Objective To assess the outcomes of navigationguided posterior fixation plus transpedicular vertebroplasty for thoracolumbar fractures.Methods From June,2005 through March,2009,30 patients with thoracolumbar fracture
Anterior lumbar interbody fusion （ALiF） followed by posterior pedicle screw fixation （PSF） in a second procedure is mostly used to implement lumbar spine fusion. ALIF followed by an- terior lumbar screw-plate has ...Anterior lumbar interbody fusion （ALiF） followed by posterior pedicle screw fixation （PSF） in a second procedure is mostly used to implement lumbar spine fusion. ALIF followed by an- terior lumbar screw-plate has a lot of advantages, but its biomechanical stability requires confirma- tion. This study evaluated the biomechanical stability of a novel anterior lumbar locked screw-plate （ALLSP） by comparison with posterior lumbar PSF. Twelve fresh human cadaveric lumbar speci- mens （L4-L5） were assigned to four groups： ALIF^PSF group, ALIF＋ALLSP （both fixed） group, ALIF group and an untreated control （both non-fixed） group. The first three groups received implan- tation of a rectangular titanium cage. Tests under axial compression, flexion, extension, lateral bend- ing, or rotation showed that the fixed groups had significantly stronger stability than the non-fixed groups （P=-0.000 for all）. The ALIF＋ALLSP group had significantly greater axial stiffness under ap- plied axial compression and significantly less angular displacement under rotational forces than the ALIF＋PSF group. The angular displacement of the ALIF＋ALLSP group was less under flexion than that of the ALIF＋PSF, and the angular displacement under lateral bending and extension was greater, but these differences were not statistically significant. In summary, the ALLSP conforms to the ante- rior lumbar spine and has good biomechanical stability. It is a reliable choice for enhancing the sta- bility of ALIF.展开更多
Purpose: Combined anterior and posterior ring (APR) fixation is classically performed in Tile B2 and C1 injuries to achieve superior biomechanical stability.However,the posterior ring (PR) is the main weight bearing p...Purpose: Combined anterior and posterior ring (APR) fixation is classically performed in Tile B2 and C1 injuries to achieve superior biomechanical stability.However,the posterior ring (PR) is the main weight bearing portion that is responsible for weight transmission from the upper parts of the body to the lower limbs through the sacrum and the linea terminalis.It is hypothesized that isolated PR fixation can achieve comparable radiological and clinical outcomes to APR fixation.Therefore,we conducted this study to compare the two fixation principles in managing Tile B2 and C1 injuries.Methods: Our study included 20 patients with Tile B2 injuries and 20 patients with Tile C1 injuries.This study was a randomized control single-blinded study via computerized random numbers with a 1:1 allocation by using random block method.The study was performed at a level one trauma center.A total of 40 patients with Tile B2 and C1 injuries underwent combined APR or isolated PR fixation (Group A and B,respectively).Matta & Tornetta radiological principles and Majeed pelvic scoring system were used for the assessment of primary outcomes and postoperative complications.Secondary outcomes included operative time,amount of blood loss,intraoperative assessment of reduction,need of another operation,length of hospital stay,ability to weight bear postoperatively and pain control metrics.We used studentt-test to compare the difference in means between two groups,and Chi-square test to compare proportions between two qualitative parameters.We set the confidence interval to 95% and the margin of error accepted to 5%.So,p ≤ 0.05 was considered statistically significant.Results: The mean follow-up duration was 18 months.The operative time (mean difference 0.575 h) and the intraoperative blood loss (mean difference 97.5 mL) were lower in Group B.Also,despite the higher frequency of rami displacement before union in the same group,there were no significant differences in terms of radiological outcome (excellent outcome withOR = 2.357),clinical outcome (excellent outcome withOR = 2.852) and postoperative complications assessment (OR = 1.556) at last follow-up.Conclusion: The authors concluded that isolated PR fixation could favorably manage Tile B2 and C1 pelvic ring injuries with Nakatani zone II pubic rami fractures and intact inguinal ligament.Its final radiological and clinical outcomes and postoperative complications were comparable to combined APR fixation,but with less morbidity (shorter operation time,lower amount of blood,and no records of postoperative wound infection).展开更多
