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1.
Medicine (Baltimore) ; 100(9): e24973, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655965

RESUMO

RATIONALE: An abdominal pseudohernia is a protrusion of the abdominal wall that there is no actual muscular disruption. This report presents a case in which abdominal muscle activities were accurately and quantitatively measured using ultrasonography (US) and surface electromyography in a patient with abdominal pseudohernia. PATIENT CONCERNS: A 62-year-old man presented with a marked protrusion on the left abdomen with increasing abdominal pressure. DIAGNOSES: First, the thickness of the abdominal muscle was measured with US while the patient constantly blew the positive expiratory pressure device. When the force was applied to the abdomen, the mean thickness of the muscle layer on the lesion site was found to be thinner. Second, the activities of the abdominal muscles were measured using surface electromyography by attaching electrodes to 8 channels at the same time. When the same pressure was applied on both sides of the abdomen, more recruitment occurred to compensate for muscle weakness at the lesion site. Through the previous 2 tests, the decrease in muscle activity in the lesion area could be quantitatively evaluated. Third, the denervation of the muscle was confirmed using US-guided needle electromyography. INTERVENTIONS: The patient in this case was wearing an abdominal binder. In addition, he had been training his abdominal muscles through McGill exercise and breathing exercises such as with a positive expiratory pressure device. OUTCOMES: The patient was able to understand his symptoms. A follow-up test will be performed to see if there is any improvement. LESSONS: By using these outstanding assessment methods, proper diagnosis and rehabilitation treatment strategies can be developed.


Assuntos
Músculos Abdominais/diagnóstico por imagem , Eletromiografia/métodos , Fraturas por Compressão/complicações , Hérnia Abdominal/diagnóstico , Vértebras Lombares/lesões , Fraturas da Coluna Vertebral/complicações , Vértebras Torácicas/lesões , Ultrassonografia/métodos , Músculos Abdominais/fisiopatologia , Fraturas por Compressão/diagnóstico , Hérnia Abdominal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/diagnóstico
2.
Zhongguo Gu Shang ; 34(2): 170-4, 2021 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-33666007

RESUMO

OBJECTIVE: To explore clinical effect of cement-augmented pedicle screw combined with vertebroplasty in treating Kümmell disease with type Ⅲ. METHODS: From January 2015 to December 2018, 37 patients with type Ⅲ Kümmell disease were retrospectively analyzed, including 11 males and 26 females, aged from 61 to 84 years old with an average of (68.6±4.2) years old, and the courses of disease ranged from 2 to 10 months with an average of(6.5±2.3) months. Nine patients were grade C, 20 patients were grade D and 8 patients were grade E according to Frankle grading. All patients were treated by cement-augmented pedicle screw combined with vertebroplasty. Operation time, blood loss, postoperative drainage, hospital stay and complicationswere observed after oeprtaion. Visual analogue scale(VAS), Oswestry Disability Index(ODI), height of anterior vertebral body, Cobb angle before and after operation were compared. RESULTS: All patients were followed up from 12 to 60 months with an average of (22.4±10.9) months. Operation time was (240.9±77.4) min, blood loss was (315.0±149.2) ml, postoperative drainage was (220.8±72.0) ml, hospital stay was (12.6±4.7) days. One patient occurred incision redness and 1 patient occurred infection after opertaion. No loosening of bone cement occurred. Postopertaive VAS and ODI were lower than that of before opertaion(P<0.05), height of anterior vertebral body after opertaion was larger than that of before opertaion, Cobb angle after operation was less than that of before operation (P<0.05). According to Frankle grading of never function at the latest follow up, 2 patients were grade D and 35 patients were grade E. Nerve function and quality of life was improved. CONCLUSION: Cement-augmented pedicle screw combined with vertebroplasty is a safe and effective method for the tretament of Kümmell disease with type Ⅲ.


