Wright's Technique with the Addition of Visualized Axial Cortical Windows in Odontoid Fractures.

This study sought to investigate and evaluate a modified axial translaminar screw fixation for treating odontoid fractures. We performed a retrospective study at Wenzhou Medical University Affiliated Second Hospital between March 2016 and June 2018. We retrospectively collected and analyzed the medical records of 23 cases with odontoid fractures. All patients were identified as type II odontoid fractures without neurological deficiency and serious diseases following the classification of Anderson. The average age, gender ratio, and body mass index (BMI) were 54.3 ± 11.1 years, 12 men to 11 women, and 22.6 ± 2.4 kg/m2 , respectively. Patients in this study accepted screw fixation using our modified axial translaminar screw fixation combined with atlas pedicle or lateral mass screw fixation. Within the technique, a small cortical "window" was dug in the middle of the axial contralateral lamina, such that the screws in the lamina were visualized to prevent incorrectly implanting the posterior spinal canal through the visualized "window." A total of 46 bone screws were accurately inserted into the axial lamina without using fluoroscopy. The length of all translaminar screws ranged between 26 and 30 mm, while the diameter was 3.5 mm. During the follow-up survey, the visual analog scale (VAS) and neck disability index (NDI) were measured. We provide a simple modification of Wright's elegant technique with the addition of "visualized windows" at the middle of the axial lamina. In all patients, screws were inserted accurately without bony breach and the screw angle was 56.1 ± 3.0°. Mean operative time was 102 ± 28 min with an average blood loss of 50 ± 25 mL. Postoperative hemoglobin and mean length of hospital stay were 12.0 ± 1.4 g/dL and 10.4 ± 3.4 days, respectively. The average follow-up time of all cases was 14.7 months and no internal fixation displacement, loosening, or breakage was found. All patients with odontoid fractures reported being satisfied with the treatment during the recheck period and good clinical outcomes were observed. At 1, 6, and 12 months, NDI and VAS showed that the symptoms of neck pain and limitations of functional disability improved significantly during follow-up. Our results suggest that the modified translaminar screw fixation technique can efficiently treat Anderson type II odontoid fracture, followed by the benefits of less soft tissue dissection, simple operation, no fluoroscopy, and accurate placement of screws.

Psoas hematoma as a rare complication of posterior lumbar interbody fusion: a case report.

BACKGROUND: Psoas hematoma rarely occurs in patients with spondylolisthesis who undergo posterior lumbar interbody fusion (PLIF) surgery. CASE PRESENTATION: Here we reported a case of a 57-year-old male patient diagnosed with spondylolisthesis who underwent PLIF at the local hospital. Seven days post-surgery, abdominal pain occurred, and the pain in the right lower limb gradually increased. The computerized tomography (CT) indicated a formation of hematoma around the psoas muscle. Digital-subtraction angiography (DSA) suggested a vascular injury, a rupture of the right segmental artery of the lumbar vertebral level 4. The patient then received DSA vascular embolization, after which the lower lumbar segmental artery active bleeding was stopped. One month after discharge, the abdominal hematoma was gradually absorbed, and the pain in the waist, leg, and abdomen disappeared. CONCLUSION: Symptoms such as abdominal pain, abdominal distension, and exacerbation of lower limb pain, may suggest the occurrence of psoas hematoma after PLIF. DSA vascular embolization is suggested as the first treatment approach for this type of complication.

A reduction clamp for an aiming component in associated acetabular fractures.

BACKGROUND: The treatment of acetabular fractures is complex and requires specialized equipment. However, all currently available instruments have some disadvantages. A new reduction clamp that can firmly enable reduction and not hinder subsequent fixation procedures for some special fracture types is needed. MATERIALS AND METHODS: In this study, we introduce a new acetabular clamp and its preliminary clinical application in three T-shaped acetabular fractures. RESULTS: This new clamp can successfully pull the posterior column back to the anterior column and firmly maintain the reduction. This clamp's aiming plate can facilitate the insertion of long lag screws. The clamp is also easy to assemble and use. CONCLUSION: This reduction clamp is a useful instrument that can facilitate open reduction and internal fixation of acetabular fractures.

Cage migration after transforaminal lumbar interbody fusion and factors related to it.

OBJECTIVE: To review and analyze cage migration and related risk factors in patients who have undergone transforaminal lumbar interbody fusion (TLIF). METHODS: A retrospective study was conducted to review the complications of cage migration in 512 patients who had undergone a TLIF procedure from January 2010 to June 2011 in five spinal centers. In all, 263 men and 249 women with a mean age of 54.7 years were included. All patients were followed up at 3, 6 and 12 months after the procedure. The clinical outcomes were evaluated by visual analogue scores, the Oswestry disability index, plain radiography and three-dimensional CT scanning to analyze the incidence of, and risk factors related to, cage migration. RESULTS: Cage migration was found in 6 of the 512 patients (1.17%). Significant differences were found between all pairs of centers. Different shapes and sizes of cages had different incidences of migration. Analysis showed that rectangular-shaped cages had a significantly greater incidence of cage migration (3.11%, 5/161) than did kidney-shaped cages (0.28%, 1/351; P < 0.05). Small cages had a tendency to more frequent post-operative cage migration (5.13%, 4/78) than did large cages (0.46%, 2/434; P < 0.05). Double segment TLIF cages migrated more frequently (5.75%, 5/87) than did mono-segment cages (0.24%, 1/425; P < 0.05)). Furthermore, when the adjacent endplates were of linear type, the cages migrated much more frequently (3.50%) than when they were of concave-concave type (0.27%; P < 0.05). CONCLUSION: Cage size, shape, number of fused segments and adjacent endplate shape might be risk factors for cage migration in addition to surgical technique, disc height and bone mineral density.

