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1.
Cleve Clin J Med ; 87(6): 339-341, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32487553
2.
Medicine (Baltimore) ; 99(21): e20276, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481306

RESUMO

RATIONALE: The most common fractures of the spine are associated with the thoracolumbar junction (T10-L2). And burst fractures make up 15% of all traumatic thoracolumbar fractures, which are often accompanied by neurological deficits and require open surgeries. Common surgeries include either anterior, posterior or a combination of these approaches. Here, we report the first attempt to treat thoracolumbar burst fracture (TLBF) with severe neurologic deficits by percutaneous pedicle screw fixation (PPSF) and transforaminal endoscopic spinal canal decompression (TESCD). PATIENT CONCERNS: A 46-year-old Chinese woman suffered from severe lower back pain with grade 0 muscle strength of lower limbs, without any sensory function below the injury level, with an inability to urinate or defecate after a motor vehicle accident. Imaging studies confirmed that she had Magerl type A 3.2 L1 burst fracture. DIAGNOSES: Burst fracture at L1. INTERVENTIONS: The patient underwent PPSF at the level of T12 to L2, but her neurological function did not fully recover after the operation. One week after the injury, we performed TESCD on her. OUTCOMES: There was an immediate improvement in her neurological function in just 1 day after 2-stage operation. During the 6-month follow-up period, her neurological functions gradually recovered, and she was able to defecate and urinate. At the last follow-up visit, her spinal cord function was assessed to be at Frankel grade D. LESSONS: PPSF plus TESCD can achieve complete spinal cord decompression, promote neurological recovery, and is therefore an effective method for the treating lumbar burst fractures with severe neurologic deficits.


Assuntos
Endoscopia/métodos , Fixação Interna de Fraturas/métodos , Dor Lombar/etiologia , Vértebras Lombares/lesões , Parafusos Pediculares , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Descompressão Cirúrgica/métodos , Feminino , Fraturas por Compressão/complicações , Fraturas por Compressão/diagnóstico , Fraturas por Compressão/cirurgia , Humanos , Laminectomia/métodos , Dor Lombar/diagnóstico , Dor Lombar/cirurgia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico , Tomografia Computadorizada por Raios X
3.
Medicine (Baltimore) ; 99(22): e20397, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481429

RESUMO

RATIONALE: Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by ossification along the anterolateral aspect of at least 4 contiguous vertebral bodies. A fracture involving the fused vertebra in patients with DISH often leads to severe instability and spinal cord injury. Spinal metastasis (Mets) and DISH can coexist in elderly patients and increase their risk of pathologic vertebral fractures. However, there are few reports on concomitant spinal Mets and DISH. PATIENT CONCERNS: A 78-year-old man who complained of gradual onset of paraparesis, sensory loss below the umbilicus, and incontinence (case 1) and a 63-year-old woman who complained of severe back pain and urinary incontinence (case 2). DIAGNOSIS: Two patients were diagnosed with spinal Mets and DISH. INTERVENTIONS: Decompression surgery was performed at the metastatic sites in case 1 whereas instrumentation surgery was performed in case 2 despite the fracture having a benign appearance with no associated neurologic symptoms. OUTCOMES: A vertebral fracture developed at the metastatic vertebra after decompression surgery in case 1. Severe instability of the surgical site in this case resulted in persistent paralysis even after subsequent revision surgery with instrumentation. In contrast, the clinical course was benign without any neurologic dysfunction at the 2-year follow-up in case 2. LESSONS: Instrumentation surgery should be performed in patients with DISH who develop spinal Mets even if there is no apparent instability.


Assuntos
Hiperostose Esquelética Difusa Idiopática/complicações , Neoplasias da Coluna Vertebral/secundário , Idoso , Blefaroptose , Neoplasias da Mama/patologia , Anormalidades Congênitas , Descompressão Cirúrgica/métodos , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Hiperostose Esquelética Difusa Idiopática/cirurgia , Região Lombossacral/anormalidades , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/patologia , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia
4.
Medicine (Baltimore) ; 99(25): e20139, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569159

