ABSTRACT
<p><b>OBJECTIVE</b>To compare the clinical efficacy of minimally invasive percutaneous plate osteosynthesis(MIPPO)and open reduction and internal fixation (ORIF) in treating senile NEER IIproximal humerus fractures.</p><p><b>METHODS</b>From March 2014 to March 2016, 46 elderly patients with Neer II proximal humerus fractures were retrospectively reviewed. Among them, 20 patients in MIPPO group included 9 males and 11 females with an average age of (70.4±4.4) years old; while 26 patients in ORIF group included 11 males and 15 females with an average age of (70.9±4.0) years old. The length of hospital stay, times of fluoroscopy, beginning time of function rehabilitation, healing time of fracture, Constant Murley score of the shoulder joint at 3, 6, 12 months after operation and complications were observed and compared.</p><p><b>RESULTS</b>All patients were followed up for 12 to 24 months with an average of 16.8±3.7. The healing time of fracture, beginning time of function rehabilitation in MIPPO group were(13.0±0.8) weeks, (3.0±0.9) days respectively and shorter than those in ORIF group which were (13.8±1.4) weeks and(6.8±1.3) days. The times of fluoroscopy in MIPPO group was 19.2±3.7 and more than that in ORIF group which was 12.1±3.4. At 3 and 6 months after operation, Constant Murley score in MIPPO group were 81.3±3.9, 86.6±5.4 and more than that in ORIF group which were 69.5±6.6, 80.5±6.7. There were no differences between two groups in the length of hospital stay, Constant Murley score at 12 months after operation and grading at the final follow-up. There was one fracture redisplacement in each group. And 1 case of axillary nerve injury in MIPPO group, 2 cases of delayed union in ORIF group. No incision infection, screw loosening or plate break was found.</p><p><b>CONCLUSIONS</b>MIPPO and ORIF are both effective in treating Neer II proximal humeral fractures. MIPPO technique has the advantages of faster recovery, earlier rehabilitative exercise and better shoulder function. The disadvantages are more exposure to radiationd and the possibility of axillary nerve injure.</p>
ABSTRACT
<p><b>OBJECTIVE</b>To assess the influence of different hinge positions on clinical results of expansive open-door laminoplasty (EOLP) for cervical spondylotic myelopathy (CSM).</p><p><b>METHODS</b>A total of 102 CSM patients who underwent EOLP from February 2006 to February 2007 were enrolled in this randomized controlled trial. Using a random digits table, 57 patients with the hinge located at the inner margin of the lateral mass were classified as wide-open group, while 45 patients with the hinge positioned at the lamina margin served as narrow-open group. All patients were observed over 24 months, and the clinical and radiological results were analyzed statistically.</p><p><b>RESULTS</b>There were no significant differences in operation duration, intraoperative bleeding volume, Japanese Orthopaedic Association (JOA) scores, cervical curvature index, range of motion and neural function recovery rate. The neural functions were satisfactorily improved after surgery in both groups, while the severity of axial symptoms was significantly lower in the narrow-open group than in the wide-open group (P equal to 0.003). The incidence of C(5) palsy in the wide-open group was higher than that in the narrow-open group (5.3% vs 0), even though the difference did not reach statistical significance (one tailed Fisher's exact test, P equal to 0.17).</p><p><b>CONCLUSIONS</b>Proper inward shift of the hinge can ensure effectiveness of surgical decompression, avoid an excessive backward shift of the spinal cord, decrease the incidence of C(5) palsy and alleviate the severity of axial symptoms.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Laminectomy , Methods , Spondylosis , Diagnostic Imaging , General Surgery , Tomography, X-Ray ComputedABSTRACT
<p><b>OBJECTIVE</b>To identify radiographic predictors of residual low back pain (LBP) after laminectomy for lumbar canal stenosis (LCS).</p><p><b>METHODS</b>Clinical results and radiographic findings in 69 patients who underwent single level laminectomy for LCS were retrospectively reviewed. Patients who had an improvement in LBP scores evaluated by Japanese Orthopaedic Association (JOA) scoring system during the follow-up periods were classified as the recovery group, and others were classified as the non-recovery group. Patients'clinical data and radiographic parameters like lordosis angle, range of motion and intervertebral rotational angle were analyzed using binary logistic regression analysis to detect factors significantly related with the occurrence of residual LBP.</p><p><b>RESULTS</b>The average preoperative JOA score of 14.8+/-5.05 improved to 21.59+/-5.51 at the final follow-up. Binary logistic regression analysis revealed that significant predictors of residual LBP were preoperative lumbar lordosis angle and range of motion.</p><p><b>CONCLUSIONS</b>Our results suggest that patients with flat back and limited lumbar mobility before surgery tend to have poor results in terms of LBP. Therefore, these sagittal radiographic parameters should be taken into account when choosing laminectomy as the surgical option for LCS.</p>