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Objective:To evaluate the long-term outcomes of posterior release, reduction, fixation, and fusion for irreducible atlantoaxial dislocation (AAD).Methods:Between January 2005 and June 2016, a total of 31 patients with irreducible AAD who had received posterior approach surgery were included. Among them, there were 13 males and 18 females, the average age was 39.1±13.5 years (range 9-72 years). The clinical data of the eligible individuals were collected and analyzed. Neck disability index (NDI) and Japanese Orthopaedic Association (JOA) scores were recorded to evaluate the recovery of neck and neurological functions. The atlantodental interval (ADI), clivus-canal angle (CCA), and cervico-medullary angle (CMA) were measured to evaluate the reduction of AAD. C 0-C 2 angle and C 2-C 7 angle were measured to evaluate the recovery of cervical alignment. For individuals with basilar invagination, the distances from the tip of odontoid process to Chamberlain line and Wackenheim line were measured to assess the reduction in the vertical direction. The duration of bony fusion and complications were also analyzed. Results:The mean follow-up period was 82.7±26.4 months (range 61-170 months). In terms of functional scores, the NDI dropped from 43.41%±11.60% before surgery to 12.19%±6.97% at the six months follow-up, and 9.45%±7.51% at the last follow-up ( F=89.56, P<0.001). The JOA increased from 9.48±2.41 points before surgery to 14.71±1.42 points at the six months follow-up, and 14.97±1.47 points at the last follow-up ( F=52.89, P<0.001). Regarding the horizontal and vertical dislocations, the ADI decreased from 9.16±2.32 mm before surgery to 1.39±1.04 mm at the six months follow-up, and 1.29±1.08 mm at the last follow-up ( F=189.61, P<0.001). The distance from the tip of odontoid process to Chamberlain line decreased from 11.15±4.35 mm before surgery to 2.03±2.83 mm at the six months follow-up, and 2.15±3.02 mm at the last follow-up ( F=37.58, P<0.001). The distance from the tip of odontoid process to Wackenheim line reduced from 6.81±2.57 mm before surgery to -2.23±1.58 mm at the six months follow-up, and -2.27±1.58 mm at the last follow-up ( F=122.16, P<0.001). For the amelioration of the compression on medulla and spinal cord, the CCA increased from 113.68°±12.67° before surgery to 143.39°±7.38° at the six months follow-up, and 142.39°±7.13° at the last follow-up ( F=67.13, P<0.001). The CMA increased from 115.71°±13.69° before operation to 145.58°±10.78° at the last follow-up ( F=41.44, P<0.001). Regarding the curvature of the cervical spine, the C 0-C 2 angle recovered from 1.94°±15.82° before surgery to 14.84°±6.45° at the last follow-up ( F=11.97, P<0.001), and the C 2-C 7 angle ameliorated from 27.26°±8.49° before operation to 19.26°±5.44° at the last follow-up ( F=11.13, P<0.001). Bony fusion was achieved in all cases, the fusion time was 9.71±2.55 months (range 5-15 months). A total of five complications occurred in the cases (two cerebrospinal fluid leakages, one deep infection, one transient neurologic deficit, and one dysphagia). They were all cured with corresponding treatments. In the last follow-up, none of the cases developed failure of internal fixation or re-dislocation. Conclusion:Posterior approach release, reduction, fixation and fusion technique is a safe and efficient surgical strategy with favorable long-term follow-up outcomes for irreducible AAD.
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Objective:To compare the diagnostic value of Copenhagen index (CPH-I), serum carbohydrate antigen 125 (CA125), human epididymis protein 4 (HE4), and risk of ovarian malignancy algorithm (ROMA) for diagnosis of ovarian cancer in premenopausal and postmenopausal women.Methods:The clinical data of 239 patients with ovarian tumor treated in People's Hospital of Rizhao in Shandong Province from January 2017 to January 2020 were retrospectively analyzed. The patients were divided into ovarian benign disease group (152 cases) and ovarian cancer group (87 cases) according to postoperative pathology. The receiver-operating characteristic curve (ROC) was drawn with surgical pathology as the gold standard; the area under the curve (AUC) and the sensitivity and specificity of CPH-I, CA125, HE4, ROMA were calculated. The diagnostic performance of CA125, HE4, ROMA and CPH-I for diagnosis of ovarian cancer was compared in overall, premenopausal and postmenopausal patients.Results:The CA125 level, HE4 level, ROMA index, and CPH-I predicted probability (PP) values of ovarian cancer group were higher than those of ovarian benign disease group, and the differences were statistically significant (all P < 0.01). The AUC of CA125, HE4, ROMA, and CPH-I in the overall patients was 0.935 (95% CI 0.896-0.963), 0.940 (95% CI 0.901-0.966), 0.964 (95% CI0.932-0.984), 0.964 (95% CI 0.932-0.984); the AUC differences of CA125 and ROMA, CA125 and CPH-I (PP values), HE4 and ROMA, HE4 and CPH-I PP values were statistically significant (P values were 0.036, 0.009, 0.018, 0.019). The AUC of HE4, ROMA, and CPH-I in the premenopausal patients was 0.947 (95% CI 0.896-0.978), 0.949 (95% CI 0.898-0.979), 0.944 (95% CI 0.893-0.976), which were all larger than AUC of CA125 (0.921) (95% CI 0.863-0.960), the differences were statistically significant (P values were 0.036, 0.036, 0.026); AUC of CA125, ROMA, CPH-I PP values in postmenopausal patients was 0.953 (95% CI 0.891-0.986), 0.947 (95% CI 0.882-0.982), 0.943 (95% CI 0.877-0.980), all of which were larger than AUC of HE4 (0.889) (95% CI 0.810-0.944), and the differences were statistically significant (P values were 0.029, 0.014, 0.015). Conclusions:The diagnostic efficacy of CPH-I and ROMA for ovarian cancer is comparable, and regardless of menopause or not, the diagnostic efficacy of CPH-I and ROMA is higher. The diagnostic efficacy of CPH-I and ROMA for ovarian cancer is better than that of CA125 and HE4 in overall patients, the diagnostic efficacy of CA125 is the lowest in premenopausal patients, and the diagnostic efficacy of HE4 is the lowest in postmenopausal patients.
