Treatment of low lumbar degenerative disease with unilateral pedicle screw combined with contralateral percutaneous transfacet screws fixation / 中国骨伤

<p><b>OBJECTIVE</b>To explore the operative skills and effect of unilateral pedicle screw combined with contralateral percutaneous transfacet screws fixation in treating degenerative low lumbar disease.</p><p><b>METHODS</b>From January 2009 to December 2011,22 patients with degenerative low lumbar disease were treated with transforaminal lumbar interbody fusion, during the operations, unilateral pedicle screw and contralateral percutaneous transfacet screw fixation were performed. There were 16 males and 6 females, aged from 32 to 71 years old with an average of (51.1 ± 10.6) years, including single segment in 20 cases and two segments in 2 cases. Clinical effects were evaluated according to visual analogue score (VAS) and Oswestry Disability Index (ODI).</p><p><b>RESULTS</b>All patients were followed up from 1 to 2.5 years with an average of 18 months. One case complicated with leakage of cerebrospinal fluid after operation and 1 case with lower limb pain of decompression-side on the 3rd day after operation. Twenty-two patients got bony fusion. There were no instability and evidence of instrument failure during follow-up. The VAS and ODI score decreased from preoperative 8.24 ± 0.72, 36.72 ± 6.84 respectively to 3.18 ± 0.66, 4.36 ± 1.12 at the final follow-up (P < 0.05).</p><p><b>CONCLUSION</b>Unilateral pedicle screw combined with contralateral percutaneous transfacet screw fixation is safe and feasible surgical technique in treating low lumbar degenerative disease. It has advantages of little trauma, rigid fixation, high fusion rate, and less complication. etc.</p>

The Surgical Management of Traumatic Lower Cervical Spondylolisthesis with Posterior Percutaneous Pedicle Screw Fixation

We reported a technical report of traumatic lower cervical spondylolisthesisca used by bilateral pedicle fracture, without neurological compression. The patient was treated with the minimally invasive technique of percutaneous pedicle screw fixation. Fracture healing and normal cervical motion were confirmed by plain films and physical examinations on the 18-monthpostoperatively. The technique of percutaneous pedicle screw fixation might be an alternative strategy for the treatment of traumatic lower cervical spondylolisthesis with pedicle fracture.

Development of shear force-induced intervertebral disc degeneration model / 医用生物力学

Objective To develop a shear force-induced intervertebral disc degeneration (IDD) in vivo animal model, and investigate the relationship between shear stress and IDD. Methods A total of 20 Japanese white rabbits were randomly divided into two groups. In loading group (n=10), shear force of 50 N was applied on the disc of L4/5 for 4 weeks by a custom-made external shear force loading device. In control group (n=10), the animals underwent a sham operation with the external loading device situated, but their discs remained unloaded. After 4 weeks, all the intervertebral discs of L4/5 were executed for the pathologic examination. Results The postoperative radiographic examination showed a perfect position of the loading device, and the operation process and implanted loading device had no effect on daily activities and diet of the experiment animals. The pathological examination showed an irregular arrangement of annulus fibrosus and a significant decrease of normal nucleus pulposus cells in loading group. Conclusions The new custom made device greatly reduced the wounds on animal vertebra and provided a reliable shear force. The development of in vivo animal model indicates that IDD can be induced by shear force, which is of significance to further study the relationship between loading and IDD.

Discectomy and discectomy plus Coflex fixation for lumbar disc herniation, a clinical comparison study / 中华外科杂志

