Objective To discuss the improved method and effectiveness of posterior pedicle-screw fixation combined with restoring and grafting through the injured vertebrae for treating thoracolumbar burst fracture. Methods Between March 2008 and September 2010, 21 patients with thoracolumbar burst fracture were treated by posterior pedicle-screw fixationcombined with restoring and grafting through the injured vertebrae. Of 21 cases, 15 were male and 6 were female with an age range of 20-61 years (mean, 38.4 years). Affected segments included T12 in 5 cases, L1 in 7 cases, L2 in 5 cases, and T12-L1 in 4 cases. According to Frankel classification for neurological function, 2 cases were rated as grade A, 4 cases as grade B, 6 cases as grade C, 5 cases as grade D, and 4 cases as grade E; based on Denis classification, all 21 cases were burst fractures, including 7 cases of type A, 11 cases of type B, and 3 cases of type C. The X-ray film was taken to measure the relative height of fractured vertebrae and Cobb’s angle, and the function of the spinal cord was evaluated at preoperation, postoperation, and last followup. Results All the incisions healed primarily. The 21 patients were followed up 12-30 months (mean, 26 months). No loosening or breakage of screws and rods occurred. X-ray films showed good bone heal ing with the heal ing time from 12 to 23 months (mean, 16 months). The Cobb’s angles at 1 week and 1 year postoperatively were (3.4 ± 2.4)° and (5.2 ± 3.2)° respectively, showing significant differences when compared with preoperative angle (22.1 ± 1.2)° (P lt; 0.05), while no significant difference between 1 week and 1 year after operation (P gt; 0.05). The anterior height of injured vertebrae recovered from (14.6 ± 2.1) mm (40.2% ± 1.5% of the normal) at preoperation to (36.0 ± 2.0) mm (95.3% ± 1.3% of the normal) at 1 week, and to (35.0 ± 2.4) mm (94.4% ± 2.5% of the normal) at 1 year; significant differences were found between preoperation and postoperation (P lt; 0.05), while no significant difference between 1 week and 1 year after operation (P gt; 0.05). At 1 year after operation, the Frankel neurological function grade was improved in varying degrees, showing significant difference when compared with preoperative grade (χ2=11.140, P=0.025). Conclusion Improved method of posterior pedicle-screw fixation combined with restoring and grafting through the injured vertebrae in treatment of thoracolumbar burst fracture can reconstructthe anterior and middle column stabil ity and prevent loss of Cobb’s angle and height of vertebrae.
Objective To explore the feasibility of combining high level Le Fort Ⅰ osteotomy with bone grafting in the same operation for correction of secondary midface deformities in cleft patients. Methods From January 2002 to January 2005, 10 patients suffering from secondary midface deformities were treated. There were 4 males and 6 females, aged from 16 to 32 years. The unilateral cleft was involved in 8 patients and the bilateral cleft in2 patients. All patients received combining high level Le Fort Ⅰ osteotomy with bone grafting in the same operation. The horizontal corticotomy of high level Le Fort Ⅰosteotomy on anterior wall of maxillary bone is higher than that of traditionalLe Fort Ⅰ osteotomy, it is only 5 mm close to infraorbital foramen. Results All 10 patients were satisfied with their appearances after operation. Dental articulation was improved greatly in 9 patients. With an X-ray re-examination, maxillary was returned to normal position in all patients. After a follow up from 6months to 2 years, dental arch had good appearance. The X-ray films showed no obvious bone absorption. The density of grafting bone was approximation to the normal bone.Conclusion High level Le Fort Ⅰ osteotomy can make notonly maxillary advance, but also regions of lateral and floor of nose and partial infraorbital region advance. Combining with bone grafting in the same operation can decrease the frequency of operation, save the treatment expense and obtain an ideal effect. So it is an effective method for correction of the secondary midface deformities in cleft patients.
