WorldWideScience

Sample records for bioabsorbable screw fixation

  1. A Comparison of Functional Outcomes After Metallic and Bioabsorbable Interference Screw Fixations in Arthroscopic ACL Reconstructions

    OpenAIRE

    Hegde, Atmananda S; Rai, Deepak K; Kannampilly, Antony J

    2014-01-01

    Introduction: Anterior Cruciate Ligament (ACL) is as one of the most frequently injured ligaments in the modern contact sports scenario. Graft fixations can be achieved during anterior cruciate ligament (ACL) reconstructions by using either bioabsorbable screws or metal screws. The objective of this study was to compare the functional outcomes after bioabsorbable and metallic interference screw fixations in arthroscopic anterior cruciate ligament reconstructions done by using hamstring grafts.

  2. Foreign body reaction to a bioabsorbable interference screw after anterior cruciate ligament reconstruction

    OpenAIRE

    Umar, Muhammad; Baqai, Nadeem; Peck, Christopher

    2009-01-01

    Bioabsorbable interference screws have been effective for graft fixation in anterior cruciate ligament (ACL) reconstruction. The overall complication rate associated with the use of these screws is low but some unique problems have been reported in the literature. We present a case of unusual tissue reaction to a bioabsorbable interference screw following ACL reconstruction.

  3. Femoral fracture following knee ligament reconstruction surgery due to an unpredictable complication of bioabsorbable screw fixation: a case report and review of literature

    OpenAIRE

    Konan, Sujith; Haddad, Fares Sami

    2009-01-01

    We report an unusual case of femoral fracture from minimal trauma, due to the rapid disappearance of a bioabsorbable interference screw used for reconstruction of the posterolateral corner of the knee. The literature on bone tunnel fractures following knee ligament reconstruction surgery is also reviewed.

  4. Cheek drooping in 2 patients with maxillary fractures after rigid fixation with bioabsorbable mesh.

    Science.gov (United States)

    Oh, Seung Hyun; Kim, Chung Hun; Choi, Hyun Gon; Hwang, Euna

    2014-03-01

    Bioabsorbable plate-screw systems are commonly used for the internal fixation of facial bone fractures. The anterior maxilla has a unique curved shape, and fractured bony fragments tend to be small and fragile; therefore, more effective rigid fixation can be achieved using a molded bioabsorbable mesh rather than a bioabsorbable plate. Herein, we describe 2 patients with cheek drooping after a rigid fixation of comminuted maxillary fracture using bioabsorbable meshes and screws.The postoperative courses were uneventful, but both showed soft tissue bulging in the cheek area of the operation site for 12 to 13 months after the operation. No other symptom or sign related to inflammation or foreign body reaction was noted.In comminuted maxillary fractures, bone fragments are more conveniently fixed with a 1-piece molded bioabsorbable mesh. However, it is believed that a single large mesh may interfere with adhesion between the maxillary surface and the overlying soft tissue. Therefore, we recommend using the least amount of mesh to fixate maxillary bone fragments.

  5. Tibial Tunnel Cyst Formation after Anterior Cruciate Ligament Reconstruction Using a Non-Bioabsorbable Interference Screw.

    Science.gov (United States)

    Joshi, Yogesh V; Bhaskar, Deepu; Phaltankar, Padmanabh M; Charalambous, Charalambos P

    2015-12-01

    Tibial cyst formation following the use of bioabsorbable interference screws in anterior cruciate ligament (ACL) reconstruction is well-described; however, cyst formation after the use of metallic interference screws is not well-documented. We describe a case of osteolytic lesion of the proximal tibia presenting to us 20 years after ACL reconstruction using an autologous bone-tendon-bone graft. The original graft fixation technique was interference fixation with a metal screw in the tibial and femoral tunnels. A two-stage revision reconstruction of the ACL was undertaken with curettage and bone grafting of the tibial lesion in the first stage and reconstruction using a four-strand hamstring tendon in the second stage. The patient recovered satisfactorily with complete healing of the cyst and returned to pre-injury level of activities. We have reviewed case reports and case series that describe the aetiology of intra-osseous cyst formation following ACL reconstruction. PMID:26673117

  6. Intrafix与界面螺钉在前交叉韧带重建中的生物力学研究%Biomechanical evaluation of tendon graft fixation at the tibial site in anterior cruciate ligament reconstruction with intrafix and bioabsorbable interference screw

    Institute of Scientific and Technical Information of China (English)

    王俊良; 刘玉杰; 王爱媛; 杨玉明; 李海峰; 李众利; 王志刚

    2009-01-01

    目的 探讨胭绳肌腱移植重建前交叉韧带(ACL)胫骨端界面螺钉与Intrafix固定的生物力学.方法 新鲜冰冻尸体膝关节标本14具,采用四股腘绳肌腱移植重建ACL,胫骨端分别采用可吸收界面螺钉(n=7)和Intrafix(n=7)固定,测试最大载荷、100 kg·m·s-2和400 kg·m·s-2位移、抗拉刚度、失败模式等数据并进行统计学分析.结果 Intrafix固定组的最大载荷大于可吸收界面螺钉组,两组间差异有统计学意义(t=0.003,P0.05),抗拉刚度两组间差异无统计学意义(t=0.0967,P>0.05).结论 四股胭绳肌腱移植重建ACL,胫骨端采用可吸收界面螺钉和Intrafix固定均可满足ACL初期固定强度的需求;Intrafix固定强度大于可吸收界面螺钉.%Objective The fixation strength of the hamstring tendon graft on the tibial side is considered the weak point in anterior eruciate ligament (ACL) reconstruction. This work tested the hypotheses that some of these devices will resist graft slippage under loads better than others, and that some will have higher ultimate strength than others. Methods Fourteen flesh frozen human cadaver knees underwent fixation of the hamstring tendon harvested from the knee to be used as graft material to reconstruct the ACL and were divided into two equal groups based on the fixation methods: bioabsorbable interference screw group and Intrafix group. A MTS 858 MiniBionix Ⅱ testing machine was used to carry out tensile testing under an axial load parallel to the tibial tunnel with a velocity of 10 mm/min. Ultimate failure load, displacement of 100N, displacement of 4OON, stiffness and mode of failure were recorded respectively. Results The maximum load for the lntrafix fixation group was (719. 094 ± 160. 478) kg · m · s-2, significantly higher than that of the bioabsorbable interference screw fixation group [(476. 640 ± 64. 226) kg · m · s-2, P 0. 05], and the stiffness of the Intratix fixation group was (96. 770 ±36. 848) kg · m-1

  7. Biomechanical evaluation of maxillary Lefort Ι fracture with bioabsorbable osteosynthesis internal fixation.

    Science.gov (United States)

    Wu, Wei; Zhou, Jiang; Xu, Chong-Tao; Zhang, Jie; Jin, Yan-Jiao; Sun, Geng-Lin

    2014-12-01

    The aim of this study was to apply biomechanical analysis model to evaluate the effects of bioabsorbable internal fixation devices on maxillary Lefort Ι fracture. CT scan technology and the finite element software (ansys) were used to establish three-dimensional finite element models of five resorbable internal fixation devices in maxillary Lefort Ι fractures. We used the model to calculate the stress of the upper jaw and internal fixation. We further analyzed the stability of fixation under four occlusions. The fixation using two bioabsorbable plates was not stable. The zygomaticomaxillary pillars fixation is more stable than other fixations. The stability of fracture fixation was influenced with the molar occlusion. The current study developed a functional three-dimensional finite element model of bioabsorbable internal fixation and compared the stability of five fixation methods for maxillary Lefort Ι fractures. The results would facilitate the application of bioabsorbable materials in dental clinic.

  8. Interference Screw vs. Suture Anchor Fixation for Open Subpectoral Biceps Tenodesis: Does it Matter?

    Directory of Open Access Journals (Sweden)

    Gobezie Reuben

    2008-09-01

    Full Text Available Abstract Background Bioabsorbable interference screw fixation has superior biomechanical properties compared to suture anchor fixation for biceps tenodesis. However, it is unknown whether fixation technique influences clinical results. Hypothesis We hypothesize that subpectoral interference screw fixation offers relevant clinical advantages over suture anchor fixation for biceps tenodesis. Study Design Case Series. Methods We performed a retrospective review of a consecutive series of 88 patients receiving open subpectoral biceps tenodesis with either interference screw fixation (34 patients or suture anchor fixation (54 patients. Average follow up was 13 months. Outcomes included Visual Analogue Pain Scale (0–10, ASES score, modified Constant score, pain at the tenodesis site, failure of fixation, cosmesis, deformity (popeye and complications. Results There were no failures of fixation in this study. All patients showed significant improvement between their preoperative and postoperative status with regard to pain, ASES score, and abbreviated modified Constant scores. When comparing IF screw versus anchor outcomes, there was no statistical significance difference for VAS (p = 0.4, ASES score (p = 0.2, and modified Constant score (P = 0.09. One patient (3% treated with IF screw complained of persistent bicipital groove tenderness, versus four patients (7% in the SA group (nonsignificant. Conclusion Subpectoral biceps tenodesis reliably relieves pain and improves function. There was no statistically significant difference in the outcomes studied between the two fixation techniques. Residual pain at the site of tenodesis may be an issue when suture anchors are used in the subpectoral location.

  9. Complications Using Bioabsorbable Cross-Pin Femoral Fixation: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Saqib Hasan

    2011-01-01

    Full Text Available The use of bioabsorbable cross-pin transcondylar fixation has remained a viable option for femoral fixation in anterior cruciate ligament reconstruction. Although numerous biomechanical studies have demonstrated high fixation strength and minimal slippage with use of this method of fixation, there have been increasing reports of a variety of clinical complications associated with these implants. We reviewed the literature for all complications associated with the Bio-TransFix implant and present a case report of a patient status after ACL reconstruction using Bio-TransFix cross-pin femoral fixation with iliotibial band friction syndrome from a broken cross-pin four month post-operatively.

  10. MRI of broken bioabsorbable crosspin fixation in hamstring graft reconstruction of the anterior cruciate ligament

    Energy Technology Data Exchange (ETDEWEB)

    Bakhru, Prashant [Department of Radiology Jacobi Medical Center, Bronx, NY (United States); Park, Brian [Albert Einstein College of Medicine, Bronx, NY (United States); Umans, Hilary [Department of Radiology Jacobi Medical Center, Bronx, NY (United States); Lenox Hill Radiology and Imaging Associates, P.C., New York, NY (United States); DiFelice, Gregory S. [Hospital for Special Surgery, New York, NY (United States); Tobin, Keith [Lenox Hill Radiology and Imaging Associates, P.C., New York, NY (United States)

    2011-06-15

    To report seven cases of broken bioabsorbable femoral crosspins identified by MRI in evaluation of hamstring grafts of the anterior cruciate ligament. Seven cases of broken bioabsorbable crosspins utilized in femoral fixation of ACL hamstring grafts were identified prospectively and retrospectively from our PACs database during a period from 9/1/08 to 8/31/09. All imaging was performed using 1.5 or 3.0 Tesla MRI and were evaluated for T2 signal within and surrounding the crosspin, osteolysis surrounding the fragments, displacement of fragments, and graft integrity. Time from surgery was also recorded. Seven cases of hamstring grafts with broken bioabsorbable crosspins were imaged 4 months to 3 years following grafting. There was osteolysis surrounding the crosspin in all but one case in which the graft was intact but a pin fragment was displaced into the joint. One graft failed due to aseptic foreign-body reaction to the fixation with aggressive osteolysis at 9 months post surgery. In the remaining five, the ACL graft was either completely torn, partially torn, lax, or degenerative and frayed. Of these, the crosspins were broken and angulated with osteolysis surrounding the apex of the angulated fragment or demonstrated lateral extrusion of the peripheral fragment. Bioabsorbable crosspins utilized in femoral fixation of hamstring graft reconstruction of the ACL may become fractured. While the natural history of osteo-integration of these devices as demonstrated by MRI has not been defined, osteolysis surrounding the fragments, extrusion or displacement of the fragments, and graft laxity or failure would suggest that these are abnormal findings that should be reported. (orig.)

  11. Translaminar facetal screw (magerl′s fixation

    Directory of Open Access Journals (Sweden)

    Rajasekaran S

    2005-01-01

    Full Text Available Translaminar facet screw fixation (TLFS achieves stabilization of the vertebral motion segment by screws inserted at the base of the spinous process, through the opposite lamina, traversing the facet joint, and ending in the base of the transverse process. It is simple, does not require any specialized equipment, and has the advantages of being a procedure of lesser magnitude, lesser operative time, less cost and few complication rate. Recently there is growing interest in this technique to augment the anterior lumbar fusions to achieve global fusion less invasively. In this review article, we discuss the clinical and biomechanical considerations, surgical technique, indications, contraindications and recent developments of TLFS fixation in lumbar spine fusion.

  12. Mechanical Comparison of Headless Screw Fixation and Locking Plate Fixation for Talar Neck Fractures.

    Science.gov (United States)

    Karakasli, Ahmet; Hapa, Onur; Erduran, Mehmet; Dincer, Cemal; Cecen, Berivan; Havitcioglu, Hasan

    2015-01-01

    For talar neck fractures, open reduction and internal fixation have been thought to facilitate revascularization and prevent osteonecrosis. Newer screw systems allow for placement of cannulated headless screws, which provide compression by virtue of a variable pitch thread. The present study compared the biomechanical fixation strength of cannulated headless variable-pitch screw fixation and locking plate fixation. A reproducible talar neck fracture was created in 14 fresh cadaver talar necks. Talar head fixation was then performed using 2 cannulated headless variable-pitch 4-mm/5-mm diameter (4/5) screws (Acutrak; Acumed, Hillsboro, OR) and locking plate fixation. Headless variable-pitch screw fixation had lower failure displacement than did locking plate fixation. No statistically significant differences were found in failure stiffness, yield stiffness (p = .655), yield load (p = .142), or ultimate load between the 2 fixation techniques. Cannulated headless variable-pitch screw fixation resulted in better failure displacement than locking plate fixation in a cadaveric talus model and could be considered a viable option for talus fracture fixation. Headless, fully threaded, variable-pitch screw fixation has inherent advantages compared with locking plate fixation, because it might cause less damage to the articular surface and can compress the fracture for improved reduction. Additionally, plate fixation can increase the risk of avascular necrosis owing to the wider incision and dissection of soft tissues.

  13. Use of polymethylmethacrylate to enhance screw fixation in bone.

    Science.gov (United States)

    Cameron, H U; Jacob, R; Macnab, I; Pilliar, R M

    1975-07-01

    Pull-out testing of screws inserted into cement and bone under various conditions showed that the cement-screw complex was significantly stronger when the screw was placed in soft cement and the cement was allowed to polymerize without further manipulation. When screw fixation in osteoporotic bone was reinforced with cement, the bone was the weakest component in the system. Fixation under these conditions should be enhanced by increasing the area of contact between the cement and bone. By cooling the cement to prolong its working time, it could be injected with a syringe in such a way that maximum endosteal and periosteal contact was provided. PMID:1150708

  14. Bioabsorbable fish scale for the internal fixation of fracture: a preliminary study.

    Science.gov (United States)

    Chou, Cheng-Hung; Chen, Yong-Guei; Lin, Chien-Chen; Lin, Shang-Ming; Yang, Kai-Chiang; Chang, Shih-Hsin

    2014-09-01

    Fish scales, which consist of type I collagen and hydroxyapatite (HA), were used to fabricate a bioabsorbable bone pin in this study. Fresh fish scales were decellularized and characterized to provide higher biocompatibility. The mechanical properties of fish scales were tested, and the microstructure of an acellular fish scale was examined. The growth curve of a myoblastic cell line (C2C12), which was cultured on the acellular fish scales, implied biocompatibility in vitro, and the morphology of the cells cultured on the scales was observed using scanning electron microscopy (SEM). A bone pin made of decellularized fish scales was used for the internal fixation of femur fractures in New Zealand rabbits. Periodic X-ray evaluations were obtained, and histologic examinations were performed postoperatively. The present results show good cell growth on decellularized fish scales, implying great biocompatibility in vitro. Using SEM, the cell morphology revealed great adhesion on a native, layered collagen structure. The Young's modulus was 332 ± 50.4 MPa and the tensile strength was 34.4 ± 6.9 MPa for the decellularized fish scales. Animal studies revealed that a fish-scale-derived bone pin improved the healing of bone fractures and degraded with time. After an 8-week implantation, the bone pin integrated with the adjacent tissue, and new extracellular matrix was synthesized around the implant. Our results proved that fish-scale-derived bone pins are a promising implant material for bone healing and clinical applications. PMID:25211643

  15. Sacroiliac screw fixation: A mini review of surgical technique

    Directory of Open Access Journals (Sweden)

    Hernando Raphael Alvis-Miranda

    2014-01-01

    Full Text Available The sacral percutaneous fixation has many advantages but can be associated with a significant exposure to X-ray radiation. Currently, sacroiliac screw fixation represents the only minimally invasive technique to stabilize the posterior pelvic ring. It is a technique that should be used by experienced surgeons. We present a practical review of important aspects of this technique.

  16. Robot-assisted Anterior Odontoid Screw Fixation: A Case Report.

    Science.gov (United States)

    Tian, Wei; Wang, Han; Liu, Ya-Jun

    2016-08-01

    Anterior odontoid screw fixation has been proved to be effective but technically challenging because the difficult approach is associated with high risks of screw malposition and damage to surrounding vital structures. Navigation techniques are therefore increasingly being used to improve safety and accuracy. However, no robot-assisted odontoid screw fixation has yet been reported. We here report a 61-year-old woman with a type II dens fracture on whom anterior odontoid screw fixation was performed under the guidance of a newly developed robotic system (TiRobot, co-designed by Beijing Jishuitan Hospital and TINAVI Medical Technologies). One odontoid screw was safely and accurately placed, the calculated deviation between the planned and actual positions being 0.9 mm. No intraoperative complications were identified and the patient was discharged on Day 5. Follow-up studies after 2 weeks showed good clinical and radiological results. We believe this is the first reported case of robot-assisted anterior odontoid screw fixation. We consider that complicated procedures can become feasible, safe and accurate using TiRobot systems. PMID:27627725

  17. Robot-assisted Anterior Odontoid Screw Fixation: A Case Report.

    Science.gov (United States)

    Tian, Wei; Wang, Han; Liu, Ya-Jun

    2016-08-01

    Anterior odontoid screw fixation has been proved to be effective but technically challenging because the difficult approach is associated with high risks of screw malposition and damage to surrounding vital structures. Navigation techniques are therefore increasingly being used to improve safety and accuracy. However, no robot-assisted odontoid screw fixation has yet been reported. We here report a 61-year-old woman with a type II dens fracture on whom anterior odontoid screw fixation was performed under the guidance of a newly developed robotic system (TiRobot, co-designed by Beijing Jishuitan Hospital and TINAVI Medical Technologies). One odontoid screw was safely and accurately placed, the calculated deviation between the planned and actual positions being 0.9 mm. No intraoperative complications were identified and the patient was discharged on Day 5. Follow-up studies after 2 weeks showed good clinical and radiological results. We believe this is the first reported case of robot-assisted anterior odontoid screw fixation. We consider that complicated procedures can become feasible, safe and accurate using TiRobot systems.

  18. Pedicle screw fixation against burst fracture of thoracolumbar vertebrae

    Institute of Scientific and Technical Information of China (English)

    L(U) Fu-xin; HUANG Yong; ZHANG Qiang; SHI Feng-lei; ZHAO Dong-sheng; HU Qiao

    2007-01-01

    Objective: To analyze the application of vertebral pedicle screw fixation in the treatment of burst fracture of thoracolumbar vertebrae.Methods: A total of 48 cases (31 males and 17 females, aged from 18-72 years, mean: 41.3 years) with thoracolumbar vertebrae burst fracture were treated by pedicle screw system since January 2004. According to the AO classification of thoracolumbar vertebrae fracture,there are 36 cases of Type A, 9 of Type B and 3 of Type C.Results: All patients were followed up for 6-25 months (average 12 months ), no secondary nerve root injury, spinal cord injury, loosening or breakage of pedicle screw were observed. The nerve function of 29 patients with cauda equina nerve injury was restored to different degrees. The vertebral body height returned to normal level and posterior process angle was rectified after operation.Conclusions: The vertebral pedicle screw internal fixation was technologically applicable, which can efficiently reposition and stablize the bursting fractured vertabrae,indirectly decompress canalis spinalis, maintain spine stablity, scatter stress of screw system, reduce the risk of loosening or breakage of screw and loss of vertebral height,and prevent the formation of posterior convex after operation.

  19. Augmentation of Pedicle Screw Fixation with Calcium Phosphate Cement

    Institute of Scientific and Technical Information of China (English)

    YANG Shu-hua; FU De-hao; LI Jin; XU Wei-hua; YANG Cao; YE Zhe-wei; ZUO Xiao-yan

    2004-01-01

    To determine whether a biodegradable calcium phosphate cement(CPC) provides significant augmentation of pedicle screw fixation or not,an in vitro biomechanical study was carried out to evaluate the biomechanical effect of CPC in the restoration and augmentation of pedicle screw fixation.Axial pullout test and cyclic bending resistance test were employed in the experiment,and polymethylmethacrylate (PMMA) was chosen as control.The results demonstrate that the pullout strengths following CPC restoration and augmentation are 74% greater on an average than those of the control group,but less than those of PMMA restoration group and augmentation group respectively (increased by 126% versus control).In cyclic bending resistance test,the CPC augmented screws are found to withstand a greater number of cycles or greater loading with less displacement before loosening,but the augmentation effect of PMMA is greater than that of CPC.

  20. Posterior atlantoaxial transpedicle screw fixation for traumatic atlatoaxial instability

    Directory of Open Access Journals (Sweden)

    Zheng-lei WANG

    2015-10-01

    Full Text Available Objective To explore the clinical efficacy of posterior atlantoaxial pedicle screw fixation for traumatic atlantoaxial instability. Methods From September 2009 to March 2013, 17 patients with atlantoaxial instability received posterior atlantoaxial pedicle screw fixation. There were 12 males and 5 females, with a mean age of 42 years old (ranged from 19 to 63 years old. Transpedicle screw fixation was employed in 8 patients with atlantoaxial fracture and dislocation, in 2 with traumatic disruption of transverse atlantal ligament, and in 7 with odontoid fracture. The Japanese Orthopaedic Association (JOA score before operation was from 5 to 14, with a mean of 11.2. Preoperative CT, MRI and radiographs, as well as intraoperative screw placement and bone graft were administered in all the patients. Results In all the patients, complete reduction was achieved without injury to the vertebral artery, spinal cord or never root, and they started to be ambulatory on the first day after the operation. The patients were followed up for 6-36 months (mean 21 months, and clinical symptoms were seen to be improved significantly. Imaging reexamination 6 months after the surgery showed satisfactory healing of implanted bone and position of all the screws without loosening of the implant. The mean JOA scores was 15.5(11.0-17.0 twelve months after the operation. Conclusion Atlantoaxial pedicle screw fixation for traumatic atlantoaxial instability is safe and reliable with a favorable clinical result. DOI: 10.11855/j.issn.0577-7402.2015.09.14

  1. Internal bioabsorbable fixation for the treatment of the tibiofibula fractures in children%可吸收内固定在儿童胫腓骨骨折中的应用

    Institute of Scientific and Technical Information of China (English)

    戴进; 王晓东; 张福勇

    2013-01-01

    Objective To explore the availability and feasibility of the bioabsorbable fixation to treat tibiofibula fractures in children.Methods Twenty patients with tibiofibula fractures underwent internal absorbable fixation in this institute from January 2011 to January 2012.The distal tibiofibula fractures were fixed with bioabsorbable screws,while the midpiece fractures of tibiofibula were fixed with bioabsorbable screws combined with elastic intramedullary nail.Distal tibial epiphyseal fractures were fixed using bioabsorbable spiral and pin.Fracture healing and functional recovery were followed up after surgery.Results Follow-up period was 6 to 12 months.All fractures were healed.One patient's tibia comminuted fracture was fixed with absorbable elastic intramedullary nail,and postoperative X-radiogram suggested bony callus formed slower than average during follow-up.However,continuous weight-bearing exercises accelerated bony callus formation and a mass of bony callus was found on the X-radiogram 6 months after surgery.Conclusions The bioabsorbable internal fixation is safe and effective for the treatment of tibiofibula fractures in children.%目的 探讨可吸收植入物在儿童胫腓骨骨折中的应用及临床疗效.方法 2011年1月至2012年1月20例儿童胫腓骨骨折行切开复位,远端斜形及螺旋形骨折应用可吸收内固定螺钉固定,中端斜形及螺旋形骨折行弹性髓内钉结合可吸收螺钉固定,远端骨骺骨折行可吸收骨棒或螺钉固定.术后定期复查X线片,对骨折愈合及临床功能恢复行回顾性分析总结.结果 随访6个月~1年,骨折全部愈合.1例胫骨中端粉碎骨折行弹性髓内钉结合可吸收螺钉固定,术后2个月复查骨痂生长缓慢,更换短腿支具后下地负重锻炼,6个月后复查骨痂生长丰富.结论 可吸收螺钉及棒应用于儿童胫腓骨骨折临床疗效明确,避免二次手术,减少儿童创伤及痛苦,可作为儿童胫骨中远端斜形及螺

  2. Transpedicular screw fixation in the thoracic and lumbar spine with a novel cannulated polyaxial screw system

    Directory of Open Access Journals (Sweden)

    Lutz Weise

    2008-10-01

    Full Text Available Lutz Weise, Olaf Suess, Thomas Picht, Theodoros KombosNeurochirurgische Klinik, Charité – Universitätsmedizin Berlin, Berlin, GermanyObjective: Transpedicular screws are commonly and successfully used for posterior fixation in spinal instability, but their insertion remains challenging. Even using navigation techniques, there is a misplacement rate of up to 11%. The aim of this study was to assess the accuracy of a novel pedicle screw system.Methods: Thoracic and lumbar fusions were performed on 67 consecutive patients for tumor, trauma, degenerative disease or infection. A total of 326 pedicular screws were placed using a novel wire-guided, cannulated, polyaxial screw system (XIA Precision®, Stryker. The accuracy of placement was assessed post operatively by CT scan, and the patients were followed-up clinically for a mean of 16 months.Results: The total medio-caudal pedicle wall perforation rate was 9.2% (30/326. In 19 of these 30 cases a cortical breakthrough of less than 2 mm occurred. The misplacement rate (defined as a perforation of 2 mm or more was 3.37% (11/326. Three of these 11 screws needed surgical revision due to neurological symptoms or CSF leakage. There have been no screw breakages or dislocations over the follow up-period.Conclusion: We conclude that the use of this cannulated screw system for the placement of pedicle screws in the thoracic and lumbar spine is accurate and safe. The advantages of this technique include easy handling without a time-consuming set up. Considering the incidence of long-term screw breakage, further investigation with a longer follow-up period is necessary.Keywords: spinal instrumentation, pedicle screws, misplacement, pedicle wall perforation

  3. SURVEY SUBAXIAL CERVICAL VERTEBRAE FOR TRANSPEDICULAR SCREW FIXATION

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    Objective In this study, the pedicles of subaxial vertebrae from C3 to C7 were measured to provide some morphometric data for cervical transpedicular screw fixation. Methods 20 dried bone cervical spinal columns (C3-C7), pedicle dimensions (pedicle height, width, length), and transverse and sagittal angles of the pedicles were performed with vernier in linear and angular measurements. Results The obtained data revealed that the mean values were approximately ranging from 6.7 to 7.2 mm for pedicle height, 4.4 to 4.9 mm for pedicle width, 22.2 to 27.7 mm for pedicle axis length, 42.3° to 51.5° for transverse angle, and 5.2° to 14.1° for sagittal angle. Conclusion Linear measurements of pedicle dimensions and also axial angles from horizontal and vertical planes may provide some anatomic limitations for subaxial cervical transpedicular screw fixation, and also contribute to the safety of the surgical procedure.

  4. Finite element analysis of osteosynthesis screw fixation in the bone stock: an appropriate method for automatic screw modelling.

    Science.gov (United States)

    Wieding, Jan; Souffrant, Robert; Fritsche, Andreas; Mittelmeier, Wolfram; Bader, Rainer

    2012-01-01

    The use of finite element analysis (FEA) has grown to a more and more important method in the field of biomedical engineering and biomechanics. Although increased computational performance allows new ways to generate more complex biomechanical models, in the area of orthopaedic surgery, solid modelling of screws and drill holes represent a limitation of their use for individual cases and an increase of computational costs. To cope with these requirements, different methods for numerical screw modelling have therefore been investigated to improve its application diversity. Exemplarily, fixation was performed for stabilization of a large segmental femoral bone defect by an osteosynthesis plate. Three different numerical modelling techniques for implant fixation were used in this study, i.e. without screw modelling, screws as solid elements as well as screws as structural elements. The latter one offers the possibility to implement automatically generated screws with variable geometry on arbitrary FE models. Structural screws were parametrically generated by a Python script for the automatic generation in the FE-software Abaqus/CAE on both a tetrahedral and a hexahedral meshed femur. Accuracy of the FE models was confirmed by experimental testing using a composite femur with a segmental defect and an identical osteosynthesis plate for primary stabilisation with titanium screws. Both deflection of the femoral head and the gap alteration were measured with an optical measuring system with an accuracy of approximately 3 µm. For both screw modelling techniques a sufficient correlation of approximately 95% between numerical and experimental analysis was found. Furthermore, using structural elements for screw modelling the computational time could be reduced by 85% using hexahedral elements instead of tetrahedral elements for femur meshing. The automatically generated screw modelling offers a realistic simulation of the osteosynthesis fixation with screws in the adjacent

  5. Finite element analysis of osteosynthesis screw fixation in the bone stock: an appropriate method for automatic screw modelling.

    Directory of Open Access Journals (Sweden)

    Jan Wieding

    Full Text Available The use of finite element analysis (FEA has grown to a more and more important method in the field of biomedical engineering and biomechanics. Although increased computational performance allows new ways to generate more complex biomechanical models, in the area of orthopaedic surgery, solid modelling of screws and drill holes represent a limitation of their use for individual cases and an increase of computational costs. To cope with these requirements, different methods for numerical screw modelling have therefore been investigated to improve its application diversity. Exemplarily, fixation was performed for stabilization of a large segmental femoral bone defect by an osteosynthesis plate. Three different numerical modelling techniques for implant fixation were used in this study, i.e. without screw modelling, screws as solid elements as well as screws as structural elements. The latter one offers the possibility to implement automatically generated screws with variable geometry on arbitrary FE models. Structural screws were parametrically generated by a Python script for the automatic generation in the FE-software Abaqus/CAE on both a tetrahedral and a hexahedral meshed femur. Accuracy of the FE models was confirmed by experimental testing using a composite femur with a segmental defect and an identical osteosynthesis plate for primary stabilisation with titanium screws. Both deflection of the femoral head and the gap alteration were measured with an optical measuring system with an accuracy of approximately 3 µm. For both screw modelling techniques a sufficient correlation of approximately 95% between numerical and experimental analysis was found. Furthermore, using structural elements for screw modelling the computational time could be reduced by 85% using hexahedral elements instead of tetrahedral elements for femur meshing. The automatically generated screw modelling offers a realistic simulation of the osteosynthesis fixation with

  6. Study of Bone-screw Surface Fixation in Lumbar Dynamic Stabilization

    Directory of Open Access Journals (Sweden)

    Yun-Gang Luo

    2015-01-01

    Full Text Available Background: We aimed to use the animal model of dynamic fixation to examine the interaction of the pedicle screw surface with surrounding bone, and determine whether pedicle screws achieve good mechanical stability in the vertebrae. Methods: Twenty-four goats aged 2-3 years had Cosmic ® pedicle screws implanted into both sides of the L2-L5 pedicles. Twelve goats in the bilateral dynamic fixation group had fixation rods implanted in L2-L3 and L4-L5. Twelve goats in the unilateral dynamic fixation group had fixation rods randomly fixed on one side of the lumbar spine. The side that was not implanted with fixation rods was used as a static control group. Results: In the static control group, new bone was formed around the pedicle screw and on the screw surface. In the unilateral and bilateral dynamic fixation groups, large amounts of connective tissue formed between and around the screw threads, with no new bone formation on the screw surface; the pedicle screws were loose after the fixed rods were removed. The bone mineral density and morphological parameters of the region of interest (ROI in the unilateral and bilateral dynamic fixation group were not significantly different (P > 0.05, but were lower in the fixed groups than the static control group (P 0.05; however the maximum pull force of the fixation groups was significantly less than the static control group (P < 0.01. Conclusions: Fibrous connective tissue formed at the bone-screw interface under unilateral and bilateral pedicle dynamic fixation, and the pedicle screws lost mechanical stability in the vertebrae.

  7. Pedicle Screw Fixation Study in Immature Porcine Spines to Improve Pullout Resistance during Animal Testing.

    Science.gov (United States)

    Le Cann, Sophie; Cachon, Thibaut; Viguier, Eric; Miladi, Lotfi; Odent, Thierry; Rossi, Jean-Marie; Chabrand, Patrick

    2015-01-01

    The porcine model is frequently used during development and validation of new spinal devices, because of its likeness to the human spine. These spinal devices are frequently composed of pedicle screws with a reputation for stable fixation but which can suffer pullouts during preclinical implantation on young animals, leading to high morbidity. With a view to identifying the best choices to optimize pedicle screw fixation in the porcine model, this study evaluates ex vivo the impact of weight (age) of the animal, the level of the vertebrae (lumbar or thoracic) and the type of screw anchorage (mono- or bi-cortical) on pedicle screw pullouts. Among the 80 pig vertebrae (90- and 140-day-old) tested in this study, the average screw pullout forces ranged between 419.9N and 1341.2N. In addition, statistical differences were found between test groups, pointing out the influence of the three parameters stated above. We found that the the more caudally the screws are positioned (lumbar level), the greater their pullout resistance is, moreover, screw stability increases with the age, and finally, the screws implanted with a mono-cortical anchorage sustained lower pullout forces than those implanted with a bi-cortical anchorage. We conclude that the best anchorage can be obtained with older animals, using a lumbar fixation and long screws traversing the vertebra and inducing bi-cortical anchorage. In very young animals, pedicle screw fixations need to be bi-cortical and more numerous to prevent pullout. PMID:26451947

  8. Pedicle Screw Fixation Study in Immature Porcine Spines to Improve Pullout Resistance during Animal Testing.

    Directory of Open Access Journals (Sweden)

    Sophie Le Cann

    Full Text Available The porcine model is frequently used during development and validation of new spinal devices, because of its likeness to the human spine. These spinal devices are frequently composed of pedicle screws with a reputation for stable fixation but which can suffer pullouts during preclinical implantation on young animals, leading to high morbidity. With a view to identifying the best choices to optimize pedicle screw fixation in the porcine model, this study evaluates ex vivo the impact of weight (age of the animal, the level of the vertebrae (lumbar or thoracic and the type of screw anchorage (mono- or bi-cortical on pedicle screw pullouts. Among the 80 pig vertebrae (90- and 140-day-old tested in this study, the average screw pullout forces ranged between 419.9N and 1341.2N. In addition, statistical differences were found between test groups, pointing out the influence of the three parameters stated above. We found that the the more caudally the screws are positioned (lumbar level, the greater their pullout resistance is, moreover, screw stability increases with the age, and finally, the screws implanted with a mono-cortical anchorage sustained lower pullout forces than those implanted with a bi-cortical anchorage. We conclude that the best anchorage can be obtained with older animals, using a lumbar fixation and long screws traversing the vertebra and inducing bi-cortical anchorage. In very young animals, pedicle screw fixations need to be bi-cortical and more numerous to prevent pullout.

  9. Comparison of two-transsacral-screw fixation versus triangular osteosynthesis for transforaminal sacral fractures.

    Science.gov (United States)

    Min, Kyong S; Zamorano, David P; Wahba, George M; Garcia, Ivan; Bhatia, Nitin; Lee, Thay Q

    2014-09-01

    Transforaminal pelvic fractures are high-energy injuries that are translationally and rotationally unstable. This study compared the biomechanical stability of triangular osteosynthesis vs 2-transsacral-screw fixation in the repair of a transforaminal pelvic fracture model. A transforaminal fracture model was created in 10 cadaveric lumbopelvic specimens. Five of the specimens were stabilized with triangular osteosynthesis, which consisted of unilateral L5-to-ilium lumbopelvic fixation and ipsilateral iliosacral screw fixation. The remaining 5 were stabilized with a 2-transsacral-screw fixation technique that consisted of 2 transsacral screws inserted across S1. All specimens were loaded cyclically and then loaded to failure. Translation and rotation were measured using the MicroScribe 3D digitizing system (Revware Inc, Raleigh, North Carolina). The 2-transsacral-screw group showed significantly greater stiffness than the triangular osteosynthesis group (2-transsacral-screw group, 248.7 N/mm [standard deviation, 73.9]; triangular osteosynthesis group, 125.0 N/mm [standard deviation, 66.9]; P=.02); however, ultimate load and rotational stiffness were not statistically significant. Compared with triangular osteosynthesis fixation, the use of 2 transsacral screws provides a comparable biomechanical stability profile in both translation and rotation. This newly revised 2-transsacral-screw construct offers the traumatologist an alternative method of repair for vertical shear fractures that provides biplanar stability. It also offers the advantage of percutaneous placement in either the prone or supine position.

  10. Study of Bone-screw Surface Fixation in Lumbar Dynamic Stabilization

    Institute of Scientific and Technical Information of China (English)

    Yun-Gang Luo; Tao Yu; Guo-Min Liu; Nan Yang

    2015-01-01

    Background:We aimed to use the animal model of dynamic fixation to examine the interaction of the pedicle screw surface with surrounding bone,and determine whether pedicle screws achieve good mechanical stability in the vertebrae.Methods:Twenty-four goats aged 2-3 years had Cosmic(R) pedicle screws implanted into both sides of the L2-L5 pedicles.Twelve goats in the bilateral dynamic fixation group had fixation rods implanted in L2-L3 and L4-L5.Twelve goats in the unilateral dynamic fixation group had fixation rods randomly fixed on one side of the lumbar spine.The side that was not implanted with fixation rods was used as a static control group.Results:In the static control group,new bone was formed around the pedicle screw and on the screw surface.In the unilateral and bilateral dynamic fixation groups,large amounts of connective tissue formed between and around the screw threads,with no new bone formation on the screw surface; the pedicle screws were loose after the fixed rods were removed.The bone mineral density and morphological parameters of the region of interest (ROI) in the unilateral and bilateral dynamic fixation group were not significantly different (P > 0.05),but were lower in the fixed groups than the static control group (P < 0.05).This showed the description bone of the ROI in the static control group was greater than in the fixation groups.Under loading conditions,the pedicle screw maximum pull force was not significantly different between the bilateral and unilateral dynamic fixation groups (P > 0.05); however the maximum pull force of the fixation groups was significantly less than the static control group (P < 0.01).Conclusions:Fibrous connective tissue formed at the bone-screw interface under unilateral and bilateral pedicle dynamic fixation,and the pedicle screws lost mechanical stability in the vertebrae.

  11. Serum albumin and fixation failure with cannulated hip screws in undisplaced intracapsular femoral neck fracture.

    Science.gov (United States)

    Riaz, O; Arshad, R; Nisar, S; Vanker, R

    2016-07-01

    Introduction Internal fixation of undisplaced intracapsular femoral neck fractures with cannulated hip screws is a widely accepted surgical technique, despite reported failure rates of 12%-19%. This study determined whether preoperative serum albumin levels are linked to fixation failure. Methods We retrospectively reviewed 251 consecutive undisplaced intracapsular femoral neck fracture patients treated with cannulated hip screws in a district general hospital. Preoperative albumin levels were measured, and the fixation technique, classification and posterior tilt on radiography assessed. Fixation failure was defined as a screw cut, avascular necrosis (AVN) or non-union. Results Of the patients, 185 were female and 66 male. The mean age was 77 years (range 60-101 years). Thirty seven (15%) patients had fixation failure: 10 (4%) due to AVN; 12 (5%) due to non-union; and 15 (6%) due to fixation collapse. Low serum albumin levels were significantly associated with failure (p=0.01), whereas gender (p=0.56), operated side (p=0.62), age (p=0.34) and screw configuration (p=0.42) were not. A posterior tilt angle greater than 20° on lateral radiography significantly predicted failure (p=0.002). Conclusions Preoperative serum albumin is an independent predictor of cannulated hip screw fixation failure in undisplaced femoral neck fractures. Nutritional status should therefore be considered when deciding between surgical fixation and arthroplasty to avoid the possibility of revision surgery, along with an increased risk of morbidity and mortality. PMID:27055409

  12. Anterior transarticular screw fixation as a conventional operation for rigid stabilization

    OpenAIRE

    Manabu Sasaki; Katsumi Matsumoto; Koichiro Tsuruzono; Kazuhiro Yoshimura; Katsuhiko Shibano; Kazuo Yonenobu

    2014-01-01

    Background: Anterior transarticular screw (ATS) fixation is a useful surgical option for atlantoaxial (AA) stabilization. This report presents a revised ATS method for AA fusion. Methods: A 79-year-old male presented with AA instability attributed both to an old odontoid fracture and severe degeneration of the lateral atlantoaxial joints (LAAJs). ATS fixation was performed through the conventional anterior cervical approach. The longest screw trajectories were planned preoperatively using...

  13. Pedicle Screw Fixation Study in Immature Porcine Spines to Improve Pullout Resistance during Animal Testing

    OpenAIRE

    Le Cann, Sophie; Cachon, Thibaut; Viguier, Eric; MILADI, Lotfi; Odent, Thierry; Rossi, Jean-Marie; Chabrand, Patrick

    2015-01-01

    The porcine model is frequently used during development and validation of new spinal devices, because of its likeness to the human spine. These spinal devices are frequently composed of pedicle screws with a reputation for stable fixation but which can suffer pull-outs during preclinical implantation on young animals, leading to high morbidity. With a view to identifying the best choices to optimize pedicle screw fixation in the porcine model, this study evaluates ex vivo the impact of weight...

