[Comparison of clinical effects of two anterior cervical decompression with fusion on treating two segment cervical spondylotic myelopathy].

OBJECTIVE: To explore the clinical effects of anterior cervical discectomy with fusion (ACDF) and anterior cervical corpectomy with fusion (ACCF) in treating adjacent two-segment cervical spondylotic myelopathy (CSM). METHODS: The clinical data of 37 patients with adjacent two segment CSM treated from January 2016 to December 2017 were retrospectively analyzed, including 15 males and 22 females, aged from 43 to 69 years old with an average of 54.6 years. The patients were divided into ACDF group (group A, n=17) and ACCF group (group B, n=20) according to the different surgery. The operation time and intraoperative blood loss were recorded;the Cobb angle and cervical curvature in the cervical fusion segments before surgery and 1, 12 months after surgery were observed;Japanese Orthopaedic Association (JOA) score was used to evaluate the surgical efficacy, and the postoperative complications were analyzed. RESULTS: All patients were followed up for 12 to 24 months with an average of 18.5 months. Operation time and intraoperative blood loss in group A were (106.3±22.6) min, (52.2±26.4) ml, respectively, while were (115.6±16.8) min, ( 61.7±20.7) ml in group B. There was no statistically significant in operation time between two groups(P>0.05);intraoperative blood loss in group B was larger than group A(P<0.05). The preoperative and postoperative 1 and 12 months, cervical curvature and Cobb angle of cervical fusion segment in group A were (11.28±1.40)°, (17.56±1.90)°, (16.64±1.80)° and (4.93±4.20) °, (9.44±2.60)°, (9.25±2.80)°, respectively, and in group B were (10.59± 1.20)°, (16.26±2.10)°, (15.76±2.50)° and (4.75±3.90)°, (7.98±2.10)°, (7.79±3.00)°. The cervical curvature and Cobb angle in all cervical fusion segments at 1, 12 months after surgery were obviously improved, and group A recovered more significantly than group B (P<0.05). The JOA scores in group A were 9.46±1.70, 11.56±1.40, 14.86±1.20 before operation and 1 and 12 months after operation, and group B were 9.11±1.50, 11.40±1.30, 15.12±1.60, respectively. The postoperative JOA scores of the two groups were significantly improved (P<0.05), and there was no statistically significant difference between two groups at the same time (P>0.05). At the final follow up, in group A, dysphagia occurred in 2 cases, cage displacement in 1 case, and no titanium plate screw loose was found;and in group B, dysphagia occurred in 4 cases, titanium mesh collapse in 2 cases, titanium plate screw loose in 1 case. CONCLUSION: Two types of anterior cervical decompression and fusion for the treatment of two segment cervical spondylotic myelopathy can effectively decompress and improve the Cobb angle and cervical curvature of the affected vertebra. The ACDF surgical procedure can directly removethe compressive thing at intervertebral level, which will lead to little vertebral body damage and favorably recovered cervical curvature. The ACCF surgical procedure has a large operation space, which can easily remove the posterior vertebral osteophyte and the calcified posterior longitudinal ligament. Long-term follow-up shows that ACDF and ACCF have good surgical procedures, mature technology, and close efficacy.

[Effect observation of percutaneous pedicle screw fixation combined with percutaneous vertebroplasty for the treatment of osteoporotic thoracolumbar fractures].

