ObjectiveTo study the effectiveness and safety of simply anterior approach for lower cervical spine fracture dislocation (Allen-Ferguson II or III type) without spinal cord injury. MethodsTwenty-five patients with lower cervical spine fracture dislocation (Allen-Ferguson II or III type) without spinal cord injury were treated between June 2013 and June 2015. There were 17 males and 8 females with an average age of 41.2 years (range, 31-57 years). Injury was caused by falling from height in 11 cases, by bruise in 5 cases, by crash of heavy object in 6 cases, and by traffic accident in 3 cases. There were 24 cases of fresh fractures and 1 case of old fracture. According to the Frankel grading criteria, 19 cases were rated as grade E and 6 cases as grade D. The injured levels included C4, 5 in 5 cases, C5, 6 in 14 cases, and C6, 7 in 6 cases. Unilateral locked-facet joint was observed in 9 cases, and bilateral locked-facet joint in 16 cases. The operation time, intraoperative blood loss, and surgical complications were recorded; the Odom standard was used to evaluate the effectiveness. The Cobb angle and D-value (the degree of cervical kyphosis or lordosis) were measured on the X-ray film, the bone graft fusion rate was recorded. ResultsThe operation was successfully completed in 25 patients; the operation time was 66 to 115 minutes, the intraoperative blood loss was 80 to 220 mL. The postoperative follow-up time was 12 to 36 months (mean, 19.3 months). Postoperative temporary dysphagia occurred in 1 case, and pain at donor site in 2 cases; there were no complications of spinal cord injury, hematoma, hoarse, and esophageal fistula. The nerve function was improved from preoperative grade D to postoperative grade E at 3 months. The X-ray films showed bone graft fusion; there was no loss of intervertebral height or loosening of internal fixation. At 3 months after operation, the effectiveness was excellent in 18 cases, good in 6 cases, and fair in 1 case, and the excellent and good rate was 96.0%. The postoperative Cobb angle and the D value were significantly improved when compared with preoperative ones (P < 0.05). ConclusionSimple anterior approach has the advantages of good effectiveness, small trauma, and fast recovery for treating lower cervical spine fracture dislocation (Allen-Ferguson II or III type) without spinal cord injury.
Objective To evaluate the effectiveness of early internal fixation combined with free anterolateral thigh perforator flap (ALTPF) transplantation in the treatment of open ankle fracture-dislocation. Methods A retrospective analysis was performed on the clinical data of 13 patients with open ankle fracture-dislocation who were admitted and met the inclusion criteria between January 2021 and May 2024. Among them, there were 9 males and 4 females, with the ages ranging from 23 to 61 years (mean, 45.3 years). Fracture types included 5 cases of simple medial or lateral malleolar fracture-dislocation, 7 cases of bimalleolar (medial and lateral) fracture-dislocation, and 1 case of trimalleolar fracture-dislocation. Additionally, 3 cases were complicated with bone defects (1 medial malleolus defect and 2 lateral malleolus defects). All injuries were classified as type ⅢB according to the Gustilo-Anderson classification for open fractures. The size of wound defects ranged from 7 cm×5 cm to 18 cm×12 cm. The time from injury to surgery was 2-20 hours (mean, 4 hours). All patients underwent emergency thorough debridement upon admission. The fracture-dislocation was temporarily stabilized with an external fixator, and the wound was covered with antibiotic-impregnated bone cement sheets or vacuum sealing drainage. Definitive internal fixation of the fracture and free ALTPF transplantation were performed 5-7 days after the initial emergency procedure. Postoperatively, wound healing, flap survival, and fracture union were monitored. At last follow-up, clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Results All 13 patients were followed up 6-24 months (mean, 8.2 months). All flaps survived completely, and all fractures achieved union, with an union time of 3-11 months (mean, 5.5 months). One patient developed a superficial infection at the wound margin, which healed after regular dressing changes and drainage. No internal fixation-related complication (e.g., deep infection, implant loosening, or secondary ankle instability) were observed. At last follow-up, the total AOFAS ankle-hindfoot score was 78.6±13.5, with 3 excellent, 7 good, 2 fair, and 1 poor cases, yielding an excellent and good rate of 76.9%. ConclusionEarly internal fixation combined with ALTPF transplantation for open ankle fracture-dislocation can shorten the treatment course and maximize the recovery of ankle joint function.
