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CLASSIFICATION OF POST-TRAUMATIC DEFORMITIES OF THE THORACIC AND LUMBAR SPINE 胸椎腰椎创伤后畸形的分类
Q3 Medicine Pub Date : 2018-06-09 DOI: 10.14531/ss2018.2.23-32
A. Afaunov, A. Kuzmenko, I. Basankin, M. Y. Ageev
Objective. To analyze the working classification of post-traumatic deformities of the thoracic and lumbar spine taking into account the main characteristics of pathological condition of the injured spinal motion segments, spinal cord and roots, affecting the choice of tactics and techniques of surgical treatment. Material and Methods. The clinical material for the classification development included 124 patients with post-traumatic deformities of the thoracic and lumbar spine operated on after 6 months to 14 years from the time of injury during 2003–2017. Results. The proposed working classification is based on the systematization of the three orthopedic features. It offers 120 variants of post-traumatic deformities of the thoracic and lumbar spine, each designated by three symbols: a digit, a letter, a digit (for example, 4.B.1 or 2.E.3). An additional option is the four surgical risk gradation of neurological status denoted by the Latin letter N with a digit from 1 to 4. Conclusion. The classification clearly systematizes numerous variants of post-traumatic deformities of the thoracic and lumbar spine based on the most clinically significant signs. Its application allows justifying the choice of a patient-specific tactical and technical option of surgical treatment.
目标。结合损伤的脊柱运动节段、脊髓和椎根的病理状况的主要特点,分析胸腰椎创伤后畸形的工作分类,影响手术治疗策略和技术的选择。材料和方法。分类发展的临床资料包括2003-2017年期间124例创伤后胸腰椎畸形患者,这些患者在受伤后6个月至14年后接受手术。结果。提出的工作分类是基于三个骨科特征的系统化。它提供了120种胸椎和腰椎创伤后畸形的变体,每种变体由三个符号表示:一个数字,一个字母,一个数字(例如,4.B)。1 .或2.E.3)。另一个选择是神经系统状态的四个手术风险等级,用拉丁字母N表示,数字从1到4。结论。该分类根据最具临床意义的体征,清晰地系统化了胸椎和腰椎创伤后畸形的多种变体。它的应用允许合理的选择患者特定的战术和技术选择的手术治疗。
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引用次数: 4
ADHESION BARRIER GEL ANTIADGEZIN FOR DEGENERATIVE LUMBAR SPINE DISEASE 粘连屏障凝胶治疗退行性腰椎疾病
Q3 Medicine Pub Date : 2018-06-09 DOI: 10.14531/ss2018.2.39-50
V. V. Shvets, S. Kolesov, I. N. Karpov, A. Panteleyev, I. V. Skorina, D. Gorbatyuk
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引用次数: 4
COMPLICATIONS IN SURGERY OF EARLY-ONSET SCOLIOSIS WITH VEPTR INSTRUMENTATION: PRELIMINARY REPORT veptr内固定治疗早发性脊柱侧凸的并发症:初步报告
Q3 Medicine Pub Date : 2018-06-09 DOI: 10.14531/ss2018.2.18-22
D. N. Dolotin, V. A. Suzdalov
Objective. To analyze complications developing during multistage correction of early severe spinal deformities of various etiologies using VEPTR instrumentation. Materials and Methods. The study included prospective group of 76 patients treated for early-onset scoliosis (EOS) with the VEPTR and VEPTR II instrumentation. Patients were classified using a randomized Classification of Early-Onset Scoliosis (C-EOS) system. In accordance with scoliosis etiology the cases were distributed as follows: 28 idiopathic, 26 congenital, 20 syndromic, and 2 neuromuscular scoliosis cases; and ratio of boys to girls was 32 : 44. The average age at the beginning of treatment was 5.4 ± 2.1 (1.6 to 9.8) years. The average follow-up period since the first stage was 2.2 (2 to 2.5) years. Results. Twenty three complications were revealed in 15 (19.7 %) patients. According to the C-EOS system, the patients with complications were referred to normoand hyperkyphotic groups. The most common complication was migration of the cranial point of implant fixation. Most complications were eliminated during the planned stage of deformity correction. In two cases, the complication resulted in cessation of the VEPTR technique using. Conclusions. The use of VEPTR instrumentation for the treatment of EOS is associated with a rather high risk of complications. This is most likely in patients with normokyphotic and hyperkyphotic deformities. Most complications are eliminated during stage correction. The need to abandon the further use of the VEPTR instrumentation is rare.
