Objective To investigate the operative indication and clinical efficacy of combination of external fixator and volar approach fixation in treatingdistal radius fracture. Methods From March 2000 to March 2005, 28 patients with distal radius fracture were treated with combination of external fixator and volar approach fixation. Dorsal external fixator was used to maintain wrist in functional position, combinated volar plate or Kirschner wire fixation after reduction was achieved. Bone graft was necessary if there were severe comminuted cortical bone or compress of cancellous bone. Of 28 patients, there were 21 males and 7 females, aging from 1854 years with a median age of 41 years. The locations were the left side in 4 cases and the right side in 24 cases. According to typing criterion for AO, 18 cases were classified as C2 and 10 cases as C3. One case wasaccompanied with dislocation of lunate bone. Results Among 28 patients, 24 were followed up for an average of 8.5 months. The anatomical relationship of their wristjoint were reestablished and retained. Overall good to excellent results were achieved in 87%, excellent in 16 cases, good in 5 cases and fair in 3 cases. Conclusion A combination of external fixator and volar approach fixation is an effective method of treating fractures of the distal radius，because distal radius fracture is unstable or difficult to close reduction. Volarfixation can avoid operative complication, and external fixator can obtain satisfactory reduction and function.
【Abstract】 Objective To investigate the clinical significances of the thoracic pedicle classification determined by inner cortical width of pedicle in posterior vertebral column resection (PVCR) with free hand technique for the treatment of rigid and severe spinal deformities. Methods Between October 2004 and July 2010, 56 patients with rigid and severe spinal deformities underwent PVCR. A total of 1 098 screws were inserted into thoracic pedicles at T2-12. The inner cortical width of the thoracic pedicle was measured and divided into 4 groups: group 1 (0-1.0 mm), group 2 (1.1-2.0 mm), group 3 (2.1-3.0 mm), and group 4 (gt; 3.1 mm). The success rate of screw-insertion into the thoracic pedicles was analyzed statistically. A new 3 groups was divided according to the statistical results and the success rate of screw-insertion into the thoracic pedicles was analyzed statistically again. And statistical analysis was performed between different types of thoracic pedicles classification for pedicle morphological method by Lenke. Results There were significant differences in the success rate of screw-insertion between the other groups (P lt; 0.008) except between group 3 and group 4 (χ2=2.540，P=0.111). The success rates of screw-insertion were 35.05% in group 1, 65.34% in group 2, and 88.32% in group 3, showing significant differences among 3 groups (P lt; 0.017). According to Lenke classification, the success rates of screw-insertion were 82.31% in type A, 83.40% in type B, 80.00% in type C, and 30.28% in type D, showing no significant differences (P gt; 0.008) among types A, B, and C except between type D and other 3 types (P lt; 0.008). In the present study, regarding the distribution of different types of thoracic pedicles, types I, II a, and II b thoracic pedicles accounted for 17.67%, 16.03%, and 66.30% of the total thoracic pedicles, respectively. The type I, II a, and II b thoracicpedicles at the concave side accounted for 24.59%, 21.13%, and 54.28%, and at the convex side accounted for 10.75%, 10.93%, and 78.32%, respectively. Conclusion A quantification classification standard of thoracic pedicles is presented according to the inner cortical width of the pedicle on CT imaging: type I thoracic pedicle, an absent channel with an inner cortical width of 0-1.0 mm; type II thoracic pedicle, a channel, including type IIa thoracic pedicle with an inner cortical width of 1.1-2.0 mm, and type IIb thoracic pedicle with an inner cortical width more than 2.1 mm. The thoracic pedicle classification method has high prediction accuracy of screw-insertion when PVCR is performed.
