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Shen Y, Xu L, Xu X, Shi L, Xu J, Shen Q, Xu H. Effect of predictive trauma nursing on emergency traumatic fracture patients. Minerva Surg 2021; 76:606-608. [PMID: 33944520 DOI: 10.23736/s2724-5691.21.08893-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Yiqian Shen
- Emergency Department, Huzhou Central Hospital, Huzhou, China
| | - Lan Xu
- Emergency Department, Huzhou Central Hospital, Huzhou, China
| | - Xin Xu
- Emergency Department, Huzhou Central Hospital, Huzhou, China
| | - Lingmei Shi
- Department of Orthopedics, Huzhou Central Hospital, Huzhou, China
| | - Jinfen Xu
- Emergency Department, Huzhou Central Hospital, Huzhou, China
| | - Qiu Shen
- Department of Orthopedics, Huzhou Central Hospital, Huzhou, China
| | - Hua Xu
- Emergency Department, Huzhou Central Hospital, Huzhou, China -
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Chen F, Shi T, Li Y, Wang H, Luo F, Hou T. Multiple parameters for evaluating posterior longitudinal ligaments in thoracolumbar burst fractures. DER ORTHOPADE 2018; 48:420-425. [PMID: 30578443 DOI: 10.1007/s00132-018-03679-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The posterior longitudinal ligament plays a key role in spinal stability. The purpose of this study was to determine the injuries of the posterior longitudinal ligament (PLL) in thoracolumbar burst fractures. PATIENTS AND METHODS Patients suffering a thoracolumbar burst fracture from January 2011 to December 2015 were divided into an intact group and a disrupted group according to the status of the PLL. Mid-sagittal canal diameter, width and height of bone fragments, inversion angle and horizontal rotation angle of bone fragments and local kyphosis angle were measured. Anterior, middle and posterior vertebrae compression ratio, mid-sagittal diameter compression ratio, ratio of height of bone fragments occupying the posterior wall of the injured vertebral body and ratio of the width of bone fragment occupying the transverse canal diameter were calculated. RESULTS A total of 95 patients were included in the study including 52 patients in the intact group and 43 patients in the disrupted group. There were significant differences on anterior and posterior vertebrae compression ratio, mid-sagittal diameter compression ratio, inversion angle and horizontal rotation angle of bone fragment (P 0.05) between the two groups. Injury of the PLL showed a positive correlation with the mid-sagittal diameter compression ratio and inversion angle of bone fragment (P 0.05). CONCLUSION The mid-sagittal diameter compression ratio and inversion angle of bone fragment can be used to assess the status of the PLL in thoracolumbar burst fractures. When the mid-sagittal diameter compression ratio was 52% and the inversion angle of the bone fragment was 33° the PLL was likely to be disrupted.
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Affiliation(s)
- Fei Chen
- Department of Orthopedics, Bozhou District People's Hospital, Zunyi City, Guizhou Province, China
| | - Tao Shi
- Center for Orthopedics and Trauma, TheThird Affiliated Hospital, Chongqing Medical University, No. 1, Shuanghu branch Road, 401120, Chongqing, Yubei District, China.
| | - Yang Li
- Center for Orthopedics and Trauma, TheThird Affiliated Hospital, Chongqing Medical University, No. 1, Shuanghu branch Road, 401120, Chongqing, Yubei District, China
| | - Han Wang
- Center for Orthopedics and Trauma, TheThird Affiliated Hospital, Chongqing Medical University, No. 1, Shuanghu branch Road, 401120, Chongqing, Yubei District, China
| | - Fei Luo
- Department of Orthopedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Tianyong Hou
- Department of Orthopedics, Southwest Hospital, Third Military Medical University, Chongqing, China
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Wu H, Zhao DX, Jiang R, Zhou XY. Surgical treatment of Denis type B thoracolumbar burst fracture with neurological deficiency by paraspinal approach. ACTA ACUST UNITED AC 2016; 49:e5599. [PMID: 27828664 PMCID: PMC5112540 DOI: 10.1590/1414-431x20165599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/23/2016] [Indexed: 12/02/2022]
Abstract
We aimed to describe the surgical technique and clinical outcomes of
paraspinal-approach reduction and fixation (PARF) in a group of patients with Denis
type B thoracolumbar burst fracture (TLBF) with neurological deficiencies. A total of
62 patients with Denis B TLBF with neurological deficiencies were included in this
study between January 2009 and December 2011. Clinical evaluations including the
Frankel scale, pain visual analog scale (VAS) and radiological assessment (CT scans
for fragment reduction and X-ray for the Cobb angle, adjacent superior and inferior
intervertebral disc height, and vertebral canal diameter) were performed
preoperatively and at 3 days, 6 months, and 1 and 2 years postoperatively. All
patients underwent successful PARF, and were followed-up for at least 2 years.
