ObjectiveTo explore the effectiveness percutaneous monoaxial screw combined with polyaxial pedical screw for treating thoracolumbar fracture by comparing with simple polyaxial pedicle screw fixation. MethodsBetween January 2012 and June 2014, 56 cases of thoracolumbar fractures were treated by percutaneous pedicle screw fixation, the clinical data were retrospectively analyzed. Of 56 cases, 30 were treated with percutaneous monoaxial screw combined with percutaneous polyaxial pedical screw fixation (group A), 26 patients with only percutaneous polyaxial pedicle screw fixation (group B). There was no significant difference in gender, age, body mass index, injury causes, time from injury to admission, involved segments, fracture type, and preoperative American Spinal Injury Association (ASIA) stage, visual analogue scale (VAS), the anterior height of the injured vertebrae, Cobb angle, and sagittal index between 2 groups (P>0.05). The operation time, intraoperative blood loss, and complications were recorded and compared between the 2 groups. The VAS score was used to evaluate the improvement of the pain. The sagittal kyphosis Cobb angle, the anterior height of the injured vertebrae, sagittal index, and the average correction (difference between 3 days after oeration and preoperation) and loss degrees (difference between last follow-up and 3 days after operation) were measured on the X-ray films at preoperation, 3 days after operation, and last follow-up. ResultsIncision healing at stage I was obtained, no related complications occurred. The operation time and intraoperative blood loss showed no significant difference between 2 groups (P>0.05). The patients were followed up 20-42 months (mean, 32 months) in group A and 21-44 months (mean, 30 months) in group B. VAS score of group A was significantly lower than that of group B at 3 days after operation (t=-2.277, P=0.027), but no significant difference was found at last follow-up (t=-0.289, P=0.774). X-ray examination showed good position of internal fixation, with no broken nails or exit of nail. There were significant differences in the anterior height of the injured vertebrae, Cobb angle, and sagittal index between at preoperation and at 3 days and last follow-up, and between at 3 days and last follow-up in 2 groups (P<0.05). The anterior height of the injured vertebrae, Cobb angle, and sagittal index of group A were significantly better than those of group B at 3 days and last follow-up (P<0.05), and correction degree were significantly higher than those of group B (P<0.05), but loss degree was not significant between 2 groups (P>0.05). ConclusionPercutaneous monoaxial screw combined with polyaxial pedicle screw fixation is better than simply polyaxial pedicle screw in effects of treating thoracolumbar fracture under the premise of strictly holding indications.
Objective To determine the feasibility, safety, and efficacy of common pedicle screw placement under direct vision combined with dome shaped decompression via small incision for double segment thoracolumbar fracture with nerve injury. Methods A retrospective analysis was performed on the clinical data of 32 patients with double segment thoracolumbar fracture with nerve injury undergoing common pedicle screw placement under direct vision combined with dome shaped decompression via small incision between November 2011 and November 2015 (combined surgery group), and another 32 patients undergoing traditional open pedicle screw fixation surgery (traditional surgery group). There was no significant difference in gender, age, cause of injury, time of injury-to-surgery, injury segments and Frankel classification of neurological function between two groups (P>0.05). The length of soft tissue dissection, the operative time, the blood loss during surgery, the postoperative drainage, the visual analogue scale (VAS) of incision after surgery, and recovery of neurological function after surgery were evaluated. Results All cases were followed up 9 to 12 months (mean, 10.5 months) in combined surgery group, and 8 to 12 months (mean, 9.8 months) in traditional surgery group. The length of soft tissue dissection, the operative time, the blood loss during surgery, the postoperative drainage, and the postoperative VAS score in the combined surgery group were significantly better than those in the traditional surgery group (P<0.05). Dural rupture during surgery and pedicle screw pulling-out at 6 months after surgery occurred in 2 cases and 1 case of the combined surgery group; dural rupture during surgery occurred in 1 case of the traditional surgery group. The X-ray films showed good decompression, and fracture healing; A certain degree of neurological function recovery was achieved in two groups. Conclusion Common pedicle screw placement under direct vision combined with dome shaped decompression via small incision can significantly reduce iatrogenic trauma and provide good nerve decompression. Therefore, it is a safe, effective, and minimally invasive treatment method for double segment thoracolumbar fracture with neurological injury.
