Objective To summarize research progress on application of Cup-cage reconstruction in revision of chronic pelvic discontinuity (CPD) in patients undergoing total hip arthroplasty (THA). Methods Relevant literature at home and abroad in recent years was reviewed to summarize the principles of the Cup-cage reconstruction, preoperative patient assessment, intraoperative skills, clinical and radiological effectiveness, limitations, and postoperative complications. Results For the treatment of CPD, the Cup-cage reconstruction achieved long-term acetabular cup bone ingrowth, CPD healing, and biologic fixation of the prosthesis by restoring pelvic continuity. Preoperative evaluation of the surgical site and general condition is necessary. The main intraoperative objectives are to reconstruct pelvic continuity, restore the center of rotation of the hip, and avoid neurovascular injury. Current studies have demonstrated significant clinical and radiological effectiveness as well as acceptable prosthesis survival rates after operation. Nevertheless, there is a lack of evidence regarding the staging of CPD, the optimal surgical approach and internal fixation, and the factors influencing postoperative prosthesis survival remain undefined. Conclusion Cup-cage reconstruction can be an effective treatment for CPD after THA, but there is still a need to explore CPD staging, Cup-cage approach and internal fixation, and influencing factors on prosthesis survival.
Objective To analyze the therapeutic effect of the posterior pedicle screw system combined with interbody fusion cage on lumbarspondylolisthesis. Methods From February 2003 to March 2006, 37 lumbar spondylolisthesis patients were treated with this operation, including21 males and 16 females and aging 3969 years.The affected lumbars were L3(3cases)，L4(23 cases), and L5(11 cases). According to the Meyerdingevaluating system, 12 cases were lassified as degree Ⅰ, 20 cases as degree Ⅱ,and 5 cases as degree Ⅲ. Taillard index, Boxall index, slipping angle, lumbar lordosis angle and intervertebral height index were measured before operation, and 2 weeks and 3 months after operation. Results All patients were followed up 336 months. There were statistically significant differences in Taillard index, Boxall index, slipping angle, lumbar lordosis angle and intervertebral height index between before operation and 2 weeks after operation (P＜0.05),and no statistically significant differences between 2 weeks and 3 months afteroperation(P＞0.05). According to Dewei Zhou’s creterior for scoring, the results were excellent in 27 cases， good in 8 cases，and fair in 2 cases. Theexcellent and good rate was 94.6%. All of the embedded osseous were fused. Thefusing time was from 3 to 8 months (mean 3-9 months). There were no breakageof screw and rod. The position and configuration of the whole cages were good. Conclusion Applying the posterior pedicle screw system combined with interbody fusion cage may achieve synergism in the treatment of lumbar vertebral spondylolisthesis. Above procedure is served as solid internal fixationand offers a satisfactory reduction, and can improve the fusion rate of the spine. So it is an ideal procedure and worthily recommended method for treatment oflumbar vertebral spondylolisthesis.
Spinal fusion is a standard operation for treating moderate and severe intervertebral disc diseases. In recent years, the proportion of three-dimensional printing interbody fusion cage in spinal fusion surgery has gradually increased. In this paper, the research progress of molding technology and materials used in three-dimensional printing interbody fusion cage at present is summarized. Then, according to structure layout, three-dimensional printing interbody fusion cages are classified into five types: solid-porous-solid (SPS) type, solid-porous-frame (SPF) type, frame-porous-frame (FPF) type, whole porous cage (WPC) type and others. The optimization process of three-dimensional printing interbody fusion cage and the advantages and disadvantages of each type are analyzed and summarized in depth. The clinical application of various types of 3D printed interbody fusion cage was introduced and summarized later. Lastly, combined with the latest research progress and achievements, the future research direction of three-dimensional printing interbody fusion cage in molding technology, application materials and coating materials is prospected in order to provide some reference for scholars engaged in interbody fusion cage research and application.
