摘要:

Fifteen fresh, intact, human male cadavers suspended head down were dropped vertically from a height of 0.9- 1.5 meters. In eight specimens the heads were restrained to simulate muscle forces. The head-neck complex was oriented for maximal axial loading of the cervical and upper thoracic spine. In several cadavers, load cells were placed in cervical bodies. Head impact forces of 3,000-7,000 N in the unrestrained, and 9,800-14,600 N in the restrained, cadavers were recorded. There were more cervical and upper thoracic fractures in the restrained cadavers than in the nonrestrained subjects. The biomechanic and pathologic findings, including results of cryomicrotomography and computed tomography (CT), are discussed.

ISSN:0362-2436    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

A total of 625 patients who sustained acute cervical spine fractures were evaluated by the Spinal Cord Injury Service at Barrow Neurological Institute, Phoenix, Arizona, between January 1976 and January 1984. Of them, 107 had fractures of the second cervical vertebra. In a retrospective review, motor vehicle accidents were found to be the most common mechanism of injury, resulting in 73 (68%) of the 107 axis fractures. All axis fracture types were encountered in this subgroup: hangman's (27%), Odontoid Type II (39%), Odontoid Type III (15%), and miscellaneous fractures (19%). Only one of the 30 patients with complete medical records and detailed information about the accident was wearing a seat belt. Equally remarkable is that 15 of the 30 accidents were single car mishaps, where occupant restraints might theoretically provide the most protection. Sixteen of the 30 patients were thrown from their vehicles, another five were found in the backseat, which leads to the conclusion that a significant portion of the driving population does not wear seat belts or shoulder restraints. Patients with axis fractures from an automobile accident had a high rate of associated severe head injuries or other cervical spine fractures, three times that of patients with C–2 fractures from other causes. Motorists who are thrown from their vehicles suffer the most severe trauma and have the highest rates of morbidity and mortality. As many as 25% to 40% of individuals who sustain high cervical fractures in motor vehicle accidents die as a result of their injuries.

ISSN:0362-2436    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Posttraumatic syringomyelia is an uncommon late complication of spinal cord injury. This study identified nine patients with posttraumatic syringomyelia and examined initial presentation, neurologic status, ability to perform functional activities, and results of treatment. Pain and numbness were the most common presenting symptoms. Motor impairment occurred later but was more disabling. Functional abilities depended mainly on the level of the original spinal cord injury. Three patients were managed conservatively and have had no significant progression of their neurologic deficit. Six patients were managed with syringoperitoneal or syringosubarachnoid shunts. Pain improved most consistently after surgery. Motor power improved less and sensation least. Ability to perform activities of daily living did not significantly change after surgery. Posttraumatic syringomyelia remains a difficult therapeutic problem in the spinal cord-injured population.

ISSN:0362-2436    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Five patients who presented with clearly defined thoracic sensory levels were found by myelography and follow-up computed tomography (CT) to have cervical spinal cord compression. None of these patients had pain or an immediate preceding history of trauma. There is currently no satisfactory explanation for the large discrepancy between the sensory level and the level of cord compression in such patients. It is crucial that the clinician recognize the possibility of a cervical cord lesion in patients with such a presentation so that appropriate radiographic studies can be performed. Failure to appreciate this syndrome could result in failure to diagnose a treatable lesion.

ISSN:0362-2436    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Twenty-two patients with epidural migration of cervical disc fragments were reviewed. Disc sequestrations can migrate to the anterior, posterior, and lateral aspects of the spinal canal and are divided into four types according to their localizations. Those migrating to the anterior or posterior surface of the spinal canal, causing myelopathy, were removed through either an anterior or posterior route. Removal of lateral sequestration by uncoforaminotomy provided full recovery for all patients with radiculopathy and drop-attacks. The number of disc sequestrations was not always one: three fragments were present in three patients and two fragments in five patients. Various routes combined with other approaches were indicated to eliminate completely the freely migrating disc sequestra.

