ABSTRACT
OBJECTIVE@#To investigate the clinical effect of One-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion for the treatment of lumbosacral tuberculosis.@*METHODS@#The clinical data of 31 patients with lumbosacral tuberculosis treated by one-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion from January 2013 to February 2018 were retrospectively analyzed. There were 18 males and 13 females, aged from 18 to 77 years old with an average of (45.9±9.1) years. The lesion segment was form L to S. The preoperative ASIA grading showed that 2 cases were grade B, 17 cases were grade C, 12 were grade D. Pre- and post-operative C reactive protein (CRP), visual analogue scale (VAS), erythrocyte sedimentation rate (ESR), ASIA grade, lumbosacral angle and intervertebral space height were analyzed, the surgery complications, stability of internal fixation, bone fusion were observed.@*RESULTS@#All the 31 patients were followed up for 10 to 24 months with an average of (16.0±3.1) months. One patient with local infection and subcutaneous hydrops was cured by dressing change. Other 30 cases got primary healing without sinus formation and no recurrence of spinal tuberculosis. All the patients were cured, no internal fixation loosening and breakage were found. All bone fusion was successful with an average fusion time of (4.7±1.1) months. At the final follow-up, ESR and CRP were normal, the VAS was decreased from (6.13±1.21) points preoperatively to (1.92±0.57) pioints, the ASIA grading showed that 2 cases were grade C, 6 cases were grade D, and 23 cases were grade E. The lumbosacral angle and intervertebral space height was increased from preoperative (21.42±3.75) °, (7.84±0.41) mm to (27.21±3.12) °, (9.80±0.38) mm at the final follow-up, respectively.@*CONCLUSION@#One-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion is a practicable, effective and safe method for the treatment of lumbosacral tuberculosis. It can be recommended in clinical application.
ABSTRACT
A rigid spino-pelvic fixation to anchor long constructs is crucial to maintain the stability of long fusion in spinal deformity surgery. Besides obtaining immediate stability and proper biomechanical strength of constructs, the S2 alar-iliac (S2AI) screws have some more advantages. Four Korean fresh-frozen human cadavers were procured. Free hand S2AI screw placement is performed using anatomic landmarks. The starting point of the S2AI screw is located at the midpoint between the S1 and S2 foramen and 2 mm medial to the lateral sacral crest. Gearshift was advanced from the desired starting point toward the sacro-iliac joint directing approximately 20degrees angulation caudally in sagittal plane and 30degrees angulation horizontally in the coronal plane connecting the posterior superior iliac spine (PSIS). We made a S2AI screw trajectory through the cancellous channel using the gearshift. We measured caudal angle in the sagittal plane and horizontal angle in the coronal plane. A total of eight S2AI screws were inserted in four cadavers. All screws inserted into the iliac crest were evaluated by C-arm and naked eye examination by two spine surgeons. Among 8 S2AI screws, all screws were accurately placed (100%). The average caudal angle in the sagittal plane was 17.3+/-5.4degrees. The average horizontal angle in the coronal plane connecting the PSIS was 32.0+/-1.8degrees. The placement of S2AI screws using the free hand technique without any radiographic guidance appears to an acceptable method of insertion without more radiation or time consuming.
Subject(s)
Humans , Anatomic Landmarks , Cadaver , Congenital Abnormalities , Hand , Joints , SpineABSTRACT
Herein, we report 5 cases of vertically unstable posterior pelvic ring injuries treated by pediculoiliac fixation. We enrolled 5 patients (male 3, female 2) with vertically unstable posterior pelvic ring injuries treated by pediculo-iliac fixation. Prior to and following the surgery, radiologic results were compared using Matta and Saucedo's method and the clinical results before and after surgery were compared using the Postel score. The outcomes of radiological evaluation were anatomic reduction in 3 cases and nearly anatomic in 1. The mean postel score at last follow up was very good in 4 cases and poor in 1 case. Lumbosacral pediculo-iliac screw fixation enables early ambulation and it is considered a useful method.
Subject(s)
Female , Humans , Early Ambulation , Follow-Up StudiesABSTRACT
Objective To study the anatomic morphology of posterior column of ilium(PCI)and valne of lumbo-iliac fixation(LIF)in pelvic ring reconstruction following communited Denis Ⅲ sacral fractures.Methods A total of 17 hemi-sectional pelvis and dry ilia were selected to observe the length,width and height(safety and standard)of PCI,when a detailed description was done on the methods determining entry point and operation techniqus for iliac screws anchoring.Nine patients with eommunited sacral fractures involving Denis Ⅲ areas combined with neurologic deficits were decompressed for recovery of neurological function and reconstruction of pelvic ring by using LIF.Postoperative follow-up was done on role of LIF and result of neural rehabilitation.Results PCI was mean 110.57 mm in length,24.24 mm in width,14.54 mm in standard height and 31.46 mm in safe height.Nine patients could turn over in bed immediately following operation and walk one month later.A follow-up for 13-37 months in eight patients showed stable reconstructed pelvic ring,sound function of movement and bone graft fusion,which met the target of keeping stability of fractured extremity and pelvis.Conclusions pCI can provide anatomic support for LIF.When decompression and fixation is needed for sacral fractures combined with anterior pelvic ring disruptions,LIP can provide stable fixation and play an important role in reconstruction,nursing and rehabilitation of pelvic ring.