ABSTRACT
The ideal surgical treatment of spondylolisthesis is PLIF. Tricortical autologous bone graft is associated with several complications so interbody cage has been developed to replace the tricortical interbody graft in PLIF procedure. The aim of this study is to evaluate the outcomes of instrumented posterior lumbar interbody fusion [PLIF] in surgical treatment of lytic spondylolisthesis using autologous tricortical iliac bone graft in comparison with cage. A prospective study. This study included 48 patients with low grade lytic lumbar spondylolisthesis [grade I and II] treated by pedicular fixation and posterior lumbar interbody fusion [PLIF]. They were divided into 2 groups: Iliac graft group [26 patients] was treated by PLIF using tricortical iliac bone graft and the cage group [22 patients] treated by PLIF using cages. Through the lateral radiograph, the percentage of slippage, disc height and foramen height were assessed preoperatively, immediate postoperatively, and at latest follow up. The fusion was assessed according to Brantigan criteria. Visual Analogue Scale [VAS] was used to assess back and radicular pain preoperatively and at latest follow up. Finally, function ability of all patients was assessed according to Oswestery Disability index [ODI] score. The average slip percentage of spondylolisthesis of both iliac graft and cage groups improved from 25% and 20.5% preoperatively to 5% and 4.3% immediate postoperatively, and 6.2% and 5.5% at latest follow up in this order. The average disc height of both groups improved from 7.4mm and 7.5 mm preoperatively to 11.4 mm and 11.4 mm immediate postoperatively, and 10.7 and 11.1 mm at latest follow up in this order. The average foramen height improved from 14.1 mm and 14.2 mm preoperatively to 18.2 mm and 18.1 mm immediate postoperatively, and 17.5 mm and 17.8 mm at latest follow up in this order. Certain fusion was achieved in 24 patients [92.3%] in iliac graft group and 21 [95.4%] in cage group. The Visual Analogue Scale [VAS] of back and radicular pain and ODi improved significantly from before surgery to latest follow up in both groups. Both groups showed significant good radiological and clinical final outcomes with no significant difference between the two groups
Subject(s)
Humans , Male , Female , Pelvic Bones/transplantation , Spinal Fusion , Comparative Study , Postoperative Complications , Follow-Up Studies , Treatment OutcomeABSTRACT
Fractures of the scaphoid comprise 70% to 80% of injuries to carpal bone. Studies suggest that only 5% to 110% of these fractures proceed to non-union. This risk of delayed healing or non-union have been attributed to delay in beginning treatment, inadequate immobilization, displacement of the fragments, instability due to ligamentous injury or inadequate blood supply of the proximal fragment. Non-union of the scaphoid usually causes pain and weakness, which interfere with work and sport, also non-union would most probably result in carpal osteoarthritis. Sixteen patients with symptomatic non-union of the scaphoid had been treated by iliac bone graft and Kirschener wire fixation in Mansoura University Hospital. The patients presented with pain, limited range of wrist motion and weak grip strength. The average age was 27.6 years. The average time of delay before the operation was 32 months [3 months - 60 months]. The average duration of follow up period was 9 months. Union was achieved in 15 patients [93. 75%] at an average period of 20 weeks [16-28 weeks]. According to weightington wrist scoring system: 13 patients [81 .25%] had excellent results, 2 patients [12.5%] had good results, one patient [6.25%] had poor results, and no fair results. Iliac bone graft and Kirschner wire fixation is an effective procedure for management of scaphoid non-union. It is simple, economic procedure that does not need special equipments and fixation does not add much to the operative time
Subject(s)
Humans , Male , Female , Fractures, Ununited/surgery , Pelvic Bones/transplantation , Bone Wires , Follow-Up Studies , Treatment OutcomeABSTRACT
