Objective To evaluate the effectiveness of microplate fixation in open-door cervical expansive laminoplasty (ELP) by comparing with anchor fixation. Methods Between January 2005 and October 2008, 35 patients with multi-segment cervical spondylotic myelopathy were treated. Of them, 15 patients underwent ELP by microplate fixation (microplate group) and 20 patients underwent ELP by anchor fixation (anchor group). In microplate group, there were 10 malesand 5 females with the age of (51.2 ± 11.5) years; the disease duration ranged from 6 to 60 months (mean, 14 months); and the preoperative Japanese Orthopoaedic Association (JOA) score was 7.7 ± 2.5. In anchor group, there were 13 males and 7 females with the age of (50.7 ± 10.8) years; the disease duration ranged from 3 to 58 months (mean, 17 months); and the preoperative JOA score was 7.8 ± 2.9. There was no significant difference in the general data, such as gender, age, and JOA score between 2 groups (P gt; 0.05). Results All incisions healed by first intention. Thirty-five cases were followed up 24-68 months (mean, 32 months). The operation time was (113 ± 24) minutes in anchor group and (111 ± 27) minutes in microplate group, showing no significant difference (t=0.231 3, P=0.818 5). The rate of spinal canal expansion in microplate group (60% ± 24%) was significantly higher than that in anchor group (40% ± 18%) (t=2.820, P=0.008). The JOA scores of 2 groups at 3 months and 24 months after operation were significantly higher than the preoperative scores (P lt; 0.01). There was no significant difference in JOA score between 2 groups at 3 months after operation (t=1.620 5, P=0.114 6), but the JOA score of microplate group was significantly higher than that of anchor group at 24 months after operation (t=3.454 3, P=0.001 5). X-ray film, MRI, and CT scan at 3-6 months after operation displayed that door spindle reached bony fusion. There was no occurrence of ‘‘re-close of door’’ in 2 groups. The rate of compl ication in microplate group (13.3%, 2/15) was significantly lower than that in anchor group (25.0%, 5/20) (χ2=7.160 0, P=0.008 6). Conclusion ELP by microplate fixation can achieve the stabil ity quickly after operation, which can help patients to do functional exercises early, and has satisfactory effectiveness and less complications.
Objective To study the cl inical appl ication of anchoring cervical intervertebral fusion cage (ACIFC) in anterior cervical discectomy with fusion. Methods From November 2006 to June 2007, 21 cases of degenerative cervical disease were treated with anterior cervical discectomy, bone graft by ACIFC and anchoring stators, and 28 ACIFCs were implanted. There were 12 males and 9 females aged 25-68 years old (average 47.9 years old). The course of disease rangedfrom 3 days to15 years (median 2.3 years). There were 7 patients with single-segment cervical spondylosis, 3 with two-segment cervical spondylosis, 2 with single-segment lower cervical spine instabil ity, 4 with single-segment cervical spondylosis and lower cervical spine instabil ity, and 5 with cervical disc herniation. Postoperatively, X-ray films were taken regularly to detect the fusion of bone graft and the intervertebral height of fused segment was measured. The symptoms, signs and cervical functions of patient before operation, shortly after operation and during the follow-up period were evaluated by “40 score” system. And the occurrence of postoperative axial symptom (AS) was assessed with the standard set by Zeng Yan et al. Results All incisions healed by first intention. AS occurred in 1 case 48 hours after operation and was improved from poor to good after symptomatic treatment. No other kind of compl ication was identified or reported during intra-operative and postoperative period. All the cases were followed up for 16-24 months (average 20.5 months), and fusion was reached in all the intervertebral discs. Evaluated by “40 score” system, the average score for the cervical spinal cord function before operation, shortly after operation and during the final follow-up period was 26.2, 30.6, and 35.5 points, respectively, indicating there were significant differences between different time points (P lt; 0.05). During the follow-up period of above 1 year, the average improvement rate was 67.4%. The average intervertebral height before operation, shortly after operation and during the last follow-up period were 1.9, 4.4 and 4.3 mm, respectively, showing there were significant differences between the preoperation and the immediate postoperative and last follow-up periods (P lt; 0.05). No degeneration of adjacent segment was observed during the follow-up period. Conclusion Using ACIFC in bone graft fusion and internal fixation for degenerative cervical disease is convenientand fast, has wide range of indications with satisfying cl inical effect, and can achieve obvious therapeutic effect in restoring and maintaining cervical intervertebral height.
