A Prospective Observational Study on Outcomes of Single Stage Posterior Decompression and Fixation for Dorsolumbar Spine Tuberculosis / Estudo observacional prospectivo sobre os desfechos da descompressão posterior e fixação em estágio único na tuberculose da coluna dorsolombar

Abstract Objective To study the results of only posterior decompression and instrumentation in dorsal and dorsolumbar spine tuberculosis. Methods The patients (n = 30) who were included in this study had dorsal or dorsolumbar spine tuberculosis, with or without neurological deficit, and with or without deformity. All 30 patients were managed by only posterior approach decompression and instrumentation. We studied cases for correction and maintenance of deformity at dorsal and dorsolumbar spine, functional outcome by the Oswestry disability index (ODI) and visual analogue scale (VAS) scores, as well as neurological outcome by the Frankel grade. Results In the current series, 30 patients were operated with single stage posterior decompression and instrumentation, and showed significant improvement in neurological status and functional outcomes, which were accessed by the ODI score, VAS score, and Frankel grade. Conclusion The posterior (extracavitary) approach provides optimum access to the lateral and anterior aspects of the spinal cord for good decompression. It facilitates early mobilization and avoids problems of prolonged recumbency, provides better functional outcome, and significantly better sagittal plane kyphosis correction.

Resumo Objetivo Estudar os desfechos da descompressão posterior isolada e instrumentação na tuberculose da coluna dorsal e dorsolombar. Métodos Os pacientes (n = 30) incluídos neste estudo apresentavam tuberculose na coluna dorsal ou dorsolombar, acompanhada ou não por déficit neurológico e/ou deformidade. Todos os 30 pacientes foram tratados apenas por descompressão posterior e instrumentação. Estudamos a correção e manutenção da deformidade na coluna dorsal e dorsolombar, o desfecho funcional segundo o índice de deficiência de Oswestry (ODI) e a escala visual analógica (EVA); o desfecho neurológico foi estudado de acordo com a classificação de Frankel. Resultados Na atual série, 30 pacientes foram submetidos à descompressão posterior e instrumentação em estágio único e apresentaram melhora significativa no estado neurológico e desfecho funcional segundo os scores de ODI, EVA e classificação de Frankel. Conclusão A abordagem posterior (extracavitária) permite o acesso ideal aos aspectos laterais e anteriores da medula espinhal para uma boa descompressão. Facilita a mobilização precoce, evita problemas associados ao decúbito prolongado, proporciona melhor desfecho funcional e corrige a cifose no plano sagital de maneira significativamente melhor.

Endoscopic resection of symptomatic talocalcaneal coalition in adolescents using a posterior approach / 中华创伤骨科杂志

Objective:To evaluate the outcomes of endoscopic resection of symptomatic talocalcaneal coalitions in adolescents using a posterior approach.Methods:A retrospective case-series study was performed to analyze the data of 15 adolescent patients (16 feet) with symptomatic talocalcaneal coalitions (TCC) who had been treated by posterior arthroscopy from February 2017 to December 2020 at Department of Orthopaedics, Xuzhou Central Hospital. There were 11 boys and 4 girls with an average of 14.3 years (from 11 to 17 years). The left side was affected in 9 and the right side in 5 patients, and both sides were involved in one. Ten patients had a history of ankle sprain. The clinical outcomes were evaluated by visual analogue scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and 36-item short form health survey (SF-36) postoperatively.Results:The 15 patients were followed up for a mean time of 19.9 months (from 12 to 36 months). At the final follow-up, the VAS significantly decreased from preoperative 6 (6, 7) points to 1 (1, 3) point, the AOFAS ankle-hindfoot score significantly increased from preoperative (54.1±10.4) points to (90.0±16.6) points, and the SF-36 score significantly improved from preoperative (55.5±12.7) points to (88.7±6.5) points ( P<0.05). Follow-ups found such complications as infection, TCC recurrence or osteoarthritis in none of the patients. Conclusion:Endoscopic TCC resection using a posterior approach is an effective surgery for symptomatic TCC in adolescents, showing advantages of limited invasion, fast recovery, a low rate of postoperative complications and precise resection.