Objective To compare the biomechanical differences among the five internal fixation modes in treatment of Day type Ⅱ crescent fracture dislocation of pelvis (CFDP), and find an internal fixation mode which was the most consistent with mechanical principles. Methods Based on the pelvic CT data of a healthy adult male volunteer, a Day type Ⅱ CFDP finite element model was established by using Mimics 17.0, ANSYS 12.0-ICEM, Abaqus 2020, and SolidWorks 2012 softwares. After verifying the validity of the finite element model by comparing the anatomical parameters with the three-dimensional reconstruction model and the mechanical validity verification, the fracture and dislocated joint of models were fixed with S1 sacroiliac screw combined with 1 LC-Ⅱ screw (S1+LC-Ⅱ group), S1 sacroiliac screw combined with 2 LC-Ⅱ screws (S1+2LC-Ⅱ group), S1 sacroiliac screw combined with 2 posterior iliac screws (S1+2PIS group), S1 and S2 sacroiliac screws combined with 1 LC-Ⅱ screw (S1+S2+LC-Ⅱ group), S2-alar-iliac (S2AI) screw combined with 1 LC-Ⅱ screw (S2AI+LC-Ⅱ group), respectively. After each internal fixation model was loaded with a force of 600 N in the standing position, the maximum displacement of the crescent fracture fragments, the maximum stress of the internal fixation (the maximum stress of the screw at the ilium fracture and the maximum stress of the screw at the sacroiliac joint), sacroiliac joint displacement, and bone stress distribution around internal fixation were observed in 5 groups. Results The finite element model in this study has been verified to be effective. After loading 600 N stress, there was a certain displacement of the crescent fracture of pelvis in each internal fixation model, among which the S1+LC-Ⅱ group was the largest, the S1+2LC-Ⅱ group and the S1+2PIS group were the smallest. The maximum stress of the internal fixation mainly concentrated at the sacroiliac joint and the fracture line of crescent fracture. The maximum stress of the screw at the sacroiliac joint was the largest in the S1+LC-Ⅱ group and the smallest in the S2AI+LC-Ⅱ group. The maximum stress of the screw at the ilium fracture was the largest in the S1+2PIS group and the smallest in the S1+2LC-Ⅱ group. The displacement of the sacroiliac joint was the largest in the S1+LC-Ⅱ group and the smallest in the S1+S2+LC-Ⅱ group. In each internal fixation model, the maximum stress around the sacroiliac screws concentrated on the contact surface between the screw and the cortical bone, the maximum stress around the screws at the iliac bone concentrated on the cancellous bone of the fracture line, and the maximum stress around the S2AI screw concentrated on the cancellous bone on the iliac side. The maximum bone stress around the screws at the sacroiliac joint was the largest in the S1+LC-Ⅱ group and the smallest in the S2AI+LC-Ⅱ group. The maximum bone stress around the screws at the ilium was the largest in the S1+2PIS group and the smallest in the S1+LC-Ⅱ group. Conclusion For the treatment of Day type Ⅱ CFDP, it is recommended to choose S1 sacroiliac screw combined with 1 LC-Ⅱ screw for internal fixation, which can achieve a firm fixation effect without increasing the number of screws.
ObjectiveTo investigate the effect of one-stage posterior reduction single nail and rod fixation combined with the anterior operation on lower cervical fracture-dislocation combined with unilateral locked facet.MethodsA retrospective analysis of 28 patients with lower cervical fracture-dislocation combined with unilateral locked facet who underwent one-stage posterior-anterior approach surgery between June 2012 and March 2017 were conducted. The Cobb angle, vertebral body horizontal displacement, height of intervertebral space, recovery of nerve function and operative complications were observed before and after operation.ResultsAll patients were followed up for 12-24 months, with an average of (18.9±4.7) months. All the patients received good reposition after operation without complications such as large blood vessels, trachea, esophagus, spinal dura mater injury and so on. The incisions healed well in all patients. Postoperative complications: postoperative hoarseness and dysphagia occured in 3 cases, pharynx and larynx pain in 8 cases, pulmonary infection in 1 case, and hyponatremia in 2 cases; all patients recovered after the related symptomatic treatment. Postoperative X-ray showed that all the patients were completely corrected without residual small joint semi dislocation and kyphosis. No spinal cord or nerve injury aggravators occurred after surgery. The neurological function of all patients was improved to different degrees 12 months after operation. American Spinal Cord Injury Association (ASIA) classification showed that, of the 6 cases classified as type B preoperatively, 4 cases turned into type C and 2 cases into type D postoperatively; of the 13 cases classified as type C preoperatively, 10 cases turned into type D and 3 into type E postoperatively; and all the 8 cases classified as type D preoperatively turned into type E postoperatively. The ASIA scores increased by 1-2 levels compared with those before operation (P<0.05). The height of cervical intervertebral space, physiological curvature and cervical stability of all patients were well maintained 7 days and 12 months after operation, which were significantly improved compared with those before operation (P<0.05). There was no significant difference between the two follow-up visits at 7 days and 12 months after operation. The Japanese Orthopaedic Association score at 12 months after operation (14.6±2.3) was significantly better than that before operation (6.8±2.6), and the average improvement rate was (79.6±18.8)% (P<0.05). No complications such as screw loosening, fracture or displacement occurred during follow-up.ConclusionOne-stage posterior reduction single nail and rod fixation combined with the anterior operation is safe and effective for the treatment of lower cervical fracture-dislocation combined with unilateral locked facet.