目标。目的:分析不同病因的早期严重脊柱畸形采用VEPTR内固定进行多阶段矫正的并发症。材料与方法。该研究包括前瞻性组76例使用VEPTR和VEPTR II器械治疗早发性脊柱侧凸(EOS)的患者。采用早发性脊柱侧凸随机分类(C-EOS)系统对患者进行分类。根据脊柱侧凸的病因分布如下:特发性侧凸28例,先天性侧凸26例,综合征型侧凸20例,神经肌肉型侧凸2例;男女比例为32:44。治疗开始时的平均年龄为5.4±2.1(1.6 ~ 9.8)岁。从第一阶段开始的平均随访时间为2.2年(2至2.5年)。结果。15例(19.7%)出现23例并发症。根据C-EOS系统将出现并发症的患者分为正常和肥大两组。最常见的并发症是颅骨内固定点移位。大多数并发症在计划的畸形矫正阶段被消除。在两个病例中,并发症导致停止使用VEPTR技术。结论。使用VEPTR内固定治疗EOS伴有相当高的并发症风险。这最可能发生在正常后凸和过度后凸畸形的患者中。大多数并发症在阶段矫正中被消除。很少需要放弃进一步使用VEPTR仪器。
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引用次数: 0
COMPUTER 3D-MODELING OF PATIENT-SPECIFIC NAVIGATIONAL TEMPLATE FOR CERVICAL SCREW INSERTION 颈椎螺钉置入患者专用导航模板的计算机3d建模
Q3 Medicine Pub Date : 2018-06-09 DOI: 10.14531/ss2018.2.33-38
A. Burtsev, O. M. Pavlova, S. Ryabykh, A. Gubin
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引用次数: 15
СКОЛИОЗ И СПОНДИЛОЛИСТЕЗ: ВАРИАНТ РЕШЕНИЯ ПРОБЛЕМЫ 脊柱侧凸和脊椎脱垂:问题解决方案
Q3 Medicine Pub Date : 2018-03-30 DOI: 10.14531/SS2018.1.18-25
Михаил Витальевич Михайловский, Вадим Васильевич Белозеров
Objective. To evaluate the results of surgical correction of scoliotic deformities in patients with spondylolisthesis. Material and Methods. A total of 51 patients with scoliosis and spondylolisthesis were observed in 1998–2016. Spondylolisthesis was asymptomatic in 49 cases. Most patients had grade I spondylolisthesis. Surgical correction of scoliotic deformity of the spine with segmental instrumentation was performed in 31 cases. Results. The average magnitude of the initial scoliotic curve before surgery was 67.2°, after surgery – 33.4°, and correction was 50.3 %. The magnitude of countercurve before surgery was 28.1°, after surgery – 11.1°, and correction was 35.5 %. In all cases, the L 5 vertebra was not included in the spinal fusion zone. Progression of the degree of the L 5 vertebra displacement in the postoperative period was not revealed. Neurological deficit was not observed. The average follow-up period was 5.4 ± 3.3 years. Conclusion. Correction of idiopathic scoliosis in the presence of L 5 spondylolisthesis can be carried out with good and satisfactory results and minimal risk of listhesis progression, and with preservation of the achieved result in the long-term period.
