Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults (version 2023) / 中华创伤杂志

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (version 2022) / 中华创伤杂志

Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.

Studies on the minimally invasive percutaneous suture technique of eight times for repairing closed injury extensor tendon zone I of finger / 中华骨科杂志

Objective:To discuss the clinical curative effect of the minimally invasive percutaneous suture technique of eight times for repairing closed injury extensor tendon zone I of finger.Methods:From February 2017 to January 2020, 12 patients (male 8, female 4) with mallet finger deformity were retrospectively studied, with an average age of 35 years (range, 18-50 years). And all the affected fingers were acute closed rupture of extensor tendon in zone I of single finger, 5 cases of the left finger and 7 cases of the right finger. There were 1 case of the thumb finger, 2 cases of the index finger, 3 cases of the middle finger, 4 cases of the ring finger and 2 cases of the little finger. 12 patients with fresh sputum mallet fingers were with 3-0 thread monofilament suture on extensor tendon zone I of finger in the minimally invasive percutaneous suture technique of eight times, and the distal end of the tendon was fixed to the base of the distal phalanx through the bone hole. Removal of the Kirschner wire 6-8 weeks, the brace was used to fix the affected finger in the dorsal extension. The flexion and extension of the affected finger was gradually strengthened. The function of the affected finger was evaluated according to the Crawford standard after operation and follow-up. The active flexion and extension range of motion of each joint of the affected finger and the contralateral healthy finger were measured, and the total action movement (TAM) of the finger were recorded. Finger function was evaluated according to TAM of the American Association of Hand Surgeons.Results:All operations were successfully completed, the operation time of the patients ranged from 18 to 25 min, with an average of 20.1±0.2 min. There was only a small amount of bleeding in the surgery. All 12 cases were followed up and the follow-up periods ranged from 6 to 14 months, with an average of 10.2±1.1 months. Mallet finger deformities were all corrected postoperatively; there were no knot exposure, skin necrosis and other complications. According to the Crawford standard, 9 cases were excellent, 2 cases were good, and 1 case was fair. The excellent and good rate was 91.7% (11/12). The mean active flexion of distal interphalangeal joints on the wounded finger and healthy finger were 82.11°±2.02° and 84.09°±2.01°, the mean active extension of distal interphalangeal joints on the wounded finger and healthy finger were -2.04°±3.01° and 0.02°±1.02°, there were significant differences between them ( t=2.447, 3.246; P=0.019, 0.004). The degrees of active joint activity of wounded finger were: 91.02°±4.01° of the metacar-pophalangeal joint, 94.04°±2.11° of the proximal interphalangeal joint, 83.01°±2.02° of the distal interphalangeal joint, and 265.05°±13.04° of total active activity; the degrees of active joint activity of healthy finger were: 93.01°±3.21° of the metacar-pophalangeal joint, 94.03°±3.07° of the proximal interphalangeal joint, 85.02°±2.01° of the distal interphalangeal joint, and 269.02°±12.10° of total active activity. The TAMs of the healthy side were 269.02°±12.10°, and the TAMs of the affected side were 265.05°±13.04°, there was no significant difference between them ( P>0.05). According to TAM system assessment criteria: excellent in 9 patients, good in 3 patients, and the excellent and good rate was 100% (12/12). Conclusion:The minimally invasive percutaneous suture technique of eight times can well repair closed injury extensor tendon zone I of finger, can have satisfactory treatment outcome in mallet finger with a simple procedure and good outcome. It is a simple, safe, effective method with minimal invasion.