Objective To investigate the surgical techniques and the cl inical outcomes of treating severe pronationexternal rotation ankle fractures combined with deltoid l igament injuries. Methods Between July 2005 and April 2007, 17 patients with grade-IV pronation-external rotation ankle fractures combined with deltoid l igament injuries were treated by open reduction and internal fixation with l igament repair by using suture anchors. There were 13 males and 4 femaleswith an average age of 36.5 years (21-56 years). All cases were closed injuries with l imitation of motion after initial physical examination. The X-ray and CT showed that all patients were characterized with lateral and posterior malleolus fractures and significant lateral shift of talus, but without medial malleous fracture before operation. All fractures were classified into grade-IV pronation- external rotation or type C according to Lauge-Hansen criterion and Danis-Weber standard respectively. The disease course was from 4 days to 7 days with an average of 5.6 days. Results All incisions healed by first intention Seventeen patients were followed up 11-24 months (mean 15.6 months). The X-ray films showed that all patients achieved bony heal ing. The heal ing time was 11-16 weeks (mean 14.8 weeks). According to the Baird-Jackson’s scoring system, the results were excellent in 5 cases, good in 9 cases, fair in 2 cases and poor in 1 case, the excellent and good rate was 82.4%. No operation compl ication occurred. Medial clear space was significantly decreased postoperatively compared with that before operation [(3.16 ± 0.37) mm vs. (4.87 ± 0.43) mm] (P lt; 0.01). In gravity stress radiographs, there was no significant difference in medial clear space between collateral ankle and injured ankle after operation [(3.47 ± 0.43) mm vs. (3.55 ± 0.44) mm] (P gt; 0.05). Conclusion It is emphasized that full attention should be given to reconstruction of medial l igament structures as well as open reduction and internal fixation in treating grade-IV pronation-external rotation ankle fractures combined with deltoid l igament injuries.
Objective To evaluate the therapeutic effect of open-door cervical expansive laminoplasty (ELP) with anchor fixation on flurosis cervical stenosis (FCS). Methods From February 2005 to February 2006, 20 patients with FCS underwent ELP using anchor fixation (group A) and 24 patients with FCS received ELP using conventional silk thread fixation (group B). In group A, there were 11 males and 9 females aged (58.0 ± 11.2) years old, the course of disease ranged from 6 months to 5 years, and the stenosis involved 3 vertebral levels in 3 cases, 4 levels in 8 cases, and 5 levels in 9 cases, andthe sagittal diameter of the cervical spinal canal was (7.30 ± 5.23) mm. While in group B, there were 11 males and 13 females aged (61.0 ± 9.1) years old, the course of disease ranged from 5 months to 5 years, the stenosis involved 3 vertebral levels in 5 cases, 4 levels in 10 cases, and 5 levels in 9 cases, and the sagittal diameter of the cervical spinal canal was (7.11 ± 4.92) mm. No significant differences were evident between two groups in terms of the general information (P gt; 0.05). Before operation and at 24 months after operation, the nerve function was assessed by JOA score, the axial symptom (AS) was evaluated using Chiba 12-point method, and the changes of cervical lordosis index (CLI) and cervical range of motion (CRM) were detected by imaging examination. Results All wounds healed by first intention. All patients were followed up for 24 months. JOA score: in group A, it was improved from 7.4 ± 1.5 before operation to 14.6 ± 2.1 at 24 months after operation with an improvement rate of 61% ± 3%; in group B, the score was increased from 7.1 ± 2.2 to 12.6 ± 2.5 with an improvement rate of 52% ± 5%; significant differences were evident in two groups between before and after operation, and between two groups in terms of the improvement rate (P lt; 0.05). AS score: in group A, it was improved from 6.2 ± 2.1 before operation to 10.8 ± 0.3 at 24 months after operation with an improvement rate of 74% ± 4%; in group B, the score was increased from 6.3 ± 1.9 to 8.8 ± 0.5 with an improvement rate of 39% ± 3%; significant differences were evident in two groups between before and after operation, and between two groups in terms of improvement rate (P lt; 0.05). X-ray films and CT scan at 24 months after operation displayed that there was no occurrence of “breakage of door spindle” or “re-close of door” in two groups, there was no occurrence of anchor loosing in group A, and the molding of the