The preliminary clinical study about the effectiveness of selective treatment for traumatic cervical disc herniation with stand alone RIO-C / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the efficacy of a new double plate self locking interbody fusion device(ROI-C) in the anterior cervical discectomy and fusion(ACDF) to treat traumatic cervical disc herniation(TCDH) without segmental instability, fracture or dislocation.</p><p><b>METHODS</b>ACDF with stand alone ROI-C was performed in 17 selective TCDH patients between December 2011 and December 2013. There were 12 males and 5 females, aged from 24 to 41 years old with a mean of 32.9 years, including 11 patients with single segment, 4 patients with double segments and 2 patients with three segments. Japanese Orthopaedics Assiciation (JOA), visual analogue scale(VAS) score and the Neck Disability Index(NDI) were recorded before and after operation in order to evaluate the clinical outcome, meanwhile, the preoperative and postoperative X ray films were collected to measure the intervertebral space height and whole cervical curvature. According to Vaccraro criteria to observe the bone fusion. The clinical effects were assessed according to Odom criteria.</p><p><b>RESULTS</b>All patients were followed up from 12 to 33 months with an average of 18.5 months. JOA score was increased significantly from preoperative 4.3±3.8 to 13.9±2.5 at final follow up (<0.05). VAS, NDI were decreased from preoperative (6.5±2.2) scores and (38.2±11.7) % to (1.0±0.9) scores and (8.7±3.4) % in final follow up, respectively (<0.05). Intervertebral space height and cervical curvature were increased from preoperative (5.2±1.7) mm and (5.1±7.5) ° to (7.8±0.6) mm and (10.5±5.1) °, respectively(<0.05). Hoarseness occurred in one patient and dysphagia occurred in 2 patients and they recovered spontaneously in 2 weeks and 3 months after operation, respectively. All the segments (25 levels) of the 17 cases achieved bony fusion in 6 months after operation. No displacement, subsidence and failure of ROI-C were found during follow up. According to Odom's criteria to evaluate clinical effects at the last follow up, 13 cases got excellent results, 3 good, and 1 fair.</p><p><b>CONCLUSIONS</b>ACDF with stand alone ROI-C is an effective, minimally invasive and reliable method in treating TCDH without segmental instability, fracture or dislocation, it can obtain satisfactory clinical outcomes and has advantage of less complications, high fusion rate.</p>

Comparison of two approaches for the treatment of distal radius fractures / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the effective operative approach for the treatment of distal radius fractures.</p><p><b>METHODS</b>From March 2003 to April 2010,107 patients with distal radius fractures suffered internal fixation with locking compression plate (LCP). There were 48 males and 59 females with an average age of 51.27 years (ranged, 23 to 79). Of them, with directed volar approach was in 55 cases and Henry approach was in 52 cases. Surgical feature, fractured exposure time, operative time, median nerve complication, repair rate of the musculus pronator quadratus were compared between the two groups. Gartland-Werley wrist score (GW score), range of motion of wrist joint, grasp force and imageology score were observed in two groups at the first year after operation.</p><p><b>RESULTS</b>The average fractured exposure time in directed volar approach group and Henry approach group was (21.18 +/- 1.69) min and (12.56 +/- 1.35) min,operative time was (89.90 +/- 4.86) min and (61.58 +/- 4.37) min, postoperative median nerve irritation rate was 34.55% and 5.77%, and repair rate of the musculus pronator quadratus was 52.73% and 100%,respectively;there was statistical difference between two groups (P < 0.01). At the one-year after operation, GW score was 3.25 +/- 2.29,and with rate of excellent and good of 90.91% in directed volar approach group;in Henry approach group that was 2.92 +/- 2.13 and 92.31%, respectively; there was no statistical difference between two groups (P > 0.05). There was no statistical difference in range of motion of wrist joint, grasp force and imageology score between two groups (P > 0.05).</p><p><b>CONCLUSION</b>Henry approach can obtain the same operative result compared with directed volar approach in treating distal radius fractures. Henry approach has advantage of simple anatomy,easy operation,better repair rate of the the musculus pronator quadratus and lower postoperative median nerve complication,which should be used preferentially to treat distal radius fractures.</p>

Treatment by limited-incision for posterior edge separation of lumbar vertebral body / 中国骨伤

<p><b>OBJECTIVE</b>To discuss effective operative method for posterior edge separation of lumbar vertebral body.</p><p><b>METHODS</b>Twelve cases of posterior edge separation of lumbar vertebral body were categorized as lateral type and central type, and were operated upon with limited-incision using lamina retractor. All patients were male and with an average age of 30 years (range, 23 to 40 years). The average history of disease was 17.9 months. In lateral type cases, separation bone was in the posterolateral lower edge of L4 vertebral body in 1 case, in the posterolateral upper edge of L5 vertebral body in 3 cases and in the posterolateral upper border of S1 vertebral body in 6 cases, all with ipsilateral disc herniation. Lateral type cases were treated with unilateral fenestration and removal of disc nucleus and posterior bony edge. Separation bone was in the central upper edge of S1 vertebral body with central disc herniation in 2 central type cases. Two central type cases were treated with bilateral fenestration and removal of disc nucleus and posterior bony edge.</p><p><b>RESULTS</b>All patients were followed up for 12 to 36 months, and the average follow-up was 22.5 months. According to Macnab postoperative evaluation criterion, the results were excellent in 10 cases, good in 2 cases.</p><p><b>CONCLUSION</b>Limited-incision for posterior edge separation of lumbar vertebral body has characteristic of less trauma and convenience. It is an effective method for removal posterior bony edge.</p>