Objective To investigate the outcome of repairing hand composite defects using pedicle osteocutaneous groin flap. Methods From February 1998 to May 2004, 33 cases of hand composite defects were repaired with pedicle osteocutaneous groin flap. There were 22 males and 11 females. The age was 19 to 54 years with an average of 243 years. The defect was caused by palmar penetrating injury in 17 cases, by dorsal hand crushing injury in 9 cases and by other injury in 7 cases. Twentythree cases complicated by metacarpal defect, 10 by phalanx defect. Thesize of skin defect was 3.5 cm×2.0 cm to 15.0 cm×10.0 cm, the size of bonedefect was 1.5 to 3.5 cm. After 3 to 7 days of primary debridement, defect was repaired by the pedicle osteocutaneous groin flap based on the superficial circumflex iliac vessels. The flap size was 4.0 cm×2.5 cm to 17.0 cm×11.0 cm. Results All the osteocutaneous flaps survived. During the 4 to 22 months follow-up postoperatively, thetexture, appearance and function of the flap were excellent and bone union was obtained in all cases after 7 to 9 weeks of operation.Conclusion The pedicle osteocutaneous groin flap is an ideal flap to repair the composite defect of the hand, with the benefit of simple procedure and reliable blood supply.
From jan.1984 through dec.1991,65 cases of hand skin defects were primarily repaired by podicled groin flap. Four of the 65 cases had skin defects on both sides of the palms and dorsal aspot of the hands which were treated by the Y-shaped hypogastric groin flap .Five easec had thumb loss in which the lxdicled groin tubed flap was used to reconstruct the thumb.The time of division of the pedicles ranged from 14 to 28 days(averaged 16 days).All flape survived after division of the podicl...
ObjectiveTo explore the feasibility and effectiveness of unilateral pedicle screw rod and single poly (ether-ether-ketone) (PEEK) Cage for lumbar intervertebral disc protrusion. MethodsA total of 126 cases of single segment of lumbar intervertebral disc protrusion between January 2006 and June 2012 were divided into 2 groups in the randomized clinical trial. Unilateral pedicle screw fixation and single PEEK Cage was used in 63 cases (research group), and bilateral pedicle screw fixation and single PEEK Cage in 63 cases (control group). There was no significant difference in gender, age, disease duration, side, and affected segment between 2 groups (P>0.05). Schulte evaluation criterion was used to assess bone graft fusion, Oswestry disability index (ODI) to estimate the quality of life situation, and visual analogue scale (VAS) to evaluate the improvements of lower back pain. Macnab standards was applied to assess postoperative effectiveness, and Emery ways to measure the height of intervertebral space. ResultsThe incision length, operation time, intraoperative blood loss, hospitalization time, and hospitalization fee in research group were significantly less than those in control group (P<0.05). The patients were followed up 12-79 months (mean, 21.3 months) in research group, and 15-73 months (mean, 22.6 months) in control group. The postoperative lordosis was recovered well, and the height of intervertebral space was increased. No loosening or breakage of internal fixation occurred. The time of bone graft fusion was (6.8±1.3) months in research group and was (7.1±1.2) months in control group, showing no significant difference (t=1.153, P=0.110). The height of intervertebral space, ODI score, and VAS score were significantly improved when compared with preoperative ones in 2 groups (P<0.05), but no significant difference was found between 2 groups at preoperation and last follow-up (P>0.05). At 3 months after operation, postoperative effectiveness was assessed according to Macnab criterion, the excellent and good rate was 95.23% in research group (excellent in 13 cases, good in 47 cases, and fair in 3 cases) and was 71.42% in control group (excellent in 7 cases, good in 38 cases, fair in 15 cases, and poor in 3 cases); the research group was significantly superior to control group (χ2=6.110, P=0.006). ConclusionUnilateral pedicle screw fixation and single PEEK Cage has the advantages of small trauma, reliable fixation, shorter operation time, less bleeding, less economic cost, and early off-bed activity time. It can provide a simple and reliable choice in single segmental lumbar intervertebral disc protrusion.
Objective To explore the feasibilities, methods, outcomes and indications of atlas pedicle screw system fixation and fusion for the treatment of upper cervical diseases. Methods From October 2004 to January 2006, 17 patients with upper cervical diseases were treated with atlas pedicle screw system fixation and fusion. There were 13 males and 4 females, ageing 19 to 52 years. Of 17 cases, there were 14 cases of atlantoaxial dislocation(including 3 cases of congenital odontoid disconnection，4 cases of old odontoid fracture，2 cases of new odontoid fracture(typeⅡC), 3 cases of rupture of the transverse ligament, and 2 cases of atlas fracture； 2 cases of tumor of C2; 1case of giant neurilemoma of C2,3 with instability after the resection oftumors. JOA score before operation was 8.3±3.0. Results The mean operative time and bleeding amount were 2.7 hours (2.1-3.4 hours) and 490 ml (300-750 ml) respectively. No injuries to the vertebral artery and spinal cord were observed. The medial-superior cortex of lateral mass was penetrated by 1 C1 screw approximately 3 mmwithout affecting occipito-atlantal motions. All patients were followed up 3-18 months. The clinical symptoms were improved in some extents and the screws were verified to be in a proper position, no breakage or loosening of screw and rob occurred. All patients achieved a solid bone fusion after 3-6 months. JOA score 3 months after operation was14.6±2.2. JOA improvement rates were 73%-91%(mean 82%). Conclusion The atlas pedicle screw system fixation and fusion is feasible for the treatment of upper cervical diseases and has betteroutcomes, wider indications if conducted properly.
