Objective To study the clinical effects of the artificial vertebral body of the biomimetic nanohydroxyapatite/polyamide 66 (nHA/PA66) compositefor the structural reconstruction and the height restoring of the vertebral body in the thoracolumbar fractures by the anterior surgical procedures. Methods From December 2003 to January 2006, 42 patients with thoracolumbar fractures received the anterior surgical procedures to decompress and reconstruct the spinal vertebral structure with the artificial vertebral body of the nHA/PA66 composite. Among the patients, there were 28 males and 14 females, aged 1767 years, averaged 43.6 years. The thoracolumbar fractures developed at T12 in 5 patients, at L1 in 17, at L2 in 14, and at L3 in 6. The height of the anterior border of thevertebral body amounted to 29%-47% of the vertebral body height, averaged 40.6%.The Cobb angle on the sagittal plane was 2138° averaged 27.6°. According tothe Frankel grading scale, the injuries to the nerves were as the following: Grade A in 7 patients, Grade B in 19, Grade C in 8, Grade D in 6, and Grade E in 2. Results All the 42 patients were followed up for 625 months. Among the patients, 36 were reconstructed almost based on the normal anatomic structure, and 6 were well reconstructed. The mean height of the anterior border of the vertebralbody was 40.6% of the vertebral body height before operation but 91.7% after operation. And the reconstructed height of the vertebra was maintained. The mean Cobb angle on the sagittal plane was 27.6°before operation but 13.4° after operation. All the patients had a recovery of the neurological function that had a 1grade or 2grade improvement except 7 patients who were still in Grade A and 2 patients who were in Grade D. The implant was fused 35 months after operation. No infection, nail break, bar/plate break or loosening of the internal fixation occurred. Conclusion The artificial vertebral body of the biomimetic nHA/PA66 composite can effectively restore the height and the structure of the vertebra, can be fused with the vertebral body to reconstruct the spinal structural stability effectively, and can be extensively used in the clinical practice.
ObjectiveTo compare the clinical results of throacolumbar fractures treated through Wiltse paraspinal approach and conventional posterior approach. MethodsSeventy-six cases of single segmental thoracolumbar fractures (Type A) were treated by posterior reduction and pedicle screw instrumentation from January 2011 to January 2013. Thirty-five cases were treated through Wiltse paraspinal approach (group A), including 27 males and 8 females with an average age of 39.7 years. Forty-one cases were treated through conventional posterior approach (group B), including 30 males and 11 females with an average age of 41.6 years. The data including incision length, operation time, intraoperative blood loss, postoperative volume of drainage, the anterior vertebral height, Cobb angle and complications were compared between the two groups. ResultsAll operations were finished successfully. The incision length, operation time, intraoperative blood loss and postoperative volume of drainage were (8.3±1.9) cm, (74.0±21.9) min, (125.0 ±46.7) mL, and (51.0±42.6) mL respectively in group A, and (10.7±2.8) cm, (97.0±18.2) min, (245.0±56.1) mL, and (190.0±72.3) mL in group B respectively. There was significant difference between the two groups (P<0.05). The restoration of anterior vertebral height and the correction of Cobb angle were well maintained in both groups. The difference was statistically significant before and after treatment (P<0.05), but there was no significant difference between the two groups (P>0.05). There was no difference in the complication rate between the two groups (P>0.05). ConclusionCompared with conventional posterior approach, Wiltse paraspinal approach has the advantage of shorter operation time, less trauma and blood loss. It is a better option for the treatment of throacolumbar fractures.
Objective To analyze the current status and temporal trends of the disease burden of spinal fractures in China from 1990 to 2021 based on data from the Global Burden of Disease Study 2021 (GBD 2021), aiming to provide evidence for developing prevention and treatment strategies. Methods Epidemiological data on spinal fractures in China, the United States of America (USA), and globally were extracted from the GBD 2021 database. Joinpoint regression models were applied to analyze temporal trends. Age-standardized incidence, prevalence, and disability-adjusted life years (DALYs) rates were calculated, with comparisons of gender- and age-group disparities. Results In 2021, the number of incident cases, prevalent cases, and DALYs of spinal fractures in China increased by 52.28%, 113.68%, and 106.98%, respectively, compared to 1990. The age-standardized incidence, prevalence, and DALYs rates rose by 11.80%, 16.11%, and 14.79%, respectively. The disease burden escalated significantly with age, peaking in individuals aged ≥75 years. Males exhibited higher age-standardized incidence and DALYs rates than females. Comparative analysis revealed that the age-standardized DALYs rate in China (4.19/100 000) was lower than that in globally (6.62/100 000) and USA (15.92/100 000). However, China showed an upward trend [annual average percentage change (AAPC)=0.19%], contrasting with a declining trend in the USA (AAPC=–0.08%). ConclusionThe escalating disease burden of spinal fractures in China is closely linked to population aging, gender disparities, and insufficient targeted prevention policies. Future strategies should integrate age- and gender-specific interventions, including strengthened osteoporosis prevention, trauma risk control, and big data-driven precision measures, to mitigate this burden.
