Objective To evaluate the clinical effect of cannulatedscrew on treatment of femoral neck fracture(FNF). Methods Forty-two FNFpatients were treated by using cannulated screw from January 2001 to December 2005.There were 22males and 20 females with an average age of 41 years (19-59 years). Fracture was caused by traffic accident in 21 cases, by falling from height in 14 cases and by bruise in 7 cases. All cases were fresh fracture. According to Garden criterion for typing, 15 cases were classified as type Ⅱ, 16 cases as type Ⅲ and 11 cases as type Ⅳ . It was 7 hours to 15 days from injury to operation. Results Thepatients were followed up for 1-6 years with an average of 2.5 years. The average fracture union time was 6.5 months. Three patients had ischemic necrosis of femoral head, andloosening and breakage of screw and rob was observed in 1 case. According to Brumback criterion for hip joint function, the result was excellent in 18 cases, good in 20 cases and bad in 4 cases, and the excellent and good rate was 90.4%. Conclusion Cannulated screw fixation is a good method to treat FNF in young adults. It can improve the rate of fracture union and reduce the rate of avascular necrosis of femoral head.
Objective To study the effectiveness of anterolateral C-shaped approach in the treatment of intertrochanteric fracture of the femur in elderly patient by comparing with traditional anterolateral approach. Methods Between April 2010 and November 2011, 66 patients with intertrochanteric fracture of the femur were analyzed retrospectively. Of 66 patients, 37 underwent improved anterolateral C-shaped approach combined with fixation of dynamic hip screw (DHS) (improved group), and 29 underwent traditional anterolateral approach combined with fixation of DHS (conventional group). There was no significant difference in gender, age, injury cause, side, disease duration, fracture type, and complication between 2 groups (P gt; 0.05). The operation time, intraoperative blood loss, postoperative drainage volume, and hospitalization time were recorded; and X-ray films were taken to observe the fracture healing. The hip function was evaluated according to self-established criterion. Results The operation was successfully completed in all patients, and primary healing of incision was achieved. All patients were followed up 12-24 months (mean, 17.8 months). Bone union was achieved in both groups; the fracture healing time was 3-6 months (mean, 4.8 months). No loosening or breaking of internal fixation was observed during follow-up period. The operation time and postoperative drainage volume of improved group were significantly less than those of conventional group (P lt; 0.05); no significant difference was found in intraoperative blood loss and hospitalization days between 2 groups (P gt; 0.05). According to self-established criterion, improved group was significantly better than conventional group in recovery of hip joint motion and function at 6 and 12 months after operation (P lt; 0.05). Conclusion Anterolateral C-shaped approach combined with DHS could minimize muscle injury and scar formation, which is beneficial to surgical exposure and early postoperative rehabilitation.
ObjectiveTo re-evaluate the systematic review and meta-analysis (SR/MAs) of the efficacy of robot-assisted pedicle screw placement. MethodsThe CNKI, VIP, WanFang Data, SinoMed, PubMed, Embase, Cochrane Library, and Web of Science databases were electronically searched to collect SR/MAs of robot-assisted pedicle screw placement from inception to April 28, 2023. Two reviewers independently screened literature, extracted data and then assessed the quality of reports, methodological quality, risk of bias, and the strength of evidence quality by using PRISMA, AMSTAR-Ⅱ, ROBIS, and GRADE tool. ResultsA total of 20 SR/MAs were included. The results of the included studies showed that robot-assisted pedicle screw placement was more accurate and had a lower number of complications compared with freehand pedicle screw placement. The quality of reports, methodology, and evidence for pedicle screw placement efficiency in all SR/MAs were low or extremely low, with a high risk of bias. The main reasons included high heterogeneity of included studies, unclear research methods and selection criteria, and missing key reporting processes. ConclusionRobot-assisted pedicle screw placement may have better clinical efficiency than traditional freehand pedicle screw placement. But the quality of relational SR/MAs is low.
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.