Comparación de resultados entre el abordaje anterior y posterior en la artroplastia total de cadera / Comparing Results between the Anterior and Posterior Approach in Total Hip Arthroplasty

Introducción: Existe una gran controversia con respecto a la existencia de un abordaje quirúrgico óptimo para artroplastia de cadera. El énfasis actual en la investigación ha sido examinar las posibles diferencias en los resultados funcionales entre el abordaje anterior y el abordaje posterior. Objetivo: Comparar las medidas de resultado informadas por los pacientes sometidos a artroplastia total de cadera, mediante abordajes anterior y posterior. Métodos: Se realiza una búsqueda sobre el tema en la base de datos PubMed entre los años 2010-2020 en inglés con los términos: comparación entre abordaje anterior y abordaje posterior de la cadera, abordaje anterior directo de la cadera, abordaje posterior de la cadera, y resultados de artroplastia de la cadera mediante abordajes anterior y posterior. Análisis y síntesis de la información: El abordaje anterior muestra una mayor mejora en la velocidad de la marcha, la longitud del paso y la simetría de la marcha, en comparación con el abordaje posterior para artroplastia de cadera al mes después de la operación. A los cuatro meses estas características de la marcha no fueron diferentes, pero los resultados de algunas pruebas funcionales fueron superiores en los pacientes intervenidos por abordaje anterior. Conclusiones: La elección del abordaje quirúrgico para artroplastia de cadera debe basarse en los factores del paciente, la preferencia del cirujano y su experiencia(AU)

Introduction: There is great controversy regarding the existence of an optimal surgical approach for hip arthroplasty. The current research emphasis has been to examine the possible differences in functional outcomes between anterior and posterior approaches. Objective: To compare the outcome measures reported by patients undergoing total hip arthroplasty, using anterior and posterior approaches. Methods: A search is carried out on the subject in the PubMed database during the years 2010-2020, in English, with the terms comparison between anterior approach and posterior approach to the hip, direct anterior approach to the hip, posterior approach to the hip, and results of hip arthroplasty using anterior and posterior approaches. Analysis and synthesis of the information: The anterior approach showed greater improvement in gait speed, stride length and gait symmetry, compared to the posterior approach for hip arthroplasty one month after the operation. At four months, these gait characteristics were not different, but the results of some functional tests were superior in patients operated on by anterior approach. Conclusions: The choice of the surgical approach for hip arthroplasty should be based on the patient´s factors, preference of the surgeons and their experience(AU)

Comparison Of Anterior And Posterior Approach Of Percutaneous Catheterization Of Internal Jugular Vein Under Real Time Ultrasound Guidance In Critically Ill Patients: A Prospective Randomised Study

Background:Central venous catheterization is a vital intervention in critically ill patients. The purpose of this study was to compare the procedural parameters and complications associated with anterior and posterior approaches of IJV catheterization under real timeultrasound guidance in critically ill patients. Material And Methods:In this prospective randomised study, 90 patients admitted in various ICUs were randomly allocated two groups of 45 each, including both males and females aged between 18 to 80 years ofage requiring central venous catheterization for various indications. Result:The first attempt success rates were comparable between both the groups. The venous visualization time was 38.52 seconds in Group A and 14.65 seconds in Group P (p<0.001). The venous puncture time and the duration of catheterization was found to be 47.60 sec & 2 minutes in Group A respectively and 24.16 sec & 1 minute 32 sec in Group P respectively (p<0.001). No statistically significant differences were found between the two groups in terms of incidence of carotid arterial puncture, haematoma formation and catheter displacement.Conclusion:It was observed that the posterior approach is better than anterior approach of USG guided IJV catheterization as it improves the accuracy, reduces the access time and duration of catheterization & leads to fewer incidences of immediate complications like carotid arterial puncture & subseque nt haematoma formation.

Outcome following cervicothoracic junction fusion in T1 pathological fracture of breast cancer spinal metastases: a case report

The cervicothoracic junction (CTJ) is defined as the area extending from vertebral segment C7 to T2. Spinal metastases of CTJ are rare, range from 10% to less than 20%. A 47-year-old woman complained sensory and motor disturbance since 3 weeks prior to admission. History of lump on the left breast was confirmed. Neurological deficit was confirmed as ASIA C at the time of diagnosis. MRI finding suggest fracture of T1 vertebral body with kypothic angle 28° that causing anterior compression of spinal cord. The patient underwent decompression and posterior fusion from C4 to T4. A biopsy sample was also collected from the spine and left breast to confirm the diagnosis. Patient evaluation was done during discharge and at certain points of follow-up for improvement on its neurological, pain, and functional status. An MRI evaluation was performed to evaluate spinal stability and fusion. Significant improvements were observed in patient ambulatory and pain status. Cervicothoracic junction fusion procedure is a considerable choice for the management of pathological vertebral fractures with cervicothoracic junction involvement caused by spinal metastases of breast cancer.

