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1.
Zhongguo Gu Shang ; 33(2): 121-6, 2020 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-32133809

RESUMO

OBJECTIVE: To investigate the surgical choice of posterior osteotomy way by the observation of clinical outcome of Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO) and vertebral column re-section (VCR) for senile osteoporotic thoracolumbar fracture with kyphosis. METHODS: From June 2015 to August 2017, an amount of 8 elderly patients with thoracolumbar kyphosis caused by osteoporotic vertebral fracture underwent osteotomy approach for posterior osteotomy. All patients were old osteoporotic vertebral fracture more than 6 months and received invalid conservative treatment for 3 months including nonsteroidal anti-inflammatory and analgesic drugs, anti-osteoporosis drugs and acupuncture, etc. There were 3 males and 5 females, with an average age of 73.4 years (66 to 83 years), with an average course of the disease of 34.6 months (8 to 60 months). Eight patients had a total of 8 vertebral fractures, and fracture segment was in T10 of 1 case, T11 of 1 case, T12 of 3 cases, L1 of 2 cases, L2 of 1 case. Eight patients showed kyphosis caused by wedge deformation of single segmental vertebral fractures. The thoracolumbar kyphosis and symptoms were progressively developing into central sagittal imbalance. SPO osteotomy was performed in 3 cases, PSO osteotomy in 3 cases, and VCR osteotomy in 2 cases. Orthopaedic effects were analyzed by imaging measurements, including pre- and post-operative kyphosis Cobb angle, localized kyphosis (LK), thoracic kyphosis (TK), lumbar lordosis (LL), sacral tilt angle (ST) and sagittal vertical axis (SVA). Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the pain and lumbar function. RESULTS: All the eight patients were followed up from 8 to 24 months with an average of 13.5 months and all the symptoms of low back pain have significantly reduced or disappeared. The VAS score decreased from 5-8 points (mean 6.5 points) before surgery to 1-4 points (mean 1.88 points) at the final follow-up, and the score was significantly improved. The ODI score decreased from 36-78 points (mean 60.25 points) before surgery to 10-32 points (mean 20.38 points) at the final follow-up, and the functional score improved significantly. During the follow-up period, X-ray examination showed that some patients had a slight decrease in the height of the intervertebral fusion, and the bone graft was healed. There was no obvious corrected degree loss and internal fixation loosening, and the thoracolumbar kyphosis was significantly improved. The mean Cobb angle of T10-L2 was reduced from 25.3° to 2.8° with corrected rate of 89.3% ; LK was reduced from 43.4° to 7.1° with corrected rate of 86.2% ; TK was reduced from 49.9° to 30.6°, LL was reduced from 43.6° to 30.8°, and ST was changed from 24.0° to 32.1°, SVA was changed from 6.23 cm to 2.40 cm. CONCLUSION: For the different pathological features and deformities of senile osteoporotic thoracolumbar fracture combined with kyphosis, SPO, PSO or VCR can achieve good orthopedic effect and clinical efficacy.


Assuntos
Cifose , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Vértebras Lombares , Masculino , Fraturas por Osteoporose/cirurgia , Osteotomia , Estudos Retrospectivos , Vértebras Torácicas , Resultado do Tratamento
2.
Zhongguo Gu Shang ; 33(2): 144-8, 2020 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-32133814

RESUMO

OBJECTIVE: To explore the safety and effectivity of ultrasonic bone knife in osteotomy of degenerative kyphosis. METHODS: The clinical data of 32 patients with degenerative kyphosis treated from February 2014 to May 2016 were retrospectively analyzed. There were 12 males and 20 females, aged 50 to 71 years with an average of (62.1±12.3) years. Preoperative Cobb angle was 25.3° to 36.7° with an average of (28.6±10.2) °. All patients underwent multi-segment Ponte osteotomy combined with posterior long segmental internal fixation. According to different osteotomy tools, the patients were divided into traditional tool group (group A, 18 cases) and ultrasonic bone knife group (group B, 14 cases). The operation time, laminectomy time, number of osteotomy segments, intraoperative blood loss, postoperative drainage, hospitalization time and postoperative complications were recorded.Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate clinical outcomes before and 1 month after surgery. RESULTS: All the patients were followed up from 8 to 24 months with an average of 16.4 months. There were no significant differences in operative time and hospitalization time between two groups (P>0.05). Intraoperative single laminectomy time of group A was more than that of group B (P<0.05). The number of osteotomy segments in group A was less than that in group B (P<0.05). Intraoperative blood loss and postoperative drainage in group A were more than that in group B (P<0.05). There were no significant differences in VAS and ODI between two groups (P>0.05). There were no dural, nerve and spinal cord injuries in both groups, and there were no complications such as improper operation of the instrument and nonunion of the osteotomy. CONCLUSION: The use of ultrasonic bone knife for Ponte osteotomy is safe and effective. It can effectively save the time of single laminectomy while reducing the amount of intraoperative blood loss and postoperative drainage. The safety and clinical efficacy of ultrasonic bone knife are no less than traditional tools.


