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BACKGROUND:The type AO-C1 thoracolumbar acute spine injury is a kind of high-energy instable injury, can cause thoracolumbar fracture-dislocation, and mainly associated with spinal nerve injury. Generaly, al needs to posterior open reduction, decompression, bone graft fusion and multiple-segmental internal fixation of pedicle screw rod system, which causes excessive loss of spinal movement segment and a large number of application of internal fixators. OBJECTIVE:To evaluate the treatment effect of posterior pedicle screw mono-segmental internal fixation for treatment of the type AO-C1 thoracolumbar vertebrae fracture-dislocations. METHODS:From January 2008 to December 2013, 17 cases of type AO-C1 thoracolumbar fracture-dislocation were folowed up. Al patients were treated with one-stage posterior open reduction and pedicle screw-rod fixation. Of them, eight cases received four screws and two rods for single-segment fixation in upper and lower vertebrae adjacent to intervertebral space after dislocation (4-screw 2-rod group). Nine cases received eight screws and two rods for multiple-segment fixation in the upper and lower vertebrae adjacent to intervertebral space after dislocation (8-screw 2-rod group). Operative time and intraoperative blood loss were compared between the two groups. The Cobb’s angle was measured on lateral X-ray film of two groups preoperatively and 1 week postoperatively and during the final folow-up. The neurological function was evaluated by Frankel classification. The visual analogue scale was adopted to assess the degree of low back pain. RESULTS AND CONCLUSION:Patients were folowed up for 1 to 5 years. Significant differences were detected in the operative time between the two groups, and operative time was better in the 4-screw 2-rod group than in the 8-screw 2-rod group (P < 0.05). No significant difference was found in intraoperative blood loss between the two groups. The deformity of fracture-dislocation had been corrected, and the pain of low back had significantly relieved in al patients after fixation. According to Frankel classification, two cases at Grade A were improved to Grade E, but eight cases at Grade A got no improvement after treatment. Two cases at Grade B were also improved to Grade E at the final folow-up. Significant differences in Cobb’s angle and visual analogue scale were detectable at 1 week postoperatively and during final folow-up as compared with preoperatively (P < 0.05), but no significant difference was visible between final folow-up and 1 week postoperatively. No significant difference in Cobb’s angle and visual analogue scale was observed between the 4-screw 2-rod group and 8-screw 2-rod group. Results indicate that there was no significant difference in the clinical efficacy between 4-screw 2-rod single-segment and 8-screw 2-rod multiple-segment fixation for treating type C1 thoracolumbar vertebrae fracture-dislocation. Therefore, AO-C1 thoracolumbar vertebrae fracture-dislocation could be treated with 4-screw 2-rod single-segment reduction fixation.
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[Objective]To observe the clinical results of adjustable hollow titanium artificial vertebra in the treating of tumor,tuberculosis and severe burst fracture of the thoracic and lumber vertebra.[Method]Totally 169 cases of thoracolumbar fractures were treated,including 64 cases of tumor,66 cases of tuberculosis and 39 cases of severe burst fracture of the thoracic and lumber spine,of which 57 cases with kyphosis of those Cobb's angle was 27.1~65.4 degrees with a mean(38.5?10.7)degrees,were treated by one-stage procedure,including pathologic vertebral resection,anterior interbody reduction and implant adjustable hollow titanium artificial vertebral body,anterior internal fixation or posterior transpedicular fixation,reconstruction of spinal stability.For anterior stabilization,the Centaur plate system,Z-plate and XIAⅡrod-screw spinal system were used.Relief of the pain,the function of spinal cord or nerve,kyphosis collection and spinal stability were monitored.[Result]Postoperatively,the period of follow-up lasted 12 months to 46 months with a mean of 32 months.All these patients had their incision healed by first intention,and no recurrence was noted in those patients of tumor and tuberculosis.All patients experienced significant palliation local pain,and 73 patients showed improved neurological status(at least one grade improvement on Frankel's functional classification).The instrumentation provided immediate stability and protected against development of kyphotic deformity in all patients.Postoperative radiological evaluation revealed that implants were stable,there was no phenomena of prosthesis subsidence,hook dislodgment and failure restoration of spinal segments height.Solid bony fusion was obtained in all patients.The residual kyphotic deformity had been corrected by(31.6?8.3)degrees with a mean(6.2?8.7)degrees after operation.[Conclusion]Pathologic vertebral resection,artificial vertebral body replacement and internal fixation are ideal treatmens in thorough decompression,release of pain,reconstruction of spinal stability and resume of spinal sequence.
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[Objective]To evaluate the outcome on patients with primary infection of intervertebral space of the thoracolumbar spine following combined one-stage debridement,strut grafting and internal fixation.[Method] From May 1999 to February 2006,18 patients with spontaneous infection of intervertebral space were analyzed retrospectively.These infections occurred at thoracic spine in 3 cases(16.7%),thoracolumbar junction in 2 cases(11.1%),lumbar spine in 10 cases(55.5%),and lumbosacral junction in 3 cases (16.7%).Their clinical data and outcome were studied.None of all had previous spinal surgery or spinal injection,and their diagnosis were confirmed by histopathology after surgery.All patients were treated by one-stage debridement,strut grafting and internal fixation after failure of nonsurgical treatment.Antibiotics was used following debridement in the infection sites,and was continued to be administered after surgery.Patients were evaluated before and after surgery in terms of pain,neurologic level,sagittal spinal balance,and radiologic fusion.[Result]Postoperatively,all patients experienced significant relief of symptoms,and no fever.Six patients showed improved neurological status(at least one grade improvement on Frankel's functional classification).Only 3 of 18 cases had a positive culture result that pathogen identified Staphylococcus aureus.Histological examination of the specimen after surgery revealed that inflammation occurred in all patients,but no evidence of tuberculosis.The period of follow-up ranged 13 to 45 months with a mean of 26 months.No evidence of recurrence or residual infection was observed in any patient.Postoperative radiological evaluation revealed that implants were stable,there was no phenomena of prosthesis subsidence,hook dislodgment and failure restoration of spinal segments height.Solid bony fusion was obtained in all patients.Eight patients were misdiagnosed for spinal tuberculosis.[Conclusion] One-stage eradication of the infection,strut grafting and internal fixation are effective treatments for primary infection of intervertebral space.The presence of the instrumentations at the site of infection has no negative influence on the course of infection healing.
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Objective To explore the improving way to repair the lower one-third of leg soft tissue defect transferred the adjacent flap with non-main vessel pedicle. Methods Analyzing 42 cases.using 4 kinds flaps with nonmain vessel pedicle.If it is fine the skin around soft tissue defect of the lower one-third shank,choosing adjacent adversed sural neurotaneous vascular flap or sapheenous nerve vascular flap.If the skin damaged,chosing gastrocnemius flap.If the soft tissue defect was large,combined adversed sural neurotaneous vascular flap with gastrocnemius flap.Osteomyelitis and peroneus previs musculocutaneous flaps were choosed for small soft tissue defect. Results All case observed 6 to 12 months,37 cases were survived completely,5 cases distal part necrsis partly,among them,2 cases transferred flap repaired;1 case musculocutaneous flap transferred, 2 cases after granulation tissue grown,skin grafted. Conclusion The flap transferred adjacent non-main vessel pedicle is the best way to repaire soft tissue defect of one-third lower leg.Different flap can fit with kinds of soft tissue defect.