Comparison between the results of bipolar hemiarthroplasty with lateral approach and posterior approach in Sanglah General Hospital in 2018: a case series

The purpose of this study was to compare the preoperative, intraoperative and postoperative parameters of Bipolar Hemiarthroplasty procedure using lateral approach and posterior approach in Sanglah General Hospital in 2018. Thirty-five patients diagnosed with femoral neck fracture or intertrochanter fracture underwent Bipolar Hemiarthroplasty using either lateral approach or posterior approach at our institution between January 2018 and December 2018. The primary outcome measures were postoperative complication and hip function. The secondary outcome measures were surgical time, transfusion rate, length of hospital stay, intraoperative blood loss and postoperative haemoglobin. There were 14 patients in Lateral Approach group and 21 patients Posterior Approach group included for analysis. There were no significant differences between the two groups regarding to the Harris Hip Score at 6 months follow up. Significant differences were found between Bipolar Hemiarthroplasty with Lateral Approach and Bipolar Hemiarthroplasty with Posterior Approach group in comparison of intraoperative blood loss (p<0.05) and length of stay (p<0.05). The present study concluded that both lateral and posterior approaches are comparable in terms of functional outcomes and complications. However, there is a tendency of longer hospital of length of stay and more of intraoperative blood loss using posterior approach which should be kept in mind when orthopaedic surgeon is performing a bipolar hemiarthroplasty.

Posterior popliteal fossa S-shaped incision with double-window approach in treating posterior column of tibial plateau fractures / 中国修复重建外科杂志

Objective: To evaluate the effectiveness and safty of posterior popliteal fossa S-shaped incision with double-window approach for the treatment of posterior column of tibial plateau fractures. Methods: A retrospective analysis was made on the clinical data of 13 patients with complex tibial plateau fractures involving both posteromedial and posterolateral columns between May 2015 and July 2017. There were 9 males and 4 females, aged 33-64 years (mean, 46.5 years). The causes of injury included traffic accident in 5 cases, falling from height in 2 cases, falling from electric bicycle in 4 cases, and falling because of skiing in 2 cases. The preoperative range of motion of the affected knees was (35.1±9.2)°. The time from injury to surgery was 7-19 days (mean, 13.3 days). All patients underwent a posterior popliteal fossa S-shaped incision through the window of medial heads of gastrocnemius muscle (medial window) and the window between medial and lateral head of gastrocnemius muscle (popliteal fossa window) approaches. After a good visual control of fracture reduction, both posteromedial and posterolateral columns of tibial plateau fractures were fixed with buttress plate respectively. Bone union, limb alignment, articular surface, and range of motion were estimated after operation. The American Hospital for Special Surgery (HSS) score was used to evaluate functional outcomes of knees. Results: After operation, 1 patient had fat liquefaction and dehiscence of incision, which healed after expanding the wound; the other patients' incisions healed by first intention, and no vascular or nerve injury occurred during operation. All the 13 patients were followed up 12-18 months (mean, 16 months). The X-ray films showed that all patients obtained good fracture unions, the fracture healing time was 14-22 weeks (mean, 18 weeks). At 12 months after operation, the articular surface was smooth without collapse, and the knee range of motion was (109.5±13.6)°, showing significant difference when compared with preoperative value ( t=18.879, P=0.000). No complication of infection, re-displacement of fracture, or secondary varus/valgus deformity was observed during follow-up. The HSS score was 82-96 (mean, 89.6) at 12 months after operation, with the result of excellent in 10 cases and good in 3 cases. Conclusion: The posterior column fracture of tibial plateau involving both posteromedial and posterolateral columns treated by double-window approach through posterior popliteal fossa S-shaped incision is safe and effective, with satisfactory results and good recovery of knee joint function.

Analysis of effectiveness of greater trochanteric osteotomy approach and K-L posterior approach in patients with type Ⅳ Pipkin fracture / 中国修复重建外科杂志

