ABSTRACT
Objective:To investigate the efficacy of opening wedge high tibial osteotomy (OWHTO) in the treatment of knee osteoarthritis, and analyze the related factors that affect its clinical efficacy.Methods:The clinical data of 80 patients with knee osteoarthritis who underwent OWHTO between December 2016 and May 2020 in Hospital of the Marine Police Corps of the Chinese People's Armed Police Force were retrospectively analyzed. These patients were divided into effective group ( n = 76) and ineffective group ( n = 4) according to clinical efficacy. The Visual Analogue Scale (VAS), the Hospital for Special Surgery Knee Score (HSS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) were used to assess the severity of knee osteoarthritis before and 3 months after surgery. The influential factors of clinical efficacy were analyzed. Results:VAS score, WOMAC score, HSS score, joint pain, joint function, joint range of motion, muscle strength, and flexion deformity of 80 patients post-surgery were improved compared with those pre-surgery ( t = 24.92, 21.45, 52.62, 15.87, 10.88, 15.28, 42.54, 11.07, all P < 0.05). After surgery, excellent outcomes were observed in 29 (36.25%) patients, good outcomes in 34 (42.50%) patients, fair outcomes in 13 (16.25%) patients, and poor outcomes in 4 (5.00%) patients. Body mass index, preoperative VAS score, and preoperative WOMAC score in the effective group were (24.10 ± 3.06) kg/m 2, (5.55 ± 1.57) points, and (36.96 ± 9.62) points, respectively, which were significantly lower than those in the ineffective group [(27.64 ± 3.62) kg/m 2, (7.87 ± 1.39) points, (47.95 ± 9.63) points, t = 2.23, 2.89, 2.22]. HSS score in the effective group was significantly higher than that in the ineffective group [(52.81 ± 3.71) points vs. (46.83 ± 3.69) points, t = 3.14, P < 0.05)]. Body mass index, preoperative VAS score, and preoperative WOMAC score were positively correlated with clinical efficacy ( r = 0.24, 0.31, 0.24, P < 0.05), and preoperative HSS score was negatively correlated with clinical efficacy ( r = -0.33, P < 0.05). Logistic regression analysis was performed to analyze the above markedly related factors. Preoperative HSS score was an independent protective factor of clinical efficacy of OWHTO, and body mass index and preoperative VAS score were risk factors of clinical efficacy of OWHTO. Conclusion:OWHTO can greatly improve knee function of patients with knee osteoarthritis and reduce postoperative pain. It should be noted that excessive obesity may affect the clinical efficacy of OWHTO, and preoperative VAS score and WOMAC score should be controlled in patients with excessive obesity.
ABSTRACT
Objective To examine the feasibility and early effects of unilateral pedicle screw fixation in combination with contralateral translaminar facet screw fixation plus interbody fusion through the channel-assisted muscle-splitting approach for the treatment of degenerative lumbar spine diseases in elderly patients.Methods A total of 82 elderly patients with degenerative lumbar spine diseases received treatment between January 2015 and June 2016.Of these patients,25 had lumbar spinal stenosis,42 had degenerative lumbar instability,13 had giant lumbar disc herniation,and two had recurrent lumbar disc herniation;There were 69 cases of single segment and 13 cases of double segment lesions.Perioperative evaluation,imaging evaluation,and clinical evaluation were performed,and surgical complications were analyzed.Results The average length of incision was (2.6 ± 0.4) cm in cases of single segment lesions and (4.4±0.5) cm in cases of two segment lesions.The mean operation time was (98.3±19.6) minutes and peri-operation blood loss was (232.2±25.8) ml.The post-operation height of the intervertebral disc space significantly increased at the last follow-up(P ＜ 0.05);the height of the intervertebral disc space was restored and well maintained with internal fixation showing no loosening,breakage or Cage shift.The post-operation lumbar coronal Cobb angle decreased(P＜0.05)while the sagittal Cobb angle increased(P＜0.05)at the last follow-up.There was no significant difference in the area and grade of the multifidus muscle on MRI 12 months after operation.Seventy-two patients were followed up for 12-18 months (mean =16.8 months),and there were 67 cases of intervertebral fusion (93.1％).The last follow-up showed a Japanese Orthopaedic Association(JOA) score of (25.8 ± 1.7),which was significantly higher than the pre-operation score (10.6±1.3),with an excellence rate of 88.9 ％.The Oswestry Disability Index score was significantly reduced,from (50.9±21.6) at pre-operation to (9.6± 4.8) at the last follow-up.There were 78 patients with primary wound healing,three cases of superficial wound necrosis,one case of dural tear,and one case of nerve root injury.No cardiovascular or cerebrovascular incident was observed during or after operation.Conclusions Combined pedicle/facet screw fixation plus interbody fusion through the channel-assisted muscle-splitting approach shows satisfactory short-term effects when used for the treatment of degenerative lumbar spine diseases in the elderly and possesses advantages such as minimal invasiveness,limited bleeding,quick recovery,high fusion rates and significantly improved clinical outcomes.However,further clinical studies are required to assess its medium-and long-term efficacy.
