Comparison of vesselplasty and percutanous kyphoplasty in the treatment of Kümmell disease / 中国骨伤

OBJECTIVE@#To compare the efficacy between vesselplasty and percutanous kyphoplasty (PKP) in the treatment of Kümmell disease.@*METHODS@#The clinical data of patients with Kümmell disease from July 2018 to December 2019 were retrospectively analyzed. According to the different therapeutic methods, the patients were divided into vesselplasty group and PKP group. There were 20 patients in vesselplasty group, including 2 males and 18 females, aged from 54 to 83 years with an average of (67.40±7.44)years, 1 case of T10 fracture, 3 cases of T12 fracture, 9 cases of L1 fractures, 5 cases of L2 fractures and 2 cases of L3 fractures. There were 20 patients in PKP group, including 3 males and 17 females, aged from 56 to 81 with an average of(67.20±7.01) years, 2 cases of T10 fracture, 1 case of T11 fracture, 6 cases of T12 fracture, 10 cases of L1 fracture and 1 case of L3 fracture. Visual analogue scale(VAS), Cobb angle, anterior vertebral height were recorded before operation, 1 day after operation and 1 year after operation. Oswestry Disability Index(ODI) was recorded before operation, 1 month after operation and 1 year after operation. And bone cement leakage rate was compared between two groups after operation.@*RESULTS@#All the patient were followed up for more than 1 year. In vesselplasty group, VAS score was 1.20±0.41, ODI was(13.50±3.10)%, Cobb angle was(17.20±3.12)° and anterior vertebral height was(20.20±1.35) mm at 1 year after operation. In PKP group, VAS score was 1.15±0.40, ODI was (13.20±3.00)%, Cobb angle was (17.10±3.19)° and anterior vertebral height was (20.10±1.37) mm at 1 year after operation. These index was significantly better than pre-operation through intra-group comparison(P<0.05), and there was no statistically difference between the two groups(P>0.05). There were 20 cases (20 vertebrae) in vesselplasty group, of which 1 case had bone cement leakage at the upper endplate, with a leakage rate of 5%(1/20). In PKP group, there were 20 cases (20 vertebrae), 3 cases of upward endplate leakage(3/7), 1 case of downward endplate leakage(1/7), 1 case of leakage to the front of the vertebral body(1/7), 2 cases of leakage to the side of the vertebral body(2/7), with a leakage rate of 35% (7/20). The difference between two groups was statistically significant(P<0.05).@*CONCLUSION@#Vesselplasty in the treatment of Kümmell disease can better reduce leakage rate of bone cement and reduce complications.

Clinical study on Thread-tooth Arc-track Screw Plate System through expandable channels in the treatment of lumbar instability diseases / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the validity and reliability of Thread-tooth Arc-track Screw Plate System (TASPS) in the fixation fusion through expandable channels.</p><p><b>METHODS</b>From August 2007 to August 2010, 108 patients with lumbar instability were treated with surgery, including 61 males and 47 females, ranging in age from 26 to 57 years, with an average of 41 years. All the patients were divided into two groups : minimally invasive fusion group and traditional operation group (54 patients in each group). The patients in the minimally invasive fusion group were treated with self-designed TASPS to conduct the fixation fusion through expandable channels by minimally invasive pedicle screw; and the patients in traditional operation group were treated with traditional interbody fixation fusion by pedicle screw. The data were collected and investigated at the 1st week, 3rd month and 1st year postoperatively. The comparative parameters of two groups contained the total operation time, the implanted time, the total amount of bleeding; the VAS score, ODI score and improvement rate at each investigated period; the intervertebral space height of preoperative and postoperative periods; the inefficiency rate of implantation and the fusion rate of postoperative period.</p><p><b>RESULTS</b>All incisions were healed by first stage without any complications such as dural tear, injury of nerve root or cauda equine, intervertebral space infection. The patients in the minimally invasive fusion group needed longer operative time than that of the traditional operation group, but had less total amount of intraoperative and postoperative bleeding and shorter implanted time of pedicle screw than those of the traditional operation group. The VAS scores of two groups at the 1st week after operation significantly decreased compared with that of the 1st day before the operation, and the difference was of high statistical significance. And the VAS scores of two groups at the 3rd month and 1st year after operation also significantly decreased compared with that of the 1st day before the operation, and the difference was highly statistically significant. By comparing the VAS score and ODI score at the 1st week, 3rd month and 1st year postoperatively, the results showed that the VAS score and ODI score of the minimally invasive fusion group were all lower than those of the traditional operation group, and the differences were of high statistical meaningfulness. After 1 year, the improvement rate of the minimally invasive fusion group was (77.46 +/- 6.34)%, while that of the traditional operation group was (72.73 +/- 4.49)%, and the difference was highly statistically significant (P < 0.01). The intervertebral space heights of two groups remarkably increased. At the 3rd month after operation, the difference of intervertebral space heights of the two groups was of no statistical significance. At the 1st year after operation, intervertebral space heights of the two groups were lost to some extent, but the height of the minimally invasive fusion group was higher than that of the traditional operation group, and the difference was statistically significant. The fusion rates of the two groups after 1 year were 100%.</p><p><b>CONCLUSION</b>The fixation fusion through expandable channels by minimally invasive pedicle screw possesses the characteristics of fewer traumas, less intraoperative blood loss, less postoperative pain and rapid recovery. Since its intervertebral fusion rate is similar to the open surgery, it can be viewed as one effective approach for the treatment of lumbar instability diseases. And TASPS is reasonably designed, easy to install and reliably fixed with good reduction effect, which can be applied through expandable channels.</p>