Objective To discuss operative strategies of posterior deformity vertebra resection and instrumentation fixation in the treatment of congenital scol iosis or kyphoscol iosis in child and adolescent patients, and to evaluate the surgicalresults. Methods From May 2003 to December 2007, 28 patients with congenital scol iosis or kyphoscol iosis were treatedwith one stage posterior deformity vertebra resection. There were 11 males and 17 females with an average age of 9.6 years (1.5-17.0 years). The locations were thoracic vertebra in 13 cases, thoracolumbar vertebra in 10 cases, and lumbar vertebra in 5 cases. All the patients underwent one stage posterior deformity vertebra resection, fusion and correction with pedicle instrumentation. According to different types of deformities, the patients underwent three different surgeries: hemivertebra resection (13 patients), hemivertebra resection combined contralateral unsegmental resection (7 patients), and total vertebral column resection (8 patients). Based on short or long segmental pedicle instrumentation, deformities were corrected and fixed, in 7 patients with short segmental fixation (group A), in 13 patients with long segmental fixation with hemivertebra resection or combined contralateral unsegmental resection (group B), and in 8 patients with long segmental fixation with total vertebral column resection (group C). The operative duration and the volume of blood loss were recorded, and the correction rate was calculated through measurement of Cobb angles of scol iosis and kyphosis before and after operation. Results The operation time of groups A, B, and C was (98 ± 17), (234 ± 42), and (383 ± 67) minutes, respectively, and the blood loss during operation was (330 ± 66), (1 540 ± 120), and (4 760 ± 135) mL, respectively; showing significant differences among three groups (P lt; 0.05). All patients achieved one-stage heal ing of incision. No deep infection, respiratory failure or deep vein thrombosis occurred. One patient had the signs of ischemical reperfusion injury of spinal cord 6 hours after operation and recovered after 2 weeks of relative therapy in group C; no neurological compl ication occurred in other patients. The mean follow-up period was 32.8 months (24-72 months). Intervertebral rigid fusion was identified from radiological data 6 months after operation according to contiguous callus crossed intervertebral gap and maintenance of correction results. No instrumentation failure occurred. There were significant differences in the Cobb angle between before and after operations (P lt; 0.01). There were significant differences in the corrective rate of scol iosis between groups A, B and group C (P lt; 0.05). Meanwhile, there were significant differences in the corrective rate of kyphosis between groups A, C and group B (P lt; 0.05). Conclusion One-stage posterior deformity vertebra resection has a good capabil ity of correcting congenital scol iosis or kyphoscol iosis on coronal and sagittal plane rel ied on removal deformity origin. It is important to select appropriated strategies on deformity resection and segmental fixation according to different ages and deformity situations of patient.
Objective To analyze the cl inical features of scol iosis associated with Chiari I malformation in adolescent patients, and to explore the val idity and safety of one-stage posterior approach and vertebral column resection for the correction of severe scol iosis. Methods Between October 2004 and August 2008, 17 adolescent patients with scol iosis associated with Chiari I malformation were treated with surgical correction through posterior approach and pedicle instrumentation. There were 9 males and 8 females with an average age of 15.1 years (range, 12-19 years). The MRI scanning showed that 16 of 17 patients had syringomyel ia in cervical or thoracic spinal cord. Apex vertebra of scol iosis were located atT7-12. One-stage posterior vertebral column resection and instrumental correction were performed on 9 patients whose Cobb angle of scol iosis or kyphosis was more than 90°, or who was associated with apparent neurological deficits (total spondylectomy group). Other 8 patients underwent posterior instrumental correction alone (simple correction group). All patients’ fixation and fusion segment ranged from upper thoracic spine to lumbar spine. Results The operative time and the blood loss were (384 ± 65) minutes and (4 160 ± 336) mL in total spondylectomy group, and were (246 ± 47) minutes and (1 450 ± 213) mL in simple correction group; showing significant differences (P lt; 0.05). In total spondylectomy group, coagulation disorder occurred in 1 case, pleural perforation in 4 cases, and lung infection in 1 case. In simple correcction group, pleural perforation occurred in 1 case. These patients were improved after symptomatic treatment. All patients were followed up 24-36 months (32.5 months on average). Bony heal ing was achieved at 6-12 months in total spondylectomy group. No breakage or pull ingout of internal fixator occurred. The angles of kyphosis and scol iosis were significantly improved at 1 week after operation (P lt; 0.01) when compared with those before operation. The correction rates of scol iosis and kyphosis (63.4% ± 4.6% and 72.1% ± 5.8%) in total spondylectomy group were better than those (69.4% ± 17.6% and 48.8% ± 19.3%) in simple correction group. Conclusion Suboccipital decompression before spine deformity correction may not always be necessary in adolescent scol iosis patients associated with Chiari I malformation. In patients with severe and rigid curve or apparente neurological deficits, posterior vertebral column resection would provide the opportunity of satisfied deformity correction and decrease the risk of neurological injury connected with surgical correction.