To investigate the effects of augmentation with bone cement on the biomechanics of the dynamic hip screw (DHS) fixation in the intertrochanteric fracture specimen that has a normal bone density.MethodsTwentyfour matched pairs of the embalmed male upper femora (48sides) were used to make the specimens of the intertrochanteric fracture of Type A2. All the specimens were fixed with DHS. The right femur specimen from each pair was fixed by augmentation with DHS (the augmentation group) and the left femur specimen was fixed with the conventional fixation (the control group). Thebiomechanical tests on the bending stiffness and the torsional stiffness were performed with the servohydraulic testing machine in the two groups.ResultsThe maximum load and the maximum torque were 3 852.160 2±143.603 1 N and 15.5±2.6 Nm in the augmentation group and 3 702.966 7±133.860 1 N and 14.7±3.4 Nm in the control group. There was no significant difference in the biomechanical effects between the two groups (P＞0.05). Conclusion The augmenting fixation with bone cement in the intertrochanteric fracture specimen with a normal bone density has no significant effect on the strength of the DHS augmentation or on the overall stability of the fractured bone.
Objective To investigate the effectiveness and the advantage of fixation with percutaneous cannulated screws assisted by robot navigation in the treatment of femoral neck fractures by comparing with the conventional surgery. Methods Between January 2013 and December 2014, 20 patients with femoral neck fracture were treated by internal fixation with percutaneous cannulated screws assisted by robot navigation (navigation group), another 18 patients undergoing conventional surgery with manual positioning were chosen as the control group. There was no significant difference in gender, age, cause of injury, the injury side, time from injury to operation, and the classification of fractures between 2 groups (P > 0.05). The operation time, X-ray fluoroscopy time, blood loss, frequency of guide pin insertion, and healing time were recorded. At 1 week after operation, the parallel degree of screws was measured on the anteroposterior and lateral X-ray films; the Harris score was used to evaluate the hip function. Results All incisions of 2?groups healed by first intention after operation. There was no significant difference in operation time between 2?groups (t= -1.139, P=0.262). The blood loss, frequency of guide pin insertion, and X-ray fluoroscopy time of navigation group were significantly less than those of control group (P < 0.05). There were 2 screws penetrating into the joint cavity in control group. The patients were followed up 12-24 months with an average of 18 months. The navigation group got significantly better parallel degree of screws than control group on the anteroposterior and lateral X-ray films (t=25.021, P=0.000; t=18.659, P=0.000). Fractures healed in all patients of navigation group (100%), and the healing time was (21.8±2.8) weeks; fracture healed in 16 patients of control group (88.9%), and the healing time was (24.0 ± 3.7) weeks. There was no significant difference in healing rate and healing time between 2 groups (χ2=2.346, P=0.126; t=1.990, P=0.055). The Harris score of navigation group (87.1±3.7) was significantly higher than that of control group (79.3±4.7) at last follow-up (t= -5.689, P=0.000). Conclusion Cannulated screw fixation assisted by robot navigation is a good method to treat femoral neck fractures, which has the advantages of more accurate positioning, better hip function recovery, less surgical trauma, and shorter X-ray exposure time.
ObjectiveTo explore the safety and effectiveness of polymethylmethacrylate-augmented screw fixation (PASF) in the treatment of elderly thoracolumbar tuberculosis combined with severe osteoporosis.MethodsThe clinical data of 20 elderly patients with thoracolumbar tuberculosis and severe osteoporosis who underwent PASF after anterior or posterior debridement and bone grafting and met the selection criteria between December 2012 and December 2014 were retrospectively analyzed. There were 8 males and 12 females with an average age of 68.5 years (range, 65-72 years). T value of bone mineral density was ?4.2 to ?3.6, with an average of ?3.9. There were 12 cases of thoracic tuberculosis, 3 cases of thoracolumbar tuberculosis, and 5 cases of lumbar tuberculosis. The diseased segments involved T3-L4, including 11 cases of single-segment disease, 6 cases of double-segment disease, and 3 cases of multi-segment disease. The disease duration was 3-9 months, with an average of 6 months. The preoperative spinal nerve function of the patients was evaluated by the American Spinal Injury Association (ASIA) grading. There were 2 cases of grade A, 5 cases of grade B, 6 cases of grade C, 4 cases of grade D, and 3 cases of grade E. Postoperative imaging examination was used to evaluate the bone graft fusion and paravertebral abscess absorption, and to measure the Cobb angle of