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find Keyword "后凸畸形" 31 results
  • APPLICATION OF PHOTOSHOP CS16.0 SOFTWARE IN PREOPERATIVE OSTEOTOMY DESIGN OF ANKYLOSING SPONDYLITIS KYPHOSIS

    ObjectiveTo introduce the application of Photoshop CS16.0 (PS) software in preoperative osteotomy design of ankylosing spondylitis kyphosis (ASK), and to investigate applied values of the preoperative design. MethodsBetween March 2009 and March 2013, 21 cases of ASK were treated through preoperative osteotomy design by using PS software. There were 16 males and 5 females, aged from 23 to 50 years (mean, 34.2 years). The deformity included thoracolumbar kyphosis in 14 cases, thoracic kyphosis in 2 cases, and lumbar kyphosis in 5 cases. The ultimate osteotomy angle of preoperative plans and the location and extent of osteotomy were determined by the osteotomy design, which guided operation procedures of the surgeon. The actual osteotomy angle was obtained by measuring Cobb angle of osteotomy segment before and after operation. The sagittal parameters of spine and pelvis including global kyphosis (GK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), and chin brow-vertical angle (CBVA) were measured at preoperation, at 1 week after operation, and last follow-up. The clinical outcomes were assessed by simplified Chinese Scoliosis Research Society-22 (SRS-22) questionnaire and Oswestry disability index (ODI). ResultsNo complications occurred in the other cases except 1 case of dural tear during operation and 1 case of nerve injury after operation, and primary healing of incision was obtained. All patients were followed up 14 to 45 months (mean, 26.3 months). The SRS-22 and ODI scores at 1 week after operation and last follow-up were significantly improved when compared with preoperative scores (P<0.05), but no significant difference was found between at 1 week and last follow-up (P>0.05). The preoperative planned osteotomy angle and the postoperative actual osteotomy angle were (34.2±10.5)° and (33.7±9.7)° respectively, showing no significant difference (t=0.84, P=0.42). The CBVA, GK, SVA, PT, and LL were significantly improved when compared with the preoperative values (P<0.05), but no significant difference was found between at 1 week and last follow-up (P>0.05). At last follow-up, no failures of internal fixation was found, and bony fusion was obtained. ConclusionThe preoperative osteotomy design by using PS software can precisely recover the spinal sagittal balance and horizontal angle of view, so it can effectively avoid excessive correction and insufficient correction of the deformity and obtain good effectiveness in treating ASK.

    Release date:2016-08-25 10:18 Export PDF Favorites Scan
  • EFFECTIVENESS OF LONG SEGMENT FIXATION COMBINED WITH VERTEBROPLASTY FOR SEVERE OSTEOPOROTIC THORACOLUMBAR COMPRESSIVE FRACTURES

