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Objective:To investigate the clinical effect of lateral rectus abdominis approach combined with presacral decompression for surgical treatment of old Denis type II sacral fractures complicated with upper sacral plexus injury.Methods:A retrospective case series study was performed on the clinical data of 9 patients with old Denis type II sacral fractures complicated with upper sacral plexus injury (L 4-S 1) admitted to Zhongnan Hospital of Wuhan University from June 2010 to December 2016. There were 6 males and 3 females, aged (33.1±7.5)years (range, 15-58 years). Embolization of internal iliac artery and preimplantation of abdominal aortic balloon were performed 2 hours before operation under the guidance of digital subtraction angiography (DSA). Surgery was performed using a single lateral rectus abdominis approach combined with presacral decompression. The operation time, intraoperative blood loss and full weight-bearing time were recorded. The visual analogue scale (VAS) and European QOL Five Dimensional health scale (EQ-5D) were compared before and after operation. The Gibbons' impairment scale was used to assess neurological function. X-ray and CT scan were used to observe internal fixation and fracture healing. The complications during and after operation were recorded. Results:The patients were followed up for 24-52 months [(35.2±5.2)months]. The operation time was (2.9±0.6)hours. The intraoperative bleeding was (573±138)ml, and the full weight-bearing time was (11.6±1.2)weeks. X-ray and CT scan showed bone healing in all patients at the latest follow-up. The VAS and EQ-5D scale improved from preoperative (7.8±0.6)points and (0.34±0.07)points to the final follow-up of (0.8±0.3)points and (0.81±0.05)points ( P<0.05). According to Gibbons classification, 8 patients were grade I and 1 patient was grade II one year after operation ( P<0.01). Namely, the radiation pain of lower extremities was significantly improved in all patients, among which 8 patients showed pain disappeared and completely returned to normal and 1 patient showed residual numbness and hypoesthesia of the affected limbs. No major complications (eg, iatrogenic lumbosacral plexus injury, vital blood vessels or pelvic organs injury) occurred during the operation. During the follow-up period, only one patient developed traumatic hip arthritis and underwent total hip arthroplasty 6 months after operation. Fractures of the remaining patients were healed well without complications like infection, pressure ulcer or implant failure. Conclusions:For old Denis type II sacral fractures complicated with upper sacral plexus injury, lateral rectus abdominis approach combined with presacral decompression can fully decompress the upper sacral plexus nerve, relieve pain, and promote functional rehabilitation, with low incidence of complications. It is an alternative surgical method for the treatment of old Denis type II sacral fractures complicated with upper sacral plexus injury.
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Objective To investigate the surgical treatment of complex Denis zone Ⅲ sacral fractures.Methods A retrospective study was conducted on the 15 complex Denis zone Ⅲ sacral fractures which had been treated from June 2011 to September 2015 in our hospital.They involved 9 men and 6 women,with an average age of 28.8 years (from 15 to 55 years).There were 8 U-shaped,6 H-shaped and 3 lambda fractures.By the Gibbons grading for the sacral nerve injury,3 cases were rated preoperatively as grade Ⅱ,5 cases as grade Ⅲ and 7 as grade Ⅳ.Of them,10 received π-shaped lumbopelvic fixation and sacral decompression 2 weeks after injury,one had lumbosacral fixation and sacral decompression 6 days after injury,and 4 underwent only sacral decompression 3 months after injury when they presented with symptoms of neural injury after fracture malunion.Their sacral malformation angle,visual analogue scale and EQ-5d scale were compared between preoperation and postoperation.Results The 15 cases were followed up for 9 to 47 months (average,24.9 months).Their full-weight-bearing time ranged from 8 to 14 weeks (average,9.9 months).All the incisions healed well without any infection,pressure sore,implant loosening or breakage.There was no significant difference between the preoperative angle of malformation (35.7° ± 5.0°,from 15° to 90°) and the postoperative value (27.9°±6.0°,from 8° to 90°) (t =1.003,P=0.324).Their VAS pain score decreased significantly from preoperative 7.0 ±0.3 to postoperative 1.9 ±0.2,and their EQ-5D score increased significantly from preoperative 0.20 ± 0.03 to postoperative 0.79 ± 0.04 (P ＜ 0.05).The final follow-ups revealed more or less recovery of neural function in all the patients.Conclusions π-shaped lumbopelivic fixation is an effective treatment for complex Denis zone Ⅲ sacral fractures.Effective decompression and stable fixation are prerequisites for early neurological and functional recovery.Simple sacral decompression can effectively promote nerve recovery in patients with old complex Denis zone Ⅲ sacral fractures.