Objective To explore the safety and effectiveness of one-stage posterior eggshell osteotomy and long-segment pedicle screw fixation in the treatment of ankylosing spondylitis kyphosis combined with acute thoracolumbar vertebral fracture. Methods A clinical data of 20 patients with ankylosing spondylitis kyphosis combined with acute thoracolumbar spine fracture, who were treated with one-stage posterior eggshell osteotomy and long-segment pedicle screw fixation between April 2016 and January 2022, was retrospectively analyzed. Among them, 16 cases were male and 4 cases were female; their ages ranged from 32 to 68 years, with an average of 45.9 years. The causes of injury included 10 cases of sprain, 8 cases of fall, and 2 cases of falling from height. The time from injury to operation ranged from 1 to 12 days, with an average of 7.1 days. The injured segment was T11 in 2 cases, T12 in 2 cases, L1 in 6 cases, and L2 in 10 cases. X-ray film and CT showed that the patients had characteristic imaging manifestations of ankylosing spondylitis, and the fracture lines were involved in the anterior, middle, and posterior columns and accompanied by different degrees of kyphosis and vertebral compression; and MRI showed that 12 patients had different degrees of nerve injuries. The operation time, intraoperative bleeding, intra- and post-operative complications were recorded. The visual analogue scale (VAS) score and Oswestry disability index (ODI) were used to evaluate the low back pain and quality of life, and the American spinal cord injury association (ASIA) classification was used to evaluate the neurological function. X-ray films were taken, and local Cobb angle (LCA) and sagittal vertical axis (SVA) were measured to evaluate the correction of the kyphosis. Results All operations were successfully completed and the operation time ranged from 127 to 254 minutes (mean, 176.3 minutes). The amount of intraoperative bleeding ranged from 400 to 950 mL (mean, 722.5 mL). One case of dural sac tear occurred during operation, and no cerebrospinal fluid leakage occurred after repair, and the rest of the patients did not suffer from neurological and vascular injuries, cerebrospinal fluid leakage, and other related complications during operation. All incisions healed by first intention without infection or fat liquefaction. All patients were followed up 8-16 months (mean, 12.5 months). The VAS score, ODI, LCA, and SVA at 3 days after operation and last follow-up significantly improved when compared with those before operation (P<0.05), and the difference between 3 days after operation and last follow-up was not significant (P>0.05). The ASIA grading of neurological function at last follow-up also significantly improved when compared with that before operation (P<0.05), including 17 cases of grade E and 3 cases of grade D. At last follow-up, all bone grafts achieved bone fusion, and no complications such as loosening, breaking of internal fixation, and pseudoarthrosis occurred. Conclusion One-stage posterior eggshell osteotomy and long-segment pedicle screw fixation is an effective surgical procedure for ankylosing spondylitis kyphosis combined with acute thoracolumbar vertebral fracture. It can significantly relieve patients’ clinical symptoms and to some extent, alleviate the local kyphotic deformity.
Objective To evaluate the effectiveness of using pedical screw at the fracture level, intervertebral distraction, and Cage insertion by posterior approach to treat thoracolumbar kyphosis caused by old fracture. Methods Between June 2008 and June 2010, 15 cases of thoracolumbar kyphosis caused by old fracture were treated with pedical screw at the fracture level, intervertebral distraction, and Cage insertion by posterior approach. There were 9 males and 6 females with a mean age of 54.6 years (range, 39-65 years). The disease duration was 5 months to 3 years with an average of 1.5 years. Fractured segments included T11 in 1 case, T12 in 4 cases, L1 in 5 cases, and L2 in 5 cases. Ten patients had nerve symptom, according to American Spinal Injury Association (ASIA) grading, 3 cases were classified as grade B, 4 cases as grade C, and 3 cases as grade D, of which 3 cases had sexual and sphincter dysfunction. At preoperation, the Cobb angle was (47.4 ± 10.2)°; the Oswestry disability index (ODI) score was 67.9% ± 6.9%; and the visual analogue scale (VSA) was 8.6 ± 1.4. Results The wounds obtained primary healing. The mean follow-up time was 28 months (range, 13-60 months). X-ray films showed intervertebral bone fusion was obtained within 6-11 months (mean, 10.2 months). No fixation loosening or breaking occurred during follow-up. Kyphosis was corrected, and lumbar back pain was relieved. At 1 year after operation, Cobb angle was significantly corrected to (13.3 ± 7.7)° (t=72.80, P=0.00); ODI score was significantly improved to 25.2% ± 4.6% (t=48.04, P=0.00); VAS score was significantly decreased to 2.3 ± 0.6 (t=26.52, P=0.00). According to ASIA grading in 10 patients with spinal cord injury, the spinal cord function was improved by 1 grade in 8 cases (3 cases from grade B to C, 3 cases from grade C to D, and 2 cases from grade D to E); 3 patients with sexual and sphincter dysfunction recovered in different degrees. Conclusion Using pedical screw at the fracture level, intervertebral distraction, and Cage insertion by posterior approach is an effective method to treat thoracolumbar kyphosis caused by old fracture.
