Zhongguo gu shang = China journal of orthopaedics and traumatology最新文献

Objective: To summarize the reasons and management strategies of reoperation after oblique lateral interbody fusion (OLIF), and put forward preventive measures.

Methods: From October 2015 to December 2019, 23 patients who underwent reoperation after OLIF in four spine surgery centers were retrospectively analyzed. There were 9 males and 14 females with an average age of (61.89±8.80) years old ranging from 44 to 81 years old. The index diagnosis was degenerative lumbar intervertebral dics diseases in 3 cases, discogenic low back pain in 1 case, degenerative lumbar spondylolisthesis in 6 cases, lumbar spinal stenosis in 9 cases and degenerative lumbar spinal kyphoscoliosis in 4 cases. Sixteen patients were primarily treated with Stand-alone OLIF procedures and 7 cases were primarily treated with OLIF combined with posterior pedicle screw fixation. There were 17 cases of single fusion segment, 2 of 2 fusion segments, 4 of 3 fusion segments. All the cases underwent reoperation within 3 months after the initial surgery. The strategies of reoperation included supplementary posterior pedicle screw instrumentation in 16 cases;posterior laminectomy, cage adjustment and neurolysis in 2 cases, arthroplasty and neurolysis under endoscope in 1 case, posterior laminectomy and neurolysis in 1 case, pedicle screw adjustment in 1 case, exploration and decompression under percutaneous endoscopic in 1 case, interbody fusion cage and pedicle screw revision in 1 case. Visual analogue scale (VAS) and Oswestry disability index (ODI) index were used to evaluate and compare the recovery of low back pain and lumbar function before reoperation and at the last follow-up. During the follow-up process, the phenomenon of fusion cage settlement or re-displacement, as well as the condition of intervertebral fusion, were observed. The changes in intervertebral space height before the first operation, after the first operation, before the second operation, 3 to 5 days after the second operation, 6 months after the second operation, and at the latest follow-up were measured and compared.

Results: There was no skin necrosis and infection. All patients were followed up from 12 to 48 months with an average of (28.1±7.3) months. Nerve root injury symptoms were relieved within 3 to 6 months. No cage transverse shifting and no dislodgement, loosening or breakage of the instrumentation was observed in any patient during the follow-up period. Though the intervertebral disc height was obviously increased at the first postoperative, there was a rapid loss in the early stage, and still partially lost after reoperation. The VAS for back pain recovered from (6.20±1.69) points preoperatively to (1.60±0.71) points postoperatively(P<0.05). The ODI recovered from (40.60±7.01)% preoperatively to (9.14±2.66)% postoperatively(P<0.05).

Conclusion: There is a risk of reoperation due to failure after OL

Objective: To explore the safety and effectiveness of the robot-assisted system for transforaminal percutaneous endoscopic in the treatment of lumbar disc herniation with lumbar instability.

Methods: From October 2021 to March 2023, 26 patients with single-segment lumbar disc herniation and lumbar spinal instability were treated with robot-assisted system for transforaminal percutaneous endoscopic. The operation time, intraoperative blood loss, incision length, postoperative drainage volume, postoperative ambulation activity time, postoperative hospitalization time were record. The intervertebral space height and the lumbar lordosis angle before and after surgery were observed and compared. Pain level was evaluated using the visual analogue scale(VAS). The clinical efficacy was evaluated by Oswestry disability index(ODI). The interbody fusion was evaluated by Brantigan Steffee criteria.

