Objective To compare the curative effect of posterior lumbar interbody fusion with autologous il iac crest to that of interbody fusion cage for adult instabil ity of lower lumbar. Methods From February 2003 to October 2006,60 inpatients with lower lumbar instabil ity were treated. Patients were randomized into 2 groups: bone-graft group (n=28) was treated with posterior lumbar interbody fusion with two autologous il iac crests, while cage group (n=32) was treated with posterior lumbar interbody fusion with two quadrate cages. In the bone-graft group, 17 males and 11 females aged (52.78 ± 10.50) years with 3-16 months of disease course, there were 12 cases of degenerative instabil ity, 14 isthmus sl it ol isthe and 2 iatrogenic instabil ity, including 1 case of L3,4, 17 cases of L4,5 and 10 cases of L5, S1. Relative disc space height was (23.24 ± 6.62) mm, disc space activity was (10.50 ± 5.07)º, sagittal saw sl ippage distance was (4.50 ± 1.15) mm and the JOA score was 18.56 ± 2.68. In the cage group, 19 males and 13 females aged (51.75 ± 10.44) years with 3.5-14.0 months of disease course, there were 16 cases of degenerative instabil ity, 14 isthmus sl it ol isthe and 2 iatrogenic instabil ity, including 16 cases of L4,5 and 16 cases of L5, S1. Relative disc space height was (24.34 ± 7.22) mm, disc space activity was (11.12 ± 5.67)º, sagittal saw sl ippage distance was (4.38 ± 0.75) mm and the JOA score was 19.00 ± 4.12. There was no significant difference between the two groups in termsof age, gender, JOA score, disc space activity and relative disc space height preoperatively (P gt; 0.05). Results All patients received the follow-up at the 1st, 3rd, 6th and 12th month postoperatively. There was no significant difference in operation time and hemorrhage amount between the two groups (P gt; 0.05), but significant difference in the cost of operation (P lt; 0.01). Two cases in the bone-graft group suffered donor site pain and received no treatment. Three cases in the bone-graft group and 2 cases in the cage group had symptom of nerve injury 1-2 days after surgery, which were cured after expectant treatment. There were no pseudoarticulation formation, intervertebral space infection and cage aversion in both groups. Significant difference of relative disc space height was found in each group pre- and post- operatively (P lt; 0.01) and significant differences were evident between the two groups at any of the time points (P lt; 0.01). One month after operation, there was significant difference between the two groups (P lt; 0.05). There was also significant difference at the 3rd, 6th and 12th month after operation (P lt; 0.01). No sign offusion was found in each group at the 1st and 3rd month after operation. In bone-graft group, there were 7 vertebral fusion cases 6 months after operation and 23 vertebral fusion cases 12 months after operation. In cage group, there were 8 vertebral fusion cases 6 months after operation and 29 vertebral fusion cases 12 months after operation. There was no significant difference in the rate of fusion at 6 and 12 months follow-up between the two groups (P gt; 0.05). Significant difference of JOA scores was found in each group pre- and post- operatively (P lt; 0.05). And no significant difference in JOA scores at 1, 3, 6, and 12 months follow-up was evident between the two groups (P gt; 0.05). Conclusion There is no significant difference between the two groups in the fusion time, the fusion rate and the cl inical symptoms alleviation, indicating autologous il iac crest is appl icable to interbody fusion for the treatment of adult instabil ity of lower lumbar and good therapeutic effect can be achieved with no immunoreaction and lower cost.