The main magnetic field, generated by the excitation coil of the magnetic induction phase shift technology detection system, is mostly dispersed field with small field strength, and the offset effect needs to be further improved, which makes the detection signal weak and the detection system difficult to achieve quantitative detection, thus the technology is rarely used in vivo experiments and clinical trials. In order to improve problems mentioned above, a new Helmholtz birdcage sensor was designed. Stimulation experiment was carried out to analyze the main magnetic field in aspects of intensity and magnetic distribution, then different bleeding volume and bleeding rates experiments were conducted to compared with traditional sensors. The results showed that magnetic field intensity in detection region was 2.5 times than that of traditional sensors, cancellation effect of the main magnetic field was achieved, the mean value of phase difference of 10 mL rabbit blood was (–3.34 ± 0.21)°, and exponential fitting adjusted R2 between phase difference and bleeding volumes and bleeding rates were both 0.99. The proposed Helmholtz birdcage sensor has a uniform magnetic field with a higher field strength, enable more accurate quantification of hemorrhage and monitored change of bleeding rates, providing significance in magnetic induced technology research for cerebral hemorrhage detection.
Objective To evaluate the security and effectiveness of nano-hydroxyapatite/polyamide 66 (n-HA/PA66) cage in reconstruction of spinal stabil ity after resection of spinal tumor. Methods Between January 2008 and December2009, 11 patients with spinal tumor underwent surgical resection and strut graft with n-HA/PA66 cage. There were 6 males and 5 females with an average age of 44.5 years (range, 16-61 years). The average disease duration was 6.8 months (range, 2-14 months). The locations of lesions included cervical spine (2 cases), thoracic spine (6 cases), and lumbar spine (3 cases). Among them, there were 5 metastatic carcinomas, 2 giant cell tumors, 1 osteoblastsarcoma, 1 chondrosarcoma, and 2 non-Hodgkin lymphoma. According to Frankel criteria for nerve function classification, there were 1 case of grade A, 3 cases of grade B, 2 cases of grade C, 2 cases of grade D, and 3 cases of grade E. Results Incisions healed by first intention in all patients, no operative or postoperative compl ication occurred. Four cases of metastatic carcinoma died of primary disease during 5-9 months after operation. Seven cases were followed up 14.4 months on average (range, 10-18 months). All patients gained significant improvement of the neurological function at 3 months after operation. All cases obtained bone fusion and good spinal stabil ity without displacement and subsidence of the n-HA/PA66 cage. The intervertebral height of the adjacent segments was (110.5 ± 16.1) mm at 3 months after operation and (109.4 ± 16.2 ) mm at the final follow-up, showing significant differenecs when compared with the preoperative height [(97.5 ± 15.4) mm, P lt; 0.05], but no significant difference between 3 months after operation and the final follow-up. In 2 patients undergoing surgery via anterior approach, bilateral pleural effusion on both sides occurred and were cured after closed thoracic drainage. During the follow-up, 2 cases (1 chondrosarcoma and 1 giant cell tumor) relapsed and underwent reoperations. Conclusion n-HA/PA66 cage can provide satisfactory bone fusion and ideal spinal stabil ity without increasing the risk of recurrence and compl ications during the surgical treatment of spinal tumors. It is an idealselection for reconstruction of spinal stability.
The present study is aimed to investigate the early clinical effects of nano-hydroxyapatite/polyamide 66 intervertebral fusion cage (n-HA/PA66 cage) for the treatment of lumbar degenerative diseases. We selected 27 patients with lumbar degenerative diseases who were managed by posterior decompression or reset operation combined with n-HA/PA66 cage intervertebral fusion and internal fixation from August 2010 to January 2012. The oswestry disability index (ODI), low back and leg pain visual analogue score (VAS), and intervertebral height (IH) were evaluated at preoperation, 1 week postoperation and the last follow-up period, respectively. Intervertebral bony fusion was evaluated at the last follow-up time. The patients were followed up for 12-24 months (averaged 19 months). The ODI, VAS and IH were significantly improved at 1 week postoperation and the last follow-up time compared with those at preoperative period (P<0.05). But there was no significant difference between 1 week postoperative and the last follow-up time (P<0.05). Brantigan's standard was used to evaluate fusion at the last follow-up time. There were 19 patients with grade 5 fusion, 8 with grade 4 fusion, with a fusion rate of 100%, and none with grade 1-3 fusions. There was no cage translocation and internal fixation breakage. These results suggested that n-HA/PA66 cage was an ideal biological material in the posterior lumbar interbody fusion and internal fixation operation for treatment of lumbar degenerative diseases. It can effectively maintain the intervertebral height and keep a high rate of bony fusion. The early clinical effect has been satisfactory.
