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.
ObjectiveTo investigate the short-term effectiveness of percutaneous pedicle fixation combined with intravertebral allograft by different methods for thoracolumbar fractures. MethodsThe clinical data of 94 patients with single segment thoracolumbar fracture who underwent percutaneous pedicle fixation combined with intravertebral allograft by different methods between October 2018 and October 2019 were retrospectively analyzed. According to the different methods of intravertebral allograft, they were divided into group A (bone grafting by Jack dilator, 40 cases) and group B (bone grafting by funnel, 54 cases). There was no significant difference between the two groups (P>0.05) in the gender, age, body mass index, cause of injury, injured segment, Wolter index, time from injury to operation, and preoperative visual analogue scale (VAS) score, injured vertebral height ratio, and Cobb angle. The operation time, fluoroscopy frequency, allograft volume, and complications were recorded and compared between the two groups. VAS score of low back pain was used to evaluate the remission of clinical symptoms before operation, at 3 days, 3 months, 12 months after operation, and at last follow-up. The injured vertebral height ratio and Cobb angle were measured before operation, at 3 days, 3 months, and 12 months after operation. ResultsThe operation time, fluoroscopy frequency, and allograft volume in group A were significantly higher than those in group B (P<0.05). No complication occurred after operation, such as loosening or fracture of internal fixation. And bone grafting in the injured vertebrae healed at last follow-up. The VAS score, injured vertebral height ratio, and Cobb angle at each postoperative time point significantly improved when compared with preoperative ones (P<0.05); compared with 3 days postoperatively, the VAS score improved further after 3 months, but the injured vertebral height ratio decreased and the Cobb angle increased, and the differences were significant (P<0.05). There was no significant difference in the VAS scores of low back pain between the two groups at each time point after operation (P>0.05); the injured vertebrae height ratio in group A was significantly higher than that in group B, and the Cobb angle was significantly lower than that in group B, all showing significant differences (P<0.05). ConclusionThe intravertebral allograft via Jack dilator can restore the height and decrease the Cobb angle of the injured vertebrae, but accompanied with higher fluoroscopy frequency and longer operation time when compared with funnel bone grafting. For patients with single level thoracolumbar fractures, intravertebral allograft via Jack dilator is recommended.
Objective To investigate the effectiveness of posterior non-decompression surgery in the treatment of thoracolumbar fractures without neurological symptoms by comparing with the conventional posterior decompression surgery. Methods Between October 2008 and October 2015, a total of 97 patients with thoracolumbar fractures with intraspinal occupying 1/3-1/2 and without neurological symptoms were divided into the decompression surgery group (51 cases) and the non-decompression surgery group (46 cases). There was no significant difference in gender, age, cause of injury, injury segment, the thoracolumbar injury severity score (TLICS), combined injury, disease duration, and preoperative relative anterior vertebral height, kyphosis Cobb angle, intraspinal occupying percentage, visual analogue scale (VAS), Oswestry disability index (ODI), and Japanese Orthopaedic Association (JOA) score between 2 groups (P>0.05). The operation time, intraoperative blood loss volume, postoperative drainage, bed rest time, hospitalization time, and relative anterior vertebral height, kyphosis Cobb angle, intraspinal occupying percentage, and VAS score, ODI, JOA score at preoperative and postoperative 3 days and 1 year were recorded and compared. Results The operation time, intraoperative blood loss volume, and postoperative drainage in non-decompression surgery group were significantly less than those in decompression surgery group (P<0.05). There was no significant difference in the postoperative bed rest time and hospitalization time between 2 groups (P>0.05). In decompression surgery group, 4 cases had cerebrospinal fluid leakage and healed after conservative treatment. All incisions healed by first intention, and no nerve injury or infection of incision occurred. All patients were followed up 10-18 months (mean, 11.7 months). The recovery of vertebral body height was satisfactory in 2 groups, without secondary kyphosis and secondary nerve symptoms. The imaging indexes and effectiveness scores of 2 groups at 3 days and 1 year after operation were significantly improved when compared with preoperative ones (P<0.05). The intraspinal occupying percentage, VAS score, and ODI at 1 year after operation were significantly lower than those at 3 days after operation in 2 groups (P<0.05), and JOA score at 1 year after operation was significantly higher than that at 3 days after operation (P<0.05). Relative anterior vertebral height at 1 year after operation was significantly higher than that at 3 days after operation in non-decompression surgery group (P<0.05); and there was no significant difference in decompression surgery group (P>0.05). At 3 days, the intraspinal occupying percentage and JOA score in non-decompression surgery group were higher than those in decompression surgery group (P<0.05), and VAS score and ODI at 3 days in non-decompression surgery group were lower than those in decompression surgery group (P<0.05). No significant difference was found in the other indexes between 2 groups at 3 days and 1 year after operation (P>0.05). Conclusion Compared with the posterior decompression surgery, posterior non-decompression surgery has the advantages of less bleeding, less trauma, less postoperative pain, and so on. It is an ideal choice for the treatment of thoracolumbar fractures with intraspinal occupying 1/3-1/2 and without neurological symptoms under the condition of strict indication of operation.