目的:讨论侧后方减压融合术治疗胸腰椎骨折的优缺点及临床应用。方法:对12例胸腰椎骨折采用侧后方减压植骨融合术,经一个手术入路完成减压及脊椎的稳定重建。 结果:12例病例随访13～36个月,术后无一例神经症状加重;6例术后原有神经症状明显改善,2例2个月后神经症状开始恢复,3例无改善;12例均获得骨性融合。 结论:侧后方减压融合术是治疗胸腰椎骨折的较好方法。但其技术要求高,视野显露有限,操作范围较窄,易出血增加了手术难度。
Objective To develop a deep learning system for CT images to assist in the diagnosis of thoracolumbar fractures and analyze the feasibility of its clinical application. Methods Collected from West China Hospital of Sichuan University from January 2019 to March 2020, a total of 1256 CT images of thoracolumbar fractures were annotated with a unified standard through the Imaging LabelImg system. All CT images were classified according to the AO Spine thoracolumbar spine injury classification. The deep learning system in diagnosing ABC fracture types was optimized using 1039 CT images for training and validation, of which 1004 were used as the training set and 35 as the validation set; the rest 217 CT images were used as the test set to compare the deep learning system with the clinician’s diagnosis. The deep learning system in subtyping A was optimized using 581 CT images for training and validation, of which 556 were used as the training set and 25 as the validation set; the rest 104 CT images were used as the test set to compare the deep learning system with the clinician’s diagnosis. Results The accuracy and Kappa coefficient of the deep learning system in diagnosing ABC fracture types were 89.4% and 0.849 (P<0.001), respectively. The accuracy and Kappa coefficient of subtyping A were 87.5% and 0.817 (P<0.001), respectively. Conclusions The classification accuracy of the deep learning system for thoracolumbar fractures is high. This approach can be used to assist in the intelligent diagnosis of CT images of thoracolumbar fractures and improve the current manual and complex diagnostic process.
Objective To analyze the clinical effect of TINAVI robotic system-assisted pedicle screw internal fixation for thoracolumbar fracture with a Thoracolumbar Injury Classification and Severity Score (TLICS) of 4. Methods A total of 38 patients with TLICS 4 thoracolumbar fracture treated between January 2019 and January 2021 who met the selection criteria of Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital were retrospectively analyzed. According to the results of doctor-patient communication, 18 cases were treated with robot-assisted minimally invasive surgery (robot group), and 20 cases were treated with traditional conservative treatment (non-surgical group). Complications during hospitalization were observed. After discharge, the patients in the two groups were followed up by telephone and outpatient clinic. The Visual Analogue Scale (VAS) score at admission, at discharge, and 3 and 6 months after discharge, and the Oswestry Disability Index (ODI) score 3 and 6 months after discharge were compared between the two groups. Results There were no statistically significant difference in age, sex, body mass index or distribution of injured vertebrae segment between the two groups (P>0.05). No serious complication occurred in any group during hospitalization. The difference in the length of hospital stay between the two groups was not statistically significant (P>0.05). The bed rest in the robot group was shorter than that in the non-surgical group [(4.83±0.92) vs. (43.05±2.70) d, P<0.05]. The VAS scores at discharge (2.50±0.51 vs. 5.05±1.00), 3 months after discharge (1.83±0.71 vs. 3.10±0.72) and 6 months after discharge (1.50±0.51 vs. 1.90±0.79) in the robot group were lower than those in the non-surgical group (P<0.05). The ODI scores 3 months after discharge (21.89±1.41 vs. 30.40±3.00) and 6 months after discharge (10.72±2.37 vs. 12.10±2.29) in the robot group were significantly lower than those in the non-surgical group (P<0.05). Conclusion For patients with TLICS 4 thoracolumbar fracture, the early clinical effect of robot-assisted surgical treatment is better than that of non-surgical treatment.