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
This study examined the clinical outcomes of one-stage surgical treatment for patients with spinal tuberculosis via a posterior-only approach. Twenty-four patients with thoracic or lumbar spinal tuberculosis whose les...This study examined the clinical outcomes of one-stage surgical treatment for patients with spinal tuberculosis via a posterior-only approach. Twenty-four patients with thoracic or lumbar spinal tuberculosis whose lesions were confined to adjacent segments were admitted to our hospital and treated. The American Spinal Injury Association（ASIA） impairment scale was used to assess the neurological function. All patients were treated with one-stage surgical treatment via a posterior-only approach. The clinical efficacy was evaluated by the Japanese Orthopaedic Association（JOA） scores and oswestry disability index（ODI） of nerve function. Patients were evaluated preoperatively and postoperatively by measurement of spinal deformity using Cobb angle and radiological examination. All the patients were followed up for 13 to 27 months. They had significantly postoperative improvement in JOA score, ODI and ASIA classification scores. The kyphotic angles were significantly corrected and maintained at the final follow-up. Bone fusion was achieved within 4–12 months. It was concluded that one-stage surgical treatment via a posterior-only approach is effective and feasible for the treatment of spinal tuberculosis.展开更多
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
Posterior lumbar interbody fusion (PLIF) is a common surgical procedure and widely used in the treatment of lumbar degenerative disc disorders. Traditionally, posterior lumbar interbody fusion is done by using the tra...Posterior lumbar interbody fusion (PLIF) is a common surgical procedure and widely used in the treatment of lumbar degenerative disc disorders. Traditionally, posterior lumbar interbody fusion is done by using the traditional pedicle screw (PS) which offers great advantages, but at the same time it has some disadvantages which include the risk of superior facet joint violation and muscle damage. Recently, an alternative method of screw insertion via cortical bone trajectory (CBT) has been invented which has less invasive process and can be placed without the drawbacks associated with the traditional pedicle screw. However, it has to remain an interest whether CBT will provide similar or greater clinical outcomes compared to PS in PLIF. So the main aim of this review is to compare the clinical outcomes of cortical bone trajectory and traditional pedicle screw fixation in posterior lumbar interbody fusion based on the articles published on this topic. Compared to the traditional pedicle screw fixation, PLIF with CBT has similar clinical outcome based on pain intensity, ODI status and JOA score, as well as similar fusion rate and radiological evaluated complication such as loosening of screw. In addition PLIF with CBT has advantages of less facet joint violation, less blood loss, less intraoperative muscle damage and perioperative pain. On the basis of this study, we can suggest that PLIF with CBT can be considered as a reasonable alternative to PS in PLIF.展开更多
Objectives: To explore the treatment and related prognosis of elderly patients with Anderson II odontoid fracture with posterior pedicle screw fixation combined with iliac bone grafting. Methods: Retrospective analysi...Objectives: To explore the treatment and related prognosis of elderly patients with Anderson II odontoid fracture with posterior pedicle screw fixation combined with iliac bone grafting. Methods: Retrospective analysis of 17 cases of elderly patients with Anderson II odontoid fracture who underwent posterior pedicle screw fixation combined with iliac bone grafting from January 2013 to December 2016. 17 patients had a history of trauma before surgery, and they all have varying degrees of atlantoaxial instability or subluxation and varying degrees of neck occipital pain and limited mobility. Result: No spinal cord or vertebral artery injury occurred during surgery. Follow-up information is complete. The follow-up period was 6 to 48 months (mean 27.4 ± 12.4 months). Postoperative imaging review prompted a good reduction of cervical spine, stable sequence;no pedicle screw loosening, fracture, iliac bone graft at the location of the situation, odontoid fracture and bone healing at the good, the patient after cervical rotation are limited to varying degrees. Conclusion: Posterior pedicle screw fixation combined with iliac bone grafting in elderly patients with Anderson II odontoid fracture can achieve good stability, and the prognosis is good, but long-term cervical rotation function may be affected to varying degrees.展开更多