RESUMO

We aimed to assess the usefulness of slice-encoding metal artifact correction (SEMAC) for the evaluation of spinal metallic implants and peripheral soft tissue lesions at 3T magnetic resonance.Twenty-seven patients with spinal metal implants underwent both SEMAC and high bandwidth (HiBW) based sequences scanning for reduction artifacts. The area size and maximum longitude of artifacts, the peri-prosthetic soft tissue, and metal visualization were assessed by 2 independent doctors, as well as the lesions signs were reviewed by 2 senior readers. A paired 2-tailed t-test and McNemar test were used for statistical analysis.The size of artifacts on SEMAC images decreased by 37% and 24%, and the scores are higher than that on HiBW images. T1 weighted (T1W)-SEMAC acquired the highest score in metal prosthesis visualization, while short tau inversion recovery SEMAC showed more signs of lesions than clinical HiBW group.SEMAC effectively reduces the metal artifacts and is useful for assessing soft tissue lesions.


Assuntos
Imagem por Ressonância Magnética/métodos , Dispositivos de Fixação Ortopédica , Complicações Pós-Operatórias/diagnóstico por imagem , Lesões dos Tecidos Moles/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Idoso , Artefatos , Feminino , Fixação de Fratura/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Melhoria de Qualidade , Fraturas da Coluna Vertebral/cirurgia
5.
Medicine (Baltimore) ; 99(25): e20524, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569172

RESUMO

BACKGROUND: It is currently controversial whether unilateral or bilateral balloon kyphoplasty (BKP) is superior in terms of postoperative outcomes in treatment of osteoporotic vertebral compression fracture (OVCF). In this context, the aim of this study was to prospectively evaluate and compare the radiographic and clinical outcomes of BKP using unilateral and bilateral approaches. METHODS: This was a randomized controlled study and was approved by the Severance Institutional Review Board in our hospital. The study protocol was designed in accordance with the Declaration of Helsinki guidelines. Patients who complained of chronic back pain secondary to OVCF, which occurred in thoracic lumbar region over 6 months and met the criteria of osteoporosis were the candidates for this procedure. A total of 150 patients were randomized to undergo either unilateral or bipedicular BKP. The outcomes measures inculded pain score, Oswestry Dysfunction Index, compression ratio, kyphotic angle, operation time, and postoperative complications. RESULTS: We were able to directly compare the outcomes of unilateral versus bilateral BKP and might reveal a better technique in OVCF. TRIAL REGISTRATION: this study protocol was registered in Research Registry (researchregistry5543).


Assuntos
Fraturas por Compressão/cirurgia , Cifoplastia/métodos , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Humanos
6.
Orthop Clin North Am ; 51(3): 339-343, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32498952

RESUMO

Pediatric spine trauma presents unique management challenges. These injuries are often the result of high-energy mechanisms and are associated with other serious injuries that can complicate surgical and nonsurgical approaches. The pediatric population presents a host of challenges related to patient compliance, healing challenges, and patient tolerance of therapy. Percutaneous pedicle screw instrumentation, temporary fixation without fusion, continues to expand in its role of pediatric spine fracture treatment. Compared with open instrumentation and fusion, this technique addresses many of the previously mentioned challenges. Additional study is needed to evaluate the clinical utility of this approach in pediatric spinal fractures.


Assuntos
Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Adolescente , Criança , Feminino , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Parafusos Pediculares , Resultado do Tratamento
7.
Medicine (Baltimore) ; 99(18): e20072, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358388

RESUMO

Vertebral compression fractures (VCFs) are common in elderly and are treated with immobilization. Moreover, immobilization and old age may increase venous thromboembolism (VTE) risk. However, the incidence of VCFs-related VTE is unknown in elderly. The purposes of this study were to determine the incidence of VTE among VCF patients, to explore whether percutaneous vertebroplasty (PV) intervention may reduce VTE risk in VCFs patients.We conducted a population-based case-control study by using the National Health Insurance Research Database. We identified 1407 patients aged ≥65 with VCF who received PV and 1407 VCFs patients who did not receive PV after developing a 1:1 propensity score-matched study cohort and were followed up for 5 years. Using PV intervention as the exposure factor, a cause-specific Cox's proportional hazards model was used to examine the association between PV and VTE.After propensity score matching, the mean age of the study participants was 78 years and ∼23% of the analyzed participants were men, incidence of VTE in the PV and control cohorts was 5.77 and 4.19 per 1000 person-years, respectively. Both groups were nonsignificant difference after examination with different adjustment models. Patients with VCF and a history of heart failure, coronary artery disease, receiving antihypertension medication were at a significantly increased VTE risk.Elderly patients with VCF who received PV had a neutral impact on risk of VTE. VCF patients with heart failure, coronary artery disease, and receiving antihypertension medication were prone to developing VTE should be monitored cautiously.