Consensus on standardized diagnosis and treatment for osteoporotic vertebral compression fracture patients during epidemic of corona virus disease 2019 / 中华创伤杂志

Since December 2019, the corona virus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (2019-nCoV) has been reported in Wuhan, Hubei Province. Almost 70% of patients susceptible to 2019-nCoV are over age of 50 years, with extremely large proportion of critical illness and death of the elderly patients. Meanwhile, the elderly patients are at high risk of osteoporotic fractures especially osteoporotic vertebral compression fractures (OVCF). During the prevention and control of COVID-19 epidemic, orthopedists are confronted with the following difficulties including how to screen and protect OVCF patients, how to accurately diagnose and assess the condition of OVCF patients with suspected or confirmed COVID-19, and how to develop reasonable treatment plans and comprehensive protective measures in emergency and outpatient clinics. In order to standardize the diagnosis and treatment of patients with OVCF diagnosed with COVID-19, the authors jointly develop this expert consensus. The consensus systematically recommends the standardized emergency and outpatient screening and confirmation procedures for OVCF patients with suspected or confirmed COVID-19 and protective measures for emergency and outpatient clinics. Moreover, the consensus describes the grading and classification of OVCF patients diagnosed with COVID-19 according to the severity of illness and recommends different treatment plans and corresponding protective measures based on the different types and epidemic prevention and control requirements.

Clinical guideline for surgical treatment of symptomatic chronic osteoporotic vertebral fractures / 中华创伤杂志

According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.

Three-dimensional CT classification of fracture site and injury mechanism of axis ring / 中华骨科杂志

Objectives:To observe the anatomical location and mechanism of axis ring fractures (ARF) using 3-D CT scans, and propose a new classification for such fractures.Methods:By reviewing prospectively maintained database collecting ARF from 7 medical centers in China, 202 patients were included in this study. According to anatomical location, ARFs were classified into axis arthrosis fracture (AAF) and axis bony damage (ABD). The axis ring was divided into anterior, middle, and posterior rings, based on the border of the pars interarticularis (or pedicle) of axis. According to the features of ARF and previous study, a new classification was proposed based on the anatomical features of different fracture patterns, which was divided into three types and six subtypes (A1, A2, B1, B2, C1 and C2). The incidence of AAF and ABD and their distribution in different location of axis ring and the new classification, were observed.Results:In 202 patients with ARF, 501 anatomical structures were involved. 288 AAFs were found in 178 patients (288/501, 57%), while 213 ABDs were found in 149 patients (213/501, 43%). In anterior ring, 304 structures (304/501, 61%) were involved in injury, with 225 AAF and 79 ABD. In middle ring, 99 structures (99/501, 20%) were involved in injury, and all of them were ABD. In posterior ring, 98 structures (98/501, 19%) were involved in injury, with 63 AAF and 35 ABD. The anterior ring injuries (61%) were more common than middle (20%) or posterior ring (19%). In anterior ring, AAF (84%) were morecommon than ABD (16%); In middle ring, all the injuries were ABD; In posterior ring, AAFs (64%) were more common than ABD (36%). Type A fractures were featured with pedicle fractures and were identified in 30 patients (30/202, 15%). Type A1 fractures were bilateral pedicle fracture lines symmetrically or asymmetrically and identified in 12 (6%) patients; Type A2 fractures were pedicle fracture lineson one side and inferior articular facet injuries or lamina fractures on the otherside and identified in 18 (9%) patients. Type B fractures were featured with superior articular facet injuries or posterior wall of C2 body fractures on one side and identified in 136 patients (67%). Type B1 fractures were superior articular facet injuries or posterior wall of C2 body fractures on one side and pedicle fracture on the other side and identified in 57 (28%) patients; Type B2 fractures were superior articular facet injuries or posterior wall of C2 body fractures on one side and inferior articular facet injuries or lamina fractures on the otherside and identified in 79 (39%) patients. Type C fractures were featured with bilateral superior articular facet injuries or posterior wall of C2 body fractures and identified in 36 patients (18%). Type C1 fractures were bilateral superior articular facet injuries or posterior wall of C2 body fractures symmetrically and identified in 22 (11%) patients; Type C2 fractures were bilateral superior articular facet injuries or posterior wall of C2 body fractures asymmetrically and identified in 14 (7%) patients.Conclusion:ARF could occur in different anatomical locations, and most of these fractures were caused by hyperextension and axial load on superior articular facet on one or two sides. The new CT classification of ARF with three types and six subtypes might provide all fracture patterns, which could be useful for the choice of proper diagnosis and treatment for such fractures.

