| objectives: To investigate the various causes of thoracolumbarChance fractures and discussion on specific mechanisms and the role of it.Trend prediction on the main causes of thoracolumbar Chance fracturesTo explore the diagnostic approaches and values of the imaging ofthoracolumbar Chance fractures. Compare the therapeutic effect oftreating thoracolumbar Chance fractures between group of long segmentpedicle screw fixation with posterolateral bone grafting and group ofshort segment pedicle screw fixation with posterolateral bone grafting. Toexplore the misdiagnosis cases, analysis the reason and seek to avoidmeasures.Methods: Select28patients who suffered thoracolumbar Chancefractures and had a surgical operation in our hospital during from January2012to January2014as the research objects. The clinical and imagingdata were retrospectively studied. The research process is divided into thefollowing several aspects.1.About causes and mechanism：Make statisticanalysis of various causes of thoracolumbar Chance fractures, countpercentage number and analyze specific mechanisms.2.About diagnosis:Review preoperative imaging, summarize characteristics of images, countthe number of all kinds of imaging characteristics. Discussion on imaging features and the value of the three imaging diagnostic methods.3.Abouttreatment in operation:28patients were all performed posterolateral bonegrafting. All patients were divided into two groups by different fixationsegment. Group A (8screws) is using long segment pedicle screw fixation.Group B (4screws) is using short segment pedicle screw fixation.Compare the general data between two groups. General data includes: age,gender, follow up time. Compare the preoperative data between twogroups. Preoperative data includes: preoperative anterior of vertebralrelative height, preoperative Cobb angle, preoperative vertebral wedgeangle, preoperative ASIA, preoperative ODI scores, preoperative VAS.Compare the data in operation between two groups. Data in operationincludes: operation time, operative blood loss. Compare the postoperativedata between two groups. Postoperative data includes: postoperativeanterior of vertebral relative height, postoperative Cobb angle,postoperative vertebral wedge angle. Compare the data at the last followup between two groups. Data at the last follow up includes: anterior ofvertebral relative height at the last follow up, correction loss rate ofanterior of vertebral relative height, Cobb angle at the last follow up,Cobb angle correction loss, vertebral wedge angle at the last follow up,vertebral wedge angle correction loss, ASIA at the last follow up, ODIscores at the last follow up, VAS at the last follow up. Statistical methods:using SPSS22.0to analyze the data. Relevant data were expressed.x ±s If the data meet the normal distribution, t test was used. Then,independent sample t test was used in the comparison between twogroups. If some data do not meet the normal distribution, Chi square testwas used in the comparison between two groups. Confidence limits wereset to95%.The meaning of p＜0.05is significant differences between thetwo groups.4. About misdiagnosis: Careful review of the relevant casehistory of all the cases, to find out misdiagnosis during the period ofhospitalization and discharge time. If misdiagnosis exists, we shouldanalyze the reasons.Results:1.About causes and mechanism：The mechanism of injurywas fall in Seventeen(60.71%);motor vehicle crash in six(21.42%);struckby a heavy object in five(17.86%).2.About diagnosis: X-ray: the numberof wide spinous process distance in anteroposterior and lateralthoracolumbar spine radiograph is23,which accounts for67.85%.thenumber of transverse fracture line with vertical separation in vertebrabody appeared in anteroposterior thoracolumbar spine radiographis16,which accounts for57.14%.the number of transverse fracture linewith vertical separation in vertebra body appeared in lateralthoracolumbar spine radiograph is20,which accounts for71.42%.CT：thenumber of dissolving pedicle sign is20,which accounts for71.42%.thenumber of Naked-facet sign is10,which accounts for35.71%。Aftermulti-planner reformation, transverse fracture line can be viewed in total cases.7cases underwent MRI examination,4cases could be observedtypical sandwich sign.3.About treatment in operation: Comparison ofgeneral and preoperative data between two groups: there is no significantdifferences between the two groups, P＞0.05.Comparison of data inoperation between two groups: group A is longer than group B inoperation time. operative blood loss of group B is less than group A.There is significant differences between the two groups, P＜0.05.Comparison of Postoperative data between two groups: there is nosignificant differences between the two groups, P＞0.05.Comparison ofthe last follow-up data between two groups: Comparison of imaging databetween two groups shows that group A has more stability than group B.There is no significant differences in ASIA, ODI scores and VAS, whichshows similar clinical effect.4.About misdiagnosis: a misdiagnosis casewas found in her emergency admission.Conclusions:1.Injury by a fall may become the main causes ofthoracolumbar Chance fractures2.Diagnosis methord of CT was superiorto X-ray. CT has the characteristic of intuitionistic and accurate especiallysagittal in reconstruction. MRI contributes to evaluate the posterior softtissue and nerve injury.3. The stability of long segment fixation is betterthan short segment fixation.The operation time and operative blood lossof short segment fixation is less than long segment fixation.There is noobvious difference in the clinical treatment effect between the two group. 4.Detailed history, careful physical examination, reasonable andcomprehensive auxiliary inspection is an important guarantee to avoidmissed diagnosis... |
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