BACKGROUND Comminuted calcaneal fractures present significant treatment challenges.Open reduction and internal fixation carries risks such as infection and skin necrosis,while minimally invasive techniques may comprom...BACKGROUND Comminuted calcaneal fractures present significant treatment challenges.Open reduction and internal fixation carries risks such as infection and skin necrosis,while minimally invasive techniques may compromise reduction stability.Conservative management is generally limited to minimally displaced fractures.Traditional Chinese manual bone-setting has a long history in fracture treatment and is renowned globally for achieving functional reduction.It offers distinct advantages including lower cost,minimal soft tissue trauma,and the avoidance of expensive reduction equipment or internal fixation materials.CASE SUMMARY A 60-year-old female presented with left foot pain and limited mobility following a fall.Computed tomography scan revealed a Sanders type IV calcaneal fracture with a Böhler angle of 0°.A standardized,stepwise Traditional Chinese manual bone-setting was initially performed,followed by percutaneous screw fixation through several mini-incisions after satisfactory alignment was confirmed under fluoroscopy.The Visual Analog Scale score decreased from 5 on postoperative day 1 to 3 by day 3.The American Orthopaedic Foot and Ankle Society score improved from 73 at 6 weeks to 90 at 3 months,indicating rapid functional recovery and high patient satisfaction.At 7 months postoperatively,the American Orthopaedic Foot and Ankle Society score reached 95,prompting removal of internal fixation.At the 6-year follow-up,reduction remained well maintained,with the Böhler angle preserved at 22°.CONCLUSION The combination of Traditional Chinese manual bone-setting and percutaneous screw fixation achieved satisfactory functional reduction for comminuted calcaneal fractures.展开更多
BACKGROUND Whether it’s better to adopt unilateral pedicle screw(UPS)fixation or to use bilateral pedicle screw(BPS)one for lumbar degenerative diseases is still controversially undetermined.AIM To make a comparison ...BACKGROUND Whether it’s better to adopt unilateral pedicle screw(UPS)fixation or to use bilateral pedicle screw(BPS)one for lumbar degenerative diseases is still controversially undetermined.AIM To make a comparison between UPS and BPS fixation as to how they work efficaciously and safely in patients suffering from lumbar degenerative diseases.METHODS We have searched a lot in the databases through 2020 with index terms such as“unilateral pedicle screw fixation”and“bilateral pedicle screw fixation.”Only randomized controlled trials and some prospective cohort studies could be found,yielding 15 studies.The intervention was unilateral pedicle screw fixation;Primarily We’ve got outcomes of complications and fusion rates.Secondarily,we’ve achieved outcomes regarding total blood loss,operative time,as well as length of stay.Softwares were installed and utilized for subgroup analysis,analyzing forest plots,sensitivity,heterogeneity,forest plots,publication bias,and risk of bias.RESULTS Fifteen previous cases of study including 992 participants have been involved in our meta-analysis.UPS had slightly lower effects on fusion rate[relative risk(RR)=0.949,95%CI:0.910 to 0.990,P=0.015],which contributed mostly to this metaanalysis,and similar complication rates(RR=1.140,95%CI:0.792 to 1.640,P=0.481),Δvisual analog scale[standard mean difference(SMD)=0.178,95%CI:-0.021 to 0.378,P=0.080],andΔOswestry disability index(SMD=-0.254,95%CI:-0.820 to 0.329,P=0.402).In contrast,an obvious difference has been observed inΔJapanese Orthopedic Association(JOA)score(SMD=0.305,95%CI:0.046 to 0.563,P=0.021),total blood loss(SMD=-1.586,95%CI:-2.182 to-0.990,P=0.000),operation time(SMD=-2.831,95%CI:-3.753 to-1.909,P=0.000),and length of hospital stay(SMD=-0.614,95%CI:-1.050 to-0.179,P=0.006).CONCLUSION Bilateral fixation is more effective than unilateral fixation regarding fusion rate after lumbar interbody fusion.However,JOA,operation time,total blood loss,as well as length of stay were improved for unilateral fixation.展开更多
Adjacent vertebral fractures are common in patients with osteoporotic vertebral compression fractures（OVCFs） after kyphoplasty.This finite element study was to examine whether short segment pedicle screw fixation（...Adjacent vertebral fractures are common in patients with osteoporotic vertebral compression fractures（OVCFs） after kyphoplasty.This finite element study was to examine whether short segment pedicle screw fixation（PSF） with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae after kyphoplasty for OVCFs.By simulating cement augmentation with or without short segment pedicle screw fixation（PSF）,two tridimensional,anatomically detailed finite element models of the T10–L2 functional spinal junction were developed.The insertion of pedicle screws into the intact vertebra apparently decreased the stress distribution of the treated vertebra in vertical compression and other load situations.The stress distribution in the bone structures of the intact vertebra adjacent to the intact-screwed vertebra was much less than that in the one adjacent to the treated vertebra.The insertion of pedicle screws into the intact vertebra greatly decreased the maximum displacement of the cortical bones and cancellous bones of the vertebrae.Our results indicated that short segment PSF with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae in the management of OVCFs.展开更多
BACKGROUND In robot-assisted(RA)spine surgery,the relationship between the surgical outcome and the learning curve remains to be evaluated.AIM To analyze the learning curve of RA pedicle screw fixation(PSF)through fit...BACKGROUND In robot-assisted(RA)spine surgery,the relationship between the surgical outcome and the learning curve remains to be evaluated.AIM To analyze the learning curve of RA pedicle screw fixation(PSF)through fitting the operation time curve based on the cumulative summation method.METHODS RA PSFs that were initially completed by two surgeons at the Beijing Jishuitan Hospital from July 2016 to March 2019 were analyzed retrospectively.Based on the cumulative sum of the operation time,the learning curves of the two surgeons were drawn and fit to polynomial curves.The learning curve was divided into the early and late stages according to the shape of the fitted curve.The operation time and screw accuracy were compared between the stages.RESULTS The turning point of the learning curves from Surgeons A and B appeared in the 18th and 17th cases,respectively.The operation time[150(128,188)min vs 120(105,150)min,P=0.002]and the screw accuracy(87.50%vs 96.30%,P=0.026)of RA surgeries performed by Surgeon A were significantly improved after he completed 18 cases.In the case of Surgeon B,the operation time(177.35±28.18 min vs 150.00±34.64 min,P=0.024)was significantly reduced,and the screw accuracy(91.18%vs 96.15%,P=0.475)was slightly improved after the surgeon completed 17 RA surgeries.CONCLUSION After completing 17 to 18 cases of RA PSFs,surgeons can pass the learning phase of RA technology.The operation time is reduced afterward,and the screw accuracy shows a trend of improvement.展开更多
