Case-control study on cortical bone trajectory screw and pedicle screw internal fixation for the treatment of senile patients with lumbar tuberculosis / 中国骨伤

OBJECTIVE@#To compare clinical effect of cortical bone trajectory (CBT) screw and pedicle screw (PS) internal fixation in treating senile patients with lumbar tuberculosis.@*METHODS@#From January 2014 to January 2017, 42 senile patients with lumbar tuberculosis were divided into CBT group and PS group, 21 patients in each group. In CBT group, there were 12 males and 9 females, aged from 64 to 81 years old with an average of (72.52±9.25) years old, T value of bone mineral density was (-2.69±0.17) g / cm, posterior CBT screw internal fixation and anterior debridement, interbody fusion with bone grafting was performed. In PS group, there were 11 males and 10 females, aged from 63 to 85 years old with an average of (71.42±9.81) years old, T value of bone mineral density was (-2.70±0.21) g / cm, PS internal fixation and anterior debridement, interbody fusion with bone grafting were performed. Length of posterior incision, intraoperative bleeding volume, operation time, time of bone graft fusion and complications between two groups were compared. Level of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), segment kyphotic Cobb angle before and after operation were compared, VAS score was used to evaluate pain releasing, JOA score was applied to evaluate clinical effect.@*RESULTS@#All patients were followed up from 12 to 21 months with an average of (15.00±3.57) months. No reoccurrence of lumbar tuberculosis and screw loosing occurred. There were statistical difference in length of incision, intraoperative bleeding volume, operation time between two groups (0.05). There were no statistical differences in complications, time of bone graft fusion and segment kyphotic Cobb angle at 1 week after operation between two groups (>0.05). There was difference in Cobb angle at 12 months after operation (0.05), but VAS score at 3 months after operation were improved after operation between two groups (<0.05).For JOA score, there were no difference between two groups before operation, 3 and 12 months after operation, and JOA score at 3 and 12 months after operation were improved than that of before operation between two groups (<0.05).@*CONCLUSION@#Both of CBT screw internal fixation and PS screw internal fixation could achieve satisfying results for the treatment of elderly patients with lumbar tuberculosis. PSinternal fixation has a long fixation but great trauma. However, CBT screw internal fixation only needs to fix adjacent segments of the lesion to reduce the fixation range, which has advantages of less trauma and strong screw holding force.

Feasibility study of preoperative percutaneous catheter drainage in the treatment of lumbar tuberculosis with psoas abscess / 中国骨伤

OBJECTIVE@#To investigate the effect of preoperative percutaneous drainage in lumbar tuberculosis with psoas abscess, through compare the clinical efficacy of two different methods.@*METHODS@#Thirty-six patients with lumbar tuberculosis complicated with psoas abscess in corresponding with the inclusion criteria were admitted in Zhejiang Province Traditional Chinese Medicine Hospital from January 2015 to January 2017. The patients were divided into group A and group B according to the different therapeutic methods. All patients were given the standard anti tuberculosis treatment, and percutaneous catheter drainage was used in group A after admission immediately for psoas abscess before operation, while group B with no special treatment. At 3 weeks after anti tuberculosis treatment, 2 patients were excluded in group B, which had to postpone operation because of no reduction in erythrocyte sedimentation rate(ESR) and C reactive protein(CRP). Finally 34 patients were enrolled in this study. There were 18 cases in group A, including 10 males and 8 females, aged from 24 to 73 years old with an average of(42.5±10.2) years. There were 16 cases in group B, including 9 males and 7 females, aged from 23 to 75 years old with an average of(42.3±9.8) years. All patients were treated with posterior pedicle screw fixation, anterior debridement and bone graft fusion. Anterior surgery bleeding volume, operation time, anterior incision length, postoperative anus exhaust time, VAS score, Cobb angle, ESR, CRP changes and postoperative sinus formation were compared between two groups.@*RESULTS@#All patients were followed up for 6 to 21 months with an average of 13 months. At the last follow-up, no mixed infection, tuberculosis recurrence, pedicle screw loosening and nail withdrawal were found. The average operative time, anterior surgery bleeding volume and anterior incision length of group A were less than that of group B(0.05). There was 1 case sinus formation in group A and 5 cases in group B, there was significant difference in sinus formation rate between two groups (0.05). Spinal cord nerve injury was obvious improved after operation, but there was no significant difference between two groups.@*CONCLUSIONS@#Preoperative percutaneous catheter drainage is a safe and feasible method for the treatment of lumbar tuberculosis with psoas abscess. It can increase the effect of anti tuberculosis before operation, reduce the surgical trauma and reduce the incidence of postoperative complications. It can be recommended in clinical application.