ISSN:0362-2436    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

A 5-year prospective study of intraoperative blood transfusion in 239 patients, most of whom had major spinal surgery, has been completed. Autotransfusion is safe, practical, and it reduces donor blood requirements and total blood loss by 50%. It eliminates host versus graft reactions and disease transmission. In 33 patients having major spinal surgery, the in vivo survival of autologous, homologous, and processed red blood cells (RBC) using the Cell Saver System were compared. The RBC survival studies were performed using chromium51isotope labeling technique. The long-term survival of processed RBCs was normal over a 30-day period. There was no significant difference in the survival rate of the three groups studied.

ISSN:0362-2436    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Fifty-seven patients with spinal metastases underwent 60 operations. 36 patients were operated on by anterior approach with decompressive coporectomy and stabilization by metal and methylmetacrylate and 24 patients by laminectomy and/or stabilization by osteosynthesis. Postoperative improvement of the pain syndrome was observed after 56 operations. Neurologic signs were present in 23 patients with paraplegia (5 patients) or paraparesis (18 patients); 15 of the latter patients improved and recovered walking capacity. Two types of metastasis were distinguished: corporal metastasis, in which vertebral wedging and posterior protrusion led to neural deficit, with a good prognosis if treated by anterior surgery, and pericordal metastasis in which the cord compression is due to metastatic proliferation into the spinal canal. Results after decompressive surgery, either by posterior or anterior approaches are more doubtful. Surgery is beneficial and should be preferred to radiation when there is medullary compression by corporal metastasis and also in the presence of intense pain or potential instability of the spine.

ISSN:0362-2436    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

This study is a report of the use of a computer-assisted biplane digitizer to locate shotgun pellets within the spinal canal in an incompletely paralyzed patient. It was necessary to determine if one or more shotgun pellets were located within the spinal cord of the patient. Because of the profusion of pellets it was not possible to determine which, if any, of the pellets were in the spinal canal by routine roentgenograms. The problem of determining the location of each pellet with respect to the spinal cord was resolved by the use of biplane radiography in conjunction with an x-ray digitizer and a computer program. This report presents the method for localizing foreign bodies and discusses the results of the procedure. It was concluded that the described method successfully located the position of pellets with respect to the spinal column and cord. This method may be useful for locating metallic fragments that have to be surgically removed in other patients sustaining spinal cord injury secondary to single missile wounds.

ISSN:0362-2436    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The quality of the reductions achieved in a consecutive series of 55 patients with unstable thoracolumbar fractures were correlated with 1) the method of instrumentation, 2) the type and level of injury, 3) the effects of laminectomy and end-plate fractures, and 4) the length of time from injury to surgery. It was found that many of these variables were associated with significant differences (<0.05) in the percent correction achieved in anterior compression, angle of deformity, and sagittal plane translation. Specifically: 1) compression combined with distraction produced the best overall anatomic results, but bilateral compression and bilateral distraction were most effective for reducing flexion-distraction and flexion-axial compression (burst) fractures, respectively; 2) two or more level laminectomies adversely affected reductions; end-plate fractures did not; 3) the best reductions were obtained in flexion-distraction injuries; and 4) the poorest reductions occurred in flexionaxial compression injuries, lumbar fractures, and fractures operated on 6 weeks or more after injury.

ISSN:0362-2436    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

One hundred forty-two patients were treated by the Scolitron method of lateral electric surface stimulation (LESS) for scoliosis. Using 10° progression as a failure point, clinicians reported the following: 56.3% of patients were classified as failures, 26.8% as successes; and 16.9% were still under treatment. When broken down into individual groups, true protocol patients, at risk for progression, had the lowest success rate; whereas those that were nonprotocol, and least at risk, had the highest success rate. This method should still be considered experimental and cannot be considered an alternative to bracing at this time.

ISSN:0362-2436    

出版商:OVID    

年代:1986

数据来源: OVID