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Objective To explore the clinical efficacy of one-stage anterolateral-posterior approach debridement,bone graft and internal fixation in treatment of thoracolumbar spinal tuberculosis.Methods From January 2010 to December 2014,56 cases of thoracolumbar spinal tuberculosis were retrospectively analyzed, including 31 males and 25 females,aged 18 -72 years (mean 43.1 years).All patients were managed by standard courses of chemotherapy with quadruple anti-TB drugs for 2 - 4 weeks.Patients were treated by anterolateral debridement,autologous iliac bone graft fixed by absorbable screw fixation,and posterior pedicle screw fixation via multi-split muscle gap (Wiltse approach).We recorded the operation time,the amount of bleeding,bone graft fusion,postoperative erythrocyte sedimentation rate (ESR),Cobb angle,VAS score,and American Spinal Injury Association (ASIA)score to evaluate the surgical results.Results The average operation time was 175-290 min, with an average of (248±42)min.The bleeding volume was 300 -900 mL with an average of (420 ±68)mL.The average follow-up time was (24 ± 5.2 )months,bone fusion rate was 100%,and fusion time was (4.7 ± 0.5 ) months.At the last follow-up,the average Cobb angle was (8.2±3.1)°,VAS was (2.1±0.8),and ESR was (17± 4.2)mm/h.The ASIA neurological functions were all classified as Grade E except for 3 cases of Grade D.All these were significantly different from the preoperative ones.Six patients had complications of different degree but without serious complications.Conclusion One-stage anterolateral debridement,autologous iliac bone graft fixedby absorbable screw fixation,and posterior pedicle screw fixation via multi-split muscle gap (Wiltse approach)can completely remove the tuberculosis lesions and achieve ideal kyphosis correction,high bone graft fusion,and satisfactory neurological function recovery.Absorbable screws can be safely applied to the bone graft site after debridement.
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<p><b>OBJECTIVE</b>To explore the therapeutic effects of distal humeral lateral closing wedge osteotomy followed by modified pinning combined with external tension band fixation in the treatment of cubitus varus deformity in children.</p><p><b>METHODS</b>Total 26 adult patients with cubitus varus deformity were treated by operation from March 2011 to June 2015, 15 patients were boys and the other 11 patients were girls, ranging in age from 4 to 13 years, with an average of 7.8 years. The cubitus varus angel ranged from 11 degrees to 24 degrees, with a mean(17.50±6.73) degrees, 3 patients complicated more than 10 degrees constriction of flexion. Lateral closing wedge osteotomy retaining the medial 3 to 4 mm intact cortex by lateral elbow approach was applied in these 26 patients. The wedge defect were closed and fixed by crossing pinning. The lateral column compression was achieved with external tension band(the crossing pins were bended laterally and the pin ends were hooked mutually). The pre-operative, post-oparetive and contralateral carrying angles were compared and Laupattarakasem criteria was used to evaluate the results at follow-up.</p><p><b>RESULTS</b>All the patients got bony union 2 months after operation and there was no infection or nerve palsy. The average follow-up period was 18.8 months (ranged, 13 to 29 months). The carrying angle was restored to(11.50±3.17) degrees(ranged, 8 to 14 degrees). According to the Laupattarakasem evaluation criteria, 14 patients got an excellent result, 13 good and 1 fair.</p><p><b>CONCLUSIONS</b>Normal carrying angle and elbow flexion could be restored by lateral closing wedge osteotomy, and stable fixation could be achieved with crossing pinning and external tension band, which is available for early mobilization.</p>
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Objective To explore the clinical efficacy of one-stage anterolateral-posterior approach debridement,bone graft and internal fixation in treatment of thoracolumbar spinal tuberculosis.Methods From January 2010 to December 2014,56 cases of thoracolumbar spinal tuberculosis were retrospectively analyzed, including 31 males and 25 females,aged 18 -72 years (mean 43.1 years).All patients were managed by standard courses of chemotherapy with quadruple anti-TB drugs for 2 - 4 weeks.Patients were treated by anterolateral debridement,autologous iliac bone graft fixed by absorbable screw fixation,and posterior pedicle screw fixation via multi-split muscle gap (Wiltse approach).We recorded the operation time,the amount of bleeding,bone graft fusion,postoperative erythrocyte sedimentation rate (ESR),Cobb angle,VAS score,and American Spinal Injury Association (ASIA)score to evaluate the surgical results.Results The average operation time was 175-290 min, with an average of (248±42)min.The bleeding volume was 300 -900 mL with an average of (420 ±68)mL.The average follow-up time was (24 ± 5.2 )months,bone fusion rate was 100%,and fusion time was (4.7 ± 0.5 ) months.At the last follow-up,the average Cobb angle was (8.2±3.1)°,VAS was (2.1±0.8),and ESR was (17± 4.2)mm/h.The ASIA neurological functions were all classified as Grade E except for 3 cases of Grade D.All these were significantly different from the preoperative ones.Six patients had complications of different degree but without serious complications.Conclusion One-stage anterolateral debridement,autologous iliac bone graft fixedby absorbable screw fixation,and posterior pedicle screw fixation via multi-split muscle gap (Wiltse approach)can completely remove the tuberculosis lesions and achieve ideal kyphosis correction,high bone graft fusion,and satisfactory neurological function recovery.Absorbable screws can be safely applied to the bone graft site after debridement.