<b style="line-height:1.5;"><span style="font-family:Verdana;">Background</span><span style="font-family:Verdana;">:</span><span style="font-size:10....<b style="line-height:1.5;"><span style="font-family:Verdana;">Background</span><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">Basic principle for the treatment of pyogenic spondylitis (PS) is conservative care, but surgical intervention is often required when conservative treatment may fail. We have experienced many conservative cases of various complications due to long-term bed rest and poor pain control. Recently we have adopted percutaneous pedicle screw (PPS) fixation for the treatment of PS as a minimally invasive spine stabilization (MISt) fusion to reduce such morbidity of the conservative care. </span><b><span style="font-family:Verdana;font-size:12px;">Objective</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">To evaluate the impact of PPS fixation in patients with PS. </span><b><span style="font-family:Verdana;font-size:12px;">Study Design</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">A retrospective analysis of the medical records. </span><b><span style="font-family:Verdana;font-size:12px;">Subjects, Methods</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="line-height:1.5;font-family:Verdana;">We reviewed 54 consecutive patients who underwent treatment in our hospital for PS during 2005-2018 and observed for more than 12 months. Of those we excluded cases show</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> effectiveness to initial treatment (it was defined fever relief or C-reactive protein (CRP) inversion in 3 weeks of antibiotics) so that this study is a retrospective study in cases show</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> initial treatment resistance. Finally, this study included 29 cases. Medical records of these 29 cases were reviewed for baseline, organism isolated and its detection rate, the clinical outcome in 12 months (Discharge, Transfer, Death), the period from </span><span style="line-height:1.5;font-family:Verdana;">the </span><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">first visit to our hospital to fever relief, CRP inversion, ambulation, and Discharge or Transfer. </span><b><span style="font-family:Verdana;font-size:12px;">Results</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span></b><span style="line-height:1.5;font-family:Verdana;"> These cases </span><span style="line-height:1.5;font-family:Verdana;">were </span><span style="line-height:1.5;font-family:Verdana;">divided into two groups, the conservative group (C-group): 17 cases, and the PPS group (P-group): 12 cases. There is no statistically significant difference in fever relief (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.051) and CRP inversion (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.208). The period to ambulation and discharge or transfer was significantly shorter in group P (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.020, p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.031). 1-Year survival rate was 92% in the P-group, and 71% in the C-group. There is no statistically significant difference (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.354) between </span><span style="line-height:1.5;font-family:Verdana;">the </span><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">two groups. The rate of Discharge to home and care facility is 58% in P-group, and 47% in C-group. And the rate of Transfer is 34% in P-group, and 35% in C-group. </span><b><span style="font-family:Verdana;font-size:12px;">Conclusion</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="line-height:1.5;font-family:Verdana;">PPS fixation was effective to achieve shorten</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> the period to ambulation and discharge or transfer. But it was not effective </span><span style="line-height:1.5;font-family:Verdana;">in</span><span style="line-height:1.5;font-family:Verdana;"> infection control. This suggests that PPS fixation should be aggressively administered to patients who can expect pain relief and early ambulation by PPS fixation in the patient of PS show</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> resistance to initial treatment.展开更多
Objective To explore the feasibility and efficiency of the treatment of lumbar degenerative diseases after transforaminal lumbar interbody fusion (TLIF) and posterolateral fusion (PLF) procedures in which unilateral p...Objective To explore the feasibility and efficiency of the treatment of lumbar degenerative diseases after transforaminal lumbar interbody fusion (TLIF) and posterolateral fusion (PLF) procedures in which unilateral pedicle screw fixation was used.展开更多
Objective To evaluate the clinical application of atlantoaxial joint fusion using anterior transarticular screw fixation and bone grafting for atlantoaxial joint instability. Methods Twenty-three cases of atlantoaxial...Objective To evaluate the clinical application of atlantoaxial joint fusion using anterior transarticular screw fixation and bone grafting for atlantoaxial joint instability. Methods Twenty-three cases of atlantoaxial joint instability were展开更多
Objective To investigate feasibility and safety of anterior pedicle screw fixation tunnel in the axis so as to provide theoretic evidence for further clinical application.Methods Thirty-two dry axis specimens were use...Objective To investigate feasibility and safety of anterior pedicle screw fixation tunnel in the axis so as to provide theoretic evidence for further clinical application.Methods Thirty-two dry axis specimens were used foranterior展开更多
Objective To explore the clinical effect of the trans-atlantoaxial pedicle screw-rod internal fixation and fusion in treatment of old odontoid fracture combined with atlantoaxial instability. Methods The study involve...Objective To explore the clinical effect of the trans-atlantoaxial pedicle screw-rod internal fixation and fusion in treatment of old odontoid fracture combined with atlantoaxial instability. Methods The study involved 48 patients with展开更多