Assuntos
Fraturas por Compressão/epidemiologia , Fraturas por Compressão/cirurgia , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/cirurgia , Tromboembolia Venosa/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Estudos de Casos e Controles , Comorbidade , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Pontuação de Propensão , Fatores de Risco , Fatores Socioeconômicos , Taiwan/epidemiologia , Vertebroplastia/métodos
8.
Medicine (Baltimore) ; 99(18): e20153, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358405

RESUMO

At present, the posterior cervical approach with open reduction and internal fixation (ORIF) remains a commonly effective treatment for unstable Atlas fracture. However, the inserted screws into the C1 lateral mass of some unstable atlas fracture are very difficult, so that the operation is forced to change into C0 to C2 fusion. In order to improve the successful rate of lateral mass screw placement, we introduced a method of fixing lateral mass with a towel clamp in posterior transpedicular fixation, and explore the efficacy and feasibility.Twenty-one consecutive patients with unstable atlas fracture were treated via this method from October 2012 to July 2017. All cases had neck pain and restricted motion of neck movement on admission. Electronic medical records and pre- and postoperative radiographs were reviewed. Screw and rod placement, bone fusion, and spinal cord integrity were assessed via long-term follow-up with anteroposterior and lateral radiographs and computed tomography. Follow-up included clinical assessment of neurological function, assessment of pain using the visual analog scale (VAS), and assessment of the activities of daily living using the neck disability index (NDI).The mean follow-up duration was 22.1 months (range: 12-54 months). No screw loosening or breakage, plate displacement, neurovascular injury, and severe complications occurred during follow-up. The mean operative time was 112.4 ±â€Š14.9 min (range: 82-135 min), and mean blood loss was 386.2 ±â€Š147.9 mL (range: 210-850 mL). One patient experienced continuous neck pain postoperatively, but this gradually disappeared with analgesic administration. At final follow-up, all patients had bone fusion, the VAS scores and NDI were significantly improved compared with preoperatively.Fixing the C1 lateral mass with a towel clamp during posterior transpedicular fixation for unstable atlas fracture appears to be a safe and reliable method, with the advantages of being a simple technique with few complications.


Assuntos
Atlas Cervical/lesões , Atlas Cervical/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas da Coluna Vertebral/cirurgia , Atividades Cotidianas , Perda Sanguínea Cirúrgica , Placas Ósseas , Parafusos Ósseos , Avaliação da Deficiência , Feminino , Humanos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Amplitude de Movimento Articular , Estudos Retrospectivos
9.
Bone Joint J ; 102-B(5): 627-631, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32349603

RESUMO

AIMS: The timing of surgical fixation in spinal fractures is a contentious topic. Existing literature suggests that early stabilization leads to reduced morbidity, improved neurological outcomes, and shorter hospital stay. However, the quality of evidence is low and equivocal with regard to the safety of early fixation in the severely injured patient. This paper compares complication profiles between spinal fractures treated with early fixation and those treated with late fixation. METHODS: All patients transferred to a national tertiary spinal referral centre for primary surgical fixation of unstable spinal injuries without preoperative neurological deficit between 1 July 2016 and 20 October 2017 were eligible for inclusion. Data were collected retrospectively. Patients were divided into early and late cohorts based on timing from initial trauma to first spinal operation. Early fixation was defined as within 72 hours, and late fixation beyond 72 hours. RESULTS: In total, 86 patients underwent spinal surgery in this period. Age ranged from 16 to 88 years. Mean Injury Severity Score (ISS) was higher in the early stabilization cohort (p = 0.020). Age was the sole significant independent variable in predicting morbidity on multiple regression analysis (p < 0.003). There was no significant difference in complication rates based on timing of surgical stabilization (p = 0.398) or ISS (p = 0.482). CONCLUSION: Our results suggest that these patients are suitable for early appropriate care with spinal precautions and delayed definitive surgical stabilization. Earlier surgery conferred no morbidity benefit and had no impact on length of stay. Cite this article: Bone Joint J 2020;102-B(5):627-631.


