| Background:Spinal fracture accounts for about5%-6%of all fractures, spinal fracture with highmorbidity has a great impact on the quality of patients’ life and society. How to effectivelyprevent and treat spinal fractures becomes a research hotspot in the field of spine surgery.In recent years, digital technology has a rapid development, it plays an extremely importantrole in the prevention and clinical treatment of spinal fractures. Medical staff can easilystore, retrieve, and browse the patients’ records through the electronic medical recordsystem (EMRS) and they can conveniently, quickly and accurately carry out all kinds ofscientific research and statistical analysis work, the development of EMRS greatlyimproves the quality of clinical research and treatment. With the development of socialindustrialization and population ageing, whether the epidemiological characteristics ofspinal fracture in Chongqing a city with special topography are consistent with previousliteratures or not needs further research. Application of finite element analysis method(FEAM) in the biomechanical evaluation of spinal fractures provides more theoretical basisfor how to choose internal fixation technique for spinal fractures. In recent years, manyresearchers put forward various posterior short-segment pedicle screw fixation withadditional pedicle screws at the level of the fracture techniques including open posteriorpedicle screw fixation (OPSF) with monoaxial pedicle screws, percutaneous pedicle screwfixation (PPSF) with polyaxial pedicle screws and monosegmental pedicle screw fixation(MSPSF) to treat spinal fractures, many in vitro biomechanical experiments confirmed thatthe additional pedicle screws at the level of the fracture may result in a stiffer constructcompared to traditional short-segment4pedicle screw fixation technique, but there were noliteratures systematically analyze all the short-segment techniques used in spinal fractures,especially not a few comparative study about biomechanical characteristics betweenpolyaxial and monoaxial pedicle screws used in short segment pedicle screw fixation techniques and most of the literatures didn’t talk about the intervertebral disc pressure andVon Mises stress of the pedicle screws and rods. Spine robot system is a hotspot in thestudy of pedicle screw placement. As is known to all, compared to the traditional opensurgery, the minimally invasive pedicle screw insertion brings much more radiation injuryto the surgeons. So we developed a spine robot system to insert the pedicle screws insteadof the surgeons for avoiding radiation injury. During the preoperative planning ofcorrection surgery for complex spine deformity such as spine fracture and scoliosis,three-dimensional imaging technology and navigation technology of spine robot systemcan make anatomical structure which we can’t see through graphic image become adynamic three-dimensional images, the spine robot system improves the accuracy ofpreoperative plan and surgical operation. Spine robot system used for pedicle screwplacement in China is still in its infancy, it has not yet been used for clinical treatment.Objective:To discuss the role of EMRS in the epidemiology study of traumatic spinal fractureand multiple level noncontiguous spinal fractures (MLNSF), analyse the application trendof pedicle screw insertion techniques for spinal fractures. To discuss the role of FEAM usedin the biomechanical evaluation of different posterior short segment fixation techniques forspinal fracture. To discuss the feasibility of our minimally invasive spine robot system usedin pedicle screw placement, find the problem of present robot system for furtherimprovement of the spine robot system.Methods:1. Through EMRS "No.1Military" project, we retrospectively reviewed the hospitalrecords of3142patients with traumatic spinal fractures and213patients with MLNSF whowere treated at the first and second affiliated hospital of third military medical universitybetween January2001and December2010. The variables assessed included age, sex,mechanism, anatomic distribution, neurological deficit, injury severity score, associatedinjury, length of hospital stay, cost of hospitalization, in-hospital complications, mortality,medical insurance and technique of pedicle screw insertion.2. Through FEAM, we assessed various posterior short segment pedicle screw fixationtechniques for spine fractures models under force loading by measuring range of motion(ROM), Von Mises stress of the pedicle screws and rods, and we focus on comparing the biomechanical characteristics of spine fractures models under displacement loadingbetween monoaxial and polyaxial pedicle screws in short segment pedicle screw fixationtechniques by measuring ROM, Von Mises stress of the pedicle screws and rods, cranialand caudal adjacent segmental maximal intervertebral disc pressure and its ratio to normalspinal model.3. Using spine robot system, we did the drilling operation on cattle lumbar spines forpedicle screw insertion. During preoperative planning, we measured the pedicle screwinsertion angle at the entry point, the vertical distance of entry point to the midline ofspinous process. We positioned the relative positions of the drill and the cattle lumbarspines, drilled the cattle spines according to preoperative plans and then placed needles inthe holes. We took notes of the surgical time and intraoperative fluoscopy times, and thenwe assessed the position of the needles through postoperative CT.Results:1. Accidental falls and traffic accidents were the two most common mechanisms oftraumatic spinal fractures. Traffic accidents tend to affect younger populations, andaccidental falls from high height are associated with a higher degree of associated injuries.The frequencies of fall from the low height injuries and sports injuries increased steadilywith age and year of admission. Thoracic+lumbar region are the most commonly injuredregion among all patients suffering MLNSF, and cervical+thoracic region are morecommonly injured among the young than the elderly. The highest frequency of MLNSFamong patients caused by direct collision with blunt object was cervical+thoracic regionand the number of intact vertebrae intervening between the2fractured vertebrae was themost. Posterior pedicle screw fixation techniques were the most common methods to treatspinal fractures and the frequrncy of minimally invasive techniques gradullay increasedwith the year of admission.2. Additional pedicle screws at the level of the fracture result in a stiffer constructcompared to traditional short-segment4pedicle screw fixation (SPSF). Index-level pediclescrew fixation to the SPSF decreased the Von Mises stress of the upper and lower pediclescrews, stress of the internal fixation was scattered. Von Mises stress of the pedicle screwswas largest in the short-segment4monoaxial pedicle screw fixation, range of motion waslargested in the short-segment4polyaxial pedicle screw fixation. Additional polyaxial pedicle screws at the level of the fracture may result in a stiffer construct than the normalspine model and less Von Mises stress of pedicle screws compared to monoaxial pediclescrew SPSF.3. The basic function of the spine robot system can satisfy spine surgeons for pediclescrew position drilling. Using the spine robot system, the drilling time per pedicle screwwas (89.5±6.1)seconds, intraoperative fluoscopy times were (2.9±0.8)times. The percentageof pedicle screws totally within the pedicles from postoperative CT scans was85.0%.Conclusion:1. We should strengthen the prevention of traumatic spinal fractures caused byaccidental falls and traffic accidents. There should be a growing concern for the preventionof falls from the low height and sports injuries with the increased age and year ofadmission.We should pay much attention to the diagnosis of long segment MLNSF whenwe treated spinal fractures caused by direct collision with blunt object to avoid delays indiagnosis and misdiagnosis. We should strengthen the study of posterior pedicle screwfixation technique and minimally invasive technique in the treatment of spinal fractures.2. Additional monoaxial pedicle screws at the level of the fracture may result in astiffer construct and less Von Mises stress of pedicle screws compared to SPSF. Additionalpolyaxial pedicle screws at the level of the fracture may result in a stiffer constructcompared to normal spine model and and less Von Mises stress of pedicle screws comparedto monoaxial pedicle screws fixation spine models, the results provided theoretical basis fortreatment of spinal fracture using minimally invasive polyaxial pedicle screws fixation withadditional pedicle screws at the level of the fracture technique.3. The basic function of the spine robot system can satisfy spine surgeons for pediclescrew position drilling. Using the spinal surgery robot, the drilling time per pedicle screwwas short and intraoperative fluoscopy times per pedicle screw was less, but we shouldimprove the accuracy of spine robot system such as gradually improving the virtual surgerysystem, building intraoperative electrophysiological monitoring system and motion capturesystem. |
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