ObjectiveTo investigate the security of pedicle screw fixation in fractured vertebra in treatment of thoracolumbar fractures by comparing with routine fixation cross fractured vertebra. MethodsA total of 101 cases of single segmental thoracolumbar fracture were selected between June 2008 and June 2011. Of them, 56 cases underwent pedicle screw fixation in fractured vertebra (group A), and 45 cases received routine fixation cross fractured vertebra (group B). There was no significant difference in gender, age, causes of injury, fracture type, fracture segment, Frankel grading, time of injury to operation, and the preoperative anterior vertebral height compression ratio and the canal occupation rate between 2 groups (P>0.05). There were 34 cases of junction fracture of pedicle and vertebra (type I), 2 cases of pedicle waist fracture (type Ⅱ), and 20 cases of junction fracture of pedicle and lamina (type Ⅲ) in group A. The position of fractured vertebral pedicle screw was observed; the anterior vertebral height compression ratio, canal occupation rate, and surgical complications were compared between 2 groups. ResultsA total of 103 pedicle screws were placed in 54 patients of group A, except 2 patients of type Ⅱ fracture; 96 screws were placed in the bone cortex completely and 7 screws deviated. The operation time of group A was significantly longer than that of group B (t=4.339, P=0.000), but there was no significant difference in intraoperative blood loss between 2 groups (t=-0.089, P=0.929). All 101 patients were followed up 6-16 months (mean, 8.5 months). The patients of 2 groups achieved nerve functional recovery. Fixation-related complications occurred in 1 case of 2 groups respectively, showing no significant difference (P=1.000). At last follow-up, according to Denis lumbago classification, 51 cases were rated as P1 level and 5 cases as P2 level in group A; 35 cases were rated as P1 level, 8 cases as P2 level, and 2 cases as P3 level in group B; and there was no significant difference between 2 groups (Z=-1.836, P=0.066). There was no significant difference between 2 groups in canal occupation rate at immediate after operation and at last follow-up (P>0.05), and in the anterior vertebral height compression ratio at immediate after operation (P>0.05), but the anterior vertebral height compression ratio of group B was significantly higher that of group A at last follow-up (P<0.05). ConclusionSingle segmental thoracolumbar fracture treated by pedicle screw fixation in fractured vertebra through posterior approach is safe and feasible according to different pedicle fracture types to guide fixation.
ObjectiveTo evaluate the clinical significance of individualized reference model of sagittal curves and navigation templates of pedicle screw by three-dimensional printing technique for thoracolumbar fracture with dislocation. MethodsBetween February 2011 and November 2013, 42 patients with thoracolumbar fracture and dislocation undergoing pedicle screw fixation were divided into 2 groups:traditional pedicle screw internal fixation by fluoroscopy assistant was used in 24 cases (control group), and individualized reference model of sagittal curves and navigation templates of pedicle screw were used in 18 cases (trial group). There was no significant difference in gender, age, injury causes, segment, degree of dislocation, and Frankel classification between 2 groups (P>0.05). The operation time, intraoperative blood loss, perspective times, and dislocation rate, sagittal angle recovery rate at different time were compared. The success rate of pedicle screw insertion, sagittal screw angle, and Frankel classification were compared. The angle between sagittal screws, difference of screw entry point at horizontal position, and difference of screw inclined angle were compared. ResultsThe operating time, intraoperative blood loss, and perspective times in trial group were significantly lower than those in control groups (P<0.05). All the patients were followed up 12-40 months (mean, 22 months). The dislocation rate at immediate after operation and last follow-up were significantly improved when compared with preoperative value in 2 groups (P<0.05). At immediate after operation and last follow-up, the dislocation rate and sagittal angle recover rate in trial group were significantly better than those in control group (P<0.05). There were significant differences in the one-time success rate, final success rate of pedicle screw insertion, and saggital screw angle between 2 groups (χ2=9.38, P=0.00; χ2=10.95, P=0.00; χ2=13.43, P=0.00). The angle between sagittal screws, difference of screw entry point at horizontal position, and difference of screw inclined angle in trail group were significantly less than those in control group (P<0.05). There was significant difference in the Frankel classification between 2 groups at last follow-up (Z=-1.99, P=0.04). ConclusionThe application of individualized reference model of sagittal curves and navigation templates of pedicle screw by three-dimensional printing technique for thoracolumbar fracture with dislocation has the advantages of shorter operation time, less intraoperative blood loss, better recovery of thoracolumbar dislocation, and better Frankel classification.