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Objective:To compare the clinical efficacy and complications of combined anterior and posterior approach and simple posterior release reduction and internal fixation in the treatment of basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD) .Methods:The medical records of 47 patients with basilar invaginationdepression complicated with refractory atlantoaxial dislocation who received surgical treatment from July 2000 to December 2017 were retrospectively analyzed. The patients were divided into anterior and posterior combined approach group (23 cases) and posterior approach group (24 cases). Key observation indicators include: Chamberlain line (CL), Wackenheim line (WL), McGae line (ML), atlantodens interval (ADI), cervicomedullary angle (CMA), clivus-canal angle (CCA), JOA scores (Japanese Orthopedic Association, JOA) and Ranawat grade.Results:The average follow-up was 48.7±31.2 months in the A-P group and 44.4±33.4 months in the P group. The average preoperative JOA score of the A-P group was 8.20±2.75 points and 14.98±1.05 points at the last follow-up, and the improvement rate was 77.35%±11.35%. The average preoperative JOA score of the P group was 8.06±2.52 points, and the last follow-up was 14.71±0.62 points, and the improvement rate was 74.38%±10.52%. There was no statistically significant difference between the two groups in JOA score ( t=0.877, P=0.262) and improvement rate ( t=1.478, P=0.206) at the last follow-up. The preoperative CL, WL, ML, ADI, CMA and CCA angles of the A-P group were 13.12±5.76 mm, 6.94±3.55 mm, 7.04±4.57 mm, 9.75±2.06 mm, 110.85°±13.6°, 95.32°±18.3°, respectively. The last follow-up was 1.68±2.53 mm, -2.76±2.26 mm,-1.52±2.43 mm, 1.12±1.55 mm, 149.26°±12.6°, and 141.42°±13.7°, respectively, with statistically significant differences from preoperative. The preoperative CL, WL, ML, ADI, CMA and CCA angles of P group were 12.52±5.17 mm, 6.59±3.04 mm, 6.94±4.32 mm, 9.88±1.93 mm, 115.35°±12.4°, 97.25°±16.4°, respectively. The results of the last follow-up were 2.00±3.67 mm, -3.06±1.85 mm, -1.76±2.88 mm, 1.17±1.18 mm, 146.76°±11.4° and 137.56°±10.4°, respectively, which were statistically significant compared with the preoperative results. There was no significant difference between the two groups in preoperative and final follow-up. The average bone graft fusion time of the A-P group was 9.2±4.9 months, and the average bone graft fusion time of the P group was 9.5±4.7 months. There was no statistically significant difference in the bone graft fusion time between the two groups ( t=0.547, P=0.382). Postoperative complications occurred in a total of 8 cases in the two groups, including 6 cases (21.7%) in the combined approach group and 2 cases (8.3%) in the posterior approach group. The incidence of complications in the posterior approach group was significantly lower than that in the combined approach group. Conclusion:The clinical and imaging results of the treatment of basilar depression with atlantoaxial dislocation by one-stage posterior release reduction and internal fixation are basically the same as those obtained by the anterior and posterior combined approach, but the complication rate of the posterior approach is significantly lower than that of the anterior and posterior combined approach.
