Download Read Online tipos de fracturas vertebrales fracturas toracolumbares ao clasificacion de vaccaro fracturas dorsolumbares clasificacion ao de fracturas de columna cervical fractura por distraccion definicion clasificacion de mccormack fracturas lumbares 1984 DENIS. 1984 ALLEN Y FERGUSON. CLASIFICACION DE LAS FRACTURAS. HISTORIA EXCEDEN 1/3 DEL TOTAL.DECRECEN DE CRANEAL A CAUDAL.1/3 DEL TOTAL DE LESIONES.MAS FRECUENTE EN LA UNION.MAS FRECUENTE EN LA COLUMNA. Fractura toracolumbar, Fractura de tipo Burst, Instrumentacion corta sin fusion. Thoracolumbar fracture, Load sharing Burst fractures, Short instrumentation without fusion. Descargar PDF.
La columna vertebral se construye a partir de la alternancia de vertebras, que interconectan con el complejo Clasificacion de las fracturas toracolumbares: comparacion entre las clasificaciones de AO y Vaccaro. Classification of thoracolumbar fractures: a comparison between the classifications of AO versus Vaccaro. Classificacao das fraturas toracolombares: comparacao entre as classificacoes de AO e Vaccaro. Pedro Luis Guillem Salo Bru. Unidad de Raquis. Servicio de COT. Hospital del Mar.
Parc de Salut Mar. Asociado U.A.B. Fracturas toracolumbares. 3 Oct 2013 Diagnostico oportuno y clasificacion de las fracturas vertebrales toracolumbares. Tratamiento quirurgico de las fracturas vertebrales toracolumbares. Lo anterior favorecera la mejora en la efectividad, seguridad y calidad de la atencion medica, contribuyendo de esta manera al bienestar de las personas 28 Mar 2014 Clasificacion de fracturas toracolumbares (Teoria de Denis).
La columna anterior esta formada por el ligamento vertebral comun,? Cuerpo vertebral y? Disco intervertebral.
La columna media esta formada por la mitad posterior del cuerpo vertebral y el discointevertebral y el ligamento vertebral. Clasificacion de las fracturas toracolumbares. Martin Tejeda Barreras. Medico Ortopedista, Especialista en Columna Vertebral, adscrito a HGZ # 2 Instituto Mexicano del Seguro Social. Hermosillo, Sonora, Mexico. Direccion para correspondencia: Martin Tejeda Barreras.
Centro Medico del Rio. 4 Dec 2014 Presentacion de la propuesta de AOSpine, para una nueva clasificacion de las fracturas toraxicas y lumbares, distribuida en una encuesta a los miembros de AOSp Las curvas fisiologicas que presenta el ra- quis en el plano sagital permiten el desa- rrollo armonico de sus funciones. Cuan- do se produce una fractura a nivel vertebral con deformidad y alteracion de dicho per- fil, se provoca la alteracion de dichas fun- ciones.
Las vertebras superiores e inferiores, a la vertebra lesionada Tratamiento de las fracturas toracolumbares: abordaje anterior. Kirkpatrick, MD. Kirkpatrick es Associate Professor, Divi- sion of Orthopaedic Surgery, University of Alaba- ma at Birmingham, Birmingham, AL. Kirkpatrick ni el departamento con el que esta asociado han recibido ningun tipo de ayu.,.
Results: The SLIC classification showed a strong correlation with neurological deficit and Pearson correlation value of -0.600. Accident reconstruction software free. The AO classification was not correlated with the Frankel scale and the value of Pearson was 0.06 with a statistical significance of 0.682 (p.
Conclusion: Among the most used classifications, the SLIC has been able to statistically define the need for surgical treatment and the severity of the neurological status, but was unable to predict the approach or the time of the surgery; the classification AO failed to predict the severity of neurological injury, surgical time, and did not help to choose the approach, just being a morphological classification. Key words: Spinal fracture; Cervical vertebrae; Classification; Arthrodesis; Statistics, nonparametric. Figure 1 AO - Magerl 1994 classification for cervical fractures (Reproduced from Marcon et al. 5 with the authors' permission). The cases were once again classified by the same surgeon using templates., published in the article by Marcon et al. Was used for the AO classification, while the SLIC2 cell phone application developed by Kubben 15 and by the website digitalneurosurgeon.com with the collaboration of the authors of the Vaccaro et al. Classification available on the Internet in the Android (r) and Apple Store (r) platforms, was used for the SLIC classification.
In the case of the AO classification, the number five (5) was used to correspond to the axial skeleton, followed by the number one (1) corresponding to the cervical segment. The letter corresponds to the type, and the number after it corresponds to the group.
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The subgroups, which are represented by a 'point' and number, were not considered, due to their low concordance. Severity criteria were also considered, such as: degree of neurological lesion on the Frankel scale, duration of surgical procedure, number of blood components transfused, levels of arthrodesis, approach, and previous use of a cranial halo for reduction. RESULTS Between August 2010 and September 2012, 77 patients underwent surgical treatment for cervical fracture in segments C3 to C7. The patients were aged between 15 and 82 years (averaging 36.5 years), the majority (88.3%) males (n=68).