Assuntos
Cifose , Ultrassom , Idoso , Feminino , Humanos , Cifose/diagnóstico por imagem , Cifose/cirurgia , Laminectomia , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Osteotomia , Estudos Retrospectivos , Vértebras Torácicas , Resultado do Tratamento
3.
Zhongguo Gu Shang ; 33(2): 149-53, 2020 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-32133815

RESUMO

OBJECTIVE: To evaluate the clinical effects of debridement and bone grafting with internal fixation via anterior approach in treatment of tuberculosis of lower cervical vertebrae. METHODS: The clinical data of 15 patients with tuberculosis of lower cervical vertebrae who accepted the treatment of one-stage debridement and bone grafting with internal fixation from June 2010 to December 2018 were retrospectively analyzed. There were 9 males and 6 females, aged from 39 to 72 years with an average of (54.67±10.75) years. The lesion segment was C4 to C6. Pre- and post-operative neurologic functions were evaluated by ASIA grade. All the patients underwent the X-ray films of positive and lateral of cervical spine before and after the operation and accepted the periodic review of CT to evaluate the bone grafting. RESULTS: All the 15 operations were successful, no neurological or vascular injury occurred during the operation, and all patients were followed up for 18 to 52 months. The clinical symptoms improved significantly during the follow-up period and CT showed good bone grafting fusion. One patient suffered a relapse of the illness 3 years later, but was healed during the follow-up visit by strengthening the anti tuberculosis therapy. CONCLUSION: For the patients with vertebral destruction and loss of cervical stability, one-stage debridement and bone grafting with internal fixation via anterior approach has definite curative effects. On the basis of standard anti tuberculosis treatment before operation, the long-term standard anti-tuberculosis treatment after operation is the key to healing the tuberculosis of lower cervical vertebrae.


Assuntos
Fusão Vertebral , Tuberculose da Coluna Vertebral , Adulto , Idoso , Transplante Ósseo , Vértebras Cervicais , Desbridamento , Feminino , Fixação Interna de Fraturas , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vértebras Torácicas , Resultado do Tratamento
4.
Zhongguo Gu Shang ; 33(2): 166-72, 2020 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-32133818

RESUMO

OBJECTIVE: To investigate the clinical effect of One-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion for the treatment of lumbosacral tuberculosis. METHODS: The clinical data of 31 patients with lumbosacral tuberculosis treated by one-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion from January 2013 to February 2018 were retrospectively analyzed. There were 18 males and 13 females, aged from 18 to 77 years old with an average of (45.9±9.1) years. The lesion segment was form L4 to S2. The preoperative ASIA grading showed that 2 cases were grade B, 17 cases were grade C, 12 were grade D. Pre- and post-operative C reactive protein (CRP), visual analogue scale (VAS), erythrocyte sedimentation rate (ESR), ASIA grade, lumbosacral angle and intervertebral space height were analyzed, the surgery complications, stability of internal fixation, bone fusion were observed. RESULTS: All the 31 patients were followed up for 10 to 24 months with an average of (16.0±3.1) months. One patient with local infection and subcutaneous hydrops was cured by dressing change. Other 30 cases got primary healing without sinus formation and no recurrence of spinal tuberculosis. All the patients were cured, no internal fixation loosening and breakage were found. All bone fusion was successful with an average fusion time of (4.7±1.1) months. At the final follow-up, ESR and CRP were normal, the VAS was decreased from (6.13±1.21) points preoperatively to (1.92±0.57) pioints, the ASIA grading showed that 2 cases were grade C, 6 cases were grade D, and 23 cases were grade E. The lumbosacral angle and intervertebral space height was increased from preoperative (21.42±3.75) °, (7.84±0.41) mm to (27.21±3.12) °, (9.80±0.38) mm at the final follow-up, respectively. CONCLUSION: One-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion is a practicable, effective and safe method for the treatment of lumbosacral tuberculosis. It can be recommended in clinical application.