Objective To evaluate the clinical effect of the free-hand cervical pedicle screw fixation in treatment of the upper cervical fracture and instability. Methods A retrospective review was performed on 15 patients
To explore the value of helical CT volume rendering technique (VRT) in post-operative evaluation of screw fixation of axis fractures.Methods There were 21 cases of screw fixation of axis fractures between February 200...To explore the value of helical CT volume rendering technique (VRT) in post-operative evaluation of screw fixation of axis fractures.Methods There were 21 cases of screw fixation of axis fractures between February 2002 and May 2004 in the study including six cases with fractures on axis body,five on odontoid process and 10 on axis body and odontoid process.All cases received X-ray plain film,helical CT scanning,multi-planar reformatting(MPR) and VRT.Results Screw fixation through axis body and massa lateralis atlantis was performed in 10 cases and that through axis body and odontoid process in 11.VRT could clearly display full aperture of screw orbit,location of screw and angle of fixation and hence was superior to X-ray plain film and MPR.Multi-angle VRT displayed asymmetrical space of odontoid process and massa lateralis atlantis in four cases and medial deviation of 2～5 mm of half screw in screw fixation through axis body and massa lateralis atlantis in six.Conclusion VRT can eliminate false shadow of fixation screw,clearly display full aperture of screw orbit and hence supply improtant imaging evidence for post-operative evaluation of screw fixation of axis fractures.7 refs,1 fig,1 tab.展开更多
Background The peculiar and highly variable C2 anatomy can make screw fixation more challenging and prone to potential vertebral artery or neurologic injury. Conventional C-arm fluoroscopy has several drawbacks. The a...Background The peculiar and highly variable C2 anatomy can make screw fixation more challenging and prone to potential vertebral artery or neurologic injury. Conventional C-arm fluoroscopy has several drawbacks. The aim of this research was to evaluate the accuracy of posterior C2 screw fixation using intraoperative three-dimensional fluoroscopy- based navigation （ITFN） and assess the perioperative complication rate related to screw placement. Methods A retrospective review identified patients who underwent operative management with C2 instruments using ITFN at our hospital between January 2006 and December 2012. Clinical data were obtained from medical records and final screw positions were graded according to a modified classification of Gertzbein and Robbins. Grade A and B screws were considered well positioned. Results The study included 99 patients （53 males and 46 females） who underwent posterior C2 screw fixation using ITFN. The mean Japan Orthopedic Association score improved from （6.7±1.9） points before surgery to （12.5±2.7） points at 6-month follow-up （z= ＋8.628, P 〈0.01）. The mean visual analogue scale improved from （4.1±1.2） points before surgery to （0.7±0.9） points at 6-month follow-up, with an improvement of 83.7% （z= 8.638, P 〈 0.01）. Of the 196 screws analyzed using computed tomography and chart review, 126 transarticular, 64 pedicle, and 6 pars screws were placed with 82.5% （104/126）, 89.1% （57/64）, and 100% （6/6） accuracy （grade A）, respectively; 98.5% （193/196） of screws were grade A or B （grade C, 1.5% （3/196））, and no neurologic injuries occurred. In normal C2 cases, 93 transarticulars and 47 pedicles were placed with high accuracy rates of 90.3% （84/93） and 93.6% （44/47） （grade A）, respectively. However, in cases with C2 deformity, 33 transarticular, 17 pedicle, and 6 pars screws were placed with only 60.6% （20/33）, 76.5% （13/17）, and 100% （6/6） accuracy （grade A）, respectively. Conclusion ITFN is a safe, accurate, and effective tool for posterior C2 fixation. Chin Med J 2014;127 （14）： 2654-2658展开更多
Accurate placement of pedicle screw(PS)is crucial in spinal surgery.Developing new real-time intra-operative monitoring and navigation methods is an important direction of clinical appli-cation research.In this paper,...Accurate placement of pedicle screw(PS)is crucial in spinal surgery.Developing new real-time intra-operative monitoring and navigation methods is an important direction of clinical appli-cation research.In this paper,we studied the spectrum along the fixation trajectory of PS in frequency domain to tackle the accuracy problem.Fresh porcine vertebrae,bovine vertebrae and ovine vertebrae were measured with the near-infrared spectrum(NIR)device to obtain the reflected spectrum from the vertebrae.Along the fixation trajectory of PS,average energy from different groups was calculated and used for identifying different tissues and compared to achieve the optimal recognition factor.Compared with the time domain approach,the frequency domain method could divide the spectra measured at different tissue points into different groups more stably and accurately,which could serve as a new method to assist the PS insertion.The results gained from this study are significant to the development of hi-tech medical instruments with independent intellectual property rights.展开更多
BACKGROUND Spinal tuberculosis,a destructive extrapulmonary form,often causes severe deformity and neurological deficits.Surgical intervention aims to debride lesions,reconstruct stability,and correct deformities.This...BACKGROUND Spinal tuberculosis,a destructive extrapulmonary form,often causes severe deformity and neurological deficits.Surgical intervention aims to debride lesions,reconstruct stability,and correct deformities.This study evaluates a combined posterior fixation and minimally invasive anterior approach for lumbar tuberculosis.AIM To evaluate the clinical outcomes and radiological parameters of posterior internal fixation combined with minimally invasive anterior lesion clearance and bone graft fusion for the treatment of lumbar tuberculosis.METHODS Clinical data from 24 patients with lumbar tuberculosis who underwent posterior pedicle screw fixation combined with minimally invasive anterior lesion clearance were analyzed.The Cobb angle,visual analog scale(VAS)score,and Frankel classification were statistically assessed preoperatively and postoperatively.Complications and bone graft fusion were also recorded.RESULTS Wounds healed in the first stage in 22 patients;one patient developed a posterior incisional sinus tract,and one experienced postoperative tuberculosis recurrence.At the final follow-up,according to the Frankel classification,there were 1,2,and 21 cases classified as grade C,grade D,and grade E,respectively.By the last follow-up,the Cobb angle,VAS score,and erythrocyte sedimentation rate had all decreased.Both X-ray and computed tomography images confirmed bone healing.The fusion time ranged from 3 to 9 months,with an average of 5.2 months.CONCLUSION Posterior pedicle screw fixation combined with minimally invasive anterior lesion clearance is an effective and safe treatment for lumbar tuberculosis.展开更多