Assuntos
Fixação de Fratura/métodos , Fraturas da Coluna Vertebral/cirurgia , Tempo para o Tratamento , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Escala de Gravidade do Ferimento , Irlanda , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
10.
Medicine (Baltimore) ; 99(14): e19684, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243406

RESUMO

BACKGROUND: Fracture is a common disease; many factors affect fracture healing. Recent studies have confirmed that hydrogen sulfide (H2S) plays an essential role in bone formation, but most of these studies are drawing conclusions based on animal experiment; whether H2S could promote fracture healing in patients is still unclear. We aim to investigate the change of serum H2S in fracture patients, and analyze its effort on fracture healing. METHODS: This is a single-center, prospective cohort study. Patients with spinal or limb fracture will be recruited. Patient's serum and urine will be collected at baseline for examination (serum H2S, ß-CTX, OC, PINP, 25-OH-VitD3, S-CTX, urinary calcium, and urinary creatinine). All patients will be followed-up for 24 months in outpatients settings, the image of X-ray or CT will be reviewed and fracture healing will be judged by 2 experienced orthopedic physicians. The difference in serum parameters especially H2S will be compared between patients with fracture healed within 9 months and those with fracture unhealed at 9 months. DISCUSSION: Results of the trial could provide insight into influence of H2S on fracture healing. ETHICS AND DISSEMINATION: The study was approved by the ethics committee of School of Medicine UESTC & Sichuan Provincial People's Hospital Ethics Committee. All the participants will be asked to provide written informed consent before data collection. The findings of the study will be published in peer-reviewed journals and will be presented at national or international conferences.


Assuntos
Consolidação da Fratura/fisiologia , Fraturas Ósseas/sangue , Sulfeto de Hidrogênio/sangue , Traumatismos do Braço/sangue , Fraturas Ósseas/urina , Humanos , Sulfeto de Hidrogênio/urina , Traumatismos da Perna/sangue , Osteogênese/fisiologia , Estudos Prospectivos , Fraturas da Coluna Vertebral/sangue
11.
AJR Am J Roentgenol ; 214(6): 1359-1368, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32228329

RESUMO

OBJECTIVE. The purpose of this study was to describe the epidemiology and imaging characteristics of cervical spine injuries in children with blunt trauma. MATERIALS AND METHODS. We conducted a retrospective review of the records of all patients 16 years old or younger with a diagnosis of cervical spine injury in the trauma registry of our level 1 trauma center between July 2006 and June 2018. RESULTS. Two hundred thirty-five patients were included in the study: 125 with subaxial cervical spine injuries, 87 with upper cervical spine injuries, and 23 with both subaxial and upper cervical spine injuries. The frequency of isolated upper cervical spine injuries was 73% in patients younger than 3 years old, 48% in patients 3-8 years old, and 29% in patients older than 8 years old. Seventy-one percent of occipital condyle fractures were avulsions, and 26% of dens fractures were avulsions. Type II dens fractures were found only in patients older than 8 years old. Type I and III dens fractures were almost exclusively in patients 8 years old or younger. Injuries classified as AOSpine types A, B, and C comprised 65.6%, 17.2%, and 17.2% of subaxial injuries, respectively. Despite similar mechanism of injury distribution across age groups, the frequency of AOSpine type A injuries in patients older than 8 years old (70.6%) was significantly higher compared with patients younger than 3 years old (40.0%) and those who were 3-8 years old (45.0%). The frequency of AOSpine type B injuries in patients younger than 3 years old (40.0%) was slightly higher than patients who were 3-8 years old (30.0%) and almost three times higher than in patients older than 8 years old (13.8%). CONCLUSION. Pediatric patients have high rates of upper cervical spine injuries, which tend to be distraction injuries that are frequently associated with avulsion fractures. Injury patterns in pediatric patients vary significantly by age, with patients younger than 3 years old being particularly prone to distraction type injuries.


