Surgical treatment of thoracolumbar burst fractures through Wiltse paraspinal approach / 中国骨伤

<p><b>OBJECTIVE</b>To investigate clinical effects and advantages of Wiltse paraspinal approach to thoracolumbar burst fractures.</p><p><b>METHODS</b>From June 2008 to June 2010, the data of 53 patients with thoracolumbar burst fractures with no obviously nerve injury were retrospectively analyzed, including 43 males and 10 females with an average age of 41 years ( ranged, 19 to 62 years). For segmental distribution, 6 cases were T11, 11 cases were T12, 22 cases were L1 and 14 cases were L2. Among them, 28 cases were treated with Wiltse paraspinal approach, and 25 cases with postmiddle approach. The operation time, blood loss, postoperative drainage,VAS score of back, Cobb angle of injured cord, changes of collapse of vertebral and median sagittal diameter of injured vertebral were observed.</p><p><b>RESULTS</b>Compared with two methods, there were advantages in improving operation time, blood loss, postoperative drainage and VAS score of back, but there were no significant differences in improving Cobb angle of injuried cord, changes of collapse of vertebral and median sagittal diameter of injuried vertebral.</p><p><b>CONCLUSION</b>Wiltse paraspinal approach to thoracolumbar burst fractures can achieve the same reduction with postmiddle approach,and has advantages of minimally invasive, less blood, simple operation and rapid recovery, and worth popularizing.</p>

Arthroscopic minimally invasive treatment of tibial intercondylar eminence fractures in children / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the characteristics of children tibial intercondylar eminence fractures, and introduce arthroscopic minimally invasive techniques for the treatment of tibial intercondylar eminence fractures in children.</p><p><b>METHODS</b>From January 2004 to December 2008, 12 children with tibial intercondylar eminence fractures were treated with cross Kirschner wire fixation after arthroscopic reduction. According to Meyers-McKeever classification systems, there were 1 case of type I, 4 cases of type II, and 7 cases of type III. There were 10 fresh and 2 old fractures in all. Among the patients, 10 patients were boy and 2 patients were girl,ranging in age from 8 to 13 years, with an average of 10 years. All the patients underwent arthroscopic exploration, reduction and fixation. During follow-up ranging from 10 to 36 months, the union of fracture, range of motion and stabilization of the knee were assessed. One patient was combined with lesions of the menisci, 1 patient with femoral trochlea cartilage injury, and 5 patients with meniscal entrapment under the bone.</p><p><b>RESULTS</b>The heeling time averaged 5 weeks. No knee laxity or instability and no intercondylar notch impingement was detected in all cases at 3 months postoperatively. At same time, full range of motion of the affected knee returned, and the average Lysholm knee score was (92.7 +/- 2.5), the average Lysholm knee score was (96.4 +/- 1.7) at 6 months postoperatively. The Lachman test and ADT test was negative.</p><p><b>CONCLUSION</b>The type II and type III tibial intercondylar eminence fractures occur frequently in children. Lesions of the menisci and cartilage occur seldom. The method of arthroscopic cross Kirschner wire fixation for the treatment of tibial intercondylar eminence fracture is easy to operate. Simultaneously, this technique is less invasive and allows early recovery. Also it coincidences with the characteristic rapid bone growth of children.</p>