Alveolar bone augmentation with fixation screws has difficulties such as non-degradable materials that could lead to secondary surgery and insufficient osseointegration due to the subgingival environment in dental pra...Alveolar bone augmentation with fixation screws has difficulties such as non-degradable materials that could lead to secondary surgery and insufficient osseointegration due to the subgingival environment in dental practice.With degradability and a high degree of osteogenesis,Mg alloy is a successful biodegrad-able material for orthopedic applications,and its application in dentistry has made certain progress.How-ever,considering the unique subgingival healing properties of oral implants,there is still a gap between the desired material properties for clinical applications and available materials.Indeed,studies on the use of Mg-based fixation screws for dentistry applications are still rare.In this study,we reported a magnesium alloy with low combined addition of strontium and lanthanum.The mechanical properties,degradation behavior,osteogenesis,and gingival compatibility were systematically investigated for assess-ing its potential application in alveolar bone fixation screws.With the alloying element content restricted to 0.3 wt.%,Mg-Sr-La alloy still exhibited good mechanical properties,with yield tensile and compressive strength twice higher than those of pure Mg.The in vitro degradation rate of this alloy was 0.10 mm y-1,which was slightly slower than high-purity Mg.The indirect and direct cell assay confirmed the elevated osteoblastic differentiation of MC3T3-E1 and migration of HGF-1 cells.Moreover,Mg-Sr-La alloy demon-strated a relatively slow degradation in the maxillary bone of Beagles.A remarkable promotion of the bone-implant contacts and significantly decreased fibrous encapsulation was observed in the subgingival environment,implying superior osseointegration of the experimental alloy than the titanium control.The empirical findings here reveal the great potential of Mg-Sr-La alloy for the application in alveolar bone fixation devices.展开更多
Objective: To investigate the effectiveness of the plate screw internal fixation technique on the clinical outcomes of patients with traumatic fractures of long bones in the lower extremities. Methods: From January 20...Objective: To investigate the effectiveness of the plate screw internal fixation technique on the clinical outcomes of patients with traumatic fractures of long bones in the lower extremities. Methods: From January 2022 to December 2023, 70 patients with traumatic fractures of long bones in the lower extremities were admitted to the hospital and randomly divided into two groups: the control group and the observation group, each consisting of 35 cases. The control group underwent traditional closed interlocking intramedullary nailing, while the observation group received internal fixation with steel plates and screws. Relevant surgical indicators, treatment effectiveness, and postoperative complication rates were compared between the two groups. Results: The observation group exhibited significantly short surgical duration (80.65 ± 5.01 vs. 88.36 ± 5.26 minutes), fracture healing time (13.27 ± 0.32 vs. 15.52 ± 0.48 weeks), and hospitalization days (10.49 ± 1.13 vs. 16.57 ± 1.15 days) compared to the control group (P = 0.000). The effective treatment rate was significantly higher in the observation group (29/82.86%) than in the control group (21/60.00%), with a significant difference observed (χ2 = 4.480, P = 0.034). Additionally, the complication rate in the observation group (2/5.71%) was significantly lower than that in the control group (8/22.86%), with a correlated difference (χ2 = 4.200, P = 0.040). Conclusion: The plate screw internal fixation technique demonstrates significant clinical efficacy in treating traumatic fractures of long bones in the lower extremities. It improves the healing rate, reduces complications, and represents a safe and effective treatment strategy worthy of widespread use and application.展开更多
Objective: to summarize the surgical treatment methods of comminuted calcaneal fracture and the effect differences of different surgical methods. Methods: patients with calcaneal fractures admitted to our hospital and...Objective: to summarize the surgical treatment methods of comminuted calcaneal fracture and the effect differences of different surgical methods. Methods: patients with calcaneal fractures admitted to our hospital and confirmed for surgical treatment were selected. All patients were comminuted fractures and met the requirements of surgical indications. The cases were selected from June 2018 to June 2020, and the conventional group took incision reduction surgery based on L-type incision. The experimental group performed minimally invasive plate internal fixation with plate screws according to the posterior heel or the tarsal sinus incision position. When observed after the operation, the items involved included the function of the heel, the recovery status of the calcaneus, the surgery-related indicators, and the complications occurring during and after the surgery. Results: the patients of the experimental group were significantly higher than the height. Bolher and Gissen angle were better than the conventional group in March and June, P <0.05;the time, bleeding volume, incision length, hospitalization time and related complications were significantly better than the conventional group, P <0.05. Conclusion: minimally invasive plate and screw internal fixation can effectively treat comminuted calcaneal fracture, which has a significant effect on the foot and ankle function, and obviously acts on the fracture site and function.展开更多
Objective To report five cases of puerile (【9 years) atlantoaxial instability which underwent C1-C2 pedicle screw internal fixation by posterior approach,and to introduce the surgical technique and the key point
Objective To study the effect of using improved 2D computer-assisted fluoroscopic navigation through simulating 3D vertebrae image to guide pedicle screw internal fixation.Methods Posterior pedicle screw internal fixa...Objective To study the effect of using improved 2D computer-assisted fluoroscopic navigation through simulating 3D vertebrae image to guide pedicle screw internal fixation.Methods Posterior pedicle screw internal fixation,distraction展开更多
基金Supported by Jin-Wen Liu Academic Experience Heritage Studio Special Fund of National Famous Traditional Chinese Medicine,No.75.