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Objective:To evaluated the indications, methods, outcomes and prognosis of surgical treatment for post-traumatic epiphyseolisthesis at odontoid process in children.Methods:Retrospective analysis was performed on 5 cases of children with delayed epiphyseolisthesis of odontoid process in our institution from July 2009 to October 2016, including 1 male and 4 females. Initial surgery age were at1.7~5.4 years old, averaged (39.6±19.4) months and were 0.67-8 months, averaged (87.0±95.1) days. Disease duration ranged from 23 days to 8 months, with an average of 88 days. X-ray, CT and MRI examinations of the occipital-cervical area were taken to evaluate the type of the fracture and the severity of spinal cord compression. Children were treated with anterior loosening combined with posterior fixation fusion or posterior loosening reduction and internal fixation respectively.The function of spinal cord was evaluated by Frankel scale at pre- and post- operation. During the follow-up, X-ray and CT were performed to assess the fusion condition of the grafted bone.Results:The duration of operation was ranged from 75-145 months, with an average of (101.0±20.7) months; Blood loss ranged from 50-100 ml, with an average of (70.0±21.2) ml; follow-up duration ranged from 6 to 48 months, with an average of (23.5±17.6) months. Two cases preoperatively evaluated as Frankel C and D recovered to postoperative Frankel E. Among the five cases, two received satisfactory reduction, two cases received incomplete reduction, and one experienced failure reduction. The epiphyseolisthesis and bone grafted sites achieved solid fusion at 6-15 months after surgery, with an average of (9.5±3.4) months. The physiological curvature of cervical remained well without bone resorption, nonunion, pseudoarthrosis, as well as screw loosening or broken. Internal fixation of 2 cases were removed.Conclusion:Children with post-traumatic epiphyseolisthesis at odontoid process are not common in clinical practice. The detailed diagnosis of medical history, physical examination and comprehensive imaging evaluation. The posterior approach technique of C1-2 was feasible and effective, which could obtain decompression, reconstruction andstability all together.
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Objective@#To introduce a new method for assessing coronal balance in surgical treatment of scoliosis, and to explore its effectiveness in preventing postoperative coronal imbalance.@*Methods@#The data of forty-six consecutive patients, who underwent posterior surgery for spine deformity correction from January 2016 to December 2016, were retrospectively analyzed. The series included 19 males and 27 females with an average age of 28.24±21.16 years (7-76 years), and with lower instrumented vertebra (LIV) located at the level of L3 or below. Point-line method was used to evaluate coronal balance by determining whether the center of upper instrumented vertebra was located at the measuring rod passing through the centers of symphysis pubis and LIV among all patients during surgery. Preoperative, postoperative 1 week and 3 months Cobb angle, coronal balance distance (CBD), Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and Scoliosis Research Society Questionnaires-22 (SRS-22) were measured and recorded, and statistical analysis was conducted. And then, subgroup analysis was performed according to preoperative coronal imbalance classification to further evaluate the effectiveness of the new method.@*Results@#Among 46 patients in this study, the prevalence of preoperative coronal imbalance was 47.82% (22/46). Of them, ten patients were type B coronal imbalance and eleven patients were type C coronal imbalance. The prevalence of coronal imbalance at one week after operation was 17.39% (8/46), and the prevalence of coronal imbalance at final follow-up was 10.87% (5/46). The results showed that the mean main Cobb angle was 57.24°±26.51° and 14.71°±10.17° at pre-operation and immediate post-operation, respectively. The difference was statistically significant compared to preoperative value (t=13.211, P=0.000), and the average improvement rate was 73.53%±1.88%. Preoperative coronal balance distance CBD ranged from 2.76 mm to 66.73 mm, with an average of 22.54±13.97 mm; the mean CBD was 16.00±14.85 mm at immediate post-operation. The difference was statistically significant (t=3.665, P=0.001), with an average correction rate of 25.58%±52.39%. Our clinical outcome analysis showed that among 46 patients, the preoperative VAS was 8.11±0.89, and the final follow-up VAS was 4.15±0.79. There was a significant difference between pre-operation and the last follow-up (t=21.529, P=0.000). The preoperative ODI score was 49.76±5.84, and the final follow-up ODI score was 25.74±3.92. The difference was statistically significant (t=44.434, P=0.000). The preoperative SRS-22 was 10.57±2.13, and the final follow-up SRS-22 was 21.89±2.35. Compared to pre-operation, the difference was statistically significant (t=24.023, P=0.000). The subgroup analysis showed that in patients with type B coronal imbalance, the mean Cobb angle correction rate was 70.34%±6.02% at immediate post-operation, and there was a significant difference compared to pre-operation (t=5.437, P=0.000); the average CBD correction rate was 37.45%±29.03%, and significant difference was found (t=2.607, P=0.028). In type C patients, the average Cobb angle and CBD correction rate at immediate post-operation was 72.92%±3.67% and 44.79%±5.63%, respectively, and significant difference was found (t=7.319, P=0.000; t=7.545, P=0.000).@*Conclusion@#Point-line method was a simple and effective technique for intraoperative assessment of coronal balance, which could assist surgeons to objectively evaluate the result of restoration of the coronal alignment. The use of point-line method is contributed to improve clinical outcomes of spinal deformity correction surgery, and to prevent the occurrence of postoperative coronal imbalance.
