<b style="line-height:1.5;"><span style="font-family:Verdana;">Background</span><span style="font-family:Verdana;">:</span><span style="font-size:10....<b style="line-height:1.5;"><span style="font-family:Verdana;">Background</span><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">Basic principle for the treatment of pyogenic spondylitis (PS) is conservative care, but surgical intervention is often required when conservative treatment may fail. We have experienced many conservative cases of various complications due to long-term bed rest and poor pain control. Recently we have adopted percutaneous pedicle screw (PPS) fixation for the treatment of PS as a minimally invasive spine stabilization (MISt) fusion to reduce such morbidity of the conservative care. </span><b><span style="font-family:Verdana;font-size:12px;">Objective</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">To evaluate the impact of PPS fixation in patients with PS. </span><b><span style="font-family:Verdana;font-size:12px;">Study Design</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">A retrospective analysis of the medical records. </span><b><span style="font-family:Verdana;font-size:12px;">Subjects, Methods</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="line-height:1.5;font-family:Verdana;">We reviewed 54 consecutive patients who underwent treatment in our hospital for PS during 2005-2018 and observed for more than 12 months. Of those we excluded cases show</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> effectiveness to initial treatment (it was defined fever relief or C-reactive protein (CRP) inversion in 3 weeks of antibiotics) so that this study is a retrospective study in cases show</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> initial treatment resistance. Finally, this study included 29 cases. Medical records of these 29 cases were reviewed for baseline, organism isolated and its detection rate, the clinical outcome in 12 months (Discharge, Transfer, Death), the period from </span><span style="line-height:1.5;font-family:Verdana;">the </span><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">first visit to our hospital to fever relief, CRP inversion, ambulation, and Discharge or Transfer. </span><b><span style="font-family:Verdana;font-size:12px;">Results</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span></b><span style="line-height:1.5;font-family:Verdana;"> These cases </span><span style="line-height:1.5;font-family:Verdana;">were </span><span style="line-height:1.5;font-family:Verdana;">divided into two groups, the conservative group (C-group): 17 cases, and the PPS group (P-group): 12 cases. There is no statistically significant difference in fever relief (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.051) and CRP inversion (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.208). The period to ambulation and discharge or transfer was significantly shorter in group P (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.020, p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.031). 1-Year survival rate was 92% in the P-group, and 71% in the C-group. There is no statistically significant difference (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.354) between </span><span style="line-height:1.5;font-family:Verdana;">the </span><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">two groups. The rate of Discharge to home and care facility is 58% in P-group, and 47% in C-group. And the rate of Transfer is 34% in P-group, and 35% in C-group. </span><b><span style="font-family:Verdana;font-size:12px;">Conclusion</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="line-height:1.5;font-family:Verdana;">PPS fixation was effective to achieve shorten</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> the period to ambulation and discharge or transfer. But it was not effective </span><span style="line-height:1.5;font-family:Verdana;">in</span><span style="line-height:1.5;font-family:Verdana;"> infection control. This suggests that PPS fixation should be aggressively administered to patients who can expect pain relief and early ambulation by PPS fixation in the patient of PS show</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> resistance to initial treatment.展开更多
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
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. Method...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).Conclusions Both all pedicle screws and hybrid instrumentation can offer good correction results of the thoracic curve and lumbar curve in posterior selective thoracic fusion in patients with adolescent idiopathic scoliosis. While with all pedicle screws, the correction results of the thoracic curve and lumbar curve are both better than those with hybrid instrumentation without increased decompensation rate.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<b style="line-height:1.5;"><span style="font-family:Verdana;">Background</span><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">Basic principle for the treatment of pyogenic spondylitis (PS) is conservative care, but surgical intervention is often required when conservative treatment may fail. We have experienced many conservative cases of various complications due to long-term bed rest and poor pain control. Recently we have adopted percutaneous pedicle screw (PPS) fixation for the treatment of PS as a minimally invasive spine stabilization (MISt) fusion to reduce such morbidity of the conservative care. </span><b><span style="font-family:Verdana;font-size:12px;">Objective</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">To evaluate the impact of PPS fixation in patients with PS. </span><b><span style="font-family:Verdana;font-size:12px;">Study Design</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">A retrospective analysis of the medical records. </span><b><span style="font-family:Verdana;font-size:12px;">Subjects, Methods</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="line-height:1.5;font-family:Verdana;">We reviewed 54 consecutive patients who underwent treatment in our hospital for PS during 2005-2018 and observed for more than 12 months. Of those we excluded cases show</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> effectiveness to initial treatment (it was defined fever relief or C-reactive protein (CRP) inversion in 3 weeks of antibiotics) so that this study is a retrospective study in cases show</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> initial treatment resistance. Finally, this study included 29 cases. Medical records of these 29 cases were reviewed for baseline, organism isolated and its detection rate, the clinical outcome in 12 months (Discharge, Transfer, Death), the period from </span><span style="line-height:1.5;font-family:Verdana;">the </span><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">first visit to our hospital to fever relief, CRP inversion, ambulation, and Discharge or Transfer. </span><b><span style="font-family:Verdana;font-size:12px;">Results</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span></b><span style="line-height:1.5;font-family:Verdana;"> These cases </span><span style="line-height:1.5;font-family:Verdana;">were </span><span style="line-height:1.5;font-family:Verdana;">divided into two groups, the conservative group (C-group): 17 cases, and the PPS group (P-group): 12 cases. There is no statistically significant difference in fever relief (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.051) and CRP inversion (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.208). The period to ambulation and discharge or transfer was significantly shorter in group P (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.020, p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.031). 1-Year survival rate was 92% in the P-group, and 71% in the C-group. There is no statistically significant difference (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.354) between </span><span style="line-height:1.5;font-family:Verdana;">the </span><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">two groups. The rate of Discharge to home and care facility is 58% in P-group, and 47% in C-group. And the rate of Transfer is 34% in P-group, and 35% in C-group. </span><b><span style="font-family:Verdana;font-size:12px;">Conclusion</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="line-height:1.5;font-family:Verdana;">PPS fixation was effective to achieve shorten</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> the period to ambulation and discharge or transfer. But it was not effective </span><span style="line-height:1.5;font-family:Verdana;">in</span><span style="line-height:1.5;font-family:Verdana;"> infection control. This suggests that PPS fixation should be aggressively administered to patients who can expect pain relief and early ambulation by PPS fixation in the patient of PS show</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> resistance to initial treatment.
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
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).Conclusions Both all pedicle screws and hybrid instrumentation can offer good correction results of the thoracic curve and lumbar curve in posterior selective thoracic fusion in patients with adolescent idiopathic scoliosis. While with all pedicle screws, the correction results of the thoracic curve and lumbar curve are both better than those with hybrid instrumentation without increased decompensation rate.
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。