Objective To evaluate the fixation technique of using the cervical lateral mass plate in the cervical posterior approach operation. Methods Eight patients in this group were admitted from September 2001 to November 2006. Among the 8 patients, there were 6 males and 2 females, with their ages ranging from 28 to 78 years. Cervical vertebral fracture with dislocation was found in 4 patients, C2 spinal cord injury in 1, C1 fracture in 1, cervical spinal stenosis in 1, and C2-5 spinal cord neurofibroma in 1. Muscle strength 3-4. TheFrankel grading system was usedin 6 patients with traumatic injury. Before operation, Grade C was observed in 2patients，Grade D in 3，and Grade E in 1. All the operations were performed according to requirements of the Margel’s method. We positioned 40 screws in all the patients, including 4 screws at C2，6 screws at C3，12 screws at C4，4 screws at C5，4 screws at C6，2 screws at C7，and 6 screws at T1. Results The followingup for an average of 14.1 months (range,645 months) revealed that there was no malposition of the screws in the patients. One of the 8 patients developed spinal instability in the fixed segment at 3 months after operation. The headchestbrace was applied to the patient for 3 months, and the spinal fusion was achieved. The further followingup to 45 months indicated that there was no instability occurring. The remaining patients recovered to their spinal stability by the spinal fusion. The patients also recovered in their neurological function after operation. The Frankel assessment showed that 1 patient had Grade E, 3 from Grade D to Grade E, 1 from Grade C to Grade D, and 1 from Grade C to Grade E. Conclusion The cervical lateral mass plate fixation can provide the immediate and b segmental immobilization for the good cervical spine stability.
Objective To evaluate the clinical effect of cannulatedscrew on treatment of femoral neck fracture(FNF). Methods Forty-two FNFpatients were treated by using cannulated screw from January 2001 to December 2005.There were 22males and 20 females with an average age of 41 years (19-59 years). Fracture was caused by traffic accident in 21 cases, by falling from height in 14 cases and by bruise in 7 cases. All cases were fresh fracture. According to Garden criterion for typing, 15 cases were classified as type Ⅱ, 16 cases as type Ⅲ and 11 cases as type Ⅳ . It was 7 hours to 15 days from injury to operation. Results Thepatients were followed up for 1-6 years with an average of 2.5 years. The average fracture union time was 6.5 months. Three patients had ischemic necrosis of femoral head, andloosening and breakage of screw and rob was observed in 1 case. According to Brumback criterion for hip joint function, the result was excellent in 18 cases, good in 20 cases and bad in 4 cases, and the excellent and good rate was 90.4%. Conclusion Cannulated screw fixation is a good method to treat FNF in young adults. It can improve the rate of fracture union and reduce the rate of avascular necrosis of femoral head.
ObjectiveTo compare the effectiveness of open reduction of posterior cruciate ligament (PCL) avulsion fracture at tibial insertion of knee joint with absorbable screws fixation and absorbable screw combined with suture anchor fixation. Methods The clinical data of 26 patients with PCL avulsion fracture at tibial insertion who met the selection criteria between March 2015 and October 2021 were retrospectively analyzed. Among them, 14 patients were fixed with simple absorbable screw (group A), and 12 patients were fixed with absorbable screw combined with suture anchors (group B). All patients were confirmed by X-ray film, CT, or MRI preoperatively, and got positive results in preoperative posterior drawer tests. There was no significant difference in gender, age, side of affected limb, time from injury to operation, comorbidities, and preoperative Meyers & McKeever classification, Lysholm score, and International Knee Documentation Committee (IKDC) score between the two groups (P>0.05). The operation time and postoperative complications were recorded and compared between the two groups. At last follow-up, Lysholm score and IKDC score were used to evaluate the improvement of knee function. ResultsThere was no significant difference in operation time between the two groups (P>0.05). All incisions healed by first intention, and no complication such as vascular and nerve injury or venous thrombosis occurred. All 26 patients were followed up 9-89 months, with an average of 55.3 months. The follow-up time of group A and group B was (55.7±23.2) and (56.8±29.3) months, respectively, with no significant difference (t=−0.106, P=0.916). Radiographs showed bone healing in both groups at 3 months after operation, and no complication such as infection and traumatic arthritis occurred. At last follow-up, the posterior drawer test was negative in both groups, and the Lysholm score and IKDC score significantly improved when compared with the pre-operative values (P<0.05). However, there was no significant difference in the improvement value between the two groups (P>0.05). ConclusionFor PCL avulsion fracture at tibial insertion of the knee joint, the open reduction and absorbable screw combined with suture anchor fixation can achieve reliable fracture reduction and fixation, which is conducive to the early rehabilitation and functional exercise, and the postoperative functional recovery of the knee joint is satisfactory.
