneous kyphoplasty assisted by three dimensional printing percutaneous guide plate for the treatment of osteoporotic vertebral compression fractures / 中国骨伤

OBJECTIVE@#To verify the safety of three dimensional printing percutaneous guide plate assisted percutaneous kyphoplasty(PKP) in the treatment of osteoporotic vertebral compression fractures(OVCFs).@*METHODS@#The clinical data of 60 patients with OVCFs treated by PKP from November 2020 to August 2021 were retrospectively analyzed. There were 24 males and 36 females, aged from 72 to 86 years old with an average of (76.5±7.9) years. Routine percutaneous kyphoplasty was performed in 30 cases (conventional group) and three dimensional printing percutaneous guide plate assisted PKP was performed in 30 cases (guide plate group). Intraoperative pedicle puncture time (puncture needle to posterior vertebral body edge) and number of fluoroscopy, total operation time, total number of fluoroscopy, amount of bone cement injection, and complication (spinal canal leakage of bone cement) were observed. The visual analogue scale (VAS) and the anterior edge compression rate of the injured vertebra were compared before operation and 3 days after operation between two groups.@*RESULTS@#All 60 patients were successfully operated without complication of spinal canal leakage of bone cement. In the guide plate group, the pedicle puncture time was(10.23±3.15) min and the number of fluoroscopy was(4.77±1.07) times, the total operation time was (33.83±4.21) min, the total number of fluoroscopy was(12.27±2.61) times;and in the conventional group, the pedicle puncture time was (22.83±3.09) min and the number of fluoroscopy was (10.93±1.62) times, the total operation time was(44.33±3.57) min, the total number of fluoroscopy was(19.20±2.67) times. There were statistically significant differences in the pedicle puncture time, intraoperative number of fluoroscopy, the total operation time, and the total number of fluoroscopy between the two groups(P<0.05). There was no significant difference in amount of bone cement injection between the two groups(P>0.05). There were no significant differences in VAS and the anterior edge compression rate of the injured vertebra at 3 days after operation between two groups(P>0.05).@*CONCLUSION@#Three dimensional printing percutaneous guide plate assisted percutaneous kyphoplasty is safe and reliable, which can reduce the number of fluoroscopy, shorten the operation time, and decrease the radiation exposure of patients and medical staff, and conforms to the concept of precise orthopaedic management.

Analysis of the causes and clinical results of vertebral fracture during oblique lateral lumbar interbody fusion / 中国骨伤

OBJECTIVE@#To analyze the causes of vertebral fracture during oblique lateral interbody fusion in the treatment of lumbar spondylopathy, summarize the clinical results, and propose preventive measures.@*METHODS@#Retrospective analysis was made on the data of 8 cases of lumbar spondylopathy and vertebral fracture treated by oblique lateral interbody fusion in three medical centers from October 2014 to December 2018. All were female, aged from 50 to 81 years with an average of 66.4 years. Disease types included 1 case of lumbar degenerative disease, 3 cases of lumbar spinal stenosis, 2 cases of lumbar degenerative spondylolisthesis and 2 cases of lumbar degenerative scoliosis. Preoperative dual energy X-ray bone mineral density test showed that 2 cases had T-value >-1 SD, 2 cases had T-value -1 to -2.5 SD, and 4 cases had T-value <-2.5 SD. Single segment fusion was in 5 cases, two segment fusion in 1 case and three segment fusion in 2 cases. Four cases were treated with OLIF Stand-alone and 4 cases were treated with OLIF combined with posterior pedicle screw fixation. Postoperative imaging examination showed vertebral fracture, and all of them were single vertebral fracture. There were 2 cases of right lower edge fracture of upper vertebral body at fusion segment, 6 cases of lower vertebral body fracture at fusion segment, and 6 cases with endplate injury and fusion cage partially embedded in vertebral body. Three cases of OLIF Stand-alone were treated with pedicle screw fixation via posterior intermuscular approach, while one case of OLIF Stand-alone and four cases of OLIF combined with posterior pedicle screw fixation were not treated specially.@*RESULTS@#The 5 cases of initial operation and 3 cases of reoperation did not show wound skin necrosis or wound infection. The follow-up time was from 12 to 48 months with an average of 22.8 months. Visual analogue scale (VAS) of low back pain was preoperative decreased from 4 to 8 points (averagely 6.3 points) and postoperative 1 to 3 points (averagely 1.7 points) at the final follow-up. Oswestry disability index (ODI) was preoperative 39.7% to 52.4% (averagely 40.2%), and postoperative 7.9% to 11.2% (averagely 9.5%) at the final follow-up. During the follow-up, there was no loosening or fracture of the pedicle screw system, and no lateral displacement of the fusion cage;however, the fusion cage at the vertebral fracture segment had obvious subsidence. The intervertebral space height of vertebral fracture segment was preoperaive 6.7 to 9.2 mm (averagely 8.1 mm), and postoperative 10.5 to 12.8 mm (averagely 11.2 mm). The improvement rate after operation was 37.98% compared to preoperative. The intervertebral space height at final follow-up was 8.4 to 10.9 mm (averagely 9.3 mm), and the loss rate was 16.71% compared with that after operation. At the final follow-up, interbody fusion was achieved in all cases except for one that could not be identified.@*CONCLUSION@#The incidence of vertebral fracture during oblique lateral interbody fusion in the treatment of lumbar spondylopathy is lower, and there are many reasons for fracture, including preoperative bone loss or osteoporosis, endplate injury, irregular shape of endplate, excessive selection of fusion cage, and osteophyte hyperplasia at the affected segment. As long as vertebral fracture is found in time and handled properly, the prognosis is well. However, it still needs to strengthen prevention.