Average surgical time, blood loss and incision length were recorded. The sagittal
vertebral canal diameter was significantly enlarged. The canal stenosis index was
also improved. Kyphosis was corrected and remained at 8.6±1.4o (P>0.05)
1 year postoperatively. Adjacent disc heights remained constant. Average Frankel
grades were significantly improved at the end of follow-up. All 62 patients were
neurologically assessed. Pain scores decreased at 6 months postoperatively, compared
to before surgery (P<0.05). PARF provided excellent reduction for traumatic
segmental kyphosis, and resulted in significant spinal canal clearance, which
restored and maintained the vertebral body height of patients with Denis B TLBF with
neurological deficits.
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Affiliation(s)
- H Wu
- China-Japan Union Hospital, Department of Orthopedics, Jilin University, Changchun, China
| | - D-X Zhao
- China-Japan Union Hospital, Department of Orthopedics, Jilin University, Changchun, China
| | - R Jiang
- China-Japan Union Hospital, Department of Orthopedics, Jilin University, Changchun, China
| | - X-Y Zhou
- China-Japan Union Hospital, Department of Operating Room, Jilin University, Changchun, China
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Decision-Making Process in Patients with Thoracolumbar and Lumbar Burst Fractures with Thoracolumbar Injury Severity and Classification Score Less than Four. Asian Spine J 2016; 10:136-42. [PMID: 26949469 PMCID: PMC4764525 DOI: 10.4184/asj.2016.10.1.136] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 05/06/2015] [Accepted: 05/07/2015] [Indexed: 01/13/2023] Open
Abstract
STUDY DESIGN Cross-sectional. PURPOSE To develop a strategy to determine a sound method for decision-making based on postoperative clinical outcome satisfaction. OVERVIEW OF LITERATURE The ideal management of thoracolumbar and lumbar burst fractures (TLBF) without neurological compromise remains controversial. METHODS This was a prospective study. Patients with thoracolumbar injury severity and classification score (TLICS) <4 were treated nonoperatively, with bed rest and bracing until the pain decreased sufficiently to allow mobilization. Surgery was undertaken in patients with intractable pain despite an appropriate nonoperative treatment (surgery group). The Oswestry disability index (ODI) measure was observed at baseline and at the last follow-up. Clinically success was defined at least a 30% improvement from the baseline ODI scores in both the conservative and surgery groups. All case records were assessed for gender, age, residual canal and angulations at the site of the fracture in order to determine which patients benefited from surgery or conservative treatment and which did not. RESULTS In all 113 patients with T11-L5, TLBFs were treated. The patients' mean age was 49.2 years. Patients successfully completed either nonoperative (n=99) or surgical (n=14) treatment based on ODI. Clinical examinations revealed that all of the patients had intact neurology. The mean follow-up period was 29.5 months. There was a significant difference between the two groups based on age and residual canal. The mean ODI score significantly improved for both groups (p <0.01). According to the findings, a decision matrix was proposed. CONCLUSIONS The findings confirm that TLICS <4, age, and residual canal can be used to guide the treatment of TLBF in conservative decision-making.
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Jaffray DC, Eisenstein SM, Balain B, Trivedi JM, Newton Ede M. Early mobilisation of thoracolumbar burst fractures without neurology. Bone Joint J 2016; 98-B:97-101. [DOI: 10.1302/0301-620x.98b1.36121] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The authors present the results of a cohort study of 60 adult patients presenting sequentially over a period of 15 years from 1997 to 2012 to our hospital for treatment of thoracic and/or lumbar vertebral burst fractures, but without neurological deficit. Method All patients were treated by early mobilisation within the limits of pain, early bracing for patient confidence and all progress in mobilisation was recorded on video. Initial hospital stay was one week. Subsequent reviews were made on an outpatient basis. Results The mean duration from admission to final follow-up was three months, and longer follow-up was undertaken telephonically. The mean kyphosis deformity on arrival was 17.4° (5° to 29°); mean kyphosis at final discharge three months later was 19.5° (1° to 28°). Spinal canal encroachment had no influence on successful functional recovery. Discussion Pain has not been a significant problem for any patient, irrespective of the degree of kyphosis and no patient has a self-perception of clinical deformity. In all, 11 patients took occasional analgesia. All patients returned to their original work level or better. Two patients died 2.5 years after treatment, from unrelated causes. Take home message: The natural history of thoracolumbar burst fractures without neurology would appear to be benign. Cite this article: Bone Joint J 2016;98-B:97–101.
