复位五法结合内固定治疗胸腰段脊柱骨折脱位

目的:探讨手法复位技术在胸腰椎骨折脱位中的应用。方法:自2007年至2017年共诊治胸腰椎骨折脱位患者72例,分为治疗组与对照组。治疗组共37例,采用山东省名中医徐展望"牵压旋扳撑"复位五法,手术切开前先行手法复位,术中椎弓根钉棒系统撑开固定矫正残余移位及维持复位后位置。对照组35例只采用术中器械撑开复位固定。术后3 d所有患者均佩戴支具在床上坐起,下肢肌力在3级以上者下地活动。比较两组术后后凸Cobb角的改善以及侧方角度的改善情况,两组椎骨旋转角度改善情况及视觉模拟评分法(VAS)评分。结果:治疗组在侧方角度改善及椎骨旋转角度的改善方面明显优于对照组,治疗组侧方成角从平均17.46°±3.67°恢复到4.39°±1.23°;对照组从18.39°±4.12°恢复到8.12°±2.10°。两组比较差异有统计学意义(P0.01)。在椎骨旋转角度方面,治疗组恢复到6.02°±1.64°,对照组则恢复到14.91°±3.50°,两组比较差异有统计学意义(P0.01)。术后VAS均有明显改善,两组间对比差异无统计学意义。治疗组37例患者中治愈16例(43.24%),好转19例(51.35%),优良率94.59%。对照组35例中治愈11例(31.43%),好转19例(54.29%),优良率为85.71%。组间对比差异无统计学意义。选取典型病例,详细介绍了复位五法的应用情况。结论:手法复位可明显改善移位复杂严重的胸腰段骨折脱位,特别是脊柱的侧方成角以及椎骨的旋转移位。配合术中椎弓根钉棒系统撑开固定可达到满意的复位,且安全实用。     

The effect of prophylactic vertebroplasty on the incidence of proximal junctional kyphosis and proximal junctional failure following posterior spinal fusion in adult spinal deformity: a 5-year follow-up study

Background Context

The incidence of proximal junctional kyphosis (PJK) ranges from 5% to 46% following adult spinal deformity surgery. Approximately 66% to 76% of PJK occurs within 3 months of surgery. A subset of these patients, reportedly 26% to 47%, develop proximal junctional failure (PJF) within 6 months postoperatively. To date, there are no studies evaluating the impact of prophylactic vertebroplasty on PJK and PJF incidence at long-term follow-up.

Self-Assessed Kyphosis and Chewing Disorders Predict Disability and Mortality in Community-Dwelling Older Adults

Objective

It is clear that each trend of kyphosis with increased age and the ability to eat firm foods with the back teeth (chewing ability) has a strong influence on both the physical and mental condition of older people. Thus, this study aimed to examine whether the combination of kyphosis and chewing disorders was associated with mortality or the need for care under the new long-term care insurance (LTCI) service requirement, over 3 years in community-dwelling older Japanese adults.

Cervical neurofibromatosis with quadriparesis: Management by fibular strut graft

This is a case report of an eight-year old boy with neurofibromatosis and a 120° dystrophic kyphosis of the cervical spine. He presented with progressive quadriparesis caused by spondyloptosis of the C2/C3, and was successfully treated by skull traction and one-stage anterior fibular strut graft lying between the tubercle of the atlas through the C2 body slot and lower vertebrae. At seven years follow-up there was, loosening of lower vertebral screws which allowed growth and residual mobility of lower vertebral joints while the fusion of upper cervical spines was still solid.     

Diastrophic dysplasia with severe primary kyphosis and ‘monkey wrench’ appearance of the femora

The cases of two sisters with severe diastrophic dysplasia who showed some unusual radiographic features (kyphosis secondary to hypoplasia/dysplasia of the lumbar spine and a ‘monkey wrench’ appearance of the proximal femur) are reported here. Absent patellae were another feature that has not previously been reported in diastrophic dysplasia.     

一期后路闭合式-张开式联合楔形截骨术矫正角形脊柱后凸

[目的]检验闭合式-张开式联合楔形截骨术治疗角形脊柱后凸的有效性和安全性.采用一期后路闭合式-张开式联合楔形截骨术的方法对7名患有胸腰椎角形脊柱后凸畸形的患者进行治疗.[方法]7名角形脊柱后凸患者,其后凸顶点位于T51例,位于T111例,位于T125例.其中5例存在有陈旧性骨折,1例为先天性畸形和1例患有神经纤维瘤病.首先用闭合式楔形截骨术将脊柱后凸矫正30°～35°,在施行椎骨切除术和脊髓减压时其矫正的中心点位于前纵韧带.随后用张开式楔形截骨术对残余的截骨角度予以矫正时,其矫正的中心点位于脊髓和剩余的截骨角之上.脊柱的稳定性则采用后路器械内固定和植骨予以保证.[结果]在2.2～7.5年的随访中,患者局部后凸的角度减少了67°～18°.自T1至骶骨的矢状位排列较术前更加符合生理曲线.所有的患者均获得了良好的骨质愈合并且没有神经性并发症发生,也没有矫正度数的丢失.[结论]在直视下,采用闭合式-张开式联合楔形截骨术的矫正效果和脊髓减压是令人满意和放心的.虽然手术的过程是异常艰巨的,但它却提供了一个没有脊髓损伤的、良好的矫正效果.     

Kyphoplasty Increases Vertebral Height,Decreases Both Pain Score and Opiate Requirements While Improving Functional Status

Vertebral compression fractures can result from advanced osteoporosis, or less commonly from metastatic or traumatic insults to the vertebral column, and result in disabling pain and decreased functional capacity. Various vertebral augmentation options including kyphoplasty aim at preventing the sequelae of pain and immobility that can develop as the result of the vertebral fractures. The mechanism for pain relief following kyphoplasty is not entirely understood, and the restoration of a portion of the lost vertebral height is a subject of debate. We retrospectively reviewed radiographic imaging, pain relief, analgesic intake and functional outcomes in 67 consecutive patients who underwent single‐ or multilevel kyphoplasty with the primary goal of quantifying the restoration of lost vertebral height. We observed a mean of 45% of the lost vertebral height restored postprocedurally. Secondarily, kyphoplasty was associated with significant decreases in pain scores, daily morphine consumption and improvement in patient‐reported functional measures.