Objective To investigate the effect of removing the implanted plate-rod system for scol iosis (PRSS) on maintaining scol iosis curve correction and preserving spinal mobil ity in patients with scol iosis. Methods From June 1998 to February 2002, 119 cases of scol iosis were treated with the implant of PRSS, which was removed 26-68 months later (average46.8 months). Complete follow-up data were obtained in 21 patients, including 6 males and 15 females aged 11-17 years old (average 13.8 years old). The disease course was 9-16 years (average 12.1 years). There were 2 cases of congenital scol iosis and 19 cases of idiopathic scol iosis, which included 5 cases of IA, 2 of IB, 1 of IIA, 2 of IIB, 2 of IIC, 2 of IIIA, 3 of IIIB, and 2 of IVA according to Lenke classification. There were 13 cases of thoracic scol iosis and 8 of thoracolumbar scol iosis. AP view and the lateral and anterior bending view of X-ray films before and at 3 to 6 months after removing PRSS were comparatively analyzed, the coronal and the sagittal Cobb angle were measured, and the height of vertebral body on the concave side and the convex side were measured, so as to know the effect of PRSS on the growth of the vertebral endplates. Results All the implants were removed successfully with an average operation time of 2.5 hours (range 2-4 hours) and a small amount of intraoperative blood loss. Twenty-one cases were followed up for 6-72 months (average 34.4 months). The coronal Cobb angle before and after the removal of PRSS was (20.25 ± 8.25)° and (23.63 ± 8.41)°, respectively, indicating there was no significant difference (P gt; 0.05); while the sagittal Cobb angle was (39.44 ± 12.38)° and (49.94 ± 10.42)°, respectively, indicating there was a significant difference (P lt; 0.05). The height of the top vertebral body on the concave side before and after the removal of PRSS was (1.78 ± 0.40) cm and (2.08 ± 0.35) cm, respectively, and there was a significant difference (P lt; 0.01); while the height on the convex side was (2.16 ± 0.47) cm and (2.18 ± 0.35) cm, respectively, indicating no significant difference was evident (P gt; 0.05). All the 21 patients had good prognosis and no major operative compl ication occurred. Conclusion PRSS is an effective instrumentation for the management of scol iosis. After the removal of the PRSS, the correction of scol iosis can be maintained, and the spinal mobil ity can be protected and restored.
Objective To investigate the latest research and the therapeutic development in the injuries to the spine and spinal cord. Methods Literature concerned was reviewed, combined with our own research and clinical experience, to summarize the trend of the researches and their clinical application in the treatment of the injured spine and spinal cord.Results Theposterior approach atlantoaxial stabilization technique changed the conventional wiring technique into the transarticular screw fixation to the plate and pedicle or the lateral mass screw fixation technique. Theclinical application of the transoralpharyngeal atlantoaxial reduction plate fixation technique showed a good effect on the reduction of atlantoaxial dislocation. However, there were no unified criteria for selection of the surgical approach, fixation level, and fusion mode in the treatment of thoracolumbar spinalfractures. Under optimal conditions, both the anterior and the posterior approaches could achieve good clinical effects on decompression and spinal reconstruction. The single level fixation technique showed some advantages in treating certaintypes of thoracolumbar spinal fractures when compared with the traditional cross-sectional fixation. The endoscopy-assistant and image-guiding spinal intervention techniques were evolved in China during these years. In the treatment of the obstinate painful osteoporotic vertebral compressive fracture, percutaneous vertebroplasty and kyphoplasty achieved good results in the pain relief and spinal reconstruction. Numerous basic and clinical researches have given us a further understanding of the medical protection of acute spinal cord injury, and biological treatments have given us new ideas on neural reparation and regeneration. Cell transplantation and gene therapy have become the most promising treatment strategies in this field.Conclusion With the rapid development of spine surgery, the repair and reconstruction ofthe injured spine and spinal cord made a great stride in the recent years.