  14. Translaminar screw fixation of a kyphosis of the cervical and thoracic spine in neurofibromatosis.

    Science.gov (United States)

    Gardner, A; Millner, P; Liddington, M; Towns, G

    2009-09-01

    The spinal manifestations of neurofibromatosis include cervicothoracic kyphosis, in which scalloping of the vertebral body and erosion of the pedicles may render conventional techniques of fixation impossible. We describe a case of cervicothoracic kyphosis managed operatively with a vascularised fibular graft anteriorly across the apex of the kyphus, followed by a long posterior construct using translaminar screws, which allow segmental fixation in vertebral bodies where placement of the pedicle screws was impracticable. PMID:19721057

  15. Is there enough evidence to regularly apply bone screws for intermaxillary fixation in mandibular fractures?

    NARCIS (Netherlands)

    A. Bins; M.A.E. Oomens; P. Boffano; T. Forouzanfar

    2015-01-01

    Purpose Intermaxillary fixation (IMF) is traditionally achieved with arch bars; however, this method has several well-known disadvantages and other techniques, such as bone screws, are available. This study evaluated current evidence regarding these IMF screws (IMFSs) for mandibular trauma and to as

  16. Feasibility study on posterior laminar screw fixation techniques in the axis

    Institute of Scientific and Technical Information of China (English)

    HU Yong; HE Xian-feng; GU Yong-jie; XU Rong-ming; MA Wei-hu; RUAN Yong-ping; Lin Rong

    2010-01-01

    Objective: To get morphologic param-eters of Chinese adults through observation and measure-ment on axial laminas, to evaluate the feasibility of placing axial laminar screws and to introduce the technique.Methods: Relative parameters of 28 sets of fresh Chi-nese adults' axial specimens, including distance from the superior and inferior entry points of axial laminar screws to the superior margins of axial laminas, superior, middle, infe-rior thickness and height of the axial laminas, length and angle of the axial laminar screw trajectories, distance from the entry points of axial laminar screws to the transverse foramen and central points of the inferior articular process, were measured with a digital caliper and a goniometer.Data were statistically analyzed.Results: Averagely, distance from the superior and inferior entry points of axial laminar screws to the superior margins of axial laminas was 5 mm and 9 ram, superior, middle, inferior thickness and the height of the axial laminas were 3.2 mm, 6.7 ram, 5.5 nun and 12.8 mm respectively, and the length of the superior and inferior axial laminar screw trajectories was 26.2 mm and 25.5 mm, respectively.Conclusions: It is feasible and reliable to apply poste-rior laminar screw fixation techniques to the axes of Chinese adults.Also the C_2 laminar screw fixation technique can be taken as a supplementary to conventional posterior screw fixations of C_2.

  17. Polymethylmethacrylate-augmented screw fixation for stabilization in metastatic spinal tumors. Technical note.

    Science.gov (United States)

    Jang, Jee Soo; Lee, Sang Ho; Rhee, Chang Hun; Lee, Seung Hoon

    2002-01-01

    Screw fixation augmented with polymethylmethacrylate (PMMA) or some other biocompatible bone cement has been used in patients with osteoporosis requiring spinal fusion. No clinical studies have been conducted on PMMA-augmented screw fixation for stabilization of the vertebral column in patients with metastatic spinal tumors. The purpose of this study was to determine whether screw fixation augmented with PMMA might be suitable in patients treated for multilevel metastatic spinal tumors. Ten patients with metastatic spinal tumors involving multiple vertebral levels underwent stabilization procedures in which PMMA was used to augment screw fixation after decompression of the spinal cord. Within 15 days, partial or complete relief from pain was obtained in all patients postoperatively. Two of four patients in whom neurological deficits caused them to be nonambulatory before surgery were able to ambulate postoperatively. Neither collapse of the injected vertebral bodies nor failure of the screw fixation was observed during the mean follow-up period of 6.7 months. Screw fixation augmented with PMMA may offer stronger stabilization and facilitate the instrumentation across short segments in the treatment of multilevel metastatic spinal tumors. PMID:11795702

  18. Anterior transarticular screw fixation as a conventional operation for rigid stabilization

    Directory of Open Access Journals (Sweden)

    Manabu Sasaki

    2014-01-01

    Full Text Available Background: Anterior transarticular screw (ATS fixation is a useful surgical option for atlantoaxial (AA stabilization. This report presents a revised ATS method for AA fusion. Methods: A 79-year-old male presented with AA instability attributed both to an old odontoid fracture and severe degeneration of the lateral atlantoaxial joints (LAAJs. ATS fixation was performed through the conventional anterior cervical approach. The longest screw trajectories were planned preoperatively using multiplanar reconstruction computed tomography (CT scans, with entry points of the screws situated at the midpoint on the inferior border of the axial body. The surgical exposure was limited to opening at the entry points alone. Our retractor of choice was the Cusco speculum; it sufficiently secured space for utilizing the required instruments for screw placement while offering sufficient protection of soft tissues. Cannulated full-threaded bicortical screws stabilized the LAAJs. Screw insertion required a significant amount of coronal angulation up to the superior articular process of the atlas under open-mouth and lateral fluoroscopy image guidance. After ATS fixation, bone grafting was performed between the posterior laminae of the axis and the atlas through a conventional posterior approach. Results: Bony fusion between the atlas and the axis was confirmed radiographically. Arthrodesis of the LAAJs occurred despite no bone grafting. Conclusions: Rigid fixation of the LAAJs was obtained by our ATS technique, indicating that it is an alternative method for AA fixation when posterior rigid internal fixation is not applicable.

  19. Sextant percutaneous pedicle screw fixation for correcting single-segment thoracolumbar fractures

    Institute of Scientific and Technical Information of China (English)

    Ming Jiang-hua; Zheng Hui-feng; Zhao Qi; Chen Qing; Wang Gang

    2014-01-01

    BACKGROUND:Though the effects of conservative or traditional open reduction and internal fixation in the treatment of thoracolumbar fractures are reliable and satisfactory for most cases, two methods also have shortages. Minimal-invasive percutaneous pedicle screw system provides a new available method. OBJECTIVE:To investigate the clinical effect of Sextant percutaneous pedicle screw system in the treatment of thoracolumbar fractures. METHODS:A total of 55 patients, who had undergone percutaneous pedicle screw fixation using Sextant system (25 patients) or traditional open internal fixation (30 patients) for single-level vertebral body compression fractures in Department of Orthopedics of Renmin Hospital of Wuhan University from February 2011 to January 2013, were enrol ed in this study. RESULTS AND CONCLUSION:Except two patients in traditional open internal fixation group were lost after discharge, al other patients were fol owed up for 8-14 months. Operative time, intraoperative blood loss, postoperative drainage amount and hospital day were better in percutaneous pedicle screw fixation group than in the traditional open internal fixation group (P0.05). The results show that percutaneous pedicle screw fixation using Sextant system has a satisfactory outcome in the treatment of thoracolumbar fractures. However, obeying indication strictly is very important for clinical application.

  20. Fixation strength of biocomposite wedge interference screw in ACL reconstruction: effect of screw length and tunnel/screw ratio. A controlled laboratory study

    Directory of Open Access Journals (Sweden)

    Herrera Antonio

    2010-06-01

    Full Text Available Abstract Background Primary stability of the graft is essential in anterior cruciate ligament surgery. An optimal method of fixation should be easy to insert and provide great resistance against pull-out forces. A controlled laboratory study was designed to test the primary stability of ACL tendinous grafts in the tibial tunnel. The correlation between resistance to traction forces and the cross-section and length of the screw was studied. Methods The tibial phase of ACL reconstruction was performed in forty porcine tibias using digital flexor tendons of the same animal. An 8 mm tunnel was drilled in each specimen and two looped tendons placed as graft. Specimens were divided in five groups according to the diameter and length of the screw used for fixation. Wedge interference screws were used. Longitudinal traction was applied to the graft with a Servohydraulic Fatigue System. Load and displacement were controlled and analyzed. Results The mean loads to failure for each group were 295,44 N (Group 1; 9 × 23 screw, 564,05 N (Group 2; 9 × 28, 614,95 N (Group 3; 9 × 35, 651,14 N (Group 4; 10 × 28 and 664,99 (Group 5; 10 × 35. No slippage of the graft was observed in groups 3, 4 and 5. There were significant differences in the load to failure among groups (ANOVA/P Conclusions Longer and wider interference screws provide better fixation in tibial ACL graft fixation. Short screws (23 mm do not achieve optimal fixation and should be implanted only with special requirements.

  1. A finite element modeling of posterior atlantoaxial fixation and biomechanical analysis of C2 intralaminar screw fixation

    Institute of Scientific and Technical Information of China (English)

    Ma Xuexiao; Peng Xianbo; Xiang Hongfei; Zhang Yan; Zhang Guoqing; Chen Bohua

    2014-01-01

    Background The objective of this study was to use three-dimensional finite element (FE) models to analyze the stability and the biomechanics of two upper cervical fixation methods:the C2 intralaminar screw method and the C2 pedicle screw method.Methods From computed tomography images,a nonlinear three-dimensional FE model from C0 (occiput) to C3 was developed with anatomic detail.The C2 intralaminar screw and the C2 pedicle screw systems were added to the model,in parallel to establish the interlaminar model and the pedicle model.The two models were operated with all possible states of motion and physiological loads to simulate normal movement.Results Both the C2 intralaminar screw method and the C2 pedicle screw method significantly reduced motion compared with the intact model.There were no statistically significant differences between the two methods.The Von Mises stresses of the internal and external laminar walls were similar between the two methods.Stability was also similar.Conclusions The C2 intralaminar screw method can complement but cannot completely replace the C2 pedicle screw method.Clinicians would need to assess and decide which approach to adopt for the best therapeutic effect.

  2. Prevention of arthrofibrosis after arthroscopic screw fixation of tibial spine fracture in children and adolescents.

    Science.gov (United States)

    Parikh, Shital N; Myer, David; Eismann, Emily A

    2014-01-01

    Arthrofibrosis is a major complication of tibial spine fracture treatment in children, potentially resulting in knee pain, quadriceps weakness, altered gait, decreased function, inability to return to sports, and long-term osteoarthritis. Thus, prevention rather than treatment of arthrofibrosis is desirable. The purpose of this study was to evaluate an aggressive postoperative rehabilitation and early intervention approach to prevent permanent arthrofibrosis after tibial spine fracture treatment and to compare epiphyseal and transphyseal screws for fixation. A consecutive series of 24 patients younger than age 18 with displaced type II and III tibial spine fractures who underwent arthroscopic reduction and screw fixation between 2006 and 2011 were retrospectively reviewed. Final range of motion was compared between patients with epiphyseal (n=12) and transphyseal (n=9) screws. One-third (4 of 12) of patients with epiphyseal screws underwent arthroscopic debridement and screw removal approximately 3 months postoperatively; 3 patients lacked 5° to 15° of extension, 1 experienced pain with extension, and 1 had radiographic evidence of screw pullout, loss of reduction, and resultant malunion. In the transphyseal screw group, 3 patients had 10° loss of extension, and all corrected after arthroscopic debridement and screw removal. The two groups did not significantly differ in time to hardware removal or return to sports or final range of motion. No growth disturbances were identified in patients after transphyseal screw removal. An aggressive approach of postoperative rehabilitation and early intervention after arthroscopic reduction and screw fixation of tibial spine fractures in children was successful in preventing permanent arthrofibrosis. PMID:24683658

  3. Biomechanical and clinical study on screw hook fixation after direct repair of lumbar spondylolysis

    Institute of Scientific and Technical Information of China (English)

    ZHAO Jian; LIU Fan; SHI Hong-guang; FAN Jian; ZHAO Wei-dong; WANG You-hua; CAI Yu-hui

    2006-01-01

    Objective: To evaluate the biomechanical effect and clinical results of hook screw fixation after direct repair of lumbar spondylous defects in the pars interarticularis.Methods: L2-L6 spines of 8 fresh-frozen and thawed calf cadavers were used for mechanical testing. Bilateral spondylous defects were created in the L4 vertebra. The intervertebral rotation ranges between L4 and Ls were scanned and computerized in various states of motion, such as flexion/extension, lateral bending and torsional loadings applied on the intact spine and the spondylous spine when the spondylous spine was fixed with modified Scott's fixation, hook screw fixation and Buck's fixation sequentially and respectively. Between July 2002 and February 2004, 14 young male patients (aged 15-31 years)suffering from symptomatic lumbar spondylolysis were treated with TSRH hook screw fixation after direct repair of the defects. MacNab criteria1 were used to assess their preand post-operative status.Results: Each fixation technique could significantly increase the intervertebral rotational stiffness and made the stiffness return to nearly the intact level. Hook screw technique provided more rotational stability than the others. Hook screw and Buck's techniques provided more flexion/extension stability than modified Scott's technique.Neither complication nor instrumental failure was observed in this study. The mean follow-up period was 21 months.All the patients except one acquired union during the follow-up period. Thirteen patients had a "good" or "excellent" result according to MacNab criteria.Conclusions: Hook screw fixation shows biomechanical advantages and is safe and effective for young patients with lumbar spondylolysis.

  4. Hydroxyapatite composite resin cement augmentation of pedicle screw fixation.

    Science.gov (United States)

    Turner, Alexander W L; Gillies, R Mark; Svehla, Martin J; Saito, Masanobu; Walsh, William R

    2003-01-01

    Pedicle screw stability is poor in osteopenic vertebrae attributable, in part, to low screw-bone interface strength. The current authors examined cement augmentation using a low curing temperature hydroxyapatite and bis-phenol-A glycidol methacrylate-based composite resin. This cement may stiffen the screw-bone interface and reduce the harmful effects associated with polymethylmethacrylate regarding temperature and toxic monomer. Thirty-five lumbar vertebrae from human cadavers were instrumented with pedicle screws, with one pedicle previously injected with cement and the other as the control. Caudocephalad toggling of +/- 1 mm for 1600 cycles was applied to the pedicle screws, and the resulting forces supported by the implant-bone interface were captured by a load cell. A curve was constructed from the peak caudal load for each cycle and three mechanical measures parameterized this curve: (1) initial load; (2) rate of load decay during the first 400 cycles; and (3) final load. The initial load increased by 16% as a result of cement augmentation, the final load increased by 65%, and the rate of load decay decreased by 59%. Cement augmentation of pedicle screws increased the stiffness and stability of the screw-bone interface. PMID:12579026

  5. Cervical pedicle screw fixation at C6 and C7 A cadaveric study

    Directory of Open Access Journals (Sweden)

    Ye Li

    2015-01-01

    Conclusion: The intersection of the horizontal line through the midpoint of the transverse process root and vertical line through the intersection of the posterolateral and posterior planes of the isthmus can be used as an entry point for C6 and C7 pedicle screw fixation. The screws should be inserted at 60 or 90° with the posterolateral isthmus in the horizontal plane and at 75° with the posterior isthmus in the sagittal plane. The LSC should not exceed 30 mm.

  6. Posterior fixation and fusion with atlas pedicle screw system for upper cervical diseases

    Institute of Scientific and Technical Information of China (English)

    LI Lei; ZHOU Feng-hua; WANG Huan; CUI Shao-qian

    2008-01-01

    Objective: To evaluate the feasibility, safety and efficacy of atlas pedicle screws system fixation and fusion for the treatment of upper cervical diseases. Methods: Twenty-three consecutive patients with up-per cervical disorders requiring stabilization, including 19 cases of atlantoaxial dislocation (4 congenital odontoid disconnections, 6 old odontoid fractures, 4 fresh odontoid fractures of Aderson Ⅱ C, 3 ruptures of the C1 transverse ligament, and 2 fractures ofC1), 2 cases ofC2 tumor (instability after the resection of the tumors), and 2 giant neurilemomas of C2-C3(instability after resection of the tumors), were treated by posterior fixation and fusion with the atlas pedicle screw system, in which the screws were inserted through the posterior arch of Cr The operative time, bleeding volume and complications were reported. All patients were immobilized without external fixation or with rigid cervical collars for 1-3 months. All patients were followed up and evaluated with radiographs and CT. Results: In the 23 patients, 46 C1 pedicle screws, 42 C2 pedicle screws and 6 lower cervical lateral mass screws and 2 lower cervical pedicle screws were placed. The mean operative time and bleeding volume was 2.7 hours and 490 ml respectively. No intraoperative complications were directly related to surgical technique. No neurological, vascular or infective complications were encountered. All patients were followed up for 3-36 months (average 15 months). Firm bony fusion was documented in all patients after 3-6 months. One patient with atlas fracture showed anterior occipitocervical fusion. There was no implant failure. Conclusions: Posterior fixation and fusion of the atlas pedicle screw system is feasible and safe for the treatment of upper cervical diseases, and may be applicable to a larger number of patients.

  7. Comparison of migration behavior between single and dual lag screw implants for intertrochanteric fracture fixation

    Directory of Open Access Journals (Sweden)

    Katonis Pavlos G

    2009-05-01

    Full Text Available Abstract Background Lag screw cut-out failure following fixation of unstable intertrochanteric fractures in osteoporotic bone remains an unsolved challenge. This study tested if resistance to cut-out failure can be improved by using a dual lag screw implant in place of a single lag screw implant. Migration behavior and cut-out resistance of a single and a dual lag screw implant were comparatively evaluated in surrogate specimens using an established laboratory model of hip screw cut-out failure. Methods Five dual lag screw implants (Endovis, Citieffe and five single lag screw implants (DHS, Synthes were tested in the Hip Implant Performance Simulator (HIPS of the Legacy Biomechanics Laboratory. This model simulated osteoporotic bone, an unstable fracture, and biaxial rocking motion representative of hip loading during normal gait. All constructs were loaded up to 20,000 cycles of 1.45 kN peak magnitude under biaxial rocking motion. The migration kinematics was continuously monitored with 6-degrees of freedom motion tracking system and the number of cycles to implant cut-out was recorded. Results The dual lag screw implant exhibited significantly less migration and sustained more loading cycles in comparison to the DHS single lag screw. All DHS constructs failed before 20,000 cycles, on average at 6,638 ± 2,837 cycles either by cut-out or permanent screw bending. At failure, DHS constructs exhibited 10.8 ± 2.3° varus collapse and 15.5 ± 9.5° rotation around the lag screw axis. Four out of five dual screws constructs sustained 20,000 loading cycles. One dual screw specimens sustained cut-out by medial migration of the distal screw after 10,054 cycles. At test end, varus collapse and neck rotation in dual screws implants advanced to 3.7 ± 1.7° and 1.6 ± 1.0°, respectively. Conclusion The single and double lag screw implants demonstrated a significantly different migration resistance in surrogate specimens under gait loading simulation with

  8. Percutaneous screw fixation of a vertebral pedicle fracture under CT-guidance: A new technique

    International Nuclear Information System (INIS)

    We report on a new minimally invasive technique for the vertebral pedicle fracture after placement of a prosthetic disc. This intervention is an adaptation of CT-guided sacroiliac and acetabular fracture screw fixation. This type of procedure enables the perfect placement and measurement of the screw, as well as an extremely small incision under local anesthesia. CT guided Transpedicular fixation could be a useful strategy in the treatment of future cases involving poorly healing pedicle fractures causing persistent symptoms. This intervention confirms the range of capacities of CT scan-controlled interventions in terms of precision, safety, speed, minimal invasiveness, rapid return to everyday activity and consequently, economical management.

  9. Augmentation of screw fixation with injectable calcium sulfate bone cement in ovariectomized rats.

    Science.gov (United States)

    Yu, Xiao-Wei; Xie, Xin-Hui; Yu, Zhi-Feng; Tang, Ting-Ting

    2009-04-01

    The objective of this study was to determine the effect of augmenting screw fixation with an injectable calcium sulfate cement (CSC) in the osteoporotic bone of ovariectomized rats. The influence of the calcium sulfate (CS) on bone remodeling and screw anchorage in osteoporotic cancellous bone was systematically investigated using histomorphometric and biomechanical analyses. The femoral condyles of 55 Sprague-Dawley ovariectomized rats were implanted with screw augmented with CS, while the contralateral limb received a nonaugmented screw. At time intervals of 2, 4, 8, 12, and 16 weeks, 11 rats were euthanized. Six pair-matched samples were used for histological analysis, while five pair-matched samples were preserved for biomechanical testing. Histomorphometric data showed that CS augmented screws activated cancellous bone formation, evidenced by a statistically higher (p < 0.05) percentage of osteoid surface at 2, 4, and 8 weeks and a higher rate of bone mineral apposition at 12 weeks compared with nonaugmented screws. The amount of the bone-screw contact at 2, 8, and 12 weeks and of bone ingrowth on the threads at 4 and 8 weeks was greater in the CS group than in the nonaugmented group (p < 0.05), although these parameters increased concomitantly with time for both groups. The CS was resorbed completely at 8 weeks without stimulating fibrous encapsulation on the screw surface. Also, the cement significantly increased the screw pull-out force and the energy to failure at 2, 4, 8, and 12 weeks after implantation, when compared with the control group (p < 0.05). These results imply that augmentation of screw fixation with CS may have the potential to decrease the risk of implant failure in osteoporotic bone.

  10. Combining of small fragment screws and large fragment plates for open reduction and internal fixation of periprosthetic humeral fractures.

    Science.gov (United States)

    Seybold, Dominik; Citak, Mustafa; Königshausen, Matthias; Gessmann, Jan; Schildhauer, Thomas A

    2011-10-01

    Operative treatment of periprosthetic humeral fractures in elderly patients with osteoporotic bone requires a stable fixations technique. The combination of 3.5 cortical screws with washers in a 4.5 Arbeitsgemeinschaft für Osteosynthesefragen, Limited-contact dynamic compression plate or Locking plate, allows a stable periprosthetic fixation with the small 3.5 screws and 4.5 screws above and below the prosthesis, respectively. This combination is a cost-effective technique to treat periprosthetic humeral fractures.

  11. 关节镜下两种固定方式重建交叉韧带的疗效比较%Comparative Evaluation of Bioabsorbable Inrerferrencs Screws and Endobutton in Anterior Cruciate Ligament Reconstruction under Arthroscope

    Institute of Scientific and Technical Information of China (English)

    燕飞; 刘斌; 薛常胜; 宋鹤天; 苗雷

    2012-01-01

    Objective:To evaluate the difference between bioabsorbable inrerferrences screws(BS) and endobutton on ligament fixation in anterior cruciate ligament reconstruction at the thighbone under arthroscopy. Methods: 57 patients with broken anterior cruciate ligament, who were treated in the hospital from 2005-01-2011-01, were reviewed and analyzed. There were 45 males and 12 females with the average age of 27.7(range 16-55 years old). The disease duration was 3 clays to 12 years and the average was 18.7 months. All the patients were evidently injured, of which 12 patients were traffic accident injuries, 30 patients were knee joint sprain and other 15 patients were knee joint tumble, and 47 cases among all the cases had unstable symptom of knee joints in varying degrees. The physical test before operation showed: 54 cases had positive anterior drawer test, 12 cases had positive external-rotation test, 38 cases had positive Laehman test and 24 cases had positive Plovot shift test. Cruciate ligament reconstruction under arthroscopy was done and routine recovery practice was made after operation. Applying Lysholm scorse to eveluate knee joint function before and after operation of the two groups, and through comparing the scorses to analyse the difference of clinical effect of the two fixations on fixing cruciate ligament by using a statistical way. Results: After the patients were followed up for a year, two group patients' unstable symptoms of knee joint were relieved and physical test showed that the anterior and posterior drawer tests, Plovot shift test, and Lachman test were all negative. Lysholm scores of knee joint of two groups showed that, for 34 patients with inrerferrences screws, the scores before operation were 17-71(average 42.51 ± 14.90), the scores after operation were 84-100(average 97.24 ± 3.63), for 23 patients with endobutton, the scores before operation were 18-79(average 44.12 ± 14.26), the scores after operation were 89- 100(average 97.24 ± 3

  12. Design of three-dimensional visualization based on the posterior lumbar pedicle screw fixation

    Directory of Open Access Journals (Sweden)

    Kai XU

    2011-09-01

    Full Text Available Objective To establish a three-dimensional visualization model of posterior lumbar pedicle screw fixation.Methods A patient with lumbar intervertebral disc hernia and another patient with compression fracture of lumbar vertebra were involved in the present study.Both patients underwent multi-slice spiral CT scan before and after lumbar pedicle screw fixation.The degree of preoperative vertebral compression,vertebral morphology before and after surgery,postoperative pedicle screw position,and decompression effects were observed.The original data of the multi-slice spiral CT were inputted into the computer.The three-dimensional reconstructed images of the lumbar and implanted screws were obtained using the software Amira 4.1 to show the three-dimensional shape of the lumbar vertebrae before and after surgery and the location of the implanted screws.Results The morphology and structure of the lumbar vertebrae before and after surgery and of the implanted screws were reconstructed using the digital navigation platform.The reconstructed 3D images could be displayed in multicolor,transparent,or arbitrary combinations.In the 3D surface reconstruction images,the location and structure of the implanted screws could be clearly observed,and the decompression of the spinal cord or nerve roots and the severity of the fracture and the compression of lumbar vertebrae could be fully evaluated.The reconstructed images before operation revealed the position of the vertebral pedicles and provided reference for intraoperative localization.Conclusions The three-dimensional computerized reconstructions of lumbar pedicle screw fixation may be valuable in basic research,clinical experiment,and surgical planning.The software Amira is one of the bases of three-dimensional reconstruction.

  13. The Mechanical Effect of Rod Contouring on Rod-Screw System Strength in Spine Fixation

    Science.gov (United States)

    Karakasli, Ahmet; Karaarslan, Ahmet A.; Ozcanhan, Mehmet Hilal; Ertem, Fatih; Erduran, Mehmet

    2016-01-01

    Objective Rod-screw fixation systems are widely used for spinal instrumentation. Although many biomechanical studies on rod-screw systems have been carried out, but the effects of rod contouring on the construct strength is still not very well defined in the literature. This work examines the mechanical impact of straight, 20° kyphotic, and 20° lordotic rod contouring on rod-screw fixation systems, by forming a corpectomy model. Methods The corpectomy groups were prepared using ultra-high molecular weight polyethylene samples. Non-destructive loads were applied during flexion/extension and torsion testing. Spine-loading conditions were simulated by load subjections of 100 N with a velocity of 5 mm min-1, to ensure 8.4-Nm moment. For torsional loading, the corpectomy models were subjected to rotational displacement of 0.5° s-1 to an end point of 5.0°, in a torsion testing machine. Results Under both flexion and extension loading conditions the stiffness values for the lordotic rod-screw system were the highest. Under torsional loading conditions, the lordotic rod-screw system exhibited the highest torsional rigidity. Conclusion We concluded that the lordotic rod-screw system was the most rigid among the systems tested and the risk of rod and screw failure is much higher in the kyphotic rod-screw systems. Further biomechanical studies should be attempted to compare between different rod kyphotic angles to minimize the kyphotic rod failure rate and to offer a more stable and rigid rod-screw construct models for surgical application in the kyphotic vertebrae. PMID:27651858

  14. Short Segment Fixation Versus Short Segment Fixation With Pedicle Screws at the Fracture Level for Thoracolumbar Burst Fracture

    Directory of Open Access Journals (Sweden)

    Anghel S

    2014-04-01

    Full Text Available Objective: The most prevailing surgical procedure in the treatment of thoracolumbar burst fractures, Short Segment Fixation (SSF, is often followed by loss of correction or hardware failure which may be significant enough to require another surgical intervention. In order to take advantage of its benefits but to avoid or diminish the risk and impact of associated drawbacks, some other alternatives have been lately developed among which we refer to short segment fixation with intermediate screws (SSF+IS. This article provides a comparative picture over the effectiveness of the two above-mentioned surgical treatments, focusing on their potential to prevent the loss of correction.

  15. Fibular grafting with cannulated hip screw fixation in late femoral neck fracture in young adults

    Directory of Open Access Journals (Sweden)

    Goyal R

    2006-01-01

    Full Text Available Background: We reviewed the operative results of fibular bone graft with cannulated hip screw fixation in femoral neck fracture in young adults. Method: Sixteen young adults with femoral neck fracture were treated by fibular bone graft with cannulated hip screw fixation. All the fractures were more than 3 weeks old. Results: Results were assessed in 15 patients while one patient died due to complications not related to surgery. Union occurred in all 15 patients. One patient had intra-operative complication in the form of screw cut out with graft in the joint space. The average fallow up was 24.4 months. Out of 15 patients assessed clinico-radiologically 11 showed good results, 3 had fair while 1 had poor result. Conclusion: We conclude that this is a simple and cost effective procedure for late femoral fleck fracture in young adults with good results.

  16. Bioabsorbable bone fixation plates for X-ray imaging diagnosis by a radiopaque layer of barium sulfate and poly(lactic-co-glycolic acid).

    Science.gov (United States)

    Choi, Sung Yoon; Hur, Woojune; Kim, Byeung Kyu; Shasteen, Catherine; Kim, Myung Hun; Choi, La Mee; Lee, Seung Ho; Park, Chun Gwon; Park, Min; Min, Hye Sook; Kim, Sukwha; Choi, Tae Hyun; Choy, Young Bin

    2015-04-01

    Bone fixation systems made of biodegradable polymers are radiolucent, making post-operative diagnosis with X-ray imaging a challenge. In this study, to allow X-ray visibility, we separately prepared a radiopaque layer and attached it to a bioabsorbable bone plate approved for clinical use (Inion, Finland). We employed barium sulfate as a radiopaque material due to the high X-ray attenuation coefficient of barium (2.196 cm(2) /g). The radiopaque layer was composed of a fine powder of barium sulfate bound to a biodegradable material, poly(lactic-co-glycolic acid) (PLGA), to allow layer degradation similar to the original Inion bone plate. In this study, we varied the mass ratio of barium sulfate and PLGA in the layer between 3:1 w/w and 10:1 w/w to modulate the degree and longevity of X-ray visibility. All radiopaque plates herein were visible via X-ray, both in vitro and in vivo, for up to 40 days. For all layer types, the radio-opacity decreased with time due to the swelling and degradation of PLGA, and the change in the layer shape was more apparent for layers with a higher PLGA content. The radiopaque plates released, at most, 0.5 mg of barium sulfate every 2 days in a simulated in vitro environment, which did not appear to affect the cytotoxicity. The radiopaque plates also exhibited good biocompatibility, similar to that of the Inion plate. Therefore, we concluded that the barium sulfate-based, biodegradable plate prepared in this work has the potential to be used as a fixation device with both X-ray visibility and biocompatibility.

  17. OPEN REDUCTION AND CANNULATED SCREW INTERNAL FIXATION OF TALUS FRACTURE-DISLOCATION THROUGH MEDIAL-ANTERIOR APPROACH

    Institute of Scientific and Technical Information of China (English)

    董宇启; 董英海; 周健; 曹聪

    2004-01-01

    Objective To evaluate the role of open reduction through anterior-medial malleolar approach with cannulated screw internal fixation in the treatment of displaced talus fractures. Methods 16 cases of Hawkin type Ⅱ - Ⅲ displaced talus fractures were treated by open reduction through single anterior medial malleofar approach with cannulated screw internal fixation. Results All the 16 cases of displaced talus fractures achieved bony heal in which 5 cases suffered talus aseptic necrosis. The whole excellence-good ratio reached 62.5%.Conclusion Open reduction through anterior-medial malleolar approach with cannulated screw internal fixation is a less trauma, easy manipulation, effective method of treatment for displaced talus fractures.

  18. Root contact with maxillomandibular fixation screws in orthognathic surgery: incidence and consequences.

    Science.gov (United States)

    Camargo, I B; Van Sickels, J E; Laureano Filho, J R; Cunningham, L L

    2016-08-01

    The use of maxillomandibular fixation (MMF) screws in orthognathic surgery has become common in recent years. The risk of injury to adjacent roots with their placement in this population has not been studied extensively. The aim of this study was to review the incidence and consequences of root contact/injury in patients undergoing orthognathic surgery. A retrospective analysis of the treatment and radiographic records of patients who underwent orthognathic surgery between January 2013 and September 2014 at a university in Kentucky, USA was performed. The mean number of screws used was correlated to the mean number of roots affected using Spearman's test, set to a level of significance of 5%. Of 125 patients who underwent orthognathic surgery, 15 (12%) had evidence of root contact. Subsequent radiographs showed resolution of the bone defects. There was no clinical evidence of pulpal necrosis or pain during follow-up. The average number of screws used was 3.14±0.35 per patient, with an average of 0.17±0.52 root contacts per patient. There was no correlation between the number of screws used and the number of roots injured (P=0.279). Based on these results, MMF screws can safely be used to establish interim fixation during orthognathic surgery. Caution should be taken during placement to avoid direct injury to the roots of teeth.

  19. The calcar screw in angular stable plate fixation of proximal humeral fractures - a case study

    Directory of Open Access Journals (Sweden)

    Simmen Hans-Peter

    2011-09-01

    Full Text Available Abstract Background With new minimally-invasive approaches for angular stable plate fixation of proximal humeral fractures, the need for the placement of oblique inferomedial screws ('calcar screw' has increasingly been discussed. The purpose of this study was to investigate the influence of calcar screws on secondary loss of reduction and on the occurrence of complications. Methods Patients with a proximal humeral fracture who underwent angular stable plate fixation between 01/2007 and 07/2009 were included. On AP views of the shoulder, the difference in height between humeral head and the proximal end of the plate were determined postoperatively and at follow-up. Additionally, the occurrence of complications was documented. Patients with calcar screws were assigned to group C+, patients without to group C-. Results Follow-up was possible in 60 patients (C+ 6.7 ± 5.6 M/C- 5.0 ± 2.8 M. Humeral head necrosis occurred in 6 (C+, 15.4% and 3 (C-, 14.3% cases. Cut-out of the proximal screws was observed in 3 (C+, 7.7% and 1 (C-, 4.8% cases. In each group, 1 patient showed delayed union. Implant failure or lesions of the axillary nerve were not observed. In 44 patients, true AP and Neer views were available to measure the head-plate distance. There was a significant loss of reduction in group C- (2.56 ± 2.65 mm compared to C+ (0.77 ± 1.44 mm; p = 0.01. Conclusions The placement of calcar screws in the angular stable plate fixation of proximal humeral fractures is associated with less secondary loss of reduction by providing inferomedial support. An increased risk for complications could not be shown.

  20. Short segmental pedicle screw fixation combined with percutaneous vertebroplasty in treatment of nonadjacent thoracolumbar fractures

    Institute of Scientific and Technical Information of China (English)

    HE Qing-yi; XU Jian-zhong

    2009-01-01

    To evaluate the short-term outcomes of short segmental pedicle screw fixation combined with per-cutaneous vertebroplasty in treatment of nonadjacent tho-racolumbar fractures. Methods: Twenty patients who suffered from nonadja-cent thoracolumbar fractures were treated by short segmental pedicle screw fixation for burst fracture and by percutane-ous vertebroplasty for compression fracture. X-rays, CT and MRI scans were conducted using the same protocol before and after surgery and during follow-up. Pre- and post-operative American Spinal Injury Association (ASIA) grades, fusion of fracture sites, visual analog scale (VAS) of back pain, and Oswestry disability index (ODI) were accessed. Results: All patients were followed up for an average period of 12 months. The sagittal profile of the thoracolum-bar spine was restored satisfactorily. No patient had neuro-logic deterioration after surgery, and 9 patients with incom-plete lesions improved postoperatively by at least one ASIA grade. The fusion rate was 100%. The average VAS of back pain was 7.6 preoperatively and 3.2 postoperatively. The average ODI was 72.5 preoperatively and 35.5 postoperatively. Conclusions: Short segmental pedicle screw fixation combined with percutaneous vertebroplasty in treatment of nonadjacent thoracolumbar fractures exhibits such advan-tages as preserving functional segment units, reliable fixation, good neurologic recovery and early mobilization and, therefore, is suitable for treating nonadjacent thora-columbar fractures.

  1. Posterior interbody fusion using a diagonal cage with unilateral transpedicular screw fixation for lumbar stenosis.

    Science.gov (United States)

    Zhao, Jian; Zhang, Feng; Chen, Xiaoqing; Yao, Yu

    2011-03-01

    Few reports have described the combined use of unilateral pedicle screw fixation and interbody fusion for lumbar stenosis. We retrospectively reviewed 79 patients with lumbar stenosis. The rationale and effectiveness of unilateral pedicle screw fixation were studied from biomechanical and clinical perspectives, aiming to reduce stiffness of the implant. All patients were operated with posterior interbody fusion using a diagonal cage in combination with unilateral transpedicular screw fixation and had reached the 3-year follow-up interval after operation. The mean operating time was 115 minutes (range=95-150 min) and the mean estimated blood loss was 150 mL (range=100-200 mL). The mean duration of hospital stay was 10 days (range=7-15 days). Clinical outcomes were assessed prior to surgery and reassessed at intervals using Denis' pain and work scales. Fusion status was determined from X-rays and CT scans. At the final follow-up, the clinical results were satisfactory and patients showed significantly improved scores (pdiagonal cage with unilateral transpedicular fixation is an effective treatment for decompressive surgery for lumbar stenosis.

  2. Cement embolism into the venous system after pedicle screw fixation: case report, literature review, and prevention tips

    Directory of Open Access Journals (Sweden)

    Ghassan Kerry

    2013-09-01

    Full Text Available The strength of pedicle screws attachment to the vertebrae is an important factor affecting their motion resistance and long term performance. Low bone quality, e.g. in osteopenic patients, keeps the screw bone interface at risk for subsidence and dislocation. In such cases, bone cement could be used to augment pedicle screw fixation. But its use is not free of risk. Therefore, clinicians, especially spine surgeons, radiologists, and internists should become increasingly aware of cement migration and embolism as possible complications. Here, we present an instructive case of cement embolism into the venous system after augmented screw fixation with fortunately asymptomatic clinical course. In addition we discuss pathophysiology and prevention methods as well as therapeutic management of this potentially life-threatening complication in a comprehensive review of the literature. However, only a few case reports of cement embolism into the venous system were published after augmented screw fixation.

  3. Percutaneous Screw Fixation of Crescent Fracture-Dislocation of the Sacroiliac Joint.

    Science.gov (United States)

    Shui, Xiaolong; Ying, Xiaozhou; Mao, Chuanwan; Feng, Yongzeng; Chen, Linwei; Kong, Jianzhong; Guo, Xiaoshan; Wang, Gang

    2015-11-01

    Crescent fracture-dislocation of the sacroiliac joint (CFDSIJ) is a type of lateral compression pelvic injury associated with instability. Open reduction and internal fixation is a traditional treatment of CFDSIJ. However, a minimally invasive method has never been reported. The purpose of this study was to assess the outcome of closed reduction and percutaneous fixation for different types of CFDSIJ and present their clinical outcome. The authors reviewed 117 patients diagnosed with CFDSIJ between July 2003 and July 2013. Closed reduction and percutaneous fixation was performed in 73 patients. Treatment selection was based on Day's fracture classification. For type I fractures, fixation perpendicular to the fracture line were performed. For type II fractures, crossed fixation was performed. For type III fractures, fixation was performed with iliosacral screws. Forty-four patients were treated by open reduction and plate fixation. Demographics, fracture pattern distribution, blood loss, incision lengths, revision surgeries, radiological results, and functional scores were compared. All 117 patients were followed for more than 6 months (mean, 14 months [range, 6-24 months]). Blood loss, extensive exposure, duration of posterior ring surgery, duration of hospital stay, and infection rates were lower in the closed group (P<.01). Patients in the closed group achieved better functional performance (P<.01). There were no significant differences in reduction quality (P=.32), revision surgery rates (P=.27), and iatrogenic neurologic injuries (P=.2) between the 2 groups. The authors' results indicate that closed reduction and percutaneous fixation is a safe and effective surgical method for CFDSIJ. PMID:26558677

  4. Interference screw fixation and short harvest using flexor digitorum longus (FDL) transfer for posterior tibial tendon dysfunction: a technique.

    Science.gov (United States)

    Bussewitz, Bradly W; Hyer, Christopher F

    2010-01-01

    Posterior tibial tendon dysfunction is a common clinical entity treated by foot and ankle specialists, and numerous surgical treatments are available to the modern foot and ankle surgeon. Fixation methods are constantly evolving as new products are developed and new uses for existing products are attempted. Interference screw fixation is the gold standard fixation for tendon autograft and allograft in orthopedic sports medicine. The technique that we describe in this article uses a less extensive harvest of the flexor digitorum longus tendon and a sound fixation method using an interference screw positioned in the tarsal navicular. PMID:20797592

  5. Estudo biomecânico da fixação transcortical ou transesponjosa do enxerto de tendão patelar com pinos bioabsorvíveis na reconstrução do LCA em ovinos Biomechanical study of transcortical or transtrabecular bone fixation of patellar tendon graft with bioabsorbable pins in ACL reconstruction in sheep

    Directory of Open Access Journals (Sweden)

    Mauro Batista Albano

    2012-02-01

    mm metal interference screws. RESULTS: comparison of the Rigidfix® method with the metal interference screw fixation method did not show any statistically significant differences in terms of maximum load and rigidity; also, there were no statistically significant differences when the rotational position of the bone block was altered inside the femoral tunnel. For these evaluations, a level of significance of p < 0.017 was considered. CONCLUSION: fixation of the bone-tendon-bone graft with 2 bioabsorbable pines, regardless of the rotational position inside the femoral tunnel, gave a comparable fixation in terms of initial resistance to the metal interference screw, in this experimental model.

  6. "NIMS technique" for minimally invasive spinal fixation using non-fenestrated pedicle screws: A technical note

    Directory of Open Access Journals (Sweden)

    Alugolu Rajesh

    2015-01-01

    Full Text Available Study Design: Case series. Objective: To reduce the cost of minimally invasive spinal fixation. Background: Minimally invasive spine (MIS surgery is an upcoming modality of managing a multitude of spinal pathologies. However, in a resource-limited situations, using fenestrated screws (FSs may prove very costly for patients with poor affordability. We here in describe the Nizam′s Institute of Medical Sciences (NIMS experience of using routine non-FSs (NFSs for transpedicular fixation by the minimally invasive way to bridge the economic gap. Materials and Methods: A total of 7 patients underwent NFS-minimally invasive spine (MIS surgery. Male to female distribution was 6:1. The average blood loss was 50 ml and the mean operating time was 2 and 1/2 h. All patients were mobilized the very next day after confirming the position of implants on X-ray/computed tomography. Results: All 7 patients are doing well in follow-up with no complaints of a backache or fresh neurological deficits. There was no case with pedicle breach or screw pullout. The average cost of a single level fixation by FS and NFS was `1, 30,000/patient and `32,000/patient respectively ($2166 and $530, respectively. At the end of 1-year follow-up, we had two cases of screw cap loosening and with a displacement of the rod cranio-caudally in one case which was revised through the same incisions. Conclusions: Transpedicular fixation by using NFS for thoracolumbar spinal pathologies is a cost-effective extension of MIS surgery. This may extend the benefits to a lower socioeconomic group who cannot afford the cost of fenestrated screw (FS.

  7. Sliding-screw plate fixation of proximal femoral fractures: Radiographic assessment

    International Nuclear Information System (INIS)

    The sliding compression screw-sideplate combination is currently the most widely employed device for internal fixation of stable and unstable intertrochanteric fractures of the femur. The normal and abnormal radiogrpahic appearances of this device in the immediate post-operative period are discussed. Potential long-term complications including mal- or non-union, intra-articular penetration, metal failure, rotation of the proximal fracture fragment, disengagement, trochanteric bursitis, leg length discrepancy, delayed cervical stress fracture, and ischemic necrosis are reviewed. (orig.)

