Anatomic investigation of the pedicle fat grafts with the third lumbar segmental artery and its application in reoperation for lumbar disc herniation / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the blood supply of the pedicle fat grafts with the third lumbar segmental artery and its clinical effects on reoperation for lumbar disc herniation.</p><p><b>METHODS</b>Twelve sides of 6 adult cadaver examples were contributed to investigate the courser of lumbar segmental vessels and the distribution of hypodermic capillary net of the dorsal branch of the third lumbar segmental artery. From January 2000 to January 2007,49 patients needed reoperation to treat lumbar disc herniation,including 26 males and 23 females with an average age of 55.6 years (ranged from 39 to 70 years). Duration between two operations ranged from 8 months to 15 years with an average of 6.9 years. Reoperative reasons included recurrent lumbar disc protrusion(30 cases)postoperative epidural scar formation (17 cases), postoperative epidural cyst formation (2 cases). Of them,9 patients underwent posterior lumbar interbody fusion at the second operation. The pedicle fat grafts with the third lumbar segmental artery were covered on the sites of the laminectomy in these patients. After negative pressure drainage tube were pulled out, 2 ml Chitsan were injected to the sites of the laminectomy and around epidural nerve root through epidural catheter. VAS score and the Oswestry Disability Index (ODI) were used to assess clinical outcomes before and after operation.</p><p><b>RESULTS</b>The courser of third lumbar segmental vessels were invariant at the lateral face of the lumbar vertebral body. The dorsal branch of the third lumbar segmental artery penetrated thoracolumbar fascia and formed rich hypodermic capillary net in the region. All patients were followed up from 5 to 8 years with an average of 5.6 years. VAS score of low back pain and leg pain decreased respectively from preoperative 7.6 +/- 1.2, 8.9 +/- 0.9 to 3.6 +/- 0.5, 3.0 +/- 0.4 at final follow-up (P < 0.01); and ODI score decreased from preoperative 44.1 +/- 6.2 to 13.9 +/- 3.6 at final follow-up (P < 0.01). According to ODI score to evaluate the clinical outcomes, 29 cases got excellent results, 11 good, 7 fair, 2 poor.</p><p><b>CONCLUSION</b>The pedicle fat grafts with the third lumbar segmental artery and Chitsan can reduce epidural scar formation and prevent peridural fibrosis and adhesion and improve clinical effects of reoperation for lumbar disc herniation.</p>

Case-control study on clavicular hook plate combined with acromiocoracoid ligament transfer in the treatment of acromioclavicular joint dislocation of type Tossy III in young patients / 中国骨伤

<p><b>OBJECTIVE</b>To study the clinical effects of acromiocoracoid ligament transfer to repair coracoclavicular ligament and acromioclavicular ligament in the treatment of acromioclavicular joint dislocation of type Tossy III in young patients.</p><p><b>METHODS</b>From January 2005 to January 2007, 52 patients with acromioclavicular joint dislocation of type Tossy III were divided into therapeutic group I (32 cases) and therapeutic group II (22 cases). There were 17 males and 13 females with an average age of 31.0 years (ranged, 19 to 40 years) in group I; as well as 12 males and 10 females with an average age of 33.6 years (ranged, 20 to 42 years) in group II. All the patients were fresh injury and the acromioclavicular joint dislocations were type Tossy III according to X-ray findings. The duration from damage to the operation time ranged from 2 to 17 days (averaged, 7.6 days). All the patients had normal shoulder function before injury and were treated with clavicular hook plate implantation. The patients in group II were treated with normal desmorrhaphy method, and the patients in group I were treated with acromiocoracoid ligament transfer to repair coracoclavicular ligament and acromioclavicular ligament. Steel plate was taken out at about 4 to 6 months after clavicular hook plate implantation. The results were evaluated according to Karlsson's standards.</p><p><b>RESULTS</b>All the incisions healed without infection. The therapeutic effects of 52 patients were evaluated at the 6th month after internal fixation was taken out. Twenty-four patients in group I got an excellent results and 6 good; 17 patients in group II got an excellent results and 5 good. There was no significant difference between the two groups. Twenty-six patients in group I and 19 patients in group II had long-term follow-up, and the duration ranged from 3 to 5 years (averaged, 4.5 years ). Twenty patients in group I got an excellent results and 6 good; 9 patients in group II got an excellent results, 7 good and 3 bad. Three patients in group II had recurrence of acromioclavicular joint dislocation. The long-term therapeutic effects of group I was better than that of group II.</p><p><b>CONCLUSION</b>After clavicular hook plate implantation in treating type Tossy III dislocation of the acromioclavicular joint in young patients, it was necessary to use acromiocoracoid ligament transfer to repair coracoclavicular ligament and acromioclavicular ligament, which can improve the stability of acromioclavicular joint to prevent dislocation recurrence.</p>