BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with ...BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with no consensus regarding the superiority of any single approach.AIM To compare early postoperative complications after implementing the direct anterior and posterior approaches(PL)for hip hemiarthroplasty after femoral neck fractures.METHODS This is a comparative,retrospective,single-center cohort study conducted at a university hospital.Between March 2008 and December 2018,273 patients(a total of 280 hips)underwent bipolar hemiarthroplasties(n=280)for displaced femoral neck fractures using either the PL(n=171)or the minimally invasive direct anterior approach(DAA)(n=109).The choice of approach was related to the surgeons’practices;the implant types were similar and unrelated to the approach.Dislocation rates and other complications were reviewed after a minimum followup of 6 mo.RESULTS Both treatment groups had similarly aged patients(mean age:82 years),sex ratios,patient body mass indexes,and patient comorbidities.Surgical data(surgery delay time,operative time,and blood loss volume)did not differ significantly between the groups.The 30 d mortality rate was higher in the PL group(9.9%)than in the DAA group(3.7%),but the difference was not statistically significant(P=0.052).Among the one-month survivors,a significantly higher rate of dislocation was observed in the PL group(14/154;9.1%)than in the DAA group(0/105;0%)(P=0.002).Of the 14 patients with dislocation,8 underwent revision surgery for recurrent instability(posterior group),and one of them had 2 additional procedures due to a deep infection.The rate of other complications(e.g.,perioperative and early postoperative periprosthetic fractures and infection-related complications)did not differ significantly between the groups.CONCLUSION These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate(<1%)than the PL.展开更多
The differences in complication rates between the direct anterior and posterior approaches for hemiarthroplasty in elderly patients with femoral neck fractures are not yet fully understood.Dislocation,a severe complic...The differences in complication rates between the direct anterior and posterior approaches for hemiarthroplasty in elderly patients with femoral neck fractures are not yet fully understood.Dislocation,a severe complication associated with increased mortality and often requiring additional surgery,may occur less frequently with the direct anterior approach compared to the posterior approach.Careful consideration of patient demographics is essential when planning the surgical approach.Future research in this area should focus on robust randomized controlled trials involving elderly patients recovering from femoral neck fractures.展开更多
We read and discussed the study entitled“Complication rates after direct anterior vs posterior approach for Hip Hemiarthroplasty in elderly individuals with femoral neck fractures”with great interest.The authors hav...We read and discussed the study entitled“Complication rates after direct anterior vs posterior approach for Hip Hemiarthroplasty in elderly individuals with femoral neck fractures”with great interest.The authors have done justice to the topic of comparison of anterior and posterior surgical approaches for bipolar hemiarthroplasty which has been an everlasting debate in the existing literature.However,there are certain aspects of this study that need clarification from the authors.展开更多
Background: The different methods of anterior reconstruction and posterior instrumentation in surgical management of thoracolumbar spine fractures are PLIF, TLIF, lateral extracaviatary and transpedicular techniques w...Background: The different methods of anterior reconstruction and posterior instrumentation in surgical management of thoracolumbar spine fractures are PLIF, TLIF, lateral extracaviatary and transpedicular techniques which are increasingly used to perform partial or total corpectomies and anterior reconstructions from a posterior approach. These techniques were being alternative to the standard anterior approach with less morbidity and mortality. Patients and Methods: This study was performed between 2011 and 2014 on 100 patients with acute unstable thoracolumbar spine fractures which were divided into four groups: 30 patients underwent (TLIF), 28 patients underwent (PLIF), 28 patients underwent (PA) and 14 patients underwent (TPA). Neurological outcome, complications, operative times, kyphotic angle, vertebral height loss, spinal canal compromise, pulmonary functions, Denis pain and work scale, VAS score, ODI score, hospital stay, and estimated blood loss (EBL) were evaluated and compared in between the four groups. Results: There was a higher complication rate, increased EBL, and longer operative time with posteroanterior (PA) compared with PLIF, TLIF and (TPA). Patients undergoing PLIF, TLIF and TPA had a greater recovery of neurological function than those in whom PA were performed. Conclusion: TPA appeared to have more favorable results in improving the clinical and radiological outcome and no complications were reported apart from superficial wound infection which healed rapidly. The PLIF, TLIF and TPA appeared to have a comparable morbidity rate to PA. The different methods of anterior reconstruction from posterior approach are more favorable, applicable and convenient than PA approach.展开更多