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。
目的 探讨经伤椎椎弓根螺钉内固定治疗胸腰椎骨折的临床疗效。 方法 2008年5月－2010年12月，选择38例胸腰椎骨折患者，采用椎弓根螺钉固定伤椎及相邻上下椎体。其中男28例，女10例；年龄21～65岁，平均36.5岁。骨折部位：胸8 1例，胸9 2例，胸10 4例，胸11 8例，胸12 7例，腰1 10例，腰2 4例，腰3 2例。受伤至手术时间3～7 d，平均4.5 d。对患者手术前后椎体高度、矢状面后凸Cobb角、神经功能Frankel分级变化等指标进行测量并随访。 结果 术后患者切口均Ⅰ期愈合。38例获随访12～18个月，平均15个月。骨折均获得骨性融合，无钉棒断裂、无死亡或神经损伤加重患者。术后神经功能Frankel分级较术前有明显改善（P＜0.05）。术后X线片复查示伤椎高度恢复达90%以上，外形正常；CT复查示椎管内有效矢状径恢复满意，椎管前方无明显骨性压迫，伤椎椎体骨愈合良好。术后1、12个月时伤椎前、后缘高度及后凸Cobb角均较术前显著改善（P＜0.05）；术后12个月随访椎体高度无丢失。 结论 经伤椎椎弓根钉复位、减压、内固定治疗胸腰椎骨折具有创伤小、固定节段少、脊柱稳定性好、能有效矫正及预防脊柱后凸畸形等优点。
ObjectiveTo evaluate the effectiveness of percutaneous monoplanar screw internal fixation via injured vertebrae for treatment of thoracolumbar fracture.MethodsBetween May 2015 and August 2017, 38 cases of thoracolumbar fractures without neurological symptom were treated with percutaneous monoplanar screw internal fixation via injured vertebrae. There were 22 males and 16 females, aged 25-52 years (mean, 32.5 years). There were 23 cases of AO type A3 and 15 cases of AO type A4. The injured vertebrae located at T11 in 4 cases, T12 in 9 cases, L1 in 11 cases, L2 in 10 cases, L3 in 3 cases, and L4 in 1 case. The mean interval between injury and operation was 4.5 days (range, 3-7 days). The pre- and post-operative degrees of lumbodorsal pain were estimated by the visual analogue scale (VAS) score. The X-ray film, CT three-dimensional reconstruction, and MRI were performed, and the ratio of anterior vertebral body height and sagittal Cobb angle were measured to assess the kyphosis of the fractured area.ResultsAll operations in 38 patients successfully completed without complications such as dural sac, nerve root, or vascular injury. The operation time was (56.2±3.7) minutes and the intraoperative blood loss was (42.3±3.5) mL. All incisions healed by first intention without redness, swelling, or exudation. All patients were followed up 17-33 months, with an average of 21.5 months. The VAS score at each time point after operation significantly improved when compared with that before operation (P<0.05), and significantly improved at 3 months and last follow-up when compared with that at 1 week (P<0.05); there was no significant difference between 3 months and last follow-up (P>0.05). There was no internal fixator loosening, breakage, or delayed kyphosis in all patients. The ratio of anterior vertebral body height and sagittal Cobb angle significantly improved postoperatively (P<0.05), and no significant difference was found between the different time points after operation (P>0.05).ConclusionPercutaneous monoplanar screw internal fixation via injured vertebrae is an easy approach to treat thoracolumbar fracture without neurological symptom, which can effectively restore vertebral body height and correct kyphosis, and avoid long-term segmental kyphosis.
ObjectiveTo explore the application of different digestive system management strategies in the perioperative period of thoracolumbar fracture.MethodsThe clinical data of the patients with thoracolumbar fractures and pedicle screw fixation in Affiliated Hospital of Southwest Medical University from January 2016 to January 2018 were retrospectively analyzed. According to different perioperative management strategies of the digestive system, they were divided into two groups. Patients with careful management strategy were included in the observation group, and patients with routine management were included in the control group. The baseline conditions, the abnormalities of digestive tract function at admission and before and after surgery, the postoperative first feeding time, exhaust time, defecation time, the incidence of other postoperative complications except digestive tract complication, length of stay and patient satisfaction were compared between the two groups. At 6 months after surgery, the fracture healing, loosening or fracture of internal plants were compared between the two groups.ResultA total of 121 patients were included in the study, including 67 cases in the observation group and 54 cases in the control group. There was no significant differences in the baseline conditions between the two groups (P>0.05). There were no significant differences between the two groups in the incidences of digestive system dysfunction at admission (P>0.05). The incidences of digestive system dysfunction in the observation group before and after surgery were lower than those in the control group (29.9% vs. 53.7%, P<0.05; 35.8% vs. 61.1%, P<0.05). The first eating time [(3.7±1.1) vs. (6.7±2.6) h], exhaust time [(7.8±2.3) vs. (13.6±4.2) h], defecation time [(26.7±8.1) vs. (40.9±11.2) h] and length of stay [(6.5±2.4) vs. (9.0±2.7) d] in the observation group were shorter than those in the control group (P<0.005), and the patients’ satisfaction was better than that of the control group (8.3±1.1 vs. 7.6±1.3; t=−3.208, P=0.002). There was no statistically significant difference in the incidence of postoperative complications except digestive tract complication, and the fracture healing rate, the incidence of nail-rod breakage at6 months after surgery between the two groups (P>0.05). No internal plant loosening was found in the two groups of patients within 6 months after surgery.ConclusionThe application of the careful digestive system management strategy in patients with thoracolumbar fractures can help reduce the incidence of perioperative gastrointestinal dysfunction, promote the recovery of perioperative gastrointestinal function, shorten the length of hospital stay, and improve patient satisfaction.
A new method of anterior decompression for thoracolumbar fractures with paralysi s in six cases was reported. In a follw-up of one to five months, was shown that the neurological functions in all six cases has improved ⅡⅢ rank in Frankl classification. The author believe that the method has the following advantages, such as: less trauma from operation; the level and the limit of decompression could be made without Xray during the operation; usually only 1/5 to 1/4 of the vertebral body was excised so that the stability of the spine was not disturbed, and the obvious favourable results.