Abstract Dual-blade plate is widely used in reconstruction of anterior stability of spine. Two hundred and ninety-eight cases were followed up since 1984. Among them, 181 cases were fractureof thoracolumbar spine; 63 cases were tuberculosis of thoracolumbar spine; 43 cases were tumor of thoracolumbar spine; 5 cases were spondylisthesis of lumbar spine; 2 cases were ankylosing spondylitis accompanied with gibbosity; 2 cases were adolescent vertebral epiphysis; I case was hemivertebra; I case was dysplasia of the first lumbar vertebra acompanied with gibbosity. Most cases were successful following operation, but in some cases, the results were unsuccessful, mainly due to the position of the dualblade plate in the vertebral body was not satisfactory. The mistakes most commonly occurred were one or two blades, or a part of the blade going into the intervertebral space, and less commonly seen was deviation of the dual -blade plate from itscorrect orientation or a little side-bent of the blade. Split of the vertebra and fall off of the dual-blade plate were happened in few cases. The causeswere analyzed and ways of prevention were provided in this article.
Objective To explore the feasibility and accuracy of ultrasound volume navigation (UVN) combined with X-ray fluoroscopy-guided percutaneous pedicle screw implantation through a prospective randomized controlled study. Methods Patients with thoracic and lumbar vertebral fractures scheduled for percutaneous pedicle screw fixation between January 2022 and January 2023 were enrolled. Among them, 60 patients met the selection criteria and were included in the study. There were 28 males and 32 females, with an average age of 49.5 years (range, 29-60 years). The cause of injury included 20 cases of traffic accidents, 21 cases of falls, 17 cases of slips, and 2 cases of heavy object impact. The interval from injury to hospital admission ranged from 1 to 5 days (mean, 1.57 days). The fracture located at T12 in 15 cases, L1 in 20 cases, L2 in 19 cases, and L3 in 6 cases. The study used each patient as their own control, randomly guiding pedicle screw implantation using UVN combined with X-ray fluoroscopy on one side of the vertebral body and the adjacent segment (trial group), while the other side was implanted under X-ray fluoroscopy (control group). A total of 4 screws and 2 rods were implanted in each patient. The implantation time and fluoroscopy frequency during implantation of each screw, angle deviation and distance deviation between actual and preoperative planned trajectory by imaging examination, and the occurrence of zygapophysial joint invasion were recorded. Results In terms of screw implantation time, fluoroscopy frequency, angle deviation, distance deviation, and incidence of zygapophysial joint invasion, the trial group showed superior results compared to the control group, and the differences were significant (P<0.05). Conclusion UVN combined with X-ray fluoroscopy-guided percutaneous pedicle screw implantation can yreduce screw implantation time, adjust dynamically, reduce operational difficulty, and reduce radiation damage.
Objective To investigate the effectiveness of kyphoplasty in treating osteoporotic vertebral fracture according to comparative study. Methods Between March 2006 and August 2007, 60 patients with osteoporotic vertebral fractures were treated. Kyphoplasty was performed in 40 patients (test group) and conservative treatment was performed in 20patients as control (control group). In test group, there were 6 males and 34 females with an average age of 68.7 years (range, 56-78 years). The disease duration was 10-18 months (mean, 12 months). A total of 73 vertebral bodies fractured. In control group, there were 5 males and 15 females with an average age of 70.1 years (range, 57-80 years). The disease duration was 9-16 months (mean, 13 months). A total of 41 vertebral bodies fractured. There was no significant difference in the general data between 2 groups (P gt; 0.05). Results All incisions healed by first intention in test group, and no leakage of bone cement occurred. The patients of 2 groups were followed up 36-38 months. The visual analogue scale (VAS) scores, European Vertebral Osteoporosis Study (EVOS) questionnaire scores, anterior and middle vertebral column heights, and Cobb angles of test group at 1-3 days, 12 and 36 months after treatment were significantly improved when compared with those before operation (P lt; 0.05); but there was no significant difference between before treatment and after treatment in control group (P gt; 0.05). After 12 and 36 months, the VAS scores, EVOS scores, anterior and middle vertebral column heights, and Cobb angles of test group were better than those of control group (P lt; 0.05). The incidence of vertebral re-fractures was higher in control group than in test group after 36 months (χ2=16.347, P=0.015). Conclusion Kyphoplasty can effectively rel ieve pain and restore the function after the procedure. The risk of vertebral re-fractures after kyphoplasty can be reduced in comparison with conservative treatment.
