Zero-profile implant for anterior cervical discectomy and fusion in treating single cervical disc herniation / 中国骨伤

<p><b>OBJECTIVE</b>To explore the efficacy and safety of zero-profile implant for anterior cervical discectomy and fusion (ACDF) in treating single cervical disc herniation.</p><p><b>METHODS</b>From August 2011 to June 2012,30 patients with single cervical disc herniation were treated with ACDF using zero-profile implant in one motion segment. There were 18 males and 12 females with a mean age of 55.3 years old (ranged, 36 to 68). Incidence of dysphagia, height of intervertebral space and condition of bone fusion were observed after operation. Spinal nerves function and clinical results were assessed according to Japanese Orthopaedic Association (JOA) score, Odom criteria.</p><p><b>RESULTS</b>All patients were followed up from 12 to 24 months with an average of 15.9 months. The mean intraoperative blood loss was (85.3 +/- 14.2) ml (70 to 120 ml) and operative time was (90.0 +/- 12.8) min (70 to 120 ml). Preoperative, postoperative at 3 months and 1 year, JOA score was 8.72 +/- 2.36 (5.0 to 13.0), 14.72 +/- 1.66 (11.5 to 17.0) and 15.65 +/- 1.03 (13.5 to 17.0), respectively. One year after operation, according Odom criteria to assess, 22 cases got excellent results, 7 good, 1 fair. All dysphagiaes vanished completely at 3 months after operation. The lost height of intervertebral space was (0.34 +/- 0.13) mm (0.1 to 0.6 mm) and (0.39 +/- 0.15) mm (0.2 to 0.7 mm) at 3, 12 months after operation, respectively. All patients obtained bone fusion at 1 year after operation.</p><p><b>CONCLUSION</b>The zero-profile implant is a valid alternative to anterior cervical plate in treating single cervical disc herniation with ACDF, it has advantages of convenient procedure, satisfactory effect, lower incidence of postoperative dysphagia, reliable stability and less implant-related complications.</p>

Single midline posterior approach for 360 degree decompression and internal fixation with interbody bone graft fusion for severe thoracolumbar spinal fractures / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the safety and effectiveness of the single midline posterior approach for 360 degree decompression and instrumented stabilization with interbody bone graft fusion for treatment severe thoracolumbar spinal fractures accompanied with spinal compression.</p><p><b>METHODS</b>From January 2009 to March 2010,5 consecutive cases with severe thoracolumbar spinal fracture of totally 108 spinal fracture cases underwent a single midline posterior approach surgery. There were 2 males and 3 females,aged from 23 to 72 years old. Two cases had both T12 and L1 fractures, and 1 case had L1 fracture. The length of the surgical procedure, estimated intra-operative blood loss, VAS score and dosages of morphine at the first 24 hours after operation, the peri-operative complications were recorded.</p><p><b>RESULTS</b>Five patients were follow-up from 12 to 18 months with an average of 14.6 months. The operative time was 3.1 to 6.2 hours. The blood loss was 1 000 to 2 300 ml. VAS score at the first post-operative 24 hours was 1 to 4. The dosage of morphine of the first post-operative 24 hours was 28.8 to 30.8 mg. The preoperative Frankel/ASIA grade was grade B in 1 case, C in 2 cases, D in 1 case and E in 1 case, the post-operative Frankel/ASIA grade was E in 4 cases and D in case. No serious peri-operative complications were found.</p><p><b>CONCLUSION</b>The single midline posterior approach is a safe and effective surgical approach for 360 degree decompression and instrumented stabilization with interbody bone graft fusion for severe thoracolumbar spinal fractures with less post-operative pains and complications.</p>

Surgical treatment of ossification of ligamentum flavum in thoracic spine and its therapeutic effect analysis / 中国骨伤

<p><b>OBJECTIVE</b>To explore the correlation between CT classification and operative method and to discuss its therapeutic effect.</p><p><b>METHODS</b>From January of 2001 to June of 2010, 30 patients with thoracic ossification of ligamentum flavum were reviewed retrospectively, including 22 males and 8 females with an average age of 52.8 years old (ranged from 37 to 68 years old). The course of duration ranged from 2 months to 6 years. Single segment lesion was in 11 cases and multiple segments were in 19 cases. Two patients were accompanied by cervical ossification of ligamentum flavum and 1 was accompanied by ossification of posterior longitudinal ligament. The ossified lesions were located at T1,2 to T4,5 in 5 cases,T5,6 to T8,9 in 7 cases, T9,10 to T11,12 in 12 cases, at the upper and middle thoracic levels in 2 cases, at the middle and lower thoracic levels in 4 cases. They were divided into 2 types according to the morphologic features of the CT scan:simple type, 18 segments with lateral, slice or unfused type; complex type, 42 segments with thickened, fused or nodular type. The clinical manifestation was paralysis of upper motor neuron in 21 cases, and of upper and lower motor neuron in other 9 cases. Sphincter dysfunction was found in 26 cases. Preoperative JOA sphincter function score was 1.97 +/- 0.56. Preoperative modified JOA motor function score of lower limb was 1.20 +/- 0.76. Different surgical procedure was applied to one of the 2 types. For the simple type, an en bloc laminectomy was performed. However,for the complex type, a laminar shelling decompression was done. Laminectomy combined with internal fixation and lateral fusion was performed in patients whose decompressive areas were wider.</p><p><b>RESULTS</b>The mean decompression length was 3.1 lamina (2 to 6 lamina). Cerebrospinal fluid leakage was found in 3 cases and hematoma in incision was found in 1 case. The mean follow-up duration was 26 months (12 to 96 months). Twenty-two patients with the feel of constriction of trunk or lower limbs were completely recovered; 18 cases with sensation disturbance, numbness and pain of the lower limb were totally recovered, and relived in 10 cases. Postoperative JOA sphincter function score was 2.73 +/- 0.45, comparing with the preoperative score, and the difference was significant (P < 0.01). Postoperative JOA motor function score was 3.57 +/- 0.77, comparing with the preoperative score, and the difference was significant (P < 0.01 ). The lower limb function relief rate was 86.1%, 24 patients got an excellent results, 3 good, 2 poor and 1 bad.</p><p><b>CONCLUSION</b>Different surgical procedures will be safely and effectively applied to treat thoracic ossification of ligamentum flavum according to CT classification.</p>

