Background The current surgical options for late posttraumatic spinal kyphosis are primarily based on standing x-rays. The degree of deformity is reduced in the prone position. This self-correction of the deformity could be achieved without osteotomy or instruments, making large osteotomies no longer necessary. Osteotomy based on prone imaging data for the treatment of late posttraumatic kyphosis has not been reported. We, therefore, aimed to evaluate the clinical efficacy of simple posterior column osteotomy or non-osteotomy based on prone x-rays. Methods From April 2017 to November 2020, we collected preoperative standing, prone, postoperative, and final follow-up imaging data of 18 patients admitted to our hospital for late posttraumatic kyphosis using simple posterior column osteotomy or non-osteotomy. Preoperative prone data of thoracic kyphosis angle (TK), local kyphosis Cobb angle (LKCA), and lumbar lordosis angle (LL), was obtained. Preoperative, immediate postoperative, and final follow-up TK, LKCA, LL, sagittal vertebral axis (SVA), pelvic tilt (PT), and pelvic incidence minus lumbar lordosis angle (PI-LL) data was also obtained on standing x-ray imaging. The operative time, bleeding, and operative complication rate was collected and analyzed. We compared the preoperative, two month postoperative, and final follow-up Oswestry disability index (ODI) and visual analog score (VAS) scores to evaluate the surgical results. Result LKCA and TK significantly reduced from the standing to prone position before surgery. The LKCA, TK, and SVA of immediate postoperative and last follow-up data were statistically different compared with those before surgery; the differences in LL, PT, and PI-LL in the postoperative period and at the last follow-up were not statistically significant compared with those before surgery. All patients were operated upon successfully, with an operative time of 152.7 ± 34.2 min, a bleeding volume of 408.3 ± 135.3 ml, no complications of infection or nerve injury, and a decrease in ODI scores and VAS scores at two months and at the last follow-up (P < 0.05) after surgery. Conclusion Based on prone imaging, simple posterior column osteotomy or non-osteotomy surgery for traumatic kyphosis with good flexibility and no neurological symptoms is safe, with potential reduction in operative time, complications, and bleeding.
Background: Posterior internal fixation is the main method used for the treatment of thoracolumbar fractures. Fractures often occur in the upper 1/3 of the vertebral body. However, they can also occur in the middle or lower 1/3 of the vertebral body. At present, there is no report discussing the potential effects of sagittal location on instrument biomechanics or surgical strategy. The objects of this study was to investigate the effect of the sagittal location of the fracture region of the vertebral body on the biomechanics of the internal fixation system and surgical strategy. Methods: A finite element model of the T11-L3 thoracolumbar segment was established based on a healthy person’s CT scan. Different sagittal fracture location finite element models were created by resection of the upper 1/3, middle 1/3, and lower 1/3 of the L1 vertebral body. Three surgical strategies were utilized in this study, namely proximal 1 level and distal 1 level (P1-D1), proximal 2 level and distal 1 level(P2-D1), and proximal 1 level and distal 2 levels (P1-D2). Nine fixation finite element models were created by combining fracture location and fixation strategies. Range of motion, von Mises stress, and stress distribution were analyzed to evaluate the effects on the instrument biomechanics and the selection of surgical strategy. Results: In all three different fixation strategies, the maximum von Mises stress location on the screw did not change with the sagittal location of the fracture site; nevertheless, the maximum von Mises stress differed. The maximum rod stress was located at the fracture site, with its value and location changed slightly. In the same fixation strategy, a limited effect of sagittal location on the range of motion was observed. P2D1 resulted in a shorter range of motion and lower nail stress for all sagittal locations of the fracture compared with the other strategies; however, rod stress was similar between strategies. Conclusions: The sagittal location of a fracture may affect the stress and distribution, but does not influence the selection of surgical strategy.
Background/Objective: We aimed to establish a hierarchical decision-making mechanism for perioperative restricted red blood cell transfusion based on cerebral regional oxygen saturation (rSO2), and evaluate its role in blood transfusion management in elderly patients undergoing total knee replacement (THR) or total hip replacement (TKA). Methods: Eighty elderly patients with perioperative hemoglobin (Hb) in the range of 70 g/L to 100 g/L were divided into study group (improved restrictive transfusion group) and control group ("peri-operative transfusion trigger score (POTTS)" group) by random number table method. The person number of blood transfusion, the average volume of red blood cells transfused, rSO2 and Hb levels of all patients, and the number of patients with postoperative delirium (POD) were recorded. Results: The person number of blood transfusion and the average volume of red blood cells transfused in the study group were higher than those in the control group (P<0.05). From the first day to the seventh day after surgery, the Hb level in the study group was significantly higher than that in the control group (P<0.05). On the second and third day after surgery, rSO2 in the study group was significantly higher than that in the control group, and POD incidence was lower than that in the control group (P<0.05). Correlation analysis of rSO2 and Hb levels in all patients throughout the whole process r=0.923, higher rSO2 on the second and third day after surgery was the protective factor of POD (P<0.05). Conclusion: The decision-making mechanism of improved restrictive transfusion consumes more blood resources, but it also significantly increases the levels of rSO2 and Hb in elderly patients and reduces the incidence of POD.
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