Background: Supracondylar fractures of the humerus are among the most common type of pediatric fractures. The outcome of severely displaced supracondylar fracture of the humerus in children subjected to wide controver...Background: Supracondylar fractures of the humerus are among the most common type of pediatric fractures. The outcome of severely displaced supracondylar fracture of the humerus in children subjected to wide controversies in term of safety, functional and cosmetic outcome. Closed reduction and percutaneous pinning is now considered as the gold standard rule, but open reduction still applicable in certain cases where intraoperative imaging is not available, in comminuted lateral column fractures and uneducable fractures. Aim of the Study: To compare the outcome (functional and cosmetic) of anterior (Henry) approach with the posterior (Campbell) approach used in two groups of patients’ sustained displaced supracondylar fractures. Patients and Methods: This prospective study was performed on 48 pediatric patients who were been admitted to the Emergency Hospital in Sulaimani province sustained displaced supracondylar humeral fractures and treated during the period from the first of October 2009 to the thirty-one of January 2011. The study included 28 boys, 20 girls;their mean age was 7.5 years;their ages range 2 - 13 years. We used the modified Gartland classification to assess the fractures displacement and only Gartland type II B and III were included and managed operatively by open reduction and internal fixation with 2 crossed K-wires. Follow up continued for 6 months and the results finally assessed using Flynn’s criteria. Results: According to the criteria of Flynn et al., 20 patients (83.3%) treated by the anterior approach had excellent functional results while 4 patients (16.7%) had good functional results. While those treated by the posterior approach, 16 patients (66.6%) had excellent functional results, 6 patients (25%) had good results and 2 (8.3%) patients had fair outcome. Cosmetic results were excellent in 22 patients in the anterior approach group and 20 patients in the posterior approach group. Conclusion: Posterior Campbell approach is simpler than anterior Henry approach, but it creates additional soft tissue damage that can affect the circulatory status and hence possible osteonecrosis of the trochlea and a higher percentage of limitation in joint mobility. While the anterior approach is technically more demanding, but it gives better functional results.展开更多
Objective:To observe the influence situation of different operation methods on the vertebral body parameters and GH-IGF axis of patients with thoracolumbar bursts fractures.Methods:A total of 50 surgical patients with...Objective:To observe the influence situation of different operation methods on the vertebral body parameters and GH-IGF axis of patients with thoracolumbar bursts fractures.Methods:A total of 50 surgical patients with thoracolumbar bursts fractures from February 2014 to January 2016 were selected as the research object, and 50 patients with fractures were divided into two groups by the principle of random allocation, then the group A were treated with surgical treatment by anterior approach, the group B were treated with surgical treatment by posterior approach, then the vertebral body parameters and the serum expression levels of GH-IGF axis indexes of two groups before the surgery and at different time after the surgery were compared.Results: The vertebral body parameters and the serum expression levels of GH-IGF axis indexes of two groups before the surgery were compared (allP>0.05), while the vertebral body parameters and the serum expression levels of GH-IGF axis indexes of two groups at different time after the surgery were all significantly better than those before the surgery, and the results of group B were all better than those of group A (allP<0.05).Conclusions:The influence of surgical treatment by posterior approach for the vertebral body parameters and GH-IGF axis of patients with thoracolumbar bursts fractures are obviously better than those of surgical treatment by anterior approach, so the application value of surgical treatment by posterior approach in the patients with fractures is higher.展开更多
Background Cervicothoracic junction spinal tuberculosis （CJST） in children is uncommon, especially when accompanied by a huge abscess. However, its consequences can be severe. Because of the special anatomic locatio...Background Cervicothoracic junction spinal tuberculosis （CJST） in children is uncommon, especially when accompanied by a huge abscess. However, its consequences can be severe. Because of the special anatomic location of the cervicothoracic junction, surgical treatment is difficult and rarely reported. The aim of this clinical study was to assess the effectiveness of combined anterior and posterior approaches for focal debridement, decompression, allografting and anterior instrumentation in the treatment of CJST in children. Methods Ten pediatric CJST patients underwent focal debridement and cord decompression