ObjectiveTo discuss the safety and effectiveness of combined dynamic cervical implant (DCI) and Cage fusion in the treatment of two-level cervical disc protrusion. MethodsBetween September 2009 and June 2011, 16 cases of two-level cervical disc protrusion were treated with combined DCI and Cage fusion. Of 16 cases, 10 were male and 6 were female, with a mean age of 44.1 years (range, 37-64 years) and with a mean disease duration of 5.1 years (range, 2-8 years), including 8 cases of cervical myelopathy, 5 cases of nerve root cervical myelopathy, and 3 cases of mixed cervical myelopathy. Radiological results indicated degenerative intervertebral discs and compressed never root or spinal cord. Involved discs included C3,4 and C4,5 (1 case), C3,4 and C5,6(5 cases), C4,5 and C5,6 (3 cases), C4,5 and C6,7 (5 cases), and C5,6 and C6,7 (2 cases). The neck disability index (NDI), Japanese Orthopedic Association (JOA) score, and visual analogue scale (VAS) were used to evaluate the neurological function and pain relief. The stabilities and activities of involved segments, intervertebral fusion, and displacement of Cages were observed during follow-up. ResultsPrimary healing of incisions was obtained in all cases; no complication of hematoma, infection, cerebrospinal fluid leakage, or neural function damage occurred. All 16 patients were followed up 18 months on average (range, 6-36 months). The cervical X-ray results indicated that the activities of involved segments was (7.8±3.1)°, showing no significant difference (t=0.655, P=0.132) when compared with preoperative value [(7.3±2.6)°]. No implant loosening was observed; slight heterotopic ossification occurred in 1 patient at the posterior rim of intervertebral space. No cage loosening or sinking was seen, and good fusion was achieved. The mean time of fusion was 4.5 months (range, 3-8 months). NDI, JOA, and VAS scores at last follow-up (18.3±5.1, 15.7±1.5, and 3.4±1.8 respectively) were significantly improved (t=2.131, P=0.016; t=3.126, P=0.024; t=6.102, P=0.038) when compared with preoperative scores (49.6±11.3, 12.8±2.0, and 6.7±1.2 respectively). ConclusionA combination of DCI and intervertebral Cage fusion has satisfactory early effectiveness in treatment of two-level cervical intervertebral protrusion for maintaining the stability and activity of cervical vertebrae.
Objective To evaluate the effect of anterolateral approach in treating thoracolumbar disc protrusion. Methods From May 2004 to May 2008, 11 patients with thoracolumbar disc protrusion (T10-L3) underwent discectomy, autologous il iac bone graft, and internal fixation via anterolateral approach. There were 9 males and 2 females aged 26-57 years old (average 42.8 years old). The course of disease was 1 week-11 years (average 2.7 years). Nine patients showed the lower l imbs weakness, 8 had sensory disturbance, 6 presented with lumbodorsal pain, 5 had the lower l imb pain, 4 presentedwith sphincter muscle disturbance, 3 suffered from foot drop, and 5 had a history of lower back injury. X-ray, CT, and MRI test showed that 9 cases had the single-segmental protrusion, 2 cases had double-segmental protrusion, 2 cases were accompanied with ossification of the thoracic vertebra yellow l igament, 2 cases were combined with ossification of the vertebra posterior longitudinal l igament, and 1 was compl icated with Scheuermann disease. Preoperatively, the intervertebral height was (7.2 ± 1.3) mm and JOA score was 6.4 ± 2.8. Results The time of operation was 2.5-5.5 hours (average 3.5 hours); the blood loss during operation was 500-1 200 mL (average 750 mL). During operation, intraoperative pleural tear occurred in 1 patient, peritoneal tear in 1 patient, and dural laceration in 1 patient. Repairing was performed intraoperative and preventive suction drainage was used for 3-5 days. No postoperative hydropneumothorax and cerebrospinal fluid leakage occurred. All incisions healed by first intention. No postoperative compl ications of nerve system occurred. All the patients were followed up for 1-4 years (average 2.4 years). X-ray films showed that all the patients achieved bony fusion without the occurrence breakage and loosening of titanium plate and screw 6-9 months after operation. Three cases displayed subtle scol iosis (10-15°) without influence on spinal equil ibration. The intervertebral height increased to (12.3 ± 1.5) mm 2 weeks after operation, indicating there was a significant difference compared with preoperative value (P lt; 0.05). The intervertebral height 1 year after operation when the bony fusion was reached decreased to (7.5 ± 1.2) mm, indicating there was no significant difference compared to the preoperative value (P gt; 0.05). The JOA score increased to 7.6 ± 3.2 at 1 year after operation, indicating there was a significant difference compared with preoperative value (P lt; 0.05). The symptoms and signs of all the patients were improved to various degrees after operation. According to improvement rate evaluation system proposed by Hirabayashi t al., 4 cases were graded as excellent, 6 as good, 1 as fair, and the excellent and good rate was 90.9%. Conclusion Treating thoracolumbar disc protrusion via anterolateral approach is safe and effective.
