Abstract Dual-blade plate is widely used in reconstruction of anterior stability of spine. Two hundred and ninety-eight cases were followed up since 1984. Among them, 181 cases were fractureof thoracolumbar spine; 63 cases were tuberculosis of thoracolumbar spine; 43 cases were tumor of thoracolumbar spine; 5 cases were spondylisthesis of lumbar spine; 2 cases were ankylosing spondylitis accompanied with gibbosity; 2 cases were adolescent vertebral epiphysis; I case was hemivertebra; I case was dysplasia of the first lumbar vertebra acompanied with gibbosity. Most cases were successful following operation, but in some cases, the results were unsuccessful, mainly due to the position of the dualblade plate in the vertebral body was not satisfactory. The mistakes most commonly occurred were one or two blades, or a part of the blade going into the intervertebral space, and less commonly seen was deviation of the dual -blade plate from itscorrect orientation or a little side-bent of the blade. Split of the vertebra and fall off of the dual-blade plate were happened in few cases. The causeswere analyzed and ways of prevention were provided in this article.
【摘要】 目的 探讨强直性脊柱炎合并脊柱骨折脱位的临床特点及手术治疗效果。 方法 2009年10月-2010年6月，共收治6例强直性脊柱炎合并脊柱骨折脱位患者，其中男5例，女1例；年龄38～76岁，平均48.6岁。下颈椎骨折脱位3例，2例为颈5-6、1例颈6-7；胸腰段骨折脱位3例，为胸10-11、胸11-12、胸12-腰1各1例。6例患者中除1例术前神经功能为Frankel分级 E级，其余5例均有不同程度的神经损伤。6例患者均行手术治疗，下颈椎骨折脱位采用前后联合入路复位及固定，胸腰段骨折脱位采用后路切开复位及椎弓根螺钉固定。术后观察手术节段内固定位置及骨融合情况，评估神经功能恢复情况，记录手术并发症。患者随访10~18个月，平均14.2个月。 结果 所有患者术后均未出现切口感染；脑脊液漏1例，换药对症处理3周后愈合。1例颈5-6骨折脱位患者行前路手术后第2天出现内固定移位，骨折椎再次脱位立即二次行前后联合入路复位固定术；3例术后神经功能由术前Frankel C级恢复至D级，2例无明显改善（术前均为A级），1例较术前加重（术前E级，术后为A级，经再次手术减压并康复治疗6个月后恢复至D级）。随访期间均达骨性融合，未出现内固定松动断裂移位现象。 结论 强直性脊柱炎脊柱骨折好发于下颈椎及胸腰段；对于下颈椎骨折脱位宜行前后联合入路复位固定，而胸腰段骨折宜行后路长节段椎弓根螺钉固定，术中应先充分减压后再精细复位，避免加重神经损伤。【Abstract】 Objective To explore the clinical characteristics of spinal fracture and dislocation in ankylosing spondylitis (AS) and its surgical treatment effect. Methods From October 2009 to June 2010, six cases with spinal fractures in AS underwent surgical treatment. There were 5 males and 1 female with an average age of 48.6 years (38-76 years old). The preoperative neural function of one case was grade E according to the Frankel classification and different degrees of neural damage could be found in other 5 cases. Three cases of lower cervical fractures underwent the operation with a combined posterior-anterior approach. Three cases of thoracolumbar fracture underwent the operation with posterior approach (posterior reduction, fixation with pedicle screws and bone graft). The situation of internal fixation and bone fusion was observed after operation, the neural function had been evaluated and the postoperative complications was recorded. Results All of the six patients were followed up for 10-18 months (mean 14.2 months). There was no incision infection. One patient with cerebrospinal fluid leakage was cured with conservative treatment for three weeks. One patient with C5-6 fracture and dislocation got anterior implant loosening and fracture-dislocation recurrence in the second day after the operation and underwent a combined posterior-anterior operation immediately. Three cases got remarkable neuronal function improvement after the operation. Two cases were remain primary situation. One case was aggravated from preoperative grade E grade to postoperative grade A and recovered to grade D after recovery treatment for 6 months. Bone fusion was achieved in all cases. There were no loosening and breakage of internal fixation in the later followed up. Conclusions Lower cervical and thoracolumbar spine are the usual locations of fracture in AS. A combined posterior-anterior surgical approach is effective for lower cervical fractures and posterior long-segmental reduction and the fixation is a desired select for thoracolumbar fractures.
目的:探讨脊柱结核一期内固定手术的围手术期处理方法。方法:一期手术治疗脊柱结核患者68例。围手术期处理主要包括正规化疗、围手术期营养支持、选择正确的手术时机、术后支具保护下逐步功能锻炼、定期随访、监测药物副作用等。结果:68例患者切口均一期愈合,无窦道形成。平均2.2 年随访,结核治愈、后凸畸形纠正,10 例患者出现化疗相关的并发症对症或调整药物后症状控制。结论:正确的围手术期处理是脊柱结核手术成功的重要保证。.