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Objective To evaluate the safety, feasibility and clinical efficacy of one-stage anterior transplantation with ili-ac crest allograft or autologous in the treatment of thoracolumbar tuberculosis. Methods From January 2012 to June 2015, 235 cases of thoracolumbar tuberculosis were treated with allogeneic or autologous iliac crest graft combined with internal fixation dur-ing one-stage after radical debridement, which were reviewed retrospectively. These cases were divided into two groups:allograft group (162 cases) and autograft group (73 cases). In allograft group, there were 87 males and 75 females, with a mean age of 42.5 (range 2-80) years. In autograft group, there were 41 males and 32 females, with a mean age of 40.3 (range 14-68) years. The oper-ation time, bleeding volume, hospital stay, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level, visual ana-logue scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores, the changes of American Spinal Injury Association (ASIA) scale for neurological classification of spinal and graft fusion satisfaction rate in each groups were evaluated respectively before and after surgery. Results The operation time was (122.41±30.55) min in allograft group and (141.56±25.69) min in auto-graft group, the difference was statistically significant. The average hospital stay and bleeding volume were no significant differ-ence between the two groups. In each group, VAS scores, JOA scores, ESR and CRP level and the changes of ASIA scale were sig-nificant difference between pre-and post-operation, but these index showed that there were no significant differences between the two groups. The mean ESR level was (16.46±7.39) mm/h in allograft group, and (13.61±6.85) mm/h in autograft group 3 months af-ter the operation. The fusion time (8.13 ± 1.97) months in allograft group was significantly longer than that in autograft group (5.37± 1.72) months, the difference was statistically significant. At final follow-up, the graft fusion satisfaction rate and the changes of ASIA showed no significant difference. Perioperative complications including gastrointestinal dysfunction in 5 cases (allograft group in 3cases;autograft group in 2cases), and pulmonary infection in 6 cases (allograft group in 4cases;autograft group in 2cas-es). Postoperative complications including kyphosis in 4 cases (allograft group in 3cases;autograft group in 1case), tuberculosis re-currence in 5 cases (allograft group in 3cases;autograft group in 2cases), sinus formation in 5 cases (allograft group in 3cases;auto-graft group in 2cases), chronic pain of the donor site in 6 cases (group autograft). Conclusion There was no significant difference between allogeneic iliac graft and autologous iliac graft in the treatment of thoracolumbar tuberculosis. Allogeneic iliac bone may be the ideal substitute of autologous iliac bone for the clinical treatment of thoracolumbar tuberculosis.
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Objective To evaluate the safety, feasibility and clinical efficacy of one-stage anterior transplantation with ili-ac crest allograft or autologous in the treatment of thoracolumbar tuberculosis. Methods From January 2012 to June 2015, 235 cases of thoracolumbar tuberculosis were treated with allogeneic or autologous iliac crest graft combined with internal fixation dur-ing one-stage after radical debridement, which were reviewed retrospectively. These cases were divided into two groups:allograft group (162 cases) and autograft group (73 cases). In allograft group, there were 87 males and 75 females, with a mean age of 42.5 (range 2-80) years. In autograft group, there were 41 males and 32 females, with a mean age of 40.3 (range 14-68) years. The oper-ation time, bleeding volume, hospital stay, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level, visual ana-logue scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores, the changes of American Spinal Injury Association (ASIA) scale for neurological classification of spinal and graft fusion satisfaction rate in each groups were evaluated respectively before and after surgery. Results The operation time was (122.41±30.55) min in allograft group and (141.56±25.69) min in auto-graft group, the difference was statistically significant. The average hospital stay and bleeding volume were no significant differ-ence between the two groups. In each group, VAS scores, JOA scores, ESR and CRP level and the changes of ASIA scale were sig-nificant difference between pre-and post-operation, but these index showed that there were no significant differences between the two groups. The mean ESR level was (16.46±7.39) mm/h in allograft group, and (13.61±6.85) mm/h in autograft group 3 months af-ter the operation. The fusion time (8.13 ± 1.97) months in allograft group was significantly longer than that in autograft group (5.37± 1.72) months, the difference was statistically significant. At final follow-up, the graft fusion satisfaction rate and the changes of ASIA showed no significant difference. Perioperative complications including gastrointestinal dysfunction in 5 cases (allograft group in 3cases;autograft group in 2cases), and pulmonary infection in 6 cases (allograft group in 4cases;autograft group in 2cas-es). Postoperative complications including kyphosis in 4 cases (allograft group in 3cases;autograft group in 1case), tuberculosis re-currence in 5 cases (allograft group in 3cases;autograft group in 2cases), sinus formation in 5 cases (allograft group in 3cases;auto-graft group in 2cases), chronic pain of the donor site in 6 cases (group autograft). Conclusion There was no significant difference between allogeneic iliac graft and autologous iliac graft in the treatment of thoracolumbar tuberculosis. Allogeneic iliac bone may be the ideal substitute of autologous iliac bone for the clinical treatment of thoracolumbar tuberculosis.