Assuntos
Fusão Vertebral , Tuberculose da Coluna Vertebral , Adolescente , Adulto , Idoso , Transplante Ósseo , Desbridamento , Feminino , Fixação Interna de Fraturas , Humanos , Ílio , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vértebras Torácicas , Resultado do Tratamento , Adulto Jovem
5.
Zhongguo Gu Shang ; 33(2): 184-9, 2020 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-32133822

RESUMO

Adolescent idiopathic scoliosis (AIS) is a common disease with the age of 10 to 18 years, the Cobb angle more than 10 ° on the coronal plane and combined with the rotation of the vertebral body without other organic lesions. The disease can lead to deformity, pain and even damage of cardiopulmonary function, which seriously affects the physical and mental health and quality of life of patients. For mild to moderate AIS patients, regular observation, braces and other conservative treatment methods can effectively delay the progress of scoliosis. For AIS patients whose conservative treatment is ineffective and reaches the surgical threshold, surgery is recommended. Currently, the prevalent surgical method is posterior vertebral body fusion represented by the pedicle screw internal fixation system, which can often achieve good clinical efficacy. In recent years, Physical Therapeutic Scoliosis Specific Exercise (PSSE) has become more and more popular because of its safety and effectiveness. At present, the specific indications for the treatment of AIS patients are gradually improving, the concept and technology of treatment are constantly updated, and the clinical efficacy is constantly improved. This article will start from two aspects of conservative treatment and surgical treatment, mainly describes the commonly used treatment methods in clinical progress and application as well as the problems faced, in order to provide a reference for the selection of clinical treatment.


Assuntos
Escoliose , Fusão Vertebral , Adolescente , Humanos , Qualidade de Vida , Radiografia , Estudos Retrospectivos , Vértebras Torácicas , Resultado do Tratamento
6.
Medicine (Baltimore) ; 99(10): e19348, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150074

RESUMO

RATIONALE: A patient presented the abdominal wall protrusion due to tophaceous gout of the spine. Similar cases were not reported in the literature. This study aimed to report a case of tophaceous gout of the spine with abdominal wall protrusion. PATIENT CONCERNS: A 38-year-old male patient had a 10-year history of gout and hyperuricemia. He complained of back pain and abdominal wall protrusion. DIAGNOSES: The patient was diagnosed with tophaceous gout of the spine with abdominal wall weakness caused by T11 nerve root compression. INTERVENTIONS: A semi-lamina decompression was performed at T11-T12. The pathological examination of the specimen demonstrated tophaceous gout of the spine. OUTCOMES: After the surgery, the patient's back pain was completely relieved and the abdominal wall weakness significant improved. LESSONS: This case highlighted that axial gout could mimic thoracic disk herniation clinically. The abdominal wall weakness might also be due to single T11 nerve compression by the tophaceous gout of the spine. In patients with a history of gout, axial gout should be considered as one of the differential diagnoses.


Assuntos
Parede Abdominal/anormalidades , Gota/cirurgia , Vértebras Torácicas/cirurgia , Parede Abdominal/cirurgia , Humanos , Hiperuricemia/complicações , Hiperuricemia/cirurgia , Laminectomia/métodos , Compressão da Medula Espinal/cirurgia
7.
Bone Joint J ; 102-B(3): 376-382, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32114809