目的:探讨经后路椎弓根钉棒系统内固定治疗胸腰椎骨折的临床疗效。方法: 对本组35例胸腰椎骨折行后路椎弓根钉棒系统内固定,其中20例行术中后路减压, 8例经椎弓根行病椎植骨。35例均行关节突及横突间植骨。并测量术前、术后伤椎前后缘平均高度(百分比)和Cobb’s角,椎管截面积.结果: 术后伤椎前后缘平均高度(百分比)和Cobb’s角,椎管截面积各项指标与术前相比较,差异有显著性 (Plt;0.01)。术后随访9~21个月,平均13.2个月。无一例出现神经症状加重,2例出现内固定断裂并完整取出。结论: 经后路椎弓根钉棒系统内固定治疗胸腰椎骨折疗效确切,是治疗胸腰椎骨折的一种创伤小,操作简单,固定可靠的手术方法。
Objective To compare the effectiveness of talonavicular-cuneiform joint fusion with iliac bone grafting and without bone grafting in the treatment of Müller-Weiss diseases (MWD). Methods The clinical data of 44 patients (44 feet) with MWD who received talonavicular-cuneiform joint fusion between January 2017 and November 2022 and met the selection criteria was retrospectively analyzed. Among them, 25 patients were treated with structural iliac bone grafting (bone grafting group) and 19 patients without bone grafting (non-bone grafting group). There was no significant difference (P>0.05) in age, gender composition, body mass index, disease duration, affected side, Maceira stage, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score, anteroposterior/lateral Meary angle, and Pitch angle between the two groups. Operation time, operation cost, and postoperative complications were recorded in the two groups. AOFAS and VAS scores were used to evaluate the function and pain degree of the affected foot. Meary angle and Pitch angle were measured on the X-ray film, and the joint fusion was observed after operation. The difference (change value) of the above indexes before and after operation was calculated for comparison between groups to evaluate the difference in effectiveness. Results The operation was successfully completed in both groups, and the incisions in the two groups healed by first intention. The operation time and cost in the bone grafting group were significantly more than those in the non-bone grafting group (P<0.05). All patients were followed up. The median follow-up time was 41.0 months (range, 16-77 months) in the non-bone grafting group and 40.0 months (range, 16-80 months) in the bone grafting group. There was skin numbness of the medial dorsalis of the foot in 1 case, internal fixation stimulation in 2 cases, and pain at the iliac bone harvesting area in 1 case of the bone grafting group. There was skin numbness of the medial dorsalis of the foot in 1 case and muscle atrophy of the lower limb in 1 case of the non-bone grafting group. There was no significant difference in the incidence of complications between the two groups (P>0.05). At last follow-up, the AOFAS scores of the two groups significantly improved when compared with those before operation, while the VAS scores significantly decreased, the anteroposterior/lateral Meary angle and Pitch angle significantly improved, and the differences were significant (P<0.05). There was no significant difference in the change values of outcome indicators between the two groups (P>0.05). There was no delayed bone union or bone nonunion in both groups, and joint fusion was achieved at last follow-up. Conclusion In the treatment of MWD, there is no significant difference in effectiveness and imaging improvement of talonavicular-cuneiform joint fusion combined with or without bone grafting. However, non-bone grafting can shorten the operation time, reduce the cost, and may avoid the complications of bone donor site.
To explore the treatment of multi-segmental lumbar disc herniation and spinal canal stenosis by laminectomy, removal of nucleus pulposus, fusion of intra-transverse process and general spine system(GSS) fixation. Methods From January 2004 to January 2006, 21 patients with multi-segmental lumbar disc herniation and spinal canal stenosis were treated by laminectomy, removal of nucleus pulposus and GSS pedicle screw spinal system. There were 14 males and 7 females with an average age of 53 years ranging from 46 to 61 years, and with an average disease course of 18 months ranging from 8 months to 15 years. All of the patients were examined by X-ray with AP position, lateral position and dynamic lateral position, CT and MRI, and all of them proved to be with multi-segmental lumbar disc herniation and different degrees of spinal canal stenosis. A total of 47 nucleuses were picked out, and 47 instable segments were filled in with granule selfbone. Results There were 21 patients who were followed up for 1 to 2 years with an average of 13 months. All patients achieved successful fusion and bony union postoperative from 8 to 12 months, and no artificial joint was formed. As to the cl inical results in 21 cases, according to the Macnab outcome criteria, 14 were excellent, 6 were good and 1 was poor, the excellent and good rate was 95.2%. Conclusion The methods of laminectomy, removal of nucleus pulposus, fusion of intra-transverse process and GSS system fixation are effective in treatment of multi-segmental lumbar disc herniation and spinal canal stenosis．
OBJECTIVE To explore a simple and effective method for the treatment of ischemic necrosis of femoral head. METHODS The anterior region of hip joint was exposed by anterior hip route, a 1.5 cm x 1.0 cm hole was made at the upper region of the femoral neck just below the head. The necrotic bone and sclerotic bone were completely cleaned by drill and curettage until the fresh cancellous bone was exposed. After irrigation, the bone cavity was filled tightly by iliac bone graft until the collapsed femoral head recovered its normal shape. Traction and continuous passive motion(CPM) were performed at the early stage after operation. RESULTS Twenty cases with 29 femoral head ischemic necrosis (Marcus III to IV stage) were treated by above methods. After 1 to 3 years follow-up, the results were all satisfactory. The pain disappeared, and the functions of the hip joint were all excellent with almost normal walking and squatting. CONCLUSION The necrotic bone and the sclerotic bone can be removed by this method, thus optimal conditions for the reconstruction of blood supply is obtained. Abundant cancellous bone graft in the residual bone cavity can support the round shape of the femoral head. CPM is very important in the repair of hyaline cartilage and prevention of joint stiffness. It is a simple and effective method in treating femoral head ischemic necrosis.
