The Clinical Outcomes and Perioperative Care of Neurofibromatosis Type 1 Thoracolumbar Kyphoscoliosis / 罕见病研究

  Objective  To evaluate the clinical outcomes and complications of posterior spinal fusion surgery in the treatment of neurofibromatosis type 1(NF1)thoracolumbar kyphoscoliosis, and to explore the mode of perioperative care for nurses provided to the patients.  Methods  We used the retrospective analysis on the 134 patients with NF1 thoracolumbar kyphoscoliosis admitted to our department from March 2012 to April 2022 and analyzed the clinical outcomes and perioperative complications by using the related statistics. We evaluated the Perioperative care by the nurses in the treatment of NF1 to explore the mode of nursing to the patients with the NF1, by using specific observation points and evaluation indicators.  Results  NF1 kyphoscoliosis patients had poor preoperative nutritional status and lung function. NF1 kyphoscoliosis underwent longer operation time, lost more blood in operation, had higher osteotomy grade and more postoperative complications. All the patients successfully completed the operation in our group. The correction rate of scoliosis was (52.8±22.7)%, and the correction rate of kyphosis was (57.3±34.6)%. 25 patients had complications but no such serious complications as nerve damage.  Conclusions  The practice of the perioperative nursing to NF1 type scoliosis patients facilitates the shortening of the recovery period, the prevention or timely detection of complications, and improvement of the therapeutic effect.

Perioperative allogenic blood transfusion for single disease in patients undergoing spinal deformity correction surgery:a longitudinal observational study / 中国输血杂志

【Objective】 To analyze the profile of perioperative allogenic blood transfusion for single disease in patients who underwent spinal deformity correction surgery and risk factors of the blood transfusion, in order to provide reference for clinical decision making. 【Methods】 Clinical data from medical record homepage of 292 patients who underwent elective spinal deformity correction surgery at Chengdu Third People′s Hospital from January 2015 to December 2017 were retrospectively analyzed. Statistical analysis of the transfusion profile of allogeneic blood based on the type of single disease in patients undergoing correction surgery was performed. Multiple factor linear regression analysis was used to identify the risk factors of perioperative allogenic blood transfusion in patients with spinal deformity correction surgery. Hospital length of stay and discharge status were compared between transfusion group and non-transfusion group using Mann Whitney U test and chi-square test respectively. 【Results】 The year prevalence of perioperative allogeneic blood transfusion from 2015 to 2017 were 90.38%(47/52), 93.62%(44/47) and 81.35%(157/193), respectively. The prevalence of perioperative allogeneic blood transfusion in patients with kyphotic deformity in ankylosing spondylitis, kyphosis, adolescent idiopathic scoliosis, scoliosis and spinal stenosis were 89.08%(106/119)、79.49%(62/78)、95.24%(40/42)、84.38%(27/32) and 61.90%(13/21), respectively. Multivariate linear regression analysis showed that the regression coefficients for age and osteotomy were -0.060 (P<0.05) and 2.060 (P<0.05), respectively. Compared with non-transfusion group, the transfusion group had longer hospital length of stay (P<0.05). 【Conclusion】 Perioperative allogeneic blood transfusion in patients with spinal deformity correction surgery is closely related to the type of single disease. Age is a protective factor for perioperative allogeneic blood transfusion, while osteotomy is a risk factor for perioperative allogeneic blood transfusion in patients undergoing the spinal deformity correction surgery. Perioperative blood transfusion can also prolong the hospital length of stay of the patients.

One-stage biplanar osteotomy correction of angulation and shortening deformity of the lower extremity after epiphyseal injury of the distal femur with a monorail external fixator / 中华实用儿科临床杂志

Objective:To investigate the clinical effectiveness of one-stage biplanar osteotomy correction of angulation and shortening deformity of the lower extremity after epiphyseal injury of the distal femur with a monorail external fixator.Methods:The data of 5 patients (2 males and 3 females) with angulation and shortening deformity in the lower extremity after epiphyseal injury of the distal femur were retrospectively analyzed.The patients underwent monorail external fixator assisted one-stage osteotomy correction of the distal femur and distraction osteogenesis of the middle and upper femur in Zhengzhou Orthopeadics Hospital from May 2017 to December 2019.The mean age was 13.6 years old (range: 10 to 17 years old). The affected limbs were shortened by 5.1 cm on average (range: 3.9 to 6.5 cm). The average angulation deformity of the distal femur was 24.9° (range: 17.0°to 30.5°). The mechanical lateral distal femoral angle (mLDFA), the mechanical posterior distal femoral angle (mPDFA), the mechanical axis deviation (MAD), the range of motion (ROM) of the knee, and the length of the lower limbs before surgery and at the final follow-up were measured and analyzed.Results:All patients were followed up for 22 months on average (range: 15 to 32 months). For all the 5 patients, the mechanical axis was well realigned, mLDFA, mPDFA, and MAD returned to normal range, and the length of the affected limb achieved the goal as planned before the surgery.Besides, the affected limbs were lengthened by 5.6 cm on average (range: 3.9 to 8.0 cm), and the median healing index was 35.6 d/cm (range: 29.0 to 45.0 d/cm). The bone callus in the distraction area and the osteotomy end were well healed at the final follow-up, as indicated by the X-ray results.At the end of the distraction period, the flexion ROM of the knee in all patients reached basically 90°.By the final follow-up, all patients had a normal knee ROM.No vascular or nerve injury, dislocation of hips or knee joints, re-fracture after disassembly, deep infection and other complications were observed in all patients.Conclusions:One-stage biplanar osteotomy correction of angulation and shortening deformity of the lower extremity after epiphyseal injury of the distal femur with a monorail external fixator is safe and feasible.The method requires no multiple operations and improves the tolerance of patients during the treatment period.

