ABSTRACT
[Objective]To introduce the safety of the spinal wedge osteotomy by a single posterior approach and to discuss the selection of fusion and fixation. [Method]Sixteen patients with severe post-adolescent congenital spinal deformities were treated by spinal wedge osteotomy by a single posterior approach from February 2000 and July 2006.There were 10 males and 6 females with an average age of 21.4 years(range 16 to 29 years).There were 11 patients with hemivertebre and 5 with fused ribs or bone bridge.Two patients had previous surgery history.The average Cobb's angles of scoliosis and kyphosis before operation were 84.7 ?and 52.6?.The average trunk shift was 15.4 mm.Bony septum in the canal was found in 2 patients on the preoperative CT or MRI.[Result]The follow-up ranged from 2 to 4 years with an average of 2 years and six months.The average fused vertebrae were 10.6 segments(range 8 to 14 segments).The postoperative average Cobb's angles of scoliosis and kyphosis were 38.5 and 27.7.The average correction rates of scoliosis and kyphosis were 54.5% and 47.4%.The average trunk shift was improved to 4.6 mm.There was no significant correction loss of the scoliosis,kyphosis and trunk shift at final follow-up evaluation.No patient developed severe complications except that two had pedicle fracture,one had L1 nerve root injury,one had superior mesenteric artery syndrome and one had exudates of incision.[Conclusion]Spinal wedge osteotomy by the single posterior approach is a reliable and safe surgical technique for correcting severe post-adolescent congenital spinal deformities.
ABSTRACT
Objective To evaluate the operative technique and the short-term clinical results of ce-mentless total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) in adults with high level dislocation. Methods Nine patients (11 hips) with DDH of Hartofilakidis type Ⅲ, who underwent cement-less THA between 1997 and 2002, were analyzed. Of 9 patients, 8 were females, and 1 male with an average age of 29.4 years (range, 17 to 56 years). There were unilateral DDH in 7, and bilateral in 2. The patients had no previous surgery. The preoperative average length difference between the two legs was 4.1 cm (range, 0 to 7 cm). The femoral head was dislocated upward from the normal position by 4.8 cm on average (range, 3.2 to 7.0 cm). The Zweym?ller cup was placed on the original acetabulum in all patients with more than 80% bony coverage on the cup, and no bone graft needed. In 4 hips with more than 5 cm of displacement, the reduction of prosthesis was achieved by shortening osteotomy below lesser trochanter. The preoperative average Harris score was 40.2. Results All of 9 patients were obtained follow-up of X-ray films and clinical evaluation. The follow-up ranged from 6 to 32 months with a mean of 18.2 months, the osteotomy of 4 hips were bony healed at 3 months postoperatively showed by X-ray films. The postoperative average difference of the two leg length reduced to an average 1.1 cm (range, 0 to 3 cm), and the postoperative average Harris score increased to 90. Femoral nerve impairment occurred in 1 case, and recovered 4 months later. There were no loosening, dislocation and infection at follow-up. Conclusion Based on the short-term results of the cementless total hip arthroplasty for the developmental dislocation of the hip in adults with high level dislocation, it is proven to be a good technique, and the satisfied clinical results would be obtained.