目标。目的评价脊柱滑脱患者脊柱侧凸畸形的手术矫正效果。材料和方法。1998-2016年共观察51例脊柱侧凸伴脊柱滑脱患者。49例脊柱滑脱无症状。大多数患者为I级脊柱滑脱。31例脊柱侧凸畸形采用节段内固定进行手术矫正。结果。初始侧凸曲线的平均大小术前为67.2°,术后为- 33.4°,矫正率为50.3%。反曲度术前为28.1°,术后为- 11.1°,矫正率为35.5%。在所有病例中,l5椎体不包括在脊柱融合区。术后l5椎体移位程度的进展情况未见报告。未观察到神经功能缺损。平均随访时间5.4±3.3年。结论。在l5椎体滑脱的情况下进行特发性脊柱侧凸的矫正可以获得良好和满意的结果,并且可以将滑脱进展的风险降到最低,并且可以长期保存所取得的结果。
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引用次数: 2
Микрохирургическая дискэктомия в поясничном отделе позвоночника: эффективность, болевой синдром, фактор ожирения 腰椎椎微外科软盘切除术:效率、疼痛综合征、肥胖症
Q3 Medicine Pub Date : 2018-03-30 DOI: 10.14531/ss2018.1.42-48
Марк Микаелович Алексанян, Алексей Леонидович Хейло, К П Микаелян, Эдуард Гемджян Gemdzhian, Александр Георгиевич Аганесов
Objective. To analyze the effectiveness and features of microsurgical discectomy of herniated intervertebral discs in patients with excessive body weight. Material and Methods . A total of 104 patients (37 men and 67 women) aged 24–58 years with intervertebral disc hernias in the lumbar spine accompanied by compression of neural structures and radicular pain syndrome were operated on. The study group consisted of 48 obese patients who underwent microdiscectomy at the lumbar level. The control group included 56 non-obese patients operated in the same way. The level of the pain syndrome was assessed using the VAS and Oswestry’s functional activity questionnaire. Results. Preoperative pain intensity was slightly higher in patients with obesity than in those with normal body weight. Six weeks after the microdiscectomy, the radicular pain syndrome was arrested. The clinical effect of microdiscectomy persisted after 6 and 12 months. By the end of the follow-up period, some patients with excessive body weight had a tendency to have pain in the back and lower extremities. Also, patients with obesity had slightly greater intraoperative blood loss, the incidence of superficial infectious complications, the duration of the operation, and the length of hospital stay. Conclusion. The overweight factor should be considered when planning anesthesia and microsurgical discectomy in the lumbar spine.
目标。目的:分析体重过重患者椎间盘突出症显微外科切除的疗效及特点。材料和方法。对104例24 ~ 58岁腰椎椎间盘突出伴神经结构受压及神经根性疼痛综合征患者进行手术治疗,其中男37例,女67例。研究组包括48例在腰椎水平行微椎间盘切除术的肥胖患者。对照组56例非肥胖患者采用相同方法。采用VAS和Oswestry功能活动问卷评估疼痛综合征水平。结果。肥胖患者术前疼痛强度略高于正常体重患者。微椎间盘切除术后6周,神经根性疼痛综合征得到缓解。显微椎间盘切除术的临床效果持续6个月和12个月。在随访期结束时,一些体重过重的患者有背部和下肢疼痛的倾向。此外,肥胖患者术中出血量、浅表感染并发症发生率、手术时间和住院时间略高于肥胖患者。结论。在计划腰椎麻醉和显微手术椎间盘切除术时应考虑超重因素。
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引用次数: 5
ЕСТЕСТВЕННОЕ ТЕЧЕНИЕ ВРОЖДЕННОЙ ДЕФОРМАЦИИ ПОЗВОНОЧНИКА У ДЕТЕЙ С ИЗОЛИРОВАННЫМ НАРУШЕНИЕМ ФОРМИРОВАНИЯ ПОЗВОНКА В ПОЯСНИЧНОМ ОТДЕЛЕ 腰部脊柱形成孤立障碍儿童先天性脊柱畸形的自然过程
Q3 Medicine Pub Date : 2018-03-30 DOI: 10.14531/SS2018.1.6-17
Сергей Валентинович Виссарионов, Кирилл Александрович Картавенко, Дмитрий Николаевич Кокушин
Objective. To assess the natural history of the lumbar spine deformity progression in children with isolated vertebral body malformation. Material and Methods . The natural course of spinal deformity associated with disrupted lumbar vertebra formation was analyzed in 40 patients aged 1 year 7 months to 17 years 11 months who received conservative treatment and dynamic follow-up during four years. Spondylography was performed in frontal and lateral projections in lying position every 6 months. Spondylograms were used to measure the magnitude of the angle of the local scoliotic and kyphotic components of deformity in the process of child’s growth and the magnitude of the angle of general lumbar lordosis. Results. The study showed that two components of deformity (scoliosis and kyphosis) were characterized by a progressive and stable course. Against the background of local curvature in the sagittal plane, the results of the study of general lordosis were distributed according to the age norm and to a flattening relative to the norm at the time of the last observation. Conclusion. At the primary examination of a patient, the initial magnitude of scoliotic curvature according to Cobb plays a predictive role in determining the further course of spinal deformity. When the magnitude of the primary curve is less than 30°, conservative therapy provides a stable course of congenital curvature, and in some children, a tendency to self-correction. Children with initial magnitude of the primary scoliotic curve of more than 30° have steady progression of congenital deformity in the lumbar spine of more than 6° during 4 years, which is an indication for surgical treatment at an early age.