    Objective To study the effectiveness of long segment fixation combined with vertebroplasty (LSF-VP) for severe osteoporotic thoracolumbar compressive fractures with kyphosis deformity. Methods Between March 2006 and May 2012, a retrospective analysis was made on the clinical data of 48 cases of severe osteoporotic thoracolumbar compressive fractures with more than 50% collapse of the anterior vertebral body or more than 40 ° of sagittal angulation, which were treated by LSF-VP in 27 cases (LSF-VP group) or percutaneous kyphoplasty (PKP) in 21 cases (PKP group). All patients suffered from single thoracolumbar vertebral compressive fracture at T11 to L2. There was no significant difference in gender, age, spinal segment, and T values of bone mineral density between 2 groups (P gt; 0.05). The effectiveness of the treatment was appraised by visual analogue scale (VAS), Cobb angle of thoracolumbar kyphosis, height of anterior/posterior vertebral body, and compressive ratio of vertebrae before and after operations. Results The LSF-VP group had longer operation time, hospitalization days, and more bone cement injection volume than the PKP group, showing significant differences (P lt; 0.05). Intraoperative blood loss in LSF-VP group ranged from 220 to 1 050 mL (mean, 517 mL). No pulmonaryor cerebral embolism or cerebrospinal fluid leakage was found in both groups. Asymptomatic bone cement leakage was found in 3 cases of LSF-VP group and 2 cases of PKP group. The patients were followed up for 16-78 months (mean, 41.1 months) in LSF-VP group, and 12-71 months (mean, 42.1 months) in PKP group. No fixation failure such as loosened or broken pedicle screw was found in LSF-VP group during the follow-up, and no re-fracture or adjacent vertebral body fracture was found. Two cases in PKP group at 39 and 56 months after operation respectively were found to have poor maintenance of vertebral height and loss of rectification (Cobb angle was more than 40º) with recurrence of pain, which were treated by second surgery of LSF-VP; another case had compressive fracture of the adjacent segment and thoracolumbar kyphosis at 16 months after operation, which was treated by second surgery of LSF-VP. There were significant differences in the other indexes between each pair of the three time points (P lt; 0.05), except the Cobb angle of thoracolumbar kyphosis, and the height of posterior vertebral body between discharge and last follow-up in LSF-VP group, and except the Cobb angle of thoracolumbar kyphosis and compressive ratio of bertebrae between discharge and last follow-up in PKP group (P gt; 0.05). After operation, the other indexes of LSF-VP group were significantly better than those of PKP group at each time point (P lt; 0.05), except the VAS score and the height of posterior vertebral body at discharge (P gt; 0.05). Conclusion The effectiveness of LSF-VP is satisfactory in treating severe osteoporotic thoracolumbar compressive fractures with kyphosis deformity. LSF-VP can acquire better rectification of kyphosis and recovery of vertebral body height than PKP.

    Release date:2016-08-31 04:05 Export PDF Favorites Scan
  • TREATMENT OF THORACOLUMBAR KYPHOSIS CAUSED BY OLD FRACTURE USING PEDICAL SCREW AT THE FRACTURE LEVEL, INTERVERTEBRAL DISTRACTION, AND CAGE INSERTION BY POSTERIOR APPROACH

    Objective To evaluate the effectiveness of using pedical screw at the fracture level, intervertebral distraction, and Cage insertion by posterior approach to treat thoracolumbar kyphosis caused by old fracture. Methods Between June 2008 and June 2010, 15 cases of thoracolumbar kyphosis caused by old fracture were treated with pedical screw at the fracture level, intervertebral distraction, and Cage insertion by posterior approach. There were 9 males and 6 females with a mean age of 54.6 years (range, 39-65 years). The disease duration was 5 months to 3 years with an average of 1.5 years. Fractured segments included T11 in 1 case, T12 in 4 cases, L1 in 5 cases, and L2 in 5 cases. Ten patients had nerve symptom, according to American Spinal Injury Association (ASIA) grading, 3 cases were classified as grade B, 4 cases as grade C, and 3 cases as grade D, of which 3 cases had sexual and sphincter dysfunction. At preoperation, the Cobb angle was (47.4 ± 10.2)°; the Oswestry disability index (ODI) score was 67.9% ± 6.9%; and the visual analogue scale (VSA) was 8.6 ± 1.4. Results The wounds obtained primary healing. The mean follow-up time was 28 months (range, 13-60 months). X-ray films showed intervertebral bone fusion was obtained within 6-11 months (mean, 10.2 months). No fixation loosening or breaking occurred during follow-up. Kyphosis was corrected, and lumbar back pain was relieved. At 1 year after operation, Cobb angle was significantly corrected to (13.3 ± 7.7)° (t=72.80, P=0.00); ODI score was significantly improved to 25.2% ± 4.6% (t=48.04, P=0.00); VAS score was significantly decreased to 2.3 ± 0.6 (t=26.52, P=0.00). According to ASIA grading in 10 patients with spinal cord injury, the spinal cord function was improved by 1 grade in 8 cases (3 cases from grade B to C, 3 cases from grade C to D, and 2 cases from grade D to E); 3 patients with sexual and sphincter dysfunction recovered in different degrees. Conclusion Using pedical screw at the fracture level, intervertebral distraction, and Cage insertion by posterior approach is an effective method to treat thoracolumbar kyphosis caused by old fracture.

