Application of Dynesys system combined with posterior lumbar interbody fusion in treating multiple lumbar degenerative disease / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical effects of Dynesys system combined with posterior lumbar interbody fusion (PLIF) in treating multiple lumbar degenerative disease.</p><p><b>METHODS</b>The clinical data of 46 patients with multiple lumbar degenerative diseases treated by Dynesys system combined with PLIF from September 2010 to May 2013 were retrospectively analyzed. There were 17 males and 29 females, aged from 38 to 68 years old with an average of (56.38±11.63) years. Operation section was in L2-L5 of 16 patients (6 with fusion of L4,5 and 10 with fusion of L4,5,L5S1) and in L3-S1 of 30 patients (11 with fusion of L5S1 and 19 with fusion of L4,5,L5S1). Patients were followed up for three times: postoperative 3 months, 1 year and final follow-up. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to assess clinical symptoms preoperatively and postoperatively. All patients underwent flexion/extension radiographs examinations before surgery and at final follow-up. Range of motion (ROM) and disc height index (DHI) were recorded.</p><p><b>RESULTS</b>All patients were followed up from 16 to 48 months with the mean of (23.23±7.34) months. At third follow-up after operation, ODI and VAS of lumbago and leg pain were significant improved than that of preoperative (P<0.01). DHI of fusion segment was significantly increased than that of preoperative (P<0.05). There was no significant difference in adjacent non-fusion segment between preoperative and postoperative (P>0.05). Postoperative ROM of fusion and non-fusion segments were obviously decreased than that of preoperative. There was no significant difference in ROM of upper adjacent non-fusion segment between 3 months and 1 year after operation (P>0.05), but at final follow-up, the ROM was increased (P<0.05).</p><p><b>CONCLUSION</b>The preliminary clinical results of the Dynesys system combined with PLIF in the treatment of multiple lumbar degenerative diseases are satisfactory. It can be determined in fusion or non-fusion according to the individual needs and can reserve the some intervertebral motion, prevent the early degeneration of adjacent segments. However, its long-term clinical efficacy should be verified with long time.</p>

Application of internal fixation of steel-wire limited loop in early Achilles tendon rupture

OBJECTIVE@#To explore the clinical effect and safety of internal fixation of steel-wire limited loop in early Achilles tendon rupture.@*METHODS@#Seventy-six patients respectively with early transected and avulsed types of Achilles tendon rupture were selected and treated with internal fixation of steel-wire limited loop. The patients began to take exercise for their lower limbs through continous passive motion as early as possible after surgical repair, and the loops were removed after 3-5 months. Six months later, the condition of complications including Achilles tendon re-rupture, wound fistula, wound infection and skin necrosis, cutaneous sensation in sural nerve dominance region, time back to preinjury work or learning as well as time to physical activities were observed. One year later, the therapeutic effect was evaluated, and the maximum circumferences of bilateral legs and ruptured plane circumferences of Achilles tendon were measured.@*RESULTS@#The wound of all patients healed well, no complications like Achilles tendon re-rupture, wound fistula, wound infection and skin necrosis occured, and the cutaneous sensation in sural nerve dominance region was normal. The mean time back to preinjury work or learning as well as to pysical activities of all patients were respectively 10 and 22 weeks. Seventy out of 76 patients (92.1%) achieved an excellent effect, and 6 (7.9%) good effect. The excellent and good rate came up to 100%. The maximum circumference in the affected leg decreased to 2 mm averagely compared with the offside, while the ruptured plane circumferences of Achilles tendon in the affected side increased to 2.2 mm compared with the offside.@*CONCLUSIONS@#For early Achilles tendon rupture, internal fixation of steel-wire limited loop can recover the ankle function better, return to the preinjury state in the shortest time, and has few complications.