客观的评估孤立性椎体畸形儿童腰椎畸形进展的自然史。材料和方法。对40名年龄在1岁7个月至17岁11个月之间的患者进行了分析,这些患者在4年内接受了保守治疗和动态随访。每6个月进行一次脊椎造影术,以平躺姿势进行额侧投影。脊椎图用于测量儿童生长过程中局部脊柱侧弯和后凸畸形成分的角度大小,以及一般腰椎前凸角度大小。后果研究表明,畸形的两个组成部分(脊柱侧弯和后凸)以渐进和稳定的过程为特征。在矢状面局部弯曲的背景下,一般前凸的研究结果根据年龄标准分布,并相对于最后一次观察时的标准变平。结论在对患者进行初步检查时,根据Cobb的说法,脊柱侧弯的初始幅度在确定脊柱畸形的进一步过程中起着预测作用。当主曲线的幅度小于30°时,保守治疗提供了一个稳定的先天性弯曲过程,在一些儿童中,有自我矫正的倾向。原发性脊柱侧弯初始幅度超过30°的儿童在4年内腰椎先天性畸形的发展稳定在6°以上,这是早期手术治疗的一个指征。
{"title":"ЕСТЕСТВЕННОЕ ТЕЧЕНИЕ ВРОЖДЕННОЙ ДЕФОРМАЦИИ ПОЗВОНОЧНИКА У ДЕТЕЙ С ИЗОЛИРОВАННЫМ НАРУШЕНИЕМ ФОРМИРОВАНИЯ ПОЗВОНКА В ПОЯСНИЧНОМ ОТДЕЛЕ","authors":"Сергей Валентинович Виссарионов, Кирилл Александрович Картавенко, Дмитрий Николаевич Кокушин","doi":"10.14531/SS2018.1.6-17","DOIUrl":"https://doi.org/10.14531/SS2018.1.6-17","url":null,"abstract":"Objective. To assess the natural history of the lumbar spine deformity progression in children with isolated vertebral body malformation. Material and Methods . The natural course of spinal deformity associated with disrupted lumbar vertebra formation was analyzed in 40 patients aged 1 year 7 months to 17 years 11 months who received conservative treatment and dynamic follow-up during four years. Spondylography was performed in frontal and lateral projections in lying position every 6 months. Spondylograms were used to measure the magnitude of the angle of the local scoliotic and kyphotic components of deformity in the process of child’s growth and the magnitude of the angle of general lumbar lordosis. Results. The study showed that two components of deformity (scoliosis and kyphosis) were characterized by a progressive and stable course. Against the background of local curvature in the sagittal plane, the results of the study of general lordosis were distributed according to the age norm and to a flattening relative to the norm at the time of the last observation. Conclusion. At the primary examination of a patient, the initial magnitude of scoliotic curvature according to Cobb plays a predictive role in determining the further course of spinal deformity. When the magnitude of the primary curve is less than 30°, conservative therapy provides a stable course of congenital curvature, and in some children, a tendency to self-correction. Children with initial magnitude of the primary scoliotic curve of more than 30° have steady progression of congenital deformity in the lumbar spine of more than 6° during 4 years, which is an indication for surgical treatment at an early age.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"15 1","pages":"6-17"},"PeriodicalIF":0.0,"publicationDate":"2018-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48577870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
РЕЗУЛЬТАТЫ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ПАЦИЕНТОВ С КОКСОВЕРТЕБРАЛЬНЫМ СИНДРОМОМ: АПРОБАЦИЯ АЛГОРИТМА РАЦИОНАЛЬНОЙ ХИРУРГИЧЕСКОЙ ТАКТИКИ 焦虑症患者的手术治疗结果:理性手术策略算法的测试
Q3 Medicine Pub Date : 2018-03-30 DOI: 10.14531/SS2018.1.55-64
Алексей Леонидович Кудяшев, Владимир Васильевич Хоминец, Владимир Михайлович Шаповалов, П. А. Метленко, Филипп Владиславович Мироевский, Михаил Владимирович Резванцев, Андрей Васильевич Теремшонок, Константин Евгеньевич Коростелев, Владимир Дмитриевич Беседин, В. В. Скворцов
Objective. To present comparative analysis of mid- and long-term results of surgical treatment in patients with hip-spine syndrome operated on using conventional approaches and the developed algorithm. Material and Methods. The study included 175 patients aged 54.4 ± 12.7 years with grade III coxarthrosis combined with degenerative disease of the spine and vertebrogenic pain syndrome, who were admitted at the clinic for hip replacement. The study (n = 94) and comparison (n = 81) groups were identified. In the study group, the developed algorithm of rational surgical tactics was applied, and in the comparison group, standard approaches to the choice of surgical tactics were used. Results of surgical treatment in 134 patients were achieved, on average, in 9 months after surgery. Long-term results were evaluated in 55 patients, on average, in 61 months after hip replacement. Results. Using the developed algorithm allowed to increase the number of patients with good clinical and functional results, and to achieve better performance of the hip joint. The analysis of changes in patients’ satisfaction with the results of treatment demonstrated significantly higher rating of long-term outcomes as compared to mid-term. Analysis of pelvis-spine relationships confirmed the effect of hip replacement on the sagittal and frontal trunk balance. Conclusion. The developed approaches to the choice of rational surgical tactics in patients with hip-spine syndrome allows reliable improving of mid- and long-term results of surgical treatment.