through combined anterior and posterior approaches. Then an appropriate allograft and titanium plate were applied to reconstruct the spine. The patients were asked to wear head-neck-chest braces for six months and received regular anti-tubercular drugs therapy for 12 months. Results The patients were followed-up for an average of 26 months （range, 15-32 months）. There was no recurrent tuberculous infection. The bone grafts incorporated well and the instrumentation was stable. Cervical and thoracic kyphosis was successfully corrected from 40° （range, 30-52°） before the operation to 18° （range, 12-26°） post-operation. Neurological function was improved in all patients. Conclusions Combined anterior and posterior approaches for focal debridement, decompression, bone allografting and anterior instrumentation provided an effective means of treatment in children of CJST with a huge abscess in the posterior part of the vertebral body.展开更多
AIM: To evaluate whether walking ability recovers early after bipolar hemiarthroplasty(BHA) using a direct anterior approach.METHODS: Between 2008 and 2010, 81 patients with femoral neck fracture underwent BHA using t...AIM: To evaluate whether walking ability recovers early after bipolar hemiarthroplasty(BHA) using a direct anterior approach.METHODS: Between 2008 and 2010, 81 patients with femoral neck fracture underwent BHA using the direct anterior approach(DAA) or the posterior approach(PA). The mean observation period was 36 mo. The age, sex, body mass index(BMI), time from admission to surgery, length of hospitalization, outcome after discharge, walking ability, duration of surgery, blood loss and complications were compared. RESULTS: There was no significant difference in the age, sex, BMI, time from admission to surgery, length of hospitalization, outcome after discharge, duration of surgery and blood loss between the two groups. Two weeks after the operation, assistance was not necessary for walking in the hospital in 65.0% of the patients in the DAA group and in 33.3% in the PA group(P < 0.05). As for complications, fracture of the femoral greater trochanter developed in 1 patient in the DAA group and calcar crack and dislocation in 1 patient each in the PA group.CONCLUSION: DAA is an approach more useful for BHA for femoral neck fracture in elderly patients than total hip arthroplasty in terms of the early acquisition of walking ability.展开更多
Objective To retrospectively analyze the relationship between curve types and clinical results in surgical treatment of scoliosis in patients with neurofibromatosis type 1 (NF-1). Methods Forty-five patients with scol...Objective To retrospectively analyze the relationship between curve types and clinical results in surgical treatment of scoliosis in patients with neurofibromatosis type 1 (NF-1). Methods Forty-five patients with scoliosis resulting from NF-1 were treated surgically from 1984 to 2002. Mean age at operation was 14.2 years. There were 6 nondystrophic curves and 39 dystrophic curves depended on their radiographic featu- res. According to their apical vertebrae location, the dystrophic curves were divided into three subgroups: thoracic curve (apical vertebra at T8 or above), thoracolumbar curve (apical vertebra below T8 and above L1), and lumber curve (apical vertebra at L1 and below). Posterior spine fusion, combined anterior and posterior spine fusion were administrated based on the type and location of the curves. Mean follow-up was 6.8 years. Clinical and radiological manifestations were investigated and results were assessed. Results Three patients with muscle weakness of low extremities recovered entirely. Two patients with dystrophic lum- bar curve maintained their low back pain the same as preoperatively. The mean coronal and sagittal Cobb’s angle in nondy- strophic curves was 80.3o and 61.7o before operation, 30.7o and 36.9o after operation, and 32.9o and 42.1o at follow-up, respectively. In dystrophic thoracic curves, preoperative Cobb’s angle in coronal and sagittal plane was 96.5o and 79.8o, postoperative 49.3o and 41.7o, follow-up 54.1o and 45.3o, respectively. In thoracolumbar curves, preoperative Cobb’s angle in coronal and sagittal plane was 75.0o and 47.5o, postoperative 31.2o and 22.8o, follow-up 37.5o and 27.8o, respectively. In lumbar curves preoperative Cobb’s angle in coronal plane was 55.3o, postoperative 19.3o, and follow-up 32.1o. Six patients with dystrophic curves had his or her curve deteriorated more than 10 degrees at follow-up. Three of them were in the thoracic subgroup and their kyphosis was larger than 95 degrees, and three in lumbar subgroup. Hardware failure occurred in 3 cases. Six patients had 7 revision procedures totally. Conclusions Posterior spinal fusion is effective for most dystrophic thoracic curves in patients whose kyphosis is less than 95 degrees. Combined anterior and posterior spinal fusion is stronger recommended for patients whose kyphosis is larger than 95 degrees and those whose apical vertebra is located below T8. Patients should be informed that repeated spine fusion might be necessary even after combined anterior and posterior spine fusion.展开更多
基金This study was reviewed and approved by the Ethics Committee of the HUB-Hospital Erasme.
