Locking plate fixation repairs lateral compression rotationally unstable pelvic ring injuries:reconstruction of pelvic stability / 中国组织工程研究

BACKGROUND:There are stil some controversies about lateral compression rotational y unstable pelvic ring injuries and fixed mode. OBJECTIVE:To evaluate the pelvic stability of locking plate fixation pelvic reconstruction repairing lateral compression rotational y unstable pelvic ring injuries. METHODS:We retrospectively analyzed 15 patients with unstable lateral compression rotational y unstable pelvic ring injuries treated with reconstruction locking plates fixation at Suzhou Xiangcheng People’s Hospital between November 2011 and November 2014. The Matta standard was used to evaluate the quality of fracture reduction. Clinical efficacy was evaluated by Majeed score. RESULTS AND CONCLUSION:Fifteen patients were fol owed up for 12-44 months (mean 24 months). According to the standard of Matta, 11 cases were excel ent, 2 cases were good, 2 cases were average, 0 case poor, and the excel ent and good rate was 87%. According to Majeed functional assessment, clinical function outcomes were graded as 9 cases excel ent, 3 cases good, 1 case average, 1 case poor;excel ent and good rate was 80%. There were no patient loss of reduction and internal fixation failure among these 15 patients in the final fol ow-up. No iatrogenic neurovascular injury occurred. Incision superficial infection was detected in 2 patients with a Morel-Laval ee lesion after subjecting to double-tube continuous negative pressure drainage, and healed after wound management. A large area of infection and skin necrosis did not occur. These results confirm that pelvic universal reconstruction locking plates in repair of lateral compression rotational y unstable pelvic ring injuries can maintain a strong and effective fixation. We should pay much attention to the cases of pelvic fractures combined with soft tissue injury around the pelvis.

Curative effect of long versus short Inter Tan intramedullary nailing of senior intertrochanteric hip fracture in conjunction with early total care / 中华创伤杂志

Objective To compare the clinical outcomes of long and short InterTan intramedullary nailing of senior intertrochanteric hip fracture in conjunction with early total care (ETC).Methods In this prospective study, records of 30 elder patients with intertrochanteric fracture hospitalized between January 2011 and September 2013 were included.Using the concept of ETC, the patients were treated with long (long-nail group, n =15) and short InterTan intramedullary nails (shortnail group, n =15) within 72 hours postinjury.The two groups were compared for operation time, intraoperative blood loss, fracture healing time, Harris hip score, time to pre-injury mobilization and hardware failure rate.Results Operation time was (77.25 ± 7.38) minutes in long-nail group versus (72.10 ± 6.90) minutes in short-nail group (P ＜ 0.01).Time to pre-injury mobilization was (7.45 ± 1.61) months in long-nail group versus (8.57 ± 2.18) months in short-nail group (P ＜ 0.05).There were no significant differences between long-and short-nail groups regarding the blood loss [(180.75 ± 38.26)ml vs (178.62 ± 34.79)ml], fracture healing time [(4.82 ± 1.12)months vs (4.76 ± 1.04) months], and Harris hip score [(83.75 ± 1.71) points vs (82.57 ± 2.18) points] (P ＞ 0.05).Conclusions Either long or short InterTan intramedullary nailing combined with ETC is effective in treatment of intertrochanteric hip fracture in the elderly.However patients treated with long nails return to pre-injury mobilization relatively earlier.Long InterTan intramedullary nail system is better for the patients combined with serious osteoporosis.

Effects of apigen on repairing articular cartilage defects by BMP-7 cells in rabbits / 中华临床营养杂志