Objective To study the cl inical appl ication of anchoring cervical intervertebral fusion cage (ACIFC) in anterior cervical discectomy with fusion. Methods From November 2006 to June 2007, 21 cases of degenerative cervical disease were treated with anterior cervical discectomy, bone graft by ACIFC and anchoring stators, and 28 ACIFCs were implanted. There were 12 males and 9 females aged 25-68 years old (average 47.9 years old). The course of disease rangedfrom 3 days to15 years (median 2.3 years). There were 7 patients with single-segment cervical spondylosis, 3 with two-segment cervical spondylosis, 2 with single-segment lower cervical spine instabil ity, 4 with single-segment cervical spondylosis and lower cervical spine instabil ity, and 5 with cervical disc herniation. Postoperatively, X-ray films were taken regularly to detect the fusion of bone graft and the intervertebral height of fused segment was measured. The symptoms, signs and cervical functions of patient before operation, shortly after operation and during the follow-up period were evaluated by “40 score” system. And the occurrence of postoperative axial symptom (AS) was assessed with the standard set by Zeng Yan et al. Results All incisions healed by first intention. AS occurred in 1 case 48 hours after operation and was improved from poor to good after symptomatic treatment. No other kind of compl ication was identified or reported during intra-operative and postoperative period. All the cases were followed up for 16-24 months (average 20.5 months), and fusion was reached in all the intervertebral discs. Evaluated by “40 score” system, the average score for the cervical spinal cord function before operation, shortly after operation and during the final follow-up period was 26.2, 30.6, and 35.5 points, respectively, indicating there were significant differences between different time points (P lt; 0.05). During the follow-up period of above 1 year, the average improvement rate was 67.4%. The average intervertebral height before operation, shortly after operation and during the last follow-up period were 1.9, 4.4 and 4.3 mm, respectively, showing there were significant differences between the preoperation and the immediate postoperative and last follow-up periods (P lt; 0.05). No degeneration of adjacent segment was observed during the follow-up period. Conclusion Using ACIFC in bone graft fusion and internal fixation for degenerative cervical disease is convenientand fast, has wide range of indications with satisfying cl inical effect, and can achieve obvious therapeutic effect in restoring and maintaining cervical intervertebral height.
Objective To evluate the clinical outcome of autograftsof ilium and interbody fusion cage or bone morphogenetic protein(BMP)／artificial bone material／ cage in treating lumbar spondylolisthesis. Methods From January 1997 to January 2004，114 patients with lumbar spondylolisthesis were treated with posterior lumbar interbody fusion and pedicle screw fixation． There were 45 males and 69 females with an average age of 43 years ranging from 32 to 61 years. Of 114patients, 85 cases were classified as degree Ⅰ, 24 cases as degree Ⅱ and 5 cases as degree Ⅲ. The patients were divided into three groups accordingto the material used for interbody fusion: autografts of ilium (group A, n=42), interbody fusion cages(group B, n=36), and BMP／artificial bone material／ cage (group C, n=36)．The clinical and radiographic results of the patients were compared among three groups． Results All patients were followed from 13 to 30 months with an average of 15 months． There were no statistically significant differences in surgical time, blood loss, and disc space height of preoperation(P＞0.05) among three groups. No severe complication occurred in the three groups(P＞0.05). The excellent and good rates in groups A，B and C were 81.0％, 80.6％, and 83.3％ respectively, showing no statisticallysignificant difference(P＞0.05)．The fusion rate of group C(97.0%) was significantly higher than those of group A(81.0%) and group B(83.3%) (P＜0.05) after 1 year of operation．And the average loss of disc space height in groups B and C was significantly lower than that in group A(P＜0.05). Conclusion Higher fusion rate and lower loss of disc space height can beobtained in treating lumbar spondylolisthesis with BMP／artificial bone materiel.It is an effective method in the treatment of spondylolisthesis.