ABSTRACT
Objective To investigate the feasibility and effectiveness of bilateral pedicle screw fixation combined with in-terbody fusion for the treatment of lumbar spondylolisthesis (degree Ⅱ or Ⅲ) through muscle-splitting approach. Methods There were 52 patients (16 males and 36 females) analyzed in our study from January 2012 to December 2015. The average age was 54.9 ± 7.21 years (from 35 to 70 years). The history of disease was from 10 months to 15 years, with an average of 66.6 ± 32.71 months. Diagnosis included:degenerative spondylolisthesis in 2 cases, and isthmic spondylolysis in 50 cases. The sites included L4,5 in 18 cases and L5S1 in 34 cases. The degree was Ⅱ in 35 cases and Ⅲ in 17 cases. 27 cases were treated by bilateral pedicle screw fixation combined with interbody fusion through median incision approach (open group) and 25 cases through muscle-split-ting approach (minimally invasive group). The clinical and imaging results were observed and compared between the two groups, including operation time, intraoperative blood loss, postoperative incision drainage, VAS score of lumbar incision pain at 72h post-operative, intraoperative and postoperative complications, interbody fusion rate, multifidus muscle areas and grades at 1 year post-operative, and the improvement of ODI index. Results All the cases were operated successfully. The operation time of open group was shorter than minimally invasive group. However, the intraoperative blood loss and postoperative incision drainage of minimally invasive group was statistically less than open group. The VAS scores of postoperative 72 h were 3.25 (2 to 6) in open group and 1.62 (1 to 3) in minimally invasive group. And the difference was statistically significant. The misplacement rate of pedi-cle screws of minimally invasive group was lower than open group. The average follow-up time was 25.5 months (ranged from 12 to 36 months). The multifidus muscle areas and grades of minimally invasive group were superior to open group at 1 year postopera-tively. Compared to preoperative, the slipping angle, slipping rate, sacral inclination angle and vertebral space height were signifi-cant improved after operation in two groups. The ODI index was improved postoperatively in both two groups, and the difference was statistically significant at the final follow-up. The interbody fusion rate was 92.6％in open group and 96％in minimally inva-sive group, and there was no significant difference between the two groups. No cerebrospinal fluid leak, never injury, pedicle frac-ture or wound infection was found after the operation in two groups. There was no pedicle screw loosening, cage shifting, or degen-eration of the adjacent segment observed during follow-up. Conclusion Bilateral pedicle screw fixation combined with inter-body fusion through muscle-splitting approach has advantages of small incision, less trauma, less bleeding, quick recovery and well clinical results, which can be a better choice in treating lumbar spondylolisthesis (degree Ⅱ or Ⅲ).
ABSTRACT
Objective To investigate the efficacy of modified 270°spinal canal decompression combined with one-stage pedicle screw fixation and vertebral reconstruction for severe thoracolumbar fractures.Methods A retrospective case-control study was made on 44 cases of severe thoracolumbar fractures treated from January 2009 to June 2014.There were 34 males and 10 females, with age range of 20-68 years (mean, 37.9 years).The injured vertebrae included T11/12 in one case, T12-L1 in 10, L1/2 in 21, L2/3 in nine and L3/4 in three.Injury type was all AO type B2.According to the American Spinal Injury Association (ASIA), neurological deficit was Grade A in three cases, Grade B in five, Grade C in 22, and Grade D in 14.Load sharing score (LSC) was 7-9 points (mean, 8.1 points), while the thoracolumbar injury classification and severity score (TLICS) was 7-9 points (mean, 8.2 points).According to the difference of surgical procedures, all cases were divided into traditional group (21 cases) and improved group (23 cases).The patients in traditional group were treated by 270° spinal canal decompression combined with one-stage pedicle screw fixation and vertebral reconstruction, and those in improved group were treated by modified 270°spinal canal decompression combined with one-stage pedicle screw fixation and vertebral reconstruction.Between-group differences were compared with regard to operation time, intraoperative blood loss, postoperative drainage, allogeneic blood transfusion, pain visual analogue scale (VAS) at postoperative 72 hours, Cobb angle, anterior vertebral height, spinal canal compromise, Denis score, work state, neurological function, bone graft fusion and complications.Results Duration of follow-up was (32.4±15.8)months (range, 12-60 months).No wound infection or deterioration of neurological function was found after operation.Operation time was (2.4±0.5)hours in traditional group, less than (2.8±0.6)hours in improved group (P0.05).VAS was (3.2±0.9)points in traditional group and (3.3±0.9)points in improved group at postoperative 72 hours (P>0.05).Cobb angle, anterior vertebral height and spinal canal compromise in both groups obtained well recovery and maintained after operation (P0.05).At the last follow-up, ASIA Grade A was noted in three cases, Grade C in two, Grade D in 23, and Grade E in 16.Bone union was achieved in all cases, with no implant loosening or breakage observed.Thirteen cases in traditional group were found with residual bone fragments in the spinal canal after surgery, and two of them received revision surgery.Conclusions Either modified or traditional 270° spinal canal decompression combined with one-stage pedicle screw fixation and vertebral reconstruction can attain satisfactory clinical results in treatment of severe thoracolumbar fractures.However, the modified 270°spinal canal decompression can achieve more thorough decompression without reducing stability of the spine.
