Objective:To evaluate the clinical effect of posterior internal fixation and fusion in the treatment of thoracolumbar fractures.Methods:36 patients with thoracolumbar fractures from January 2018 to December 2020 were ...Objective:To evaluate the clinical effect of posterior internal fixation and fusion in the treatment of thoracolumbar fractures.Methods:36 patients with thoracolumbar fractures from January 2018 to December 2020 were selected and divided into study group and control group according to the random number table model.The control group was treated with anterior internal fixation,while the study group was treated with posterior internal fixation and fusion.The indexes of the two groups were compared and analyzed.Results:Compared with the operation related indexes of the two groups,the study group had more advantages(P<0.05);The postoperative kyphosis Cobb angle,height of anterior and posterior vertebral body,wedge index of the two groups were better than those before operation(P<0.05),and there was no significant difference between the two groups(P>0.05);There was no significant difference between the two groups(P>0.05).Conclusion:The clinical effect of posterior internal fixation and fusion in the treatment of thoracolumbar fractures is significant,and the body damage is slight,which is worthy of comprehensive promotion.展开更多
Objective:To investigate the short-term and medium-term efficacy of one-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation in the treatment of Brucella spondylitis of the l...Objective:To investigate the short-term and medium-term efficacy of one-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation in the treatment of Brucella spondylitis of the lumbar spine.Method:156 cases of Brucella spondylitis of lumbar spine were selected and divided into experimental group(n=80)and combined group(n=76)according to different surgical methods.The experimental group was treated with one-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation.The combined group was treated with one-stage anterior debridement and intertransverse process bone grafting combined with posterior internal fixation.The operative indexes and clinical effects were compared between the two groups.Result:The operation time,intraoperative bleeding volume and time of landing after operation in the experimental group were less than those in the combined group,with statistical significance(P<0.05).VAS score,ODI index,Cobb angle and Frankel grade of nervous function in the two groups were significantly improved after 3 months and 36 months of treatment(P<0.05),but there was no significant difference between the two groups at the same time(P>0.05).There was no significant difference in the excellent and good rate between the two groups after 3 and 36 months of treatment(P>0.05).There was no recurrence of the lesion in both groups.The intertransverse process bone graft healed and the screw-rod system was well fixed.Conclusion:One-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation for treatment of Brucella spondylitis of lumbar spine are effective,with short operation time and less trauma,which are worthy of clinical promotion.展开更多
Study Design: Original article. Objective: Guidelines for deciding whether to perform open or percutaneous surgery in burst fractures. Summary of Background Data: The authors propose an algorithm for deciding whether ...Study Design: Original article. Objective: Guidelines for deciding whether to perform open or percutaneous surgery in burst fractures. Summary of Background Data: The authors propose an algorithm for deciding whether to perform open surgery or percutaneous surgery with short fixation in patients with fractures of the thoracolumbar junction and lumbar spine. Methods: Between July 2005 and July 2009, 72 patients underwent surgical stabilization by posterior route for fractures of the thoracolumbar junction and lumbar spine. In 44 the lesion involved the thoracolumbar junction, in 28 the lumbar spine (L2 in6 cases, L3 in15 cases, L5 in7 cases). The fractures were assessed morphologically according to Magerl’s classification (52 type A, 12 type B, 8 type C). All patients were analyzed according to the algorithm proposed, according to which patients must fulfil certain criteria: the fracture must be Magerl type A.3, it must involve one level, McCormack score must be 6 or less, invasion of the spinal canal must be 25% or less according to Hashimoto’s formula, Magnetic Resonance Imating (MRI) must confirm discoligamentous integrity. Neurologically, the patient must be