胸腰椎骨折行短节段经伤椎内固定手术后再发后凸畸形的相关因素Logistic回归分析

目的探讨后路经伤椎置钉短节段内固定手术治疗胸腰段单椎体骨折术后的后凸畸形发生情况以及相关因素。方法纳入2015年1月-2017年10月收治的91例胸腰段单椎体骨折患者,均予以经伤椎置钉短节段内固定手术治疗。随访观察术后1年的后凸畸形发生情况。统计所有患者年龄、性别、BMI值、伤椎分布、骨折AO分型和术前伤椎高度、Cobb角等影像学指标,以及术前疼痛VAS评分和LSC评分等相关资料;将后凸畸形为因变量,对上述因素进行组间单因素分析和多因素Logistic回归分析。结果术后再发后凸畸形29例,发生率为31. 87%。单因素分析表明,两组性别、年龄、BMI指数、伤椎分布、骨折AO分型、术前上位椎间盘角(upper intervertebral angle,UIVA)、伤椎前缘高度比(anterior vertebra height ratio,AVH)、伤椎前后缘高度比(anteroposterior ratio,A/P)等指标的差异有统计学意义(P0. 05);多因素Logistic回归分析表明,年龄、BMI、UIVA、L1骨折、A3. 3型骨折均为独立危险因素(P0. 05);而AVH、T12骨折、A3. 1型骨折,则为保护因素(P0. 05)。结论胸腰段单椎体骨折行经伤椎置钉短节段内固定术后,部分患者可再发后凸畸形,年龄越大、BMI值越高、UIVA值越低,以及A3. 3型、L1骨折均为其独立危险因素;而AVH值越高、T12骨折和A3. 1型骨折,均为其保护因素。     

椎体压缩性骨折患者术后再发骨折的影响因素分析

目的分析骨质疏松椎体压缩性骨折(OVCF)经皮椎体成形术患者进行术后再次发生骨折的影响因素。方法选择2016年1月至2018年1月期间在本院创伤科诊断为OVCF的患者109例进行随访,分为再骨折组及非再骨折组。采用logistics分析OVCF患者PVP术后发生再骨折的危险因素。结果 109例OVCF患者22例椎体成形术后非手术椎体发生再次骨折,再骨折发生率为20.18%。二元logistics回归分析,结果显示,BMI(OR=2.15)、骨密度(OR=6.57)、Cobb角(OR=0.56)、伤椎前缘高度(AVH)恢复(OR=0.88)、术中骨水泥注射量(OR=0.05)为OVCF患者椎体成形术后再发骨折的独立危险因素(P0.05)。结论 BMI、骨密度、Cobb角、AVH恢复百分比、术中骨水泥注射量是OVCF患者椎体成形术后再发骨折的独立危险因素,对术后再骨折的高危患者应采取相应预防措施,降低术后再骨折发生率,改善患者远期预后。     

腰椎骨折行后路短节段钉棒内固定术后矫正度丢失的影像学因素分析

目的 探究腰椎骨折行后路短节段钉棒内固定术后的伤椎矫正情况,以及矫正度丢失的影像学预测因素。方法 以我科2017年3月～2020年3月收治的61例腰椎(L₂-L₄)骨折患者作为研究对象,均采用后路短节段钉棒内固定手术治疗。对所有患者术前、术后1周和内固定取出后(即骨折愈合且取出内固定之后1周)的影像学参数进行测量并分析其变化情况,包括伤椎楔形角(vertebral wedge angle, VWA)、伤椎前缘相对高度(anterior vertebrae height, AVH)和局部后凸角(local kyphosis angle, LKA)。矫正丢失度以“△”表示,采用Pearson相关性分析验证△VWA、△AVH、△LKA与患者年龄、随访时间、脊柱骨折载荷分享评分(load sharing scores, LSS)、脊柱脊髓损伤分类及严重程度评分(thoracolumbar injury classification and Severity, TLICS)、邻近椎间盘损伤评分(intervertebral disc injuries,...     