  8. Surgical complications in neuromuscular scoliosis operated with posterior- only approach using pedicle screw fixation

    Directory of Open Access Journals (Sweden)

    Singh Surya Udai

    2009-05-01

    Full Text Available Abstract Background There are no reports describing complications with posterior spinal fusion (PSF with segmental spinal instrumentation (SSI using pedicle screw fixation in patients with neuromuscular scoliosis. Methods Fifty neuromuscular patients (18 cerebral palsy, 18 Duchenne muscular dystrophy, 8 spinal muscular atrophy and 6 others were divided in two groups according to severity of curves; group I ( 90°. All underwent PSF and SSI with pedicle screw fixation. There were no anterior procedures. Perioperative (within three months of surgery and postoperative (after three months of surgery complications were retrospectively reviewed. Results There were fifty (37 perioperative, 13 postoperative complications. Hemo/pneumothorax, pleural effusion, pulmonary edema requiring ICU care, complete spinal cord injury, deep wound infection and death were major complications; while atelectesis, pneumonia, mild pleural effusion, UTI, ileus, vomiting, gastritis, tingling sensation or radiating pain in lower limb, superficial infection and wound dehiscence were minor complications. Regarding perioperative complications, 34(68% patients had at least one major or one minor complication. There were 16 patients with pulmonary, 14 with abdominal, 3 with wound related, 2 with neurological and 1 cardiovascular complications, respectively. There were two deaths, one due to cardiac arrest and other due to hypovolemic shock. Regarding postoperative complications 7 patients had coccygodynia, 3 had screw head prominence, 2 had bed sore and 1 had implant loosening, respectively. There was a significant relationship between age and increased intraoperative blood loss (p = 0.024. However it did not increased complications or need for ICU care. Similarly intraoperative blood loss > 3500 ml, severity of curve or need of pelvic fixation did not increase the complication rate or need for ICU. DMD patients had higher chances of coccygodynia postoperatively. Conclusion

  9. Technique and nuances of an S-2 alar iliac screw for lumbosacral fixation in patients with transitional and normal anatomy.

    Science.gov (United States)

    Ohya, Junichi; Vogel, Todd D; Dhall, Sanjay S; Berven, Sigurd; Mummaneni, Praveen V

    2016-07-01

    S-2 alar iliac (S2AI) screw fixation has recently been recognized as a useful technique for pelvic fixation. The authors demonstrate two cases where S2AI fixation was indicated: one case was a sacral insufficiency fracture following a long-segment fusion in a patient with a transitional S-1 vertebra; the other case involved pseudarthrosis following lumbosacral fixation. S2AI screws offer rigid fixation, low profile, and allow easy connection to the lumbosacral rod. The authors describe and demonstrate the surgical technique and nuances for the S2AI screw in a case with transitional S-1 anatomy and in a case with normal S-1 anatomy. The video can be found here: https://youtu.be/Sj21lk13_aw . PMID:27364429

  10. Combining of small fragment screws and large fragment plates for open reduction and internal fixation of periprosthetic humeral fractures

    Directory of Open Access Journals (Sweden)

    Dominik Seybold

    2011-01-01

    Full Text Available Operative treatment of periprosthetic humeral fractures in elderly patients with osteoporotic bone requires a stable fixations technique. The combination of 3.5 cortical screws with washers in a 4.5 Arbeitsgemeinschaft fόr Osteosynthesefragen, Limited-contact dynamic compression plate or Locking plate, allows a stable periprosthetic fixation with the small 3.5 screws and 4.5 screws above and below the prosthesis, respectively. This combination is a cost-effective technique to treat periprosthetic humeral fractures.

  11. Combined Percutaneous Iliosacral Screw Fixation With Sacroplasty Using Resorbable Calcium Phosphate Cement for Osteoporotic Pelvic Fractures Requiring Surgery.

    Science.gov (United States)

    Collinge, Cory A; Crist, Brett D

    2016-06-01

    Osteoporotic sacral fractures, including acute and chronic insufficiency fractures, are increasing in frequency and present a number of management problem. Many of these patients are treated nonoperatively with relative immobility (eg, bedrest, wheelchair, or weight-bearing restrictions) and analgesics, which likely make the osteoporotic component worse. Surgery in this patient population may be desirable in some cases with the goals of improving mobility, relieving pain, and healing in an aligned position while minimizing deformity progression. However, internal fixation of the osteoporotic pelvis can be difficult. Large unicortical lag screws are the workhorse of posterior pelvic fixation, and yet fixation in cancellous bone corridors of an osteoporotic sacrum seems unlikely to achieve optimal fixation. As a result, the operative management and clinical results of these difficult injuries may not be uniformly successful. The authors present a technique for treating osteoporotic patients with a sacral fracture when operative treatment is indicated using percutaneous screw fixation combined with screw augmentation using a resorbable calcium phosphate bone substitute or "cement." The guide wire for a 7.3-mm or other large cannulated lag screw is fully inserted along the desired bony sacral corridor as is standard. The lag screw is then inserted over the wire to the depth where cement is desired. The guide wire is removed, and the aqueous calcium phosphate is injected through the screw's cannulation. For acute fractures, cement was applied to the areas distant to the fracture; whereas in insufficiency fractures, the cement was inserted along most of the screw path. The guide wire then can be reinserted and the lag screw fully inserted. The rationale for using these 2 modalities is their synergistic effect: the cannulated screw provides typical screw fixation and also a conduit for cement application. The cement augments the lag screw's purchase in osteoporotic bone

  12. Effects of Lateral Mass Screw Rod Fixation to the Stability of Cervical Spine after Laminectomy

    Science.gov (United States)

    Rosli, Ruwaida; Kashani, Jamal; Kadir, Mohammed Rafiq Abdul

    There are many cases of injury in the cervical spine due to degenerative disorder, trauma or instability. This condition may produce pressure on the spinal cord or on the nerve coming from the spine. The aim of this study was, to analyze the stabilization of the cervical spine after undergoing laminectomy via computational simulation. For that purpose, a three-dimensional finite element (FE) model for the multilevel cervical spine segment (C1-C7) was developed using computed tomography (CT) data. There are various decompression techniques that can be applied to overcome the injury. Usually, decompression procedures will create an unstable spine. Therefore, in these situations, the spine is often surgically restabilized by using fusion and instrumentation. In this study, a lateral mass screw-rod fixation was created to stabilize the cervical spine after laminectomy. Material properties of the titanium alloy were assigned on the implants. The requirements moments and boundary conditions were applied on simulated implanted bone. Result showed that the bone without implant has a higher flexion and extension angle in comparison to the bone with implant under applied 1Nm moment. The bone without implant has maximum stress distribution at the vertebrae and ligaments. However, the bone with implant has maximum stress distribution at the screws and rods. Overall, the lateral mass screw-rod fixation provides stability to the cervical spine after undergoing laminectomy.

  13. Alternative technique of cervical spinal stabilization employing lateral mass plate and screw and intra-articular spacer fixation

    OpenAIRE

    Atul Goel

    2013-01-01

    Aim: The author discusses an alternative technique of segmental cervical spinal fixation. Material and Methods: The subtleties of the technique are discussed on the basis of experience with 3 cases with a follow-up of between 30 and 36 months. Technique: The technique involves debridement of facetal articular cartilage, distraction of facets, jamming of ′Goel spacer′ into the articular cavity and fortification of the fixation by lateral mass plate and screw fixation. The ′double-insurance′ me...

  14. Lateral Condyle Fracture of the Humerus in Children Treated with Bioabsorbable Materials

    Directory of Open Access Journals (Sweden)

    Véronique Andrey

    2013-01-01

    Full Text Available The aim of this study was to compare clinical and radiological outcome of lateral condyle fracture of the elbow in children treated with bioabsorbable or metallic material. From January 2008 to December 2009, 16 children with similar fractures and ages were grouped according to the fixation material used. Children were seen at 3, 6, and 12 months and more than 4 years (mean 51.8 months postoperatively. The clinical results were compared using the Mayo Elbow Performance Score (MEPS. Radiographic studies of the fractured and opposite elbow were assessed at last follow-up control. Twelve children had a sufficient followup and could be included in the study. Seven could be included in the traditional group and 5 in the bioabsorbable group. At 12 months, the MEPS was 100 for every child in both groups. Asymptomatic bony radiolucent visible tracks and heterotopic ossifications were noted in both groups. There were no significant differences in terms of clinical and radiological outcome between the two groups. The use of bioabsorbable pins or screws is a reasonable alternative to the traditional use of metallic materials for the treatment of lateral condyle fracture of the elbow in children.

  15. Internal fixation with headless compression screws and back buttress plate for treatment of old Hoffa fracture

    Institute of Scientific and Technical Information of China (English)

    Min Li; Tu Chongqi; Wang Guanglin; Fang Yue; Duan Hong; Liu Lei; Zhang Hui

    2014-01-01

    Objective:To analyze the early clinical and radiographic outcomes of Hoffa fractures treated by a standard protocol of open reduction and internal fixation using headless compression screws combined with back buttress plate in a consecutive series of 8 Chinese patients.Methods:Open reduction and internal fixation was performed on all patients.The fractures were anatomically reduced and held temporarily by K-wire.If the ends of fractures were atrophic,autologous bone graft from the ipsilateral iliac crest was packed between the ends.Then the fracture fragments were fixed with AO 6.5 mm headless compression cannulated screws.At least two screws were used to provide rotational stability.One pre-contoured reconstruction plate was placed on the nonarticular surface posteromedially or posterolaterally as back buttress plate.Results:All the patients were followed up for at least 12 months (range 12-25 months).All fractures achieved anatomical reduction and healed clinically and radiographically.At recent follow-up,the mean flexion degree was 120.6° (range 110°-135°) and the mean extension degree was 2.5° (range 0°-5°).The average visual analogue scale score was 1.6 points (range 0-3).Six patients were assessed as excellent and 2 as good according to the hospital for special surgery knee score system.There were no superficial or deep infections,or hardware breakages.No patient had giving way or locking of the knee,though some had intermittent pain and swelling after strenuous exercise.Injury mechanism had significant influence on the functional outcome (P=0.046).Conclusion:Headless compression screws combined with back buttress plate and/or autologous bone grafting to treat old Hoffa fracture is one of effective measures.It would be conducive to not only fracture healing but also early exercise and functional recovery.

  16. Anterior transarticular screw fixation for atlantoaxial arthrodesis: A report of two cases

    OpenAIRE

    Carrier, C. S.; A A Sama; Girardi, F. P.; Lebl, D. R.

    2013-01-01

    The sequelae of atlantoaxial instability (AAI) range from axial neck pain to life-threatening neurologic injury. Instrumentation and fusion of the C1-2 joint is often indicated in the setting of clinical or biomechanical instability. This is the first clinical report of anterior Smith-Robinson C1-2 transarticular screw (TAS) fixation for AAI. The first patient presented with ischemic brain tissue secondary to post-traumatic C1-2 segment instability from a MVC 7 years prior to presentation. Th...

  17. Experimental and Numerical Analysis of Screw Fixation in Anterior Cruciate Ligament Reconstruction

    Science.gov (United States)

    Chizari, Mahmoud; Wang, Bin; Snow, Martyn; Barrett, Mel

    2008-09-01

    This paper reports the results of an experimental and finite element analysis of tibial screw fixation in anterior cruciate ligament (ACL) reconstruction. The mechanical properties of the bone and tendon graft are obtained from experiments using porcine bone and bovine tendon. The results of the numerical study are compared with those from mechanical testing. Analysis shows that the model may be used to establish the optimum placement of the tunnel in anterior cruciate ligament reconstruction by predicting mechanical parameters such as stress, strain and displacement at regions in the tunnel wall.

  18. Efficacy of arthroscopic reconstruction of anterior cruciate ligament with autogenous semitendinosus, gracilis muscle fixed by Endobutton system and bioabsorbable screw%关节镜下自体半腱肌、股薄肌、Endobutton系统和可吸收螺钉重建前交叉韧带疗效

    Institute of Scientific and Technical Information of China (English)

    朱伟; 孙俊英; 朱礼贤; 顾联

    2012-01-01

    目的 探讨利用Endobutton系统配合可吸收界面螺钉固定自体半腱肌、股薄肌肌腱重建膝关节前交叉韧带(ACL)的临床效果.方法 关节镜下利用自体半腱肌和股薄肌肌腱重建ACL治疗膝关节ACL损伤患者37例,ACL股骨髁部应用Endobutton系统方法固定,胫骨侧应用可吸收界面螺钉固定,ACL在胫骨和股骨侧的断裂残端保留.结果 所有患者随访时间6-18个月,术后Lysholm评分较术前提高[(91.7±4.2)分vs.(53.6±4.8)分](P<0.05).结论 自体半腱肌、股薄肌、Endobutton系统和可吸收界面螺钉重建ACL具有近期疗效满意、移植物固定可靠、操作简单、并发症少等优点.%Objective To investigate the efficacy of arthroscopic reconstruction of anterior cruciate ligament(ACL) with autogenous semitendinosus,gracilis muscle fixed by Endobutton system and bioabsorbable screw. Methods The injured ACLs of 37 cases were reconstructed by means of autogenous semitendinosus and gracilies tendon autograft under arthroscopy. The femoral side was fixed using Endobutton system and the tibial side was fixed by absorbable interference screw. ACL tibial and femoral stumps were reserved. Results All patients were followed up for 6 to 18 months. Compared to before, the Lysholm score after operation was elevated from (53. 6±4. 8) points to (91. 7 ±4. 2) points(P<0. 05). Conclusion Autogenous semitendinosus and gracilies tendon autograft fixed by Endobutton system and absorbable interference screw has the advantages of simple operation, firm fixation and less complications.

  19. Improving fixation strength of pedicle screw by microarc oxidation treatment: an experimental study of osteoporotic spine in sheep.

    Science.gov (United States)

    Shi, Lei; Wang, Ling; Zhang, Yang; Guo, Zheng; Wu, Zi-xiang; Liu, Da; Gao, Ming-xuan; Chen, Huan; Fu, Suo-chao; Lei, Wei

    2012-08-01

    Failure of fixation caused by loosening of pedicle screws in osteoporosis is a problem in spinal surgery. We compared the in vivo fixation strength between pedicle screws treated with microarc oxidation (MAO) and untreated screws in an osteoporotic model of ovariectomized sheep. The MAO treated and untreated screws were placed in lumbar vertebral bodies. After 3 months of implantation, biomechanical tests, micro-CT analysis, and histological observations were conducted to examine the performance of the two groups. At time 0, no significant difference was found between the two groups in biomechanical tests (p > 0.05); 3 months later, higher pull-out strength and load with less displacement were detected in the MAO-treated group (p CT analysis showed that the tissue mineral density, bone volume fraction, trabecular thickness, and trabecular number in the MAO-treated group were all higher than those in untreated group (p sheep.

  20. Tibial inlay press-fit fixation versus interference screw in posterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Max Ettinger

    2013-11-01

    Full Text Available Reconstruction of the posterior cruciate ligament (PCL by a tibial press-fit fixation of the patellar tendon with an accessory bone plug is a promising approach because no foreign materials are required. Until today, there is no data about the biomechanical properties of such press-fit fixations. The aim of this study was to compare the biomechanical qualities of a bone plug tibial inlay technique with the commonly applied interference screw of patellar tendon PCL grafts. Twenty patellar tendons including a bone block were harvested from ten human cadavers. The grafts were implanted into twenty legs of adult German country pigs. In group P, the grafts were attached in a press-fit technique with accessory bone plug. In group S, the grafts were fixed with an interference screw. Each group consisted of 10 specimens. The constructs were biomechanically analyzed in cyclic loading between 60 and 250 N for 500 cycles recording elongation. Finally, ultimate failure load and failure mode were analyzed. Ultimate failure load was 598.6±36.3 N in group P and 653.7±39.8 N in group S (not significant, P>0.05. Elongation during cyclic loading between the 1st and the 20th cycle was 3.4±0.9 mm for group P and 3.1±1 mm for group S. Between the 20th and the 500th cycle, elongation was 4.2±2.3 mm in group P and 2.5±0.9 mm in group S (not significant, P>0.05. This is the first study investigating the biomechanical properties of tibial press-fit fixation of the patellar tendon with accessory bone plug in posterior cruciate ligament reconstruction. The implant-free tibial inlay technique shows equal biomechanical characteristics compared to an interference screw fixation. Further in vivo studies are desirable to compare the biological behavior and clinical relevance of this fixation device.

  1. Computed tomography- and fluoroscopy-guided percutaneous screw fixation of low-grade isthmic spondylolisthesis in adults: a new technique

    Energy Technology Data Exchange (ETDEWEB)

    Amoretti, Nicolas; Huwart, Laurent; Browaeys, Patrick; Nouri, Yasir; Ibba, Caroline [Hopital Archet 2, Centre Hospitalo-Universitaire de Nice, Department of Radiology, Nice (France); Hauger, Olivier [Hopital Pellegrin, Centre Hospitalo-Universitaire de Bordeaux, Department of Radiology, Bordeaux (France); Marcy, Pierre-Yves [Antoine Lacassagne Cancer Research Institute, Department of Radiology, Nice (France); Boileau, Pascal [Hopital Archet 2, Centre Hospitalo-Universitaire de Nice, Department of Orthopedic Surgery, Nice (France)

    2012-12-15

    To evaluate the feasibility of computed tomography (CT)- and fluoroscopy-guided percutaneous screw fixation for the treatment of low-grade isthmic spondylolisthesis in adults. Ten consecutive adult patients (four men and six women; mean age: 57.1 [range, 44-78 years]) were prospectively treated by percutaneous screw fixation for low-grade (six grade 1 and four grade 2) isthmic spondylolisthesis of L5. For each patient, two 4.0-mm Asnis III cannulated screws were placed to fix the pars interarticularis defects. All procedures were performed under local anaesthesia by using CT and fluoroscopy guidance. Post-operative outcome was assessed using the visual analogue scale and Oswestry Disability Index (ODI) scores. The procedure time ranged from 45 to 60 min. The mean screw length was 27 mm (range, 24-32 mm). The VAS and ODI measurements {+-} SD decreased from 7.8 {+-} 0.9 preoperatively to 1.5 {+-} 1.1 at the last 2-year follow-up, and from 62.3 {+-} 17.2 to 15.1 {+-} 6.0, respectively (P < 0.001 in both cases). Neither slip progression nor screw failure was noted. This feasibility study showed that CT- and fluoroscopy-guided percutaneous screw fixation could be a rapid, safe and effective method of treating low-grade isthmic spondylolisthesis. (orig.)

  2. CT analysis of the axis for transarticular screw fixation of rheumatoid atlantoaxial instability

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Sung Soo; Lee, Chong Suh; Kang, Chang Seok [Sungkyunkwan University School of Medicine, Department of Orthopedic Surgery, Samsung Medical Center, Seoul (Korea); Chung, Hye Won [Sungkyunkwan University School of Medicine, Department of Radiology, Samsung Medical Center, Seoul (Korea)

    2006-09-15

    To investigate the morphological characteristics of the axis of rheumatoid arthritis (RA) patients with atlantoaxial instability and to determine, by means of sagittal reconstructed computed tomography (CT), the suitability for atlantoaxial transarticular screw fixation. Twenty-seven patients, who had undergone reconstructed cervical spine CT scanning preoperatively and posterior atlantoaxial arthrodesis for atlantoaxial instability, were identified from a database for inclusion in this study. The isthmus height and internal height of the lateral mass of the axis were measured using digital imaging software. The mean isthmus height and internal height of the lateral mass of the axis in RA patients (n=14) were significantly lower than in non-RA patients (n=13) (P<0.01). A high-riding vertebral artery (VA) was present in 54% (15 joints, 9 patients) of the 28 atlantoaxial joints in the RA group and in 12% (3 joints, 2 patients) of the 26 atlantoaxial joints in the non-RA group (P<0.01). In RA patients, the axis showed more extensive thinning of the isthmus and lateral mass than in non-RA patients. A precise preoperative evaluation of screw trajectory using reconstruction CT imaging may be useful in atlantoaxial transarticular fixation, particularly for RA patients with atlantoaxial instability. (orig.)

  3. Evaluation of Occipitocervical Arthrodesis Rates with Screw-based Fixation and Osteoinductive Fusion Adjuncts.

    Science.gov (United States)

    Stone, Jeremy G; Panczykowski, David M; Tempel, Zachary J; Tormenti, Matthew; Kanter, Adam S; Okonkwo, David O

    2015-09-01

    Occipitocervical (OC) instability may be associated with neurologic impairment and even death. There is a paucity of research on the rate of arthrodesis utilizing modern screw-based constructs coupled with adjuvant osteoinductive agents. We reviewed our experience with OC constructs and compared the fusion rate, functional outcome, and rate of adverse events between recombinant human bone morphogenetic protein (BMP)-2, autologous iliac crest bone graft (ICBG), a combination of BMP and ICBG, and local bone autograft alone. We performed a retrospective cohort analysis of all adult admissions for operative treatment of OC instability utilizing segmental screw-based constructs for OC arthrodesis between January 2003 and September 2012. Data concerning demographic characteristics, diagnostic and procedural details, radiographic pathology, and clinical course were abstracted from medical records. The primary end point was evidence of stable fixation and osseous union on either dynamic lateral radiographs or computed tomography (CT) imaging at most recent follow-up. Secondary end points included functional outcome as determined by Nurick scale and Neck disability index (NDI) at ≥ 1year postoperation, as well as perioperative morbidity and mortality at 30 days and 3 months. During the study period, 94 patients (mean age: 62 ± 18 years) underwent OC fixation with segmental screw-based constructs. The four fusion adjunct cohorts analyzed included local autograft alone (32%), ICBG (41%), BMP (14%), or a combination of ICBG and BMP (14%). Notably, demineralized bone matrix was also used in 61% of cases overall, but its use did not differ significantly among the four cohorts (p = 0.28). Median radiographic follow-up was 6 months postoperatively (range: 1.5-54 months). Clinical outcomes were assessed at a median postoperative follow-up of 45 months (range: 12-87 months). Overall, radiographic evidence of arthrodesis was present in 83% of patients assessed and was

  4. Comparison of Surgical Outcomes Between Short-Segment Open and Percutaneous Pedicle Screw Fixation Techniques for Thoracolumbar Fractures.

    Science.gov (United States)

    Fu, Zhiguo; Zhang, Xi; Shi, Yaohua; Dong, Qirong

    2016-01-01

    BACKGROUND This study aimed to compare the surgical outcomes between open pedicle screw fixation (OPSF) and percutaneous pedicle screw fixation (PPSF) for the treatment of thoracolumbar fractures, which has received scant research attention to date. MATERIAL AND METHODS Eight-four patients with acute and subacute thoracolumbar fractures who were treated with SSPSF from January 2013 to June 2014 at the Changzhou Hospital of Traditional Chinese Medicine (Changzhou, China) were retrospectively reviewed. The patients were divided into 4 groups: the OPSF with 4 basic screws (OPSF-4) group, the OPSF with 4 basic and 2 additional screws (OPSF-6) group, the PPSF with 4 basic screws (PPSF-4) group, and the PPSF with 4 basic and 2 additional screws (PPSF-6) group. The intraoperative, immediate postoperative, and over 1-year follow-up outcomes were evaluated and compared among these groups. RESULTS Blood loss in the PPSF-4 group and the PPSF-6 group was significantly less than in the OPSF-4 group and the OPSF-6 group (Pfractured vertebra than the other 3 groups (Pfractured vertebrae at final follow-up among the 4 groups (P>0.05). CONCLUSIONS OPSF with 6 screws had an advantage in the correction of injured vertebral height and kyphosis, and PPSF reduced the intraoperative blood loss of patients. PMID:27602557

  5. Comparison of the safety of three methods of lumbar transpedicular screw fixation

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective: To choose a proper method of lumbar transpedicular screw fixation at different lumbar levels among the three methods ( Roy-Camille's method, Magerl's method and Du's method) in the Chinese population.Methods: Three-dimensional ( 3-D ) images were reconstructed with image data of 42 adult lumbar segments that were scanned by Electron Beam CT. The three methods of lumbar pedicle screw fixation were simulated on the 3-D reconstructed images and the parameters of implanting pedicle screws were measured.Results: There was statistically significant difference at the distance from the entrance point to the pedicle axis between the three methods (P < 0. 001). The distances measured by Du's method were shortest from L1 to L4,and the distances measured by Magerl's method were shortest at L5 (P < 0.05). There was no significant difference from L1 to L2 (P > 0.05) but significant difference from L3 to L5 at inserting safe ranges of TSA (transverse section angle) was found between the three methods (P <0.05). From L3 to L4, the inserting safe ranges of TSA measured by Du's and Magerl's methods were significantly larger than that measured by Roy-Camille's method (P <0.05), but there was no significant difference between them (P > 0.05). At L5, the inserting safe ranges of TSA measured by Magerl's method were largest among the three methods (P < 0.05).Conclusions: Among the three methods, Du's method is the best choice from L1 to LA because its distance from the entrance point to the pedicle axis is shortest and the safe range of TSA is largest; Magerl's method can be used from L3 to L5 and is the best choice at L5; Roy-Camille's method is applicable at L1 and L2.

  6. Odontoid balloon kyphoplasty associated with screw fixation for Type II fracture in 2 elderly patients.

    Science.gov (United States)

    Terreaux, Luc; Loubersac, Thomas; Hamel, Olivier; Bord, Eric; Robert, Roger; Buffenoir, Kevin

    2015-03-01

    Anterior screw fixation is a well-recognized technique that is used to stabilize Type IIB fractures of the odontoid process in the elderly. However, advanced age and osteoporosis are 2 risk factors for pseudarthrosis. Kyphoplasty has been described in the treatment of lytic lesions in C-2. The authors decided to combine these 2 techniques in the treatment of unstable fractures of the odontoid. Two approximately 90-year-old patients were treated for this type of fracture. Instability was demonstrated on dynamic radiography in one patient, and the fracture was seen on static radiography in the other. Clinical parameters, pain, range of motion, 36-Item Short Form Health Survey (SF-36) score (for the first patient), and radiological examinations (CT scans and dynamic radiographs) were studied both before and after surgery. After inflating the balloon both above and below the fracture line, the authors applied a high-viscosity polymethylmethacrylate cement. Some minor leakage of cement was noted in both cases but proved to be harmless. The screws were correctly positioned. The clinical result was excellent, both in terms of pain relief and in the fact that there was no reduction in the SF-36 score. The range of motion remained the same. A follow-up CT scan obtained 1 year later in one of the patients showed no evidence of change in the materials used, and the dynamic radiographs showed no instability. This combination of kyphoplasty and anterior screw fixation of the odontoid seems to be an interesting technique in osteoporotic Type IIB fractures of the odontoid process in the elderly, with good results both clinically and radiologically.

  7. Biomechanical Comparison Between Bashti Bone Plug Technique and Biodegradable Screw for Fixation of Grafts in Ligament surgery

    OpenAIRE

    Kaveh Bashti; Mohammad Naghi Tahmasebi; Hasan Kaseb; Farzam Farahmand; Mohammad Akbar; Amir Mobini

    2015-01-01

      Background: Ligament reconstruction is a common procedure in orthopedic surgery. Although several popular techniques are currently in use, new methods are proposed for secure fixation of the tendon graft into the bone tunnel. Purposes: We sought to introduce our new technique of Bashti bone plug for fixation of soft tissue graft in anterior cruciate ligament (ACL) reconstruction and to compare its biomechanical features with conventional absorbable interference screw technique in a bovine ...

  8. A STUDY OF FUNCTIONAL AND RADIOLOGICAL OUTCOME OF UNDISPLACED SCAPHOID FRACTURES TREATED WITH PERCUTANEOUS HEADLESS SCREW FIXATION

    Directory of Open Access Journals (Sweden)

    Tarigopula

    2016-04-01

    Full Text Available BACKGROUND Scaphoid is the most commonly fractured carpal bone, accounting for approximately 60% of all carpal fractures. This injury is commonly seen in active young adults after a fall on an outstretched hand. Management of scaphoid fractures is controversial. Displaced scaphoid fractures are associated with risk of non-union and osteonecrosis. Surgical fixation is recommended for displaced scaphoid fractures of proximal pole, fractures with delayed treatment or diagnosis and non-union. Open reduction and internal fixation of acute scaphoid fractures has been reported to give good results in several nonrandomised, retrospective studies. The incidence of complications after operative treatment of non-displaced fractures has decreased with the advent of safer, more reliable implants and percutaneous techniques. CONCLUSION Percutaneous headless screw fixation is a well-documented surgical procedure. Undisplaced scaphoid fractures fixed by percutaneous headless screw fixation yield better results than patients treated conservatively. Good range of motion is achieved after fixation. It relieves pain and functional disability experienced by patients. Patients achieve good range of motion. Trabecular continuity is achieved in most of the patients before 8 weeks. Most of the patients had resumed normal daily activities before 3 months. This study suggests that percutaneous headless screw fixation for undisplaced scaphoid fractures provides satisfactory clinical and radiographic outcomes after an intermediate duration follow-up. Even though the procedure is not free of complications, the overall functional and clinical outcome had shown good results.

  9. Biomechanical Comparison Between Bashti Bone Plug Technique and Biodegradable Screw for Fixation of Grafts in Ligament surgery

    Directory of Open Access Journals (Sweden)

    Kaveh Bashti

    2015-01-01

    Full Text Available   Background: Ligament reconstruction is a common procedure in orthopedic surgery. Although several popular techniques are currently in use, new methods are proposed for secure fixation of the tendon graft into the bone tunnel. Purposes: We sought to introduce our new technique of Bashti bone plug for fixation of soft tissue graft in anterior cruciate ligament (ACL reconstruction and to compare its biomechanical features with conventional absorbable interference screw technique in a bovine model. Methods: Twenty pairs of bovine knees were harvested after death. Soft tissue was removed and the Achilles tendon was harvested to be used as an ACL graft. It was secured into the bone tunnel on the tibial side via two different methods: Bashti Bone Plug technique and conventional screw method. Biomechanical strength was measured using 200 N and 300 N cyclic loading on the graft. Pull out strength was also tested until the graft fails. Results: No graft failure was observed after 200 N and 300 N cyclic loading in either fixation methods. When testing for pull out failure, 21 tendons (53% were torn and 19 tendons (48% slipped out. No fixation failure occurred, which did not reveal a significant difference between the bone plug or interference screw group (P=0.11. The mean pull out force until failure of the graft was 496±66 N in the screw group and 503±67 N in the bone plug group (P=0.76. Conclusions: Our suggested fixation technique of Bashti bone plug is a native, cheap, and feasible method that provides comparable biomechanical strength with interference screw when soft tissue fixation was attempted in bovine model.

  10. Percutaneous Cement-Augmented Screws Fixation in the Fractures of the Aging Spine: Is It the Solution?

    Directory of Open Access Journals (Sweden)

    Sébastien Pesenti

    2014-01-01

    Full Text Available Introduction. Management of elderly patients with thoracolumbar fractures is still challenging due to frequent osteoporosis and risk of screws pull-out. The aim of this study was to evaluate results of a percutaneous-only procedure to treat these fragile patients using cement-augmented screws. Methods. 12 patients diagnosed with a thoracolumbar fracture associated with an important loss of bone stock were included in this prospective study. Surgical procedure included systematically a percutaneous osteosynthesis using cemented fenestrated screws. When necessary, additional anterior support was performed using a kyphoplasty procedure. Clinical and radiographic evaluations were performed using CT scan. Results. On the whole series, 15 fractures were diagnosed and 96 cemented screws were inserted. The difference between the pre- and postoperative vertebral kyphosis was statistically significant (12.9° versus 4.4°, P=0.0006. No extrapedicular screw was reported and one patient was diagnosed with a cement-related pulmonary embolism. During follow-up period, no infectious complications, implant failures, or pull-out screws were noticed. Discussion. Aging spine is becoming an increasing public health issue. Management of these patients requires specific attention due to the augmented risk of complications. Using percutaneous-only screws fixation with cemented screw provides satisfactory results. A rigorous technique is mandatory in order to achieve best outcomes.

  11. Alternative technique of cervical spinal stabilization employing lateral mass plate and screw and intra-articular spacer fixation

    Directory of Open Access Journals (Sweden)

    Atul Goel

    2013-01-01

    Full Text Available Aim: The author discusses an alternative technique of segmental cervical spinal fixation. Material and Methods: The subtleties of the technique are discussed on the basis of experience with 3 cases with a follow-up of between 30 and 36 months. Technique: The technique involves debridement of facetal articular cartilage, distraction of facets, jamming of ′Goel spacer′ into the articular cavity and fortification of the fixation by lateral mass plate and screw fixation. The ′double-insurance′ method of fixation is safe for vertebral artery, nerve roots and spinal neural structures and the fixation is strong. Conclusions: The discussed technique is safe and provides a strong fixation and a ground for ultimate arthrodesis.

  12. Anterior transarticular screw fixation for atlantoaxial arthrodesis: A report of two cases

    Directory of Open Access Journals (Sweden)

    C S Carrier

    2013-01-01

    Full Text Available The sequelae of atlantoaxial instability (AAI range from axial neck pain to life-threatening neurologic injury. Instrumentation and fusion of the C1-2 joint is often indicated in the setting of clinical or biomechanical instability. This is the first clinical report of anterior Smith-Robinson C1-2 transarticular screw (TAS fixation for AAI. The first patient presented with ischemic brain tissue secondary to post-traumatic C1-2 segment instability from a MVC 7 years prior to presentation. The second patient presented with a 3 year history of persistent right-sided neck and upper scalp pain. Both were treated with transarticular C1-2 fusion through decortication of the atlantoaxial facet joints and TAS fixation via the anterior Smith-Robinson approach. At 16 months follow-up, the first patient maintained painless range of motion of the cervical spine and denied sensorimotor deficits. The second patient reported 90% improvement in her pre-operative symptoms of neck pain and paresthesia. Anterior Smith-Robinson C1-2 TAS fixation provides a useful alternative to the posterior Goel and Magerl techniques for C1-2 stabilization and fusion.

  13. Accuracy and complications of posterior C2 screw fixation using intraoperative three-dimensional fluoroscopy-based navigation

    Institute of Scientific and Technical Information of China (English)

    Tao Xiaohui; Tian Wei; Liu Bo; Li Qin; Zhang Guilin

    2014-01-01

    Background The peculiar and highly variable C2 anatomy can make screw fixation more challenging and prone to potential vertebral artery or neurologic injury.Conventional C-arm fluoroscopy has several drawbacks.The aim of this research was to evaluate the accuracy of posterior C2 screw fixation using intraoperative three-dimensional fluoroscopybased navigation (ITFN) and assess the perioperative complication rate related to screw placement.Methods A retrospective review identified patients who underwent operative management with C2 instruments using ITFN at our hospital between January 2006 and December 2012.Clinical data were obtained from medical records and final screw positions were graded according to a modified classification of Gertzbein and Robbins.Grade A and B screws were considered well positioned.Results The study included 99 patients (53 males and 46 females) who underwent posterior C2 screw fixation using ITFN.The mean Japan Orthopedic Association score improved from (6.7±1.9) points before surgery to (12.5±2.7) points at 6-month follow-up (z=+8.628,P <0.01).The mean visual analogue scale improved from (4.1±1.2) points before surgery to (0.7±0.9) points at 6-month follow-up,with an improvement of 83.7% (z=8.638,P < 0.01).Of the 196 screws analyzed using computed tomography and chart review,126 transarticular,64 pedicle,and 6 pars screws were placed with 82.5% (104/126),89.1% (57/64),and 100% (6/6) accuracy (grade A),respectively; 98.5% (193/196) of screws were grade A or B (grade C,1.5% (3/196)),and no neurologic injuries occurred.In normal C2 cases,93 transarticulars and 47 pedicles were placed with high accuracy rates of 90.3% (84/93) and 93.6% (44/47) (grade A),respectively.However,in cases with C2 deformity,33 transarticular,17 pedicle,and 6 pars screws were placed with only 60.6% (20/33),76.5% (13/17),and 100% (6/6) accuracy (grade A),respectively.Conclusion ITFN is a safe,accurate,and effective tool for posterior C2

  14. Biomechanical effects of polyaxial pedicle screw fixation on the lumbosacral segments with an anterior interbody cage support

    Directory of Open Access Journals (Sweden)

    Chen Hsiang-Ho

    2007-03-01

    Full Text Available Abstract Background Lumbosacral fusion is a relatively common procedure that is used in the management of an unstable spine. The anterior interbody cage has been involved to enhance the stability of a pedicle screw construct used at the lumbosacral junction. Biomechanical differences between polyaxial and monoaxial pedicle screws linked with various rod contours were investigated to analyze the respective effects on overall construct stiffness, cage strain, rod strain, and contact ratios at the vertebra-cage junction. Methods A synthetic model composed of two ultrahigh molecular weight polyethylene blocks was used with four titanium pedicle screws (two in each block and two rods fixation to build the spinal construct along with an anterior interbody cage support. For each pair of the construct fixed with polyaxial or monoaxial screws, the linked rods were set at four configurations to simulate 0°, 7°, 14°, and 21° lordosis on the sagittal plane, and a compressive load of 300 N was applied. Strain gauges were attached to the posterior surface of the cage and to the central area of the left connecting rod. Also, the contact area between the block and the cage was measured using prescale Fuji super low pressure film for compression, flexion, lateral bending and torsion tests. Results Our main findings in the experiments with an anterior interbody cage support are as follows: 1 large segmental lordosis can decrease the stiffness of monoaxial pedicle screws constructs; 2 polyaxial screws rather than monoaxial screws combined with the cage fixation provide higher compression and flexion stiffness in 21° segmental lordosis; 3 polyaxial screws enhance the contact surface of the cage in 21° segmental lordosis. Conclusion Polyaxial screws system used in conjunction with anterior cage support yields higher contact ratio, compression and flexion stiffness of spinal constructs than monoaxial screws system does in the same model when the spinal segment

  15. Posterior lumbar interbody fusion using one diagonal fusion cage with transpedicular screw/rod fixation.

    Science.gov (United States)

    Zhao, Jie; Hou, Tiesheng; Wang, Xinwei; Ma, Shengzhong

    2003-04-01

    Posterior lumbar interbody fusion (PLIF) using threaded cages has gained wide popularity for lumbosacral spinal disease. Our biomechanical tests showed that PLIF using a single diagonal cage with unilateral facetectomy does add a little to spinal stability and provides equal or even higher postoperative stability than PLIF using two posterior cages with bilateral facetectomy. Studies also demonstrated that cages placed using a posterior approach did not cause the same increase in spinal stiffness seen with pedicle screw instrumentation, and we concluded that cages should not be used posteriorly without other forms of fixation. On the other hand, placement of two cages using a posterior approach does have the disadvantage of risk to the bilateral nerve roots. We therefore performed a prospective study to determine whether PLIF can be accomplished by utilizing a single diagonal fusion cage with the application of supplemental transpedicular screw/rod instrumentation. Twenty-seven patients underwent a PLIF using one single fusion cage (BAK, Sulzer Spine-Tech, Minneapolis, MN, USA) inserted posterolaterally and oriented anteromedially on the symptomatic side with unilateral facetectomy and at the same level supplemental fixation with a transpedicular screw/rod system. The internal fixation systems included 12 SOCON spinal systems (Aesculap AG, Germany) and 15 TSRH spinal systems (Medtronic Sofamor Danek, USA). The inclusion criteria were grade 1 to 2 lumbar isthmic spondylolisthesis, lumbar degenerative spondylolisthesis, and recurrent lumbar disc herniations with instability. Patients had at least 1 year of low back pain and/or unilateral sciatica and a severely restricted functional ability in individuals aged 28-55 years. Patients with more than grade 2 spondylolisthesis or adjacent-level degeneration were excluded from the study. Patients were clinically assessed prior to surgery by an independent assessor; they were then reassessed at 1, 3, 6, 12, 18, and 24

  16. Trans-sacral screw fixation in the treatment of high dyplastic developmental spondylolisthesis.

    Science.gov (United States)

    Landi, Alessandro; Marotta, Nicola; Mancarella, Cristina; Tarantino, Roberto; Delfini, Roberto

    2013-06-16

    We describe the case of a 67-year-old woman with L5-S1 ontogenetic spondylolisthesis treated with pedicle fixation associated with interbody arthrodesis performed with S1-L5 trans-sacral screwing according to the technique of Bartolozzi. The procedure was followed by a wide decompressive laminectomy. The patient had a progressive improvement of the symptoms which gradually disappeared in 12 mo. The radiograph at 6 and 12 mo showed complete fusion system. The choice of treatment in L5-S1 ontogenetic spondylolithesis is related to a correct clinical and diagnostic planning (X-ray, computer tomography magnetic resonance imaging, Measurement). In particular, the severity index and the square of unstable zone, and the standard measurements already described in the literature, are important to understand and to plane the correct surgical strategy, that require, in most of the times, fusion and interbody artrodesis.

  17. Bone cement enhanced pedicle screw fixation combined with vertebroplasty for elderly patients with malignant spinal tumors

    Institute of Scientific and Technical Information of China (English)

    TAN Jiang-wei; SHEN Bing-hua; DU Wei; LIU Jiang-qing; LU Shi-qiao

    2013-01-01

    Background Older patients with malignant spinal tumors are difficult to treat because they have many co-morbidities including osteoporosis.The purpose of this research is to discuss the technique and clinical outcome of bone cement enhanced pedicle screw fixation combined with vertebroplasty (the Sandwich Procedure) for elderly patients with severe osteoporosis and malignant spinal tumors.Methods This study includes 28 consecutive elderly patients with malignant thoracic or lumbar spinal tumors.There were nine patients with myelomas,and 19 patients with metastatic bone tumors.The Sandwich Procedure began with curettage of the tumor and a vertebroplasty with bone cement (polymethyl methacrylate,PMMA),followed by PMMA enhanced pedicle screw fixation.Patients were evaluated with the visual analogue scale (VAS),oswestry disability index (ODI),American Spinal Cord Injury Association (ASIA) neurological function classification,and the radiographic degree of kyphosis (Cobb angle).Data were analyzed using paired t-test to compare the pre-and post-operative values.The complications,local recurrences,and the survival status were also recorded.Results There was no operative mortality,and the mean operative time was 210 minutes (range 150-250 minutes).The average blood loss was 1550 ml (range 650-3300 ml).The average amount of cement for vertebroplasty was 3.6 ml (range 3-5 ml).The VAS,ODI,and ASIA scores were significantly improved after surgery (P <0.05).However,we found no differences between the pre and post-operative Cobb angles.The shortest survival time was 3 months,and we found no evidence of local recurrence in this group of patients.Conclusion The Sandwich Procedure is a safe operation and provides symptomatic relief in these difficult patients,permitting further treatment with chemotherapy or radiotherapy.

  18. Determination of the most appropriate stress distribution by Finite Element Analysis in fixation with resorbable screws after Bilateral Sagittal Split Ramus Osteotomy surgery

    Directory of Open Access Journals (Sweden)

    Sarkarat F.

    2009-12-01

    Full Text Available "nBackground and Aim: Due to the complications associated with fixation by Titanium screws and plates in Bilateral Sagittal Split Ramus Osteotomy (BSSRO surgery, the use of resorbable polymers has been increasingly recommended. Since there are not enough studies on this issue, this study aimed to assess the most appropriate stress distribution in fixation with resorbable screws after BSSRO surgery by Fnite Element Analysis (FEA."nMaterials and Methods: This experimental study was performed on simulated human mandible using Ansys and Catia softwares. The osteotomy line was applied to the simulated model and experimental loads of 75, 135 and 600 N were respectively exerted according to the natural direction of occlusal force. The distribution pattern of stress was assessed and compared for fixation with one resorbable screw, two resorbable screws in vertical pattern, two resorbable screws in horizontal pattern, three resorbable screws in L pattern and three resorbable screws in inverted backward L pattern using Ansys software."nResults: Among the four simulated fixations, L pattern showed the highest primary stability. Two screws in vertical pattern were also associated with sufficient primary stability and less trauma and cost for patients. One screw did not provide enough stability under 600 N."nConclusion: Polymer-based resorbable screws (polyglycolic acid and D, L polylactide acid provided satisfactory primary stability in BSSRO surgery.