ASIA E. 25 patients (17 thoracolumbar junction, 8 lumbar spine) fulfilled these criteria and were treated by percutaneous short fixation. Results: The average length of the surgical procedure was 80 minutes and the loss of blood 10 cc. All patients were dismissed without brace and were submitted to follow-upComputed Tomography CTscan 3 and 6 months after surgery. Follow-up ranged from 6 months to 4 years. In all cases CT scan confirmed fusion and there were no cases of rupture of the device. None of the patients presented neurological deficits. Conclusion: The algorithm described permits a proper selection of patients with thoracolumbar fractures who can be treated by percutaneous short fixation, thus avoiding the risks connected with failure of the stabilization system.展开更多
AIM:To explore the long term therapeutic effects of surgical treatment for isthmic spondylolisthesis.METHODS:42 cases of isthmic spondylolisthesis were analyzed retrospectively among which 13 cases underwent simple lu...AIM:To explore the long term therapeutic effects of surgical treatment for isthmic spondylolisthesis.METHODS:42 cases of isthmic spondylolisthesis were analyzed retrospectively among which 13 cases underwent simple lumbar interlaminar bone implant and 29 cases underwent transpedicular fixation combined with bone implantation.Assessment was made according to JOA standards before and after treatment.RESULTS:At a 3 years of follow up assessment,the functional outcome in transpedicular fixation assessed by JOA was excellent and good in 79.3%as compared with the group without fixation in which the excellent and good result was 76.9%.The level of pain and functional disability were similar in the two groups,but fusion rate in the group with transpedicular fixation was higher than that in group without it.CONCLUSION:Surgical treatment for isthmic spondylolisthesis improves function and relieves pain.展开更多
Objective To evaluate the outcome of two methods for stabilization and fusion: posterolateral fusion and circumferential fusion involving posterior lumbar interbody fusion for lumbar stenosis with Grades 1 and 2 lumba...Objective To evaluate the outcome of two methods for stabilization and fusion: posterolateral fusion and circumferential fusion involving posterior lumbar interbody fusion for lumbar stenosis with Grades 1 and 2 lumbar spondylolisthesis.Methods From April 1998 to April 2003, 45 patients suffering from lumbar stenosis with low degree lumbar spondylolisthesis treated in our hospital were retrospectively reviewed and assigned to two groups.Among them, 24 patients (group A) were treated with instrumented posterolateral fusion and 21 patients (group B) with instrumented circumferential fusion.The two groups were compared for clinical and radiological outcomes.Results All patients were followed up for 12 to 72 months.In group A, results showed preoperative clinical symptoms disappeared completely in 12 of 24 patients, and pain relief was seen in 91.7% (22/24).Two cases suffered from residual symptoms.Twenty-two cases obtained complete reduction of olisthy vertebral bodies, and anatomical reduction rate was 91.7%.No infection or neurological complication occurred in this group.In group B, results showed preoperative clinical symptoms disappeared completely in 13 of 21 patients, and pain relief was seen in 90.5% (19/21).One case suffered from residual symptoms.Twenty cases obtained complete reduction of the olisthy vertebral bodies, and anatomical reduction rate was 95.2%.Four cases of infection or neurological complication occurred in this group.Both groups indicated no significant difference in clinical outcomes and anatomical reduction rate during follow-up.But group A had better intraoperative circumstances and postoperative outcome than group B, while group B had better postoperative parameters in X-ray of Angle of Slipping and Disc Index than group A.Conclusions The first choice of surgical method for lumbar stenosis with low degree lumbar spondylolisthesis is instrumented posterolateral fusion.Only when patients suffer from severe preoperative disc degeneration and low back pain or intervertebral instability should we consider indications for additional use of CAGE.展开更多