Objective: To evaluate the surgical results of posterior lumber interbody fusion with transpedicular fixation with rod screw system in management of spondylolisthesis. Study Design: Retrospective study reviewed all pa...Objective: To evaluate the surgical results of posterior lumber interbody fusion with transpedicular fixation with rod screw system in management of spondylolisthesis. Study Design: Retrospective study reviewed all patient treated by lumber interbody fusion with transpedicular fixation with rod screw system. Patients and Methods: They were 40 patients operated for lumber and lumbosacral spondylolisthesis from Feb 2014 to April 2017 in Al-Azhar university hospital. These patients followed postoperatively clinically for improved neural function and for fusion stability and hardware fixation by radiological investigation. Data about pain intensity (by Visual Analogue Scale) was collected pre- and postoperatively;and outcome was assessed by Oswetry disability index (ODI). Outcome was graded as excellent, good, fair, or poor. Pre- and Post-operative data were statistically compared. Results: The mean age was 45 years (range between 30 - 60 years) with female sex predominance (male:female = 1:3). They had lytic (n = 30) or degenerative (n = 10) spondylolisthesis;and all underwent PLIF (posterior lumbar interbody fusion). In lytic group, the level was L4/L5 in 19 patients and L5/S1 in 11 patients, while in degenerative group the level was L4/L5 in 4 patients, L5/S1 in 3 patients, L2/L3 in 2 and L3/L4 in one patient. The spondylolisthesis grade was grade I among 25 subjects, grade two among 11 subjects and retrolisthesis among 4 subjects. Sensory deficits reported in 22 subjects (19 had lytic and 3 had degenerative spondylolisthesis);while motor deficits reported among 10 subjects and reduced reflexes among 8 subjects. The outcome was excellent, good, and fair among 30, 7, and 3 subjects respectively. The return to previous levels of activity was reported among 32 patients. VAS was 3.5 ± 2.94 at the end of follow up, while ODI was 28% and 36.0% and 3 and 6 months respectively. Conclusion: PLIF associated with transpedicular rod screw fixation system for management of spondylolisthesis is considered a safe and effective surgical intervention in both lytic and degenerative types.展开更多
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
Triple arthrodesis is an invasive procedure that involves denuding and fusion of three foot joints;Talocalcaneal (T-C), Talonavicular (T-N) and Calcaneocuboid (C-C). Traditionally, with external fixation triple arthro...Triple arthrodesis is an invasive procedure that involves denuding and fusion of three foot joints;Talocalcaneal (T-C), Talonavicular (T-N) and Calcaneocuboid (C-C). Traditionally, with external fixation triple arthrodesis has been per-formed without corresponding internal fixation. The purpose of this study is to take a scientific look at the compressive forces acting on the joint surfaces using the arch wire technique without the use of rigid internal fixation. Five fresh cadaveric lower-limb specimens were prepared for the triple arthodesis by anatomic dissection. External fixators were applied to the limbs and pressure sensors from the Tekscan 6900C were placed in the three foot joints where tension was applied. After several trials with different variables it was seen that the arched wire technique on the footplate alone does not allow constant compression at the three joints. However weightbearing increased compression across all three joints regardless of the arch wire compression. This study proves that weightbearing alone provides more compression at all 3 joints in a triple arthrodesis.展开更多
BACKGROUND The effect of posterior spinal fusion(PSF)incorporating the pelvis on an ambulatory patient’s ability to mobilize after the fusion is not well understood.AIM To see whether a posterior spinal fusion with p...BACKGROUND The effect of posterior spinal fusion(PSF)incorporating the pelvis on an ambulatory patient’s ability to mobilize after the fusion is not well understood.AIM To see whether a posterior spinal fusion with pelvic fixation using iliac or sacral alar iliac screws in ambulatory neuromuscular scoliosis(NMS)patients influences postoperative ambulatory ability.METHODS A retrospective review of all patients with NMS that underwent PSF with fixation incorporating the pelvis between January 1,2012 and February 29,2019.A total of 118 patients were eligible,including 11 ambulatory patients.The primary outcome was the maintenance of ambulatory status postoperatively.Secondary outcomes included postoperative curve magnitude,pelvic obliquity,and complications,comprising infections,instrumentation failure,and any unplanned returns to the operative room.RESULTS The ambulatory function was maintained in all 11 ambulatory NMS patients.One patient had an improvement in functional status with equipment-free ambulation postoperatively.An average postoperative follow-up was 19 mo.The overall complication rate was 19.4%(n=23)with no significant differences between the groups in infection(P=0.365),hardware failure(P=0.505),and reoperation rate(P=1.0).Ambulatory status did not affect complication rate(P=0.967).CONCLUSION Spinal fusion to the pelvis in ambulatory patients with NMS provides effective deformity correction without the reduction in ambulatory capabilities.展开更多