Surgical Decision for Elderly Spine Deformity Patient / 대한정형외과학회잡지

Globally, the elderly population is increasing rapidly, which means that the number of deformity correction operations for elderly spine deformity patient has increased. On the other hand, for aged patients with deformity correction operation, preoperative considerations to reduce the complications and predict a good clinical outcome are not completely understood. First, medical comorbidity needs to be evaluated preoperatively with the Cumulative Illness Rating Scale for Geriatrics or the Charlson Comorbidity Index scores. Medical comorbidities are associated with the postoperative complication rate. Managing these comorbidities preoperatively decreases the complications after a spine deformity correction operation. Second, bone densitometry need to be checked for osteoporosis. Many surgical techniques have been introduced to prevent the complications associated with posterior instrumentation for osteoporosis patients. The preoperative use of an osteogenesis inducing agent

Delayed Vertebral Collapse in Osteoporotic Vertebral Compression Fractures: Risk Factors and Treatment Strategies

STUDY DESIGN: Literature review. OBJECTIVES: To review the complications of osteoporotic vertebral compression fractures (OCFs) with regard to risk factors and treatment strategies. SUMMARY OF LITERATURE REVIEW: Understanding the complications and treatment methods of OCFs is important given their increasing prevalence. MATERIALS AND METHODS: Review of the literature. RESULTS: The complications of OCFs include kyphotic deformity due to a delayed collapse of the vertebral body and neurologic deficits. The pathophysiologic mechanism of these complications has not been established; however, the most accepted theory is posttraumatic avascular necrosis of the vertebral body. The risk factors for these complications include fracture at the thoracolumbar junction, systemic usage of steroids, severe osteoporosis, and radiological intravertebral vacuum cleft. Most of these complications require surgical treatment, the indications for which include progressing axial back pain, pseudarthrosis, kyphotic deformity, and neurologic deficits. Surgical approaches for treating the complications of OCFs include anterior, posterior, and combined anterior-posterior approaches. Osteotomies should be done when deformity correction is needed. The decision among these various surgical methods should be made considering patient factors and the surgeon's ability to achieve the best outcomes with solid fusion. CONCLUSIONS: complications of OCFs include kyphotic deformity due to delayed collapse of the vertebral body and neurologic deficits. Most of these complications require surgical treatment, in which achieving solid fusion at the fracture site is the ultimate goal. Patient-related factors and the surgeon's ability should be considered prior to making decisions regarding surgery.

Domestic external fixator application in the treatment of limb deformities: 7 289 cases application report / 中华外科杂志

Objective@#To discuss the clinical application and effects of domestic external fixator in the treatment of patients with malformations of limbs.@*Methods@#A total of 7 289 patients with malformation of limbs who had been operated in Qin Sihe orthopedic surgery team from January 1989 to June 2016 were retrospective analyzed. The patients were treated with domestic external fixator, including 4 033 males and 3 256 females, aging from 2 to 82 years with a mean age of 23.4 years. There were 2 732 patients using Ilizarov external fixator, 4 713 patients using hybrid external fixator, 57 patients using monobrachial external fixator, 232 patients using Ilizarov external fixator and hybrid external fixator. The Ilizarov, hybrid and monobrachial external fixator were used in 67, 65 and 0 patients on the upper limbs and in 2 665, 4 616 and 57 patients on the lower limbs. There were 3 028 patients operated on the left limbs, 3 260 patients operated on the right limbs and 1 001 patients operated on the bilateral limbs. The top three types of diseases were sequelae of poliomyelitis, cerebral palsy and post-traumatic stress disorder peromely. Deformity types inclued talipes equinovarus, knee flexion deformity, cavus foot and so on.@*Results@#All the patients were followed up for a period of 2.5 months to 22.4 years, with an average follow-up time of 5.4 years. All of the external fixators were used for single once, and there was no substitute for external fixator quality problem. All the patients were completed surgery goal until removing external fixation except 1 patient gave up treatment and 1 removed the fixator because of metal allergy. The common complications included wire or pin infection and joint movement limitation and so on.@*Conclusions@#The domestic external fixator developed and produced based on the characteristics of Chinese limb deformity disability. The domestic external fixator can be used to treat kinds of limb deformities with the advantages of practical, economical, adjustable, universal and portable. The domestic external fixator could meet the clinical demand for fixation of the osteotomy end of the limbs, the correction of the deformity, the repair of the defects and the limb lengthening.