文摘Objective To assess the outcomes of navigationguided posterior fixation plus transpedicular vertebroplasty for thoracolumbar fractures.Methods From June,2005 through March,2009,30 patients with thoracolumbar fracture
基金supported by the Chongqing Key Tech nologies R&D Program(CSTC,No.2010AB5118-4)
文摘Anterior lumbar interbody fusion （ALiF） followed by posterior pedicle screw fixation （PSF） in a second procedure is mostly used to implement lumbar spine fusion. ALIF followed by an- terior lumbar screw-plate has a lot of advantages, but its biomechanical stability requires confirma- tion. This study evaluated the biomechanical stability of a novel anterior lumbar locked screw-plate （ALLSP） by comparison with posterior lumbar PSF. Twelve fresh human cadaveric lumbar speci- mens （L4-L5） were assigned to four groups： ALIF^PSF group, ALIF＋ALLSP （both fixed） group, ALIF group and an untreated control （both non-fixed） group. The first three groups received implan- tation of a rectangular titanium cage. Tests under axial compression, flexion, extension, lateral bend- ing, or rotation showed that the fixed groups had significantly stronger stability than the non-fixed groups （P=-0.000 for all）. The ALIF＋ALLSP group had significantly greater axial stiffness under ap- plied axial compression and significantly less angular displacement under rotational forces than the ALIF＋PSF group. The angular displacement of the ALIF＋ALLSP group was less under flexion than that of the ALIF＋PSF, and the angular displacement under lateral bending and extension was greater, but these differences were not statistically significant. In summary, the ALLSP conforms to the ante- rior lumbar spine and has good biomechanical stability. It is a reliable choice for enhancing the sta- bility of ALIF.
文摘Purpose: Combined anterior and posterior ring (APR) fixation is classically performed in Tile B2 and C1 injuries to achieve superior biomechanical stability.However,the posterior ring (PR) is the main weight bearing portion that is responsible for weight transmission from the upper parts of the body to the lower limbs through the sacrum and the linea terminalis.It is hypothesized that isolated PR fixation can achieve comparable radiological and clinical outcomes to APR fixation.Therefore,we conducted this study to compare the two fixation principles in managing Tile B2 and C1 injuries.Methods: Our study included 20 patients with Tile B2 injuries and 20 patients with Tile C1 injuries.This study was a randomized control single-blinded study via computerized random numbers with a 1:1 allocation by using random block method.The study was performed at a level one trauma center.A total of 40 patients with Tile B2 and C1 injuries underwent combined APR or isolated PR fixation (Group A and B,respectively).Matta & Tornetta radiological principles and Majeed pelvic scoring system were used for the assessment of primary outcomes and postoperative complications.Secondary outcomes included operative time,amount of blood loss,intraoperative assessment of reduction,need of another operation,length of hospital stay,ability to weight bear postoperatively and pain control metrics.We used studentt-test to compare the difference in means between two groups,and Chi-square test to compare proportions between two qualitative parameters.We set the confidence interval to 95% and the margin of error accepted to 5%.So,p ≤ 0.05 was considered statistically significant.Results: The mean follow-up duration was 18 months.The operative time (mean difference 0.575 h) and the intraoperative blood loss (mean difference 97.5 mL) were lower in Group B.Also,despite the higher frequency of rami displacement before union in the same group,there were no significant differences in terms of radiological outcome (excellent outcome withOR = 2.357),clinical outcome (excellent outcome withOR = 2.852) and postoperative complications assessment (OR = 1.556) at last follow-up.Conclusion: The authors concluded that isolated PR fixation could favorably manage Tile B2 and C1 pelvic ring injuries with Nakatani zone II pubic rami fractures and intact inguinal ligament.Its final radiological and clinical outcomes and postoperative complications were comparable to combined APR fixation,but with less morbidity (shorter operation time,lower amount of blood,and no records of postoperative wound infection).
