Clinical analysis of interspinous dynamic internal fixation with the Coflex system in treating lumbar degenerative disease / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinical effects between interspinous dynamic internal fixation with Coflex system and posterior lumbar interbody fusion in treating lumbar degenerative disease.</p><p><b>METHODS</b>From Jan. 2007 to Jan. 2010, 42 patients with lumbar degenerative disease were treated with interspinous dynamic internal fixation with Coflex system (non-fusion group, 21 cases) and posterior lumbar interbody fusion (fusion group, 21 cases), including 19 males and 23 females with an average age of (46.5 +/- 8.5) years (range, 33 to 62 years). The range of course of disease was from 6 to 84 months with an average of 36 months. All pathological changes were single segment in L4.5 by X-ray films or CT scanning, among them, single lumbar disc herniation was in 14 cases,combined with lumbar spinal stenosis in 28 cases. The clinical effects of all patients were evaluated according to Japanese orthopaedic association (JOA, 29 points) and Oswestry disability index (ODI); range of motion (ROM) of lumbar segments were measured by X-ray films; operative time, intraoperative blood loss,hospital stay were compared between two groups.</p><p><b>RESULTS</b>All patients were followed up for 10 months at least. In non-fusion group, JOA increased from 13.8 +/- 3.7 preoperatively to 24.6 +/- 4.6 at final follow-up (P < 0.01); ODI decreased from 65.8 +/- 7.5 to 25.6 +/- 5.1 (P < 0.01), ROM improved from 4.2 +/- 0.7 to 5.3 +/- 0.6 at L4,5 (P < 0.01 ). In fusion group,JOA increased from 13.2 +/- 3.2 preoperatively to 24.5 +/-4.3 at final follow-up (P < 0.01); ODI decreased from 65.5 +/- 8.2 to 26.5 +/- 6.1 (P < 0.01); all ROM at L.4,5 had lose (decreased from 4.2 +/- 3.2 to 0). There were significant differences in the operative time, intraoperative blood loss, hospital stay between two groups (P < 0.01), in non-fusion group was respectively (71.2 +/- 12.8) min, (56.6 +/- 25.5) ml, (4.4 +/- 1.3) d and in fusion group was respectively (121.0 +/- 23.2) min, (135.8 +/- 19.8) ml, (12.6 +/- 2.4) d. No complications were found with the Coflex system.</p><p><b>CONCLUSION</b>Interspinous dynamic internal fixation with Coflex system in treating lumbar degenerative disease is better than that of posterior lumbar interbody fusion in some aspects. Coflex system have high safety, less trauma, and can reserve lumbar mobility, which is effective in preventing adjacent intervertebral disc degeneration.</p>

Taking ilium inner table to repair the articular surface defects of complex fracture of tibial plateau / 中国骨伤

<p><b>OBJECTIVE</b>To study the feasibility of application of ilium inner table to repair the articular surface defects of tibial plateau complex fractures.</p><p><b>METHODS</b>Twenty-three patients with tibial plateau complex fractures included 17 males and 6 females with an average age of 28.3 years old ranging from 18 to 51 years. The area of the articular surface defects ranged from 1 cmx2 cm to 3 cmx3 cm, averaged 6.7 cm2. Taking ilium inner table with periosteum after trimmed and implanting into the articular surface defect area with the concavity upward and drilled with diameter 1.5 mm Kirschner pin interval 3 to 4 mm. Bone grafting were placed under the ilium inner table and were fixed by T-shaped or L-shaped plate. The wounded limb were braked by plaster for 4 weeks after operation.</p><p><b>RESULTS</b>Twenty-three patients were followed-up for 8 months to 3 years, averaged 13.6 months. X-ray film showed solid union and the smooth articular surface in all cases. According to the Rasmussen evaluation system, the results were excellent in 11 cases, good in 8 cases,fair in 3 cases, poor in 1 case.</p><p><b>CONCLUSION</b>Taking ilium inner table to repair the articular surface defects of tibial plateau complex fractures is a good resolving measures. It can repaire major area of articular surface defects, restore the smooth articular surface and acquire good function of knee joint with easy to operate, less complications at donor area.</p>