Objective To study the effect of apigen on articular cartilage repair involving chondrocytes transfected with bone morphogenic protein-7 (BMP-7).Methods lnterleukin (IL-8) and soluble intercellular adhesion molecule-1 (sICAM-1) were induced by IL-1 β in rabbit chondrocytes.After apigen at different concentrations (10 μmol/L,25 μmol/L,and 50 μmol/L) was added into the culture system,the effect of apigen on IL8 and sICAM-1 production was observed using enzyme linked immunosorbent assay.Then chondrocytes were seeded on improved matrigel gel bracket and culturedin vitro to construct the compound,which was then transplanted into the rabbit model of articular cartilage defection.The rabbits were randomly divided into sham group (n =4),trans-BMP-7 group (n =4),and trans-BMP-7 + apigen group (n =4).Histological observation was conducted and Wakitani score calculated after 5 weeks.Results The concentrations of IL-8 and sICAM-1 in the chondrocytes supernatant in vitro significantly decreased after apigen treatment at 10 μmol/L,25 μmol/L,and 50 μmol/L [(6803.63 ±162.31) ng/g,(6005.74 ±201.49) ng/g,and (5202.34 ±271.67) ng/gvs.(10011.84±239.29) ng/g ; P =0.00].Five weeks after the cartilage cells on matrigel gel bracket were transplanted into rabbit models,the Wakitani scores of the trans-BMP-7 group and the trans-BMP-7 + apigen group were significantly lower than that of the sham group [(3.68 ± 0.86) vs.(8.25 ± 0.90),P =0.00 ; (3.21 ± 0.78) vs.(8.25 ±=0.90),P =0.00].In addition,no inflammatory reaction was noted during the repair in the trans-BMP-7 + apigen group.Conclusion Apigen can promote the construction of compound and repair of articular cartilage defects by trans-BMP-7 chondrocyte.

Experimental study on lumbar interbody fusion with silk fibroin enhanced calcium phosphate cement composite loaded with recombinant human bone morphogenetic protein-2 in sheep / 中华骨科杂志

Objective To evaluate the osteogenic characteristics of an injectable silk fibroin (SF) enhanced calcium phosphate cement (CPC) composite loaded with recombinant human bone morphogenetic protein-2 (rhBMP-2) on lumbar interbody fusion in sheep. Methods Twenty-four mature sheep were randomly divided into two groups. Each sheep underwent L1.2, L3.4 and L5.6 lumber interbody fusion, and the three disc spaces were randomly implanted with three of the following materials: SF/CPC, CPC/rhBMP-2, SF/CPC/rhBMP2 and autogenous iliac crest bone. One group was killed at 6 months and the other at 12 months. The fusion segments were observed and analyzed by manual palpation, CT scan, undestructive biomechanical testing, undecalcified histology, and histomorphology. Results The fusion rates of SF/CPC, CPC/rhBMP-2, SF/CPC/rhBMP-2 and autogenous bone assessed by manual palpation were 0, 33.33%, 55.56% and 77.78% respectively at 6 months. At 12 months, the fusion rates improved to 11.11%, 44.44%, 77.78% and 77.78%, respectively.The biomechanical results showed that fusion stiffness was significantly greater in autograft compared with SF/CPC/rhBMP-2, CPC/rhBMP-2, and SF/CPC in 4 degrees of freedom (flexion, extension, right bending, and left bending) at 6 months. The SF/CPC/rhBMP-2 composite showed similar stiffness as autograft, which was significantly greater than CPC/rhBMP-2 and SF/CPC at 12 nonths. Both CPC/rhBMP-2 and SF/CPC/rhBMP-2 showed significantly greater stiffness at 12 months compared with that of at 6 months. The results showed that bone volume was significantly greater in autograft compared with SF/CPC/rhBMP-2, CPC/rhBMP-2, and SF/CPC at 6 months. There was significant difference among ceramic residue among SF/CPC, CPC/rhBMP-2 and SF/CPC/rhBMP-2, with SF/CPC the greatest and SF/CPC/thBMP-2 the least. At 12 months, the bone volume of SF/CPC/rhBMP-2 composite was comparable with autograft, and greater than that of CPC/rhBMP-2 and SF/CPC. The bone volume of SF/CPC, CPC/rhBMP-2 and SF/CPC/rhBMP-2 was significantly greater at 12 months than that of at 6 months. The ceramic residue of SF/CPC, CPC/rhBMP-2 and SF/CPC/rhBMP-2 were significantly decreased. Conclusion The SF/CPC/rhBMP-2 composite had excellent osteoconduction and osteoinduction, and balanced degradation and osteogenesis, which may be a kind of ideal bone grafts in spinal fusion.

