Objective To report five cases of puerile (【9 years) atlantoaxial instability which underwent C1-C2 pedicle screw internal fixation by posterior approach,and to introduce the surgical technique and the key point
Objective To study the effect of using improved 2D computer-assisted fluoroscopic navigation through simulating 3D vertebrae image to guide pedicle screw internal fixation.Methods Posterior pedicle screw internal fixa...Objective To study the effect of using improved 2D computer-assisted fluoroscopic navigation through simulating 3D vertebrae image to guide pedicle screw internal fixation.Methods Posterior pedicle screw internal fixation,distraction展开更多
BACKGROUND Whether it’s better to adopt unilateral pedicle screw(UPS)fixation or to use bilateral pedicle screw(BPS)one for lumbar degenerative diseases is still controversially undetermined.AIM To make a comparison ...BACKGROUND Whether it’s better to adopt unilateral pedicle screw(UPS)fixation or to use bilateral pedicle screw(BPS)one for lumbar degenerative diseases is still controversially undetermined.AIM To make a comparison between UPS and BPS fixation as to how they work efficaciously and safely in patients suffering from lumbar degenerative diseases.METHODS We have searched a lot in the databases through 2020 with index terms such as“unilateral pedicle screw fixation”and“bilateral pedicle screw fixation.”Only randomized controlled trials and some prospective cohort studies could be found,yielding 15 studies.The intervention was unilateral pedicle screw fixation;Primarily We’ve got outcomes of complications and fusion rates.Secondarily,we’ve achieved outcomes regarding total blood loss,operative time,as well as length of stay.Softwares were installed and utilized for subgroup analysis,analyzing forest plots,sensitivity,heterogeneity,forest plots,publication bias,and risk of bias.RESULTS Fifteen previous cases of study including 992 participants have been involved in our meta-analysis.UPS had slightly lower effects on fusion rate[relative risk(RR)=0.949,95%CI:0.910 to 0.990,P=0.015],which contributed mostly to this metaanalysis,and similar complication rates(RR=1.140,95%CI:0.792 to 1.640,P=0.481),Δvisual analog scale[standard mean difference(SMD)=0.178,95%CI:-0.021 to 0.378,P=0.080],andΔOswestry disability index(SMD=-0.254,95%CI:-0.820 to 0.329,P=0.402).In contrast,an obvious difference has been observed inΔJapanese Orthopedic Association(JOA)score(SMD=0.305,95%CI:0.046 to 0.563,P=0.021),total blood loss(SMD=-1.586,95%CI:-2.182 to-0.990,P=0.000),operation time(SMD=-2.831,95%CI:-3.753 to-1.909,P=0.000),and length of hospital stay(SMD=-0.614,95%CI:-1.050 to-0.179,P=0.006).CONCLUSION Bilateral fixation is more effective than unilateral fixation regarding fusion rate after lumbar interbody fusion.However,JOA,operation time,total blood loss,as well as length of stay were improved for unilateral fixation.展开更多
Objective To analyze the influence of segmental pedicle screws versus hybrid instrumentation on the correction results in adolescent idiopathic scoliosis patients undergoing posterior selective thoracic fusion. Metho...Objective To analyze the influence of segmental pedicle screws versus hybrid instrumentation on the correction results in adolescent idiopathic scoliosis patients undergoing posterior selective thoracic fusion. Methods By reviewing the medical records and roentgenograms of adolescent idiopathic scoliosis patients who underwent selective thoracic fusion from February 2000 to January 2007 in our hospital, the patients were divided into 2 groups according to different instrumentation fashions: Group A was hook-screw-rod (hybrid) internal fixation type, Group B was screw-rod (all pedicle screws) internal fixation type, and the screws were used in every segment on the concave side of the thoracic curve. The parameters of the scoliosis were measured and the correction results were analyzed. Results Totally, 48 patients (7 males, 41 females) were included, with an average age of 14.4 years old and a mean follow-up time of 12.3 months. Thirty and 18 patients were assigned to group A and group B, respectively. The mean preoperative coronal Cobb angles of the thoracic curve were 48.8° and 47.4°, respectively. After surgery, they were corrected to 13.7° and 6.8°, respectively. At final follow-up, they were 17.0° and 9.5°, with an average correction rate of 64.6% and 