Retrospective study on treating thoracolumbar fractures with video-assisted thoracoscopic surgery and traditional anterior approach surgery / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the feasibility and the efficacy of video-assisted thoracoscopic surgery in treating thoracolumbar fractures.</p><p><b>METHODS</b>From October 2000 to December 2009, the data of 44 patients with thoracolumbar fractures were retrospetively analyzed. All patients were treated with anterior decompression, auto-iliac bone graft and anterior internal fixation system. They were divided into thoracoscopic group (23 cases, treated with video-assisted thoracoscopic surgery) and traditional group (21 cases, treated with traditional anterior approach surgery). In the thoracoscopic group, there were 15 males and 8 females with an average age of 41.4 years (ranged, 19 to 76); and in the traditional group, there were 14 males and 7 females with an average age of 39.3 years (ranged, 20 to 74). All patients were followed up from 6 to 36 months with an average of 18 months. The operative time, volume of the blood loss, the decreased value of the occupation ratio of spinal canal (OR), the corrected and loss degree of Cobb angle, the improved condition of ASIA classification were compared between two groups.</p><p><b>RESULTS</b>In traditional group, operative time, volume of the blood loss, the decreased value of the occupation ratio of spinal canal (OR), the corrected and loss degree of Cobb angle, the improved grade of ASIA classification were (150.0 +/- 19.4) min, (970.0 +/- 72.0) ml, (35.5 +/- 6.4)%, (25.1 +/- 4.8) degrees, (1.0 +/- 0.7) degrees, (1.8 +/- 0.9) grades, respectively; and in thoracoscopic group, the above items were (170.0 +/- 20.8) min, (650.0 +/- 65.4) ml, (33.2 +/- 8.0)%, (23.6 +/- 5.4) degrees, (1.1 +/- 0.8) degrees, (2.0 +/- 1.1) grades, respectively. There was significant difference in volume of the blood loss between two groups (P < 0.05); there was no significant difference in operative time, the decreased value of the occupation ratio of spinal canal (OR), the corrected and loss degree of Cobb angle,the improved grade of ASIA classification between two groups (P > 0.05). The rate of fusion of all patients was 100%.</p><p><b>CONCLUSION</b>Compared with the traditional anterior approach surgery, video-assisted thoracoscopic surgery has advantages of little incision,less blood loss, less trauma, can obtain same clinical outcome and is a safe,effective method in treating thoracolumbar fractures.</p>

Treatment of odontoid process fracture with pedicle screws by location through inferior and inner wall of atlas and superior and inner wall of axis / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the therapeutic effects of atlantoaxial pedicle screw in treating odontoid process fracture by location through inferior and inner wall of atlas and superior and inner wall of axis.</p><p><b>METHODS</b>From June 2006 to September 2010, 12 patients with odontoid process fracture were treated with the atlantoaxial pedicle screw fixation by location through inferior and inner wall of atlas and superior and inner wall of axis. There were 8 males and 4 females, ranging in age from 18 to 62 years, with an average of 37.9 years. According to classification of Anderson, type II was in 10 cases and type III was in 2 cases. Fresh fracture was in 9 cases and old fracture was in 3 cases. All patients had symptoms such as cervical pain, stiffness and limitation of activity and 9 cases with symptoms were found physical signs of cervical spinal injury. According to grade of ASIA, grade C was in 4 cases and grade D was in 5 cases.</p><p><b>RESULTS</b>There were no severe complications such as injuries of vertebral artery, nerve root and spinal cord during operation. The mean time of follow-up was 14 months (6 to 24 months). The X-ray film and CT scanning showed that all patients had steady bony union and all screws were in the proper position, no screws loosening or breaking were found. Clinical symptoms of all patients improved significantly. Nine patients with spinal injury before operation, of which nerve function obtained improvement, grade C was in 1 case, grade D was in 2 cases and grade E was in 6 cases according to grade of ASIA.</p><p><b>CONCLUSION</b>Location through inferior and inner wall of atlas and superior and inner wall of axis is an effective method for the atlantoaxial pedicle screw implantation; atlantoaxial pedicle screw could be accurately and safely implanted thought this way.</p>

Clinical analysis of vertebral laminae reconstruction after laminectomy and pedicle screw fixation in treating lumbar spinal stenosis / 中国骨伤

<p><b>OBJECTIVE</b>To observe the curative effects of vertebral laminae reconstruction after laminectomy and pedicle screw fixation for the treatment of lumbar spinal stenosis in early (at the 3rd months after operation) and metaphase (at the more than 1 year after operation).</p><p><b>METHODS</b>Twenty-two patients with lumbar spinal stenosis were treated by vertebral laminae reconstruction after laminectomy and pedicle screw fixation, there were 12 males and 10 females, the age was from 55 to 76 years with an average of 65.8 years, including single segment (6 cases), double segments (13 cases) and three segments (3 cases) of L3-S1. The follow-up period was for 1-3 years, preoperative and postoperative (at the 3rd months after operation and last follow-up) to assess the subjective symptoms, physical signs, the limit of daily activities and bladder function according to JOA scoring; and observe saggital diameter measurement and radiological changes through X-ray and CT.</p><p><b>RESULTS</b>All the patients were followed up, the JOA scoring were respectively 5.3 +/- 1.6, 23.2 +/- 2.0, 22.9 +/- 2.4 before operation and after operation (at the 3rd after operation and last follow-up); at the 3rd months after operation, 18 cases obtain excellent results, 3 good, fair 1, and at the last follow-up, 17 cases obtain excellent results, 3 good, fair 2, there was no significant difference between two postoperative periods (u = 0.413, P < 0.05). The mean sagittal diameter of narrow segment was respectively (6.8 +/- 0.9), (17.6 +/- 2.5), (16.9 +/- 1.8) mm before operation, at the 3rd months after operation and the last follow-up. Through statistics processing, there was significant different comparing JOA scoring at 3 months after operation, last follow-up with preoperative (P < 0.05). There was significant difference of vertebral canal sagittal diameter between at the 3rd months after operation and before operation (t = 35.116, P < 0.01); there was no significant difference between at the 3rd months after operation and last follow-up (t = 1.814, P > 0.05). The CT examination of last follow-up showed the vertebral canal have no stenosis, the dural sac and nerve roots have no compression, the rebuilt vertebral laminae have fused well, the graft bone are no absorbed and the fixation have no failure.</p><p><b>CONCLUSION</b>Treatment of lumbar spinal stenosis with vertebral lamina reconstruction after vertebral laminectomy and pedicle screw fixation can obtain satisfactory results in early and metaphase. The method had advantages of decompression thoroughly and fixation solidly, and could prevent vertebral canal restenosis causing by nerve oppression of the postoperative scar and nerve adhesion.</p>