RESUMO

AIMS: To compare the rates of sagittal and coronal correction for all-pedicle screw instrumentation and hybrid instrumentation using sublaminar bands in the treatment of thoracic adolescent idiopathic scoliosis (AIS). METHODS: We retrospectively reviewed the medical records of 124 patients who had undergone surgery in two centres for the correction of Lenke 1 or 2 AIS. Radiological evaluation was carried out preoperatively, in the early postoperative phase, and at two-year follow-up. Parameters measured included coronal Cobb angles and thoracic kyphosis. Postoperative alignment was compared after matching the cohorts by preoperative coronal Cobb angle, thoracic kyphosis, lumbar lordosis, and pelvic incidence. RESULTS: A total of 179 patients were available for analysis. After matching, 124 patients remained (62 in each cohort). Restoration of thoracic kyphosis was significantly better in the sublaminar band group than in the pedicle screw group (from 23.7° to 27.5° to 34.0° versus 23.9° to 18.7° to 21.5°; all p < 0.001). When the preoperative thoracic kyphosis was less than 20°, sublaminar bands achieved a normal postoperative thoracic kyphosis, whereas pedicle screws did not. In the coronal plane, pedicle screws resulted in a significantly better correction than sublaminar bands at final follow-up (73.0% versus 59.7%; p < 0.001). CONCLUSION: This is the first study to compare sublaminar bands and pedicle screws for the correction of a thoracic AIS. We have shown that pedicle screws give a good coronal correction which is maintained at two-year follow-up. Conversely, sublaminar bands restore the thoracic kyphosis better while pedicle screws are associated with a flattening of the thoracic spine. In patients with preoperative hypokyphosis, sublaminar bands should be used to restore a proper sagittal profile. Cite this article: Bone Joint J 2020;102-B(3):376-382.


Assuntos
Escoliose/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Adolescente , Feminino , Seguimentos , Humanos , Masculino , Parafusos Pediculares , Radiografia , Estudos Retrospectivos , Escoliose/diagnóstico , Vértebras Torácicas/diagnóstico por imagem
8.
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
9.
Unfallchirurg ; 123(2): 143-154, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-32016493

RESUMO

Posttraumatic kyphotic deformities of the thoracolumbar spine may result in significant clinical complaints. If conservative treatment is not successful, surgical correction of the kyphosis becomes an option. In contrast to degenerative deformities, posttraumatic kyphotic deformities are usual limited to few segments and can be treated with shorter constructs. The surgical strategy depends on the rigidity and the localization of the posttraumatic kyphotic deformity. In this respect purely posterior approaches and combined posteroanterior surgical approaches are available each with different advantages and disadvantages.


Assuntos
Cifose , Fusão Vertebral , Traumatismos da Coluna Vertebral , Tratamento Conservador , Humanos , Cifose/etiologia , Cifose/cirurgia , Vértebras Lombares , Osteotomia , Traumatismos da Coluna Vertebral/cirurgia , Vértebras Torácicas , Resultado do Tratamento
10.
Medicine (Baltimore) ; 99(7): e19046, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049803

RESUMO

INTRODUCTION: It is well known that the main segments of spinal fracture is thoracolumbar (T11-L11). Therefore, in addition to the lumbar, the lower thoracic vertebra (T9-T12) often has the clinical needs of implantation of cortical bone trajectory (CBT) screws. However, the anatomic parameters of the lower thoracic vertebrae are quite different from those of the lumbar vertebrae, which means that if CBT screws are to be implanted in the lower thoracic vertebrae, the selection of the screw entry point, the length, diameter, angle and path of the screws in each segment need to be redefined. Methods In this part, 3-dimensional finite element model was established to analyze the stress and fixation efficiency of CBT screws in thoracic vertebrae after 5000 times of fatigue loading of normal model and osteoporosis model. Discussion If the outcomes indicate the trial is feasible and there is evidence to provide some basic anatomical parameters for CBT screw implantation in the lower thoracic spine, so that the ideal insertion point, length, diameter, and angle of CBT screw in different segments of the lower thoracic spine were determined.Trial Registration Chinese Clinical Trial Registry, ChiCTR1900026915.Registered on September 26, 2019.


