BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with ...BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with no consensus regarding the superiority of any single approach.AIM To compare early postoperative complications after implementing the direct anterior and posterior approaches(PL)for hip hemiarthroplasty after femoral neck fractures.METHODS This is a comparative,retrospective,single-center cohort study conducted at a university hospital.Between March 2008 and December 2018,273 patients(a total of 280 hips)underwent bipolar hemiarthroplasties(n=280)for displaced femoral neck fractures using either the PL(n=171)or the minimally invasive direct anterior approach(DAA)(n=109).The choice of approach was related to the surgeons’practices;the implant types were similar and unrelated to the approach.Dislocation rates and other complications were reviewed after a minimum followup of 6 mo.RESULTS Both treatment groups had similarly aged patients(mean age:82 years),sex ratios,patient body mass indexes,and patient comorbidities.Surgical data(surgery delay time,operative time,and blood loss volume)did not differ significantly between the groups.The 30 d mortality rate was higher in the PL group(9.9%)than in the DAA group(3.7%),but the difference was not statistically significant(P=0.052).Among the one-month survivors,a significantly higher rate of dislocation was observed in the PL group(14/154;9.1%)than in the DAA group(0/105;0%)(P=0.002).Of the 14 patients with dislocation,8 underwent revision surgery for recurrent instability(posterior group),and one of them had 2 additional procedures due to a deep infection.The rate of other complications(e.g.,perioperative and early postoperative periprosthetic fractures and infection-related complications)did not differ significantly between the groups.CONCLUSION These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate(<1%)than the PL.展开更多
BACKGROUND Spinal meningiomas(SMs)are common benign tumors that are typically treated with surgical resection.The choice of surgical approach may vary depending on the location of dural attachment of the SM,with a pos...BACKGROUND Spinal meningiomas(SMs)are common benign tumors that are typically treated with surgical resection.The choice of surgical approach may vary depending on the location of dural attachment of the SM,with a posterior approach being the traditional preference.However,there is limited research available on the impact of dural attachment location on outcomes following posterior approach for SM resection.The average age of the included 34 patients’(10 males and 24 females)age was 62.09 years.Mean follow-up duration was 22.65 months.The location of SM was the thoracic spine in 32 cases,with only 2 in the cervical spine.On average,intraoperative blood loss was 520.59 mL,and operating time was 176.76 minutes.Thirty three cases had successful outcomes while only 1 experienced an unexpe-cted outcome.The tumor recurrence rate was 2.9%.After surgery,there were 3 cases of cerebral spinal fluid leakage,1 case of pneumonia,and 1 case of urinary tract infection.Dural attachments were predominantly found dorsal or dorso-lateral(13 cases),followed by ventral or ventrolateral(14 cases),and lateral(7 cases).The outcomes among these subgroups were similar.CONCLUSION The posterior approach for SM resection is safe and effective,yielding comparable surgical and neurological outcomes regardless of the dural attachment location.展开更多
The differences in complication rates between the direct anterior and posterior approaches for hemiarthroplasty in elderly patients with femoral neck fractures are not yet fully understood.Dislocation,a severe complic...The differences in complication rates between the direct anterior and posterior approaches for hemiarthroplasty in elderly patients with femoral neck fractures are not yet fully understood.Dislocation,a severe complication associated with increased mortality and often requiring additional surgery,may occur less frequently with the direct anterior approach compared to the posterior approach.Careful consideration of patient demographics is essential when planning the surgical approach.Future research in this area should focus on robust randomized controlled trials involving elderly patients recovering from femoral neck fractures.展开更多
We read and discussed the study entitled“Complication rates after direct anterior vs posterior approach for Hip Hemiarthroplasty in elderly individuals with femoral neck fractures”with great interest.The authors hav...We read and discussed the study entitled“Complication rates after direct anterior vs posterior approach for Hip Hemiarthroplasty in elderly individuals with femoral neck fractures”with great interest.The authors have done justice to the topic of comparison of anterior and posterior surgical approaches for bipolar hemiarthroplasty which has been an everlasting debate in the existing literature.However,there are certain aspects of this study that need clarification from the authors.展开更多