Efficacy of balloon Kyphoplasty for the treatment of multi-vertebral osteoporotic compression frac-ture / 中华骨科杂志

Objective To evaluate the efficacy and safety of balloon kyphoplasty in the treatment of painful multi-vertebral osteoporotic compression fractures. Methods From October 2002 to April 2007, 42 patients (96 vertebrae) with painful multi-vertebral osteoporotic compression fractures underwent kyphoplasty. The group included 14 men and 28 women with an average age of 72.5 years (range 56-91 years). Each pro-cedure included insertion and insertion of balloon, fracture reduction and cement filling under "C"-arm monitoring. Preoperative and postoperative pain level, SF-36 score, vertebral height restoration, local kypho-sis correction and complications were recorded and analysed. Results All 42 patients tolerated the opera-tion well and were followed up for average 31.4 months (range 12-71 months). The mean VAS pain score decreased significantly from 7.1±2.4 preoperatively to 2.7±1.3 postoperatively, the mean height of anterior and medial vertebral body were (1.8±0.5) cm, (1.6±0.6) cm preoperatively and (2.3±0.6) cm, (2.2±0.7) cm postoperatively. No significant change of posterior vertebral height was recorded postoperatively.The mean correction of local kyphosis was 9.2°at each level. 6 of 8 subscahs measured by SF-36, including physical function, role function, bodily pain, vitality, role emotion, mental health, were significantly improved by the operation. Complications were found in 7 patients including 6 cases of cement leakage with no clinical symptoms (intradiscal cement leakage in two cases, paravertebral vessel leakage in two cases, paravertebral leakage in one case and cement leakage into canal in one case), and 1 case of pulmonary embelization with symptoms relieved after conservative treatment. Conclusion Kyphoplasty is effective and relatively safe for multi-vertebral osteoporotic compression fractures.

Comparison of X-ray and CT in evaluating indirect reduction of spinal canal bone fragment / 中华创伤杂志

Objective To compare the value of "linear shadow" of posterior vertebral body wall under standard lateral X-ray fluoroscopy and CT scan in evaluating the reduction of bone fragment retro-pulsed into the spinal canal so as to provide evidence for indirect reduction degree of bone fragment under X-ray fluoroscopy during operation. Methods A retrospective study was done on 25 cases of thoraco-lumbar burst fractures treated at our department. There were 15 males and 10 females, at age range of 24-66 yeas(average 44. 9 years). Preoperative CT scan confirmed burst fractures in all cases. Bone frag-ment occupied mearl 35. 2% of midsngittal diameter of injured segment. All cases were treated by indirect reduction with short-sesment pedicle instrumentation, rather than laminotomy or partial laminectomies. When imging of posterior vertebral body wall manifested a continuous and smooth"linear shadow" under standard lateral X-ray fluoroscopy during operation, bone fragment War considered to be under reduction. CT span was performed to evaluate the reduction of bone fragment postoperatively. Results The bone fragment occupation of midsngittal diameter of injured segment was decreased from preoperative 35. 2%to postoperative 8. 6%, with statistical difference(t=9. 122, P<0. 01). Neurological function of all 25 cases was normal at last follow-up. The decompression of spinal canal was effective. Conclusions A continuous and smooth"linear shadow"on posterior vertebral body wall imaging is a simple and effective way to judge the reduction of bone fragment retropulsed into the spinal canal and can provide evidence for whether laminotomies and pushing bone fragment are necessary during operation.

Follow-up of intradiscal cement leakage during kyphoplasty / 中华骨科杂志

Objective To investigate the causes and clinical significance of cement leakage into disc space during kyphoplasty. Methods Since 2002, 178 patients with osteoporotic vertebral compression fractures underwent kypboplasty and 15 of them were detected intradiscal cement leakage and followed up more than 2 years (mean 2 years and 8 months). The mean injection of cement in these patients was 4.2ml.The series comprised 10 females and 5 males, with an average of 71.2 years old ( range, 54～84 years old).Visual analog scale was used to score back pain pre- and postoperatively. The height and MRI index of the involved disc were recorded and compared. Results The discs involved were as following: T10-11 for 4 cases,T11-12 for 1, T12L1for 4, L1-2 for 2, L2-3 for 3, L3-4 for 1. Cement leakage was detected in the disc above the fractured vertebrae in 10 cases, and in the disc below the fractured vertebrae in 5 patients. The back pain significantly alleviated and the average visual analog scale (VAS) score was decreased from 8.5±2.1 preoper-atively to 3.3±1.4 postoperatively (P< 0.05). The anterior disc height was (5.1±2.1)mm preoperatively and (4.8±1.9) mm at the final follow-up, the middle disc height was (7.4±3.2) mm preoperatively and (7.3±2.9) mm at the final follow-up, the posterior disc height was (4.9±2.5) mm preoperatively and (5.0±1.8) mm at fi-nal follow-up, the heights of intervertebral space were well maintained. The signal intensity decreased and became inconsistent in some discs, and the preoperative MRI index significantly decreased from 25482.4± 3467.5 to 18927.6±2519.4 at the final follow-up (t=1.967,P< 0.05). Conclusion Pain relief is impressive in patients with intradiseal cement leakage during kyphoplasty. However, cement leakage into disc space may accellerate the process of disc degeneration.