目标。目的:比较分析传统入路与新算法治疗髋-脊柱综合征的中长期疗效。材料和方法。该研究纳入175例年龄54.4±12.7岁的III级关节关节病合并脊柱退行性疾病和椎体源性疼痛综合征的患者,这些患者在诊所接受髋关节置换术。确定研究组(n = 94)和对照组(n = 81)。研究组采用已开发的合理手术策略算法,对照组采用标准手术策略选择方法。134例患者平均术后9个月获得手术治疗结果。对55例患者的长期结果进行评估,平均为髋关节置换术后61个月。结果。使用所开发的算法,可以增加具有良好临床和功能结果的患者数量,并获得更好的髋关节性能。对患者对治疗结果满意度变化的分析显示,患者对长期疗效的满意度明显高于中期疗效。骨盆-脊柱关系的分析证实了髋关节置换术对矢状位和前侧躯干平衡的影响。结论。在髋关节-脊柱综合征患者中选择合理手术策略的发展方法可以可靠地改善手术治疗的中期和长期结果。
{"title":"РЕЗУЛЬТАТЫ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ПАЦИЕНТОВ С КОКСОВЕРТЕБРАЛЬНЫМ СИНДРОМОМ: АПРОБАЦИЯ АЛГОРИТМА РАЦИОНАЛЬНОЙ ХИРУРГИЧЕСКОЙ ТАКТИКИ","authors":"Алексей Леонидович Кудяшев, Владимир Васильевич Хоминец, Владимир Михайлович Шаповалов, П. А. Метленко, Филипп Владиславович Мироевский, Михаил Владимирович Резванцев, Андрей Васильевич Теремшонок, Константин Евгеньевич Коростелев, Владимир Дмитриевич Беседин, В. В. Скворцов","doi":"10.14531/SS2018.1.55-64","DOIUrl":"https://doi.org/10.14531/SS2018.1.55-64","url":null,"abstract":"Objective. To present comparative analysis of mid- and long-term results of surgical treatment in patients with hip-spine syndrome operated on using conventional approaches and the developed algorithm. Material and Methods. The study included 175 patients aged 54.4 ± 12.7 years with grade III coxarthrosis combined with degenerative disease of the spine and vertebrogenic pain syndrome, who were admitted at the clinic for hip replacement. The study (n = 94) and comparison (n = 81) groups were identified. In the study group, the developed algorithm of rational surgical tactics was applied, and in the comparison group, standard approaches to the choice of surgical tactics were used. Results of surgical treatment in 134 patients were achieved, on average, in 9 months after surgery. Long-term results were evaluated in 55 patients, on average, in 61 months after hip replacement. Results. Using the developed algorithm allowed to increase the number of patients with good clinical and functional results, and to achieve better performance of the hip joint. The analysis of changes in patients’ satisfaction with the results of treatment demonstrated significantly higher rating of long-term outcomes as compared to mid-term. Analysis of pelvis-spine relationships confirmed the effect of hip replacement on the sagittal and frontal trunk balance. Conclusion. The developed approaches to the choice of rational surgical tactics in patients with hip-spine syndrome allows reliable improving of mid- and long-term results of surgical treatment.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"15 1","pages":"55-64"},"PeriodicalIF":0.0,"publicationDate":"2018-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66710759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Результаты дифференцированного хирургического лечения агрессивных гемангиом позвонков 外科手术治疗攻击性血管炎的结果
Q3 Medicine Pub Date : 2018-03-30 DOI: 10.14531/SS2018.1.79-90
Владимир Сергеевич Климов, М. А. Косимшоев, Алексей Владимирович Евсюков, В. С. Киселев, Е. Ю. Воронина
