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.
ObjectiveTo review the research progress on intra-articular screw penetration in proximal humeral fracture treated with locking plate. MethodsThe domestic and foreign literature about the proximal humeral fracture treated with locking plate was extensively reviewed. The incidence of screw penetration and risk factors were summarized from both primary and secondary screw penetrations, and the reasons of the intra-articular screw penetration and the technical solutions to avoid the penetration were analyzed. ResultsThe incidence of intra-articular screw penetration is about 11%-30%, which includes primary and secondary screw penetrations. The primary screw penetration is related to improper operation, inaccurate measurement, and “Steinmetz solid” effect, which results in inadequate fluoroscopy and blind zone. The secondary screw penetration is related to the loss of reduction and varus, collapse, and necrosis of the humeral head. The risk factors for intra-articular screw penetration include the bone mass density, the fracture type, the quality of fracture reduction, the applied location, number, and length of the plate and screws, and whether medial column buttress is restored. Improved fracture reduction, understanding the geometric distribution of screws, good intraoperative fluoroscopy, and reconstruction of medial column buttress stability are the key points for success. ConclusionThe risk of the intra-articular screw penetration in the proximal humeral fractures treated with locking plates is still high. Follow-up studies need to further clarify the cause and mechanism of screw penetration, and the risk factors that lead to screw penetration, in order to effectively prevent the occurrence of this complication.
ObjectiveTo introduce a medical metal debris adsorption apparatus and to discuss the application value in removal of locking plate internal fixation. MethodsBetween January 2011 and May 2013, 83 cases underwent removal of locking plate fixation. There were 44 males and 39 females, aged 21-59 years (mean, 35.4 years). The time from the first operation to internal fixation removal was 16-40 months (mean, 22.6 months). Thirty-two screws of 9 patients were removed difficultly due to slide fastener. The screws were removed eventually after plates and screws were separated by grinding locking screw with manganese steel drill. In the process of grinding, the medical metal debris adsorption apparatus was used in 16 screws of 4 patients (group A), and was not used in 16 screws of 5 patients (group B). The operation time, removal time of single slipping screw, intraoperative blood loss, and the score of metal debris residues were compared between 2 groups. And the postoperative complications were recorded. ResultsA total of 658 screws were removed, and 32 slipping screws were found, accounting for 4.86%. The lock screw slipping rates of 3.5 mm and 4.5 or 5.0 mm respectively were 6.53% and 2.31%; and the lock screw slip ping rates of internal fixation time < 2 years and > 2 years respectively were 3.21% and 6.08%. The operation time, removal time of single slipping screw, intraoperative blood loss, and the score of metal debris residues of group A were significantly lower than those of group B (P < 0.05). Re-fracture (1 case) and incision infection (1 case) occurred in group B, and no complication was observed in group A. The cases of 2 groups were followed up 8-35 months (mean, 23.4 months). No heterotopic ossification occurred in both groups during the follow-up. ConclusionThe medical metal debris adsorption apparatus can significantly shorten the operation time, reduce the residual metal debris and surgical bleeding when removing the slipping screws in removal of locking plate internal fixation.