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Objective To evaluate the safety and effectiveness of one stage surgery of release and bone reduction by posterior approach to treat basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD),and to explore the indications and crucial techniques of posterior approach.Methods All of 17 Consecutive patients (8 males and 9 females) with BI and IAAD who underwent release and reduction by posterior approach from July 2000 to June 2015 were enrolled in the present study,the mean age was 35.2±13.8 years with a range of 12-56 years.The clinical symptoms and signs was recorded,and preoperative imaging examination,including anteroposterior,lateral,dynamic films,MRI and CT of cervical spine,were performed to identify the series.There were 14 cases with atlanto-occipital fusion,7 cases with C2,3 fusion,6 cases with Chiari malformation,6 cases with Syringomyelia,and 8 cases with myelomalacia.The clinic symptoms include occiput/neck pain in 15 cases,cervical movement limitation in 13 cases,short neck in 9 cases,torticollis in 12 cases,Paresthesia in 14 cases,weakness in 13 cases,tendon reflexes hyperfunction in 16 cases and ataxia in 13 cases.The postoperative X-rays,MRI or CT were used to observed the results of decompression,fixation and fusion.Neurological function was assessed by JOA scale and Ranawat's score before,after surgery and at final follow-up.Pre-and post-operative Chamberlain (CL),Wackenheim (WL),McGae (ML),atlantodental interval (ADI) and cervico-medullary angle (CMA) were analyzed by student t-test.Results The average operation time was 145 mins (90-210 mins) and blood loss was 175 ml (150-350 ml).The average follow-up was 44.47 months (9-94 months).JOA score was increased from 8.06 preoperatively to 15.20 postoperatively,the improvement rate was 77.2％.Preoperative Ranawat's score was Ⅱ in 1 case,Ⅲla in 12 cases,ⅢB in4 cases.Postoperative score was Ⅰ in 13 cases,Ⅱ in 4 cases.The preoperative CL,WL,ML,ADI and CMA were (12.52±5.17) mm,(6.59±3.04) mm,(6.96±4.32) mm,(9.88± 1.93) mm,115.35°± 12.40°,respectively.and the postoperative CL,WL,ML,ADI and CMA were (2.0±3.67) mm,(-3.06±1.85) mm,(-1.76±2.88) mm,(1.17± 1.18) mm,136.76°±11.44°,respectively.The perioperative complications were discovered in 2 cases,including 1 case of infection and1 case of cerebrospinal fluid(CSF) leakage.Conclusion Primary surgery of nerve release and bone reduction by posterior approach may be safe and efficient for the treatment of BI and IAAD.Preoperative evaluation,proper surgical indications and advanced surgical techniques are important for treatment results.
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BACKGROUND: Studies showed that both anterior cervical disc replacement and anterior cervical decompression and fusion can achieve good clinical result in cervical spondylosis. However, it is not conclusive about which kind of surgical method has an advantage in avoiding the adjacent segment degeneration. OBJECTIVE: To compare the effect on adjacent segment degeneration of single segment cervical disc herniation treated with anterior cervical decompression and fusion and anterior cervical disc replacement. METHODS: We col ected clinical data of 178 patients with cervical disc herniation and receiving anterior cervical disc replacement or anterior cervical decompression and fusion from January 2009 to December 2012. A retrospective analysis was performed. There were 116 cases in the anterior cervical decompression and fusion group and 62 cases in the anterior cervical disc replacement group. RESULTS AND CONCLUSION: (1) Evaluation: visual analogue scale score, Japanese Orthopaedic Association Scores and neck disability index were improved significantly in both groups during final fol ow-up compared with that pre-treatment (P 0.05). At 3 months after surgery, in the anterior cervical decompression and fusion group, surgical segment was confluent, and range of motion lost. During final fol ow-up, range of motion of adjacent upper segment and adjacent lower segment was significantly increased, and the increased range of motion in the upper segment was bigger than that of the lower segment (P < 0.05). (3) During final fol ow-up, X-ray films and MRI images revealed the number of degenerated adjacent segment was more in the anterior cervical decompression and fusion group than in the anterior cervical disc replacement group (P <0.05). The number of degenerated middle and upper segments was more than that of the lower segment in both groups (P < 0.05). (4) The findings confirmed that anterior cervical disc replacement or anterior cervical decompression and fusion for treating cervical disc herniation could effectively relieve nerve symptoms of patients. However, compared with the anterior cervical disc replacement, adjacent segment degeneration occurs more commonly after anterior cervical decompression and fusion.