    Release date:2016-08-31 04:05 Export PDF Favorites Scan
  • PEDICLE SUBTRACTION OSTEOTOMY FOR CORRECTION OF KYPHOSIS IN ANKYLOSING SPONDYLITIS

    Objective To assess the effectiveness of single-level lumbar pedicle subtraction osteotomy for correction of kyphosis caused by ankylosing spondylitis. Methods Between July 2006 and July 2010, 45 consecutive patients with kyphosis caused by ankylosing spondylitis underwent single-level pedical subtraction osteotomy. There were 39 males and 6 females with an average age of 36.9 years (range, 21-59 years). The average disease duration was 18.6 years (range, 6-40 years). All patients had low back pain, fatigue, abnormal gaits, and disability of looking and lying horizontally. Radiological manifestations included sacroiliac joints fusion, bamboo spine, pelvic spin, and kyphosis. Cervical spine was involved in 30 patients; thoracolumbar spine was affected in 15 patients. Results Wound hydrops and dehiscence occurred in 1 case, and was cured after debridement; primary healing of incision was obtained in the other patients. Two patients had abdominal skin blisters, which were cured after magnesium sulfate wet packing. Forty-two patients were followed up 24-74 months (mean, 30 months). All osteotomy got solid fusion. The average bony fusion time was 6.8 months (range, 3-12 months). All patients could walk with brace and looked or lied horizontally postoperatively. The Scoliosis Research Society-22 Patient Questionnaire (SRS-22) score, T1-S1 kyphosis Cobb angle, L1-S1 lordosic Cobb angle, sagittal imbalance distance, and chin-brow vertical angle at 1 week and last follow-up were significantly improved when compared with those at preoperation (P lt; 0.05), but no significant difference was found between at 1 week and last follow-up (P gt; 0.05). Conclusion Single-level pedicle subtraction osteotomy has satisfactory effectiveness for the correction of kyphosis caused by ankylosing spondylitis.

    Release date:2016-08-31 04:07 Export PDF Favorites Scan
  • MANAGEMENT OF RIGID POST-TRAUMATIC THORACOLUMBAR KYPHOSIS BY SIMULTANEOUS POSTERIO-ANTERIOR CIRCUMFERENTIAL RELEASING AND CORRECTION WITH PRESERVED POSTERIOR VERTEBRAL WALL

    【Abstract】 Objective To evaluate the surgical management of rigid post-traumatic thoracolumbar kyphosis (RPTK) by simultaneous posterio-anterior circumferential releasing, correction and anterior corpectomy with preserved posterior vertebral wall. Methods Twenty patients with RPTK were treated between October 2004 and October 2010 by posterior releasing, anterior subtotal corpectomy with preserved posterior vertebral wall, correction, strut graft, and short segmental fixation. There were 14 males and 6 females with an average age of 43.2 years (range, 23-63 years). The time between injury and operation was 4 months to 23 years (mean, 1.4 years). The affected locations were T11 in 1 case, T12 in 8 cases, L1 in 10 cases, and L2 in 1 case. The Cobb angle and the intervertebral height of the fractured vertebra body were measured before and after operations. The degrees of low back pain were assessed by Japanese Orthopaedic Association (JOA) scores. Results No incision infection, nerve injury, or cerebral spinal fluid leakage occurred. Seventeen patients were followed up 1-5 years with an average of 2.8 years. The JOA score at last follow-up (26.2 ± 3.9) was significantly improved when compared with the pre-operative score (14.0 ± 5.7) (t=4.536, P=0.001). One patient had aggravation of kyphosis at 3 months postoperatively, who was in stabilized condition after prolonging immobilizated time. The Cobb angle was corrected from (43.2 ± 11.5)° preoperatively to (9.8 ± 5.7)° at last follow-up, showing significant difference (P lt; 0.01). There was significant difference in the intervertebral height of the fractured vertebra body between preoperation and last follow-up (P lt; 0.05). The intervertebral height of fractured vertebra was restored to 87.0% ± 11.2% of adjacent disc height. Conclusion Posterio-anterior circumferential releasing and anterior corpectomy with preserved posterior vertebral wall can achieve satifactory clinical results, not only in pain relieving, kyphosis correction, vertebral height restoration, and spinal stability restoration, but also in the risk reduce of bleeding and spinal cord disturbance.