ObjectiveTo investigate the accuracy of the two-dimension computer-aided surgery navigation system in the lumbar pedicle screw fixation on recombinant CT section after operation. MethodsBetween February 2011 and April 2013, 218 patients undergoing lumbar spinal pedicle screw fixation were divided into 2 groups:two-dimension computer-aided surgery navigation system was used in 95 cases (the navigation group) and X-ray fluoroscopy assistant technology in 123 cases (the fluoroscopy assistant group). There was no significant difference in age, gender, and type of disease between 2 groups (P>0.05). The mean operating time, blood loss volume, and fluoroscopy times, and the one-time success rate of pedicle screw implant were observed. The sagittal screw angle (SSA), the relationship between the pedicle cortex and screw, the accuracy rate of pedicle screw, and the sagittal angle on both sides (SBA) were observed. ResultsA total of 504 screws were inserted in navigation group, 432 (85.7%) were inserted successfully at first time and 472 (85.7%) were inserted successfully at end time. A total of 656 screws were inserted in fluoroscopy assistant group, 474 (72.3%) were successfully inserted at first time, and 563 (85.8%) were inserted successfully at end time. There were significant differences in the one-time success rate and final success rate of pedicle screw implant between 2 groups (χ2=30.19, P=0.00; χ2=18.16, P=0.00). There was no significant difference in the mean operating time and the blood loss volume of pedicle screw implant between 2 groups (t=0.88, P=0.38; t=1.47, P=0.14); but the fluoroscopy times of pedicle screw implant in navigation group 0.7±0.3 were significantly less than that in fluoroscopy assistant group 1.5±1.0 (t=-8.09, P=0.00). The SSA and SBA in navigation group[(3.7±0.9)° and (1.7±0.8)°] were significantly less than those in fluoroscopy assistant group[(6.0±1.7)° and (3.5±1.6)°] (t=-26.92, P=0.00; t=-22.49, P=0.00). ConclusionThe sagittal screw angle and accuracy of pedicle screw implant can be significantly improved using the two-dimension computer-aided surgery navigation system in lumbar posterior fixation.
ObjectiveTo evaluate the clinical significance of individualized reference model of sagittal curves by three-dimensional (3D) printing technique and computer-aided navigation system for lumbar spondylolisthesis. MethodsBetween February 2011 and October 2012, 66 patients with lumbar spondylolisthesis underwent posterior lumbar interbody fusion (PLIF) by traditional operation in 36 cases (control group) and by individualized reference model of sagittal curves by 3D printing technique and computer-aided navigation system in 30 cases (trial group). There was no significant difference in gender, age, disease duration, segment, type of disease, degree of spondylolisthesis, and preoperative the visual analogue scale (VAS) of low back pain and leg pain between 2 groups (P>0.05). The operation time, blood loss, fluoroscopy times, VAS score of low back pain and leg pain were compared between 2 groups; the sagittal screw angle (SSA), accuracy rate of pedicle screw, Taillard index, disc height recovery rate, and sagittal angle recovery rate were compared between 2 groups. ResultsThere was no significant difference in operation time and blood loss between 2 groups (P>0.05). But fluoroscopy times of control group were significantly higher than those of trial group (P<0.05). One case had radicular symptoms after operation in control group. The patients of 2 groups were followed up 24-36 months (mean, 26 months). The VAS scores of low back pain and leg pain at last follow-up were significantly better than pre-operative scores in 2 groups (P<0.05); VAS score of low back pain in trial group at last follow-up was significantly lower than that in control group (P<0.05). The accuracy rate of pedicle screw was 81.9% (118/144) in control group and 91.7% (110/120) in trial group, showing significant difference (χ2=5.25, P=0.03). There was significant difference in SSA between 2 groups at immediate after operation (t=-6.21, P=0.00). At immediate after operation and last follow-up, Taillard index, disc height recovery rate, and sagittal angle recovery rate in trial group were significantly better than those in control group (P<0.05). ConclusionPLIF by individualized reference model of sagittal curves by 3D printing technique and computer-aided navigation system can effectively correct spondylolisthesis, recover the lumbar sagittal angle and improve the VAS score of low back pain though it has similar operation time and blood loss to traditional PLIF.