Experimental study about absorbable balloon vertebroplasty for the treatment of thoracolumbar burst fracture / 中国矫形外科杂志

[Objective]To study the changes of biomechanical efficiency of absorbable balloon vertebraplasty associated with pedicle screw system for treatment of thoracolumbar fracture.[Method]Six fresh adult thoracolumbar specimens were harvested and 10 segmental specimens(T_(11)~L_1、 L_(2~4)、 L_(1~3)) were processed.After burst fracture created by free-drop test,the specimens were braced and reduced by APF pedicle screw,then absorbable balloon were placed through the traumatic vertebral pedicle and were infused with autosolidification calcium phosphate cement to process vertebroplasty.The stiffness in middle vertebrae were measured under flexion,extension,lateral flexion and torsion stress before fracture and after absorbable balloon vertebroplasty respectively.[Result]The crushing strength in traumatic vertebrae after vertebroplasty with absorbable saeculi increased showed 8% under flexion,15% under extension and 9.8% under lateral flexion,but with significant increasing under extension(P0.05).[Conclusion](1)absorbable balloon vertebraplasty associated with pedicle screw system conduces to the reconstruction of traumatic vertebrae,and making postoperative spinal biomechanical characteristics approach the level before fracture;(2)Vertebroplasty with absorbable sacculus for treatment of thoracolumbar burst fracture based on the premise that avoid the potential danger induced by leakage of bone cement,and can reestablish intact corporeal structure of traumatic vertebrae and restore their height essentially,so that spinal physiologic curve can be gained to restore and maintain,tardive lumbodorsal pain and spinal cord injury and nerve injury caused by secondary kyphosis can be prevented,this can fundamentally solve complications left over by thoracolumbar burst fracture treated using pedicle screw system simply.The new method prorides a rational method for clinical treatment of thoracolumbar burst fractures.

Analysis of Zephir or Window plates with autogenous cortical bone graft in treating cervical spondylotic myelophathy / 中国医师进修杂志

Objective To analyse the results of Zephir semiconstrained or Window dynamic cervical plates with autogenous cortical bone graft in treating the cervical spondylotic myelophathy(CSM). Methods A retrospective review was performed with 43 patients who underwent anterior cervical discectomy, autogenous cortical bone graft with endplate retaining, fixation with Zephir or Window cervical plates. Follow-up period ranged from 0.5 to 4.0 years (in average of 22 months). The clinical effect, the fusion rate, the intervertebral height and the degeneration of adjacent levels were observed. Results The JOA score after operation was significant higher than that before operation (P

Endoscopic anterior cervical decompression and fusion based on the use of a working tube / 中国矫形外科杂志

[Objective]To investigate feasibility and efficacy of clinical application of endoscopic anterior cervical decompression and fusion.[Method]With Metrx MED system and modified working tube and decompression instruments,endoscopic anterior cervical decompression and fusion were performed on 15 patients with cervical spondylotic myelopathy.A paramidline right transverse incision of 2 cm long was made.A channel between the neurovascular and visceral sheath was created through finger dissection.The dilators were inserted sequentially.An original one arm working tube or a modified,shortened working tube with double arms was inserted over the dilators.Then decompression and fusion with autologus graft was performed under endoscope.[Result]Once the tubular retractor was stably fixed throughout the operation,releasing of the discomfort was observed.All the compression tissue such as soft disc tissue or hard osteophyte and anterior longitudinal ligament or dura sac were clearly visualized under the endoscope.Shortened working tube provided improved visual field and increased manipulation space for the decompression instrument.The double arms enhanced stability of the working tube but could not eliminate moving of it during operation.Intraoperative blood loss was 200 ml to 800 ml.The operation lasted 80 to 210 minutes.The incision healed in one week.Postoperative discomfort in laryngeal region was light.All of the cases showed thorough decompression on postoperative MRI films and gained better spinal cord function at postoperative follow-up.No surgery-related complication were encountered.[Conclusion]Endoscopic anterior cervical decompression and fusion based on the use of a working tube is technically feasible.Compared with conventional method,this technique has the advantages of improved intraoperative visualization,thorough decompression,minimal trauma,quicker recovery and improved cosmetic result.Disadvantages waiting for further improving include:limited manipulation space,discomfort and potential hazards to the surrounding structure resulted from moving of the working tube.