BACKGROUND The pedicle screw-laminar hook system has strong fixation and is conducive to bone graft fusion for lumbar spondylolysis.However,the current pedicle screwlaminar hook fixation system is not specifically des...BACKGROUND The pedicle screw-laminar hook system has strong fixation and is conducive to bone graft fusion for lumbar spondylolysis.However,the current pedicle screwlaminar hook fixation system is not specifically designed for lumbar spondylolysis.AIM To investigate the clinical effects of a new anatomical hook-rod-pedicle screw system in the treatment of lumbar spondylolysis in young adults.METHODS We designed a new anatomic hook-rod-pedicle screw system for young patients with lumbar spondylolysis.The isthmus and the corresponding pedicle screw entry point were exposed through the intermuscular approach.Autogenous iliac bone graft was obtained to bridge the isthmus defect,and then the anatomic hook-rod-pedicle screw system was used to fix the isthmus in 15 young patients.RESULTS At 24 mo follow-up,the visual analogue scale score of low back pain decreased from 6.73±0.88 to 0.73±0.59,and the Oswestry disability index score decreased from 58.20±8.99 to 7.87±4.97.Computed tomography showed bilateral isthmic bone healing in 14 cases and unilateral isthmic bone healing in 1 case.Magnetic resonance imaging showed that the lumbar disc signal of diseased segment and adjacent segments had no change compared with that before surgery.The pain visual analogue scale score of the donor site was 0.20±0.41 at the last follow-up.According to the Modified Macnab score,the excellent and good rate was 100%.CONCLUSION The application of this new anatomical hook-rod-pedicle screw system to treat young patients with lumbar spondylolysis has the advantages of less trauma,a simple operation and satisfactory clinical effects.展开更多
The lumbar spine is the most common sites for fractures because of the high mobility of the lumbar spine. A spinal cord injury usually begins with a sudden, traumatic blow to the spine that fractures or dislocates ver...The lumbar spine is the most common sites for fractures because of the high mobility of the lumbar spine. A spinal cord injury usually begins with a sudden, traumatic blow to the spine that fractures or dislocates vertebrae. A 32-year-old man presented to us after traffic accident. In our patient, unstable fracture-dislocation of the lumbar spine at the L2-L3 level due to traffic accident occurred. The vertebral bodies were fractured and the anterior dislocation happened without spinal cord injury. The patient was a candidate for an open reduction and internal fixation surgery. The posterolateral approach was performed. After insertion of all the pedicle screws, the rods were transversally placed on L2-L3-L4 vertebral bodies and tightened. The reduction of the dislocations was carried out by pushing downwards (foreside) L2 and L4 vertebras and upwards (backside) L3 vertebrae, simultaneously. After securing the reduction of the dislocations, the rods were opened and placed along the spinal column and tightened. This technique is more effective when the pedicle of fractured vertebrae is intact.展开更多
目的探讨Bioflex系统治疗腰椎椎间盘退行性疾病的临床疗效。方法2007年3月～2009年4月，行椎管减压、椎间融合（视椎间盘退变程度而定）联合Bioflex系统治疗腰椎椎间盘退行性疾病患者19例。记录视觉模拟评分（visual analog scale，VAS...目的探讨Bioflex系统治疗腰椎椎间盘退行性疾病的临床疗效。方法2007年3月～2009年4月，行椎管减压、椎间融合（视椎间盘退变程度而定）联合Bioflex系统治疗腰椎椎间盘退行性疾病患者19例。记录视觉模拟评分（visual analog scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）、节段活动范围（range of motion，ROM）及融合情况。结果患者均获随访，随访时间为9—25个月，平均16．8个月。术后及末次随访时患者VAS、ODI评分明显改善，与术前相比差异有统计学意义（P〈0．05）。术后和末次随访时非融合节段ROM明显减低，与术前相比差异有统计学意义（P〈0．05）；邻近节段ROM略有增加，与术前相比差异无统计学意义（P〉0．05）。融合节段的融合率为91．6％。结论使用Bioflex系统治疗腰椎椎间盘退行性疾病是一种安全、有效的新方法，它能够在提供稳定的力学环境的同时，在一定程度上保留手术节段的活动度，有利于缓解椎间盘退变，可能避免刚性内固定引起的邻近椎间盘退变。展开更多
文摘Objective:To evaluate the clinical effect of posterior internal fixation and fusion in the treatment of thoracolumbar fractures.Methods:36 patients with thoracolumbar fractures from January 2018 to December 2020 were selected and divided into study group and control group according to the random number table model.The control group was treated with anterior internal fixation,while the study group was treated with posterior internal fixation and fusion.The indexes of the two groups were compared and analyzed.Results:Compared with the operation related indexes of the two groups,the study group had more advantages(P<0.05);The postoperative kyphosis Cobb angle,height of anterior and posterior vertebral body,wedge index of the two groups were better than those before operation(P<0.05),and there was no significant difference between the two groups(P>0.05);There was no significant difference between the two groups(P>0.05).Conclusion:The clinical effect of posterior internal fixation and fusion in the treatment of thoracolumbar fractures is significant,and the body damage is slight,which is worthy of comprehensive promotion.
