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BACKGROUND: Lumbar spondylolysis is the common cause of teenagers' low back pain. It should apply internal fixation if conservative treatment is invalid. There are a variety of surgeries, which aims to alleviate pain and bony fusion of pars defect.OBJECTIVE: To observe clinical outcome of bone graft of pars defect plus temporary single segmental pedicle screw rod fixation for adolescent lumbar spondylolysis.METHODS: A total of 32 adolescent patients of lumbar spondylolysis were treated by bone graft of pars defect plus temporary single segmental pedicle screw rod fixation. All the patients had bilateral spondylolysis. 20 patients had no lumbar spondylolisthesis, while the others had I° spondylolisthesis. All the patients received lumbar radiograph, CT and MRI. Visual analogue scale and Oswestry disability index were utilized to evaluate pain improvement before and after operation. MacNab was used to assess efficacy. Bone graft healing at isthmus was observed with lumbar CT after fixation. The internal fixation was removed after bone fusion, then the motion of the fixed segment and the degeneration of adjacent intervertebral disc occurred were recorded.RESULTS AND CONCLUSION: (1) Completed bone fusion of pars defect was achieved in all the patients. The average period of bone union was 7.4 months. (2) The visual analogue scale and Oswestry disability index scores were significantly improved after surgery in all patients (P < 0.05). (3) The fixed segment reserved the motion after internal fixation removal. The signal of adjacent intervertebral disc of fixed segment had no changes compared to preoperative MRI. (4) Bone graft to repair isthmus defect plus temporary single segmental screw rod fixation for adolescent lumbar spondylolysis is very effective, the bone fusion is completed, and temporary fixation may effectively alleviate the degeneration of adjacent disc.
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Objective To investigate the surgery outcomes between patients with different recovery states measured by visual analog scores (VAS),explore the relationships among surgery outcomes,bone cement,and degrees of pain relief,and to find out the best combination of cement volume and cement distribution for Percutaneous kyphoplasty (PKP).Methods There were 220 patients with 220 vertebra,from January 2012 to January 2014,who received PKP in our hospital.Patients were divided into two groups,on the basis of different VAS.The epidemiological data,operative effect,and surgical complications were compared between two groups.Characteristic curve (ROC) was used to analyze the effect of bone cement dosage and distribution on the diagnosis of patients with different recovery state.The correlation was analyzed between the dose and distribution of bone cement and surgery outcomes.Moreover,logistic regression analysis was used to assess the safety of cement implantation.Results A total of 77 recuperators and 143 non-recuperators were included in the study.Two groups of patients in epidemiological data showed no significant difference.The surgery duration,bone cement injection dose,cement distribution,vertebral height restoration rate and improvement of kyphotic angle in the recuperator group were all significantly higher than those in the non-recuperator group.Whether small dose and large dose of bone cement volume and expanded the bone cement distribution area could significantly improve the patient of operation after the recovery rate and bone cement dose with extensive bone cement distribution area and large bone cement dose with limited bone cement distribution area had the same operation after the recovery effect (x2 =2.880,P =0.090).When the cement volume was constant,cement distribution was positively correlated with the restoration rate of vertebral height and improvement of the kyphotic angle (r2 =0.207,P ＜ 0.01;r2 =0.159,P =0.02).Conclusions The value of cement distribution is better than cement volume in relieving patient pain for diagnostic.For PKP,cement distribution above 0.49 with small cement should be suggested.
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BACKGROUND: Most scholars believed that injured vertebral body needs to be fixed in the open surgery of thoracolumbar vertebral fractures; however, it is unclear whether injured vertebra needs to be fixed in the minimaly invasive surgery. OBJECTIVE: To investigate the clinical outcomes of minimaly invasive percutaneous self-dilating pedicle in repair of injured vertebral fixation in thoracolumbar vertebral fractures. METHODS: Totaly 36 patients with thoracolumbar vertebral fractures without nervous system injury who received treatment in Honghui Hospital, Xi’an Jiaotong University Health Science Center from February 2013to February 2014 were enroled and divided into injured vertebral fixation and cross-injured vertebral fixation groups (n=18/group). Patients in these two groups were al subjected to minimaly invasive percutaneous self-dilating pedicle treatment. The injured vertebral body, upper, and lower vertebrae of injured vertebral body were fixed in injured vertebral fixation group, and the upper and lower vertebrae of injured vertebral body was fixed in cross-injured vertebral fixation group. RESULTS AND CONCLUSION: Compared with the injured vertebral fixation group, the cross-injured vertebral fixation group had smaler incisions, less intraoperative blood loss, less operation tine and intraoperative X-ray fluoroscopy time (P 0.05). These results demonstrate that anterior vertebral height cross-injured vertebral fixation has the similar clinical effect with injured vertebral fixation, but cross-injured vertebral fixation had more advantage in the operation. Therefore, there is little significance of conducting injured vertebral fixation in the surgery of minimaly invasive percutaneous self-dilating pedicle in repair of thoracolumbar vertebral fractures.