Clinical application of atlantoaxial pedicle screw internal fixation for treatment of atlantoaxial dislocation / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical effect of atlantoaxial pedicle screw internal fixation for treatment of atlantoaxial dislocation.</p><p><b>METHODS</b>Sixteen patients with atlantoaxial dislocation were treated from Dec. 2005 to June 2007, included 10 males and 6 females, aged from 38 to 45 years old (means 40.5 years). Among them 12 patients combined with nerve injury, according to ASIA grade: there were 3 cases in grade B, 5 cases in grade C, 4 cases in grade D. All patients received preoperative CT, radiograph and skull traction. Intraoperative posterior approach general spine pedicle screw-rod orthopaedics fixation system used and iliac bone block were implanted in space of posterior atlantal arch and axial vertebral plate. The outcome and complications were observed in the near future.</p><p><b>RESULTS</b>There was no vascular or neural injury found. The patients were followed up for 12 to 24 months (means 18 months). All head pain, acid storm symptoms were improved after operation. According to the Odom's clinical efficacy evaluation standard, 12 cases were excellent, 4 were good. Eleven cases of 12 with nerve injury recovered significantly. By ASIA classification: 1 cases was in grade B, 2 cases were in grade C, 5 cases were in grade D, 4 cases were in grade E. No looseness or breakage of screw occurred. Bony fusion was achieved in all cases.</p><p><b>CONCLUSION</b>Posterior approach atlantoaxial pedicle screw internal fixation have the advantages of direct screw placement, short-segment fusion, intraoperative reduction, fixation reliable, high fusion rate, and it can restablish the upper cervical vertebrae stability and help to recover the spinal cord and nerve function.</p>

Core decompression and implantation of calcium phosphate cement/Danshen drug delivery system for treating ischemic necrosis of femoral head at Stages I, II and III of antigen reactive cell opsonization / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To introduce a new method using calcium phosphate cement/Danshen drug delivery system for treating ischemic necrosis of the femoral head and evaluate its curative effect.</p><p><b>METHODS</b>From May 2000 to June 2005, 48 adult patients (54 hips) with ischemic necrosis of the femoral head at Stages I, II and III of antigen reactive cell opsonization (ARCO) were treated with implantation of calcium phosphate cement/Danshen drug delivery system in the involved femoral head. The operation consisted of removal of the necrotic bone under weight-loading cartilage and the implantation of phosphate cement/Danshen drug delivery system, and all manipulations were made percutaneously through a bone tunnel in the trochanter. The functions of the hip joint were evaluated and X-ray films were taken preoperatively and postoperatively.</p><p><b>RESULTS</b>Postoperative follow-up was 45.5 months on average, ranging from 27 to 78 months. According to the evaluation criterion of "Dandong 1995" for therapeutic effect of adult ischemic necrosis of the femoral head, the therapeutic effects were excellent in 33 hips, good in 17, fair in 3 and poor in 1, with the excellent and good rate of 92.6%.</p><p><b>CONCLUSIONS</b>This method is relatively simple with little invasion. It not only improves the microcirculation of the femoral head by local application of traditional Chinese medicine, but also provides mechanic buttress in the weight-loading area to prevent collapse during repairing, which is beneficial to repair and reconstruction of femoral head. It may be a choice of minimal invasion surgery for ischemic necrosis of the femoral head at Stages I, II and III of ARCO.</p>

