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OBJECTIVE@#To explore the effect of robot-assisted internal fixation in lateral decubitus position for the treatment of ankylosing spondylitis (AS) complicated with thoracolumbar fractures.@*METHODS@#The clinical data of 26 patients with ankylosing spondylitis complicated with thoracolumbar fractures treated from January 2018 to June 2020 was retrospectively analyzed. According to different surgical methods, these patients were divided into observation group and control group. There were 8 patients in observation group, which were treated with robot-assisted percutaneous screw fixation in lateral decubitus position, including 4 males and 4 females, aged form 55 to 85 years old with an mean of (66.25±9.42) years, the course of disease was (4.00±0.76) days on average, 2 cases were T11 fracture, 2 cases were T12, 3 cases were L1 and 1 case was L2. And there were 18 patients in control group, which were treated with conventional percutaneous screw fixation in prone position, including 6 males and 12 females, aged from 48 to 81 years old with a mean of (61.22±9.53) years, the course of disease was (4.11±0.83) days on average, 2 cases were T10 injury, 3 cases were T11, 4 cases were T12, 7 cases were L1, and 2 cases were L2. The intraoperative blood loss, operation time, position time and postoperative neurological complications were compared between two groups. Postoperative visual analogue scale (VAS) at 1d and 3 months, and Oswestry Disability Index (ODI) before and 3 months after operation were observed. According to Gertzbein-Robbins standard to evaluate the accuracy of pedicle screw placement.@*RESULTS@#There was no nerve injury due to pedicle screw placement in both groups. The intraoperative blood loss in observation group and control group was (34.13±4.61) ml and (78.17±22.02) ml, operation time was(92.13±9.82) min and (106.22±11.55) min, position time was(10.00±2.14) min and (15.17±2.66) min, the differences was statistically significant(P<0.05);VAS of the two groups were (2.38±0.52) points and (4.56±0.98) points one day after surgery, respectively, with statistically significant differences (P<0.05), while VAS and ODI three months after surgery showed no statistically significant differences (P>0.05). The screw accuracy was 96.88%(62/64) in observation group and 81.48%(88/108) in control group, the difference was statistically significant(P<0.05).@*CONCLUSION@#Robot-assisted internal fixation in lateral decubitus position for the treatment of ankylosing spondylitis complicated with thoracolumbar fractures can shorten the position time and operation time, significantly improve the accuracy of internal fixation screw placement, relieve the early postoperative pain, reduce intraoperative blood loss and postoperative complications, and facilitate the fast track rehabilitation of patients.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Fracture Fixation, Internal , Lumbar Vertebrae/surgery , Pedicle Screws , Retrospective Studies , Robotics , Spinal Fractures/surgery , Spondylitis, Ankylosing/surgery , Thoracic Vertebrae/surgery , Treatment OutcomeABSTRACT
The mechanism of degenerative intervertebral disc is very complex, which may be associated with multiple factors such as the mechanical stress force injury of intervertebral disc, nutritional deficiency, inflammatory stimulation, etc. Recently, many studies detected propionibacterium acnes(P. acnes) in degenerative intervertebral disc and supposed P. acnes was associated with degenerative intervertebral disc. Here, the papers related to P. acnes and degenerative intervertebral disc were reviewed. Further, we deduced the approach of P. acnes enterring into the intervertebral disc as well as the mechanism of P. acnes aggravating the disc degeneration. These may provide suggestions for treating degenerative intervertebral disc.
