Thoracolumbar fractures are common injuries. Accurate diagnosis and classification are of great significance for guiding treatment. Although there are many classification systems, they have not been universally accepted and used to guide clinical practice. Denis classification, load sharing classification, Magerl/AO classification, and Thoracolumbar Injury Classification and Severity Score have a great clinical influence, but they also have some shortcomings. Recently, some new classifications of thoracolumbar fractures have been proposed, and some of them have been updated and revised, which makes it easy to cause confusion, and puts forward new requirements on how to grasp and apply these classification systems. This article reviews the main and commonly used classification systems of thoracolumbar fractures, discusses the main viewpoints, advantages and disadvantages of each classification system, and looks ahead to the future research direction.
【Abstract】 Objective To study the short-term effects of thoracoscopic anterior spine release combined with posterior correction on the pulmonary function in patients with idiopathic scoliosis (IS). Methods Between April 2004 and June 2008, 21 cases of IS underwent thoracoscopic anterior spine release combined with posterior correction. There were 9 males and 12 females with a mean age of 15.6 years (range, 12 to 24 years). Of 11 patients, 2 had left protrusion deformity and 19 had right protrusion deformity, including 12 cases of Lenke type I and 9 cases of Lenke type II, with an average coronal Cobb’s angle of 79.6° (range, 65-125°). The disease duration ranged from 1 year and 6 months to 9 years (mean, 2.5 years). The results of pulmonary function tests (PFTs) were compared between pre-operation and postoperative 6th month, including lung capacity, ventilation function, and thoracic compliance. Results The opening time of the chest was 90 to 150 minutes (mean, 127 minutes) at the thoracoscopic anterior spine release and all incisions healed by first intention with no chest cavity infection. All the patients were followed up from 6 to 36 months (mean, 13.5 months). The average coronal Cobb’s angle was 43.7° (range, 36-75°) at 1 week after posterior correction. At 6 months after operation, the vital capacity and total capacity were significantly increased (P lt; 0.05), but no significant change was observed in the percentage of actual value and expected one when compared with pre-operation (P gt; 0.05). The functional residual capacity and the percentage of actual value and expected one of residual volume was significantly decreased when compared with those at pre-operation (P lt; 0.05). The forced expiratory volume in one second (FEV1) and FEV1/FEV were not significantly improved (P gt; 0.05) , but the maximum ventilatory volume was significantly increased when compared with the preoperative value (P lt; 0.05). In addition, the Raw Total, Raw Insp, and Raw Exp decreased significantly after operation (P lt; 0.05). Conclusion Although the thoracoscopic anterior spine release combined with posterior correction might disturb the function of the thoracic cavity, the PFTs of the patients could be improved at different aspects because of the shape changes of the thoracic cavity, and the pulmonary function still needed further observation.
Objective To investigate the effectiveness of posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting for lumbar spondylolysis. Methods Between January 2005 and October 2009, 22 patients with lumbar spondylolysis underwent posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting. There were 19 males and 3 females with an average age of 18.4 years (range, 12-26 years). The main symptom was low back pain with an average disease duration of 16 months (range, 8-56 months). The visual analogue scale (VAS) was 6.0 ± 1.2 and Oswestry disability index (ODI) was 72.0% ± 10.0% preoperatively. The X-ray films showed bilateral spondylolysis at L4 in 9 cases and at L5 in 13 cases. The range of motion (ROM) at upper and lower intervertebral spaces was (11.8 ± 2.8)°and (14.1 ± 1.9)°, respectively. ResultsAll incisions healed by first intention. All patients were followed up 12-45 months (mean, 25 months). Low back pain was significantly alleviated after operation. The VAS score (0.3 ± 0.5) and ODI (17.6% ± 3.4%) were significantly decreased at last follow-up when compared with preoperative scores (P lt; 0.05). CT showed bone graft fusion in the area of isthmus defects, with no loosening or breaking of internal fixator. At last follow-up, the lateral flexion-extension X-ray films of the lumbar spine showed that the ROM at upper and lower intervertebral spaces was (12.3 ± 2.1)°and (13.5 ± 1.7)°, respectively; showing significant differences when compared with preoperative values (P lt; 0.05). Pain at donor site of iliac bone occurred in 1 case, and was cured after pain release treatment. ConclusionThe posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting is a reliable treatment for lumbar spondylolysis, having a high fusion rate, low complication rate, and maximum retention of lumbar ROM.
ObjectiveTo compare the predictive abilities of O-C2 angle (O-C2a), O-EA angle (O-EAa), and Oc-Ax angle (Oc-Axa) for development of dysphagia in patients after occipitocervical fusion (OCF).MethodsBetween April 2010 and May 2019, 114 patients who underwent OCF and met the selection criteria were selected as the research objects. Among them, 54 were males and 60 were females; they were 14-76 years old, with an average of 50.6 years old. The follow-up time was 13-122 months (median, 60.5 months). The O-C2a, O-EAa, Oc-Axa, and the narrowest oropharyngeal airway space (nPAS) were measured by the lateral X-ray films before operation and at last follow-up, and the differences before and after operation (dO-C2a, dO-EAa, dOc-Axa, and dnPAS) were calculated. Patients were divided into two groups according to whether they had developed postoperative dysphagia. The general data including age, gender, fixed segment, proportion of patients with rheumatoid arthritis (RA), atlantoaxial subluxation (AS), and combined with anterior release surgery (ARS), and imaging indicators were compared between the two groups. The correlations between dO-C2a, dO-EAa, and dOc-Axa and dnPAS in 114 patients were analyzed to further compare the predictive value of three imaging indicators for occurrence of dysphagia after OCF.ResultsDysphagia occurred after OCF in 31 cases with the incidence of 27.2%. There was significant difference in gender between the dysphagia group and the non-dysphagia group (χ2=7.940, P=0.005). There was no significant difference between the two groups in age, fixed segment, the proportion of patients with RA, the proportion of patients with AS, and the proportion of patients combined with ARS (P>0.05). There was no significant difference in O-C2a and Oc-Axa of 114 patients before operation and at last follow-up (P>0.05). The differences in O-EAa and nPAS were significant (P<0.05). There was no significant difference in preoperative O-EAa, Oc-Axa, and nPAS between the dysphagia group and the non-dysphagia group (P>0.05); the difference in the O-C2a was significant (t=2.470, P=0.016). At last follow-up, the differences in the above imaging indicators were significant (P<0.05). There were significant differences in the dO-C2a, dO-EAa, dOc-Axa, and dnPAS between the two groups (P<0.05). Correlation analysis showed that the dO-C2a, dO-EAa, dOc-Axa were all positively correlated with dnPAS (P<0.05). The dO-C2a≤−5°, postoperative O-EAa≤100°, postoperative Oc-Axa≤65° were all related to postoperative dysphagia (P<0.05), and the highest risk factor suffering postoperative dysphagia was dO-C2a ≤−5° with a significant OR of 14.4.ConclusionThe dO-C2a, postoperative O-EAa, and postoperative Oc-Axa can be used as the predictive indexes of dysphagia after OCF, among which dO-C2a has the highest predictive value.