spinal canal was satisfactory in two groups. Preoperatively, the CLI was 11.9 ± 1.9 in group A and 11.3 ± 2.2 in group B and the CRM was (39.5 ± 2.4)° in group A and (40.2 ± 1.8)° in group B. While at 24 months after operation, the CLI was 9.5 ± 2.2 in group A and 8.2 ± 2.8 in group B, and the CRM was (30.6 ± 2.0)° in group A and (28.7 ± 2.4)° in group B, suggesting there was a significant decrease when compared with the preoperative value and group A was superior to group B (P lt; 0.05). The saggital diameter of the cervical spinal canal 24 months after operation was (13.17 ± 2.12) mm in group A and (12.89 ± 3.21) mm in group B, indicating there was a significant difference when compared with the preoperative value (P lt; 0.01). Conclusion Compared with conventional silk thread fixation, ELP using anchor fixation brings more stabil ity to vertebral lamina, less invasion to the posterior muscular-skeletal structure of the cervical spine, sl ight postoperative neck AS, andsatisfactory cl inical outcomes.
To prove and improve the technique of fibrin glue adhesion repair peripheral nerve, 20 male rats were chosen. All the rats was randomly divided into two groups: Suture group (n = 10) and glue adhesion group (n = 10). Left sciatic nerves of the rats were cut with knife and repaired by suture or adhesion methods separately according to their groups. When adhesive method being used, the epineurial was fixed with a suture method similar to anchor suture for preventing suture line broken. Immediatly after the repair and 8 weeks after the surgery, the histologic and electrophysiologic changes of the repaired nerve were observed. The result showed: The axonal copation was soon improved in glue adhesion group. At the eighth week, nerve fiber alignment of the adhesion group was more regular than that of the suture group. Moreover, there were great improvement of axon cross rate and the recovery rate of sectional area of nerve fiber at the distal end in glue adhesion group (P lt; 0.05, P lt; 0.01). It was concluded that glue adhesion was prior to suture in repair of peripheral nerve, and anchor suture could improve the technique of glue adhesion method.
ObjectiveTo explore the early outcome of 3 different operation methods in the treatment of multi-segmental cervical spondylotic myelopathy (CSM). MethodsA retrospective analysis was made on the clinical data of 74 patients with multi-segmental CSM treated between January 2011 and March 2013. The patients were divided into 3 groups according to operation methods:open-door expansive laminoplasty by plate was used in 21 patients (group A), open-door expansive laminoplasty by anchor fixation in 28 patients (group B), and conventional unilaterally open-door expansive laminoplasty in 25 patients (group C). There was no significant difference in gender, age, disease druation, affected segments, preoperative Japanese Orthopaedic Association (JOA) score, and cervical curvature of C2-7 among 3 groups (P > 0.05). The peration time, intraoperative blood loss, and JOA score, cervical curvature, incidence of axial symptoms were recorded. ResultsThere was no significant difference of operation time and intraoperative blood loss between group A and group B (P > 0.05). All incisions healed by first intention. Cerebrospinal leak occurred in 2 cases (1 case of group B and 1 case of group C) and C5 nerve root palsy in 4 cases (2 cases of group A, 1 case of group B, and 1 case of group C); all the symptoms disappeared after symptomatic treatment. The patients were followed up 12-39 months (mean, 18.3 months). The position of internal fixation was good without loosening and pulling out in groups A and B. Reclosed open-door was observed in 2 cases of group C, which disappeared after the second surgery. The JOA scores were significantly increased at 6 months after operation when compared with preoperative scores in groups A, B, and C (P < 0.05). The cervical curvature of C2-7 at postoperation was significantly improved when compared with preoperative one in groups B and C (P < 0.05) except group A (P > 0.05). There were significant differences in JOA score and the cervical curvature among 3 groups at 6 months after operation (P < 0.05). The incidence of axial symptoms were 4.76% (1/21), 35.71% (10/28), and 72.00% (18/25) in groups A, B, and C respectively, showing significant differences (P < 0.017). ConclusionOpen-door expansive laminoplasty by plate has better early outcome than open-door expansive laminoplasty by anchor fixation and conventional unilaterally open-door expansive laminoplasty in the treatment of multi-segmental CSM.