To investigate the shortsegment pedicle screw in treating degenerative L4 spondylolisthesis and the relationship of the preliminarily bending degree of the titanium rod with the lumbar lordosisangle, the slipping angle and the slipping percentage and to evaluate the clinical coincidence and curative effects of the preliminarilybent rod. MethodsFrom September 2005 to March 2007, 31 female patients (age, 40-70 years; average, 58.3 years) were admitted for surgical treatment of their L4 degenerative spondylolisthesis (MeyerdingⅠ°, Ⅱ°)． Their lumbar lordosis angle （x1）, slipping angle (x2), and slipping percentage (x3) were measured in the L4,5 segment before operation. During the operation, the titanium rod bent beforehand according to the corresponding standards was inserted. The angle of the bent rod (Y) was measured, and then the multiple linear regression equation was established. The regression equation was applied to the surgical treatment of the 30 patients.Results According to the criteria in the JOA scoring system, the 31 patients had scores of 8.300± 1.080 and 26.916±1.859 before operation and after operation, respectively. There was a significant difference between before operation and after operation（Plt;0.05）. The established multiple linear regression equation was as follows:Y=0.1390-0.327logx1+0.463x2+0.288x32．The operating time was 51.290±3.408 min in the 30 patients who underwent an insertion of the preliminarilybent rod during the operation; however, the operating time was 102.360±5.004 min in the 31 patients who underwent an insertion of the bent rod that was made based on experience during the previous operations. There was a significant difference in the operating time between the two kinds of the rods （Plt;0.05）. Estimated according to 90%, 95% and 99% of the areas under the normalcurve, the clinical coincidence rates in the preliminarily bending degrees of the titanium rod in the 30 patients were 80.00％，90.00％ and 96.67％, respectively.Conclusion The titanium rod that has been bent into a certain angle before operation according to the established criteria can definitely diminish its strain during operation and efficiently shorten the operating time．Thiskind of the titanium rod has a good coincidence in clinical application and can be effectively used in clinical practice.It is worth reference during the clinical operation.
ObjectiveTo evaluate the effectiveness of pedicle subtraction osteotomy (PSO) assisted with anterior column reconstruction in the treatment of chronic osteoporotic vertebral compression fracture (OVCF). MethodsBetween January 2008 and October 2014, 11 cases of chronic OVCF were treated. There were 2 males and 9 females, aged 65-76 years (mean, 72.3 years). The vertebral compression fracture segment involved T11 in 2 cases, T12 in 2 cases, L1 in 4 cases, L2 in 2 cases, and L3 in 1 case. At preoperation, the Oswestry disability index (ODI) score was 31.1±10.2; kyphosis Cobb angle of fractured vertebrae was (36.5±10.2)° on the lateral X-ray films of the spine; and distance between C7 plumb vertical line (C7 PL) and sagittal vertical axis (SVA) of the S1 superior border was (5.2±2.5) cm. Six cases had spinal cord injury (SCI), including 4 cases of Frankel grade C and 2 cases of grade D. At last follow-up, ODI score, kyphosis Cobb angle of fractured vertebrae, and distance between C7 PL and SVA were recorded and compared with preoperative values. Postoperative Frankle scores were recorded in SCI cases. X-ray film and CT scan were taken to evaluate bone fusion at 12 months after operation. ResultsThe operation was completed successfully without serious complications. Nerve root radiation symptoms occurred in 2 cases undergoing lumbar PSO, which was relieved after conservative treatment. Cerebrospinal fluid leakage occurred in 1 case and was cured after 2 weeks. All cases were followed up 12-24 months (mean, 15.6 months). No internal fixation failure or pseudarthrosis was found postoperatively.Screw loosening was found in 1 case (2 screws of the upper level) and titanium Cage cutting vertebral body was found in 1 case. Bone fusion was obtained in all cases at 12 months after operation. At last follow-up, ODI score was significantly improved to 13.7±5.7(t=4.417, P=0.018), kyphosis Cobb angle of fractured vertebrae to (7.0±15.2)° (t=5.113, P=0.009), and the distance between C7 PL and SVA to (2.8±2.2) cm (t=3.285, P=0.032). In 6 SCI cases, Frankle grade was recovered to E (1 case), to D (1 case), and no improvement (2 cases) from C, and to E from D (2 cases). ConclusionPSO assisted anterior column reconstruction was an effective method in treatment of chronic OVCF.