  19. Study on pedicle screw fixation of cervical spine assisted CT-based navigation system compared with the individual cervical peddle screws placement technique

    International Nuclear Information System (INIS)

    Objective: To explore a safe and effective method for placing the cervical pedicle screws. Methods: There were ten adult cadaver specimens of cervica spine (C1-C7) with intact structures including ligament and perivertebral muscles. The spiral computed tomography scan (Elscint CT Twin flash) at the section of 1 mm and three-dimensional reconstruction of all 10 cervical specimens were taken. By CT scan, the parameters of the cervical pedicles were measure,Then taking randomly 5 cervical specimens, according to the CT measurements, an appropriate screw was inserted into pedicle individually. In the other 5 human cadaver cervical vertebraes, Φ3.5 mm screws were inserted into the C2-C7 pedicles by assisted by CT-based navigation system. Cortical integrity of every sample was examined by anatomic dissection, the spiral computed tomography scan and arrows,and coronal reconstruction. Results: Sixty screws was inserted into pedicle individually, and the achievement ratio was 90%, the perfectness ratio was 75%, 60 screws was placed into pedicle assisted by CT-based navigation system, and the achievement ratio was 96.6%, the perfectness ratio was 90%. By chi-square test for statistical analysis, there were no statistical significance between the accuracy rate of two methods(P>0.05). However there was statistical significance between the perfectness ratio between two methods(P<0.05). Conclusion: Compared with the individual cervical peddle screws placement technique, the perfectness ratio of pedicle screw fixation of cervical spine assisted by CT-based navigation system is higher, but there are no significant difference in accuracy. (authors)

  20. Medial pelvic migration of the lag screw in a short gamma nail after hip fracture fixation: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Li Xinning

    2010-08-01

    Full Text Available Abstract Hip fractures are a common injury among the elderly. Internal fixation with an intramedullary (IM system has gained popularity for the treatment of intertrochanteric femur fractures. Multiple complications associated with IM fracture fixation have been described, however, we report a rare complication of medial pelvic migration of the lag screw of a short IM nail in a stable construct ten weeks post surgery. The patient was subsequently treated with Lag Screw removal and revision surgery with a shorter Lag Screw and an accessory cannulated screw acting as a de-rotational device. The patient did well with the revision surgery and was able to return to full activities.

  1. Evaluation of a prototype correction algorithm to reduce metal artefacts in flat detector computed tomography of scaphoid fixation screws

    Energy Technology Data Exchange (ETDEWEB)

    Filli, Lukas; Finkenstaedt, Tim; Andreisek, Gustav; Guggenberger, Roman [University Hospital of Zurich, Department of Diagnostic and Interventional Radiology, Zurich (Switzerland); Marcon, Magda [University Hospital of Zurich, Department of Diagnostic and Interventional Radiology, Zurich (Switzerland); University of Udine, Institute of Diagnostic Radiology, Department of Medical and Biological Sciences, Udine (Italy); Scholz, Bernhard [Imaging and Therapy Division, Siemens AG, Healthcare Sector, Forchheim (Germany); Calcagni, Maurizio [University Hospital of Zurich, Division of Plastic Surgery and Hand Surgery, Zurich (Switzerland)

    2014-12-15

    The aim of this study was to evaluate a prototype correction algorithm to reduce metal artefacts in flat detector computed tomography (FDCT) of scaphoid fixation screws. FDCT has gained interest in imaging small anatomic structures of the appendicular skeleton. Angiographic C-arm systems with flat detectors allow fluoroscopy and FDCT imaging in a one-stop procedure emphasizing their role as an ideal intraoperative imaging tool. However, FDCT imaging can be significantly impaired by artefacts induced by fixation screws. Following ethical board approval, commercially available scaphoid fixation screws were inserted into six cadaveric specimens in order to fix artificially induced scaphoid fractures. FDCT images corrected with the algorithm were compared to uncorrected images both quantitatively and qualitatively by two independent radiologists in terms of artefacts, screw contour, fracture line visibility, bone visibility, and soft tissue definition. Normal distribution of variables was evaluated using the Kolmogorov-Smirnov test. In case of normal distribution, quantitative variables were compared using paired Student's t tests. The Wilcoxon signed-rank test was used for quantitative variables without normal distribution and all qualitative variables. A p value of < 0.05 was considered to indicate statistically significant differences. Metal artefacts were significantly reduced by the correction algorithm (p < 0.001), and the fracture line was more clearly defined (p < 0.01). The inter-observer reliability was ''almost perfect'' (intra-class correlation coefficient 0.85, p < 0.001). The prototype correction algorithm in FDCT for metal artefacts induced by scaphoid fixation screws may facilitate intra- and postoperative follow-up imaging. (orig.)

  2. A meta-analysis of unilateral versus bilateral pedicle screw fixation in minimally invasive lumbar interbody fusion.

    Directory of Open Access Journals (Sweden)

    Zheng Liu

    Full Text Available STUDY DESIGN: Meta-analysis. BACKGROUND: Bilateral pedicle screw fixation (PS after lumbar interbody fusion is a widely accepted method of managing various spinal diseases. Recently, unilateral PS fixation has been reported as effective as bilateral PS fixation. This meta-analysis aimed to comparatively assess the efficacy and safety of unilateral PS fixation and bilateral PS fixation in the minimally invasive (MIS lumbar interbody fusion for one-level degenerative lumbar spine disease. METHODS: MEDLINE/PubMed, EMBASE, BIOSIS Previews, and Cochrane Library were searched through March 30, 2014. Randomized controlled trials (RCTs and controlled clinical trials (CCTs on unilateral versus bilateral PS fixation in MIS lumbar interbody fusion that met the inclusion criteria and the methodological quality standard were retrieved and reviewed. Data on participant characteristics, interventions, follow-up period, and outcomes were extracted from the included studies and analyzed by Review Manager 5.2. RESULTS: Six studies (5 RCTs and 1 CCT involving 298 patients were selected. There were no significant differences between unilateral and bilateral PS fixation procedures in fusion rate, complications, visual analogue score (VAS for leg pain, VAS for back pain, Oswestry disability index (ODI. Both fixation procedures had similar length of hospital stay (MD = 0.38, 95% CI = -0.83 to 1.58; P = 0.54. In contrast, bilateral PS fixation was associated with significantly more intra-operative blood loss (P = 0.002 and significantly longer operation time (P = 0.02 as compared with unilateral PS fixation. CONCLUSIONS: Unilateral PS fixation appears as effective and safe as bilateral PS fixation in MIS lumbar interbody fusion but requires less operative time and causes less blood loss, thus offering a simple alternative approach for one-level lumbar degenerative disease.

  3. Clinical study on the application of minimally invasive percutaneous pedicle screw fixation in single segment thoracolumbar fracture without neurological symptoms

    Directory of Open Access Journals (Sweden)

    Jin-ping LIU

    2016-04-01

    Full Text Available Objective To discuss the clinical effects of minimally invasive percutaneous pedicle screw fixation in the treatment of single segment thoracolumbar fracture without neurological symptoms.  Methods From June 2012 to October 2014, 38 neurologically intact patients with thoracolumbar fracture underwent surgeries, including open pedicle screw fixation in 16 cases and percutaneous pedicle screw fixation in 22 cases. The incision length, operation time, intraoperative blood loss, postoperative drainage and postoperative complication were recorded and compared between 2 groups. Thoracolumbar orthophoric, lateral and flexion-extension X-ray was used to measure sagittal Cobb angle and height of injured anterior vertebral body before and after operation. Modified Macnab evaluation was used to assess the curative effects 3 months after operation. Results The success rate of operations in 38 patients was 100%. There were a total of 114 vertebral bodies fused and 228 pedicle screws implanted. Patients in the percutaneous pedicle screw group had smaller incision length [(10.55 ± 1.23 cm vs (18.50 ± 2.50 cm, P = 0.000], less intraoperative blood loss [(32.55 ± 7.22 ml vs (320.50 ± 15.48 ml, P = 0.000], shorter hospital stay [(6.55 ± 1.50 d vs (13.50 ± 2.52 d, P = 0.000], and without postoperative drainage. The follow-up after operation ranged from 3 to 6 months, with the average time of (4.65 ± 1.24 months. Cobb angle was reduced (P = 0.000 and height of injured anterior vertebral body were improved signifcantly (P = 0.000 3 months after surgery in both groups. The total effective rate was 14/16 in open surgery group, and 86.36% (19/22 in percutaneous pedicle screw group, however, the difference between 2 groups was not significant (P = 1.000. Conclusions Minimally invasive percutaneous pedicle screw fixation is a surgical method with less iatrogenic injury, less intraoperative blood loss and quick recovery for patients with thoracolumbar fracture

  4. Posterior Wall Blowout During Anterior Cruciate Ligament Reconstruction: Suspensory Cortical Fixation With a Screw and Washer Post.

    Science.gov (United States)

    Mitchell, Justin J; Chahla, Jorge; Dean, Chase S; Menge, Travis J; Vap, Alexander R; Cram, Tyler R; LaPrade, Robert F

    2016-06-01

    Posterior wall blowout can be a devastating intraoperative complication in anterior cruciate ligament reconstruction. This loss of osseous containment can cause difficulty with graft fixation and can potentially lead to early graft failure if unrecognized and left untreated. If cortical blowout occurs despite careful planning and proper surgical technique, a thorough knowledge of the local anatomy and surgical salvage options is paramount to ensure positive patient outcomes. This article highlights our preferred salvage technique using suspensory cortical fixation with a screw and washer construct. PMID:27656377

  5. Percutaneous Facet Screw Fixation in the Treatment of Symptomatic Recurrent Lumbar Facet Joint Cyst: A New Technique

    Energy Technology Data Exchange (ETDEWEB)

    Amoretti, Nicolas, E-mail: amorettinicolas@yahoo.fr; Gallo, Giacomo, E-mail: giacomo.gallo83@gmail.com; Bertrand, Anne-Sophie, E-mail: asbertrand3@hotmail.com [Centre Hospitalier Universitaire de Nice (France); Bard, Robert L., E-mail: rbard@cancerscan.com [New York Medical College (United States); Kelekis, Alexis, E-mail: akelekis@med.uoa.gr [University General Hospital “ATTIKON” (Greece)

    2016-01-15

    We present a case of percutaneous treatment of symptomatic recurrent lumbar facet joint cyst resistant to all medical treatments including facet joint steroid injection. Percutaneous transfacet fixation was then performed at L4–L5 level with a cannulated screw using CT and fluoroscopy guidance. The procedure time was 30 min. Using the visual analog scale (VAS), pain decreased from 9.5, preoperatively, to 0 after the procedure. At 6-month follow-up, an asymptomatic cystic recurrence was observed, which further reduced at the 1-year follow-up. Pain remained stable (VAS at 0) during all follow-ups. CT- and fluoroscopy-guided percutaneous cyst rupture associated with facet screw fixation could be an alternative to surgery in patients suffering from a symptomatic recurrent lumbar facet joint cyst.

  6. Percutaneous Facet Screw Fixation in the Treatment of Symptomatic Recurrent Lumbar Facet Joint Cyst: A New Technique.

    Science.gov (United States)

    Amoretti, Nicolas; Gallo, Giacomo; Bertrand, Anne-Sophie; Bard, Robert L; Kelekis, Alexis

    2016-01-01

    We present a case of percutaneous treatment of symptomatic recurrent lumbar facet joint cyst resistant to all medical treatments including facet joint steroid injection. Percutaneous transfacet fixation was then performed at L4-L5 level with a cannulated screw using CT and fluoroscopy guidance. The procedure time was 30 min. Using the visual analog scale (VAS), pain decreased from 9.5, preoperatively, to 0 after the procedure. At 6-month follow-up, an asymptomatic cystic recurrence was observed, which further reduced at the 1-year follow-up. Pain remained stable (VAS at 0) during all follow-ups. CT- and fluoroscopy-guided percutaneous cyst rupture associated with facet screw fixation could be an alternative to surgery in patients suffering from a symptomatic recurrent lumbar facet joint cyst.

  7. Biomechanical Comparison of Spinal Fusion Methods Using Interspinous Process Compressor and Pedicle Screw Fixation System Based on Finite Element Method

    Science.gov (United States)

    Choi, Jisoo; Kim, Sohee

    2016-01-01

    Objective To investigate the biomechanical effects of a newly proposed Interspinous Process Compressor (IPC) and compare with pedicle screw fixation at surgical and adjacent levels of lumbar spine. Methods A three dimensional finite element model of intact lumbar spine was constructed and two spinal fusion models using pedicle screw fixation system and a new type of interspinous devices, IPC, were developed. The biomechanical effects such as range of motion (ROM) and facet contact force were analyzed at surgical level (L3/4) and adjacent levels (L2/3, L4/5). In addition, the stress in adjacent intervertebral discs (D2, D4) was investigated. Results The entire results show biomechanical parameters such as ROM, facet contact force, and stress in adjacent intervertebral discs were similar between PLIF and IPC models in all motions based on the assumption that the implants were perfectly fused with the spine. Conclusion The newly proposed fusion device, IPC, had similar fusion effect at surgical level, and biomechanical effects at adjacent levels were also similar with those of pedicle screw fixation system. However, for clinical applications, real fusion effect between spinous process and hooks, duration of fusion, and influence on spinous process need to be investigated through clinical study. PMID:26962413

  8. Biomechanical Evaluation of the Fixation Methods for Transcondylar Fracture of the Humerus:ONI Plate Versus Conventional Plates and Screws

    Directory of Open Access Journals (Sweden)

    Shimamura,Yasunori

    2010-04-01

    Full Text Available

    We biomechanically evaluated the bone fixation rigidity of an ONI plate (Group I during fixation of experimentally created transcondylar humerus fractures in cadaveric elbows, which are the most frequently observed humeral fractures in the elderly, and compared it with the rigidity achieved by 3 conventional fixation methods:an LCP reconstruction plate 3.5 using a locking mechanism (Group II, a conventional reconstruction plate 3.5 (CRP with a cannulated cancellous screw (Group III, and a CRP with 2 cannulated cancellous screws (CS in a crisscross orientation (Group IV. In the axial loading test, the mean failure loads were:Group I, 98.9+/-32.6;Group II, 108.5+/-27.2;Group III, 50.0+/-7.5;and Group IV, 34.5+/-12.2 (N. Group I fixations failed at a significantly higher load than those of Groups III and IV (p0.05. In the extension loading test, the mean failure loads were:Group I, 34.0+/-12.4;Group II, 51.0+/-14.8;Group III, 19.3+/-6.0;and Group IV, 14.7+/-3.1 (N. Group IV fixations showed a significantly lower failure load than those of Group I (p0.05. The fixation rigidities against mechanical loading by the ONI plate and LCP plate were comparable. These results suggested that an ONI system might be superior to the CRP and CS method, and comparable to the LCP method in terms of fixation rigidity for distal humerus fractures.

  9. When Planning Screw Fracture Fixation Why the 5.5 mm Screw is the Goldilocks Screw. An Observational Computer Tomographic Study of Fifth Metatarsal Bone Anatomy in a Sample of Patients.

    Science.gov (United States)

    Iselin, Lukas D; Ramawat, Sunil; Hanratty, Brian; Klammer, Georg; Stavrou, Peter

    2015-05-01

    We wanted to verify our clinical experience that the 5.5 mm screw was ideal in the majority of fifth metatarsal fracture fixation. The size of a screw is important for the successful surgical treatment of these fractures in order to obtain the maximal stability while reducing the risk for iatrogenic fracture.A sample of patients undergoing computer tomographic imaging of the foot for investigation other than fifth metatarsal pathology were recruited. The parameters of the fifth metatarsal bone anatomy were measured.These parameters of the 5.5 mm screw were correlated with this data. The upper parameter (the diameter of the threads) was 5.5 and the lower parameter (the diameter of the shank) was 4.0 mm.Twenty seven patients were recruited.The proximal third internal diameter ranged from 3.6 to 7.0 mm with a mean of 5.0 mm. 93% of the metatarsals could easily accommodate the 5.5 mm screw. Two of the metatarsals had an internal diameter of < 4 mm (7%).It is our belief that the 5.5 mm screw may be used safely in the majority of patients with fifth metatarsal fractures.

  10. Combined circular external fixation and open reduction internal fixation with pro-syndesmotic screws for repair of a diabetic ankle fracture

    Directory of Open Access Journals (Sweden)

    Zacharia Facaros

    2010-10-01

    Full Text Available The surgical management of ankle fractures among the diabetic population is associated with higher complication rates compared to the general population. Efforts toward development of better methods in prevention and treatment are continuously evolving for these injuries. The presence of peripheral neuropathy and the possible development of Charcot neuroarthropathy in this high risk patient population have stimulated much surgical interest to create more stable osseous constructs when open reduction of an ankle fracture/dislocation is required. The utilization of multiple syndesmotic screws (pro-syndesmotic screws to further stabilize the ankle mortise has been reported by many foot and ankle surgeons. In addition, transarticular Steinmann pins have been described as an adjunct to traditional open reduction with internal fixation (ORIF of the ankle to better stabilize the talus, thus minimizing risk of further displacement, malunion, and Charcot neuroarthropathy. The authors present a unique technique of ORIF with pro-syndesmotic screws and the application of a multi-plane circular external fixator for management of a neglected diabetic ankle fracture that prevented further deformity while allowing a weight-bearing status. This technique may be utilized for the management of complex diabetic ankle fractures that are prone to future complications and possible limb loss.

  11. Anatomic and radiological study on posterior pedicle screw fixation in the atlantoaxial vertebrae of children

    Institute of Scientific and Technical Information of China (English)

    DENG Xiong-wei; MIN Zhi-hai; LIN Bin; ZHANG Fa-hui

    2010-01-01

    Objective: To investigate the feasibility of posterior fixation with 3.5-mm pedicle screws in the atlantoaxial vertebrae of children.Methods: In this study, atlantoaxial vertebrae specimens were obtained from 10 cadavers of children aged 6-8 years. We measured the height and width of the C1 pedicle and the midportion of C1 lateral mass; the width of C1 posterior arch under the vertebral artery groove and the height of the external and internal one-third of this part; the external,internal height and the superior, middle, inferior width of the C2 pedicle (transverse foramen). Furthermore, computed tomography (CT) axial scan was performed on 20 agematched volunteers to obtain relative data of their atlantoaxial vertebrae. We measured the length and width of the C1 and C2 pedicles in the atlantoaxial cross-sectional plane. On CT workstation, we also measured the angles between the longitudinal axes of the atlantoaxial pedicles and the midsagittal plane.Results: For the cadaveric specimen group, the height and width of the C1 pedicle were (5.26±0.44) mm and (6.26±0.75) mm respectively. The height of the medial one-third of the C1 posterior arch under the vertebral artery groove was (4.07±0.24) mm. The external, internal height and superior,middle, inferior width of the C2 pedicle was (6.86±0.48) mm,(6.67±0.49) mm, (6.63 ±0.61 ) mm, (5.41±0.39) mm and (3.71±0.30) mm, respectively. For the volunteer group measured by CT scan, the height and width of the Ct pedicle were (5.47±0.34) mm and (6.63±0.54) mm respectively, while (6.59±0.51) mm and (5.13±0.42) mm of the C2 pedicle. The angles between the atlas, axis pedicles and the midsagittal plane were (9.60±1.32)° and (27.80±2.22)° respectively.Conclusion: It is feasible to place a 3.5-mm pedicle screw in the C1 and C2 pedicles of children aged 6-8 years old.

  12. Clinical results of the re-fixation of a Chevron olecranon osteotomy using an intramedullary cancellous screw and suture tension band

    OpenAIRE

    Wagener, Marc L.; Dezillie, Marleen; Hoendervangers, Yvette; Eygendaal, Denise

    2015-01-01

    Exposure of the distal humerus in case of an articular fracture is often performed through a Chevron osteotomy of the olecranon. Several options have been described for re-fixation of the Chevron osteotomy. Pull-out of the hard-wear is often seen as complication. In this study, an evaluation of the re-fixation of the Chevron osteotomy through a cancellous screw and suture tension band was performed. The data of 19 patients in whom a Chevron osteotomy was re-fixated with a cancellous screw in ...

  13. Interference screw versus Endoscrew fixation for anterior cruciate ligament reconstruction: A biomechanical comparative study in sawbones and porcine knees

    Directory of Open Access Journals (Sweden)

    Chu-Chih Hung

    2014-04-01

    Full Text Available Interference screw fixation is one of the most common methods for ligament reconstruction. Although the advantages and clinical outcomes of this procedure have been widely reported, post-surgical complications often arise. The purpose of this study was to evaluate a new femoral fixation device, the Endoscrew, for anterior cruciate ligament (ACL reconstruction. We performed a mechanical test in accordance with American Society for Testing and Materials (ASTM standards and an in vitro biomechanical study. An axial pullout test was conducted to evaluate the mechanical properties of the new device and the interference screw when implanted in solid rigid polyurethane foam test blocks. The biomechanical test used porcine femora to evaluate the initial fixation strength between these two implants. The maximum pullout force of the interference screw group [722.05 ± 130.49 N (N] was significantly greater (p < 0.01 than the Endoscrew group (440.79 ± 26.54 N when implanted in polyurethane foam 320 kg/m3 density. With polyurethane foam 160 kg/m3 density, the maximum pullout forces were (242.61 ± 37.36 N (p < 0.001 and (99.33 ± 30.01 N for the interference screw group and Endoscrew group, respectively. In the in vitro mechanical study, the Endoscrew (646.39 ± 72.38 N required a significantly greater ultimate load prior to failure (p < 0.05 when compared with the interference screw (489.72 ± 138.64 N. With regard to pullout stiffness, there was no statistically significant difference (p < 0.13 between the Endoscrew group (99.15 ± 12.16 N/mm and the interference screw group (87.96 ± 11.12 N/mm. The cyclic stiffness was also not significantly different (p < 0.44 between the Endoscrew group (93.09 ± 16.07 N/mm and the interference screw group (85.78 ± 14.76 N/mm. The axial pullout test showed that the strength of the Endoscrew was close to the fixation strength required for daily activities, but it is

  14. The Use of Percutaneous Lumbar Fixation Screws for Bilateral Pedicle Fractures with an Associated Dislocation of a Lumbar Disc Prosthesis

    Directory of Open Access Journals (Sweden)

    William D. Harrison

    2013-01-01

    Full Text Available Study Design. Case report. Objective. To identify a safe technique for salvage surgery following complications of total disc replacement. Summary of Background Data. Lumbar total disc replacement (TDR is considered by some as the gold standard for discogenic back pain. Revision techniques for TDR and their complications are in their infancy. This case describes a successful method of fixation for this complex presentation. Methods and Results. A 48-year-old male with lumbar degenerative disc disease and no comorbidities. Approximately two weeks postoperatively for a TDR, the patient represented with acute severe back pain and the TDR polyethylene inlay was identified as dislocated anteriorly. Subsequent revision surgery failed immediately as the polyethylene inlay redislocated intraoperatively. Further radiology identified bilateral pedicle fractures, previously unseen on the plain films. The salvage fusion of L5/S1 reutilized the anterior approach with an interbody fusion cage and bone graft. The patient was then turned intraoperatively and redraped. The percutaneous pedicle screws were used to fix L5 to the sacral body via the paracoccygeal corridor. Conclusion. The robust locking screw in the percutaneous screw allowed a complete fixation of the pedicle fractures. At 3-year followup, the patient has an excellent result and has returned to playing golf.

  15. Fixation of tibial avulsion fractures of the posterior cruciate ligament using pull through suture and malleolar screw

    Directory of Open Access Journals (Sweden)

    Farzad Omidi Kashani

    2007-05-01

    Full Text Available BACKGROUND: Tibial avulsion fractures of the posterior cruciate ligament are not infrequent. However, controversies exist between the fixation of the fragments and their reconstruction in the cases with small bony fragments. This prospective study was undertaken to study the results after fixation of the fragments by the malleolar screw and the pull through suture techniques.  METHODS: From June 2003 to March 2005, 26 patients with acute isolated posterior cruciate ligament avulsion fracture of the tibial attachment were treated surgically at Qhaem and Emam Reza hospitals at Mashhad University of Medical Sciences. The screw fixation was used in 18 cases with large bony fragments and the suturing method for other cases who had small or comminuted fragments. The patients were followed for an average of 14 months; and according to The International Knee Documentation Committee the results were evaluated.  RESULTS:  All our patients were men and all the avulsion fractures achieved union at an average of 4.8 months (range, 3-8 months. All the patients had sever posterior instability (>10mm pre-operatively. However, when the union of the fracture was achieved, no one suffered severe instability.

    CONCLUSIONS: Both of these two techniques (especially screw fixation had satisfactory results. Although the number

  16. Bioabsorbable thread for tight tying of bones.

    Science.gov (United States)

    Hattori, K; Tomita, N; Tamai, S; Ikada, Y

    2000-01-01

    The purpose of this research was to develop a bioabsorbable thread for tight fixation of fractured bones and to examine its mechanical performance in an in-vitro simulation study. The thread is a blend of bioabsorbable poly(L-lactic acid); (PLLA) and poly(epsilon-caprolactone); (PCL) fibers and can be tightly connected by fusion welding of the PCL fibers. The tying strength of the PLLA-PCL blend thread was 39.7 N, which was comparable to that of stainless steel wire. A testing machine was fabricated to measure the fatigue strength of the tying by simulating bone fixation. The results showed that metal wires always failed because of breakage within 25,000 loading cycles, whereas the blend threads did not fail until 50,000 loading cycles. The looseness of tying for simulated bone fixation by the blend thread was within 1mm even after 50 000 loading cycles. In-vivo testing using rats revealed that the blend thread did not cause any severe inflammatory reaction.

  17. Bold镙钉治疗Jones骨折%Treatment of 16 cases Jones fractures by open reduction and bold screw fixation

    Institute of Scientific and Technical Information of China (English)

    单宇; 蒋富贵; 张晓剑; 徐能

    2013-01-01

    Objective To evaluate the clinical effect of Bold screw fixation in the treatment of jones fracture.Method From March 2006 to May 2012,16 case of Jones fracture were treated by open reduction and Bold screw fixation.Result All the patients were obtained healing of bone reunion and followed up for 6~12 months,no residual pain and nonunion.According to Maryland foot scording system,9 cases were excellent,5 good,2 fair and the rate of excellent and good was 87.5 %.Conclusion Bold screw fixation is an effective therapy for Jones fracture of open reduction and it has the benefit of early exercise,no need to remove,fixed solid.%目的 探讨Bold螺钉内固定治疗Jones骨折的临床疗效.方法 2006年3月~2012年5月,采用切开复位Bold螺钉内固定治疗Jones骨折16例.结果 16例均获随访,随访时间6~12m,均获得骨性愈合,未残留疼痛或骨不愈合.按Maryland足部评分系统评分,优9例,良5例,可2例,优良率87.5%.结论 Bold螺钉治疗Jones骨折具有早期功能锻炼、无需取出、固定稳固等优点,是治疗Jones骨折的有效方法.

  18. A comparison of unilateral and bilateral pedicle screw fixation combined with transforaminal lumbar interbody fusion for lumbar degenerative diseases

    Institute of Scientific and Technical Information of China (English)

    Yang Xiaoming; Wang Hong; Zhao Quanlai; Xu Hongguang; Liu Ping; Jin Yuelong

    2014-01-01

    Background Bilateral transpedicular screw fixation in conjunction with interbody fusion is widely used to treat lumbar degenerative diseases; however,there are some disadvantages of using this fixation system.This study comparatively analyzes the results of unilateral and bilateral pedicle screw fixation combined with transforaminal lumbar interbody fusion (TLIF) for one-level lumbar degenerative diseases.Methods Sixty-six cases with one-level lumbar degenerative diseases were studied.The patients were divided according to surgical approach into a unilateral group (Group A) and a bilateral group (Group B).The patients were evaluated for pain by visual analog scale (VAS) and Oswestry Disability Index (ODI).Operating time,blood loss,duration of hospitalization,and complication rate were also evaluated.Patients were examined at 1,3,6,and 12 months postoperatively and every year thereafter.Results Group A patients' average preoperative VAS and ODI scores were 7.03 ± 0.98 and (64.22±6.38)%,respectively,significantly decreased to 2.91 ± 0.88 and (14.42±2.08)%,respectively,at the last follow-up (P =0.000).In Group B,the average preoperative VAS and ODI scores were 6.79±0.86 and (63.22±4.70)%,respectively,significantly decreased to 3.12±0.96 and (14.62±2.08)%,respectively,at the last follow-up (P=0.000).No significant difference in the duration of hospitalization was found between groups.Operating time and blood loss of (125.9±13.0) minutes and (211.4±28.3) ml,respectively,in Group A were significantly less than (165.2±15.3) minutes and (258.6±18.3) ml,respectively,in Group B (P=-0.000).All patients achieved good bone union and had no pseudarthrosis at the last follow-up.Conclusions There are no clinical differences between unilateral and bilateral pedicle screw fixation combined with TLIF for one-level lumbar degenerative diseases.Unilateral fixation reduces operating time,bleeding,and cost of hospitalization.

  19. Evaluation of initial biomechanical stability of screw-rod fixation system with lateral mass screw and pedicle screw for cervical vertebra%颈椎侧块与颈椎弓根内固定后初始稳定性评价及实验研究

    Institute of Scientific and Technical Information of China (English)

    袁欣华; 庞清江; 许柯; 张宗凯; 祝惠敏; 叶奕; 赵卫东

    2013-01-01

    目的 评价钉棒系统分别行颈椎侧块及椎弓根固定后的初始稳定性,为临床应用提供理论依据.方法 取8具新鲜冷冻人体颈椎标本,切断C4,5棘上韧带、棘间韧带、双侧关节囊,制成C4,5后柱不稳损伤模型,每个标本分别行正常标本、双侧C4,5侧块及椎弓根固定标本三维运动范围测定.结果 两种内固定组的三维运动范围均明显小于正常组,椎弓根固定组三维运动组小于侧块螺钉固定组,两组差异有统计学意义.结论 在颈椎后柱损伤模型中,用钉棒系统分别行侧块及椎弓根固定后均能明显提高脊柱三维稳定性,椎弓根内固定稳定性优于侧块钉棒系统.%Objective To investigate the initial biomechanical stability of the screw-rod system with lateral mass screw and pedicle screw for cervical vertebra fixation, and to provide theoretical basis for clinical applications of the screw-rod system. Methods Eight fresh human cervical specimens were obtained. Each specimen received a 3-D range of movement (ROM) test (normal group). Then the model of instable posterior column of C4.5 injury was set up by transection of supraspinous, interspinous ligament and bilateral articular capsule. For each specimen, another two 3-D ROM tests were carried out after receiving a lateral mass screw fixation and a pedicle screw fixation respectively. Results The ROM of the internal fixation groups was notably smaller than the normal group. There was significant difference. Conclusion For the instable cervical posterior column injury model, the screw-rod fixation system with lateral mass screw and pedicle screw for cervical vertebra fixation would evidently improve the 3-D stability of the vertebral column. And the stability of pedicle screw fixation is superior to it of mass screw fixation. within the internal fixation groups. The ROM of the pedicle screw group is much smaller.

  20. In vivo study of extracellular matrix coating enhancing fixation of the pedicle screw-bone's interface

    Institute of Scientific and Technical Information of China (English)

    LIU Guo-min; ZHANG Xing-yi; XU Chuan-jie; ZHU Xiao-min; WANG Jun; LIU Yi

    2011-01-01

    Background Based on in vivo research on the effect of the coating of the extracellular matrix composition of pedicle screws on the conduction and induction of bone formation in young sheep,the aim of this study was to investigate the application of coated pedicle screws in sheep with scoliosis whose spines are under constant development.Methods Four groups of pedicle screws were randomly implanted into bilateral L2-L5 pedicles of 2.5- to 3-month-old sheep.A static experiment was performed on one side and a loading test was performed on the other side by implanting connecting rods at the L2-L3 and L4-L5 segments.The changes in the force on the coated screws and the combination of the surface of the coated screws with the surrounding bone in the growth process of young sheep's spines with aging were observed.After 3 months,the lumbar vertebrae with the screws were removed and examined by micro-CT,histological,and biomechanical analyses.Results Under nonloading conditions,there is bone formation around the surfaces of coated screws.The bone forming on the surface of collagen/chondroitin sulfate/hydroxyapatite coating of pedicle screws is the most,the one of the collagen / chondrcitin sulfate coating and hydroxyapatite coating is followed,and no significant difference between the two groups.In terms of the trabecular bone morphology parameters of the region of interest around the surface of the pedicle screws,such as bone mineral content,bone mineral density,tissue mineral content,tissue bone mineral density,bone volume fraction,and connection density,those associated with collagen/chondroitin sulfate/hydroxyapatite coatings are largest and those unassociated with coatings are smallest.Under nonloading conditions,the pullout strength of the collagen/chondroitin sulfate/hydroxyapatite-coated screws was largest,and that of the uncoated screws was minimal (P <0.01).Under loading conditions,the maximum pullout strength of each group of pedicle screws was less than that

  1. Efficacy of open reduction and internal fixation with a miniplate and hollow screw in the treatment of Lisfranc injury

    Directory of Open Access Journals (Sweden)

    Li Baoliang

    2015-07-01

    Full Text Available Purpose: To investigate efficacy of open reduction and internal fixation with the miniplate and hollow screw in the treatment of Lisfranc injury. Methods: Ten cases of Lisfranc injury treated by open reduction, miniplate and hollow screw in our hospital were retrospectively analyzed. There were 6 males and 4 females with age ranging from 25 to 45 years (mean 32 years. Among them, one case was classified as Type A, six Type B and three Type C. Injury mechanism included road traffic accidents (3 cases, fall from height (5 cases and hit by heavy object (2 cases. All injuries were closed without cerebral trauma or other complicated injuries. The time interval between injury and operation was 6e10 days (average 6.6 days. Postoperatively, the foot function was assessed using Visual Analogue Scales (VAS and American Orthopaedic Foot and Ankle Society (AOFAS Scales. Healing time and complications were observed. Results: All patients were followed up for 18e24 months (average 20 months. Anatomic reduction was achieved in all patients on images. There was statistical significance between preoperative score (7.89 ± 0.34 and score at postoperative 8 weeks (0.67 ± 0.13. According to the AOFAS score, 5 cases were defined as excellent, 3 cases as good and 2 cases as fair. During follow-up, there was no wound infection or complications except for osteoarthritis in 2 cases. Healing time ranged from 3 to 6 months with an average of 3.6 months. Conclusion: Anatomical reduction of Lisfranc injury can be achieved by open reduction and internal fixation with the miniplate and hollow screw. Normal structure of Lisfranc joint is regained to a great extent; injured ligaments were also repaired. Therefore, this method offers excellent curative effect and can avoid postoperative complications and improve the patients' quality of life.

  2. Efficacy of open reduction and internal fixation with a miniplate and hollow screw in the treatment of Lisfranc injury

    Institute of Scientific and Technical Information of China (English)

    Baoliang Li; Wenbo Zhao; Lei Liu; Fuguo Huang; Guanglin Wang; Yue Fang

    2015-01-01

    Purpose:To investigate efficacy of open reduction and internal fixation with the miniplate and hollow screw in the treatment of Lisfranc injury.Methods:Ten cases of Lisfranc injury treated by open reduction,miniplate and hollow screw in our hospital were retrospectively analyzed.There were 6 males and 4 females with age ranging from 25 to 45 years (mean 32 years).Among them,one case was classified as Type A,six Type B and three Type C.Injury mechanism included road traffic accidents (3 cases),fall from height (5 cases) and hit by heavy object (2 cases).All injuries were closed without cerebral trauma or other complicated injuries.The time interval between injury and operation was 6-10 days (average 6.6 days).Postoperatively,the foot function was assessed using Visual Analogue Scales (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) Scales.Healing time and complications were observed.Results:All patients were followed up for 18-24 months (average 20 months).Anatomic reduction was achieved in all patients on images.There was statistical significance between preoperative score (7.89 ± 0.34) and score at postoperative 8 weeks (0.67 ± 0.13).According to the AOFAS score,5 cases were defined as excellent,3 cases as good and 2 cases as fair.During follow-up,there was no wound infection or complications except for osteoarthritis in 2 cases.Healing time ranged from 3 to 6 months with an average of 3.6 months.Conclusion:Anatomical reduction of Lisfranc injury can be achieved by open reduction and internal fixation with the miniplate and hollow screw.Normal structure of Lisfranc joint is regained to a great extent;injured ligaments were also repaired.Therefore,this method offers excellent curative effect and can avoid postoperative complications and improve the patients' quality of life.

  3. Computer navigated percutaneous screw fixation for traumatic pubic symphysis diastasis of unstable pelvic ring injuries

    Institute of Scientific and Technical Information of China (English)

    MU Wei-dong; WANG Hong; ZHOU Dong-sheng; YU Ling-zhi; JIA Tang-hong; LI Lian-xin

    2009-01-01

    Displaced and unstable pelvic ring injuries have been treated mainly by open reduction and internal fixation. The goal of treatment relies on restoration of pelvic anatomy with stable internal fixation, allowing early mobilization of the patient.1,2 The symphysis pubis dislocation (>25 mm) is consistent indication for anterior internal fixation.3 In most situations, the fixation of the displaced symphysis pubis requires extensive exposure, which may lead to complications including blood loss, neural or vascular injury, postoperative infections, wound healing problems and heterotopic bone formation.

  4. Effects of bioabsorbable miniplateversus miniature titanium fixation system on the stability of mandibular fractures%生物可吸收性微型接骨板与微型钛内固定系统对下颌骨骨折稳定性的影响

    Institute of Scientific and Technical Information of China (English)

    邱勋定

    2015-01-01

    BACKGROUND:Bioabsorbable miniplates have good achievements after implantation, which have similar effect to the miniature titanium fixation system. Due to its absorbability, the bioabsorbable miniplate cannot exist in the body for a long time, which cannot influence bone stresses, cannot result in bone tissue atrophy, and have fewer complications than traditional metal internal fixations. OBJECTIVE:To explore and analyze the effects of miniature titanium internal fixation systemversus bioabsorbable miniplates on fracture stability in patients with mandibular fractures. METHODS:Ninety patients with mandibular fractures admitted at the Department of Stomatology, Hainan General Hospital from January 2013 to May 2015 were enroled. Al the subjects were divided into two groups according to different internal fixations: miniature titanium group and bioabsorbable miniplate group. RESULTS AND CONCLUSION:At 3 months after internal fixation, the stability rate was significantly higher in the bioabsorbable miniplate group than the miniature titanium group. At 1 year after internal fixation, the range of motion of the processus condyloideus was significantly higher in the miniature titanium group than the bioabsorbable miniplate group. These findings suggest that the bioabsorbable miniplate and miniature titanium internal fixation system both have good clinical outcomes in the treatment of mandibular fractures. The miniature titanium internal fixation system is easy to use and has good stability; the bioabsorbable miniplate can reduce foreign body reaction and prevent osteoporosis, and it has an ideal stability in combination with intermaxilary traction. Therefore, what kind of internal fixations is selected should be determined based on the wilingness and conditions of patients.%背景:生物可吸收性微型接骨板植入后患者恢复较好,且效果与微型钛内固定相似,并且由于其可吸收性,不会作为异物长期存在体内,无需二次手术

  5. Effect of twist-orientation on mechanical properties of self-reinforced poly(lactic acid) screws in simulated body environment

    Science.gov (United States)

    Sakaguchi, Masato; Kobayashi, Satoshi; composite engineering lab Team

    Poly(lactic acid) (PLA) attracts much attention as a typical biodegradable polymer, and has been applied as a bone fixation device. As one of the methods to improve mechanical properties of PLA bone fixation device, orientations of molecular chains have been investigated. However, conventional uniaxial drawing could not improve mechanical properties along the other loading direction than the drawing direction, such as torsion. In this study, screw is treated as a bone fixation device. In order to improve torsional strength of a bioabsorbable PLA screw, twist-orientation method has been developed. PLA screw is prepared through a series of routes including extrusion molding, extrusion drawing, twist-orientation and forging. This screw was immersed in the phosphate buffer solution for 0, 8, 16 and 24 weeks, then shear strength, orientation function, crystallinity and molecular weight were measured. As a result, twist-orientation improves the initial torsional strength of PLA screw without the decrease in initial shear strength. In addition, the shear strength on twist-oriented screw is equivalent that of non-twist oriented screw during immersion until 24 weeks. This result shown that the twist-orientation does not decrease shear strength after immersion.

  6. Percutaneous cannulated screw fixation of sacral fractures and sacroiliac joint disruptions with CT-controlled guidewires performed by interventionalists: Single center experience in treating posterior pelvic instability

    International Nuclear Information System (INIS)

    Highlights: • Minimally invasive sacroiliac screw fixation can be performed under CT-imaging. • Guidewires help in precise placement of cannulated sacroiliac screw. • Only a diminishing rate of misplacements can be seen. • The method appears to be a safe and very accurate procedure. - Abstract: Objective: The purpose of our study was to evaluate minimally invasive sacroiliac screw fixation for treatment of posterior pelvic instability with the help of CT controlled guidewires, assess its accuracy, safety and effectiveness, and discuss potential pitfalls. Methods: 100 guidewires and hollow titan screws were inserted in 38 patients (49.6 ± 19.5 years) suffering from 35 sacral fractures and/or 16 sacroiliac joint disruptions due to 33 (poly-)traumatic, 2 osteoporotic and 1 post-infectious conditions. The guidewire and screw positions were analyzed in multiplanar reconstructions. Results: The mean minimal distance between guidewire and adjacent neural foramina was 4.5 ± 2.01 mm, with a distinctly higher precision in S1 than S2. Eight guidewires showed cortical contacts, resulting in a total of 2% mismatched screws with subsequent wall violation. The fracture gaps were reduced from 3.6 ± 0.53 mm to 1.2 ± 0.54 mm. During follow-up 3 cases of minor iatrogenic sacral impaction (<5 mm) due to the bolting and 2 cases of screw loosening were observed. Interventional time was 84.0 min with a mean of 2.63 screws per patient whilst acquiring a mean of 93.7 interventional CT-images (DLP 336.7 mGy cm). Conclusions: The treatment of posterior pelvic instability with a guidewire-based screw insertion technique under CT-imaging results in a very high accuracy and efficacy with a low complication rate. Careful attention should be drawn to radiation levels

  7. Atlantoaxial arthrodesis using C1-C2 transarticular screw fixation in a case of Morquio syndrome

    Directory of Open Access Journals (Sweden)

    Arvind G Kulkarni

    2011-01-01

    Full Text Available Prophylactic or therapeutic arthrodesis is recommended for atlantoaxial instability in Morquio syndrome. Occipitocervical fusion, the common approach for upper cervical fusion in Morquio syndrome sacrifices the movements at the occipitoatlantal joints. The use of C1-C2 transarticular screws for achieving C1-C2 arthrodesis, without compromising mobility at the occipitoatlantal joint in Morquio syndrome has not been reported. We report a case of Morquio syndrome with atlantoaxial instability and odontoid hypoplasia, where we successfully achieved C1-C2 arthrodesis using transarticular screws and bone graft. The advantages of this method over other methods of atlantoaxial arthrodesis in Morquio syndrome have also been discussed.

  8. Minimally invasive transforaminal lumbar interbody fusion with percutaneous navigated guidewireless lumbosacral pedicle screw fixation.