Assuntos
Vértebras Cervicais/lesões , Imagem por Ressonância Magnética , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Traumatismos da Coluna Vertebral/epidemiologia , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Sistema de Registros , Estudos Retrospectivos , Fraturas da Coluna Vertebral/classificação , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia , Traumatismos da Coluna Vertebral/classificação , Centros de Traumatologia
12.
Bone Joint J ; 102-B(6): 671-676, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32323563

RESUMO

AIMS: The current pandemic caused by COVID-19 is the biggest challenge for national health systems for a century. While most medical resources are allocated to treat COVID-19 patients, several non-COVID-19 medical emergencies still need to be treated, including vertebral fractures and spinal cord compression. The aim of this paper is to report the early experience and an organizational protocol for emergency spinal surgery currently being used in a large metropolitan area by an integrated team of orthopaedic surgeons and neurosurgeons. METHODS: An organizational model is presented based on case centralization in hub hospitals and early management of surgical cases to reduce hospital stay. Data from all the patients admitted for emergency spinal surgery from the beginning of the outbreak were prospectively collected and compared to data from patients admitted for the same reason in the same time span in the previous year, and treated by the same integrated team. RESULTS: A total of 19 patients (11 males and eight females, with a mean age of 49.9 years (14 to 83)) were admitted either for vertebral fracture or spinal cord compression in a 19-day period, compared to the ten admitted in the previous year. No COVID-19 patients were treated. The mean time between admission and surgery was 1.7 days, significantly lower than 6.8 days the previous year (p < 0.001). CONCLUSION: The structural organization and the management protocol we describe allowed us to reduce the time to surgery and ultimately hospital stay, thereby maximizing the already stretched medical resources available. We hope that our early experience can be of value to the medical communities that will soon be in the same emergency situation. Cite this article: Bone Joint J 2020;102-B(6):671-676.


Assuntos
Infecções por Coronavirus , Modelos Organizacionais , Procedimentos Neurocirúrgicos , Procedimentos Ortopédicos , Pandemias , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral , Compressão da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Clínicos/organização & administração , Eficiência Organizacional , Emergências , Feminino , Alocação de Recursos para a Atenção à Saúde/organização & administração , Hospitais Urbanos , Humanos , Itália , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos Prospectivos , Tempo para o Tratamento/estatística & dados numéricos , Adulto Jovem
13.
Medicine (Baltimore) ; 99(15): e18964, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282692

RESUMO

BACKGROUND: We performed a systematic review and meta-analysis of the efficacy and safety of teriparatide and bisphosphonates in managing postmenopausal osteoporosis. METHODS: PubMed, EMBASE, Web of Science, and China National Knowledge Infrastructure were searched for relevant randomized controlled trials that were published before April 2018 and compared teriparatide and bisphosphonates in treating postmenopausal osteoporosis. Stata 12.0 was used for the meta-analysis. The pooled risk ratio (RR) or weighted mean difference and 95% confidence interval (CI) were calculated using a fixed effects or random effects meta-analysis. RESULTS: A total of 14 randomized controlled trials were included in this meta-analysis. The teriparatide group was associated with a lower total occurrence of vertebral fractures (RR = 0.55, 95% CI: 0.40-0.77; P = .001) and nonvertebral fractures (RR = 0.65, 95% CI: 0.46-0.90; P = .009) than the bisphosphonate group. Moreover, compared with the bisphosphonate group, the teriparatide group had improved bone mineral density at the lumbar spine and femoral neck at the final follow-up (P < .05). There was no significant difference between the teriparatide and bisphosphonate groups in terms of complications (RR = 1.05, 95% CI: 0.90, 1.22, P = .516). CONCLUSIONS: Teriparatide significantly reduced the occurrence of vertebral and nonvertebral fractures in osteoporosis patients. More studies should focus on the quality of life of patients using these 2 drugs.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Densidade Óssea/efeitos dos fármacos , Difosfonatos/uso terapêutico , Osteoporose Pós-Menopausa/tratamento farmacológico , Teriparatida/uso terapêutico , Conservadores da Densidade Óssea/farmacologia , Difosfonatos/farmacologia , Colo do Fêmur/efeitos dos fármacos , Humanos , Vértebras Lombares/efeitos dos fármacos , Osteoporose Pós-Menopausa/complicações , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/prevenção & controle , Teriparatida/farmacologia
14.
Medicine (Baltimore) ; 99(16): e19780, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32311986

