OBJECTIVE: To evaluate the curative effect of percutaneous vertebroplasty (PVP) for senile osteoporotic vertebral compressive fractures with posterior vertebral defect and spinal canal compromise.
 METHODS: A total of 50 patients with osteoporotic vertebral compressive fractures (50 vertebrae) underwent PVP from July, 2010 to October, 2013. Subsequent visual analogue scale (VAS) rating, analgesic utilization and mobility were recorded before and after the surgery.
 RESULTS: A total of 42 patients were followed up completely. The median VAS, analgesic administration score and patients' mobility score was significantly decreased at the 2nd hour, the 3rd day, the 1st month, the 3rd month, the 6th month and the 1st year after the surgery compared with those at the pre-operation (P<0.01). Five recurrence fractures were observed after PVP.
 CONCLUSION PVP is safe and effective and it is worthy for clinical popularization and application.
Fractures, Compression ; surgery ; Humans ; Osteoporotic Fractures ; surgery ; Pain Measurement ; Spinal Canal ; pathology ; Spinal Fractures ; surgery ; Spine ; pathology ; surgery ; Treatment Outcome ; Vertebroplasty

Accidents, Traffic ; Adult ; Fractures, Compression ; diagnostic imaging ; etiology ; pathology ; surgery ; Humans ; Male ; Radiography ; Spinal Fractures ; diagnostic imaging ; etiology ; pathology ; surgery

OBJECTIVETo observe the morphological characteristics of sacral fracture under different impact loads.

METHODTen fresh pelvic specimens were loaded in dynamic or static state. A series of mechanical parameters including the pressure strain and velocity were recorded. Morphological characteristics were observed under scanning electron microscope.

RESULTSThe form of sacral fracture was related to the impact energy. Under low energy impact loads, ilium fracture, acetabulum fracture and crista iliaca fracture were found. Under high energy impact loads, three types of sacral fracture occurred according to the classification of Denis: sacral ala fracture, Type I fracture; sacral foramen cataclasm fracture, Type II fracture; central vertebral canal fracture, Type III fracture. Nerve injury of one or two sides was involved in all three types of sacral fracture. The fracture mechanism of sacrum between the dynamic impact and static compression was significantly different. When the impact energy was above 25 J, sacral foramen cataclasm fracture occurred, involving nerve root injury. When it was below 20 J, ilium and sacral fracture was most likely to occur. When it was 20 approximately 25 J, Type I fracture would occur. While in the static test, most of the fracture belonged to ilium or acetabulum fracture. The cross section of sacrum was crackly and the bone board of Haversian system was brittle, which could lead to separation of bone boards and malposition of a few of cross bone boards.

CONCLUSIONSIn dynamic state, sacrum fracture mostly belongs to Type I and Type II, and usually involves the nerve roots. Sacrum fracture is relevant to the microstructures, the distribution of the bone trabecula, the osseous lacuna and the Haversian system of sacrum. The fracture of ilium and acetabulum more frequently appears in static state, with slight wound of peripheral tissues.

Biomechanical Phenomena ; Humans ; Male ; Microscopy, Electron, Scanning ; Sacrum ; injuries ; pathology ; Spinal Fractures ; pathology ; physiopathology ; surgery ; Spinal Nerve Roots ; injuries

PURPOSE: Although Denis classification is considered as one of most clinically useful schemes for the evaluation of spinal fracture, there is little documentation on the relationship between fracture pattern and the neurologic recovery. The purpose is to evaluate the correlation between the fracture patterns according to Denis classification and neurologic recovery. MATERIALS AND METHODS: The 38 patients (26 men and 12 women) in this series had an average follow-up of 47.1 months, and they were all managed surgically. Denis classification had been used prospectively to determine the fracture morphology. Frankel Scale and American Spinal Injury Association Spinal Cord Injury Assessment Form [American Spinal Injury Association (ASIA) score] were obtained before surgery, after surgery and at the final follow-up. RESULTS: The common injuries making neurologic deterioration were burst fracture and fracture-dislocation. The degree of neurologic deficits seen first and at the final follow-up was more severe in fracture-dislocation than burst fracture. The neurologic recovery was not different between burst fracture and fracture-dislocation, assessed by Frankel grading and ASIA scoring system. The neurologic recovery evaluated by ASIA score was not different between the lumbar and thoracic spinal fracture. The neurologic recovery assessed by Frankel grade was greater in the lumbar spinal fractures in than the thoracic spinal fractures. CONCLUSION: The severity of initial and the final follow-up neurologic deficits were correlated with the fracture patterns according to Denis classification, but the neurologic recovery was not correlated.
Female ; Follow-Up Studies ; Humans ; Male ; Recovery of Function ; Spinal Fractures/classification/pathology/*rehabilitation/surgery

