Supercapsular percutaneously assisted total hip arthroplasty versus conventional posterior approach: Comparison of early functional results.

OBJECTIVE: This study aimed to explore the early functional results of total hip arthroplasty (THA) using the supercapsular percutaneously assisted total hip (SuperPATH) microposterior approach. METHODS: In this retrospective study, 58 patients treated with THA from October 2015 to April 2016 in our hospital were enrolled. A total of 28 patients (11 men and 17 women; mean age: 74.95±7.06 years) were operated on using the SuperPATH approach (group 1), and the remaining 30 patients (12 men and 18 women; mean age: 75.63±7.89 years) were operated on using the conventional posterior approach (group 2). To summarize the early functional results of the SuperPATH approach, we retrospectively analyzed the following demographics, perioperative factors, and measures of joint function: age, sex, preoperative diagnosis, preoperative visual analog scale (VAS) for pain, body mass index, the American Society of Anesthesiologists physical status, operation time (skin-to-skin), intraoperative bleeding, incision length, postoperative VAS, Harris Hip Score (HHS), Barthel Index (BI), length of hospital stay, positioning of the implants, and postoperative complications. RESULTS: All 58 operations were successfully completed, and the average follow-up time was 45 (45.03±2.44) months. The patients in group 1 had shorter incision length (8.84±0.59 versus 13.26±2.41 cm) and length of stay (7.86±0.51 versus 10.80±1.93 days), lower postoperative VAS score (2.43±0.69 versus 3.13±0.94), and better postoperative HHS (88.37±4.31 versus 83.81±6.00) and BI (91.47±5.27 versus 83.59±6.83) at 3 months than the patients in group 2; however, group 1 patients had longer operation time (113.95±25.36 versus 87.22±25.43 min) than group 2 patients (all P<0.05). No significant intergroup differences were found with respect to intraoperative bleeding, cup abduction angle, anteversion angle, and stem positioning. During the follow-up, no deep venous thrombosis, postoperative infection, and hip dislocation were observed in any patient. CONCLUSION: Compared with the conventional posterior approach, the SuperPATH approach provided better early functional results with less postoperative pain and shorter hospitalization time. However, the operation time was longer in the SuperPATH approach group. LEVEL OF EVIDENCE: Level III, Therapeutic study.

[Analysis of outcome and prognostic factors of anterior approach for two-level cervical spondylotic myelopathy].

OBJECTIVE: To investigate the efficacy and possibly prognositic factors of anterior approach on two-level cervical spondylotic myelopathy. METHODS: A retrospective review was performed on 44 cases of two-level cervical spondylotic mydopathy from Jun. 2007 to Sep. 2009. Among the patients, 24 cases were male and 20 cases female, with an average age of (60.072 +/- 10.77) years (ranged from 39 to 80 years). The affected segments ranged from C(3.4)-C(6.7). Improvements of cervical curvature and segmental height, preoperative sagittal diameter of the spinal cord at the site of maximal compression and signal intensity changes on T2WI were respectively measured. Function of nerves was assessed according to Japanese orthopaedic association system (JOA:17 score) before and after surgery. Operation by anterior approach including: anterior corpectomy and titanium cage fusion with internal fixation, anterior corpectomy body and auto iliac bone fusion with internal fixation. Statistical analysis was made on the correlation between JOA recovery rate and prognostic factors. RESULTS: Improvements of cervical curvature was -9.1 degrees to 16.6 degrees with the mean of (1.30 +/- 5.77) degrees and improvements of segmental height was -0.3 to 12.3 mm with the mean of (4.23 +/- 3.08) mm. Sagittal diameter of the spinal cord at the site of maximal compression was 1.6 to 7.2 mm with the mean of (4.01+/- 1.25) mm. T2WI with high signal changes was in 29 cases, no change in 15 cases. Bleeding amount was 50 to 700 ml with the mean of (242.05 +/- 148.22) ml. Operative time was 90 to 250 min with the mean of (153.75 +/- 34.54) min. All patients were followed up from 6 to 31 months with an average of (17.18 +/- 7.41) months. The mean JOA score preoperatively was (12.73 +/- 2.23); at the final follow-up, the JOA score was(15.09 +/- 1.91); and the recovery rate was (60.01 +/- 26.98)%. According to standard of JOA scoring, 16 cases obtained excellent result, 12 good, 15 fair and 1 poor. The effect of anterior approach had correlations with age, time of course, preoperative JOA score, sagittal diameter of the spinal cord at the site of maximal compression and signal intensity changes on T2WI, but had no correlations with operation time, bleeding amount and improvements of cervical curvature and segmental height. CONCLUSION: Two-level cervical spondylotic myelopathy can achieve good effect through anterior approach. The extent of the spinal cord compression may be a reliable and direct factor to judge effect.

[Therapeutic effects and complications of percutaneous pedicle screw fixation for thoracolumbar fractures].

OBJECTIVE: To investigate the therapeutic effects and complications of percutaneous pedicle screw fixation for thoracolumbar fractures. METHODS: From January 2002 to December 2008, 103 patients with thoracolumbar fractures were treated with percutaneous pedicle screw fixation, including 75 males and 28 females, the average age was 45.6 years (range, 18 - 72 years). All of them were of no neurological deficits. There were 65 cases of traffic injury, 23 cases of fall injury and 15 cases of smashed injury. According to the Denis classification, 64 patients were of compression fractures, and 39 patients of burst fractures. There were 5 cases had fractures in T(11), 30 in T(12), 42 in L(1), 15 in L(2), 4 in L(3), 3 in L(4), 2 in T(11-12), 1 in L(1-2), and 1 in L(2-3). Radiological examinations, including X-ray and CT examinations, and clinical examinations were carried out to evaluate the therapeutic effects. RESULTS: Twenty one patients were lost to follow up, the remaining were followed up from 10 to 48 months with an average of 27.4 months. Before the operation, the vertebral height, the kyphosis angle and the occupation of spinal canal were (54.5 ± 8.7)%, 16.4° ± 2.9° and 1.2 ± 1.0, and were improved to (88.6 ± 6.4)%, 11.6° ± 2.7° and 0.5 ± 0.6 respectively after the operation. Preoperatively the visual analogue scale and the Oswestry disability index were 8.0 ± 1.2 and 41.2 ± 9.3, and were improved to 1.7 ± 1.8 and 6.7 ± 5.6 postoperatively, respectively. All of these values between pre- and post-operatively were significantly different (P < 0.01). Screw misplacement was found in 7 patients, superficial wound infection in 1, screw breakage in 3, screw dislodgment in 2, cement leakage in 5, transient neurological symptoms in 4, and 8 patients with low back pain remained, of which 2 patients required occasional oral analgesics. Bone fusion achieved in all cases. CONCLUSIONS: The clinical efficacy of percutaneous pedicle screw fixation is similar with conventional open surgery. With the advantages of convenient procedure, less invasive, and rapid recovery, percutaneous pedicle screw fixation is an alternative method for thoracolumbar fractures without neurological deficits.