经伤椎短节段内固定术后再发后凸畸形的危险因素研究

目的 研究胸腰椎爆裂性骨折经伤椎短节段内固定术后再发后凸畸形的危险因素.方法 纳入2011年3月～2016年3月于本院治疗的224例胸腰椎爆裂性骨折患者,均采用经伤椎短节段内固定治疗,随访3年以上,将末次随访Cobb角丢失≥5°以及<5°者分别设为观察组与对照组.调查两组患者病历资料,并经单因素分析以及Logistic回归分析调查术后再发后凸畸形的危险因素.结果 224例患者术后再发后凸畸形40例,发生率17.86％,平均丢失角度(7.02±1.21)°;两组年龄、伤椎前缘高度比(anterior vertebra height ratio,AVH)、伤椎植骨、后凸Cobb角(Cobb angle,CA)、功能锻炼、体质量指数(body mass index,BMI)差异有统计学意义(P<0.05);Logistic回归分析显示,AVH<50％(OR=2.811)、伤椎未植骨(OR=2.322)、功能锻炼不合理(OR=2.130)、CA>30°(OR=2.785)、年龄>60岁(OR=2.105)是胸腰椎爆裂性骨折经伤椎短节段内固定术后再发后凸畸形的独立危险因素.结论 胸腰椎爆裂性骨折经伤椎短节段内固定术后易再发后凸畸形,受到AVH、伤椎植骨、CA、功能锻炼、年龄等多种因素影响.     

Denis B型胸腰椎爆裂骨折术后Cobb角度丢失的危险因素分析

目的探讨Denis B型胸腰椎爆裂骨折术后Cobb角度丢失的危险因素。方法纳入2013年1月~2017年1月本院收治的154例Denis B型胸腰椎爆裂骨折患者,均采用后路椎弓根钉内固定治疗,随访27~60个月,将Cobb角度丢失≥4°以及4°者分别设为观察组与对照组。调查两组患者性别、年龄、固定方式等病历资料,并经单因素分析以及Logistic回归分析调查Cobb角度丢失的危险因素。结果术后Cobb角度丢失53例,发生率34. 42%,丢失角度1~9°,平均(6. 05±1. 23)°;两组患者的伤椎置钉、功能锻炼情况、伤椎植骨、术前椎体压缩率、术前Cobb角、年龄、伤椎前缘高度比、体质量指数等差异有统计学意义(P0. 05); Logistic回归分析显示,伤椎未植骨(OR=3. 031)、椎体压缩率50%(OR=2. 875)、功能锻炼不合理(OR=2. 733)、术前Cobb角30°(OR=2. 723)、伤椎未置钉(OR=3. 012)是Denis B型胸腰椎爆裂骨折术后Cobb角度丢失的独立危险因素。结论Denis B型胸腰椎爆裂骨折术易发生Cobb角丢失,受伤椎植骨、椎体压缩率、功能锻炼、术前Cobb角以及伤椎置钉等多种因素影响。     

球囊扩张椎体后凸成形术后继发相邻节段椎体骨折的危险因素分析

目的分析骨质疏松性椎体压缩骨折球囊扩张椎体后凸成形(PKP)术后继发相邻节段椎体骨折的危险因素。方法选取2006-03—2013-07在本院行PKP治疗并获得1年以上随访,且自愿参与课题的135例骨质疏松性椎体压缩骨折患者作为研究对象。根据随访结果有无出现继发相邻节段椎体新鲜骨折,将研究对象分为骨折组(28例)和对照组(107例)。观察记录2组性别、年龄、BMI指数、骨密度、术前伤椎个数、手术前后Cobb角,以及骨水泥量、骨水泥注射方法(单或双侧注射)、有无骨水泥渗漏、伤椎前缘高度恢复程度。结果多因素Logistic回归分析结果发现低BMI指数、低骨密度、伤椎个数多、骨水泥发生渗漏是引起PKP术后继发相邻节段椎体再骨折的危险因素,差异有统计学意义(P0.05)。其中低骨密度和骨水泥渗漏是最主要的危险因素。结论低骨密度和骨水泥渗漏是引起骨质疏松性椎体压缩骨折PKP术后继发相邻节段椎体骨折的主要危险因素,完善术前准备和坚持抗骨质疏松治疗是主要预防措施。     

髋部骨折老年患者发生严重术后谵妄的多因素分析

目的探讨髋部骨折老年患者发生严重术后谵妄的危险因素。方法回顾性分析我院骨科2005年1月~2014年12月572例髋部骨折老年患者接受内固定手术的临床资料,对性别、年龄、术前内科合并症、术前卧床时间、手术方式、麻醉方式、手术时间和术中出血量进行单因素分析,多因素logistic回归模型分析髋部骨折老年患者发生严重术后谵妄的危险因素。结果 25例发生严重术后谵妄(25/572,发生率4.4%)。单因素分析结果显示年龄和麻醉方式有统计学差异(P0.05);多因素logistic回归分析显示年龄(OR=1.12,95%CI:1.05~1.19,P=0.001)和全身麻醉(OR=5.03,95%CI:2.10~12.04,P=0.000)是髋部骨折老年患者发生严重术后谵妄的独立危险因素。结论年龄和全身麻醉是髋部骨折老年患者发生严重术后谵妄的独立危险因素。     