Sequential drugs treatment for central pain following spinal cord injury / 中国骨伤

<p><b>OBJECTIVE</b>To investigate methods and therapeutic effects of sequential drugs treatment for central pain following spinal cord injury.</p><p><b>METHODS</b>A total of 28 patients suffered from central pain following spinal cord injury were treated with sequential drugs from 1994 to 2008, including 23 males and 5 females, ranging in age from 25 to 59 years (mean 42 years). According to the patients' response to drugs, the therapy grade was adjusted step by step until the pain was relieved. Basing on VAS scores before and after drugs treatment, analgesic effect was evaluated. The first grade drugs: COX-2 inhibitors. The second grade drugs: Tricyclic antidepressant drugs (Amitriptyline) + COX-2 inhibitors + Carbamazepine. The third grade drugs: Tricyclic antidepressant drugs (Amitriptyline) + Gabapentin + Neurotropin/COX-2 inhibitors.</p><p><b>RESULTS</b>The pain of all of 28 patients was relieved to different extent. The VAS scores decreased by 23.3 +/- 1.2 in the first grade drugs treatment group. The VAS scores decreased by 54.5 +/- 3.8 in the second grade drugs treatment group. The VAS scores decreased by 65.8 +/- 5.1 in the third grade drugs treatment group (P<0.05).</p><p><b>CONCLUSION</b>The sequential drugs treatment for central pain following spinal cord injury has a good analgesia effect and little adverse reaction.</p>

Comparison between mini-traumatic bone-grafting and non-bone-grafting in percutaneous K-wire fixation to treat the calcaneal fractures / 中国骨伤

<p><b>OBJECTIVE</b>To compare the effect between mini-traumatic bone-grafting and non-bone-grafting in percutaneous K-wire fixation for treating the calcaneal fractures.</p><p><b>METHODS</b>From 2002 to 2006, 112 patients with the type II (Paley type) fractures of calcaneus were studied. There were 56 cases in bone-grafting group involving 36 males and 20 famales,aged from 21 to 65, averaged (42.0 +/- 2.3) years; 11 cases were in type II a and 45 were in type II b; the course was from 3 to 14 days, averaged (6.0 +/- 1.2) days. And there were 56 cases in non-bone-grafting group involving 38 males and 18 famales,aged from 22 to 67, averaged (43.0 +/- 2.5)years; 13 cases were in type II a and 43 were in type II b; the course was from 2 to 15 days, averaged (5.0-2.1) days. All the cases were treated by closed reduction and percutaneous K-wire fixation, and bone-grafting group(56 cases) were treated by mini-traumatic bone-grafting, but the other group (56 cases) were not. The collapsing rate and fineness rate were compared.</p><p><b>RESULTS</b>All the cases were followed up from 5 to 52 months. There were no collapsing cases in the bone-grafting group after operation, but 3 cases occurrenced re-collapsing in the non-bone-grafting group. According to the Zhang Tie-liang's evaluation criterion, in the bone-grafting group,the results were excellent in 43 cases, good in 12, fair in 1, the fineness rate was 98.2%. In the non-bone-grafting group,the results were excellent in 37 cases, good in 16, fair in 2, poor in 1, the fineness rate was 94.7%.</p><p><b>CONCLUSION</b>Treatment of the type II fracture of calcaneus with closed reduction, percutaneous K-wire fixation and mini-traumatic bone-grafting can prevent the posterior talar articular surface of caltaneus from collapsing again after operation, enhance the union of fracture, elevate the curative effect, thus it should be taken with the standard therapeutic regimen.</p>

The randomized controlled trial of the treatment for clavicular fracture by rotatory manual reduction with forceps holder and retrograde percutaneous pinning transfixation / 中国骨伤

<p><b>OBJECTIVE</b>To study the curative effect and safety of rotatory manual reduction with forceps holder and retrograde percutaneous pinning transfixation in treating clavicular fracture.</p><p><b>METHODS</b>All 201 cases of clavicular fractures were randomly divided into treatment group (101 cases) and control group (100 cases). The treatment group was treated by rotatory manual reduction with forceps holder and retrograde percutaneous pinning transfixation. The control group was treated by open reduction and internal fixation with Kirschner pin. All cases were followed up for 4 to 21 months (mean 10.6 months). SPSS was used to analyze clinic healing time of fracture and shoulder-joint function in both two groups.</p><p><b>RESULTS</b>After operation, 101 cases of treatment group achieved union of fracture and the clinical healing time was 28 to 49 days (mean 34.5+/-2.7 days). In control group,there were 4 cases with nonunion of fracture,the other 96 cases were union,the clinical healing time was 36 to 92 days (mean 55.3+/-4.8 days). The excellent and good rate of shoulder-joint function was 100% in treatment group and 83% in control group. By t-test and chi2-test, there was significant difference between the two groups in curative effect (P<0.05).</p><p><b>CONCLUSION</b>Rotatory manual reduction with forceps holder and retrograde pinning transfixation can be used in various kinds of clavicular shaft fracture, with many virtues such as easy operation, reliable fixation, short union time of fracture, good functional recovery of shoulder-joint and no incision scar affecting appearance.</p>