Objective: To investigate the effectiveness of two surgical approaches in the treatment of type Ⅳ Pipkin fracture. Methods: The clinical data of 15 patients with type Ⅳ Pipkin fracture treated surgically between July 2013 and June 2018 were retrospectively analyzed. According to different surgical approaches, they were divided into group A (8 cases, using K-L posterior approach) and group B (7 cases, using greater trochanter osteotomy approach). There was no significant difference in gender, age, cause of injury, and interval from injury to operation between the two groups ( P>0.05). The incision length, operation time, intraoperative blood loss, hospital stay, fracture healing time, and complications of the two groups were recorded. Hip joint function recovery was evaluated according to Thompson-Epstein functional evaluation system. Results: All the 15 patients were followed up 1-5 years, with an average of 2.5 years. There was no significant difference in operation time between the two groups ( t=14.681, P=0.100); the incision length, intraoperative blood loss, and fracture healing time in group A were all greater than those in group B, and the hospital stay was shorter than that in group B, showing significant differences ( P<0.05). In group A, 1 patient presented hip pain, clasthenia, and limited mobility after operation, 1 patient presented ossifying myositis, 1 patient presented osteonecrosis of the femoral head, 1 patient presented fat liquefaction of incision, and 1 patient presented sciatica, with a complication incidence of 62.5%. Postoperative hip pain occurred in 1 patient and ossifying myositis in 2 patients in group B, with a complication incidence of 42.9%. There was no significant difference in the incidence of complications between the two groups ( χ2=-0.735, P=0.462). At last follow-up, according to Thompson-Epstein functional evaluation system, the results in group A were excellent in 3 cases, good in 2 cases, fair in 2 cases, and poor in 1 case, with an excellent and good rate of 62.5%; in group B, the results were excellent in 4 cases, good in 2 cases, and fair in 1 case, and the excellent and good rate was 85.7%. There was no significant difference in good and fair rate between the two groups ( χ2=-0.990, P=0.322). Conclusion: K-L posterior approach is more convenient in the fracture treatment during operation, but it has greater trauma, greater vascular damage, and more blood loss. The greater trochanter osteotomy approach can better protect the blood supply of femoral head, shorten the operation time, reduce intraoperative blood loss, and reduce postoperative complications. It is an ideal way in the surgical treatment of type Ⅳ Pipkin fracture.

Supra-pancreatic lymph node dissection in 4K laparoscopic radical gastrectomy of hepatic artery posterior approach with portal vein protection / 中华消化外科杂志

In recent years, the proportion of laparoscopic radical gastrectomy has increased in China. It is worth studying how to improve surgical treatment and prognosis of patients. Using the "portal vein triangle" as anatomic landmark, the authors investigate supra-pancreatic lymph node dissection in 4K laparoscopic radical gastrectomy of hepatic artery posterior approach with portal vein protection.

Anterior versus posterior decompression for the treatment of thoracolumbar fractures with spinal cord injury:a Meta-analysis / 中国骨伤

OBJECTIVE@#To systematically evaluate the efficacy and safety of anterior decompression and posterior decompression in the treatment of thoracolumbar fractures with spinal cord injury, so as to provide a good scientific basis for more effective treatment of thoracolumbar fractures with spinal cord injury.@*METHODS@#A clinical data about comparative study of anterior decompression and posterior decompression in the treatment of thoracolumbar fractures with spinal cord injury was searched and collected. The databases of Pubmed, Embase, Cochrane Library, CNKI, CBM, Wanfang Medical Network were searched by computer. Artificially collected journals included Spine, European Spine Journal, The Journal of Bone and Joint Surgery. Two spine surgeons independently screened the literature according to established inclusion and exclusion criteria and assessed the quality of the included studies. Meta-analysis was performed on the data using Review Manager 5.3 software, the indicators included operative time, intraoperative blood loss, postoperative tactile score, postoperative motor score, postoperative vertebral height, hospitalization time, neurological function recovery, efficiency of treatment, postoperative complications.@*RESULTS@#Fifteen randomized controlled trials (RCTs) were enrolled in a total of 1 360 patients, including 680 anterior decompression and 680 posterior decompression. The results of Meta-analysis showed that the anterior decompression group had longer operation time [MD=80.09, 95% CI(36.83, 123.34), P=0.000 3], more intraoperative blood loss [MD=225.21, 95%CI(171.07, 279.35), <0.000 01], longer hospitalization time [MD=2.31, 95% CI(0.32, 4.31), P=0.02]. And the postoperative tactile score [MD=13.39, 95% CI(9.86, 16.92), <0.000 01], postoperative motor score [MD=13.15, 95% CI(7.02, 19.29), <0.000 1], vertebral height [MD=1.36, 95% CI(0.79, 1.92), <0.000 01] in anterior decompression were higher than that in posterior decompression. There was no statistically significant differences in the efficacy of treatment [OR=1.14, 95% CI(0.56, 2.31), P=0.72], neurological recovery [OR=0.87, 95% CI(0.57, 1.33), P=0.52] between two groups.@*CONCLUSIONS@#Compared with posterior decompression, the anterior decompression has the advantages of longer operating time, more intraoperative blood loss, longer hospitalization time, higher postoperative tactile score, higher postoperative motor score, and higher injury vertebral height, But there was no significant difference in the treatment efficiency and nerve function recovery between two groups.

