The clinical value of end plate rings in preventing subsidence of titanium cage in anterior cervical corpectomy and fusion surgery / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical results of using end plate rings in preventing subsidence of titanium cage in anterior cervical corpectomy and fusion (ACCF) surgery.</p><p><b>METHODS</b>The clinical data of 71 patients with cervical spondylotic myelopathy underwent ACCF in single segment from February 2008 to February 2011 were retrospectively analyzed. There were 38 males and 33 females, aged from 39 to 74 years old with a mean of 53.8 years. Thirty-three were used end plate rings and thirty-eight were not used (end plate rings group and no end plate ring group, respectively). The Japanese Orthopaedic Association (JOA) score, Odom's scale, imaging data were used to evaluate the clinical effects. Imaging data including Cobb angle of fusion segment, intervertebral height of anterior border (Da) and posterior border (Dp), the mean intervertebral height (Dm).</p><p><b>RESULTS</b>All patients were followed up from 13 to 34 months with an average of 19.5 months. Between two groups, there was no significant difference in Cobb angle of fusion segment and the mean intervertebral height (Dm) before surgery and one week after surgery. Whereas, one year after surgery, the Cobb angle of end plate ring group was (9.4 ± 3.8) degrees, and contral group was (7.5 ± 3.9) degrees, which was significantly lower than that of end plate ring group. Meanwhile, the Dm of end plate ring group was (57.3 ± 2.2) mm, and no end ring group was (55.2 ± 2.6) mm which was significantly lower than that of end plate ring group. The subsidence in end plate ring group was 57.6%, and was 78.9% in no end plate ring group. There was no significant difference in JOA score before and after surgery between two groups. At 1 year after operation, 90.9% (30/33) got excellent or good results in end plate ring group, 89.5% (33/38) got excellent or good results in contral group.</p><p><b>CONCLUSION</b>The use of end plate rings could not completely prevent the subsidence of titanium cage, however, which can decrease the occurrence rate of the subsidence and lessen its degree.</p>

Bilateral transpedicular balloon kyphoplasty for the treatment of osteoporotic vertebral compressive fractures / 中国骨伤

<p><b>OBJECTIVE</b>To compare clinical outcomes of bilateral transpedicular balloon kyphoplasty for the treatment of ordinary osteoporotic vertebral compressive fracture (OVCF) and severe osteoporotic vertebral compressive fracture.</p><p><b>METHODS</b>From Junary 2009 to Febuary 2011, 60 patients (70 vertebrae) with osteoporotic vertebral compressive fracture were included. All patients were treated by bilateral transpedicular balloon kyphoplasty combined with postural reduction, including 10 males and 50 females aged from 59 to 90 years old with an average of 72.1 years old. In ordinary osteoporotic vertebral compressive fracture group, there were 38 patients (44 vertebrae) including 7 males and 31 females aged from 59 to 87 years old with an average of (71.8±6.1) years old. There were 6 patients with two vertebral fractures, 1 vertebra in T9, 5 vertebrae in T10, 7 vertebrae in T11, 13 vertebrae in T12, 9 vertebrae in L1, 4 vertebrae in L2, 4 vertebrae in L3, 1 vertebra in L4. While in severe osteoporotic vertebral compressive fracture group, there were 22 patients (26 vertebrae) including 3 males and 19 females aged from 63 to 90 years old with an average of (72.6±7.2) years old. There were 4 patients with two vertebral fractures, 1 vertebra in T9, 2 vertebrae in T10, 3 vertebrae in T11, 9 vertebrae in T12, 6 vertebrae in L1, 3 vertebrae in L2, 2 vertebrae in L3. Operative time, volume of bone cement injection, and vertebral height and changes of Cobb angle before and after operation were observed and compared. Postoperative average recovery rate of vertebral height and correct degree of Cobb angle were caculated and compared, VAS scoring were used to evaluate therapeutic effect.</p><p><b>RESULTS</b>All operations were completed sucessfully, and pain were relieved at 72 h after operation. All patients were followed up from 6 to 13 months with an average of 10.1 months. Postoperative vertebral height, Cobb angle and VAS score were improved better than that of before operation (P<0.05). Operative time in ordinary group was shorter than severe group, while volume of bone cement injection was more than that of severe group. Average recovery rate of vertebral height and correct degree of Cobb angle in ordinarty group was better than that of in severe group (P<0.05). There was no significant differences between two groups in VAS scores before and after operation (P> 0.05). Three cases (3 vertebrae) ocurred bone cement leakage in ordinarty group, while 5 cases (5 vertebrae) ocurred bone cement leakage in severe group, and there was no meaning between two groups (P>0.05).</p><p><b>CONCLUSION</b>Kyphoplasty could receive satisfied curative effect in treating ordinary and servere patients with osteoporotic vertebral compressive fracture, but recovery of vertebral height and correct degree of Cobb angle in ordinary gourp was better than that of in servere group.</p>