Consensus on standardized diagnosis and treatment for osteoporotic vertebral compression fracture patients during epidemic of corona virus disease 2019 / 中华创伤杂志

Since December 2019, the corona virus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (2019-nCoV) has been reported in Wuhan, Hubei Province. Almost 70% of patients susceptible to 2019-nCoV are over age of 50 years, with extremely large proportion of critical illness and death of the elderly patients. Meanwhile, the elderly patients are at high risk of osteoporotic fractures especially osteoporotic vertebral compression fractures (OVCF). During the prevention and control of COVID-19 epidemic, the orthopedists are confronted with the following difficulties including how to screen and protect OVCF patients, how to accurately diagnose and assess the condition of suspected or confirmed COVID-19 patients, and how to develop reasonable treatment plans and comprehensive protective measures in emergency and outpatient clinics. In order to standardize the diagnosis and treatment of OVCF patients diagnosed with COVID-19, the authors jointly develop this expert consensus to systematically recommend the standardized emergency and outpatient screening and confirmation procedures for OVCF patients with suspected or confirmed COVID-19 and protective measures for emergency and outpatient clinics. Moreover, the consensus describes the grading and classification of OVCF patients diagnosed with COVID-19 according to the severity of illness and recommends different treatment plans and corresponding protective measures.

Comparison between non-fusion and fusion internal fixation with posterior pedicle screw for odontoid fracture / 中华创伤杂志

Objective To investigate the clinical efficacy of non-fusion and fusion internal fixation with posterior pedicle screw for odontoid fractures. Methods A retrospective case control study was conducted to analyze the clinical data of 46 patients with odontoid fractures admitted to Henan Provincial People's Hospital from January 2013 to June 2015. There were 35 males and 11 females, aged 19-62 years [(36. 9 ± 1. 6)years]. The preoperative odontoid fractures were classified as type IIA in five patients, type IIB in eight, type IIC in 22, shallow type III in six according to Anderson and D'Alonzo typing. The fractures of five patients were not classified. According to the ASIA grading, the preoperative spinal cord function was graded as D or E in the 46 patients. Among the patients, 15 underwent posterior pedicle screw non-fusion internal fixation ( Group A) , with 60 pedicle screws removed 12-29 months after operation. A total of 31 patients were treated with fusion internal fixation with posterior pedicle screw ( Group B) , with 124 pedicle screws free from removal after operation. The follow-up time, operation time, intraoperative fluoroscopy time, intraoperative blood loss as well as visual analog scale (VAS), cervical rotation degree, and neck disability index ( NDI) before operation, 1 year after surgery ( when no internal fixation was removed ) and at the last follow-up were compared between the two groups. Results There were no significant differences between the two groups in the follow-up time, operation time, intraoperative fluoroscopy time, intraoperative blood loss, VAS score, neck rotation degree, NDI score before operation and at 1 year after operation (P >0. 05). There were significant differences between two groups in VAS scores, neck rotation degree, NDI scores indicating driving and walking and recreational activities at the last follow-up ( P <0. 05 ) . There were no significant differences between two groups in other NDI scores items, including neck discomfort, personal care, lifting heavy objects, reading & watching TV, headache situation, attention, working status, and sleep disorder at the last follow-up ( P> 0. 05 ) . Conclusions Posterior pedicle screw internal fixation for odontoid process fracture has good curative effect. Non-fusion internal fixation with posterior pedicle screw is more conducive to the recovery of cervical spine rotation function, the relief of neck and back pain, and the improvement of patients' driving, walking and entertainment activities.