ObjectiveTo discuss the security and effectiveness of fixing the unstable region of sagittal injured unit symmetrically with pedicle screws combined with bone graft fusion for treating thoracolumbar fractures.MethodsA series of 65 patients with a single level thoracolumbar fracture between November 2011 and November 2015 were included in the study. There were 41 males and 24 females with an average age of 36.7 years (range, 23-60 years). The fracture segments included T7 1 case, T9 in 2 cases, T10 in 4 cases, T11 in 8 cases, T12 in 14 cases, L1 in 19 cases, L2 in 13 cases, L3 in 3 cases, and L4 in 1 case. According to AO classification, there were 34 cases classified as type A, 27 cases type B, and 4 cases type C. The neurological function was evaluated by American Spinal Injury Association (ASIA) grade score, there were 1 case at grade A, 2 cases grade B, 6 cases grade C, 15 cases grade D, and 41 cases grade E. The thoracolumbar injury severity score (TLICS) was 4 in 9 cases, 5 in 29 cases, 6-8 in 23 cases, 9-10 in 4 cases. The time form injury to operation was 2-12 days (mean, 5.3 days). The fractured vertebra, along with the superior and inferior discs were defined as a injured unit and divided into three parts on the sagittal position: region Ⅰ mainly including the superior disc, cephalic 1/3 of injured vertebra, and posterior ligamentous complex as to oppose; region Ⅱ mainly including the middle 1/3 of injured vertebra, pedicles, lamina, spinous process, and supraspinal ligament; region Ⅲ mainly including the inferior disc, caudal 1/3 of injured vertebra, and posterior ligamentous complex as to oppose. The unstable region was defined as the key injured region of the vertebra. Pedicle screws were fixed symmetrically and correspondingly with bone grafting to treat thoracolumbar fractures. The neurological status, ratio of anterior body height, and sagittal Cobb angle were collected at preoperation, immediate after operation, and last follow-up to evaluate surgical and clinical outcomes.ResultsAll patients accepted operation safely and were followed up 12-24 months (mean, 17.3 months). Cerebrospinal fluid leakage occurred in 3 patients, and cured by symptomatic treatment. There was no complications such as loosening, displacement, and breakage of internal fixator. Bony fusion was achieved in all patients at 10-13 months (mean, 11.4 months) after operation. At last follow-up, according to ASIA grading, 1 case was grade A, 1 grade B, 3 grade C, 9 grade D, and 51 grade E, showing significant difference when compared with preoperative data (Z=–2.963, P=0.014). The ratio of anterior body height at preoperation, immediate after operation, and last follow-up were 53.2%±6.8%, 91.3%±8.3%, 89.5%±6.6% respectively; and the sagittal Cobb angle were (16.3±8.1), (2.6±7.5), (3.2±6.8)° respectively. The ratio of anterior body height and the sagittal Cobb angle at immediate after operation and at last follow-up were significantly improved when compared with preoperative values (P<0.05), but no significant difference was found between at immediate after operation and at last follow-up (P>0.05).ConclusionIt is safe and reliable to treat thoracolumbar fractures under the principle of fixing the unstable region of injured unit symmetrically with pedicle screws combined with bone grafting.