BACKGROUND The anatomical features of the atlantoaxial spine increase the difficulty of complete and safe removal of atlantoaxial intradural extramedullary(IDEM)tumors.Studies concerning surgical interventions via a p...BACKGROUND The anatomical features of the atlantoaxial spine increase the difficulty of complete and safe removal of atlantoaxial intradural extramedullary(IDEM)tumors.Studies concerning surgical interventions via a posterior approach are limited.AIM To investigate the safety and efficacy of atlantoaxial IDEM tumor resection using a one-stage posterior approach.METHODS We retrospectively analyzed clinical databases for one-stage atlantoaxial IDEM tumor resection via a posterior approach between January 2008 and January 2018.The analyzed data included tumor position,histopathological type,pre-and postoperative Japanese Orthopedic Association(JOA)scores and Nurick grades,postoperative complication and recurrence status.RESULTS A total of 13 patients who underwent C1-C2 Laminectomy and/or unilateral facetectomy via the posterior approach were enrolled in the study.In all cases reviewed,total tumor resection and concomitant C1-C2 fusion were achieved.The average follow-up was 35.3±6.9 mo(range,26-49 mo).A statistically significant difference was noted between the preoperative JOA score(11.2±1.1)and the score at the last final follow-up(15.6±1.0)(P<0.05).A statistically significant difference was noted between the preoperative Nurick grade(2.3±0.9)and that at the last follow-up(1.2±0.4)(P<0.05).However,no statistically significant difference was noted between the preoperative and last follow-up C1-2 Cobb angle and C2-7 Cobb angle(P>0.05).No mortalities,severe complications or tumor recurrence were observed during the follow-up period.CONCLUSION Total resection of atlantoaxial IDEM tumors is feasible and effective via a posterior approach.Surgical reconstruction should be considered to avoid iatrogenic kyphosis and improve spinal stability and overall clinical outcomes.展开更多
Objective: to study and analyze the clinical value of posterolateral anterior spinal canal decompression combined with injured vertebral internal fixation in the treatment of thoracolumbar burst fracture. Methods: for...Objective: to study and analyze the clinical value of posterolateral anterior spinal canal decompression combined with injured vertebral internal fixation in the treatment of thoracolumbar burst fracture. Methods: forty patients with thoracolumbar burst fractures admitted to our hospital from April 2018 to December 2020 were randomly divided into study group and control group with 20 cases in each group. The control group was treated with short-segment minimally invasive internal fixation combined with injured vertebral bone graft, and the study group was treated with posterior approach anterior spinal canal decompression combined with injured vertebral internal fixation. The perioperative conditions, postoperative vertebral height, endplate angle and bony fusion of the two groups were evaluated and compared. Results: the operation time of the study group was shorter than that of the control group, and the amount of hemorrhage was less than that of the control group. At the stage of 12 months after operation, the height of the vertebral body in the study group was higher than that of the control group, and the endplate angle was smaller than that of the control group. The difference was statistically significant (P < 0.05). There was no significant difference in the osseous fusion between the two groups (P > 0.05). Conclusion: posterior anterolateral spinal canal decompression combined with internal fixation for thoracolumbar burst fractures has less intraoperative bleeding, which can reduce the risk of vertebral height loss and vertebral deformity on the basis of ensuring the effect of bony fusion.展开更多
Objective To investigate the operation key points,instrument improvement and shortterm effects in total en bloc spondylectomy (TES) via a single posterior approach for thoracic and lumbar tumors.Methods A series of mo...Objective To investigate the operation key points,instrument improvement and shortterm effects in total en bloc spondylectomy (TES) via a single posterior approach for thoracic and lumbar tumors.Methods A series of modified展开更多
Presacral tumors are rare,but can comprise a great variety of histological types.Congenital tumors are the most common.Once the diagnosis is established,surgical resection is essential because of the potential for mal...Presacral tumors are rare,but can comprise a great variety of histological types.Congenital tumors are the most common.Once the diagnosis is established,surgical resection is essential because of the potential for malignancy or infection.Previous biopsy is not necessary or may be even harmful.To decide the best surgical approach(abdominal,sacral or combined) an individual and multidisciplinary analysis must be carried out.We report three cases of cystic presacral masses in which a posterior approach(Kraske procedure) enabled complete resection,the only way to decrease local recurrence.All patients had a satisfactory recovery.A brief overview of retrorectal tumors is presented,focusing on classification,clinical presentation,diagnosis and surgical management.展开更多
Background: Supracondylar fractures of the humerus are among the most common type of pediatric fractures. The outcome of severely displaced supracondylar fracture of the humerus in children subjected to wide controver...Background: Supracondylar fractures of the humerus are among the most common type of pediatric fractures. The outcome of severely displaced supracondylar fracture of the humerus in children subjected to wide controversies in term of safety, functional and cosmetic outcome. Closed reduction and percutaneous pinning is now considered as the gold standard rule, but open reduction still applicable in certain cases where intraoperative imaging is not available, in comminuted lateral column fractures and uneducable fractures. Aim of the Study: To compare the outcome (functional and cosmetic) of anterior (Henry) approach with the posterior (Campbell) approach used in two groups of patients’ sustained displaced supracondylar fractures. Patients and Methods: This prospective study was performed on 48 pediatric patients who were been admitted to the Emergency Hospital in Sulaimani province sustained displaced supracondylar humeral fractures and treated during the period from the first of October 2009 to the thirty-one of January 2011. The study included 28 boys, 20 girls;their mean age was 7.5 years;their ages range 2 - 13 years. We used the modified Gartland classification to assess the fractures