ObjectiveTo investigate the safety and effectiveness of pedicle screw implantation via vertebral arch-transverse pathway in clinical application by a prospective randomized controlled trial.MethodsTwenty-four patients who were admitted between May 2015 and June 2017 and met the selection criteria for thoracic pedicle screw fixation were included in the study. According to the random number table method, they were divided into the trial group (screw implantation via vertebral arch-transverse pathway) and the control group (traditional screw implantation technology), with 12 patients in each group. There was no significant difference between the two groups in age, gender, cause of injury, injured segment, and the interval between injury and operation (P>0.05). The time of screw implantation was recorded and compared between the two groups. The acceptable rate of screw implantation and the penetration rate of pedicle wall were calculated after operation.ResultsThe time of screw implantation of trial group was (5.08±1.74) minutes, which was significantly shorter than that of control group [(5.92±1.66) minutes], and the difference was significant (t=4.258, P=0.023). Patients in both groups were followed up 1-2 years, with an average of 1.5 years. During the follow-up, no failure of internal fixation occurred. At 1 week after operation, the screw implantation in trial group was rated as gradeⅠin 54 screws, gradeⅡ in 3 screws, and grade Ⅲ in 2 screws, with the acceptable rate of 93.61%. The screw implantation in control group was rated as gradeⅠin 40 screws, grade Ⅱin 10 screws, grade Ⅲ in 8 screws, and grade Ⅳ in 1 screw, with the acceptable rate of 84.75%. There was significant difference in the acceptable rate of screw implantation between the two groups (χ2=3.875, P=0.037). The penetration rate of pedicle wall in trial group was 8.47% (5/59), which was significantly lower than that in the control group [32.20% (19/59); χ2=4.125, P=0.021].ConclusionCompared with the traditional technique, the pedicle screw implantation via vertebral arch-transverse pathway can obtain a good position of the screw canal with higher accuracy and simpler operation.
OBJECTIVE: To discuss the value of anterior operation in fracture-dislocation of connect of cervical vertebrae and thoracic vertebrae. METHODS: From 1997, 21 patients with fracture-dislocation of connect of cervical vertebra and thoracic vertebrae were operated on. The interval between injury and operation was within 24 hours in 4 cases, 2-7 days in 9 cases, 8-14 days in 3 cases and within 4 weeks in 5 cases. The locations were C6,7 in 7 cases, C7 in 9 cases and T1 in 5 cases. The nerves function of spinal of all the cases have different degrees of injury. Classification of Frankel were the following: 3 cases of grade A, 6 cases of grade B, 9 cases of grade C, and 3 cases of grade D. The operative procedure included the following: anterior operation of cervical vertebrae; incision of most fracture vertebral body to decompress; transplantation of ilium bone grafting fusion; and internal fixation of anterior cervical vertebrae with locking-steel. RESULTS: In 21 patients, 1 died of accompanying by pulmonary infection; 20 were followed up 8 months to 3 years with an average of 21 months. All transplanted ilium had fused. The nerve function of spinal cord had recovered in different degrees(2 cases of grade A, 1 case of grade C, 9 cases of grade D and 8 cases of grade E); the turn of vertebral column was normal. No internal fixation failed. CONCLUSION: Anterior operation is a better way to treat fracture-dislocation of connect of cervical vertebrae and thoracic vertebrae with easy operation, less complications, satisfactory reduction of fracture and good stability.
ObjectiveTo observe the clinical efficacy of lesion clearing, decompression and fusing, and fixation with single nail from the anterior way for thoracic vertebra tuberculosis. MethodsFrom January 2008 to September 2011, 42 patients with thoracic vertebra tuberculosis were treated in our hospital. There were 28 males and 14 females with the age between 27 and 63 years old, averaging 45. The course of the disease ranged from 4 to 12 months, averaging 8 months. According to the affected parts and segments, there was 1 case of upper thoracic vertebrae involvement, 20 of inner thoracic spine, 21 of lower thoracic vertebrae, 9 of multiple segments, and 2 of multi-level noncontiguous tuberculosis. All patients accepted preoperative normal anti-tuberculosis drugs for 2 to 4 weeks. After confirming that the anti-tuberculosis treatment was effective, we cleared the lesion, fused by decompression at iliac crest bone graft sites and fixed by single nail from the anterior way. Postoperative regular follow-up was carried out. X ray film was used to detect the fusion, paralysis Frankel classification was adopted to evaluate the function recovery of patients, and visual analog pain score (VAS) was used to assess the relief of patients' symptoms. ResultsAll incisions of the patients were healed by the first intention. There was no recurrence in the tuberculosis focus area. Follow-up was done in forty cases for 12 to 34 months, averaging 23 months. X-ray review showed that the bone graft area turned into osseous fusion in all patients with the fusion time ranging from 10 to 16 months, averaging 13 months. No nail bar system loose or fracture occurred. Paralyzed patients Frankel classification showed that there were 2 A-level, 3 B-level, 9 C-level, 25 D-level, and 3 E-level cases before operation. During the last follow-up, there were no A-level, 1 B-level, 5 C-level, 10 D-level, and 26 E-level cases. Local pain VAS score results showed that preoperative point was 7.82±1.03, and the final follow-up point was 0.52±0.31, with a significant difference (P<0.05). ConclusionLesion clearing, fusion and single nail application from the anterior way is one of the reliable and efficient ways in thoracic vertebra tuberculosis surgery and the results are satisfying.