Treatment choices for atlantoaxial complex fractures / 中华创伤杂志

Objective To discuss the clinical characteristics,injury mechanisms,and treatment options of atlantoaxial complex fractures.Methods Twenty-three patients with atlantoaxial complex fractures were enrolled in the study,including 13 men and 10 women with age ranging from 23 to 63 years (average 42.6 years).Treatment options were determined on the basis of injury patterns of the patients,including nonoperative treatments for 11 patients and operative treatments for 12 patients.Complications and prognosis were evaluated for all patients in follow-up.Results All patients were followed up for average 32 months (range,6-58 months),which showed the recovery of atlantoaxial stability and the bony union or fusion.At postoperative six months,Japanese Orthopedics Association (JOA) score of all patients averaged 14.1 points (range,11.5-15.8 points) with the improvement rate of 82.7％.No complications like spinal cord injury,vertebral artery injury or cerebrospinal fluid leakage occurred in operative treatment group.Conclusions Mechanisms of atlantoaxial complex fractures are largely overextension/compression and lateral bending/compression.Furthermore,treatment plans should be determined in the light of fracture types.

Lumbopelvic reconstruction for treatment of unstable sacral fractures / 中华创伤杂志

Objective To evaluate the clinical outcome of lumbopelvic reconstruction in treatment of unstable sacral fractures.Methods A retrospective study was performed on 17 cases (12 males and 5 females； at 23-55 years of age,mean 35.5 years) of unstable sacral fractures treated from January 2007 to June 2012.There were 11 cases of zone Ⅱ fracture and six zone Ⅲ fracture according to Denis classification and nine cases of type B fracture and eight type C fracture according to Tile classification.Sacral nerve injury assessed by Gibbons criteria was 3 points in seven cases and 4 points in 10 cases.Lumbar-pelvic ring stability of the patients was restored by posterior decompression and lumbar pedicle screw fixation combined with sacral pedicle screw or iliac screw fixation.Fracture reduction and healing were measured by X-ray film or CT scan； functional outcomes by Majeed scale； neurological outcome by Gibbons criteria.Results All the cases were followed up for mean 16 months (range,8-24 months).X-ray and CT follow-up revealed all fractures had bone union at average 6 months in the absence of remnant sacrum malformation,pseudarthrosis and fracture redisplacement.Iliac screw loosening not yet breakage happened to one case.In total,12 cases had full recovery of neurological function； four significant improvement,but experienced different degree of footdrop and hypoesthesia of lower extremities； one poor improvement and experienced not only lower extremity dysfunction but also bladder and bowel dysfunction.According to Majeed scale in the final follow-up,clinical functional outcome was excellent in 12 cases,good in three,fair in one and poor in one,with excellent-good rate of 88％.Gibbons score improved from preoperative (3.29 ±0.47) points to postoperative (1.53±0.94) points (t=12.94,P＜0.01).Conclusion Posterior decompression plus lumbar pedicle screw fixation combined with sacral pedicle screw and/or iliac screw fixation is an effective method for treatment of unstable sacral fracture,for it can restore general stability of spine-pelvis,facilitate neurological function recovery and allow early weight-bearing.

Therapy effect of transforaminal lumbar interbody fusion technical on complex lumbar spinal stenosis / 中国综合临床

Objective To investigate the surgical effect on complex spinal canal stenosis of lumbar spine through the technical of transforaminal lumbar interbody fusion (TLIF).Methods The retrospective analysis was performed on 46 patients admitted from December 2008 to March 2012.Of all patients,spinal canal stenosis of lumbar spine associated with lumbar scoliosis were 13 cases,lumbar sondylolisthesis for 17 cases,lumbar discogenic pain for 11 cases,lumbar revision surgery for 5 cases.All were underwent the surgical procedures including correction,internal fixation with pedicle screw,then use TLIF technology to compression and fusion.JOA,VAS,Nahal evaluating standards were applied to evaluate the therapeutic effect.The intervertebral height and bone fusion were observed by X ray.Results Forty-six patients were get follow-up for 6-36 months with an average of 12 months.There was significant difference (P ＜0.05) in JOA score between preparation (11.5 ± 2.2) and postoperation (22.5 ± 3.5).VAS score was (2.68 ± 2.08) at pre-operation,lower than that in postoperation (7.25 ± 1.85).There showed the excellent bone fusion,non loss of correction angle and the height of intervertebral disc space.Conclusion The complex of lumbar stenosis is difficult to operate and with high risk.Application of the TLIF procedure combined with clinical symptom,imaging of the spinal cord to decompression,fusion and fixation can restore the spine physical curve and improve patient's symptom.