Anterior small-incision focus debridement with posterior internal fixation for the treatment of lumbar spinal tuberculosis / 中国骨伤

<p><b>OBJECTIVE</b>To explore clinical outcomes and advantages of anterior small-incision focus debridement with posterior internal fixation through muscle spa ring in treating patients with lumbar spinal tuberculosis.</p><p><b>METHODS</b>From February 2010 to February 2014, totally 82 patients with lumbar spinal tuberculosis were treated by posterior individual fixation with small-incision focus debridement,including 50 males and 32 females with an average of 50.5 years old. All patients were divided into two groups according to different procedures. Forty-nine patients in group A were treated with anterior small-incision focus debridement with posterior internal fixation through muscle spa ring at stage I ; and 33 patients in group B were treated with focus debridement with posterior internal fixation by extraperitoneal approach at stage I . Postoperative mechanical ventilation time, preoperative and postoperative Cobb angle, visual analogue scale (VAS), erythrocyte sedimentation rate (ESR) and Frankel grading were observed and compared. Postoperative complications, stability of internal fixation and bone union were compared.</p><p><b>RESULTS</b>All patients were followed-up from 15 to 36 months with an average of 23.7 months. Psoas abscess of three patients in group A and 1 patient in group B on the opposite side increased and were healed by the secondary apocenosis. The other 78 cases were healed at stage I, and no sinus tract formation, incisional hernia, leakage of cerebrospinal and occurrence of spinal tuberculosis were occurred. Fracture healing time ranged from 3 to 7 months with an average of 4.6 months. Postoperative mechanical ventilation time and VAS score in group A was better than group B. There were no statistical differences in Cobb angle, ESR and Frankel grading at the final following-up between two groups.</p><p><b>CONCLUSION</b>Anterior small-incision focus debridement with posterior internal fixation through muscle spa ring in treating patients with lumbar spinal according to degree of damage is a safe and effective method.</p>

Comparison of proximal femoral locking plate and Gamma nail in the treatment of the femoral intertrochanteric fractures in the elder / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate and compare the clinical effects of proximal femoral locking plate with Gamma nail in the treatment of the femoral intertrochanteric fractures in the elder.</p><p><b>METHODS</b>From June 2008 to June 2010, 83 patients with femoral intertrochanteric fracture were randomly divided into two groups(group A and group B). In group A,there were 42 cases including 23 males and 19 females, the range of their age was from 64 to 92 years old;according to Jensen classification, there were 19 cases of type II fracture,17 of type III fracture, 4 of type IV fracture, 2 of type V fracture. In group B,there were 41 cases including 24 males and 17 females, the range of their age was from 65 to 90 years old; 20 cases were type II, 16 cases were type III, 3 cases were type IV, 2 cases were type V. The patients of group A were treated with locking plate, the patients of group B with Gamma nail. The observing and comparing items of the two groups included (1) After the operation, the operational duration was assessed; (2) After the operation, intraoperative bleeding volume was assessed; (3) Hemoglobin reduction was assessed in second day after the operation; (4) At the last follow-up, fracture healing time was assessed. (5) Functional recovery was evaluated according to Parker and Palmer mobility score.</p><p><b>RESULTS</b>All patients were followed-up for 10.6 months in average (ranging from 8 to 12). In group A, the average operation time was (62.46 +/- 21.61) min, the range of intraoperative bleeding volume was from 50 to 260 ml, the average hemoglobin reduction after the operation was (18.20 +/- 6.25) g/L, the rang of fracture healing time was from 12 to 24 weeks and the average Parker-Palmer mobility score was (7.68 +/- 1.09) points. In group B, the average operation time was (67.42 +/- 19.46) min, the range of intraoperative bleeding volume was from 40 to 280 ml, the average hemoglobin reduction after the operation was (40.14 +/- 8.62) g/L, the rang of fracture healing time was from 14 to 22 weeks and the average Parker-Palmer mobility score was (7.59 +/- 1.12) points. There were no statistically significant differences (P > 0.05) between two groups for the average operation time,the volume of intraoperative bleeding and Park and Palmer mobility score. Hemoglobin reduction after the operation in group A was less than in group B, there were statistically significant differences (P < 0.05) between two groups.</p><p><b>CONCLUSION</b>The method of proximal femoral locking plate had advantages of less bleeding after operation and relative strong fixing in the femoral intertrochanteric fractures, was more suitable for the femoral intertrochanteric fracture in the elder.</p>

Influence of pedicle screws with different insertion depth on neighboring uninfused segments in a goat lumbar spinal fusion model / 中国骨伤

<p><b>OBJECTIVE</b>To observe the influences of pedicle screws in various insertion depth on the adjacent segment disc degeneration following lumbar spinal fusion. To explore the relationship between the internal fixation rigidity and incidence of adjacent segment disease.</p><p><b>METHODS</b>Sixteen hybrid male Bohr goats of 10 months old, weighting between 25 and 30 kg, were randomly devided into a control group (N group), and 3 experimental groups, each group had 4 goats. The L4 vertebra of each goat in the experimental groups was fractured, L3-L5 segments were internal fixed with pedicle screws followed by intervertebral joint fusion by a posterior approach. Three experimental groups were devided according to the length of pedicle screws applied, vertebras of goats in L group were internal fixed by the screws at the length of 25 mm, for M group and S group, 20 mm and 15 mm, accordingly. The goats in the control group were treated without any operation. Biomechanical changes and MRI index of upper unfused segment (L2) were measured 24 weeks after operation, and histological changes were observed as well.</p><p><b>RESULTS</b>The pressure and straining of L2 vertebral body and intervertebral disc of L group increased more than N group (P < 0.05), and degenerated cell counting in nucleus pulposus increased as well (P < 0.05). However, MRI index remain unchanged (P > 0.05).</p><p><b>CONCLUSIONS</b>Rigid internal fixation increases the pressure and straining of vertebral body and intervertebral disc of upper adjacent segment, accelerating the degeneration process following lumbar spinal fusion in goats.</p>