Assuntos
Procedimentos Ortopédicos/instrumentação , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Adulto , Fenômenos Biomecânicos , Parafusos Ósseos , Osso Cortical/anatomia & histologia , Osso Cortical/cirurgia , Estudos de Viabilidade , Feminino , Análise de Elementos Finitos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Vértebras Torácicas/anatomia & histologia , Adulto Jovem
11.
Medicine (Baltimore) ; 99(3): e18794, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011480

RESUMO

RATIONALE: Spinal involvement in adult Langerhans cell histiocytosis (LCH) is rare, and epidural involvement is unusual. LCH is mostly indistinguishable from other spinal lesions such as infection, lymphoma, and metastasis. So, it could be easily misdiagnosed without suspicion. PATIENT CONCERNS: We report a case of a 33-year-old man who complained of gait disturbance with weakness in both legs and severe back pain. DIAGNOSES: A continuous enhancing epidural lesion with cord compression from the T7 to L1 level was detected in magnetic resonance imaging. Laboratory analysis indicated the possibility of spinal infectious disease. We assumed that the lesion could be tuberculous spondylitis. INTERVENTIONS AND OUTCOMES: The patient underwent posterior laminectomy with marginal excision of the epidural mass to relieve cord compression. Pathological examination confirmed the diagnosis of LCH. The 12-month follow-up evaluation revealed that the patient was neurologically intact and had no gait disturbance. LESSONS: This case report presents a patient with epidural LCH of the thoracic spinal cord, which can mimic spinal infections such as tuberculous spondylitis with abscess formation. Therefore, LCH could be considered as a possible diagnosis when a patient presents with features of infectious spondylitis with vertebral involvement.


Assuntos
Histiocitose de Células de Langerhans/complicações , Histiocitose de Células de Langerhans/diagnóstico , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/etiologia , Adulto , Diagnóstico Diferencial , Histiocitose de Células de Langerhans/patologia , Histiocitose de Células de Langerhans/cirurgia , Humanos , Masculino , Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/patologia , Compressão da Medula Espinal/cirurgia , Vértebras Torácicas
12.
Khirurgiia (Mosk) ; (2): 84-88, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32105261

RESUMO

A 55-year-old patient M. with compression fractures of Th7-Th8 underwent Th7-Th8 decompressive laminectomy, Th6-Th9 transpedicular spine fusion procedure on January 31, 2017. After that, multiple myeloma was diagnosed at the National Research Center for Hematology. Computed tomography revealed misplacement of a left Th6 screw, its anterior cortical perforation and penetration into the aorta. Signs of intramural hematoma were noticed in this area. The patient was referred to the Petrovsky National Research Center of Surgery. Two-stage surgical approach was preferred. Endovascular repair of the thoracic aorta (TEVAR) was followed by revision of transpedicular fusion system and reinstallation of the screw. Operation was performed on July 14, 2017. Postoperative period was uneventful.


Assuntos
Aorta Torácica , Hematoma , Fraturas da Coluna Vertebral , Fusão Vertebral , Hematoma/etiologia , Humanos , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/efeitos adversos , Vértebras Torácicas , Tomografia Computadorizada por Raios X , Resultado do Tratamento
13.
Medicine (Baltimore) ; 99(2): e18202, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914013

RESUMO

To observe thoracolumbar segmental mobility using kinetic magnetic resonance imaging (kMRI) in patients with minimal thoracolumbar spondylosis and establish normal values for translational and angular segmental motion as well as the relative contribution of each segment to total thoracolumbar segmental motion in order to obtain a more complete understanding of this segmental motion in healthy and pathological conditions.Mid-sagittal images obtained by weight-bearing, multi-position kMRI in patients with symptomatic low back pain or radiculopathy were reviewed. The translational motion and angular variation of each segment from T10-L2 were calculated using MRAnalyzer Automated software. Only patients with a Pfirrmann grade of I or II, indicating minimal disc disease, for all thoracolumbar discs from T10-T11 to L1-L2 were included for further analysis.The mean translational motion measurements for each level of the lumbar spine were 1.15 mm at T10-T11, 1.20 mm at T11-T12, 1.23 mm at T12-L1, and 1.34 mm at L1-L2 (P < .05 for L1-L2 vs T10-T11). The mean angular motion measurements at each level were 3.26° at T10-T11, 3.92° at T11-T12, 4.95° at T12-L1, and 6.85° at L1-L2. The L1-L2 segment had significantly more angular motion than all other levels (P < .05). The mean percentage contribution of each level to the total angular mobility of the thoracolumbar spine was highest at L1-L2 (36.1%) and least at T10-T11 (17.1%; P < .01).Segmental motion was greatest in the proximal lumbar levels, and angular motion showed a gradually increasing trend from T10 to L2.