OBJECTIVE: To discuss the clinical properties, operative results of thoracic spinal stenosis and factors correlating with prognosis. METHODS: From September 1992 to January 2001, 16 patients who suffered from thoracic spinal stenosis caused by degeneration, ossified ligamentum flavum, diffuse idiopathic hyperostosis and trauma, were decompressed by operation. The operative method was selected according to the compressed position of spinal cord. All patients were followed up 6 months to 9 years. The pain severity, ambulatory status and paraplegia index were compared between before operation and after operation. The correlation between prognosis and ages, the length of stenosis and the duration of disease was studied. RESULTS: The results of Wilcoxon Signed Ranks Test show significant difference in pain severity, ambulatory status and paraplegia index between before operation and after operation (P lt; 0.01). The results of partial correlation analyzing show that only the duration of disease was correlated with paraplegia index (P lt; 0.05). CONCLUSION: Thoracic spinal stenosis frequently develops in the lower-thoracic segments in middle and old aged men. Decompression by operation early can achieve a good clinical result. Duration of disease affects the prognosis.
Objective To compare the effectiveness of TiRobot-assisted and C-arm X-ray fluoroscopy assisted percutaneous kyphoplasty (PKP) via pedicle of vertebra in the treatment of osteoporotic vertebral compression fracture (OVCF) of thoracic vertebrae. Methods The clinical data of 85 patients with OVCF of thoracic vertebrae who were admitted between January 2020 and March 2023 and met the selection criteria was retrospectively analyzed including 40 patients (50 vertebrae) undergoing PKP assisted by TiRobot (group A) and 45 patients (50 vertebrae) undergoing PKP assisted by C-arm X-ray fluoroscopy (group B). There was no significant difference in the comparison of baseline data such as gender, age, body mass index, bone mineral density T-value, fracture segment, trauma history, and preoperative numerical rating scale (NRS) score, Oswestry disability index (ODI), and Cobb angle of injured vertebra between the two groups (P>0.05). The effectiveness evaluation indexes of the two groups, including the operation time, the volume of injected cement, the times of fluoroscopies, the length of hospital stay, and the occurrence of postoperative complications were collected and compared. Anteroposterior and lateral X-ray films and CT of the injured vertebra were reviewed at 1 day after operation to observe whether there was cement leakage and to evaluate the distribution of cement in the injured vertebra. Before and after operation, pain was assessed using the NRS score, dysfunction was assessed using the ODI, and vertebral height recovery was assessed by measuring the Cobb angle of the injured vertebrae by X-ray films. Results Both groups of patients successfully completed the operation, the operation time, the volume of injected cement, the times of fluoroscopies, and the length of hospital stay in group A were significantly less than those in group B (P<0.05). The patients in two groups were followed up 4-12 months (mean, 9.6 months). Bone cement leakage occurred in 5 vertebrae in group A and 15 vertebrae in group B after operation, all of which leaked to the intervertebral space and around the vertebral body, and the patients had no obvious clinical symptoms. The difference of bone cement leakage between the two groups was significant (P<0.05). No severe complication such as intraspinal leakage, infection, or vascular embolism was found in the two groups. At 1 day after operation, the distribution index of bone cement in group A was mostly grade Ⅴ, which was well dispersed; while in group B, it was mostly grade Ⅱ and grade Ⅴ; the difference of bone cement distribution index between the two groups was significant (P<0.05). The NRS score, ODI, and Cobb angle of injured vertebra in both groups were significantly improved at 1 day after operation when compared with preoperative ones (P<0.05). There was no significant difference in the difference of the above indexes between the two groups before and after operation (P>0.05). Conclusion TiRobot-assisted unilateral PKP in the treatment of OVCF of thoracic vertebrae is safe and effective, which can reduce the X-ray transmission times during operation, shorten the operation time, reduce the volume of bone cement injection, and thus decrease incidence of bone cement leakage.