文摘BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with no consensus regarding the superiority of any single approach.AIM To compare early postoperative complications after implementing the direct anterior and posterior approaches(PL)for hip hemiarthroplasty after femoral neck fractures.METHODS This is a comparative,retrospective,single-center cohort study conducted at a university hospital.Between March 2008 and December 2018,273 patients(a total of 280 hips)underwent bipolar hemiarthroplasties(n=280)for displaced femoral neck fractures using either the PL(n=171)or the minimally invasive direct anterior approach(DAA)(n=109).The choice of approach was related to the surgeons’practices;the implant types were similar and unrelated to the approach.Dislocation rates and other complications were reviewed after a minimum followup of 6 mo.RESULTS Both treatment groups had similarly aged patients(mean age:82 years),sex ratios,patient body mass indexes,and patient comorbidities.Surgical data(surgery delay time,operative time,and blood loss volume)did not differ significantly between the groups.The 30 d mortality rate was higher in the PL group(9.9%)than in the DAA group(3.7%),but the difference was not statistically significant(P=0.052).Among the one-month survivors,a significantly higher rate of dislocation was observed in the PL group(14/154;9.1%)than in the DAA group(0/105;0%)(P=0.002).Of the 14 patients with dislocation,8 underwent revision surgery for recurrent instability(posterior group),and one of them had 2 additional procedures due to a deep infection.The rate of other complications(e.g.,perioperative and early postoperative periprosthetic fractures and infection-related complications)did not differ significantly between the groups.CONCLUSION These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate(<1%)than the PL.
文摘The differences in complication rates between the direct anterior and posterior approaches for hemiarthroplasty in elderly patients with femoral neck fractures are not yet fully understood.Dislocation,a severe complication associated with increased mortality and often requiring additional surgery,may occur less frequently with the direct anterior approach compared to the posterior approach.Careful consideration of patient demographics is essential when planning the surgical approach.Future research in this area should focus on robust randomized controlled trials involving elderly patients recovering from femoral neck fractures.
文摘We read and discussed the study entitled“Complication rates after direct anterior vs posterior approach for Hip Hemiarthroplasty in elderly individuals with femoral neck fractures”with great interest.The authors have done justice to the topic of comparison of anterior and posterior surgical approaches for bipolar hemiarthroplasty which has been an everlasting debate in the existing literature.However,there are certain aspects of this study that need clarification from the authors.
文摘Background: The different methods of anterior reconstruction and posterior instrumentation in surgical management of thoracolumbar spine fractures are PLIF, TLIF, lateral extracaviatary and transpedicular techniques which are increasingly used to perform partial or total corpectomies and anterior reconstructions from a posterior approach. These techniques were being alternative to the standard anterior approach with less morbidity and mortality. Patients and Methods: This study was performed between 2011 and 2014 on 100 patients with acute unstable thoracolumbar spine fractures which were divided into four groups: 30 patients underwent (TLIF), 28 patients underwent (PLIF), 28 patients underwent (PA) and 14 patients underwent (TPA). Neurological outcome, complications, operative times, kyphotic angle, vertebral height loss, spinal canal compromise, pulmonary functions, Denis pain and work scale, VAS score, ODI score, hospital stay, and estimated blood loss (EBL) were evaluated and compared in between the four groups. Results: There was a higher complication rate, increased EBL, and longer operative time with posteroanterior (PA) compared with PLIF, TLIF and (TPA). Patients undergoing PLIF, TLIF and TPA had a greater recovery of neurological function than those in whom PA were performed. Conclusion: TPA appeared to have more favorable results in improving the clinical and radiological outcome and no complications were reported apart from superficial wound infection which healed rapidly. The PLIF, TLIF and TPA appeared to have a comparable morbidity rate to PA. The different methods of anterior reconstruction from posterior approach are more favorable, applicable and convenient than PA approach.