    Science.gov (United States)

    Chen, Kevin S; Park, Paul

    2016-07-01

    This video details the minimally invasive approach for treatment of a symptomatic Grade II lytic spondylolisthesis with high-grade foraminal stenosis. In this procedure, the use of a navigated, guidewireless technique for percutaneous pedicle screw placement at the lumbosacral junction is highlighted following initial decompression and transforaminal interbody fusion. Key steps of the procedure are delineated that include positioning, exposure, technique for interbody fusion, intraoperative image acquisition, and use of a concise 2-step process for navigated screw placement without using guidewires. The video can be found here: https://youtu.be/2u6H4Pc_8To . PMID:27364422

  9. Safety screw fixation technique in a case of coracoid base fracture with acromioclavicular dislocation and coracoid base cross-sectional size data from a computed axial tomography study.

    Science.gov (United States)

    Kawasaki, Yoshiteru; Hirano, Tetsuya; Miyatake, Katsutoshi; Fujii, Koji; Takeda, Yoshitsugu

    2014-07-01

    Coracoid base fracture accompanied by acromioclavicular joint dislocation with intact coracoclavicular ligaments is a rare injury. Generally, an open reduction with screw fixation is the first treatment choice, as it protects the important structures around the coracoid process. This report presents a new technique of screw fixation for coracoid base fracture and provides anatomic information on cross-sectional size of the coracoid base obtained by computed tomography (CT). An axial image of the coracoid base was visualized over the neck of the scapula, and a guidewire was inserted into this circle under fluoroscopic guidance. The wire was inserted easily into the neck of scapula across the coracoid base fracture with imaging in only 1 plane. In addition, 25 measurements of the coracoid base were made in 25 subjects on axial CT images. Average length of the long and short axes at the thinnest part of the coracoid base was 13.9 ± 2.0 mm (range 10.6-17.0) and 10.5 ± 2.2 mm (6.6-15.1), respectively. This new screw fixation technique and measurement data on the coracoid base may be beneficial for safety screw fixation of coracoid base fracture.

  10. Clinical study on minimally invasive transforaminal lumbar interbody fusion combined with percutaneous pedicle screw fixation for degenerative lumbar scoliosis

    Directory of Open Access Journals (Sweden)

    Hao WU

    2016-04-01

    Full Text Available Objective To discuss the operative essentials and therapeutic effects of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF combined with percutaneous pedicle screw fixation for degenerative lumbar scoliosis (DLS.  Methods A total of 17 DLS patients without prior spinal diseases were treated by MIS-TLIF and percutaneous pedicle screw fixation from January 2013 to September 2015 in Xuanwu Hospital, Capital Medical University. The operation time, intraoperative blood loss, hospital stay, and postoperative complication were recorded in each patient. Visual Analogue Scale (VAS and Oswestry Disability Index (ODI were used to evaluate postoperative improvement of low back and leg pain, and clinical effects were assessed according to Medical Outcome Study 36-Item Short-Form Health Survey (SF-36. Coronal Cobb angle, sagittal lordosis angle and spinal deviation distances on coronal and sagittal plane were measured before operation, one week, 3 months after operation and in the last follow-up in spinal full-length X-ray examination. Fusion rate was calculated according to X-ray or CT scan, and the degree of decompression was evaluated by MRI.  Results Decompression and fusion levels ranged from T12-S1 vertebrae, and interbody fusion was performed in 17 patients and 56 levels were fused. Average operation time was 200 min (180-300 min, intraoperative blood loss was 320 ml (200-1000 ml and hospital stay was 8.21 d (5-12 d. All patients were followed-up for 12.13 months (5-24 months. Compared with preoperation, VAS (P = 0.000, for all and ODI scores (P = 0.000, for all decreased significantly, SF-36 score increased (P = 0.000, for all, coronal Cobb angle (P = 0.000, for all, sagittal lordosis angle (P = 0.000, for all, coronal and sagittal deviation (P = 0.000, for all decreased significantly one week and 3 months after operation and in the last follow-up. The improvement rate of ODI was (86.51 ± 6.02%, fusion rate of vertebral bodies

  11. [C1-C2 transarticular screw fixation of atlanto-axial instability with tetraparesis in rheumatoid patient--case report].

    Science.gov (United States)

    Chrzanowska, Anetta; Chrzanowski, Robert; Skura, Antoni

    2010-01-01

    A case of a 50-year-old patient with C1-C2 subluxation and concomitant neurological deficits in the course of rheumatoid arthritis has been described. In the article the diagnostic and therapeutic procedures, consisting mainly of surgical treatment, have been presented. Indications for the surgery were: a rapid disease progression observed during the last six months, and tetraparesis. The authors propose the choice of applied surgical technique by taking into account difficulties consequential to the anatomy of this region, as well as additional complications regarding the chronic inflammation process. The use of transarticular screw fixation method, together with concurrent spinal cord decompression allowed the stabilization of C1-C2 subluxation and improvement of the neurological state of the patient. PMID:21591367

  12. Superior fixation of pegged trabecular metal over screw-fixed pegged porous titanium fiber mesh

    OpenAIRE

    Stilling, Maiken; Madsen, Frank; Odgaard, Anders; Rømer, Lone; Andersen, Niels Trolle; Rahbek, Ole; Søballe, Kjeld

    2011-01-01

    Background and purpose Lasting stability of cementless implants depends on osseointegration into the implant surface, and long-term implant fixation can be predicted using radiostereometric analysis (RSA) with short-term follow-up. We hypothesized that there would be improved fixation of high-porosity trabecular metal (TM) tibial components compared to low-porosity titanium pegged porous fiber-metal (Ti) polyethylene metal backings. Methods In a prospective, parallel-group, randomized unblind...

  13. No effect of additional screw fixation of a cementless, all-polyethylene press-fit socket on migration, wear, and clinical outcome.

    Science.gov (United States)

    Minten, Michiel J M; Heesterbeek, Petra J C; Spruit, Maarten

    2016-08-01

    Background and purpose - Additional screw fixation of the all-polyethylene press-fit RM cup (Mathys) has no additional value for migration, in the first 2 years after surgery. However, the medium-term and long-term effects of screw fixation remain unclear. We therefore evaluated the influence of screw fixation on migration, wear, and clinical outcome at 6.5 years using radiostereometric analysis (RSA). Patients and methods - This study involved prolonged follow-up from a previous randomized controlled trial (RCT). We analyzed RSA radiographs taken at baseline and at 1-, 2-, and 6.5-year follow-up. Cup migration and wear were assessed using model-based RSA software. Wear was calculated as translation of the femoral head model in relation to the cup model. Total translation, rotation, and wear were calculated mathematically from results of the orthogonal components. Results - 27 patients (15 with screw fixation and 12 without) were available for follow-up at 6.5 (5.6-7.2) years. Total translation (0.50 mm vs. 0.56 mm) and rotation (1.01 degrees vs. 1.33 degrees) of the cup was low, and was not significantly different between the 2 groups. Wear increased over time, and was similar between the 2 groups (0.58 mm vs. 0.53 mm). Wear rate (0.08 mm/year vs. 0.09 mm/year) and clinical outcomes were also similar. Interpretation - Our results indicate that additional screw fixation of all-polyethylene press-fit RM cups has no additional value regarding medium-term migration and clinical outcome. The wear rate was low in both groups. PMID:27299418

  14. 单侧腰椎弓根螺钉及经椎板关节突螺钉固定与双侧固定的比较*☆%Clinical outcomes of unilateral lumbar pedicle screw combined with translamina facet screw fixation versus bilateral fixation

    Institute of Scientific and Technical Information of China (English)

    薛剑; 靳安民; 孙小平; 王延斌; 谢伟勇

    2013-01-01

    BACKGROUND: The translaminar facet joint screw fixation and interbody fusion in the treatment of spinal disorders is a unique fixation method which can be used for degenerative lumbar spinal fusion. OBJECTIVE: To observe the clinical effect of the minimal y invasive transforaminal lumbar interbody fusion combined with unilateral lumbar pedicle screw and translamina facet screw fixation versus conventional posterior lumbar interbody fusion combined with bilateral pedicle screw fixation for the treatment of low back pain. METHODS: Forty-nine patients had lumbar disc herniation with lumbar spinal mild instability were selected from Wu Jing Zong Dui Hospital of Guangdong Province between June 2010 and June 2012. Al the patients were treated with posterior decompression and interbody fusion and internal fixation. Among the 49 patients, 24 patients were treated with minimal y invasive transforaminal lumbar interbody fusion combined with unilateral lumbar pedicle screw and translamina facet screw fixation, and 25 patients were treated with conventional posterior lumbar interbody fusion combined with bilateral pedicle screws fixation. The clinical effects of the two methods above were compared. RESULTS AND CONCLUSION: There were no significant differences of vertebral fusion rate, Japanese Orthopedic Association score and visual analogue scale score between two groups (P > 0.05). These two approaches had similar clinical outcomes for single-level lumbar degenerative disorders with no instability. These two methods could effectively improve intervertebral fusion rate, make the smal joint stability, relieve clinical symptoms and make outpatient fol ow-up satisfaction. In addition the incision length, operative time, intraoperative blood loss, postoperative incision drainage of minimal y invasive transforaminal lumbar interbody fusion combined with unilateral lumbar pedicle screw and translamina facet screw fixation technology were significantly reduced (P 0.05)。可见对

  15. A Biomechanical Study Comparing Helical Blade with Screw Design for Sliding Hip Fixations of Unstable Intertrochanteric Fractures

    Directory of Open Access Journals (Sweden)

    Qiang Luo

    2013-01-01

    Full Text Available Dynamic hip screw (DHS is a well-established conventional implant for treating intertrochanteric fracture. However, revision surgery sometimes still occurs due to the cutting out of implants. A helical blade instead of threaded screw (DHS blade was designed to improve the fixation power of the osteoporotic intertrochanteric fracture. In this study, the biomechanical properties of DHS blade compared to the conventional DHS were evaluated using an unstable AO/OTA 31-A2 intertrochanteric fracture model. Fifty synthetic proximal femoral bone models with such configuration were fixed with DHS and DHS blade in five different positions: centre-centre (CC, superior-centre (SC, inferior-center (IC, centre-anterior (CA, and centre-posterior (CP. All models had undergone mechanical compression test, and the vertical and rotational displacements were recorded. The results showed that DHS blade had less vertical or rotational displacement than the conventional DHS in CC, CA, and IC positions. The greatest vertical and rotational displacements were found at CP position in both groups. Overall speaking, DHS blade was superior in resisting vertical or rotational displacement in comparison to conventional DHS, and the centre-posterior position had the poorest performance in both groups.

  16. Comparison of the effect of posterior lumbar interbody fusion with pedicle screw fixation and interspinous fixation on the stiffness of adjacent segments

    Institute of Scientific and Technical Information of China (English)

    LI Chun-de; SUN Hao-lin; LU Hong-zhang

    2013-01-01

    stiffness of the cephalic adjacent segment L3/4 after fixation in the Wallis group was significantly higher than that of the PLIF group (P <0.05).Cadaver experiments showed that the stiffness of the cephalic adjacent segment in the Wallis group was significantly higher than that of the PLIF group after L4/5 segment fixation (P <0.05); the stiffness of the L5/S1 segment showed no significant difference between PLIF surgery and Wallis implantation (P >0.05).Conclusions After interspinous (Wallis) fixation,the stiffness of the cephalic adjacent segment increased.After PLIF with pedicle screw fixation,the stiffness of the cephalic adjacent segment decreased.An interspinous fixation system (Wallis) has a protective effect for cephalic adjacent segments for the immediate post-operative state.

  17. Atlantoaxial arthrodesis using C1-C2 transarticular screw fixation in a case of Morquio syndrome

    OpenAIRE

    Kulkarni, Arvind G; Siddharth M Shah

    2011-01-01

    Prophylactic or therapeutic arthrodesis is recommended for atlantoaxial instability in Morquio syndrome. Occipitocervical fusion, the common approach for upper cervical fusion in Morquio syndrome sacrifices the movements at the occipitoatlantal joints. The use of C1-C2 transarticular screws for achieving C1-C2 arthrodesis, without compromising mobility at the occipitoatlantal joint in Morquio syndrome has not been reported. We report a case of Morquio syndrome with atlantoaxial instability an...

  18. Fixation of femoral capital physeal fractures with 7.0 mm cannulated screws in five bulls

    International Nuclear Information System (INIS)

    Salter-Harris type I fractures of the femoral capital physis were repaired in five Holstein bulls with three 7.0 mm cannulated screws placed in lag fashion. Radiographically at months 7 to 10, the fractures were healed and there was periarticular bone production on the femoral necks and the dorsal acetabular rims. Four bulls had normal gaits, and one bull had muscle atrophy and barely detectable lameness

  19. Caput valgum associated with developmental dysplasia of the hip: management by transphyseal screw fixation

    OpenAIRE

    Torode, Ian P.; Young, Jeffrey L.

    2015-01-01

    Purpose A late finding of some hips treated for developmental dysplasia of the hip (DDH) is a growth disturbance of the lateral proximal femoral physis, which results in caput valgum and possibly osteoarthritis. Current treatment options include complete epiphysiodesis of the proximal femoral physis or a corrective proximal femoral osteotomy. Alternatively, a transphyseal screw through the inferomedial proximal femoral physis that preserves superolateral growth might improve this deformity. M...

  20. Stress analysis between“X”-shaped spine dynamic fixation and traditional pedicle screw fixation%“X”形弹性脊柱内固定与传统椎弓根内固定的应力分析

    Institute of Scientific and Technical Information of China (English)

    王宇; 梅继文; 穆尚强; 高峰; 黄锐

    2015-01-01

    背景:目前国内外许多学者研发了多种动态弹性脊柱内固定器,经过生物力学研究、动物实验及临床应用发现,尚无一种脊柱弹性内固定器得到临床上的普遍认可。  目的:比较自制“X”形弹性内固定器与传统椎弓根螺钉内固定的应力差异。  方法:根据成人脊柱影像学资料,分别建立“X”形弹性脊柱内固定器与传统椎弓根螺钉内固定系统三维有限元模型,比较两组模型在垂直压缩、屈、伸、侧屈、扭转时的力学差异。  结果与结论:两模型在垂直压缩状态应下的应力均小于屈、伸、侧屈及扭转状态下的应力;在垂直压缩、前屈、后伸、侧弯及旋转时,“X”形弹性脊柱内固定器的应力更多集中在“X”形连接棒上,而传统椎弓根螺钉内固定的应力更多集中在螺钉近棒段,且“X”形弹性脊柱内固定器螺钉所受应力明显小于传统椎弓根螺钉内固定(P<0.001)。表明“X”形弹性内固定器较传统椎弓根螺钉内固定系统更能分担螺钉应力,减少螺钉术后应力集中情况。%BACKGROUND:Many scholars have developed a variety of dynamic elastic spine fixator. After biomechanical research, animal experiments and clinical application found that no one elastic spine fixator was general y recognized clinical y. OBJECTIVE:To compare the stress difference between“X”-shaped spine dynamic fixation and traditional pedicle screw fixation. METHODS:Three-dimensional finite element models of“X”-shaped spine dynamic fixation and traditional pedicle screw fixation were established according to adult spine imaging data. Mechanical differences in vertical compression, flexion, extension, lateral bending and rotation were compared between the two groups. RESULTS AND CONCLUSION:The stress at vertical compression was lower than that at flexion, extension, lateral bending and rotation in both groups. The stress at

  1. Supra-acetabular fixation and sacroiliac screws for treating unstable pelvic ring injuries: preliminary results from 20 patients☆

    Science.gov (United States)

    Guimarães, Rodrigo Pereira; de Góes Ribeiro, Arthur; Ulson, Oliver; de Ávila, Ricardo Bertozzi; Ono, Nelson Keiske; Polesello, Giancarlo Cavalli

    2016-01-01

    Objective To analyze the treatment results from 20 patients who underwent an alternative osteosynthesis method as definitive treatment for pelvic ring fractures. Methods A retrospective analysis was conducted on a series of 20 patients with pelvic ring fractures (Tile type C) and a high risk of postoperative infection, who were treated at Santa Casa de Misericórdia de São Paulo between August 2004 and December 2012. The patients underwent percutaneous supra-acetabular external fixation in association with cannulated 7.0 mm iliosacral screws. Results The patients’ mean age was 40 years (range 22–77 years) and the mean length of follow-up was 18.5 months (range 3–69 months). At the end of the treatment, ten patients (50%) were classified as having good results, nine patients (45%) had fair results and one patient (5%) did not have any improvement. Six patients presented complications, and paresthesia of the lateral femoral cutaneous nerve was the most frequent of these (two patients). Conclusion Supra-acetabular external fixation in association with iliosacral percutaneous osteosynthesis is a good definitive treatment method for patients with a high risk of postoperative infection. PMID:27069879

  2. Results of screw fixation combined with cortical drilling for treatment of dorsal cortical stress fractures of the third metacarpal bone in 56 Thoroughbred racehorses

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate screw fixation with cortical drilling as a surgical treatment for dorsal cortical stress fractures of MCIII in the Thoroughbred racehorse. Details of age, sex, limb affected, fracture assessment, and post operative recommendations were obtained from medical records and radiographs. Fracture healing was assessed radiographically at the time of screw removal. Performance evaluation was determined from race records obtained from The Jockey Club Information System, Lexington, Kentucky. Fifty-six Thoroughbred racehorses were treated surgically for stress fracture of MCIII with screw fixation and cortical drilling. Stress fractures occurred primarily in the left front limb of the male 3-year-olds, in the dorsolateral cortex of the middle third of MCIII. Ninety-seven percent of the fractures travelled in a dorsodistal to palmaroproximal direction. Median period to screw removal was 2.0 months. Evaluation at time of screw removal revealed 98% of single stress fractures of the left front limb were healed radiographically. Median period to resume training was 2.75 months (single stress fractures); median period to race was 7.62 months. There was no statistically significant difference in earnings/start before and after surgical intervention. Of the 63 fractures treated, two recurred. There were no catastrophic failures, and no incisional infections

  3. Treatment of Thoracolumbar Vertebrate Fracture by Transpedicular Morselized Bone Grafting in Vertebrae for Spinal Fusion and Pedicle Screw Fixation

    Institute of Scientific and Technical Information of China (English)

    Jinguo WANG; Hua WU; Xiaolin DING; Yutian LIU

    2008-01-01

    To enhance the fusion of graft bone in thoracolumbar vertebrae and minimize the postoperative loss of correction, short-segment pedicle screw fixation was reinforced with posterior moselizee bone grafting in vertebrae for spinal fusion in patients with thoracrolumbar vertebrate fractures. Seventy patients with thoracrolumbar vertebrate fractures were treated by short-segment pedicle screw fixation and were randomly divided into two groups. Fractures in group A (n=20) were reinforced with posterior morselized bone grafting in vertebrae for spinal fusion, while patients group B (n=50) did not receive the morselized bone grafting for bone fusion. The two groups were compared in terms of kyphotic deformity, anterior vertebral height, instrument failure and neurological functions after the treatment. Frankel grading system was used for the evaluation of neurological evaluation and Denis scoring scale was employed for pain assessment. The results showed that the kyphosis correction was achieved in both group A and group B (group A: 6.4 degree; group B: 5.4 degree)/At the end of follow-up, kyphosis correction was maintained in group A but lost in group B (P=0.0001). Postoperatively, greater anterior height was achieved in group A than in group B (P<0.01). During follow-up study, anterior vertebral height was maintained only in Group A (P<0.001). Both group A and group B showed good Denis pain scores (P1 and P2) but group A outdid group B in terms of control of severe and constant pain (P4 and P5). By Frankel criteria, the changes in neurological functions in group A was better than those of group B (P<0.001). It is concluded that reinforcement of short-segment pedicle fixation with morselized bone grafting for the treatment of patients with thoracolumbar vertebrae fracture could achieve and maintain kyphosis correction, and it may also increase and maintain anterior vertebral height. Morselized bone grafting in vertebrae offers immediate spinal stability in patients with

  4. Clinical results of the re-fixation of a Chevron olecranon osteotomy using an intramedullary cancellous screw and suture tension band.

    Science.gov (United States)

    Wagener, Marc L; Dezillie, Marleen; Hoendervangers, Yvette; Eygendaal, Denise

    2015-04-01

    Exposure of the distal humerus in case of an articular fracture is often performed through a Chevron osteotomy of the olecranon. Several options have been described for re-fixation of the Chevron osteotomy. Pull-out of the hard-wear is often seen as complication. In this study, an evaluation of the re-fixation of the Chevron osteotomy through a cancellous screw and suture tension band was performed. The data of 19 patients in whom a Chevron osteotomy was re-fixated with a cancellous screw in combination with a suture tension band were used. Evaluation was performed by assessment of the post-operative X-rays and documentation of complications. In all 19 cases, evaluation of the post-operative X-rays showed complete consolidation without dislocation or other complications. Re-fixation of a Chevron osteotomy of the olecranon with a large cancellous screw with a suture tension band provides adequate stability to result in proper healing of the osteotomy in primary cases when early post-operative mobilisation is allowed. Complications as pull-out of the hard-wear were not reported. PMID:25697273

  5. Computed tomography-based morphometric analysis of cervical pedicles in Indian population: A pilot study to assess feasibility of transpedicular screw fixation

    Directory of Open Access Journals (Sweden)

    A R Patwardhan

    2012-01-01

    Full Text Available Background: Cervical transpedicular screw fixation is safe and is probably going to be the gold standard for cervical spine fixation. However, cervical transpedicular screw use in the Asian population can be limited as the transverse diameter in this group of patients may not be adequate to accommodate the 3.5-mm pedicular screw thus injuring the vital structures located in the close proximity of the pedicles. Thus lateral mass fixation remains the mainstay of treatment. The present study evaluated the transverse cervical pedicle diameter of C2-C7 vertebrae in a pilot study in 27 Indian subjects using computed tomography (CT imaging and evaluated the feasibility of transpedicular screw fixation in them. Aims: To evaluate the feasibility of transpedicular screw fixation in the Indian population. Settings and Design: The cervical pedicle diameter size differs between the Asian and non-Asian population. The authors studied the transverse pedicle diameter of the C2-C7 of the cervical spine in the Indian population using CT measurements. This cross-sectional study was carried out at a tertiary care centre for a period of four months from October 2010 to December 2010. Material and Methods: Measurements of cervical pedicles in the subjects were performed on the CT workstation from the CT images taken at 2.5-mm interval. The transverse pedicle diameter was defined as the outermost diameter of the pedicle, taken perpendicular to the axis of the pedicle at the narrowest point and measured in millimeters±0.1 mm. Statistical Analysis: Descriptive statistics was used to represent percentage of transverse diameter of cervical pedicles less than 5 mm in male and female subjects at C2-C7 levels. Since there is no previous study done in India, we initiated the study with sample size of 27 as a pilot study. The statistical analysis was performed using SPSS software. Results: The mean transverse diameters of the cervical pedicles of C2, C3, C4, C5, C6 and C7 in

  6. Chinese traditional medicine rehabilitative treatment of femoral neck fracture after screw thread needle internal fixation%螺纹针内固定术后中药康复治疗股骨颈骨折

    Institute of Scientific and Technical Information of China (English)

    高广升; 李凤辉

    2001-01-01

    @@ Background:Femoral neck fracture is one of common and severe injury in old people. We utilize transcutaneous Screw thread needle internal fixation treat it, cooperated with Chinese medicine treatment, and gained good effects.

  7. Segmental pedicle screw fixation for a scoliosis patient with post-laminectomy and post-irradiation thoracic kyphoscoliosis of spinal astrocytoma

    International Nuclear Information System (INIS)

    Spinal deformity is an important clinical manifestation after surgery for spinal cord tumors. One-third of patients who receive laminectomies and irradiation of the spinal column develop scoliosis, kyphosis, or kyphoscoliosis. Recent reports indicate good results after scoliosis surgery using segmental pedicle screws and a navigation system, but these reported studies have not included surgery for post-laminectomy kyphosis. Hooks and wires are ineffective in such patients who undergo laminectomy, and there are also high perioperative risks with insertion of pedicle screws because landmarks have been lost. Here, we report on the 5-year follow-up of a 13-year-old male patient with post-laminectomy and post-irradiation thoracic kyphoscoliosis after surgical treatment of spinal astrocytoma. Posterior segmental pedicle screw fixation was performed safely using a computer-assisted technique. The authors present the first case report for treatment of this condition using a navigation system. (author)

  8. Role of valgus osteotomy and fixation with dynamic hip screw and 120° double angle barrel plate in the management of neglected and ununited femoral neck fracture in young patients

    OpenAIRE

    Khan, Abdul Qayyum; Khan, Mohammad Shahnawaz; Sherwani, Mohammed Khalid Anwar; Agarwal, Rahul

    2009-01-01

    Background Head preservation is the mainstay of management in younger patients with neglected or ununited intracapsular fracture neck of femur. Very few reports have dealt with the results of valgus intertrochanteric osteotomy and fixation with dynamic hip screw in such cases. In this prospective study, we have tried to evaluate the role of valgus osteotomy and fixation with dynamic hip screw and 120° double angle barrel plate in neglected or ununited intracapsular fracture neck of femur in p...

  9. Percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system: an analysis of 38 cases

    Institute of Scientific and Technical Information of China (English)

    WANG Hong-wei; LI Chang-qing; ZHOU Yue; ZHANG Zheng-feng; WANG Jian; CHU Tong-wei

    2010-01-01

    Objective:To prospectively evaluate the feasibility,safety and efficacy of the percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system in the retrospective non-randomized case-control study.Methods:A total of 38 consecutive non-randomized patients with type A thoracolumbar fractures, which had been stabilized posteriorly from December 2006 to March 2009,were examined retrospectively more than 9 months after surgery.Twenty-one patients had been treated conventionally with open pedicle screw fixation (OPSF) and 17 patients received minimally invasive treatment with Sextant percutaneous pedicle screw fixation (SPPSF). As a method of evaluation, the incision size, the intraoperation and postoperative volume of blood loss, operation time, postoperative hospital stay, blood transfusion, the radiological assessment of the sagittal Cobb's angle, vertebral body angle and vertebral body height were recorded and compared.Results: All patients were followed up for 8-24 months (average 11.6 months). There were significant differences in the incision size, surgical blood loss, surgical draining loss, operation time, hospital stay after operation, blood transfusion, the proportion of antalgic supplement and postoperative incisional VAS between the two groups (P0.05),but there was significant difference in the postoperative anterior height of the fractured vertebra between the two groups (P<0.05).Conclusion: The percutaneous pedicle screw fixation through the pedicle of fractured vertebra using Sextant system is a good minimally-invasive surgical therapeutic choice for patients with type A thoracolumbar fracture except for that the SPPSF has a little insufficiency in resuming the anterior height of the fractured vertebra compared with OPSF.

  10. Novel pedicle screw and plate system provides superior stability in unilateral fixation for minimally invasive transforaminal lumbar interbody fusion: an in vitro biomechanical study.

    Directory of Open Access Journals (Sweden)

    Jie Li

    Full Text Available This study aims to compare the biomechanical properties of the novel pedicle screw and plate system with the traditional rod system in asymmetrical posterior stabilization for minimally invasive transforaminal lumbar interbody fusion (MI-TLIF. We compared the immediate stabilizing effects of fusion segment and the strain distribution on the vertebral body.Seven fresh calf lumbar spines (L3-L6 were tested. Flexion/extension, lateral bending, and axial rotation were induced by pure moments of ± 5.0 Nm and the range of motion (ROM was recorded. Strain gauges were instrumented at L4 and L5 vertebral body to record the strain distribution under flexion and lateral bending (LB. After intact kinematic analysis, a right sided TLIF was performed at L4-L5. Then each specimen was tested for the following constructs: unilateral pedicle screw and rod (UR; unilateral pedicle screw and plate (UP; UR and transfacet pedicle screw (TFS; UP and TFS; UP and UR.All instrumented constructs significantly reduced ROM in all motion compared with the intact specimen, except the UR construct in axial rotation. Unilateral fixation (UR or UP reduced ROM less compared with the bilateral fixation (UP/UR+TFS, UP+UR. The plate system resulted in more reduction in ROM compared with the rod system, especially in axial rotation. UP construct provided more stability in axial rotation compared with UR construct. The strain distribution on the left and right side of L4 vertebral body was significantly different from UR and UR+TFS construct under flexion motion. The strain distribution on L4 vertebral body was significantly influenced by different fixation constructs.The novel plate could provide sufficient segmental stability in axial rotation. The UR construct exhibits weak stability and asymmetrical strain distribution in fusion segment, while the UP construct is a good alternative choice for unilateral posterior fixation of MI-TLIF.

  11. Segmental correction of adolescent idiopathic scoliosis by all-screw fixation method in adolescents and young adults. minimum 5 years follow-up with SF-36 questionnaire

    Directory of Open Access Journals (Sweden)

    Yu Ching-Hsiao

    2012-02-01

    Full Text Available Abstract Background In our institution, the fixation technique in treating idiopathic scoliosis was shifted from hybrid fixation to the all-screw method beginning in 2000. We conducted this study to assess the intermediate -term outcome of all-screw method in treating adolescent idiopathic scoliosis (AIS. Methods Forty-nine consecutive patients were retrospectively included with minimum of 5-year follow-up (mean, 6.1; range, 5.1-7.3 years. The average age of surgery was 18.5 ± 5.0 years. We assessed radiographic measurements at preoperative (Preop, postoperative (PO and final follow-up (FFU period. Curve correction rate, correction loss rate, complications, accuracy of pedicle screws and SF-36 scores were analyzed. Results The average major curve was corrected from 58.0 ± 13.0° Preop to 16.0 ± 9.0° PO(p p = 0.12 FFU. This revealed a 72.7% correction rate and a correction loss of 2.4° (3.92%. The thoracic kyphosis decreased little at FFU (22 ± 12° to 20 ± 6°, (p = 0.25. Apical vertebral rotation decreased from 2.1 ± 0.8 PreOP to 0.8 ± 0.8 at FFU (Nash-Moe grading, p Conclusion Follow-up more than 5 years, the authors suggest that all-screw method is an efficient and safe method.

  12. The Use of Posterior Short Segment Screw Fixation and Balloon Kyphoplasty in the Surgical Treatment of Traumatic Vertebral Fracture: A Case Report

    Directory of Open Access Journals (Sweden)

    Sevim Ondul

    2012-04-01

    Full Text Available Surgical treatments for the fracture of the spine are frequently used in clinical practice. Posterior spine stabilization with transpedicular screw fixation is one of the surgical treatment methods in the surgical treatment of spinal fractures. A 48-year old male patient was admitted to our hospital with a diagnosis of the L1 compression fracture resulting from traumatic injury. Posterior transpedicular screws were placed at one level above and one level below of the fractured vertebrate. Anterior column of the fractured vertebrate was strengthened with balloon kyphoplasty application. The system was completed with the placement of transverse rods. Fusion with allograft was performed. According to the ASIA neurological grading system, the patient was assessed as Grade E. 10 cm skin and fascia incision was done. Operation time of about 70 minutes and blood loss was less than 100 cc. The patient was mobilized on the first day of surgery and was discharged from the hospital on the third day after the surgery. Short segment transpedicular fixation on the one level above and one level below of the fractured vertebrate together with balloon kyphoplasty on the corpus of the fractured vertebrate may be used as a minimally invasive surgical treatment in such kind of injuries. The advantages are short duration of hospital stay, less blood loss, providing early mobilization, and a reliable method for fixation and stabilization. In this article, a case with traumatic fracture that fixed and stabilized with short segment transpedicular screw placement and balloon kyphoplasty application was presented.

  13. Percutaneous Pedicle Screw Fixation with Polymethylmethacrylate Augmentation for the Treatment of Thoracolumbar Intravertebral Pseudoarthrosis Associated with Kummell's Osteonecrosis.

    Science.gov (United States)

    Kim, Hyeun-Sung; Heo, Dong-Hwa

    2016-01-01

    Purpose. The purpose of our study is to evaluate the therapeutic efficacy of short-segment percutaneous pedicle screw fixation with polymethylmethacrylate (PMMA) augmentation for the treatment of osteoporotic thoracolumbar compression fracture with osteonecrosis. Methods. Osteoporotic thoracolumbar compression fractures with avascular necrosis were treated by short-segment PPF with PMMA augmentation. Eighteen were followed up for more than 2 years. The kyphotic angle, compression ratio, visual analog scale (VAS) score for back pain, and the Oswestry Disability Index (ODI) were analyzed. In addition, radiologic and clinical parameters of PPF group were compared with percutaneous vertebroplasty (PVP) group. Results. Vertebral height and kyphotic angle of the compressed vertebral bodies were significantly corrected after the operation (P lower in the PPF group (P < 0.05). The postoperative ODI and VAS of the PVP group were significantly higher than the PPF (P < 0.05). Conclusions. According to our results, short-segment PPF with PMMA augmentation may be an effective minimally invasive treatment for osteoporosis in cases of osteoporotic vertebral compression fractures with Kummell's osteonecrosis. PMID:27595101

  14. A Biomechanical Study of Two Modified Dioabsorbable Interference Screw for Fixation of Soft Tis-sue Grafts in Anterior Cruciate Ligament Reconstruction%两种改性可吸收界面螺钉重建前交叉韧带的生物力学研究

    Institute of Scientific and Technical Information of China (English)

    杨坤; 王大平; 朱伟民; 黄江鸿; 段莉; 陈洁琳; 崔家鸣; 解磊; 林威; 熊建义

    2016-01-01

    目的:探索两种改性可吸收界面螺钉聚乳酸/羟基磷灰石/α-Fe2 O3(PLLA/ HA/α-Fe2 O3)和聚乳酸-聚乙二醇/羟基磷灰石(PLLA-PEG/ HA)重建前交叉韧带(anterior cruciate ligament,ACL)早期是否能满足对移植物固定的初始力学要求。方法猪胫骨及游离的猪伸趾肌腱被随机分为3组,每组包括8个胫骨及8个伸趾肌腱,分别应用 PL-LA/ HA/α-Fe2 O3、PLLA-PEG/ HA 及临床使用聚乳酸/羟基磷灰石(BioRCI-HA,Smith ﹠ Nephew,USA)三种界面螺钉对胫骨端移植物进行挤压固定。移植物固定完成后对三组实验样本实施生物力学测试,包括最大载荷、刚度和失败模式。结果最大载荷:BioRCI-HA 组为(483.4±103.8)N,PLLA/ HA/α-Fe2 O3组为(456.0±102.0)N,PLLA-PEG/ HA组为(445.7±90.1)N,三组最大载荷差异无统计学意义。抗拉刚度:BioRCI-HA 组(48.0±6.7)N/ mm ﹥ PLLA-PEG/HA 组(40.7±6.7)N/ mm 和 PLLA/ HA/α-Fe2 O3组(41.2±4.6)N/ mm,前者抗拉强度较后两者差异有统计学意义。失败模式:所有样本测试失败模式均为移植物滑出,并无出现移植物撕裂或者固定装置损坏发生。结论改性界面螺钉 PLLA/ HA/α-Fe2 O3、PLLA-PEG/ HA 在重建猪 ACL 中能满足生物力学要求。%Objective To evaluate the biomechanical properties of soft-tissue grafts reconstructed anterior cruciate liga-ment(ACL)with two modified bioabsorbable interference screws,Poly-L-lactic acid/ hydroxyapatite/ α-Fe2 O3(PLLA/ HA/ α-Fe2 O3 )screw and Poly-L-lactic acid-polyethylene glycol/ hydroxyapatite( PLLA-PEG/ HA)screw. Methods Porcine tibia and hoof extensor tendons were divided into 3 matched groups with 8 tibia and 8 extensor tendons in each group. PLLA/ HA/ α-Fe2 O3 screws、PLLA-PEG/ HA screws and poly-L-lactic acid and hydroxyapatite(BioRCI-HA,Smith ﹠ Nephew,USA)screws were used for tibial fixation in soft-tissue grafts ACL reconstruction. All specimens

  15. The influence of sacral morphology on the existence of secure S1 and S2 transverse bone corridors for iliosacroiliac screw fixation.

    Science.gov (United States)

    Mendel, T; Noser, H; Kuervers, J; Goehre, F; Hofmann, G O; Radetzki, F

    2013-12-01

    Sacroiliac (SI) screw fixation for unstable pelvic fractures stands out as the only minimally invasive method among all other ORIF procedures. A strictly transverse screw trajectory is needed for central or bilateral fracture patterns up to a complete iliosacroiliac fixation. However, secure screw insertion is aggravated by a narrow sacroiliac bone stock. This study investigates the influence of a highly variable sacral morphology to the existence of S1 and S2 transverse corridors. The analysis contained in this study is based on 125 CT datasets of intact human pelvises. First, sacral dysplasia was identified using the "lateral sacral triangle" method in a lateral 3-D semi-transparent pelvic view. Second, 3-D corridors for a 7.3mm screw in the upper two sacral levels were visualised using a proprietary IT workflow of custom-made programme scripts based on the Amira(®)-software. Shape-describing measurement variables were calculated as output variables. The results show a significant linear correlation between ratioT and the screw-limiting S1 isthmus height (Pearson coefficient of 0.84). A boundary ratio of 1.5 represented a positive predictive value of 96% for the existence of a transverse S1-corridor for at least one 7.3mm screw. In 100 out of 125 pelvises (80%), a sufficient S1 corridor existed, whereas in 124 specimens (99%), an S2 corridor was found. Statistics revealed significantly larger S1 and S2 corridors in males compared to females (pS1 and 1 screw in S2. The expanse of the S1 corridor is highly influenced by the dimensions of the dysplastic elevated upper sacrum, whereas the S2 corridor is not affected. Hence, in dysplastic pelvises, sacroiliac screw insertion should be recommended into the 2nd sacral segment. Our IT workflow for the automatic computation of 3-D corridors may assist in surgical pre-operative planning. Furthermore, the workflow could be implemented in computer-assisted surgery applications involving pelvic trauma.

  16. New Technique for C1 Double-Door Laminoplasty Using Allograft Spacers and Titanium Miniplate Screw Fixation: Technical Report.