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Affiliation(s)
- D. C. Jaffray
- Robert Jones and Agnes Hunt Orthopaedic
Hospital, Oswestry, SY10
7AG, UK
| | - S. M. Eisenstein
- Robert Jones and Agnes Hunt Orthopaedic
Hospital, Oswestry, SY10
7AG, UK
| | - B. Balain
- Robert Jones and Agnes Hunt Orthopaedic
Hospital, Oswestry, SY10
7AG, UK
| | - J. M. Trivedi
- Robert Jones and Agnes Hunt Orthopaedic
Hospital, Oswestry, SY10
7AG, UK
| | - M. Newton Ede
- The Royal Orthopaedic Hospital, Bristol
Road South, Birmingham B31 2AP, UK
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Peng Y, Zhang L, Shi T, Lv H, Zhang L, Tang P. Relationship between fracture-relevant parameters of thoracolumbar burst fractures and the reduction of intra-canal fracture fragment. J Orthop Surg Res 2015; 10:131. [PMID: 26306404 PMCID: PMC4549871 DOI: 10.1186/s13018-015-0260-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/12/2015] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Posterior longitudinal ligament reduction (PLLR) has been widely used for treatment of thoracolumbar burst fractures. However, there are no systemic studies assessing the influence of position parameters of intra-canal fracture fragment (IFF) itself on outcome of reduction. The aim of this study was to analyze the relationship between position parameters of IFF and the reduction efficacy of PLLR. METHODS Sixty-two patients (average age, 36.9 years) with single thoracolumbar burst fractures and intact posterior longitudinal ligaments were recruited. Patients were divided into reduced and unreduced groups based on IFF reduction situations by PLLR. Preoperative and intraoperative computed tomography (CT) were used to evaluate reduction and location parameters of IFF, such as position, width, height, inversion, and horizontal angle, ratio of width of IFF to the transverse diameter of vertebral canal (R 1), and ratio of height of IFF to height of injured vertebrae (R 2) before and after PLLR. RESULTS There were significant differences in width (P < 0.001), height (P = 0.0141; R 1, P < 0.001), and R 2 (P = 0.0045) between the two groups. When width of IFF was more than 75 % of transverse diameter of vertebral canal and height of IFF was more than 47 % of height of injured vertebrae, the IFF could not be reduced by PLLR. CONCLUSIONS In patients with thoracolumbar burst fractures, IFF in apterium of the posterior longitudinal ligament cannot be reduced by PLLR. For thoracolumbar burst fractures that cover the posterior longitudinal ligament, the width and height of IFF are important parameters that influence reduction quality.
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Affiliation(s)
- Ye Peng
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Licheng Zhang
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Tao Shi
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Houchen Lv
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Lihai Zhang
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
| | - Peifu Tang
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
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The options of the three different surgical approaches for the treatment of Denis type A and B thoracolumbar burst fracture. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2012; 24:29-35. [DOI: 10.1007/s00590-012-1152-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 12/08/2012] [Indexed: 10/27/2022]
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Yan YB, Qi W, Wu ZX, Qiu TX, Teo EC, Lei W. Finite element study of the mechanical response in spinal cord during the thoracolumbar burst fracture. PLoS One 2012; 7:e41397. [PMID: 23028426 PMCID: PMC3454413 DOI: 10.1371/journal.pone.0041397] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 06/25/2012] [Indexed: 11/19/2022] Open
Abstract
Background The mechanical response of the spinal cord during burst fracture was seldom quantitatively addressed and only few studies look into the internal strain of the white and grey matters within the spinal cord during thoracolumbar burst fracture (TLBF). The aim of the study is to investigate the mechanical response of the spinal cord during TLBF and correlate the percent canal compromise (PCC) with the strain in the spinal cord. Methodology/Principal Findings A three-dimensional (3D) finite element (FE) model of human T12-L1 spinal cord with visco-elastic property was generated based on the transverse sections images of spinal cord, and the model was validated against published literatures under static uniaxial tension and compression. With the validated model, a TLBF simulation was performed to compute the mechanical strain in the spinal cord with the PCC. Linear regressions between PCC and strain in the spinal cord show that at the initial stage, with the PCC at 20%, and 45%, the corresponding mechanical strains in ventral grey, dorsal grey, ventral white, dorsal white matters were 0.06, 0.04, 0.12, 0.06, and increased to 0.14, 0.12, 0.23, and 0.13, respectively. At the recoiled stage, when the PCC was decreased from 45% to 20%, the corresponding strains were reduced to 0.03, 0.02, 0.04 and 0.03. The strain was correlated well with PCC. Conclusions/Significance The simulation shows that the strain in the spinal cord correlated well with the PCC, and the mechanical strains in the ventral regions are higher than those in the dorsal regions of spinal cord tissue during burst fracture, suggesting that the ventral regions of the spinal cord may susceptible to injury than the dorsal regions.
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Affiliation(s)
- Ya-Bo Yan
- Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi'an, China
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
| | - Wei Qi
- Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi'an, China
- Surgery Department of 520th Hospital of PLA, Mian yang, China
| | - Zi-Xiang Wu
- Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Tian-Xia Qiu
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
| | - Ee-Chon Teo
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
| | - Wei Lei
- Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi'an, China
- * E-mail:
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Truumees E. Commentary: "minimally invasive corpectomy and posterior stabilization for lumbar burst fracture". Spine J 2011; 11:909-11. [PMID: 21951612 DOI: 10.1016/j.spinee.2011.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Accepted: 07/14/2011] [Indexed: 02/03/2023]
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