OBJECTIVES: To analyze the characteristics and mechanisms of pelvic fractures in the cases of road traffic accident deaths. METHODS: Total 65 cases of road traffic accident deaths with pelvic fracture were collected, and the sites, characteristics and injury mechanisms of pelvic fracture were statistically analyzed. RESULTS: Among the 65 cases of pelvic fracture, 38 cases of dislocation of sacroiliac joint were found, and most combined with pubis symphysis separation or fracture of pubis. In the fractures of pubis, ischium and acetabulum, linear fractures were most common, while comminuted fractures were most common in sacrum and coccyx fractures. There were 54 cases combined with pelvic soft tissue injury, and 8 cases with pelvic organ injury and 44 cases with abdominal organ injury. In the types of pelvic ring injury, 32 cases were separation, 49.32%, followed by compression, 26.15% and only one case was verticality, 1.54%. CONCLUSIONS Detailed and comprehensive examination of the body and determination of the pelvic fracture type contribute to analyze the mechanisms of injury.
Accidents, Traffic ; Acetabulum/injuries* ; Death ; Forensic Pathology ; Fractures, Bone/diagnosis* ; Fractures, Comminuted/diagnosis* ; Humans ; Ischium/injuries* ; Pelvic Bones/injuries* ; Soft Tissue Injuries/diagnosis* ; Spinal Fractures/diagnosis*

Objective To provide a reference for the assessment of the disability grade of Kümmell's disease cases, through the analysis of the basic situation, the disability grade and the causality of Kümmell's disease cases. Methods Data of appraised individuals in 8 cases of Kümmell's disease from traffic accident spinal injury cases accepted by the Institute from 2015 to 2017 were collected, and the basic situation, vertebral fracture sites and disability grades of the appraised individuals were analyzed. Results Among 8 cases of appraised individuals, there were 2 males and 6 females, the oldest 75 years and the youngest 50 years, with an average age of 62.5 years, all of whom suffered from single vertebral fracture. Among them, 1 patient had thoracic 11 vertebra fracture, 3 thoracic 12 vertebra fracture, 2 lumbar 1 vertebra fracture, 1 lumbar 2 vertebra fracture, and 1 lumbar 4 vertebra fracture, all of whom were assessed as grade 10 disability. Conclusion In the assessment of disability grade of vertebral fracture, dynamic observation of the vertebral fracture and its recovery should be made based on imaging data. If it is suspected that there is Kümmell's disease, it should be differentiated from other diseases. Also, the disability grade will be assessed according to the corresponding standards when the morphology of the injured vertebral body is relatively stable.
Accidents, Traffic ; Aged ; Disability Evaluation ; Female ; Forensic Medicine ; Humans ; Lumbar Vertebrae ; Male ; Middle Aged ; Spinal Diseases/pathology* ; Spinal Fractures/pathology* ; Thoracic Vertebrae

Having manufactured the bone fatigue damage testing device SL-2000, we applied it to research on bone fatigue damage and on the bone microdamage which can indicate bone biomechanical property. According to the general principle of industry fatigue machine and bone fatigue test, the strength, frequency and times of loading, temperature and degree of wetness were controlled in the SL-2000 Device for making the experiment condition stable. After the fatigue damage to SD rats' vertebrae, the models of bone microdamage in SD rat were established. 0-200 N of strength, 0-10 Hz frequency, and 0-999999 times of loading, ambient temperature 50 degrees C experiment, and approximately 99% of the ambient degree of wetness could be adjusted continuously. Three kinds of microdamage such as microcrack, cross-hatch staining, and diffuse staining were observed in the SD rats' vertebrae fatigue damaged by the device. The microcrack density was 19.76+/-15.05 #/mm2, the microcrack length was 36. 74+/-11. 51 microm, and the area ratio of diffuse staining was 0.4117%. Therefore the device is suitable for bone fatigue damage test and for establishment of the model of bone microdamage.
Animals ; Biomechanical Phenomena ; Compressive Strength ; Equipment Design ; Fractures, Stress ; diagnosis ; physiopathology ; Rats ; Rats, Sprague-Dawley ; Spinal Fractures ; diagnosis ; physiopathology ; Spine ; pathology ; Weight-Bearing

OBJECTIVE: Thoracoscopic spinal surgery provides minimally invasive approaches for effective vertebral decompression and reconstruction of the thoracic and thoracolumbar spine, while surgery related morbidity can be significantly lowered. This study analyzes clinical results of thoracoscopic spinal surgery performed at our institute. METHODS: Twenty consecutive patients underwent video-assisted thoracosopic surgery (VATS) to treat various thoracic and thoracolumbar pathologies from April 2000 to July 2006. The lesions consisted of spinal trauma (13 cases), thoracic disc herniation (4 cases), tuberculous spondylitis (1 case), post-operative thoracolumbar kyphosis (1 case) and thoracic tumor (1 case). The level of operation included upper thoracic lesions (3 cases), midthoracic lesions (6 cases) and thoracolumbar lesions (11 cases). We classified the procedure into three groups: stand-alone thoracoscopic discectomy (3 cases), thoracoscopic fusion (11 cases) and video assisted mini-thoracotomy (6 cases). RESULTS: Analysis on the Frankel performance scale in spinal trauma patients (13 cases), showed a total of 7 patients who had neurological impairment preoperatively : Grade D (2 cases), Grade C (2 cases), Grade B (1 case), and Grade A (2 cases). Four patients were neurologically improved postoperatively, two patients were improved from C to E, one improved from grade D to E and one improved from grade B to grade D. The preoperative Cobb's and kyphotic angle were measured in spinal trauma patients and were 18.9+/-4.4 degrees and 18.8+/-4.6 degrees, respectively. Postoperatively, the angles showed statistically significant improvement, 15.1+/-3.7 degrees and 11.3+/-2.4 degrees, respectively (P<0.001). CONCLUSION: Although VATS requires a steep learning curve, it is an effective and minimally invasive procedure which provides biomechanical stability in terms of anterior column decompression and reconstruction for anterior load bearing, and preservation of intercostal muscles and diaphragm.
Decompression ; Diaphragm ; Diskectomy ; Humans ; Intercostal Muscles ; Kyphosis ; Learning Curve ; Pathology* ; Spinal Fractures ; Spinal Fusion ; Spine ; Spondylitis ; Thoracic Surgery, Video-Assisted ; Weight-Bearing