Surgical treatment strategy for the "shell" phenomenon after thoracolumbar fracture / 中国修复重建外科杂志

Objective: To explore the surgical treatment strategy of the vertebral "shell" after thoracolumbar fracture, and provide clinical reference for the intervention and treatment of "shell". Methods: Between June 2015 and January 2017, 53 patients with high risk of vertebral "shell" after thoracolumbar fracture surgery were enrolled in a prospective study according to the selection criteria. All patients were randomly divided into two groups according to the order of treatment, 27 cases in the treatment group were treated with short-segment fixation combined with vertebral reconstruction, 26 cases in the control group were treated with short-segment fixation. There was no significant difference in gender, age, injury cause, Denis classification, fracture segment, the degree of injured vertebra compression, bone mineral density, and American Spinal Cord Injury Association (ASIA) classification between the two groups ( P>0.05). The degree of injured vertebra compression, visual analogue scale (VAS) score, and Oswestry disability index (ODI) score at preoperation, immediate after operation, and last follow-up were calculated and compared between the two groups. The "shell" phenomenon and surgery complications were observed at the same time. Results: All patients were followed up 12-18 months with an average of 14.4 months. There were 5 cases of "shell" phenomenon in the treatment group and 4 cases of nonunion at last follow-up, 23 cases of "shell" phenomenon in the control group and 19 cases of nonunion at last follow-up; there was a significant difference between the two groups ( P0.05), but which was significantly higher in the control group than that in the treatment group at last follow-up ( P0.05). Conclusion: The treatment of thoracolumbar fracture with short-segment fixation combined with injured vertebral reconstruction can effectively prevent the "shell" phenomenon, which is conducive to maintaining the height of injured vertebral and improving the long-term function. The effectiveness is satisfactory.

Application of one-stage posterior surgery via unilateral musculussacrospinalis iliac flap approach in treatment of lumbosacral tuberculosis / 中国修复重建外科杂志

Objective: To evaluate the safety and effectiveness of one-stage posterior surgery via unilateral musculussacrospinalis iliac flap approach in treatment of lumbosacral tuberculosis. Methods: Between August 2011 and October 2014, 13 patients with lumbosacral tuberculosis were treated by one-stage posterior reserved posterior ligament complex, lesion debridement, bone graft fusion, and internal fixation via unilateral musculussacrospinalis iliac flap approach. There were 8 males and 5 females, aged from 22 to 57 years, with an average age of 35 years. The disease duration ranged from 2 to 19 months, with an average of 6.7 months. According to the American Spinal Injury Association (ASIA) classification criteria, the patients were graded as grade B in 2 cases, grade C in 4 cases, grade D in 5 cases, and grade E in 2 cases before operation. The preoperative Oswestry disability index (ODI) was 36.4±5.7; the preoperative lumbosacral angle was (20.7±0.7)°; the preoperative erythrocyte sedimentation rate (ESR) was (63.4±8.4) mm/1 h; and the preoperative C-reactive protein (CRP) was (38.8±5.2) mmol/L. The operation time and intraoperative blood loss were recorded. The ODI, ASIA grade, lumbosacral angle, and ESR were recorded at last follow-up. Bridwell criterion was used to judge the interbody fusion. Results: The operation time was 150-240 minutes (mean, 190 minutes), and the intraoperative blood loss was 420-850 mL (mean, 610 mL). No major blood vessel, dural sac, nerve root, and lumbosacral plexus injuries occurred during the operation. Delayed wound healing occurred in 3 cases, and primary wound healing achieved in the other patients. No wound infection or sinus formation was found. All 13 patients were followed up 1.5-6.1 years (mean, 2.8 years). During the follow-up period, there was no tubercular symptom, cerebrospinal fluid leakage, loosening and rupture of internal fixator; and no complications such as retrograde ejaculation and erectile dysfunction occurred in 8 male patients. Solid spinal fusion obtained in all patients with the mean fusion time of 6.4 months (range, 4.2-9.9 months); and all iliac osteotomies healed. At last follow-up, the ODI was 7.2±3.5, the lumbosacral angle was (31.2±0.5)°, and ESR was (9.8±2.5) mm/1 h, all of which improved significantly when compared with pre-operative ones ( P<0.05). The patients were classified as grade D in 2 cases and grade E in 11 cases, which improved significantly when compared with preoperative ones ( Z=-3.168, P=0.002). Conclusion: One-stage posterior surgery via unilateral musculussacrospinalis iliac flap approach in treatment of lumbosacral tuberculosis is effective and safe.