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Objective To investigate the anatomy of upper cervical vertebrae's stable reconstruction by poster arch of atlas screw by anatomic study. Methods To collect the anatomical data of 39 dry atlas with the average inner diameter of vessel of atlas, the average high and wide of the screw point of poster arch of atlas, the average high and wide of poster arch of atlas beneath the groove for vertebral artery, the tract length of poster arch screw, the tract length of lateral mass screw, the direction and angle of poster arch screw, and the direction and angle of lateral mass. Statistical comparison were performed with Student test between the tract length of poster arch screw and the tract length of lateral mass screw. Results The average inner diameter of vessel of atlas was (26.8±2.58) mm(21.7-31.0 mm). The screw point high and wide of poster arch of atlas were (6.83±1.97) mm and (6.40±1.36) mm respectively. The average high and wide of poster arch of atlas beneath the groove for vertebral artery were (4.37±1.11) mm and (8.05±1.33) mm respectively. The tract length of poster arch screw were (30.54±1.705) mm. The direction and angle of poster arch screw was 15°-20° incline laterally and 0°-5°incline cephalo. 25.6%(10 cases) patients with the diameter less than 3.5mm beneath the groove for vertebral artery. The direction and angle of lateral mass screw was 32.05°±6.03° incline medially and 5° incline cephalo. There were significant differences between the tract length of poster arch screw and the tract length of lateral mass screw(t=59.528, P＜0.001 ). Conclusion About 74.4% patients can reconstruct the upper cervical stable by poster arch of atlas screw. The technique can gain instant upper cervical stable, and reduce the risk of injury of blood vessel by over explore the atlas arch compare with the technique of lateral mass screw fixation of atlas. The technique is worth to promoting with its character of safe, easy perform and rigid fixation.
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0.05).There were no pseudoarthrosis and internal fixation failure.The incidence of proximal junction kyphosis was higher in group B(P
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[Objective]To discuss the methods of insertion the pedicle screws of thoracic vertebrae and sum the results of correction of idiopathic scoliosis.[Method]Bone of entrance was removed with rongeur forceps.According to the depth and rotation preoperative,to drill using 1.5 mm and 2.5 mm Kirschner wire.If the resistance was increasing and Kirschner wire was bending,it needs to adjust the direction.Stop to drill whenachieve the depth,after checking the hole using special probe then strike awl in the hole.Checking the hole using specillum again then insert the screws.[Result]97% were successful inserted by one time.There were no patients with spinal cord injury and leakage of cerebrospinal fluid and no infection of incisionsl wound.The correction rate in coronal plane was 73% after surgery.The Cobb's angle in sagittal plane was from 6? to 30?,with average of 23?.Rotation deformity was corrected Ⅰ to Ⅱ degree.There were 103 patients.Follow-up duration was with average 4.9 years.Trunk balance was good and no flat back was happen.Bone graft fused well.The correction lost 3.7% in coronal plane at final follow up.One case was with late infection and 2 patients were with screws broken.The internal fixations were removed out.[Conclusion]Using Kirschner wire to made screw hole is a good way to insert thoracic vertebrace pedicle screw.Screw-rod system had favourable three diamensions correct control force.Fully pedicle screw to correct idiopathic scoliosis has good results.