Results: All patients successfully completed the operation, the operation time ranged form 105 to 109 min with an average of (150.8±24.1) min. Intraoperative blood loss ranged form 35 to 88 ml with an average of (55.5±16.4) ml. Incision length ranged form 1.4 to 3.5 cm with an average of (2.3±0.8) cm. Postoperative drainage volume ranged form 15 to 40 ml with an average of (28.5±7.8) ml. Postoperative ambulation time ranged form 15 to 30 h with an average of (22.8±4.5) h. Postoperative hospitalization time was 3 to 7 d with an average of (4.2±1.3) d. Total of 26 patients were followed up, the duration ranged from 12 to 16 months with an average of (14.0±1.3) months. The VAS and ODI at 1 week [(2.96±0.72) points, (41.63±4.79)%] and 12 months[(1.27±0.60) points, (13.11±2.45)%] were significantly different from those before surgery[(6.69±0.93) points, (59.12±5.92)%], P<0.01. The height of the intervertebral space (11.95±1.47) mm and lumbar lordosis (57.46±7.59)° at 12 months were significantly different from those before surgery [(6.67±1.20) mm, (44.08±7.79)°], P<0.01. At 12 months after surgery, all patients had no pedicle screw rupture or dislocation of the fusion cage, and the intervertebral fusion was successful. According to Brantigan-Steffee classification, 17 cases were grade D and 9 cases were grade E.

Conclusion: Robot-assisted system for transforaminal percutaneous endoscopic for the treatment of single-segment lumbar disc herniation with lumbar instability improved the accuracy and safety of the operation, and the clinical effect of early follow-up is accurate.

Objective: To investigate global optimisation of anterior acetabular column pinning channels can be achieved based on large density point cloud data.

Methods: Data were collected on the CT scans of the normal pelvis in 40 adults from January 2022 to January 2023, including 22 males and 18 females, aged 20 to 54 years old. Medical imaging data from three of the samples were selected for experimental study. In planning access for anterior acetabular column pinning, to address the issue of whether the current CAD planning methods were advanced or not, four combinations of the same point cloud acquisition channels, different directional line creation software, and the same 3D design and virtual experiment software were proposed: Mimics+Imageware+UG, Mimics+3DReshaper+UG, Mimics+ZEISS Quality Suite+UG and Mimics+Design X+UG, and directional lines created based on the centroid point set and solid point cloud of the secondary pruning model, respectively, and it applied to the planning of the left anterior column pinning channel of the three acetabular samples. The maximum internally connected cylinder without acetabular socket and pubic bone penetration was used as a safe passage for nailing of the anterior acetabular column to evaluate the advancement of each method.

Results: The fitting effect of the directional line was better than that of the unnoised solid point cloud when the central point set with obvious relevant features was selected as the sample points;and the combination of Mimics+Imageware+UG and Mimics+3DReshaper+UG could efficiently and stably obtain the desirable planning results when planning with the central point set, respectively, in the three acetabular samples 1, 2, 3. The maximum internal joint circle diameters obtained in samples 1, 2, and 3 were 10.35 mm, 9.62 mm, and 9.24 mm;and when the directional lines were based on the solid point cloud the combined methods of Mimics+ZEISS Quality Suite+UG and Mimics+Design X+UG were not applicable;whereas the Mimics+3DReshaper+UG the solid point cloud denoising planning method could stably obtain the maximum value of the safe channel for nail placement, and the maximum internal joint circle diameters obtained in acetabular samples 1, 2, and 3 are 10.66 mm, 10.96 mm, and 9.48 mm, respectively.

Conclusion: It is recommended that the nail placement channel planners use robust Mimics+Imageware+UG or Mimics+3DReshaper+UG centre point set planning method, and if there is enough time, it is recommended to use the solid point cloud denoising planning method of Mimics+3DReshaper+UG in order to obtain the maximum value of safe channels for nail placement.

Objective: To compare the safety and clinical efficacy of freehand and 3D printing navigation template assisted screw placement in patients with old odontoid fractures of typeⅡ.

Methods: Total of 38 patients with old odontoid fractures of typeⅡwere treated from November 2018 to December 2022, all of which presented as chronic neck pain. According to the different methods of screw insertion into the pedicle, the patients were divided into a navigation template group and a freehand group. In the navigation template group, there were 17 patients including 9 males and 8 females with an average age of (51.30±13.20) years old, disease duration was (22.18±7.59) months. In the freehand group, there 21 patients including 7 males and 14 females with an average age of (49.46±11.92) years old, disease duration was (19.52±9.17) months. The intraoperative blood loss, operation time, and postoperative drainage output were recorded and compared between two groups. The accuracy of screw placement was evaluated by CT scan. Before operation and 1 year after operation, cervical pain was assessed by visual analogue scale(VAS), neurological changes were evaluated by the Japanese Orthopaedic Association (JOA) score, and the degree of spinal cord injury was assessed by the American Spinal Injury Association (ASIA) injury scale.