【Abstract】 Objective To study a new method of alveolar cleft bone graft repair. Methods From April 2005to August 2006, 26 cases (30 sides) of alveolar cleft were treated with trabecular substance of self-il ium combined with the decalcified dentinal matrix of human (DDM). There were 16 males and 10 females, aged 6-12 years. Unilateral alveolar cleft was involved in 22 cases, bilateral alveolar cleft in 4 cases. All cases were accompanied by nasal wing collapse, 5 by deciduous tooth retention, 3 by malposed teeth and 1 by tooth deformity. Anterior occlusal radiographs and panoramic oral radiographs were taken to observe union and bone absorption before and after operation. Results Twenty-three patients achieved heal ing by first intention, oronasal fistulas were closed successfully. Infection occurred in one bilateral alveolar cleft case and bone tissue exposure in 2 cases. Wound healed by rinse or dressing change and inunction with MEBO. The X-ray films after operation showed bone bridge formation in the alveolar cleft. The stabil ity and continuity of body of maxilla were resumed. Four cases (6-9years old) were observed 6.5 months, 22 cases (9-12 years old ) were observed 8.6 months. According to Bergland for evaluation,the X-ray films after 3 months of operation showed 16 cases (16 sides) in class I (53.3%), 7 cases (8 sides) in class II (26.7%),2 cases (4 sides) in class III (13.3%), and 1 case(2 sides) in class IV (6.7%). The overall survival ratio of alveolar bone grafting was 93.3%, and the cl inical success ratio was 80%. Conclusion The DDM is good in alveolar cleft bone graft repair. It is better than using self-il ium only cl inically.
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.
Open reduction and internal fixation with plate and screw is one of the most widely used surgical methods in the treatment of proximal humeral fractures in the elderly. In recent years, more and more studies have shown that it is very important to strengthen the medial column support of the proximal humerus during the surgery. At present, orthopedists often use bone graft, bone cement, medial support screw and medial support plate to strengthen the support of the medial column of the proximal humerus when applying open reduction and internal fixation with plate and screw to treat proximal humeral fractures. Therefore, the methods of strengthening medial column support for proximal humerus fractures and their effects on maintaining fracture reduction, reducing postoperative complications and improving functional activities of shoulder joints after operation are reviewed in this paper. It aims to provide a certain reference for the individualized selection of medial support methods according to the fracture situation in the treatment of proximal humeral fractures.
Objective
To investigate the effectiveness of posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting for lumbar spondylolysis.
Methods
Between January 2005 and October 2009, 22 patients with lumbar spondylolysis underwent posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting. There were 19 males and 3 females with an average age of 18.4 years (range, 12-26 years). The main symptom was low back pain with an average disease duration of 16 months (range, 8-56 months). The visual analogue scale (VAS) was 6.0 ± 1.2 and Oswestry disability index (ODI) was 72.0% ± 10.0% preoperatively. The X-ray films showed bilateral spondylolysis at L4 in 9 cases and at L5 in 13 cases. The range of motion (ROM) at upper and lower intervertebral spaces was (11.8 ± 2.8)°and (14.1 ± 1.9)°, respectively. ResultsAll incisions healed by first intention. All patients were followed up 12-45 months (mean, 25 months). Low back pain was significantly alleviated after operation. The VAS score (0.3 ± 0.5) and ODI (17.6% ± 3.4%) were significantly decreased at last follow-up when compared with preoperative scores (P lt; 0.05). CT showed bone graft fusion in the area of isthmus defects, with no loosening or breaking of internal fixator. At last follow-up, the lateral flexion-extension X-ray films of the lumbar spine showed that the ROM at upper and lower intervertebral spaces was (12.3 ± 2.1)°and (13.5 ± 1.7)°, respectively; showing significant differences when compared with preoperative values (P lt; 0.05). Pain at donor site of iliac bone occurred in 1 case, and was cured after pain release treatment. ConclusionThe posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting is a reliable treatment for lumbar spondylolysis, having a high fusion rate, low complication rate, and maximum retention of lumbar ROM.