Objective To sum up the recent progress of common bone graft substitute and to forecast the possible directions for further research. Methods Recent original articles about investigation and appl ication for bone graft substitute were extensively reviewed. Several common bone graft substitutes were selected and expounded in different categories. Results Bone graft was an essential treatment in order to provide structural support, fill bone cavity and promote bone defect heal ing. The gold standard for bone graft was autograft which is subject to many restrictions. In recent years, theresearch and development of bone graft substitute have received publ ic attention. A very great progress has been made in the research and appl ication of allograft bones, synthetic bones and engineered bones, and some research results have been put into use for real products. Conclusion There still exist many problems in present bone graft substitutes. Combining various biomaterials and using the specific processing technology to develop a biomaterial which has the similar mechanical and chemical properties and physical structures to autograft so as to promote bone defect heal ing is the direction for future research.
OBJECTIVE: To present a surgical choice for nonunion and bone defect. METHODS: From November 1994 to October 1997, 17 cases of nonunion of fracture and massive bone defect were treated by autogenous iliac bone and fibular bone with vascular anastomosis. Of 17 cases, there were 10 cases of nonunion of bone fracture, 7 cases of bone defect following tumor resection (4 cases of benign and 3 cases of malignant). Autogenous fibular bone grafting with vascular anastomosis, ranging from 12 cm to 29 cm in length, were employed in 12 cases; autogenous iliac bone grafting, ranging from 7 cm x 3 cm to 9 cm x 5 cm in size, were utilized in the other 5 cases. All of 17 cases were followed up for 10 months to 5 years, 3 years and 7 months in average, and were evaluated from clinical manifestation. RESULTS: Bone union was achieved in 10 cases of nonunion of fracture after bone grafting, bony refilling of the bone defect was observed in 4 cases due to benign tumor and 1 case due to malignant tumor. The other 2 cases of malignant tumor died from lung metastasis of the tumor 10 months and 12 months after bone grafting, respectively. CONCLUSION: Bone grafting is an effective surgical option in treatment of nonunion of fracture and bone defect.
【Abstract】 Objective To assess the results of treatment of unstable distal radius fractures with leverage reductionand bone graft assisted by external fixators. Methods From September 2005 to May 2007, 27 cases of unstable distal radius fractures were treated by leverage reduction and bone graft, meanwhile assisted by external fixators. The cases included 16 males and 11 females, aged from 18 to 69 years with an average of 49. 3 years. Fractures were caused by fall ing in 19 cases, crash from high place in 1 case, traffic accident in 6 cases, and obtuse strike directly in 1 case, which were all closed fresh bone fractures. According to the standard of AO, all cases were classified as type C1 in 13 cases, type C2 in 11 cases, and type C3 in 3 cases. The palmar incl inination was from － 38° to 10°(mean － 12.2°); the ulnar deviation angle was from 6° to 30° (mean 19. 1°) before operations. The operations were performed from 1 to 3 days after injuries. The function of the carpal joints and the boneheal ing conditions were evaluated after operations. Results All cases were followed up for 4-24 months(mean 13. 1 months). No compl ications such as pin loosening, dislocation of fixators, injury of blood vessels and radial nerves, pin track infections occurred. According to Mcbride scoring, the results were excellent in 10 cases, good in 13 cases, fair in 3 cases and poor in 1 case, the excellent and good rate being 85. 2%. One case had traumatic arthritis and 1 case had wrist joint stiffness. All achieved fractures uniton 8-10 weeks (mean 9.3 weeks) after operations. The palmar incl inination angle was from 0° to 20° (mean 13. 4°); the ulnar deviation angle was from 10° to 33° (mean 22. 1°) after operations. Conclusion Treatment of unstable fractures of the distal radius by use of leverage reduction and bone graft with external fixator offers many advantages, such as simple operation, satisfactory reduction, rigid fixation, excellent function and lower incidence rate of traumatic arthritis.