Assuntos
Parafusos Pediculares , Fraturas da Coluna Vertebral , Vertebroplastia , Idoso , Cimentos para Ossos , Feminino , Fixação Interna de Fraturas , Humanos , Lactente , Vértebras Lombares/lesões , Masculino , Qualidade de Vida , Estudos Retrospectivos , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Resultado do Tratamento
4.
Medicine (Baltimore) ; 100(4): e24440, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530247

RESUMO

BACKGROUND: Acupuncture at Yaotongdian (EX-UE 7) is increasingly used in acute lumbar sprain (ALS), and many studies have published that it is effective in the treatment of ALS. However, it is controversy if acupuncture at (EX-UE 7) can provide an evidence-based clinical benefit in the ALS population. METHODS: We will go through 8 databases, and conduct a systematic review of acupuncture on (EX-UE 7) and health-related outcomes in ALS patients according to the Preferred Reporting Items for Systematic Reviews. The primary objective is to assess the impact of Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on clinical outcomes relevant to ALS patients, such as effective rate, life-quality evaluation, and adverse events. Cochrane Risk Assessment Tool will be used to assess the quality of eligible studies according to the Cochrane handbook. RESULTS: The results of this systematic review will provide a synthesis of current evidence of Acupuncture at Yaotongdian (EX-UE 7) and we have a specific opportunity to determine the efficacy and safety of it. CONCLUSION: This study will explore whether or not acupuncture on (EX-UE 7) can be used as one of the non-drug therapies to prevent or treat ALS. REGISTRATION NUMBER: 10.17605/OSF.IO/29QV7 (https://osf.io/29qv7/).


Assuntos
Pontos de Acupuntura , Terapia por Acupuntura/métodos , Vértebras Lombares/lesões , Entorses e Distensões/terapia , Humanos , Metanálise como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
5.
Br J Radiol ; 94(1119): 20200234, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33417486

RESUMO

OBJECTIVES: To analyze vertebral fractures risk in patients with chest scans by evaluating vertebral hydroxyapatite concentration measured on spectral CT compared to trabecular attenuation value measured on conventional CT. METHODS: Our retrospective study reviewed CT of 216 patients. Analysis of vertebral (T11 - L1) hydroxyapatite concentration by spectral imaging and trabecular attenuation value by conventional CT imaging were performed in patients with chest CT examinations. Specificity, sensitivity, negative predictive value (NPV), and positive predictive value (PPV) were performed by using receiver operating characteristic (ROC) curves in patients with and without vertebral fractures. RESULTS: In male patients, vertebral hydroxyapatite concentration had high area under the ROC curve (0.916), by using the optimal threshold of 72.27 mg/cm3, specificity, sensitivity, NPV, and PPV were 91.7, 80.2, 36.7, and 98.7%, respectively. In female patients, vertebral hydroxyapatite concentration also had high area under the ROC curve (0.870), by using the optimal threshold of 74.79 mg/cm3, specificity, sensitivity, NPV, and PPV were 100.0, 77.8, 47.4, and 100.0%, respectively. Area under the ROC curve was significantly different between spectral CT-measured bone hydroxyapatite concentration and conventional CT-measured attenuation value in distinguishing vertebral fractures (p = 0.007 for males; p = 0.005 for females). CONCLUSIONS: Quantitative assessment with spectral CT may appear as higher accuracy than that of conventional CT imaging to analyze risk of vertebral fractures. Hydroxyapatite concentration measured with chest spectral CT may be used to evaluate risk of bone fractures. ADVANCES IN KNOWLEDGE: Hydroxyapatite concentration measured with chest spectral CT may be used to evaluate risk of bone fractures.


Assuntos
Durapatita/metabolismo , Radiografia Torácica/métodos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Vértebras Lombares/metabolismo , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade , Fatores Sexuais , Fraturas da Coluna Vertebral/metabolismo , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões
6.
Medicine (Baltimore) ; 100(2): e24099, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466177

RESUMO

BACKGROUND: To explore the ideal trajectory of lumbar cortical bone trajectory screws and provide the optimal placement scheme in clinical applications. METHODS: Lumbar computed tomography (CT) data of 40 patients in our hospital were selected, and the cortical vertebral bone contour model was reconstructed in three dimensions (3D). Depending on the different regions of the screw through the entrance and exit of the pedicle, 9 trajectories were obtained through combinational design: T-Aa, T-Ab, T-Ac, T-Ba, T-Bb, T-Bc, T-Ca, T-Cb, and T-Cc. Cortical bone trajectory (CBT) screws with appropriate diameters were selected to simulate screw placement and measure the parameters corresponding to each trajectory (screw path diameter, screw trajectory length, cephalad angle, and lateral angle), and then determine the optimal screw according to the screw parameters and screw safety. Then, 23 patients in our hospital were selected, and the navigation template was designed based on the ideal trajectory before operation, CBT screws were placed during the operation to further verify the safety and feasibility of the ideal trajectory. RESULTS: T-Bc and T-Bb are the ideal screw trajectories for L1-L2 and L3-L5, respectively. The screw placement point is located at the intersection of the inner 1/3 vertical line of the superior facet joint and the bottom 1/3 horizontal line of the outer crest of the vertebral lamina (i.e., 2-4 mm inward at the bottom 1/3 of the outer crest of the vertebral lamina). CBT screws were successfully placed based on the ideal screw trajectory in clinical practice. During the operation or the follow-up period, there were no adverse events. CONCLUSION: CBT screw placement based on the ideal screw trajectory is a safe and reliable method for achieving effective fixation and satisfactory postoperative effects.