Objective. To evaluate the outcomes of the differentiated surgical treatment in patients with aggressive vertebral hemangiomas. Material and Methods . The study included 127 patients with aggressive vertebral hemangiomas operated on in 2013–2016. The tumor localization was cervical in 9.5% of cases, thoracic in 59.8 % and lumbar in 30.7 %. Patients were divided into two groups: Group I (n = 110) with type IIIA aggressive hemangiomas, and Group II (n = 17) with type IIIB aggressive hemangiomas. Preoperative assessment included clinical and neurological examination, VAS, ODI, JOA, Weinstein-Boriani-Biagini classification, and radiography; MSCT and MRI studies of the spine were performed before treatment and in 12 months after surgery. Results. Patients in Group I underwent puncture vertebroplasty. Back pain was 6 VAS, after 12 months – 2 VAS. The average preoperative ODI score was 32 and decreased to 9 in 12 months after surgery. In Group II, patients underwent decompression and stabilization with intraoperative open vertebroplasty of the affected vertebra. Preoperative embolization of tumor vessels was performed in two of 17 patients to reduce intraoperative blood loss. Preoperative back pain was 6 VAS, in 12 months after surgery – 2 VAS. The ODI score showed the improvement in all patients as compared to preoperative values. Conclusion . Puncture vertebroplasty ensures the achievement of good functional result in 95.4 % of cases of type IIIA aggressive hemangioma. Decompression and stabilization surgery with intraoperative open vertebroplasty provides good functional result in 93.4 % of cases of type IIIB aggressive hemangioma. The use of vertebroplasty in type IIIB aggressive hemangiomas allows for vertebral segment stabilization with a low risk of the tumor recurrence.
客观的评估侵袭性脊椎血管瘤患者的差异化手术治疗结果。材料和方法。该研究纳入了2013-2016年手术治疗的127名侵袭性脊椎血管瘤患者。肿瘤定位于颈部占9.5%,胸部占59.8%,腰部占30.7%。患者被分为两组:第一组(n=110)为IIIA型侵袭性血管瘤,第二组(n=17)为IIIB型侵略性血管瘤。术前评估包括临床和神经系统检查、VAS、ODI、JOA、Weinstein Boriani-Biagini分类和放射学;在治疗前和手术后12个月对脊柱进行MSCT和MRI研究。后果I组患者行穿刺椎体成形术。背痛为6 VAS,12个月后为2 VAS。术前平均ODI评分为32分,术后12个月降至9分。在第二组中,患者接受了减压和稳定,并在术中对受影响的椎骨进行了开放性椎体成形术。17例患者中有2例在术前进行肿瘤血管栓塞,以减少术中出血。术前背痛为6 VAS,术后12个月为2 VAS。ODI评分显示,与术前值相比,所有患者的ODI评分均有改善。结论穿刺椎体成形术可确保95.4%的IIIA型侵袭性血管瘤患者获得良好的功能效果。减压和稳定手术结合术中开放性椎体成形术在93.4%的IIIB型侵袭性血管瘤病例中提供了良好的功能结果。在IIIB型侵袭性血管瘤中使用椎体成形术可以稳定椎体,降低肿瘤复发的风险。
{"title":"Результаты дифференцированного хирургического лечения агрессивных гемангиом позвонков","authors":"Владимир Сергеевич Климов, М. А. Косимшоев, Алексей Владимирович Евсюков, В. С. Киселев, Е. Ю. Воронина","doi":"10.14531/SS2018.1.79-90","DOIUrl":"https://doi.org/10.14531/SS2018.1.79-90","url":null,"abstract":"Objective. To evaluate the outcomes of the differentiated surgical treatment in patients with aggressive vertebral hemangiomas. Material and Methods . The study included 127 patients with aggressive vertebral hemangiomas operated on in 2013–2016. The tumor localization was cervical in 9.5% of cases, thoracic in 59.8 % and lumbar in 30.7 %. Patients were divided into two groups: Group I (n = 110) with type IIIA aggressive hemangiomas, and Group II (n = 17) with type IIIB aggressive hemangiomas. Preoperative assessment included clinical and neurological examination, VAS, ODI, JOA, Weinstein-Boriani-Biagini classification, and radiography; MSCT and MRI studies of the spine were performed before treatment and in 12 months after surgery. Results. Patients in Group I underwent puncture vertebroplasty. Back pain was 6 VAS, after 12 months – 2 VAS. The average preoperative ODI score was 32 and decreased to 9 in 12 months after surgery. In Group II, patients underwent decompression and stabilization with intraoperative open vertebroplasty of the affected vertebra. Preoperative