Extensive decompression through transforaminal lumbar interbody fusion pathway combined with pedicle screw fixation for the treatment of lumbar stenosis in elderly patients / 中国综合临床

Objective To observe the efficacy of extensive decompression through transforaminal lumbar interbody fusion (TLIF) pathway combined with pedicle screw fixation on treating degenerative lumbar stenosis in the dderly.Methods Seventy-five elderly patients (28 males and 47 females) with degenerative lumbar stenosis were treated with extensive decompression through transforaminal pathway at our hospital from Jan.2007 to Aug.2010.The operation is through the TLIF pathway to resect part of the articular facet,and expose unilaterally the intervertebral vertebral foramen.Decompression of the vertebral canal was conducted by removing the disc.In the end,we performed posterolateral fixation with pedicle screw and placement of bone graft in posterolateral part of the lumbar or did the interbody fusion.JOA scores were obtained before and 1 day after operation and in 3 month follow-up consultation.The intervertebral height and bone fusion were observed by X ray.Results The follow-up period of the 75 patients was 6-36 months with an average of 12 months.There was significant difference (t =20.79,P ＜ 0.05 ;t =25.89,P ＜ 20.05) in JOA score between 3 month follow-up (21.08 ± 3.60) and preoperation (10.91 ± 2.23),between 1 d follow-up (22.72 ± 3.26) and preoperation (10.91 ±2.23),respectively.The rate of improvement was (88.6 ± 10.8)％,with 98％ of excellent or good in 3-month follow-up.Lumbar plane films showed neither instability or internal fixation loosening,breakage or distortion in follow-up consultation.There were 2 cases in whom Cage dislocation occurred without any neurological symptoms.Conclusion Extensive decompression through TLIF pathway combined with pedicle screw fixation is an efficacious method of treating degenerative lumbar stenosis in elderly patients.This method can retain the structure of lumbar posterior complex,reduce the risk of low back pain.It is a safe choice for treatment of degenerative lumbar stenosis in the elderly.

Treatment of osteoporotic vertebral compressive fracture with percutaneous vertebroplasty and percutaneous kyphoplasty / 中华创伤杂志

Objective To observe the clinical effect of percutaneous vertebroplasty f PVP)and percutaneous kyphoplasty(PKP)in the treatment of ostcoporotic vertebral compressive fracture. Methods Forty-two patients with osteoporotic vertebral compressive fractures were treated with PVP or PKP from August 2007 to July 2009.VAS and SF-36 scoring systems were employed to evaluate the Dain and quality of life.X-ray was used to evaluate the vertehral height restoration rate and the kyphosis correction rate.The bone cement leakage was determined based on the Chest X-ray. Results There was staitistical difference on PMMA leakage between PVP and PKP group.VAS and SF-36 scores at 2 wePks and 6months after operation were much better than those counted before operation in both PVP and PKP groups(P<0.05).The VAS and SF-36 scores at 6 months after operation showed no statistical difference in comparison with those before operation between PVP and PKP groups(P>0.05).At tWO weeks after operation,the height restoration rate of the fractured vertebral body(anterior and central column)in the PKP group waa better than that in the PVP group(P<0.05).The kyphotic correction rate in the PKP group was a little better than that in the PVP group(P>0.05).Conclusions In the treatment of osteoporotic vertebral compressive fracture,PVP and PKP have the similar effect on the pain relief,can refresh the height of the fractured vertebral body and correct the kyphotic angel of the fracture level to some extent.PVP has more PMMA leakage than PKP.