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<p><b>OBJECTIVE</b>To investigate the approach of open reduction and internal fixation for the treatment of anteromedial coronoid facet fractures and associated injury.</p><p><b>METHODS</b>From July 2009 to August 2011, 6 coronoid anteromedial facet fractures were treated (4 males and 2 females,the average age was 32.6 years old,ranged from 19 to 49 years old) in our hospital. Three patients had fractures in the left side and 3 in the right(4 dominant sides and 2 non dominant sides). All the patients had close fractures. All the fractures were subtype 2 or subtype 3 of coronoid anteromedial facet fracture according to O'Driscoll classification. The anteromedial incision of elbow and the approach of splitting flexor digitorum superficialis between flexor carpi radialis and palmaris longus were used to apply internal fixation with mini-plate. After fixation of coronoid fracture, widening of radiohumeral joint interspace under varus stress occurred in 3 cases,elbow varus posteromedial rotational instability was showed,and the exploration and repair of radial collateral ligament was not carried out. Plaster was applied for 2 weeks before rehabilitation and the time of plaster application extended to 4 weeks in the patients showed varus posteromedial rotational instability. The motion degree,pain and stability, strength of elbow and hand were recorded,the elbows were evaluated with modified An and Morrey functional rating index.</p><p><b>RESULTS</b>All the patients were followed up,and the average duration was 9.3 months (ranged from 7.5 to 13 months). The strength of elbow and hand were equal to that in the contralateral side. The average flexion was (129.0+/-6.5) degree (ranged from 120 to 135 degree); the average extention was (4.0+/-4.2) degree (ranged from 0 to 10 degree); the average forearm pronation was (84.0+/-6.5) degree (ranged from 75 to 90 degree); average supination was (89.0+/-7.1) degree (ranged from 80 to 100 degree). One patient had ulnar sensory neuropathy after operation and healed in half-year, no postoperative complications as pain and instability accured. All the patients obtained excellent results according to modified An and Morrey functional rating index.</p><p><b>CONCLUSION</b>The approach of splitting flexor digitorum superficialis between flexor carpi radialis and palmaris longus could be used in open reduction and internal fixation of anteromedial coronoid facet farcture, rehabilitation should be postponed in the patient showed elbow varus posteromedial rotational instability.</p>
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Adult , Female , Humans , Male , Middle Aged , Casts, Surgical , Fracture Fixation, Internal , Methods , Ulna Fractures , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To investigate the clinical effects of modified Nirschl surgical techniique in treating refractory lateral epicondylitis.</p><p><b>METHODS</b>From March 2009 to January 2011,21 patients (21 elbows) with refractory lateral epicondylitis were treated in our hospital. There were 8 males and 13 females,ranged in age from 25 to 59 years with an average of (48.3+/-13.4) years and the duration time from 8 to 33 months with an average of (17.1+/-7.7) months;affected position in dominant sides of 16 cases and non-dominant sides of 5 cases. The patients had already received multiple non-operative treatments. Modified Nirschl surgical technique was performed,and operative origination from origin of musculus extensor carpi radialis brevis to discard process with small incision, the process place of extensor digitorum communis would be removed. The incisions were nursed by ice compress for 2 days after operation. Range of motion (ROM) and strengthening exercise of elbow joints started at the 1 week after plaster slab fixation; ROM and strengthening exercise of wrist joints also started at the 2 week after fixation. The pain, power of gripping and patient staisfaction were recorded after operation. Verhaar scaling were used to estimate the recovery.</p><p><b>RESULTS</b>Seventeen patients were followed up from 13 to 22 months with an average of 16.3 months. According to Verhaar standard, 15 cases obtained excellent results and 2 good. No postoperative complication such as instability was found.</p><p><b>CONCLUSION</b>Modified Nirschl surgical technique is an effective method in treating refractory lateral epicondylitis but correct to diagnosis and exclusion the coexisting diseases,accurate removal the process are important guarantee.</p>