<p><b>OBJECTIVE</b>To compare clinical efficacy between discectomy and discectomy plus Coflex fixation for lumbar disc herniation.</p><p><b>METHODS</b>From December 2007 to August 2008, 50 patients (31 males and 19 females) were treated by surgery of discectomy and discectomy plus Coflex fixation. The average age was 52.5 years (range, 30 - 72 years). There were 24 cases in the group of discectomy plus Coflex fixation and 26 cases in the group of discectomy. Preoperative and postoperative visual analogue scales (VAS), Japanese Orthopadic Association (JOA) and Oswestry disability index (ODI) were recorded, as well as radiological index. And use a paired t-test and one-way analysis of variance (one-way ANOVA) statistical method to evaluate the Coflex dynamic stabilization system in value in the treatment of lumbar disc herniation.</p><p><b>RESULTS</b>Both groups received significant improvement of JOA, ODI and VAS (t = -33.2 - 64.5, P < 0.01), but the group of discectomy was found with deterioration of ODI at last follow-up, 12 months after surgery 6.7 ± 1.5 to 10.2 ± 2.3 (t = -19.3, P < 0.05). The group of discectomy plus Coflex fixation was found with significant increase of height of dorsal intervertebral discs (HD), distance across the two adjacent spinous processes (DS), distance of intervertebral foramina (DIF) and spinal canal area(SA) (t = -34.4 - 4.5, P < 0.05). In contrast, the group of discectomy was found with significant decrease of HD, DS, DIF and SA (t = 3.4 - 52.8, P < 0.05). Coflex fixed group in HD, DIF, DS significant difference with simple discectomy group, with a statistically significant (F = 14.1 - 25.6, P < 0.05).</p><p><b>CONCLUSIONS</b>Both discectomy and discectomy plus Coflex fixation are apparently effective when treating lumbar disc herniation. Coflex can significantly increase the HD and DIF when used for lumbar disc herniation, and it has positive influence for keeping height of lumbar vertebral space and treating the nerve root symptom of lumbar disc herniation. Discectomy plus Coflex is better than pure discectomy in preventing lumbar degeneration.</p>

Vertebral Compression Fracture with Intravertebral Vacuum Cleft Sign: Pathogenesis, Image, and Surgical Intervention

The intravertebral vacuum cleft (IVC) sign in vertebral compression fracture patients has obtained much attention. The pathogenesis, image character and efficacy of surgical intervention were disputed. Many pathogenesis theories were proposed, and its image characters are distinct from malignancy and infection. Percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) have been the main therapeutic methods for these patients in recent years. Avascular necrosis theory is the most supported; PVP could relieve back pain, restore vertebral body height and correct the kyphotic angulation (KA), and is recommended for these patients. PKP seems to be more effective for the correction of KA and lower cement leakage. The Kummell's disease with IVC sign reported by modern authors was incomplete consistent with syndrome reported by Dr. Hermann Kummell.

Clinical evaluation of interspinous process device Coflex for degenerative disk diseases / 中华外科杂志

<p><b>OBJECTIVE</b>To study indications and complications of interspinous process device Coflex for degenerative disk diseases.</p><p><b>METHODS</b>One hundred and eight patients with degenerative lumbar disc diseases were underwent procedures of surgical decompression and additional fixation of Coflex between November 2007 and October 2010. Sixty-eight patients were male and the other fourty were female, and their average age was 53.5 years (range from 37 to 75 years). Fifty-nine patients were underwent surgery of excision of nucleus pulposus and Coflex fixation, 41 patients were underwent surgery of decompression by fenestration and Coflex fixation, 6 patients were underwent surgery of topping-off, and 2 patients were underwent surgery of Coflex fixation for two level. Preoperative and postoperative visual analogue scales (VAS) and Oswestry disability index (ODI) were recorded, as well as height of ventral intervertebral space (HV), height of dorsal intervertebral space (HD), height of intervertebral foramen (HIF) and segmental range of motion (ROM). One-way ANOVA was used for statistical analysis. Surgical complications were also recorded.</p><p><b>RESULTS</b>The average follow-up time was 28.8 months. All groups had apparent improvement of VAS and ODI, and maintained well to last follow-up (F = 6.16-25.92, P = 0.00). Statistical analysis showed that HD and HIF increased significantly in group with excision of nucleus pulposus and Coflex fixation and group with decompression by fenestration and Coflex fixation (F = 7.37 - 11.68, P < 0.05). Although both HD and HIF decreased one-year after surgery, they were still higher than those preoperatively (F = 6.31 and 7.05, P = 0.00). Preoperative segmental ROM was respectively 6.3° ± 1.8° and 6.2° ± 1.7° in group with excision of nucleus pulposus and Coflex fixation and group with decompression by fenestration and Coflex fixation, and 3.1° ± 0.6° and 3.0° ± 0.8° at last follow-up. Three cases were found with device-related complications and five with non-device-related complications, and all five cased were cured after appropriate treatment.</p><p><b>CONCLUSIONS</b>Surgical method assisted with Coflex has significant clinical efficacy for degenerative disc disease, it can maintain segmental stability, simultaneously, partly reserve movement. It's key to strictly master indications and precisely choose patients.</p>

Case-control study on therapeutic effects of elastic stable intramedullary nails in the treatment of stable and unstable fractures of femoral shaft in children / 中国骨伤

