O-arm real-time guidance in cervical pedicle screw fixation / 中国骨伤

OBJECTIVE@#To explore the technical aspects of the accuracy of cervical pedicle screw placement with O-arm guidance.@*METHODS@#The clinical data of 21 patients who underwent cervical pedicle screw fixation by O-arm real-time guidance from December 2015 to January 2020 were analyzed retrospectively. There were 15 males and 6 females, aged from 29 to 76 years old with an average of (45.3±11.5) years. The postoperative CT scan was utilized to evaluate the placement of the pedicle screw and classified according to the Gertzbein and Robbins classification.@*RESULTS@#A total of 132 pedicle screws were implanted in 21 patients, 116 at C3-C6 and 16 at C1 and C2. According to Gertzbein & Robbins classification, the overall breach rates were found to be 11.36% (15/132) with 73.33% (11 screws) Grade B, 26.67% (4 screws) Grade C, and no Grade D or E screw breaches. There were no pedicle screw placement related complications at final follow-up.@*CONCLUSION@#The application of O-arm real-time guidance technology can make cervical pedicle screw placement reliable. High accuracy and better intra-operative control can increase surgeon's confidence in using cervical pedicle instrumentation. Considering the high-risk nature of anatomical area around cervical pedicle and the possibility of catastrophic complications, the spine surgeon should have sufficient surgical skills, experience, ensures stringent verification of the system, and never relies solely on the navigation system.

Factors of prognosis in cervical spondylotic myelopathy: a review / 中国骨伤

Cervical spondylotic myelopathy (CSM) is a common cause of spinal cord dysfunction clinical disease. Surgery is the main therapeutic tool for CSM. However, there are obvious differences in clinical functional recovery after operation. For the past few years, the influence factors of prognosis in cervical spondylosis myelopathic has been widely concerned. Age, nerve function, course of desease, imaging findings,surgical method and related factors became the investigative point for prognosis of cervical spondylotic myelopathy. Present viewpoint showed that the older patient, preoperative worse nerve function, longer the course of disease would result in worse outcomes. Imaging examination maybe can indicate the prognosis, but the correlation is unclear. Selection of surgical method and approach should be based on the principles of sufficient decompression, stabilize the alignment of the cervical spine, keeping backward extension of cervical spine, maintain effective decompression, preventing complications. Therefore, the treatment of cervical spondylotic myelopathy should be on the basis of pathogenic condition and imaging examination at early stage and a suitable usrgical procedure should be performed to obtain a better prognosis.

Case-control study on patellar fixed pin and Kirschner's nail with tension band for the treatment of patellar fracture / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinical efficiency of patellar fixed pin and Kirschner's nail with tension band in treating patellar fracture.</p><p><b>METHODS</b>From November 2010 to January 2012, the clinical data of 42 patients with patella fracture were treated with patella fixed needle and Kirschner's nail with tension band. The patellar fixed needle group included 21 cases (14 males and 7 females,aged 26 to 65 with an average of 43.6 years old); The Kirschner's nail with tension band group included 21 cases (12 males and 9 females,aged 32 to 58 with an average of 41.5 years old). The operation time, intra-operative blood loss and healing time were compared between two groups. Böstman score was applied to compare the therapeutic effects.</p><p><b>RESULTS</b>All patients were followed up with an average of 11.5 months ranged from 6 to 14 months. The fractures healed well without complications such as nonunion and infection. According to Böstman score, there was no significant difference between two groups in clinical efficiency (Z = -0.83, P = 0.407). There was significant difference in operation time (t = 6.67, P = 0.00), while no difference in intra-operative blood loss, bone healing time (t = 1.90, P = 0.064; t = 0.612, P = 0.544).</p><p><b>CONCLUSION</b>Both methods can obtain good results. However, patellar fixed pin combined with tension band is one of the ideal methods for the treatment of patellar fracture, it has an advantage of simple with shorter operation time, rigid fixation, less complications and well recovery.</p>