79.0%, respectively, and the correction rate of group B was significantly higher than that of group A (P=0.003). The mean preoperative coronal Cobb angles of the lumbar curve were 32.6° and 35.2°, respectively. After surgery, they were corrected to 8.6° and 8.3°, respectively. At final follow-up, they were 10.3° and 11.1°, with an average correction rate of 66.8% and 69.9%, respectively, and the correction rate of group B was significantly higher than that of group A (P=0.003). The correction loss of the thoracic curve and lumbar curve in the 2 groups were 3.1° and 1.8°, 2.4° and 2.4°, respectively. No significant difference was noted (both P〉0.05). The decompensation rate at final follow-up in these 2 groups were 4% (1/25) and 7.1% (1/14) respectively, with no significant difference (P〉0.05).展开更多
目的:骨水泥强化椎弓根螺钉技术近年来被广泛应用于合并骨质疏松的脊柱内固定手术中,可以显著提高固定强度,但与常规椎弓根螺钉内固定比较是否更具有优势尚缺乏循证医学定论。文章系统评价骨水泥强化椎弓根螺钉固定治疗骨质疏松性胸腰...目的:骨水泥强化椎弓根螺钉技术近年来被广泛应用于合并骨质疏松的脊柱内固定手术中,可以显著提高固定强度,但与常规椎弓根螺钉内固定比较是否更具有优势尚缺乏循证医学定论。文章系统评价骨水泥强化椎弓根螺钉固定治疗骨质疏松性胸腰椎退行性疾病的临床疗效及安全性。方法:在中国知网、中国生物医学文献、万方、维普、PubMed、Cochrane Library、Web of Science以及Embase数据库中,检索有关传统椎弓根螺钉与骨水泥强化螺钉固定治疗骨质疏松性胸腰椎退行性疾病的临床对照研究,按相关标准对文献进行筛选和质量评价,采用Rev Man 5.4软件进行Meta分析。结果:①纳入2篇随机对照研究和18篇回顾性队列研究,共20篇文献,包括1566例患者,其中骨水泥强化螺钉组789例,传统螺钉组777例;②Meta分析结果显示,骨水泥强化螺钉组术后日本矫形外科协会评分、椎间隙高度及融合率均高于传统螺钉组(MD=1.60,95%CI:1.14,2.07,P<0.00001;MD=1.26,95%CI:0.62,1.90,P=0.0001;OR=11.24,95%CI:2.86,44.14,P=0.0005),手术时间长于传统螺钉组(SMD=0.82,95%CI:0.42,1.23,P<0.0001),术后目测类比评分、Oswestry功能障碍指数及螺钉松动率均低于传统螺钉组(MD=-0.50,95%CI:-0.78,-0.21,P=0.0007;SMD=-0.49,95%CI:-0.88,-0.10,P=0.01;OR=0.08,95%CI:0.05,0.12,P<0.00001),两组间住院时间、术中出血量、术后引流量比较差异无显著性意义(P>0.05)。结论:相较于传统椎弓根螺钉固定,骨水泥强化椎弓根螺钉固定治疗骨质疏松性胸腰椎退行性疾病时更能有效改善术后融合率及椎间隙高度、降低术后螺钉松动率,提高远期临床疗效。展开更多
文摘Objective To report five cases of puerile (【9 years) atlantoaxial instability which underwent C1-C2 pedicle screw internal fixation by posterior approach,and to introduce the surgical technique and the key point
文摘Objective To study the effect of using improved 2D computer-assisted fluoroscopic navigation through simulating 3D vertebrae image to guide pedicle screw internal fixation.Methods Posterior pedicle screw internal fixation,distraction
基金Supported by the Health Science and Technology of Tianjin Municipality,No.RC20204Tianjin Institute of Orthopedics,No.2019TJGYSKY03the National Natural Science Foundation of China,No.818717771177226。
文摘BACKGROUND Whether it’s better to adopt unilateral pedicle screw(UPS)fixation or to use bilateral pedicle screw(BPS)one for lumbar degenerative diseases is still controversially undetermined.AIM To make a comparison between UPS and BPS fixation as to how they work efficaciously and safely in patients suffering from lumbar degenerative diseases.METHODS We have searched a lot in the databases through 2020 with index terms such as“unilateral pedicle screw fixation”and“bilateral pedicle screw fixation.”Only randomized controlled trials and some prospective cohort studies could be found,yielding 15 studies.The intervention was unilateral pedicle screw fixation;Primarily We’ve got outcomes of complications and fusion rates.Secondarily,we’ve achieved outcomes regarding total blood loss,operative time,as well as length of stay.Softwares were installed and utilized for subgroup analysis,analyzing forest plots,sensitivity,heterogeneity,forest plots,publication bias,and risk of bias.RESULTS Fifteen previous cases of study including 992 participants have been involved in our meta-analysis.UPS had slightly lower effects on fusion rate[relative risk(RR)=0.949,95%CI:0.910 to 0.990,P=0.015],which contributed mostly to this metaanalysis,and similar complication rates(RR=1.140,95%CI:0.792 to 1.640,P=0.481),Δvisual analog scale[standard mean difference(SMD)=0.178,95%CI:-0.021 to 0.378,P=0.080],andΔOswestry disability index(SMD=-0.254,95%CI:-0.820 to 0.329,P=0.402).In contrast,an obvious difference has been observed inΔJapanese Orthopedic Association(JOA)score(SMD=0.305,95%CI:0.046 to 0.563,P=0.021),total blood loss(SMD=-1.586,95%CI:-2.182 to-0.990,P=0.000),operation time(SMD=-2.831,95%CI:-3.753 to-1.909,P=0.000),and length of hospital stay(SMD=-0.614,95%CI:-1.050 to-0.179,P=0.006).CONCLUSION Bilateral fixation is more effective than unilateral fixation regarding fusion rate after lumbar interbody fusion.However,JOA,operation time,total blood loss,as well as length of stay were improved for unilateral fixation.