文摘BACKGROUND Comminuted calcaneal fractures present significant treatment challenges.Open reduction and internal fixation carries risks such as infection and skin necrosis,while minimally invasive techniques may compromise reduction stability.Conservative management is generally limited to minimally displaced fractures.Traditional Chinese manual bone-setting has a long history in fracture treatment and is renowned globally for achieving functional reduction.It offers distinct advantages including lower cost,minimal soft tissue trauma,and the avoidance of expensive reduction equipment or internal fixation materials.CASE SUMMARY A 60-year-old female presented with left foot pain and limited mobility following a fall.Computed tomography scan revealed a Sanders type IV calcaneal fracture with a Böhler angle of 0°.A standardized,stepwise Traditional Chinese manual bone-setting was initially performed,followed by percutaneous screw fixation through several mini-incisions after satisfactory alignment was confirmed under fluoroscopy.The Visual Analog Scale score decreased from 5 on postoperative day 1 to 3 by day 3.The American Orthopaedic Foot and Ankle Society score improved from 73 at 6 weeks to 90 at 3 months,indicating rapid functional recovery and high patient satisfaction.At 7 months postoperatively,the American Orthopaedic Foot and Ankle Society score reached 95,prompting removal of internal fixation.At the 6-year follow-up,reduction remained well maintained,with the Böhler angle preserved at 22°.CONCLUSION The combination of Traditional Chinese manual bone-setting and percutaneous screw fixation achieved satisfactory functional reduction for comminuted calcaneal fractures.
基金Supported by the Health Science and Technology of Tianjin Municipality,No.RC20204Tianjin Institute of Orthopedics,No.2019TJGYSKY03the National Natural Science Foundation of China,No.818717771177226。
文摘BACKGROUND Whether it’s better to adopt unilateral pedicle screw(UPS)fixation or to use bilateral pedicle screw(BPS)one for lumbar degenerative diseases is still controversially undetermined.AIM To make a comparison between UPS and BPS fixation as to how they work efficaciously and safely in patients suffering from lumbar degenerative diseases.METHODS We have searched a lot in the databases through 2020 with index terms such as“unilateral pedicle screw fixation”and“bilateral pedicle screw fixation.”Only randomized controlled trials and some prospective cohort studies could be found,yielding 15 studies.The intervention was unilateral pedicle screw fixation;Primarily We’ve got outcomes of complications and fusion rates.Secondarily,we’ve achieved outcomes regarding total blood loss,operative time,as well as length of stay.Softwares were installed and utilized for subgroup analysis,analyzing forest plots,sensitivity,heterogeneity,forest plots,publication bias,and risk of bias.RESULTS Fifteen previous cases of study including 992 participants have been involved in our meta-analysis.UPS had slightly lower effects on fusion rate[relative risk(RR)=0.949,95%CI:0.910 to 0.990,P=0.015],which contributed mostly to this metaanalysis,and similar complication rates(RR=1.140,95%CI:0.792 to 1.640,P=0.481),Δvisual analog scale[standard mean difference(SMD)=0.178,95%CI:-0.021 to 0.378,P=0.080],andΔOswestry disability index(SMD=-0.254,95%CI:-0.820 to 0.329,P=0.402).In contrast,an obvious difference has been observed inΔJapanese Orthopedic Association(JOA)score(SMD=0.305,95%CI:0.046 to 0.563,P=0.021),total blood loss(SMD=-1.586,95%CI:-2.182 to-0.990,P=0.000),operation time(SMD=-2.831,95%CI:-3.753 to-1.909,P=0.000),and length of hospital stay(SMD=-0.614,95%CI:-1.050 to-0.179,P=0.006).CONCLUSION Bilateral fixation is more effective than unilateral fixation regarding fusion rate after lumbar interbody fusion.However,JOA,operation time,total blood loss,as well as length of stay were improved for unilateral fixation.
基金supported by the National High Technology Research and Development Program("863"Program)of China(No.SS2012AA022811)the Science and Technology Program of Guangzhou(No.201508020253)the Special Project on the Integration of Industry,Education and Research of Guangzhou(No.158100062)
文摘Adjacent vertebral fractures are common in patients with osteoporotic vertebral compression fractures（OVCFs） after kyphoplasty.This finite element study was to examine whether short segment pedicle screw fixation（PSF） with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae after kyphoplasty for OVCFs.By simulating cement augmentation with or without short segment pedicle screw fixation（PSF）,two tridimensional,anatomically detailed finite element models of the T10–L2 functional spinal junction were developed.The insertion of pedicle screws into the intact vertebra apparently decreased the stress distribution of the treated vertebra in vertical compression and other load situations.The stress distribution in the bone structures of the intact vertebra adjacent to the intact-screwed vertebra was much less than that in the one adjacent to the treated vertebra.The insertion of pedicle screws into the intact vertebra greatly decreased the maximum displacement of the cortical bones and cancellous bones of the vertebrae.Our results indicated that short segment PSF with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae in the management of OVCFs.