累及后柱的胫骨平台骨折内固定失败的危险因素

目的探讨累及后柱的胫骨平台骨折内固定失败的危险因素。方法自2010-02—2013-02对356例累及后柱的胫骨平台骨折患者行内固定治疗,比较不同性别、年龄、骨折类型、骨质疏松与否、关节面塌陷程度、膝关节周围合并伤、手术时机、术中骨折复位、术中植骨、术后并发症、术后康复治疗患者内固定失败的发生情况,并统计分析其危险因素。结果 359例患者获随访18个月~3年,平均2.1年。共有内固定失败19例。骨折类型(χ~2=4.573,P=0.026)、骨质疏松(χ~2=63.256,P0.001)、关节面塌陷程度(χ~2=6.521,P=0.010)、膝关节周围合并伤(χ~2=7.263,P=0.009)、术中骨折复位(χ~2=72.32,P0.001)、术中植骨(χ~2=17.403,P0.001)、术后并发症(χ~2=16.572,P0.001)、术后康复治疗(χ~2=19.149,P0.001)方面差异比较有统计学意义。结论骨质疏松、术中骨折复位、术中植骨、术后并发症、术后康复治疗是累及胫骨平台后柱骨折内固定失败的独立预后因素。     

胸腰椎压缩骨折后路内固定术后复位丢失的临床研究

目的观察经皮角度椎弓根螺钉修复急性胸腰椎压缩骨折术后复位丢失最大发生的时间段,并分析对临床效果影响的相关因素。方法回顾分析2013年7月至2016年1月通过经皮角度椎弓根螺钉修复急性胸腰椎压缩骨折患者共78例,男57例,女21例;年龄21～65岁,平均(48±12)岁。所有患者于术后8～10个月间取出内固定物,于术后3个月、6个月、取内固定时、取出内固定后3个月、1年、2年、末期进行随访。测量不同时间点X线片上病椎前缘高度百分比(anterior vertebral height,AVH)、后缘高度百分比(posterior vertebral height,PVH)、后凸角(Cobb角)。使用视觉模拟评分(visual analogue scale,VAS)及Oswestry功能障碍指数(Oswestry disability index,ODI)评价腰背部疼痛及功能状况。结果患者随访时间2.8～4.9年,平均随访时间3.6年。术后即刻及末次随访时病椎前后缘高度百分比、后凸角较术前明显改善,差异有统计学意义(P0.01)。病椎前后缘高度、后凸角丢失随时间推移一直存在,其丢失最大发生在术后3个月及内固定取出后3个月内(组间ANOVA对比P0.05,差异有统计学意义),内固定取出1年后复位丢失不大。末次随访患者腰背部平均ODI评分为(7.84±2.05)%,影响因素为术前AVH(回归系数B=-0.062,P=0.048)和末次随访AVH(B=-0.034,P=0.046),PVH、Cobb角度以及内固定取出前后各指标丢失值与ODI评分无相关性。末次随访平均VAS评分(2.25±0.58)分,与上述指标均无明显相关性。结论经皮角度椎弓根螺钉系统对于急性胸腰椎压缩骨折具有良好的畸形矫正能力和临床疗效,但在术后3个月及内固定取出后3个月内复位丢失最大,需要有效的预防。椎体前缘高度可以预测远期的手术效果,而不同时间段椎体少量的丢失并不影响这种治疗的效果。     

胸腰椎骨折内固定后“空壳现象”发生情况及危险因素分析

目的研究胸腰椎骨折内固定后"空壳现象"发生情况及危险因素。方法纳入2016年1月~2018年1月本院收治的204例胸腰椎骨折患者,均采用后路椎弓根螺钉内固定系统治疗,平均随访(18. 65±4. 02)个月,根据是否发生"空壳现象"设为观察组与对照组。调查两组患者性别、年龄、椎体压缩率等病历资料,并经单因素分析及Logistic回归分析调查"空壳现象"的独立危险因素。结果 204例术后发生"空壳现象"114例,发生率55. 88%;两组患者的骨密度T值、椎体压缩率、骨折类型、撑开复位情况、年龄、伤椎置钉、术前Cobb角、术后卧床时间、性别差异等资料有统计学意义(P0. 05); Logistic回归分析显示,骨密度T值-2. 5 SD(OR=2. 755)、椎体压缩率50%(OR=3. 331)、爆裂性骨折(OR=2. 733)、过度撑开(OR=2. 321)是术后"空壳现象"的独立危险因素。结论胸腰椎骨折内固定后"空壳现象"发生率较高,受骨密度T值、椎体压缩率、骨折类型以及撑开复位情况等因素影响。     

