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Objective To comparemodified bone cement injection sleeve (front end closed,unilateral opening) and traditional straight push bone cement sleeve in percutaneous vertebral plasty (PVP) for clinical application.Methods From January 2015 to June 2016,78 patients with PVP indications of single osteoporotic vertebral compression fracture (OVCF) were randomly divided into a study group and a control group (39 patients for each group),and both groups received PVP under DSA.Intraoperative X-ray exposure dose,surgical duration,postoperative bone cement leakage,VAS score (preoperative and postoperative 3 days and 6 months),and refracture rate after half a year and postoperative bone cement distribution were compared between the two groups.Results Both groups received a follow-up for 6 to 12 months.5 patients had paravertebralleakage in the study group,while 9 patients developed paravertebralleakage and orie patient had anterior leakage in the control group.No neurologic and vascular injury occurred,no pulmonary embolism and other serious complications developed.The patients in both groups were followed up for half a year without re-fracture.The radiation dose and surgical duration in the two groups were statistically significant (P＜0.05).Bone cement injection and postoperative VAS scoresdid not differ obviously between the two groups (P＞0.05),There was no significant difference between the two groups in distribution of bone cement (P＞0.05).The bone cement leakage rate was lower in the study group than in the control group,with a statistical significance (P＜0.05).Conclusions The improvement in bone cement injection sleeve can shorten surgical duration,reduce intraoperative X-ray exposure,and decrease the rate of leakage of bone cement.It is worth popularizing clinically.
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BACKGROUND:Short-segment pedicle screw technology has been extensively used in the treatment and repair of thoracolumbar burst fractures. The technique of operative treatment through the paraspinal muscle approach has advantages such as less trauma and bleeding, and rapid recovery. However, it requires further investigations to verify the superiority of the paraspinal muscle approach of two lateral incisions near the posterior median line. OBJECTIVE:To evaluate the clinical efficacy and Cobb’s angle of short-segment pedicle screw fixation through paraspinal muscle approach of two lateral incisions near the posterior median line in the treatment of thoracic and lumbar fractures. METHODS:From September 2010 to June 2012, 56 patients with thoracic and lumbar fractures were included in the retrospective study, including 42 males and14 females, with an average of 45 years (range 18-59 years). According to the surgical approach, patients were divided into two groups, traditional approach (n=25) and paraspinal muscle approach (n=31). The operative time, intraoperative blood loss, postoperative drainage and postoperative ambulant time in the two groups were observed and compared. The visual analog scale scores at 7 days, 1 month and 6 months postoperatively were recorded. The Cobb’s angles of suffered vertebra were measured preoperatively and at 7 days and 6 months postoperatively. RESULTS AND CONCLUSION:Al patients were fol owed up after internal fixation. The paraspinal muscle approach was superior to traditional approach in the operation time, intraoperative blood loss, postoperative drainage and postoperative ambulant time, and visual analog scale scores at 7 days and 1 month postoperatively (P0.05). The short-segment pedicle screw fixation through paraspinal muscle approach of two lateral incisions near the posterior median line in the treatment of thoracic and lumbar fractures, is an effective and minimal y invasive treatment, with less trauma, less bleeding, rapid recovery, and simple operations. Similar to open surgery, this treatment can recover the anatomical morphology and reconstruct spinal stability, and had good biocompatibility to the host.
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Objective To compare the clinical effects in patients treated with anterograde reamed intramedullary nail (IMN) and dynamic compression plate (DCP) for diaphyseal fractures of the humerus.Methods Forty-seven patients with diaphyseal fractures of the humerus,were divided into two groups by random digits table:IMN group (23 cases) and DCP group (24 cases),IMN and DCP were performed fixation,respectively.After the surgery,perioperative,functional outcomes of shoulder and elbow,postoperative complications between two groups were compared.Results The average follow-up time was (22.3 ± 5.7)months,3 cases were lost in 12-month-follow-up,1 case in IMN group and 2 cases in DCP group.The operation time,intraoperative blood loss in IMN group were significantly shorter than those in DCP group [(67.7 ± 15.3) min vs.(87.0 ± 12.5) min,(106.3 ±57.6) ml vs.(226.7 ±60.2) ml,P＜0.05].The incidence rate of subacromial impingement in IMN group was significantly higher than that in DCP group [18.2％ (4/22) vs.0,P ＜ 0.05].The incidence rate of wound infection in IMN group was significantly better than that in DCP group [4.5％(1/22) vs.22.7％(5/22),P ＜ 0.05].There were no statistically significant differences between two groups in other indexes (P ＞ 0.05).Conclusions DCP has some advantage in perioperative period,but they are comparable in the functional outcomes of shoulder and elbow and complications.
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Objective To evaluate the clinical efficacy of multiple target burst frequency thermocoagulation in treatment of lumbar disc herniation.Methods One hundred and twelve patients suffering from lumbar disc herniation were treated with stepped heating multiple target burst frequency thermocoagulation using of domestic R-2000B radiofrequency ablation machine.The visual analogue scale (VAS) score,Oswestry disability index (ODI) and effect of grade before operation and after operation were compared.Results The VAS score before operation was (7.60 ± 1.12) scores,3 d after operation was (3.10 ± 1.05) scores,6 months after operation was (2.90 ± 0.92) scores,there was significant difference between before operation and 3 d,6 months after operation (P ＜ 0.05).The ODI before operation was 47.6 ± 8.3,3 months after operation was 25.5 ± 6.7,6 months after operation was 23.7 ± 6.2,there was significant difference between before operation and 3,6 months after operation (P ＜0.05).The clinical efficacy:excellent grade was in 66 cases,the good was in 32 cases,the improvement was in 10 cases,the inefficacy was in 4 cases,the excellent and good rate was 87.5％ (98/112).There was no nerve injury,infection or death after operation.Conclusion Multiple target burst frequency thermocoagulation in the treatment of lumbar disc herniation has the advantages of little incision and tissue damage,fast recovery,good clinical outcome,it is worth to clinical practice.