[Treatment of thoracic vertebrae tumor with posterior total vertebral resection and internal fixation].

OBJECTIVE: To evaluate the clinical outcome of posterior total vertebral resection in treating thoracic vertebrae tumor in order to provide a safe and effective method in rebuilding spine stability. METHODS: From 2002.1 to 2007.12, 18 patients with thoracic spine tumor underwent posterior total vertebral resection and internal fixation. Among the patients, 10 patients were male and 8 patients were female, ranging in age from 45 to 78 years, with an average of 56 years. The course of the diseases ranged from 2 to 13 months. After the operation, the tumor reccurence was monitored by X-ray, and the tumor markers were detected. RESULTS: All the patients were followed up for a period ranging from 12 to 60 months, averaged 29 months. All the patients showed a postoperative neurologic improvement, as well as showed radiographic evidence of solid fusion in the follow-up examinations during 3 to 9 months, with an average of (8 +/- 1.4) months. CONCLUSION: Posterior total vertebral resection for the treatment of thoracic spine tumor is safe and effective.

[Less invasive fixation for the treatment of comminuted fracture of distal tibia].

OBJECTIVE: To study the result of less invasive fixation in treating comminuted fracture of distal tibia. METHODS: From 2002 to 2008, 48 patients with comminuted fracture of distal tibia were treated with surgery. The closed reduction and less invasive fixation were done to stable broken fibula, and the reduction by Kirschner wire to pick was used for relatively larger debris of tibia. The Kirschner wire or screw were used to fix fracture after the restore of the ankle cavity position and the alignment of the tibia. Partial weight loading and functional exercise of ankle joint were done at 6th week after operation. RESULTS: Forty-eight patients were followed up for 1-24 months with an average of 12 months. All the fractures were united. According to Johner-Wruhs standard to value the result by factors of pain, deformity, motion range of joint,with or without injury of nerve and blood vessel. Thirty-eight cases obtained excellent result, 8 good, fair 2. The rate of excellent and good were 95.8%. CONCLUSION: Less invasive fixation has ascendancy such as easy operation, less injury of soft tissue, reliable fixation, which can maximally protect periosteum. It is a choice for treating comminuted fracture of distal tibia.

[Different approaches of vertebroplasty for management of severe osteoporotic vertebral compression fractures].

OBJECTIVE: To compare the clinical efficacy of 3 approaches of vertebroplasty in the treatment of severe osteoporotic vertebral compression fractures. METHODS: Twenty-five patients with severe osteoporotic vertebral compression fractures were observed, whose average age was 72 years with average disease history of 12 days and average compression of the affected vertebral bodies of 73%. The patients were divided into 3 groups for 3 different fracture types according to Rao's classification of osteoporotic vertebral structure and deformity, namely wedge type (group A, n= 12), biconcave type (group B, n= 7) and crush type (group C, n=6). Unipedicular approach was adopted in group A, far lateral bipedicular approach in group B, and posterior wall vertebroplasty and pedicle screw fixation in group C. The average follow-up time was 1 year. Visual analog scale (VAS), analgesic use and the mobility were measured in the patients preoperatively and 3 days (7 days in group C) and 6 months after the operation, respectively, and the success rates and complications were observed. RESULTS: All the surgical procedures were successful. The average operation time was 35 min in group A, 50 min in group B, and 2 h in group C. The average volume of cement injected into each vertebral body was 2.0 ml. The average blood loss was 30 ml in groups A and B, and 600 ml in group C. The procedure increased mobility and decreased analgesic use. VAS was decreased by a mean of 4.8 in Group A, 6.2 in group B 3 days after the operation and 5.4 in group C 7 days postoperatively, and remained stable till 6 months after the operation (P<0.01). Cement extravasation occurred in 9 cases, cement in the vertebral canal in 2 cases with transient neurological symptoms, and cement extravasation in the intervertebral space and the anterior space of the vertebral bodies took place in 5 and 2 cases, respectively. No neurological complications were observed. CONCLUSION: Different types of severe osteoporotic vertebral compression fractures require management with different approaches of vertebroplasty for adequate filling of the remaining vertebral body, which provides significant pain relief with wider indications.

[Application of restorative laminoplasty combined with spinous process osteotomy and internal fixation for treatment of degenerative scoliosis].

OBJECTIVE: For treatment of mild degenerative scoliosis (DS) complicated with lumbar canal stenosis (LCS), posterior decompression and the spinal canal enlargement with spinous process osteotomy was performed in combination with fusion and pedicle screw instrument fixation. METHODS: Between 1999 and 2003, 18 male and 26 female elderly patients (with mean age of 63 years, ranging from 47 to 72 years) with DS complicated with LCS were treated with the described surgical procedures, including 25 with single segment lesion and 19 with involvement of 2 segments. A posterior medical incision from one vertebra superior to the target fusion area till the vertebral segment below it was made for spinal exposure. Undermining enlargement of the spinal canal was carried out according to the segments of the stenosis; in some cases the intervertebral disc was resected. Osteotomy was subsequently performed at the base of the spinous process, and the bony defect was covered with the spinous processes. Finally Moe fusion and Isola (17 cases) or Diapason (27 cases) instrument fixation were performed. The therapeutic effects were evaluated according to Oswestry scores and postoperative imaging examinations. RESULTS: The average follow-up period was 3 years, ranging from 1 to 4 years. Thirty-three patients were followed up for one year and 93.9% of them had excellent or good outcome; 27 patients were followed up of 2 years and showed a rate for excellent or good results of 88.9%. Both sagittal and transverse diameters of the lumbar spinal canal were increased obviously as found by CT scanning without spinal canal scar. A rate of 92.6% of the ostetomized spinous processes had bony fusions. Successful covering bone healing was achieved in a mean of 4 months after surgery. Compressive vertebral fractures superior to the fixed segments occurred in 2 cases, including 1 with pedicle screw loosening and the other with pedicle screw breakage. Another patient had delayed wound healing. No recurrence of LCS, spondylolisthesis and decompensation, or pseudarthrosis of the spine was observed in these cases. CONCLUSION: The described surgical procedures for DS can decrease the occurrence of spinal canal scar and promote the healing of the covering bone, and can be a satisfactory treatment for mild DS complicated with LCS in the lumbar sagittal curve.

[Value of arthroscopy in the diagnosis of acute traumatic cartilage injuries to the knee joint].

We assessed the clinical value of arthroscopy in the diagnosis of acute traumatic cartilage injuries of the knee joint in 27 patients. Cartilage fracture was detected in the patella in 7, in the femur condyle in 3 and the tibial plateau in 6 cases. Arthroscopy proves to be a valuable modality for diagnosis of acute traumatic cartilage fracture of the knee.