Objective To evaluate the deviation between actual and simulated screw placement after cervical pedicle screw placement assisted by 3D printed navigation template, and analyze the correlation between screw placement deviation and navigation pipe length. Methods A total of 40 patients undergoing cervical 1-7 pedicle screw insertion assisted by 3D printed navigation template in Zigong Fourth People’s Hospital between February 2018 and August 2020 were included in this prospective study. These patients were divided into 3 groups randomly, including 12 patients with a 5-mm pipe length (5 mm group), 13 patients with a 10-mm pipe length (10 mm group), and 15 patients with a 15-mm pipe length (15 mm group). Three-dimensional modeling was performed on preoperative cervical CT images of these patients and simulated pedicle screw was placed. Individualized pedicle screw navigation templates were designed according to the position and direction of simulated pedicle screws, and 3D printing was performed on the cervical model and navigation templates. Preoperative 3D printed model and navigation templates were used to simulate the surgical process to confirm the safety of screws. During the operation, pedicle screw placement was performed according to the preoperative design and simulated surgical process. The postoperative CT images were registered with the preoperative CT images in 3D model. The safety of screw placement was evaluated by the postoperative screw placement Grade, and the accuracy of screw placement was evaluated by measuring the deviation of screw placement point and the deviation of screw placement direction in horizontal plane (inclination angle) and sagittal plane (head inclination angle). The influence of different navigation pipe lengths on the safety and accuracy of screw placement was analyzed. Results A total of 164 pedicle screws were inserted with navigation template assistance, including 48 screws (38 in Grade 0 and 10 in Grade 1) in the 5 mm group, 52 screws in the 10 mm group (all in Grade 0), and 64 screws (52 in Grade 0 and 12 in Grade 1) in the 15 mm group, and the difference in the grade among the three groups was statistically significant (P<0.05). When the navigation pipe length was 5, 10, and 15 mm, respectively, the screw entry point deviation was (1.87±0.63), (1.44±0.63), and (1.66±0.54) mm, respectively, the inclination angle deviation was (2.72±0.25), (0.90±0.21), and (1.84±0.35)°, respectively, and the head inclination angle deviation was (8.63±1.83), (7.15±1.38), and (8.24±1.52)°, respectively. The deviations in the 10 mm group were all significantly less than those in the other two groups (P<0.05). Conclusions In the cervical pedicle screw placement assisted by navigation template, all the screws were Grade 0 or Grade 1, with high safety. The mean deviation of the screw entry point is within 2 mm, with high accuracy. When the length of navigation pipe is 10 mm, the safety and accuracy of screw placement can be fully guaranteed.
OBJECTIVE: To investigate the etiology, pathological mechanism and treatment of cervical fracture-dislocation without spinal cord injury. METHODS: Nine patients with cervical fracture-dislocation without spinal cord injury were male and aged 22 to 63 years. Based on the clinical symptoms and roentgenographic changes, the injury mechanism was analyzed; and the pathological characteristics and treatment principle were put forward. RESULTS: Anterior reduction was employed in all 9 cases. Eight cases were reduced completely while 1 case was reduced partially. After following up 1 to 3 years, 7 cases recovered completely and the other 2 cases relieved their symptoms obviously. No nervous symptoms aggravated during the following-up period. CONCLUSION: Fracture-dislocation of the cervical spine without spinal cord injury has special pathological mechanism. The surgical intervention is needed for solid fixation and complete decompression without any delayed neurosymptoms.
ObjectiveTo evaluate the clinical significance of individualized reference model of sagittal curves and navigation templates of pedicle screw by three-dimensional printing technique for thoracolumbar fracture with dislocation. MethodsBetween February 2011 and November 2013, 42 patients with thoracolumbar fracture and dislocation undergoing pedicle screw fixation were divided into 2 groups:traditional pedicle screw internal fixation by fluoroscopy assistant was used in 24 cases (control group), and individualized reference model of sagittal curves and navigation templates of pedicle screw were used in 18 cases (trial group). There was no significant difference in gender, age, injury causes, segment, degree of dislocation, and Frankel classification between 2 groups (P>0.05). The operation time, intraoperative blood loss, perspective times, and dislocation rate, sagittal angle recovery rate at different time were compared. The success rate of pedicle screw insertion, sagittal screw angle, and Frankel classification were compared. The angle between sagittal screws, difference of screw entry point at horizontal position, and difference of screw inclined angle were compared. ResultsThe operating time, intraoperative blood loss, and perspective times in trial group were significantly lower than those in control groups (P<0.05). All the patients were followed up 12-40 months (mean, 22 months). The dislocation rate at immediate after operation and last follow-up were significantly improved when compared with preoperative value in 2 groups (P<0.05). At immediate after operation and last follow-up, the dislocation rate and sagittal angle recover rate in trial group were significantly better than those in control group (P<0.05). There were significant differences in the one-time success rate, final success rate of pedicle screw insertion, and saggital screw angle between 2 groups (χ2=9.38, P=0.00; χ2=10.95, P=0.00; χ2=13.43, P=0.00). The angle between sagittal screws, difference of screw entry point at horizontal position, and difference of screw inclined angle in trail group were significantly less than those in control group (P<0.05). There was significant difference in the Frankel classification between 2 groups at last follow-up (Z=-1.99, P=0.04). ConclusionThe application of individualized reference model of sagittal curves and navigation templates of pedicle screw by three-dimensional printing technique for thoracolumbar fracture with dislocation has the advantages of shorter operation time, less intraoperative blood loss, better recovery of thoracolumbar dislocation, and better Frankel classification.