Objective To assess the outcomes of pedicle subtration osteotomy and short-segment pedicle screw internal fixation in kyphosisdeformity. Methods From June 2001 to November 2003, 16 cases of kyphosis deformity were treated with pedicle subtration osteotomy and short-segment pedicle screw internal fixation, including 11 males and 5 females and aging 24-51 years. The kyphosis deformity was caused by ankylosing spondylitis in 12 cases, old lumbothoracic fracturedislocation in 2 cases, and vertebral dysplasia in 2 cases. The disease course was 7-25 years with an average of 12.8years. The whole spine radiographs were taken pre-and postoperatively. The sagittal balance was assessed by measuring thoracic kyphosis angle, lumbar lordosis angle, acrohorizontal angle and distance between posterosuperior point of S1and the vertical line. The clinical outcomes were assessed by Bridwell-Dewald scale for spinal disorders. Results The mean follow-up period was25.6 months. The mean bleeding was 1 100 ml. Satisfactory bone graft healing was achieved at final follow-up. Complications were paralytic intestinal obstruction in 1 case, dura laceration in 1 case, and temporary lower limb paralysis in 2 cases. Final follow-up radiograph showed an increase in lumbar lordosis angle from 9.6±16.4° to 42.6±14.3°(P＜0.05), whereas thoracic kyphosis angle remained relative stable. The distance between posterosuperior point of S1 and the vertical line was decreased from 97.5±45.6 mm to 10.7±9.6 mm(P＜0.05). Satisfactory clinical outcome was achieved by evaluating the changes of pain, social and working status. Conclusion Pedicle subtraction osteotomy and short-segment pedicle screw internal fixation is effective for correction of kyphosis deformity.
ObjectiveTo explore the efficacy of percutaneous pedicle screw internal fixation and minimally invasive lateral small incisions lesion debridement and bone graft fusion via dilated channels in the treatment of lumbar tuberculosis.MethodsThe clinical data of 22 cases of lumbar tuberculosis treated with percutaneous pedicle screw internal fixation combined with dilated channels with minimally invasive lateral small incision lesion debridement and bone graft fusion between January 2016 and June 2018 were retrospectively analyzed. There were 12 males and 10 females, with an average age of 47.5 years (range, 22-75 years). The affected segments were L2, 3 in 5 cases, L3, 4 in 8 cases, and L4, 5 in 9 cases, with an average disease duration of 8.6 months (range, 4-14 months). Preoperative neurological function was classified according to the American Spinal Injury Association (ASIA), with 3 cases of grade C, 9 cases of grade D, and 10 cases of grade E. The operation time, intraoperative blood loss, and postoperative complications were recorded. At preoperation, 3 months after operation, and last follow-up, the C reactive protein (CRP) and erythrocyte sedimen- tation rate (ESR) were tested to evaluate tuberculosis control; the pain visual analogue scale (VAS) score was used to evaluate the recovery of pain, and the Oswestry disability index (ODI) was used to evaluate the function recovery of the patient’s lower back; the kyphosis Cobb angle was measured, and the loss of Cobb angle (the difference between the Cobb angle at last follow-up and 3 months after operation) was calculated. At last follow-up, the ASIA classification was used to evaluate the recovery of neurological function, and the effectiveness was evaluated according to the modified MacNab standard.ResultsThe operation time was 110-148 minutes (mean, 132.8 minutes) and the intraoperative blood loss was 70-110 mL (mean, 89.9 mL). Two patients experienced fat liquefaction of the incision and delayed healing; the incisions of the remaining patients healed by first intention. All patients were followed up 18-24 months, with an average of 21.3 months. All bone grafts achieved osseous fusion, the pedicle screws were fixed in reliable positions, without loosening, displacement, or broken rods. There was no recurrence of tuberculosis. The ESR, CRP, VAS scores, ODI scores, and kyphosis Cobb angle of the affected segment at 3 months after operation and last follow-up were significantly improved (P<0.05); there were no significant differences between at last follow-up and 3 months after operation (P>0.05), and the loss of Cobb angle was (0.6±0.5)°. The patient’s neurological function recovered significantly. At last follow-up, the ASIA grades were classified into 1 case with grade C, 1 case with grade D, and 20 cases with grade E, which were significantly improved when compared with preoperative grading (Z=−3.066, P=0.002). According to the modified MacNab standard, 16 cases were excellent, 3 cases were good, 2 cases were fair, and 1 case was poor. The excellent and good rate was 86.4%.ConclusionPercutaneous pedicle screw internal fixation combined with dilated channels with minimally invasive lateral small incisions lesion debridement and bone graft fusion has the advantages of less bleeding, less trauma, and faster recovery, which is safe and effective in the treatment of lumbar tuberculosis.