基金Supported by National Natural Science Foundation of China,No.U1713221.
文摘BACKGROUND In robot-assisted(RA)spine surgery,the relationship between the surgical outcome and the learning curve remains to be evaluated.AIM To analyze the learning curve of RA pedicle screw fixation(PSF)through fitting the operation time curve based on the cumulative summation method.METHODS RA PSFs that were initially completed by two surgeons at the Beijing Jishuitan Hospital from July 2016 to March 2019 were analyzed retrospectively.Based on the cumulative sum of the operation time,the learning curves of the two surgeons were drawn and fit to polynomial curves.The learning curve was divided into the early and late stages according to the shape of the fitted curve.The operation time and screw accuracy were compared between the stages.RESULTS The turning point of the learning curves from Surgeons A and B appeared in the 18th and 17th cases,respectively.The operation time[150(128,188)min vs 120(105,150)min,P=0.002]and the screw accuracy(87.50%vs 96.30%,P=0.026)of RA surgeries performed by Surgeon A were significantly improved after he completed 18 cases.In the case of Surgeon B,the operation time(177.35±28.18 min vs 150.00±34.64 min,P=0.024)was significantly reduced,and the screw accuracy(91.18%vs 96.15%,P=0.475)was slightly improved after the surgeon completed 17 RA surgeries.CONCLUSION After completing 17 to 18 cases of RA PSFs,surgeons can pass the learning phase of RA technology.The operation time is reduced afterward,and the screw accuracy shows a trend of improvement.
文摘<b style="line-height:1.5;"><span style="font-family:Verdana;">Background</span><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">Basic principle for the treatment of pyogenic spondylitis (PS) is conservative care, but surgical intervention is often required when conservative treatment may fail. We have experienced many conservative cases of various complications due to long-term bed rest and poor pain control. Recently we have adopted percutaneous pedicle screw (PPS) fixation for the treatment of PS as a minimally invasive spine stabilization (MISt) fusion to reduce such morbidity of the conservative care. </span><b><span style="font-family:Verdana;font-size:12px;">Objective</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">To evaluate the impact of PPS fixation in patients with PS. </span><b><span style="font-family:Verdana;font-size:12px;">Study Design</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">A retrospective analysis of the medical records. </span><b><span style="font-family:Verdana;font-size:12px;">Subjects, Methods</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="line-height:1.5;font-family:Verdana;">We reviewed 54 consecutive patients who underwent treatment in our hospital for PS during 2005-2018 and observed for more than 12 months. Of those we excluded cases show</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> effectiveness to initial treatment (it was defined fever relief or C-reactive protein (CRP) inversion in 3 weeks of antibiotics) so that this study is a retrospective study in cases show</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> initial treatment resistance. Finally, this study included 29 cases. Medical records of these 29 cases were reviewed for baseline, organism isolated and its detection rate, the clinical outcome in 12 months (Discharge, Transfer, Death), the period from </span><span style="line-height:1.5;font-family:Verdana;">the </span><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">first visit to our hospital to fever relief, CRP inversion, ambulation, and Discharge or Transfer. </span><b><span style="font-family:Verdana;font-size:12px;">Results</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span></b><span style="line-height:1.5;font-family:Verdana;"> These cases </span><span style="line-height:1.5;font-family:Verdana;">were </span><span style="line-height:1.5;font-family:Verdana;">divided into two groups, the conservative group (C-group): 17 cases, and the PPS group (P-group): 12 cases. There is no statistically significant difference in fever relief (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.051) and CRP inversion (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.208). The period to ambulation and discharge or transfer was significantly shorter in group P (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.020, p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.031). 1-Year survival rate was 92% in the P-group, and 71% in the C-group. There is no statistically significant difference (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.354) between </span><span style="line-height:1.5;font-family:Verdana;">the </span><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">two groups. The rate of Discharge to home and care facility is 58% in P-group, and 47% in C-group. And the rate of Transfer is 34% in P-group, and 35% in C-group. </span><b><span style="font-family:Verdana;font-size:12px;">Conclusion</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="line-height:1.5;font-family:Verdana;">PPS fixation was effective to achieve shorten</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> the period to ambulation and discharge or transfer. But it was not effective </span><span style="line-height:1.5;font-family:Verdana;">in</span><span style="line-height:1.5;font-family:Verdana;"> infection control. This suggests that PPS fixation should be aggressively administered to patients who can expect pain relief and early ambulation by PPS fixation in the patient of PS show</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> resistance to initial treatment.
文摘Objective To explore the feasibility and efficiency of the treatment of lumbar degenerative diseases after transforaminal lumbar interbody fusion (TLIF) and posterolateral fusion (PLF) procedures in which unilateral pedicle screw fixation was used.