    Science.gov (United States)

    Kim, Seok Woo; Lee, Jae-Hoo; Lee, Ho-Won; Oh, Jae-Keun; Kwak, Yoon-Hae

    2016-03-01

    Although conventional C1 laminectomy is the gold standard for decompression at the atlas, it provides little space for the bone graft to fuse. The fusion area can be extended cranially up to the occipital bone, but it requires sacrificing the function of the craniocervical junction. To date, no reports have focused on surgical techniques for successful decompression and fusion without disruption of the posterior C1 arch while providing enough room for the bone graft to fuse. This study introduces a new technique for C1-C2 fusion and C1 double-door laminoplasty in patients with C1-C2 instability, canal stenosis, and cervical spondylotic myelopathy. A 66-year-old man who had undergone C1-C2 fusion at a local clinic 2 years earlier visited our hospital due to progressive myelopathy. A preoperative computed tomography (CT) scan showed the tip of the odontoid process, extending into the spinal canal. On the axial view of T2-weighted magnetic resonance images, the tip of the odontoid process significantly compressed the spinal cord on the left side. The atlantodental interval was 7 mm on radiography; however, C1-C2 instability was not evident on flexion-extension X-rays due to the previous screw fixation. The patient underwent C1-C2 decompression and fusion surgery with our new surgical technique. The segmental screws were repositioned at C1 and C2, and we performed C1 double-door laminoplasty augmented with an allograft spacer and a titanium miniplate. A marked reduction was seen at postoperative radiograph and CT scan. Neurologic symptoms were relieved dramatically after surgery without any discomfort. No complications were noted. We introduced a new surgical technique that allows bone grafting, decompression, and fusion to be performed without disruption of the posterior C1 arch in the event of C1-C2 canal stenosis combined with instability. This technique may be indicated for other conditions that cause instability and stenosis at the C1-C2 area. PMID:26689563

  17. Biomechanical comparison of bilateral pedicle screw and unilateral pedicle screw fixation%双侧钉棒及同侧单钉棒置入内固定的生物力学比较

    Institute of Scientific and Technical Information of China (English)

    陈立业; 夏虹; 王建华; 尹庆水

    2011-01-01

    BACKGROUND: Most of lumbar degenerative diseases, such as lumbar instability and lumbar spondylolisthesis, need lumbarspinal fusion for the spine stability, but the choice of internal fixation approaches is an argument.OBJECTIVE: To investigate the biomechanical difference of unilateral and bilateral minimally I nvasive transforaminal lumbarinterbody fusion (TLIF) for the treatment of lumbar degenerative diseases.METHODS: Minimally invasive TLIF with different internal fixations were performed on L4-5 segments from six fresh frozenhuman lumbar cadaveric specimens. Then, the specimens were divided into two groups according to different internal fixationmethods: bilateral pedicle screw group and unilateral pedicle screw group. Range of motion (ROM) for the lumbar function unitwas measured on the biomechanical machine and compared between the two groups.RESULTS AND CONCLUSION: Compared with the compact lumbar function unit, the ROM of the two fixation groups weresignificantly lower (P < 0.05). The ROM value of the bilateral pedicle screw group was significantly lower than that of the unilateralpedicle screw group in all working states (P < 0.05). Biomechanical experiments show that unilateral TLIF provides favorablebiomechanical effect and stiffness, which offers the dependable stability of the lumbar vertebra e. However, compared with thebilateral pedicle screw fixation, there are still gaps in the unilateral pedicle screw fixation.%背景:腰椎失稳、腰椎滑脱等腰椎退行性疾病常常需要实施腰椎融合,其目标是稳定脊柱,但究竟采取何种内固定方式仍存在争论.目的:比较单侧与双侧经椎间孔减压椎体间融合治疗腰椎退行性病变的生物力学差异.方法:人新鲜尸体腰椎标本6具,L4~5模拟微创经椎间孔减压椎体间融合,根据不同的内固定组合方式分为2组,即双侧钉棒组及同侧单钉棒组.在生物力学试验机上测量各种固定方式不同工况下的运动范围(ROM

  18. 骨水泥强化椎弓根螺钉固定L1压缩性骨折:与单纯椎弓根螺钉固定的比较%Pedicle screw fixation with bone cementversus pedicle screw fixation alone for L1 compression fractures

    Institute of Scientific and Technical Information of China (English)

    亚力坤•亚森

    2015-01-01

    背景:椎体成形术与椎弓根螺钉内固定都是胸腰椎骨折的有效修复方案,但胸腰椎压缩性骨折内固定取出后脊柱角度丢失是较为常见的并发症,经皮椎体成形术可能是预防脊柱角度丢失的较好选择。  目的:观察骨水泥强化椎弓根螺钉置入内固定修复L1压缩性骨折的临床疗效及并发症,并与单纯椎弓根螺钉内固定比较。  方法:纳入L1压缩性骨折患者76例,根据内固定修复方案分为两组,经皮椎体成形组40例行骨水泥联合椎弓根螺钉置入内固定治疗,单纯椎弓根内固定组36例仅行椎弓根螺钉置入内固定治疗。比较两组的修复效果,置入后即刻、置入后3,6个月以伤椎为中心进行MRI检查测量Cobb角、伤椎椎体前缘高度,同时记录目测类比评分;另外了解有无内固定松动断裂。  结果与结论:两组患者随访6个月内均获骨性愈合,无螺钉松动、折断。两组置入后6个月损伤节段后凸Cobb角、伤椎椎体前缘高度均较置入前明显改善(P0.05)。表明应用骨水泥强化椎弓根螺钉内固定及椎弓根钉内固定修复L1压缩性均可获得满意复位,重建椎体高度。但抗压稳定性结果表明应用骨水泥强化椎弓根螺钉内固定的固定效果更好一些,未见短期断钉、矫正丢失等并发症,椎体骨水泥灌注可提高椎弓根螺钉置入后的稳定性。%BACKGROUND:Vertebroplasty and edicle screw fixation are effective repair methods for thoracolumbar fractures. Spine angle loss is a more common complication after removal of implant for thoracolumbar compression fractures. Percutaneous vertebroplasty may be a better choice for preventing spine angle loss. OBJECTIVE:To investigate the clinical curative effect and complication of pedicle screw fixation with bone cement for repair of L1 compression fractures, and to compare with pedicle screw fixation alone. METHODS: A total

  19. Avaliação dos resultados da tenodese artroscópica do bíceps, utilizando-se parafuso de interferência bioabsorvível Evaluation of arthroscopic tenodesis of the biceps using a bioabsorbable interference screw

    Directory of Open Access Journals (Sweden)

    Sérgio Luiz Checchia

    2007-08-01

    Full Text Available OBJETIVO: Avaliar os resultados obtidos com a realização da tenodese da cabeça longa do bíceps (CLB pela técnica artroscópica, com a utilização de parafuso de interferência bioabsorvível biotenodese Arthrex®. MÉTODOS: Entre março de 2004 e abril de 2005, 16 ombros de 16 pacientes foram submetidos a tenodese da CLB com essa técnica. O seguimento mínimo foi de 12 meses, com média de 19,5 meses. A idade variou de 32 a 69 anos, com média de 56,1 anos. Houve predomínio do sexo masculino em 75% dos casos. O membro dominante foi acometido em 62,5% dos pacientes. Foi encontrada lesão parcial da CLB em 75% dos pacientes e instabilidade em 25%. Houve associação com lesão do manguito rotador (LMR em 93,75% dos casos. A avaliação clínica foi feita por meio dos critérios da University of California at Los Angeles (UCLA. RESULTADOS: Observamos excelentes resultados em todos os casos. Não foi observado em nenhum caso sinal de retração do músculo bíceps (sinal do Popeye, caracterizando soltura da tenodese. CONCLUSÃO: A tenodese da CLB pela técnica artroscópica, com a utilização de parafuso de interferência bioabsorvível biotenodese Arthrex® mostrou-se uma técnica eficiente para o tratamento das alterações da CLB.OBJECTIVE: To evaluate results obtained with arthroscopic tenodesis of the long head of the biceps (LHB using a bioabsorbable interference screw Arthrex® biotenodesis. METHODS: Between March 2004 and April 2005, 16 shoulders of 16 patients were submitted to LHB tenodesis using this technique. Minimum follow-up was 12 months, with a mean of 19.5 months. Age ranged from 32 to 69 years, mean of 56.1 years. Male patients prevailed, with 75% of the cases. The dominant limb was involved in 62.5% of the patients. Partial lesion of the LHB was found in 75% of the patients, and instability in 25%. Association to rotator cuff lesion (RCL was found in 93.75% of the cases. Clinical evaluation was based on the University of

  20. Role of Joshi's external stabilization system with percutaneous screw fixation in high-energy tibial condylar fractures associated with severe soft tissue injuries

    Institute of Scientific and Technical Information of China (English)

    Ashish Kumar Gupta; Rahul Sapra; Rakesh Kumar; Som Prakash Gupta; Devwart Kaushik; Sahil Gaba; Mahesh Chand Bansal

    2015-01-01

    Purpose: The treatment of high-energy tibial condylar fractures which are associated with severe sott tissue injuries remains contentious and challenging.In this study, we assessed the results of Joshi's external stabilization system (JESS) by using the principle of ligamentotaxis and percutaneous screw fixation for managing high-energy tibial condylar fractures associated with severe soft tissue injuries.Methods: Between June 2008 and June 2010, 25 consecutive patients who were 17-71 years (mean, 39.7), underwent the JESS fixation for high-energy tibial condylar fractures associated with severe soft tissue injuries.Out of 25 patients, 2 were lost during follow-up and in 1 case early removal of frame was done, leaving 22 cases for final follow-up.Among them, 11 had poor skin condition with abrasions and blisters and 2 were open injuries (Gustilo-Anderson grade Ⅰ & Ⅱ).The injury mechanisms were motor vehicle accidents (n =19), fall from a height (n =2) and assault (n =1).The fractures were classified according to Schatzker classification system.Results: There were 7 type-Ⅴ, 14 type-Ⅵ and 1 type-Ⅳ Schatzker's tibial plateau fractures.The average interval between the injury and surgery was 6.8 days (range 2-13).The average hospital stay was 13 days (range, 7-22).The average interval between the surgery and full weight bearing was 13.6 weeks (range 11-20).The average range of knee flexion was 121° (range 105°-135°).The normal extension of the knee was observed in 20 patients, and an extensor lag of 5°-8° was noted in 2 patients.The complications included superficial pin tract infections (n =4) with no knee stiffness.Conclusion: JESS with lag screw fixation combines the benefit of traction, external fixation, and limited internal fixation, at the same time as allowing the ease of access to the soft tissue for wound checks, pin care, dressing changes, measurement of compartment pressure, and the monitoring of the neurovascular status.In a nutshell, JESS

  1. C1-C2 transarticular screw fixation for atlantoaxial instability due to rheumatoid arthritis: a seven-year analysis of outcome.

    LENUS (Irish Health Repository)

    Nagaria, Jabir

    2009-12-15

    STUDY DESIGN.: Observational study. Retrospective analysis of prospectively collected data. OBJECTIVE.: The purpose of this article was to report long-term (minimum 7 years) clinical and radiologic outcome of our series of patients with Rheumatoid Arthritis who underwent transarticular screw fixation to treat atlantoaxial subluxation. SUMMARY OF BACKGROUND DATA.: The indications for intervention in patients with atlantoaxial instability are pain, myelopathy, and progressive neurologic deficit. The various treatment options available for these patients are isolated C1-C2 fusion, occipitocervical fusion with or without transoral surgery. Review of current literature suggests that C1-C2 transarticular screw fixation has significant functional benefits, although there is discrepancy in this literature regarding improvement in function following surgery. METHODS.: Myelopathy was assessed using Ranawat myelopathy score and Myelopathy Disability Index. Pain scores were assessed using Visual Analogue Scale. The radiologic imaging was assessed and the following data were extracted; atlanto-dens interval, space available for cord, presence of signal change on T2 weighted image, and fusion rates. RESULTS.: Thirty-seven patients, median age 56, were included in the study. Average duration of neck symptoms was 15.8 months. Average duration of rheumatoid arthritis before surgery was 20.6 years. Preoperative symptoms: suboccipital pain in 26 patients; neck pain, 32; myelopathy, 22; and 5 were asymptomatic. After surgery: suboccipital pain, 2; neck pain, 3; and myelopathy, 10. Ninety percent patients with neck and suboccipital pain improved after surgery in their Visual Analogue pain scores, with all of them having >50% improvement in VAS scores (6.94-2.12 [P < 0.05]).Preoperative Ranawat grade was as follows: grade 1 in 15 patients, grade 2 in 7, and grade 3a in 14, grade 3b in 1.After surgery: grade 1 in 27 patients, grade 2 in 7, grade 3a in 1, and grade 3b in 2. The mean

  2. Bacterial adherence to titanium, poly-L-lactic acid, and composite hydroxyapatite and poly-L-lactic acid interference screws.

    Science.gov (United States)

    Masini, Brendan D; Stinner, Daniel J; Waterman, Scott M; Wenke, Joseph C; Gerlinger, Tad L

    2012-01-01

    This study investigates a potential site of bacterial adherence, the implant surface, comparing titanium, poly-L-lactic acid (PLLA), and composite hydroxyapatite and poly-L-lactic acid (PLLA-HA) interference screws using a bioluminescent in vitro model. Interference screws of three materials, titanium (Arthrex, Naples, FL), bioabsorbable poly-L-lactic acid (BIORCI, Smith & Nephew, Andover, MA), and bioabsorbable composite hydroxyapatite and poly-L-lactic acid (BIORCI-HA, Smith & Nephew, Andover, MA) were immersed in a broth of bioluminescent Staphylococcus aureus. The screws were irrigated and then imaged with a photon-capturing camera system yielding a total photon count correlating with residual adherent bacteria. The titanium screws had the lowest mean total bacterial counts followed by the PLLA-HA screws and with the PLLA screws having the highest mean total counts. The difference in means between the titanium group and the PLLA group was statistically significant (p bacterial adherence than comparable bioabsorbable PLLA screws.

  3. Anterior subcutaneous fixation with screw-rod internal fixator for the treatment of unstable anterior pelvic ring fractures%经皮钉-棒内支架治疗不稳定骨盆前环骨折

    Institute of Scientific and Technical Information of China (English)

    王朝晖; 何波涌; 曾敏川; 郭建辉; 唐艳平; 赵快平; 刘建伟

    2016-01-01

    目的探讨经皮钉-棒内支架治疗不稳定骨盆前环骨折临床应用。方法回顾性分析经皮钉-棒内支架治疗的12例不稳定骨盆前环骨折患者的临床资料,男性8例,女性4例;年龄23~63岁,平均43.8岁。骨盆骨折按照Tile分类:B34例,C14例,C23例,C31例。后环损伤采用经皮骶髂螺钉固定2例,髂腰固定1例,钢板固定6例,其中M张力带钢板固定4例。结果前环固定平均出血70mL(50~90mL),平均手术时间65min(50~85min)。单侧股外侧皮神经损伤5例,均恢复正常;随访4~15个月,无切口感染、内固定失效等,骨折均获骨性愈合,疗效满意。结论经皮钉-棒内支架是治疗不稳定骨盆前环骨折微创舒适、简便、安全的方法,疗效好,但术中应警惕股外侧皮神经损伤。%Objective To study percutaneous internal fixation with screw-rod system for the treatment of unstable anterior pelvic ring fractures .Methods The clinical data of 12 cases of unstable anterior pelvic ring frac-tures treated with anterior subcutaneous fixation with screw-rod system was retrospectively analyzed . According to the Tile’s classification,4 cases were B3,4 cases were C1,3 cases were C2,and 1 case was C3.In all these poste-rior ring fractures,2 cases were treated with percutaneous iliosacral screw fixation ,1 case with ilio-lumbar fixation,and 6 cases with plate fixation (including M-shaped tension plate fixation in 4 cases).Results The average blood loss and operation time of anterior pelvic ring fixation were 70 mL ( ranged from 50 to 90 mL) and 65 min( ranged from 50 to 85min)respectively.Unilateral lateral femoral cutaneous nerves were inpaired in 5 cases and the symptoms resolved after 2 weeks.All cases were followed up for 4 to 15 months,indicating bone healing and satisfactory clinical results , without wound infection or fixation failure .Conclusion The percutaneous internal fixation with screw-rod system

  4. Biomechanical and finite element analyses of bone cement-Injectable cannulated pedicle screw fixation in osteoporotic bone.

    Science.gov (United States)

    Liu, Yaoyao; Xu, Jianzhong; Sun, Dong; Luo, Fei; Zhang, Zehua; Dai, Fei

    2016-07-01

    The objectives of this study were to investigate the safety and biomechanical stability of a polymethylmethacrylate (PMMA)-augmented bone cement-injectable cannulated pedicle screw (CICPS) in cancellous bone model, and to analyze the stress distribution at the screw-cement-bone interface. The OMEGA cannulated pedicle screw (OPS) and conventional pedicle screw (CPS) were used as control groups. Safety of the CICPS was evaluated by the static bending and bending fatigue tests. Biomechanical stability was analyzed by the maximum axial pullout strength and maximum torque tests. Stress distribution at the screw-cement-bone interface was analyzed by the finite element (FE) method. The CICPS and CPS produced statistically similar values for bending stiffness, bending structural stiffness, and bending yield moment. The maximum pullout force was 53.47 ± 8.65 N in CPS group, compared to 130.82 ± 7.32 N and 175.45 ± 43.01 N in the PMMA-augmented OPS and CICPS groups, respectively (p screw-cement-bone interface in the CICPS group. In conclusion, PMMA-augmentation with CICPS may be a potentially useful method to increase the stability of pedicle screws in patients with osteoporosis. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 960-967, 2016. PMID:25976272

  5. Smallness kerf pedicle screw internal fixation cure thoracolumbar fracture%小切口椎弓根钉棒内固定治疗胸腰椎骨折

    Institute of Scientific and Technical Information of China (English)

    胡红耘

    2009-01-01

    Objective Smallness kerr rout of retreat pedicle screw posting restoration fixing cure thoracolum-bar fracture. Methods Versus 12 example thoracolumbar fracture adopt smallness keff micro-wound rout of retreat pedicle screw posting restoration fixing technology. Results 12 example fracture patient follow-up survey 8 loaf months to 2 year, average long dozen month, fracture restoration satisfaction, pedicle screw position all right, without height lost, without looseness,lapse sever natl. Conclusion Thoracolumbar fracture met pedicle screw push off resto-ration internal fixation, reestablish physiologic protrusion, operation kerf smallness, esthetic appearance, hemorrhage fewness wound reaction smallness, in favor of skill post-recovery.%目的 探讨椎弓根钉棒置入复位固定治疗胸腰椎骨折的手术入路方法.方法 对12例胸腰椎骨折的病例采用小切口微创后路椎弓根钉棒置入复位固定技术.结果 12例骨折患者随访8个月至2年,平均13个月,骨折复位满意,椎弓根钉棒位置良好,无高度丢失、无松动、失效、断钉.结论 胸腰椎骨折可选择后路小切口术式行椎弓根钉棒撑开复位内固定,重建生理前突,手术切口小、美观、出血少、创伤反应小,有利于术后恢复.

  6. 髓内固定与钉板固定治疗股骨粗隆间骨折的疗效比较%A comparison study of intramedullary fixation and screw-plate fixation treatment on intertrochanteric fracture

    Institute of Scientific and Technical Information of China (English)

    孔祥安; 董力军; 金韡

    2014-01-01

    目的:对比观察两种方法(髓内固定系统和钉板固定系统)治疗股骨粗隆间骨折的临床疗效,为临床推广作出指导。方法选择53例股骨粗隆间骨折患者为研究对象,按手术方法分为髓内组和钉板组,髓内组采用髓内固定系统治疗,钉板组采用钉板固定系统治疗,比较两组患者术中、术后的各项指标以及治疗后的临床疗效。结果①两组患者术中、术后各项指标的比较:髓内组术中、术后各项指标均优于钉板组,其结果比较差异有统计学意义(P<0.05);②两组患者临床疗效的比较:髓内组的优良率为88.89%,钉板组的优良率为88.57%,其结果比较差异无统计学意义( P>0.05)。结论髓内固定系统和钉板固定系统治疗股骨粗隆间骨折的临床疗效均较好,但髓内固定系统具有切口小、出血少和恢复快等优势。%Objective To explore two different internal fixation methods ,intramedullary fixation system and screw -plate fixation system for the treatment of intertrochanteric fractures ,in order to direct the clinical application .Methods From Jan.2007 to May 2013,53 cases of intertrochanteric fractures were retrospectively studied ,and the patients were divided into two groups:the intramedullary fixation group and the screw-plate fixation group .Procedure related index and postoperative recover situation of the two groups were compared .Results ①Procedure related index in the intramedullary fixation group were better than those of the screw -plate fixation group with a statistically signifi-cant difference(P0.05).Conclusion Both of the two treatment methods for intertrochanteric fractures can get excellent clinical efficacy .However,the intramedullary fixation system has advantages in smaller surgical injury ,less blood loss and faster recovery ,which is worth clinical application .

  7. Comparison of Head Center Position and Screw Fixation Options Between a Jumbo Cup and an Offset Center of Rotation Cup in Revision Total Hip Arthroplasty: A Computer Simulation Study.

    Science.gov (United States)

    Faizan, Ahmad; Black, Brandon J; Fay, Brian D; Heffernan, Christopher D; Ries, Michael D

    2016-01-01

    Jumbo acetabular cups are commonly used in revision total hip arthroplasty (THA). A straightforward reaming technique is used which is similar to primary THA. However, jumbo cups may also be associated with hip center elevation, limited screw fixation options, and anterior soft tissue impingement. A partially truncated hemispherical shell was designed with an offset center of rotation, thick superior rim, and beveled anterior and superior rims as an alternative to a conventional jumbo cup. A three dimensional computer simulation was used to assess head center position and safe screw trajectories. Results of this in vitro study indicate that a modified hemispherical implant geometry can reduce head center elevation while permitting favorable screw fixation trajectories into the pelvis in comparison to a conventional jumbo cup.

  8. 钉道强化提高椎弓根螺钉固定强度的生物力学研究%Biomechanical study of the improvement of pedicle screw fixation with application of local screw tunnel augmentation technique and expansive pedicle screws

    Institute of Scientific and Technical Information of China (English)

    杨彬奎; 雷伟; 王军; 吴子祥; 刘达; 李运明

    2008-01-01

    Objective To evaluate the improvement of pedicle screw fixation with the application of local screw tunnel augmentation technique and expansive pediele screws.Methods Injecting CaSO4 bone cement into the perine of pediele screw tunnel by new design instruments in order to augment the screw tunnel.Twenty lumbar vertebrae from five frozen human spine specimens were divided into 10 blocks by randomized block design.Four fixation methods were applied:group A(common pedicle screws),group B(common pedicle screws+local screw tunnel augmentation technique),group C(expansive pedicle screws+local screw tunnel augmentation technique),group D(common pedicle screws+CaSO4 bone cement filled into pedicle screw tunnels).Four fixation methods were performed in four screw tunnels of each two blocks at random.And then the maximum axial pullout strength(Fmax)and energy absorbed were measured for comparison.Results Mean values of the Fmax and energy absorbed of group C or D were statistically significantly greater than those of group A(P<0.01)and group B(P<0.05).Mean values of the Fmax and energy absorbed of group B were also statistically significantly greater than those of group A(P<0.01).There was no statistical significant difference between group C and group D(P>0.05).Conclusion The pedicle screw fixation might be improved with the application of local screw tunnel augmentation technique and it might be even finner if combined with expansive pedicle screws.%目的 评价椎弓根钉道局部强化技术及其结合膨胀式椎弓根螺钉提高椎弓根螺钉固定强度的效果.方法 通过自行设计及加工的钉道局部强化装置,向钉道周壁点状注入CaSO4骨水泥以强化椎弓根钉道.5具新鲜冻存人体脊柱标本,每具随机选取4个腰椎共20个腰椎标本,采用随机区组设计方法分为10个区组.设计四种固定方法:A组(普通椎弓根螺钉)、B组(普通椎弓根螺钉+钉道局部强化)、C组(膨胀式椎弓根螺钉+钉

  9. Foreign body reaction after PLC reconstruction caused by a broken PLLA screw.

    Science.gov (United States)

    Kim, Tae-Kwon; Jeong, Tae-Wan; Lee, Dae-Hee

    2014-12-01

    Foreign body reactions may occur in patients who receive bioabsorbable implants during orthopedic surgery for fractures and ligament repair. The authors describe a 34-year-old man who presented with a palpable tender mass on the lateral aspect of the left knee of 1 month's duration. He underwent posterior cruciate ligament and posterolateral corner reconstruction 3 years earlier. Physical examination showed a 1×1-cm soft, nontender mass without localized warmth on the lateral epicondyle of the distal femur. Magnetic resonance imaging showed a broken screw fragment surrounded by a cyst-like mass. Under general anesthesia, the surgeon excised the screw fragment and the fibrotic mass, enclosing it in the subcutaneous tissue at the lateral epicondyle, the site at which a poly-L-lactic acid bioabsorbable screw had been inserted to fix the graft for posterolateral corner reconstruction. Histologic evaluation showed a foreign body reaction to the degraded screw particles. To the authors' knowledge, this report is the first description of a patient presenting with a delayed foreign body reaction to a broken poly-L-lactic acid bioabsorbable screw at the lateral femoral epicondyle after posterolateral corner reconstruction. Because delayed foreign body reactions can occur at any site of poly-L-lactic acid bioabsorbable screw insertion, care should be taken to avoid screw protrusion during ligament reconstruction because it can lead to screw breakage and delayed foreign body reaction.

  10. Foreign body reaction after PLC reconstruction caused by a broken PLLA screw.

    Science.gov (United States)

    Kim, Tae-Kwon; Jeong, Tae-Wan; Lee, Dae-Hee

    2014-12-01

    Foreign body reactions may occur in patients who receive bioabsorbable implants during orthopedic surgery for fractures and ligament repair. The authors describe a 34-year-old man who presented with a palpable tender mass on the lateral aspect of the left knee of 1 month's duration. He underwent posterior cruciate ligament and posterolateral corner reconstruction 3 years earlier. Physical examination showed a 1×1-cm soft, nontender mass without localized warmth on the lateral epicondyle of the distal femur. Magnetic resonance imaging showed a broken screw fragment surrounded by a cyst-like mass. Under general anesthesia, the surgeon excised the screw fragment and the fibrotic mass, enclosing it in the subcutaneous tissue at the lateral epicondyle, the site at which a poly-L-lactic acid bioabsorbable screw had been inserted to fix the graft for posterolateral corner reconstruction. Histologic evaluation showed a foreign body reaction to the degraded screw particles. To the authors' knowledge, this report is the first description of a patient presenting with a delayed foreign body reaction to a broken poly-L-lactic acid bioabsorbable screw at the lateral femoral epicondyle after posterolateral corner reconstruction. Because delayed foreign body reactions can occur at any site of poly-L-lactic acid bioabsorbable screw insertion, care should be taken to avoid screw protrusion during ligament reconstruction because it can lead to screw breakage and delayed foreign body reaction. PMID:25437089

  11. 下颈椎经关节螺钉联合侧块或椎弓根螺钉固定的效果%The effect of trausarticular screws combined with lateral mass screws or pedicle screws fixation in the lower cervical spine

    Institute of Scientific and Technical Information of China (English)

    马维虎; 刘观燚; 徐荣明; 孙韶华; 胡勇; 赵刘军; 蒋伟宇; 顾勇杰

    2009-01-01

    目的 探讨在下颈椎经颈后正中入路应用经关节螺钉联合侧块螺钉或椎弓根螺钉行内固定治疗的固定效果.方法 2003年2月至2007年10月,对22例患者通过后路应用经关节螺钉联合侧块螺钉或椎弓根螺钉行内固定治疗,男14例,女8例;年龄24~73岁,平均43岁.其中下颈椎创伤性骨折脱位13例,颈椎后纵韧带骨化症4例,颈椎管狭窄伴Ⅱ型齿突骨折1例,颈椎间盘突出伴椎管狭窄4例.结果 共置入经关节螺钉45枚,其中C4,5 2枚,C5,639枚,C6,74枚;共置入侧块螺钉12枚,C3、C4各6枚;共置入椎弓根螺钉41枚,其中C24枚,C32枚,C46枚,C721枚,T18枚.术中所有螺钉均成功置入,未出现椎动脉、神经根和脊髓损伤等置钉相关并发症.22例患者均获随访,随访时间10个月~3年8个月,平均17个月.植骨融合时间3~5个月,平均3.5个月.术后发现1例患者的2枚经关节螺钉松动,部分脱出.经加强颈托制动,术后4个月获得融合.结论 通过后路固定下颈椎时,采用经关节螺钉联合侧块螺钉或椎弓根螺钉固定,均可取得较好的固定效果.%Objective To discuss the effect of transarticular screws combined with lateral mass screws or pedicle screws through posterior approach in the lower cervical spine. Methods From February 2003 to October 2007, 22 patients were treated using transarticular screws internal fixation combined with lateral mass screws or pedicle screws in Axis plating system and Vertex system. There were cervical fracture and dislocation in 13 patients, ossification of the posterior longitudinal ligament in 4, cervical canal stenosis associated with dentoid process fracture in 1, and cervical disc herniation associated with cervical stenosis in 4 patients. Lamina or facet bone grafting were used to achieve a long-term stability, with decompression and anterior approach or not. The starting point for screw insertion was located 1 mm medial to the midpoint of the lateral mass and

  12. Clinical outcome of internal fixation of unstable juvenile osteochondritis dissecans lesions of the knee.

    Science.gov (United States)

    Webb, Jonathan E; Lewallen, Laura W; Christophersen, Christy; Krych, Aaron J; McIntosh, Amy L

    2013-11-01

    Juvenile osteochondritis dissecans (OCD) lesions of the knee are a common cause of knee pain in skeletally immature patients.The authors sought to determine lesion healing rates, the risk factors associated with failure to heal, and the clinical outcomes for patients who underwent internal fixation for unstable OCD lesions. A retrospective review was conducted of all patients who underwent internal fixation of OCD lesions from 1999 to 2009. Using validated scoring systems, clinical outcome and functional activity were evaluated at the follow-up. The study group comprised 19 patients (20 knees). Mean patient age was 14.5 years (range, 12-17 years). Mean clinical follow-up was 7 years (range, 2-13 years). Mean radiographic follow-up was 2.5 years (range, 0.5-9 years). Fourteen (70%) lesions were grade 3 and 6 (30%) were grade 4. Eleven knees had lateral condyle lesions and 9 had medial lesions. Bioabsorbable fixation was used in 13 knees, metal fixation was used in 5 knees, and 2 knees were fixed with a combination of methods. Osseous integration was evident in 15 (75%) of 20 knees at final follow-up. The 5 unhealed lesions were lateral condylar lesions. Mean Tegner activity scores improved from 3.3 preoperatively to 5.6 at final follow-up. Mean Lysholm and International Knee Documentation Committee scores were 86.8 and 88.7, respectively, at final follow-up. Further operative intervention was required in 11 knees, with 50% of patients undergoing removal of hardware and 15% requiring subsequent osteochondral allograft transplantation. The authors recommend bioabsorbable fixation for symptomatic stable lesions and metal compression screws with staged removal for unstable lesions.

  13. Clinical Comparison of Femoral Rigid fixation and Interference Screw Fixation in Anterior Cruciate Ligament Reconstruction%横穿钉与界面螺钉重建前交叉韧带的临床对比研究

    Institute of Scientific and Technical Information of China (English)

    涂峰; 王皓; 鲁周同

    2012-01-01

    Objective: A randomized clinical study was conducted to compare the outcome between RigidFix and interference screw fixation in anterior cruciate ligament (ACL) reconstructions with 4 —strand hamstring tendon . Methods: From March 2005 to February 2007, a total of 32 patients with hamstring ACL reconstruction were divided into RigidFix group (n=18, 11 males and 7 females, range 19 — 49 years) and the interference screw fixation group (n= 14> 10 males and 4 females, range 20~42 years). There were no significant differences between the 2 groups with regard to range of motion and ly-sholra score. All patients followed the same postoperative program and got a clinical assessment at 3, 6, and 12 months after surgery. Results:There were no complications in the two groups. The Lysholm score in RigidFix group at 12-month follow-up was (89. 60±3. 28) t and in interference screw group, the score at 12 month follow-up was (88. 80±2. 92), indicating no significant difference between the two groups (P>0. 05). Conclusion;The clinical results in this study clarified that Rigidfix is an effective and safe method for femoral hamstring fixation in ACL reconstruction, and there is no difference in Rigidfix and interference screw fixation technique in the comparison of the short-term follow-up.%目的:比较关节镜下应用横穿钉(Rigidfix)和可吸收界面螺钉(Biocryl)固定腘绳肌重建膝关节前交叉韧带的疗效,探讨应用Rigidfix固定系统重建ACL的临床效果.方法:2005年3月-2007年2月,对32例经关节镜检证实前交叉韧带损伤的病人随机使用股骨端Rigidfix系统固定或者界面螺钉固定腘绳肌两种方法重建前交叉韧带.结果:2组病人术后无并发症发生,Rigidfix组获随访15~32个月,术后12个月Lysholm评分85~93分(89.60±3.28)分;界面螺钉组获随访17~29个月,术后12个月Lysholm评分83~92分(88.80±2.92)分,组间比较差异无统计学意义(P>0.05).结论:Rigidfix固定系统在

  14. Latarjet Fixation

    Science.gov (United States)

    Alvi, Hasham M.; Monroe, Emily J.; Muriuki, Muturi; Verma, Rajat N.; Marra, Guido; Saltzman, Matthew D.

    2016-01-01

    Background: Attritional bone loss in patients with recurrent anterior instability has successfully been treated with a bone block procedure such as the Latarjet. It has not been previously demonstrated whether cortical or cancellous screws are superior when used for this procedure. Purpose: To assess the strength of stainless steel cortical screws versus stainless steel cannulated cancellous screws in the Latarjet procedure. Study Design: Controlled laboratory study. Methods: Ten fresh-frozen matched-pair shoulder specimens were randomized into 2 separate fixation groups: (1) 3.5-mm stainless steel cortical screws and (2) 4.0-mm stainless steel partially threaded cannulated cancellous screws. Shoulder specimens were dissected free of all soft tissue and a 25% glenoid defect was created. The coracoid process was osteomized, placed at the site of the glenoid defect, and fixed in place with 2 parallel screws. Results: All 10 specimens failed by screw cutout. Nine of 10 specimens failed by progressive displacement with an increased number of cycles. One specimen in the 4.0-mm screw group failed by catastrophic failure on initiation of the testing protocol. The 3.5-mm screws had a mean of 274 cycles (SD, ±171 cycles; range, 10-443 cycles) to failure. The 4.0-mm screws had a mean of 135 cycles (SD, ±141 cycles; range, 0-284 cycles) to failure. There was no statistically significant difference between the 2 types of screws for cycles required to cause failure (P = .144). Conclusion: There was no statistically significant difference in energy or cycles to failure when comparing the stainless steel cortical screws versus partially threaded cannulated cancellous screws. Clinical Relevance: Latarjet may be performed using cortical or cancellous screws without a clear advantage of either option. PMID:27158630

  15. Pedicle lag screw fixation in the treatment of Hangman's fracture%椎弓根拉力螺钉内固定治疗Hangman骨折

    Institute of Scientific and Technical Information of China (English)

    刘德宝; 张复文; 卜海富; 胡孔足; 周健

    2012-01-01

    探讨应用椎弓根拉力螺钉技术治疗Hangman骨折的临床疗效.方法 对12例Hangman骨折患者经颅骨牵引获得复位后,行C2椎弓根拉力螺钉内固定术治疗.术后行X线片检查观察骨折复位及愈合情况.结果 手术时间50~90min,失血量100~300ml.术中无脊髓神经损伤,骨折复位满意.12例均获随访,时间3~36个月.骨折完全愈合,无迟发畸形.2例脊髓神经损伤者术前Franke1分级为D级,术后3~6个月均恢复至E级.结论 C2椎弓根拉力螺钉技术治疗Hangman骨折,复位满意,固定可靠,疗效满意.%Objective To stuty the clinical outcomes of Hangman's fracture treated by using pedicle lag screw fixation. Methods 12 patients with Hangman's fracture were recruited. All patients achieved reduction by skull traction, and fixed with C2 pedicle lag screw. X-ray was performed during the follow-up to observe fracture reduction and healing process. Results The operation time was 50 ~ 90 minutes, and the blood loss was 100 ~ 300 ml. And intra-operative no spinal nerves injury the reduction of the Hangman's fracture was satisfied. No postoperative complications were confirmed. 12 cases were followed up for 3~36 months. All got healing without deformity. 2 cases of Frankel D were restored to E in 3 ~ 6 months. Conclusions Pedicle lag screw fixation provides good reduction and stability to Hangman's fracture. It is a less trauma, safe and effective method in the treatment of Hangman's fracture.

  16. Análise fotoelástica de parafuso de sistema de fixação vertebral The photoelastic analisys of vertebral fixation system screws

    Directory of Open Access Journals (Sweden)

    Sarah Fakher Fakhouri

    2009-01-01

    Full Text Available INTRODUÇÃO: A fotoelasticidade é utilizada para avaliar as tensões/deformações produzidas nos materiais fotoelásticos, quando submetidos a determinado carregamento, através da observação de efeitos óticos. O desempenho do parafuso e as funções mecânicas estão diretamente relacionados com a qualidade da fixação dos parafusos nas vértebras. A fotoelasticidade é uma ferramenta importante para realizar estudos comparativos desta natureza. OBJETIVO: O objetivo deste estudo foi comparar por meio da fotoelasticidade, as tensões internas produzidas pelo parafuso com 6 mm de diâmetro externo, quando submetido a duas diferentes forças de arrancamento. MATERIAIS E MÉTODOS: Para isso, foram confeccionados quatro modelos fotoelásticos. A simulação foi realizada utilizando duas forças de arrancamento 0,75 e 1,50 kgf. As tensões cisalhantes foram calculadas nos 19 pontos em torno dos parafusos, utilizando o método de compensação de Tardy. RESULTADOS: Os valores das tensões cisalhantes foram maiores quando utilizada a força de arrancamento de 1,50 kgf. CONCLUSÃO: Assim sendo, o parafuso estará mais suscetível ao arrancamento com a aplicação de força de maior intensidade. De acordo com as análises realizadas verificamos também que o local de maior tensão cisalhante foi observado no pico das cristas, principalmente próxima às pontas dos parafusos, independente da força utilizada.INTRODUCTION: The photoelasticity is used for assessing the tensions/deformations involved in photoelastic materials when submitted to a given load by the observation of optical effects. The screw performance and mechanical functions are directly associated to the quality of the screws fixation in the vertebrae. Photoelasticity is an important tool to perform comparative studies of this nature OBJECTIVE: The aim of this study was to compare, by using photoelasticity, internal stresses produced by the screw with an external diameter of 6 mm

  17. Atlantoaxial fixation: Overview of all techniques

    Directory of Open Access Journals (Sweden)

    Mummaneni Praveen

    2005-01-01

    Full Text Available Over the past century, steady advances have been made in fixating an unstable atlantoaxial complex. Current options for fixation of the atlantoaxial complex include posterior clamps, posterior wiring techniques, C1-C2 transarticular screw fixation, posterior C1 lateral mass screw with C2 pars or pedicle screw fixation, and anterior transoral C1 lateral mass to C2 vertebral body fixation.

  18. Posterior transodontoid fixation: A new fixation (Kotil technique

    Directory of Open Access Journals (Sweden)

    Kadir Kotil

    2011-01-01

    Full Text Available Anterior odontoid screw fixation or posterior C1-2 fusion techniques are routinely used in the treatment of Type II odontoid fractures, but these techniques may be inadequate in some types of odontoid fractures. In this new technique (Kotil technique, through a posterior bilateral approach, transarticular screw fixation was performed at the non-dominant vertebral artery (VA side and posterior transodontoid fixation technique was performed at the dominant VA side. C1-2 complex fusion was aimed with unilateral transarticular fixation and odontoid fixation with posterior transodontoid screw fixation. Cervical spinal computed tomography (CT of a 40-year-old male patient involved in a motor vehicle accident revealed an anteriorly dislocated Type II oblique dens fracture, not reducible by closed traction. Before the operation, the patient was found to have a dominant right VA with Doppler ultrasound. He was operated through a posterior approach. At first, transarticular screw fixation was performed at the non-dominant (left side, and then fixation of the odontoid fracture was achieved by directing the contralateral screw (supplemental screw medially and toward the apex. Cancellous autograft was scattered for fusion without the need for structural bone graft or wiring. Postoperative cervical spinal CT of the patient revealed that stabilization was maintained with transarticular screw fixation and reduction and fixation of the odontoid process was achieved completely by posterior transodontoid screw fixation. The patient is at the sixth month of follow-up and complete fusion has developed. With this new surgical technique, C1-2 fusion is maintained with transarticular screw fixation and odontoid process is fixed by concomitant contralateral posterior transodontoid screw (supplemental screw fixation; thus, this technique both stabilizes the C1-2 complex and fixes the odontoid process and the corpus in atypical odontoid fractures, appearing as an

  19. The Weak Link in Anterior Cruciate Ligament Reconstruction: What is the Evidence for Graft Fixation Devices?

    Science.gov (United States)

    Campbell, Kirk A; Looze, Christopher; Bosco, Joseph A; Strauss, Eric J

    2016-03-01

    Anterior cruciate ligament (ACL) rupture is a common injury that mostly affects young adults. The mechanisms of injury and surgical treatment have been extensively studied in both the laboratory and clinical arenas; however, great controversy still exists in regards to the best surgical technique, graft choice, and graft fixation device. In the area graft fixation, multiple breakthroughs have occurred in terms of fixation devices. These devices generally fall within the broad categories of interference screw, cross-pins, or cortical-based devices. Furthermore, some of these devices are available in either metal or bioabsorbable materials, which adds to the already great variety of options. Although biomechanically these devices have been shown to be able to withstand the typical forces experienced by the ACL graft during the early phases of rehabilitation before the graft has fully incorporated into the bone, little is known about the clinical outcomes. It is well recognized that graft fixation is the weakest link in the early postoperative period after ACL reconstruction. This review of the outcomes of ACL fixation devices explores some of the evidence available for the different devices. PMID:26977545

  20. Biomechanical properties of monosegmental pedicle screw fixation via the fractured thoracolumbar vertebrae%经胸腰段伤椎单节段椎弓根螺钉固定后的生物力学特性

    Institute of Scientific and Technical Information of China (English)

    刘上楼; 徐军; 倪卓民; 张云庆; 周枫; 姜雪峰

    2013-01-01

    背景:临床常采用经伤椎椎弓根螺钉内固定治疗胸腰椎骨折,研究已证实经伤椎双侧椎弓根螺钉固定后脊柱稳定性加强,但也有研究认为经伤椎单节段椎弓根螺钉固定足以增加脊柱的稳定性,但此结论缺乏生物力学结果支持。  目的:观察胸腰段椎体骨折经伤椎单节段固定的相关生物力学特性。  方法:取扬州大学医学院解剖教研室提供8具中国人新鲜胸腰段标本(T11-L3),锯条横断2/3椎体,制成完整胸腰段椎体实验标本,将8具标本等分成跨伤椎固定组和单节段经伤椎固定组,分别在跨伤椎临近椎体四钉固定和临近椎体四钉固定+经伤椎单侧椎弓根固定。  结果与结论:胸腰段椎体骨折后经跨伤椎固定与经单节段伤椎固定的载荷-应变关系相差12%、载荷-位移关系相差11%、强度相差18%、轴向刚度相差11%、扭转力相差11%及拔出力相差1.8%,两组差异有显著性意义(P OBJECTIVE:To evaluate the biomechanical properties of monosegmental pedicle screws fixation via fractured vertebrae for thoracolumbar fracture. METHODS:Eight cadavers’ thoracolumbar specimens (T11-L3) were provided by the Department of Anatomy, Yangzhou University School of Medicine. Saw was used to transect 2/3 of the vertebrae in order to make complete experimental thoracolumbar specimens. Eight specimens were divided into two group;beyond-fractured vertebrae fixation group and monosegmental fixation via fracture vertebrae group. The specimens in the two groups were treated with adjacent vertebral four screw fixation beyond fractured vertebrae and adjacent vertebral four screw fixation+monosegmental pedicle screw fixation via fractured vertebrae respectively. RESULTS AND CONCLUSION:After thoracolumbar fracture, the differences between beyond fractured vertebrae fixation and monosegmental pedicle screw fixation via fractured vertebrae were as fol ows

  1. Preparation of bioabsorbable nerve guide tubes.

    Science.gov (United States)

    Luciano, R M; de Carvalho Zavaglia, C A; de Rezende Duek, E A

    2000-03-01

    The use of bioabsorbable polymers in applications as temporary structural function, recovering damage in live tissues, is a promising research area. Membranes of poly(lactic acid) (PLA) may act as support to adhesion and cellular invasion or as devices for guided tissue regeneration (GTR). In this study, the same casting technique used to prepare membranes was used to prepare PLA tubes. These tubes can be used for tests in nerve guided regeneration (NGR). To improve flexibility of the device, a bioabsorbable plasticizer was added to the polymer. The initial results showed that the proposed technique allowed the preparation of flexible tubes that can be used for NGR. PMID:10759642

  2. Therapeutic efficacy of pedicle screw-rod internal fixation after one-stage posterior transforaminal lesion debridement and non-structural bone grafting for tuberculosis of lumbar vertebra

    Directory of Open Access Journals (Sweden)

    Jia-ming LIU

    2015-11-01

    Full Text Available Objective To evaluate the efficacy and safety of pedicle screw-rod internal fixation after one-stage posterior transforaminal lesion debridement and non-structural bone grafting in the treatment of tuberculosis of mono-segmental lumbar vertebra. Methods From January 2010 to April 2013, 21 patients (9 males and 12 females with an average age of 49.1 years with mono-segmental tuberculosis of lumbar vertebra underwent surgery in our hospital were included. Eight patients had neurological deficit. The focus of tuberculosis was located on one side of the vertebral body, and all the patients had obvious signs of bone destruction on CT and MRI. All the patients were given anti-tuberculosis chemotherapy for 2-3 weeks before surgery. The local bone chips and autologous iliac cancellous bone were used as the intervertebral bone graft. Postoperative plain radiographs and CT were obtained to evaluate the fusion rate and degree of lumbar lordosis. The visual analogue scale score (VAS, erythrocyte sedimentation rate (ESR, and C-reactive protein (CRP before and after operation, and at final follow-up date were recorded. Results All the patients were followed up for 25.3±4.2 months. The mean operation time was 157±39 minutes, and the average blood loss was 470±143ml. The fusion rate of the interbody bone graft was 95.2%, with an average fusion period of 6.1±2.5 months. The neurological function was improved by 100%, and no severe complication or neurological injury occured. The preoperative and postoperative lordosis angles of the lumbar spine were 21.4°±5.7° and 33.6°±3.1°, respectively, and it was 31.3°±2.7° at the final follow up. The preoperative and postoperative VAS scores were 7.8±2.6 and 2.4±1.7 respectively, and it was 0.9±0.7 at the final follow up. The ESR and CRP were significantly decreased 3 months after surgery, and they became normal at 6 months. Conclusion Pedicle screw-rod internal fixation after one-stage posterior

  3. Treatment of acute thoracolumbar burst fractures with kyphoplasty and short pedicle screw fixation: Transpedicular intracorporeal grafting with calcium phosphate: A prospective study

    Directory of Open Access Journals (Sweden)

    Korovessis Panagiotis

    2007-01-01

    Full Text Available Background: In the surgical treatment of thoracolumbar fractures, the major problem after posterior correction and transpedicular instrumentation is failure to support the anterior spinal column, leading to loss of correction and instrumentation failure with associated complaints. We conducted this prospective study to evaluate the outcome of the treatment of acute thoracolumbar burst fractures by transpedicular balloon kyphoplasty, grafting with calcium phosphate cement and short pedicle screw fixation plus fusion. Materials and Methods : Twenty-three consecutive patients of thoracolumbar (T 9 to L 4 burst fracture with or without neurologic deficit with an average age of 43 years, were included in this prospective study. Twenty-one from the 23 patients had single burst fracture while the remaining two patients had a burst fracture and additionally an adjacent A1-type fracture. On admission six (26% out of 23 patients had neurological deficit (five incomplete, one complete. Bilateral transpedicular balloon kyphoplasty with liquid calcium phosphate to reduce segmental kyphosis and restore vertebral body height and short (three vertebrae pedicle screw instrumentation with posterolateral fusion was performed. Gardner kyphosis angle, anterior and posterior vertebral body height ratio and spinal canal encroachment were calculated pre- to postoperatively. Results : All 23 patients were operated within two days after admission and were followed for at least 12 months after index surgery. Operating time and blood loss averaged 45 min and 60 cc respectively. The five patients with incomplete neurological lesions improved by at least one ASIA grade, while no neurological deterioration was observed in any case. The VAS and SF-36 (Role physical and Bodily pain domains were significantly improved postoperatively. Overall sagittal alignment was improved from an average preoperative 16° to one degree kyphosis at final follow-up observation. The anterior

  4. One Case of Patient had an Allergy to Internal Fixation with Metal of Pedicle Screw System%椎弓根系统内固定金属过敏一例报道

    Institute of Scientific and Technical Information of China (English)

    王勇; 陈久毅

    2013-01-01

    Internal fixation with metal in the Department of orthopedics is a common treatment method. Metal implants allergy have been reported, but relatively rare. This paper reported a case of patient in our hospital had an allergy to internal fixation with metal of pedicle screw system.%  金属内固定在骨科为常见的治疗方法,金属内植物过敏曾有报道,但较为少见,现将我院椎弓根系统内固定过敏一例报道如下。

  5. Coracoid bone graft osteolysis after Latarjet procedure: A comparison study between two screws standard technique vs mini-plate fixation

    Directory of Open Access Journals (Sweden)

    Giovanni Di Giacomo

    2013-01-01

    Full Text Available Aims: One of the reason for Latarjet procedure failure may be coracoid graft osteolysis. In this study, we aimed to understand if a better compression between the coracoid process and the glenoid, using a mini-plate fixation during the Latarjet procedure, could reduce the amount of coracoid graft osteolysis. Materials and Methods: A computed tomography scan analysis of 26 prospectively followed-up patients was conducted after modified Latarjet procedure using mini-plate fixation technique to determine both the location and the amount of coracoid graft osteolysis in them. We then compared our current results with results from that of our previous study without using mini-plate fixation to determine if there is any statistical significant difference in terms of corcacoid bone graft osteolysis between the two surgical techniques. Results: The most relevant osteolysis was represented by the superficial part of the proximal coracoid, whereas the deep part of the proximal coracoid graft is least involved in osteolysis and has best bone healing. The current study showed a significant difference only for the deep part of the distal coracoid with our previous study (P < 0.01. Discussion: To our knowledge, there are no studies in literature that show the causes of coracoid bone graft osteolysis after Latarjet procedure. Conclusion: Our study suggests that there is a significant difference only for the deep part of the distal coracoid in terms of osteolysis. At clinical examination, this difference did not correspond with any clinical findings. Level of Evidence: Level 4. Clinical Relevance: Prospective case series, Treatment study.

