The design and application of anterior cervical pedicle screw-plate system in lower cervical spine / 中国骨伤

<p><b>OBJECTIVE</b>To explore the applied feasibility of the anterior cervical pedicle screw-plate system in lower cervical spine,in order to provide basic data for clinical application.</p><p><b>METHODS</b>Total thirty-two units (functional spinal unit, FSU) were got randomly from 16 cervical speciments, 8 units in each group of C3,4, C4,5, C5,6 and C6,7. The anterior cervical pedicle screw-plate system was implanted to reconstruct the stability of FSU after discectomy and bone graft. The adaptability was measured between the screw-plate system and vertebral body. X-ray and CT were used to evaluate the accuracy of anterior cervical pedicle screws. The subject will be dissected to identify the situation of involvement if screw perforating the pedicle.</p><p><b>RESULTS</b>Sixty-four anterior pedicle screws were inserted smoothly in the 32 units. The screw and the plate were harmonious locked in the system. The position and length of all screws were satisfactory through X-ray views. However,6 screws perforated the transpedicular (degree 1) according to CT axial views,2 internally cortex and 4 laterally cortex. None perforation was degree 2 or more. None cervical sac compression and nerve root injury was observed in two internal perforation cadavers. One vertebral vein involvement was found in the four lateral perforation screws. The vertebral artery was not pinched though one screw near to the artery.</p><p><b>CONCLUSION</b>The anterior cervical pedicle screw-plate system is adapted to reconstruct in lower cervical spine and it deserved to be used for clinical application.</p>

Analysis of epidural hematoma formative reason and its preventive measure after anterior cervical operation / 中国骨伤

<p><b>OBJECTIVE</b>To explore the risk factors,preventive measure of epidural hematoma after anterior cervical operation.</p><p><b>METHODS</b>From June 2005 and December 2012, 1,452 patients underwent anterior cervical operation in our hospital. Epidural hematoma occurred in 5 cases after operation and the incidence rate was 0.34%. There were 4 males and 1 female with an average age of 46.4 years (ranged, 33 to 55); 3 cases with cervical myelopathy, 1 case with cervical myelopathy and C5 vertebral angeioma, 1 case with ossification of cervical posterior longitudinal ligament. The occurred time,main clinical situation,duration of symptoms,operative management of epidural hematoma were analyzed.</p><p><b>RESULTS</b>Five patients with epidural hematoma occurred within 24 h; the average interval between onset of symptoms and surgery was 4 h (ranged, 2 to 7). Operative treatment was accomplished in 5 cases by exploration and hematoma evacuation. There was significant improvement in all patients after reoperation. Epidural hematoma occurred again in one patient at 5 h after hematoma evacuation, and reoperation were performed to treat it. All patients were followed up from 6 to18 months with an average of 13.8 months. No recurrence was found.</p><p><b>CONCLUSION</b>Intensive care in 24 h postoperatively is important because of epidural hematoma often occurs in this period,especialy in the period of 6-8 h postoperativey. Clinical findings and MRI can early diagnose epidural hematoma and help treatment. Once it is identified and surgical evacuation would be performed on time.</p>

Case-control study on injured vertebra pedicle instrumentation and injured vertebra bone grafting for the treatment of thoracolumbar fractures / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinical effects of injured vertebra pedicle instrumentation and injured vertebra bone grafting in treating thoracolumbar fractures.</p><p><b>METHODS</b>A retrospective study was performed on 48 patients with single thoracolumbar fractures (type A3) from August 2008 to August 2010. Twenty-four patients were treated with injured vertebra pedicle instrumentation (group A) and 24 were treated with injured vertebra bone grafting (group B). There were 14 males and 10 females with an average age of (44.0 +/- 7.4) years old (34 to 56) in group A and there were 13 males and 11 females with an average age of (42.5 +/- 7.1) years(ranged, 31 to 54) in group B. Operation time, volume of blood loss, complications and the relative parameter of imageology were compared between two groups.</p><p><b>RESULTS</b>There was no significant difference in gender,age, position of injury, volume of blood loss between two groups. Operation time of group A was shorter than that of group B. Cobb angle and injured vertebral height obviously improved at the immediately postoperatively between two groups; there was no significant difference in group A between the immediately and three months postoperatively, but there was significant difference in group B; there was no significant difference between three months and one year postoperatively in two groups. The failure rate of group B was significantly higher than that of group A.</p><p><b>CONCLUSION</b>Pedicle screw fixation in the injured vertebrae has advantage of short operation time,can obtain satisfactory effects and is better than injured vertebra bone grafting in maintaining the reduction in treating single thoracolumbar fractures.</p>