Surgical treatment of complicated atlas fracture combined with adjacent segment instability / 中华创伤杂志

Objective To study the clinical and radiographic characteristics of complicated axis fractures combined with adjacent segment instability and explore reasonable surgical treatment strategy. Methods A retrospective study was performed on 21 patients with axis fractures treated from August 2003 to June 2009. There were 14 males and 7 females at mean age of 34 years. The treatment strategy was based on the fracture type and the stabilities of adjacent atlantoaxial joint and intervertebral C2/3.Treatment strategies included anterior C2/3 interbody discectomy and fusion, anterior cervical plate internal fixation, odontoid screw fixation, posterior C1-2 pedicle screw fixation, cervical lateral mass screw fixation or combined anteroposterior approach. Results All patients were immobilized in a hard collar for thee months and followed up for 6-36 months (average 12 months), which showed bony fusion and cervical stability, with no intraoperative surgery-related complications such as loosening, extrusion or breakage of fixation, vertebral artery injury, nerve damage, cerebrospinal fluid leakage or wound infection. Neurological recovery was observed in five patients. Conclusions For complicated atlas fractures, correct identification of fracture type and instability disturbance of adjacent atlantoaxial joint and C2/3 as well as active treatment can conduce to better effect.

Discussion of surgery treatment of serious dislocation of acromio-clavicular joint / 中国矫形外科杂志

[Objective] To explore the surgery protocol of the serious dislocation of acromio-clavieular joint,and compare the outcome of ORIF with AO/ASIF clavicle hook plate only to ORIF with eoraco-clavieular ligament reconstruction.[Method]Fity-two cases of the dislocation of acromio-clavicular joint were reviewed,Group A was ORIF only including 29 cases(male 20,female 9,mean age 45),according to the system of Rockwood,as TypeⅢ in 12 patients,TypeⅣ in 15 patients and TypeⅤ in 2 patients,the other 23 cases ORIF with eoraeo-clavieular l ligament reconstruction was Group B(male 15,female 8,mean age 50.6),according to the system of Rockwood,as TypeⅢ in 9 patients,TypeⅣ in 13 patients and TypeⅤ in 1 patients,AO/ASIF claviadar hook plates were used for all of the ORIF,and modified Weaver's method was used to reconstruct eoraco-clavieular ligament.Outcome was evaluated by Lazzcano scale after 8~12 months,and data was analyzed by SPSS 10.0.[Result]Good outcome was achieved in all of the patients,there was no significanty statistical difference between the two groups.[Conclusion]Clavicle hook plate is a kind of perfect internal fixation.Reconstruction of eoraco-clavleular ligament is not necessary if the AO/ASIF plate is used,unless serious avulsion of deltoid and trapezius muscle involved.

Study of operative complications of ossification of posterior longitudinal ligament / 中国矫形外科杂志

[Objective]To Probe the causes of significant operatiive complications of ossification of posterior longitudinal ligament as well as the treatment outcomes in order to reduce the surgical morbidities and to suggest preventive measures of complications.[Method]The surgical data of 85 cases with ossification of posterior longitudinal ligament were reviewed form March 2002 to May 2006.In continuous long segment OPLL which were treated by bilaminectomy with internal fixation system;short segment OPLL which were treated by corpectomy of anterior cervical approach with bone of autograft and anterior cervical spine locking plates.[Result]Totally 66 cases were followed-up from 3 to 25 months with an average of 13 months.Complication of posteior cervical approach:8 cases with the pain of neck-shoulder,which resulted from postoperative radiculopathy and nerve root irritation or injury.Most of 8 cases were recovered in 2 to 20 weeks by conservative treatment such as antalgica,dehydration and physiotherapy.Four cases with quadriparesis or symptom deteriorate,which resulted from reperfusion injury of spine cord.Two cases were recovered by hyperbaric oxygen and medication and 1 cases recovered not enough.Two cases with posterior cervical hemotoma were caused by bleeding of smaller blood vessels and obstruction of drainage.One case of CSF leakage were cured in 3 days with cervical spinal immobilization and moderate local compressiom.Two cases of local infection were cured during 20 days with antibiotics or combined with debridement and suturing.Complications of anterior cervical approach:a cases with quadriparesis or symptom deteriorate;1 case of CSF leakage.Complications related to instruments included 1 case of titanium net subsidence and 1 case of single lateral mass screw back-out.[Conclusion]Many kinds of operative complications could occur in either anterior or posterior approach of surgery of ossification of posterior longitudinal ligament.Preoperative good preparation,intraoperative carefull operation and postoperative strengthened management are the key points to decrease and prevent operative related complications.

