Clinical characteristics and stage I operation of anterior and posterior approaches for the treatment of cervicothoracic junction (C7T1) fracture-dislocation / 中国骨伤

<p><b>OBJECTIVE</b>To summary the characteristics of cervicothoracic junction (C7T1) fracture-dislocation,and explore the surgical treatment of combined anterior-posterior procedure.</p><p><b>METHODS</b>From January 2005 to March 2010,8 cases of cervicothoracic junction (C7T1) fracture-dislocation were treated by stage I operation through anterior and posterior approacheg, supplemented by non-structural bone graft. All patients were male with a mean age of 45.0 years old ranging from 32 to 68 years. Six cases were diagnosed clearly by CT scan but with normal cervical spine X-ray film at admission. According to AO classification, 4 cases were of type B, 4 cases of type C, with unilateral locked articular process in 2 cases, bilateral in 2 cases. Preoperative MRI showed intervertebral disc injury in 6 cases.</p><p><b>RESULTS</b>The average operation time was 246.3 min ranging from 150 to 320 min. The blood loss was with an average of 307.5 ml (150 to 600 ml). One patient got hoarseness but recovered without special treatment 6 months later; No other complications happened. One patient of preoperative Frankel grade A died, the remaining patients were followed up from 12 to 63 months (38.6 months in average). These fracture-dislocations were completely reduction after operation, healed with bony union 12 months later, and no pseudoarthrosis. The function of the spinal cord improved obviously at the final follow-up, 1 patient of preoperative grade A had died,and the spinal cord function of the other one had no significant changes,the 2 cases of grade B recovered to C and D respectively, 1case recovered from grade C to D, and 3 case recovered from D to E.</p><p><b>CONCLUSION</b>Cervicothoracic junction (C7T1) fracture-dislocation is a rare clinical spine trauma, and missed easily. The CT is a necessary complement to these patients highly suspected C7T1 fracture-dislocation but with negative cervical spine X-ray film. The patients diagnosed clearly could receive stage I operation of anterior and posterior approaches, supplemented with non-structural bone graft.</p>

The mid-term follow-up of Coflex non-fusion internal fixation in the treatment of degenerative lumbar disease / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the mid-term effectiveness of Coflex non-fusion internal fixation treatment of degenerative lumbar disease.</p><p><b>METHODS</b>From October 2008 to December 2010, a retrospective analysis was carried out on 39 patients (29 males and 10 females) diagnosed as degenerative lumbar disease and treated with Coflex interspinous dynamic device, who had been followed up for 1 year at least, the average age was 45.5 years (range, 23 - 67 years). The results were assessed by Japanese Orthopedic Association (JOA) scores, visual analogue scale (VAS) scores, Oswestry disability index (ODI) scores and SF-36 scores; and the range of mobility (ROM), intervertebral disc height of the responsible and adjacent segments were measured on X-film before the operation and at last follow-up. Observed the therapeutic effect of the patients and compared the effect on the patients of different body mass index (BMI) and different age by the One-way analysis of variance and paired t test.</p><p><b>RESULTS</b>The 39 patients were followed up for 30.9 months (range, 12 - 37 months). At the last follow-up, JOA, ODI, VAS and SF-36 scores were improved by 70% ± 12%, 54% ± 12%, 77% ± 10% and 51% ± 9%, and were statistically significant (t = -33.289, 26.448, 26.596 and -20.772, P = 0.00). Patients with BMI ≥ 25 kg/m(2) had lower improvement rates in the scores than those with BMI < 25 kg/m(2) (F = 10.561, 5.850, 5.651 and 6.519, P < 0.05). The patients were 50 years older or younger couldn't affected the improvement rates in the scores statistically (P > 0.05). There were no significant difference in remaining disc height (P > 0.05), except that the intervertebral disc height of L4-5 increased slightly compared with the preoperative (t = -2.819, P = 0.008). In addition to the ROM of L3-4, L5-S1 and L1-S1 were not significantly different from the preoperative(P > 0.05), the ROM of L4-5 were decreased (t = 12.598, P = 0.000).</p><p><b>CONCLUSIONS</b>The mid-term effectiveness of Coflex non-fusion interspinous fixation in treatment of degenerative lumbar disease is worthy of recognition, and Coflex combined with Isobar has advantages in the treatment of multi-segment degenerative lumbar disease.</p>

Comparison of screw' inserting angle through the 11th and 12th rib anterior approaches for L1 burst fracture / 中国骨伤