displacement and only Gartland type II B and III were included and managed operatively by open reduction and internal fixation with 2 crossed K-wires. Follow up continued for 6 months and the results finally assessed using Flynn’s criteria. Results: According to the criteria of Flynn et al., 20 patients (83.3%) treated by the anterior approach had excellent functional results while 4 patients (16.7%) had good functional results. While those treated by the posterior approach, 16 patients (66.6%) had excellent functional results, 6 patients (25%) had good results and 2 (8.3%) patients had fair outcome. Cosmetic results were excellent in 22 patients in the anterior approach group and 20 patients in the posterior approach group. Conclusion: Posterior Campbell approach is simpler than anterior Henry approach, but it creates additional soft tissue damage that can affect the circulatory status and hence possible osteonecrosis of the trochlea and a higher percentage of limitation in joint mobility. While the anterior approach is technically more demanding, but it gives better functional results.展开更多
Background Cervicothoracic junction spinal tuberculosis （CJST） in children is uncommon, especially when accompanied by a huge abscess. However, its consequences can be severe. Because of the special anatomic locatio...Background Cervicothoracic junction spinal tuberculosis （CJST） in children is uncommon, especially when accompanied by a huge abscess. However, its consequences can be severe. Because of the special anatomic location of the cervicothoracic junction, surgical treatment is difficult and rarely reported. The aim of this clinical study was to assess the effectiveness of combined anterior and posterior approaches for focal debridement, decompression, allografting and anterior instrumentation in the treatment of CJST in children. Methods Ten pediatric CJST patients underwent focal debridement and cord decompression through combined anterior and posterior approaches. Then an appropriate allograft and titanium plate were applied to reconstruct the spine. The patients were asked to wear head-neck-chest braces for six months and received regular anti-tubercular drugs therapy for 12 months. Results The patients were followed-up for an average of 26 months （range, 15-32 months）. There was no recurrent tuberculous infection. The bone grafts incorporated well and the instrumentation was stable. Cervical and thoracic kyphosis was successfully corrected from 40° （range, 30-52°） before the operation to 18° （range, 12-26°） post-operation. Neurological function was improved in all patients. Conclusions Combined anterior and posterior approaches for focal debridement, decompression, bone allografting and anterior instrumentation provided an effective means of treatment in children of CJST with a huge abscess in the posterior part of the vertebral body.展开更多
Objective: To treat injury of the lower cervical spine C6 to C7 with cervical lateral mass plates and T1 pedicle screws through posterior approach. Methods: The data of 8 patients with lower cervical spine C6 or C7 in...Objective: To treat injury of the lower cervical spine C6 to C7 with cervical lateral mass plates and T1 pedicle screws through posterior approach. Methods: The data of 8 patients with lower cervical spine C6 or C7 injury （6 patients with fracture and dislocation in C6 and C7 and 2 with fracture in C7） were analyzed retrospectively in this study. For the preoperative American Spinal Injury Association （ASIA） classification, Grade C was found in 3 cases and Grade D in 5 cases. Screws were placed on the lateral masses and the first thoracic pedicle with Margerl technique. Lamina or facet bone allografting was used to achieve a long-term stability. Results: All the 8 patients were followed up for 5-37 months （mean: 15 months）. No operative death occurred. There were no examples of aggravation of spinal cord injury or vertebral artery injury, cerebrospinal fluid leak, nerve roots injury, screw malposition or back-out, loose of alignment or implant failure. Clinical symptoms and ASIA classification were improved in all the patients. Postoperative MRI scanning confirmed the satisfactory screw placement in all the cases. Conclusions: Lateral mass plates and pedicle screws through posterior approach are safe and beneficial for patients with lower cervical spine C6 or C7 injury.展开更多
[Objective]This study was designed to describe the fracture patterns and early results of operations of posterior Pilon fractures through a posterolateral approach.[Method]This study consisted of 14 cases,10 males and...[Objective]This study was designed to describe the fracture patterns and early results of operations of posterior Pilon fractures through a posterolateral approach.[Method]This study consisted of 14 cases,10 males and 4 females with the mean age of 47 years(range,28-63 years).The causes were traffic accident in 2,falling in 6 and sprain injuries in 6 cases.The duration from injury to operation was 7-14 days.Including 12 cases combined with distal fibula fracture and3 cases with medial malleolus fracture.There were 3 posterior dislocation fracture.All cases were treated with open reduction and internal fixation(ORIF).[Result]A consistent fracture pattern was identified with a primary,inferiorly posterior Pilon fracture that likely occur through a combined rotational and axial load mechanism.The average duration of follow-up was 26(range,24-37)months.The postoperation average of American Orthopedic Foot Ankle Society score(AOFAS)was 92points which was much higher than before operation.Anatomical reduction were obtained in all cases.Two complications(1wound superficial infection and 1 sural cutaneous nerve injury)were all managed nonoperatively.[Conclusion]Posterior Pilon fractures form a consistent pattern.They can be successfully managed through a posterolateral approach with direct reduction and buttress fixation of articular fragments.展开更多