ObjectiveTo compare the effective of short-segment pedicle instrumentation with bone grafting and pedicle screw implanting in injured vertebra and cross segment pedicle instrumentation with bone grafting in injured vertebra for treating thoracolumbar fractures.
MethodsA prospective randomized controlled study was performed in 40 patients with thoracolumbar fracture who were in accordance with the inclusive criteria between June 2010 and June 2012. Of 40 patients, 20 received treatment with short-segment pedicle screw instrumentation with bone grafting and pedicle screw implanting in injured vertebra in group A, and 20 received treatment with cross segment pedicle instrumentation with bone grafting in injured vertebra in group B. There was no significant difference in gender, age, affected segment, disease duration, Frankel grade, Cobb angle, compression rate of anterior verterbral height, visual analogue scale (VAS) score, and Japanese Orthopaedic Association (JOA) score between 2 groups before operation (P>0.05). The operation time, blood loss, Cobb angle, compression rate of anterior vertebral height, loss of disc space height, Frankel grade, VAS and JOA scores were compared between 2 groups.
ResultsThere was no significant difference in the operation time and blood loss between 2 groups (P>0.05). Primary healing of incision was obtained in all patients, and no early complication of infection or lower limb vein thrombus occurred. Forty patients were followed up 12-16 months (mean, 14.8 months). No breaking or displacement of internal fixation was observed. The improvement of Frankel grading score was 0.52±0.72 in group A and 0.47±0.63 in group B, showing no significant difference (t=0.188, P=0.853) at 12 months after operation. The Cobb angle, compression rate of anterior verterbral height, and VAS score at 1 week and 12 months, and JOA score at 12 months were significantly improved when compared with preoperative ones in 2 groups (P<0.05). No significant difference was found in Cobb angle, disc space height, VAS score, and JOA score between 2 groups at each time point (P>0.05), but the compression rate of anterior verterbral height in group A was significantly lower than that in group B (P<0.05). The loss of disc space height next to the internal fixation or the injured vertebra was observed in 2 groups at 12 months, but showing no significant difference (P>0.05).
ConclusionCompared with cross segment pedicle instrumentation, short-segment pedicle screw instrumentation with bone grafting and pedicle screw implanting in injured vertebra can recover and maintain the affected vertebra height in treating thoracolumbar fractures, but it could not effectively prevent degeneration of adjacent segments and the loss of kyphosis correction degree.
ObjectiveTo explore the effectiveness of stage I anterior approach debridement and autologous iliac crest graft with single self-locked titanium plate internal fixation for the treatment of lumbosacral tuberculosis.
MethodsSeven cases of lumbosacral tuberculosis were treated by stage I anterior approach debridement, autologous iliac crest graft, and single self-locked titanium plate internal fixation between February 2010 and October 2014. There were 5 males and 2 females, aged 18-65 years (mean, 41.6 years). The disease duration was 5-21 months (mean, 8 months). The patients had signs and symptoms of pain in lumbosacral region, radiating pain in unilateral lower limb or bilateral lower limbs, decreased muscular strength and disorders of superficial sensation. According to Frankel classification for spinal injury, 1 case was rated as grade C, 3 cases as grade D, and 3 cases as grade E. Preoperative imaging examination suggested L5, S1 lesions in line with the manifestations of tuberculosis; the lumbosacral angle was 16.4-28.5° (mean, 18.6°). The erythrocyte sedimentation rate was 28-105 mm/1 hour (mean, 61 mm/1 hour). All patients received 4-drug antituberculosis therapy.
ResultsAll patients underwent the operation successfully and all incisions healed at stage I, without relevant complication. All patients were followed up 14-70 months (mean, 25.6 months). All symptoms of tuberculosis disappeared and the erythrocyte sedimentation rate returned to normal. At last follow-up, Frankel classification was returned to E from D in 3 cases, returned to D from C in 1 case. Two cases suffered from pains in the lumbosacral region and at the donor site, 1 case suffered from upper abdominal discomfort and poor appetite,but these symptoms disappeared after symptomatic treatment. At last follow-up, X-ray examination indicated that the lumbosacral angle was 23.4-34.2° (mean, 28.6°). According to Bridwell criteria, 5 cases gained grade I bone fusion, and 2 cases gained grade II bone fusion, without migration of bone graft, or loosening or breakage of titanium plate or bolt.