Mobilization range of the vertebral bodies after treatment of lumbar instability with titanium-coated fusion cage / 中国组织工程研究

BACKGROUND: Posterior lumbar interbody fusion(PLIF) has been an effective method for treating the instability of the lumbar spine.OBJECTIVE: To explore the changes in mobilization range after treatment of lumbar segmental instability with titanium-coated fusion cages (Prospace).DESIGN: A before-and-after controlled observational trial based on the patients.SETTING: Orthopedic department of a university-affiliated hospital.PARTICIPANTS: Totally 16 patients with lumbar instability(4 males and 12 females aged 37 to 68 years with the average age of 51.6 years) were treated by posterior lumbar interbody fusion(PLIF) using titanium-coated cage from December 2002 to. December 2003. There were 4 cases of disc herniation, 6 lumbar spinal stenosis, 3 degenerative spondylolisthesis and 3 isthmic spondylolisthesis, among which 5 cases were spondylolisthesis Ⅰ and one spondylolisthesis Ⅱ.METHODS: All the cases received PLIF. In each case, double cages were inserted with the postlateral bone graft and pedicle screw systems were supplemented. The radiology and clinical effects before and after operation were compared.MAIN OUTCOME MEASURES: ① The average height of disc space and foramina and mobilization range of the vertebral bodies before and after operation; ② The Oswestry Disability Index score.RESULTS: All the cases were followed up for 6 to 16 months with an average of 12 months. The total fusion rate was 100%, and the postoperative height of disc space and foramina recovered satisfactorily. The Qswestry Disability Index score was 44. 2 ± 3.9 before operation and 25.5 ± 3.6 after operation with a significant difference. The rate of excellent and good curative effects was 93.8%.CONCLUSION: The titanium-coated cage used in PLIF to treat lumbar instability can achieve good immediate stability after operation.

Complications associated with posterior lumbar interbody fusion using Bagby and Kuslich method for treatment of spondylolisthesis / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To analyze complications associated with posterior lumbar interbody fusion (PLIF) in which two Bagby and Kuslich (BAK) interbody fusion cages were implanted.</p><p><b>METHODS</b>A total of 118 patients with spondylolytic spondylolisthesis underwent single-level PLIF using two BAK cages filled with morselized autogenous bone. The major clinical and radiographic complications were analyzed after a follow-up with an average time of 2 years and 9 months.</p><p><b>RESULTS</b>Complications were divided into intraoperative and postoperative complications. Intraoperative complications mainly included dural tear (4 patients, 3.4%), nerve root injury (3 patients, 2.5%) and suboptimal cage position (9 patients, 7.5%). No death was caused by the operation. Postoperative complications chiefly consisted of cage retropulsion (3 patients, 2.5%), cage subsidence (4 patients, 3.4%), and postlaminectomy arachnoiditis (2 patients, 1.7%). Pseudarthrosis was noted radiographically with evidence of motion between adjacent vertebra on lateral flexion-extension films and luciencies around the cages (2 patient, 1.7%), continuous posterior cage migration (2 patients, 1.7%) or continuous cage subsidence (2 patients, 1.7%). Two patients died, one from a traffic accident and the other from metastatic cancer 1 year postoperatively.</p><p><b>CONCLUSIONS</b>The results of this study indicate that PLIF with BAK cages is an effective but also technically difficult procedure. The relatively high incidence of complications reminds us of the importance of surgical indications and proper manipulations.</p>

