Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (version 2022) / 中华创伤杂志

Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.

Anterior construction after resection for axis tumors through the sub mandible approach / 中华骨科杂志

Objective To investigate procedure and therapeutic effect of resection and reconstruction for axis tumors through the sub mandible approach. Methods Between December 2004 to June 2010,17 patients with axis neoplasm underwent tumor resection and antero-posterior reconstruction through the combined the sub mandible-inner sternocleidomastoid muscle (SMIS) approach and posterior approach. Tumor lesions involved C2 in 11 cases, C2-3 in 4, C2-4 in 2. Eight cases involved vertebral body, and 9 involved both vertebral body and element. Fourteen primary lesions including 4 giant cell tumors, 4 plasmocytomas, 2 chordomas, 2 eosinophilic granulomas, 1 hemangiopericytomas and 1 lymphoma, and 3 metastatic lesions were involved in this study. Three types of reconstruction in upper cervical spine including titanium mesh plus vertically placed titanium plate, titanium mesh plus obliquely placed titanium plate and trimmed titanium mesh alone, were adopted after anterior tumor resection, and then posterior tumor resection and reconstruction were performed. Results All patients experienced pain relief and neurological improvement after surgery. Except for one incidence of screw pull-out which was corrected by a revision surgery, solid fusion was achieved in all patients. A follow-up period of 6 months to 6 years was available for this study. One patient died of cerebral infarction 9 months postoperative. Two patients with chordoma relapsed 13 months and18 months postoperative, respectively, of whom one died of high plegia and respiratory failure, and the other was alive with disease. Two patients with metastasis died of multiple remote metastases 12 months and 18 months postoperative, respectively. Conclusion Through the SMIS apporach, a satisfactory exposure can be obtained for axis tumor resection and reconstruction. Anterior reconstruction of upper cervical spine after tumor resection can be achieved with internal fixation system of cervical spine, which can improve intraopera-tive safety. The combined anterior reconstruction and posterior occipito-cervcial fixation can provide immediate stability, and benefit maintaining stability of upper cervical spine.

Causes tar and management of in anterior cervical surgery related nerve injuries / 中华创伤杂志

Objective To review the relevant causes for and treatment of nerve injuries in the anterior cervical surgery. Methods From January 2008 to December 2009,859 cages of cervical spondylosis,ossification of cervical posterior longitudinal ligament and cervical spine trauma were treated by anterior cervical surgery.This study retrospectively analyzed the clinical data of seven cases who were with worsened symptoms of spinal cord injury and related nerve injury. Results Of 859 cases,five cases(0.58%)were with spinal cord injury,one(0.12%)with recurrent laryngeal nerve injury and one (0.12%)with laryngeal nerve injury.Hematoma occurred in four cases after surgery caused spinal cord injury and all the four patients recovered to normal after removal of the hematoma and timely treatment with mythylprednisolone and hyperbaric oxygen.Cervical spine trauma was worsened in one patient after the anterior cervical surgery.The patient restored to its original level of spinal cord gradually through some measures such as tracheotomy,ventilator support,hormone therapy and hyperbaric oxygen treatment.Laryngeal nerve injuries in two cases recovered to normal after conservative treatment with hormone,dehydration and other drugs within three months after surgery. Conclusions Anterior cervical surgery of cervical spondylosis,ossification of cervical posterior longitudinal ligament and cervical spine trauma are likely to induce the related nerve damage.The good prognosis can be obtained under timely prevention and treatment.

Treatment of dens fracture combined with recoverable atlantoaxiai dislocation with posterior fusion plus pedicle screw / 中华创伤杂志

Objective To summarize the clinical results of posterior fusion plus pedicle screw fixation in treatment of dens fracture combined with recoverable atlantoaxial dislocation. Methods Twenty-seven patients with dens fractures combined with recoverable atlantoaxial dislocation were treated with posterior pedicle screw fixation, reduction and fusion. In this series of patients, skull traction was made to restore the normal atlantoaxial joint before the operation. Results Atlantoaxial alignment or stability were restored, without complication due to instrumentation. A follow-up for 12-48 months (average 24 months) showed osseous union. Conclusion Posterior aflantoaxial pedicle screw and rod fixation provides immediate three-dimensional rigid fixation of aflantoaxial joint and is a more effective technique compared with previously reported techniques.