<p><b>OBJECTIVE</b>To investigate curative effects of elastic stable intramedullary nails in the treatment of stable and unstable fractures of femoral shaft in children and to guide its clinical application.</p><p><b>METHODS</b>From January 2008 to October 2010,44 children with femoral shaft fractures were treated,including 24 boys and 20 girls,ranging in age from 5 to 12 years, with an average of 7.4 years. Based on the fractures stable or not, the patients were divided into stable fractures group(group S) and unstable fractures group (group U). All the children received the same operation to fix broken femoral with elastic stable intramedullary nails and some children received traction or small splint protection after operation when reduction and fixation were considered unsatisfied or his/her weight beyond 30 kg. During the followed-up, the healing time, irritation of the soft tissue (ache, cyst, t al), malunion (angulation above 5 degree in X-ray), limb shortening or lengthening and excellent and good rate were observed.</p><p><b>RESULTS</b>All the patients were followed up,and the duration ranged from 5 to 19 months, with an average of 13 months. All the fractures were healed at the latest follow-up. The average healing time was 10.2 weeks (ranges, 8 to 14 weeks). The incidence rate of malunion was 23.8% in group U and the average angulation was 9 degree (6 to 12 degree), which was higher than those of patients in the group S (0%). The average healing time, limb shortening or lengthening, irritation of the soft tissue and the excellent and good rate between two groups had no significance differences, which were (10.6 +/- 1.3) vs. (9.9 +/- 1.2) weeks, 0 vs. 3 cases, 3 vs. 1 case and 2 vs. 4 cases respectively. In the group U, among 5 patients had malunion, 4 patients were not treated with traction or small splint protection,and the incidence was higher than those who were given traction or small splint protection.</p><p><b>CONCLUSION</b>Both the stable and unstable femoral shaft fractures in children treated with elastic stable intramedullary nails can receive well short-term curative effects. If given certain postoperative protection like as traction or small splint, the malunion incidence can be reduced.</p>

Successful short-segment fixation for thoracolumbar burst fractures using CYL-pedicle screw / 中华外科杂志

<p><b>OBJECTIVE</b>To access the efficacy of posterior short-segment fixation for single level thoracolumbar burst fractures without spinal injury using CYL-pedicle screw.</p><p><b>METHODS</b>From September 2007 to December 2009, 74 cases who underwent posterior short-segment fixation for single level thoracolumbar burst fractures (Denis burst fracture type A, B, C) without spinal injury were analyzed retrospectively. There were 53 male and 21 female, mean age was (39 ± 15) years. Neither of them treated with direct decompression, grafting or fusion. Changes in the anterior vertebral height ratio, vertebral wedge angle, Cobb angle, regional angle were measured preoperatively, postoperatively, before implant removal, and at final follow-up to find the statistic difference. Pain status and work status were evaluated using Denis criterion. The incidence of incision infection, screw breakage, iatrogenic spinal injury were recorded as well.</p><p><b>RESULTS</b>The time of follow-up was (20 ± 11) months, no significant change was noted in anterior vertebral height ratio and vertebral wedge angle (P > 0.05). A significant loss was noted in Cobb angle and regional angle, which were 9.8° ± 5.1° and 9.1° ± 4.8° respectively (t = 2.48 and 3.41, P < 0.05). Comparing with the patients with Cobb angle > 20°, the patients with Cobb angle ≤ 20° had better pain scale rate (χ(2) = 4.16, P = 0.04) and work scale rate (χ(2) = 24.34, P < 0.01). There were incision infection in 1 case, screw breakage in 1, screw loose in 1, and no iatrogenic spinal injury.</p><p><b>CONCLUSIONS</b>CYL-pedicle screw could be successfully used in posterior short-segment fixation for single level thoracolumbar burst fractures without spinal injury based on radiographic and clinic outcomes.</p>

Influence of intravertebral cleft for outcome of percutaneous kyphoplasty / 中华外科杂志