Anterior-posterior operation with posteriorly limited fixation for the irreducible old dislocation of the inferior cervical vertebra combined with tiny joint interlocking / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical outcome and application value of single stage circumferential surgery for irreducible old dislocation of the inferior cervical vertebra combined with tiny joint interlocking.</p><p><b>METHODS</b>From Mar. 2004 to Aug. 2010,18 patients with old dislocation of the inferior cervical vertebra, in which 16 showed double joint interlocking and the others 2 showed single by the three dimensional CT scan. MRI showed that all patients had intervertebral disc injury including intervertebral disc rupture (9 cases), intervertebral disc herniation (2 cases) and the fracture of inferior cervical vertebra accompanying with intervertebral disc rupture (7 cases). All patients were treated with anterior-posterior operation with posteriorly limited fixation. Stability and fusion rate of injury segment were observe by X-ray and CT scan;function of spinal cord was assessed by Frankel grade criteria.</p><p><b>RESULTS</b>All patients were followed up from 6 to 12 months with an average of 8.6 months. Dislocation of cervical vertebra got complete reduction and all grafts got fusion. There was no complication of internal fixation breakage, loosening ,displacement and there was no injury of blood vessel, nerve, esophagus during the operation. No function of spinal cord got worse after operation and the function improved by 1.2 grades in average in Frankel grade.</p><p><b>CONCLUSION</b>Single stage circumferential surgery in treating irreducibly old dislocation of inferior cervical vertebra combined with tiny joint interlocking can complete recover the sequence of the cervical vertebra and relieve the compression of spinal cord and can obtain postoperative immediate stability for injury segment and will not aggravate the injury of the spinal cord and may create beneficial condition for functional recovery of the spinal cord.</p>

Retrospective study of comparing the different internal fixation methods in treating intertrochanteric fracture of femur / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the selective strategy of the internal fixation methods in treating intertrochanteric femoral fracture by comparing the different methods.</p><p><b>METHODS</b>Data of 326 cases of intertrochanteric femoral fractures treated with different internal fixation methods were concluded. One hundred and sixty-five cases were treated with the dynamic hip screws (DHS group), 78 male, 87 female, age 38 to 98 years. One hundred and three cases were treated with the anatomical plates of proximal femur (AP group), 48 male, 55 female, age 39 to 89 years. Fifty-eight cases were treated with the fixation expandable proximal femoral nails (PFN group), 31 male, 27 female, age 41 to 92 years. According to Evans classification of intertrochanteric femoral fractures, fractures were divided into type I, II, III, IV and retro-intertrochanteric type. The cases of each type of three groups were DHS(12, 35, 61, 42, 15); AP(9, 23, 38, 25, 8); PFN (6, 13, 21, 13,5). Data of each group was collected for statistical analysis on the following aspects: operation time,blood loss, fluoroscopy exposures, drainage, clinical healing time of fracture, post-operative restored function and the total complications.</p><p><b>RESULTS</b>The difference of operation time, blood loss, fluoroscopy exposures, drainage, clinical healing time of fracture, post-operative restored function were of statistical significance (P < 0.01). In comparing with group DHS and AP, group PFN was of less operation time, blood loss, drainage, clinical healing time of fracture, but more fluoroscopy exposures, and the post-operative restored function of group PFN was more satisfied. The difference of operative complications were of no statistical significance (P = 0.05).</p><p><b>CONCLUSION</b>The fixation expandable proximal femoral nail is a good choice for intertrochanteric femoral fracture.</p>

Repair of finger defect wiht reverse digital artery bland flap combined with digital nerve by end to side anastomosis / 中华创伤杂志

Objective To investigate role of reverse digital artery island flap combined with dig- ital nerve end to side anastomosis.Methods Reverse digital artery island flaps were used for recon- struction of 65 fingertip defects in 57cases,in which the restoration of the flap sense was attained via dig- ital nerve end to side anastomosis.Results After primary repair,all flaps survived,with good appear- ance and wear-resisting as well as satisfactory two-point discriminations.Conclusion Digital artery re- verse island flap combined with digital nerve end to side anastomosis is a simple and effective procedure for repair of finger defect.