Clinical comparison of two types of clavicular hook plates / 中华创伤杂志

Objective To analyze and compare clinical application of two types of clavicular hook plates. Methods From September 2000 to October 2003, 33 cases with acromioclavicular joint dislocation (Tossy Ⅲ) or distal clavicle fractures (Neer Ⅱ) were treated with insertion type (AO/ASIF) or knuckle-protruded type (WALDEMAR LINK) clavicular hook plates. The former one was used in 18 cases and the latter one in 15. Results In insertion type group, the average operation time was 28 minutes, with average incision length for 7.6 cm. All the cases got good reduction and fixation without any subluxation, except for one case suffering from impingement of the shoulder joint. In knuckle-protruded type group, the average operation time was 40 minutes, with an average incision length for 9.8 cm. After operation, one case lost hooking-up, one had born shoulder joint impingement, while another two suffered from skin pain at acromion caused by hook tip for a long time. Except for one case losing hooking-up, all cases of both groups achieved good recovery of function of shoulder joint and won satisfactory reduction without any redislocation after the implants being taken out. Conclusion Because of the advantages like convenient manipulation, short operation time, minor incisions and less potential complications, the insertion type clavicular hook plate is more suitable for cases with Tossy Ⅲ or Neer Ⅱ fractures.

Expressions of heme oxygenase-1 in the traumatized rat spinal cord / 中华创伤杂志

Objective To observe the expression changes of heme oxygenase-1(HO-1) and its mRNA after spinal cord injury (SCI). Methods SD rats were randomly divided into normal (n=5), control (n=5) and experimental group (n=10). The rats were given no operation in the normal group, laminectomy only in the control and both laminectomy and traumatic injury in the experimental group. The SCI animal models were made by using a modified Allen's weight-drop device (50 g.cm) on T 12 . Rats were sacrificed at 1 and 3 days after injury. The distribution and content changes of HO-1 and its mRNA in spinal cord segments were observed by means of immunohistochemistry and in situ hybridization. Results Expression of HO-1 was mainly in neurons in the normal spinal cord. After injury, HO-1 expressed primarily in astrocytes and microglia and the distribution of positive cells closely correlated with intraparenchymal hemorrhage. Protein began to increase at the first day after injury. The expression intensity and the area of positive cells were (148.26?11.39) and (90.50?8.70)?10 3 ?m 2 respectively. At the third day, protein expressed more significantly with expression intensity of (128.03? 12.59) and area of (112.99?10.01)?10 3 ?m 2. The expression intensity and area of positive cells expressed by mRNA were (106.02?9.10) and (70.05?9.26)?10 3 ?m 2 respectively at the first day after injury, (85.82?9.07) and (87.37?10.95)?10 3 ?m 2 respectively at the third day after injury. There was significant difference between experimental and control groups ( P

Effects of nutritional status on wound healing after hip fracture in the elderly / 中华创伤骨科杂志

Objective To evaluate the effects of nutritional status on wound healing after hip fracture in the elderly. Methods From July 2002 to December 2004, 127 patients with hip fracture who were older than 65 years were treated surgically in our department. Their preoperative nutritional status was reviewed. There were 69 males and 58 females, with an average age of 72.7 years (from 65 to 99 years). 60 cases had femoral neck fractures, and 67 cases had intertrochanteric fractures. The parameters indicative of nutritional status (serum albumin, serum transferrin and total lymphocyte count levels) at the time of admission were assessed, along with Rainey McDonald nutritional index and age. Suture removal was performed on postoperative day 14. Results Delayed wound healing complicated 31 of the 127 cases. The preoperative serum transferrin levels were significantly lower in patients who subsequently had delayed wound healing. Only preoperative serum transferrin levels( P

Extraforaminal lumbar disc herniation: anatomical study and surgical treatment / 中华外科杂志

<p><b>OBJECTIVES</b>To provide the anatomical basis for surgical treatment of extraforaminal lumbar disc herniation (EFLDH) by paraspinous muscle splitting approach and to investigate the effect of its application.</p><p><b>METHODS</b>The relationship among the intertransverse processes, lateral margin of the pars interarticularis, anterior ramus of the lumbar nerve, and anterior ramus of the lumbar artery was studied in 34 cadaveric specimens. From October 1993 to October 1999, eleven cases of extraforaminal lumbar disc herniation were treated by paraspinous muscle splitting approach and retroperitoneal approach.</p><p><b>RESULTS</b>In the extraforaminal region, the anterior ramus of the lumbar artery and venus locate ventrally to the superior half of the intertransverse space, and the anterior ramus of the lumbar artery runs downward behind the nerve. The distance from the lateral margin of the pars interarticularis to the nerve root and the angle between the nerve root and midline sagittal plane were 1.0 - 2.0 cm and 7 degrees - 25 degrees respectively which increased gradually from L(1) to L(5). The period of follow up in 10 of 11 cases was 23 - 98 months. Evaluation according to Low Back Outcome Score showed excellent results in 8 cases, and good in 2.</p><p><b>CONCLUSION</b>Surgical treatment of EFLDH by paraspinous muscle splitting approach is safe, effective and minimal invasive.</p>