  6. 单侧椎弓根螺钉固定在腰椎退行性疾病的研究进展%Research advances in the fixation of unilateral pedicle screw for lumber degenerative

    Institute of Scientific and Technical Information of China (English)

    黄凯; 刘展亮; 刘少喻

    2014-01-01

    The patients with lumber degenerative spondylolisthesis often have to undergo surgical treatment. Conventional surgical approach is performed by bilateral pedicle screw fixation in lumbar interbody fusion, and this maybe accelerate segment degeneration of adjacent vertebral bodies. The recent studies indicate that unilateral pedicle screw fixation in lumbar interbody fusion can achieve the same effect on stability and interbody fusion by using conventional bilateral pedicle screw fixation in lumbar interbody fusion,.and prevent from segment degeneration of vertebral bodies. But the operation indication must be restrictedly controlled, the operation technique be skilled.%保守失败的腰椎退行性疾病常需要手术治疗,传统的双侧椎弓根螺钉腰椎融合术可能增加邻近节段退变的发生率。近年研究表明,单侧椎弓根螺钉结合椎体间融合术治疗腰椎退行性疾病可获得与传统双侧椎弓根螺钉固定相似的稳定性与融合率,并可预防固定融合节段的邻近节段退变,但应用单侧椎弓根螺钉固定需要严格掌握手术适应证。

  7. Clinical observation of posterior internal fixation with vertebral pedicle screw and rod system on thoracolumbar spine fractures%椎弓根钉棒系统在胸腰椎骨折的疗效分析

    Institute of Scientific and Technical Information of China (English)

    黎华茂; 李敬中; 向峥; 林晓岗

    2012-01-01

    Objective To observe the clinical efficacy of posterior internal fixation of vertebral pedicle screw and rod system for thoracolumbar spine fractures. Methods Totally 59 patients with thoracic or lumbar vertebral fractures were treated with internal fixation of vertebral pedicle screw and rod system. The Frankel scale combined with X ray and CT images was used for the judgment of efficacy. Results Radiographic parameters were significantly improved after the experiment, the Frankel degree of cases with nerve injury symptoms was improved 2-4 degrees after surgery. Conclusions Internal fixation of vertebral pedicle screw and rod system is efficient for thoraco lumbar spine fractures.%目的 观察椎弓根钉棒系统内固定治疗胸腰椎骨折的临床疗效.方法 应用椎弓根钉棒系统内固定治疗胸腰椎骨折59例,采用Frankel分级结合X线片、CT影像表现判断疗效.结果 术后各项影像学指标均有明显改善,患者术后神经功能Frankel分级大多数都有2~4级提高.结论 椎弓根钉棒系统内固定是治疗胸腰椎骨折的一种有效方法,值得临床推广应用.

  8. Transpedicular vertebral body augmentation reinforced with pedicle screw fixation in fresh traumatic A2 and A3 lumbar fractures: comparison between two devices and two bone cements.

    Science.gov (United States)

    Korovessis, Panagiotis; Vardakastanis, Konstantinos; Repantis, Thomas; Vitsas, Vasilios

    2014-07-01

    This retrospective study compares efficacy and safety of balloon kyphoplasty (BK) with calcium phosphate (Group A) versus KIVA implant with PMMA (Group B) reinforced with three vertebrae pedicle screw constructs for A2 and A3 single fresh non-osteoporotic lumbar (L1-L4) fractures in 38 consecutive age- and diagnosis-matched patient populations. Extracanal leakage of both low-viscosity PMMA and calcium phosphate (CP) as well as the following roentgenographic parameters: segmental kyphosis (SKA), anterior (AVBHr) and posterior (PVBHr) vertebral body height ratio, spinal canal encroachment (SCE) clearance, and functional outcome measures: VAS and SF-36, were recorded and compared between the two groups. All patients in both groups were followed for a minimum 26 (Group A) and 25 (Group B) months. Extracanal CP and PMMA leakage was observed in four (18 %) and three (15 %) vertebrae/patients of group A and B, respectively. Hybrid fixation improved AVBHr, SKA, SCE, but PVBHr only in group B. VAS and SF-36 improved postoperatively in the patients of both groups. Short-segment construct with the novel KIVA implant restored better than BK-fractured lumbar vertebral body, but this had no impact in functional outcome. Since there was no leakage difference between PMMA and calcium phosphate and no short-term adverse related to PMMA use were observed, we advice the use of PMMA in fresh traumatic lumbar fractures. PMID:23982115

  9. 空心螺钉内固定术治疗Jones骨折32例分析%The analyses of 32 Jones fracture by using hollow screw internal fixation

    Institute of Scientific and Technical Information of China (English)

    唐兵; 秦定扬

    2010-01-01

    目的 观察空心螺钉内固定术治疗Jones骨折的临床疗效.方法 回顾性分析采用切开复位空心螺钉内固定术治疗Jones骨折32例患者的临床资料.结果 32例患者均治愈出院,平均随访18个月,根据Maryland足部评分系统评分:优25例,良6例,差1例,优良率96.9%.结论 空心螺钉内固定术治疗Jones骨折,操作简单,术后不用外固定,功能恢复快,并发症少,疗效满意.%Objective To analyze the therapy method and the therapeutic effect of Jones fracture by using hollow screw internal fixation.Methods All the Jones fractures were treated by open reduction hollow screw internal fixation and the plaster external fixation were not used after operation.Results The 32 cases with Jones fractures got excellent 25 cases,good 6cases and poor 1 case which used by Maryland foot score system to appraisal.All the cases were followed up for 6 months to 30 months and the average follow-up time is 18 months.Conclusion The treatment of hollow screw internal fixation was a satisfactory method to cure Jones fracture,which had get advantages of simple operation,small wound,short operation time,not external fixation,quick recovery and few complications.

  10. 单侧椎板关节突螺钉固定与双侧椎弓根螺钉固定应用于下腰椎退变性疾病的比较%Clinical ontcomes of unilateral translamina facet screw fixation vs bilateral pedicle screws fixation for lower lumbar vertebra disease

    Institute of Scientific and Technical Information of China (English)

    曾忠友; 汤永华; 陈国军; 严卫峰; 吴鹏; 张建乔; 金才益

    2011-01-01

    目的:比较后路减压椎间融合器植骨后行单侧椎板关节突螺钉同定与双侧椎弓根螺钉固定治疗下腰椎退变性疾病的优缺点.方法:2007年6月~2008年12月采用后路减压椎间融合器植骨内固定治疗51例下腰椎退变性疾病患者,均为单节段病变,无严莺不稳.其中26例在瞄准器引导下经皮单侧椎板关节突螺钉固定(A组),25例采用双侧椎弓根螺钉固定(B组).两组患者性别比例,年龄、病程、疾病类型、病变部位、疾病严重程度和术前病变节段椎间隙高度无统计学差异,比较两组患者手术创伤和临床疗效.结果:两组病例均顺利完成手术,均未输血,术中、术后未出现手术相关并发症.两组手术切口长度、手术时间、术中出血量、术后切口引流液量和住院费用比较差异有显著性差异(P<0.05),A组优于B组;所有病例均获随访,随访时间12~42个月,平均19.5个月,随访过程中两组病例均未出现螺钉松动、移位、断裂等,融合率无显著性差异(P>0.05),末次随访时两组JOA评分改善率无显著性差异(P>0.05).结论:对无严重不稳的单节段退变性腰椎疾病患者两种内固定方法的效果相当.但相对双侧椎弓根螺钉固定,在瞄准器引导下经皮单侧椎板关节突螺钉固定切口小、创伤小、操作简单、费用低.%Objective: To investigate the surgical outcome of unilateral translamina facet screw fixation vs bilateral pedicle screws fixation after posterior decompression and intervertebral cage fusion for lower lumbar vertebra diseases. Method: 51 patients with lower lumbar vertebra diseases who underwent the surgery were reviewed retrospectively,26 cases (group A) underwent unilateral translamina facet screw fixation by gunsight guiding, while the others (group B) underwent bilateral pedicle screws fixation. No significant difference was noted between two groups with respect to sex,age,duration,type of disease

  11. Hollow screw and suture fixation for treatment of tibial intercondylar eminence fractures under arthroscopy%关节镜下空心螺钉与缝线内固定治疗胫骨髁间棘骨折

    Institute of Scientific and Technical Information of China (English)

    陈维东

    2013-01-01

    BACKGROUND:Intercondylar eminence fractures of the tibia are often treated by arthroscopic surgery, but the fixation methods are controversial. OBJECTIVE:To compare curative effect of hol ow screw and suture fixation in treatment of tibial intercondylar eminence fractures under arthroscopy. METHODS:A total of 46 patients with tibial intercondylar eminence fractures were recruited from the Third People’s Hospital of Yancheng, China from June 2010 to January 2013. According to the patient’s wil ing and physician’s suggestions, the involved patients were divided into hol ow screw group (n=25) and suture fixation group (n=21), undergoing hol ow screw and suture fixation under arthroscopy, respectively. RESULTS AND CONCLUSION:According to Ikeuchi grade, the excellent and good rate after fixation showed no significant differences between the two groups (P>0.05), but the functional training time in hol ow screw group was significantly shorter than that in suture fixation group (P  目的:比较关节镜下应用空心螺钉与缝线内固定治疗胫骨髁间棘骨折的临床疗效。  方法:收集盐城市第三人民医院自2010年6月至2013年1月收治的46例胫骨髁间棘骨折患者,根据患者意愿及医师建议分为空心螺钉组(n=25)和缝线组(n=21),分别在关节镜下行空心螺钉与缝线内固定。  结果与结论:空心螺钉组与缝线组胫骨髁间棘骨折患者固定后 Ikeuchi 膝关节评分优良率差异无显著性意义(P >0.05),但空心螺钉组患者固定后功能训练时间明显比缝线组短(P <0.05)。提示关节镜下空心螺钉治疗胫骨髁间棘骨折比缝线有利于胫骨髁间棘骨折患者的恢复。

  12. 寰椎椎板钩联合枢椎椎弓根螺钉内固定的力学稳定性评价%Biomechanical stability of fixation with bilateral C1 hooks plus C2 pedicle screws

    Institute of Scientific and Technical Information of China (English)

    李松凯; 倪斌; 王明飞; 张锋; 郭翔; 王健; 赵卫东

    2010-01-01

    目的 评价寰椎椎板钩联合枢椎椎弓根螺钉内固定的生物力学稳定性.方法 取6具新鲜尸体颈椎标本置于1.5 N·m载荷下,测量C_(1-2)节段的三维运动范围(ROM).标本按随机顺序,依次行完整状态(完整状态组)、不稳状态(齿状突周围韧带切除,为不稳状态组)、经寰枢关节间隙螺钉联合Gallic内固定(固定A组)、寰椎椎板钩联合枢椎椎弓根螺钉内固定(固定B组)、寰枢椎椎弓根螺钉内固定(固定C组)5种状态下的三维ROM值测量.比较各组标本的屈伸、侧屈、旋转ROM值.结果 完整状态组、不稳状态组、固定A、B、C组的平均屈伸ROM值分别为17.78°、30.69°、2.25°、2.93°、2.73°,组间比较差异有统计学意义(F=216.69,P=0.000);平均侧屈ROM值分别为9.56°、17.18°、1.91°、2.30°、2.05°,组间比较差异有统计学意义(F=122.75,P=0.000);平均旋转ROM值分别为44.19°、57.30°、1.22°、2.88°、2.07°,组间比较差异有统计学意义(F=154.54,P=0.000).固定A、B、C组较完整状态组和不稳状态组各个方向的ROM值均明显减少,差异均有统计学意义(P0.05).结论 寰椎椎板钩联合枢椎椎弓根螺钉内固定可提供与经寰枢关节间隙螺钉联合Gallic内固定和寰枢椎椎弓根螺钉内固定相当的力学稳定性.在以上两种方法无法实施时,可作为一种安全的替代.%Objective To compare the biomechanical stabilities of fixation with bilateral C1 hooks plus C2 pedicle screws, fixation with C1-C2 transarticular screws plus Gallic wires and fixation with C1-C2 pedicle screws. Methods Six specimens of cervical spines (C0-C4) taken from 6 fresh-frozen human their intact condition, destabilization by disrupting the transverse-Mar-apical ligament, fixation with transar-ticular screws plus Gallic posterior wires, fixation with C1 hooks plus C2 pedicle screws, and fixation with C1-C2 pedicle screws.Pure moment loading, up to 1.5 N·m, was applied to the occiput

  13. CT-guided screw fixation of vertical sacral fractures in local anaesthesia using a standard CT; CT-kontrollierte Schraubenosteosynthese von vertikalen Frakturen des hinteren Beckenringes in Lokalanaesthesie

    Energy Technology Data Exchange (ETDEWEB)

    Reuther, G.; Dehne, I. [Thueringen-Klinik, Saalfeld (Germany). Radiologische Klinik; Roehner, U.; Will, T.; Petereit, U. [Thueringen-Klinik, Saalfeld (Germany). Orthopaedics and Trauma Surgery

    2014-12-15

    To evaluate time efficiency, radiation dose, precision and complications of percutaneous iliosacral screw placement under CT-guidance in local anaesthesia. Retrospective analysis of 143 interventions in 135 patients during a period of 42 months. Implant failures could be evaluated in 85/182 screws and bony healing or refracturing in 46/182 screws. A total of 182 iliosacral screw placements in 179 vertical sacral fractures (105 unilateral, 37 bilateral) took place in 135 patients. 166/179 of the sacral fractures were detected in Denis zone 1, 10 in Denis zone 2 and 3 in Denis zone 3. No screw misplacements including the simultaneous bilateral procedures were noted. The average time for a unilateral screw placement was 23 minutes (range: 14-52 minutes) and 35 minutes (range: 21-60 minutes) for simultaneous bilateral screwing. The dose length product was 365 mGy x cm (range: 162-1014 mGy x cm) for the unilateral and 470 mGy x cm (range: 270-1271 mGy x cm) for the bilateral procedure. 1 gluteal bleeding occurred as the only acute minor complication (0.7%). Fracture healing was verified with follow-up CTs in 42/46 sacral fractures after screw placement. Backing out occurred in 12/85 screws between 6 and 69 days after intervention. In 8 patients contralateral stress fractures were detected after unilateral screw placement between day 10 and 127 (average: 48 days). CT-guided iliosacral screw placement in sacral fractures is a safe tool providing a very high precision. The radiation dose is in the order of a diagnostic CT of the pelvis for both unilateral and bilateral screws. Contralateral stress fractures in unilateral screw placements have to be considered during the first weeks after intervention.

  14. Biomechanical comparison of interspinous distraction device and facet screw fixation system on the motion of lumbar spine: a finite element analysis

    Institute of Scientific and Technical Information of China (English)

    Wang Hongwei; Wang Xiaohong; Chen Wenchuan; Zhao Fuqiang; Xiang Liangbi; Zhou Yue; Cheng Chengkung

    2014-01-01

    Background A large amount of biomechanical and clinical evidence from previous studies suggest the efficiency of the two different posterior lumber non-fusion methods,interspinous distraction device (ISDD) and facet screw fixation system (FSS),but the biomechanical comparison of ISDD and FSS has not been thoroughly clarified.Methods In the current study,finite element methods were used to investigate the biomechanical comparison of ISDD and FSS.The range of motion (ROM),intradiscal pressure (IDP) and the protective effects gained by maintaining disc heights were evaluated.Results The ROM was similar between the two non-fusion methods under static standing,flexion and lateral bending.The FSS appeared to be more effective in resisting extension.At the implanted level L3/4,FSS displayed better results for maintaining and increasing posterior disc heights.At the L4/5 level in extension and lateral bending,FSS was better than ISDD,with comparable results observed in other motions.Comparing the posterior and lateral disc heights,FSS appeared to be more effective than ISDD.FSS also had a minor effect on the inferior adjacent segment than ISDD.FSS was more effective in reducing IDP than ISDD in extension.Conclusion Through the finite element analysis study,it can be seen that FSS demonstrates more beneficial biomechanical outcomes than does ISDD,such as being more effective in resisting extension,maintaining and increasing lumbar disc heights and reducing the inferior adjacent IDP in extension.

  15. Odontoid cannulated screw fixation using digital navigation based on three-dimensional printing technique%基于3D打印齿状突空心钉置入的数字化导航

    Institute of Scientific and Technical Information of China (English)

    陈宣煌; 张国栋; 吴长福; 林海滨; 陈旭; 余正希; 孙宇庆

    2015-01-01

    BACKGROUND:Odontoid fracture is very common in cervical spine injuries, the special position of odontoid process, which is adjacent to important anatomic structure, makes screw placement difficult, and a slight discrepancy in position and orientation of the inserted screw leads to a decrease in intensity of internal fixation, even invalid internal fixation. Therefore, it is very necessary to develop an individualized treatment protocol by which screws can be precisely and safely placed and which is worthy of clinical popularization. OBJECTIVE:To study the navigation of Mimics software and three dimensional (3D)-printed module in anterior odontoid cannulated screw fixation and to investigate its feasibility and accuracy. METHODS:Sixteen human cadaveric cervical spines were scanned by a continuous thin-slice CT scanner. Original DICOM CT images were three-dimensional y reconstructed using Mimics software. The screw channel and support column were designed for C2 vertebra odontoid cannulated screw fixation for odontoid fracture. Segmentation of bone surface was performed. Navigation modules with screw channel were built using 3D printing technique. Navigation modules were used to aid screw placement. Screw fitting and placement were evaluated using X-ray and CT scan. RESULTS AND CONCLUSION:Total y 16 navigation modules were built and 22 screws were implanted. During and after screw placement, the cortical bone along screw channel and surrounding the vertebral body was not cracked. Postoperative X-ray and CT scans showed that some factors regarding screw placement such as entry point, orientation and depth of placement were consistent with those ideal factors simulated by Mimics software. The navigation modules were closely attached to the corresponding bony structure in front of the vertebral body, with a satisfactory gomphosis. Screw fitting and stability were good during application. These results verify that with the aid of navigation module, anterior odontoid

  16. Possible Usage of Cannulated Pedicle Screws without Cement Augmentation

    Directory of Open Access Journals (Sweden)

    Teyfik Demir

    2014-01-01

    Full Text Available Background: The use of pedicle screws is becoming increasingly popular for spinal surgery practice as the technology advances. Screw pullout due to bone quality and loading conditions is one of the most common problems observed after pedicle screw fixation. Several solutions were studied to prevent screw pullout. These can be investigated under three main categories: screw design, expandable screws and cement augmentation.

  17. Biomechanical evaluation of connectible skills using iliac screw and lumbar-sacral spine pedicle screw in the fixation between lumbar-sacral spine and pelvis%髂骨钉与腰骶椎弓根钉连接技术在腰骶骨盆固定中的生物力学评价

    Institute of Scientific and Technical Information of China (English)

    苏汝堃; 刘兴漠; 邓颖辉; 李佛保; 潘滔

    2008-01-01

    BACKGROUND: There have been many methods of fixation between lumbar-sacral spine and pelvis. However, a safe, firm, and ideal method of internal fixation has not been found.OBJECTIVE: This study was designed to investigate the stability of the fixation between lumbar-sacral spine and pelvis with the connectible skills using iliac screw and lumbar-sacral spine pedicle screw.DESIGN, TIME AND SETTING: This study, a control experiment, was performed at the Institute of Biomechanics, Sun Yat-sen University, Guangzhou, Guangdong Province, China between January 2006 and December 2007.MATERIALS: The lumbar-sacral spine and pelvis specimens were collected from six freshly cryo-preserved male adult corpses caused by trauma. Iliac screw (8.5mm×100mm), L5 pedicle screw (6.5mm×45mm), and S1 pedicle screw (6.5mm×35mm) were provided by Sofamor Company, USA. MTS 858 Bionix Material Testing System (USA) was also used.METHODS: The lumbar and iliac vertebrae, pelvis from six fresh frozen cadaveric specimens were operated in three different ways of fixation respectively: iliac ala lag screw, L5-S1 pedicle screw rod system, iliac screw and L5 pedicle screw connecting system. Three ways of fixation as mentioned above were compared with the intact group in biomechanical stability.MAIN OUTCOME MEASURES: The mobility of whirl, lateral bending, proneness, and backward stretching among groups.RESULTS: Using iliac screw for the fixation between lumbar-sacral spine and pelvis turned out to be the best in stability. The range of motion (ROM) decreased obviously in each situation. The three-dimensional mobility in the 6.4Nm moment of force was (1.07±0.86)° for whirl, (0.95±0.47)° for lateral bending, (1.22±0.67)° for proneness, and (1.80±0.73)° for backward stretching. There was significant difference between the intact group and the group carried out by iliac screw and L5 pedicle screw for the fixation between lumbar-sacral spine and pelvis (P<0.01).CONCLUSION: The connectible skills

  18. Surgical treatment of lumbar spondylolisthesis using short or long segment pedicle screw fixation%不同节段椎弓根钉置入脊椎内固定治疗腰椎滑脱

    Institute of Scientific and Technical Information of China (English)

    沈宁江; 王先安; 林庆彪; 陈建; 李一波

    2012-01-01

    BACKGROUND: There are a lot of controversies regarding the choice of short versus long segment pedicle screw fixation for the treatment of isthmic spondylolisthesis and degenerative spondylolisthesis treatment. OBJECTIVE: To investigate clinical efficacy of short versus long segment pedicle screw fixation in treatment of lumbar spondylolisthesis.METHODS: A total of 146 spondylolisthesis patients were included in this study, 36 males and 110 females, aged 22-73 years at a mean of 53 years; disease duration was from 1 to 18 years at a mean of 5 years. These patients were treated with lumbar spinal window-opened decompression or laminectomy decompression, a short or long segment pedicle screw internal fixation, transverse interbody fusion.RESULTS AND CONCLUSION: Among 146 involved patients, 72 cases were treated with four pedicle screw fixation (short segments), while 74 cases with six pedicle screw fixation (long segments). Interbody graft was performed in 101 cases, while intertransverse fusion given in 45 cases. Totally 134 cases were followed up for postoperative 1.5-14 years. According to clinical grading standards of Steffee system, the clinical efficacy was assayed excellent in 74 cases, good in 41 cases, mild in 13 cases and poor in 6 cases, with good rate of 85.8%. 77 cases achieved a complete reduction, including 32 cases using a short segment fixation and 45 cases using a long segment fixation. 69 cases achieved partial reduction, including 40 cases using a short segment fixation and 29 cases using a long segment fixation. Pedicle screws ruptures were found in 13 screws of eight patients undergoing short segment fixation, while no pedicle screw fracture was found in long segment fixation. Choice of short or long segment for the fixation is based on the analysis of spondylolisthesis type, severity, duration of disease, emergence of adjacent segment disc degeneration and instability.%背景:对椎弓峡部裂腰椎滑脱、退行性腰椎滑脱的治疗,到

  19. A laboratory investigation to assess the influence of cement augmentation of screw and plate fixation in a simulation of distal femoral fracture of osteoporotic and non-osteoporotic bone.

    Science.gov (United States)

    Wähnert, D; Lange, J H; Schulze, M; Gehweiler, D; Kösters, C; Raschke, M J

    2013-10-01

    The augmentation of fixation with bone cement is increasingly being used in the treatment of severe osteoporotic fractures. We investigated the influence of bone quality on the mechanics of augmentation of plate fixation in a distal femoral fracture model (AO 33 A3 type). Eight osteoporotic and eight non-osteoporotic femoral models were randomly assigned to either an augmented or a non-augmented group. Fixation was performed using a locking compression plate. In the augmented group additionally 1 ml of bone cement was injected into the screw hole before insertion of the screw. Biomechanical testing was performed in axial sinusoidal loading. Augmentation significantly reduced the cut-out distance in the osteoporotic models by about 67% (non-augmented mean 0.30 mm (sd 0.08) vs augmented 0.13 mm (sd 0.06); p = 0.017). There was no statistical reduction in this distance following augmentation in the non-osteoporotic models (non-augmented mean 0.15 mm (sd 0.02) vs augmented 0.15 mm (sd 0.07); p = 0.915). In the osteoporotic models, augmentation significantly increased stability (p = 0.017). PMID:24078541

  20. 单侧椎弓根螺钉内固定治疗腰椎退行性疾病的研究进展%Progress of unilateral pedicle screw internal fixation for the treatment of lumbar degenerative diseases

    Institute of Scientific and Technical Information of China (English)

    谷金(综述); 梁斌(审校)

    2015-01-01

    Unilateral pedicle screw internal fixation is one of the important means of treatment of lumbar de-generative diseases.It plays an important role on solving the postoperative immediate stability of the lumbar spine, and provide enough rigid internal fixation for intervertebral fusion.This paper expounds the research present situation, advantages, limitations and future research direction of unilateral pedicle screw internal fixation.%单侧椎弓根螺钉内固定是治疗腰椎退行性疾病的重要手段之一,其在解决腰椎术后的即刻稳定性方面起着重要作用,为椎间融合术提供足够刚性内固定。该文对单侧椎弓根螺钉内固定的研究现状、优势、局限性与未来的研究方向进行综述。

  1. Early efficacy analysis on Herbert screw internal fixation for carpal scaphoid fracture%Herbert螺钉治疗腕舟状骨骨折的早期临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    施纯南; 庄志伟; 王志杰; 吴金凤; 张金山; 李懿

    2014-01-01

    目的:分析 Herbert螺钉治疗腕舟状骨骨折的早期临床疗效.方法:2010年1月~2013年6月我院通过手术方法使用 Herbert螺钉内固定治疗23例腕舟状骨骨折,通过随访评价骨折愈合情况和腕关节功能.结果:随访6~18个月(平均12.6个月),所有骨折均达到骨性愈合,腕关节功能通过 Mayo法评分:其中优15例,良7例,差1例,优良率达86.9%.结论:腕舟状骨骨折采用方法通过 Herbert进行内固定治疗,骨折愈合率高,腕关节功能恢复良好,疗效确切.%Objective:To analyze the early clinical ef ect of carpal scaphoid fracture treated by Herbert screw fixation.Methods:From 2010.01-2013.06,23 carpal scaphoid fracture patients were operated by Herbert screw internal fixation in our Hospital.To observe the union of fracture and the function of wrist was evaluated according to Mayo score system.Conclusion:Carpal scaphoid fracture treated by Herbert screw fixation can elevate the rate of union of fracture and improved the wrist function,the clinical ef ect is gratification.

  2. Treatment of wrist joint dislocation by movable external fixator and Anchor screws%可活动外固定支架结合Anchor钉治疗腕关节脱位

    Institute of Scientific and Technical Information of China (English)

    尹自飞; 韩培; 柴益民; 蒋垚

    2012-01-01

    目的 探讨应用可活动外固定支架结合Anchor钉治疗腕关节脱位的可行性及治疗效果.方法 对16例腕关节脱位患者进行腕关节可活动外固定支架固定,同时切开复位,加压空心钉固定骨折,Anchor钉修复腕骨间韧带和桡腕韧带,克氏针临时固定腕骨.结果 随访3~6个月,16例患者均基本恢复腕关节功能,未出现再脱位、舟骨月骨坏死等.采用Cooney评价标准:优7例,良7例,可2例.结论 可活动外固定支架结合Anchor钉治疗腕关节脱位可有效固定腕关节,韧带修复可靠,利于破损韧带愈合及促进早期逐步功能锻炼,疗效满意.%Objective To discuss feasibility and clinical result of wrist joint dislocation by movable external fixator and Anchor screw. Methods 16 cases of wrist joint dislocations were treated with movable external fixators, open reduction , and cannulated screws fixation of fracture. Anchor screws were used to repaire intercarpal and radiocarpal ligaments and Kirschner wire fixing fracture temperately. Results All cases were followed up for 3 ~ 6 months. 16 patients recoveried wrist joint functions basically, and no dislocations and osteonecrosis were found. Based on Cooney's clinical scoring system,the scores of our series were 7 excellent ,7 good and 2 fair. Conclusions Treatment of wrist joint dislocations by movable external fixator and Anchor screw can fix wrist joint effectively, repairing ligaments reliably and allow function movements early.

  3. Finite element analysis of abruption of lower tibiofibular ligament union with single screw fixation%下胫腓联合分离单螺钉固定的有限元分析

    Institute of Scientific and Technical Information of China (English)

    戴海飞; 余斌; 张凯瑞; 熊小龙; 崔壮; 陈志刚

    2012-01-01

    [Objective] To explore the biomechanical characteristics of different ways of single screw internal fixation for abruption of lower tibiofibular ligament union through finite element (FE) analysis and therefore to provide scientific foundation for clinic application. [ Method ] Three-dimensional FE models of the different ways of single screw internal fixation for abruption of lower tibiofibular ligament union were established by helical CT scan data of normal adult human ankles. The static weight-bearing state of human body in neutral position with one foot standing were simulated to compare the differences between different ways of internal fixation in screw von Mises stress distribution,the displacement of the tibia and fibula. [ Result] A total of twelve types of abruption of lower tibiofibular ligament union FE models including bones, ligaments and screw were constructed. FE simulation showed significant differences between the different ways of fixation with regard to the biomechanical characteristics in the model. A 4. 5 mm screw to be fixed through four layers of cortical bone at 2 cm away from the horizontal plane of the ankle showed minimum von Mises stress and displacement of the tibia and fibula. [ Conclusion ] A better fixation stability may be achieved by using 4. 5 mm screw through four layers of cortical bone at 2 cm away from the horizontal plane of the ankle for abruption of lower tibiofibular ligament union.%[目的]通过三维有限元法对下胫腓联合分离使用单螺钉固定的各方式进行对比评价,比较不同内固定生物力学特征,为临床提供理论依据.[方法]利用正常男性的足踝部螺旋CT扫描数据,建立下胫腓联合分离单螺钉内固定的三维有限元模型.模拟人体中立位单足站立踝关节受力方式,比较不同的内固定方式螺钉von Mises应力分布、胫腓骨的位移.[结果]建立12种包括骨、韧带在内的下胫腓联合分离单螺钉内固定的有限元模型.

  4. 寰枢椎椎弓根钉内固定重建上颈椎不稳%Atlanto-axial pedicle screw internal fixation to reconstruct upper cervical spine instability

    Institute of Scientific and Technical Information of China (English)

    杨飞; 武永刚; 赵敏; 贾卫斗; 云得才; 王建华

    2010-01-01

    目的 探讨寰枢椎椎弓根钉内固定融合重建上颈椎不稳的临床疗效.方法 采用寰枢椎椎弓根钉内固定自体髂骨植骨治疗上颈椎不稳患者21例,其中Ⅱ型齿状突骨折13例,齿状突不连5例,横韧带损伤3例.在寰枢椎后弓间植骨融合,使寰枢椎复合体得到稳定.结果 共置入84枚螺钉,术中2枚螺钉穿破寰椎左侧椎弓根外侧壁,未发生脊髓、椎动脉损伤.所有患者X线片示寰椎完全复位,枢椎齿状突骨折处复位良好.CT片示螺钉与椎动脉及脊髓位置关系良好.按JOA评分标准,优15例,良3例,可2例,差1例,优良率85.71%(18/21).17例患者获得随访,随访时间12~26(12.83±4.23)个月,均获得骨性融合,未发现钉板断裂.结论 寰枢椎椎弓根螺钉结合钉板系统固定重建上颈椎不稳能显著增强寰枢椎间生物力学稳定性,植骨融合率高,该术式在寰枢椎融合术中具有较高的推广应用价值.%Objective To explore the clinical effect of the atlanto-axial pedicle screw internal fixation to reconstruct upper cervical spine instability. Methods Using atlanto-axial pedicle screw and internal fixation system combined with autogenous iliac bone graft to treat 21 patients with upper cervical spine instability. Type Ⅱ odontoid process old fracture was 13 patients, odontoid process nonunion was 5 patients, injury of the transverse ligament was 3 patients. They were placed in 84 atlanto-axial pedicle screws, autogenous bones were placed in the posterior arch of atlas and axis to fusion, so that atlanto-axial complex got stabilized. Results The left lateral cortical bone of atlas vertebral pedicle was broken by screws in 2 patients, but the spinal cord and vertebral artery was intact. X-ray film showed the atlas and the fracture of dens of axis was completely replaced in all patients. The position of screw and vertebral artery or spinal cord was good in CT image. According to JOA score standard, 15 cases of all were

  5. 骨水泥强化治疗骨质疏松症伴脊柱侧弯疗效分析%Effects of pedicle screw fixation with bone cement tract augmentation on scoliolosis accompanying osteoporosis

    Institute of Scientific and Technical Information of China (English)

    丁金勇; 洪少勇; 晋大祥; 梁德; 江晓兵

    2012-01-01

    目的 探讨对伴骨质疏松症的退行性脊柱侧弯病人行后路减压、骨水泥强化钉道椎弓根内固定融合治疗的临床疗效.方法 2006-10-2009-07收治伴骨质疏松症的退变性脊柱侧弯患者18例,女11例,男7例,平均年龄64.5岁,均冠状面畸形,Cobb's角>15°或合并椎体旋转半脱位以及合并椎体骨质疏松性病理性骨折.手术采取部分椎板切除,松解神经根以充分减压,骨水泥强化钉道的椎弓根长节段钉棒系统进行矫形,记录手术前后Cobb's角、前凸角,手术前后进行ODI评分.结果 所有病例切口均Ⅰ期愈合,无感染或深静脉血栓等近期并发症;进行24~54个月随访(平均36个月),未出现断钉、断棒,及椎弓根钉拔出、松动、融合节段假关节形成或感染等远期并发症.患者术后冠状面Cobb's角均低于术前(P<0.05),腰椎矢状面前凸角均高于术前(P<0.05),ODI综合评分均低于术前(P<0.05).结论 在充分减压消除症状的基础上,用骨水泥强化钉道进行侧弯的矫形,可以获得脊柱平衡并能够避免矫形的丢失.%Objective To evaluate the clinical effect of the treatment that part or full laminecto-my and correction with posterior long segment pedicle screw/rod internal fixation system by augmentation and restoration with bone cement in the screw tract and posterolateral or intervertebral spinal fusion, about degenerative scoliolosis accompanying with osteoporosis. Methods Eighteen patients, 11 females and 7 males (average age of 643 years),with degenerative scoliosis accompanying by osteoporosis were selected from our hospital, between October 2006 and July 2009. The patients were treated with part or full laminectomy and posterior long segment pedicle screw/rod internal fixation system by augmentation and restoration with bone cement in the screw tract and posterolateral or intervertebral spinal fusion. Result All cases were followed up for 36 months (range 24-54 months). No

  6. Bioabsorbable Pins for Treatment of Osteochondral Fractures of the Knee after Acute Patella Dislocation in Children and Young Adolescents

    Directory of Open Access Journals (Sweden)

    A. Gkiokas

    2012-01-01

    Full Text Available A retrospective study was performed on the use of bioabsorbable pins in the fixation of osteochondral fractures (OCFs after traumatic patellar dislocation in children. Eighteen children (13 females, 5 males aged 11 to 15 years (mean age 13.1 years with osteochondral fracture (OCF of the knee joint were treated at the authors’ institution. Followup ranged from 22 months to 5 years. Diagnosis was verified by X-ray and magnetic resonance imaging (MRI of the knee and patella. In seven patients the osteochondral fragment was detached from the patella and in 11 it was detached from the lateral femoral condyle. All patients were subjected to open reduction and fixation of the lesion with bioabsorbable pins. Postoperatively, the knee was immobilized in a cast and all patients were mobilized applying a standardized protocol. Bone consolidation was successful in 17 of the 18 patients. Bioabsorbable pins reliably fix OCF in children and adolescents, demonstrating a high incidence of consolidation of the detached osteochondral fragment in short- and middle-term followup without requiring further operative procedures.

  7. 骨水泥强化椎弓根螺钉固定对骨质疏松患者有利无弊?★%Pedicle screw fixation augmented with bone cement benefits osteoporosis patients?

    Institute of Scientific and Technical Information of China (English)

    岳文峰; 夏虹; 王建华

    2013-01-01

    BACKGROUND:During the pedicle screw fixation for lumbar disease patients accompanied with osteoporosis, addition of bone cement in osteoporotic vertebral body can significantly increase the stability of internal fixation, but the effect on adjacent segments is not clear. OBJECTIVE:To observe the effect on adjacent segments of osteoporosis patients after pedicle screw fixation augmented with bone cement in early and medium-term fol ow-up period. METHODS:We reviewed the medical information of 87 patients suffering from lumbar disease accompanied with osteoporosis who underwent operation of pedicle screw fixation and posterior lumbar spinal decompression, and the patients were divided into three groups:conventional pedicle screw group, conventional pedicle screw+bone cement group, novel perfusional pedicle screw+bone cement group. The samples were fol owed-up for 6-18 months, averaged 9 months. The Oswestry disability index, intervertebral distance of the upper adjacent segments, deformation index of the upper adjacent vertebral body, concave angle of the fixed lumbar vertebrae superior end-plate and the upper adjacent vertebral body inferior end-plate, and Cobb angle were measured before operation, at 3 days postoperation and during final fol ow-up. RESULTS AND CONCLUSION:The Oswestry disability index of the final fol ow-up in the three groups were decreased when compared with that before operation (P0.05). This showed that in posterior spinal fixation operation, there was no significant difference in the early and medium-term subjective effect between addition of bone cement or not and different adding ways, and addition of bone cement or not and different adding ways could remarkably improve the life quality of the patients. The change of Cobb angle of fixed lumbar vertebrae between the final fol ow-up and 3 days after operation in conventional pedicle screw+bone cement group and novel perfusional pedicle screw+bone cement group was both less than that in the

  8. Cause analysis of the screw loosening after the internal fixation with thoracolumbar vertebral pedicle screw in the elderly%老年人胸腰椎椎弓根螺钉内固定术后螺钉松动原因分析

    Institute of Scientific and Technical Information of China (English)

    张思萌; 李放; 刘秀梅; 王崇伟; 王秀红

    2015-01-01

    目的 探讨老年人胸腰椎椎弓根螺钉内固定术后螺钉松动的原因及预防措施. 方法 对2011年5月至2013年5月在我院行胸腰椎椎弓根螺钉内固定手术≥60岁老年患者187例临床资料进行回顾性分析,按是否发生螺钉松动分为松动组和固定良好组,观察并比较两组患者手术时间、出血量、术后6个月及末次随访视觉模拟疼痛评分(VAS)及Oswestry功能障碍指数(ODI)评分,分析螺钉松动的原因. 结果 本组行胸腰椎椎弓根螺钉内固定手术主要病因为胸腰椎侧后凸畸形、骨折、滑脱、肿瘤及退行性疾病等,术后平均随访(35.2±8.7)个月.发生内固定松动13例(7.0%),男性5例,女性8例,平均年龄(78.4±3.5)岁.发现螺钉松动时间为术后3~12个月,平均(7.6±3.7)个月.13例患者中,螺钉松动单节段1例,双节段3例,3个或3个以上节段9例.螺钉松动患者中骨质疏松10例.VAS及ODI评分,术后6个月及末次随访与术前比较,差异均有统计学意义(P<0.05);末次随访与术后6个月比较,差异无统计学意义(P>0.05).松动组性别及术前骨质疏松患病率与固定良好组比较,差异有统计学意义(P<0.05). 结论 骨质疏松是影响老年患者胸腰椎椎弓根螺钉内固定术后螺钉松动的原因之一,长节段螺钉松动概率增高,可能与老年患者脊柱力学改变有关.对于老年骨质疏松患者,是否需要骨水泥强化治疗,仍需进一步随机对照研究.%Objective To explore what cause the screw loosening after the internal fixation with thoracic and lumbar pedicle screws in the elderly and to develop the preventive measures.Methods Retrospective analysis were used to collect the clinical data from patients ager 60 years and over who had undergone surgeries of thoracolumbar pedicle screw internal fixation in our hospital during May 2011 and May 2013.Totally 187 cases were included in this study.According to whether there was a loosening of

  9. 微创椎弓根螺钉经伤椎固定治疗胸腰椎骨折%Minimally Invasive Pedicle Screw Fixation Through Injury of Thoracic and Lumbar Vertebral Fractures

    Institute of Scientific and Technical Information of China (English)

    张东

    2015-01-01

    目的:探讨微创椎弓根螺钉经伤椎内固定术在治疗胸腰椎骨折后路手术中的临床疗效和应用价值。方法:采用微创椎弓根螺钉经伤椎内固定经皮椎弓根螺钉内固定术治疗胸腰椎爆裂性骨折20例,手术均在气管插管全身麻醉下进行,采用俯卧位,棘突旁作1~2厘米小切口,经皮椎弓根螺钉内固定经伤椎固定撑开椎体复位。术后定期复查X线片以观察固定节段的稳定性和骨折愈合率。结果:术后20例全部获得随访,随访6~12个月,平均8个月。椎体撑开复位,脊柱序列恢复良好,无骨折不融合,无椎管内神经压迫等并发症。内固定节段稳定,胸腰椎椎间高度及生理曲度都得到良好重建及维持,未出现内固定断裂、松动及脱出,无血管、神经损伤等并发症。结论:微创椎弓根螺钉经伤椎内固定术治疗胸腰椎骨折,防止了棘突旁肌肉和韧带的剥离,完全恢复脊柱序列,复位良好,腰背肌肉力量得到了保护,可早期下床活动,方便术后护理和功能锻炼,为一积极有效的方法。%Objective: To investigate the clinical efficacy of minimally invasive pedicle fixation and application value in the treatment of thoracolumbar fracture surgery in the posterior screw the injured vertebrae.Methods: Minimally invasive pedicle screw fixation was injured vertebra fixation treatment by percutaneous pedicle screw within the thoracolumbar burst fracture 20 cases,the operations were carried out in endotracheal intubation under general anesthesia in the prone position,the spinous process as a -2 cm incision,percutaneous pedicle screw fixation was injured vertebra vertebral distraction reset.Periodic review of postoperative X-ray to see stability and fracture healing rate fixed segment.Results:20 cases of surgery were followed uPfor 6 to 12 months,an average of eight months.Vertebral distraction reduction,spinal sequence

  10. 3D打印模型辅助后路内固定治疗儿童颈椎畸形%Individualized 3-dimensional printing model-assisted posterior screw fixation in the treatment of cervical deformity of children

    Institute of Scientific and Technical Information of China (English)

    李浩; 李承鑫; 张学军; 郭东; 范敬一; 刘虎; 孙记航; 潘少川

    2015-01-01

    Objective To explore the method and efficacy of individualized 3-dimensional (3D) printing model-assisted posterior screw fixation for the treatment of cervical deformity of children.Methods A total of 29 surgical patients with cervical deformity associated with upper cervical instability as diagnosed by computed tomography (CT) were retrospectively analyzed.For 22 cases,3D printing cervical model was establisged by 3D printing technology.And screw insertion and fixation were simulated for assisting actual operations.At last implemented one-stage posterior orthomorphia plus internal fixation.Results Among them,22 patients with cervical deformity successfully underwent posterior screw fixation assisted by individual 3D printing model.Without injury to vertebral artery or nerve root,there was no internal fixation loosening or fracture.The average followup period was 13.5 (3-23) months.Postoperative atlantodens interval (ADI) significantly decreased,cervicomedullary angle (CMA) increased markedly while ventral compression of medulla oblongata diminished or even disappeared.There was no operative mortality.The procedures included secondary fusion of bone graft (n =1),sternocleidomastoid muscle amputationlysis (n =1),foramen magnum decompression (n =1) and posterior arch of atlas decompression (n =1).Conclusions Posterior screw fixation operation assisted by individualized 3D printing model can improve the success rate and safety of screw insertion and effectively protect vertebral artery and nerve root.And it is particularly suitable for children with cervical deformity.%目的 研究个体化3D打印模型辅助后路内固定治疗儿童颈椎畸形的方法和效果.方法 对北京儿童医院骨科2012年9月至2014年5月CT确诊并手术的29例颈椎畸形伴上颈椎不稳患儿的临床资料进行回顾性分析.其中22例采用3D打印技术建立颈椎个体化3D打印模型,在模型上进行模拟置钉及内固定手术,获得个体化置钉数据,再

  11. A Biomechanical Comparison of Expansive Pedicle Screws for Severe Osteoporosis: The Effects of Screw Design and Cement Augmentation.

