Intraoperative IPC combined with 3M warming instrument to prevent lower extremity deep venous thrombosis in patients undergoing proximal femoral anti rotation intramedullary nailing / 中国骨伤

OBJECTIVE@#To explore the effect of intermittent pneumatic compression(IPC) combined with 3M thermometer on the prevention of deep venous thrombosis(DVT) in patients with femoral intertrochanteric fracture.@*METHODS@#From March 2016 to August 2019, 127 patients with femoral intertrochanteric fractures who underwent proximal femoral nail antirotation(PFNA) were retrospectively analyzed. They were divided into two groups according to different methods of thrombus prevention and treatment. Among them, 63 patients in group A did not use IPC and 3M thermometer;64 cases in group B were treated with IPC combined with 3M thermometer. Color Doppler ultrasound was used to dynamically monitor the DVT and changes of lower limbs during perioperative period. The venous thrombosis of lower limbs was monitored at 0, 24, 72 h and > 72 h after operation(recheck every 3 days until discharge).@*RESULTS@#Occurrence of DVT of lower limbs after PFNA operation in two groups:there were 5 cases (7.8%) in group B and 20 cases (31.7%) in group A, there was significant difference between two groups (P=0.001). There was no significant difference in lower limb DVT between two groups at 0, 72 and > 72 h after operation(P>0.05), but the formation rate of group A was significantly higher than that of group B at 24 h after operation (P=0.049). There was no significant difference in DVT formation between group A and group B(P>0.05). However, the formation of DVT in group A was significantly higher than that in group B(P=0.012).@*CONCLUSION@#Intraoperative IPC combined with 3M thermostat can effectively prevent DVT of lower limbs in patients undergoing PFNA surgery.

Treatment of migrated lumbar disc herniation with percutaneous endoscopic lumbar discectomy and target foraminoplasty / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical outcome of percutaneous endoscopic lumbar discectomy with target foraminoplasty in treating migrated lumbar disc herniation.</p><p><b>METHODS</b>From June 2015 to January 2016, 25 patients with migrated lumbar disc herniation were treated with percutaneous endoscopic lumbar discectomy with target foraminoplasty. A total of 14 males and 11 females, aging from 23 to 52 years old (average: 37.6) were enrolled in this study. Discectomy occurred in L₂,₃ of 1 case, L₃,₄ of 3 cases, L₄,₅ of 12 cases, L₅S₁ of 9 cases. Preoperative, 1-week and 1-year postoperative visual analogue scale (VAS) scores were collected to evaluate lower back and leg pain; Oswestry Disability Index(ODI) was used to assess the lumbar function.</p><p><b>RESULTS</b>All the patients were followed up for 12 to 19 months with an average of 15.2 months. The mean operation time was 108.6 min. No injury of dura, nerve root, or wound infection were found. Preoperative, 1-week and 1-year postoperative visual analogue scale(VAS) scores of lower back pain were 5.8±0.5, 2.5±0.4, 0.9±0.2, respectively, with significant differences among each other(<0.05);VAS scores of leg pain were 7.1±0.6, 1.5±0.4, 0.7±0.6, respectively, with significant differences among each other(<0.05). Lumbar ODI scores were 69.2±1.8, 22.5±4.7, 10.2±2.4 at the above time points and showed significant differences among each other(<0.05).</p><p><b>CONCLUSIONS</b>Percutaneous endoscopic lumbar discectomy with target foraminoplasty for migrated lumbar disc herniation showed advantages of less injuries, bleeding and complication. It also promotes rapid recovery, being curative safely and effectively.</p>

Application of the pedicle screw in the subaxial cervical spine / 中国骨伤

<p><b>OBJECTIVE</b>To research the clinical application of lower cervical pedicle screw fixation procedure.</p><p><b>METHODS</b>From September 2011 to July 2013,32 patients underwent posterior pedicle screw-rod system fixation were retrospective analyzed includinig 20 males and 12 females with an average age of 56.4 years old ranging from 21 to 78 years. Among them, 10 patients were traumatic cervical spinal injury, 9 patients were cervical spinal canal tumors, 7 cases were posterior longitudinal ligament ossification of cervical vertebrae, 6 cases were multiple segmental cervical spondylopathy. Preoperatively, X-ray, computed tomography, magnetic resonance imaging and magnetic resonance angiography of the vertebral artery were performed in all patients. After the operation and during the follow-up,X-ray and computed tomography were performed to confirm the pedicle screw position. The accuracy of the pedicle screw placement was evaluated by 4 grades classification from Lee. The spinal cord function was assessed by ASIA impairment scale for traumatic patients and JOA score for non traumatic patients.</p><p><b>RESULTS</b>Totally 144 pedicle screws performed on 32 patients from C3 to C7 involving 132 screws of grade 0,5 screws of grade 1,5 of screws grade 2 and 2 screws of grade 3 according to postoperative CT. There were 12 screws penetrating the pedicle cortex including 8 screws at lateral,2 screws at caudal, 1 screw at medial and 1 screw at cranial. The follow-up time was 12 to 33 months with an average of (21.0±1.5) months. The spinal cord function was not improved in 6 complete cervical spinal cord injury patients,but their paraplegic level descended 1 to 3 segments. Four incomplete cervical spinal cord injury patients' ASIA impairment scale was increased by 1 to 2 grades in average. The JOA score of 22 atraumatic patients increased from preoperative 11.5±0.8 to 15.9±0.6 of postoperative at 6 months (P<0.01). There were no screw loosening,screw pullout and screw-rod breakage.</p><p><b>CONCLUSION</b>The lower cervical pedicle screw fixation can provide excellent 3D stability of the vertebral column. The operation risk and Complication could be minimized by adequate preoperative evaluation for appropriate cases and individual pedicle screw placement. It deserved the clinical expansion.</p>