Reasearch on mechanism of neurotrophins in discogenic low back pain / 中国骨伤

Discogenic low back pain is the common type of chronic low back pain. However,its mechanism has not been completely clarified. Considerable evidence shows that neurotrophins play an important role in discogenic low back pain. The paper summarizes the mechanism of neurotrophins on discogenic low back pain according to the pain transfer pathway of neurotrophins in intervertebral disc, dorsal horn ganglia and spinal trigeminal nucleus. Changing the pain transmission by regulating neurotrophins and its receptor will provide a new way for the treatment of discogenic low back pain.

The clinical observation about Coflex of dynamic interspinous implant on the treatment of lumbar spinal stenonis / 中国骨伤

<p><b>OBJECTIVE</b>To identify the initial effect of dynamic interspinous implant of Coflex on the treatment of lumbar spinal stenosis.</p><p><b>METHODS</b>A retrospective study of 18 patients who underwent posterior lumbar decompression and fixation with interspinous implant of Coflex between March 2008 and October 2009 was taken to compare the Cobb angel of nature and dynamic position on the segment of Coflex fixation at the time of before and after operation and following time,including 10 males and 8 females with average age of 62.2 years old (54 to 71 years). The symptoms of patients included chronic lower back pain and intermittent claudication and lower extremity numbness. All cases including 17 cases of L4,5 and 1 case of L3,4 were central canal stenosis without obviously segmental instability. Clinical outcomes were evaluated with VAS and ODI.</p><p><b>RESULTS</b>All patients were followed up from 10 to 18 months with an average of 14.4 months. There did not about internal fixation failure. It was found that postoperative Cobb angel of fixation segment [(12.1 +/- 2.6) degrees] was significantly decreased than preoperative [(14.8 +/- 3.2) degrees] (t = 2.61, P = 0.03). But the Cobb angel [(14.9 +/- 4.1) degrees] increased at final follow-up, even reached the level of before operation (t = 1.39, P = 0.65). The Cobb angle of upper adjacent segment did not obviously change in preoperation, postoperation and final follow-up [(12.1 +/- 2.3) degrees, (12.3 +/- 3.2) degrees, (11.9 +/- 3.0) degrees, respectively]. Dynamic measure showed that Coflex can adequately limit the ROM of extension (t = 4.01, P = 0.001), but the ROM of flexion increased (t = 2.57, P = 0.02). The VAS score in follow-up (2.2 +/- 0.7) was significantly decreased than before operation (4.9 +/- 1.1, t = 2.95, P = 0.02). The ODI score in follow-up [(29.1 +/- 9.0)%] was significantly decreased than before operation [(56.5 +/- 14.2)%, (t = 3.02, P = 0.02)].</p><p><b>CONCLUSION</b>The Coflex implanting combined with decompression can get good result clinically, but imaging showed that Coflex can not maintain the relatively kyphosis gained after operation except for extension limitation.</p>

Complications of surgical treatment for femoral intertrochanteric fractures using dynamic hip screw / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the complications of surgical treatments for femoral intertrochateric fractures using dynamic hip screw (DHS).</p><p><b>METHODS</b>From Jan. 2002 to Dec. 2007, sixty-nine patients with intertrochanteric fractures were treated by dynamic hip screw fixation included 27 males and 42 females,with an average age of 72.9 years ranging from 53 to 96 years. According to Evans classification there were 10 cases in type I ,21 in type II, 22 in type III, and 16 in type IV, of which 51 patients (73.9%) suffered from systematic diseases preoperatively.</p><p><b>RESULTS</b>Fifty-seven patients were followed up for 8 to 70 months (41 months on average). Four patients died, 17 cases occurrenced systematic complications postoperatively. Internal fixation related complications occurred in 12 patients. There were 8 cases with mechanical failure of DHS including 4 of screw loosen,3 of cutting-out of device through femoral head and neck and 1 of plate breakage. Five patients had a coxa vara, and delayed union occurred in 4 patients.</p><p><b>CONCLUSION</b>Unstable fracture pattern produced high percentage of mechanical failure. In such cases DHS should not be the first choice for treatment. The appropriate treatment should be in relation to pre-operative fracture stability and osteoporosis.</p>