基金2018 Hebei health technology research and achievement transformation key project(No.zh2018014)2018 Hebei Medical applicable technology tracking project(No.gl2018074)+1 种基金2017 Zhangjiakou city level plan(No.17120010d)2018 Hebei North University School level scientific research project(No.yb2018010)
文摘Objective:To investigate the short-term and medium-term efficacy of one-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation in the treatment of Brucella spondylitis of the lumbar spine.Method:156 cases of Brucella spondylitis of lumbar spine were selected and divided into experimental group(n=80)and combined group(n=76)according to different surgical methods.The experimental group was treated with one-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation.The combined group was treated with one-stage anterior debridement and intertransverse process bone grafting combined with posterior internal fixation.The operative indexes and clinical effects were compared between the two groups.Result:The operation time,intraoperative bleeding volume and time of landing after operation in the experimental group were less than those in the combined group,with statistical significance(P<0.05).VAS score,ODI index,Cobb angle and Frankel grade of nervous function in the two groups were significantly improved after 3 months and 36 months of treatment(P<0.05),but there was no significant difference between the two groups at the same time(P>0.05).There was no significant difference in the excellent and good rate between the two groups after 3 and 36 months of treatment(P>0.05).There was no recurrence of the lesion in both groups.The intertransverse process bone graft healed and the screw-rod system was well fixed.Conclusion:One-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation for treatment of Brucella spondylitis of lumbar spine are effective,with short operation time and less trauma,which are worthy of clinical promotion.
文摘Study Design: Original article. Objective: Guidelines for deciding whether to perform open or percutaneous surgery in burst fractures. Summary of Background Data: The authors propose an algorithm for deciding whether to perform open surgery or percutaneous surgery with short fixation in patients with fractures of the thoracolumbar junction and lumbar spine. Methods: Between July 2005 and July 2009, 72 patients underwent surgical stabilization by posterior route for fractures of the thoracolumbar junction and lumbar spine. In 44 the lesion involved the thoracolumbar junction, in 28 the lumbar spine (L2 in6 cases, L3 in15 cases, L5 in7 cases). The fractures were assessed morphologically according to Magerl’s classification (52 type A, 12 type B, 8 type C). All patients were analyzed according to the algorithm proposed, according to which patients must fulfil certain criteria: the fracture must be Magerl type A.3, it must involve one level, McCormack score must be 6 or less, invasion of the spinal canal must be 25% or less according to Hashimoto’s formula, Magnetic Resonance Imating (MRI) must confirm discoligamentous integrity. Neurologically, the patient must be ASIA E. 25 patients (17 thoracolumbar junction, 8 lumbar spine) fulfilled these criteria and were treated by percutaneous short fixation. Results: The average length of the surgical procedure was 80 minutes and the loss of blood 10 cc. All patients were dismissed without brace and were submitted to follow-upComputed Tomography CTscan 3 and 6 months after surgery. Follow-up ranged from 6 months to 4 years. In all cases CT scan confirmed fusion and there were no cases of rupture of the device. None of the patients presented neurological deficits. Conclusion: The algorithm described permits a proper selection of patients with thoracolumbar fractures who can be treated by percutaneous short fixation, thus avoiding the risks connected with failure of the stabilization system.
文摘AIM:To explore the long term therapeutic effects of surgical treatment for isthmic spondylolisthesis.METHODS:42 cases of isthmic spondylolisthesis were analyzed retrospectively among which 13 cases underwent simple lumbar interlaminar bone implant and 29 cases underwent transpedicular fixation combined with bone implantation.Assessment was made according to JOA standards before and after treatment.RESULTS:At a 3 years of follow up assessment,the functional outcome in transpedicular fixation assessed by JOA was excellent and good in 79.3%as compared with the group without fixation in which the excellent and good result was 76.9%.The level of pain and functional disability were similar in the two groups,but fusion rate in the group with transpedicular fixation was higher than that in group without it.CONCLUSION:Surgical treatment for isthmic spondylolisthesis improves function and relieves pain.
文摘Objective To evaluate the outcome of two methods for stabilization and fusion: posterolateral fusion and circumferential fusion involving posterior lumbar interbody fusion for lumbar stenosis with Grades 1 and 2 lumbar spondylolisthesis.Methods From April 1998 to April 2003, 45 patients suffering from lumbar stenosis with low degree lumbar spondylolisthesis treated in our hospital were retrospectively reviewed and assigned to two groups.Among them, 24 patients (group A) were treated with instrumented posterolateral fusion and 21 patients (group B) with instrumented circumferential fusion.The two groups were compared for clinical and radiological outcomes.Results All patients were followed up for 12 to 72 months.In group A, results showed preoperative clinical symptoms disappeared completely in 12 of 24 patients, and pain relief was seen in 91.7% (22/24).Two cases suffered from residual symptoms.Twenty-two cases obtained complete reduction of olisthy vertebral bodies, and anatomical reduction rate was 91.7%.No infection or neurological complication occurred in this group.In group B, results showed preoperative clinical symptoms disappeared completely in 13 of 21 patients, and pain relief was seen in 90.5% (19/21).One case suffered from residual symptoms.Twenty cases obtained complete reduction of the olisthy vertebral bodies, and anatomical reduction rate was 95.2%.Four cases of infection or neurological complication occurred in this group.Both groups indicated no significant difference in clinical outcomes and anatomical reduction rate during follow-up.But group A had better intraoperative circumstances and postoperative outcome than group B, while group B had better postoperative parameters in X-ray of Angle of Slipping and Disc Index than group A.Conclusions The first choice of surgical method for lumbar stenosis with low degree lumbar spondylolisthesis is instrumented posterolateral fusion.Only when patients suffer from severe preoperative disc degeneration and low back pain or intervertebral instability should we consider indications for additional use of CAGE.