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 find an effective method of surgical treatment of fibrous dysplasia of bone involving the proximal femur. Methods From January 2001 to January 2006, 57 patients with fibrous dysplasia of bone involving the proximal femur were treated. There were 29 males and 28 females, aging 8-50 years (mean 22 years). Thirty-five patients wereinvolved one bone and 22 patients were involved more than two bones. According to Guille’s classification, there were 34 cases of type A, 8 cases of type B, 8 cases of type C and 7 cases of type D. Fourteen cases compl icated by coax varus and the neck-shaft angle of femur was 78° on average (55-100°). The duration of the disease was 2.3 years on average (4 months to 10 years). The choice of the various operative procedures depended on the qual ity of the bone and the extent of the lesion. When the qual ity of the bone was good, then curettage and bone-grafting was performed. When the qual ity of the bone was poor, curettage and bone-grafting combined with internal fixation was performed. Medial displacement valgus or valgus osteotomies were used to treat fibrous dysplasia of bone involving the proximal part of the femur with coax varus. Results All patients were followed up for 6 months to 5 years with an average of 2.8 years. All bone graft were absorbed sl ightly at 3 months and markedly at 10 to 14 months postoperatively. The femoral mechanical al ignments were corrected completely radiologically in patients compl icated by coax varus; the average neck-shaft angle was corrected from 78° (55-100°) preoperatively to 122° (95-130°) postoperatively. The relative length of femur was increased 1.8-3.6 cm (mean 2.7 cm). After operation, 49 patients could walk without support, 5 with claudication, 3 ambulated with the aid of unilateral cane. Pain disappeared in 52 patients and pain was improved in 5 patients. No infections and recurrent fracture and progression of the deformity occurred in all patients. Conclusion Impactionallograft is the key of prompting allograft incorporating fully and preventing pathological fracture. An effective internal fixation must be used when the qual ity of the bone is poor. Medial displacement valgus or varus osteotomies can correct varus deformity, improve function, as well as restore biomechanical axis of femur. It is also able to effectively eradicate lesions and prevent recurrence.
Objective To observe the effect of biological fixation of femoral stem prosthesis with multilayer macropores coating by combined use of autologousbone grafting. Methods The reconstructing femoral stem prostheses were designed personally, proximal 2/3 surfaces of which were reformed by thick multilayer stereo pore structure. Twentyfour adult mongrel canines underwent right femoralhead replacement and were divided randomly into two groups. The autogenous bonemud of femoral head and neck were not used in the control group. The histologicexamination, roentgenograms and biomechanical test were carried out in the 1st,3rd and 6th month after operation to observe the bone formation and fixation inthe exterior and interior sides of the prostheses. Results Onthe whole view,bone reconstruction occurred in experimental group in the 3rd and 6th month. Roentgenograms also proved to be superior to the control group. Histological examinationshowed that both the maximum bone inserting depth（μm） and average engorging ratio(%) of newly formed bone in experimental group surpassed those in the control group. The maximum shear strength of prosthesisbone interface in experimental group was significantly higher than that in the control group（Plt;0.01）. Conclusion Intensity of biological fixation can be strengthened remarkably by using femoral stem prothesis with multilayer macropores coating by combined use of autologous bone grafting.