the segment to evaluate the improvement of kyphosis. The levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were tested. The visual analogue scale (VAS) score, Oswestry disability index (ODI), and ASIA grading were used to evaluate the effectivreness before operation, at 1 month after operation, and at last follow-up. The clinical cure of tuberculosis was also evaluated.ResultsAll operation successfully completed. The operation time was 154-250 minutes, with an average of 202 minutes; the intraoperative blood loss was 368-656 mL, with an average of 512 mL. All 20 patients were followed up 18-42 months, with an average of 26.8 months. The postoperative pain and symptoms of tuberculosis in all patients relieved, and the paravertebral abscess was absorbed, reaching the cure standard for spinal tuberculosis. All bone grafts fusion achieved within 1 year after operation. Only 1 case had asymptomatic bone cement leakage into the paravertebral veins, and the remaining patients had no serious complications such as bone cement leakage in the spinal canal, pulmonary embolism, and neurovascular injury. At last follow-up, spinal cord nerve function significantly improved when compared with preoperative one. Among them, ASIA grading were 7 cases of grade C, 8 cases of grade D, and 5 cases of grade E, showing significant difference when compared with preoperative one (Z=2.139, P=0.000). VAS score, ODI score, segmental Cobb angle, ESR, and CRP at 1 month after operation and at last follow-up were significantly improved when compared with preoperative ones (P<0.05); there was no significant difference between 1 month after operation and last follow-up (P>0.05). During the follow-up, no complications such as failure of internal fixation, proximal junctional kyphosis, or tuberculosis recurrence occurred.ConclusionFor elderly patients with thoracolumbar tuberculosis and severe osteoporosis, PASF treatment is safe and effective.
Objective To investigate the short-term effectiveness of percutaneous pedicle screw (PPS) guided with photoelectric navigation for thoracolumbar fractures. Methods Between May 2013 and June 2015, the clinical data of 39 patients with thoracolumbar fractures in accordance with the selection criteria were retrospectively analyzed. The patients were divided into photoelectric navigation PPS group (trial group, 20 cases) and C-arm X-ray guidance PPS group (control group, 19 cases). There was no significant difference in gender, age, injury cause, fracture vertebrae, AO classification, operation time after injury, visual analogue scale (VAS) score, and vertebral compression ratio (VCR) between 2 groups (P > 0.05). The operation time, bleeding amount, perspective times, VAS score, and one-time success rate (OSR) of screw placement were recorded; VCR and endplate-screw angle (ESA) were measured; and pedicle-screw relationship (PSR) was assessed by Ringel’s method in radiographic result. Results Differences in operation time and bleeding amount were not significant between 2 groups (P > 0.05); perspective times of control group was significantly more than t hat of trial group (t=-15.658, P=0.000). The OSR of trial group (95.60%, 87/91) was significantly better than that of control group (86.75%, 72/83) (χ2=4.323, P=0.038). The patients were followed up 6-11 months (mean, 7.6 months) in trial group, and 7-11 months (mean, 7.8 months) in control group. No neurovascular complications associated with screw insertion occurred. Difference was not significant in VAS score at 7 days and 6 months after operation between 2 groups (P > 0.05), but VAS scores at 7 days and 6 months were significantly improved when compared with preoperative score in 2 groups (P < 0.05), and significant difference in VAS score was shown between at 7 days and 6 months in 2 groups (P < 0.05). VCR of trial group and control group were significantly improved to 94.75%±5.10% and 92.40%±5.09% at 6 months after operation from preoperative 71.97%±5.66% and 73.50%±5.97% (t=11.865, P=0.000; t=11.359, P=0.000), but there was no significant difference between 2 groups (t=1.442, P=0.158). ESA of trial group and control group were (1.82±1.13)° and (3.36±2.43)° at 6 months after operation, showing significant difference (t=5.421, P=0.000). At 6 months after operation, according to PSR classification, 83 screws rated as grade I, 6 as grade II, and 2 as grade III, and excellent and good rate of screw replacement was 97.80% in trial group; 54 screws were rated as grade I, 19 as grade II, 7 as grade III, and 3 as grade IV, and excellent and good rate of screw replacement was 87.95% in control group; difference was significant between 2?groups (χ2=18.347, P=0.000). Conclusion Application of photoelectric navigation can guide screws placement by the two-dimensional multi pl ane dynamic image, has better accuracy of screws position in thoracolumbar fractures, reduces the introperative X-ray perspective times, maintains good reduction of vertebral body, and achieves satisfactory effectiveness.
