ABSTRACT
BACKGROUND:There are stil about 10%-30%of patients presenting no obvious improvement of symptoms after lumbar disc herniation surgery, which are col ectively known as the lumbar spine post-surgery failure syndrome, and lumbar instability is one of the important reasons. OBJECTIVE:To evaluate the feasibility and efficacy of surgery including posterior lumbar spinal canal decompression, intervertebral disc resection, lumbar interbody fusion, and pedicle screw fixation on lumbar intervertebral disc protrusion concurring lumbar instability via MAST Quadrant retractor. METHODS:From December 2011 to October 2012, 62 cases of lumbar intervertebral disc protrusion concurring lumbar instability were treated with posterior lumbar spinal canal decompression, intervertebral disc resection, lumbar interbody fusion, and pedicle screw fixation via MAST Quadrant retractor. There were 38 female and 24 male ranging in age from 37 to 69 years (average 53.7 years). After operation, al patients were fol owed-up to evaluate the effect of the treatment. RESULTS AND CONCLUSION:The operative time was 90-210 minutes, average 145 minutes, and the amount of blood loss was 50-300 mL, average 120 mL. The hospitalization time was 5-9 days, average 6 days. Al incisions healed by first intention. Al patients were fol owed up 7.2 months on average (from 3 to 10 months). The preoperative JOA score was (10.25±2.34) points. The postoperative JOA score decreased to (18.31±3.12) points at the fol ow-up after 1 month and (25.35±2.61) points at the last fol ow-up, showing significant difference when compared with preoperative score (P<0.01). The preoperative VAS score was (8.24±1.15) points. The postoperative VAS score decreased to (2.97±1.12) points after 1 month and (1.13±0.39) points at the last fol ow-up, showing significant difference when compared with preoperative score (P<0.01). According to reforming Macnab standard, the results were excel ent in 53 cases and good in 9 cases at the last fol ow-up. The surgery including posterior lumbar spinal canal decompression, intervertebral disc resection, lumbar interbody fusion, and pedicle screw fixation via MAST Quadrant retractor is a safe, effective and minimal y invasive surgical technique in treating lumbar intervertebral disc protrusion concurring lumbar instability.
ABSTRACT
BACKGROUND:Treatment prescription for intervertebral space infection is controversial. Conventionally,lying in bed,physical therapy,symptomatic therapy,and a large dosage of antibiotics were used frequently;however,the application of antibiotics was still controversial. OBJECTIVE:To explore the implantation of calcium sulfate powder combined with antibiotics for the treatment of suppurative spondyfitis of the thoracic vertebra. DESIGN,TIME AND SETTING:A retrospective case analysis was performed at Department of Orthopaedics,Affiliated Hospital of Guangdong Medical College from October 2000 to August 2008. PARTICIPANTS:A total of 24 patients with suppurative spondyfitis of the thoracic vertebra,including 9 males and 15 females and aging 42-71 years,were provided by Department of Orthopaedics,Affiliated Hospital of Guangdong Medical College. Suppurative spondyfitis of thoracic vertebra occurred on T6/7(n=9) ,T7/8(n=6) ,T8/9(n=3) ,T10/11(n=4) ,and T6/8(n=2) . Among all patients,8 cases had severe pain,myospasm of dorsal muscles,passive position,difficulty of turning over,and lateral or bilateral melosalgia;11 had anorexia and athrepsy;2 had paresis of both lower extremities and difficulty of automatic micturition;3 had diabetes mellitus. METHODS:After the 24 patients with suppurative spondyfitis of the thoracic vertebra received the cleaning operation on focus infection through latero-anterior thoracic cavity,the defect area of bone was inserted with titanium case filled with the calcium sulfate cement combined with antibiotics,and then the internal fixation and a plenty of antibiotics were applied after the operation. MAIN OUTCOME MEASURES:Recovery rate was evaluated using JOA assay,and blood sedimentation and bone healing were observed. RESULTS:All the 24 patients received the follow-up with the mean duration of 5.8 years. One case did not recovered,but other 23 patients recovered obviously. The recovery rate was 30%-100%. Blood sedimentation decreased from(86.74?10.56) mm/h before operation to(26.40?5.42) mm/h at 5 months after operation. Bone fusion occurred on all 24 patients,and the time lasted for 3-8 months. Relative death,complications,and infection-induced relapse were not found during the following up. CONCLUSION:To insert the titanium case filled with the calcium sulfate cement combined with antibiotics into the defect area of bone created by the cleaning operation on focus infection and combine with the application of the internal fixation by one stick and two screw and the brace for back and lumbar is an effective therapy for treatment of suppurative spondyfitis of the thoracic vertebra.
