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Objective:To compare the clinical outcomes and correction effects of kyphosis between Zero-profile device (Zero-p) and plate/cage structures (PCC) in treating cervical spondylotic myelopathy (CSM) patients with cervical kyphosis.Methods:From August 2016 to July 2018, a total of 54 cases of cervical spondylotic myelopathy patients with cervical kyphosis were analyzed retrospectively, including 26 cases treated with Zero-p and 28 cases treated with PCC system. There was no significant difference between the two groups in gender, age, body mass index (BMI) and operative segment. The operation duration and the blood loss were recorded. The clinical outcomes of the patients were measured by visual analogue score (VAS) for neck pain and Japanese Orthopedic Association (JOA) score for neurological function. Moreover, JOA recovery rate was obtained to assess the surgical results. The cervical lordosis (C 2-C 7 Cobb angle), the Cobb angle of the operation segment, the C 2-C 7 vertical axis (C 2 SVA) and the cervical range of motion (ROM) were measured on the lateral and dynamic radiographs of the cervical spine, respectively. Results:In the Zero-p group, the operation duration was 83.0±14.9 (range 60-120) min, intraoperative blood loss was 70.5±27.3 (range 30-150) ml. In PCC group, the operation duration was 100.0±23.9 (range 65-145) min, intraoperative blood loss was 104.2±38.8 (range 30-250) ml. There were significant difference in above parameters between two groups ( t=3.40, 2.06; P=0.00, 0.04). The follow-up duration in Zero-p group was 30.4±5.8 (range 24-36) months and 31.2±4.9 (range 24-36) months in PCC group without significant difference ( t=1.061, P=0.291). The VAS/JOA score of the Zero-p group was improved from (5.9±1.0)/(9.2±1.7) preoperatively to (2.1±0.8)/(14.9±1.0) at 1 month postoperatively, and to (3.4±1.0)/(15.1±0.9) at the last follow-up. The difference between them was statistically significant ( F=130.96, 221.40, P=0.00). The VAS/JOA score of the PCC group was improved from (5.9±1.1)/(8.7±1.6) preoperatively to (2.3±0.9)/(14.9±1.0) at 1 month after surgery, and to (2.6±0.9)/(15.6±1.1) at the last follow-up. The difference between them was statistically significant ( F=303.35, 126.64, P=0.00). However, the VAS score of neck pain in the Zero-p group at the last follow-up was significantly deteriorated, which was significantly higher than that in PCC group ( P<0.05). The cervical lordosis/operative segment Cobb angle in the Zero-p group was improved from preoperative (-6.7°±2.7°)/(-6.5°±3.2°) preoperatively to (14.2°±4.9°)/(12.9°±4.9°) at 1 month postoperatively, and to (5.9°±4.7°)/(5.0°±4.0°) at the last follow-up with statistical significance ( F=196.98, 179.97, P=0.00). The cervical lordosis/operative segment Cobb angle in the PCC group was improved from (-5.7°±3.5°)/(-6.1°±4.0°) preoperatively to (13.9°±6.9°)/(13.0°±6.4°) 1 month after surgery, and to (11.0°±5.5°)/(10.4°±5.6°) at the last follow-up with statistical significance ( F=127.27, 119.98, P=0.00). However, the cervical lordosis and operative segment Cobb angle at the last follow-up in the Zero-p group were significantly lost compared with those at 1 month after surgery, which were significantly smaller than those in the PCC group ( P<0.05). The incidence of dysphagia after operation was 7.7% (2/26) in the Zero-p group and 28.6% (8/28) in the PCC group (χ 2=5.11, P=0.02). Conclusion:For CSM patients with cervical kyphosis, PCC could achieve much better mid-term kyphotic correction and clinical outcomes. However, Zero-p should be avoided as much as possible.
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Objective To discuss method,operative characters and curative effect of total hip arthroplasty(THA)in treatment of acetabular fractures combined with ipsilateral femoral head or neck fractures.Methods One stage THA was done in seven patients with acetabular fractures combined with ipsilateral femoral head fracture(one patient)or femoral neck fractures(six patients)7-21 days after fractures.There were five males and two females,at age range of 41-65 years(average 50 years).According to AO classification,there were one patient with type A fracture,three with type B and three with type C.Of all,five patients received biological acetabular replacement after reduction and internal fixation of acetabular fracture and two received PMMA acetabular replacement with metal enforcement ring.All patients received biological femoral stem.Results Of all,six patients were followed up for from 2 years and 3 months to 6 years and 5 months(mean 3 years and 9 months),which showed heterotopic ossitlcation in one patient and dislocation in one who recovered after manipulative reduction.The Harris score was increased from mean prooperative 48 points to mean postoperative 91 points.X-ray found no loosening of prosthesis during follow-up.Conclusions THA can improve function of hip joint significantly,avoid further operation and lessen the burden of patients mentally and economically and hence is effective in treatment of acetabular fracture combined with ipsilateral femoral head or neck fractures.
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[Objective]To investigate the characteristics and clinical results of open reduction and internal fixation for fractures of the calcaneus for earthquake patients.[Method]The fractures were classified according to Sanders classification.Fifteen cases(24 fractures) were treated by open reduction and internal fixation.Thirteen cases(21 fractures) were followed up from four,four and half months(average of 4.2 months).[Result]All fractures had been healed.Functional results were evaluated using Marryland Foot Score and excellent results occured in 9(42.9%),good in 10(47.6%),fair in 2(9.5%) and the satisfactory rate was 90.5%.Two cases of incision infection were cured by skin flap transplantation.[Conclusion]Open reduction and internal fixation is an effective method for treatment of displaced intra-articular fractures of the calcaneus.Earthquake patients are not fit for early operation.They should be treated with operation after normal functional index and stable psychological situation.