Results: All patients were followed up for (25.31±1.21) months. The operation time of template group (112.00±20.48) min had significantly shorter than that of the freehand group(124.29±15.24) min(P<0.05), while there were no significant differences between two groups in terms of intraoperative blood loss, postoperative drainage, and hospital stay(P>0.05). At 1 year after operation, in template group and freehand group, the VAS [(2.88±0.86), (2.90±0.83)] and JOA [(14.94±1.82), (14.62±2.19)] improved with preoperative [VAS(4.71±0.92), (4.86±0.79) and JOA (12.18±2.30), (11.95±2.31)](P<0.05), with no significant difference between two groups (P>0.05). No significant improvement was observed in ASIA grading in either group at 1 year after operation(P>0.05), and there was no significant difference between two groups(P>0.05). The template group had significantly better accuracy of screw placement in the pedicle of the axis than the freehand group (P<0.05), while no significant difference was observed between two groups in the accuracy of screw placement in the pedicle of the atlas (P>0.05).

Conclusion: In the treatment of typeⅡold odontoid fractures with posterior pedicle screw fixation, 3D printing navigation template screw placement can significantly shorten the operation time, achieve similar clinical efficacy as free-hand screw placement, and significantly improve the accuracy of screw placement in the pedicle of the axis.

Objective: To compare the clinical efficacy of the posterior hemipelvectomy of the greater trochanter approach with the standard Kocher-Langenbeck(K-L) approach in the treatment of posterior acetabulum wall fractures and to explore a more optimal approach for the treatment of posterior acetabulum wall fractures.

Methods: Total of 26 patients with posterior acetabulum wall fractures were retrospectively analysed and divided into two groups:the posterior hemipelvectomy of the greater trochanter group (test group) and the standard K-L approach group (control group). In the test group, there were 24 patients including 16 males and 8 females with an average age of (42.00±4.52) years old, the time of injury to surgery was (6.75±1.15) d. In the control group, there were 23 patients including 16 males and 7 females with an average age of (41.00±5.82) years old, the time of injury to surgery was (7.09±1.20) days. The total hospital stay, length of incision, operation time, intraoperative bleeding, postoperative drainage, discharge, fracture reduction quality (Matta criteria), hip abduction muscle strength, hip function (Merle d'Aubigne-Postel score), postoperative complications and the incidence of ectopic ossification were compared.

Results: All cases were followed up for 6 months. There was no significant difference in incision length, intraoperative bleeding and postoperative drainage between two groups(P>0.05). However, the operation time of the test group was shorter than that of the control group (P<0.05). There was no statistically significant difference in fracture reduction and hip function between two groups (P>0.05). The hip abduction muscle strength of test group was better than that of control group(P<0.05). In addition, there was no significant difference in the incidence of postoperative complications and heterotopic ossification between two groups(P>0.05).

Conclusion: Compared with the standard K-L approach, the posterior hemipelvectomy of the greater trochanter approach can shorten the operative time, has better recovery of the postoperative hip abduction muscle strength, exposes the view of the fracture involving the more comminuted posterior acetabulum wall or the fracture of the roof of the socket, improved the rate of fracture anatomical repositioning, provides a new idea for the clinical treatment of posterior acetabulum wall fractures, and allows patients to perform functional exercises at an early stage.

Objective: To investigate the 1 year mortality after hip fractures in super advanced age patients and summarize the death associated risk factors in order to provide basis for targeted intervention countermeasures.