Assuntos
Osso Cortical/lesões , Fixação de Fratura/instrumentação , Vértebras Lombares/lesões , Parafusos Pediculares , Fraturas da Coluna Vertebral/cirurgia , Simulação por Computador , Osso Cortical/diagnóstico por imagem , Osso Cortical/cirurgia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Modelos Anatômicos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Articulação Zigapofisária/diagnóstico por imagem , Articulação Zigapofisária/cirurgia
7.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(12): 1533-1538, 2020 Dec 15.
Artigo em Chinês | MEDLINE | ID: mdl-33319531

RESUMO

Objective: To evaluate the effectiveness of cement-injectable cannulated pedicle screw combined with multiple level Schwab grade Ⅰ osteotomy for chronic thoracolumbar osteoporotic fractures with kyphosis. Methods: The clinical data of 27 patients with symptomatic chronic thoracolumbar osteoporotic fractures combined with kyphosis treated between June 2015 and June 2017 were retrospectively analysed. Among them, there were 8 males and 19 females, with an average age of 69.5 years (range, 56-81 years). The damage segment (kyphosis vertex) included T 11 in 4 cases, T 12 in 12 cases, L 1 in 10 cases, and L 2 in 1 case. The disease duration ranged from 3 to 21 months, with an average of 12.5 months. The T value of lumbar vertebral bone mineral density ranged from -4.9 to -2.5, with an average value of -3.61. The American Spinal Injury Association (ASIA) classification was used to evaluate spinal cord injury, there were 1 case of grade D and 26 cases of grade E. The visual analogue scale (VAS) score, Oswestry disability index (ODI), kyphosis Cobb angle of fracture site, and sagittal vertical axis (SVA) data were obtained before operation, at 2 weeks after operation, 3 months after operation, and last follow-up, to evaluate the quality of life and improvement of sagittal spine parameters. Results: No complications related to pedicle screw and bone cement occurred. The incisions healed by first intention in 26 cases, and 1 incision healed after dressing change due to poor blood glucose control. There were no complications such as bedsore, hypostatic pneumonia, or deep venous thrombosis. All patients were followed up 8-24 months, with an average of 16.6 months. The VAS score, ODI score, Cobb angle, and SVA were significantly improved when compared with those before operation ( P<0.05). There was no significant difference in Cobb angle between each time point after operation ( P>0.05); the VAS score and ODI score at 3 months after operation and last follow-up were significantly better than those at 2 weeks after operation ( P<0.05), and the ODI score at last follow-up was further improved when compared with the score at 3 months ( P<0.05), but there was no significant difference in VAS score ( P>0.05); SVA at last follow-up was significantly worse than that at 2 weeks and 3 months after operation ( P<0.05), but there was no significant difference between at 2 weeks and 3 months after operation ( P>0.05). During the follow-up period, there was no complication such as pedicle screw loosening, breakage or cutting, adjacent vertebral fracture, proximal junctional kyphosis, and so on. Conclusion: For the chronic thoracolumbar osteoporotic fractures combined with kyphosis, the cement-injectable cannulated pedicle screw and multiple level Schwab grade Ⅰ osteotomy has the advantages of less operation trauma, quick recovery, and remarkable effectiveness.