ConclusionStage I anterior approach debridement and autologous iliac crest graft with single self-locked titanium plate internal fixation is safe and effective in treating lumbosacral tuberculosis. It can achieve good bone fusion and stable lumbosacral stability, and maintain good deformity correction.
Objective To study the cl inical effects of modified Galveston technology in the treatment of lumbosacral tuberculosis. Methods From January 2001 to May 2008, 19 patients with lumbosacral tuberculosis were treated, including13 males and 6 females aged 21-58 years old (average 38 years old). The course of disease was 8-22 months. The tuberculosis was at the L4-S1 level in 3 cases, the L5, S1 level in 10 cases, the L5-S2 level in 5 cases, and the S1, 2 level in 1 case. Seven cases were compl icated with neural symptom of the lower l imbs, 3 cases of them were grade C and 4 cases were grade D according to the Frankel scale of nerve function. The preoperative JOA score of lower back pain was 5-22 (average 19). Six cases were compl icated with il iac abscess, 3 cases with psoas abscess, 3 cases with sacroil iac joint tuberculosis, and 2 cases with pulmonary tuberculosis. For 12 patients, the operation of modified Galveston internal fixation via the posterior approach, focus debridement via vertebral canal, and interbody fusion with autogeneous il iac bone fragment grafting was performed; for 7 cases, the operation of modified Galveston internal fixation via the posterior approach, vertebral lamina fusion with autogeneous il iac bone fragment grafting, and anterior focus debridement was performed. Results The incision of 18 cases was healed by first intention, and 1 case had sinus 3 weeks after operation and healed 3 months after operation. Nineteen patients were followed up for 12-82 months (average 21 months). There was no recurrence of the local tuberculosis, and the common toxic symptom of tuberculosis disappeared 6-12 months after operation. All the patients achieved bony fusion 4-6 months postoperatively, and 3 patients with sacroil iac joint tuberculosis achieved sacroil iac joint fusion. For those 7 patients with combinations of the neural symptomof the lower l imbs, the symptoms disappeared and their Frankel scales were improved to grade E. The JOA score of low back pain at the final follow-up was 22-29 (average 26). There was a significant difference between preoperation and postoperation (P lt; 0.05). Conclusion The modified Galveston technology is helpful to reconstruct the stabil ity of lumbosacral vertebrae, improve bony fusion rate, reduce the postoperative in-bed time.
Objective To investigate the clinical effect of medical grade calcium sulfate(Osteoset) as a bone graft substitute. Methods From December 2004 to May 2005, 9 cases of bone defect(limb group)were repaired with Osteoset pellets; bone defect was caused by benign tumor inlimbs, including 3 cases of fibroma xanthomas in humerus(1 case) and acetabulum (2 cases), 2 cases of bone cysts in humerus(1) and radius(1), 1 case of nonossifying fibroma, 1 case of ossifying fibroma and 2 cases of osteofibrous dysplasia in femurs. Five cases of lumbar posterolateral fusion (spine group) were treated with Osteoset pellets as autograft volume expander, including 2 cases of lumbar spinal stenosis, 2 cases of lumbar spondylolisthesis and 1 case of lumbar spondylolysis. Radiological method was used to evaluate the repair effect of Osteoset pellets. Results The mean follow-up time was 6.2 months (3to 9 months). Osteoset pellets began to be absorbed after 1 to 3 months of operation, and were totally absorbed and replaced by osseous tissue after 4 to 6months. No local recurrence was detected in limb group and the function of limbs was normal. At 6 months after operation, all patients in spine group got bony fusion. Conclusion Medical grade calcium sulfate (Osteoset) isan ideal bone graft substitute with excellent bone repair effect.