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Objective To evaluate the effect of treatment of the intervertebral infection via single?stage posterior midline incision and bilateral muscle gap approach. Methods A retrospective of 39 cases (male 25 cases, female 14 cases) of lumbar in?tervertebral infected patients from October 2012 to December 2014 who were treated by posterior debridement, interbody fusion using allograft and posterior instrumentation through paraspinal muscle gap approach were analyzed, whose mean age was 48 years (range 11-70 years). According to the confirming diagnosis, patients underwent postoperatively anti?inflammatory or chemotherapy treatment. The disease controlling statues were evaluated based on laboratory results of ESR, CRP;Imaging examinations were tak?en to evaluate the fusion of vertebral body;Clinical effects were evaluated using the Visual Analog Scale (VAS) and the JOA score of lumbar function. Results In these 39 cases of intervertebral infection patients, 8 cases ware diagnosed as pyogenic infec?tious, 25 cases were diagnosed as tuberculosis infections, 2 cases were diagnosed as unknown infections, and brucellosis infec?tious was found in 4 cases. All patients' symptoms were significantly improved. The lower back VAS score: average 8.22±0.93 points before operation, average 2.21 ± 0.88 points one week after operation, and an average score of 0.80 ± 0.58 points by the last follow?up time. The lower extremity VAS score: average 2.32 ± 1.82 points before operation, average 1.89 ± 0.62 points one week after operation, and an average score of 0.61±0.47 points by the last follow?up time. All patients were followed up for 12-18 months (average 13 months), One patient with pyogenic infectious occurred wound infection 1 week postoperatively, and healed after a repeatedly surgery. No internal fixation loosening, fracture, or segmental collapse was observed ,and good fusion was present in all patients after 12 months. JOA lumbar function score: all patients were effective after operation, the improve?ment rate was excellent in 76.9%, good in 17.9%, and passable in 5.2%. Comparing with preoperation, the excellent and good rate was 94.8%. Conclusion The treatment of lumbar intervertebral infection via single?stage posterior midline incision and bi?lateral muscle gap approach was clinically effective, which can completely remove the lesion, and achieve rigid internal fixation.
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BACKGROUND:The method in repair of primary lumbar intervertebral infection is different in different positions, mainly containing anterior, posterior and anteroposterior pathways. In posterior pathway, muscle gap approach is recognized by many fel ows. This program has its special advantage compared with conventional posteromedial approach. OBJECTIVE:To evaluate the clinical effects of debridement, bone graft and internal fixation of pedicle screw placement in repair of primary lumbar intervertebral infection through posterior paraspinal muscle approach. METHODS:Clinical data of 13 patients with primary lumbar intervertebral infection were analyzed retrospectively. There were one case of L 2-L 3 , two cases of L 3-L 4 , four cases of L 4-L 5 and six cases of L 5-S 1 . Lumbar pain was obvious in al patients. Nine cases suffered from radioactive lower limb pain. Al patients received debridement, bone graft and internal fixation of pedicle screw placement through paraspinal muscle approach via posteromedial incision. After treatment, clinical effects were evaluated using Visual Analog Scale and lumbar Japanese Orthopaedic Association scores. RESULTS AND CONCLUSION:Al patients were fol owed up for 12-18 months, no recurrence. X-ray review demonstrated bony fusion, so loosening and breakage were not found in al patients. Visual Analog Scale scores revealed that Visual Analog Scale score was 8.15 preoperatively, 2.15 at 1 week postoperatively, 1 at final fol ow-up, showing significant difference (P<0.05). There was significant difference in pain between pre-treatment and post-treatment, and pain apparently relieved after treatment. Lumbar Japanese Orthopaedic Association score showed that effective outcomes were found in al patients after treatment, including nine cases of excel ent effects, three cases of good effects, one case of average effects, with the excel ent and good rate of 92%. Above findings confirmed that one-stage debridement, bone graft and internal fixation of pedicle screw placement through posterior muscle gap approach provides a good repair method for patients with primary lumbar intervertebral infection. It can achieve intervertebral space directly through intervertebral foramen, retain the central spinous process and lamina, reduce the injury to paraspinal muscle, and keep spinal ligament complex. However, strong spine fixation contributes to bone fusion, and keeps the stability of the spine after repair.
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28 days after injury (P < 0.05). In the fracture+spinal cord injury group, the level of serum transforming growth factor beta 1 had a rapid increase on the 7th day, and reached the peak on the 14th day, and then, this level had no significant decrease until the 28th day. In the simple fracture group, the level of serum transforming growth factor beta 1 began to increase on the 2nd day, reached the peak on the 7th day, and then decreased gradualy. Remarkable changes of serum transforming growth factor beta 1 levels in patients with bone fracture combined with spinal cord injury may be associated with fracture healing in different periods.