Biomechanical evaluation of transverse acetabular fracture fixation / 中华创伤骨科杂志

Objective To conduct a biomechanical evaluation of the four internal fixation methods to treat transverse acetabular fracture and find the b est one. Methods The transverse acetabular fracture models were created by osteo tomy in 12 pairs of embalmed cadaveric hip joints, and fixed with one of the fou r different methods: an anterior column plate (P/N), an anterior column plate w ith a posterior column screw (P+S), a posterior column plate with an anterior screw (S+P) and two posterior column plates (N/P?2). The biomechanical stabi lity was evaluated on longitudinal displacement, level displacement and stiffnes s measurements for fixed fracture fragments which were under 800 Newton vertical compression load. Results The longitudinal displacement in S+P was 3.99mm, in P+S 4.09mm, in N/P?2 5.07mm and in P/N 5.66mm; the level displacement in S+P was 0.015mm, in P+S 0.016mm, in N/P?2 0.022mm and in P/N 0.025mm; the average stiffness in S+P was 205.77N/mm, in P+S 207.52N/mm, in N/P?2 162.36N/mm and i n P/N 146.67N/mm. There were significant differences between the groups of S+P and P+S and the groups of N/P?2 and P/N (P

Progress in research on techniques of pedicle screw insertion in thoracolumbars pine / 中华创伤骨科杂志

Application of the techniques of pedicle screw fixation in t horacolumbar spine has forcefully promoted the development of spinal surgery. Th e key to the techniques is that the pedicle screw insertion must be located into the sole exact routeway of the three-dimensional-space, that is, into the inn er vertebral body through the pedicle according to the exact arrow plane angle a nd horizontal plane angle. Recently great development has been made in the resea rch on the techniques of pedicle screw insertion in thoracolumbar spine, especia lly in the supervising means during operation. The means have been developed fro m the traditional X-ray perspective or photograph apposition to the application of computer-assisted technique. This paper reviews and discusses the current d evelopment and prospects in the research on the techniques of pedicle screw inse rtion in thoracolumbar spine.

Acute traumatic spondylolisthesis / 中华创伤骨科杂志

Objective To discuss the clinical characteristics of the Acu te Traumatic Spondylolisthesis (ATS). Methods 7 cases of ATS treated from 1990 t o 2002 were analyzed retrospectively. One case with slight symptoms was treated without operation and others were treated with open reduction and internal fixat ion of the graft. The ages of the patients ranged from 13 to 57 years, with an a verage of 26.9 years. Results All patients were followed up for an average of 5 .2 years. By Henderson standard, the result was excellent in 6, and good in 1. C onclusions Compared with non-acute traumatic spondylolisthesis,ATS involves de finite trauma accompanied with soft tissue lesion and small articular fractures. There is no sclerosis manifestation in x-ray and CT. Isthmic fractures can alw ays be seen during operation. Operation is needed in most cases.

Long term follow- up study of lumbar spondylolytic spondylolisthesis treated with Steffee system / 中华骨科杂志

Objective To evaluate the long term outcome of spondylolytic spondylolisthesis treated with Steffee system and posterolateral fusion. Methods Thirty- four patients were followed up for an average of 77.2 months. The follow- up study include slipping percentage, slipping angle, heights of intervertebral space and foramen, fusion rate, screw broken rate and clinical outcomes. Results 1) Solid fusion was obtained in 88.2％ of patients. screw broken rate was 2.9％ . 2) Comparison of pre- and post- operative slip showed correction rate of 45.1％ . The heights of intervertebral space and foramen increased, slipping angle decreased. 3) During the period of follow- up, recurrence of deformity was found. 4) The subjective outcome was better than the objective outcome. Conclusion 1) Lumbar spondylolytic spondylolisthesis with radicular symptom need complete decompression and reduction as much as possible. 2) A positive slipping angle indicates significant shearing force and the need of an interbody fusion to restore the weight- bearing capacity. 3) Objective criteria is more suitable to evaluate surgical outcome.