文摘Background: Supracondylar fractures of the humerus are among the most common type of pediatric fractures. The outcome of severely displaced supracondylar fracture of the humerus in children subjected to wide controversies in term of safety, functional and cosmetic outcome. Closed reduction and percutaneous pinning is now considered as the gold standard rule, but open reduction still applicable in certain cases where intraoperative imaging is not available, in comminuted lateral column fractures and uneducable fractures. Aim of the Study: To compare the outcome (functional and cosmetic) of anterior (Henry) approach with the posterior (Campbell) approach used in two groups of patients’ sustained displaced supracondylar fractures. Patients and Methods: This prospective study was performed on 48 pediatric patients who were been admitted to the Emergency Hospital in Sulaimani province sustained displaced supracondylar humeral fractures and treated during the period from the first of October 2009 to the thirty-one of January 2011. The study included 28 boys, 20 girls;their mean age was 7.5 years;their ages range 2 - 13 years. We used the modified Gartland classification to assess the fractures displacement and only Gartland type II B and III were included and managed operatively by open reduction and internal fixation with 2 crossed K-wires. Follow up continued for 6 months and the results finally assessed using Flynn’s criteria. Results: According to the criteria of Flynn et al., 20 patients (83.3%) treated by the anterior approach had excellent functional results while 4 patients (16.7%) had good functional results. While those treated by the posterior approach, 16 patients (66.6%) had excellent functional results, 6 patients (25%) had good results and 2 (8.3%) patients had fair outcome. Cosmetic results were excellent in 22 patients in the anterior approach group and 20 patients in the posterior approach group. Conclusion: Posterior Campbell approach is simpler than anterior Henry approach, but it creates additional soft tissue damage that can affect the circulatory status and hence possible osteonecrosis of the trochlea and a higher percentage of limitation in joint mobility. While the anterior approach is technically more demanding, but it gives better functional results.
文摘Objective:To observe the influence situation of different operation methods on the vertebral body parameters and GH-IGF axis of patients with thoracolumbar bursts fractures.Methods:A total of 50 surgical patients with thoracolumbar bursts fractures from February 2014 to January 2016 were selected as the research object, and 50 patients with fractures were divided into two groups by the principle of random allocation, then the group A were treated with surgical treatment by anterior approach, the group B were treated with surgical treatment by posterior approach, then the vertebral body parameters and the serum expression levels of GH-IGF axis indexes of two groups before the surgery and at different time after the surgery were compared.Results: The vertebral body parameters and the serum expression levels of GH-IGF axis indexes of two groups before the surgery were compared (allP>0.05), while the vertebral body parameters and the serum expression levels of GH-IGF axis indexes of two groups at different time after the surgery were all significantly better than those before the surgery, and the results of group B were all better than those of group A (allP<0.05).Conclusions:The influence of surgical treatment by posterior approach for the vertebral body parameters and GH-IGF axis of patients with thoracolumbar bursts fractures are obviously better than those of surgical treatment by anterior approach, so the application value of surgical treatment by posterior approach in the patients with fractures is higher.