ObjectiveTo evaluate the clinical efficacy of domestic minimally-invasive percutaneous screw system for thoracolumbar fractures without neurological damage. MethodsSixty patients suffering from unstable thoracolumbar fractures without obvious neurologic deficits treated from January 2011 to April 2012 were studied retrospectively. The patients were divided into two groups:group A (domestic minimally-invasive percutaneous screw system) and group B (imported minimally-invasive percutaneous screw system). Perioperative parameter, pre-and post-operative imaging indexes, visual analog scale (VAS) and modified MacNab evaluation standard were studied for comparison. ResultsAll the patients were followed up from 6 to 18 months with an average of (12.2±3.0) months. The Cobb's angle and anterior height of the fracture vertebral body changed significantly in each group (P<0.05). There was no significant difference in incision size, surgical time, postoperative improvement of Cobb's angle, anterior height of the fracture vertebral body and accuracy of pedicle screw placement between the two groups (P>0.05). ConclusionDomestic minimally-invasive percutaneous screw system is reliable with minimal invasion, which is comparable to imported minimally-invasive percutaneous screw system.
目的 探讨经伤椎椎弓根螺钉内固定治疗胸腰椎骨折的临床疗效。 方法 2008年5月－2010年12月，选择38例胸腰椎骨折患者，采用椎弓根螺钉固定伤椎及相邻上下椎体。其中男28例，女10例；年龄21～65岁，平均36.5岁。骨折部位：胸8 1例，胸9 2例，胸10 4例，胸11 8例，胸12 7例，腰1 10例，腰2 4例，腰3 2例。受伤至手术时间3～7 d，平均4.5 d。对患者手术前后椎体高度、矢状面后凸Cobb角、神经功能Frankel分级变化等指标进行测量并随访。 结果 术后患者切口均Ⅰ期愈合。38例获随访12～18个月，平均15个月。骨折均获得骨性融合，无钉棒断裂、无死亡或神经损伤加重患者。术后神经功能Frankel分级较术前有明显改善（P＜0.05）。术后X线片复查示伤椎高度恢复达90%以上，外形正常；CT复查示椎管内有效矢状径恢复满意，椎管前方无明显骨性压迫，伤椎椎体骨愈合良好。术后1、12个月时伤椎前、后缘高度及后凸Cobb角均较术前显著改善（P＜0.05）；术后12个月随访椎体高度无丢失。 结论 经伤椎椎弓根钉复位、减压、内固定治疗胸腰椎骨折具有创伤小、固定节段少、脊柱稳定性好、能有效矫正及预防脊柱后凸畸形等优点。
ObjectiveTo explore the feasibility and effectiveness of unilateral pedicle screw rod and single poly (ether-ether-ketone) (PEEK) Cage for lumbar intervertebral disc protrusion. MethodsA total of 126 cases of single segment of lumbar intervertebral disc protrusion between January 2006 and June 2012 were divided into 2 groups in the randomized clinical trial. Unilateral pedicle screw fixation and single PEEK Cage was used in 63 cases (research group), and bilateral pedicle screw fixation and single PEEK Cage in 63 cases (control group). There was no significant difference in gender, age, disease duration, side, and affected segment between 2 groups (P>0.05). Schulte evaluation criterion was used to assess bone graft fusion, Oswestry disability index (ODI) to estimate the quality of life situation, and visual analogue scale (VAS) to evaluate the improvements of lower back pain. Macnab standards was applied to assess postoperative effectiveness, and Emery ways to measure the height of intervertebral space. ResultsThe incision length, operation time, intraoperative blood loss, hospitalization time, and hospitalization fee in research group were significantly less than those in control group (P<0.05). The patients were followed up 12-79 months (mean, 21.3 months) in research group, and 15-73 months (mean, 22.6 months) in control group. The postoperative lordosis was recovered well, and the height of intervertebral space was increased. No loosening or breakage of internal fixation occurred. The time of bone graft fusion was (6.8±1.3) months in research group and was (7.1±1.2) months in control group, showing no significant difference (t=1.153, P=0.110). The height of intervertebral space, ODI score, and VAS score were significantly improved when compared with preoperative ones in 2 groups (P<0.05), but no significant difference was found between 2 groups at preoperation and last follow-up (P>0.05). At 3 months after operation, postoperative effectiveness was assessed according to Macnab criterion, the excellent and good rate was 95.23% in research group (excellent in 13 cases, good in 47 cases, and fair in 3 cases) and was 71.42% in control group (excellent in 7 cases, good in 38 cases, fair in 15 cases, and poor in 3 cases); the research group was significantly superior to control group (χ2=6.110, P=0.006). ConclusionUnilateral pedicle screw fixation and single PEEK Cage has the advantages of small trauma, reliable fixation, shorter operation time, less bleeding, less economic cost, and early off-bed activity time. It can provide a simple and reliable choice in single segmental lumbar intervertebral disc protrusion.