To evaluate the method and effectiveness of anterior focus clearance with autograft bone fusion and internal fixation in treating of adjacent multivertebral tuberculosis in one-stage. Methods Between March 2007 and September 2009, 8 cases of thoracic vertebra tuberculosis were treated. Of 8 cases, 6 were male and 2 were female, aged 32 years on average (range, 20-42 years). The disease duration ranged from 8 to 14 months (mean, 10.2 months). Affected vertebrae included thoracic vertebrae in 35 cases and lumbar vertebrae in 11 cases; 5 vertebrae were involved in 4 cases, 6 vertebrae in 3 cases, and 8 vertebrae in 1 case. According to Frankel classification, there were 2 cases of grade C, 4 cases of grade D, and 2 cases of grade E. All patients had different kyphosis with the Cobb angle of (25.1 ± 6.6)°. All patients received antituberculous therapy 4-6 weeks preoperatively; after complete clearance lesions, autograft bone fusion and internal fixation were performed, and then antituberculous therapy was given for 18 months. Results All incisions healed by first intention. Eight patients were followed up 18-48 months (mean, 29 months). According to JIN Dadi et al. criterion, 7 cases recovered after first operation, 1 case of relapsed tuberculosis with sious was cured after re-focus clearance. The Cobb angle was (19.5 ± 4.2)° at 7 days after operation and was (22.3 ± 3.6)° at last follow-up, showing significant differences when compared with the preoperative value (P lt; 0.05). The nerve function of all cases were classified as Frankel grade E. CT scan showed bone graft fusion at 6-8 months after operation. No loosening or displacement of grafted bone and internal fixation occurred during follow-up. Conclusion The treatment of adjacent multivertebral tuberculosis by anterior focus clearance, intervertebral autograft, and internal fixation in one-stage is effective. Anterior bone fusion and internal fixation in one-stage can correct kyphosis effectively and rebuild spinal stabil ity, so it is a good choice for surgical treatment of adjacent multivertebral tuberculosis.
Objective To evaluate the cl inical significance of the combination of intensified anti-tuberculosis treatment, posterior transpedicular screw system internal fixation, intertransverse bone grafting, and anterior approach focus debridement for the treatment of thoracolumbar tuberculosis. Methods From January 2005 to December 2007, 20 patients with thoracolumbar tuberculosis (T10-L3) were treated. There were 13 males and 7 females aged 21-64 years old (average 44 years old). The course of disease was 3 months to 3 years (average 10 months). The focus involved single vertebrae bodies in 8 cases, two vertebrae bodies in 9 cases, and three vertebrae bodies in 3 cases. The preoperative Cobb angle was 9-35° (average 26.7°). The neurological function was evaluated according to the Frankel grading criterion, there were 2 cases of grade B, 5 of grade C, 7 of grade D, and 6 of grade E. Vertebral body defect index score: 9 cases of 1-2 points, 7 cases of 2-3 points, and 4 cases above 3 points. After receiving the systemic five-drug treatment of anti-tuberculosis for 2-3 weeks, the patients underwent the posterior transpedicular screw system internal fixation and intertransverse bone grafting, and then received tuberculosis focus debridement via anterior approach, nerve decompression, and bone grafting fusion. Results The time of operation averaged 210 minutes and the mean blood loss during operation was 650 mL. Postoperatively, 2 patients had mild belting sensation in their thorax and 2 patients had mild pneumothorax. Their symptoms rel ived 2-3 weeks later without specific treatment. All the patients were followed up for 12-23 months. X-ray films showed that all the patients achieved successful bony fusion 6-18 months after operation, and the Cobb angle was 7-21° (average 15.2°) 12 months after operation without aggravation. The Frankel gradingsystem was used to assess the postoperative neurological function, 1 patient in grade B before operation was improved to grade C after operation, 1 patient in grade B was improved to grade D, 1 patient in grade C was improved to grade D, 4 patients in grade B were improved to grade E, and 7 patients in grade D were improved to grade E. All of the incisions healed and erythrocyte sedimentation rate became normal 2 weeks to 3 months after operation. All the patients showed no obvious abnormity in l iver and kidney function. There was no recurrence of tuberculosis. Conclusion It seems that the systemic drug treatment of antituberculosis before and after operation, the thorough debridement of focus during operation, and the effective and rel iable wayto reconstruct for the spinal stabil ity are the key points for the treatment of spinal tuberculosis.