Management of hip fractures in the elderly

A fracture of the proximal femur (or hip fracture) is a devastating injury to an elderly patient. Nearly all patients require surgery as part of their treatment but their care necessitates complex multidisciplinary involvement. In the last few years there have been a number of initiatives to help improve care for this challenging patient group, as well as establishment of National Hip Fracture Databases, to allow us to audit the care provided. With this focus we have seen both mortality and length of stay decrease. The aim of this article is to summarize the current recommendations for patients who suffer a hip fracture.     

Management of hip fractures in the elderly

A fracture of the proximal femur (or hip fracture) is a devastating injury to an elderly patient. Nearly all patients require surgery as part of their treatment but their care necessitates complex multidisciplinary involvement. In the last ten years there have been a number of initiatives to help improve care for this challenging patient group, as well as establishment of The National Hip Fracture Database, to allow us to audit the care provided. With this focus, we have seen both mortality and length of stay decrease. The aim of this article is to summarize the current recommendations for patients who suffer a hip fracture.     

Decision-making in burst fractures of the thoracolumbar and lumbar spine

The most common site of injury to the spine is the thoracolumbar junction which is the mechanical transition junction between the rigid thoracic and the more flexible lumbar spine. The lumbar spine is another site which is more prone to injury. Absence of stabilizing articulations with the ribs, lordotic posture and more sagitally oriented facet joints are the most obvious explanations. Burst fractures of the spine account for 14% of all spinal injuries. Though common, thoracolumbar and lumbar burst fractures present a number of important treatment challenges. There has been substantial controversy related to the indications for nonoperative or operative management of these fractures. Disagreement also exists regarding the choice of the surgical approach. A large number of thoracolumbar and lumbar fractures can be treated conservatively while some fractures require surgery. Selecting an appropriate surgical option requires an in-depth understanding of the different methods of decompression, stabilization and/or fusion. Anterior surgery has the advantage of the greatest degree of canal decompression and offers the benefit of limiting the number of motion segments fused. These advantages come at the added cost of increased time for the surgery and the related morbidity of the surgical approach. Posterior surgery enjoys the advantage of being more familiar to the operating surgeons and can be an effective approach. However, the limitations of this approach include inadequate decompression, recurrence of the deformity and implant failure. Though many of the principles are the same, the treatment of low lumbar burst fractures requires some additional consideration due to the difficulty of approaching this region anteriorly. Avoiding complications of these surgeries are another important aspect and can be achieved by following an algorithmic approach to patient assessment, proper radiological examination and precision in decision-making regarding management. A detailed understanding of the mechanism of injury and their unique biomechanical propensities following various forms of treatment can help the spinal surgeon manage such patients effectively and prevent devastating complications.     

Fractures of the thumb and finger metacarpals in athletes

Most metacarpal fractures are minimally displaced and are treated without surgery. Markedly displaced fractures, fractures causing finger rotation, and displaced intra-articular fractures require surgical intervention. The challenge with the elite athlete is achieving an early return to play without compromising fracture position. Casts, splints, and surgery each have a role in getting the athlete back into action as soon as possible.     

Incidence and outcome of osteoporotic fractures in 2004 in Sado City,Niigata Prefecture,Japan