[Analysis of delayed diagnosis of the vertical unstable pelvic fractures].

OBJECTIVE: To explore the causes of delayed diagnosis of the vertical unstable pelvic fractures in patients with multiple trauma so in order to minimize these incidence. METHODS: A retrospective study was conducted in 176 patients with the vertical unstable pelvic fractures from January 2003 to December 2008. The classification of vertical unstable pelvic fractures was recorded. Medical data were compared and statistically analyzed to identify the incidence, and the contributing factors of the delayed diagnosis of the vertical unstable pelvic fractures. Of the 176 patients, 46 (26.1%) had delayed diagnosis of the vertical unstable pelvic fractures. There were 29 males and 17 females with an average age of 34 years old. RESULTS: Of the factors contributing to 46 cases of delayed diagnosis, 41.3% (19/46) closely related to the evaluation by the doctors and were potentially avoidable, and 58.7% (27/46) were associated with the severity of the injuries. CONCLUSION: The patients with multiple trauma had high incidence of delayed diagnosis of the vertical unstable pelvic fractures. The recognition of pelvic fractures, careful clinical assessments, and the awareness of the orthopedic doctors, emergency doctors and ICU doctors. Most of the delayed diagnosis of the vertical unstable pelvic fractures in patients with multiple trauma are potentially avoidable.

[Comparative study of two operation methods on complicated fractures of the distal radius and ulna].

OBJECTIVE: To compare the differences between external fixator and volar T-shaped plate in the treatment of complicated fractures of the distal radius and ulna, and evaluate the appropriate operation method for the fractures. METHODS: From July 2005 to July 2007, forty-eight cases of complicated fractures of the distal radius and ulna were treated with operation. There were 21 males and 9 females in the internal fixator group, ranged from 22 to 52 years old (with an average of 38.4 +/- 1.5 years). There were 10 mals and 8 femals in the external fixator group,ranged from 25 to 56 years old (with an average of 40.5 +/- 2.3 years). The X-ray films were measured to acquire radial length, palmar tilt and radial inclination after operations. The functional evaluation were scored with a modified Gartland and Werley's (GW) scoring system at 6 and 12 months after operation. RESULTS: The patients were followed up for 12 to 18 months with an average of 14.2 months. The radial length was (8.82 +/- 0.55) mm, palmar tilt (9.23 +/- 0.86) degrees, radial inclination (19.66 +/- 1.38) degrees in the internal fixator group, while those were (8.25 +/- 0.36) mm, (8.56 +/- 0.72) degrees, (18.82 +/- 1.42) degrees in the external fixator group. The film parameter of internal fixator group was better than the external fixator group, but with no statistical significance (P > 0.05). In the internal fixator group, 16 cases obtained excellent, 7 good, 5 fair, 2 poor, while in the external fixator group, 4 cases obtained excellent, 2 good, 8 fair, 4 poor in 6 months. The GW scores of internal fixator group were lower than that of the external fixator group (P < 0.05). At 12 months after surgery, in the internal fixator group, 17 cases obtained excellent, 7 good, 5 fair, 1 poor; while in the external fixator group, 5 cases obtained excellent, 9 good, 2 fair, 2 poor. The GW score was similar between the two groups (P > 0.05). CONCLUSION: The volar T-shaped plate fixation may offer effective stability,the short-term outcome is better than the external fixator group,and there are relatively fewer complications. But the treatment outcome of the two operation methods are similar for the long time follow up.

[Study on expression of mkp-1 and P-ERK in acutecontusive spinal cord injury rat's model].

To observe the expression of mitogen activated protein kinase phosphatase-1 (MKP-1) and phosphorylation of extracellular signal-regulated kinases (P-ERK) of spinal cord in acute contusive spinal cord injury model, 20 Sprague Dawley rats were divided into two groups at random, Ten rats' spinal cord contusive injuries were produced by using modified Allen's method (using a weight-drop device) after the T10 spinous process and the corresponding vertebral lamina were removed as experimental group. The rest 10 rats received only T10 laminectomies and didn't injury the spinal cord as Sham-operated control group. The injury spinal cord was carried out respectively in two groups at 12h after injury. Pathological alterations were detected by H-E stain. The expression of MKP-1 and P-ERK were analyzed by immunohistochemistry and Western blot analysis. In Sham-operated control group, the micro structure of spinal cord was normal. The pathological alterations were very apparent in the damaged spinal cord area in the experiment group. We also found MKP-1 expression of spinal cord was decreased while P-ERK was increased in experimental group when compared with Sham-operated control group (P<0.01). The results suggested that acute contusive spinal cord injury down-regulated the expression of MKP-1 and up-regulated the PERK, which might play a role in the pathophysiological of spinal cord injury.