Objective To investigate the operative methods, cl inical outcomes and compl ications of total hi p arthroplasty (THA) in the treatment of patient with hi p joint flexion rigidity due to ankylosing spondyl itis (AS). Methods From May 1992 to July 2004, 56 patients (32 left hips and 39 right hips) with AS received THA through a modified anterolateral approach, including 52 males (67 hips) and 4 females (4 hips) aged 17-48 years with an average of 35.5 years. All the hips were ankylosed in (43.1 ± 7.2)° of flexion and 15 patients had bilaterally ankylosed hips. Preoperatively, Harris hip score was (42.6 ± 5.3) points and all the hips were classified as stage IV according to the standard of American College of Rheumatology (ACR). And the course of disease was 3-11 years. Results Intraoperatively, 1 patient suffering from proximal femur fracture due to severe osteoporosis was treated with titanium wire fixation, and the fracture was healed 6 weeks later. All the patients were followed up for 3-15 years (average 5.3 years). Postoperatively, 1 patient (1 hip) got subcutaneous soft tissue infection at 8 days, 1 patient (1 hip) got wound disunion at 11 days, 2 patients (2 hips) got infection at 11 months and 3 years, respectively. All the infections were healed after symptomatic treatment. The wounds of the rest 52 patients were healed by first intention without joint infections. The postoperative X-rays demonstrated that 4 hips (5.6%) had loose acetabulum prosthesis, 3 hips (4.2%) had loose femoral prosthesis and 5 hips had loose acetabulum and femoral prosthesis (7.0%), and the total loosening rate was 16.8%. Among which, 8 hips received revision resulting in satisfactory therapeutic effects, and the rest 4 hips had no further treatment. Fifteen hips (21.1%) had heterotopic ossification, which was rel ieved after taking nonsteroidal anti-inflamatory drugs. Harris hip score at final follow-up was (82.7 ± 4.1) points, indicating there was a significant difference between before and after operation (P lt; 0.05). Ten hips were evaluated as excellent, 43 hips good, 14 hips fare, and 4 hips bad, and the excellent and good rate was 74.7%. Conclusion THA through the anterolateral approach is effective for the treatment of patient with hip joint flexion rigidity caused by AS.
OBJECTIVE: Both primary and metastatic tumor of spine can influence spinal stability, spinal cord and nerves. The principles of dealing spinal tumor are resection of tumor decompression on spinal cord and reconstruction of spinal stability. METHODS: Since Aug. 1993 to Oct. 1996, 15 cases with spinal tumor were treated, including 4 primary spinal tumor and 11 metastatic tumor. Tumor foci were mainly in thoracic and lumbar spine. Graded by Frankel classification of spinal injuries, there were 1 case of grade A, 1 of grade B, 3 of grade C, 5 of grade D and 5 of grade E. Tumors of upper lumbar spine and thoracic spine were resected through anterior approach. Posterior approach also was adopted once posterior column was affected. Tumors of lower lumbar spine were resected by two-staged operation: firstly, operation through posterior approach to reconstruct spinal stability: secondly, operation through anterior approach. After resection of tumor, the spines were fixed by Kaneda instrument, Steffee plate or Kirschner pins. To fuse the spine, bone grafting was used in benign tumor and bone cement used in malignant tumor. RESULTS: Except one patient died from arrest of bone marrow, the others were followed up for 3 to 20 months. Postoperatively, 11 patients could sit up on one foot with the help of body supporter, and 9 patients could walk in two weeks under careful monitoring. There was no exacerbation of symptom and failure of fixation. The function of spinal cord was improved: 1 case from grade B to grade E, 1 from A to C, 2 from C to E and 4 from D to E. CONCLUSION: The spine can be reconstructed for weight bearing early by internal fixation. The symptom can be relieved and the nervous function can be improved by resection of tumor and decompression.