Is It Real False Negative Finding in Motor Evoked Potential Monitoring during Corrective Surgery of Ankylosing Spondylitis? A Case Report

We performed L1 posterior vertebral columnar resection and posterior correction for Andersson's lesion and thoracolumbar kyphosis in an ankylosing spondylitis patient during motor evoked potential (MEP) monitoring. We checked MEP intra-operatively, whenever a dangerous procedure for neural elements was performed, and no abnormal findings were seen during surgery. After the operation, we examined neurologic function in the recovery room; the patient showed a progressive neurologic deficit and no response to MEP. After emergency neural exploration and decompression surgery, the neurologic deficit was recovered. We questioned whether to acknowledge the results of this case as a false negative. We think the possible reason for this result may be delayed development of paralysis. So, we recommend that MEP monitoring should be performed not only after important operative steps but also after all steps, including skin suturing, for final confirmation.

Change in Effective Leg Length after Angular Deformity Correction by Hemiepiphyseal Stapling

BACKGROUND: The hemiepiphyseal stapling has both positive and negative effects on effective leg length. The purpose of this study was to analyze change in effective leg length after angular correction by hemiepiphyseal stapling, and to validate in clinical cases. METHODS: Mathematical analysis of a hemiepiphyseal stapling model was conducted. The induced formula was validated in 6 cases fulfilling the assumptions of the model. Anatomical parameters involved in this formula were measured in additional 21 cases undergoing hemiepiphyseal stapling or hemiepiphysiodesis. RESULTS: Effective leg length increased or decreased according to three parameters in this model: 1) limb length distal to the operated physis (L), 2) width of the operated physis (d), and 3) the amount of angular deformity to be corrected (theta). Actual change in effective leg length of 6 cases similar to this model coincided with the predicted change at least in its direction. L/d ratio was 4.82 +/- 0.51. CONCLUSIONS: Considering the narrow range of the L/d ratio, hemiepiphyseal stapling is likely to decrease effective leg length if the amount of angular correction is less than 10degrees, whereas to increase it if the amount of angular correction is larger than 16degrees. This should be taken into consideration when selecting the surgical method for angular deformity correction in skeletally immature patients.

The Kyphotic Deformity After Multi-level Laminectomy / 대한척추외과학회지

STUDY DESIGN: A Retrospective study OBJECTIVES: To analyze the characteristics, risk factors, and outcomes of postlaminectomy kyphosis. SUMMARY OF LITERATURE REVIEW: Postlaminectomy kyphosis is uncommon and poorly understood, with controversy over the cause, risk factors, and treatment. MATERIAL AND METHODS: We included 17 patients (8 male, 9 female) who had undergone multilevel laminectomy between 1982 to 2006. Their mean age at the time of laminectomy was 16.3 years. The locations of laminectomy were: 4 cervical/cervicothoracic, 10 thoracic/thoracolumbar, and 3 lumbar. Possible factors for developing kyphotic deformities, such as an age at the time of laminectomy, sex, location, laminectomy extent, and radiation therapy were analyzed with the deformity angle and the time interval from the operation to the occurrence of deformity. RESULTS: The mean time after surgery was 18.3 months, and the mean kyphotic angle was 58 degrees. Patients younger than 12 years or surgery involving more than 4 segments had a slightly shorter time interval, but not significantly. Location had no significant correlation with angle and time interval. Radiation therapy and sex were not significant factors. Most (15) patients received corrective surgery 49.9 months after laminectomy, which reduced deformities to an average of 34.5 degrees, whereas 2 patients had mild curvatures of 38 degrees (mean) One patient received a second operation due to pull-out of a rod, and one patient had a postoperative infection. CONCLUSION: Postlaminectomy kyphosis attends to occur earlier in younger patients and patients with a large number of laminas resected, so careful observation should be done for early detection and management.