Objective To investigate the short-term effectiveness of percutaneous pedicle screw (PPS) guided with photoelectric navigation for thoracolumbar fractures. Methods Between May 2013 and June 2015, the clinical data of 39 patients with thoracolumbar fractures in accordance with the selection criteria were retrospectively analyzed. The patients were divided into photoelectric navigation PPS group (trial group, 20 cases) and C-arm X-ray guidance PPS group (control group, 19 cases). There was no significant difference in gender, age, injury cause, fracture vertebrae, AO classification, operation time after injury, visual analogue scale (VAS) score, and vertebral compression ratio (VCR) between 2 groups (P > 0.05). The operation time, bleeding amount, perspective times, VAS score, and one-time success rate (OSR) of screw placement were recorded; VCR and endplate-screw angle (ESA) were measured; and pedicle-screw relationship (PSR) was assessed by Ringel’s method in radiographic result. Results Differences in operation time and bleeding amount were not significant between 2 groups (P > 0.05); perspective times of control group was significantly more than t hat of trial group (t=-15.658, P=0.000). The OSR of trial group (95.60%, 87/91) was significantly better than that of control group (86.75%, 72/83) (χ2=4.323, P=0.038). The patients were followed up 6-11 months (mean, 7.6 months) in trial group, and 7-11 months (mean, 7.8 months) in control group. No neurovascular complications associated with screw insertion occurred. Difference was not significant in VAS score at 7 days and 6 months after operation between 2 groups (P > 0.05), but VAS scores at 7 days and 6 months were significantly improved when compared with preoperative score in 2 groups (P < 0.05), and significant difference in VAS score was shown between at 7 days and 6 months in 2 groups (P < 0.05). VCR of trial group and control group were significantly improved to 94.75%±5.10% and 92.40%±5.09% at 6 months after operation from preoperative 71.97%±5.66% and 73.50%±5.97% (t=11.865, P=0.000; t=11.359, P=0.000), but there was no significant difference between 2 groups (t=1.442, P=0.158). ESA of trial group and control group were (1.82±1.13)° and (3.36±2.43)° at 6 months after operation, showing significant difference (t=5.421, P=0.000). At 6 months after operation, according to PSR classification, 83 screws rated as grade I, 6 as grade II, and 2 as grade III, and excellent and good rate of screw replacement was 97.80% in trial group; 54 screws were rated as grade I, 19 as grade II, 7 as grade III, and 3 as grade IV, and excellent and good rate of screw replacement was 87.95% in control group; difference was significant between 2 groups (χ2=18.347, P=0.000). Conclusion Application of photoelectric navigation can guide screws placement by the two-dimensional multi pl ane dynamic image, has better accuracy of screws position in thoracolumbar fractures, reduces the introperative X-ray perspective times, maintains good reduction of vertebral body, and achieves satisfactory effectiveness.
