Lumbar pedicle cortical bone trajectory screw / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>The purpose of this study was to demonstrate the lumbar pedicle cortical bone trajectory (CBT) screw fixation technique, a new fixation technique for lumbar surgery.</p><p><b>DATA SOURCES</b>The data analyzed in this review are mainly from articles reported in PubMed published from 1994 to 2014.</p><p><b>STUDY SELECTION</b>Original articles and critical reviews relevant to CBT technique and lumbar pedicle fixation were selected.</p><p><b>RESULTS</b>CBT technique was firstly introduced as a new fixation method for lumbar pedicle surgery in 2009. The concepts, morphometric study, biomechanical characteristics and clinical applications of CBT technique were reviewed. The insertional point of CBT screw is located at the lateral point of the pars interarticularis, and its trajectory follows a caudocephalad path sagittally and a laterally directed path in the transverse plane. CBT technique can be used for posterior fixation during lumbar fusion procedures. This technique is a minimally invasive surgery, which affords better biomechanical stability, fixation strength and surgical safety. Therefore, CBT technique has the greatest benefit in lumbar pedicle surgery for patients with osteoporosis and obesity.</p><p><b>CONCLUSION</b>CBT technique is a better alternative option of lumbar pedicle fixation, especially for patients with osteoporosis and obesity.</p>

Diagnosis and treatment of unstable posterior pelvic ring fracture combined with sacral plexus in / 中华创伤杂志

Objective To analyze the methods and effects for treating unstable posterior pelvic ring fracture combined with sacral nerve injury and further identify the relationships among the diagnostic methods,surgical approaches and clinical outcomes.Methods A total of 38 patients with posterior pelvic ring fracture combined with sacral plexus injury treated from January 2000 to January 2010 were enrolled in the study.There were 20 males and 18 females at an average age of 35 years (range,10 to 59 years).The causes of fractures included traffic injury in 20 patients,fall injury in 12,weighty object impingement injury in five,and stabbing injury in one.Classification of posterior pelvic ring fractures included fracture and dislocation of sacroiliac joints in eight patients,fracture of ilium wing in two and sacrum fracture in 28.According to the Denis typing of sacrum fractures,there was one patient with type Ⅰ fracture,14 with type Ⅱ fracture and 13 with type Ⅲ fracture.All 38 patients presented the decrease or loss of skin sensation around the lower extremities,perineal region and crissum.Simultaneously,30 patients suffered motor dysfunction of the lower extremities,while 20 patients had bladder and anus sphincter dysfunction or sexual disorder.Thirteen patients were suspected of sacral plexus avulsion and four of them were confirmed by myelography or MRI examination.All patients had at least one associated injury.The average ISS was 21.9 points ( range,9 to 47 points).Therapeutic methods were fracture reduction and fixation in the absence of nerve decompression for eight patients and nerve decompression for 30 patients including 26 patients being also managed by fracture reduction and fixation.Operation time ranged from 6 days to 6 months.The clinical outcomes were evaluated according to the British Medical Research Council (BMRC) evaluation criteria of sensation and movement function.Results Thirty-four patients were followed up for average 4.9 years ( range,1 to 10 years),during which their pelvis obtained stable recovery.The neurological outcome was excellent in two patients,good in four and unchanged in two in the nondecompression group and was excellent in 16 patients,good in nine and unchanged in one in the decompression group,with the decompression group superior to the non-decompression group ( P ＜ O.05 ).Conclusions For unstable posterior pelvic ring fracture combined with sacral nerve injury,nerve decompression and release combined with internal fixation can better improve the sacral nerve function and obtain good pelvic ring stability and is worth of clinical application.

Treatment of Tile type C pelvic fracture with legacy pedicle screw system plus minimally invasive technique / 中华创伤杂志

ObjectiveTo investigate the feasibility of Legacy pedicle screw system plus minimally invasive technique in treatment of Tile type C pelvic fracture and evaluate its therapeutic effects.MethodsFrom January 2008 to March 2010, 12 patients with closed Tile type C pelvic fractures were treated with Legacy pedicle screw system plus minimally invasive technique.There were seven males and five females, at age range of 21-60 years (average 39.6 years).All patients had sacrum fractures of the posterior pelvic rings.The anterior pelvic ring fractures included unilateral ischiadic ramus fractures in four patients and bilateral ischiadic ramus fractures in eight.Three patients were combined with shock.The anterior pelvic rings were fixed with minimally invasive reconstruction plates and the posterior pelvic rings fixed with minimally invasive technique plus Legacy pedicle screw system.ResultsThe operation lasted for average 90 minutes (range, 80-110 minutes) , with average intraoperative blood loss of 105 ml (range, 80-150 ml).All patients were followed up for average 18 months (range, 6-32 months), which showed that all patients got satisfactory reductions and that the fractures were healed at one stage, with average period of 11.5 weeks (range, 9-13 weeks).There occurred no infections, failures of internal fixations or nerve injuries.According to improved Lindahl standard of pelvic injury function assessment, the result was excellent in 10 patients and good in two, with average score of 78.6 points.Conclusions Under master of the surgical indications, Legacy pedicle screw system plus minimally invasive technique takes advantages of minor trauma, less intraoperative fluoroscopy, short operation time, good curative resuhs and few complications in treatment of Tile type C pelvic fractures by fixation of the posterior pelvic rings and reconstruction of the anterior pelvic rings.

Treatment of comminuted patella fractures with medical titanium cable cerclage / 中国矫形外科杂志

[Objective]To study the effects of titanium cable system used as a treatment alternative for comminuted patella fractures.[Method]Fifty-seven cases of comminuted patella fractures were treated from November 2004 to August 2007.The patients were divided into three groups:the group of titanium cables,AO modified tension band and nickel titanium-patella catcher respectively,according to the choice of internal fixation.The operation time,the amount of blood loss,the first knee exercise time after operation,length of hospitalisation,medical expenses,time off for employees,complication and long-term knee function were studied.All the data were analyzed and compared by statistical ways.[Result]The 57 patients were followed up for 11 to 48months(means,22.4 m).Patients who were fixed with titanium cables could start most early extending and flexing the knee(5.6 d after operation),but most expense in medical usages(9500 RMB).The good or excellence rate was 95.1% in patients treated with titanium cables cerclage,which was better than that of the other two groups.[Conclusion]Titanium cables cerclage can cure comminuted patella fractures.The method had advantage of better long-term curative effect and less complication,and so on.It's worthy to be recommended for the therapy of comminuted patella fracture.

Pathological typing of posterior longitudinal ligament in cervical spondylotic myelopathy / 中国矫形外科杂志

[Objective]To discuss the pathological typing of posterior longitudinal ligament(PLL) in cervical spondylotic myelopathy.[Method]Data of pathological typing and resection methods of PLL were reviewed in 87 patients with cervical spondylotic myelopathy.[Result]The degeneration of the posterior longitudinal ligament(DPLL) was divided into single-DPLL(n=34,39.1%) and proliferation-DPLL(n=53,60.9%) by the results of resecton and pathological studies.The proliferation-DPLL was subdivided into hyperplasy-DPLL(n=26,29.9%),accretion-DPLL(n=12,13.8%)and ossification-DPLL(n=15,17.2%).[Conclusion]The posterior longitudinal ligament can thoroughly be resected in cervical spondylotic myelopathy combined with single-DPLL or with hyperplasy-DPLL.In cervical spondylotic myelopathy combined with accretion-DPLL or ossification-DPLL,complete decompression can be obtained by isolating the accretion and the ossification-chondrification of DPLL.