Résumé
BACKGROUND:Complex scapular fractures were mainly treated by implant fixation. Standard fixation approach (Judet approach) had long incision and big trauma. With the application of spiral CT and three-dimensional reconstruction, minimal y invasive incision could be designed before implant fixation, and then fixation could be finished by physicians. Thus, trauma was reduced and repair effect was elevated. OBJECTIVE:To observe the effects of the three-dimensional reconstruction design combined with titanium plate reconstruction or lag screw for treatment of scapular fractures. METHODS:From February 2007 to January 2012, 33 cases of scapular fractures were enrol ed from Department of Orthopedics, No. 1 Hospital of Qinhuangdao in China. They were scanned by three dimensional reconstruction of CT before implant fixation to identify the regions needed to be repositioned and fixed. Thus, minimal y invasive incision of implant fixation was designed. The dissection of skin, subcutaneous tissue and muscle was reduced. Reposition was performed. Titanium plate and/or lag screw were used for fixation. RESULTS AND CONCLUSION:The operation lasted for 90-130 minutes in 33 patients, with intraoperative blood loss for 300-400 mL. Fracture was total y healed, and the healing time was 2-4 months. The fol ow up lasted for 12-24 months. According to Hardegger standard, there were excellent in 17 cases, good in 12 cases, average in 3 cases and poor in 1 case, with an excellent and good rate of 88%. These results suggested that three-dimensional reconstruction design combined with minimal y invasive incision treatment for scapular fractures showed fewer traumas, can complete the satisfactory fracture reduction and implant fixation, and obtain good repair effect.
Résumé
BACKGROUND:The percutaneous pedicle screw technique effectively reduces the excessive injury of screw placement on paraspinal muscles, and promotes the recovery of the function of low back muscle after surgery. Minimal y invasive technique avoids some disadvantages such as large surgical trauma and more bleeding. Folding U-shaped hol ow pedicle screw has hol ow design and good distraction effect. After fixation, stress intensity, compression time, bending stiffness and torsional mechanical properties have been verified in the clinic. OBJECTIVE:To observe the clinical effect of folding U-shaped hol ow pedicle screw fixation combined with minimal access-posterior lumbar interbody fusion for single-level lumbar disc herniation. METHODS:Between January and December 2012, folding U-shaped hol ow pedicle screw fixation with minimal access-posterior lumbar interbody fusion was performed in 30 patients with lumbar disc herniation. The mean fol ow-up period was 12 months. Lumbago Visual Analog Scale, Oswestry Disability Index and imaging indicators were utilized to evaluate clinical therapeutic effects. RESULTS AND CONCLUSION:Preoperative Visual Analog Scale pain score and Oswestry Disability Index for al patients were 7.3±0.7 and 71.4±7.1, 2.9±0.7 and 29.8±3.6 at 3 days after surgery, showing significant differences. At 12 months, no significant difference in Visual Analog Scale pain score and Oswestry Disability Index was detected. Postoperative short-period fol ow-up demonstrated that al lumbar interbody fusion was achieved in one year. There was no complication such as implant failure or infection. These findings indicated that folding U-shaped hol ow pedicle screw fixation with minimal access-posterior lumbar interbody fusion for lumbar disc herniation showed good clinical therapeutic effects, high rate of interbody fusion and a low rate of complications and smal trauma.