RESUMO

Segmental fusion is not necessarily needed in treatment of thoracolumbar unstable burst fracture requiring surgery. Our objective was to report the results of follow-up for at least 10 years in patients with thoracolumbar unstable burst fracture requiring surgery in which fractured segment was healed following temporary posterior instrumentation without fusion, and in whom implants were subsequently removed.Retrospective Cohort Study.Nineteen patients in whom union of fractured vertebra was observed following surgery and in whom implants were removed within an average 12.2 months, and who could be followed up for at least 10 years, were enrolled.At the last follow-up, we evaluated the segmental motions, anterior body height ratio, progress of further kyphotic deformity, Oswestry Disability Index, Rolland Morris Disability Questionnaire and Short Form 36.Results: The follow-up period after implant removal surgery was 151 months on average. The local kyphotic angle was 26.89 ±â€Š6.08 degrees at the time of injury and 10.11 ±â€Š2.22 degrees at the last follow-up. The anterior body height ratio was 0.54 ±â€Š0.16 at the time of injury and 0.89 ±â€Š0.05 at the last follow-up. Thus, the fractured vertebra was significantly reduced after surgery and maintained till last follow-up. The segmental motion was 9.84 ±â€Š3.03, Oswestry Disability Index was 7.95 ±â€Š7.38, Rolland Morris Disability Questionnaire was 2.17 ±â€Š2.67, short form 36 Physical Component Score was 77.50 ±â€Š16.61, and short form 36 Mental Component Score was 79.21 ±â€Š13.32 at last follow-up.We conducted at least 10-year follow-up and found that temporary posterior instrumentation without fusion should be considered one of the useful alternative treatments for thoracolumbar unstable burst fracture in place of the traditional posterior instrumentation and fusion.


Assuntos
Fixação Interna de Fraturas/instrumentação , Vértebras Lombares/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Radiografia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Adulto Jovem
15.
Zhonghua Wai Ke Za Zhi ; 58(3): 161-164, 2020 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-32187918

RESUMO

Vertebral compression fractures(VCFs) are severe and common complications of osteoporosis. Most VCFs were caused by osteopenia or osteoporosis. Nevertheless, spinal metastases probably result in pathological fractures that easily confused with osteoporotic vertebral compression fractures(OVCFs). Using biopsy during vertebral augmentation(VA) is considered as the golden standard protocol to rule out pathological VCFs. Up to data, conventionally using biopsy during VA is suggested by more and more researchers to confirm the etiology of VCFs and to avoid missed diagnosis and misdiagnosis of spinal metastases with pathological vertebral fractures as the first manifestation. For patients with spinal metastases, histological evaluation of vertebral biopsy specimens is convenient for further treatment.


Assuntos
Fraturas por Compressão/cirurgia , Osteoporose/complicações , Fraturas da Coluna Vertebral/cirurgia , Biópsia , Fraturas por Compressão/etiologia , Humanos , Fraturas da Coluna Vertebral/etiologia , Coluna Vertebral/patologia , Resultado do Tratamento
16.
Artigo em Inglês | MEDLINE | ID: mdl-32131965

RESUMO

PURPOSE OF THE STUDY In this randomized prospective study, we monitored and compared perioperative changes in skeletal muscle enzymes blood levels in open and mini-invasive stabilization of thoracolumbar spine fractures. The established hypothesis was to confirm higher blood levels of muscle enzymes in open stabilization. MATERIAL AND METHODS This study included 38 patients with the mean age of 46.4 years. 19 injuries were managed in an open procedure and 19 procedures were mini-invasive. Venous blood was taken intermittently at short intervals to determine the levels of skeletal muscle enzymes. The catalytic concentration of creatine kinase was determined via an enzymatic UV-test, and the concentration of myoglobin via electro-chemiluminescent immunoassay. Enzyme levels were processed statistically. The Wilcoxon test was used. RESULTS The median increase in the values of both enzymes is higher in the mini-invasive method than in the open method in both the surgery phase for the injury and in the extraction phase. The median increase in the values of both enzymes is higher in both methods for the primary procedure phase compared to the extraction phase. All results are statistically significant at p of <0.05. All tests were calculated using the MATLAB Statistics Toolbox. DISCUSSION A very surprising finding, when testing the hypothesis of the levels increasing mainly in open stabilization, was confirming the opposite. Both enzymes were higher in the mini-invasive approach to stabilising the spine after the injury, but also after the extraction. This contradicts the available literature. However, this can be explained by the methodology of enzyme levels determination in the previously published studies. We believe that this phenomenon can be partially caused by an iatrogenic mini-compartment of muscles in the postoperative period, absence of wound drainage, but also by higher muscle contusion when inserting bolts through the tubes via small incisions, when the tubes penetrate to the entry points relatively violently and the muscles in this area are affected more than in the classical skeletization. CONCLUSIONS Analysis of biochemical changes in open and mini-invasive surgery did not confirm the hypothesis that levels of creatine kinase and myoglobin enzymes increase especially in open stabilization. On the contrary, they were statistically significantly higher in mini-invasive procedures. Key words: creatine kinase, myoglobin, muscle enzymes, spine fracture, spine surgery, miniinvasive surgery.