Methods: The clinical data of 332 super advanced age patients with femoral neck or intertrochanteric fractures treated by hip replacement or intramedullary femoral nail fixation from January 2015 to January 2023 were retrospectively analyzed. There were 128 males and 204 females with the mean age of (92.2±2.5) years ranging from 90 to 103 years old. Among them, 92 cases died within 1 year after surgery. Correlation with the occurrence of death on age, gender, body mass index, fracture type, treatment method, timing of operation, preoperative hemoglobin and serum albumin level, operation time, combined medical diseases, pre-injury mobilityand American Society of Anesthesiology(ASA) classification were analyzed. The risk factors of death within 1 year after operation were screened by univariate analysis. The results were entered into the multivariate Logistic regression analysis, screening the high risk factors for 1 year mortality after hip fractures.

Results: The mortality of super advanced age patients with hip fracture within 1 year after surgery accounted for 27.7%(92/332). Univariate analysis showed high body mass index, long interval from injury to surgery, low preoperative serum albumin levels, inability to walk independently before injury, accompanied by heart failure, pulmonary infection, obstructive pulmonary disease, stroke, and a higher proportion of ASA grades Ⅲ-Ⅳ. Multivariate Logistic regression analysis showed preoperative serum albumin below 30g g·L^-1[OR=2.973, 95%CI(2.461, 5.344), P=0.039], inability to walk independently before injury [OR=3.519, 95%CI(2.224, 5.413), P=0.018], heart function grade C-D[OR=4.213, 95%CI(2.952, 6.99), P=0.021], pulmonary infection[OR=3.927, 95%CI(2.187, 7.731), P=0.016] and ASA Ⅲ-Ⅳ[OR=5.124, 95%CI(3.092, 8.235), P=0.032] were the independent risk factors for death within 1 year in super advanced age patients with hip fractures.

Conclusion: Preoperative serum albumin below 30g.L-1, poor preinjury activity, heart function grade C-D, pulmonary infection, and ASA grade Ⅲ-Ⅳ are independent risk factors for postoperative mortality in super advanced age patients with hip fractures.

Pelvic acetabular fractures(PAFs) are one of the most common types of pelvic fractures, mostly high-energy injuries, with complex pelvic acetabular structure and limited surgical methods. The trauma of the acetabular fracture itself and the need for long-term bed rest after surgery cause particularly complicated clinical complications. Venous thromboembolism (VTE) is one of its high incidence and serious complications. This review mainly focuses on VTE after PAFs, and describes the epidemiology, risk factors and prevention measures of VTE, aiming to help improve the prognosis and avoid the occurrence of serious complications.

Objective: To investigate the clinical efficacy of the placement of the main mechanical support points in the early and middle stages of mechanical repair of femoral head necrosis in preventing collapse of the femoral head.

Methods: A retrospective analysis was performed for 17 cases 22 hips of non-traumatic femoral head necrosis in the early and middle stages from June 2018 to June 2019, including 14 males 18 hips and 3 females 4 hips, aged 34 to 47 years old. Among them, 6 cases were hormonal, 8 were alcoholic and 3 were idiopathic. According to China-Japan Friendship Hospital(CJFH) classification, 9 hip were type L1, 8 were L2, 5 were L3. All cases were given dead bone scraping, autologous iliac granules pressed bone grafting, and allogeneic fibula column support treatment. After surgery, Sanqi Jiegu Pill() was administered orally for 3 months. X-rays of both hips were performed after surgery and follow-up, and the clinical efficacy was evaluated by hip Harris score before and after surgery.

Results: All cases were followed up for 24 to 38 months. The Harris score of 22 hips increased from 58 to 77 preoperative to 68 to 94 at the final follow-up. At the final follow-up, 3 hips were excellent, 11 hips were good, 3 hips were acceptable, 5 hips were poor. Two hips of L2 type progressed to ARCO ⅢB stage and continued to be observed, 2 hips of L2 type and 2 hips of L3 type progressed to ARCO Ⅳ stage, and received total hip replacement, and 1 hip infection at 3 months after surgery was given a cement spacer.

Conclusion: Based on CJFH classification, collapse can be predicted to a certain extent according to the area, volume, location and human biological characteristics of osteonecrosis, and the main mechanical support points are found on this basis to prevent collapse.