OBJECTIVETo evaluate the feature of experimental endplate fracture in lumbar spine and its related factors.

METHODSNineteen cadaveric lumbar motion segments aged 48 - 77 years were compressed by overload to fracture the endplate and dissected into isolated vertebrae to evaluate feature of their endplate failure. Before and after failure of endplate, radiographic tests were taken on every motion segment. The bone mineral density (BMD), bone mineral content (BMC) of the vertebral body and endplate were tested respectively before endplate fracture.

RESULTSAmong 19 motion segments, 16 were fractured and accounted for 84.2% of all and fracture featured as stellate, step, depression and intrusion. Fracture concentrated on the center or anterior of superior endplate of the inferior vertebrae in one motion segment. Failure load of endplate was positively correlated with BMD, BMC of vertebral endplate. Within one vertebral body, the BMD and BMC of its superior endplate was markedly less than that of inferior endplate, on the other hand, the difference of BMD and BMC of endplate around one disc was opposite.

CONCLUSIONSFractures usually concentrate on the center or anterior part of superior endplate of one vertebrae and are hard to be identified by conventional radiographic examination. Failure load of endplate is positively correlated with BMD, BMC of vertebral body and endplate. There might be certain relationship between feature of fracture and severity of disc degeneration.

Aged ; Bone Density ; Cadaver ; Female ; Fractures, Stress ; diagnostic imaging ; pathology ; Humans ; Intervertebral Disc ; diagnostic imaging ; pathology ; Lumbar Vertebrae ; diagnostic imaging ; injuries ; pathology ; Male ; Middle Aged ; Radiography ; Spinal Fractures ; diagnostic imaging ; pathology

OBJECTIVETo study the clinical effect and surgical operating points of pararectus approach for the internal fixation of acetabular both-column fractures with concurrent displaced quadrilateral plate fractures.

METHODSFrom January 2012 to December 2013, in the Third Affiliated Hospital of Southern Medical University, 15 patients with acetabular both-column fractures and displaced quadrilateral plate fractures were surgically managed through the pararectus approach. There were 11 male and 4 female patients, with an average age of 40 years (from 19 to 61 years). According to Judet-Letournel classification, there were 9 anterior column plus posterior hemitransverse fractures, 6 both-column fractures, 8 cases involving the pelvic fracture. All these fractures were treated through the pararectus approach, in the horizontal position with general anesthesia. The pre-bended plate was placed in interior pelvic ring to fix the anterior wall, anterior column and quadrilateral plate in direct sight. Then, the posterior column was exposed and fixed with antegrade lag screw. Patients were followed up in 4 weeks, 12 weeks, 6 months, 1 year after the operation, and the anteroposterior radiograph of pelvis and the X-ray examination of the fractured hip was performed.

RESULTSAll the 15 cases underwent the operation successfully. Postoperative X-ray and CT exams showed excellent and good reduction of anterior column, posterior column and quadrilateral plate, with none surgical complication occurred. According to the Matta radiological evaluation postoperatively, reduction of acetabular fracture was rated as excellent in 9 cases, good in 3 cases and poor in 3 cases. The rate of excellent and good was 12/15. After 8 to 18 months' follow-up (median follow-up time was 14 months), all the patients gained bone union. According to the modified Merle D'Aubigne and Postel scoring system, 9 cases were excellent, 4 were good, and 2 were fair. The rate of excellent and good was 13/15.

CONCLUSIONSSurgical management of acetabular fractures through the pararectus approach can provide adequate exposure of reducing and fixing both-column acetabular fractures with concurrent displaced quadrilateral plate fractures, which has a good effect in clinical application.

Acetabulum ; pathology ; surgery ; Adult ; Anesthesia, General ; Bone Plates ; Bone Screws ; Female ; Fracture Fixation, Internal ; methods ; Hip Fractures ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Pelvic Bones ; pathology ; surgery ; Postoperative Period ; Spinal Fractures ; Treatment Outcome ; Young Adult