Assuntos
Creatina Quinase , Doenças Musculares , Mioglobina , Fraturas da Coluna Vertebral , Creatina Quinase/metabolismo , Humanos , Vértebras Lombares , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Doenças Musculares/diagnóstico , Doenças Musculares/etiologia , Mioglobina/metabolismo , Estudos Prospectivos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas
17.
Acta Chir Orthop Traumatol Cech ; 87(1): 52-57, 2020.
Artigo em Tcheco | MEDLINE | ID: mdl-32131972

RESUMO

Hemicorporectomy or translumbar amputation is an extensive surgical procedure consisting in removing the lower portion of the body. Thakur et al. found a total of 71 hemicorporectomies described in literature before 2017. In the form of a case study we present the case of our patient with terminal pelvic osteomyelitis, in whom hemicorporectomy was subsequently performed, namely from the spine surgery perspective. The man, 19 years old, was exposed to high-voltage electricity and fell down from a height of 4 meters. He suffered an instable comminuted fracture of T10 (AO A3.3.) with paraplegia (Frankel A) and multiple third-degree burns affecting 25% of his total body surface area. Subsequently, the patient underwent a total of 16 surgical procedures performed by medical experts in various specialties (orthopaedic surgery, general surgery, plastic surgery, urology, vascular surgery), but in spite of that the extensive pelvic osteomyelitis has not been successfully managed. At first, urine and stool diversion were performed. After 3 weeks, i.e. 18 months after the injury, the removal of the lower portion of the body was scheduled. The hemicorporectomy was divided into 4 stages. The surgery started by posterior transecting the spine at L4-L5 segment with nerve root and dural sac ligation and treating the bleeding venous plexus in the spinal canal. After turning the patient to the supine position, the second stage of the operation followed, consisting in transecting large vessels and harvesting a musculocutaneous flap from the right thigh. During the third stage of the surgery the separation of the L4-L5 motion segment was completed by the transaction of the anterior longitudinal ligament and m. psoas major, subsequently followed by the amputation of the lower portion of the body. During the last stage of the surgery, the wound was closed by musculocutaneous flap from the fight thigh with preserved a. femoralis. The patient was discharged to home in a generally good condition 127 days after the amputation of the lower portion of the body. Now, 1 year after the surgery, the patient enjoys good physical as well as mental health. Hemicorporectomy is an extensive surgical technique, which can despite multiple complications be offered to patients with otherwise unmanageable condition. Terminal pelvic osteomyelitis is currently the most frequent diagnostic indication and the resulting condition makes possible a long-term survival of the patient in a satisfactory condition. The spinal surgeon is an irreplaceable member of the multidisciplinary team performing the surgical procedure, the primary treatment of the spinal column considerably limits blood losses. Key words: hemicorporectomy, en bloc sacrectomy, terminal pelvic osteomyelitis, sacral tumors.


Assuntos
Procedimentos Ortopédicos , Osteomielite , Procedimentos Cirúrgicos Reconstrutivos , Adulto , Amputação , Humanos , Masculino , Osteomielite/cirurgia , Pelve , Fraturas da Coluna Vertebral/complicações , Adulto Jovem
18.
Medicine (Baltimore) ; 99(10): e19048, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150051

RESUMO

This study aimed to evaluate the risk of dementia after distal radius, hip, and spine fractures.Data from the Korean National Health Insurance Service-National Sample Cohort were collected for the population ≥ 60 years of age from 2002 to 2013. A total of 10,387 individuals with dementia were matched for age, sex, income, region of residence, and history of hypertension, diabetes, and dyslipidemia with 41,548 individuals comprising the control group. Previous histories of distal radius, hip, and spine fractures were evaluated in both the dementia and control groups. Using ICD-10 codes, dementia (G30 and F00) and distal radius (S525), hip (S720, S721, and S722), and spine (S220 and S320) fractures were investigated. The crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of dementia in distal radius, hip, and spine fracture patients were analyzed using conditional logistic regression analyses. Subgroup analyses were conducted according to age, sex and region of residence.The adjusted ORs for dementia were higher in the distal radius, hip, and spine fracture group than in the non-fracture group (adjusted OR = 1.23, 95% CI = 1.10 -1.37, P < .001 for distal radius fracture; adjusted OR = 1.64, 95% CI = 1.48 - 1.83, P < .001 for hip fracture; adjusted OR = 1.31, 95% CI = 1.22 - 1.41, P < .001 for spine fracture). The results in subgroup analyses according to age, sex and region of residence were consistent.Distal radius, hip, and spine fractures increase the risk of dementia.


