Objective： To discuss the pathological characteristics of cervical spinal fracture complicating ankylosing spondylitis （AS） and the effect of combined anterior and posterior operation. Methods： Eighteen AS patien...Objective： To discuss the pathological characteristics of cervical spinal fracture complicating ankylosing spondylitis （AS） and the effect of combined anterior and posterior operation. Methods： Eighteen AS patients with traumatic cervical fracture-dislocation were treated operatively from January 2000 to January 2006. The symptom duration of AS was 14.5 years on average. Three cases had undergone osteotomy in lumbar spine. There were 4 cases of Grade A, 3 cases of Grade B, 9 cases of Grade C and 2 cases of Grade D according to Frankel＇s score. There were 15 cases of Grade III dislocation and 3 cases of Grade II. All patients underwent surgical procedures by combined anterior and posterior approach. Results： There were 4 anterior-posterior procedures, 8 anterior-posterior-anterior procedures and 6 posterior-anterior procedures. Seven patients had one stage operation and 11 cases underwent two stage surgeries. There was certain extent of neurological improvement in 14 incomplete paraplegic patients, but no improvement in 4 complete paraplegic patients. The follow-up period was 21.2 months on average and the time for bone fusion was 3.6 months. There were 4 complications during operation and a longterm complication in follow-up. Conclusions： The study suggests that anterior combined with posterior approach makes the spine stable and relieves the pressure immediately. It is a reasonable surgical strategy for treatment of cervical spinal fracture-dislocation with AS.展开更多
Objective： To explore the safety and effect of the technique of reconstructing anterior and middle columns by posterior approach in treating lumbar burst fractures. Methods： From July 2005 to January 2007, 22 cases ...Objective： To explore the safety and effect of the technique of reconstructing anterior and middle columns by posterior approach in treating lumbar burst fractures. Methods： From July 2005 to January 2007, 22 cases （18 males and 4 females, aged 28-57 years, 42.7 years on average） of lumbar burst fractures were treated with surgical procedures in our hospital. Based on the routine posterior approach, one of the transverse processes of the injured vertebra was incised to get access to the lateral side of the injured vetebral body. After all the displaced fracture fragments were cleared away and the spinal canal was decompressed, the titanium mesh packed with autografts was implanted from the lateral side to reconstruct the anterior and middle columns. The adjacent above and below segments of the vetebral body were fixed with transpedicular screws. The operation time, intraoperative blood loss, vertebral height, degree of kyphotic deformity and comprised spinal canal were documented. Results： The average operation time was 3.5 hours （ranging 2.8-5.8 hours） and the average blood loss was 820 ml （ranging 650-2 100 ml）. All the cases were followed up for 17.2 months on average （ ranging 12-28 months）. The height of the injured vetebral body was restored from 24 % （12%- 45%） preoperatively to 96% （95%-99%） postoperatively （P〈0.05）. The natural spinal curvatures and spinal canal were restored. Three cases were involved in transient iatrogenic nerve root injury and 1 case was involved in the loosening of the connected rod of the pedicle screw system 3 months postoperatively. Conclusions： The technique of implanting the titanium mesh by posterior approach is effective and safe enough to reconstruct the anterior and middle columns in treating lumbar burst fractures.展开更多
文摘Objective： To discuss the pathological characteristics of cervical spinal fracture complicating ankylosing spondylitis （AS） and the effect of combined anterior and posterior operation. Methods： Eighteen AS patients with traumatic cervical fracture-dislocation were treated operatively from January 2000 to January 2006. The symptom duration of AS was 14.5 years on average. Three cases had undergone osteotomy in lumbar spine. There were 4 cases of Grade A, 3 cases of Grade B, 9 cases of Grade C and 2 cases of Grade D according to Frankel＇s score. There were 15 cases of Grade III dislocation and 3 cases of Grade II. All patients underwent surgical procedures by combined anterior and posterior approach. Results： There were 4 anterior-posterior procedures, 8 anterior-posterior-anterior procedures and 6 posterior-anterior procedures. Seven patients had one stage operation and 11 cases underwent two stage surgeries. There was certain extent of neurological improvement in 14 incomplete paraplegic patients, but no improvement in 4 complete paraplegic patients. The follow-up period was 21.2 months on average and the time for bone fusion was 3.6 months. There were 4 complications during operation and a longterm complication in follow-up. Conclusions： The study suggests that anterior combined with posterior approach makes the spine stable and relieves the pressure immediately. It is a reasonable surgical strategy for treatment of cervical spinal fracture-dislocation with AS.
文摘Objective： To explore the safety and effect of the technique of reconstructing anterior and middle columns by posterior approach in treating lumbar burst fractures. Methods： From July 2005 to January 2007, 22 cases （18 males and 4 females, aged 28-57 years, 42.7 years on average） of lumbar burst fractures were treated with surgical procedures in our hospital. Based on the routine posterior approach, one of the transverse processes of the injured vertebra was incised to get access to the lateral side of the injured vetebral body. After all the displaced fracture fragments were cleared away and the spinal canal was decompressed, the titanium mesh packed with autografts was implanted from the lateral side to reconstruct the anterior and middle columns. The adjacent above and below segments of the vetebral body were fixed with transpedicular screws. The operation time, intraoperative blood loss, vertebral height, degree of kyphotic deformity and comprised spinal canal were documented. Results： The average operation time was 3.5 hours （ranging 2.8-5.8 hours） and the average blood loss was 820 ml （ranging 650-2 100 ml）. All the cases were followed up for 17.2 months on average （ ranging 12-28 months）. The height of the injured vetebral body was restored from 24 % （12%- 45%） preoperatively to 96% （95%-99%） postoperatively （P〈0.05）. The natural spinal curvatures and spinal canal were restored. Three cases were involved in transient iatrogenic nerve root injury and 1 case was involved in the loosening of the connected rod of the pedicle screw system 3 months postoperatively. Conclusions： The technique of implanting the titanium mesh by posterior approach is effective and safe enough to reconstruct the anterior and middle columns in treating lumbar burst fractures.
