ObjectiveTo investigate the reasons for failure to treat thoracolumbar tuberculosis by anterior internal fixation and its countermeasures. MethodsA total of 485 patients with thoracolumbar spinal tuberculosis underwent anterior focus clearance and fixation from January 2005 to January 2012. Eighteen of them failed with a rate of 3.71%. Screws were pulled out in two patients. Vertebra cutted by screws occurred in three patients. In another three patients, screws dropped into the intervertebral disc. Tuberculosis relapsed in 10 patients (5 accompanied with spinal deformity, 2 with pure malunion, 2 with abscess formation, and 1 with sequestra). Twelve of the patients underwent two-stage posterior pedicle screw internal fixation and anterior focus clearance and autogenous bone grafts fusion. Four were treated by shifting antituberculosis drugs and staying in bed. Two were cured by multiple abscesses puncture and antituberculosis injection. ResultsThese patients were followed up for 15~30 months. Twelve cases of spinal tuberculosis were completely cured and 6 cases of them got clinical cure. However, 3 cases of them had scoliosis deformity followed and 1 had kyphosis. No tuberculosis relapse, cold abscess or sinus formation, or pedicle screw internal fixation failure occurred again. ConclusionAlthough there are many complications of anterior internal fixation for spinal tuberculosis, anterior internal fixation is still a perfect choice if we can make an appropriate choice of operation and strengthen the management after operation.
Objective To analyze the reasons for internal fixation failure after internal fixation of nickel-titanium memory alloy patella claw for patella fracture, and to explore the countermeasures. Methods The clinical data of patients with patellar fracture treated by internal fixation of nickel-titanium memory alloy patella claw in the Second Orthopedic Ward of Chongqing Orthopedic Hospital of Traditional Chinese Medicine from May 2015 to April 2020 were analyzed retrospectively. Patients with postoperative internal fixation failure were identified. The reasons for internal fixation failure were analyzed. Results A total of 436 patients were included. Internal fixation failure occurred in 10 patients. There were 6 cases (1.38%) of patellar claw detachment, and 4 cases of simple fracture block displacement witharticular surface displacement≥2 mm (0.92%). Internal fixation failure occurred 4 to 48 days postoperatively, with an average of (18.20±10.86)days. The analysis showed that the reason for internal fixation failure in 4 patients was improper early postoperative functional exercise. The reason for 3 patients was that the auxiliary internal fixation was not selected. The reason for 2 patients was that the size of the patellar claw was too small. The reason for 1 patient was the improper fixation of the auxiliary internal fixation. Conclusion The failure of internal fixation after patella fracture with nickel-titanium memory alloy patella claw is mainly related to whether the model of the patella claw is appropriate, whether the auxiliary internal fixation is selected, whether the auxiliary internal fixation is properly fixed, and whether the early postoperative functional exercise is appropriate.