Objective To investigate the operation key points,instrument improvement and shortterm effects in total en bloc spondylectomy (TES) via a single posterior approach for thoracic and lumbar tumors.Methods A series of mo...Objective To investigate the operation key points,instrument improvement and shortterm effects in total en bloc spondylectomy (TES) via a single posterior approach for thoracic and lumbar tumors.Methods A series of modified展开更多
Background Cervicothoracic junction spinal tuberculosis （CJST） in children is uncommon, especially when accompanied by a huge abscess. However, its consequences can be severe. Because of the special anatomic locatio...Background Cervicothoracic junction spinal tuberculosis （CJST） in children is uncommon, especially when accompanied by a huge abscess. However, its consequences can be severe. Because of the special anatomic location of the cervicothoracic junction, surgical treatment is difficult and rarely reported. The aim of this clinical study was to assess the effectiveness of combined anterior and posterior approaches for focal debridement, decompression, allografting and anterior instrumentation in the treatment of CJST in children. Methods Ten pediatric CJST patients underwent focal debridement and cord decompression through combined anterior and posterior approaches. Then an appropriate allograft and titanium plate were applied to reconstruct the spine. The patients were asked to wear head-neck-chest braces for six months and received regular anti-tubercular drugs therapy for 12 months. Results The patients were followed-up for an average of 26 months （range, 15-32 months）. There was no recurrent tuberculous infection. The bone grafts incorporated well and the instrumentation was stable. Cervical and thoracic kyphosis was successfully corrected from 40° （range, 30-52°） before the operation to 18° （range, 12-26°） post-operation. Neurological function was improved in all patients. Conclusions Combined anterior and posterior approaches for focal debridement, decompression, bone allografting and anterior instrumentation provided an effective means of treatment in children of CJST with a huge abscess in the posterior part of the vertebral body.展开更多
Purpose:To analyze the curative effect and technical points of a modified posteromedial approach in the treatment of Klammer III posterior Pilon fracture.Methods:A retrospective analysis of patients with Klammer III p...Purpose:To analyze the curative effect and technical points of a modified posteromedial approach in the treatment of Klammer III posterior Pilon fracture.Methods:A retrospective analysis of patients with Klammer III posterior Pilon fractures were conducted in our department from January 2018 to December 2019.Before the surgery,the patients were fully relieved of swelling and pain,and a comprehensive examination was carried out.The posteromedial approach exposed the posterior and medial fracture block of the distal tibia.According to the fracture of external malleolus,it is determined whether to combine a lateral incision and protect tendons and vascular nerves by a retractor,and then perform a fracture reduction and internal fixation.Postoperatively,the patients were treated with analgesia,detumescence,anticoagulation and rehabilitation exercise.The American orthopaedic foot and ankle society(AOFAS)score and visual analogue score were recorded at regular follow-up after surgery.A t-test was used for the comparison of the preoperative and final AOFAS score.Results:There were 7 male and 13 female(n=20)included in the study,aged 22 to 88 years(average age 54.2 years).The injury mechanisms were falling from a height(n=7),traffic accident(n=6),walking injury(n=2)and heavy injury(n=5).The postoperative follow-up duration was 12—24 months(mean 16.95 months).The AOFAS score of the 20 patients before and after surgery were compared.The preoperative AOFAS score was 38.90±3.91,and the final AOFAS score was 80.55±4.20,(p<0.001).The mean final visual analogue scores at rest,active and weight-bearing walking were 0.30,0.85 and 1.70,respectively.One patient reported poor postoperative wound healing and required a return to hospital for debridement and anti-infection treatment.Conclusion:In the treatment of Klammer III posterior Pilon fractures,the modified posteromedial approach can fully expose the fracture block and the collapsed articular surface of the medial malleolus,achieve good reduction and internal fixation with limited injury of the tendon and vascular nerves,and have a better prognosis.展开更多
文摘Objective To investigate the operation key points,instrument improvement and shortterm effects in total en bloc spondylectomy (TES) via a single posterior approach for thoracic and lumbar tumors.Methods A series of modified
文摘Background Cervicothoracic junction spinal tuberculosis （CJST） in children is uncommon, especially when accompanied by a huge abscess. However, its consequences can be severe. Because of the special anatomic location of the cervicothoracic junction, surgical treatment is difficult and rarely reported. The aim of this clinical study was to assess the effectiveness of combined anterior and posterior approaches for focal debridement, decompression, allografting and anterior instrumentation in the treatment of CJST in children. Methods Ten pediatric CJST patients underwent focal debridement and cord decompression through combined anterior and posterior approaches. Then an appropriate allograft and titanium plate were applied to reconstruct the spine. The patients were asked to wear head-neck-chest braces for six months and received regular anti-tubercular drugs therapy for 12 months. Results The patients were followed-up for an average of 26 months （range, 15-32 months）. There was no recurrent tuberculous infection. The bone grafts incorporated well and the instrumentation was stable. Cervical and thoracic kyphosis was successfully corrected from 40° （range, 30-52°） before the operation to 18° （range, 12-26°） post-operation. Neurological function was improved in all patients. Conclusions Combined anterior and posterior approaches for focal debridement, decompression, bone allografting and anterior instrumentation provided an effective means of treatment in children of CJST with a huge abscess in the posterior part of the vertebral body.
文摘Purpose:To analyze the curative effect and technical points of a modified posteromedial approach in the treatment of Klammer III posterior Pilon fracture.Methods:A retrospective analysis of patients with Klammer III posterior Pilon fractures were conducted in our department from January 2018 to December 2019.Before the surgery,the patients were fully relieved of swelling and pain,and a comprehensive examination was carried out.The posteromedial approach exposed the posterior and medial fracture block of the distal tibia.According to the fracture of external malleolus,it is determined whether to combine a lateral incision and protect tendons and vascular nerves by a retractor,and then perform a fracture reduction and internal fixation.Postoperatively,the patients were treated with analgesia,detumescence,anticoagulation and rehabilitation exercise.The American orthopaedic foot and ankle society(AOFAS)score and visual analogue score were recorded at regular follow-up after surgery.A t-test was used for the comparison of the preoperative and final AOFAS score.Results:There were 7 male and 13 female(n=20)included in the study,aged 22 to 88 years(average age 54.2 years).The injury mechanisms were falling from a height(n=7),traffic accident(n=6),walking injury(n=2)and heavy injury(n=5).The postoperative follow-up duration was 12—24 months(mean 16.95 months).The AOFAS score of the 20 patients before and after surgery were compared.The preoperative AOFAS score was 38.90±3.91,and the final AOFAS score was 80.55±4.20,(p<0.001).The mean final visual analogue scores at rest,active and weight-bearing walking were 0.30,0.85 and 1.70,respectively.One patient reported poor postoperative wound healing and required a return to hospital for debridement and anti-infection treatment.Conclusion:In the treatment of Klammer III posterior Pilon fractures,the modified posteromedial approach can fully expose the fracture block and the collapsed articular surface of the medial malleolus,achieve good reduction and internal fixation with limited injury of the tendon and vascular nerves,and have a better prognosis.