Objective To compare the therapeutic effect of transforaminal lumbar interbody fusion (TLIF) and posterior lateral fusion (PLF) in treatment of thoracolumbar spine fracture and dislocation. Methods From January 2005 to July 2007, 35 patients (22 males, 13 females, aged 17-53 years old) with thoracolumbar spine fracture and dislocation (T11-L3) received posterior open reduction and pedicle nail-stick system internal fixation. Among which, 14 patients underwent TLIF(group TLIF), and the rest 21 patients underwent PLF (group PLF). According to AO classification, group TLIF had 3 cases of A3, 7 cases of B and 4 cases of C, while group PLF had 4 cases of A3, 10 cases of B and 7 cases of C. Based on American Spinal Injury Association (ASIA) Scoring Standard formulated in 2000, the motor score of group TLIF and group PLF was (50.6 ± 3.6) and (50.8 ± 4.2) points, respectively; and the sensory score was (170.5 ± 42.7) and (153.8 ± 23.7) points, respectively. No significant difference was noted between 2 groups in general information (P gt; 0.05). Results The operation time of group TLIF and group PLF was (316 ± 32) minutes and (254 ± 27) minutes, and the blood loss of group TLIF and group PLF was (487 ± 184) mL and (373 ± 72) mL, indicating there were significant differences between 2 groups (P lt; 0.05). Wounds of all patients were healed by first intention and there was no death, aggravation of neurological function impairment and compl ication of internal fixation instrument loosening and breaking. All 35 cases were followed up for 9-23 months with an average of 14.6 months. Postoperatively, the thoracolumbar bone fusion rate of group TLIF and group PLF was 100% and 85.7%, respectively, indicating there was a significant difference (P lt; 0.05). At 3 months after operation, the motor score of group TLIF and group PLF was increased by (10.4 ± 10.0) and (9.4 ± 9.3) points, respectively; and the sensory score was upgraded by (26.5 ± 22.8) and (28.8 ± 28.4) points, respectively, showing there were no significant difference (P gt; 0.05). At immediate moment, 3, 6 and 12 months after operation, the spine height restoration of group TLIF was (5.4 ± 2.1), (5.4 ± 1.9), (5.4 ± 1.4) and (5.3 ± 1.3) mm, respectively; while it was (5.3 ± 2.6), (5.3 ± 2.2), (4.8 ± 3.1) and (4.2 ± 3.6) mm for group PLF. Meanwhile, the Cobbangle recovery of group TLIF was (14.5 ± 3.5), (14.5 ± 3.6), (14.4 ± 3.4) and (14.4 ± 3.6)o, respectively; while it was (14.3 ± 2.7), (14.2 ± 3.1), (12.2 ± 2.8) and (11.7 ± 3.3)o for group PLF. Concerning the spine height restoration and the Cobb angle recovery, no significant difference was observed between 2 groups at immediate moment and 3 months after operation (P gt; 0.05), but significant differences were noted at 6 and 12 months after operation (P lt; 0.05). Conclusion For the treatment othoracolumbar spine fracture and dislocation, TLIF is superior to PLF in bony fusion and restoration of spine column height.
