Objective To evaluate the fixation technique of using the cervical lateral mass plate in the cervical posterior approach operation. Methods Eight patients in this group were admitted from September 2001 to November 2006. Among the 8 patients, there were 6 males and 2 females, with their ages ranging from 28 to 78 years. Cervical vertebral fracture with dislocation was found in 4 patients, C2 spinal cord injury in 1, C1 fracture in 1, cervical spinal stenosis in 1, and C2-5 spinal cord neurofibroma in 1. Muscle strength 3-4. TheFrankel grading system was usedin 6 patients with traumatic injury. Before operation, Grade C was observed in 2patients，Grade D in 3，and Grade E in 1. All the operations were performed according to requirements of the Margel’s method. We positioned 40 screws in all the patients, including 4 screws at C2，6 screws at C3，12 screws at C4，4 screws at C5，4 screws at C6，2 screws at C7，and 6 screws at T1. Results The followingup for an average of 14.1 months (range,645 months) revealed that there was no malposition of the screws in the patients. One of the 8 patients developed spinal instability in the fixed segment at 3 months after operation. The headchestbrace was applied to the patient for 3 months, and the spinal fusion was achieved. The further followingup to 45 months indicated that there was no instability occurring. The remaining patients recovered to their spinal stability by the spinal fusion. The patients also recovered in their neurological function after operation. The Frankel assessment showed that 1 patient had Grade E, 3 from Grade D to Grade E, 1 from Grade C to Grade D, and 1 from Grade C to Grade E. Conclusion The cervical lateral mass plate fixation can provide the immediate and b segmental immobilization for the good cervical spine stability.
From January 1984 to November 1997, the boiling xenogenic bone (porcine and bovine bone) was applied in 65 patients. The xenogenic bone was used to promote bone healing in 24 cases, intramedullary bone graft in 37 and osteomyelitis in 4. All of the patients were followed up for 2 to 35 months. The results showed that in five cases there was infection after operation, and all other the wounds had primary healing. The xenogenic bone seemed to induce rejection in vivo. In the sevious cases immunosuppressive treatment was often needed. The volume of the bone grafted and the extent of the periosteum being stripped seemed to be important whether xenogenic bone graft would be successful or. There were lots of problem needed investigation.
Objective To study the surgical procedures and results for treating the nonunion of lateral humeral condyle fracture combined with cubitus valgus in adolescents. Methods From June 2004 to October 2006, 5 patients with nonunion of lateral humeral condyle fracture and cubitus valgus were treated, including 3 males and 2 females aged 8-17 yearsold. Three cases received external fixation for 2-3 weeks in other hospital, while 2 cases were misdiagnosed as soft tissue injury. The patients were hospital ized after they were diagnosed with nonunion of lateral humeral condyle fracture and cubitus valgus 4-12 years after injury. Preoperatively, the angle of cubitus valgus deformity was 25-55° (average 44.8°), and the elbow motion range of flexion and extension was 135-140° (average 139°) and 0-20° (average 7°), respectively. One case with the symptoms of ulnar neuritis was diagnosed as incomplete injury of ulnar nerve. The time between admission to hospital and operation was 3-7 days. All the patients were treated with wedge shaped supracondylar osteotomy of the distal aspect of humerus and humerus lateral column reconstruction. Regular follow-up was conducted after operation and the elbow function was evaluated according to the scale system of Jupiter et al. Results All incisions healed by first intention and all the cases were followed up for 14-28 months (average 20 months). X-ray films revealed that bone union was attained in all the 5 cases, among which the bone union at the supracondylar osteotomy site was reached 5-8 weeks after operation (average 6 weeeks) and the bone union at the lateral column reconstruction site was reached 3-6 months after operation. The deformity of cubitus valgus was corrected in all thecases. At latest follow-up, the flexion motion of the elbow was 100-135° (average 121°), and the extension range was 0-30° (average 13°), the angle of postoperative cubitus valgus deformity was — 5-10° (average 2°). According to the system of Jupiter et al, 2 cases were excellent, 2 cases were good and 1 case was fair. One patient and symptoms of radial nerve traction injury after operation and achieved complete recovery 3 months later; and 1 case suffering from ulnar neuritis before operation recovered 6 months after operation. No other compl ications occurred. Conclusion It is effective to use wedge-shaped supracondylar osteotomy of the distal aspect of the humerus and lateral colum reconstruction through internal fixation to treat the nonunion of the lateral humeral condyle fracture combined with cubitus valgus.