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This study examined the clinical outcomes of one-stage surgical treatment for patients with spinal tuberculosis via a posterior-only approach. Twenty-four patients with thoracic or lumbar spinal tuberculosis whose lesions were confined to adjacent segments were admitted to our hospital and treated. The American Spinal Injury Association（ASIA） impairment scale was used to assess the neurological function. All patients were treated with one-stage surgical treatment via a posterior-only approach. The clinical efficacy was evaluated by the Japanese Orthopaedic Association（JOA） scores and oswestry disability index（ODI） of nerve function. Patients were evaluated preoperatively and postoperatively by measurement of spinal deformity using Cobb angle and radiological examination. All the patients were followed up for 13 to 27 months. They had significantly postoperative improvement in JOA score, ODI and ASIA classification scores. The kyphotic angles were significantly corrected and maintained at the final follow-up. Bone fusion was achieved within 4–12 months. It was concluded that one-stage surgical treatment via a posterior-only approach is effective and feasible for the treatment of spinal tuberculosis.
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Posterior lumbar interbody fusion (PLIF) is a common surgical procedure and widely used in the treatment of lumbar degenerative disc disorders. Traditionally, posterior lumbar interbody fusion is done by using the traditional pedicle screw (PS) which offers great advantages, but at the same time it has some disadvantages which include the risk of superior facet joint violation and muscle damage. Recently, an alternative method of screw insertion via cortical bone trajectory (CBT) has been invented which has less invasive process and can be placed without the drawbacks associated with the traditional pedicle screw. However, it has to remain an interest whether CBT will provide similar or greater clinical outcomes compared to PS in PLIF. So the main aim of this review is to compare the clinical outcomes of cortical bone trajectory and traditional pedicle screw fixation in posterior lumbar interbody fusion based on the articles published on this topic. Compared to the traditional pedicle screw fixation, PLIF with CBT has similar clinical outcome based on pain intensity, ODI status and JOA score, as well as similar fusion rate and radiological evaluated complication such as loosening of screw. In addition PLIF with CBT has advantages of less facet joint violation, less blood loss, less intraoperative muscle damage and perioperative pain. On the basis of this study, we can suggest that PLIF with CBT can be considered as a reasonable alternative to PS in PLIF.
文摘Objectives: To explore the treatment and related prognosis of elderly patients with Anderson II odontoid fracture with posterior pedicle screw fixation combined with iliac bone grafting. Methods: Retrospective analysis of 17 cases of elderly patients with Anderson II odontoid fracture who underwent posterior pedicle screw fixation combined with iliac bone grafting from January 2013 to December 2016. 17 patients had a history of trauma before surgery, and they all have varying degrees of atlantoaxial instability or subluxation and varying degrees of neck occipital pain and limited mobility. Result: No spinal cord or vertebral artery injury occurred during surgery. Follow-up information is complete. The follow-up period was 6 to 48 months (mean 27.4 ± 12.4 months). Postoperative imaging review prompted a good reduction of cervical spine, stable sequence;no pedicle screw loosening, fracture, iliac bone graft at the location of the situation, odontoid fracture and bone healing at the good, the patient after cervical rotation are limited to varying degrees. Conclusion: Posterior pedicle screw fixation combined with iliac bone grafting in elderly patients with Anderson II odontoid fracture can achieve good stability, and the prognosis is good, but long-term cervical rotation function may be affected to varying degrees.
