Application of the expanding forming under the plate through cervical spatium intermusculare approach in treating multi-segmental myelopathic cervical spondylosis / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the application of the expanding forming under the plate through cervical spatium intermusculare approach to treat multi-segmental myelopathic cervical spondylosis.</p><p><b>METHODS</b>From July 2005 to June 2013, 25 patients with multi-segmental myelopathic cervical spondylosis were treated by the expanding forming under the plate through cervical spatium intermusculare approach including 16 males and 9 females with an average age of 56.5 years old ranging from 35 to 78 years old. Among them, 10 cases were onset without causes slowly, 7 cases were onset without causes suddenly, 8 cases were onset after mild trauma or tired. JOA scoring, incidence of postoperative axial symptoms and imaging studies were used to evaluate the effect.</p><p><b>RESULTS</b>Twenty-five cases were followed up for 6 months to 7 years and 6 months with an average of 2 years and 9 months. There were no infection, cerebrospinal fluid leakage after the operation, and complications such as nerve damage were occurred. The operation time was 120 to 150 min, the bleeding was 300 to 500 ml. Imaging examination showed vertebral canal sagittal diameter increased, the vertebral canal increased significantly in the cross sectional area of the spinal cord, cervical curvature was straighten in 4 cases (2 cases of them became normal sequence). There were no more cases of cervical protruding and segmental instability increased. Postoperative walking ability enhanced, the finger activity of majority of patients improved on flexibility, grip strength, and accuracy of using chopsticks improved, numbness and chest waist band feeling had different degree of reduce, preoperative urine impairment were improved to varying degrees. Preoperative JOA scores were 3 to 13 points with an average of (8.86 ± 4.25) points; Postoperative 12 months' JOA scores were 7 to 17 points with an average of (13.76 ± 3.56) points, period was 60.19% in average, JOA score had statistically difference between before and after operation (P < 0.05). The result were excellent in 14 cases, good in 6 cases, and fair in 4 cases and poor in 1 case.</p><p><b>CONCLUSION</b>Application of the expanding forming under the plate through cervical spatium intermusculare approach to treat multi-segmental myelopathic cervical spondylosis, through muscular clearance, can retain complete cervical back muscle, maintain stability of cervical spine, and vertebral canal can get effective decompression at the same time.</p>

Surgical treatment for adjacent spinal segment degeneration after anterior cervical fusion / 中国骨伤

<p><b>OBJECTIVE</b>To explore the surgical method and its effects of adjacent spinal segment degeneration after anterior cervical fusion.</p><p><b>METHODS</b>From March 2000 to March 2011, 27 patients with spinal segment degeneration who had accepted the operation of anterior cervical fusion were treated with surgical treatment. There were 16 males and 11 females with an average age of 55.3 years (ranged from 48 to 72 years). JOA scores and image examination were used to evaluate the clinical effects.</p><p><b>RESULTS</b>All patients were followed up for 1.8 to 7.2 years with an average of 3.6 years. All pathological segments obtained fully decompression with good spinal bombe, no internal fixation loosening and cervical spine instability were found. Nerve root pain had disappeared and nerve function had significantly improved. Before operation, 3 days after operation and at last follow-up, JOA scores were 9.15 +/- 3.46, 13.96 +/- 2.79 and 13.52 +/- 2.91, respectively, and there was significant difference between preoperation and postoperation (P < 0.05). Intervertebral height and physiological curvature improved obviously than preoperation (P < 0.05).</p><p><b>CONCLUSION</b>In order to relief spinal compression and rebuild spinal stability, a surgical treatment will be recommend to adjacent spinal segment degeneration combining spinal nerve symptoms and physical sign as soon as possible. Selecting an appropriate surgery to treat different compressed segment would receive satisfactory results.</p>

Significance of percutaneous vertebroplasty with Genex in the treatment of thoracolumbar burst fractures / 中国骨伤

<p><b>OBJECTIVE</b>To explore the therapeutic effects of percutaneous vertebroplasty with Genex combined with pedical screw fixation in the treatment of thoracolumbar burst fractures.</p><p><b>METHODS</b>From February 2007 to October 2009, 38 patients with thoracolumbar burst fractures were treated with percutaneous vertebroplasty with Genex and pedical screw fixation. There were 25 males and 13 females, with a mean age of 42 years old (ranged, 30 to 68 years). The cause of injuries included road accident of 9 cases,crush injury of 7 cases,crash of 21 cases and others of 1 case. The fractures were classified according to Denis classification: 6 cases of type A, 22 cases of type B, 7 cases of type C and 3 cases of type D. Functional assessment of nerves was assessed according to ASIA criteria: 4 cases of type A,7 cases of type B, 10 cases of type C, 6 cases of type D and 11 cases of type E. Therapeutic effects were assessed by imaging and ASIA standard.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 6 months to 34 months,with a mean period of 16.5 months. The results were observed after 1 week by X-ray inspection that vertebrate column array of all patients were restored to normal, anterior height of centrum restored to (98.50 +/- 2.17)%, posterior height of centrum for (98.87 +/- 1.82)%; and Cobb angle of injured vertebra decreased to average of (1.63 +/- 2.15) degree; the stenosis rate restored to (1.45 +/- 3.47)%. By X-ray inspection, it was observed that the vertebral height kept good at 6 months after operation, and the bone density almostly normal. By CT scanning, it was observed that bone defects of vertebrae disappeared, and restored to normal bony tissue. The nerve function restored 1 to 2 grades 6 months after operation.</p><p><b>CONCLUSION</b>Artificial bone of Genex applied in vertebral body-plasty has good biocompatibility, strong bone inducibility, no complications, little loss of vertebrae height and Cobb angle, and satisfactory results in the near future.</p>

