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CHAPTER 2. SUBJECTS AND RESEARCH METHODS

CHAPTER 2. SUBJECTS AND RESEARCH METHODS

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operated to correct, fix, compress under the posterior method at

Military Hospital 103 from 12/2010 to 1/2013.

2.1.1. Selection criteria

Patients diagnosed with thoracic and lumbar spinal injury

according to the criteria for each fracture type of the Greenberg MS,

single-band lesions, c operated to correct, fix, compress by screw

under the posterior method . No sex discrimination, age ≥ 18.

2.1.2. Exclusion criteria

Patients have chronic diseases that affect the research results

such as heart failure, liver failure, kidney failure, other

cardiovascular diseases, diabetes ... Multiple injuries, fractures

due to tuberculosis, cancer, mentally ill disorders, no

cooperation in treatment, non-compliance with follow-up and

re-examinaiton procedures, and lack of adequate research

documentation.

2.2. Research Methodology

2.2.1. Research design

A prospective research describes the clinic status with

intervention, evaluates the result results on each patient before

and after surgery.

2.2.2. Sample size

Favorable sample selection includes all patients eligible for

selection criteria and exclusion criteria during the study period.

2.2.3. Data collection method

Information collected according to the unified medical

records include: examination and evaluation of patients before

surgery; participate in surgery, follow up and treat patients after

surgery, directly visit to examine patients after surgery under

the medical record form of the research; check patients who

return for re-examination in the Department of Neurological

Surgery - Military Hospital 103.



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2.2.4. Research content

– Determine the mechanism of injury.

– Evaluate muscle strength and sensory disorders according

to Greenberg M.S. criteria, applicable. – Evaluate the level of

nerve damage accroding to Frankel improvement.

– Evaluate via x-ray images: fracture position, kyphotic

angle, reduction of column height in front of vertebral body,

injury level of vertebral body according to McCormack, level

of spinal stenosis, position pressing the spine, type of fracture,

damage to the rear ligament system.

– Surgery for removing, correction, fixation by the screw

and plint as indicated by Greenberg M.S.

– Postoperative evaluation at two points: 10 days after

surgery and last examination (12 months after surgery).

Criteria: Neurological rehabilitation according to Frankel;

results of the correction of the kyphotic angle, the height of the

column in front of the broken vertebra on the conventional xray according to Keynal; backache, labor recovery by Denis;

surgery time, blood loss during surgery, complications,

condition of the screw system.

2.2.5. Data processing method

Use of medical statistic software SPSS 22.0.

2.2.6. Research ethics

The information about the patient’s illness status in the

medical file is completely confidential and only used in the

study with the consent of the Vietnam Military Medical

University, Military Hospital 103.

CHAPTER 3 . RESEARCH RESULTS

3.1. Common features

3.1.3. Causes of injury



10



Labor accident



Injured accident



Traffic accident



Normal accident



Chart 3.3. Distribution rate of accident causes.



11



3.1.4. Mechanism of injury



Chart 3.4. Distribution rate of injury mechanism.

3.2. Characteristics of vertebral injury

3.2.1. Fracture position

Table 3.1. Distribution rate of fracture position.

Fracture position

Quantity

Rate (%)

P1

T11

02

2.25

T12

18

20.22

L1

41

46.07

< 0.001

L2

15

16.85

L3

12

13.48

L4

01

1.12

Tổng

89

100



P2



<

0.001



3.2.3. Fracture group frequency according to Denis classification



Table 3.2. Distribution rate of fracture group.

Type of fracture

Quantity

Rate (%)

P

Compression fracture

17

19.10

< 0.01

Burst fracture

67

75.28

Dislocation fracture

5

5.62

Total

89

100



12



3.2.6. Evaluate the fracture

level of vertebral body according

100

100

to McCormack

Compression

82.09

100

fracture



80

60

40



17.91



20

0



0 I0



II



0



0 III



0



Chart 3.8. Distribution rate of fracture level of fracture groups.



3.2.7. Evaluate the cohesion of71.64

fractured pieces according to

Compression

64.71 60

McCormack

80

fracture

60

35.29 40

40

16.42

11.94

20

0

I



II



0 III 0



Chart 3.9. Distribution rate of the cohesion of fractured pieces.

3.2.8. Evaluate

the kyphotic level according to McCormack

100

50

0

Lún

Compression fracture



I



Vỡ



III



Trật



Burst fracture



I



II



II



Dislocation fracture

III



Chart 3.10. Distribution rate of the kyphotic level.



13

71.64

3.2.9. Evaluate

the fracture types64

according

to McCormack

80

.71

60

rating scale

Compression

70

60

50

40

30

20

10

0



fracture



40



35.29

16.4 2



11.94



0 50



7 0



6



09 0



Chart 3.11. Distribution rate of points.



3.2.10. Evaluate the height reduction of the column in front

of vertebral body

Table 3.3. Height reduction of column in front of vertebral body.

Reduction index

Fracture type

Compression fracture

(n = 17)

Burst fracture

(n = 67)

Dislocation fracture

(n = 5)



Standard

Smallest Biggest Mean

deviation

(%)

(%)

(%)

(+/- %)

50



56



51.35



2.29



20



56



35.78



7.54



20



35



27



5.7



p



< 0.001



3.2.11. Evaluate the angle bending of the injured area

Table 3.4. Kyphotic angle of the injured area.



Bending level



Fracture type

Compression fracture

Burst fracture



Smalles

Mea Standard

Biggest n deviation

t

( 0)

(0)

(0)

(+/-0)

19



29



20



40



23.2

4

26.3

7



3.38

3.89



p



<

0.001



14

Dislocation fracture



22



35



28.8



5.26



3.2.12. Fracture types and spinal canal narrow levels

Table 3.5. Table of spinal canal narrow levels.