Objective To evaluate the cl inical appl ication value and short-term results of Vertex rod-screw system in cervical expansive open-door laminoplasty. Methods Between February 2008 and January 2010, 28 patients underwent Vertex rod-screw system fixation in cervical expansive open-door laminoplasty, including 15 cases of cervical spondylotic myelopathy, 5 cases of ossification of posterior longitudinal l igament，and 8 cases of cervical spondylosis with spinal stenosis. There were 16 males and 12 females, aged 42-77 years (mean, 61.3 years). The disease duration was 2 months to 11 years. The decompression range of cervical spine was from C3 to C7. The operation time, blood loss, Japanese Orthopedic Association (JOA) scores, and incidence of axial symptom were recorded. Pre- and postoperative curvature angles were demonstrated by the cross angle between posterior vertebral body margins of C2 and C7 on cervical X-ray films. The angle of the opened laminae was measured on CT scan at last follow-up. Results The operation time was (142.5 ± 22.8) minutes, and the blood loss was (288.2 ± 55.1) mL. All incisions healed by first intention. All patients were followed up 14-25 months (mean, 22 months). CT showed that no reclosed open-laminae or loosening and breakage of rod-screw system occurred at 1 week and 1 year after operation. The axial bony fusion rate was 89.3% (25/28). The improvement rate of JOA scores at 1 week after operation (29.5% ± 15.0%) was significantly smaller than that at 1 year after operation (64.9% ± 28.1%) (t=0.810, P=0.000). No case presented with C5 nerve root palsy. The cervical curvature angle was (24.29 ± 5.04)° before operation, was (23.89 ± 3.57)° at 1 week, and was (23.41 ± 3.35)° at 1 year after operation, showing no significant difference between pre- and postoperative angles (P gt;0.05). The angle of the opened laminae was (27.90 ± 4.74)° at 1 week after operation, and was (28.07 ± 4.21)° at 1 year after operation, showing no significant difference (P gt; 0.05). Conclusion Vertex rod-screw system in cervical expansive opendoor laminoplasty is effective in preventing reclosed open-laminae, which can reduce the loss of cervical curvature angle.
Objective To provide the anatomic basis for thelag screw placement in the anterior column of the acetabulum. Methods Twenty-two pelvis specimens with 44 acetabula of the native adult cadavers were studied. The anthropometric measurement was performed on 44 acetabula to determine the shape of the transverse section of the anterior column of the acetabulum, the optimal entry point for the lag screw on the outer table of the ilium, the direction of the screw, and the distance from the entry point to the obturator groove. Results The transverse section of the anterior column of the acetabulum was almost triangle-shaped. The path for the lag screw placement was 10.5±0.8 mm in diameter. The optimal entry point on the posterolateral ilium for the screw fixation was found toexist 9.2±2.4 mm superior to the line between the anterior superior iliac spine and the greater sciatic notch and 38.5±3.8 mm superior to the greater sciatic notch. The distance from the entry point to the obturator groove was 84.1±6.2 mm. The inclination of the lag screw was 54.2±5.5° at the caudal direction in the sagittal plane and 40.7±3.8° in the horizontal plane. The device for the safe screw placement in the anterior column was designed. Conclusion The above datacan facilitate an insertion of one 6.5 mm lag screw into the anterior acetabular column and minimize the risk of articular violation or cortical penetration, which has a narrow margin of safety. The safe length of the lag screw should be 70 mm.The optimal entry point on the posterolateral ilium for the screw fixationis determined to be 10 mm superior to the line between the anterior superior iliac spine and the greater sciatic notch and 40 mm superior to the greater sciatic notch. The inclination of the lag screw should be 55° at the caudal direction in the sagittal plane and 40° in the horizontal plane. It is safe to place thelag screw in the anterior column with the help of the targeting device.