文摘Background Cervicothoracic junction spinal tuberculosis （CJST） in children is uncommon, especially when accompanied by a huge abscess. However, its consequences can be severe. Because of the special anatomic location of the cervicothoracic junction, surgical treatment is difficult and rarely reported. The aim of this clinical study was to assess the effectiveness of combined anterior and posterior approaches for focal debridement, decompression, allografting and anterior instrumentation in the treatment of CJST in children. Methods Ten pediatric CJST patients underwent focal debridement and cord decompression through combined anterior and posterior approaches. Then an appropriate allograft and titanium plate were applied to reconstruct the spine. The patients were asked to wear head-neck-chest braces for six months and received regular anti-tubercular drugs therapy for 12 months. Results The patients were followed-up for an average of 26 months （range, 15-32 months）. There was no recurrent tuberculous infection. The bone grafts incorporated well and the instrumentation was stable. Cervical and thoracic kyphosis was successfully corrected from 40° （range, 30-52°） before the operation to 18° （range, 12-26°） post-operation. Neurological function was improved in all patients. Conclusions Combined anterior and posterior approaches for focal debridement, decompression, bone allografting and anterior instrumentation provided an effective means of treatment in children of CJST with a huge abscess in the posterior part of the vertebral body.
文摘AIM: To evaluate whether walking ability recovers early after bipolar hemiarthroplasty(BHA) using a direct anterior approach.METHODS: Between 2008 and 2010, 81 patients with femoral neck fracture underwent BHA using the direct anterior approach(DAA) or the posterior approach(PA). The mean observation period was 36 mo. The age, sex, body mass index(BMI), time from admission to surgery, length of hospitalization, outcome after discharge, walking ability, duration of surgery, blood loss and complications were compared. RESULTS: There was no significant difference in the age, sex, BMI, time from admission to surgery, length of hospitalization, outcome after discharge, duration of surgery and blood loss between the two groups. Two weeks after the operation, assistance was not necessary for walking in the hospital in 65.0% of the patients in the DAA group and in 33.3% in the PA group(P < 0.05). As for complications, fracture of the femoral greater trochanter developed in 1 patient in the DAA group and calcar crack and dislocation in 1 patient each in the PA group.CONCLUSION: DAA is an approach more useful for BHA for femoral neck fracture in elderly patients than total hip arthroplasty in terms of the early acquisition of walking ability.
文摘Objective To retrospectively analyze the relationship between curve types and clinical results in surgical treatment of scoliosis in patients with neurofibromatosis type 1 (NF-1). Methods Forty-five patients with scoliosis resulting from NF-1 were treated surgically from 1984 to 2002. Mean age at operation was 14.2 years. There were 6 nondystrophic curves and 39 dystrophic curves depended on their radiographic featu- res. According to their apical vertebrae location, the dystrophic curves were divided into three subgroups: thoracic curve (apical vertebra at T8 or above), thoracolumbar curve (apical vertebra below T8 and above L1), and lumber curve (apical vertebra at L1 and below). Posterior spine fusion, combined anterior and posterior spine fusion were administrated based on the type and location of the curves. Mean follow-up was 6.8 years. Clinical and radiological manifestations were investigated and results were assessed. Results Three patients with muscle weakness of low extremities recovered entirely. Two patients with dystrophic lum- bar curve maintained their low back pain the same as preoperatively. The mean coronal and sagittal Cobb’s angle in nondy- strophic curves was 80.3o and 61.7o before operation, 30.7o and 36.9o after operation, and 32.9o and 42.1o at follow-up, respectively. In dystrophic thoracic curves, preoperative Cobb’s angle in coronal and sagittal plane was 96.5o and 79.8o, postoperative 49.3o and 41.7o, follow-up 54.1o and 45.3o, respectively. In thoracolumbar curves, preoperative Cobb’s angle in coronal and sagittal plane was 75.0o and 47.5o, postoperative 31.2o and 22.8o, follow-up 37.5o and 27.8o, respectively. In lumbar curves preoperative Cobb’s angle in coronal plane was 55.3o, postoperative 19.3o, and follow-up 32.1o. Six patients with dystrophic curves had his or her curve deteriorated more than 10 degrees at follow-up. Three of them were in the thoracic subgroup and their kyphosis was larger than 95 degrees, and three in lumbar subgroup. Hardware failure occurred in 3 cases. Six patients had 7 revision procedures totally. Conclusions Posterior spinal fusion is effective for most dystrophic thoracic curves in patients whose kyphosis is less than 95 degrees. Combined anterior and posterior spinal fusion is stronger recommended for patients whose kyphosis is larger than 95 degrees and those whose apical vertebra is located below T8. Patients should be informed that repeated spine fusion might be necessary even after combined anterior and posterior spine fusion.