Treatment of odontoid fractures complicated by significant C_(2、3) displacement / 中国矫形外科杂志

[Objective]The purpose of this study was to determine the treatment odontoid fractures complicated by significant C2、3 displacement.[Method]Sixteen patients with odontoid fractures(12 type Ⅱ and 4 type Ⅲ,according to Anderson-D'Alonzo standard)were treated in this study.There were 11 male and 5 female with an average of 36 years(range 19-54 years).Group A included 9 cases of odontoid fracture with Hangman fracture and group B includcd 7 cases of odontoid fractures with C2、3 anterior fusion and 6 underwent dens screw with C2、3 posterior fusion.Postoperatively,neck collars were applied for 3 months.[Result]Successfully closed reduction of C1～2 was achieved in 16 patients.No complication occurred in the two groups.[Conclusion]Postoperatively there was no motion restriction in the neck or residual neck pain.Direct osteosynthesis of the fractured dens with screws is an effective procedure for unstable type Ⅱ fracture of the dens.Postoperative external immobilization with a neck collar seems to contribute much to the treatment.

Surgical treatment of lumbar scoliosis in elderly patients over 65 years / 中国矫形外科杂志

[Objective]To evaluate the surgical results of spinal scoliosis in the elderly and to investigate the indications,surgical techniques and factors which may contribute to the outcome. [Methods]A retrospective study was held.Sixty-four patients≥65 years undergoing different kinds of operation for lumbar spinal scoliosis from Sep.2004 to Apr.2008 were recruited.The mean patient age at surgery was 69.2 years(61~75 years).[Results]There were a variety of treatment methods of degenerative scoliosis based on symptomatology and radiologic measurements of scoliosis and stenosis.Sixty-four patients were followed up for an average of 37 months.The average correction rate of scoliosis was 51.2% after operation.No case was found spinal cord injury.Clinical symptoms and functional tolerance for daily activities improved after surgery.Radiographic evaluation showed a reduction in the deformity on the frontal and sagittal planes.There were no infections,pseudoarthrosis,instrument related failures or reoperations in this series.[Conclusion]The surgical results of lumbar scoliosis in the elderly are better than to those reported for the general population.Carefully perioperative preparation is very important in the treatment of elderly patients with lumbar spinal scoliosis.

Research approach of cervical kyphosis / 中国矫形外科杂志

According to the concept of sagittal spinal balance, the alternating curves of cervical and lumbar lordosis and thoracic and sacral kyphosis enable the head to be positioned over the trunk and pelvis. But the sagittal imbalance represents departure from this ideal form. Cervical kyphosis may represent the most disabling of these imbalances, for it can cause pain, postural difficulties, or neurologic deficit. A summary and discussion is reviewed regarding the anatomy, biomechanics, etiology, clinical presentation, laboratory examination and treatment of this condition.

A clinical study of pedicle screw implanting treatment of multi-level lumbar fractures / 中国矫形外科杂志

[Objective]To review the clinical data on patients suffering from multi-level lumbar spine fracture treated with TSRH-3D pedicle screw system,and to investigate the post-operative efficacy.[Method]Eighteen patients with multi-level lumbar spine fracture were treated with TSRH-3D pedicle screw system.The operations were performed 4 hours to 2 days after injury,and the follow-up period was 15-32 months(average,23 months).The X-ray and CT scan were taken preoperatively and postoperatively.[Result](1)Twelve patients injured from height falling(67%),5 from traffic accident(28%) and 1 from crush injury(5%).(2)The improvement rates of the spine motion,back pain and the lower extremity pain were 67%,94% and 78%,respectively.(3) Compared with preoperation,the height of anterior border of vertebra improved by 59.2%,lost by 5.2% on average(P