<p><b>OBJECTIVE</b>To compare screw's inserting angle through the 11th and 12th rib in treating L1 burst fracture, explore effects on inserting screw and postoperative angle.</p><p><b>METHODS</b>From October 2007 to October 2010, 108 patients with L1 brust fracture treated through anterior approach were analyzed,including 68 males and 40 females, aged from 21 to 64 years (mean 38.22 years). All patients were divided into the 11th (A, 51 cases) and 12th (B, 57 cases) approach. The data of operation time,blood loss, duration of incision pain, JOA score, Oswestry score, VAS score, quality of life (SF-36), recovery of nervous function, coronal Cobb angle, included angle between screw and plate were observed.</p><p><b>RESULTS</b>All patients were followed up for 9 to 37 months, mean 23 months. The operation time, blood loss, duration of incision pain, in group A were lower than group B (P<0.05), JOA score, Oswestry score, VAS score, SF-36, recovery of nervous function had no significant differences (P>0.05). There were no differences in Cobb angle before operation, but had significance after operation (P=0.000). There were statistically significance between two group in angle between screw and plate (P=0.000, P=0.003).</p><p><b>CONCLUSION</b>The 11th rib approach for the treatment of L1 burst fracture has less effects on screw, less trauma and less angle between screw and plate.</p>

Application of n-HA/PA66 composite artificial vertebral body in anterior reconstruction of lower cervical spine fracture and dislocation / 中华外科杂志

<p><b>OBJECTIVE</b>To initially evaluate the application of artificial vertebra of n-HA/PA66 in anterior reconstruction of lower cervical spine fracture and dislocation.</p><p><b>METHODS</b>In this study, 84 patients with lower cervical spine fracture and dislocation received anterior cervical discectomy, spinal canal decompression or subtotal corpectomy, spinal canal decompression and reconstruction by n-HA/PA66 composite artificial vertebral body combined with plate instrumentation. Neurological function was followed up by improvement rate of Frankel and situations of the supporting body was observed by X ray and 3D-CT in 3, 12, 24 months postoperatively. The intervertebral height, physical arc (reflected by Cobb angle) and the locations and fusion rate of the supporting body were assessed in order to evaluate the stability of the cervical spine and alignment improvements.</p><p><b>RESULTS</b>All the patients underwent operation successfully and were followed up for 6 to 24 months with an average of 12 months. The preoperative symptoms were improved to varying degrees. Imaging studies showed that in all cases graft fusion were achieved, and cervical alignments, intervertebral height, cervical spine stability and the locations of the artificial vertebral body were well maintained. No displacement and subsidence of the artificial vertebral body occurred. Postoperative immediate intervertebral height (2.4 ± 0.2) cm, preoperative intervertebral height (1.9 ± 0.1) cm, comparisons of the two groups was statistically significant (q = 2.48, P < 0.001). The immediate, 3 month, 1 year, 2 year period follow-up group intervertebral height was not statistically significant (P > 0.05). Preoperative Cobb angle was 9.8° ± 1.2°, postoperative immediate Cobb angle was 16.6° ± 1.2°, comparisons of the two groups was statistically significant (q = 14.25, P < 0.001). The immediate, 3 month, 1 year, 2 year period follow-up group Cobb angle was not statistically significant (P > 0.05).</p><p><b>CONCLUSIONS</b>n-HA/PA66 artificial vertebral body can provide early cervical spine support and stability and effectively maintain the biological alignment and cervical intervertebral height. It has high rate of graft fusion and is convenient to observe by X-ray. Therefore, n-HA/PA66 can be taken as an ideal graft for anterior lower cervical spine fracture and dislocation operation, but further follow-up study is still required to evaluate the long-term effects.</p>

Analysis of patients with bone injury in Wenchuan earthquake / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the patients with bone injury in Wenchuan earthquake.</p><p><b>METHODS</b>From May 12th to June 15th 2008 the data of 1410 patients with bone injury in Wenchuan earthquake were analyzed to evaluate clinical intervention and remedy-managing experience.</p><p><b>RESULTS</b>The 1410 patients average age was from 4 to 103 years old. And 744 cases (52.7%) suffered from blunt injuries, 379 cases (26.9%) from buried injuries, 287 cases (20.4%) from falling injuries; And 1317 cases were with fracture, 93 with limbs soft tissue injuries; 261 patients combined with other parts of injuries including 45 cases with paralysis; 66 cases were with crush syndrome, 25 with gas gangrene, 76 with acute kidney failure, 26 with multiple organ failure. And 912 operations were performed including 402 fracture fixation, 224 debridement, 152 debridement and suture, 85 amputation, 29 implant skin, 8 fixation of joint dislocation, 5 surgical flaps transplantation, 4 nerve and tendon suture, 2 arthroscopes, 1 joint replacement. Among the 66 crush syndrome patients, 49 accepted continuous renal replacement therapy, in which 9 cases were bleeding from named arteries and 20 blood vessels were getting embolism. Among the 1410 cases, 1 died from multiple organ failure.</p><p><b>CONCLUSIONS</b>Among the patients with bone injury in Wenchuan earthquake, the elderly patients are more than the youth; The injuries are always combined with other complications; Opened injuries are polluted severely; It is difficult to deal with the crush syndrome; Paraplegia cases are less, but the amputees are more.</p>