Clinical application of hook plate for the treatment of distal clavicular trauma and analysis on its complications / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the clinical results of hook plate internal fixation for the treatment of distal traumatic injuries of clavicle,and to analysis the mechanism of the complications.</p><p><b>METHODS</b>From 2001.9 to 2008.2, 36 patients with fresh distal clavicle fractures of Neer type II and 14 patients with dislocation of Acromioclavicular joint of Tossy type III were treated with hook plate internal fixations. Among the patients, 36 patients were male and 14 patients were female, ranging in age from 19 to 77 years, with an average of 43 years. After the operation, the range of motion of shoulder joint was measured and the complications were studied. The Karlsson and Constant-Murley criteria were used to evaluate the therapeutic effects.</p><p><b>RESULTS</b>All the patients were followed up with a mean duration of 12 months (7 to 18 months). All the patients could move shoulder joint actively 1 week after operation, and recover to the normal ROM at the 6th week after operation. According to Karlsson criteria, 44 patients got an excellent result, 6 good. According to Constant-Murley criteria, the average score of wound shoulder was (73.8 +/- 8.3) before operation, and (59.6 +/- 6.7) after operation, and the postoperative score was higher than preoperative score. No incision infections were found and 5 patients with complications were cured. No re-dislocation of acromioclavicular joint occurred.</p><p><b>CONCLUSION</b>It is advocated that hook plate for the treatment of distal clavicular fractures of Neer type II and acromioclavicular dislocation of Tossy type III could provide sufficient stability to allow early functional rehabilitation, and to decrease the rate of complications.</p>

Value of somatosensory evoked potentials in diagnosis, surgical monitoring and prognosis of cervical spondylotic myelopathy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The value of somatosensory evoked potentials (SEPs) in the diagnosis and prognosis of cervical spondylotic myelopathy, as well as the usefulness of monitoring intraoperative potentials in terms of safety and predictive factors were investigated.</p><p><b>METHODS</b>Each of the 76 myelopathic patients underwent surgical intervention. According to the wave configurations of the SEPs, the cases were categorised into four groups: Type I, II, III and IV. The clinical myelopathy disability was classified and the severity of neurological deficits was scored. Clinical function after surgery was evaluated. Preoperative potentials and intraoperative monitoring were categorized. The correlations between .evoked potentials detection, monitoring, myelopathy disability and surgical outcome in the different groups were discussed.</p><p><b>RESULTS</b>According to the configurations of the SEPs, there were 27 patients (36%) of Type I, 30 patients (39%) of Type II, 8 patients (11%) of Type III, and 11 patients (14%) of Type IV. The categorised evoked potentials were shown to be significantly associated with the clinical representation of myelopathy (P<0.01) and the recovery rate from identifiable SEPs waves (groups A, B and C) was significantly higher than unidentifiable waves (group D, P<0.01). A deterioration of SEPs was detected in 23 cases (30%), whereas there was no change in 40 cases (53%) and improvements in 13 cases (17%). A significant difference in recovery rates could be observed in various monitoring groups within the short-term follow-up period, while there were no obvious differences in the long-term follow-up groups.</p><p><b>CONCLUSIONS</b>SEP technique is a valuable and practical tool for the diagnosis, monitoring and prognosis of myelopathy. Classified evoked potentials are well correlated with cervical spondylotic myelopathy disability, and unidentifiable SEPs waves in patients are indicative of a relatively poor outcome. In addition, intraoperative monitoring of SEPs plays an important role in protecting neural structures during cervical spine surgery.</p>