Canal narrow

level

Fracture types

Compression

fracture

Burst fracture

Dislocation

fracture

p



Quantity



Not

narrow



Narrow < 50%



Narrow ≥ 50%



Quantity



%



Quantity



%



3



17.65



0



0



67



14

(82.35)

8 (11.94)



26



38.81



33



49.25



5



0



2



40.00



3



60.00



17



< 0.001



3.2.13. Causes of spinal canal narrow



Chart 3.12. Distribution rate of compression causes.

3.2.14. Spinal canal compressing positions



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Chart 3.14. Distribution rate of spinal canal compressing positions.

3.2.15. Fracture type and spinal decompression methods

Table 3.6. Decompression method.

Decompression



Direct

Quantity

%



Fracture types

Compression fracture

Burst fracture

Dislocation fracture



3

34

3



Indirect

Quantity

%



17.65

50.75

60.0



14

33

2



82.35

49.25

40.0



3.2.16. Decompression time



Chart 3.16. Rate of decompression time.

3.2.17.Decompression group and deformation

Table 3.7. Decompression group and deformation.

Deformation

Fracture types

Compressio Group 1



Quanti

-ty

6



Smalles

Standard

Biggest Mean

t

deviation

    







20 50 29 52 25.1 50.3 3.1 0.8



16

n



fracture

Burst

fracture

Dislocation

fracture



Group 2

Group 1

Group 2



11

37

30



19 50 29 56 22.1 51.9 3.1

20 25 35 50 27.7 38.5 3.2

20 20 40 56 24.6 32.3 3.9



2.6

6.9

6.9



Group 1



5



22 20 35 35 28.8 27.0 5.2



5.7



3.3. Injury to the posterior ligament system

3.3.1. Fracture types and injury to the posterior ligament

system

Table 3.9. Determine injury to the posterior ligament system by

MRI and surgery.

Criteria

MRI

Fracture

types

Compressio

n fracture

Burst

fracture

Dislocation

fracture

Total



Quantit

y (n)



Surgery



Injury to the

posterior

ligament

system



p



Quantit

Rate Quantit Rate

y

(%) y (n) (%)

(n)

23.53

4

23.53

4

23.53



Quantit Rate

y (n) (%)

17



4



< 0.01

67



10



14.93



10



14.93



10



14.93



5



3



60



5



100



5



100



89



17



19.10



19



21.35



19



21.35



3.3.2. Evaluate fracture types according to TLICS scale



17

100

100

80

60



Compression

fracture



64 .71

53.73



40



5.88



2.99



20

0



4 3.28



29.4 1



1-3 0



0



4



5-10



Chart 3.17. Distribution according to TLICS scale.

3.4. Nerve damage

3.4.1. Nerve damage levels

Table 3.14. Nerve damage levels.

Frankel level

A

B

C

D1

D2

D3

E

Quantity

6

3

11

1 6

8

54

3.4.3. Nerve damage and the spinal canal narrow levels in

each fracture type

Table 3.16. Spinal canal narrow levels and nerve damage.



Narrow level - ND Not narrow



< 50%



≥ 50%



ND No ND ND No ND

Fracture types

Compression fracture 2

13

1

1

Burst fracture

0

8

3

23

Dislocation fracture

0

0

0

2

Total

2

21

4

26



p



ND No ND



0

26

3

29



0

7

0

7



> 0.05

< 0.05



3.5. Evaluation of surgery results

3.5.1. Near result

3.5.1.3. Results of deformation correction 10 days after surgery

Table 3.20. Results of deformation correction

Deformation

Fracture type

Compression Group 1

fracture

Group 2



Quantity

6

11



Smallest



2

2





12

14



Standard

deviation

 







16 6.6 14.6 3.3 1.5

18 4.5 15.7 3.2 1.2



Biggest



10

10



Mean



18

Group 1

Burst

fracture

Group 2

Dislocation

Group 1

fracture



37

30

5



2

2

8



4

5

7



19

33

10



15 6.9 10.5 3.2

15 8.5 10.2 7.7

15 9.0 10.2 1.0



1.2

2.3

3.1



3.5.1.4. Results of neurological recovery 10 days after surgery

Table 3.21. Results of neurological recovery

Frankel –

10 days after surgery

Total

Bradford

A B

C D1 D2 D3

E

level

A

6

6

B

3

3

C

6

3

2

11

Before

D1

1

1

surgery

D2

2

4

6

D3

3

5

8

E

54

54

Total

6

3

6

3

2

6

63

89

3.5.2. Far results

3.5.2.2. Results of deformation correction in the final examination

Table 3.23. Results of deformation correction

Deformation



Quantity



Fracture types

Compressio Group 1

n fracture Group 2

Group 1

Burst

fracture Group 2

Dislocation

Group 1

fracture



6

11

37

30

5



Smallest Biggest



3

3

3

3

9





15

17

5

7

10





12

11

20

34

12



Mean







19 7.8

20 5.4

17 8.4

17 9.8

20 10.8





17.3

18.0

12.4

11.8

13.2



Standard

deviatio

n





3.5 1.5

3.2 1.0

5.1 2.5

7.6 2.4

1.3 3.9



3.5.2.3. Results of neurological recovery in the final examination

Table 3.24. Results of neurological recovery.

Frankel –

Bradford

levels

Before

A



Final examination

A



B



4



2



C



D1



D2



Total

D3



E

6



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