Objective To compare the curative effect of dynamic hi p screw (DHS) combined with anti-rotation screw and cannulated screw in treating patients with Pauwels type II or III femoral neck fracture and to provide the basis for the choice of surgical procedure. Methods Between March 2008 and September 2009, 51 patients with fresh Pauwels type II or III femoral neck fracture were treated with DHS combined with anti-rotation screw (DHS group) and three cannulated screws (cannulated screw group). The DHS group included 23 patients, 13 males and 10 females, aging 27-59 years (mean, 43.2 years); fracture was caused by fall ing in 1 case, by traffic accident in 17, by fall ing from height in 5 with a mean time of 27 hoursfrom injury to hospital ization (range, 12-70 hours); and 23 fractures included 9 Pauwels type II and 14 Pauwels type III femoral neck fracture. The cannulated screw group included 28 patients, 12 males and 16 females, aging 20-60 years (mean, 40.7 years); fracture was caused by fall ing in 1 case, by traffic accident in 22, by fall ing from height in 5 with a mean time of 25 hours from injury to hospital ization (range, 9-38 hours); and 28 fractures included 12 Pauwels type II and 16 Pauwels type III femoral neck fracture. There was no significant difference in the basel ine characteristics between 2 groups (P gt; 0.05). Results The incision heal ing of both groups by first intention was achieved. There were significant differences in operation time, incision size, operation blood loss, the cases of blood transfusion, the amount of blood transfusion, C reaction protein level on the 2nd postoperative day, and hospital ization days between 2 groups (P lt; 0.05). In DHS group, anatomic reduction was observed in 20 cases (86.96%) and satisfactory reduction in 3 cases (13.04%), while in cannulated screw group, anatomic reduction was observed in 25 cases (89.29%) and satisfactory reduction in 3 cases (10.71%) ; there was no significant difference (χ2=0.660, P=1.000). The patients were followed up 12-30 months with an average of 14.8 months. There was no significant difference (P gt; 0.05) in the rate of nonunion (10.71% vs. 0), the implant failure (3.57% vs. 0), and avascular necrosis of the femoral head (10.71% vs. 0) between the DHS group and the cannulated screw group. The union time was (94.5 ± 2.0) days in the DHS group and (106.0 ± 33.5) days in the cannulated screw group, showing no significant difference (t=—1.641, P=0.107). The re-opereation rates and the overall success rates were 25% and 75% in the cannulated group and were 0 and 100% in the DHS group, showing significant differences (χ2=6.650, P=0.012). At last follow-up, there was no significant difference in Harris hip score and visualanalogue scale (VAS) score between DHS group and cannulated screw group (P gt; 0.05). Conclusion The optimal treatment of young adults Pauwels type II or III femoral neck fracture is DHS combined with anti-rotation screw with an high overall success and less compl ications.
Objective To evaluate the clinical effect of cannulatedscrew on treatment of femoral neck fracture(FNF). Methods Forty-two FNFpatients were treated by using cannulated screw from January 2001 to December 2005.There were 22males and 20 females with an average age of 41 years (19-59 years). Fracture was caused by traffic accident in 21 cases, by falling from height in 14 cases and by bruise in 7 cases. All cases were fresh fracture. According to Garden criterion for typing, 15 cases were classified as type Ⅱ, 16 cases as type Ⅲ and 11 cases as type Ⅳ . It was 7 hours to 15 days from injury to operation. Results Thepatients were followed up for 1-6 years with an average of 2.5 years. The average fracture union time was 6.5 months. Three patients had ischemic necrosis of femoral head, andloosening and breakage of screw and rob was observed in 1 case. According to Brumback criterion for hip joint function, the result was excellent in 18 cases, good in 20 cases and bad in 4 cases, and the excellent and good rate was 90.4%. Conclusion Cannulated screw fixation is a good method to treat FNF in young adults. It can improve the rate of fracture union and reduce the rate of avascular necrosis of femoral head.
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 investigate the effectiveness of open reduction by mini incision and absorbable screw internal fixation for the treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture. MethodsBetween January 2006 and July 2012, 90 patients (90 knees) with ACL tibial eminence avulsion fracture were treated. There were 58 males and 32 females, aged from 10 to 58 years with an average of 33.7 years. The causes of injury were traffic accident injury in 60 cases, sports injury in 22 cases, and falling injury in 8 cases. The disease duration was 1-365 days with a median of 106 days. Combined injuries included 14 cases of meniscus injury, 5 cases of medial collateral ligament injury, and 3 cases of avulsion fracture of the anterior horn of the lateral meniscus. All patients underwent open reduction by mini incision and internal fixation with absorbable screw. Postoperative rehabilitation exercise was performed. ResultsTwo patients had delayed healing of incision, and others obtained primary healing. All the patients were followed up 6-72 months (mean, 40.1 months). X-ray examination showed that bone union was achieved in all patients at 3-12 months after operation; nail tail came off in 7 cases at 4-13 months after operation, and the nail tail was taken out under arthroscopy. At 6-12 months after operation, the range of motion (ROM), Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) score were significantly increased when compared with preoperative ones (P < 0.05). ConclusionA combination of open reduction by mini incision and absorbable screw internal fixation for the treatment of ACL tibial eminence avulsion fracture has the advantages of easy operation, firm fixation, and satisfactory functional rehabilitation, so it is a safe and effective method for the treatment of ACL tibial eminence avulsion fracture.