Objective To investigate the effectiveness of trans-intervertebral space osteotomy (TIO) combined with cage implantation in treatment of old thoracolumbar compression fracture with kyphosis. Methods A clinical data of 59 patients with old thoracolumbar compression fracture and kyphosis, who met the selection criteria between January 2010 and August 2020, was retrospectively analyzed. Among them, 20 cases underwent TIO combined with cage implantation (group A), 21 patients underwent TIO (group B), and 18 patients underwent pedicle subtraction osteotomy (PSO; group C). There was no significant difference in gender, age, time from injury to operation, fracture segment, and preoperative Cobb angle, average height of functional spinal unit (FSU), sagittal vertical axis (SVA), visual analogue scale (VAS) score, Japanese Orthopedic Association (JOA) score, and Oswestry disability index (ODI) between groups (P>0.05). The operation time, intraoperative blood loss, and postoperative complications were recorded. Imaging review was performed to observe the fusion of the bone graft. Cobb angle, average height of FSU, and SVA were measured. VAS score, JOA score, and ODI were used to evaluate the degree of low back pain and lumbar function. Frankel grading was used to evaluate neurological function. Results The operations of 3 groups were successfully completed. The operation time and intraoperative blood loss were significantly lower in groups A and B than in group C (P<0.05); there was no significant difference between group A and group B (P>0.05). All incisions healed by first intention. Patients in all groups were followed up 23-27 months, with an average of 24.8 months. There was no significant difference in follow-up time between groups (P>0.05). At last follow-up, VAS score, JOA score, ODI, and SVA of 3 groups significantly improved when compared with those before operation (P<0.05), there was no significant difference in the differences of pre- and post-operation between groups (P>0.05). The neurological function grading of 3 groups was Frankel grade E. The Cobb angle and the average height of FSU in 3 groups at immediate and last follow-up significantly improved when compared with preoperative ones (P<0.05), there was no significant difference between immediately after operation and last follow-up (P>0.05). And there were significant differences in above indexes between groups at each time point (P<0.05). At last follow-up, the osteotomy site fused without internal fixation failure or pseudarthrosis formation were observed in 3 groups. ConclusionFor patients with old thoracolumbar compression fractures with kyphosis, the effectiveness of TIO combined with cage implantation is satisfactory. Compared with TIO and PSO, it can obtain more deformity correction degree and less invasive.
ObjectiveTo compare the effectiveness between anterior cervical Zero-profile interbody fusion device (Zero-P) and anterior cervical plate device (plate cage benezech, PCB) for cervical disease. MethodsBetween February 2011 and January 2013, 98 patients with cervical spondylosis who accorded with the inclusion criteria were treated with Zero-P in 49 cases (group A) and with PCB in 49 cases (group B). There was no significant difference in gender, age, disease type, disease duration, and disease segments between 2 groups (P>0.05). The Cobb angle, short-form 36 health survey scale (SF-36 scale), Japanese Orthopedic Association (JOA) score, postoperative dysphagia cases, neck disability index (NDI), and visual analogue scale (VAS) score were compared between 2 groups. ResultsThe operation time and intraoperative blood loss of group A were significantly less than those of group B (t=4.089, P=0.000;t=3.587, P=0.001). The patients were followed up 3-36 months (mean, 18.5 months). No loosening or breaking of internal fixation and bone absorption or collapse occurred in the other patients except 2 patients who suffered from screw loosening at 3 months after operation. Within 6 months after operation, dysphagia occurred in 8 cases (16.33%) of group A and in 13 cases (26.53%) of group B, showing significant difference (χ2=10.616, P=0.001). At last follow-up, JOA score, VAS score, NDI, SF-36 scale, and Cobb angle were significantly improved when compared with preoperative ones in 2 groups (P<0.05);the other indexes of group A were significantly better than those of group B (P<0.05) except SF-36 scale and Cobb angle (P>0.05). The excellent and good rate of JOA score was 81.63% in group A and 71.43% in group B, showing significant difference (χ2=4.346, P=0.037). ConclusionZero-P and PCB can get good results in treatment of cervical disease, but the Zero-P is better than PCB in reducing postoperative dysphagia because less wounds and strong stability.