<p><b>OBJECTIVES</b>To study incidence and radiological features of intravertebral cleft (IVC) in patients with chronic pain due to osteoporotic vertebral compression fractures (OVCFs), and analyze influence of IVC for surgery of percutaneous kyphoplasty (PKP).</p><p><b>METHODS</b>Seventy-six patients with osteoporotic vertebral compression fractures and pain duration more than one month were underwent procedures of PKP between August 2005 and August 2010. The incidence and radiological features of IVC were analyzed. Sixty-one patients with single-level OVCFs were divided into two groups with and without IVC. Preoperative and postoperative kyphotic angle and relative anterior vertebral height were recorded, as well as visual analogue scales (VAS) and Oswestry disability index (ODI). Cement patterns of opacification and leakage were also recorded.</p><p><b>RESULTS</b>Thirty two patients with 39 vertebrates were found with IVC sign. The diagnostic sensitivity of X ray, CT and MRI for IVC was respectively 33.3%, 85.7% and 84.6%. Two groups with IVC and without IVC both had apparent correction of kyphotic angle and reduction of anterior height at 3 days after surgery and last follow-up (F = 21.82 - 72.18, P < 0.01). There was no statistical significance between two groups (P > 0.05). In addition, both groups had significant improvement as regard to VAS and ODI (F = 131.06 - 364.12, P < 0.01). Solid pattern accounted for 72.0% of all cemented vertebrates in the group with IVC and 19.4% in the group without IVC. Four cement leakage were found in the group with IVC and another four in the group without IVC.</p><p><b>CONCLUSIONS</b>There is a high incidence of IVC in patients with chronic pain due to osteoporotic vertebral compression fractures. CT and MRI are sensitive for detection of IVC. The procedure of PKP is effective for both groups with and without IVC. IVC produces an apparent influence on cement opacification and leakage location during the procedure of PKP.</p>

Therapeutic effects and complications of percutaneous pedicle screw fixation for thoracolumbar fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the therapeutic effects and complications of percutaneous pedicle screw fixation for thoracolumbar fractures.</p><p><b>METHODS</b>From January 2002 to December 2008, 103 patients with thoracolumbar fractures were treated with percutaneous pedicle screw fixation, including 75 males and 28 females, the average age was 45.6 years (range, 18 - 72 years). All of them were of no neurological deficits. There were 65 cases of traffic injury, 23 cases of fall injury and 15 cases of smashed injury. According to the Denis classification, 64 patients were of compression fractures, and 39 patients of burst fractures. There were 5 cases had fractures in T(11), 30 in T(12), 42 in L(1), 15 in L(2), 4 in L(3), 3 in L(4), 2 in T(11-12), 1 in L(1-2), and 1 in L(2-3). Radiological examinations, including X-ray and CT examinations, and clinical examinations were carried out to evaluate the therapeutic effects.</p><p><b>RESULTS</b>Twenty one patients were lost to follow up, the remaining were followed up from 10 to 48 months with an average of 27.4 months. Before the operation, the vertebral height, the kyphosis angle and the occupation of spinal canal were (54.5 ± 8.7)%, 16.4° ± 2.9° and 1.2 ± 1.0, and were improved to (88.6 ± 6.4)%, 11.6° ± 2.7° and 0.5 ± 0.6 respectively after the operation. Preoperatively the visual analogue scale and the Oswestry disability index were 8.0 ± 1.2 and 41.2 ± 9.3, and were improved to 1.7 ± 1.8 and 6.7 ± 5.6 postoperatively, respectively. All of these values between pre- and post-operatively were significantly different (P < 0.01). Screw misplacement was found in 7 patients, superficial wound infection in 1, screw breakage in 3, screw dislodgment in 2, cement leakage in 5, transient neurological symptoms in 4, and 8 patients with low back pain remained, of which 2 patients required occasional oral analgesics. Bone fusion achieved in all cases.</p><p><b>CONCLUSIONS</b>The clinical efficacy of percutaneous pedicle screw fixation is similar with conventional open surgery. With the advantages of convenient procedure, less invasive, and rapid recovery, percutaneous pedicle screw fixation is an alternative method for thoracolumbar fractures without neurological deficits.</p>

Development of an experimental device for measuring three-dimensional movement of the spine / 医用生物力学

Objective To develop a set of loading device that can simulate the spinal movement in vitro so as to carry out the biomechanical experiment on human spine. Methods Based on the principle of bearing, the rotary locking device was designed and fixed on the loading plate, which was rotated to the position for testing and then locked by the bolt before loading. And then, with the auto-loading power provided by the universal testing machine, the pure moment of flexion/extension, left/right bending and left/right axial rotation were applied on the spine specimen to simulate the spinal movement in vivo. Finally, the position of the spine specimen before/after loading was measured by the 3D scanner. With the loading device, the range of motion under these six loading conditions for six fresh (one-year age) porcine cervical spines (C2-C6) was tested, and precision of the loading device as well as error analysis were testified by experiments. Results A set of experimental device for the three-dimensional movement measuring for human spine was developed. Data of neutral zone and range of motion for the porcine cervical spine in six directions were acquired with the total measurement error being less than 3.5％. Conclusions The delicate design of this loading device could simulate the spinal motion in vitro and thus achieve the rapid loading of the human spine. This is an inexpensive, simple and practical device, which can significantly increase the test efficiency and has great application value in loading on the spine in vitro.