Assuntos
Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Espondilose/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Adolescente , Adulto , Feminino , Humanos , Degeneração do Disco Intervertebral/classificação , Degeneração do Disco Intervertebral/patologia , Cinética , Dor Lombar/patologia , Vértebras Lombares/patologia , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Espondilose/fisiopatologia , Vértebras Torácicas/patologia , Vértebras Torácicas/fisiopatologia , Suporte de Carga , Adulto Jovem
15.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(1): 69-75, 2020 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-31939238

RESUMO

Objective: To compare the effectiveness and screw planting accuracy of percutaneous reduction and internal fixation with robot and traditional fluoroscopy-assisted in the treatment of single-level thoracolumbar fractures without neurological symptoms. Methods: The clinical data of 58 patients with single-level thoracolumbar fractures without neurological symptoms between December 2016 and January 2018 were retrospectively analysed. According to different surgical methods, the patients were divided into group A (28 cases underwent robot-assisted percutaneous reduction and internal fixation) and group B (30 cases underwent fluoroscopy-assisted percutaneous reduction and internal fixation). There was no neurological symptoms, other fractures or organ injuries in the two groups. There was no significant difference in general data of age, gender, fracture location, AO classification, time from injury to surgery, and preoperative vertebral anterior height ratio, sagittal Cobb angle, visual analogue scale (VAS) score, and Oswestry disability index (ODI) score between the two groups ( P>0.05). The screw placement time, operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, hospitalization time, operation cost, postoperative complications, VAS score, ODI score, anterior vertebral height ratio, and sagittal Cobb angle before operation, at 3 days, 6 months after operation, and at last follow-up were recorded and compared between the two groups. The accuracy of the pedicle screw placement was evaluated by Neo's criteria. Results: The screw placement time, operation time, and intraoperative fluoroscopy frequency of group A were significantly less than those of group B, and the operation cost was significantly higher than that of group B ( P<0.05). But there was no significant difference in intraoperative blood loss and hospitalization time between the two groups ( P>0.05). Both groups were followed up 12-24 months, with an average of 15.2 months. The accuracy rate of screw placement in groups A and B was 93.75% (150/160) and 84.71% (144/170), respectively, and the difference was significant ( χ 2=5.820, P=0.008). Except for 1 case of postoperative superficial infection in group A and wound healing after dressing change, there was no complication such as neurovascular injury, screw loosening and fracture in both groups, and there was no significant difference in the incidence of complications between the two groups ( χ 2=0.625, P=0.547). The anterior vertebral height ratio, sagittal Cobb angle, VAS score, and ODI score of the two groups were significantly improved ( P<0.05); there was no significant difference between the two groups at all time points after operation ( P>0.05). Conclusion: The spinal robot and traditional fluoroscopy-assisted percutaneous reduction and internal fixation can both achieve satisfactory effectiveness in the treatment of single-level thoracolumbar fractures without neurological symptoms. However, the former has higher accuracy, fewer fluoroscopy times, shorter time of screw placement, and lower technical requirements for the operator. It has wide application potential.


Assuntos
Fixação Interna de Fraturas , Parafusos Pediculares , Robótica , Fraturas da Coluna Vertebral , Fluoroscopia , Humanos , Vértebras Lombares , Estudos Retrospectivos , Vértebras Torácicas , Resultado do Tratamento
16.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(1): 76-82, 2020 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-31939239