OBJECTIVE: To review the anatomic character of lower cervical pedicle, the placement and the biomechanical stability of the cervical pedicle screw fixation, the clinical application and the complication caused by fixation. METHODS: The literature concerned the cervical pedicle screw fixation in recent years were extensively reviewed. RESULTS: The cervical pedicle screw fixation can be widely used in the lower cervical spine instability according to the anatomic character of lower cervical pedicle, and the good biomechanical stability of the cervical pedicle screw fixation, and the complication can be controlled. CONCLUSION: The cervical pedicle screw fixation is an effective internal fixation for the lower cervical spine instability.
Objective To review the progress of the pedicle screw augmentation technique by bone cement. Methods Recent literature about the pedicle screw augmentation technique by bone cement was reviewed and analysed. The characters were summarized. Results Pedicle augmentation technique includes the augmentation of ordinary solid pedicle screw and hollow pedicle screw. Both types could increase the fixation strength and gain satisfactory clinical results. Bone cement leakage had a certain incidence rate, but most of cases were asymptom. Conclusion Bone cement augmentation of pedicle screw is an effective and safe internal fixation for poor bone condition.
【摘要】 目的 探讨胸腰椎椎弓根钉内固定并发症原因及预防措施。 方法 回顾性分析2006年12月-2010年12月行胸腰椎经椎弓根钉内固定治疗失败的21例患者临床资料。手术均采用经椎弓根钉内固定。误入椎管或穿出椎弓根外壁4例，螺钉断裂4例，定位失误3例；术后1~23个月内固定松动9例，其中术后1~2个月第1次X线片检查发现松动3例，术后1~3个月内固定松动并感染2例；误诊1例（腰椎肿瘤、病理性骨折诊断为骨质疏松骨折）。19例再次手术。 结果 21例均获随访，随访时间3~34个月，平均18.5个月。12例重新固定、植骨融合患者内固定位置良好，未发现内固定松动、断裂或脱出，植骨获得骨性愈合。8例内固定物取出，5例无腰、背部疼痛，腰部活动正常，3例述偶感腰、背部不适，腰部活动尚好，1例感腰、背部疼痛，影响日常活动。1例死亡。 结论 椎弓根螺钉内固定并发症多方面因素引起的，应充分认识，有效的骨折节段融合、术中仔细操作、预防感染、正确的康复锻炼等，可有效减少胸腰椎椎弓根内固定失败。【Abstract】 Objective To discuss the reasons and preventive measures for complications of thoracolumbar pedicle screw fixation. Methods Retrospective analysis of thoracolumbar pedicle screw fixation failure in 21 cases between December 2006 and December 2010 was carried out in this study. The pedicle screw fixation was used in all operations. Straying into the spinal canal or piercing the outer wall of the pedicle during operations happened in 4 cases, screw breakage in 4 cases, and positioning error in 3 cases. Internal fixation was loosened 1 to 23 months after operation in 9 cases, among which 3 were detected at the first X-ray examination 1 to 2 months after operation, 2 were found with infections 1 to 3 months after operation, and 1 was misdiagnosed (spinal tumor with pathological fracture misdiagnosed as osteoporotic fractures). Reoperation was performed for 19 cases. Results All the patients were followed up for 3 to 34 months with an average time of 18.5 months. In the 12 patients who had undergone refixation, the location of the internal fixation was good without loosening, breakage or extrusion, and the grafts obtained bone healing. Internal fixation was removed in 8 patients, among whom 5 had no pain in the waist or back with normal waist activity, and 3 described waist and back discomfort occasionally with fair lumbar activity. One patient felt waist and back pain affecting daily activities. And one patient died. Conclusions Pedicle screw fixation complications are caused by various factors. Fully understanding of the effective integration of the fracture segments, careful intraoperative management, infection prevention, and proper rehabilitation exercises can effectively reduce the thoracic and lumbar pedicle screw failure.