Application of vacuum sealing drainage in treating large avulsion injuries of limbs / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the therapeutic effectes of vacuum sealing drainage (VSD) technique and reattachment of avulsed skin in treating avulsion injuries of limbs.</p><p><b>METHODS</b>A retrospective analysis was done on 25 patients suffering from avulsion injuries of limbs, who were treated with vacuum sealing drainage and reattachment of the avulsed skin. Among the patients, 19 patients were male and 6 patients were female, ranging in age from 21 years to 57 years, with an average of 41 years. After debridement, the patients got reattachment of skin graft with subdermal vascular network or split-thickness skin graft, and the wound surface was covered with polyvinyl sponge. VSD was removed after 7 to 14 days. The color, survival rate and sensory function of the skin were observed after operation.</p><p><b>RESULTS</b>All the wounds infection was controlled with VSD. The skin survival rate was more than 96% in 16 cases, more than 90% in 7 cases, and skin edge of 2 cases had little necrosis but rehabilitated after dress-changing. The reattached skins had almost normal skin color, soft and abrasion resistant, satisfactory sensory function, and no compression ulcer was observed after 4 weeks.</p><p><b>CONCLUSION</b>VSD combined with graft with subdermal vascular network or split-thickness skin graft helps to promote wound drainage, reattachment of skin, and decrease infection. It is an effective method in treating avulsion injuries of limbs.</p>

Use of vacuum sealing drainage and mesh grafting in treating defects of skin and soft tissue in foot / 中国骨伤

<p><b>OBJECTIVE</b>To explore the therapeutic effectiveness of vacuum sealing drainage (VSD) technique and mesh grafting in treating defects of skin and soft tissues in foot.</p><p><b>METHODS</b>A retrospective analysis was done on 17 cases (11 male and 6 female) suffering from defects of skin and soft tissues in foot, which were treated by vacuum sealing drainage and mesh grafting. The age of patients was from 18 to 67 years with an average of 43 years. The wound surface was filled with polyvinyl alcohol gelatin sponge after debridement and continuous negative pressure drainage was taken for 24 h. After 7 days, granulation tissue growing mesh grafting was performed and to observe the skin colour, survival rate and feet function.</p><p><b>RESULTS</b>All the infection of wounds was controlled with VSD for 1 to 3 times. Skin survival rate of 14 cases more than 98%, 2 cases more than 95%; skin edge of 1 case had little necrosis, but foot function obtained rehabilitation after dress-changing.</p><p><b>CONCLUSION</b>Vacuum sealing drainage (VSD) technique and mesh grafting is effective methods for the treatment of defects of skin and soft tissues in foot and is worthy generalization and application.</p>

Selective fenestration lamina of cervical vertebral lamina to excise ligamentum flavum for treating hypertrophic ligamentum flavum / 中国骨伤

<p><b>OBJECTIVE</b>To explore operative method and clinical effect of selective fenestration of cervical vertebral lamina to excise ligamentum flavum for treating hypertrophic ligamentum flavum (HLF).</p><p><b>METHODS</b>From March 1998 to May 2007, 21 patients (14 males and 7 females) with HLF were reviewed retrospectirely, whose age was from 37 to 76 years with an average of 52.2 years. The history of HLF was from 5 h to 25 years with an average of 3 years and 10 months. Reason of onset: 4 cases were no inducement, 10 cases were slow-moving,and 7 cases caused by injury. The operative effect was assessed according to JOA scores and radiologic results.</p><p><b>RESULTS</b>All patients were followed up with an average of 2.5 years(ranging from 3 months to 7.5 years). Radiologic results: sagittal diameter of vertebral canal and trans.sec.area increased and spinal cord were well than preoperative status. The majority of cases got stronger in the walking, improvement in the fingers mobility and holding power and using chopsticks, abatement in the limbs numb and thoracic waist zonesthesia, amelioration in the urination and defecation functional disturbance than preoperative symptom. The JOA scoring was 5-16 scores with an average of 11.48 +/- 2.94 before operation,and 7-17 scores with an average of 13.81 +/- 2.98 after operation. That results had statistical significance between before and after operation (t = 3.51, P < 0.05). There were 13 cases excellent (improvement rate more than 75%), 5 cases good (improvement rate in 50%-74%), 2 cases fair (improvement rate in 25%-49%), 1 case poor (improvement rate less than or equal to 24%) with an average improvement rate of 85.2%.</p><p><b>CONCLUSION</b>It is simple in the operative procedure and tiny in trauma in treatment for hypertrophic ligamentum flavum with selective fenestration of cervical vertebral lamina to excise ligamentum flavum. The method can obtain effective decompression for vertebral canal but choice of indication must be reasonable.</p>