OBJECTIVE: To evaluate the clinical effects of percutaneous pedicle screw fixation(PPSF) combined with percutaneous vertebroplasty(PVP) for the treatment of osteoporotic thoracolumbar fractures. METHODS: The clinical data of 94 patients with osteoporotic thoracolumbar fractures treated from January 2014 to December 2015 were retrospectively analyzed. There were 31 males and 63 females, aged from 65 to 70 years old with an average of 67.2 years. Fracture level was T11 on 15 cases, T12 on 32 cases, L1 on 29 cases and L2 on 18 cases. The patients were divided into two groups according to different therapeutic methods. Percutaneous pedicle screw fixation combined with percutaneous vertebroplasty were applied in 43 patients(group A) and percutaneous vertebroplasty was applied to 51 patients(group B). Operation time, intraoperative blood loss, bone cement volume, postoperative in-bed time were recorded; preoperatively, 3 d, 1 year after the operation, the ratios of anterior border heights, sagittal Cobb angles, visual analogue scale(VAS) scores were compared between two groups. The condition of postoperative complication in two groups was analyzed. RESULTS: All the patients were followed up for 12 to 24 months with an average of 18.5 months. Operation time of group A [(96.2±28.7) min] was longer than that of group B [(31.8±10.6) min]. Intraoperative blood loss of group A[(62.2±25.5) ml] was more than that of group B [(25.4±10.9) ml]. Bone cement volume of group A [(5.5±0.5) ml] was larger than that of group B [(4.9±1.1) ml]. Postoperative in-bed time of group A[(5.1±1.8) d] was longer than that of group B[(1.8±0.7) d]. There were significant differences in operation time, intraoperative blood loss, bone cement volume, postoperative in-bed time between two groups(P<0.05). Three days, 12 months after the operation, the ratios of anterior border heights and Cobb angles in two groups were significantly improved. At final follow-up, the ratio of anterior border height and Cobb angle of group A[(85.6±3.5)%, (11.9±5.3)°] were better than of group B[(84.2±4.5)%, (15.3±3.4)°](P<0.05). Three cases in group B had re-collapse of cemented vertebral bodies. Postoperative at 3 d, 1 year, VAS score of all patients had significantly decreased(P<0.05), and there was no significant difference between two groups(P>0.05). CONCLUSIONS: Compared to simple PVP, PPSF combined with PVP in treating osteoporotic thoracolumbar fracture can obtain stronger vertebral strength and stiffness, furthermore to improve vertebral reduced effect, keeping vertebral heights, and preventing vertebral re-collapse.

[Case-control study on minimally invasive percutaneous plate osteosynthesis for the treatment of distal tibial comminuted fractures at different operation times].

OBJECTIVE: To compare clinical outcomes of minimally invasive percutaneous plate osteosynthesis (MIPPO) in treating distal tibial comminuted fractures at early and delayed stage. METHODS: From January 2006 to January 2012,66 patients with distal tibial comminuted fractures were treated by MIPPO. All patients were divided into primary group and delayed group according to operation time. There were 31 patients in primary group, including 18 males and 13 females aged 21 to 57 years old with an average of (39.0 +/- 17.8), treated by MIPPO at primary stage,according to Tscherne soft tissue injury, 18 cases were grade I ,12 cases were grade II and 1 case were grade III. Thirty-five patients were treated by MIPPO at delayed stage, including 16 males and 19 females aged 24 to 55 years old with an average of (39.5 +/- 15.2), according to Tscherne soft tissue injury, 6 cases were grade I, 26 cases were grade II and 3 cases were grade III. Operation time, blood loss, hospital stay, fracture healing time and complications of two groups were recorded and observed, Lowa scoring of ankle joint were used to evaluated therapeutic effects at final following and AP and lateral X-rays were used to evaluated fracture reduction and alignment. RESULTS: All patients were followed up, the time of following-up of primary group was (13.5 +/- 3.5) months, (15.2 +/- 3.8) months in delayed group, there was no significant meaning between two groups (t = 1.882, P = 0.064). There was no significant differences between two groups in operation time and blood loss (P > 0.05), but hospital stay in primary group was shorter than that of delayed group(P<0.05). There was no significant meaning between primary group (5.5 +/- 2.8) and delayed group (6.2 +/- 3.1) in fracture healing time (t = 0.958, P = 0.342); there was no significant meaning between primary group (87.6 +/- 6.8) and delayed group (89.6 +/- 5.2) in Lowa scores at final following-up (t = 1.351, P = 0.182). Two cases occurred postoperative superficial inflammatory reaction around fibular incision in primary group, 1 case occurred postoperative superficial inflammatory reaction around fibular incision and 1 case occurred delayed deep incision infection in delayed group at four months after operation. There was no significant differences in incidence of postoperative soft tissue complications between primary group (6.5%) and delayed group (5.7%) (t = 0.016, P = 0.900). CONCLUSION: For distal tibial comminuted fractures with grade I and II of Tscherne soft tissue injury, MIPPO at primary stage can not increase incidence of soft tissue complications, also can obtain the same clinical outcomes just like delayed MIPPO.