Objective To introduce the application of the pedicled anterolateral thigh flap transferring for coverage of the oversized skin defect of the hand. Methods The pedicled anterolateral thigh flap was transferred to cover the large skin defects of the hands or the skin defects of theabdomen after the abdominal flap transferred to the hand in 5 male patients aged 16-44 years from April 2002 to August 2005. The injured sites were as follows:4 right hands and 1 left hand, including 2 hands injured by a machine and 3 hands injured by burning.The mechanically injured patients underwent an operation within 6 hours after the injury. The burned patients were reconstructed by the flap transferring 4-7 days after the burn when the decayed tissues could be clearly indentified.The areas of the hand defects were 12.19 cm×18.22 cm.The areas of the pedicled anterolateral thigh flaps were 7.12 cm×16.24 cm. The areas of the abdominal flaps were 13.20 cm×19.23 cm.The pedicles were separated 3 weeks after the repairing operation. Results All the flaps survived well and there was no vascular crisis, with the wound healing of the first intention. The skin defects of the hand were covered completely. Five patients were followed up for 6-12 months. The texture of the flaps was soft and the flaps had a good blood circulation. Of the patients, 3 underwent the finger exclusion and degreasing operation 47 months after operation. All the flaps of the hands had protective sensation, which could meet the requirement of the daily life. Conclusion The pedicled anterolateral thigh flap can provide the large coverage for the skin defects of the hands. The risk of the operation can be greatly decreased by obviation of the vessel anastomosis. It can be an optimal choice for themanagement of the oversized skin defects of the hands.
Eight patients with macromastia were treated with spoialy designed dermis preserved crossingmammary pedicle flap. A crossed curved scar situated below the edge of the breast was left behind andwas covered by the breast ofter operation. The breast had a good appearlance, mammary mecrosisdidn t occur in any cases. In four patients who had been followed up for six months of longer, thesensation of the nipple and areola had completely recovered in two patients, partially recovered in oneand h...
ObjectiveTo re-evaluate the systematic review and meta-analysis (SR/MAs) of the efficacy of robot-assisted pedicle screw placement. MethodsThe CNKI, VIP, WanFang Data, SinoMed, PubMed, Embase, Cochrane Library, and Web of Science databases were electronically searched to collect SR/MAs of robot-assisted pedicle screw placement from inception to April 28, 2023. Two reviewers independently screened literature, extracted data and then assessed the quality of reports, methodological quality, risk of bias, and the strength of evidence quality by using PRISMA, AMSTAR-Ⅱ, ROBIS, and GRADE tool. ResultsA total of 20 SR/MAs were included. The results of the included studies showed that robot-assisted pedicle screw placement was more accurate and had a lower number of complications compared with freehand pedicle screw placement. The quality of reports, methodology, and evidence for pedicle screw placement efficiency in all SR/MAs were low or extremely low, with a high risk of bias. The main reasons included high heterogeneity of included studies, unclear research methods and selection criteria, and missing key reporting processes. ConclusionRobot-assisted pedicle screw placement may have better clinical efficiency than traditional freehand pedicle screw placement. But the quality of relational SR/MAs is low.
ObjectiveTo investigate the stability of unilateral fractured vertebral pedicle screw fixation in the treatment of thoracolumbar fracture. MethodsEighteen fresh calf thoracolumbar spine specimens (T11-L3) were obtained to establish the L1 burst fracture models with Panjabi's high speed trauma apparatus, and were divided into 3 groups:pedicle fixation for adjacent upper and lower vertebrae of fractured vertebra (4 pedicle screws in group A), combined with pedicle screw fixation for unilateral fractured vertebrae (5 pedicle screws in group B), and three-level 6 pedicle fixation (group C). Under normal, fractured, and reconstructed conditions, the range of motion (ROM) of adjacent upper and lower vertebrae of fractured vertebra were measured in flexion, extension, bilateral bending, and axial rotation. Axial stiffness under flexion-compression was measured on the MTS-858 testing system. ResultsThere was no significant difference in ROM and axial stiffness under normal and fractured conditions in all directions among groups (P<0.05), indicating load balance in the groups. ROM of groups B and C were significantly less than that of group A under reconstructed condition in all directions (P<0.05), but no significant difference was found between group B and group C (P>0.05). Biomechanical test showed that group B was significantly higher than group A in the axial stiffness value (P<0.05), but difference was not significant between group B and group C (P>0.05). ConclusionTranspedicular fixation of fractured vertebrae can enhance the stability of the spine. Both unilateral and bilateral fractured vertebral pedicle screw fixations have the same stability.