ObjectiveTo study the effectiveness of posterior laminotomy decompression and bone grafting via the injured vertebrae for treatment of thoracolumbar burst fractures. MethodsBetween November 2010 and November 2012, 58 patients with thoracolumbar burst fractures were treated by posterior fixation combined with posterior laminotomy decompression and intervertebral bone graft in the injured vertebrae. There were 40 males and 18 females with a mean age of 48 years (range, 25-58 years). According to Denis classification, 58 cases had burst fractures (Denis type B); based on neurological classification of spinal cord injury by American Spinal Injury Association (ASIA) classifications, 5 cases were rated as grade A, 18 cases as grade B, 20 cases as grade C, 14 cases as grade D, and 1 case as grade E. Based on thoracolumbar burst fractures CT classifications there were 5 cases of type A, 20 cases of type B1, 10 cases of type B2, and 23 cases of type C. The time between injury and operation was 10 hours to 9 days (mean, 7.2 days). The CT was taken to measure the space occupying of vertebral canal. The X-ray film was taken to measure the relative height of fractured vertebrae for evaluating the vertebral height restoration, Cobb angle for evaluating the correction of kyphosis, and ASIA classification was conducted to evaluate the function recovery of the spinal cord. ResultsThe operations were performed successfully, and incisions healed primarily. All the patients were followed up 12-18 months (mean, 15 months). CT showed good bone graft healing except partial absorption of vertebral body grafted bone; no loosening or breakage of screws and rods occurred. The stenosis rates of fractured vertebral canale were 47.56%±14.61% at preoperation and 1.26%±0.62% at 1 year after operation, showing significant difference (t=24.46, P=0.00). The Cobb angles were (16.98±3.67)° at preoperation, (3.42±1.45)° at 1 week after operation, (3.82±1.60)° at 1 year after operation, and (4.84±1.70)° at 3 months after removal of internal fixation, showing significant differences between at pre-and post-operation (P < 0.05). The relative heights of fractured vertebrae were 57.10%±6.52% at preoperation, 96.26%±1.94% at 1 week after operation, 96.11%±1.97% at 1 year after operation, and 96.03%±1.96% at 3 months after removal of internal fixation, showing significant differences between at pre-and post-operation (P < 0.05). At 1 year after operation, the neural function was improved 1-3 grades in 56 cases. Based on ASIA classifications, 1 case was rated as grade A, 4 cases as grade B, 10 cases as grade C, 23 cases as grade D, and 20 cases as grade E. ConclusionTreatment of thoracic and lumbar vertebrae burst fractures by posterior laminotomy decompression and bone grafting via the injured vertebrae has satisfactory effectiveness, which can reconstruct vertebral body shape and height with spinal cord decompression and good vertebral healing. It is a kind of effective solution for thoracolumbar burst fracture.
OBJECTIVE: To compare the clinical results of repairing bone defect of limbs with tissue engineering technique and with autogeneic iliac bone graft. METHODS: From July 1999 to September 2001, 52 cases of bone fracture were randomly divided into two groups (group A and B). Open reduction and internal fixation were performed in all cases as routine operation technique. Autogeneic iliac bone was implanted in group A, while tissue engineered bone was implanted in group B. Routine postoperative treatment in orthopedic surgery was taken. The operation time, bleeding volume, wound healing and drainage volume were compared. The bone union was observed by the X-ray 1, 2, 3, and 5 months after operation. RESULTS: The sex, age and disease type had no obvious difference between groups A and B. all the wounds healed with first intention. The swelling degree of wound and drainage volume had no obvious difference. The operation time in group A was longer than that in group B (25 minutes on average) and bleeding volume in group A was larger than that in group B (150 ml on average). Bone union completed within 3 to 7 months in both groups. But there were 2 cases of delayed union in group A and 1 case in group B. CONCLUSION: Repair of bone defect with tissue engineered bone has as good clinical results as that with autogeneic iliac bone graft. In aspect of operation time and bleeding volume, tissue engineered bone graft is superior to autogeneic iliac bone.
Objective To investigate the effectiveness and feasibil ity of modified single-stage transpedicular decompression, debridement, and posterior instrumentation in treatment of thoracic tuberculosis. Methods Between January 2005 and December 2009, 22 cases of thoracic tuberculosis were treated with modified single-stage transpedicular decompression, debridement, and posterior instrumentation. There were 12 males and 10 females with an average age of 39.4 years (range, 22-52 years). The mean disease duration was 1.2 years (range, 3 months to 10 years). The involved vertebral bodies were T5-12, including 2 segments in 17 cases and 3 segments in 5 cases. The kyphosis Cobb angle was (31.2 ± 14.5)° before operation. According to Frankel score system for neurological deficits, 2 cases were classified as grade A, 1 case as grade B, 8 cases as grade C, 5 cases as grade D, 1 case as grade E, and 5 cases had no neurological deficits before operation. Results All incisions healed by first intention. All patients were followed up 22.2 months on average (range, 12-65 months). Pain in low back was rel ieved in varying degrees 2 weeks after operation. Fusion was achieved in the bone implant area at 3 months after operation. According to Frankel score system, 1 case was rated as grade B, 2 cases as grade C, 4 cases as grade D, 7 cases as grade E, and 8 cases had no neurological deficits at last follow-up. The kyphosis Cobb angle was (16.2 ± 3.6)°, showing significant difference when compared with the value before operation (t=5.952, P=0.001). No loosening, emersion, breakage of internal fixation or pneumothorax occurred 1 year after operation. Conclusion Single-stage transpedicular decompression and posterior instrumentation is an effective and safe method in treatment of thoracic tuberculosis.