Treatment of thoracolumbar spinal tuberculosis with single posterior debridement, bone grafting, internal fixation and local chemotherapy / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical effects of single posterior debridement, bone grafting, internal fixation and local chemotherapy in treating thoracolumbar spinal tuberculosis.</p><p><b>METHODS</b>From February 2009 to September 2012,11 patients with thoracolumbar spinal tuberculosis were treated by single posterior debridement, bone grafting, internal fixation and local chemotherapy. There were 7 males and 4 females, aged from 27 to 65 years old with an average of 53.7 years. The courses of disease was from 3 months to 2 years with the mean of 9 months. According to ASIA standard of spinal cord injury, 3 cases were grade C and 8 cases D. After treatment, clinical effects were evaluated by ASIA grade, visual analogue score (VAS) and Oswestry Disability Index (ODI); kyphosis Cobb angle change was observed by X-rays.</p><p><b>RESULTS</b>Eleven patients were followed up from 12 to 29 months with an average of 18 months. ASIA grade of spinal cord injury, 3 patients with grade C improved to grade D in 2 cases and grade E in 1 case 8 patients with grade D improved to grade E in 7 cases and unchanged in 1 case. VAS decreased from preoperative 6.10 ± 1.30 to 1.70 ± 0.80 at 3 d after operation (P < 0.05). ODI improved from preoperative (68.36 ± 10.41)% to (14.55 ± 8.99)% (P < 0.05) at 3 d after operation. Kyphotic Cobb angle was corrected from preoperative (22.64 ± 4.84)° to (4.27 ± 1.49)° (P < 0.05) on the 3rd day after operation, and angle loss was mild at final follow-up, there was no significant difference between postoperative at 3 d and final follow-up.</p><p><b>CONCLUSION</b>Single posterior debridement, bone grafting, internal fixation and local chemotherapy for the treatment of thoracolumbar spinal tuberculosis can effectively remove the lesion, improve nerve function and correct deformity, has advantage of single incision, little trauma, and low recurrence rate. But it still need long-term and systemic treatment with anti-TB drugs.</p>

Effective comparison between improved lateral incision and the traditional L-shaped extension incision in treatment of intra-articular calcaneal fractures / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinical outcome between the two different approaches of improved lateral incision and the traditional L-shaped extension incision to treat intra-articular calcaneal fractures.</p><p><b>METHODS</b>From January 2005 to January 2008, 36 cases of intra-articular calcaneal fractures were treated by improved lateral incision or the traditional L-shaped extension incision. In improved lateral incision group, there were 19 cases including 12 males and 7 females with an average age of (38.1 +/- 9.1) years; According to Sanders classification: 8 cases were type II, 9 were type III, 2 were type IV; The time from injury to the operation was (10.5 +/- 1.7) days. In the traditional L-shaped extension incision group,there were 17 cases including 11 males and 6 females with an average age of (38.4 +/- 7.3) years; according to Sanders classification of fractures: 7 cases were type II, 9 were type III, 1 was type IV; The time from injury to the operation was (10.6 +/- 1.8) days. Observing and comparing some items of the two groups including (1) operation time, blood loss, incision length, number of graft cases, (2) VAS pain scores after the first day, (3) wound healing, (4) Maryland foot scoring, (5) postoperative imaging results were comparative analyzed.</p><p><b>RESULTS</b>Two groups of patients were followed up from 10 to 15 months with an average of 11 months. The operative time and number of graft cases were compared between two groups with no statistically significant differences. The blood loss were (94.0 +/- 9.5) ml in improved lateral incision group and (109.9 +/- 13.7) ml in L-shaped extension incision group, incision length were (6.8 +/- 1.1) cm in improved lateral incision group and (15.7 +/- 2.2) cm in L-shaped extension incision group with significant differences. Postoperative VAS pain score at the first day were (1.95 +/- 0.71) points in improved lateral incision group and (3.65 +/- 1.00) points in L-shaped incision group with significant difference. In improved lateral incision group there was 1 case of grade B wound healing, and in the traditional L-shaped extension incision group, there were 6 cases of grade B wound healing, these patients were healing by protensive time for change dress.</p><p><b>CONCLUSION</b>These two incision of improved lateral incision and the traditional L-shaped extension incision for treating the intra-articular calcaneal fractures are therapeutic equivalence. However, improved lateral incision has advantage of small incision and operative wound, and fewer wound complications.</p>

Curative effect comparison of two methods of treatment for distal tibial fractures / 中国骨伤

<p><b>OBJECTIVE</b>Evaluation of two different methods of treatment of distal tibial fractures of the clinical indications, complications and efficacy.</p><p><b>METHODS</b>Forty-five cases of closed distal tibial fractures were assigned to two groups, 25 cases in group A included 18 males and 7 females, according to the AO/ASIF classification: 4 cases of type A, 14 cases of B, 7 cases of C, open reduction and anatomic plate fixation were used. Twenty cases in group B included 12 males and 8 females, 5 of type A, 9 of B, 6 of C, minimally invasive percutaneous locking compression plate osteosynthesis were used. Observed on the postoperative pain, skin necrosis of the incision, the incidence of deep infection and other complications, as well as the healing of fractures, ankle motor function for comparative study.</p><p><b>RESULTS</b>All patients were followed up 10 to 15 months, according to the visual analogue scale (VAS) score, group A were moderate to severe in, group B were mild to moderate between. Bone healing time: group A averaged (16.0+/-4.2) weeks, group B averaged (13.0+/-3.2) weeks, the difference was significant (P<0.01). Postoperative complications of group A was more than that of group B (P<0.05), there were significant differences. Ankle function in accordance with the assessment criteria Kofoed, the good and excellent rate of group B was higher than that of group A (P<0.05), there were significant differences.</p><p><b>CONCLUSION</b>Minimally invasive percutaneous locking compression plate osteosynthesis compared open reduction and anatomic plate fixation for distal tibial fractures with less trauma surgery, bone blood supply to the affected small, fracture healing faster, less complications, and ankle function better advantage of. It is consistent with the biomechanics of internal fixation, and is the treatment of tibial fractures ideal method.</p>