Objective To elucidate the surgical indicationsand treatment outcome of total spondylectomy and reconstruction for thoracolumbar spinal tumors with neurological deficit. Methods From January 1999 to December 2005, 16 patients with thoracolumbar spinal tumors with neurological deficit were treated with total spondylectomy and reconstruction. There were 10 males and 6 females, with an average age of 31.5 years(16-62 years).There were 10 cases of primary tumors of spine (4 giant cell tumor of bone, 3 chondrosarcoma, 2 recurrent aneurysmal bone cyst, and 1 osteosarcoma), and 6 cases of solitary metastasis of thoracic or lumbar spine. Tomita’s surgical classification was as follows: 9 cases of type 4, 6 of type 5, and 1 of type 6. Frankel’s neurological classification was as follows: grade A in 1 case, B in 4, C in 7,and D in 4. All patients were treated with total spondylectomy and reconstruction through combined anterior and posterior approach. Results All patients were followed up from 10 to 63 months with an average of 27.5 months. Pain was relieved completely in all patients. The neurological function returned to grade D in 5 cases, to grade E in 11 cases. Among the 10 patients with primary spinal tumor, nine patients survived with tumor-free, and one with osteosarcoma died because of lung metastases 18 months after surgery. Among the 6 patients with spinal metastasis, three patients survived with tumorfree, and lung metastasis occurred in 1 case 10 months after surgery, two died because of multiple metastases of internal organs 10 months and 32 months after surgery. Conlusion Total spondylectomy and reconstruction is a safe and effective surgery for thoracolumbar spinal tumors with neurological deficit, with pain relief, neurological improvement and minimum tumor recurrence. It will be an optimal choice for patients with primary malignant, aggressive benign, or solitary metastatic bone tumors of the thoracolumbar spine with Tomita surgical classification type 3 to 5.
ObjectiveTo analyze the curative effect of vacuum sealing drainage for early deep infection after posterior spinal internal fixation. MethodsFrom March 2009 to March 2012, 9 patients with early deep infection after posterior spinal internal fixation, including 5 males and 4 females aged between 21 and 64 years, averaging at 44.6, underwent debridement and vacuum sealing drainage (VSD). Original fixtures in all the patients were not taken out. ResultsThe patients were treated by VSD for once to three times with an average of 2.1 times, and VSD continued for 3 to 7 days every time. Two patients underwent one time of VSD, 4 underwent twice, and 3 underwent three times. In these patients, 6 achieved wound healing after VSD, one changed to ordinary dressing and wound suturing two weeks later due to hemorrhage of VSD, one changed to ordinary dressing and wound suturing wound three weeks later due to impeded drainage, one accepted skin-grafting after three times of VSD. All the patients were followed up for 6 to 38 months (18 months on average) and all of them were cured. There was no obvious back pain or signs of incision infection. The X-ray films showed that there were no bone destruction and the white blood cell count, erythrocyte sedimentation rate, and C-reactive protein significantly decreased to normal after surgery. ConclusionOne-stage debridement and vacuum sealing drainage therapy is an effective method for treating early deep infection after posterior spinal internal fixation.
Objective To review the research progress of the vacuum phenomenon in spine. Methods The recent articles about the vacuum phenomenon in spine were reviewed; the features of imaging and the cl inical correlation were summarized. Results The vaccum phenomenon has been described in every segment of the spine. This phenomenon occurs mostly to the disc space and represents a transparent area on radiograph. Conclusion The causes of the vacuum phenomenoninclude degeneration of the anatomic structures of spine, trauma, and other pathologic changes. The vacuum phenomenon has important diagnostic and cl inical significances.