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<p><b>OBJECTIVE</b>To compare clinical outcomes of perpendicular or parallel double plate in treating type C fractures of distal humerus in adults.</p><p><b>METHODS</b>From March 2009 and March 2013, 40 adult patients with type C distal humerus fractures were treated. The patients were divided into two groups according to fixed form. In perpendicular group(group A), there were 13 males and 9 females with a mean age of (37.56±9.24) years old(ranged 18 to 56);while in parallel plating group(group B), including 11 males and 7 females, with a mean age of (41.35±9.03) year old(ranged 20 to 53). All fractures were fresh and closed without blood vessels or nerve damaged. Incision length, operating time, blood loss, hospital stay, preoperative and postoperative radiological change, range of activity of elbow joint, Mayo score, flexor and extensor elbow strength, and postoperative complications were observed and compared.</p><p><b>RESULTS</b>All incisions were healed well. One patient occurred myositis ossificans between two groups. Two patients in group A and 1 patient in group B occurred elbow joint stiffness. All fractures were obtained bone union. Group A were followed up from 20 to 36 months with an average of (25.2±7.1) months, while group B were followed up from 18 to 35 months with an average of(24.3±6.0) months. There were significant differences in blood loss and operative time, while there was no obvious meaning in incision length, hospital stay, muscle strength, fracture healing time, range of activity of elbow joint. Mayo score of group A was 82.27±10.43, 6 cases obtained excellent results, 12 good, 3 moderate and 1 poor;in group B was 81.94±12.02, 5 cases obtained excellent results, 9 good, 3 moderate and 1 poor;and there were no statistical significance between two groups.</p><p><b>CONCLUSIONS</b>There was no significant differences in clinical effects between perpendicular and parallel double plate for adult patients with type C distal humerus fractures, while the operation should choose according to facture and proficiency of operator.</p>
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<p><b>OBJECTIVE</b>To evaluate the clinical effects of single posterior debridement, bone grafting, internal fixation and local chemotherapy in treating thoracolumbar spinal tuberculosis.</p><p><b>METHODS</b>From February 2009 to September 2012,11 patients with thoracolumbar spinal tuberculosis were treated by single posterior debridement, bone grafting, internal fixation and local chemotherapy. There were 7 males and 4 females, aged from 27 to 65 years old with an average of 53.7 years. The courses of disease was from 3 months to 2 years with the mean of 9 months. According to ASIA standard of spinal cord injury, 3 cases were grade C and 8 cases D. After treatment, clinical effects were evaluated by ASIA grade, visual analogue score (VAS) and Oswestry Disability Index (ODI); kyphosis Cobb angle change was observed by X-rays.</p><p><b>RESULTS</b>Eleven patients were followed up from 12 to 29 months with an average of 18 months. ASIA grade of spinal cord injury, 3 patients with grade C improved to grade D in 2 cases and grade E in 1 case 8 patients with grade D improved to grade E in 7 cases and unchanged in 1 case. VAS decreased from preoperative 6.10 ± 1.30 to 1.70 ± 0.80 at 3 d after operation (P < 0.05). ODI improved from preoperative (68.36 ± 10.41)% to (14.55 ± 8.99)% (P < 0.05) at 3 d after operation. Kyphotic Cobb angle was corrected from preoperative (22.64 ± 4.84)° to (4.27 ± 1.49)° (P < 0.05) on the 3rd day after operation, and angle loss was mild at final follow-up, there was no significant difference between postoperative at 3 d and final follow-up.</p><p><b>CONCLUSION</b>Single posterior debridement, bone grafting, internal fixation and local chemotherapy for the treatment of thoracolumbar spinal tuberculosis can effectively remove the lesion, improve nerve function and correct deformity, has advantage of single incision, little trauma, and low recurrence rate. But it still need long-term and systemic treatment with anti-TB drugs.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Bone Transplantation , Debridement , Internal Fixators , Lumbar Vertebrae , General Surgery , Retrospective Studies , Thoracic Vertebrae , General Surgery , Tuberculosis, Spinal , TherapeuticsABSTRACT
<p><b>OBJECTIVE</b>Evaluation of two different methods of treatment of distal tibial fractures of the clinical indications, complications and efficacy.</p><p><b>METHODS</b>Forty-five cases of closed distal tibial fractures were assigned to two groups, 25 cases in group A included 18 males and 7 females, according to the AO/ASIF classification: 4 cases of type A, 14 cases of B, 7 cases of C, open reduction and anatomic plate fixation were used. Twenty cases in group B included 12 males and 8 females, 5 of type A, 9 of B, 6 of C, minimally invasive percutaneous locking compression plate osteosynthesis were used. Observed on the postoperative pain, skin necrosis of the incision, the incidence of deep infection and other complications, as well as the healing of fractures, ankle motor function for comparative study.</p><p><b>RESULTS</b>All patients were followed up 10 to 15 months, according to the visual analogue scale (VAS) score, group A were moderate to severe in, group B were mild to moderate between. Bone healing time: group A averaged (16.0+/-4.2) weeks, group B averaged (13.0+/-3.2) weeks, the difference was significant (P<0.01). Postoperative complications of group A was more than that of group B (P<0.05), there were significant differences. Ankle function in accordance with the assessment criteria Kofoed, the good and excellent rate of group B was higher than that of group A (P<0.05), there were significant differences.</p><p><b>CONCLUSION</b>Minimally invasive percutaneous locking compression plate osteosynthesis compared open reduction and anatomic plate fixation for distal tibial fractures with less trauma surgery, bone blood supply to the affected small, fracture healing faster, less complications, and ankle function better advantage of. It is consistent with the biomechanics of internal fixation, and is the treatment of tibial fractures ideal method.</p>