文摘Objective To evaluate the clinical application of atlantoaxial joint fusion using anterior transarticular screw fixation and bone grafting for atlantoaxial joint instability. Methods Twenty-three cases of atlantoaxial joint instability were
文摘Objective To investigate feasibility and safety of anterior pedicle screw fixation tunnel in the axis so as to provide theoretic evidence for further clinical application.Methods Thirty-two dry axis specimens were used foranterior
文摘Objective To explore the clinical effect of the trans-atlantoaxial pedicle screw-rod internal fixation and fusion in treatment of old odontoid fracture combined with atlantoaxial instability. Methods The study involved 48 patients with
文摘Objective To evaluate the clinical effect of the free-hand cervical pedicle screw fixation in treatment of the upper cervical fracture and instability. Methods A retrospective review was performed on 15 patients
文摘To explore the value of helical CT volume rendering technique (VRT) in post-operative evaluation of screw fixation of axis fractures.Methods There were 21 cases of screw fixation of axis fractures between February 2002 and May 2004 in the study including six cases with fractures on axis body,five on odontoid process and 10 on axis body and odontoid process.All cases received X-ray plain film,helical CT scanning,multi-planar reformatting(MPR) and VRT.Results Screw fixation through axis body and massa lateralis atlantis was performed in 10 cases and that through axis body and odontoid process in 11.VRT could clearly display full aperture of screw orbit,location of screw and angle of fixation and hence was superior to X-ray plain film and MPR.Multi-angle VRT displayed asymmetrical space of odontoid process and massa lateralis atlantis in four cases and medial deviation of 2～5 mm of half screw in screw fixation through axis body and massa lateralis atlantis in six.Conclusion VRT can eliminate false shadow of fixation screw,clearly display full aperture of screw orbit and hence supply improtant imaging evidence for post-operative evaluation of screw fixation of axis fractures.7 refs,1 fig,1 tab.
文摘Background The peculiar and highly variable C2 anatomy can make screw fixation more challenging and prone to potential vertebral artery or neurologic injury. Conventional C-arm fluoroscopy has several drawbacks. The aim of this research was to evaluate the accuracy of posterior C2 screw fixation using intraoperative three-dimensional fluoroscopy- based navigation （ITFN） and assess the perioperative complication rate related to screw placement. Methods A retrospective review identified patients who underwent operative management with C2 instruments using ITFN at our hospital between January 2006 and December 2012. Clinical data were obtained from medical records and final screw positions were graded according to a modified classification of Gertzbein and Robbins. Grade A and B screws were considered well positioned. Results The study included 99 patients （53 males and 46 females） who underwent posterior C2 screw fixation using ITFN. The mean Japan Orthopedic Association score improved from （6.7±1.9） points before surgery to （12.5±2.7） points at 6-month follow-up （z= ＋8.628, P 〈0.01）. The mean visual analogue scale improved from （4.1±1.2） points before surgery to （0.7±0.9） points at 6-month follow-up, with an improvement of 83.7% （z= 8.638, P 〈 0.01）. Of the 196 screws analyzed using computed tomography and chart review, 126 transarticular, 64 pedicle, and 6 pars screws were placed with 82.5% （104/126）, 89.1% （57/64）, and 100% （6/6） accuracy （grade A）, respectively; 98.5% （193/196） of screws were grade A or B （grade C, 1.5% （3/196））, and no neurologic injuries occurred. In normal C2 cases, 93 transarticulars and 47 pedicles were placed with high accuracy rates of 90.3% （84/93） and 93.6% （44/47） （grade A）, respectively. However, in cases with C2 deformity, 33 transarticular, 17 pedicle, and 6 pars screws were placed with only 60.6% （20/33）, 76.5% （13/17）, and 100% （6/6） accuracy （grade A）, respectively. Conclusion ITFN is a safe, accurate, and effective tool for posterior C2 fixation. Chin Med J 2014;127 （14）： 2654-2658
基金This work was supported by the Nanjing Institute of Technology high level introduction of talents Research Fund(YKJ201862)the National Major Scientific Instruments and Equipment Development Project Funded by the National Natural Science Foundation of China(Grant Nos.81827803 and 81727804)+1 种基金the National Natural Science Foundation of China(Grant Nos.61703201,61875085 and 81601532)Natural Science Foundation of Jiangsu Province(Grant Nos.BK20160814 and BK20170765).
文摘Accurate placement of pedicle screw(PS)is crucial in spinal surgery.Developing new real-time intra-operative monitoring and navigation methods is an important direction of clinical appli-cation research.In this paper,we studied the spectrum along the fixation trajectory of PS in frequency domain to tackle the accuracy problem.Fresh porcine vertebrae,bovine vertebrae and ovine vertebrae were measured with the near-infrared spectrum(NIR)device to obtain the reflected spectrum from the vertebrae.Along the fixation trajectory of PS,average energy from different groups was calculated and used for identifying different tissues and compared to achieve the optimal recognition factor.Compared with the time domain approach,the frequency domain method could divide the spectra measured at different tissue points into different groups more stably and accurately,which could serve as a new method to assist the PS insertion.The results gained from this study are significant to the development of hi-tech medical instruments with independent intellectual property rights.
基金Supported by Medical Research Project of Wuhan Municipal Health Commission,No.WX21M02.