Osteoporotic fracture in elderly populations is increasing worldwide, but there are few data on the incidence and outcome of osteoporotic fractures, including upper extremity and vertebral fracture, during a certain period in a defined geographic area. The purpose of this study was to determine the incidence of osteoporotic fractures in a particular area: Sado City, Niigata Prefecture, Japan. From January to December 2004, osteoporotic fractures of the vertebra, hip, distal radius, and proximal humerus in Sado City were recorded. The incidence, age, gender, type of fracture (for hip fracture), right or left side (for distal radius, proximal humerus, and hip fracture), place of injury, cause of injury, outcome, hospitalization period, and patient status regarding taking of drugs for osteoporosis treatment were checked for each fracture. The incidence was calculated based on the whole population of Sado City. The incidence per 100,000 population was 232.8, 121.4, 108.6, and 37.1 for fractures of the vertebra, hip, distal radius, and proximal humerus, respectively. The total incidence of these four kinds of fracture was 499.9 per 100,000 persons per year. The average age at the time of injury was 81.4, 77.7, 75.7, and 60.2 years old for fractures of the hip, vertebra, proximal humerus, and distal radius, respectively. As the average age increased, the percentage of fractures that occurred indoors also increased; that is, a higher percentage of hip fractures occurred indoors, followed by fractures of the vertebra, proximal humerus, and distal radius. Most patients were not taking anti-osteoporosis drugs before fractures of the hip or vertebra. We determined the incidence of major osteoporotic fractures in 1 year in a defined geographic area. Our data showed that 81% of hip fracture patients also had a vertebral fracture and that the average age at the time of injury was higher for hip fractures than for vertebral fractures. Therefore, these results suggest that vertebral fracture leads to hip fracture, indicating that early fracture prevention and continuous prevention strategies through positive treatment are of importance in osteoporotic elderly people.     

影响胫骨Pilon骨折疗效的相关因素分析

[目的]探讨影响Pilon骨折疗效的相关因素.[方法]胫骨Pilon骨折152例,根据骨折粉碎、移位的影像学改变,将骨折分为4型.按治疗方法分为开放复位内固定组和其他治疗方法组,其中内固定组92例、其他治疗方法组60例,平均随访9.6年(1～19年).对影响其疗效的相关因素进行临床分析.[结果]内固定组和其他方法治疗组复位质量优良率分别为83.70％、55.00％,治疗效果优良率平均为77.63％,其中内固定组优良率88.04％,其他方法组优良率61.67％.各型骨折内固定组的治疗效果优良率均高于其他方法组.术后并发症有浅表感染9例,创口裂开皮肤坏死延期愈合13例,外固定针道感染3例,骨延迟愈合2例,创伤性关节炎23例,深部感染骨髓炎1例.[结论]影响Pilon骨折临床疗效的主要因素是骨折类型、治疗方法、复位质量.Ⅰ型骨折两种治疗方法复位均满意;Ⅱ、Ⅲ型骨折切开复位内固定能获得优良疗效,Ⅳ型骨折两种治疗方法均难于达到解剖复位,部分Ⅳ型骨折伴有软组织严重损伤者适宜选择外固定器治疗.     

The risk and burden of vertebral fractures in Sweden

The aim of this study was to determine the risk and burden of vertebral fractures judged as those coming to clinical attention and as morphometric fractures. Incidence and utility loss were computed from data from Malmo, Sweden. Clinical fractures accounted for 23% of all vertebral deformities in women and for 42% in men. The average 10-year fracture probability for morphometric fractures increased with age in men from 2.9% at the age of 50 years (7.2% in women) to 8.4 at the age of 85 years (26.7% in women). As expected, probabilities increased with decreasing T-score for hip BMD. Cumulative utility loss from a clinical vertebral fracture was substantial and was 50–62% of that due to a hip fracture depending on age. When incidence of fractures in the population was weighted by disutility, all spine fractures accounted for more morbidity than hip fracture up to the age of 75 years. We conclude that vertebral fractures have a major personal and societal impact that needs to be recognised in algorithms for assessment of risk and in health economic strategies for osteoporosis.     

带锁髓内钉在下肢骨干多段骨折的应用

目的：探讨带锁髓内钉在下肢骨干多节段骨折应用的临床疗效及有关问题。方法：回顾性分析31例股骨、胫骨干多节段骨折应用带锁髓内钉的临床资料，有关适应证、切开复位、扩髓及动力和静力固定问题进行讨论。结果：31例中除2例失访，29例随访8～31个月，平均随访12．5个月，关节功能恢复优良率93．1％，骨折愈合率98．3％。结论：只有掌握好操作技术，带锁髓内钉是目前治疗下肢骨干多节段骨折的一种良好内固定方法，值得推广应用。     

Stress fracture of the radius diaphysis in a skeletally immature wrestler

Stress fractures in the forearm are rare events. Failure to detect a nondisplaced stress fracture could lead to further injury or fracture displacement. We present a case of a 15-year-old male wrestler without overt risk factors, who presented with a transverse stress fracture in the middle third of the radial diaphysis. The clinician should consider this diagnosis when examining athletes with otherwise unexplained forearm pain.