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BACKGROUND:At present, a large number of studies have proved that the discectomy and interbody fusion are effective in treatment of lumbar disc herniation. But for the treatment of lumbar disc herniation with Modic change, the advantages and disadvantages of above two kinds of surgical methods are stil inconclusive. OBJECTIVE: To systematicaly review the effectiveness of discectomy versus interbody fusion in treatment of lumbar disc herniation with Modic change. METHODS: We searched PubMed, Embase, The Cochrane Library (Issue 2, 2015), CBM, CNKI, VIP and WanFang database for randomized controled trials on discectomyversus interbody fusion for lumbar disc herniation with Modic change from inception to May 1st, 2015. Clinical outcomes were back pain Visual Analog Scale, leg pain Visual Analog Scale, Oswestry Disability Index, lumbar Japanese Orthopaedic Association score, the number of cases affecting complications, and MacNab criteria. Meta-analysis was performed using RevMan 5.2 software. RESULTS AND CONCLUSION:Nine randomized controled trials were included, involving 945 patients. The results of meta-analysis showed that compared with discectomy group, back pain Visual Analog Scale was lower [MD=0.81, 95%CI (0.69, 0.92),P < 0.000 01]; Oswestry Disability Index was lower [MD=2.07, 95%CI (1.62, 2.52),P< 0.000 01]; lumbar Japanese Orthopaedic Association score was higher [MD=-2.32, 95%CI(-4.32,-0.32),P=0.02] in the interbody fusion group. No significant difference in leg pain Visual Analog Scale and MacNab criteria outcomes was detected between both groups. These findings verified that interbody fusion was safer and more effective for lumbar disc herniation with Modic change, compared with discectomy.
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BACKGROUND:Many studies concern the comparison of micro-titanium plate fixation and suture suspension fixation during cervical posterior expansive open-door laminoplasty, but the sample size of many studies has limitations. There is lack of objective evaluation on advantages and disadvantages of micro-titanium plate. OBJECTIVE:To systemicaly evaluate the efficacy and safety of micro-titanium plate fixationversus suture suspension fixation in cervical posterior expansive open-door laminoplasty. METHODS: English and Chinese randomized controled trials were searched by two reviewers. They retrieved the Cochrane Central Register of Controled Trials (CENTRAL), PubMed, EMbase, the ISI Web of Knowledge Database, CNKI, CMB, VIP and Wanfang database for randomized controled trials addressing micro-titanium plate fixationversus suture suspension fixation in cervical posterior expansive open-door laminoplasty published from database foundation to March 1, 2015. The references were also searched by hand. Meta-analyses were performed by using the Rev-Man 5.3 software, provided by the Cochrane Colaboration. RESULTS AND CONCLUSION: A total of 9 studies involving 642 patients were included. The results of meta-analyses showed that: (1) safety: There were no significant differences between the two groups in operation time [SMD=-0.02, 95%CI (-0.57, 0.54),P=0.95 > 0.05], and intraoperative blood loss [SMD=0.07, 95%CI (-0.26, 0.40),P=0.69 > 0.05]. (2) Efficacy: compared with suture suspension fixation, Japanese Orthopaedic Association Scores were higher [SMD=0.26, 95%CI (0.10, 0.42),P=0.001 < 0.05], the angle of the opened laminae was bigger [SMD=0.25, 95%CI (0.02, 0.48),P=0.04 < 0.05], cervical curvature was better [SMD=0.46, 95%CI (0.27, 0.65),P < 0.000 01], and incidence of axial symptoms was lower [RR=0.40, 95%CI(0.29, 0.56),P< 0.000 01] after micro-titanium plate fixation. These findings suggest that during expansive open-door laminoplasty for treatment of cervical spondylosis, micro-titanium plate fixation and suture suspension fixation can obtain good clinical outcomes. However, Japanese Orthopaedic Association Scores were higher and the angle of the opened laminae was better in micro-titanium plate fixation than in suture suspension fixation. Micro-titanium plate fixation could effectively prevent loss of cervical curvature and reduce the incidence of axial symptoms. For the poor quality of the original studies and smal sample size, a prudent choice is suggested. More high-quality large-sample studies are needed for further verification.
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BACKGROUND:At present, a large number of studies have proved that the expandable intramedul ary nail and interlocking intramedul ary nail are effective in treatment of limb fractures. However, for the treatment of tibial fractures, the advantages and disadvantages of the two kinds of fixation methods are stil inconclusive. OBJECTIVE:To systematical y review the effectiveness and safety of expandable intramedul ary nail and interlocking intramedul ary nail for treatment of tibia fracture. METHODS:We searched PubMed, Embase, The Cochrane Library (Issue 1, 2015), CBM, CNKI, VIP and WanFang Data for articles concerning randomized control ed trials on expandable intramedul ary nail versus interlocking intramedul ary nail published from inception to January 1, 2015. The key words were“tibia, fracture, tibia fracture, tibia fractures, expandable intramedul ary nail, expandable nail, intramedul ary nail, interlocking intramedul ary nail”. Meta-analysis was performed using RevMan 5.2 software. RESULTS AND CONCLUSION:Ten randomized control ed trials involving 574 patients were included. The results of meta-analysis showed that, compared with interlocking intramedul ary nail, expandable intramedul ary nail was shorter in operation time [MD=-23.42, 95%CI (-26.94,-19.90), P<0.000 01], less in intraoperative hemorrhage [MD=-47.64, 95%CI (-52.21,-43.09), P<0.000 01], less in fluoroscopy times [MD=-1.40, 95%CI (-1.49,-1.30), P<0.000 01], shorter in union time [MD=-30.84, 95%CI (-35.27,-26.41), P<0.000 01], and less in incidence of complications [OR=0.20, 95%CI (0.10, 0.40), P<0.000 01]. The Johner-Wruh scores showed on significant difference. These findings suggest that expandable intramedul ary nail for tibia fracture has more advantages than interlocking intramedul ary nail. That is to say, the expandable intramedul ary nail is an improved nail of interlocking intramedul ary nail, but a large sample of high quality randomized control ed trials are stil needed to confirm the conclusion.