A total of 11 patients were excluded, seven due to lack of satisfactory radiological investigation, three presenting with fractures related to ankylosing spondylitis, and one with a pathological fracture. Sixty-six patients remained within the inclusion criteria, 53% (n=35) without neurological deficit, classified as Frankel E, 33.3% (n=22) with complete deficit Frankel A, and 13.7% (n= 9) with incomplete deficit Frankel D, C and B. Only three patients had associated spinal injury. Associated higher cervical fracture at C1 C2 was present in 7.6% (n=5). The mean duration of the surgical procedure (from incision to dressing the wound) was 184 minutes, and only one patient required a blood component transfusion. According to the AO classification, fractures classified as 51B1 represented the majority (25.8%) (n=17), followed by those of type 51B2 with 22.7% (n=15). When the SLIC classification was used, four patients (6%) had scores of below four and were candidates for conservative treatment, while six patients (9%) obtained scores of four, i.e., they were candidates for both types of treatment, with the decision being made at the surgeon's discretion.
Analyzing the surgical approach, 47% of the patients were operated by the posterior approach and 43.9% by the anterior approach, while 9.1% required a double approach. Figure 2 AO classification of the fractures in operated patients. To evaluate the classifications, we used Pearson's correlation test, considering statistically significant values below 0.05. The classifications were initially tested in relation to the degree of neurological deficit using the Frankel scale.
When the SLIC classification was correlated with the neurological deficit scale, Pearson's correlation value was -0.600, with statistical significance below 0.01. The AO classification did not present correlation with the Frankel scale, and the Pearson value was 0.06 with statistical significance of 0.682 (p. DISCUSSION The population made up of cervical fracture victims continues to consist predominantly men of productive age, with a proportion of 83%, representing an extremely high socioeconomic cost. Four of the operated patients had SLIC scores of below three, i.e., they were candidates for conservative treatment, according to the classification.
Two of these patients required surgery due to association of higher cervical fracture with indication of fixation, and the other two presented symptoms of polytrauma requiring admission to the ICU, with indication of rapid removal of the neck brace in order to avoid pressure ulcers caused by the brace in contact with the patient's skin. Another six cases presented a score of four; according to the classification the treatment decision in these cases would need to be made by the surgeon.
These cases were not analyzed separately. No case with a score of less than three was operated on, demonstrating that the surgical indication of the team respects the patterns of instability of the SLIC classification, even without calculating the scores previously in all cases. When the SLIC classification was compared to Frankel's neurological scale, there was a very strong correlation, as the former uses neurological lesion as one of its criteria. Likewise, it was noted that the classification of the AO SPINE group does not have the same purpose, and that the progression from A1 to C3 did not accompany the neurological severity of the subject. Neither of the two classifications was correlated with surgery time. It is hypothesized that this may be related to other factors, such as the approach selected and the surgeon's experience.
Figure 3 Correlation between the AO and SLIC classifications. The classifications presented a statistically significantly correlation with each another, due to the fact that the SLIC classification contains, in its morphological criteria, a scale similar to the classification of the AO group, if we consider only the segment and the type and group, and exclude the subtypes represented by 'score' and number. The SLIC classification proved to be a useful tool in the indication of surgical treatment, as 94% of the operated cases had a score of four or more, and cases with a score below four had surgical indication relative to associated higher cervical fracture, or contraindications for the use of immobilization. It also proved useful in determining neurological deficit, as the highest scores were associated with patients with partial or total neurological deficit, and it is useful for determining which cases should be prioritized. The AO classification did not represent the severity of the cases, as it is a strictly morphological classification. Its gradation from A1 to C3 did not progress in keeping with the severity of the neurological deficit.
Both classifications presented here have been validated and have shown good intra- and interobserver evaluation results. The publication of a new AO classification in February 2015 takes into account other factors besides the morphological pattern of the fracture, which was also altered. In this current classification, any fractures with dislocation are classified as type C, which are those in rotation, flexion or distraction.
The neurological status and condition of the discs, ligaments and facets were also considered modifiers, and were included in this new classification. Independent data on inter- and intraobserver concordance were not published.
Biological Classification
To reduce interobserver concordance bias, we used a single observer, who analyzed the same images twice. The intraobserver concordance rate was not calculated, as this was not the objective of this study. The classifications in our department are used routinely as a means of communication, but are not used prospectively. Surgical decisions are made based on the surgeons' experience during the daily visits. We believe that a prospective analysis of the classifications, and of the algorithms proposed by them, would make a considerable contribution. Yet even retrospectively, as demonstrated in this study, we noted that 94% of the operated patients had a score greater than or equal to four in the SLIC classification. Chabbra et al.
Consulted several surgeons involved in academic hospitals about their perspectives and the existing classifications for subaxial cervical fractures. The results obtained show that the majority of departments (37.5%) still use the Allen Ferguson classification, followed by the classification SLIC (35%). The advantages discovered by these surgeons in relation to the SLIC classification, as compared to other classifications, were the fact that the SLIC takes into account the neurological deficit and its severity; it offers guidelines for the choice of treatment; and it promotes information about the severity of bone and ligament injuries, besides being a tool for future studies. CONCLUSION Both classifications should be taught and practiced in daily use by traumatologists, spine surgeons and neurosurgeons.
They are easy to memorize, with satisfactory rates of inter- and intraobserver concordance, besides being important tools for facilitating communication and standardization of data for scientific studies. Even though they are widely disseminated, the classifications shown in the study do not yet satisfactorily meet all the criteria of reliability and reproducibility, and are not being adopted by most surgeons.
This is the first study comparing the two main classifications. Further studies are necessary to determine whether these classifications are correlated with the clinical outcomes of patients. The adoption of new classifications for subaxial cervical fractures, such as the AO SPINE classification published in February 2015, as well as others that have emerged, should be studied at length before being used prospectively. The surgeon's experience, as well as the patient's clinical and psychological aspects, should be taken into account when making the decision about the type of treatment, choice of approach, and method to be used.