目的:明确脊柱骨巨细胞瘤的多层螺旋CT、MRI表现。方法:回顾性分析经病理证实的脊柱骨巨细胞瘤6例(男5例,女1例,年龄21～40岁,平均32岁)。6例CT检查,3例有MRI检查。结果:发生于胸椎3例,腰椎1例,骶椎2例。CT主要表现为膨胀性溶骨性破坏和较大软组织肿块;MRI表现T1加权成像为低等信号,T2加权成像为高低混杂信号特点,可显示瘤内坏死、囊变、出血等。结论:脊柱骨巨细胞瘤具有侵袭性强、生长活跃、易复发等特点,结合CT、MRI检查可对该病做出及时诊断,且对临床分期、手术方案制订及术后定期随访有重要价值。
ObjectiveTo evaluate the effectivity and safety of posterior osteotomy for thoracolumbar stress fracture in ankylosing spondylitis (AS) through the gap of a pathological fracture.MethodsBetween April 2012 and August 2015, 8 patients with AS combined with thoracolumbar stress fracture were treated with posterior osteotomy through the gap of a pathological fracture to correct the kyphosis. There were 7 males and 1 female, with an average age of 51 years (range, 37-74 years). The history of AS was 1-40 years (mean, 21.7 years) and disease duration of stress fracture was 2-60 months (mean, 18.5 months). The segmental lesions included T8, 9 in 1 case, T10, 11 in 2 cases, T11 in 2 cases, T12, L1 in 1 case, L1, 2 in 1 case, and L2, 3 in 1 case. The nerve function before operation according to Frankel grading was grade D in 3 cases and grade E in 5 cases. The pre- and post-operative X-ray films, CT three-dimensional reconstruction, and MRI were collected to measure the global kyphosis (GK), local kyphosis (LK), angle of the fusion levels (AFL), pelvic incidence (PI), pelvic tilt (PT), and sagittal vertical axis (SVA). Visual analogue scale (VAS) score was used to assess the back pain intensity.ResultsThe operation time was 210-320 minutes (mean, 267 minutes), and the intraoperative blood loss was 400-2 000 mL (mean, 963 mL). Cerebrospinal fluid leakage was found in 3 patients, and the wound healed by removal of drainage tube and suturing drainage outlet after 5-7 days of operation. The wounds of the rest patients healed by first intention. Lower extremity numbness occurred in 1 case and recovered after 1 month of postoperative administration of oral mecobalamin. All the patients were followed up 20-43 months (mean, 28.4 months). No internal fixator loosening, fracture, and other complications occurred. All the fractures healed with the healing time of 3-12 months (mean, 6.8 months). At 3 months after operation, 3 cases with spinal cord injury of preoperative Frankel grade D recovered to grade E. The GK, LK, AFL, PI, PT, SVA, and VAS scores at 1 week after operation and at last follow-up were significantly improved when compared with preoperative ones (P<0.05). Except for VAS score at last follow-up was significantly improved when compared with that at 1 week after operation (P<0.05), there was no significant difference in the other indexes between at 1 week after operation and at last follow-up (P>0.05).ConclusionPosterior osteotomy through the gap of a pathological fracture is a safe and effective surgical procedure for kyphosis correction and relief of back pain in AS patients combined with thoracolumbar stress fracture. Successful bony fusion and good clinical outcomes can also be achieved by this surgical procedure.
Objective To explore the practicability and safety of ultrasonic bone curette in the laminoplasty of spinal canal after resection of intraspinal tumors. Methods The clinical data of 17 patients with thoracolumbar intraspinal tumors treated with ultrasonic bone curette after resection of intraspinal tumors between December 2015 and April 2017 were retrospectively analyzed. All patients were male, aged 42-73 years with an average of 57.4 years. The disease duration was 2-47 months with an average of 21.1 months. Among them, there were 4 cases of thoracic intrathoracic tumors (T10 in 1, T12 in 3) and 13 cases of lumbar intrathoracic tumors (L1 in 5, L2 in 4, L3 in 2, and L4 in 2). Postoperative pathological diagnosis showed that 8 cases were schwannoma, 4 cases were meningioma, 2 cases were neurofibroma, 2 cases were dermoid cyst, and 1 case was ependymoma. Spinal nerve function was evaluated preoperatively according to Frankel classification criteria, with 2 cases of grade B, 7 cases of grade C, and 8 cases of grade D. During the operation, the time of single segmental vertebral canal posterior wall incision, the overall operation time, intraoperative blood loss, intraoperative dural injury, and cerebrospinal fluid leakage, spinal cord and nerve root injury were recorded. At 3-6 months after operation, the tumor and bone healing were observed according to MRI and CT three-dimensional reconstruction, and the spinal nerve function was evaluated by Frankel classification. Results The time of ultrasonic osteotomy for the posterior wall of a single segmental vertebral canal was 3.4-5.7 minutes, with an average of 4.1 minutes. The overall operation time was 135-182 minutes, with an average of 157.3 minutes. The intraoperative blood loss was 300-500 mL, with an average of 342.6 mL. There was no accidental dural injury, and cerebrospinal fluid leakage, nerve root injury, or spinal cord injury. The incision healed by first intention after operation. All the 17 patients were followed up 9-18 months, with an average of 12.7 months. MRI examination showed no tumor recurrence, and CT three-dimensional reconstruction showed good bone healing in all patients. During the follow-up, there was no loosening or rupture of the internal fixator and there was no re-compression of the spinal cord. At last follow-up, according to Frankel classification, there were 1 case as grade B, 5 cases as grade C, 7 cases as grade D, and 4 cases as grade E. Conclusion The application of ultrasonic bone curette in laminoplasty of spinal canal after resection of intraspinal tumors can preserve the integrity of the bone ligament structure of posterior column, maintain the volume of vertebral canal, and has high safety, practicability, and good postoperative effectiveness.