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Objective To summarize the experiences of the diagnosis and treatment of the intraspinal tumors. Methods One hundredand twenty-three cases of the intraspinal tumors were analyzed retrospectively. Results The intraspinal tumors in those patients included meningiomas/neurofibroma in 32 cases (19.5%), neurinoma in 32 cases (26.0%), ependymoma in 8 cases (6.5%), astrocytoma in 13 cases (10.6%), lipoma in 10 cases (8.1%), metastatic tumors and hemangioma each in 5 cases (4.1%), arachnoid cyst in 9 cases (7.3%), and others in 17 cases (13.8%). The extramedullary subdural, epidural and intramedullary tumors accounted for 56.9%, 21.1% and 22.8%. According to the locations, 30.1% tumors located at cervical region, 37.4% at thoracic region, 19.5% at lumbar region and 13.0% at sacral segments. The total removal rates of tumors were 69.1% (the total removal rates of extramedullary tumors were 70.1%, and the removal rates of intramedullary tumors were 60.7%).The improvement rates of different degree of movement, sense and sphincter function were 75.2%, 73.8% and 77.8%. Conclusion Most of the intraspinal tumors are benign, and the surgical outcome is satisfied. The keys of therapeutic efficacy were MRI and microsurgical techniques application. The spinal stability reconstruction is in the extreme need if spinal stability is breached in surgery.
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[Objective]To review the therapeutic effect of TSRH in correction of coronal plane,sagittal plane and horizontal plane malformation of the idiopathic scoliosis,and to evaluate the result of screw-rod and screw-crook-rod system.[Method]A total of 79 idiopathic scoliosis patients who were corrected with TSRH were analyzed.There were 48 males and 31 females with an average age of 15.5 years.Only pedicle screws system was used in 56 cases,pedicle crook or vertebral plate crook in thoracic vertebra,pedicle screws system in lumbar vertebrae were used in 23 cases,then the results of two groups were compared.[Result]Cobb's angel in coronal plane was corrected from 18 to 31 after operation,the correction rate was from 56 percent to 87 percent,with an average of 68 percent;while Cobb's angel in sagittal plane was corrected from 21 to 33 after operation,with an average of 25.Rotation was corrected by I degree,heights were increased by 3 cm in average.The mean followed-up duration of 63 cases was two years and a half year.There was significant difference between the two groups in correction rate in coronal plane and sagittal plane,also in loss of correction in coronal plane.[Conclusion]TSRH could make satisfying results in correction of idiopathic scoliosis,and the result would be better if pedicle screws system is used.
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@#Objective To explore effect of Axis internal fixation system while decompression and fusion for the treatment of timeworn atlantoaxial dislocation with incomplete spinal cord injury.Methods 29 cases of timeworn atlanto-axial dislocation with incomplete spinal cord injury underwent decompression fusion and Axis internal fixation with a 7～46 months (mean 20 months) flowing-up.ResultsAfter treatment, all patients got completed fusion, there was no deterioration of neurofunction, and rate of JOA scores increased was 78.6%.ConclusionAxis internal fixation system can provide immediately a rigid stability and maintain axial correction for the segment ahile decompression and fusion for the treatment of timeworn atlantoaxial deslocation with incomplete spinal cord injury.
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@# ObjectiveTo analyse the state of traumatic conditions, associated injury and complications of patients with acute spinal cord injury (SCI) and provide the therapeutic principles of early treatment.Methods1352 cases with acute SCI were studied retrospectively.ResultsAmong patients, 875 cases had complete SCI and 477 cases had incomplete SCI. Complications included pulmonary infection, urinary system infection, bedsore and so on. The associated injuries included craniocerebral injury, fractures of limbs and pelvic, hemopneumothorax and so on. Conservative treatments involved high doses of methylprednisolone pulse therapy (MPPT), hyperbaric oxygen treatment (HOT), the use of dehydrating and neurotrophy agents, etc. The operation of decompress and internal fixation was applied in cases with spinal instability, vertebral dislocation and spinal compression. The associated injury was treated by specialist.ConclusionThe key point of raising remedy level includes thinking highly of field first aid, prompt and perfect early treatment, dealing with associated injury, preventing secondary SCI and complications and early rehabilitation directions.
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Objective To explore the clinical features and operative method of complicated spinal tuberculosis. Methods Totally 562 inpatients suffering from spinal tuberculosis during January 1997 to December 2006 were reviewed retrospectively. A new definition of complicated spinal tuberculosis was made. Complicated spinal tuberculosis was classified into different types. Every type had its special surgical operation approach. Results Among the 87 cases being followed up for 45 months, 75 patients were totally recovered, and 12 patients were obvious improved on the mend according to Dr. Fang Xian-zhi’s standard. The classification of function which above good was 97.1%. The fusion rate was 96.3% during 87 patients who received bone grafting treatment 9 months ago. Posterior convex angle was 24? to 57?, average 35.3?. Conclusion We consider that complicated spinal tuberculosis will not be surgical contraindication. Different types of complicated spinal tuberculosis by different operation approach, and careful preparation before operation will gain good curative outcome.