RESUMEN
BACKGROUND: Internal fixation of unstable thoracolumbar spine fractures requires correction of the lacking anterior column support. This usually entails insertion of a vertebral body replacement strut through an anterior approach, or a long posterior construct spanning at least two vertebrae above and two vertebrae below the fracture. Posterior short-segment pedicle instrumentation (SSPI)--one vertebra above and below--is suitable for approximately 40% of fractures, but not for all. METHODS: A total of 52 patients with unstable thoracolumbar burst fractures meeting our inclusion criteria were instrumented using a novel approach, combining percutaneous SSPI, pedicle screw augmentation with polymethyl methacrylate (PMMA) and fractured vertebra kyphoplasty. We retrospectively reviewed patient and fracture data, operative results and 1 year radiographic follow-up postoperatively in 40 of the patients. We reviewed operative complications of all 52 patients. RESULTS: Most fractures were AO/Magerl type A3.1, A3.2 and A3.3. They were instrumented within 72 h and ambulated without additional external bracing. Operative time averaged 2 h and blood loss was less than 50 cc in most cases. Complications were mostly related to PMMA leakage. On average, 3.3° (0-13) of correction was lost after 3 months, but remained constant afterward. CONCLUSIONS: Percutaneous augmented short-segment pedicle instrumentation of unstable thoracolumbar fractures can be done with short operative times, minimal blood loss and a low complication rate. The radiographical results at 1 year are equal to anterior stabilization and are better than other posterior-only techniques.
Asunto(s)
Cifoplastia/métodos , Vértebras Lumbares/lesiones , Procedimientos Ortopédicos/métodos , Fracturas de la Columna Vertebral/cirugía , Vértebras Torácicas/lesiones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Tornillos Óseos , Femenino , Humanos , Fijadores Internos , Cifoplastia/instrumentación , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos/instrumentación , Polimetil Metacrilato , Radiografía , Estudios Retrospectivos , Fracturas de la Columna Vertebral/diagnóstico por imagen , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/cirugía , Resultado del Tratamiento , Adulto JovenRESUMEN
Cerebro-spinal fluid leakage from a spinal stab wound is rare, and usually not a life-threatening injury. Pneumocephalus, a possible rare complication of traumatic cerebro-spinal fluid leakage, can potentially lead to intracranial hemorrhage and death. We describe two cases of spinal stab wounds complicated by cerebro-spinal fluid leakage, one of them developing into severe pneumocephalus. Both patients recovered completely with the following treatment protocol: (a) trendelenburg positioning of the patient, (b) insertion of a continuous-drainage cerebro-spinal fluid catheter into the lumbar thecal sac, (c) primary suture of the leaking skin wound, (d) IV antibiotic therapy.
Asunto(s)
Vértebras Lumbares , Neumocéfalo/etiología , Efusión Subdural/etiología , Heridas Punzantes/complicaciones , Adulto , Anciano , Cateterismo , Drenaje , Femenino , Inclinación de Cabeza , Cefalea/diagnóstico por imagen , Cefalea/etiología , Cefalea/terapia , Humanos , Masculino , Neumocéfalo/diagnóstico por imagen , Neumocéfalo/terapia , Canal Medular , Efusión Subdural/diagnóstico por imagen , Efusión Subdural/terapia , Tomografía Computarizada por Rayos XRESUMEN
Ultrasound is the most sensitive method for detecting hip pathology in the first year of life. However, it has been shown that neonatal sonography, or combined sonographic-clinical screening, can cause some over-diagnosis which, when not used properly, can lead to over-treatment. We developed the concept of 'true developmental dysplasia of the hip' on the basis of our experience. Despite the still-growing popularity of Pavlik's method in the treatment of the condition, we were unable to find a study dealing with the relationship between sex, sonographic and clinical pathology, age at the start of treatment, and duration and outcome of treatment. To answer these questions, we assessed patients we had treated using Pavlik's method in a 5-year period at a special developmental dysplasia of the hip clinic. The influence of sex, clinical stability, severity of sonographic pathology and age when treatment was started was assessed according to duration, outcome of treatment and rate of avascular necrosis. In spite of the relatively small number of hips treated in this study, some conclusions can be drawn. The short period of treatment for clinically unstable hips can be surprising. As treatment was started before the age of 14 weeks, the favorable results can be attributed to this fact. There are hips which, according to our theory, will not improve spontaneously to normal; therefore, we believe that our figures reflect the real results of treatment using Pavlik's method. Practically 0% avascular necorosis for all the treated population (only one child had transient avascular necorosis of type 1) is, in our opinion, due to this fact. The high rate of success (98%) can also be attributed to early treatment.
Asunto(s)
Luxación Congénita de la Cadera/cirugía , Aparatos Ortopédicos , Algoritmos , Moldes Quirúrgicos , Femenino , Luxación Congénita de la Cadera/diagnóstico por imagen , Humanos , Lactante , Recién Nacido , Masculino , Resultado del Tratamiento , UltrasonografíaRESUMEN
A 15-year-old boy sustained severe multisystem injuries from a satchel charge while in his native village in southern Lebanon. After evacuation and resuscitation measures, he had successful intensive multidisciplinary surgical care. His long-bone fractures were stabilized by tubular external fixation systems, and his lacerated right tibialis anterior artery was grafted. Twenty days after injury, he developed a pseudoaneurysm of the left distal ulnar artery, which was surgically resected and the ulnar artery proximally ligated. Two weeks later, a pseudoaneurysm of the left peroneal artery, distal to the knee and coupled with an arteriovenous fistula, was diagnosed. This was treated by fluoroscopic controlled embolization with placement of stents. The patient recovered uneventfully. He was last seen two years after surgery, and no gross vascular compromise of any of his limbs was evident. This appears to be the only reported patient with late-developing multiple posttraumatic pseudoaneurysms after severe blast and shrapnel injuries. This development suggests that late sequelae of blast injuries may be topographically widespread and can evolve months after the injury. As such, these patients should be followed closely with a high degree of suspicion for the appearance of new signs or symptoms.