To investigate the method and cl inical effect of double-plating fixation in treatment of distal humerus fractures. Methods From April 2003 to January 2009, 21 patients with distal humerus fracture were treated with l imited contact compression plate and reconstruction plate via posterior elbow incision and approach inside and outside the edge of both sides of the triceps. There were 12 males and 9 females, aged from 20 to 63 years (39 years on average). The causes of injury were fall ing in 13 cases, traffic accident in 6 cases, and fall ing from height in 2 cases. According to the classification of Association for the Study of Internal Fixation (AO/ASIF), 8 cases were classified as type 12-B1, 2 as type 12-B2, 7 as type12-B3, 3 as type 13-A2, and 1 as type 13-A3. The course of disease averaged 4.8 days. Results Secretion was observed at incision in 1 case 2 weeks after operation, and incision healed after dressing change; other incisions healed by first intention. Transient numbness of ring and l ittle fingers occurred in 2 cases 2 days after operation; no iatrogenic nerve paralysis occurred. All patients were followed up 13 to 18 months (15 months on average). The X-ray films showed bone healed 6 months after operation. No postoperative joint adhesion occurred, and the motion of elbow joint ranged from 0° to 135°. According to Morrey evaluation standard, the results were excellent in 17 cases, good in 2 cases, and fair in 2 case; the excellent and good rate was 90.5%. Conclusion Double-plating fixation has the advantages of wide indications, rigid internal fixation, and significant curative effects in treatment of distal humerus fractures.
Objective To explore the technique and clinicaleffects of internal fixation of complicated distal femoral fractures using the supporting steel of AO femoral condyles.Methods From October 2001 to February 2004, 23 cases of complicated distal femoral fractures were treated with open reduction and internal fixation using the supporting steel of AO femoral condyles. Of 23 cases, there were 19 males and 4 females, aged 27-55 years. The locations were the right side in 10 cases and the left side in 13 cases. Fracture caused by traffic accident in 16 and by fall in 7, including 14 closed fracture and 9 open fracture, 21 fresh fracture and 2 old fracture. Accordingto AO classification, 6 cases were classified as type A extra-articular fracture and 17 cases as type C intra-articular fracture. The X-ay films before operation showed comminuted fracture of femoral intercondyles and femoral supracondyles. All cases received scientific and rational rehabilitative treatment postoperatively. Results The postoperative follow-up ranged from 6months to 20 months, 23 cases achieved fracture healing with an average healing period of 10.3 months (from 7 months to 16 months). According to the criteria of Kolmert and Wulff, the results were excellent in 16 cases, good in 4 cases, fair in 2 case andpoor in 1 case. The excellenct and good rate was 86.9%.Conclusion Internal fixation with the supporting steel of AO femoral condyles for treatment of complicated distal femoral fractures has advantages of reasonable design, convenient operation, firm fixation and reliable clinical outcome .
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 explore the clinical value of computer-assisted surgical planning in the treatment of ankle fractures.
MethodsBetween January 2012 and January 2014, open reduction and internal fixation were performed on 42 patients with ankle fractures. There were 22 males and 20 females with an average age of 52 years (range, 19-72 years). The causes were spraining injury (20 cases), traffic accident injury (14 cases), and falling from height injury (8 cases). The time from injury to operation was 5 hours to 12 days (mean, 2.5 days). All fractures were closed trimalleolar fractures. According to Lauge-Hansen classification, 25 cases were rated as supination extorsion type IV, 13 as pronation extorsion type IV, and 4 as pronation abduction type Ⅲ. The preoperative planning was made by virtual reduction and internal fixation using Superimage software.
ResultsThe mean operation time was 93.7 minutes (range, 76-120 minutes). Delayed wound healing occurred in 1 case, and secondary healing was obtained after treatment; primary healing of incision was achieved in the other patients. Postoperative X-ray films and CT images showed anatomic reduction of fracture and good position of internal fixation. All patients were followed up 14.6 months on average (range, 9-27 months). The range of motion of the affected ankle was close to the normal side at 6-8 weeks. The mean fracture healing time was 13.1 weeks (range, 11-17 weeks). Degenerative change of the ankle joint was observed in 3 cases (7.1%) with manifestation of mild narrowing of joint space on the X-ray films at last follow-up. According to Baird-Jackson score system, the results were excellent in 24 cases, good in 13 cases, and fair in 5 cases, with an excellent and good rate of 88%.
ConclusionComputer-assisted surgical planning for ankle fractures can help surgeons identify type of ankle fractures and improve surgical scheme for guiding fracture reduction and selecting and placing implants, so good effectiveness can be obtained.