Objective To evaluate the effectiveness of three-dimensional (3-D) printing assisting minimally invasive for intraarticular calcaneal fractures with percutaneous poking reduction and cannulate screw fixation. Methods A retrospective analysis was performed of the 19 patients (19 feet) with intraarticular calcaneal fracture who had been treated between March 2015 and May 2016. There were 13 males and 6 females with an average age of 38.2 years (range, 24-73 years). There were 3 open fractures and 16 closed fractures. By Sanders classification, 12 cases were type Ⅱ, 7 cases were type Ⅲ. By Essex-Lopresti classification, 13 cases were tongue type, 6 cases were joint-depression type. The time from injury to surgery was 1-10 days (mean, 4.7 days). A thin slice CT scan was taken of bilateral calcaneus in patients. By using the mirror imaging technique, the contralateral mirror image and the affected side calcaneus model were printed according to 1∶1 ratio. The displacement of fracture block was observed and contrasted, and the poking reduction was simulated. Calcaneal fracture was treated by percutaneous minimally invasive poking reduction and cannulate screw fixation. The B?hler angle and Gissane angle at immediate after operation and last follow-up was measured on X-ray films, and compared with preoperative measurement. The functional recovery was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) scores. Results The operation time was 25-70 minutes (mean, 45 minutes). The intraoperative blood loss was 10-40 mL (mean, 14.5 mL). All the incisions healed by first intention and had no relevant postoperative complications such as skin necrosis, nail tract infection, and osteomyelitis. All the patients were followed up 12-25 months (mean, 14.6 months). All patients obtained fracture healing, and the fracture healing time was 8-14 weeks (mean, 10.3 weeks). No screw withdrawal or breakage occurred during follow-up; only 1 patient with Sanders type Ⅱ fracture, whose calcaneus height was partially lost at 6 weeks after operation, the other patients had no reduction loss and fracture displacement, and no traumatic arthritis occurred. The B?hler angle and Gissane angle at immediate after operation and last follow-up were significantly improved when compared with preoperative ones (P<0.05), but there was no significant difference between at immediate after operation and last follow-up (P>0.05). The AOFAS score was 76-100 (mean, 88.2), and the results were excellent in 10 feet, good in 7, and fair in 2, the excellent and good rate was 89.5%. Conclusion 3-D printing assisting minimally invasive for intraarticular calcaneal fractures with percutaneous poking reduction and cannulate screw fixation can reduce the surgical trauma, improve the quality of reduction and fixation, and make the operation more safe, accurate, and individualized.
Objective? ? To explore the surgical feasibil ity and cl inical outcome of transpedicle screw fixation in treatment of atlantoaxial instabil ity and dislocation. Methods From January 2007 to June 2009, 16 patients with atlantoaxial instabil ity and dislocation were treated with transpedicle screw fixation. There were 13 males and 3 females, with a mean age of 42 years (range, 24-61 years). The transpedicle screw fixation was employed in 5 patients with old odontoid fracture (4 of Anderson type II and 1 of type III), in 4 patients with fresh odontoid fracture, in 4 patients with traumatic disruption of transverse atlantal l igament, and in 3 patients with congenital odontoid disconnection for atlantoaxial instabil ity. All patients had symptoms of cervical pain and l imition of cervical motion, 10 patients compl icated by dyscinesia and hypoesthesia of extremities. The Japanese Orthopaedic Association (JOA) score before operation was from 5 to 13, with an average of 8.5. The image examination showed atlantoaxial instabil ity or dislocation in all patients. Granulated autogenous il ium (20-30 g) was placed onto the surface of the posterior arches of both atlas and axis in some patients with old fracture of odontoid process or disruption of transverse atlantal l igament. Results? The mean operative time and bleeding amount were 1.6 hours (1.2-2.5 hours) and 100 mL (50-200 mL), respectively. All the incision healed by first intension. All patients were followed up for 3-18 months, with an average of 11.5 months. The JOA score 3 months after operation was from 12 to 17, with an average of 14.2. All screws were successfully placed in atlas and axis. No postoperative compl ications such as vertebral artery injury, dural rupture, exacerbation of neurological symptoms, wound infection, and broken srews were observed in 16 cases. Postoperative radiograph and CT showed that only one screw penetrated into vertebral canal, but there was no neurological symptoms. Bony fusion was observed after 6 to 18 months of operation, and atlantoaxial rotational function in all patients restored satisfactorily, but axial rotation was partially lost. Conclusion Transpedicle screw fixation in upper cervical spine for treatment of atlantoaxial instabil ity and dislocation is safe and rel iable