Assuntos
Cifose , Fraturas por Osteoporose , Parafusos Pediculares , Fraturas da Coluna Vertebral , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos , Feminino , Fixação Interna de Fraturas , Humanos , Vértebras Lombares/lesões , Masculino , Pessoa de Meia-Idade , Osteotomia , Qualidade de Vida , Estudos Retrospectivos , Vértebras Torácicas/lesões , Resultado do Tratamento
8.
Zhongguo Gu Shang ; 33(12): 1128-33, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33369320

RESUMO

OBJECTIVE: To explore the effect of anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach for severe thoracolumbar burst fractures with spinal cord injury. METHODS: From January 2016 to June 2018, 16 patients with severe thoracolumbar burst fractures (more than 50% of ratio of spinal canal encroachment, reverse fragment at the posterior edge of the vertebral body) with spinal cord injury were retrospectively analyzed, including 10 males and 6 females, ranging in age from 19 to 57 years old. Causes of injury:8 cases of fall injury, 6 cases of traffic accident injury and 2 cases of other injuries. Fracture site:T11 in 4 cases, T12 in 5 cases, L1 in 5 cases, L2 in 2 cases. All the patients underwent anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach. The curative imaging effects were evaluated by measuring the loss height of the anterior edge of the injured vertebra, Cobb angle of the adjacent segment of the injured vertebra, and ratio of spinal canal encroachment. The clinical effects were evaluated by Frankel spinal cord injury rating and visual analogue scale (VAS). RESULTS: All 16 patients were followed up, and the average follow up time was (15.9±5.4) months. The average operation time was (234±41) minutes and the average amount of bleeding was (431±93) ml. The loss of anterior height of injured vertebrae was (52.25±10.10)% before operation, (8.93± 3.61)% at 3 days after operation, and (9.25±2.88)% at the latest follow up. The results of 3 days after operation and the latest follow up were better than that before operation, and there was no significant differencesbetween results at the latest follow up and 3 days after operation (P<0.01). Cobb angle of adjacent segment of injured vertebrae was (28.19±10.89)°before operation, (5.31±5.14)° 3 days after operation, and (6.81±4.59)°at the latest follow-up. The ratio of spinal canal encroachment was (67.68±12.45)% before operation, (7.69±4.46)% at 3 days after operation, and (4.75±1.63)% at the latest follow-up. At 3 days and the latest follow-up, the rate recovered to a certain extent (P<0.05). At the latest follow up, spinal nerve function was improved in 12 patients, no improvement in 4 patients and no deterioration in nerve function. VSA score was improved from preoperative 7.8±0.9 to final follow-up 1.8±0.7. CONCLUSION: For severe thoracolumbar burst fracture and spinal cord injury, with more than 50% of ratio of spinal canal encroachment and reverse fragment at the posterior edge of the vertebral body, the anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach has the characteristics of accurate reduction, complete decompression and firm fixation, and the clinical effect is satisfactory.


Assuntos
Traumatismos da Medula Espinal , Fraturas da Coluna Vertebral , Adulto , Parafusos Ósseos , Descompressão , Feminino , Fixação Interna de Fraturas , Humanos , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Canal Vertebral , Traumatismos da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Adulto Jovem
9.
Medicine (Baltimore) ; 99(44): e22468, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126302

RESUMO

RATIONAL: Vertebral compression fracture (VCF) is one of the most common diseases in spinal surgery. Traditional percutaneous vertebroplasty (PVP) under fluoroscopy is an effective method to treat vertebral compression fracture. However, there is still a risk of vascular nerve injury and infection caused by inaccurate or repeated puncture. Therefore, the purpose of this paper was to assess the accuracy of unilateral PVP guided by screw view model of navigation (SVMN) for VCF. PATIENT CONCERNS: A 59-year-old female patient suffered high falling injury, and with back pain as its main clinical symptom. DIAGNOSES: The patient was diagnosed with a L1 VCF. INTERVENTIONS: We placed the puncture needle under the guidance of SVMN to reach the ideal position designed before operation, and then injected the bone cement to complete the percutaneous kyphoplasty (PKP). OUTCOMES: The operative time was 29.5 minutes, the puncture time was 1 time, the fluoroscopy time was 2.9 minutes, and the bone cement distribution was satisfactory. VAS and ODI scores were significant improved postoperatively. No surgical complications, including neurovascular injury and infection, were observed during 28-month follow up. LESSONS: The SVMN guided percutaneous puncture needle insertion in PKP operation for VCF is an effective and safety technique. Besides, the SVMN has also been a contributor to reduce radiation doses and replace conventional fluoroscopy.