Prediction of spinal cord decompression after cervical laminoplasty: the SC-line / 中华外科杂志

<p><b>OBJECTIVES</b>To report a new index (the SC-line) and a new classification for predicting of postoperative spinal cord decompression after cervical laminoplasty.</p><p><b>METHODS</b>From March 2008 to August 2009, MRI images of 25 patients treated with cervical laminoplasty were retrospectively studied. Using T2-weighted images of the cervical spine, point A was anterior point of the spinal cord at inferior endplate level of cranial compressed vertebra. Point B was anterior point of the spinal cord at superior endplate level of caudal compressed vertebra. The SC-line was defined as a line that connects A and B. Posterior surface of compressor at compression level did not exceed the line in Type I, connected the line in Type II, and exceeded it in Type III. Twenty-five patients who underwent cervical laminoplasty were classified into 3 groups according to the SC-line classification. The posterior shift of the spinal cord after the posterior decompression procedure was evaluated by using a modified gradation of degree of anterior spinal cord compression by MRI finding. The relationship between the degree of anterior spinal cord compression after surgery and the SC-line types were analyzed.</p><p><b>RESULTS</b>Preoperative cervical SC-line classification showed high correlations to the degree of spinal cord decompression. There were 3.82 ± 0.39 points in Type I before surgery, 3.90 ± 0.32 points in Type II, and 4.00 ± 0.00 points in Type III, respectively. After surgery, there were 1.15 ± 0.50 points in Type I, 2.70 ± 0.48 points in Type II, and 3.50 ± 0.55 points in Type III, respectively. Significant differences were found between each Type (F = 42.49, P < 0.01; Type I vs. Type II: P < 0.01; Type I vs. Type III: P < 0.01; Type II vs. Type III: P = 0.038).</p><p><b>CONCLUSION</b>SC-line can be used to predict the degree of postoperative spinal cord decompression following cervical laminoplasty.</p>

Application of anterior percutaneous screw fixation in treatment of odontoid process fractures in aged people / 中国骨伤

<p><b>OBJECTIVE</b>To explore the efficacy of anterior percutaneous screw fixation in the treatment of odontoid process fractures in aged people.</p><p><b>METHODS</b>From February 2001 to April 2009, 15 elderly patients with odontoid fracture were treated with anterior percutaneous screw fixation,including 13 males and 2 females; the average age was 69.3 years (ranged, 60 to 86 years). According to Anderson classification, there were 10 patients with type II fractures (type II A in 7 cases, type II B in 3 cases, based on Eysel and Roosen classification), 4 patients with shallow type III fractures, 1 patient with deep type III fractures. Thirteen patients were fresh fractures, 2 patients were obsolete fractures. All patients had varying degrees of neck or shoulder pain, and limit activity of neck. There were 4 patients with neural symptoms including 2 grade D and 2 grade C according to Frankel classification. All the patients were followed up and were assessed by radiology. Clinical examination included neck activity, neurological function and the degree of neck pain. Radiology examinations including anteroposterior, lateral, open mouth position and flexion-extension radiographs of cervical vertebra were performed.</p><p><b>RESULTS</b>After surgery, all patients were followed up,and the duration ranged from 6 to 60 months (averaged 31.3 months). Two patients died of other diseases during the follow-up period (18 and 22 months after surgery respectively). All patients got satisfactory results, and all screws were in good position. As the screw was too long, esophagus was compressed by screw tail in one case. One case showed fibrous union, 12 cases had achieved solid bony union, 2 cases showed nonunion without clinical symptoms. The rotation of neck in 3 cases was mildly limited,the neck function of the remaining patients were normal. Four patients with symptoms nerve injuries improved after operation (Frankel E in 3 cases, Frankel D in 1 case). The symptom of neck pain had a significant improvement after surgery (P < 0.001). The VAS score decreased from preoperative (6.07 +/- 1.44) (4 to 8 scores),to postoperative (1.13 +/- 0.92) (0 to 3 scores). And there were no severe postoperative complications.</p><p><b>CONCLUSION</b>The anterior percutaneous screw fixation is less traumatic than conventional approaches for aged people in dealing with odontoid process fractures. Most patients will achieve satisfactory clinical results, as long as the general conditions of them are comprehensively assess. However, this procedure should not be used in patients with comminuted odontoid fractures or severe osteoporosis.</p>