ObjectiveTo investigate the effectiveness of cervical pedicle screw implantation technique under regional method.MethodsThe clinical data of 85 patients who met the selection criteria between April 2010 and May 2018 were retrospectively analyzed. There were 57 males and 28 females, aged 35-68 years, with an average of 57.6 years. Among them, there were 10 cases of ossification of posterior longitudinal ligament, 68 cases of cervical spondylosis with multilevel stenosis, 3 cases of cervical tumor, 1 case of congenital malformation, and 3 cases of cervical trauma; the lower cervical spine lesions involved C3-C7. Preoperative Frankel spinal cord injury grading: 2 cases of grade C, 51 cases of grade D, and 32 cases of grade E. Cervical pedicle screw implantation technique under regional method was performed with a total of 618 pedicle screws. Postoperative changes in neurological symptoms were observed; cervical mouth opening anteroposterior and lateral X-ray films and cervical CT examinations were performed to evaluate the pedicle screws position.ResultsThe operation time was 2.5-4.0 hours, with an average of 3.0 hours. The intraoperative blood loss was 180-550 mL, with an average of 345 mL. No intraoperative vascular or nerve injury occurred. The patients with neurological symptoms were relieved to varying degrees. There were 2 cases of superficial incision infection after operation, the wound healed after enhanced dressing change. The postoperative hospital stay was 5-14 days, with an average of 8.4 days. At discharge, Frankel neurological grading was grade D in 26 patients and grade E in 59 patients. All the patients were followed up 6-24 months, with an average of 13 months. At last follow-up, cervical X-ray films showed the good pedicle screw fixation without loosening. Cervical CT evaluated the position of pedicle screws: 523 pedicle screws (84.7%) in grade Ⅰ, 80 (12.9%) in grade Ⅱ, and 15 (2.4%) in grade Ⅲ; the accuracy rate of the screw position was 97.6%.ConclusionCervical pedicle screw implantation technique under regional method can significantly improve the success rate of screw implantation. It is easy to operate, does not destroy the bone cortex, and has stable fixation.
ObjectiveTo investigate reliability and short-term effectiveness of axis laminar screws for reducible atlantoaxial dislocation (RAAD).MethodsA clinical data of 41 patients with RAAD who were admitted between February 2013 and February 2018 and met the inclusion criteria was retrospectively analyzed. The atlases in all patients were fixated by lateral mass screws, and the axes were fixed by laminar screws in 13 cases (LS group) and by pedicle screws in 28 cases (PS group). There was no significant difference in gender, age, and preoperative Japanese Orthopedic Association (JOA) score between the two groups (P>0.05). The effectiveness was estimated by post-operative JOA score; and the accuracy of the axis screw, atlantoaxial bone graft fusion, and the fixation stability were examined by X-ray film and CT.ResultsAll incisions healed by first intention. All patients were followed up 12-17 months (mean, 13.8 months) in LS group and 12-20 months (mean 14.1 months) in PS group, and the difference in follow-up time was not significant (Z=−0.704, P=0.482). At last follow-up, JOA scores were 13.9±1.6 in LS group and 14.3±1.8 in PS group, which significantly improved when compared with the pre-operative scores in the two groups (t=−9.033, P=0.000; t=−15.835, P=0.000); while no significant difference was found between the two groups (t=−0.630, P=0.532). Twenty-five screws of 26 screws in LS group and 54 screws of 56 screws in PS group were implanted accurately, with no significant difference in the accuracy of the axis screw between the two groups (Z=−0.061, P=0.951). All patients obtained atlantoaxial bone graft fusion, except 1 case in PS group. There was no significant difference in the atlantoaxial bone graft fusion between the two groups (Z=−0.681, P=0.496).ConclusionFor RAAD, Axis laminar screws can maintain the atlantoaxial primary stability and had a good short-term effectiveness. So, it could be an alternative and reliable technique for axis screw.