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100 OVCF patients admitted to our hospital from January 2021 to January 2022 are selected for analysis and randomly divided into PVP group and PKP group, 50 cases in each group. The PVP group and the PKP group undergo PVP and PKP operations respectively. The differences in efficacy indicators and adverse reactions are compared, and the multivariate Logistic regression method is used to analyze the influencing factors of postoperative secondary fractures in patients with vertebral compression fractures.
In conclusion, PKP surgery in the treatment of OVCF patients can improve the efficacy, reduce the incidence of pain and adverse reactions, and improve the kyphotic Cobb Angle of patients. PKP surgery has promotion value in the treatment of OVCF. Many factors, such as age, gender, glucocorticoid use, bone cement distribution and bone cement leakage, can increase the risk of secondary fracture after minimally invasive surgery in OVCF patients. In this study, the reduction of VAS, ODI, and Cobb Angle in the PKP group is greater than that in the PVP group, which further suggests that PKP treatment can improve the efficacy of minimally invasive surgery in patients with OVCF, and reduce the symptoms of patients with low back pain, limb dysfunction, and abnormal increase of Cobb Angle. The main mechanism of its effect is speculated as follows: PKP holding operation mainly destroys the vertebral body and peripheral nerve endings through skin perfusion and pedicle bone cement. The analgesic effect is successively in the sleeve when the vertebral body is compressed, the balloon expands, can rise and reposition, support and compress the vertebral body and other multiple effects. At the same time, the bone cement can also support and strengthen the vertebral body, and promote the rapid convergence of vertebral body small fractures.
Blunt abdominal traumas are often associated with intra-abdominal injuries and pelvic fractures. Traumatic abdominal wall hernias due to disruption of the abdominal wall muscles may be overlooked. Delayed diagnosis can lead to hernia related complications.
We present two cases of high kinetic trauma with pelvic fractures and acute traumatic abdominal wall herniation. Both of these cases suffered from a delayed diagnosis and needed surgery to treat the symptomatic herniation.
Given the paucity of reported cases we hereby present a review of the literature on pelvic fractures and associated disruptions of the abdominal wall muscles, after describing two cases of delayed diagnosis and treatment of abdominal wall muscle disruption following a high energy trauma.
The costal fractures, clavicle fracture and left ankle fracture were surgically treated. The pelvic fractures were treated conservatively, and full weight bearing as tolerated was authorised, with a cast on the left leg, for 6 weeks.
Traumatic abdominal wall hernias linked to pelvic fractures have rarely been described [2, 4, 5], even though they can be encountered in our everyday practice. They are defined as a bowel or abdominal organ herniation through a disruption of the musculature and fascia following adequate trauma , with no skin penetration or pre-existing hernia . The muscles that make up the abdominal wall are all attached to the pelvic bone.
Abdominal wall hernias may occur whenever there is a disruption of the abdominal wall muscles following blunt abdominal trauma, even more so if a pelvic fracture is associated. Pelvic fractures often occur in high energy trauma, such as in road accidents. They are often associated with several intra-abdominal injuries, or other life-threatening injuries.
According to the Young and Burgess classification, traumatic abdominal wall hernias are most often associated to lateral compression fractures of the pelvis. Other pelvic fractures may nevertheless also be associated with abdominal wall hernias: one report for example described an open book pelvic fracture presenting with an inguinal hernia .
Conservative treatment is often chosen in lateral compression pelvic fractures. However, a possible tearing mechanism may occur during trauma, with contralateral disruption of the abdominal wall muscles, as is described in our cases. Through analysing cadaveric human abdominal muscles, the external and internal oblique muscles have a compromised ability to generate active force when the spine is laterally bent to the contralateral side .
Several reports recommended an early abdominal exploration and repair of the hernia with surgical mesh, due to a possible and potential incarceration [18, 19]. Furthermore, an internal fixation of the pelvic fracture (though often stable in lateral compression fractures) may be a relative indication in blunt abdominal traumas, as these are often associated with acute traumatic abdominal wall hernias. Surgery is however not innocuous, and can lead to several complications, such as infections, chronic pain, or digestive fistulae.