AIM:To study our novel caudal approach laparoscopic posterior-sectionectomy with parenchymal transection prior to mobilization under laparoscopy-specific view.METHODS:Points of the procedure are:(1) Patients are put i...AIM:To study our novel caudal approach laparoscopic posterior-sectionectomy with parenchymal transection prior to mobilization under laparoscopy-specific view.METHODS:Points of the procedure are:(1) Patients are put in left lateral position and posterior sector is not mobilized;(2) Glissonian pedicle of the sector is encircled and clamped extra-hepatically and divided afterward during the transection;(3) Dissection of inferior vena cava(IVC) anterior wall behind the liver is started from caudal.Simultaneously,liver transection is performed to search right hepatic vein(RHV) from caudal;(4) Liver transection proceeds to the bifurcation of the vessels from caudal to cranial,exposing the surfaces of IVC and RHV.Since the remnant liver sinks down,the cutting surface is well-opend;and(5) After the completion of transection,dissection of the resected liver from retroperitoneum is easily performed using the gravity.This approach was performed for a 63 years old woman with liver metastasis close to RHV.RESULTS:RHV exposure is required for R0 resection of the lesion.Although the cutting plane is horizontal in supine position and the gravity obstructs the exposure in the small subphrenic space,the use of specific characteristics of laparoscopic hepatectomy,such as the good vision for the dorsal part of the liver and IVC and facilitated dissection using the gravity with the patient positioning,made the complete RHV exposure during the liver transection easy to perform.The operation time was 341 min and operative blood loss was 1356 mL.Her postoperative hospital stay was uneventfull and she is well without any signs of recurrences 14 mo after surgery.CONCLUSION:The new procedure is feasible and useful for the patients with tumors close to RHV and the need of the exposure of RHV.展开更多
Posterior malleolus fractures are quite common and usually result from rotational ankle injuries. For the management of posterior malleolus fractures, more studies are still required, though it is already well-recogni...Posterior malleolus fractures are quite common and usually result from rotational ankle injuries. For the management of posterior malleolus fractures, more studies are still required, though it is already well-recognized for medial and lateral structure. Therefore, fracture of posterior malleolus is striking subject of study among orthopedic surgeons. Most orthopedic surgeons recommend fixing the posterior malleolus fracture if it is larger than 25% to 33% of the distal articular surface. Further attention is required for the reduction and fixation of fractures involving posterior malleolus. Several approaches and methods for fixation of posterior malleolus have been defined in the literature. Previously, the most common method of fixation of the posterior malleolus is by indirect reduction and antero-posterior screws, it is minimally invasive, the anterior incision does not allow satisfactory visualization of the fragment, so good anatomical reduction is difficult to achieve thorough this approach. Operative management goals to reach a stable ankle with maximal function, decrease the risk of post-traumatic degenerative changes, and diminish the risk of complication. Nowadays, posterolateral approach is gaining the popularity due to adequate visualization and accurate anatomic reduction.展开更多
Objective To investigate the feasibility and surgical effects of posterior articular process approach for the treatment of L1-L3 lumbar disc herniation.Methods A retrospective study,of17patients with upper lumbar inte...Objective To investigate the feasibility and surgical effects of posterior articular process approach for the treatment of L1-L3 lumbar disc herniation.Methods A retrospective study,of17patients with upper lumbar intervertebml disc展开更多
Objective To evaluate the feasibility,safety and efficacy of surgical treatment of the thoracic and thoracolumbar disc herniations through the posterior far lateral approach.Methods From April 2005 to June 2010,24 con...Objective To evaluate the feasibility,safety and efficacy of surgical treatment of the thoracic and thoracolumbar disc herniations through the posterior far lateral approach.Methods From April 2005 to June 2010,24 consecutive patients展开更多
[目的]比较Wiltse入路与后正中入路Dynesys动态稳定系统治疗腰椎退变性疾病的临床疗效。[方法]回顾性分析2017年9月—2022年6月本院收治的Dynesys动态稳定系统固定手术治疗的90例腰椎退变性疾病患者的临床资料,按照医患沟通结果将其分...[目的]比较Wiltse入路与后正中入路Dynesys动态稳定系统治疗腰椎退变性疾病的临床疗效。[方法]回顾性分析2017年9月—2022年6月本院收治的Dynesys动态稳定系统固定手术治疗的90例腰椎退变性疾病患者的临床资料,按照医患沟通结果将其分为两组,61例采用后正中小切口经双侧肌间隙入路(Wiltse组);29例采用常规显露单节段后正中入路(后正中组)。比较两组围手术期指标、随访和影像资料。[结果]两组患者均顺利完成手术,未发生严重手术并发症。Wiltse组术中出血量[(114.0±51.6) mL vs (149.3±54.6) mL, P=0.003]、术后引流量[(64.4±16.1) mL vs (173.1±26.8) mL, P<0.001]、下地行走时间[(3.0±1.2) d vs (4.0±1.8) d, P=0.003]、住院时间[(7.0±1.2) d vs (8.0±1.5) d, P=0.012]均显著少于后正中组。两组患者均获得超过12个月的随访,Wiltse组恢复完全负重活动时间[(32.5±3.0) d vs (38.2±4.5) d, P<0.001]显著早于后正中组。随时间推移,两组腰痛VAS、腿痛VAS、ODI评分均显著减少(P<0.05)。术后1周及术后1个月,Wiltse组腰痛VAS评分[(2.6±1.5) vs (4.0±1.9), P<0.001;(1.9±1.3) vs (3.0±1.5), P<0.001]、JOA评分[(16.7±1.1) vs (15.5±1.2), P<0.001;(21.0±1.1) vs (18.5±0.7), P<0.001]均显著优于后正中组。影像方面,Wiltse组在L4[(27.1±4.1)°vs (22.6±4.2)°, P<0.001]、L5[(26.4±4.1)°vs (21.5±4.5)°, P<0.001]、S1[(20.4±3.4)°vs (18.1±3.8)°, P<0.001]螺钉水平置入角度均显著大于后正中组。两组置钉准确率的差异无统计学意义(P>0.05)。与术前相比,术后3个月及末次随访时,两组手术节段ROM、椎管占位率均显著减小(P<0.05),椎间隙高度和腰椎前凸角无显著变化(P>0.05)。相应时间点,两组间上述影像指标的差异均无统计学意义(P>0.05)。[结论] Wiltse入路和传统后正中入路在Dynesys稳定系统治疗腰椎退变性疾病中疗效相同,但Wiltse入路术中肌肉损伤小、出血少、螺钉置入位置更理想,术后引流量少、疼痛轻,更符合脊柱微创外科理念。展开更多
基金This study was reviewed and approved by the Ethics Committee of the HUB-Hospital Erasme.