Analysis and strategy on the early complications of lumbar disc herniation with Coflex system / 中国骨伤

<p><b>OBJECTIVE</b>To explore the short-term effectiveness and the cause of the early complications of lumbar disc herniation with Coflex system in order to provide evidence for the prevention.</p><p><b>METHODS</b>From November 2007 to August 2008, 37 patients (20 males and 17 females) were treated with Coflex system. The age was from 33 to 70 years with an average of 52 years and the history was from 6 to 50 months with an average of 16.5 years. Complications were observed and the short-term effectiveness was evaluated by scores of JOA and ODI before and after operation.</p><p><b>RESULTS</b>All patients were followed up from 1 to 2 years with an average 20 months. The JOA score increased from 9.09 +/- 1.10 preoperatively to 25.40 +/- 1.20 in the last follow-up. ODI decreased from 24.70 +/- 4.80 preoperatively to 4.80 +/- 1.00 in the last follow-up. The VAS score decreased from 7.86 +/- 0.80 preoperatively to 3.20 +/- 0.50 in the last follow-up. The symptoms remarkably improved. Complications occurred in 4 pa-tients (10.8%), among them, persistent low back pain was in 1 case and conservative treatment did not work; opposite lower limb pain was in 1 case at the 3rd week after operation and symptomatic treatment was effective; displacement of Coflex was in 1 case and Coflex breakage happened in 1 case at the 6th month after operation, but both did not have related clinical symptom.</p><p><b>CONCLUSION</b>Coflex can obtain good clinical outcomes in treating lumbar disc herniation, but it has special complications. The indications and manipulations should be chosen properly.</p>

The application of minimally invasive surgery for different type of thoracolumbar fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To study the therapeutic method and effect of minimally invasive surgery for the thoracolumbar fractures.</p><p><b>METHODS</b>A retrospective review of the minimally invasive surgically treatment thoracolumbar fractures from February 2005 to June 2010 was performed. There were 183 cases, 126 males and 57 females, aged 18 to 68 years, average 38.9 years. The involved levels of fractures were T(11) in 22, T(12) in 61, L(1) in 71, L(2) in 29. According to Gertzbein classification, 145 cases were type A fractures, 34 cases were type B fractures, 4 cases were type C fractures; According to Load-sharing score, 51 cases were 4 scores, 56 cases were 5 scores, 17 cases were 6 scores, 12 cases were 7 scores, 24 cases were 8 scores, 23 cases were 9 scores. Different surgical methods were selected according to the minimally invasive surgical strategy, 22 patients were treated with the minimally invasive percutaneous pedicle screws osteosynthesis (MIPPSO group), 102 patients were treated with the small-incision pedicle screws osteosynthesis (SISPSO group), 31 patients were treated with the small incision anterior thoracolumbar surgery (SIATS group) assisted by thoracoscope or headlight, and 28 patients were treated with the 270° decompression and reconstruction surgery (270° DRS group) via a posterior small incision. Preoperative and postoperative neurological status, the correction and loss of Cobb's angle, the decompression scope of spinal canal, the location and union of bone graft were followed up and reviewed.</p><p><b>RESULTS</b>All of 183 cases had successful surgery and were followed up. In the MIPPSO group, operative time was 52 - 100 min, blood loss was 35 - 55 ml. In the the SISPSO group, operative time was 48-68 min, the blood loss was 45 - 65 ml the correction of Cobb's angle in the two groups was 8° - 19°. In the SIATS group, operative time was 140 - 220 min, the blood loss was 160 - 1500 ml the correction of Cobb's angle was 15° - 25°, 1 case had pleural effusion, 1 had lateral femoral cutaneous nerve damage, the complications disappeared after treatment. In the 270° DRS group the operative time was 160-280 min, the blood loss was 700 - 4700 ml, the correction of Cobb's angle was 15° - 28°. The spinal canal mass was removed, the spinal canal was enlarged and completely decompressed. Neurological status improved in all of the preoperative incomplete paraplegia patients except 1 case whose neurological symptoms aggravated.</p><p><b>CONCLUSION</b>It is satisfactory that the minimally invasive surgical strategy was rational used in the treatment of thoracolumbar fractures.</p>