Assuntos
Demência/epidemiologia , Fraturas Ósseas/complicações , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Demência/etiologia , Feminino , Serviços de Saúde para Idosos , Fraturas do Quadril/complicações , Humanos , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fraturas por Osteoporose/complicações , Fraturas do Rádio/complicações , República da Coreia/epidemiologia , Fatores de Risco , Fraturas da Coluna Vertebral/complicações
19.
Rev Med Suisse ; 16(685): 492-497, 2020 Mar 11.
Artigo em Francês | MEDLINE | ID: mdl-32167251

RESUMO

Should we continue to treat patients suffering from an acute osteoporotic vertebral fracture with vertebroplasty ? What is the potential benefit ? What are its indications ? What are its risks ? Which way to perform it ? How to manage the osteoporosis evaluation and therapy ? In 2009 we published the «â€…CHUV consensus ¼ on the management of vertebral osteoporotic fractures by vertebroplasty. We here propose an update including recent knowledge on the management of vertebral fractures by bone insufficiency by percutaneous cementoplasty.


Assuntos
Fraturas por Osteoporose/cirurgia , Guias de Prática Clínica como Assunto , Vertebroplastia , Consenso , Humanos , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
20.
Zhongguo Gu Shang ; 33(2): 111-5, 2020 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-32133807

RESUMO

OBJECTIVE: To investigate the guiding significance of lumbar quantitative computed tomography (QCT) in percutaneous vertebroplasty (PKP) for osteoporotic vertebral compression fractures (OVCF). METHODS: The clinical data of 90 patients with OVCF underwent PKP from December 2017 to December 2018 were retrospectively analyzed. There were 24 femalesand66males, withanaverage agedof (74.47±6.60) yearsold. Allpatientswere received QCT examination before surgery, andaccording to the QCT value oflumbarspine, the patientswere dividedinto osteopenia decrease group (80 to 120 g/L, 17 cases, 30 vertebrae), osteoporosis group (40 to 80 g/L, 44 cases, 66 vertebrae) and severe osteoporosis group (<40 g/L, 29 cases, 39 vertebrae). Bone cement was injected into vertebral body, AP and lateral X-rays were done during operation. The diffusion and leakage of bone cement in injured vertebrae of patients with different QCT values were observed. Unilateral approach was used for patients whose bone cement diffused beyond the midline of the vertebral body, otherwise, and bilateral approach was adopted, and guiding significance of QCT in PKP for OVCF was analyzed. RESULTS: In 90 cases of 135 vertebrae, 72 cases of 98 vertebral bone cement diffused beyond the midline, accounting for 72.59%. Unilateral approach was used for the 72 patients whose bone cement diffused beyond the midline of the vertebral body, among them, there were 5 cases with 8 vertebrae in osteopenia group, 40 cases with 55 vertebrae in osteoporosis group and 27 cases with 35 vertebrae in severe osteoporosis group. There was significant difference in the bone cement dispersion between three groups (χ2=41.397, P=0.000). Moreover, no bone cement leakage occurred in osteopenia group, 3 cases of 4 vertebrae occurred in osteoporosis group and 2 cases of 3 vertebrae in severe osteoporosis group. However, none of the patients with bone cement leakage caused nerve injury and other symptoms, and there was no significant difference in bone cement leakage between the three groups (χ2=2.242, P=0.326). CONCLUSION: According to the QCT examination of lumbar spine, defining the degree of osteoporosis and guiding the puncture method can shorten the operation time, reduce the number of fluoroscopy, and effectively improve the safety of vertebroplasty.


Assuntos
Fraturas por Compressão , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Cimentos para Ossos , Fraturas por Compressão/cirurgia , Humanos , Estudos Retrospectivos , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
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