Assuntos
Fraturas por Compressão/cirurgia , Vértebras Lombares/lesões , Neuronavegação/métodos , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Cimentos para Ossos , Feminino , Humanos , Cifoplastia/métodos , Pessoa de Meia-Idade , Punções/métodos , Resultado do Tratamento
10.
J Vasc Interv Radiol ; 31(10): 1683-1689.e1, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32921566

RESUMO

PURPOSE: To assess the safety and efficacy of multilevel thoracolumbar vertebroplasty in the simultaneous treatment of ≥ 6 painful pathologic compression fractures. MATERIALS AND METHODS: Retrospective review was conducted of 50 consecutive patients treated with vertebroplasty for ≥ 6 pathologic compression fractures in a single session for pain palliation at a tertiary single cancer center from 2015 to 2019. Outcomes measured included procedural safety according to Common Terminology Criteria for Adverse Events (CTCAE), change in 4-week postprocedure back pain by numeric rating scale (NRS), comparison of daily opioid medication consumption, and development of skeletal-related events. RESULTS: A total of 397 pathologic compression fractures were treated during 50 sessions (mean, 7.9 per patient ± 1.5). Mean procedure duration was 162 minutes ± 35, mean postoperative hospitalization duration was 1.6 days ± 0.9, and mean follow-up duration was 401 days ± 297. Seven complications were recorded, including 1 case of symptomatic polymethyl methacrylate pulmonary embolism. No major complications (CTCAE grade 4/5) were reported. NRS pain score was significantly decreased (5.0 ± 1.8 vs 1.7 ± 1.4; P < .0001), with a mean score decrease of 3.3 points (66%). Opioid agent use decreased significantly (76 mg/24 h ± 42 vs 45 mg/24 h ± 37; P = .0003), with a mean decrease of 30 mg/24 h (39%). Skeletal-related events occurred in 7 patients (14%). CONCLUSIONS: Multilevel vertebroplasty for ≥ 6 pathologic compression fractures is safe and provides significant palliative benefit when performed simultaneously.


Assuntos
Dor nas Costas/prevenção & controle , Fraturas por Compressão/terapia , Fraturas Múltiplas/terapia , Fraturas Espontâneas/terapia , Vértebras Lombares/lesões , Cuidados Paliativos , Fraturas da Coluna Vertebral/terapia , Vértebras Torácicas/lesões , Vertebroplastia , Idoso , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Feminino , Fraturas por Compressão/complicações , Fraturas por Compressão/diagnóstico por imagem , Fraturas Múltiplas/complicações , Fraturas Múltiplas/diagnóstico por imagem , Fraturas Espontâneas/complicações , Fraturas Espontâneas/diagnóstico por imagem , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Resultado do Tratamento , Vertebroplastia/efeitos adversos
12.
AJR Am J Roentgenol ; 215(4): 970-977, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32809864

RESUMO

OBJECTIVE. The purpose of this study was to evaluate whether CT features can predict bone marrow edema (BME) on MRI and fracture age in vertebral fragility fractures. MATERIALS AND METHODS. A total of 189 thoracolumbar compression fractures in 103 patients (14 men, 89 women; mean age, 76 years) imaged with both spine CT and MRI were retrospectively included. The presence and extent of BME were assessed on MRI to divide fractures into those with and without BME. The group with BME was then classified for subgroup analysis into fractures with extensive BME (comprising 50% or more of the vertebral body) and those with BME comprising less than 50% of the vertebral body. On CT, five features (presence of cortical or endplate fracture line, presence of trabecular fracture line, presence of condensation band, change in trabecular attenuation, and width of paravertebral soft-tissue change) were analyzed. RESULTS. All five CT findings were predominantly seen in fractures with BME (p < 0.001). Elevated trabecular attenuation, presence of a cortical or endplate fracture line, and paravertebral soft-tissue width showed excellent diagnostic indication for fractures with BME (ROC AUCs: 0.990, 0.976, and 0.950, respectively). In the subgroup with extensive BME, paravertebral soft-tissue width was significantly higher, whereas the change in trabecular attenuation was lower compared with those with BME comprising less than 50% of the vertebral body (p < 0.001). When BME was present, fracture age was not significantly different between the two subgroups, and only greater trabecular attenuation elevation was predictive of older fracture age on linear mixed model analyses (p < 0.001). Interobserver agreement was good for the trabecular fracture line factor and excellent for all other factors. CONCLUSION. CT features accurately correlate with the presence and extent of BME in vertebral fragility fractures. Elevation of trabecular attenuation was the only significant image predictor of fracture age.