Osteogenic potential of fibrous ring tissue in cervical intervertebral disc / 中国组织工程研究

BACKGROUND: Ossification of intervertebral disc, and ossification of spinal ligament and fibrous tissues are still uncertain.OBJECTIVE: To observe osteogenic potential of fibrous ring in the cervical intervertebral disc during bone fusion.DESIGN, TIME AND SETTING: The comparative observation was performed at the Experimental Animal Center of Second Military Medical University and Shanghai Institute of Orthopedics in October 2006.MATERIALS: Ten healthy goats, including 6 males and 4 females; titanium alloy cervical hollow threaded columnar internal fixator (CHTF) for goat, simulated human used internal fixator by Kanghui Medical Innovation Co., Ltd., Changzhou.METHODS: Every goat underwent conventional anterior cervical decompression and internal fixation. Two adjacent intervertebral spaces among C2-6 were selected and implanted with 2 CHTFs for each space. Of the 4 CHTFs, 3 were filled with cancellous bone alone, cancellous bone plus fibrous ring, and fibrous ring alone, respectively; the other one filled with nothing served as blank control.MAIN OUTCOME MEASURES: Implant location and fusion condition on anteroposterior and lateral radiographs and CT plain scanning at 6 and 12 weeks postoperatively; bone graft fusion and regional tissue reaction by histology.RESULTS: Radiographs and CT showed that CHTF was in the position during the whole experimental procedure with no loosening, displacement or dislocation. At 6 weeks, bone tissue was found surrounding CHTF and the vertebral body, and bone bridge formed in the connection site of CHTF and the vertebral body. New cartilage and bone trabecula formation were found in the CHTF filled with cancellous bone alone, accompanied by necrotic original bone graft; in the CHTF filled with cancellous bone and fibrous ring, necrotic fibrous tissue and newly formed cartilage accumulation surrounding original bone trabecula and fibrous ring were found; 6 weeks after surgery, there were fibrocartilage in fibrous tissue of CHTF filled with fibrous ring alone, and at 12 weeks postoperatively, newly formed cartilage was observed. In blank control group, only few newly formed cartilages were found at 12 weeks postoperatively. CONCLUSION: Enchondral ossification of fibroblast may be the osteogenic pattern of fibrous ring of cervical intervertebral disc.

Correlation analysis of post-operation functional restoration in surgical treatment of 56 patients with ossification of ligamentum fiavum in thoracic spine / 中国组织工程研究

BACKGROUND: It is difficult to conduct the operation of ossification of ligamentum flavum (OLF) in thoracic spine, and the operation needs complecated operative skill, and unmerited disposal tends to worsen neurological dysfunction.OBJECTIVE: To analyze the operative method for OLF of thoracic spineand functional restoration.DESIGN: Case analysis.SETTING: Department of Orthopaedics, Changzheng Hospital, SecondMilitary Medical University of Chinese PLA.PARTICIPANTS: Totally 56 patients with OLF of thoracic spine, whowere treated at the Department of Orthopaedics, Changzheng Hospital fromAugust 1996 to August 2003.METHODS: The operative therapy was performed in all the patients, and the method was determined by the results of MRI and CT examination: ①The 19 patients, whose OLF in thoracic spine was focal type, and range of lesion did not exceed two segments, were treated with simple resection and decompres sion in posterior wall of vertebral canal. ②Fenestration and sledging-allocating manipulation in the whole piece unilateral lamina of vertebra were carried out in 29 cases involving more than 2 segments. ③If coplanar OLF in thoracic spine combined with protrusion of thoracic spine disc or ossification of posterior longitudinal ligament, decompression of posterior midline approach+posterior lateral approach was performed, totally 8 cases.MAIN OUTCOME MEASURES: Post-operation functional restoration was evaluated with Epstein standard, excellent: recovery of sensation and exercise was near to normal; good: spinal cord function was improved significantly, and permitted to walk with brace; fair: small partial restoration of sensory and motor function, unable to walk; bad: Inefficiency or becoming severe.RESULTS: A total of 55 cases were followed up for more than one year and 1 case only for two months after operation. ①Functional restoration: excellent: 39 cases; good: 8 cases; fair: 5 cases; bad: 4 cases. ②Symptom recovery after operation was confirmed by disappearance of tight sensation, reduction of muscular tension, relieving of numbness in order. ③The recovery was rapid for 3 to 6 months after operation. Part of patients' condition was still ameliorating during one year after operation, and rare advancement 2 years later. The recovery of complete paraplegics was bad, so was the severe paraplegia with long history. CONCLUSION: Compressive myelopathy caused by OLF in thoracic spine should be treated in an earlier period by operation. Resection and decompression of posterior wall of thoracic spine and decompression of posterior approach could be choosed according to different condition.