Objective To study the clinical results of focal debridement and primary internal fixation with CD rod in treatment of multisegmental spinaltuberculosis.Methods From July 1999 to November 2002, 16 patients with multisegmental spinal tuberculosis were given focal debridement and primary internal fixation with CD rod trans sick vertebra. There were 9 males and 7 females, aging from 21 to 59 years. The course of disease was 2 to 11 months. The locations of lesion were T 6T 11 in 11 patients and T 10 -L2 in 5 patients.The involved vertebral bodies were 3 segments in 13 patients, 4 or more than 4 segments in 3 patients. There were 5 cases of Pott’s paralysis (according to Frankel classification system: 3 cases of degree C, 2 cases of degree D) and 4 cases of kyphosis and 2 cases of collapse. Focal debridement and internal fixation was performed in 1 or 2 incisions according to concrete conditions. Results All patients were followed up 11 months (6 months-3years), spinal tuberculosis was completely cured and the grafted bones were fused in all 16 patients. All patients obtainedprimary healing of the incision. Postoperative complication met with cerebrospinal fluid leakage in 1 case. After 6 months, 5 cases of paraplegia recovered. The kyphosis was corrected partly. No loose and dislocation of the nails and rods was found. Conclusion Focal debridement and primary internal fixation with CD rod can stabilize involved spinal segments, prevent and correct local deformity,and improve its curative ratio and fused ratio of grafted bone.
ObjectiveTo investigate the effectiveness of selective-partial hemivertebra resection and instrumentation via posterior approach only for congenital kyphoscoliosis.
MethodsBetween January 2008 and August 2011, 17 patients with congenital kyphoscoliosis were treated by selective-partial hemivertebra resection and instrumentation via posterior approach. There were 10 boys and 7 girls with the mean age of 10.8 years (range, 9-14 years). Of them, 15 cases had lumbar back pain, and 3 cases had lower limb numbness of nervous system damage symptoms. Risser sign was rated as grade 0 in 3 cases, grade 1 in 2 cases, grade 2 in 7 cases, and grade 3 in 5 cases. The classification of deformity was fully segmental hemivertebra. The deformity located at the thoracic segment in 9 cases, at the thoracolumbar segment in 4 cases, and at the lumbar segment in 4 cases. The Cobb angles of the main curves, segmental curves, and segmental kyphotic curves were measured at pre-operation, at 10 days after operation, and last follow-up to evaluate the correction effect.
ResultsThe 2-7 segments (mean, 3.7 segments) were fixed. The operation time was 4-6 hours (mean, 4.77 hours). The intraoperative bleeding was 300-1 100 mL (mean, 611.76 mL). All incisions healed by first intention, with no infection or complication of nervous system. All patients were followed up 6-37 months (mean, 20.12 months). Back pain and numbness of lower limbs were eliminated. X-ray films showed complete bone graft fusion at 6-18 months (mean, 12 months). At 10 days after operation and last follow-up, the Cobb angles of the main curves, segmental curves, and segmental kyphotic curves were significantly decreased compared with the preoperative angles (P<0.05); the Cobb angles of the main curves and segmental curves at last follow-up were significantly greater than those at 10 days after operation (P<0.05) except the segmental kyphotic curves angle (P>0.05). Postoperative correction rates of the Cobb angles of the segmental curve, the main curves, and segmental kyphotic curves were 64.35%±0.07%, 65.08%±0.07%, and 72.26%±0.11%, respectively; loss of correction was (3.04±1.17), (2.81±0.93), and (0.75±0.50)°, respectively.
ConclusionFor patients at the age of 9-14 years, with the Risser sign between grade 0-3, and with the Cobb angles less than 60°, the selective-partial hemivertebra resection and instrumentation via posterior approach can balance the growth on the two sides of the spine, and achieve satisfactory therapeutic effect through individualized treatment of extra growth center resection.
ObjectiveTo evaluate the clinical outcome of stellated plate fixation of olecranal avulsion fracture.
MethodsA retrospective analysis was made on the clinical data from 24 cases of olecranal avulsion fracture treated with stellated plate between April 2007 and April 2012. There were 13 males and 11 females, with an average age of 32 years (range, 18-65 years). The causes of injury included falling injury (14 cases), sports injury (7 cases), and machine injury (3 cases). The left elbow was involved in 4 cases and the right side in 20 cases. The average disease duration was 11 hours (range, 3 hours-2 days). According to Colton's classification criteria, all cases were classified as type Ⅱ A (avulsion fracture). One case had supracondylar humeral avulsion fracture, and 15 cases had triceps tendon tears.
ResultsAll the cases obtained healing of incision by first intention, without infection and ulnar nerve injury. The average follow-up period was 24 months (range, 18-48 months). All fractures healed after 6-10 weeks (mean, 7 weeks). According to Morrey's elbow performance score, the results were excellent in 17 cases, good in 4 cases, and fair in 3 cases, with an excellent and good rate of 87.5%. There was no significant difference in the elbow range of motion (ROM) between the injured side (136.0±16.2)° and normal side (143.1±2.9)° (t=2.007, P=0.052). The ROM of normal elbow was significantly larger than that of the injured side in 3 patients who achieved fair results (t=2.820, P=0.048), but no significant difference was found in patients who achieved excellent and good results (P>0.05).
ConclusionThe stellated plate has good clinical outcome in treatment of olecranal avulsion fracture, which has advantages of simple operation, firm fixation, and early functional exercise.