Mid-term outcomes of minimally invasive transforaminal lumbar interbody fusion with unilateral pedicle screw fixation for lower lumbar degenerative diseases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the mid-term clinical outcomes of minimally invasive transforaminal lumbar interbody fusion (TLIF) with unilateral pedicle screw fixation for lower lumbar degenerative diseases.</p><p><b>METHODS</b>From April 2004 to December 2005, minimally invasive TLIF through paramedian approach with unilateral pedicle screw fixation was performed in a consecutive series of 43 patients, including 24 male and 19 female, aging from 38 to 71 years, with an average age of 49 years. The length of surgical incision was 3 cm. The operation level at L(3-4) were 3 cases, L(4-5) 27 cases, L(5)-S(1) 13 cases and no case was at multilevel. Clinical outcomes were assessed by ODI scores and JOA questionnaires before and after operation. Operation time, intraoperative blood loss, incision status and complications were recorded. Radiological examination was obtained for each patient to assess the height of intervertebral space, postoperative intervertebral fusion conditions and the degeneration of adjacent segments.</p><p><b>RESULTS</b>The mean operation time was 110 minutes, the mean blood loss was 150 ml and all the incisions were healed primarily. The follow-up time ranged from 36 to 58 months. The ODI scores decreased significantly from 60 ± 10 preoperatively to 12 ± 4 postoperatively (P < 0.01). The JOA scores were improved remarkably from 9.6 ± 2.2 preoperatively to 23.8 ± 2.0 postoperatively (P < 0.01) and the proportion with optimal effect was 86%. The ventral and dorsal heights of intervertebral disc were significantly higher than those before operation (P < 0.01). The fusion rate was 94%. The incidence of adjacent segment degeneration was 17%. There were no complications such as secondary scoliosis, screw loosening, internal fixation failure and cage slippage.</p><p><b>CONCLUSIONS</b>The minimally invasive TLIF through paramedian approach with unilateral pedicle screw fixation is an effective and convenient method with little surgical trauma. The mid-term follow up results showed favorable outcomes in patients receiving this surgery.</p>

Assessment for the stability of fracture thoracic lumber spine(T11~L3) fixed with crossbar equipped pedicle screws / 医用生物力学

Objective To determine the stability of fracture thoracic lumber spine (T11~L3) fixed with crossbar equipped pedicle screws. MethodThe thoracic lumber spine segments (T11~L3) were obtained from calves. A wedge cut was performed on L1 vertebral body to produce a model resembling severe vertebral compressive fracture. Some of the fracture spine segments were fixed with pedicle screws with and without crossbar. Thus, 4 types of spine segments were available: (1) normal segments; (2) unfixed fracture; (3) fracture fixed with crossbar equipped pedicle screws and (4) fracture fixed with pedicle screws without crossbar. The segmental stability was determined by measuring the range of motion (ROM) at directions of flexion/extension, left/right axial rotation and left/right lateral bending using a three dimensional laser scanner. Each ROM was standardized into a stability potential index (SPI) for the comparison among 4 groups. ResultsCompared to unfixed fracture, both fixations significantly increase stability of injuried specimens at each motion direction. The stability of injured segment fix with crossbar equipped pedicle screws is higher than that fixed without crossbar, but the difference does not reach statistically significant. ConclusionsPedicle screw fixation can significantly increase the stability of fracture spine. However, crossbar may not play a further role in raising fixative stability.