目的:探討前路手術治療胸椎轉移瘤的臨床療效、手術方法及手術適應證。方法:2003年11月至2005年11月收治胸椎轉移瘤38例,男21例,女17例;所有患者均伴有不同程度疼痛,伴神經功能障礙29例。結果:術后隨訪6個月,患者疼痛均有不同程度緩解, 視覺類比評分(VAS)由術前平均7.13降至術后平均1.71。術后患者使用止痛藥的級別和用量均明顯下降,其中多數患者(15例)無需再使用止痛藥。伴神經功能障礙29例患者中,術后27例有改善,其中2例Frankel C級和9例Frankel D級患者感覺、運動基本恢復正常。局部腫瘤無復發,內固定器無松動斷裂。結論:前路手術治療胸椎轉移瘤可以充分顯露病灶, 有利于減壓以及重建脊柱穩定性,從而有效控制疼痛、防治神經功能損害,提高生存質量。
ObjectiveTo explore the effectiveness of intertransverse bone graft after debridement and fusion combined with posterior instrumentation in patients with single segmental thoracic tuberculosis. MethodsBetween March 2014 and May 2015, 17 cases of thoracic tuberculosis were treated by the surgery of intertransverse bone graft after debridement and fusion combined with posterior instrumentation. There were 10 males and 7 females with an average age of 48.5 years (range, 18-70 years), and with a mean disease duration of 4 months (range, 1-9 months). The affected segments included T4, 5 in 2 cases, T6, 7 in 5 cases, T7, 8 in 3 cases, T9, 10 in 2 cases, T10, 11 in 4 cases, and T11, 12 in 1 case. The operation time, intraoperative blood loss, and hospitalization time were recorded. Postoperative plain radiography was taken to assess the decompression and internal fixation, and the fusion effect was evaluated by X-ray or CT examination. The erythrocyte sedimentation rate (ESR), C reactive protein (CRP), visual analogue scale (VAS), Oswestry disability index (ODI), and Kyphosis angle were recorded and compared; the nerve function was evaluated by American Spinal Injury Association (ASIA). ResultsThe mean operation time, intraoperative blood loss, and hospitalization time were 184 minutes (range, 165-220 minutes), 231 mL (range, 150-800 mL), and 18 days (range, 12-26 days) respectively. No complication of hematoma or wound dehiscence was found. All patients were followed up 17.9 months on average (range, 9-22 months). No bone graft failure, internal fixation broken, pleural effusion, cerebrospinal fluid leakage, wound infection, fistula formation, and other complications occurred. Satisfactory intervertebral fusion was obtained in all patients at 3-8 months (mean, 5.3 months) after surgery. The ESR, CRP, VAS score, ODI score, and Kyphosis angle were significantly improved at immediate after operation and last follow-up when compared with preoperative ones (P < 0.05), and the ESR, CRP, VAS score and ODI score at last follow-up were significantly better than those at immediate after operation (P < 0.05). At last follow-up, the nerve function was recovered to ASIA grade E from grade C (1 case) and grade D (6 cases). ConclusionIntertransverse bone graft is a reliable, safe, and effective way of bone graft applied to the single segmental thoracic spinal tuberculosis.
Objective To investigate the effectiveness in the treatment of single segment thoracic vertebra tuberculosis by limited decompression combined with epidural absorbable haemostat covering and vertebral plate reconstruction based on one-stage posterior approach, debridement, bone fusion, and internal fixation. Methods Between September 2005 and March 2010, 90 cases of single segment thoracic vertebra tuberculosis were treated by using limited decompression combined with epidural absorbable haemostat covering and vertebral plate reconstruction based on one-stage posterior approach, debridement, bone fusion, and internal fixation in 44 patients (treatment group) and by one-stage posterior approach, bone fusion, and internal fixation in 46 patients (control group). There was no significant difference in gender, age, disease duration, affected segment, Cobb angle, Frankle grade, erythrocyte sedimentation rate (ESR), and Oswestry disability index (ODI) between 2 groups (P gt; 0.05). Results All incisions healed by first intension. All 90 cases were followed up 24-44 months (mean, 38 months). There was no significant difference in ESR between 2 groups at 1 week and 3 months after operation (P gt; 0.05). Postoperative iconography indicated that the bone fusion rate of the treatment group was 100% and no epidural cicatricial tissue or failure of internal fixation was observed, showing significant difference when compared with control group (3 cases having failure of internal fixation) (P=0.032). The Cobb angles were significantly corrected after operation when compared with preoperative angles in 2 groups (P lt; 0.05). At 2 years after operation and at last follow-up, the Cobb angle and correction loss in treatment group were significantly better than those in control group (P lt; 0.05). The ODI and Frankel grade were significantly improved at last follow-up when compared with preoperative ones in 2 groups (P lt; 0.05); the treatment group was significantly better than the control group in the ODI, improvement rate of ODI (P lt; 0.05), and in Frankel grade (Uc=4.368, P=0.000). Conclusion Compared with conventional operation method, it is an ideal operation method to use limited decompression combined with epidural absorbable haemostat covering and vertebral plate reconstruction based on one-stage posterior approach, debridement, bone fusion, and internal fixation for treatment of single segment thoracic vertebra tuberculosis, with minimal wound, less complications, and good function recovery.