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Objective: To investigate the clinical effect and treatment strategy of percutaneous endoscopic interlaminar discectomy (PEID) in the treatment of calcified L5S1 lumbar disc herniation. Methods: A total of 15 patients with calcified L5S1 lumbar disc herniation were selected and treated with PEID combined with variable power system. The Visual Analogue scale (VAS) and Oswestry dysfunction index (ODD scores of the patients were evaluated before operation, and Id, 1 week, 3 months, 6 months after operation. Macnab score was used to evaluate the curative effect of the patients 6 months after operation. Results: The scores of VAS and ODI of the patients Id, 1 week, 3 months, and 6 months after operation were significantly lower than those before operation (P<0. 05); the modified Macnab score showed that the excellent and good rate was 86. 67%; the postoperative image results showed that the calcification area of intervertebral disc was removed, the nerve root was decompressed effectively, and there were no nerve root injury, cerebrospinal fluid leakage and infection. Conclusion: PEID combined with variable power system can effectively treat the calcified L5S1 lumbar disc herniation with the advantages of less trauma, short operation time and short recovery period.
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Objective To compare the bony fusion in different degrees of vertebral plate hinge fracture after single open-door cervical expansive laminoplasty with centerpiece mini-plate fixation.Methods The clinical data of 79 patients received the unilateral simple open-door cervical expansive laminoplasty with centerpiece mini-plate fixation from January 2010 to December 2012 were retrospectively analyzed.The vertebral plate hinge fracture was divided into incomplete fracture and complete fracture according to thepostoperative CT scan.The complete fracture was divided into four types:type Ⅰ in which there was no displacement;type Ⅱ in which there was mild to moderate displacement;type Ⅲ in which there was complete displacement or separated; type Ⅳ in which there was hinge' s collapse into cervical canal.The hinge fracture healing was observed and the difference of different types of fracture healing rate was compared.Results Follow-up of 12-45 (21.2 ± 5.6) months.CT scan found 395 segments 1 week after the operation,vertebral plate hinge complete fracture accounted for 58.2％ (230/395).And type Ⅰ accounted for 66.1％ (152/230),type Ⅱ accounted for 25.7％(59/230),type Ⅲ accounted for 6.5％(15/230) and type Ⅳ accounted for 1.7％ (4/230).The fusion rate of incomplete fracture at 6 months after the operation was higher than that complete fracture [97.6％(161/165) vs.80.9％(186/230)],there was significant difference (P＜ 0.05).The fracture rate in different types of complete fracture at 3,6 months after the operation had significant difference (P ＜ 0.05).Type Ⅲ fracture had the lowest healing rate.Conclusion Type Ⅰ fracture is the major type for vertebral plate hinge complete fracture,complete fracture get a relatively bad bony fusion and type Ⅲ fracture has the lowest healing rate.
ABSTRACT
[Objective] To investigate the effectivity and reliability of individualized method to localize the entrance point of the lumbar pedicle screws by vertebral plate borderline.[Methods]Four vertebra specimen were taken the X-ray film of anterior-posterior views as the center of L2.On the X-ray film,the distance between the centre-point of the pedicle to the lateral and superior margins of the vertebral plate were measured,after applied barium at the centre-point of the pedicle,the specimen were taken the X-ray film once more,the relation of the barium to the centre-point of the pedicle was measured;the distance between the centre-point of the pedicle to the lateral and superior margins of the vertebral plate were measured on the normal lumbar X-ray film in 107 cases,the data in different sex and different projection 's center were compared;the method were applied to 40 patients of lumbar pedicle internal fixation,the information in hospital were reviewed to 30 patients of the lumbar pedicle screw localization by transverse process and transverse process.[Results]All(except L5)of lumbar plate borderline were displayed clear in the experiment,accurate rate of setpoint to be 92.5%.The principal X-ray affected scarely to the relation of the pedicle with the plate borderline of nearby two segment,but affected obviously far from three segment on the normal lumbar X-ray film;the accurate rate of one time 's setpoint in clinical application was 96%,average operation 's time being 96 minute,average lose blood being 212 ml,transverse articular process 's group showed significant difference.[Conclusion]Individualized localization of the lumbar pedicle screw entrance points by vertebral plate borderline is one of feasible method,displayed less trauma and accurate rate highly in the clinical application.