文摘BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with no consensus regarding the superiority of any single approach.AIM To compare early postoperative complications after implementing the direct anterior and posterior approaches(PL)for hip hemiarthroplasty after femoral neck fractures.METHODS This is a comparative,retrospective,single-center cohort study conducted at a university hospital.Between March 2008 and December 2018,273 patients(a total of 280 hips)underwent bipolar hemiarthroplasties(n=280)for displaced femoral neck fractures using either the PL(n=171)or the minimally invasive direct anterior approach(DAA)(n=109).The choice of approach was related to the surgeons’practices;the implant types were similar and unrelated to the approach.Dislocation rates and other complications were reviewed after a minimum followup of 6 mo.RESULTS Both treatment groups had similarly aged patients(mean age:82 years),sex ratios,patient body mass indexes,and patient comorbidities.Surgical data(surgery delay time,operative time,and blood loss volume)did not differ significantly between the groups.The 30 d mortality rate was higher in the PL group(9.9%)than in the DAA group(3.7%),but the difference was not statistically significant(P=0.052).Among the one-month survivors,a significantly higher rate of dislocation was observed in the PL group(14/154;9.1%)than in the DAA group(0/105;0%)(P=0.002).Of the 14 patients with dislocation,8 underwent revision surgery for recurrent instability(posterior group),and one of them had 2 additional procedures due to a deep infection.The rate of other complications(e.g.,perioperative and early postoperative periprosthetic fractures and infection-related complications)did not differ significantly between the groups.CONCLUSION These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate(<1%)than the PL.
文摘BACKGROUND Spinal meningiomas(SMs)are common benign tumors that are typically treated with surgical resection.The choice of surgical approach may vary depending on the location of dural attachment of the SM,with a posterior approach being the traditional preference.However,there is limited research available on the impact of dural attachment location on outcomes following posterior approach for SM resection.The average age of the included 34 patients’(10 males and 24 females)age was 62.09 years.Mean follow-up duration was 22.65 months.The location of SM was the thoracic spine in 32 cases,with only 2 in the cervical spine.On average,intraoperative blood loss was 520.59 mL,and operating time was 176.76 minutes.Thirty three cases had successful outcomes while only 1 experienced an unexpe-cted outcome.The tumor recurrence rate was 2.9%.After surgery,there were 3 cases of cerebral spinal fluid leakage,1 case of pneumonia,and 1 case of urinary tract infection.Dural attachments were predominantly found dorsal or dorso-lateral(13 cases),followed by ventral or ventrolateral(14 cases),and lateral(7 cases).The outcomes among these subgroups were similar.CONCLUSION The posterior approach for SM resection is safe and effective,yielding comparable surgical and neurological outcomes regardless of the dural attachment location.
文摘The differences in complication rates between the direct anterior and posterior approaches for hemiarthroplasty in elderly patients with femoral neck fractures are not yet fully understood.Dislocation,a severe complication associated with increased mortality and often requiring additional surgery,may occur less frequently with the direct anterior approach compared to the posterior approach.Careful consideration of patient demographics is essential when planning the surgical approach.Future research in this area should focus on robust randomized controlled trials involving elderly patients recovering from femoral neck fractures.
文摘We read and discussed the study entitled“Complication rates after direct anterior vs posterior approach for Hip Hemiarthroplasty in elderly individuals with femoral neck fractures”with great interest.The authors have done justice to the topic of comparison of anterior and posterior surgical approaches for bipolar hemiarthroplasty which has been an everlasting debate in the existing literature.However,there are certain aspects of this study that need clarification from the authors.