ObjectiveTo compare the effectiveness of minimally invasive percutaneous internal fixation and traditional open reduction via Henry approach and internal fixation in the treatment of unstable distal radial fractures.MethodsFifty-six patients with unstable distal radial fractures that met the selection criteria between October 2013 and December 2014 were randomly divided into minimally invasive group (26 cases) and traditional group (30 cases). They were treated with oblique T-shaped locking plate internal fixation via minimally invasive percutaneous approach or traditional Henry approach. There was no significant difference in gender, age, side, causes of injury, fracture classification, and time from injury to operation between 2 groups (P>0.05). The length of incision, operation time, intraoperative blood loss, hospitalization time, and fracture healing time were recorded in 2 groups. The difference of the length of the radial styloid process, the volar tilting angle, and the ulnar inclining angle between at 3 months postoperatively and preoperation were compared between 2 groups. The visual analogue scale (VAS) score, the percentage of the lateral wrist flexion and extension range, forearm rotation, and the hand grip strength (recorded as FS%, FR%, and HG% , respectively) were compared between 2 groups at 4 weeks and 3 months postoperatively. The wrist function was evaluated through the disability of arm-shoulder-hand (DASH) scores at 3 months postoperatively.ResultsThe length of incision, operation time, intraoperative blood loss, and hospitalization time in minimally invasive group were significantly less than those in traditional group (P<0.05). The incisions of 2 groups were all achieved primary healing. All patients were followed up 10-16 months (mean, 12.6 months). There was no radial artery injury, screw too long, or screw entering the joint space. In minimally invasive group, 1 patient had the symptoms of median nerve irritation after operation, and recovered completely at 1 month; in traditional group, there were 2 cases of tendon irritation after operation. There was no significant difference in the fracture healing time, the difference of the length of the radial styloid process, the volar tilting angle, and the ulnar inclining angle between at 3 months postoperatively and preoperation between 2 groups (P>0.05). At 4 weeks after operation, the VAS score in minimally invasive group was significantly less than that in traditional group, and the FS%, FR%, and HG% were significantly higher than those in traditional group (P<0.05). There was no significant difference in above indicators between 2 groups at 3 months after operation (P>0.05). The DASH score in minimally invasive group was significantly less than that in traditional group at 3 months after operation (t=–5.308, P=0.000). The patient’s aesthetic evaluation of postoperative wound in minimally invasive group was better than in traditional group.ConclusionFor treatment of unstable distal radial fractures, the metacarpal minimally invasive internal fixation has the advantages of smaller wound, incisional concealment, and quicker recovery of wrist joint.
ObjectiveTo investigate the reconstruction mode selection of acetabular bone defect and the effect on the acetabular cup position in cementless total hip arthroplasty (THA). MethodsA retrospective analysis was made on the clinical data of 78 patients (78 hips) with acetabular bone defect according to the selection criteria who underwent THA between February 2008 and February 2014. In 39 cases having acetabular posterosuperior bone defect with defect area less than 30%, impaction bone grafting was performed (group A); in 24 cases having acetabular posterosuperior bone defect with defect area of 30%-50%, structural bone or tantalum block grafting was performed (group B); in 10 cases having acetabular medial wall bone defect with defect area less than 30%, impaction bone grafting was performed (group C); and in 5 cases having acetabular medial wall bone defect with defect area of 30%-50%, titanium mesh combined with impaction bone grafting was performed (group D). There was no significant difference in gender, age, and side between groups A and B, and between groups C and D (P>0.05). The acetabular abduction angle, anteversion, the horizontal and vertical distances of actual and true rotation center after operation were compared. ResultsThe patients were followed up 7-25 months. Prosthesis loosening occurred in 2 cases of group A, sciatic nerve injury and hip joint dislocation in 1 case of group B, respectively. At immediate after operation and last follow-up, there was no significant differences in the horizontal or vertical distance of actual and the true rotation center between groups A and B (P>0.05); significant difference was found in the horizontal distance between groups C and D (P<0.05), but no significant difference in the vertical distance (P>0.05). Difference was statistically significant in the acetabular abduction angle and anteversion between groups A and B (P<0.05), but difference was not significant between groups C and D (P>0.05). ConclusionIn patients with acetabular posterosuperior bone defect, reconstruction methods will have effect on acetabular abduction and anteversion; early acetabulum prosthesis loosening may be associated with too large acetabular abduction angle and inappropriate reconstruction methods. In patients with acetabular medial wall bone defect, the vertical distances of rotation center will shift upward in varying degrees, and reconstruction methods have effect on the horizontal distances of rotation center.