Objective To evaluate the accuracy of pedicle guide device for the placement of the pedicle screws. Methods Pedicle guide device was designed and made for the anatomical trait of pedicle. The 3-Danatomical data of the thoracic pedicles were measured by multislice spiral CT in two embalmed human cadaveric thoracic pedicles spine(T1 -T10). Depending on transverse section angle(TSA) and sagittal section angle(SSA) of pedicle axis, the degree of horizontal dial and sagittal dial were adjusted in the guide device. The screws wereinserted bilaterally in the thoracic pedicles by using the device. After pulling the screws out, the pathways were filled with contrast media. The TSA and SSA of developed pathways were measured. Results Analysis of the difference between pedicle axis and developed pathway was of no statistical significance(P＞0.05). Conclusion The guide device could be easilyoperated and guarantee high accuracy of the pathways of screws and the incidence of pedicle penetration could be significantly reduced.
ObjectiveTo investigate the effect of the screw blade position on the effectiveness of proximal femoral nail anti-rotation (PFNA) internal fixation for unstable intertrochanteric fractures in the elderly.MethodsA clinical data of 131 elderly patients with unstable intertrochanteric fractures who were treated with PFNA internal fixation between January 2010 and January 2017 was retrospectively analyzed. According to the anteroposterior X-ray films, the screw blades were placed in the middle of the femoral neck in 72 patients (group A) and at one-third of the femoral neck in 59 patients (group B). There was no significant difference between the two groups (P>0.05) in the gender, age, bone density, classification of fractures, other medical diseases, and the time between injury and operation. Multiple treatment indexes were analyzed, including complications, hip Harris score, the healing status of fracture, tip-apex distance (TAD), and the height of the tail nail.ResultsAll patients were followed up 11-14 months, with an average of 12.1 months. All incisions healed by first intention with no complications. All fractures healed and no significant difference in bone healing time between the two groups (Z=−0.190, P=0.849). At 6 months after operation, TAD was (2.23±0.07) cm in group A and (2.85±0.12) cm in group B, showing significant difference (t=−47.643, P=0.000); and the height of the tail nail was (1.72±0.14) cm in group A and (0.53±0.26) cm in group B, showing significant difference (t=31.031, P=0.000). According to the Harris score, the hip functions were rated as excellent in 48 cases, good in 15 cases, and poor in 9 cases in group A, while as excellent in 38 cases, good in 16 cases, and poor in 5 cases in group B, with no significant difference between the two groups (Z=−0.075, P=0.941).ConclusionFor the unstable intertrochanteric fracture in the elderly, the PFNA internal fixation with appropriated TAD and the screw blades placed in the middle or at one-third of the femoral neck can obtain good effectiveness.
Objective To explore the feasibilities, methods, outcomes and indications of atlas pedicle screw system fixation and fusion for the treatment of upper cervical diseases. Methods From October 2004 to January 2006, 17 patients with upper cervical diseases were treated with atlas pedicle screw system fixation and fusion. There were 13 males and 4 females, ageing 19 to 52 years. Of 17 cases, there were 14 cases of atlantoaxial dislocation(including 3 cases of congenital odontoid disconnection，4 cases of old odontoid fracture，2 cases of new odontoid fracture(typeⅡC), 3 cases of rupture of the transverse ligament, and 2 cases of atlas fracture； 2 cases of tumor of C2; 1case of giant neurilemoma of C2,3 with instability after the resection oftumors. JOA score before operation was 8.3±3.0. Results The mean operative time and bleeding amount were 2.7 hours (2.1-3.4 hours) and 490 ml (300-750 ml) respectively. No injuries to the vertebral artery and spinal cord were observed. The medial-superior cortex of lateral mass was penetrated by 1 C1 screw approximately 3 mmwithout affecting occipito-atlantal motions. All patients were followed up 3-18 months. The clinical symptoms were improved in some extents and the screws were verified to be in a proper position, no breakage or loosening of screw and rob occurred. All patients achieved a solid bone fusion after 3-6 months. JOA score 3 months after operation was14.6±2.2. JOA improvement rates were 73%-91%(mean 82%). Conclusion The atlas pedicle screw system fixation and fusion is feasible for the treatment of upper cervical diseases and has betteroutcomes, wider indications if conducted properly.