ABSTRACT
Objective To compare the advantages and disadvantages of three different fixation methods via muscle-splitting approach for the treatment of single segmental lumbar vertebral diseases.Methods All of 90 patients with the single segmental lumbar vertebral diseases were treated from June 2012 to June 2013,including 34 males and 56 females,at the age of 27-76 years old,averagely (53.37± 15.41) years.Twenty-seven patients were treated with unilateral pedicle screws via unilateral muscle-splitting approach (unilateral fixation group).Thirty-three patients were treated with unilateral pedicle screws and contralateral translaminar facet screw via unilateral muscle-splitting approach (combined fixation group).Thirty patients were treated with unilateral pedicle screws via bilateral muscle-splitting approach (bilateral fixation group).Observe and compare the imaging and clinical results of these three groups.Results There were no significant difference in incision length and postoperative wound drainage between these three groups.The operation time was shortest in unilateral fixation group,while longest in bilateral fixation group.In the intraoperative blood loss,the unilateral fixation group was the same as the combined fixation group,while less than the bilateral fixation group.No infection was found after operations.Seven patients experienced epidermal necrosis of the incision,including 1 patient of unilateral fixation group,4 patients of combined fixation group and 2 patients of bilateral fixation group.Three patients suffered from nerve injury,including 2 patients of combined fixation group and 1 patients of bilateral fixation group.The follow-up time was from 12 to 36 months,averagely 25.5 months.The intervertebral height of lesion segments was apparently recovered after surgery,and maintained during the follow-up in these three groups.No significant changes of area and grade of multifidus muscle were detected at 1 year after surgery compared with preoperative.Seven patients experienced endplate cutting and cage partially embedded into vertebral body,including 3 patients of unilateral fixation group,3 patients of combined fixation group and 1 patient of bilateral fixation group.There was no loosening,displacement,breakage or cage shifting.Except 5 patients (2 patients of unilateral fixation group,2 patients of combined fixation group and 1 patient of bilateral fixation group),the remaining cases had well interbody fusion.At the final follow-up time,the JOA score significantly increased compared with preoperative.Besides,unilateral fixation group and combined fixation group were superior to bilateral fixation group.Conclusion Three different fixation methods via muscle-splitting approach for the treatment of single segmental lumbar vertebral diseases had well clinical results.The unilateral fixation and combined fixation via muscle-splitting approach had more advantages.The combined fixation via muscle-splitting approach is an innovation in approach,exposure and fixation aspects.
ABSTRACT
Objective To analyze the clinical effect of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in combination with unilateral pedicle fixation on lumbar degenerative diseases in the elderly.Methods From June 2011 and June 2013,51 elderly patients with lumbar degenerative diseases who underwent MI-TLIF in combination with unilateral pedicle fixation,including 39 males and 12 females,aged from 60 to 72 years (average 65 years old),were included in this study.All the 51 cases had mono segmental lesion,including 11 cases with the lesion in L3.4,22 cases with the lesion in L4.5,and 18 cases with the lesion in L5-S1.The operation time,blood loss,postoperative drainage and complications were recorded.Postoperative outpatient follow-ups were conducted once every 2-3 months for all cases,and JOA scoring criteria (29 points) of lower back pain were adopted to evaluate the clinical effects.Thin-layer helical CT scanning reconstruction was applied to evaluate the fusion rate of bone grafting.X-ray film of lumbar vertebra AP & LAT was employed to evaluate the intervertebral space height,the internal fixation and the position of cage.Results The operation time ranged between 50-90 min with a mean value of 65 min; blood loss ranged between 80-180 ml (average 110 ml); and postoperative drainage volume ranged between 20-70 ml (average 40 ml).Healing phase I was achieved in 49 cases,while post-operative local cutaneous necrosis around the incision site occurred in 2 case and the wound healed well after wound dressing.Dural laceration without nerve root injury occurred in 2 cases.The follow up in 51 patients ranged between 18 24 months (average 20 months).In terms of JOA scoring,the preoperative score was (9.7± 1.6),the post operative score was (21.4 ± 1.4) 7 d after operation and the score was (25.4 ± 1.2) in the final follow up.During the final follow-up,35 cases were evaluated as excellent,11 cases as good and 5 cases as moderate,the excellent and good rate was 90.2％,and the fusion rate of bone grafting was 88.2％.The intervertebral space height ranged from (9.2±1.5) mm before operation to (11.2±1.3) rnm 7 d after operation,to (11.0±1.2) mm in the final follow-up.There were significant difference in intervertebral space height before and after operation (both P＜0.05),and no difference was found between 7d after operation and the final follow-up (P＞0.05).Looseness,fracture or cage displacement were not observed.Conclusions The clinical effect of MI-TLIF in combination with unilateral pedicle fixation on lumbar degenerative diseases in the elderly is satisfied.It has the advantages of high fusion rate,less trauma,quicker recoverer,higher cost effectiveness and convenience.However,the indications for operation should be restricted and the long-term curative effect remains to be studied in further clinical studies.