ObjectiveTo explore the effectiveness of knee extensor mechanism reconstruction in the treatment of recurrent patellar subluxation with bone anchor in adolescents. MethodsBetween January 2010 and December 2013, 20 patients with patellar subluxation were treated by knee extensor mechanism reconstruction with bone anchor. There were 11 males and 9 females, aged from 12 to 17 years (mean, 15.3 years). The left knee was involved in 12 cases and the right knee in 8 cases. The disease duration was 5-10 years (mean, 7 years). All the patients had knee pain and lateral subluxation of the patella. Preoperative Lysholm knee score was 71.4±4.7. All the patients received the MRI examination to exclude menisci or ligaments lesion. CT examination showed the tibial tuberosity trochlear groove spacing ranged from 15 to 20 mm (mean, 17 mm). X-ray film examination indicated that no varus or valgus was observed, and bony structure was normal. ResultsAll the incisions healed at first stage. The patients received follow-up of 12-24 months (mean, 13 months). Knee pain occurred in 2 cases and were cured after symptomatic treatment. The axial X-ray films showed good position of the patella and normal anatomic relationship of the patellofemoral joint. No anchor loosening and pulling out, internal fixation failure, pseudoarthrosis formation, and postoperative recurrent patellar subluxation occurred during follow-up. At 1 year, the Lysholm knee score was significantly improved to 94.2±3.4 (t=22.705, P=0.000). According to Insall criterion, the results were excellent in 9 cases, good in 9 cases, and fair in 2 cases, with an excellent and good rate of 90%. ConclusionThe bone anchor for extensor mechanism reconstruction is a convenient and reliable way to treat the recurrent patellar subluxation, with a satisfactory early effectiveness and less complications; however, its long-term effectiveness is required a further follow-up.
ObjectiveTo investigate the effectiveness of arthroscopic multi-point fixation with anchor and suture in the treatment of tibial insertion avulsion fracture of anterior cruciate ligament (ACL) involving the anterior root of lateral meniscus (LM). Methods A retrospective analysis was conducted on the clinical data of 28 patients with tibial insertion avulsion fracture of ACL involving the anterior root of LM who were treated with arthroscopic multi-point fixation with anchor and suture between October 2017 and January 2023. There were 12 males and 16 females with the mean age of 26 years (range, 13-57 years). There were 20 cases of sports injury and 8 cases of traffic accident injury. In 2 cases of old fracture, the time from injury to operation was 45 days and 90 days, respectively; in 26 cases of fresh fracture, the time from injury to operation was 3-20 days (mean, 6.7 days). According to the Meyers-McKeever classification, there were 4 cases of type Ⅱ, 11 cases of type Ⅲ, and 13 cases of type Ⅳ. The preoperative Lysholm knee function score was 42.1±9.0, the International Knee Documentation Committee (IKDC) score was 40.0±7.3, and the Tegner score was 0.7±0.7. ResultsAll operations were successfully completed, and the incisions healed by first intention. All the 28 patients were followed up 5-60 months (mean, 20.4 months). During the follow-up, there was nocomplication such as infection, vascular or nerve injury, loosening or breakage of internal fixator, or stiffness of knee joint. Postoperative X-ray films showed satisfactory fracture reduction and firm fixation. All fractures healed clinically, and the healing time was 8-16 weeks (mean, 10.3 weeks). At last follow-up, Lachman test and anterior drawer test were negative. At last follow-up, Lysholm knee function score was 92.4±5.5, IKDC score was 91.6±4.4, and Tegner score was 5.2±1.1, which significantly improved when compared with preoperative scores (t=−22.899, P<0.001; t=−29.870, P<0.001; t=−19.979, P<0.001). ConclusionMulti-point fixation with anchor and suture in the treatment of tibial insertion avulsion fracture of ACL involving the anterior root of LM can not only fix the LM, but also effectively reduce and fix the avulsion fracture, which can obtain good effectiveness.