Application of posterior approach for atlantoaxial subdural extramedullary nerve sheath tumors / 中国修复重建外科杂志

Objective: To investigate the procedure and effectiveness of posterior approach for operation of atlantoaxial subdural extramedullary nerve sheath tumors. Methods: Between January 2012 and March 2017, 9 patients with atlantoaxial subdural extramedullary nerve sheath tumors were treated, including 7 males and 2 females, aged 25-62 years (mean, 45.4 years). There were 8 cases of neurinoma and 1 case of neurofibroma. The tumors were located at C1 in 1 case and C1, 2 in 8 cases. The disease duration ranged from 5 to 120 months, with an average of 45.9 months. The neural function was rated as grade D in 8 cases and grade E in 1 case according to the American Spinal Injury Association (ASIA) grading system. The Japanese Orthopaedic Association (JOA) score was 12.8±2.5. All patients underwent posterior cervical surgery. The laminae were replanted and fixed in 2 cases. The atlantoaxial or occipitocervical axis was not fixed in all patients. Results: The operation time was 90-343 minutes, with an average of 179.2 minutes. The intraoperative blood loss was 50-1 000 mL, with an average of 335.6 mL. No relevant complication occurred after operation. All patients were followed up 6-21 months (mean, 11.1 months). The postoperative X-ray films showed the good stability of the cervical spine. All patients had complete tumor resection and no recurrence. The replanted laminae achieved fusion and the internal fixation was firm. According to ASIA grading system, 3 patients of preoperative ASIA grade D had upgraded to grade E at 3 months after operation, while the remaining patients had no change in grading. The JOA score was 15.1±1.4 at 6 months after operation, which was significantly improved when compared with that before operation (t=4.221, P=0.003). Conclusion: The atlantoaxial subdural extramedullary nerve sheath tumor (including the ventral tumor) can be removed completely via posterior approach. The axis lamina can be replanted and fixed with the small titanium plate or lamina screw when necessary, and the atlantoaxial or occipitocervical fixation was not needed.

Reduction of the atlantoaxial dislocation associated with basilar invagination through single-stage posterior approach: using Xuanwu occipital-cervical reduction surgical suite / 中华外科杂志

Objective@#To examine the effect of posterior reduction in atlantoaxial dislocation (AAD) associated with basilar invagination(BI) using Xuanwu occipital-cervical fusion system in single stage.@*Methods@#Thirty-seven AAD accompanied with BI cases treated at Department of Neurosurgery, Xuanwu Hospital, Capital Medical Universiy and the Second Hospital of Hebei Medical University were retrospective analyzed. There were 15 males and 22 females with age of (42.3±12.3) years (range: 18-69 years). All the cases had congenital osseous abnormalities, such as assimilation of atlas and abnormal cervical fusion. Anterior tissue was released through posterior route followed by cage implantation into facet joint and occipital-cervical fixation with cantilever technique. The clinical results were evaluated using Japanese Orthopedic Association scale(JOA) and the main radiological measurements including anterior atlantodental interval (ADI), the distance of odontoid tip above Chamberlain line, clivus-canal angle(CCA) and the length of syrinx were collected. The preoperative and postoperative JOA score and radiological measurements were compared by paired t-test.@*Results@#The mean JOA score of the patients increased from 10.5 to 14.4 at the one-year follow-up(t=14.3, P=0.00). Complete reduction of AAD and BI was achieved in 34 patients.The mean clivus-canal angle improved from (118.0±6.5) degrees preoperative to (143.7±5.0) degrees postoperative(t=6.2, P=0.00). Shrinkage of the syrinx was observed 1 week after surgery in 24 patients, and 6 months in 31 patients.Twenty-eight patients achieved bone fusion 6 months after surgery. All the patients achieved bone fusion 12 months after surgery. One-side vertebral artery occlusion was diagnosed in 1 case postoperatively for transient dizziness, and relieved in 2 weeks.Two patients developed moderate neck pain after surgery, and relieved in 1 month. No implant failure, spacer subsidence or infection was observed.@*Conclusions@#The treatment of AAD associated with BI using Xuanwu occipital-cervical fusion system from posterior approach in single stage is effective and safe. Cage implantation intraarticularly and fixation with cantilever technique achieve complete reduction in most cases.