Objective To compare the effectiveness of spinal robot-assisted pedicle screw placement through different surgical approaches and to guide the clinical selection of appropriate robot-assisted surgical approaches. MethodsThe clinical data of 14 patients with thoracolumbar vertebral diseases who met the selection criteria between January 2023 and August 2023 were retrospectively analyzed, and all of them underwent pedicle screw placement under assistant of the Mazor X spinal surgery robot through different surgical approaches. The patients were divided into posterior median approach (PMA) group (n=6) and intermuscular approach (IMA) group (n=8) according to the surgical approaches, and there was no significant difference in age, gender, body mass index, disease type, and fixed segment between the two groups (P>0.05). The operation time, intraoperative blood loss, screw-related complications, and reoperation rate were recorded and compared between the two groups; the inclination angle of the screw, the distance between the screw and the midline, and the caudal inclination angle of the screw were measured based on X-ray films at immediate after operation. Results There was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). There was no screw-related complication such as nerve injury in both groups, and no patients underwent secondary surgery. At immediate after operation, the inclination angle of the screw, the distance between the screw and the midline, and the caudal inclination angle of the screw in the IMA group were significantly greater than those in the PMA group (P<0.05). ConclusionThere are differences in the position and inclination angle of screws placed with robot-assisted surgery through different surgical approaches, which may be due to the obstruction of the screw path by soft tissues such as skin and muscles. When using spinal robot-assisted surgery, selecting the appropriate surgical approach for different diseases can make the treatment more reasonable and effective.
目的:分析脊柱外科患者术后并发谵妄综合征的原因,总结其诊断、预防、治疗。方法:回顾性分析我科2008年10月至2009年4月脊柱手术167例,其中11例患者术后发生谵妄综合征。结果:11例患者均给予氟哌啶醇5mg im bid治疗,平均使用5.6天,症状缓解;并获3~6月随访,无一例复发谵妄综合征。结论:谵妄综合征是脊柱外科患者术后常见并发症,其发生与年龄,性别,低血糖等有关,目前治疗首选氟哌啶醇。
目的 探讨前路小切口顶椎切除联合后路矫形手术治疗重度僵硬性脊柱侧凸的可行性及疗效。 方法 2009 年7月－2010年9月，采用前路小切口顶椎切除联合后路矫形手术治疗重度僵硬性脊柱侧凸18例。其中男9例，女9例，年龄10～24岁，平均14.5岁。其中15 例特发性脊柱侧凸（Lenke 2型6例，Lenke 3型1例，Lenke 4型8例），2 例脊髓空洞合并脊柱侧凸，1 例Chiari畸形合并脊柱侧凸。术前剃刀背高度（6.8 ± 2.3）cm，主胸弯Cobb角（99.6 ±10.0）°，主胸弯顶椎偏距（7.3 ± 1.3）cm。 结果 前路手术切口10～13 cm，平均（11.4 ± 1.0）cm；前路手术时间170～300 min，平均（215.3 ± 36.8）min；失血量300～1 300 mL，平均（662.5 ± 274.8） mL。所有患者随访25～39个月，平均30.7个月。末次随访时，剃刀背高度（1.0 ± 0.6）cm，矫正率86.7%；主胸弯Cobb角（31.4 ± 11.4）°，矫正率68.7%；主胸弯顶椎偏距（2.2 ± 0.9） cm，矫正率69.6%。上胸弯、胸腰弯/腰弯的Cobb 角及顶椎偏距亦明显矫正，冠状面及矢状面平衡与术前相比，差异无统计学意义（P＞0.05）。未发生神经系统并发症，1例患者在前路手术后入ICU行呼吸支持治疗12 h，1例患者出现椎弓根螺钉穿透椎弓根上壁，2例患者出现钛网位置不佳，随访未见钛网位置改变。 结论 采用前路小切口顶椎切除联合后路矫形治疗重度僵硬性脊柱侧凸安全可行，矫形效果满意。
The current unilateral biportal endoscopy (UBE) technique was originated from Argentina and developed in South Korea, which was rapidly growing and popularizing in China. The adoption of spinal endoscopy, using small cameras placed inside body with continuous water irrigation, providing better surgical field with less tissue dissection and quicker recovery for patients. As with other disciplines, the use of spinal endoscopy in spinal surgery will become increasingly widespread. UBE technique will promote the popularization of spinal endoscopy in China with monoportal endoscopy technique. At the same time, biportal endoscopy has better expansibility, the application of accessory incision may provide solution for more complicated spinal disease. Chinese spine surgeon should better understand the trends in spinal endoscopy, seize the opportunity of the rapidly evolving in spinal healthcare, and to promote the popularization of UBE across the globe.