Objective To compare the effectiveness of suspension fixation plus hinged external fixator with double plate internal fixation in the treatment of type C humeral intercondylar fractures. Methods Between January 2014 and April 2016, 30 patients with type C (Association for the Study of Internal Fixation, AO/ASIF) humeral intercondylar fractures were treated. Kirschner wire suspension fixation plus hinged external fixator was used in 14 cases (group A), and double plate internal fixation in 16 cases (group B). There was no significant difference in gender, age, injury cause, disease duration, injury side, and type of fracture between 2 groups (P>0.05). Results There was no significant difference in operation time and hospitalization stay between 2 groups (P>0.05). But the intraoperative blood loss in group A was significantly less than that in group B (P<0.05); the visual analogue scale (VAS) score at 1 day and 3 days after operation in group A were significantly less than those in group B (P<0.05). Primary healing of incision was obtained in all patients of 2 groups, and no surgery-related complications occurred. The patients were followed up 6-24 months (mean, 12.3 months) in group A and 6-24 months (mean, 12.8 months) in group B. The self-evaluation satisfaction rate was 85.7% (12/14) in group A and was 81.2% (13/16) in group B at 3 months after operation, showing no significant difference (χ2=0.055, P=0.990). Based on the improved Gassebaum elbow performance score at 6 months after operation, excellent and good rate of the elbow function was 78.6% (excellent in 5 cases, good in 6 cases, fair in 2 cases, and poor in 1 case) in group A and was 81.2% (excellent in 6 cases, good in 7 cases, fair in 2 cases, and poor in 1 case) in group B, showing no significant difference between 2 groups (χ2=0.056, P=0.990). Heterotopic ossification occurred at 3 months after operation in 1 case of each group respectively. The X-ray films showed bony union in all cases; no loosening or breakage of screw was observed. The bone union time showed no significant difference between 2 groups (t=–0.028, P=0.978). The time of internal fixation removal, the intraoperative blood loss, and VAS score at 1 day and 3 days after operation in group A were significant better than those in group B (P<0.05). Conclusion The suspension fixation plus hinged external fixator and double plate internal fixation for the treatment of type C humeral intercondylar fractures have ideal outcome in elbow function. But the suspension fixation plus hinged external fixator is better than double plate internal fixation in intraoperative blood loss, postoperative VAS score, and time of internal fixation removal.
ObjectiveTo investigate the accuracy of progressive three-dimensional navigation template system (abbreviated as progressive template) to assist atlas-axial pedicle screw placement. MethodsThe clinical data of 33 patients with atlas-axial posterior internal fixation surgery between May 2015 and May 2017 were retrospectively analyzed. According to the different methods of auxiliary screw placement, the patients were divided into trial group (19 cases, screw placement assisted by progressive template) and control group (14 cases, screw placement assisted by single navigation template system, abbreviated as initial navigation template). There was no significant difference in gender, age, cause of injury, damage segments, damage types, and preoperative Frankel classification between the two groups (P>0.05). The operation time and intraoperative blood loss of the two groups were compared. The safety of screw placement was evaluated on postoperative CT by using the method from Kawaguchi et al, the deviation of screw insertion point were calculated, the angular deviation of the nailing on coordinate systems XOZ, XOY, YOZ were calculated according to Peng’s method. ResultsAll patients completed the operation successfully; the operation time and intraoperative blood loss in the trial group were significantly less than those in the control group (t=–2.360, P=0.022; t=–3.006, P=0.004). All patients were followed up 12–40 months (mean, 25.3 months). There was no significant vascular injury or nerve injury aggravation. Postoperative immediate X-ray film and CT showed the dislocation was corrected. Postoperative immediate CT showed that all 76 screws were of grade 0 in the trial group, and the safety of screw placement was 100%; 51 screws were of grade 0, 3 of gradeⅠ, and 2 of gradeⅡ in the control group, and the safety of screw placement was 91.1%; there was significant difference in safety of screw placement between the two groups (χ2=7.050, P=0.030). The screw insertion point deviation and angular deviation of the nailing on XOY and YOZ planes in the trial group were significantly less than those in the control group (P<0.05). There was no significant difference in angular deviation of the nailing on XOZ between the two groups (t=1.060, P=0.290). ConclusionCompared with the initial navigation template, the progressive navigation template assisting atlas-axial pedicle screw placement to treat atlas-axial fracture with dislocation, can reduce operation time and intraoperative blood loss, improve the safety of screw placement, and match the preoperative design more accurately.