RESUMO

Objective: To compare short-term effectiveness between robot-guided percutaneous minimally invasive pedicle screw internal fixation and traditional open internal fixation in the treatment of thoracolumbar fractures. Methods: The clinical data of 52 cases of thoracolumbar fracture without neurological injury symptoms admitted between January 2018 and May 2018 were retrospectively analyzed. According to the different surgical methods, they were divided into minimally invasive group (24 cases, treated with robot-assisted percutaneous minimally invasive pedicle screw internal fixation) and open group (28 cases, treated with traditional open internal fixation). There was no significant difference between the two groups in the general data such as gender, age, cause of injury, fracture segment, thoracolumbar injury classification and severity score (TLICS), preoperative back pain visual analogue scale (VAS) score, Oswestry disability index (ODI) score, fixed segment height, and fixed segment kyphosis Cobb angle ( P>0.05). The operation time, intraoperative blood loss, and hospitalization time of the two groups were recorded and compared; as well as the VAS score, ODI score, fixed segment height, and fixed segment kyphosis Cobb angle of the two groups before operation and at 3 days, 1 month, 6 months, and 10 months after operation. CT scan was reexamined at 1-3 days after operation, and the pedicle screw insertion accuracy rate was determined and calculated according to Gertzbein-Robbins classification standard. Results: The operation time of the minimally invasive group was significantly longer than that of the open group, but the intraoperative blood loss and hospitalization time were significantly shorter than those of the open group ( P<0.05). There were 132 pedicle screws and 158 pedicle screws implanted in the minimally invasive group and the open group respectively. According to the Gertzbein-Robbins classification standard, the accuracy of pedicle screws was 97.7% (129/132) and 96.8% (153/158), respectively, showing no significant difference between the two groups ( χ 2=0.505, P=0.777). The patients in both groups were followed up 10 months, and there was no rejection or internal fixation fracture. In the minimally invasive group, the internal fixator was removed at 10 months after operation, but not in the open group. The VAS score, ODI score, fixed segment heigh, and fixed segment kyphotic Cobb angle of the two groups were improved in different degrees when compared with preoperative ones ( P<0.05). Except that the VAS score and ODI score of the minimally invasive group were significantly better than those of the open group at 3 days after operation ( P<0.05), there was no significant difference between the two groups at other time points ( P>0.05). Conclusion: Robot-assisted percutaneous minimally invasive pedicle screw internal fixation for thoracolumbar fractures has significant advantages in intraoperative blood loss, hospitalization time, and early postoperative effectiveness and other aspects, and the effect of fracture reduction is good.


Assuntos
Parafusos Pediculares , Procedimentos Cirúrgicos Robóticos , Robótica , Fraturas da Coluna Vertebral , Fixação Interna de Fraturas , Humanos , Vértebras Lombares , Estudos Retrospectivos , Vértebras Torácicas , Resultado do Tratamento
17.
J Surg Res ; 246: 19-25, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31550671

RESUMO

BACKGROUND: Some surgeons have adopted the use of video-assisted thoracoscopic surgery (VATS) or robotic surgery to perform resections for lung cancer. VATS is associated with less pain and a decrease in pulmonary complications compared with open thoracotomies. Long-acting liposomal bupivacaine (LB) intercostal nerve blocks are reported to provide superior pain relief compared with epidural catheters in the first 3 d after a thoracotomy. This study examined whether LB improves pain after VATS and if it provides effective analgesia after a thoracotomy. MATERIALS AND METHODS: A retrospective review was performed on 151 consecutive patients undergoing a VATS or thoracotomy who received paravertebral nerve blocks. VATS patients received paravertebral nerve blocks with LB (VATS-LB) or 0.25% bupivacaine with epinephrine (BE; VATS-BE). Thoracotomy patients received paravertebral nerve blocks via LB injections. Pain scores, narcotic utilization, complications, and hospital length of stay were examined. RESULTS: Fifty patients underwent a VATS-LB, 53 underwent a VATS-BE, and 32 underwent a thoracotomy. Thoracotomy and VATS-LB patients had pain scores lower than VATS-BE patients in the first 48 h after surgery (P < 0.004). Opioid use was not significantly different between the thoracotomy and VATS-LB patients throughout the first 2 wk postoperatively. CONCLUSIONS: LB paravertebral blocks significantly improve postoperative pain in comparison with 0.25% BE blocks in VATS patients. LB paravertebral blocks also provide effective analgesia in patients undergoing thoracotomies.