Ten patients had ankle arthrodesis for post traumatic ankle arthritis. Full thickness iliac bone graft with cancellous screw fixation was used. There were seven male and three females. The mean age at the time of surgery was 32.2 years [range 18-46 years]. The right ankle was involved in six patients. The mean duration from trauma to surgery was 15.7 months [range 8-28 months], with a mean follow-up duration of 24.6 months [range 15-36 months]. All ankles had fused in an average time of 12.3 weeks with improvement of Mazur score [1979] from a mean preoperative score of 57.9 points to a mean postoperative score of 82.4 points. The functional results at end of follow-up were excellent in seven patients and good in three. The mean talotibial angle was 6.5 degrees of plantarflexion with no ankle placed in calceneus. The hind foot was placed in neutral to valgus in all patients but one. The mean leg length discrepancy as measured by scanogram was 5.5 millimeters [range 4-8 millimeters].No complications had been reported through this study apart from pain over the head of a medial screw in one patient that necessitated its removal after fusion. The use of full thickness iliac bone graft with screws fixation was found to give a satisfactory clinical outcome regarding the rate of union, the improvement of pain and the minimal leg length discrepancy
Subject(s)
Humans , Male , Female , Pelvic Bones/transplantation , Bone Screws , Ankle Joint , Follow-Up Studies , Recovery of FunctionABSTRACT
Los autores revisaron una serie de 22 pacientes en los que se ha practicado una artrodesis cervical anterior con la técnica de Caspar de 1987 a 1992. La etiología original fue traumática, con un seguimiento medio de 23.5 meses. Se discuten las diferentes técnicas, comentando en profundidad de descrita por Caspar y su empleo en nuestros pacientes; se estudian los resultados encontrando una mejoría clínica en la escala de Frankel y de Toledo de más de un grado y una satisfacción subjetiva de un 80 por ciento excelente, 10 por ciento de resultados buenos y 10 por ciento de resultados regulares. Fueron escasas las complicaciones intraoperatorias. En conclusión, reseñamos que es una muy buena técnica por su estabilidad inmediata, ausencia de complicaciones y recuperación precoz de los pacientes.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Spinal Injuries/surgery , Surgical Procedures, Operative , Bone Transplantation , Evaluation of Results of Therapeutic Interventions , Neurologic Examination , Fracture Fixation, Internal/instrumentation , Pelvic Bones/transplantation , Bone Plates , Bone Screws , Cervical Vertebrae/injuriesABSTRACT
Se presenta una revisión sobre el uso del injerto óseo homólogo considerado como implante biológico de hueso esponjoso, como sustituto del injerto óseo autólogo. El estudio se hizo en el Hospital de Ortopedia Lomas Verdes del IMSS entre agostos de 1987 y agosto de 1989. El material se obtuvo de enfermos operados de artroplastia total de la cadera o de la rodilla, siempre que no tuvieran padecimientos agregados. El hueso se almacenó en bolsas de polietileno, en simple refrigeración a temperaturas bajo cero. De acuerdo con la necesidad de su uso, se fragmentó; los fragmentos se agitaron dentro de peróxido de hidrógeno durante 30 minutos, después se la varon con jabón quirúrgico y solución salina hasta que quedaron sin detritus; se colocaron en frascos de vidrio con tapa metálica fenestrada y con doble cubierta de tela. Se calcinaron mediante esterilización en autoclave en un ciclo de 45 minutos a 250 grados centígrados. Se almacenaron en vitrinas a temperatura ambiente durante 14 días y después se sometieron a nuevo proceso de esterilización hasta por tres ciclos. Estos implantes se utilizaron considerándolos como sustitutos de injerto óseo autólogo. De 40 enfermos en quienes se usó el implante, solamente se pudieron seguir 24 a un plazo de 16 a 28 meses después de haber recibido el injerto. Fueron pacientes de uno y otro sexo, con edad promedio de 36.7 años. Se obtuvo integración del implante en 85.4 por ciento de los casos. En todos los injertos pricesados, los cultivos para pacterias aerobias, anaerobias y hongos fueron negativos.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Arthroplasty , Transplantation, Autologous , Bone Transplantation , Graft Rejection/immunology , Tissue Preservation/methods , Pelvic Bones/transplantation , Graft Enhancement, Immunologic , Cryopreservation/methodsABSTRACT
Se realiza un estudio sobre craneoplastia con autotrasplante de hueso ilíaco en el Hospital Provincial clinicoquirúrgico Docente "Saturnino Lora" y en el Hospital Militar "Castillo Duany", de Santiago de Cuba, por un grupo multidisciplinario formado por cirujanos maxilofaciales y neurocirujanos, en el período comprendido desde junio de 1980 hasta julio de 1982. Se presenta una síntesis bibliográfica de la literatura médica internacional sobre los distintos métodos y materiales utilizados en al plastia de los defectos craneales. Se describe el método empleado en 9 pacientes con defectos en dicha región, y se muestran los resutlados mediante ilustraciones fotográficas de los pacientes tratados, después de 6 meses