Assuntos
Doenças da Medula Óssea/diagnóstico por imagem , Edema/diagnóstico por imagem , Fraturas por Compressão/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Fraturas da Coluna Vertebral/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Doenças da Medula Óssea/etiologia , Edema/etiologia , Feminino , Fraturas por Compressão/complicações , Humanos , Vértebras Lombares/lesões , Imagem por Ressonância Magnética , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Fraturas da Coluna Vertebral/complicações , Vértebras Torácicas/lesões
13.
Medicine (Baltimore) ; 99(34): e21572, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846765

RESUMO

Traumatic end plate fractures (EPFs) refers to the EPF caused by trauma, rather than the pathological status of the end plate (EP). However, some old traumatic EPFs may be mistaken as osteoporotic in the elderly. The objective of this study is to describe the radiological features of traumatic EPF in different traumatic fracture type patients presenting in the Emergency department setting. And to compare the result with osteoporotic vertebral fracture (VF).This study retrospectively analyzed the anatomical location of acute thoracolumbar vertebral traumatic EPFs in males (age≤55 years) and females (age≤50 years). The anatomic distribution of EPFs, the anterior and posterior wall fracture were analyzed in patients, who were scanned with 1 or more of the following methods: radiography, CT, and magnetic resonance imaging.There were 194 cases of acute spine trauma involving at least 1 EPF, including 118 males and 76 females. The involved vertebra was mostly at L1 (29.7%), followed by T12 (18.3%), and then by L2 (12.9%). Excluding those with both upper and lower EP involvements, the ratio of superior EPF to inferior EPF was 33.5 for males and 45.5 for females. With the EP divided into 5 segments of equal length in the anteroposterior direction in different fracture types, fractures occurred mostly at a2 segment (71.48% for superior EPs and 7.60% for inferior EPs), followed by a1 segment (66.16% for superior EPs). The upper third of the anterior and posterior walls were most prone to fracture in traumatic vertebral fracture.Traumatic EPFs more likely involve the anterior EP more than the posterior EP and is correlated with fracture type. These characteristics may help radiologist differential diagnosis between traumatic and osteoporotic EPF.


Assuntos
Vértebras Lombares/lesões , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/lesões , Adolescente , Adulto , China/epidemiologia , Diagnóstico Diferencial , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose , Radiografia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Vértebras Torácicas/diagnóstico por imagem , Adulto Jovem
15.
Chin J Traumatol ; 23(4): 211-215, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32571532

RESUMO

Since December 2019, COVID-19, an acute infectious disease, has gradually become a global threat. We report a case of thoracolumbar fractures (T12 and L1) and incomplete lower limb paralysis in a patient with COVID-19. After a series of conservative treatment which did not work at all, posterior open reduction and pedicle screw internal fixation of the thoracolumbar fracture were performed in Wuhan Union Hospital. Three weeks later, the patient could stand up and the pneumonia is almost cured. We successfully performed a surgery in a COVID-19 patient, and to our knowledge it is the first operation for a COVID-19 patient ever reported.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Vértebras Lombares/lesões , Paralisia/cirurgia , Pneumonia Viral/complicações , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Fixação Interna de Fraturas , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Pandemias , Parafusos Pediculares , Vértebras Torácicas/cirurgia
16.
Aging (Albany NY) ; 12: 11259-11262, 2020 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-32568102