Assuntos
Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Dor Pós-Operatória/terapia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Toracotomia/efeitos adversos , Idoso , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Epinefrina/administração & dosagem , Feminino , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Nervos Espinhais/efeitos dos fármacos , Vértebras Torácicas/inervação , Resultado do Tratamento , Vasoconstritores/administração & dosagem
18.
World Neurosurg ; 133: 185-187, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606509

RESUMO

We report a rare case of bony diastematomyelia associated with intraspinal teratoma. The patient was surgically treated with bony diastematomyelia and intradural teratoma resection, followed by lumbar duroplasty, and posterior fusion from L2-L4 in order to maintain the spinal stability of the approached segments. Despite the risks, it was necessary to perform early surgical treatment because of rapid neurologic deterioration. The patient had a good postoperative outcome.


Assuntos
Vértebras Lombares/cirurgia , Defeitos do Tubo Neural/cirurgia , Neoplasias da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Teratoma/cirurgia , Vértebras Torácicas/cirurgia , Adulto , Humanos , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Defeitos do Tubo Neural/complicações , Defeitos do Tubo Neural/diagnóstico por imagem , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico por imagem , Teratoma/complicações , Teratoma/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
World Neurosurg ; 133: 275-277, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31629145

RESUMO

We report a rare case of cervicothoracic intramedullary and extramedullary lipoma. Complete resection of the extramedullary lipoma and almost complete resection of the intramedullary lipoma were performed using a microscope, followed by posterior fusion and internal fixation from C4-T2 to maintain the stability of the cervicothoracic junction. Despite the high risk, it was still necessary to perform the decompression surgery and the surgical results were favorable.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Lipoma/diagnóstico por imagem , Neoplasias da Medula Espinal/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Adulto , Vértebras Cervicais/cirurgia , Humanos , Laminectomia , Lipoma/cirurgia , Imagem por Ressonância Magnética , Masculino , Neoplasias da Medula Espinal/cirurgia , Fusão Vertebral , Vértebras Torácicas/cirurgia , Resultado do Tratamento
20.
World Neurosurg ; 133: e391-e396, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31526882

RESUMO

OBJECTIVE: We sought to report the safety of implementation of a novel standard of care protocol using spinal cord perfusion pressure (SCPP) maintenance for managing traumatic spinal cord injury (SCI) in lieu of mean arterial pressure goals at a U.S. Level I trauma center. METHODS: Starting in December 2017, blunt SCI patients presenting <24 hours after injury with admission American Spinal Injury Association Impairment Scale (AIS) A-C (or AIS D at neurosurgeon discretion) received lumbar subarachnoid drain (LSAD) placement for SCPP monitoring in the intensive care unit and were included in the TRACK-SCI (Transforming Research and Clinical Knowledge in Spinal Cord Injury) data registry. This SCPP protocol comprises standard care at our institution. SCPPs were monitored for 5 days (goal ≥65 mm Hg) achieved through intravenous fluids and vasopressor support. AISs were assessed at admission and day 7. RESULTS: Fifteen patients enrolled to date were aged 60.5 ± 17 years. Injury levels were 93.3% (cervical) and 6.7% (thoracic). Admission AIS was 20.0%/20.0%/26.7%/33.3% for A/B/C/D. All patients maintained mean SCPP ≥65 mm Hg during monitoring. Fourteen of 15 cases required surgical decompression and stabilization with time to surgery 8.8 ± 7.1 hours (71.4% <12 hours). At day 7, 33.3% overall and 50% of initial AIS A-C had an improved AIS. Length of stay was 14.7 ± 8.3 days. None had LSAD-related complications. There were 7 respiratory complications. One patient expired after transfer to comfort care. CONCLUSIONS: In our initial experience of 15 patients with acute SCI, standardized SCPP goal-directed care based on LSAD monitoring for 5 days was feasible. There were no SCPP-related complications. This is the first report of SCPP implementation as clinical standard of care in acute SCI.


Assuntos
Pressão do Líquido Cefalorraquidiano , Traumatismos da Medula Espinal/terapia , Padrão de Cuidado , Idoso , Vértebras Cervicais/cirurgia , Protocolos Clínicos , Terapia Combinada , Descompressão Cirúrgica , Drenagem , Hidratação , Humanos , Infusões Intravenosas , Isquemia/prevenção & controle , Laminectomia , Pessoa de Meia-Idade , Medula Espinal/irrigação sanguínea , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/cirurgia , Vértebras Torácicas/cirurgia , Centros de Traumatologia , Resultado do Tratamento , Vasoconstritores/uso terapêutico
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