Hook-screw combination to treat for the unstable Hangman's fracture / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical effect of Hook-screw combination treatment for the unstable Hangman's fracture.</p><p><b>METHODS</b>From March 2005 to May 2008, 17 patients with unstable Hangman's fracture, of whom there were 15 males and 2 females aged from 28 to 75 years old with an average age of 46 years, were treated by Hook-screw combination. Of injury reasons, there were 8 patients caused by falling injury, 5 patients caused by traffic accident injury, 3 patients by tumble and 1 patient by crash injury of heavy object. Type of bone fracture: there were 3 patients with type II, 5 patients with type I a and 9 patients with type Ill. The level of nerve injury according to ASIA criteria, there were 3 patients with grade C, 5 patients with grade D and 9 patienst with grade E.</p><p><b>RESULTS</b>All patients were followed up for 3 to 22 months averaged 8 months. All patients were recover completely without upper cervical spine pain and C2, C3 loss of reduction. No patients' nerve function was injured in the patients with normal function before operation. The patients with injured nerve function before operation improved 1 to 2 grade.</p><p><b>CONCLUSION</b>The method of transarticular Hook-screw combination treatment for the unstable Hangman's fracture can obtain effective anatomical reduction and biological stability.</p>

Surgical treatment of pronation and supination external rotation trimalleolar fractures / 中国骨伤

<p><b>OBJECTIVE</b>To explore the operative method and its clinical effects of pronation and supination external rotation trimalleolar fractures.</p><p><b>METHODS</b>From March 2000 to July 2006,42 patients of the pronation and supination external rotation trimalleolar fractures treated with open reduction and internal fixation. Thirty-one were males and 11 were females,with an average age of 40.5 years (from 19 to 76 years). Four cases were open fractures and 38 cases close fractures. The fractures were classified as pronation-external rotation (grade IV) injury in 18 cases and supination-external rotation (grade IV)in 24 cases according to the system of Lauge-Hansen. The time of injury to operation was 2 hours to 27 days. The medial, lateral and posterior malleolus were exposed by standard anteromedial and Gatellier-Chastang approaches. The reduction and internal fixation started with the posterior,then the medial and the lateral malleolus and distal tibiofibular syndesmosis in sequence. The anteroposterior, lateral and mostise X-ray films were taken after operation.</p><p><b>RESULTS</b>All the patients were followed up for an average time of 13.5 months(from 6 to 24 months). The time of union was from 12 to 16 weeks. The results were excellent in 20,good in 16, fair in 4 and poor in 2 cases according to Baird-Jackson ankle scoring system based on pain, stability, walking ability,range of motion and radiological manifestations. The excellent and good rate was 85.7%. There were no infection,malunion and nonunion of the fractures except that the inserted screw to distal tibiofibular syndesmosis was broken in 1 case.</p><p><b>CONCLUSION</b>The key of operative treatment is to restore the anatomy of ankle and to regain the ankle function maximally.</p>

Clinical therapeutic effect observation of using the modified reconstruction of spinous processes for treating cervical vertebrae degenerative disease / 中国骨伤

<p><b>OBJECTIVE</b>To report clinical application and therapeutic effect on the modified reconstruction of spinous processes for treating cervical vertebrae degenerative disease.</p><p><b>METHODS</b>Twenty-nine cases with cervical vertebrae degenerative disease were treated with the modified reconstruction of spinous processes. Among them, 21 cases were male and 8 cases were female. The age was from 37 to 76 years with an average age of 55 years. Of them, 4 cases occured immediately with no factors, 15 cases occured chronically, and 10 cases occured following substantial trauma. The last-time of disease was 5 h to 25 years, with an average of 1 year and 8 months.</p><p><b>RESULTS</b>After 3 months to 5 years and 6 months followed-up, the results were excellent in 18 cases (recovery rate >75%), good in 7 cases (recovery rate 50% to 75%), fair in 3 cases (recovery rate 25% to 49%), poor in 1 case (recovery rate < or =24%)with average recovery rate 86.6% according to JOA 17 score system.</p><p><b>CONCLUSION</b>The reconstruction of spinous processes may be an effective measure in spinal decompression absolutely, meanwhile, it can maintain the spinal sequences stable, also can avoid or reduce the axial symptoms and the correction of cervical kyphosis.</p>