Comparative study of measuring pulse blood oxygen saturation and osteofascial compartmental pressure in forecasting osteofascial compartmental syndrome / 中国骨伤

<p><b>OBJECTIVE</b>To investigate of the value of monitoring of saturation of blood oxygen of the injured extremity on prevention of osteofascial compartmental syndrome.</p><p><b>METHODS</b>Twenty patients of osteofascial compartmental syndrome included 13 male and 7 female with an average age of 32 years ranging from 13 to 60. There were 13 cases of tibial and fibual fractures, 3 cases of tibial plateau fractures, 4 cases of femoral shaft fractures. SpO2 on the end of injured extremities were dynamic monitored and osteofascial compartmental pressure was measured by modified Whiteside method. The data of two group were compared.</p><p><b>RESULTS</b>Among 20 cases, it's negative correlation between the data of pulse blood oxygen saturation and osteofascial compartmental pressure.</p><p><b>CONCLUSION</b>The method of dynamic monitor extremity SpO2 can reflect indirectly the ischemia in muscle and nerve and report the early diagnosis and management of osteofascial compartmental syndrome.</p>

A short-term follow-up results of lumbar disc herniation by Coflex / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the short term effectiveness of lumbar disc herniation by Coflex.</p><p><b>METHODS</b>From December 2007 to June 2008, 31 patients (16 males and 15 females) were treated by Coflex. The average age was 51.4 years (range, 33 - 70 years). The average period of follow-up was 10 months. To evaluate the short term effectiveness of lumbar disc herniation by Coflex by JOA, VAS, the conventional radiography and oswestry disability index (ODI).</p><p><b>RESULTS</b>The average JOA score increased from 9.1 +/- 1.1 preoperatively to 26.4 +/- 1.7 at 6 month postoperatively. ODI decreased from 24.7 +/- 4.8 preoperatively to averaged 4.5 +/- 1.1 at 6 months postoperatively. The VAS score decreased from 7.9 +/- 0.8 to 3.0 +/- 0.9. The clinical symptoms after operation were improved significantly. There were statistically significant differences between the preoperative and postoperative HD (height of dorso- intervertebral discs), DS(distance across the two adjacent spinous processes), DI (distance of intervertebral foramina). The average HD increased from (7.9 +/- 1.1) mm preoperatively to (10.8 +/- 1.3) mm after operation. The average DS increased from (28.3 +/- 2.4) mm preoperatively to (36.4 +/- 1.7) mm postoperatively. The average DI changed from (18.8 +/- 1.0) mm preoperatively to (21.6 +/- 1.7) mm postoperatively. Complications occurred in 3 patients (9.6%). One case complained of persistent low back pain. One case showed opposite lower limb pain in 3 weeks after operation, and was cured after appropriate treatment. One case had the loosening of Coflex in 6 months after surgery, but did not appear related clinical symptoms.</p><p><b>CONCLUSION</b>Coflex for lumbar disc herniation can increase the HD and DI significantly, and it has positive meaning for keeping height of lumbar vertebral space and treating the nerve root symptom of lumbar disc herniation.</p>

Coflex interspinous dynamic internal fixation for the treatment of degenerative lumbar spinal stenosis / 中国骨伤

<p><b>OBJECTIVE</b>To assess the clinical outcomes of Coflex interspinous dynamic internal fixation and the imaging changes for degenerative lumbar spinal stenosis.</p><p><b>METHODS</b>From October 2007 to February 2009, 30 patients with degenerative lumbar spinal stenosis were treated with Coflex interspinous dynamic internal fixation, including 17 males and 13 females with an average age of 45 years (range, 39 to 65 years). The operation level at L4,5 were 20 cases, L5S1 9 cases and 1 case was in both the two levels. The ODI scores and JOA questionnaires were assessed before and after operation. The radiological measurement included ventral and dorsal intervertebral space height, segmental intervertebral angles formed by lines drawn on the upper and lower endplates of the instrumented and adjacent levels on flexion-extension radiographs; the area of spinal canal, dural sac, the sagittal and transverse diameter of the spinal canal and dural sac on CT scan. All the patients were treated with limited laminectomy and were implanted with Coflex device.</p><p><b>RESULTS</b>All the patients were followed up for 5 to 19 months. There were significant differences in the ODI scores and the JOA questionnaires by paired t-test (P<0.01). All the patients were satisfied with surgical outcomes except 3 patients whose pain were not obviously relieved and need drugs or block therapy; 3 patient complaining of progressive hypoesthesia. There were no complications associated with the Coflex device. The height of dorso-intervertebral disc was increased obviously while the range of motion in adjacent levels was not increased on flexion-extension radiographs; the area of spinal canal and dural sac were significantly increased.</p><p><b>CONCLUSION</b>It shows a good clinical result to release the degenerative lumbar spinal stenosis symptoms and decrease short-term complications by using Coflex device. It is available for patients with increasing the intervertebral space, area of spinal canal and preventing the adjacent segment degeneration.</p>