RESUMO

In December 2019, the 2019 novel coronavirus (SARS-CoV-2) began spreading in China. At present, there are no special protocols for treating lumbar burst fracture (LBF) patients infected with SARS-CoV-2. Here, we present our lessons and experiences with a patient presenting with a severe LBF complicated by an occult SARS-CoV-2 infection. The clinical data for a 52-year-old male LBF patient were collected during the incubation period of COVID-19. The patient exhibited no obvious COVID-19-related symptoms prior to his surgery, and his vital signs were stable on the first day after the operation. By postoperative day 3, however, the patient was exhibiting chills and high fever. A chest CT showed a patchy high-density shadow surrounded by ground-glass opacity in the lower portion of his right lung. A nucleic acid test for SARS-CoV-2 was positive, and the patient was then transferred to the Department of Infectious Disease for further special treatment. This case taught that when treating patients with severe trauma within an epicenter of this pandemic, it is crucial for healthcare workers to be vigilant so as to avoid potential widespread outbreaks of COVID-19 within hospitals.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Fraturas Ósseas/complicações , Fraturas Ósseas/cirurgia , Vértebras Lombares/cirurgia , Pneumonia Viral/complicações , Complicações Pós-Operatórias/virologia , Betacoronavirus/genética , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/virologia , Humanos , Vértebras Lombares/lesões , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/virologia
17.
Turk Neurosurg ; 30(4): 588-594, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32530483

RESUMO

AIM: To elucidate the characteristics of kyphoplasty in correlation with spinal metastasis. MATERIAL AND METHODS: Data of patients treated by kyphoplasty between January 2017 and December 2019 were reviewed retrospectively. Preoperative prophylactic antibiotics and low-molecular-weight heparin injections were performed. Postoperative follow-up was conducted at least 24 hours after the procedure. All patients were treated under sedoanalgesia. Bone biopsies were collected from all patients. RESULTS: One hundred ninety-nine vertebra fractures were treated in 130 patients. The mean age of the patients was 65.27 ± 8.79 years (18?90 years) and 66 patients were male (50.7%). Forty-five patients had osteoporosis, six patients showed malignancy, and osteomyelitis was found in three patients, while the others? presentations were secondary to trauma. Most commonly, the L1 (n=59), Th12 (n=45), and L2 (n=34) levels were found to develop vertebral fractures. Forty patients had multiple levels of vertebral fracture, with a higher rate of osteoporosis (n=24; 60%). Three patients showed undiagnosed oncologic disease with an initial diagnosis of acute fracture following minor trauma, while the primary oncologic diagnosis was established by bone biopsy taken during the routine procedure in each procedure (e.g., plasmacytoma, lymphoma, adenocarcinoma of the lung). None of the patients developed an infection due to kyphoplasty, permanent neuromotor deficit, or mortality. The mean postoperative hospital length of stay was 1.6 days. CONCLUSION: Bone biopsy should be performed to diagnose early spinal metastases. Although an accurate bone biopsy may not be obtained from some patients, particularly from those with osteoporosis, performing bone biopsy during the procedure does not cause time loss or any other complications, and protects the surgeon from possible medicolegal problems.


Assuntos
Detecção Precoce de Câncer/métodos , Cifoplastia/métodos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas por Compressão/cirurgia , Humanos , Cifoplastia/efeitos adversos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Osteomielite/complicações , Osteomielite/cirurgia , Osteoporose/complicações , Osteoporose/cirurgia , Estudos Retrospectivos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Vertebroplastia/métodos , Adulto Jovem
18.
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
19.
Rev. Asoc. Argent. Ortop. Traumatol ; 85(2): 119-124, jun. 2020. []
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1125548

RESUMO

Introducción: La acrobacia en tela es una práctica circense con muchos adeptos en la población urbana. Consiste en sostenerse en altura tomado por dos extremos de tela, para realizar posturas fijas y cambiar entre ellas mediante deslizamiento y caídas. La práctica profesional no está libre de lesiones. Objetivo: Conocer la naturaleza de la lesión, reconocer los factores predisponentes de lesión y las medidas de prevención utilizadas, evaluar la cinemática, clasificar la lesión y analizar el tratamiento. Materiales y Métodos: Se incluyeron seis pacientes. Se evaluaron la estructura física personal, la cinemática de la caída, los sistemas de protección, la clasificación de las fracturas según la nueva clasificación AO, el cuadro neurológico, el tratamiento y las complicaciones. Resultados: La muestra incluyó a 6 mujeres, con un promedio de edad de 24 años y un índice de masa corporal de 19,29. Caída de 3,08 m de altura, cuatro con colchoneta <5 cm. Las lesiones principales fueron: 6 A1, 4 B2 y 1C. No se observaron déficits neurológicos. Cuatro pacientes fueron sometidas a cirugía. Conclusiones: La práctica de acrobacia en tela es una actividad circense de reciente aparición global. Las mujeres están más expuestas a las lesiones. El entrenamiento riguroso y el empleo de elementos de seguridad son necesarios para evitar las lesiones. No se observó un patrón único de lesión, la causa fue multifactorial. El tratamiento indicado depende de la lesión vertebral. Nivel de Evidencia: IV