embolization of tumor vessels was performed in two of 17 patients to reduce intraoperative blood loss. Preoperative back pain was 6 VAS, in 12 months after surgery – 2 VAS. The ODI score showed the improvement in all patients as compared to preoperative values. Conclusion . Puncture vertebroplasty ensures the achievement of good functional result in 95.4 % of cases of type IIIA aggressive hemangioma. Decompression and stabilization surgery with intraoperative open vertebroplasty provides good functional result in 93.4 % of cases of type IIIB aggressive hemangioma. The use of vertebroplasty in type IIIB aggressive hemangiomas allows for vertebral segment stabilization with a low risk of the tumor recurrence.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"15 1","pages":"79-90"},"PeriodicalIF":0.0,"publicationDate":"2018-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48891516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 6
ФЕНОМЕН ADDING-ON ПРИ ИДИОПАТИЧЕСКИХ СКОЛИОЗАХ ПОДРОСТКОВ ТИПА LENKE I 青少年特发性脊柱侧凸症的附加现象,如Lenke I型
Q3 Medicine Pub Date : 2018-03-30 DOI: 10.14531/SS2018.1.26-31
Александр Юрьевич Сергунин, Александр Сергеевич Васюра, Артем Николаевич Сорокин
Objective. To analyze the incidence of adding-on phenomenon in the surgery of Lenke type 1 idiopathic scoliosis. Material and Methods. The study included prospective analysis of radiographs of 89 patients (82 females and 7 males) with idiopathic scoliosis who met the criteria for inclusion. The age of patients at the time of surgery ranged from 12 to 25 years (mean: 16.3 ± 4.4 years). The average follow-up period was 2.3 ± 0.4 years. Scoliotic deformity corresponded to grade III according to V.D. Chaklin’s classification in 24 patients, and to grade IV in 65. The magnitude of the primary thoracic curve varied from 30° to 103° of Cobb angle (mean: 61.1° ± 17.1°). In all cases, segmental third generation instrumentation (hybrid or laminar) was used in combination with intraoperative skeletal traction with an afford equal to 50 % of the patient’s body weight. Laminar fixation was used in 6 patients, and hybrid fixation with different extent of screw installation in 83. Results. The following parameters showed significant increase: the magnitude of thoracic curve according to Cobb – 16.0° ± 4.3°, the distance from the center of the vertebra located one level distal to the lowest instrumented vertebra, to the central sacral vertical line (LIV+1-CSVL) – 3.6 ± 2.5 mm, the tilt of the lower instrumented vertebra in the coronal plane (LIV tilt angle) – 3.6° ± 2.8°, the tilt of the vertebra located one level distal to the lowest instrumented vertebra (LIV+1 tilt angle) – 4.6° ± 2.5°, and the distance from the center of the apical vertebra of the primary curve to the central sacral vertical line (AV-CSVL) – 17.2 ± 12.0 mm. A significant correlation was found between postoperative magnitude of the scoliotic curve and AV-CSVL distance, postoperative LIV+1-CSVL distance and postoperative LIV+1 tilt angle. An increase in LIV+1 tilt angle in combination with an increase in LIV+1-CSVL distance by more than 4 mm (or degrees) could be a parameter for measuring the adding-on phenomenon. Conclusion. The indication for reoperation may probably be a significant tilt of the vertebra located below the lowest instrumented vertebra, accompanied by pain syndrome and coronal imbalance.
