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OBJECTIVE: In a variety of thoracolumbar diseases, corpectomy followed by interbody bone graft and anterior instrumentation has allowed direct neural decompression and reconstruction of the weight-bearing column by short segments fusion. In this study, we compared spinal stability of the two different anterior thoracolumbar instruments : Z-plate and Kaneda device representing plate and two-rods type, respectively. METHODS: A retrospective review was performed for all the patients with thoracolumbar diseases or traumas treated with anterior corpectomy, autologous iliac bone graft, and fixation with instruments from 1996 to 2000. For the anterior instrumentation, Z-plate or Kaneda device was used for 24 (M:F=5:9, average age=37) and 12 (M:F=9:3, average age=41) patients, respectively. The plain AP and lateral flexion-extension films were taken immediately after surgery and at each follow-up. The sagittal and coronal Cobb's angles at the operation segments were used to observe the change of initial fixation status. The surgical time length and bleeding amount of the two groups were compared. Intra-operative and post-operative instrumentassociated complications were evaluated. Student t-test was used for statistical analysis and p-value less than 0.05 was considered to be significant. RESULTS: Mean follow-up durations for Z-plate and Kaneda device were 24 and 21 months, respectively. The fusion rate was 91% for Z-plate and 100% for Kaneda device. Two cases of Z-plate group showed instrumentation failure during the followup period, in which additional surgery was necessary. The mean differences of sagittal Cobb's angles among the AP images immediate after surgery and at follow-up were 7 and 2 degrees for Z-plate and Kaneda device, respectively (p<0.05). The mean differences of coronal Cobb's angles were 5 and 2 degrees for Z-plate and Kaneda device, respectively (p<0.05). No intra-operative complication has occurred in both groups. There was no difference in surgery time and bleeding amount between two groups. CONCLUSION: We think that Kaneda device (rod type) is stronger than Z-plate (plate type) to keep the spinal stability after anterior thoracolumbar surgery.
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Humanos , Descompressão , Seguimentos , Hemorragia , Duração da Cirurgia , Estudos Retrospectivos , Transplantes , Suporte de CargaRESUMO
Objective:To evaluate clinical efficacy of Z-plate and indications for the anterior fixation system for thoracolumbar fracture.Methods:50 cases of thoracolumbar fracture underwent direct anterolateral decompression with sagittal reduction and corpectomy,antologous bone-grafting reconstruction and Z-plate fixation procedure.Results:4 cases were lost to follow-up,and 46 cases were followed up from 4 to 36 months.According to Frankel classification of neurologic deficit,36cases with neurologic deficits recovered completely;8 cases obtained a good functional outcome;2 case didn’t recoved;No patient had neurologic deterioration after surgery Neither breakage of loosening of connections wac found.conclusion:Z-plate system is an effective ideal thoracoiumbar anternal fixation system.It has the advantages of reliable easy manipuplation,safety andless comlications.
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[Objective]To evaluate the short-term and long-term effectiveness of the surgical technique of one-stage one-step surgical techniques of Z-plate-Ⅱ~(TM) internal fixation apparatus system and anterior debridement and autograft bone graft fusion in the treatment thoraco-lumbar spinal tuberculosis with kyphotic deformity.[Method]The outcome of sixty eight cases suffered from thoraco-lumbar spinal tuberculasis with kyphotic deformity between July 1998 and March 2004 managed by the surgical techniques of Z-plate-Ⅱ~(TM) internal fixation apparatus system and anterior debridement and antograft bone graft fusion through posteroiateral costotransversectomy or kidney incision was analyzed.All cases wer given a longitudinal study follow-up for a mean of 3.3(2.2~6.3)years postoperatively.[Result]All patients showed successful autograft bone graft fusion.Among 45 cases accompanied with neurotic symptom of Potts paraplegia,25 were completely recovered,15 were partly recovered,total the ratio of recovery was 88.89% at the end of postoperative follow-up.The average immediate postoperative correction of kyphosis angle was 28.9?,the average loss of correction was only 2.7? at final follow-up.[Conclusion]The surgical technique of one-stage one-step Z-plate-Ⅱ~(TM) internal fixation apparatus system and anterior debrideraent and autograft bone graft fusion is found helpful in strengthening the stability of the spine in thoraco-lumbar spinal tuberculosis with kyphotic deformity,providing successful interbody fusion and recovery of Potts paraplegia,correcting the kyphosis,and preventing progress of kyphosis.
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[Objective]To discuss the methods selection for lumbar compressed fracture.[Method]137 cases were respectively treated with non-operation,AF nail,Z-Plate steel board internal fixation and protruding formation behind centrum.[Result]All were cured in 10~14w,(12?0.6)w in average;the pain VAS score,Frankel score,Cobb’s angle,the height of front and back edge of centrum were all relieved a lot after treatment,without operation sequela or marked loss of injured vertebra.[Conclusion]The methods shall be selected for lumbar compressed fracture under compressing degree,bone occupation degree in lumbar tube,nerve injure degree,stability of spine structure or fracture dislocation,etc.The stable fracture shall rest in bed with cushion under back.