Posterior approach for uniportal video-assisted thoracic surgery right upper lobectomy in the semiprone position / 中国胸心血管外科临床杂志

@#Objective To increase the advantage and decrease the disadvantage of posterior approach for uniportal video-assisted thoracic surgery (VATS) right upper lobectomy. Methods Data of 97 consecutive patients who received uniportal VATS right upper lobectomy using posterior approach in the semiprone position were retrospectively analyzed from Dec, 2014 to Dec, 2017. There were 41 males and 56 females at age of 26–79 (57.8±10.6) years. The hilar structure was cut from posterior to anterior one by one. The mediastinal lymph nodes were dissected if lung cancer was diagnosed. Results Ninety three of 97 patients were successfully completed with uniportal VATS right upper lobectomy using posterior approach, 3 of them were completed with posterior approach combined with anterior approach, and 1 of them needed thoracotomy. The mean operative time was 76–192 (127.0±32.0) min. The thoracic drainage time was 2–20 (3.4±2.7) d. The postoperative length of hospital stay was 3–23 (5.4±3.1) d. There were postoperative complications in 7 patients and no postoperative mortality. Conclusion Posterior approach for uniportal video-assisted thoracic surgery right upper lobectomy is safe and feasible, which can decrease the fatigue of both the surgeon and the assistant. It also provides with better exposure of posterior mediastinum, less dragging lung, and less interference of the instruments and help keep the clear surgical field. In complicated cases, posterior approach could combine with anterior approach to complete the VATS lobectomy.

Role of posteromedial plating in condylar fractures of Tibia in adults

Background: The purpose of this study was to evaluate role of Posteromedial Plating in condylar fractures of Tibia, especially patients with posterior tibial shear fractures. Materials and methods: This prospective study included 12 patients with mean age 40 years (range 30 to 50 years) who sustained high velocity posterior tibial plateau fracture-subluxations with/ without associated Bicondylar fractures (Moore I & II Types, Schatzker’s Groups – IV, V and VI). Surgical management included stabilisation plating through a posteromedial/ posterior approach and additional postero lateral or antero lateral approach as needed. The patients were followed up at six week, three month, six month and one year postoperatively and assessed using Oxford Knee Score and Lyshom Score. Results: The mean OKS score was 40 (range 36 to 44) at the end of one year. The main clinical measures were early post-operative non weight bearing ROM, post-operative complication and functional outcome. The time to full weight bearing, the rate of post-operative complications and functional outcome was significantly better as evident by over 94 % showing good to excellent OKS and Lyshom scores. Conclusion: A posterior/ postero medial approach for posterior tibial plateau shear fractures (which are otherwise irreducible by conventional approaches) and buttress/ antiglide plate are usually needed to reduce the fractures anatomically, achieving absolute stability and mobilize early NWB, ROM of the knee joint to optimize the functional outcomes and minimize the complications, without the need for revision surgery.

Principios quirúrgicos en fracturas de platillos tibiales con compromiso de columna posterior / Surgical principles in posterior column tibial plateau fractures

Las fracturas de platillos tibiales son lesiones complejas que incluyen una variedad de patrones morfológicos cada vez mejor caracterizados en la literatura. Históricamente, los esquemas de clasificación se han basado en evaluar los rasgos de fractura en el plano frontal y las técnicas quirúrgicas en lograr la fijación de esos fragmentos, sin tomar en consideración el compromiso óseo que ocurre en la región posterior de los platillos tibiales. Con el advenimiento de la clasificación columnar basada en tomografía computada, se han logrado desarrollar estrategias de fijación optimizada, dando cada vez más relevancia a la columna posterior. Este artículo realiza una revisión extensa de la literatura, otorgando los fundamentos quirúrgicos que explican la importancia del tratamiento específico de la columna posterolateral y posteromedial, con el fin de restablecer la biomecánica normal de la rodilla y el razonamiento quirúrgico de las diversas vías de abordaje específicas para una reducción y osteosíntesis satisfactoria de esos fragmentos.

Tibial plateau fractures are complex injuries which include a variety of morphological patterns that have been increasingly better characterized in the literature. Historically, classifications have focused on description of fracture patterns in the frontal plane, while surgical techniques have focused on reduction of these fragments not considering the osseous defects that occur on the posterior region of the tibial plateau. With new CT scan column based classifications, strategies to optimize fixation have been developed, giving relevance to the posterior column. This article is an exhaustive review of the literature, providing the surgical foundations that explain the importance of specific treatment of the posterolateral and posteromedial column, aiming to restore normal knee biomechanics. Furthermore, this article provides the diverse specific surgical approaches rationale for a satisfactory open reduction and internal fixation of these fragments.