目标。目的分析Lenke 1型特发性脊柱侧凸手术中附加现象的发生率。材料和方法。该研究包括89名符合纳入标准的特发性脊柱侧凸患者(82名女性和7名男性)的x线片的前瞻性分析。患者手术时年龄12 ~ 25岁,平均16.3±4.4岁。平均随访时间2.3±0.4年。根据V.D. Chaklin分类,24例脊柱侧凸畸形属于III级,65例属于IV级。原发性胸椎弯曲的大小从Cobb角30°到103°不等(平均:61.1°±17.1°)。在所有病例中,节段性第三代内固定(混合型或层流型)与术中骨骼牵引联合使用,牵引力等于患者体重的50%。6例采用椎板固定,83例采用不同程度螺钉混合固定。结果。以下参数显著增加:胸椎弯曲幅度按Cobb - 16.0°±4.3°,椎体中心距最低固定椎体远一水平,距骶骨正中线(LIV+1- csvl) - 3.6±2.5 mm,下固定椎体在冠状面倾斜(LIV倾斜角度)- 3.6°±2.8°,椎体倾斜距最低固定椎体远一水平(LIV+1倾斜角度)- 4.6°±2.5°,从初级曲线的根椎中心到骶正中垂直线(AV-CSVL)的距离- 17.2±12.0 mm。术后侧凸曲线大小与AV-CSVL距离、术后LIV+1- csvl距离和术后LIV+1倾斜角度有显著相关。如果LIV+1的倾斜角增加,并且LIV+1- csvl的距离增加超过4毫米(或度),则可以作为测量附加现象的参数。结论。再次手术的指征可能是椎体明显倾斜,位于最低的固定椎体下方,并伴有疼痛综合征和冠状失衡。
{"title":"ФЕНОМЕН ADDING-ON ПРИ ИДИОПАТИЧЕСКИХ СКОЛИОЗАХ ПОДРОСТКОВ ТИПА LENKE I","authors":"Александр Юрьевич Сергунин, Александр Сергеевич Васюра, Артем Николаевич Сорокин","doi":"10.14531/SS2018.1.26-31","DOIUrl":"https://doi.org/10.14531/SS2018.1.26-31","url":null,"abstract":"Objective. To analyze the incidence of adding-on phenomenon in the surgery of Lenke type 1 idiopathic scoliosis. Material and Methods. The study included prospective analysis of radiographs of 89 patients (82 females and 7 males) with idiopathic scoliosis who met the criteria for inclusion. The age of patients at the time of surgery ranged from 12 to 25 years (mean: 16.3 ± 4.4 years). The average follow-up period was 2.3 ± 0.4 years. Scoliotic deformity corresponded to grade III according to V.D. Chaklin’s classification in 24 patients, and to grade IV in 65. The magnitude of the primary thoracic curve varied from 30° to 103° of Cobb angle (mean: 61.1° ± 17.1°). In all cases, segmental third generation instrumentation (hybrid or laminar) was used in combination with intraoperative skeletal traction with an afford equal to 50 % of the patient’s body weight. Laminar fixation was used in 6 patients, and hybrid fixation with different extent of screw installation in 83. Results. The following parameters showed significant increase: the magnitude of thoracic curve according to Cobb – 16.0° ± 4.3°, the distance from the center of the vertebra located one level distal to the lowest instrumented vertebra, to the central sacral vertical line (LIV+1-CSVL) – 3.6 ± 2.5 mm, the tilt of the lower instrumented vertebra in the coronal plane (LIV tilt angle) – 3.6° ± 2.8°, the tilt of the vertebra located one level distal to the lowest instrumented vertebra (LIV+1 tilt angle) – 4.6° ± 2.5°, and the distance from the center of the apical vertebra of the primary curve to the central sacral vertical line (AV-CSVL) – 17.2 ± 12.0 mm. A significant correlation was found between postoperative magnitude of the scoliotic curve and AV-CSVL distance, postoperative LIV+1-CSVL distance and postoperative LIV+1 tilt angle. An increase in LIV+1 tilt angle in combination with an increase in LIV+1-CSVL distance by more than 4 mm (or degrees) could be a parameter for measuring the adding-on phenomenon. Conclusion. The indication for reoperation may probably be a significant tilt of the vertebra located below the lowest instrumented vertebra, accompanied by pain syndrome and coronal imbalance.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"15 1","pages":"26-31"},"PeriodicalIF":0.0,"publicationDate":"2018-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66710535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Hirurgia Pozvonochnika
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