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No abstract available.
RESUMEN
Recently posterior stabilization with various instrumentation and fusion has been used for fractures of the thoracolumbar spine involving anterior and middle columns. However, these methods are sometimes inadequate to gain anatomical reduction and complete decompression especially in burst fractures. So anterior decompression and interbody fusion were frequently added as a second operation. Biomechanically a rigid anterior spinal instrument such as kaneda device can provide enough anterior decompression through partial or total corpectomy and adequate correction of kyphosis as an one stage operation. We have experienced 27 cases of Kaneda instrumentation via anterior approach for thoracolumbar fracture, most of them were burst fractures, from Jan. 1989 to June 1990. Of there 27 cases, 12 were followed up at least 1 year and reviewed. The results were as followed: l. Anterior spinal approach using Kaneda instrumentation provided sufficient anterior neural decompression and adequate correction of kyphotic deformity. It eliminates the second posterior procedure in most cases and enhances early solid union. Simultaneously, it allows early mobilization of patient with an application of brace. 2. Post-operative courses were eventful in most cases except a case of pathological fracture. 3. This procedure seemed to be one of the most suitable method for the treatment of burst fractures of the thoracolumber region. 4. Complications by Kaneda device itself were not developed in the early evaluation stage. However, on longer follow-up study over 1 year revealed some complications including 2 cases of screw breakage and one lateral wedging deformity.
Asunto(s)
Humanos , Tirantes , Anomalías Congénitas , Descompresión , Ambulación Precoz , Estudios de Seguimiento , Fracturas Espontáneas , Cifosis , Métodos , Columna VertebralRESUMEN
For the evaluation of the clinical and radiologicaI result in the surgical reduction and internal stabilization of the fracture-dislocations in the thoracic and lumbar area, the authors analysed the 39 patients who were treated with Harrington instrumentation supplemented by segmental sublaminar wiring and were follow up 24 months in average. l. Indications for the operation were: compression type with more than 50% of body wedging, bursting type with less than 30% of canal involvement without cord injury, fracture-dislocation type with instability and any type with complete cord injury. 2. Amount of fusion were 6 segments in 25 cases, 7 segments in 11 cases, 5, 8 and 10 segments in 1 case each. 3. Among 31 cases whose lumbar segment were involved in fusion, numbers of movable lumbar motion segments were three or less in 26 and two or less in 8. 4. Angular deformity were changed from 27 preoperatively to 8 postoperatively and to 12 at the end of follow up. Wedging amount of anterior vertebral height were 53% preoperatively, 23% postoperatively and 27% at the end of follow up. 5. External support were applied for 4 months in 35 cases; Taylor brace in 22, TLSO in 10 and body cast in 3. Ambulation was started within a week according to the general status. 6. Solid bony union were observed in 38 cases within 4 months period. Dislodgement of instrumentation and deep infection in one each patient were observed as operative complications. 7. Among 21 cases with cord injury symptoms, 18 cases with complete type showed no neurological recovery, but 3 cases with incomplete type showed complete recovery. It is concluded that the Harrington instrumentation with sublaminar wiring is an effective method of reduction and stabilization for the fracture and dislocations of the thoracic and lumbar spine. On the other hand, the operation is an extensive procedure with significant involvement of lumbar motion segments.
Asunto(s)
Humanos , Tirantes , Anomalías Congénitas , Luxaciones Articulares , Estudios de Seguimiento , Mano , Métodos , Columna Vertebral , CaminataRESUMEN
18 humerus fractures in multiple injured patients were treated by closed intramedullary Ender nailing from June 1987 to June 1988. Follow-up over 3 months were obtained for 11 patients(11 fractures) and results were as follows : 1. Male was 10 in 11 cases and age was widely distributed to that of active life. 2. Trauma was the main cause of injury. 3. Ender nails were inserted through retrograde of entry in 6 cases and antegrade in 5 cases. 4. Coaptation splint was removed at postop. 3rd day and active joint exercise was started. 5. The average time of initial callus formation was post injury 19.2 days and that of solid periosteal callus bridge formation was post injury 7.5 weeks. 6. Early joint exercise, early mobilization of patient, ease of general care, small amount of blood loss, etc. were thought to be the adventages of closed Ender intramedullary nailing for humerus fractures especially in multiple injured patients.
Asunto(s)
Humanos , Masculino , Callo Óseo , Ambulación Precoz , Estudios de Seguimiento , Fijación Intramedular de Fracturas , Húmero , Articulaciones , Férulas (Fijadores)RESUMEN
Intraosseous neurogenic tumors are rare and have been reported most commonly in the mandible, possibly because of the long course of the mental nerve within this bone. They have also been reported very rarely in a vertebra. We experienced a case of intraosseous neurilemmoma arising from the body of the first lumbar vertebra, which resulted in paraplegia. The tumor was removed completely through anterior and posterior approaches by staged operation. Postoperative course was uneventful and paraplegia was recovered within three months postoperatively.