ABSTRACT
<p><b>OBJECTIVE</b>To compare the short term curative effect of posterior open door laminoplasty between continuous placement of shaping plate and intermittent placement in treating multilevel cervical spondylotic myelopathy.</p><p><b>METHODS</b>From January 2012 to March 2015, 43 patients with multi segment cervical spondylotic cervical were treated with posterior open door laminoplasty, 21 patients with continuous placement of shaping plate(continuous group), 22 patients with intermittent placement of shaping plate(intermittent group). Operative time, intraoperative blood loss, JOA score, VAS score, postoperative spinal sagittal diameter and cervical curvature, postoperative cervical activity, complications, hospitalization expenses etc. were observed.</p><p><b>RESULTS</b>The patients of two groups were followed up with an average of (23.2±8.1) months and (23.3±8.0) months in continuous group and intermittent group, respectively. There was no significant difference in operative time, intraoperative blood loss, hospitalization time between two groups(>0.05). JOA and VAS scores of all patients at final follow up were obviously improved than preoperative(<0.05). Postoperative spinal sagittal diameter at 3 days and final follow up were obviously improved(<0.05), and there was no significant difference between postoperative at 3 days and final follow up(>0.05). Cervical activity of all patients at final follow up was decreased than preoperative(<0.05), but there was no significant difference between two groups(>0.05). There was no significant difference in postoperative complication and there was significant difference in hospitalization expenses between two groups.</p><p><b>CONCLUSIONS</b>Posterior open door laminoplasty with continuous or intermittent placement of shaping plate have similar clinical effects in ameliorating nerve function for the treatment of multilevel cervical spondylotic myelopahty. However, the hospitalization expenses of intermittent group is obviously reduced, and the medical resources can be saved.</p>
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the clinical effects and prevent the complications of posterior and anterior decompression and internal fixation in the revision of cervical anterior internal fixation failure.</p><p><b>METHODS</b>From 2008 January to 2011 December, 17 patients with cervical anterior internal fixation failure were treated with posterior and anterior decompression and internal fixation. There were 12 males and 5 females, aged from 26 to 68 years old with an average of 44.1 years. The lower screw loosening was found in 6 cases, the upper screw loosening in 5 cases, titanium mesh caving in 3 cases, the upper screw breakage in 2 cases, the lower screw breakage in 1 case. Informations of bone fusion were observed by X-ray, CT, MRI. Clinical effects were evaluated by modified JOA score.</p><p><b>RESULTS</b>All the revision operations were successfully completed. One case with poor blood coagulation function before operation resulted in postoperative hematoma and occurred neurological symptoms; after hematoma removal and fresh frozen plasma infusion later, neurological symptoms of the patient disappeared. All patients were followed up from 6 to 38 months with an average of (22.4±10.0) months. Postoperative at 2 weeks, 3 months, and final follow-up, JOA score had obviously improved and respectively was 13.1±1.6, 13.4±1.6, 14.2±1.5. All internal fixation locations were good after revision,and obtained bone fusion at 10 months after operation, with an average fusion time of 6 months.</p><p><b>CONCLUSION</b>The combined posterior and anterior decompression and internal fixation in the revision of cervical anterior internal fixation failure is safe, can achieve thoroughly decompression, maintain the cervical curvature, reconstruct the three column stability, and it may be used for the patients of cervical anterior fixation failure.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Cervical Vertebrae , General Surgery , Decompression, Surgical , Methods , Fracture Fixation, Internal , MethodsABSTRACT
<p><b>OBJECTIVE</b>To compare the therapeutic effectiveness of inverted less invasive stabilization system (LISS) and proximal femoral nail anlirotafion (PFNA) in treatment of complex unstable intertrochanteric fracture in aged, and to investigate the selective strategy of the internal fixation.</p><p><b>METHODS</b>From February 2007 to June 2009, 47 senior patients with complex and unstable intertrochanteric fractures (Evans IV, V, R-type) were treated. Among them 23 patients were treated by inverted LISS, including 7 males and 16 females, aged from 76 to 97 years; 24 patients were treated by PFNA, including 9 males and 15 females, aged from 73 to 90 years old. The mean operating time,blood loss, intraoperative photographs frequency, incision length, length of stay, bone healing,hip function were analyzed and compared.</p><p><b>RESULTS</b>All patients were followed up for 8 to 18 months (averaged 13.1 months). All fractures got bone healing. No complications such as wound infection, varus and internal fixation cut out occurred. The operative time, incision length, in PFNA group had a slight ascendant than that in LISS inversion group, but there were no significant differences. According to postoperative Harris hip score outcome of LISS inversion group compared with the PFNA group, there was no significant difference.</p><p><b>CONCLUSION</b>Both of PFNA and LISS have ideal effect in treatment of complex unstable intertrochanteric fracture in aged, and are good internal fixations.</p>