文摘Objective To analyze the influence of segmental pedicle screws versus hybrid instrumentation on the correction results in adolescent idiopathic scoliosis patients undergoing posterior selective thoracic fusion. Methods By reviewing the medical records and roentgenograms of adolescent idiopathic scoliosis patients who underwent selective thoracic fusion from February 2000 to January 2007 in our hospital, the patients were divided into 2 groups according to different instrumentation fashions: Group A was hook-screw-rod (hybrid) internal fixation type, Group B was screw-rod (all pedicle screws) internal fixation type, and the screws were used in every segment on the concave side of the thoracic curve. The parameters of the scoliosis were measured and the correction results were analyzed. Results Totally, 48 patients (7 males, 41 females) were included, with an average age of 14.4 years old and a mean follow-up time of 12.3 months. Thirty and 18 patients were assigned to group A and group B, respectively. The mean preoperative coronal Cobb angles of the thoracic curve were 48.8° and 47.4°, respectively. After surgery, they were corrected to 13.7° and 6.8°, respectively. At final follow-up, they were 17.0° and 9.5°, with an average correction rate of 64.6% and 79.0%, respectively, and the correction rate of group B was significantly higher than that of group A (P=0.003). The mean preoperative coronal Cobb angles of the lumbar curve were 32.6° and 35.2°, respectively. After surgery, they were corrected to 8.6° and 8.3°, respectively. At final follow-up, they were 10.3° and 11.1°, with an average correction rate of 66.8% and 69.9%, respectively, and the correction rate of group B was significantly higher than that of group A (P=0.003). The correction loss of the thoracic curve and lumbar curve in the 2 groups were 3.1° and 1.8°, 2.4° and 2.4°, respectively. No significant difference was noted (both P〉0.05). The decompensation rate at final follow-up in these 2 groups were 4% (1/25) and 7.1% (1/14) respectively, with no significant difference (P〉0.05).
文摘目的:骨水泥强化椎弓根螺钉技术近年来被广泛应用于合并骨质疏松的脊柱内固定手术中,可以显著提高固定强度,但与常规椎弓根螺钉内固定比较是否更具有优势尚缺乏循证医学定论。文章系统评价骨水泥强化椎弓根螺钉固定治疗骨质疏松性胸腰椎退行性疾病的临床疗效及安全性。方法:在中国知网、中国生物医学文献、万方、维普、PubMed、Cochrane Library、Web of Science以及Embase数据库中,检索有关传统椎弓根螺钉与骨水泥强化螺钉固定治疗骨质疏松性胸腰椎退行性疾病的临床对照研究,按相关标准对文献进行筛选和质量评价,采用Rev Man 5.4软件进行Meta分析。结果:①纳入2篇随机对照研究和18篇回顾性队列研究,共20篇文献,包括1566例患者,其中骨水泥强化螺钉组789例,传统螺钉组777例;②Meta分析结果显示,骨水泥强化螺钉组术后日本矫形外科协会评分、椎间隙高度及融合率均高于传统螺钉组(MD=1.60,95%CI:1.14,2.07,P<0.00001;MD=1.26,95%CI:0.62,1.90,P=0.0001;OR=11.24,95%CI:2.86,44.14,P=0.0005),手术时间长于传统螺钉组(SMD=0.82,95%CI:0.42,1.23,P<0.0001),术后目测类比评分、Oswestry功能障碍指数及螺钉松动率均低于传统螺钉组(MD=-0.50,95%CI:-0.78,-0.21,P=0.0007;SMD=-0.49,95%CI:-0.88,-0.10,P=0.01;OR=0.08,95%CI:0.05,0.12,P<0.00001),两组间住院时间、术中出血量、术后引流量比较差异无显著性意义(P>0.05)。结论:相较于传统椎弓根螺钉固定,骨水泥强化椎弓根螺钉固定治疗骨质疏松性胸腰椎退行性疾病时更能有效改善术后融合率及椎间隙高度、降低术后螺钉松动率,提高远期临床疗效。