基金the National Natural Science Foundation of China,No.81860406Guangxi Natural Science Foundation,No.2018GXNSFAA281127Medical Excellence Award Funded by the Creative Research Development Grant from The First Affiliated Hospital of Guangxi Medical University.
文摘BACKGROUND The anatomical features of the atlantoaxial spine increase the difficulty of complete and safe removal of atlantoaxial intradural extramedullary(IDEM)tumors.Studies concerning surgical interventions via a posterior approach are limited.AIM To investigate the safety and efficacy of atlantoaxial IDEM tumor resection using a one-stage posterior approach.METHODS We retrospectively analyzed clinical databases for one-stage atlantoaxial IDEM tumor resection via a posterior approach between January 2008 and January 2018.The analyzed data included tumor position,histopathological type,pre-and postoperative Japanese Orthopedic Association(JOA)scores and Nurick grades,postoperative complication and recurrence status.RESULTS A total of 13 patients who underwent C1-C2 Laminectomy and/or unilateral facetectomy via the posterior approach were enrolled in the study.In all cases reviewed,total tumor resection and concomitant C1-C2 fusion were achieved.The average follow-up was 35.3±6.9 mo(range,26-49 mo).A statistically significant difference was noted between the preoperative JOA score(11.2±1.1)and the score at the last final follow-up(15.6±1.0)(P<0.05).A statistically significant difference was noted between the preoperative Nurick grade(2.3±0.9)and that at the last follow-up(1.2±0.4)(P<0.05).However,no statistically significant difference was noted between the preoperative and last follow-up C1-2 Cobb angle and C2-7 Cobb angle(P>0.05).No mortalities,severe complications or tumor recurrence were observed during the follow-up period.CONCLUSION Total resection of atlantoaxial IDEM tumors is feasible and effective via a posterior approach.Surgical reconstruction should be considered to avoid iatrogenic kyphosis and improve spinal stability and overall clinical outcomes.
文摘Objective: to study and analyze the clinical value of posterolateral anterior spinal canal decompression combined with injured vertebral internal fixation in the treatment of thoracolumbar burst fracture. Methods: forty patients with thoracolumbar burst fractures admitted to our hospital from April 2018 to December 2020 were randomly divided into study group and control group with 20 cases in each group. The control group was treated with short-segment minimally invasive internal fixation combined with injured vertebral bone graft, and the study group was treated with posterior approach anterior spinal canal decompression combined with injured vertebral internal fixation. The perioperative conditions, postoperative vertebral height, endplate angle and bony fusion of the two groups were evaluated and compared. Results: the operation time of the study group was shorter than that of the control group, and the amount of hemorrhage was less than that of the control group. At the stage of 12 months after operation, the height of the vertebral body in the study group was higher than that of the control group, and the endplate angle was smaller than that of the control group. The difference was statistically significant (P < 0.05). There was no significant difference in the osseous fusion between the two groups (P > 0.05). Conclusion: posterior anterolateral spinal canal decompression combined with internal fixation for thoracolumbar burst fractures has less intraoperative bleeding, which can reduce the risk of vertebral height loss and vertebral deformity on the basis of ensuring the effect of bony fusion.
文摘Objective To investigate the operation key points,instrument improvement and shortterm effects in total en bloc spondylectomy (TES) via a single posterior approach for thoracic and lumbar tumors.Methods A series of modified
文摘Presacral tumors are rare,but can comprise a great variety of histological types.Congenital tumors are the most common.Once the diagnosis is established,surgical resection is essential because of the potential for malignancy or infection.Previous biopsy is not necessary or may be even harmful.To decide the best surgical approach(abdominal,sacral or combined) an individual and multidisciplinary analysis must be carried out.We report three cases of cystic presacral masses in which a posterior approach(Kraske procedure) enabled complete resection,the only way to decrease local recurrence.All patients had a satisfactory recovery.A brief overview of retrorectal tumors is presented,focusing on classification,clinical presentation,diagnosis and surgical management.
文摘Background: Supracondylar fractures of the humerus are among the most common type of pediatric fractures. The outcome of severely displaced supracondylar fracture of the humerus in children subjected to wide controversies in term of safety, functional and cosmetic outcome. Closed reduction and percutaneous pinning is now considered as the gold standard rule, but open reduction still applicable in certain cases where intraoperative imaging is not available, in comminuted lateral column fractures and uneducable fractures. Aim of the Study: To compare the outcome (functional and cosmetic) of anterior (Henry) approach with the posterior (Campbell) approach used in two groups of patients’ sustained displaced supracondylar fractures. Patients and Methods: This prospective study was performed on 48 pediatric patients who were been admitted to the Emergency Hospital in Sulaimani province sustained displaced supracondylar humeral fractures and treated during the period from the first of October 2009 to the thirty-one of January 2011. The study included 28 boys, 20 girls;their mean age was 7.5 years;their ages range 2 - 13 years. We used the modified Gartland classification to assess the fractures displacement and only Gartland type II B and III were included and managed operatively by open reduction and internal fixation with 2 crossed K-wires. Follow up continued for 6 months and the results finally assessed using Flynn’s criteria. Results: According to the criteria of Flynn et al., 20 patients (83.3%) treated by the anterior approach had excellent functional results while 4 patients (16.7%) had good functional results. While those treated by the posterior approach, 16 patients (66.6%) had excellent functional results, 6 patients (25%) had good results and 2 (8.3%) patients had fair outcome. Cosmetic results were excellent in 22 patients in the anterior approach group and 20 patients in the posterior approach group. Conclusion: Posterior Campbell approach is simpler than anterior Henry approach, but it creates additional soft tissue damage that can affect the circulatory status and hence possible osteonecrosis of the trochlea and a higher percentage of limitation in joint mobility. While the anterior approach is technically more demanding, but it gives better functional results.
