ABSTRACT
ObjectiveTo evaluate the clinical outcomes of anterior lumbar discectomy and interbody fusion with cage under laparoscopic assistant.MethodsFrom January 2006 to June 2009,37 cases with degenerative low back pain were entered the study,including 22 males and 15 females with an average age of 43.7 years(range,16-55).The responsible discs were determined according to the three dimensional computed tomography of artery and vein angiography of anterior lumbosacral spine and discography,including L5S1 in 21 cases,L4-5 in 11,L3-4 in 2,L2-3 in 2,and L1-2 in 1.All cases underwent anterior lumbar discectomy and interbody fusion with cage under laparoscopic.ResultsThe operation time was 100 min in average (range,60-140),the blood loss was 120 ml in average(range,50-300).There was no case with severe complications of retrograde ejaculation and injury of great vessels or nerves.Delayed intestinal obstruction was discovered in two intraperitoneal route patients.The average follow-up time was 18.7 months(range,6-35).According to the back pain grading criteria of Chinese Medical Association Orthopedics Society of Spine Group,the results were excellent in 23 patients,good in 11,and fair in 3.The interbody fusion was obtained in 3 months later in 23 cases and 6 months later in 12 cases.Cage subsidence occurred in 2 cases in 6months after operation,in which the height loss of intervertebral space was 1.3 mm and 1.9 mm,but no obvious symptoms of discomfort.No fixation displacement or loosening occurred.ConclusionThe anterior discectomy and interbody fusion by internal fixation with laparoscopic technique is feasible with low complications rate,less trauma and shorter bedtime.Postoperative ileus by abdominal approach is relatively common.The surgeons experience and the anatomy of artery and vein of anterior lumbosacral spine should be considered before the choice of surgical approach.
ABSTRACT
BACKGROUND: Posttraumatic kyphosis and neurologic compromise secondary to osteoporotic fractures, which needs surgery treatment. However, the choice of approach method is an argument. OBJECTIVE: To explore the therapeutic effect of transpedicular decompression and pedicle fixation for the treatment of obsolete thoracolumbar vertebral fractures combined with kyphosis deformity.METHODS: A total of 23 cases with obsolete thoracolumbar fractures combined with kyphosis admitted at the Department of Spinal Surgery, First Affiliated Hospital, University of South China were selected, including 14 males and 9 females, aged 18-60 years, mean aged 36 years; The JOA scores of patients were (11.02±1.24) points prior to operation, with (37.43±3.76)° Cobbangel. All patients were treated by transpedicular decompression and pedicle fixation. The functional recovery of lumbar vertebra,bone healing, as well as the complications was compared before and after operation.RESULTS AND CONCLUSION: All patients were followed-up for 6-28 months with an average of 12.5 months. The lumbar vertebra function and kyphosis deformity was notably improved postoperatively. After treatment, the JOA score and Cobb angle was (14.04±2.12) points and (11.02±3.58)°, which was obviously different than that of preoperative (P<0.05). The surfaces of cut bone were healed at 6 months after operation, without complications of pseudoarticulation formation or correction loss. The results suggested that transpedicular decompression and pedicle fixation can achieve a satisfactory result in deformity correction and neurological decompression, which can precipitate the functional recovery.
ABSTRACT
BACKGROUND: T-type or linear type external fixator is applied in transcervical fracture in the elderly. Because its fixing force is weak, so it is difficult to avoid the aggravation of complication due to long term lay up in severe osteoporosis. Based on this reason,percutaneous penetrating arch tri-claw external fixator is designed to treat elderly transcervical fracture with strong fixing force for the realization of early restoration to the active status before injury to reduce complication.OBJECTIVE:To design pereutaneous penetrating arch tri-claw external fixator for the treatment of elderly transcervical fracture for the investigation of its feasibility.DESIGN: A self-controlled study by employing patients as subjects.SETTING: Department of orthopedic surgery of the first affiliated hospital of a universityPARTICIPANTS: Thirty-one cases of elderly transcervical fracture including 18 males and 13 females aged between 71 and 86 years old with an average age of 79 years were admitted by the Department of Orthopedics of the First Affiliated Hospital of Nanhua University between December 2002 and June 2004.METHODS: Percutaneous penetrating arch tri-claw external fixator was applied in the treatment of 31 cases with elderly transcervical fracture for the observation of its clinical effects, and the force-bearing situation and stability of the external fixator during application were analyzed by theoretical mechanics.MAIN OUTCOME MEASURES: ① The functional effects of percutaneous penetrating arch tri-claw external fixator applied in the therapy of transcervical fracture(sub-femoral head type,transcervical type and femoral basilar type); 2② The force-bearing situation and the stability of the fixing point on the fixator; ③ The restoration of activity in hip joint and fracture union time RESULTS: ① Patients could sit and stand immediately after the applicationof the fixator, and its fixing reinforce was analyzed by theoretic mechanics during standing(the force on upper fixing point A, B or C was 1/22, 1/2 or 1/2 of the lower fixing point) . The unidirectional flexion and extension activity of the hip joint overcame hip-inversion and rotational disposition at the distal end of the fracture. The hip-joint axial compression board caused compact embedment and insertion of the fracture end and vertical crush to simulate fracture union by stability and compressive strain. ② The stability of percutaneous penetrating arch tri-claw external fixator: No disposition was found during the application except rotational disposition during activity in sub-femoral head type fracture. The fixation was stable, the operative trauma was less,and the operation was simple with good accommodation. No complication was found due to long-term lay up and no re-disposition due to the loosening of the external fixator was found. ③ The hip-joint flexion-extension function was restored within 7 days averagely and fracture healing time was about 2 to 3 months, average of 2.4 months.CONCLUSION: No re-injury is found dter the application of percutaneous penetrating arch tri-claw external fixator, which has small force bearing at upper fixing point with strong stability. There is strain stimulation on the cross section of the fracture to promote fracture healing. The articular function status before injury could be restored at early stage.