Preliminary study of the optimal time for operation on patients with ossification of the posterior longitudinal ligament of the cervical spine / 中国矫形外科杂志

[Objective]To explore the optimal time for the surgical operation on patients with ossification of the posterior longitudinal ligament of the cervical spine. [Methods]The clinical symptoms,the persistent time of the symptoms and the interval from exacerbation to operation in 168 patients with OPLL were analyzed.[Results]The average time was 27.6 months from the onset of myelopathy to the operation on patients with OPLL,and 17.4 months from the decrease of muscle strength in extremities to the operation,and 5.3 months from the symptomatic exacerbation of the extremities especially the decrease of muscle strength in lower extremities to the operation.[Conclusion]The patient should be treated earlier by surgical operation after his/her illness has been diagnozed as OPLL.It is the optimal time for surgical operation when the patient has imaging change of hypertrophy or ossification of the posterior longitudinal ligament and severe compression of spinal cord(more than 60% spinal canal stenosis),or the decrease of muscle strength in extremities especially in lower extremities.

Observation of therapeutic effects of treating lower cervical spine fracture and dislocation on 30 cases by anterior approach / 中国矫形外科杂志

[Objective]To explore the value of anterior approach in the surgical treatment of cervical fracture and dislocation.[Method]Thirty cases of lower cervical fractures and dislocations were treated with anterior decompression,reduction,autograft and plate fixation or titanic net.[Result]Patients were followed up for 6 to 24 months,the regular X-ray film to observe the stability of segmental injury and the Frankel grade to determine the recovery of the spinal cord were recorded.All cases were improved and obtained solid fusion within 3～5 months.The intervertebral heights and physiologic curves were kept well,without plate or screw complications occurring in these cases.[Conclusion]It is feasible to get complete decompression,good reduction and excellent maintenance of intervertebral heights and physiologic curves by employing anterior approach to treat lower cervical fractures and dislocations.More importantly,it can get immediate stabilization to cervical spine and prevent secondary injury to spinal cord and recover nervous function.

Cultivation of Medical Students'Clinical Work Ability in Orthopaedic Surgery Practice / 中华医学教育探索杂志

Orthopaedic surgery is a fast developing subject in clinical surgery.Based on the characteristics of the orthopaedic surgery and aiming to enhance the medical students’practical ability of basic skills and clinical thinking we adopt the explorative clinical teaching which can be helpful to training students’initiative of finding and working out a solution by themselves and cultivating their capability of innovation and creation.

The study on hematological changes of nontraumatic osteonecrosis of the femoral head / 中华骨科杂志

Objective To study the hematological changes o f nontraumatic osteonecrosis of the femoral head,select the sensitive molecular symbols for early diagnosis and distinguish the high risk peopl e.Methods The studied subjects were divided in to three groups:1)NONFH early stage group(n=30);2)NONFH late stage group(n=30);3)the normal controlled group(n=30).Blood samples from cubital veins were collected.GMP -140,PC,D -Dime r were examined using ELISA.PAI was e xamined with chromogenic assay.Results1)The platelet GMP -140levels of early or late stage groups NONFH were signi ficantly higher than that of the normal contro lled group;the plasma PC levels of both groups were lower than that of the normal controlled group significan tly(P