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Objective To evaluate the clinical outcomes of external fixator with lumbopelvic distraction spondylodesis in treatment of vertically unstable pelvic fractures. Methods From January 2008 to March 2009, 9 patients (4 males and 5 females) with a vertically unstable pelvic fracture were treated with modular external fixator with lumbopelvic distraction spondylodesis. According to the classification of Tile, 9fractures were classified as type C. This fixation construct comprises a vertical lumbopelvic distraction component which fixed L4.5 and the posterior superior iliac spine and a transverse fixation which fixed anterior iliac spine with external fixator. Results All patients were followed up 12-18 months after surgery, with an average of 14.3 months. Postoperative X-ray showed satisfactory reduction of pelvic fracture. Pelvic fractures healed in all patients without loss of reduction 3-6 months after operation. According to Matta reduction evaluation criteria, 6 patients were excellent and 3 good. For the two patients with sacral neurological injuries,appropriate surgical decompression was performed to improve the symptom and minimize the deformity. No iatrogenic complications of neurovascular injury occurred. Patients now walk unassistedly without pain in the waist or legs, and with no shortening of lower limbs or claudication. By considering symptom and satisfactory scores, the Majeed functional assessment revealed that seven patients had excellent results and two good at one year. Conclusion External fixator with lumbopelvic distraction spondylodesis that allowed early mobilization and ambulation, with general applicability and definite safety, is an effective surgical technique for the treatment of vertically unstable pelvic fracture.
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Objective To explore the clinical effect of posterior pedicle screw internal fixation in the treatment of multiple level noncontiguous thoracolumbar fractures.Methods Thirteen patients with multiple level noncontiguous thoracolumbar fractures were treated by posterior pedicle screw internal fixation.The Frankel score,percentage of vertebral compression and Cobb angle of the injured vertebral segment were analyzed to evaluate the surgery efficacy.Results All patients were followed up from 12 to 24 months ( averaged 15 months ).All cases achieved bone fusion with no implant failure.The Cobb angle of the injured vertebral segment was corrected from preoperative(22.2 ±5.3) degree to postoperative(5.3 ±3.5) degree and(6.2 ±3.6) degree at the last follow up.The percentage of vertebral compression was corrected from preoperative (45.7 ± 14.1 )％ to postoperative ( 6.1 ± 3.8 ) ％ and ( 7.2 ± 3.9 ) ％ at the last follow up.All improvements showed significant differences when compared statistically( t =15.03,t =12.05,Ps ＜0.05 ).The spinal cord function was improved 1 to 2 degree in all patients except 2 patients of grade A.Conclusion The posterior fixation with pedicle screw is a secure,safe and effective method in treating multiple level noncontiguous thoracolumbar fracture.
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Objective To investigate the surgical operation technique,clinical curative effect and the choice of the indication in the treatment of cervical spondylosis by radiofrequency nucleoplasty.Methods From January to July in 2006,the ArthroCare system 2000 radio frequency instrument that the American ArthroCare company produce were odopted,to treat 20 patients with cervical spondylosis by radiofrequency nucleoplasty under the leading of the C form grill X-ray fluoroscopic machine.Among them,there were 9 males and 11 females with age from 38 to 62 years,equally 45.12 years old,the average course of illness was 2 years. 15 cases with lumbar disc herniation,4 cases with nerve-root cervical sDandylosis and 1 case with spinal cervical spondylosis.Single segment affection in 4 cases,double or multistage segment affection in 16 cases.Among those multistage segment eases,all choose 2 segments for research according to fixed physical sign the body advertise for and the MRI image.After the operation all cases underwent follow-up.with follow-up time for 1-6 months.Results The results shown an effect among those 20 sufferers of excellence in 16 cases,valid in 4 cases,efficient power reach to 100%in short term.Ahhough this case was limited.the early case choice compares strictly,the subjective satisfaction of sufferer was higher.Conclusion Application of radiofrequency nucleoplasty in the treatment of cervical sDondylosis has advantages of small wound,safety and high efficacy in short term.However, its indication still need further research.