Modified Stoppa approach in treatment of pelvic and acetabular fractures / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the modified Stoppa approach in treatment of pelvic and acetabular fractures.</p><p><b>METHODS</b>From March 2010 to May 2012,16 patients with pelvic fractures and 7 patients with acetabutar fractures were treated by open reduction and internal fixation through the modified Stoppa approach,involving 18 males and 5 females with an average age of 39 years ranging from 17 to 65. By Tile classification, 16 cases of pelvic fractures included 1 case of B1, 2 of B2, 3 of B3, 4 of C1-1, 2 of C1-2, 2 of C1-3, and 1 of C2. By Letournel classification, 7 cases of acetabular fractures included 1 case of anterior column fractures, 1 of transverse fractures, 2 of type T, 1 of anterior column plus posterior transverse fractures, and 2 cases of both columns fractures. For 16 pelvic fractures, the modified Stoppa approach was used exclusively in 9 cases,in combination with the iliac fossa approach in 6 cases, and in combination with the posterior approach in 1 case. For 7 acetabular fractures, the modified Stoppa approach was used exclusively in 4 cases, in combination with the Kocher-Langenbeck approach in 2 cases, and in combination with the Kocher-Langenbeck and iliac fossa approaches in 1 case of both columns fractures.</p><p><b>RESULTS</b>The average operation time was 130 min (50 to 350 min) and the blood loss averaged 320 ml (100 to 1200 ml). There were no operative complications. The reductions of the pelvic and acetabular fractures were all excellent and good. Twenty-one patients were followed-up from 4 to 24 months (averaged 8 months). The fractures were all healed,the fracture healing time was 2.5 to 5 months (means 3.2 months). Among them, 1 case occurrenced screw loosening, 1 case had mild limited of hip flexion, no case had plate breakage and lateral ventral syndrome.</p><p><b>CONCLUSION</b>The modified Stoppa approach can be used to treat pelvic and acetabular fractures effectively, and it has advantages of easy manipulation and a low complication rate.</p>

Clinical application study of modified Moore classification in lower cervical spine injuries / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the clinical application of modified Moore classification in lower cervical spine injuries.</p><p><b>METHODS</b>Modified Moore classification was applied in the morphologic description of 200 patients (including 165 males, 35 females,age ranging from 19 to 88 years,with an average age of 52 years) with lower cervical spine injuries from August 2006 to March 2010, cervical spine injury severity score (quantification of stability) in combination with yes/no neurological injury status to classify their clinical diagnosis and management. The treatment was selected according to the fracture type, stability, compression injury of spinal cord or nerve roots, stability of ligamentous injury and other reference factors. According to the ASIA score, 130 cases with injury of spinal cord or nerve root (i.e. 6 cases in Grade A,13 cases in Grade B,43 cases in Grade C, 68 cases in Grade D); and 70 cases with no injury of spinal cord or nerve root. The ASIA score was applied in the evaluation of curative effect in cases with injury of spinal cord or nerve root. Radiodiagnostics was used to observe sequential measurement of cervical vertebrae and height in cases without spinal cord or nerve root injuries.</p><p><b>RESULTS</b>The cervical spine injury distribution is that 35 cases of anterior, left, right lateral and posterior column injury; 33 cases of anterior column injury; 90 cases of anterior and posterior column injury; 5 cases of anterior, left lateral and posterior column injury; 3 cases of anterior, right lateral and posterior column injuries; 3 cases of anterior, left and right lateral column injuries; 2 cases of anterior and right lateral column injuries; 5 cases of anterior and left lateral column injury; 12 cases of posterior column injury; 7 cases of left lateral column injury; 5 cases of right lateral column injury. Surgery operation was given in 98 patients out of 200 cases. Non-surgical treatment was given to 102 patients (including 39 patients who are qualified to receive operation, but patient's relative required non -surgical treatment). Three cases of complete injury of spinal cord showed no recovery of the spinal cord function after operation, no change on the ASIA score, but pain and numbness of limb relieved slightly. Three non-surgical treatment cases showed no change after the treatment. Cases of incomplete injury of spinal cord showed certain recovery on spinal cord function after operation, and the ASIA score was raised 1.2 grades averagely. The ASIA score of cases of incomplete injury of spinal cord after non-surgical treatment was raised 0.3 grades averagely. The alignment and height of cervical vertebras were normal on post-operative radiodiagnostics in patients without injury of spinal cord or nerve root.</p><p><b>CONCLUSION</b>According to modified Moore classification, when the stability quantification score is higher than or equal to 4, it indicated that the cervical vertebras are instability in lower cervical spine injuries. Surgery operation is required in higher score and less stability cases. Cases associated with neurological injury must receive surgery operation. Cases with stability quantification score equals to 3 and neurological injury should also receive surgery operation in general. Surgery operation is not required in cases of stability quantification equal to 3 and without neurological injury,or cases of stability quantification score lower than 3. Applying modified Moore classification in the treatment of lower cervical spine injuries is beneficial for the clinical standardization, diagnosis and treatment and receives satisfactory therapeutic effects.</p>