Posterior spinal canal decompression with screw fixation and reconstruction of three vertebral column for thoracolumbar burst fractures complicated with nerve injury / 中国骨伤

<p><b>OBJECTIVE</b>To explore the feasibility and clinical effect of posterior spinal canal decompression with pedicle screw fixation and reconstruction of anterior and middle vertebral column for thoracolumbar burst fractures complicated with nerve injury.</p><p><b>METHODS</b>A total of 36 patients with thoracolumbar burst fractures treated from March 2011 to April 2016 were enrolled in the retrospective study. There were 20 males and 16 females, aged from 21 to 52 years old with an average of 37.6 years. All the fractures were located on a single segment, 8 cases of T11₁₁, 10 cases of T₁₂, 12 cases of L₁, 6 cases of L₂. According to thoracolumbar injury classification and severity score(TLICS) system, the score was 7 to 9 points, with an average of 7.4 points. According to the America Spine Injury Association(ASIA) grade, 4 cases were type A, 10 cases were type B, 14 cases were type C, 8 cases were type D. All the patients underwent posterior spinal canal decompression with pedicle screw fixation and reconstruction of anterior and middle vertebral column. The recovery of nerve function was evaluated by ASIA grading. The correction of kyphosis(Cobb angle), the volume change of injuried spinal canal, the change of anterior border height of injury vertebra which can be observed by X-rays;the internal fixation loosening and breakage and all the information of bone fusion were recorded.</p><p><b>RESULTS</b>All the operations were successful, the mean operative time and intraoperative blood loss were(2.8±0.3) h (2.1 to 3.5 h) and (880±120) ml(550 to 1 350 ml), respectively. All the incisions got primary healing. All the patients were followed up for 12 to 28 months with an average of 18.4 months. All the patients obtained satisfactory bone fusion. No pseudoarticulation formation was found, and there was no loosening, breakage of pedicle screws or displacement of titanium mesh. Neurological function was improved in different degree, except in one patient with grade A and another one with grade B. According to the ASIA grade, there were 1 case of type A, 1 case of type B, 7 cases of type C, 10 cases of type D and 17 cases of type E, postoperatively. At 3 days after operative, the anterior border height of injury vertebra, Cobb angle and the volume changes of injury spinal canal were obviously improved(<0.05), and there was no significant difference between postoperative at 3 days and final follow-up(>0.05).</p><p><b>CONCLUSIONS</b>Spinal canal decompression with screw fixation and reconstruction of anterior and middle vertebral column through posterior midline approach is a safe and effective method in the treatment of thoracolumbar burst fractures with nerve injury, it is worthy to be popularized. It can complete the spinal canal decompression of 360 degree, reduction of fractures and reconstruction of vertebral three-column at the same time through a single posterior approach. The advantages includes less trauma, perfect decompression, good stability and etc.</p>

Analysis on clinical effects of one-stage anterior and posterior combined approach and lateral anterior approach in treating lumbar tuberculosis / 重庆医学

Objective To investigate the clinical efficacy of one-stage posterior percutaneous transpedicular screw fixation combined with lateral anterior approach for focus debridement bone graft fusion in the treatment of lumbar tuberculosis(TB).Methods Eighty-seven cases of lumbar tuberculosis treated by operation respectively adopted the one-stage anterior and posterior combined approach operation(group A) and simple lateral anterior approach operation(group B).The levels of CRP and ESR,Cobb angle,ODI score and Frankl score before and after surgery were statistically analyzed,and operation situation was analyzed in the two groups.Results The operation time and intraoperative bleeding volume in the group A were significantly more than those in the group B(P＜0.05),but there was no statistically significant difference in average hospitalization time between the two groups(P＞0.05).All cases were postoperatirely followed up for average (20.30-4-3.70) months.The levels of ESR and CRP,ODI score,Frankel score and Cobb angle after operation and at last follow up in the two group were significantly improved compared with before operation(P＜0.05).The bone graft healing time in the group A was significanlly shester than that in the group B.Conclusion Posterior approach fixation combined with anterior approach debridement operation has the advantages of less trauma,fixation stability and high bone healing rate for treating lumbar tuberculosis.

Comparison of early rehabilitation effects of total hip arthroplasty with direct anterior approach versus posterior approach / 中国修复重建外科杂志

Methods: A retrospective analysis was made in the data of 83 patients with unilateral osteonecrosis of the femoral head between March 2014 and May 2017. Forty-eight patients were treated with THA via PA (PA group) and 35 patients were treated with THA via DAA (DAA group). There was no significant difference in gender, age, body mass index, stage of osteonecrosis of the femoral head, and disease duration between 2 groups ( P>0.05). The length of incision, operation time, total amount of bleeding, the time of first postoperative walking with crutch, the time of first postoperative walking without crutch, the Harris scores, and the visual analogue scale (VAS) scores of 2 group were recorded and compared.