Objective To summarize the treatment method and to analyze short-term therapeutic effect of Pipkin fracture. Methods From January 2002 to January 2007, 14 cases of Pipkin fracture were treated. There were 10 males and 4 females with an average of 33.5 years (ranged from 28 to 52 years). Fractures were caused by traffic accident. According to Pipkin’s classification, there were 4 cases of type I, 6 cases of type II, 2 cases of type III and 2 cases of type IV. The time from injury to operation was 24 hours to 8 weeks. All patients received open reduction under Kocher-Langenbeck approach, mel iorative posterior-lateral approach or combined approaches. Absorbable screws and suture l ine internal fixation wereperformed in fracture of the femoral head, titanium cannulated screws were used to fix the femoral intertrochanteric fracture in type III, and acetabular tridimensional memory fixation systems were used to fix the posterior acetabular fractur in type IV. Results All cases had one-stage wound heal ing, no compl ications of deep infection and thrombosis of deep vein of lower l imb occurred. All the patients were followed up for 12 - 48 months (mean 26 months). One case of type III fracture for Pipkin had necrosis of femoral head after 1 year of reduction and fixation, and received total hip replacement; other patients achieved bony heal ing after 6-10 months (mean 8 months). According to D’Aubigue-Postel score, the results were excellent in 5 cases, good in 6 cases, fair in 2 cases and poor in 1 case; the excellent and good rate was 78.6%. Conclusion It is important for the patients with Pipkin fracture to early diagnose, to select proper operation approach, to stably fix fracture and to manage after operation in reducing compl ication and recovering hip joint function.
Objective To compare the effectiveness of the proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS) in the treatment of elderly patients with intertrochanteric fractures. Methods Between May 2007 and May 2010, 63 elderly patients with intertrochanteric fractures were treated, and fractures were fixed with PFNA in 31 patients (PFNA group) and with DHS in 32 patients (DHS group). There was no significant difference in gender, age, injury cause, disease duration, and fracture type between 2 groups (P gt; 0.05). Results All incisions healed by first intention. The incision length, operation time, and blood loss in PFNA group were significantly less than those in DHS group (P lt; 0.05). The averagefollow-up time was 13.6 months in PFNA group and was 13.8 months in DHS group. The fracture heal ing time was (11.80 ± 1.32) weeks in PFNA group and was (12.21 ± 1.26) weeks in DHS group, showing no significant difference (t=1.23, P=0.29). The complication rate was 0 in PFNA group and was 12.5% (4/32) in DHS group, showing no significant difference (P=0.06). After 1 year, Harris hip score of PFNA group (86.55 ± 10.32) was higher than that of DHS group (80.36 ±11.18) (t=2.28, P=0.03). Conclusion There are two surgical methods to treat intertrochanteric fractures in the elderly patient: PFNA and DHS, and each has advantages; for unstable intertrochanteric fractures, PFNA treatment is the first choice.
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.
To evaluate the cl inical effect of pedical screw systems fixed between lumbar and il ium for treatment of sacral fractures. Methods From June 2003 to June 2009, 21 cases of sacral fracture (29 sides including monolateral 13 cases and bilateral 8 cases) were treated with pedical screw systems to have reduction and fixation. There were 12 males and 9 females, aging 23-59 years (38.2 years on average). Fractue was caused by traffic accident in 12 cases, by fall ingfrom height in 7 cases, and by crash in 2 cases. Screws were inserted into lumbar pedicles and il iac crests. Decompression was used in 4 cases compl icated by sacral nerves injury, and reductions and fixations were used in 12 cases compl icated anterior pelvic or acetabulum injury. The preoperative proximal displacement at the injured side of the pelvis was (16.29 ± 6.47) mm compared with contralateral pelvis. Results All incisions healed primarily with no compl ication of infection. Twentyone patients were followed up 6 months to 6 years. Cl inical heal ing time of fracture was 6-9 weeks. In 4 cases compl icated by S1 or S2,3 nerves injury, the function recovered completely after 4-9 weeks. In other 17 patients, no compl ication of intraoperative nerve injury occurred. All patients could walk and squat after 6-12 weeks of operation. No breakage or displacement of implant occurred. The postoperative proximal displacement at the injured side of the pelvis was (3.51 ± 0.68) mm compared with contralateral pelvis, showing significant difference (P lt; 0.01) when compared with preoperative one. Conclusion It is a novel choice to have reduction and internal fixation for sacral fracture with pedical screw systems fixed between lumbar and il ium. The strict regulation of indication and skill is the key to prevent compl ication.