Introduction: Aerial silk is a circus practice that has become very popular in urban populations. It involves hanging from two pieces of fabric in order to make fixed positions and change between them by sliding and dropping from different heights. The professional practice is not free of injuries. Objective: To learn the nature of the injury, to recognize the injury predisposing factors and the safety measures used, to study the kinematics, to classify the injury, and to analyze the treatment. Materials and Methods: Six patients were included. The evaluation included individual body structure, drop kinematics, safety measures, classification of fractures according to the new AO classification, neurological symptoms, treatment, and complications. Results: The study included six female patients, averaging 24 years, a body mass index of 19.29 and a fall from 3.08m, 4 of which included mattress <5cm. The main injuries classification resulted in 6 A1, 4 B2 and 1 C. No neurological deficit was found. Four patients underwent surgical treatment. Conclusions: Aerial silk is a circus activity that has recently become a worldwide practice. Women are more exposed. Rigorous training and the use of safety elements are necessary to avoid injuries. We did not observe a unique pattern of injury, because of its multifactorial cause. The therapeutic decision-making is related to the spinal injury. Level of Evidence: IV


Assuntos
Traumatismos em Atletas , Traumatismos da Coluna Vertebral , Vértebras Torácicas/lesões , Fraturas da Coluna Vertebral , Ginástica/lesões , Vértebras Lombares/lesões
20.
Scand J Trauma Resusc Emerg Med ; 28(1): 42, 2020 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-32448190

RESUMO

BACKGROUND: Major trauma often comprises fractures of the thoracolumbar spine and these are often accompanied by relevant thoracic trauma. Major complications can be ascribed to substantial simultaneous trauma to the chest and concomitant immobilization due to spinal instability, pain or neurological dysfunction, impairing the respiratory system individually and together. Thus, we proposed that an early stabilization of thoracolumbar spine fractures will result in significant benefits regarding respiratory organ function, multiple organ failure and length of ICU / hospital stay. METHODS: Patients documented in the TraumaRegister DGU®, aged ≥16 years, ISS ≥ 16, AISThorax ≥ 3 with a concomitant thoracic and / or lumbar spine injury severity (AISSpine) ≥ 3 were analyzed. Penetrating injuries and severe injuries to head, abdomen or extremities (AIS ≥ 3) led to patient exclusion. Groups with fractures of the lumbar (LS) or thoracic spine (TS) were formed according to the severity of spinal trauma (AISspine): AISLS = 3, AISLS = 4-5, AISTS = 3 and AISTS = 4-5, respectively. RESULTS: 1740 patients remained for analysis, with 1338 (76.9%) undergoing spinal surgery within their hospital stay. 976 (72.9%) had spine surgery within the first 72 h, 362 (27.1%) later on. Patients with injuries to the thoracic spine (AISTS = 3) or lumbar spine (AISLS = 3) significantly benefit from early surgical intervention concerning ventilation time (AISLS = 3 only), ARDS, multiple organ failure, sepsis rate (AISTS = 3 only), length of stay in the intensive care unit and length of hospital stay. In multiple injured patients with at least severe thoracic spine trauma (AISTS ≥ 4) early surgery showed a significantly shorter ventilation time, decreased sepsis rate as well as shorter time spend in the ICU and in hospital. CONCLUSIONS: Multiply injured patients with at least serious thoracic trauma (AISThorax ≥ 3) and accompanying spine trauma can significantly benefit from early spine stabilization within the first 72 h after hospital admission. Based on the presented data, primary spine surgery within 72 h for fracture stabilization in multiply injured patients with leading thoracic trauma, especially in patients suffering from fractures of the thoracic spine, seems to be beneficial.


Assuntos
Traumatismo Múltiplo/terapia , Fraturas da Coluna Vertebral/terapia , Traumatismos Torácicos/terapia , Adulto , Idoso , Cuidados Críticos , Feminino , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação , Vértebras Lombares/lesões , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/complicações , Sistema de Registros , Fraturas da Coluna Vertebral/complicações , Traumatismos Torácicos/complicações , Vértebras Torácicas/lesões , Tempo para o Tratamento
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