文摘BACKGROUND The pedicle screw-laminar hook system has strong fixation and is conducive to bone graft fusion for lumbar spondylolysis.However,the current pedicle screwlaminar hook fixation system is not specifically designed for lumbar spondylolysis.AIM To investigate the clinical effects of a new anatomical hook-rod-pedicle screw system in the treatment of lumbar spondylolysis in young adults.METHODS We designed a new anatomic hook-rod-pedicle screw system for young patients with lumbar spondylolysis.The isthmus and the corresponding pedicle screw entry point were exposed through the intermuscular approach.Autogenous iliac bone graft was obtained to bridge the isthmus defect,and then the anatomic hook-rod-pedicle screw system was used to fix the isthmus in 15 young patients.RESULTS At 24 mo follow-up,the visual analogue scale score of low back pain decreased from 6.73±0.88 to 0.73±0.59,and the Oswestry disability index score decreased from 58.20±8.99 to 7.87±4.97.Computed tomography showed bilateral isthmic bone healing in 14 cases and unilateral isthmic bone healing in 1 case.Magnetic resonance imaging showed that the lumbar disc signal of diseased segment and adjacent segments had no change compared with that before surgery.The pain visual analogue scale score of the donor site was 0.20±0.41 at the last follow-up.According to the Modified Macnab score,the excellent and good rate was 100%.CONCLUSION The application of this new anatomical hook-rod-pedicle screw system to treat young patients with lumbar spondylolysis has the advantages of less trauma,a simple operation and satisfactory clinical effects.
文摘The lumbar spine is the most common sites for fractures because of the high mobility of the lumbar spine. A spinal cord injury usually begins with a sudden, traumatic blow to the spine that fractures or dislocates vertebrae. A 32-year-old man presented to us after traffic accident. In our patient, unstable fracture-dislocation of the lumbar spine at the L2-L3 level due to traffic accident occurred. The vertebral bodies were fractured and the anterior dislocation happened without spinal cord injury. The patient was a candidate for an open reduction and internal fixation surgery. The posterolateral approach was performed. After insertion of all the pedicle screws, the rods were transversally placed on L2-L3-L4 vertebral bodies and tightened. The reduction of the dislocations was carried out by pushing downwards (foreside) L2 and L4 vertebras and upwards (backside) L3 vertebrae, simultaneously. After securing the reduction of the dislocations, the rods were opened and placed along the spinal column and tightened. This technique is more effective when the pedicle of fractured vertebrae is intact.
文摘目的探讨Bioflex系统治疗腰椎椎间盘退行性疾病的临床疗效。方法2007年3月～2009年4月，行椎管减压、椎间融合（视椎间盘退变程度而定）联合Bioflex系统治疗腰椎椎间盘退行性疾病患者19例。记录视觉模拟评分（visual analog scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）、节段活动范围（range of motion，ROM）及融合情况。结果患者均获随访，随访时间为9—25个月，平均16．8个月。术后及末次随访时患者VAS、ODI评分明显改善，与术前相比差异有统计学意义（P〈0．05）。术后和末次随访时非融合节段ROM明显减低，与术前相比差异有统计学意义（P〈0．05）；邻近节段ROM略有增加，与术前相比差异无统计学意义（P〉0．05）。融合节段的融合率为91．6％。结论使用Bioflex系统治疗腰椎椎间盘退行性疾病是一种安全、有效的新方法，它能够在提供稳定的力学环境的同时，在一定程度上保留手术节段的活动度，有利于缓解椎间盘退变，可能避免刚性内固定引起的邻近椎间盘退变。