Apparatus assembly and clinical application of Ilizarov technique for correcting ankle and foot deformities / 中国矫形外科杂志

[Objective] According to the basic principle of Ilizarov technique,the apparatus assembly,indications,operation methods and clinical effectiveness of Ilizarov technique in the correction of foot and ankle deformities were explored.[Method]In accordance with pathological changes and requirements for correctioning talipes equinus,cavus,calcaneus and forefoot varus or valgus,four standard external fixators were designed on the basis of Ilizarov apparatus assembly and tested biomechanically to correct the above four foot deformities.The innovation had expanded Ilizarov technique to correcting scar talipes equinus and severe foot valgus caused by rheumatoid arthritis and congenital fibular deficiency.[Result]The clinical applications of the four kinds of external fixators showed reasonable apparatus structure,convenient installation and adequate adjustment of distraction tension.They had been used in 105 cases and achieved satisfactory correction of deformity and functional recovery without severe complications.[Conclusion]The four new assemblies of external fixators showed simple structures,good performance,and practicality.Ilizarov technique has played an irreplaceable role in the correction of severe foot and ankle deformities.

Clinical Application of Unilateral-Ring Hybrid Fixation Using DynaExtor(R) / 대한정형외과학회잡지

PURPOSE: We have used a hybrid fixation, in which DynaExtor(R) and Ilizarov rings are connected each other with special connectors. Here, we report upon the technical tips learned and the clinical outcomes of the first twenty five consecutive cases treated using this method. MATERIALS AND METHODS: Between May 1997 and December 1999, 25 patients were treated using hybrid fixation aimed at simple lengthening (8 patients), concomitant deformity correction and lengthening (12), deformity correction alone (3), and fracture fixation (2). RESULTS: In the group requiring simple lengthening, the healing index (H.I.) was 38.3 day/cm (23.6-66.8 day/cm). For concomitant deformity correction and lengthening, the mean amount of angular correction was 33.8degrees (15-75degrees) and the length gain, 4.7 cm (2.2-8.9 cm). For deformity correction alone, the amount of angular correction was 50.1degrees (15-120degrees). For fracture fixation, the mean external fixation time was 59.5 days (26-93 days). Complications included mild pin-tract infection in 8 patients, a temporary stiff joint in 5, and equinus of the foot and delayed union in one patient each. CONCLUSION: The DynaExtor(R) hybrid-fixation system is an effective and convenient method that can be selectively applied to cases that need deformity correction, lengthening, or fixation of the long bone.

Lengthening & Deformity Correction in Upper Extremities by the Ilizarov Method / 대한정형외과학회잡지

We report our series of the Ilizarov surgery for lengthening and deformity correction in upper extremity at the Severance Hospital and the Yong-Dong Severance Hospital between February 1992 and October 1994. We performed the Ilizarov surgery in 12 limb segments, there were 3 humerus, 5 radius, 3 ulna and 1 metacarpal bone. The etiologies of the limb length discrepancies were 7 posttraumatic physeal injuires, 2 congenital deformities, 1 posttraumatic bone loss, 1 posttraumatic amputation and 1 postinfectious physeal injury. The goals of treatment were bone lengthening alone in 8 cases, bone lengthening and deformity correction including angular correction in 4 cases. The bone was lengthened between 1.0 cm and 9.2 cm (mean 3.7 cm) representing a 8.1% to 63.0% (mean 24.5%) increase in length. The healing index varies from 1.0 mos/cm to 10.5 mos/cm (mean 3.4 mos/cm) except three cases which need additional fixation with plate and screws add to wedge osteotomy. By radiologic appearance of the distraction callus, the straight type were 6 cases, the attenuated type were 4 cases and the pillar type were 2 cases. The healing indices of each type were 1/5 mos/cm, 7.7 mos/cm and 12.4 mos/cm, respectively. In conclusion, lengthening and deformity correction of the upper extremity can be successfully achieved by gradual mechanical distraction using the Ilizarov method. In case of pillar type, healing index was high and therefore control of the rate and the rhythm should be tried. If this control is of no use, early interventional procedure would be beneficial. The healing index of the straight type was much lower than that of the attenuated or the pillar type.

The correction of spinal deformities due to Tuberculous Spondylitis: 6 cases Report / 대한정형외과학회잡지

The Halo-pelvic traction has been considered as a powerful and strong method for correction of the severely deformed rigid spine whether it is kyphotic or scoliotic. It also affords firm stabilization during the operation and postoperative management with immobilization for a long time. Ambulation with this instrument enhances the usefulness. We have succeeded in treating and correcting 6 cases of Tuberculous Kyphosis, and 3 of which accompanied paraplegia. Especially one case of severe kyphosis, 78 was corrected to 20 and anterior strut graft was accomplished with vascuiarized free fibular graft with aid of microvascular technique. The correction rate was 38% in average. No significant complications have developed except osteoporosis of the spine.