An invitro biomechanical study of treatment for lumbar spondylolithesis using nail-grooved tail steel plate and intervertebral implant (Wendeng Fusion Cage, WDFC) / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the biomechanics of treatment for lumbar spondlolisthesis using nail-grooved tail steel plate and WDFC (Wendeng Fusion Cage) implant.</p><p><b>METHODS</b>There were nine permanent waist-sacrum wet bone (L3-S3) in 1 to 2 clay-cold hours including 6 men and 3 women. They were seldom separated into 3 groups, which were fixed by nail-grooved fail plus WDFC. The model was separate into two kinds for single and across. With electrometry, deal experiment date with Graftool software. Each piece should be tested twice respectively.</p><p><b>RESULTS</b>The single and across segment non-destructive compression experiment. No-mid-compression from 0 to 750 N,the related coefficient and curves had no obvious change on inclined rate. In the single segment curvedly serial experiment, the stress at all point measured by two sides steel plate-was mostly linear growth. In the across segment curvedly serial experiment, the inclined rate become big and appear anisomerous.</p><p><b>CONCLUSION</b>It's proved by biomechanics that the steel plates with single furrow and cylinder wing plus WDFC has a good stability to cure lumbar vertebra slips.</p>

Biomechanical test of the general spinal pedicle screw-rod orthopaedics fixation system in the treatment of diseases related to spinal instability / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the biomechanical performance of the spinal universal fixation system(GSPS) in treating the diseases related to spinal instability.</p><p><b>METHODS</b>Four instable models and 4 fracture models were made of fresh pig's thoracolumbar specimens (T10-L3). Self-designed GSPS were used in the simulated operation. Axial loading test and torsion test were made. The stress-strain relation of the GSPS was observed. The extracting force of link bar from elastic jig was tested.</p><p><b>RESULTS</b>The strain value of each tested point changed linearly when the axial load changed from 0 to 600 N. There was linear relation between the torsion and the torsion angle. The latter was less than 6 degrees when the former reached 300 N x cm. The minimum extracting force of the link bar from the elastic jig was more than 3 300 N.</p><p><b>CONCLUSION</b>The GSPS has high energy and high elasticity on anti-axial and anti-torsion load. It is stable to use elastic link bar.</p>

Treatment of lumbar spondylolisthesis by posterior restoration and three-column fixation / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the late results of using posterior restoration and three-column fixation to treat lumbar spondylolisthesis.</p><p><b>METHODS</b>One hundred and eighty-four patients with lumbar spondylolisthesis were collected from March 1999 to May 2007, they were treated by posterior restoration and fixation with single nail-grooved tail steel plate and fixed with cage (WDFC). Among these cases, 87 cases were fixed with one WDFC, 97 cases were used two WDFCs.</p><p><b>RESULTS</b>All patients were followed up for 8 to 69 months(averaged 23 months). According to Nakai standard, the results was excellent in 142 cases, good in 34, fair in 8, the excellent and good rates were 95.6%. Seventy-nine vertebraes with I degree spondylolisthesis were reduced after surgery. Eighty-seven vertebraes with II degree spondylolisthesis were reduced except 9 with I degree spondylolisthesis left. Twenty-one with III degree spondylolisthesis were reduced except 5 with I degree spondylolisthesis left; In 2 with IV degree spondylolisthesis, one with I degree spondylolisthesis left and the other with II degree spondylolisthesis left. The follow-up results showed that there was no statistical significance in the height of intervertebral space between preoperation and post-operation, and no recurrence was observed and no single nail-grooved tail steel plate and WDFC were loose or crashed.</p><p><b>CONCLUSION</b>Posterior restoration and three-column fixation is a positive modus operandi to treat lumbar spondylolisthesis,which can reduce excellently,keep the height of intervertebral space and stabilization of segment, obtain high rate of fusion, and cut down complication.</p>