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BACKGROUND:In the animal model of spinal cord injury associated with fractures, the trauma is severe and postoperative survival rate is low. The improved Al en method and open femoral osteotomy method for making animal model has many advantages, such as simple operation, no need of special equipment, quick establishment, shortened operation time and reduced intraoperative bleeding, so they are suitable for preparing a femoral fracture model combined with spinal cord injury. OBJECTIVE:To design an animal model of femoral fracture combined with spinal cord injury, which can maintain long time survival, meet clinical features, and is simple and easy. METHODS:Forty-eight male Sprague-Dawley rats were randomly divided into simple femoral fracture group and femoral fracture merging spinal cord injury group. Femoral fracture model was caused by opening osteotomy to cause transverse fracture and implantation of internal fixator in femur. According to the improved Al en method, a self-made blow device was applied to cause acute T 10 segment contusion injury of spinal cord in rats. Thus the femoral fracture model merging spinal cord injury was successful y established. The rats in two groups were grossly observed at different time points after the modeling, and the fracture healing at 4 weeks was detected. RESULTS AND CONCLUSION:Al the animal models of femoral fracture with spinal cord injury survived, which exhibited the loss of sensory and motor function of the lower limbs, but could slowly creep forward by the upper limbs. In the first 3 days, the rats had poor appetite and few activity, with tail suspension at night there were no ischemia and necrosis of the limb fracture. At 4 weeks, one rat in simple femoral fracture group died, while four rats in femoral fracture merging spinal cord injury group died, with the survival rate of 83.33%, intramedul ary fixation were not prolapsed. In the two groups, continuous bone cal us formation was found in the fracture, and the bone cal us volume in femoral fracture merging spinal cord injury group was significantly higher than those in simple femoral fracture group. The results demonstrated that combining the improved Al en method with smal lateral incision open femoral osteotomy is a simple and feasible method for the establishment of femoral fracture model merging spinal cord injury, and the models survive for 4 weeks.
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Objective To evaluate the efficacy and safety of one-stage posterior wedge osteotomy ffor correction ot kyphosis or kyphoscoliosis in children with healed stages of spinal tuberculosis.Methods From January 2002 to December 2012,we retrospectively reviewed 18 patients with tuberculosis of the spine in healed stages which underwent one-stage posterior wedge osteotomy.There were 6 males and 12 females,whose average age was 8.2 (4 to 15) years and average followed-up time was 37.1 (10 to 120) months.The apical vertebrae were located at cervicothoracic segment in 2 cases,thoracic segment in 10 cases,thoracolumbar segment in 5 cases and lumbar segment in 1 case.The lesions involved 2 segments in 3 cases,3 to 5 segments in 9 cases and more than 5 segments in 6 cases.There were 6 cases with neurological dysfunction whose Frankel' s classification was C in 2 cases and D in 4 cases.The coronal and sagittal Cobb angels,thoracic kyphosis,lumbar lordosis,sagittal trunk shifts,number of fixation and fusion segments and bony union were measured on the standing AP and lateral radiographs before,after surgery and at the final follow-up.Results The Cobb' s angels in the sagittal plane were corrected from 71.6° to 14.5°,representing 79.7％ correction rate.The Cobb' s angels in the coronal plane were corrected from 9.4° to 0.7°.Sagittal trunk shift was obviously improved from 3.7mm to 0.5mm.The average fixation segment was 9.6 (5 to 17) segments while the average fusion segment was 4.4 (2 to 8) segments.The neurological function had all been improved at final follow-up.Perioperative complications consisted of fixation loosening in 4 cases,gastrointestinal dysfunction in 2 cases,pleura injury in 5 cases,and cerebrospinal fluid leakage in 3 cases.Conclusion One-stage posterior wedge osteotomy is a safe and effective surgical technique for correction of kyphosis or kyphoscoliosis in children with healed stages of spinal tuberculosis.Both the selection of fusion levels and the appropriate technique of osteotomy are crucial to good outcomes.
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Objective To study the clinical,laboratory,imaging characteristics and surgical outcomes of Brucellar spondylitis.Methods The clinical,laboratory,imaging characteristics and surgical outcomes of 27 patients with Brucella spondylitis were analyzed in our department from September 2000 to December 2010.There were 18 males and 9 females,aged from 23 to 57 years(average,32.8 years ).There were 3 cases in cervical vertebra,8 cases in thoracolumbar vertebra,16 cases in lumbosacral vertebra respectively.Before admission,17 patients were misdiagnosed as tuberculosis,2 ones were as postoperative change of lumbar disc herniation.Eight patients underwent posterior debridement,autologous bone grafting and instrumentation,19 cases were treated with anterior debridement,autologous bone grafting and instrumentation.Streptomycin was placed in localized lesions for 24 patients,except for 3 cases whose streptomycin skin test positive.External fixation brace were used for 4 to 6 weeks,oral medication was used for a half month to 3 months.Clinical evaluation included clinical cure rate,pain visual analog scale (VAS) and the fusion rate.Results All of 27 patients were followed up for an average of 19.7 months (range,6 to 48 months).According to evaluation standard for Brucella spondylitis,24 patients were cured,3 patients got improvement.Three patients underwent the second operation owing to wound infection and sinus formation.Conclusion The pain of spine with intermittent fever,the imaging features as well as positive serum agglutination test can confirm the diagnosis of Brucellar spondylitis.Operation should be considered in patients with persistent pain and neurologic disorders as well as systemic symptoms.Instrumentation is effective and safe in the treatment of patients with spinal brucellosis following debridement,autogenous bone grafting,combined with antibiotic therapy.
