Modified incision to prevent the postoperative spinal lateral angulation in surgery via anterior approach for lumbar fracture / 中国骨伤

OBJECTIVE@#To explore a method of modified incision to prevent the postoperative spinal lateral angulation via anterior approach for lumbar fracture.@*METHODS@#A total 40 patients with lumbar fracture from January 2016 to Jun 2017 were internalized in the study. Including 28 males and 12 females, aged from 27 to 68 years with an average of (39.5±14.9) years. Among them, 28 cases caused by high fall, 9 cases by heavy injury, 3 cases by traffic accidents; and 35 fractures were located at L₁,4 at L₂,1 at L₃. All the fractures were type A based on AO classification. According to Frankel classify of spinal cord injury, 5 cases were grade A, 1 case was B, 10 cases were C, 15 cases were D, 9 cases were E. The patients were divided randomly into modified incision groups and routine incision groups. All patients were treated with decompression, internal fixation and titanium mesh supported bone graft fusion via anterior approach. All the internal fixation materials were ANTERIOR (Medtronic Inc). Incision direction and incision plane were improved in modified incision groups. The coronal Cobb angle and the angle between the vertebral screw and the corresponding endplate were analyzed before and after operation.@*RESULTS@#Pre-and post-operative coronal Cobb angles were (1.20±3.26) °, ( 2.16±3.55)° in modified incision groups and(1.22±4.42)°, (3.91±3.78)° in routine incision groups respectively. And there was no statistical difference before operation, and there was statistical difference after operation between two groups(=0.017). There was no lateral angulation of more than 5 degrees in modified incision group, but there was lateral angulation of 5 to 10 degrees in routine incision group in 6 cases. The incidence of lateral angulation about 5 degrees after operation was significantly different between two groups (=0.010). There was significant difference in the angle between the proximal two vertebral screws and the corresponding endplate between two groups (0.05).@*CONCLUSIONS@#The improvement of incision direction and plane can effectively prevent the postoperative spinal lateral angulation via anterior approach for lumbar fracture.

Imaging measurement and clinical significance of occipitocervical angle in healthy people at different ages / 中国骨伤

<p><b>OBJECTIVE</b>To measure imaging data of occipitocervical angle in healthy people at different ages by X-ray.</p><p><b>METHODS</b>One hundred and fifty asymptomatic volunteers(75 males and 75 females) aged from 20 and 70 years old with an average of(44.83±13.88) years old were divided into 5 groups according to different ages(20 to 29 years old, 30 to 39 years old, 40 to 49 years old, 50 to 59 years old and 60 to 70 years old), and 30 people in each group. All people underwent lateral radiography of neck on neutral position. McGregor line (the lowest connection line between upper margin of hard palate and occipital scales of plating), occipitocervical angle(OCA) formed by edge of C2 vertebral body, takami's occipitocervical angle formed between connection line of posterior marginal of C2 vertebral body and parallel lines of hard palate were collected. The data were performed statistical analysis according to gender and different ages, and analyzed correlation between OCA and TOCA.</p><p><b>RESULTS</b>OCA of 75 males at different ages were (14.71±3.09)° and(14.22±4.27)° in 75 females. TOCA of 75 males at different ages were (90.50±4.63)° and (90.57±6.67) ° in 75 females. There were no statistical difference in OCA and TOCA in people at different ages(<0.05). There were no significant meaning among 5 groups at different ages in OCA and TOCA(>0.05). The relation analysis results showed positive correlation between OCA and TOCA(=0.454, <0.01).</p><p><b>CONCLUSIONS</b>The paper provided normal values for occipitocervical angle in population of southwestern China between 20 and 70 years old, and results may be useful for posterior occipitocervical fixation and fusion.</p>

Analysis of clinical effects of absorbable hemostatic fluid gelatin and absorbable gelatin sponge on the hemostasis during operation of unilateral open-door cervical expansive laminoplasty / 中国骨伤

<p><b>OBJECTIVE</b>To compare the hemostatic effect between absorbable hemostatic fluid gelatin (HFG) and absorbable gelatin sponge(GS) during operation of unilateral open-door cervical expansive laminoplasty.</p><p><b>METHODS</b>The clinical data of 83 patients underwent unilateral open-door cervical expansive laminoplasty from February 2014 to May 2016 were retrospectively analyzed. According to the used hemostatic materials, patients were divided into two groups. In HFG group, there were 30 males and 11 females, ranging in age from 29 to 81 years, with an average of(55.6±11.6)years; 14 cases were simple cervical spinal stenosis, 9 were cervical spinal stenosis and ossification of posterior longitudinal ligament, and 18 were cervical spinal stenosis complicated with multiple cervical disc herniation. And in GS group, there were 32 males and 10 females, ranging in age from 36 to 78 years, with an average of (55.4±11.1) years; 12 cases were simple cervical spinal stenosis, 10 were cervical spinal stenosis complicated with ossification of posterior longitudinal ligament, and 20 were cervical spinal stenosis complicated with multiple cervical disc herniation. There was no significant difference in the age, gender, and disease categories of patients between two groups (>0.05). The operative time, intraoperative bleeding, postoperative drainage, and postoperative complications were compared between two groups.</p><p><b>RESULTS</b>The average operative time, intraoperative bleeding, and postoperative drainage in HFG group were(137.2±30.0) min, (156.1±74.6) ml, and (212.1±67.6) ml, respectively; and in GS group were (154.8±33.5) min, (242.9±120.7) ml, and(303.3±115.5) ml, respectively. There were significantly differences in above items between two groups(<0.05). No acute heamatoma or related complications was found postoperatively.</p><p><b>CONCLUSIONS</b>Compared with GS, HFG can obviously decrease operative time, intraoperative bleeding, and postoperative drainage. It is a safe and effective hemostatic material for the operation of unilateral open-door cervical expansive laminoplasty.</p>