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Objective To discuss the surgical treatment of spinal injury, and provide insights on key points and related issues for operations. Methods Two hundred and five cases of spinal fracture were treated through posterior surgical treatment. Under C-arm X-ray monitoring, surgeries had been operated on pedicle screws insertion, vertebral canal decompression, over-extending reduction position, and placed the connecting rod, knocked in the bone graft and finally transplanted the paraspinal bone. Results After operations , the height and morphology of vertebral bodies and spinal physiological curvature were basically recovered analyzed by X ray examination. The follow-up results (in the average of 14 to 36 months) indicated that there were 4 cases of delayed infection, 7 cases of loosen screw, 6 cases of broken screw (14 screws)and 1 case of broken stick, with no secondary nerve injury or other syndromes. Conclusion The vertebral pedicle screw internal fixation manipulated easily, which could sufficiently enlarge vertebral canal in order to decompression. In addition, during the operation, together with over-extending reduction position is beneficial to regain the height of fractured vertebral bodies.
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When the patients with senile or secondary osteoporosis are treated with screw fixation, the screws are likely to get loose or pulled out. Polymethylmethacrylate (PMMA) can enhance screw fixation strength to some extent in clinic, but PMMA has such disadvantages as irresorbability, polymeric heating effect and toxic reaction so that its clinical application is limited. Calcium phosphate cement, however, has drawn much attention because it gets rid of the shortcomings of PMMA. This article introduces recent progress made in research on fixation with calcium phosphate cement enhancing screw.
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Objective To evaluate the clinical efficacy of vertebroplasty using vertebral pedicle screw technique combined with calcium sulfate cement injection in the treatment of thoracolumbar vertebrae fractures.Methods Twenty-eight patients with thoracolumbar vertebrae fractures admitted in our department in recent 2 years were enrolled in this study,including 21 cases of type A,3 cases of type B,and 4 cases of type C.All patients were fixed with vertebral pedicle screw,and then verteplasty was performed using calcium sulfate cement injection.Results All patients were followed up for an average time of 16 months.Within the follow-up,there was no complication noted,such as loosening or breakage of internal fixation,chronical lumbar back pain,and loss of effected vertebral height.Artificial bones injected into vertebrae were absorbed in about 3 months.Conclusion Vertebroplasty using vertebral pedicle screw technique combined with calcium sulfate cement injection is an effective and safe procedure for thoracolumbar vertebrae fractures,which renders it possible to bear weight early and to maintain corrected vertebral height postoperatively.
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Objective To study the clinical effect of pedicle screw fixation in treatment of unstable upper and middle thoracic vertebrae fractures. Methods A retrospective study was performed on 17 cases of unstable upper and middle thoracic vertebrae fractures treated with vertebral pedicle screw system (GSS 全称in 11 cases and USS 全称in six) fixation, posterolateral bone grafting and fusion from March 2001 on. There were one case of T_3, two T_4, two T_5, four T_6, six T_7 and two T_8. Of all, nine cases were with compression fractures, five with fracture-dislocation and three with burst fractures. Results All cases were followed up for 10-38 months (average 21.1 months). During the follow up, the anterior vertebral body height was restored from preoperative 40% to postoperative 91%. Except for four screw malpositions, there was no postoperative neurologic deterioration, screw loose or breakage of the internal fixation, or loss of the normal spine curve and the spinal height of the injured vertebra. Conclusions Pedicle screw fixation is an effective way for treating unstable upper and middle thoracic vertebrae fractures. Correct placement depend on a comprehensive familiarity of pedicle anatomy, appropriate pedicle diameter and entry point and depth can avoid potential risks in placing pedicle screws into the upper and middle thorax.
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Objective To explore the efficacy of computer-assisted fluoroscopic navigation to guide the treatment of thoracolumbar burst fractures. Methods 18 patients with thoracolumbar unstable fractures were treated with short-segment vertebral pedicle screw fixation guided by computer-assisted fluoroscopic navigation, and fractures were reinforced with CPC cement vertebroplasty. Postimplantatively, the implants' images-error between virtual image of fluoroscopy and X-ray image was measured. Results The implant's location was excellent. All patients were allowed sitting-up or bearing body weight one week after operation. The vertebral height restored 40% postoperatively. 12 months after operation the vertebral height only changed 0.15%. Dynamic X-ray films showed no abnormal segment instability and no instrument breaking. Conclusion Using computer-assisted fluoroscopic navigation to guide the treatment of thoracolumbar burst fractures with CPC vertebroplasty and short-segment pedicle srew fixation could determine the internal fixation approach and let implants to the precise position by one time of X-ray image. It increases the security of pedicle screw fixation and vertebroplasty.