文摘Background Cervicothoracic junction spinal tuberculosis （CJST） in children is uncommon, especially when accompanied by a huge abscess. However, its consequences can be severe. Because of the special anatomic location of the cervicothoracic junction, surgical treatment is difficult and rarely reported. The aim of this clinical study was to assess the effectiveness of combined anterior and posterior approaches for focal debridement, decompression, allografting and anterior instrumentation in the treatment of CJST in children. Methods Ten pediatric CJST patients underwent focal debridement and cord decompression through combined anterior and posterior approaches. Then an appropriate allograft and titanium plate were applied to reconstruct the spine. The patients were asked to wear head-neck-chest braces for six months and received regular anti-tubercular drugs therapy for 12 months. Results The patients were followed-up for an average of 26 months （range, 15-32 months）. There was no recurrent tuberculous infection. The bone grafts incorporated well and the instrumentation was stable. Cervical and thoracic kyphosis was successfully corrected from 40° （range, 30-52°） before the operation to 18° （range, 12-26°） post-operation. Neurological function was improved in all patients. Conclusions Combined anterior and posterior approaches for focal debridement, decompression, bone allografting and anterior instrumentation provided an effective means of treatment in children of CJST with a huge abscess in the posterior part of the vertebral body.
文摘Objective: To treat injury of the lower cervical spine C6 to C7 with cervical lateral mass plates and T1 pedicle screws through posterior approach. Methods: The data of 8 patients with lower cervical spine C6 or C7 injury （6 patients with fracture and dislocation in C6 and C7 and 2 with fracture in C7） were analyzed retrospectively in this study. For the preoperative American Spinal Injury Association （ASIA） classification, Grade C was found in 3 cases and Grade D in 5 cases. Screws were placed on the lateral masses and the first thoracic pedicle with Margerl technique. Lamina or facet bone allografting was used to achieve a long-term stability. Results: All the 8 patients were followed up for 5-37 months （mean: 15 months）. No operative death occurred. There were no examples of aggravation of spinal cord injury or vertebral artery injury, cerebrospinal fluid leak, nerve roots injury, screw malposition or back-out, loose of alignment or implant failure. Clinical symptoms and ASIA classification were improved in all the patients. Postoperative MRI scanning confirmed the satisfactory screw placement in all the cases. Conclusions: Lateral mass plates and pedicle screws through posterior approach are safe and beneficial for patients with lower cervical spine C6 or C7 injury.
文摘[Objective]This study was designed to describe the fracture patterns and early results of operations of posterior Pilon fractures through a posterolateral approach.[Method]This study consisted of 14 cases,10 males and 4 females with the mean age of 47 years(range,28-63 years).The causes were traffic accident in 2,falling in 6 and sprain injuries in 6 cases.The duration from injury to operation was 7-14 days.Including 12 cases combined with distal fibula fracture and3 cases with medial malleolus fracture.There were 3 posterior dislocation fracture.All cases were treated with open reduction and internal fixation(ORIF).[Result]A consistent fracture pattern was identified with a primary,inferiorly posterior Pilon fracture that likely occur through a combined rotational and axial load mechanism.The average duration of follow-up was 26(range,24-37)months.The postoperation average of American Orthopedic Foot Ankle Society score(AOFAS)was 92points which was much higher than before operation.Anatomical reduction were obtained in all cases.Two complications(1wound superficial infection and 1 sural cutaneous nerve injury)were all managed nonoperatively.[Conclusion]Posterior Pilon fractures form a consistent pattern.They can be successfully managed through a posterolateral approach with direct reduction and buttress fixation of articular fragments.
