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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.
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Humans , Discitis , Tuberculinum kochABSTRACT
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.
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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)
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Humans , Outcome Assessment, Health Care , Arthroplasty, Replacement, Hip/methods , Surgical Procedures, Operative/methods , Choice BehaviorABSTRACT
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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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@#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.
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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.
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Humans , Decompression, Surgical , Lumbar Vertebrae , Spinal Cord Injuries , Spinal Fractures , Thoracic Vertebrae , Treatment OutcomeABSTRACT
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.
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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.
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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.
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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.
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Humans , Fracture Fixation, Internal/methods , Patient Positioning/methods , Tibial Fractures/surgery , Biomechanical Phenomena , Bone Plates , Fracture Healing , Fractures, Comminuted/surgery , Tibial Fractures/pathologyABSTRACT
Introducción Para las fracturas de húmero diafisario de manejo quirúrgico, los abordajes por mínima invasión mejoran desenlaces. Se han descrito varios. Sin embargo, para el abordaje posterior no existe claridad entre la relación anatómica del nervio radial y las incisiones o la posición de la placa. El objetivo de este estudio es describir la relación anatómica del nervio radial tanto con las incisiones del abordaje posterior por mínima invasión como con la punta distal de la placa. Materiales y métodos se realizó un estudio descriptivo en cadáveres sin traumatismo de miembros superiores, en prono con 45° de abducción de hombro y 90° de flexión de codo, tras deslizar una placa de 2,7 mm. Se consignaron en milímetros las distancias del nervio radial respecto a los puntos de referencia del abordaje y la punta distal de la placa. Resultados Por término medio, la longitud humeral fue 286,6 mm; la distancia del epicóndilo lateral al nervio radial, 155,1 mm; la aponeurosis tricipital al nervio radial, 138,9 mm, y la punta distal de la placa al nervio radial, 155,6 mm. Discusión La fijación con placa por mínima invasión por abordaje posterior puede ser segura para las fracturas de húmero diafisario respecto a la lesión del nervio radial, al ubicar los tornillos de la placa por fuera de 128,5-169,5 mm medidos desde la punta de la placa aunque se requieren estudios clínicos para demostrar la seguridad de este abordaje. Nivel de evidencia clínica Nivel IV.
Background It is well known that the various minimally invasive approaches described improve outcomes for the surgical fixation of diaphyseal humerus fractures. However, there is a lack of information between the anatomical relationship of the radial nerve for the required incisions or for the position of the plate when a posterior approach is used. The objective of the study is to describe the anatomical relationship of the radial nerve with both incisions of the posterior minimally invasive approach, and with the distal tip of the osteosynthesis plate. Materials and methods A descriptive study was performed on cadavers without trauma of upper limbs, in prone with 45° of abduction of shoulder and 90° of elbow flexion. After sliding a plate of 2.7 mm, the distances of the radial nerve with respect to the reference points of the approach and distal tip of the plate were recorded in millimetres. Results A mean humeral length of 286.6 mm was found. The mean distance from the lateral epicondyle to the radial nerve was 155.1 mm. The mean distance from the tricipital aponeurosis to the radial nerve was 138.9 mm, and from the distal tip of the plate to the radial nerve was 155.6 mm. Discussion Plate fixation using minimal invasive technique using a posterior surgical approach may be safe for diaphyseal fractures of the humerus with respect to radial nerve injuries, as long as the plate screws are located outside the range of 128.5 mm to 169.5 mm measured from the tip of the plate. Clinical studies are required to demonstrate the safety of this approach. Evidence level IV.
Subject(s)
Humans , Humeral Fractures , Radial Nerve , Fracture Fixation, InternalABSTRACT
Introducción Las fracturas de húmero diafisarias corresponden al 3-5% de las fracturas en general. La distribución de las fracturas que comprometen el tercio distal de la diáfisis es variable con incidencias estimadas entre el 10 y el 48%. El objetivo del estudio es evaluar los resultados funcionales y la tasa de consolidación de un grupo de pacientes con fractura diafisaria de húmero del tercio distal con técnica mínimamente invasiva por vía posterior. Materiales y métodos Entre 2013 y 2016 se intervino a 23 pacientes, con una media de edad de 36 años. La valoración funcional se realizó por medio de la Escala de Discapacidades del Hombro, el Codo y la Mano (DASH) abreviada y la medición de los arcos de movilidad de hombro y codo con goniometría; el dolor fue evaluado de acuerdo con la Escala Visual Análoga del Dolor (EVA). Resultados Todas las fracturas consolidaron de forma exitosa, excepto dos casos que presentaron retardo en la consolidación. La lesión del nervio radial previa a la intervención se recuperó de forma progresiva sin requerimiento de transferencias. Los resultados funcionales fueron satisfactorios en un grupo de diez pacientes que completaron más de 1 año de seguimiento. Discusión El abordaje posterior de humero con mínima invasión en el tratamiento de este patrón particular de fracturas parece que muestra una ventaja biológica al permitir una consolidación completa en todos los pacientes. La lesión del nervio radial iatrogénica no parece que aumente en relación con su aislamiento y protección en la porción proximal del tríceps. Nivel de evidencia clínica Nivel IV.
