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BACKGROUND:With more and more elderly patients suffering lumbar degenerative disease undergoing internal fixation, infection after spinal internal fixation is a common complication in orthopedic surgeries, but its treatment strategy remains controversial.OBJECTIVE: To explore the curative efficacy of incision infection after internal fixation in the elderly with lumbar degenerative disease.METHODS: 197 patients with lumbar degenerative disease undergoing internal fixation and followed up for more than 2 years admitted in Department of Orthopedics, Beijing Shijitan Hospital Affiliated to Capital Medical University from January 2012 to January 2015, were analyzed retrospectively. The follow-up time was 2-4.9 years. There were 97 cases of lumbar stenosis, 29 cases of lumbar disc herniation, 33 cases of lumbar spondylolisthesis, 17 cases of degenerative scoliosis and 21 cases of lumbar compression fractures.RESULTS AND CONCLUSION: (1) Eleven patients experienced incision infection, including ten acute, and one delayed infection. (2) Among acute infected cases, three were superficial infection in three cases and seven had deep infection,who characterized as exudation (10/10), local pain (8/10) and fever (9/10). Acute infected cases received bacterial culture, drug sensitive test, antibiotic therapy, and debridement of the infected wound, and leaving all internal fixators in situ in all but one case. (3) For delayed infection, one patient had local pain, incision exudation, and intermittent fever,and then the internal fixators were removed. (4) Pseudarthrosis was not founded during 2-year follow-up in all patients.(5) These results suggest that for the elderly patients suffering lumbar degenerative disease with infection after internal fixation, intravenous antibiotics, debridement plus drainage are recommended, but without internal fixator removal, and repetitive debridement and drainage is a rational choice if necessary.
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[Objective]To analyze the clinical and radiographic outcome of surgical treatment for idiopathic scoliosis in patients treated at the age of 20 years or older.[Methods]In this study,62 adult patients with idiopathic scoliosis who underwent surgery using pedicle screw instrumentation were followed up for 2 to 5 years,and the results were analyzed clinically and radiographically.[Results]The prevalence of pain requiring specific treatment decreased from 16% to 4%,and the pain relieve was reliably obtained in the older patients.Radiographically,the mean correction rate of Cobb's angle was 56% for both the thoracic and lumbar curves,whereas it decreased with the age increasing,especially in relation to the thoracic curve.The sagittal plane correction was satisfactory.[Conclusion]This study clarified different specific characteristics and problems in the surgical treatment of adult idiopathic scoliosis in different age groups.Pain is the most important indication for surgery in patients older than 40 years,and it has been improved reliably by surgery in most of these patients.On the other hand,the correction rate of Cobb's angle would be decreased with the increased age,the sagittal plane correction rate is not related to age.
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BACKGROUND: Selective posterior rhizotomy has been extensively acknowledged as an effective method of relieving lower limb spasticity in cerebral palsy. However, the postoperative complications such as reduced muscle strength and imbalance of the spine are of concern among surgeons and therapists. The combination of limited selective posterior rhizotomy (LSPR) with adductor tenotomy can decrease these complications without compromising the treatment effects.OBJECTIVE: To investigate the effects of combination therapy of LSPR with adductor tenotomy on lower limb spasticity, gait and movement of the patients.DESIGN: A self-controlled trial and observational follow-up taking children with cerebral palsy as the subjects.SETTING: Orthopedic Department of First Hospital Affiliated to Dalian Medical University.PARTICIPANTS: Thirty children patients with cerebral palsy treated in the Orthopedics Department of the First Affiliated Hospital of Jilin University from January 2001 to December 2002 were recruited in this trial. They presented scissors gait, flexed knee and tiptoeing of different degree. There were 18 cases of brisk tendon reflex and ankle clonus, and 15 cases of positive Babinski' s sign. All the patients had no immobile soft tissue contracture and could either accomplish walking and crouching independently or walk with arms on assistant devices.INTERVENTIONS: The patients received LSPR of L5 and S1 dorsal roots together with bilateral adductor tenotomy. Muscle tone and strength, knee and Achilles tendon reflexes, ankle clonus and pathologic signs were recorded before and after operation. X-ray examination on lumbar spine and pelvic was also taken for detection of deformity. The patients' movements were assessed according to their standing and walking postures, standing and crouching movements before operation and on follow-up. During follow-up all the mentioned indices were recorded by reference to the original case history, hospital reexamination and correspondence with the patients.MAIN OUTCOME MEASURES: The amelioration in lower limb spasticity and grading of lower limb()movements.RESULTS: During the follow-up for six months to three years(the mean of 11 months), the patients' lower limb spasticity was decreased by 2. 5 grades. The gait was also improved with disappeared scissors gait and tiptoeing, knee flexion was improved and the patients could walk with heels on the ground. All ankle clonus and pathologic reflexes disappeared. The brisk knee reflex in 12 patients became sluggish after operation. There was no decrease in lower limb strength or permanent hypesthesia. X-ray examination of lumbar spine and pelvic showed no deformity in 9 patients after over 2-year follow-up. The upper limb spasticity, salivation and aphasia in 8 patients were also ameliorated. The grading for postoperative standing, walking and crouching-standing alternation[(4.25±0.91), (3.92±0.65) and(4.02±0.74)] wasimproved(t=2.04-2.98, P ＜0.05-0.01).CONCLUSION: The combination of LSPR with adductor tenotomy can effectively ameliorate lower limb spasticity and movement with decreased operative damage.