Traumatic abdominal wall hernias are rarely diagnosed in patients with pelvic fractures. Patients with pelvic fractures after high energy trauma are often subject to several other injuries diagnosed during the immediate and delayed management, and disruptions or avulsions of the muscles of the abdominal wall can be missed. Further studies must be conducted in order to obtain a systematic pattern of physical examination for patients presenting with pelvic fractures, in the acute and chronic stage of the trauma, to include the diagnosis of traumatic abdominal wall disruption.
The fluid flow through rock fractures and fracture networks can influence the mechanical behaviors of rock masses, and in turn, the deformation of rock masses can change the aperture of fractures and then impact the hydraulic properties. Therefore, it is important to study the coupled hydro-mechanical behaviors of rock fractures/fracture networks.
In previous studies, linear flow through simplified fractures such as smooth parallel-plate models has been extensively investigated. However, the linear/nonlinear flow through 2D/3D fractures and fracture networks with realistic surface morphology, as well as their interactions with mechanical processes subjected to normal and/or shear stresses under different boundary conditions, have not been systematically estimated. Recently, with the development of computational techniques, methods for such complex multiphysics simulations are available and some new findings have been reported.
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The horizontal displacement field reveals the occurrence of slab fractures despite the crack travelling to the far end of the column. Figure 6a shows the normalized tangential displacement field in the final state of the experimental PST. From the 0 to 2.6 m, at the top, we observed a color continuity; at 2.6 m, the color slightly jumps from blue to yellow, which suggests a slab fracture stopped approximately 0.25 m below the top. At 3.15 m the color jumps from light orange to red; this color jump clearly indicates a slab fracture and rigid body behavior isolated from the rest of the beam. The location of the shallow, blurry slab fracture (2.6 m) corresponds to the location where the simulated and experimental normal displacement behavior start to diverge (Fig. 3b). The location of the second more distinct slab fracture (3.15 m) corresponds to the location where the simulated and experimentally observed collapse height start to diverge (Fig. 3b). In the experiment, the collapse height is larger possibly due to isolated rigid body behavior. We observed that the left and the right part of the beam kept its tangential displacement at the end of the experiment, which suggests plasticity (Fig. 6b).
For the simulation shown in Fig. 7c, the normalized tangential displacement field in the final state of the simulated experiment, we relaxed the assumption of infinite slab strength and introduced a vertical linear tensile strength gradient within the simulated slab to reproduce the slab fracture behavior (top: \(\sigma _slab^th=\) 3 kPa, bottom: \(\sigma _slab^th=\) 3.4 kPa). The positions of the broken bonds indicate that the observed positions of the slab fractures were qualitatively well-reproduced (black dots in Fig. 6c). Figures 6b and 7d show the temporal evolution of subsets of tangential displacements located at the top of the beam. From 0 to 2.5 m, i.e. up to 0.36 s, the experimental and simulated data show similar behavior. After 0.36 s, the simulated tangential displacement tends to return to its initial state, while in the experiment the deformation is not recovered. Figure 6d shows a clear change in behavior when the slab fractures occurred, from 3 m to the end of the column the subsets show a different behavior than at the beginning of the column. This behavior is well reproduced by the simulation until 0.38 s when the simulated displacements return to its initial state, while in the experiment the displacements are not recovered. However, unlike to the experiment, in the simulation the beam tends to recover its deformation. While adding slab strength allowed reproducing the slab fractures, the contact model does not account for plasticity. Hence, in the simulation, we cannot reproduce the final state of deformation observed in the experiment.
Similar to Figs. 3b, d and 7a show the temporal evolution of the normal displacement of the slab and Fig. 7c the temporal evolution of the slab normal acceleration and (d) the slab tangential acceleration. In addition, Fig. 7b shows the temporal evolution of the tangential (horizontal) displacement of the slab. Slab behavior observed in the experiment is well reproduced by the simulation (dashed lines); the main differences appear after the so-called touchdown when the simulated tangential displacements return to its initial state, whereas the displacements in the experiment exhibit non-recoverable deformation (plasticity). This phenomenon is accentuated at the free edges of the beam and by slab fractures (Appendix 1). 350c69d7ab