Background Diaphyseal humeral fractures correspond to 3-5% of all fractures. The proportion of these fractures in which the distal third of the diaphysis is involved is variable with estimated incidences between 10-48%. The aim of the study is to evaluate the functional results and rate of fracture consolidation for a group of patients with distal third diaphyseal humeral fractures managed using a minimally invasive technique through a posterior approach. Materials and methods Twenty-two patients (mean age of 36 years) were evaluated between 2013 and 2016. Functional assessment was performed using the DASH abbreviated functional scale. Shoulder and elbow mobility range of motion were measured with goniometry, and pain was measured following the VAS scale. Results All fractures consolidated successfully, with two cases exhibiting delay in consolidation. Radial nerve injury prior to the intervention was progressively recovered without the need for supplementary tendons transfers. Functional results were satisfactory for ten patients that completed more than one year of follow-up. Discussion Minimally invasive technique with posterior approach in the treatment of this particular pattern of humeral fractures seems to show a biological advantage in allowing complete consolidation in all patients. Iatrogenic radial nerve injury does not appear to increase in relation to its isolation and protection in the proximal portion of the triceps. Evidence level IV.
Subject(s)
Humans , Humeral Fractures , Minimally Invasive Surgical Procedures , AnatomyABSTRACT
Objective To investigate the application value of secondary splenic pedicle separation technology through superior posterior approach of the pancreatic tail in laparoscopic partial splenectomy.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 13 patients who underwent laparoscopic partial splenectomy in the Ningbo First Hospital from March 2016 to October 2017 were collected.After preoperative assessment using computed tomography(CT) angiography,13 patients underwent laparoscopic partial splenectomy using secondary splenic pedicle separation technology through superior posterior approach of the pancrcatic tail.Observation indicators:(1) intra-and post-operative recovery situations;(2) follow-up situations.Follow-up using outpatient examination was performed to detect postoperative changes of peripheral blood platelet (PLT),thrombosis of splenic vein,lesions residual or recurrence up to November 2017.Measurement data were represented as average (range).Results (1) Intra-and post-operative recovery situations:13 patients underwent successful laparoscopic partial splenectomy using secondary splenic pedicle separation technology through superior posterior approach of the pancreatic tail,without conversion to open surgery,including 6 with laparoscopic partial splenectomy of inferior pole of the spleen and 7 with laparoscopic partial splenectomy of upper pole of the spleen.Operation time was 42-93 minutes,with an average of 61 minutes;volume of intraoperative blood loss was 30-260 mL,with an average of 92 mL;postoperative gastrointestinal function recovery time was 22-47 hours,with an average of 34 hours;postoperative drainage tube removal time was 3.0-6.0 days,with an average of 4.2 days.The postoperative pathological examination of 13 patients:7,2,2,1 and 1 patients were respectively confirmed with splenic cysts,splenic hemangiomas,vascular hemangiomas,splenic hamartoma and splenic lymphangioma.Of 13 patients,1 was complicated with splenic recess effusion and fever,and was improved with B ultrasound-guided percutaneous catheter drainage.Duration of hospital stay of 13 patients was 7.0-16.0 days,with an average of 9.6 days.(2) Follow-up situations:13 patients were followed up for 1.0-19.5 months,with a median time of 8.5 months.During the follow-up,PLT level of 13 patients was normal.Color Doppler ultrasound examination showed no venous embolism,and CT angiography showed good vascular perfusion.There was no recurrence of splenic cysts in 7 patients and no tumor residual or recurrence in 6 patients.Conclusion Laparoscopic partial splenectomy using secondary splenic pedicle separation technology through superior posterior approach of the pancreatic tail is safe and effective,and it can precisely dissect splenic hilum,preserve blood supply and function of the remnant spleen,and reduce surgical injury.