Objective To explore some operative problems of correcting paralytic scoliosis(PS) by using vertebral pedicle screwsrods system. Methods From May 2000 to May 2005, 18 patients with PS were corrected by screwsrods system which were made of titanium alloy.There were 10 males and 8 females, aging from 11 to 26 years. The primary disease included poliomyelitis in 13 patients and myelodysplasia (MS) in 5 patients (2 cases for second correction) with scoliosis of an average 85° Cobb angle (55-125°). The pelvic obliquity was found in all patients with an average 24° angle (355°).Of the 18 patients,3 cases were given perioperative halo-pelvic traction, 2 cases were given vertebral wedge osteotomy and correction and fixation, the other patients were purely underwent the treatment of pedicle screwrods system implants. Fusion segment at operation ranged from 6 to 15 sections, applied screws the most was 16,the fewest was 6. Results There were no wound infections and neurologic complications, all wounds healed by the first intention. Allscoliosis obtained obvious correction (P＜0.001), the correction rate averaged 52.95% (44%-81%); the majority of lumbar kyphosis and pelvic obliquity were apparently corrected. The average clinical follow-up (16 cases) was 21 months(6-36 months),there was no implants failure. One patient with MS had a worse Cobb magnitude, the other patients had no curve progression (P＞0.05). Conclusion The use of vertebral pedicle screwsrods fixation to multiple vertebral bodys and short segment fusion for PS, the treatment method is reliable and the outcome is satisfactory. While performing the correcting operative procedures, the spinal, pelvic and lower extremity deformities and functions should be all considered as a whole.
Objective To investigate the effectiveness of single Taylor external fixator combined with biplanar osteotomy on correction of tibial multiplanar deformities. Methods Between October 2016 and December 2021, 11 patients with tibial multiplanar deformities (20 sides) were treated with single Taylor external fixator and biplanar osteotomy. Of them, 4 were male and 7 were female; the average age ranged from 13 to 33 years (mean, 21.9 years). Diagnosis included rickets severe genu varum deformity (7 cases, 14 sides), rickets severe genu valgum deformity (2 cases, 4 sides), multiple osteochondromatosis calf deformity (1 case, 1 side), neurofibromatosis medial lower leg anterior arch deformity with short of leg (1 case, 1 side). After fibular osteotomy and tibial multiplanar osteotomy, a Taylor external fixator was installed. After operation, the deformities were corrected successively and fixed completely. The osteotomy healed, then the external fixator was removed. Before operation and at 12 months after operation, the full-length X-ray films were taken. The leg-length discrepancy, medial proximal tibial angle (MPTA), lateral distal tibial angle (LDTA), posterior proximal tibial angle (PPTA), anterior distal tibial angle (ADTA), and tibial rotation angle were measured. The degree of lower limb deformity was scored with reference to a customized tibial mechanical axis scoring table. Results Osteotomy was successfully completed without neurovascular injury and other complications. The external fixator was adjusted for 28-46 days, with an average of 37 days, and the external fixator was worn for 136-292 days, with an average of 169 days. Mild needle infection during the fixation period occurred in 3 sides, refracture at the distal tibial osteotomy in 1 side after removing the external fixator, and nonunion of the distal fibular osteotomy in 1 side. All patients were followed up 369-397 days (mean, 375 days). At 12 months after operation, the lower limb discrepancy decreased, but there was no significant difference (P>0.05). MPTA, LDTA, PPTA, ADTA, and tibial rotation angle improved, and the differences in LDTA, ADTA, and tibial rotation angle were significant (P<0.05). The score of lower limb deformity was significantly higher than that before operation (P<0.05), and the results were excellent in 9 sides, good in 8 sides, fair in 3 sides, with the excellent and good rate of 85%. ConclusionSingle Taylor external fixator combined with biplanar osteotomy is effective in the correction of tibial multiplanar deformities.
ObjectiveTo evaluate the effectiveness of modified Ilizarov hip reconstruction in the treatment of hip instability.MethodsThe clinical data of 13 young patients with hip diseases treated with modified Ilizarov hip reconstruction between January 2010 and March 2018 were retrospectively analyzed. There were 2 males and 11 females, aged from 14 to 34 years, with an average age of 24.2 years. There were 1 case of hip dysplasia and dislocation due to spinal bifida, 3 cases of hip dysplasia after pyogenic arthritis of the hip, 2 cases of developmental dysplasiaof the hip (DDH) accompanying femoral head necrosis who rejected hip replacement, 6 cases of young DDH refused to undergo hip replacement, and 1 case of bilateral hip dysplasia with dislocation due to sputum cerebral palsy. The disease duration was 2-20 years, with an average of 8.5 years. Preoperative Trendelenburg sign was positive in 12 cases and negative in 1 case. The preoperative Harris score of hip joint was 53.5±8.9 and the unequal length of lower limbs was (46.08±15.73) mm. Postoperative Harris hip score and patients' satisfaction with effectiveness evaluated according to their self scoring were used to assess the effectiveness.ResultsAll 13 patients were followed up 1-5 years, with an average of 2.6 years. Five patients developed postoperative needle infection, which improved after dressing change; 7 patients had limited knee joint activity and improved after knee joint function training. The Trendelenburg sign was negative at 1 year after operation, and the patient’s hip pain symptoms were relieved or disappeared. The Harris hip score of patients at 1 year after operation was 84.5±6.1, which was significantly improved when compared with preoperative one (t=－10.538, P=0.000). According to Harris hip score, the effectiveness results were excellent in 4 cases, good in 5 cases, and fair in 4 cases, with an excellent and good rate of 69.2%. The unequal length of lower limbs was (15.38±7.27) mm, which was significantly better than that before operation (t=11.826, P=0.000). At last follow-up, the patients' satisfaction score was 80%-95%, with an average of 88%.ConclusionModified Ilizarov hip reconstruction can be used to treat young patients with hip disease who are unsuitable or refuse to undergo artificial hip replacement. Its effectiveness is reliable, and it has unique advantages in limb limp improvement and limb shortening correction.