文摘AIM:To study our novel caudal approach laparoscopic posterior-sectionectomy with parenchymal transection prior to mobilization under laparoscopy-specific view.METHODS:Points of the procedure are:(1) Patients are put in left lateral position and posterior sector is not mobilized;(2) Glissonian pedicle of the sector is encircled and clamped extra-hepatically and divided afterward during the transection;(3) Dissection of inferior vena cava(IVC) anterior wall behind the liver is started from caudal.Simultaneously,liver transection is performed to search right hepatic vein(RHV) from caudal;(4) Liver transection proceeds to the bifurcation of the vessels from caudal to cranial,exposing the surfaces of IVC and RHV.Since the remnant liver sinks down,the cutting surface is well-opend;and(5) After the completion of transection,dissection of the resected liver from retroperitoneum is easily performed using the gravity.This approach was performed for a 63 years old woman with liver metastasis close to RHV.RESULTS:RHV exposure is required for R0 resection of the lesion.Although the cutting plane is horizontal in supine position and the gravity obstructs the exposure in the small subphrenic space,the use of specific characteristics of laparoscopic hepatectomy,such as the good vision for the dorsal part of the liver and IVC and facilitated dissection using the gravity with the patient positioning,made the complete RHV exposure during the liver transection easy to perform.The operation time was 341 min and operative blood loss was 1356 mL.Her postoperative hospital stay was uneventfull and she is well without any signs of recurrences 14 mo after surgery.CONCLUSION:The new procedure is feasible and useful for the patients with tumors close to RHV and the need of the exposure of RHV.
文摘Posterior malleolus fractures are quite common and usually result from rotational ankle injuries. For the management of posterior malleolus fractures, more studies are still required, though it is already well-recognized for medial and lateral structure. Therefore, fracture of posterior malleolus is striking subject of study among orthopedic surgeons. Most orthopedic surgeons recommend fixing the posterior malleolus fracture if it is larger than 25% to 33% of the distal articular surface. Further attention is required for the reduction and fixation of fractures involving posterior malleolus. Several approaches and methods for fixation of posterior malleolus have been defined in the literature. Previously, the most common method of fixation of the posterior malleolus is by indirect reduction and antero-posterior screws, it is minimally invasive, the anterior incision does not allow satisfactory visualization of the fragment, so good anatomical reduction is difficult to achieve thorough this approach. Operative management goals to reach a stable ankle with maximal function, decrease the risk of post-traumatic degenerative changes, and diminish the risk of complication. Nowadays, posterolateral approach is gaining the popularity due to adequate visualization and accurate anatomic reduction.
文摘Objective To investigate the feasibility and surgical effects of posterior articular process approach for the treatment of L1-L3 lumbar disc herniation.Methods A retrospective study,of17patients with upper lumbar intervertebml disc
文摘Objective To evaluate the feasibility,safety and efficacy of surgical treatment of the thoracic and thoracolumbar disc herniations through the posterior far lateral approach.Methods From April 2005 to June 2010,24 consecutive patients
文摘[目的]比较Wiltse入路与后正中入路Dynesys动态稳定系统治疗腰椎退变性疾病的临床疗效。[方法]回顾性分析2017年9月—2022年6月本院收治的Dynesys动态稳定系统固定手术治疗的90例腰椎退变性疾病患者的临床资料,按照医患沟通结果将其分为两组,61例采用后正中小切口经双侧肌间隙入路(Wiltse组);29例采用常规显露单节段后正中入路(后正中组)。比较两组围手术期指标、随访和影像资料。[结果]两组患者均顺利完成手术,未发生严重手术并发症。Wiltse组术中出血量[(114.0±51.6) mL vs (149.3±54.6) mL, P=0.003]、术后引流量[(64.4±16.1) mL vs (173.1±26.8) mL, P<0.001]、下地行走时间[(3.0±1.2) d vs (4.0±1.8) d, P=0.003]、住院时间[(7.0±1.2) d vs (8.0±1.5) d, P=0.012]均显著少于后正中组。两组患者均获得超过12个月的随访,Wiltse组恢复完全负重活动时间[(32.5±3.0) d vs (38.2±4.5) d, P<0.001]显著早于后正中组。随时间推移,两组腰痛VAS、腿痛VAS、ODI评分均显著减少(P<0.05)。术后1周及术后1个月,Wiltse组腰痛VAS评分[(2.6±1.5) vs (4.0±1.9), P<0.001;(1.9±1.3) vs (3.0±1.5), P<0.001]、JOA评分[(16.7±1.1) vs (15.5±1.2), P<0.001;(21.0±1.1) vs (18.5±0.7), P<0.001]均显著优于后正中组。影像方面,Wiltse组在L4[(27.1±4.1)°vs (22.6±4.2)°, P<0.001]、L5[(26.4±4.1)°vs (21.5±4.5)°, P<0.001]、S1[(20.4±3.4)°vs (18.1±3.8)°, P<0.001]螺钉水平置入角度均显著大于后正中组。两组置钉准确率的差异无统计学意义(P>0.05)。与术前相比,术后3个月及末次随访时,两组手术节段ROM、椎管占位率均显著减小(P<0.05),椎间隙高度和腰椎前凸角无显著变化(P>0.05)。相应时间点,两组间上述影像指标的差异均无统计学意义(P>0.05)。[结论] Wiltse入路和传统后正中入路在Dynesys稳定系统治疗腰椎退变性疾病中疗效相同,但Wiltse入路术中肌肉损伤小、出血少、螺钉置入位置更理想,术后引流量少、疼痛轻,更符合脊柱微创外科理念。