【摘要】 目的 探討經皮脊柱后凸成形手術中骨水泥的應用療效。 方法 2008年10月-2010年10月，應用注射用Ⅲ型丙烯酸樹脂骨水泥及其椎體成形系統，采取經皮脊柱后凸成形術治療40例椎體疾病患者。其中男5例，女35例；年齡53～84歲，平均65歲。老年骨質疏松性椎體壓縮骨折37例，椎體惡性腫瘤2例，椎體血管瘤1例。采用視覺模擬評分（visual analogue scale，VAS）對患者手術前后疼痛程度的改善情況進行評分統計，并觀察術中及術后并發癥的發生情況。 結果 患者出院前行脊柱正、側位透視，發現椎體內骨水泥分布良好；3例有少量骨水泥向椎體外滲漏現象，但均無臨床癥狀。所有患者獲隨訪1～12個月，平均8個月。腰背部疼痛均明顯緩解或消失，日常生活質量大大提高。術前VAS評分為（8.30±0.48）分，術后3 d、1個月及末次隨訪時VAS評分分別為（3.11±0.41）、（2.50±0.36）、（2.50±0.36）分，與術前比較差異均有統計學意義（Plt;0.05）。 結論 骨水泥應用于經皮脊柱后凸成形手術中可取得很好療效，固化的骨水泥對脊柱起到很好的支撐、穩定作用。【Abstract】 Objective To assess the clinical effect of using bone cement in percutaneous kyphoplasty. Methods From October 2008 to October 2010, type Ⅲ Acrylic resin bone cement and the system of vertebroplasty were used in percutaneous kyphoplasty (PKP) to treat 40 patients. There were 5 males and 35 females with an average of 65 years old (53-84 years). There were 37 older patients with osteoporotic vertebral compression fracture, 2 cases of vertebral tumor and one hemangioma. Visual analogue scale (VAS) was used to evaluate the pain before and after the operation. The complications in and after the operation were also recorded. Results Before discharge, posterior-anterior and lateral X-ray films were taken to evaluate the distribution of bone cement. Three patients showed a little bone cement leakage from the vertebral body, but no clinical symptoms were found. All patients were followed for 1 to 12 months with an average of 8 months. Pain in the back decreased obviously or disappeared, and the qualities of daily life were improved greatly. The score of VAS was (8.30±0.48) before the operation, and (3.11±0.41), (2.50±0.36), and (2.50±0.36) 3 days, 1 month after the operation, and during the last follow-up, respectively. Significant differences were found between the VAS score before and after operation (Plt;0.05). Conclusions Good results can be expected when bone cement is used in percutaneous kyphoplasty. Solidified bone cement can effectively support and stablize the spinal column.
ObjectiveTo explore the safety and preliminary effectiveness of transintervertebral release, bone impaction grafting, and posterior column compressed-closing in the treatment of osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis.MethodsThe clinical data of 21 elderly patients with osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis were retrospectively analyzed between March 2016 and November 2017. There were 1 male and 20 females, aged 55-75 years, with an average of 64.8 years. The disease duration was 8-24 months, with an average of 13.1 months. The bone density T value ranged from ?3.4 to ?2.1, with an average of ?2.3. Lesion segments: T11 in 2 cases, T12 in 6 cases, L1 in 8 cases, L2 in 1 case, T11, 12 in 1 case, T12, L1 in 2 cases, and T12, L2 in 1 case. Preoperative neurological function was classified according to the American Spinal Injury Association (ASIA): 5 cases of grade D and 16 cases of grade E. All patients underwent transintervertebral release, bone impaction grafting, and posterior column compressed-closing. The effectiveness was evaluated by visual analogue scale (VAS) score and Oswestry dysfunction index (ODI) score before operation, at 3 months after operation, and at last follow-up. The neurological function was assessed by ASIA at last follow-up. Local kyphosis Cobb angle (LKCA), thoracic kyphosis (TK), lumbar lordosis (LL), and sagittal vertebral axis (SVA) were measured on the X-ray films of the full-length lateral spine of the patient before operation, at 1 week after operation, and at last follow-up.ResultsNo complication such as fracture of internal fixator or nerve injury occurred. LKCA, TK, and SVA were significantly improved at 1 week after operation and at last follow-up (P<0.05). There was no significant difference between at 1 week after operation and at last follow-up (P>0.05). There was no significant difference in LL before and after operation (F=3.013, P=0.057). The VAS and ODI scores were significantly improved at 3 months after operation and at last follow-up, and further improved at last follow-up when compared with the scores at 3 months after operation, showing significant differences between time points (P<0.05). Five patients with ASIA grade D neurological function recovered to grade E at 6 months after operation.ConclusionTransintervertebral release, bone impaction grafting, and posterior column compressed-closing for treating osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis has definite effectiveness, strong orthopaedic ability, and minimal trauma, which can effectively restore the sagittal balance of the spine, alleviate pain, and improve the patients’ quality of life.
Thoracolumbar injury is a common injury in clinic. Accurate diagnosis and classification is of great significance for guiding treatment. Although there are many typing systems, no typing system has been widely accepted and used to guide clinical practice. Denis classification, spinal load classification, thoracolumbar injury classification system and severity score or thoracolumbar injury classification and severity score and AO classification have great influence in clinical practice, but they all have some shortcomings. In recent years, the classification of thoracolumbar injury has been updated, modified and supplemented constantly. When using these fracture types in clinical practice, different people often have some deviation. This paper reviews the widely used thoracolumbar injury classification system, discusses the main viewpoints, advantages and disadvantages of each classification system, and looks into the future research direction based on the current research progress.