    Release date:2016-08-31 04:22 Export PDF Favorites Scan
  • RESEARCH PROGRESS OF COMPLICATIONS OF EXPANSIVE LAMINOPLASTY

    【Abstract】 Objective To review the progress in the research of complications after expansive laminoplasty such as axial symptom, kyphotic deformity, and segmental motor paralysis. Methods Recent articles about complications after expansive laminoplasty were reviewed, and comprehensive analysis was done. Results The pathogenesis of axial symptom, kyphotic deformity, and segmental motor paralysis has not yet fully been understood, but has brought new finding, such as the importance of the spinous process-ligament-muscle complex, C5 palsy theory, and the involvement of the spinal cord mechanism. Conclusion The pathogenesis of axial symptom, kyphotic deformity, and segmental motor paralysis should be further investigated to prevent and treat the complications.

    Release date:2016-08-31 04:22 Export PDF Favorites Scan
  • EFFECTIVENESS COMPARISON BETWEEN PEDICLE SUBTRACTION OSTEOTOMY AND NON-OSTEOTOMYTECHNIQUES IN TREATMENT OF MEDIUM-TO-SEVERE KYPHOSCOLIOSIS

    Objective To evaluate the effectiveness of pedicle subtraction osteotomy (PSO) and non-osteotomy techniques in treatment of medium-to-severe kyphoscoliosis by retrospective studies. Methods Between January 2005 and January 2009, 99 patients with medium-to-severe kyphoscoliosis were treated by PSO (PSO group, n=46) and non-osteotomytechnique (non-osteotomy group, n=53) separately. There was no significant difference in sex, age, Cobb angle of scol iosis on coronal plane, and Cobb angle of kyphosis on saggital plane between 2 groups (P gt; 0.05). The operation time and blood loss were recorded; the Cobb angle of scol iosis on coronal plane and kyphosis on sagittal plane were measured at pre- and postoperation to caculate the rates of correction on both planes. Results The operation was successfully completed in all the patients. The operation time and blood loss of the patients in PSO group were significantly greater than those of the patients in non-osteotomy group (P lt; 0.05). All patients were followed up 12-56 months (mean, 22.4 months); no spinal cord injury occurred, and bone fusion was achieved at last follow-up. The Cobb angles of scol iosis and kyphosis at 2 weeks and last follow-up were significantly improved when compared with the preoperative angles in the patients of 2 groups (P lt; 0.05). There was no significant difference in Cobb angle of scol iosis and the rate of correction between 2 groups (P gt; 0.05), but the correction loss of PSO group was significantly smaller than that of non-osteotomy group (P lt; 0.05) at last follow-up. At 2 weeks and last follow-up, the Cobb angle of kyphosis, the rate of correction, and correction loss were significantly better in PSO group than in non-osteotomy group (P lt; 0.05). Conclusion There is no signifcant difference in scol iosis correction between PSO and non-osteotomy techniques.PSO can get better corrective effect in kyphosis correction than non-osteotomy technique, but the operation time and blood losswould increase greatly.

    Release date:2016-08-31 04:23 Export PDF Favorites Scan
  • 经椎弓根腰椎截骨术矫治强直性脊柱炎后凸畸形

    目的 总结经椎弓根单椎体截骨术矫治强直性脊柱炎(ankylosing spindylitis,AS)胸腰椎后凸畸形的临床疗效。 方法 2002 年3 月- 2007 年12 月,采用腰椎单节段经椎弓根截骨术治疗AS 胸腰椎后凸畸形15 例。男10 例,女5 例;年龄25 ~ 54 岁,平均36 岁。病程6 ~ 22 年。后凸畸形位于胸腰段11 例,腰段4 例。后凸畸形Cobb 角为38 ~ 82°,平均58°。无明显神经症状。影像学检查示脊柱前柱骨化明显,呈典型竹节样改变。 结果 患者手术时间平均3.5 h,术中出血量平均1 180 mL。术中出现硬脊膜破裂1 例,术后双下肢麻木、肠系膜上动脉综合征各1 例,经对症治疗后均治愈。15 例均获随访,随访时间1 ~ 5 年,平均3 年。无感染、死亡、瘫痪等并发症发生。术后Cobb 角为6 ~ 28°,平均21°。末次随访X 线片示植骨均达骨性融合,未发现内固定松动、断裂现象,截骨部位骨面闭合良好。患者腰背症状消失或大部分缓解。 结论 在病变稳定期采用经椎弓根腰椎椎体截骨术治疗AS 后凸畸形,可获得较满意的矫形效果。