ABSTRACT
[Objective]To evaluate the therapeutic effects of the operation of latero-anterior internal fixation by plate screw and vertebroplasty by calcium sulfate cement for treatment of thoracolumbar more vertebral compression fractures with osteoporosis.[Method]Twenty-two patients with osteoporosis and more vertebal compression fractures received latero-anterior internal fixation by plate screw and vertebroplasty by calcium sulfate cement.Functions of spinal cord nerve were damaged in different degrees.Preoperative auxiliary examination of X-ray,CT and MRI was used.The spinal stabilization,spinal cord function and the state of chronic lumbodynia were observed by postoperative photographs.[Result]All the patients were followed up,and the implants showed bone union.Sensation and motor function were improved in various degrees.The pain of chest and back or other complaints were obviously relieved.No recurrence occurred.Vertebral bodies by vertebroplasty had no leakage and the short-term effects were satisfactory.[Conclusion]The operation of latero-anterior internal fixation by plate screw combining vertebroplasty is profitable to simultaneously improve nerve compression of thoracolumbar kyphosis,spine instability,and other chronic pain caused by osteoporotic vertebral compression fractures.
ABSTRACT
BACKGROUND: Three kinds of donor meniscus are commonly used at present, namely cryopreserved, fresh and deep-frozen meniscus, which,however, almost invariably give rise to degenerative changes of various degrees after transplantation.OBJECTIVE: To compare the outcome of transplantation of allograft deep-frozen meniscus and meniscal acellular matrix to determine the most preferable means of allograft meniscus preservation.DESIGN: Randomized controlled experiment with rabbits.SETTING: Department of Orthopedics, Second Hospital Affiliated to Harbin Medical University.MATERIALS: Sixty-four male Japanese white rabbits with body mass of 3.0 - 3.5 kg.METHODS: This experiment was carried out in the Animal Experimental Center, Second Hospital Affiliated to Harbin Medical University between September 2002 and September 2003. Totally 64 adult rabbits were assigned into 32 pairs according to the body weight to served as the donor and the recipient animals, respectively. The medial menisci was obtained from the bilateral knees of the donor animals with the right one cryopreserved at -80 ℃ and the left prepared into acellular matrix for deep-frozen preservation. The donor menisci were respectively transplanted into the corresponding knee joints of the recipient animal's hindlimbs, with the left side taken as the experimental side and right as control. Gross observation,X-ray examination, and histological examination of the tissues were carried out at postoperative 4, 8, 12 and 16 weeks, respectively.MAIN OUTCOME MEASURES: Findings in X-ray, gross observation and histological observation of the grafted meniscus with meniscal measurement and findings in abdominal aorta perfusion.RFSULTS: All the 64 rabbits were observed for result analysis. X-ray examination of the grafted meniscus revealed no obvious changes in either the experimental and control side at 4 and 8 weeks postoperatively, but mild changes occurred on the control side at 12 weeks, which became obvious at 16 weeks, presented by joint space narrowing, hyperostosis and osteosclerosis below the cartilage of varied severities (with scores of 1.3 and 0.6, respectively, P ＜ 0.05). By gross observation, meniscal atrophy on the experimental side was milder and slower than the control side, with al so lower atrophy rate [(15.14±4.62) % vs (20.97±4.72) % at week 4, P ＜ 0.001, and (19.23±11.27) % vs (32.74±10.43) % at week 16, P ＜ 0.05].Perfusion of the abdominal aorta revealed no revascularization in the surrounding tissues of the meniscus by gross observation in either groups, but histologically, the experimental side showed more favorable structure than the control side at postoperative weeks 4, 8, 12 and 16.CONCLUSION: Meniscal acellular matrix may produce better outcome than deep-frozen meniscus after transplantation and can be a more practical means for preservation of the meniscus.