文摘Objective: To evaluate the surgical results of posterior lumber interbody fusion with transpedicular fixation with rod screw system in management of spondylolisthesis. Study Design: Retrospective study reviewed all patient treated by lumber interbody fusion with transpedicular fixation with rod screw system. Patients and Methods: They were 40 patients operated for lumber and lumbosacral spondylolisthesis from Feb 2014 to April 2017 in Al-Azhar university hospital. These patients followed postoperatively clinically for improved neural function and for fusion stability and hardware fixation by radiological investigation. Data about pain intensity (by Visual Analogue Scale) was collected pre- and postoperatively;and outcome was assessed by Oswetry disability index (ODI). Outcome was graded as excellent, good, fair, or poor. Pre- and Post-operative data were statistically compared. Results: The mean age was 45 years (range between 30 - 60 years) with female sex predominance (male:female = 1:3). They had lytic (n = 30) or degenerative (n = 10) spondylolisthesis;and all underwent PLIF (posterior lumbar interbody fusion). In lytic group, the level was L4/L5 in 19 patients and L5/S1 in 11 patients, while in degenerative group the level was L4/L5 in 4 patients, L5/S1 in 3 patients, L2/L3 in 2 and L3/L4 in one patient. The spondylolisthesis grade was grade I among 25 subjects, grade two among 11 subjects and retrolisthesis among 4 subjects. Sensory deficits reported in 22 subjects (19 had lytic and 3 had degenerative spondylolisthesis);while motor deficits reported among 10 subjects and reduced reflexes among 8 subjects. The outcome was excellent, good, and fair among 30, 7, and 3 subjects respectively. The return to previous levels of activity was reported among 32 patients. VAS was 3.5 ± 2.94 at the end of follow up, while ODI was 28% and 36.0% and 3 and 6 months respectively. Conclusion: PLIF associated with transpedicular rod screw fixation system for management of spondylolisthesis is considered a safe and effective surgical intervention in both lytic and degenerative types.
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
文摘Triple arthrodesis is an invasive procedure that involves denuding and fusion of three foot joints;Talocalcaneal (T-C), Talonavicular (T-N) and Calcaneocuboid (C-C). Traditionally, with external fixation triple arthrodesis has been per-formed without corresponding internal fixation. The purpose of this study is to take a scientific look at the compressive forces acting on the joint surfaces using the arch wire technique without the use of rigid internal fixation. Five fresh cadaveric lower-limb specimens were prepared for the triple arthodesis by anatomic dissection. External fixators were applied to the limbs and pressure sensors from the Tekscan 6900C were placed in the three foot joints where tension was applied. After several trials with different variables it was seen that the arched wire technique on the footplate alone does not allow constant compression at the three joints. However weightbearing increased compression across all three joints regardless of the arch wire compression. This study proves that weightbearing alone provides more compression at all 3 joints in a triple arthrodesis.
文摘BACKGROUND The effect of posterior spinal fusion(PSF)incorporating the pelvis on an ambulatory patient’s ability to mobilize after the fusion is not well understood.AIM To see whether a posterior spinal fusion with pelvic fixation using iliac or sacral alar iliac screws in ambulatory neuromuscular scoliosis(NMS)patients influences postoperative ambulatory ability.METHODS A retrospective review of all patients with NMS that underwent PSF with fixation incorporating the pelvis between January 1,2012 and February 29,2019.A total of 118 patients were eligible,including 11 ambulatory patients.The primary outcome was the maintenance of ambulatory status postoperatively.Secondary outcomes included postoperative curve magnitude,pelvic obliquity,and complications,comprising infections,instrumentation failure,and any unplanned returns to the operative room.RESULTS The ambulatory function was maintained in all 11 ambulatory NMS patients.One patient had an improvement in functional status with equipment-free ambulation postoperatively.An average postoperative follow-up was 19 mo.The overall complication rate was 19.4%(n=23)with no significant differences between the groups in infection(P=0.365),hardware failure(P=0.505),and reoperation rate(P=1.0).Ambulatory status did not affect complication rate(P=0.967).CONCLUSION Spinal fusion to the pelvis in ambulatory patients with NMS provides effective deformity correction without the reduction in ambulatory capabilities.