    Release date:2016-08-31 05:47 Export PDF Favorites Scan
  • 后路全脊椎截骨联合椎弓根钉棒固定术治疗脊柱后凸畸形

    目的 总结后路全脊椎截骨联合椎弓根钉棒固定术治疗胸腰椎脊柱后凸畸形的手术方法及临床疗效。 方法 2003 年1 月- 2008 年1 月,采用后路全脊椎截骨联合椎弓根钉棒固定术治疗脊柱后凸畸形24 例。男15 例,女9 例;年龄21 ~ 68 岁,平均53 岁。先天性脊柱畸形2 例,结核性后凸9 例,陈旧创伤性后凸13 例。Frankel 分级:E 级14 例,D 级8 例,C 级2 例。后凸顶点分别位于:T11 5 例,T12 10 例,L1 7 例,L2 2 例。脊柱后凸Cobb 角为37 ~ 65°,平均46°。 结果 术后24 例均获随访,随访时间8 个月~ 3 年,平均2.5 年。根据自定评价标准,疗效优15 例,良7 例,可2例,优良率91.7%。术后3 个月Cobb 角为4.2 ~ 5.1°,平均5.3°,平均矫正率87.6%。术后2 例Frankel C 级均恢复至D 级;8 例D 级中5 例恢复至E 级,3 例无变化;余患者仍为E 级。术后8 ~ 12 个月X 线片可见原截骨平面发生骨性融合,未发现内植物松动、断裂、假关节形成和矫正度数丢失等并发症。 结论 后路全脊椎截骨联合椎弓根钉棒固定术损伤小、并发症少,减压、矫形可同时进行,治疗脊柱后凸畸形临床效果明显。

    Release date:2016-09-01 09:05 Export PDF Favorites Scan
  • 后路单节段楔形截骨联合短节段椎弓根内固定系统治疗脊柱后凸畸形

    目的 总结后路单节段截骨联合短节段椎弓根内固定系统治疗脊柱后凸畸形的临床疗效。方法 2001 年5 月- 2004 年1 月,采用后路单节段楔形截骨联合AF 内固定系统治疗脊柱后凸畸形患者15 例。男10 例,女5 例;年龄17 ~ 64 岁。病程10 个月~ 3 年。结核性后凸畸形9 例,骨折继发性后凸畸形4 例,发育性后凸畸形2 例。病变椎体:T5 ~ 10 4 例,T11 ~ L2 9 例,L3、L4 各1 例。术前Cobb 角为47 ~ 81°,平均61°。神经功能按Frankel 分级:A 级、C 级各1 例,D 级4 例,E 级2 例;余7 例有程度不同的神经根病损症状和体征。 结果 术后15 例均获随访,随访时间14 ~ 48 个月,平均27 个月。术后Cobb 角为0 ~ 55°,平均30°。后凸畸形明显改善,矫正率为32% ~ 100%,平均68%。Frankel 分级:A 级、D 级各1 例,E 级6 例;7 例神经根病损患者症状体征均恢复正常。X 线片示患者术后4 ~ 5 个月植骨融合。1 例术后2 年出现迟发性切口感染,取出内植物后愈合,其余患者未发现内植物松动、断裂、假关节形成等并发症。 结论 对于局限性胸腰段脊柱后凸畸形,单节段楔形截骨术能够较好地解除脊髓神经根的压迫或牵张、矫正畸形和重建脊柱的稳定性。

    Release date:2016-09-01 09:19 Export PDF Favorites Scan
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