文摘BACKGROUND Spinal tuberculosis,a destructive extrapulmonary form,often causes severe deformity and neurological deficits.Surgical intervention aims to debride lesions,reconstruct stability,and correct deformities.This study evaluates a combined posterior fixation and minimally invasive anterior approach for lumbar tuberculosis.AIM To evaluate the clinical outcomes and radiological parameters of posterior internal fixation combined with minimally invasive anterior lesion clearance and bone graft fusion for the treatment of lumbar tuberculosis.METHODS Clinical data from 24 patients with lumbar tuberculosis who underwent posterior pedicle screw fixation combined with minimally invasive anterior lesion clearance were analyzed.The Cobb angle,visual analog scale(VAS)score,and Frankel classification were statistically assessed preoperatively and postoperatively.Complications and bone graft fusion were also recorded.RESULTS Wounds healed in the first stage in 22 patients;one patient developed a posterior incisional sinus tract,and one experienced postoperative tuberculosis recurrence.At the final follow-up,according to the Frankel classification,there were 1,2,and 21 cases classified as grade C,grade D,and grade E,respectively.By the last follow-up,the Cobb angle,VAS score,and erythrocyte sedimentation rate had all decreased.Both X-ray and computed tomography images confirmed bone healing.The fusion time ranged from 3 to 9 months,with an average of 5.2 months.CONCLUSION Posterior pedicle screw fixation combined with minimally invasive anterior lesion clearance is an effective and safe treatment for lumbar tuberculosis.
基金supported by the National Key R&D,Program of China (No.2018YFC1106600)the National Natural Science Foundation of China (Nos.52071008 and U20A20390)Beijing Natural Science Foundation (No.2192027).
文摘Alveolar bone augmentation with fixation screws has difficulties such as non-degradable materials that could lead to secondary surgery and insufficient osseointegration due to the subgingival environment in dental practice.With degradability and a high degree of osteogenesis,Mg alloy is a successful biodegrad-able material for orthopedic applications,and its application in dentistry has made certain progress.How-ever,considering the unique subgingival healing properties of oral implants,there is still a gap between the desired material properties for clinical applications and available materials.Indeed,studies on the use of Mg-based fixation screws for dentistry applications are still rare.In this study,we reported a magnesium alloy with low combined addition of strontium and lanthanum.The mechanical properties,degradation behavior,osteogenesis,and gingival compatibility were systematically investigated for assess-ing its potential application in alveolar bone fixation screws.With the alloying element content restricted to 0.3 wt.%,Mg-Sr-La alloy still exhibited good mechanical properties,with yield tensile and compressive strength twice higher than those of pure Mg.The in vitro degradation rate of this alloy was 0.10 mm y-1,which was slightly slower than high-purity Mg.The indirect and direct cell assay confirmed the elevated osteoblastic differentiation of MC3T3-E1 and migration of HGF-1 cells.Moreover,Mg-Sr-La alloy demon-strated a relatively slow degradation in the maxillary bone of Beagles.A remarkable promotion of the bone-implant contacts and significantly decreased fibrous encapsulation was observed in the subgingival environment,implying superior osseointegration of the experimental alloy than the titanium control.The empirical findings here reveal the great potential of Mg-Sr-La alloy for the application in alveolar bone fixation devices.
文摘Objective: To investigate the effectiveness of the plate screw internal fixation technique on the clinical outcomes of patients with traumatic fractures of long bones in the lower extremities. Methods: From January 2022 to December 2023, 70 patients with traumatic fractures of long bones in the lower extremities were admitted to the hospital and randomly divided into two groups: the control group and the observation group, each consisting of 35 cases. The control group underwent traditional closed interlocking intramedullary nailing, while the observation group received internal fixation with steel plates and screws. Relevant surgical indicators, treatment effectiveness, and postoperative complication rates were compared between the two groups. Results: The observation group exhibited significantly short surgical duration (80.65 ± 5.01 vs. 88.36 ± 5.26 minutes), fracture healing time (13.27 ± 0.32 vs. 15.52 ± 0.48 weeks), and hospitalization days (10.49 ± 1.13 vs. 16.57 ± 1.15 days) compared to the control group (P = 0.000). The effective treatment rate was significantly higher in the observation group (29/82.86%) than in the control group (21/60.00%), with a significant difference observed (χ2 = 4.480, P = 0.034). Additionally, the complication rate in the observation group (2/5.71%) was significantly lower than that in the control group (8/22.86%), with a correlated difference (χ2 = 4.200, P = 0.040). Conclusion: The plate screw internal fixation technique demonstrates significant clinical efficacy in treating traumatic fractures of long bones in the lower extremities. It improves the healing rate, reduces complications, and represents a safe and effective treatment strategy worthy of widespread use and application.
文摘Objective: to summarize the surgical treatment methods of comminuted calcaneal fracture and the effect differences of different surgical methods. Methods: patients with calcaneal fractures admitted to our hospital and confirmed for surgical treatment were selected. All patients were comminuted fractures and met the requirements of surgical indications. The cases were selected from June 2018 to June 2020, and the conventional group took incision reduction surgery based on L-type incision. The experimental group performed minimally invasive plate internal fixation with plate screws according to the posterior heel or the tarsal sinus incision position. When observed after the operation, the items involved included the function of the heel, the recovery status of the calcaneus, the surgery-related indicators, and the complications occurring during and after the surgery. Results: the patients of the experimental group were significantly higher than the height. Bolher and Gissen angle were better than the conventional group in March and June, P <0.05;the time, bleeding volume, incision length, hospitalization time and related complications were significantly better than the conventional group, P <0.05. Conclusion: minimally invasive plate and screw internal fixation can effectively treat comminuted calcaneal fracture, which has a significant effect on the foot and ankle function, and obviously acts on the fracture site and function.
文摘Objective To report five cases of puerile (【9 years) atlantoaxial instability which underwent C1-C2 pedicle screw internal fixation by posterior approach,and to introduce the surgical technique and the key point
文摘Objective To study the effect of using improved 2D computer-assisted fluoroscopic navigation through simulating 3D vertebrae image to guide pedicle screw internal fixation.Methods Posterior pedicle screw internal fixation,distraction