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Objective To evaluate the clinical effects of a single posterior translaminal or transforaminal debridement and internal fixation with bone graft for the treatment of lumbosacral regional spinal tuberculosis. Methods From January 2004 to October 2009, 32 patients with lumbosacral regional spinal tuberculosis were treated by a single posterior debridement and internal fixation with bone graft, including 21 males and 11 females with the mean age of 46 years (range, 32-65). The lesions located: 3 in L3,4, 19 in L4,5, 10 in L5S1. 20 cases were pedormed operation via translaminal approach, 12 via transforaminal approach. The modified Prolo scale, visual analogue scale (VAS), kyphosis angle and the vertebral body loss were measured before and after surgery, and in the final follow-up. Results All the patients were followed up for average 16 months (range, 12-24). The pre-, postoperative and final follow-up mean kyphosis angle were -24.3°,-34.8°, and -32.4° in the translaminal group, -25.4°, -35.2°, and 33.6° in the transforaminal group,respectively. According to the modified Prolo scale, the excellent and good result was 93.8%. VAS decreased significantly from 7.6 points to 2.9 after surgery. Conclusion Debridement and internal fixation with bone graft via a single posterior approach for the treatment of lumbosacral regional spinal tuberculosis was an easy and effective technique. The appropriate selection of indications, careful imaging evaluation and thorough surgical debridement played an important role in the treatment of lumbosacral regional spinal tuberculosis.
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[Objective]To introduce the safety of the spinal wedge osteotomy by a single posterior approach and to discuss the selection of fusion and fixation. [Method]Sixteen patients with severe post-adolescent congenital spinal deformities were treated by spinal wedge osteotomy by a single posterior approach from February 2000 and July 2006.There were 10 males and 6 females with an average age of 21.4 years(range 16 to 29 years).There were 11 patients with hemivertebre and 5 with fused ribs or bone bridge.Two patients had previous surgery history.The average Cobb's angles of scoliosis and kyphosis before operation were 84.7 ?and 52.6?.The average trunk shift was 15.4 mm.Bony septum in the canal was found in 2 patients on the preoperative CT or MRI.[Result]The follow-up ranged from 2 to 4 years with an average of 2 years and six months.The average fused vertebrae were 10.6 segments(range 8 to 14 segments).The postoperative average Cobb's angles of scoliosis and kyphosis were 38.5 and 27.7.The average correction rates of scoliosis and kyphosis were 54.5% and 47.4%.The average trunk shift was improved to 4.6 mm.There was no significant correction loss of the scoliosis,kyphosis and trunk shift at final follow-up evaluation.No patient developed severe complications except that two had pedicle fracture,one had L1 nerve root injury,one had superior mesenteric artery syndrome and one had exudates of incision.[Conclusion]Spinal wedge osteotomy by the single posterior approach is a reliable and safe surgical technique for correcting severe post-adolescent congenital spinal deformities.
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Objective To evaluate the operative technique and the short-term clinical results of ce-mentless total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) in adults with high level dislocation. Methods Nine patients (11 hips) with DDH of Hartofilakidis type Ⅲ, who underwent cement-less THA between 1997 and 2002, were analyzed. Of 9 patients, 8 were females, and 1 male with an average age of 29.4 years (range, 17 to 56 years). There were unilateral DDH in 7, and bilateral in 2. The patients had no previous surgery. The preoperative average length difference between the two legs was 4.1 cm (range, 0 to 7 cm). The femoral head was dislocated upward from the normal position by 4.8 cm on average (range, 3.2 to 7.0 cm). The Zweym?ller cup was placed on the original acetabulum in all patients with more than 80% bony coverage on the cup, and no bone graft needed. In 4 hips with more than 5 cm of displacement, the reduction of prosthesis was achieved by shortening osteotomy below lesser trochanter. The preoperative average Harris score was 40.2. Results All of 9 patients were obtained follow-up of X-ray films and clinical evaluation. The follow-up ranged from 6 to 32 months with a mean of 18.2 months, the osteotomy of 4 hips were bony healed at 3 months postoperatively showed by X-ray films. The postoperative average difference of the two leg length reduced to an average 1.1 cm (range, 0 to 3 cm), and the postoperative average Harris score increased to 90. Femoral nerve impairment occurred in 1 case, and recovered 4 months later. There were no loosening, dislocation and infection at follow-up. Conclusion Based on the short-term results of the cementless total hip arthroplasty for the developmental dislocation of the hip in adults with high level dislocation, it is proven to be a good technique, and the satisfied clinical results would be obtained.