Objective To evaluate the therapeutic effect of open-door cervical expansive laminoplasty (ELP) with anchor fixation on flurosis cervical stenosis (FCS). Methods From February 2005 to February 2006, 20 patients with FCS underwent ELP using anchor fixation (group A) and 24 patients with FCS received ELP using conventional silk thread fixation (group B). In group A, there were 11 males and 9 females aged (58.0 ± 11.2) years old, the course of disease ranged from 6 months to 5 years, and the stenosis involved 3 vertebral levels in 3 cases, 4 levels in 8 cases, and 5 levels in 9 cases, andthe sagittal diameter of the cervical spinal canal was (7.30 ± 5.23) mm. While in group B, there were 11 males and 13 females aged (61.0 ± 9.1) years old, the course of disease ranged from 5 months to 5 years, the stenosis involved 3 vertebral levels in 5 cases, 4 levels in 10 cases, and 5 levels in 9 cases, and the sagittal diameter of the cervical spinal canal was (7.11 ± 4.92) mm. No significant differences were evident between two groups in terms of the general information (P gt; 0.05). Before operation and at 24 months after operation, the nerve function was assessed by JOA score, the axial symptom (AS) was evaluated using Chiba 12-point method, and the changes of cervical lordosis index (CLI) and cervical range of motion (CRM) were detected by imaging examination. Results All wounds healed by first intention. All patients were followed up for 24 months. JOA score: in group A, it was improved from 7.4 ± 1.5 before operation to 14.6 ± 2.1 at 24 months after operation with an improvement rate of 61% ± 3%; in group B, the score was increased from 7.1 ± 2.2 to 12.6 ± 2.5 with an improvement rate of 52% ± 5%; significant differences were evident in two groups between before and after operation, and between two groups in terms of the improvement rate (P lt; 0.05). AS score: in group A, it was improved from 6.2 ± 2.1 before operation to 10.8 ± 0.3 at 24 months after operation with an improvement rate of 74% ± 4%; in group B, the score was increased from 6.3 ± 1.9 to 8.8 ± 0.5 with an improvement rate of 39% ± 3%; significant differences were evident in two groups between before and after operation, and between two groups in terms of improvement rate (P lt; 0.05). X-ray films and CT scan at 24 months after operation displayed that there was no occurrence of “breakage of door spindle” or “re-close of door” in two groups, there was no occurrence of anchor loosing in group A, and the molding of the spinal canal was satisfactory in two groups. Preoperatively, the CLI was 11.9 ± 1.9 in group A and 11.3 ± 2.2 in group B and the CRM was (39.5 ± 2.4)° in group A and (40.2 ± 1.8)° in group B. While at 24 months after operation, the CLI was 9.5 ± 2.2 in group A and 8.2 ± 2.8 in group B, and the CRM was (30.6 ± 2.0)° in group A and (28.7 ± 2.4)° in group B, suggesting there was a significant decrease when compared with the preoperative value and group A was superior to group B (P lt; 0.05). The saggital diameter of the cervical spinal canal 24 months after operation was (13.17 ± 2.12) mm in group A and (12.89 ± 3.21) mm in group B, indicating there was a significant difference when compared with the preoperative value (P lt; 0.01). Conclusion Compared with conventional silk thread fixation, ELP using anchor fixation brings more stabil ity to vertebral lamina, less invasion to the posterior muscular-skeletal structure of the cervical spine, sl ight postoperative neck AS, andsatisfactory cl inical outcomes.
Objective To summarize the biomechanical research progress on different fixation methods in medial opening-wedge high tibial osteotomy (MOWHTO) and provide references for selecting appropriate fixation methods in clinical applications of MOWHTO for treating knee osteoarthritis (KOA). Methods Recent domestic and international literature on the biomechanical studies of MOWHTO fixation methods was reviewed to analyze the characteristics and biomechanical performance of various fixation techniques. Results The medial-specific osteotomy plate system has become the mainstream due to its high stiffness and stability, but issues such as soft tissue irritation and stress shielding remain. The use of filler blocks significantly enhances fixation stability and promotes bone healing when the osteotomy gap is large, reducing axial displacement by 73%-76% and decreasing plate stress by 90%. Auxiliary screws improve axial and torsional stability, particularly in cases with large correction angles, effectively preventing lateral hinge fractures. Alternative fixation methods like external fixators hold unique clinical value by minimizing soft tissue irritation and allowing postoperative adjustment. Conclusion There is currently no unified standard for selecting MOWHTO fixation methods. Clinical decisions should comprehensively consider factors such as bone quality, correction angle, and postoperative rehabilitation needs.