    Science.gov (United States)

    Tai, Ching-Lung; Tsai, Tsung-Ting; Lai, Po-Liang; Chen, Yi-Lu; Liu, Mu-Yi; Chen, Lih-Huei

    2015-01-01

    Expansive pedicle screws significantly improve fixation strength in osteoporotic spines. However, the previous literature does not adequately address the effects of the number of lengthwise slits and the extent of screw expansion on the strength of the bone/screw interface when expansive screws are used with or without cement augmentation. Herein, four designs for expansive pedicle screws with different numbers of lengthwise slits and different screw expansion levels were evaluated. Synthetic bones simulating severe osteoporosis were used to provide a comparative platform for each screw design. The prepared specimens were then tested for axial pullout failure. Regardless of screw design, screws with cement augmentation demonstrated significantly higher pullout strength than pedicle screws without cement augmentation (p screws without cement augmentation, solid screws exhibited the lowest pullout strength compared to the four expansive groups (p screws with different designs (p > 0.05). Taken together, our results show that pedicle screws combined with cement augmentation may greatly increase screw fixation regardless of screws with or without expansion. An increase in both the number of slits and the extent of screw expansion had little impact on the screw-anchoring strength. Cement augmentation is the most influential factor for improving screw pullout strength. PMID:26720724

  12. Geometric accuracy of 3D coordinates of the Leksell stereotactic skull frame in 1.5 Tesla- and 3.0 Tesla-magnetic resonance imaging: a comparison of three different fixation screw materials.

    Science.gov (United States)

    Nakazawa, Hisato; Mori, Yoshimasa; Yamamuro, Osamu; Komori, Masataka; Shibamoto, Yuta; Uchiyama, Yukio; Tsugawa, Takahiko; Hagiwara, Masahiro

    2014-11-01

    We assessed the geometric distortion of 1.5-Tesla (T) and 3.0-T magnetic resonance (MR) images with the Leksell skull frame system using three types of cranial quick fixation screws (QFSs) of different materials-aluminum, aluminum with tungsten tip, and titanium-for skull frame fixation. Two kinds of acrylic phantoms were placed on a Leksell skull frame using the three types of screws, and were scanned with computed tomography (CT), 1.5-T MR imaging and 3.0-T MR imaging. The 3D coordinates for both strengths of MR imaging were compared with those for CT. The deviations of the measured coordinates at selected points (x = 50, 100 and 150; y = 50, 100 and 150) were indicated on different axial planes (z = 50, 75, 100, 125 and 150). The errors of coordinates with QFSs of aluminum, tungsten-tipped aluminum, and titanium were 2.0 mm in most positions. The geometric accuracy of the Leksell skull frame system with 1.5-T MR imaging was high and valid for clinical use. However, the geometric errors with 3.0-T MR imaging were larger than those of 1.5-T MR imaging and were acceptable only with aluminum QFSs, and then only around the central region.

  13. Resorbable screws versus pins for optimal transplant fixation (SPOT in anterior cruciate ligament replacement with autologous hamstring grafts: rationale and design of a randomized, controlled, patient and investigator blinded trial [ISRCTN17384369

    Directory of Open Access Journals (Sweden)

    Rademacher Grit

    2005-02-01

    Full Text Available Abstract Background Ruptures of the anterior cruciate ligament (ACL are common injuries to the knee joint. Arthroscopic ACL replacement by autologous tendon grafts has established itself as a standard of care. Data from both experimental and observational studies suggest that surgical reconstruction does not fully restore knee stability. Persisting anterior laxity may lead to recurrent episodes of giving-way and cartilage damage. This might at least in part depend on the method of graft fixation in the bony tunnels. Whereas resorbable screws are easy to handle, pins may better preserve graft tension. The objective of this study is to determine whether pinning of ACL grafts reduces residual anterior laxity six months after surgery as compared to screw fixation. Design/ Methods SPOT is a randomised, controlled, patient and investigator blinded trial conducted at a single academic institution. Eligible patients are scheduled to arthroscopic ACL repair with triple-stranded hamstring grafts, conducted by a single, experienced surgeon. Intraoperatively, subjects willing to engage in this study will be randomised to transplant tethering with either resorbable screws or resorbable pins. No other changes apply to locally established treatment protocols. Patients and clinical investigators will remain blinded to the assigned fixation method until the six-month follow-up examination. The primary outcome is the side-to-side (repaired to healthy knee difference in anterior translation as measured by the KT-1000 arthrometer at a defined load (89 N six months after surgery. A sample size of 54 patients will yield a power of 80% to detect a difference of 1.0 mm ± standard deviation 1.2 mm at a two-sided alpha of 5% with a t-test for independent samples. Secondary outcomes (generic and disease-specific measures of quality of life, magnetic resonance imaging morphology of transplants and devices will be handled in an exploratory fashion. Conclusion SPOT aims at

  14. Percutaneous fixation with Schanz screws for displaced two- and three- part fractures of the proximal humerus in patients above fifty years of age

    OpenAIRE

    Abdelsalam Eid; Mohamed Osman; Hosam-Eldeen Fekry

    2011-01-01

    Purpose: The aim of this study is to evaluate whether two 3.0 mm Schanz screws in two-part proximal humeral fractures (plus one additional Schanz screw or K wire in three-part fractures) can provide enough stability to allow early mobilization until healing occurs in elderly patients. Settings and Design: This prospective study was performed in the Orthopaedic Department of our University Hospital. Patients and Methods: We performed closed reduction and percutaneous pinning for thirt...

  15. 椎弓根螺钉内固定及计算机导航技术的发展与应用%Development and application of pedicle screw fixation and computer navigation technology

    Institute of Scientific and Technical Information of China (English)

    靳冬; 张果忠

    2012-01-01

    BACKGROUND: Thoracolumbar pedicle screw fixation techniques play an important role in the development of spinal surgery, and spine computer navigation system can significantly improve the accuracy and safety of pedicle screws. OBJECTIVE: To study the clinical application of pedicle screw fixation. MESHODS: A computer-based retrieve was performed for the articles on the application of pedicle screw fixation and computer navigation technology in the fixation from January 1999 to December 2011 with the key words of "pedicle screw fixation, computer navigation technology, clinical application" in Chinese. Repetitive articles and Meta analysis articles were eliminated. Finally, 25 articles were included to discuss the research progress of pedicle screw fixation and relevant evaluation. RESULTS AND CONCLUSION: Computer-aided surgical technique is a new technology that can help surgeons to make the surgery safer and accurately through virtual the surgical environment based on the high-speed processing of large amounts of data information and control capabilities of computer. Recently, we have achieved great development on the study of thoracolumbar pedicle screws technology, especially the intraoperative monitoring tool, it has developed from traditional X-ray fluoroscopy or radiography monitoring and positioning to visualize monitoring by computer-aided technology. Computer navigation technology can simulate and measure the length and angle of the pin tract and the diameter of pedicle from the three-dimensional image data stored in the computer, which is benefit to select the pedicle screw with the best length and diameter, so that to make the pedicle screw surgery more precise, simple, fast and safe and then reduce the occurrence of postoperative complications.%背景:胸腰椎椎弓根螺钉内固定技术的开展,有力地推动了脊柱外科的发展,而脊柱计算机导航系统可以明显改进椎弓根螺钉植入的精确性和安全性.目的:研究近年

  16. Cancellous Screws Are Biomechanically Superior to Cortical Screws in Metaphyseal Bone.

    Science.gov (United States)

    Wang, Tim; Boone, Christopher; Behn, Anthony W; Ledesma, Justin B; Bishop, Julius A

    2016-09-01

    Cancellous screws are designed to optimize fixation in metaphyseal bone environments; however, certain clinical situations may require the substitution of cortical screws for use in cancellous bone, such as anatomic constraints, fragment size, or available instrumentation. This study compares the biomechanical properties of commercially available cortical and cancellous screw designs in a synthetic model representing various bone densities. Commercially available, fully threaded, 4.0-mm outer-diameter cortical and cancellous screws were tested in terms of pullout strength and maximum insertion torque in standard-density and osteoporotic cancellous bone models. Pullout strength and maximum insertion torque were both found to be greater for cancellous screws than cortical screws in all synthetic densities tested. The magnitude of difference in pullout strength between cortical and cancellous screws increased with decreasing synthetic bone density. Screw displacement prior to failure and total energy absorbed during pullout strength testing were also significantly greater for cancellous screws in osteoporotic models. Stiffness was greater for cancellous screws in standard and osteoporotic models. Cancellous screws have biomechanical advantages over cortical screws when used in metaphyseal bone, implying the ability to both achieve greater compression and resist displacement at the screw-plate interface. Surgeons should preferentially use cancellous over cortical screws in metaphyseal environments where cortical bone is insufficient for fixation. [Orthopedics.2016; 39(5):e828-e832.].

  17. MRI of menisci repaired with bioabsorbable arrows

    Energy Technology Data Exchange (ETDEWEB)

    Mustonen, Antti O.T.; Kiuru, Martti; Koskinen, Seppo K. [Helsinki University Hospital - Radiology, Helsinki (Finland); Tielinen, Laura; Lindahl, Jan; Hirvensalo, Eero [Helsinki University Hospital - Traumatology, Helsinki (Finland)

    2006-07-15

    To analyze with conventional magnetic resonance imaging (MRI) the signal appearance of menisci repaired with bioabsorbable arrows. Forty-four patients with 47 meniscal tears treated with bioabsorbable arrows underwent follow-up conventional MRI examination. The time interval between the surgery and MRI varied from 5 to 67 months (mean 26 months). Twenty-six patients also had concurrent repair of torn anterior cruciate ligament. The following grades were used to classify meniscal signal intensity: (a) G0; low signal intensity on all sequences and regular configuration in every plane, (b) G1; increased signal intensity within the meniscus, not extending to the meniscal surface, (c) G2; increased signal intensity linear in shape, which may or may not communicate with the capsular margin of the meniscus, without extending to the meniscal surface, and (d) G3; increased signal intensity extending to the meniscal surface. Thirteen menisci (27.5%) had normal signal intensity, 13 menisci (27.5%) Grade 1 signal intensity, 9 menisci (19%) Grade 2 signal intensity and 12 menisci (26%) Grade 3 signal intensity. The time difference between operation and MRI was statistically significant between the G0 (36 months) and G3 groups (14 months; P=0.0288). There was no statistical significance in different grades between medial and lateral meniscus or between patients with operated or intact ACL. On physical examination sixteen patients reported slight symptoms, seen evenly in each group. (orig.)

  18. Biomechanical characteristics of calcium phosphate cement in the reinforcement of vertebral pedicle screw fixation%磷酸钙骨水泥强化椎弓根螺钉固定的生物力学特性

    Institute of Scientific and Technical Information of China (English)

    黎逢峰; 张庆宏; 黄野; 王云华

    2006-01-01

    组椎骨,用磷酸钙骨水泥重新固定12 h后拔松的椎弓根螺钉,测定其两侧的最大轴向拔出力.主要观察指标:①磷酸钙骨水泥最终凝固时强化椎弓根螺钉固定的生物力学测试结果.②磷酸钙骨水泥初步凝固时强化椎弓根螺钉固定的生物力学测试结果.③磷酸钙骨水泥强化松动椎弓根螺钉固定的生物力学测试结果.结果:①50岁组对照侧和强化侧的椎弓根螺钉最大轴向拔出力中位数分别为620 N和1 136 N,强化侧较对照侧增加83%(P<0.01).强化骨-螺钉界面的抗剪切应力中位数从1.16 N/mm2增加到2.13 N/mm2.②52岁组对照侧和强化侧的椎弓根螺钉最大轴向拔出力中位数分别为554.5 N和859.5 N,强化侧较对照侧增加55%(P<0.01).强化骨-螺钉界面的抗剪切应力中位数从1.039 N/mm2增加到1.61 N/mm2.③50岁组椎骨对照侧和强化侧重新固定12 h后最大轴向拔出力中位数分别为517 N和876 N,和同侧松动后轴向拔出力中位数比较,分别增加了63.6%和54.2%(P均<0.01).结论:磷酸钙骨水泥初步凝固和最终凝固时能强化椎弓根螺钉的固定,并且椎弓根螺钉松动后使用磷酸骨水泥能使螺钉重新获得固定.椎体强化侧的椎弓根螺钉均从骨-螺界面剥离开来,不伴周边骨质和椎弓根的严重损害,有利于螺钉松动、拔出后的二次置入.%BACKGROUND: Polymethylmethacrylate (PMMA) can ameliorate the condition between vertebral pedicle screws and peripheral bone-matrix interfaces and notably enhance the strength of screw fixation. However, there are several disadvantages during and after operation such as polymerized thermal damaging effect, toxicity and unabsorbable etc. Calcium phosphate cement (CPC) is biocompatible and biodegradable with good biosafty and produce no heat of polymerization, which is a perfect substitute for PMMA.OBJECTIVE: To evaluate the reinforcing effect of CPC on vertebral pedicle screw fixation at

  19. The Potential of Magnesium Alloys as Bioabsorbable/ Biodegradable Implants for Biomedical Applications

    Directory of Open Access Journals (Sweden)

    F. Živić

    2014-03-01

    Full Text Available The potential of magnesium alloys as bioabsorbable / biodegradable implants for biomedical applications has been extensively studied as emerging direction. This paper gives a review of current topics in this field. Research activities related to biomedical magnesium alloys have been pursued in two main directions, orthopedic and cardiovascular implants, by investigating different aspects of alloying system design, novel structures, degradation rate control, and surface modification methods. Magnesium alloys are currently considered for applications as load-bearing implant devices such as plates, screws and pins for repairing bone fracture. Highly important direction of research is degradable coronary stents. Degradable vessel stents promote stable vessel regeneration, unlike permanent stents. Different combinations of alloying elements have been investigated in order to decrease corrosion rate.Tribological issues are also important for understanding of different phenomenon related to prolongation of Mg alloys corrosion degradation time/rate, such as tribocorrosion, corrosion fatigue, and fatigue crack growth behavior.

  20. Surgical treatment of the osteoporotic spine with bone cement-injectable cannulated pedicle screw fixation: technical description and preliminary application in 43 patients

    Directory of Open Access Journals (Sweden)

    Fei Dai

    2015-02-01

    Full Text Available OBJECTIVES: To describe a new approach for the application of polymethylmethacrylate augmentation of bone cement-injectable cannulated pedicle screws. METHODS: Between June 2010 and February 2013, 43 patients with degenerative spinal disease and osteoporosis (T-score <-2.5 underwent lumbar fusion using cement-injectable cannulated pedicle screws. Clinical outcomes were evaluated using a Visual Analog Scale and the Oswestry Disability Index. Patients were given radiographic follow-up examinations after 3, 6, and 12 months and once per year thereafter. RESULTS: All patients were followed for a mean of 15.7±5.6 months (range, 6 to 35 months. The Visual Analog Scale and Oswestry Disability Index scores showed a significant reduction in back pain (p = 0.018 and an improvement in lower extremity function (p = 0.025 in patients who underwent lumbar fusion using the novel screw. Intraoperative cement leakage occurred in four patients, but no neurological complications were observed. Radiological observation indicated no loosening or pulling out of the novel screw, and bone fusion was excellent. CONCLUSIONS: The described polymethylmethacrylate augmentation technique using bone cement-injectable cannulated pedicle screws can reduce pain and improve spinal dysfunction in osteoporotic patients undergoing osteoporotic spine surgery.

  1. C2 Pedicle Screw Combined with C3 Lateral Mass Screw Fixation for Treatment of Instable Hangman's Fracture%C2椎弓根螺钉联合C3侧块螺钉固定治疗不稳定性Hangman骨折

    Institute of Scientific and Technical Information of China (English)

    杨国进; 章筛林; 石志才

    2012-01-01

    Objective To evaluate the surgical management and result of C2 pedicle screw combined with C3 lateral mass screw fixation for treatment of instable Hangman's fracture. Methods From August 2005 to December 2010,16 patients with instable Hangman's fracture were all treated with C2 pedicle screw combined with C3 lateral mass screw fixation,which involved 11 males and 5 females with an average age of 35. 4 years old (range 19- 59). According to Levine-Edwards classification ,11 cases were type Ⅰ ,5 cases were type Ⅱ a,2 cases were type Ⅲ . All the patients complained neck pain and limitation of cervical movement. There were D spinal injury in 3 cases and E in 13 cases according to Frankel scale. Results All patients were followed up for a mean time of 13. 5 months (range 9~36 months). The operative time was 95~170 min (average 114 min) and the blood loss was 290~450 mL(average 353 mL). All fractures healed at 6 months postoperatively. There was no internal fixation fracture or loosing occurred. The cervical movement was excellent. Three cases of grade D spinal injury recovered to grade E. Conclusion C2 pedicle screw combined with C3 lateral mass screw fixation is an effective method for treatment of instable Hangman's fracture.%目的 探讨C2椎弓根螺钉联合C3侧块螺钉内固定治疗不稳定性Hangman骨折的临床效果及应用价值.方法 2005年8月至2010年12月采用后路C2椎弓根螺钉联合C3侧块螺钉内固定治疗16例不稳定性Hangman骨折患者,男11例,女5例;年龄19~59岁,平均35.4岁.骨折按Levine-Edwards分类,Ⅱ型9例,Ⅱa型5例,Ⅲ型2例.脊髓损伤按Frankel分级,D级3例,E级13例.结果 所有患者均获随访,随访时间9~36个月(平均18个月).手术时间95~170 min(平均114 min),术中出血290~450 mL(平均353mL),术后6个月复查时,骨折均愈合,无断钉、断棒及螺钉松动发生,颈部活动功能恢复良好.脊髓功能D级3例均恢复至E级.结论 经后路C2

  2. Atlantoaxial pedicle screw fixation for old odontoid fracture combined with atlantoaxial instability%寰枢椎椎弓根螺钉技术治疗陈旧性齿状突骨折并寰枢椎失稳

    Institute of Scientific and Technical Information of China (English)

    郝定均; 许正伟; 贺宝荣; 郭华; 刘团江; 王晓东

    2011-01-01

    目的 探讨后路寰枢椎椎弓根钉技术治疗陈旧性齿状突骨折并寰枢椎失稳的疗效.方法 2005年1月-2010年1月,对48例陈旧性齿状突骨折并寰枢椎失稳患者行后路寰枢椎椎弓根钉复位固定,其中男30例,女18例;年龄19~56岁,平均45.1岁.本组术前均行颅骨牵引.结果 本组48例患者共置入寰椎和枢椎椎弓根螺钉各96枚,寰枢椎复位满意,术中无脊髓损伤.术中出血250~900 ml,平均370 ml,手术时间110~280 min,平均155 min.术中3例出现椎动脉损伤,3例出现寰椎后弓下壁破裂.术后均获随访9~64个月,平均46.6个月.所有患者均在术后6个月获得骨性融合,未发现螺钉松动、移位、螺钉断裂和寰枢椎再移位、失稳现象.日本骨科学会(JOA)评分由术前的(7.1±2.8)分改善至术后的(13.3±2.1)分(P<0.05).结论 寰枢椎椎弓根螺钉内固定技术具有良好的复位效果,为寰枢椎不稳患者治疗提供了一种较好的内固定术式.%Objective To explore the clinical effect of the trans-atlantoaxial pedicle screw-rod internal fixation and fusion in treatment of old odontoid fracture combined with atlantoaxial instability.Methods The study involved 48 patients with old odontoid fractures combined with atlantoaxial instability treated with trans-atlantoaxial pedicle screw-rod internal fixation and fusion from January 2005 to January 2010.There were 30 males and 18 females,at average age of 45.1 years old(19-56 years).All the patients underwent the skull traction preoperatively.Results A total of 192 pedicle screws(96 screws for the atlas and another 96 for the axis)were implanted in all the 48 patients who obtained satisfactory atlantoaxial reduction,with no spinal cord injuries.The operation lasted for average 155 min,with blood loss for average 370 ml.There were three patients with vertebral artery injury and three with inferior posterior arch fracture of the atlas during operation.All the patients were

  3. "徒手法"个体化颈椎椎弓根螺钉技术治疗上颈椎骨折脱位%Free-hand cervical pedicle screw fixation for upper cervical fracture and instability

    Institute of Scientific and Technical Information of China (English)

    韩岳; 夏群; 徐宝山; 张继东; 苗军

    2011-01-01

    目的 探讨应用颈椎椎弓根钉治疗上颈椎骨折及脱位的临床效果.方法 2006年9月-2009年1月,应用颈椎椎弓根钉治疗的上颈椎骨折或脱位的患者15例.其中男11例,女4例;年龄18~60岁,平均41.2岁.寰椎骨折脱位5例,枢椎骨折脱位3例,齿状突陈旧骨折不愈合1例,C2,3骨折脱位2例,无骨折寰枢椎失稳4例.临床主要症状为颈部疼痛或伴有四肢麻木无力、步态不稳.患者术前均行Halo架牵引试行复位.所有患者均采用颈椎椎弓根钉固定并植骨融合,根据术前X线片及CT个体化确定入钉点及置钉角度,徒手法钻出骨性通道,选用22~26 mm长的Vertex或Summit钛金属螺钉固定,并行后路椎板间自体或同种异体骨植骨融合.术后1~2 d佩戴颈托离床活动.结果 本组15例共置入颈椎椎弓根螺钉64枚,均未发生椎动脉和脊髓损伤,无脑脊液漏.术后行X线正、侧位片和CT检查证实损伤节段复位满意、螺钉位置良好.术后疼痛症状基本消失,神经症状较术前有不同程度的改善.14例患者获得随访,时间12~36个月,患者颈椎序列良好,均获得骨性融合,未发生螺钉及钛棒的松动、脱出及折断.神经损伤症状较术前明显改善.结论 颈椎椎弓根钉是颈椎后路手术中坚强的固定方法,只要掌握手术操作技巧,严格个体化置钉,颈椎椎弓根钉具有固定可靠、术后并发症少、融合率高等优势,具有良好的临床疗效.%Objective To evaluate the clinical effect of the free-hand cervical pedicle screw fixation in treatment of the upper cervical fracture and instability.Methods A retrospective review was performed on 15 patients with upper cervical fracture and instability treated with cervical pedicle screw fixation and fusion from September 2006 to January 2009.There were 11 males and 4 females,at average age of 41.2 years(range,18-60 years).Of all,there were five patients with atlas fracture and dislocation

  4. 单螺钉内固定法在髁突矢状骨折治疗中的应用%Clinical comparsion of single screw-fixation treatment and conservative treatment in sagittal fracture of the madibular condyle

    Institute of Scientific and Technical Information of China (English)

    李健; 张智星; 柳江太; 邓末宏; 龙星

    2014-01-01

    目的:探讨单螺钉内固定治疗下颌骨髁突矢状骨折的临床效果和应用价值。方法:对27例髁突矢状骨折病例进行回顾研究,根据治疗方式分为单螺钉内固定组和保守治疗组,比较术后3个月两组患者术后并发症、咬合关系、最大开口度、颞下颌关节功能障碍指数(DI)和肌肉压痛指数(PI)等情况,进行统计学分析。结果:单螺钉内固定组术后未出现关节区疼痛、张口受限和关节强直等严重并发症,DI和PI各指标均优于保守治疗组,两组的差异具有显著统计学意义。结论:单螺钉内固定手术方法是一种行之有效的髁突矢状骨折治疗手段,疗效确切。%Objective:To compare the effects of single screw-fixation treatment and conservative treatment in sagittal fracture of the madibular condyle(SFMC). Method:Patients with SFMC were single-screw fixation(SSF) group and the con-servative treatment (CON) group. Index,such as occlusion, maximum opening,and function of temporomandibular joint, were recorded and analyzed. Result:All patients in the SSF group had favorable results,including good occlusion,satisfying function and without serious complications or ankylosis,etc. Conclusion:Single screw-fixation surgery is an effective treat-ment used in sagittal fracture of the mandibular condyle.

  5. Clinical observation of posterior internal fixation with vertebral pedicle screw and rod system on thoracolumbar spine fracture%采用后路椎弓根钉棒系统治疗胸腰椎骨折疗效观察

    Institute of Scientific and Technical Information of China (English)

    王洽君

    2013-01-01

    目的 观察后路椎弓根钉棒系统治疗胸腰椎骨折的临床疗效.方法 回顾性分析32例采用后路椎弓根钉棒系统治疗胸腰椎骨折患者的临床资料,术后最长获得2年随访,分析椎体高度、椎体序列和Cobb角的改变.结果 32例患者获得6~ 48个月随访,平均15.8个月.术后椎体前、后缘高度分别为(96.85±14.33)%、(97.44±12.38)%,明显大于术前的(46.67±11.25)%、(76.76±12.62)%(均P<0.05);术后Cobb角为(7.45±2.12)°,显著小于术前的(20.56±7.51).(P<0.05).术后患者Frankel分级均有改善.结论 应用椎弓根钉棒系统治疗胸腰椎骨折能取得良好的临床疗效.%Objective To observe the clinical effect of posterior internal fixation with vertebral pedicle screw and rod system on thoracolumbar spine fracture.Methods The clinical data of 32 patients diagnosed as thoracolumbar spine fracture in our hospital who treated with posterior internal fixation with vertebral pedicle screw and rod system were retrospectively analyzed.The Frankel scale combined with X-ray and CT images were used for the judgment of efficacy.Results The vertebral Height and Cobb angles were improved significantly after the operations (P <0.05).And the Frankel degree of cases with nerve symptoms was also improved.Conclusion Posterior internal fixation with vertebral pedicle screw and rod system is effective in treating patients with thoracolumbar spine fracture.

  6. 重度骨质疏松条件下椎弓根螺钉内固定的可靠性研究%The Reliability of Pedicle Screw Fixation in the Spine Surgery with Severe Osteoporosis

    Institute of Scientific and Technical Information of China (English)

    李旭升; 高明暄; 赵锟; 邵宏斌; 李生贵; 陈彦飞; 常彦峰

    2015-01-01

    目的:评价重度骨质疏松条件下椎弓根螺钉的稳定性,为椎弓根内固定在合并有重度骨质疏松症的患者中的选用提供力学理论基础。方法采用新鲜尸体脊柱标本,检测骨密度后,根据诊断标准,选用正常骨质的2具尸体标本、重度骨质疏松的4具尸体标本,分离T12~L5节段成单个椎体以备后用;然后在骨质正常椎体置入椎弓根螺钉12枚作对照组;在重度骨质疏松水平,分单纯置入椎弓根螺钉( pedicle screw,PS)、经磷酸钙骨水泥( calcium phos-phate cement,CPC)强化钉道后置入椎弓根螺钉、经聚甲基丙烯酸甲酯( polymethylmethacrylate,PMMA)强化钉道后置入椎弓根螺钉三种方法置钉,依次为PS组、CPC/PS组和PMMA/PS组,进行螺钉轴向拔出实验,测最大拔出力、刚度和能量吸收值,对所测指标进行组间对比分析。结果重度疏松条件下,PS组、CPC/PS组和PMMA/PS各组最大拔出力、刚度、能量吸收值均显著低于对照组( P0.05)。结论重度骨质疏松条件下,椎弓根螺钉固定强度明显下降,不宜单纯应用普通椎弓根螺钉行脊柱内固定治疗,采用普通骨水泥强化钉道后置钉可以提高椎弓根螺钉稳定性。%Objective To evaluate the fixation of pedicle screw in the lumbar spine with severe osteoporosis,further to provide theoretical evidence for clinical application of pedicle screw in patient with severe osteoporosis. Methods Fresh hu-man cadaver spines were used. Two of them were normal and four were severe osteoporosis,according to the value of bone min-eral density. The vertebra was bilaterally instrumented pedicle screws,resulting in 24 screws in normal BMD group,as the con-trol group. The vertebrae at severe osteoporosis level was bilaterally instrumented with pedicle screws according to three proto-cols,including pedicle screw without augmentation,pedicle screw with calcium phosphate cement

  7. Clinical study of combined C2 laminar screw fixation technique for cervical vertebral injury%组合枢椎椎板螺钉固定技术治疗颈椎损伤的临床研究

    Institute of Scientific and Technical Information of China (English)

    胡勇; 马维虎; 徐荣明; 阮永平; 孙韶华

    2009-01-01

    目的 探讨组合枢椎椎板螺钉固定技术治疗颈椎损伤的可行性和应用价值.方法 对32具颈椎标本行枢椎椎板轴向CT加密扫描,测量枢椎椎板的长度、高度,枢椎椎板上、中、下部的厚度,椎板轴线与欠状面的夹角.8例颈椎损伤患者中,Anderson Ⅱ型齿状突骨折伴寰枢关节向后脱位2例、向前脱位1例、齿状突骨不愈合1例,Ⅲ型齿状突骨折伴寰枢关节不稳、横韧带撕裂2例,Ⅱ型Hangman骨折伴C不稳1例,寰枢关节前脱位伴横韧带断裂1例.牵引复位后,根据患者病情组合枢椎椎板螺钉进行组合式固定,并行后路自体髂骨植骨融合.结果 枢椎椎板的长度为(26.2±1.2)mm,高度为(12.8±1.6)mm,枢椎椎板上、中、下部的厚度分别为(300±1.4)mm、(6.0±1.6)mm、(5.6±1.2)mm、椎板轴线与矢状面的夹角平均为43.5°.8例患者枢椎椎板螺钉位于椎板中,无偏斜.全部患者随访6~14个月,平均10.5个月.术中和术后没有任何并发症发生,获得了良好的骨性愈合.本组无一例发生螺钉松动及断裂.结论 枢椎椎板螺钉固定技术避免了螺钉置入过程中损伤椎动脉的风险.此技术操作简单,不受C2横突孔中椎动脉的位置限制.全程在直视下进行,该方法可作为传统枢椎后路螺钉固定技术的补充.%Objective To explore the feasibility and application value of combined C2 laminar screw fixation technique in treatment of cervical vertebral injury. Methods Dense axial CT scanning was done on C2 laminar of 32 specimens of cervical vertebra to measure the length and height of the axis, the thickness of upper, middle and lower parts of the axis as well as the angle between the axial ray and the sagittal plane. There were eight patients with cervical vertebral injury including two with type Ⅱ odon-told process fractures combined with backward dislocation of atlanto-axial joint, one with forward disloca-tion of atlanto-axial joint, one with nonunion

  8. Bone cement and bone grafting in nail path to strengthen dynamic hip screw fixation for senile osteoporotic intertrochanteric fracture%骨水泥、钉道植骨强化动力髋螺钉固定修复老年骨质疏松性股骨转子间骨折

    Institute of Scientific and Technical Information of China (English)

    林周胜; 孙鸿涛; 夏雄智; 江成; 黎飞猛

    2015-01-01

    背景:对于老年骨质疏松性髋部骨折的动力髋螺钉固定,如能避免使用过程中造成的骨量丢失,或是采用其他手段增加固定螺钉把持力,将改善动力髋螺钉固定的治疗效果。目的:对比研究3种固定方式修复老年骨质疏松性股骨转子间骨折的效果。方法:回顾性分析近5年来采用常规动力髋螺钉内固定、骨水泥强化后动力髋螺钉固定及主钉道压配植骨配合动力髋螺钉固定3种固定方式治疗老年骨质疏松性股骨转子间骨折患者的资料,分别设为对照组、骨水泥组和植骨组。结果与结论:经固定后2年随访,植骨组、骨水泥组和对照组Harris髋关节功能评分优良率分别为95%,80%,70%。植骨组骨折临床愈合时间明显缩短(P <0.05),出现螺钉固定失败情况与骨水泥组相当。对照组较其他2组相对更多出现退钉等内固定失败情况。结果表明,与其他常规动力髋螺钉内固定、骨水泥强化后动力髋螺钉固定方式相比较,主钉道压配植骨配合动力髋螺钉内固定的疗效及安全性更好。%BACKGROUND:In dynamic hip screw fixation for treating aged osteoporotic intertrochanteric fracture, avoiding the loss of bone mass, or by other means that can increase the fixed screw pulout strength, wil improve the therapeutic effect of dynamic hip screw fixation. OBJECTIVE: To compare the effects of three kinds of repair methods on aged osteoporotic intertrochanteric fracture. METHODS:Data of aged osteoporosis intertrochanteric fracture patients, who received conventional dynamic hip screw fixation, bone cement augmentation with dynamic hip screw fixation and bone grafting with dynamic hip screw fixation, were retrospectively analyzed. They were divided into control group, bone cement group and bone grafting group. RESULTS AND CONCLUSION:After two years of folow-up, the excelent and good rates of Harris hip function were 95%, 80% and 70% in

  9. C2,3 pedicle screw fixation and fusion for unstable Hangman’ s fractures%C2,3椎弓根螺钉固定融合治疗不稳定型 Hangman骨折

    Institute of Scientific and Technical Information of China (English)

    卢一生; 黄波; 徐静芳; 施建东; 刘振刚; 符楚迪; 潘兵

    2014-01-01

    目的:探讨C2,3椎弓根螺钉固定融合术治疗不稳定型Hangman骨折的疗效。方法2006年4月~2013年3月,采用C2,3椎弓根螺钉固定融合术治疗不稳定型Hangman骨折患者8例。根据Levine分型标准Ⅱ型骨折6例,ⅡA型骨折2例。手术均采用OASYS内固定系统,并在C2,3椎板及关节突间植骨。为确保安全及准确,所有操作在C形臂X线机导航下完成。术后平均随访18个月,采用正侧位、动力位X线片及CT扫描评估固定融合节段的完整性和稳定性。结果8例患者颈椎骨折均获得满意复位,术中无一例发生脊髓及椎动脉损伤。术后1例切口愈合不良,经换药后愈合。末次随访时影像学检查显示患者均获得骨性愈合。随访期间所有患者无螺钉松动、断裂等并发症发生。结论 C2,3椎弓根螺钉固定融合术是治疗不稳定型Hangman骨折的有效方法,可以复位骨折并使之达到骨性愈合,并发症发生率低。%Objective To evaluate the clinical efficacy of posterior C2,3 pedicle screw fixation and fusion in the treatment of unstable Hangman’ s fracture.Methods From April 2006 to March 2013, 8 patients with unstable Hangman’ s fracture were treated with posterior C2,3 pedicle screw fixation and fusion.According to Levine classification, 6 cases were graded as Type-Ⅱand 2 cases Type-ⅡA.The OASYS internal fixation system were implanted between C2,3 segments through posterior midian longitudinal incision after pamplegia.Bone grafting was done between C2,3 lamina and facet.C-arm fluoroscopy was used for the whole procedure to ensure the safety and accuracy.All patients were followed up for 9-36 months ( averaged 18 months) postoperatively.Static and dynamic radiographs combining with CT scans were used to assess graft-complex integrity and stability.Results Eight patients with unstable Hangman’ s fracture achieve satisfactory reduction postoperatively.There was no spinal

  10. The clinical effects of osteoporosis of lumbar degenerative disease by injectable calcium sulfate bone cement to strengthen pedicle screw internal fixation%骨质疏松腰椎退行性疾病的手术治疗分析

    Institute of Scientific and Technical Information of China (English)

    孔祥瑞; 刘德政; 刘海峰; 杨计策; 赵志超

    2015-01-01

    ObjectiveTo explore the clinical effects of osteoporosis of lumbar degenerative disease by injectable calcium sulfate bone cement to strengthen pedicle screw internal fixation. Methods 82 cases of patients with lumbar degenerative dis-ease of osteoporosis word randomly divided into experiment group(41 cases) and control group(41 cases). The control group were treated by transpedicle screws fixation, the experiment group were treated by injectable calcium sulfate bone cement to strengthen pedicle screw internal fixation. The time of operation, mean bleeding volum, the scores of VAS, ODI, JOA were com-pared for the two groups. ResultsThe time of operation, mean bleeding volum for the experiment group were better than the control group; There was no significant difference on the scores of VAS, ODI, JOA; The scores of VAS, ODI for the experiment group were lower than the control group postoperation for 1 week, 2 months, 12 months; The scores of JOA for the experiment group were higher than the control group postoperation for 1 week, 2 months, 12 months. ConclusionIt can improve the scores of VAS, ODI, JOA for the patients with osteoporosis of lumbar degenerative disease by injectable calcium sulfate bone cement to strengthen pedicle screw internal fixation. It is worthy of clinical promotion.%目的:探讨可注射硫酸钙骨水泥强化椎弓根钉内固定治疗骨质疏松腰椎退行性疾病的临床疗效。方法:按照随机数字表法将我院收治的82例骨质疏松腰椎退行性疾病患者均分为实验组和对照组,对照组给予单纯椎弓根内固定治疗,实验组给予可注射硫酸钙骨水泥强化椎弓根钉内固定治疗。比较两组患者手术时间、术中出血量以及治疗前后疼痛视觉模拟评分(VAS)、Oswestry 功能障碍指数(ODI)、JOA 腰椎病疗效评分变化情况。结果:实验组患者手术时间和术中出血量显著高于对照组;两组患者术前 VAS 评分、ODI 评分、JOA

  11. 闭合复位空心钉内固定治疗Ideberg Ⅲ型肩胛盂骨折的近期疗效%Closed reduction and cannulated screws fixation of Ideberg Ⅲ type glenoid fractures

    Institute of Scientific and Technical Information of China (English)

    杨国跃; 贾健; 张银光; 张海彬; 江汉

    2013-01-01

    Objective To explore the recent clinical efficacy of closed reduction and cannulated screws internal fixation for the treatment of Ideberg Ⅲ type glenoid fractures.Methods From October 2005 to January 2012,9 cases of Ideberg Ⅲ type gleuoid fractures with closed reduction and cannulated screws internal fixation were studied retrospectively,including 6 males and 3 females,4 cases on the left and 5 on the right,with the average age of 42.2 years (range,28-56).There were three cases combined with clavicle fractures,take S-shaped incision reset for clavicle reconstruction and plate fixation.Three cases combined with acromioclavicular joint dislocation were used the hook plate fixation,and 3 cases with combined acromion fracture were used tension band wire fixation.Suspension structures in the reconstruction of the shoulder glenoid fracture underwent closed reduction and cannulated screw internal fixation.After giving adjustable shoulder abduction brace,rehabilitation exercises were performed under the guidance of doctors.After 1,6 weeks,and 3,6,12 months,X-ray examinations at anteroposterior shoulder view were conducted.By X-ray and clinical examination to determine the fracture healing time,to assess shoulder function with the American Shoulder and Elbow Society (ASES) scoring system,and recorded complications and corresponding outcome.Results Nine cases were obtained from 12 to 46 months,the average (30.8±9.1) months follow-up all fractures healed,with an average healing time of X-rays 12 to 24 weeks,mean (16.8±4.8) weeks.After 12 months surgery,row ASES scores was 82.3 (range,57-95),compared with the preoperative difference was statistically significant.ASES scores were excellent in 5 cases,good in 2,fair in 1 and poor in 1.One patient with traumatic arthritis obtained satisfactory clinical results through oral nonsteroidal drugs and intra-articular injection of sodium hyaluronate.No screw loosening,fracture fixation failure complications were observed

  12. A Biomechanical Comparison of Expansive Pedicle Screws for Severe Osteoporosis: The Effects of Screw Design and Cement Augmentation.

    Directory of Open Access Journals (Sweden)

    Ching-Lung Tai

    Full Text Available Expansive pedicle screws significantly improve fixation strength in osteoporotic spines. However, the previous literature does not adequately address the effects of the number of lengthwise slits and the extent of screw expansion on the strength of the bone/screw interface when expansive screws are used with or without cement augmentation. Herein, four designs for expansive pedicle screws with different numbers of lengthwise slits and different screw expansion levels were evaluated. Synthetic bones simulating severe osteoporosis were used to provide a comparative platform for each screw design. The prepared specimens were then tested for axial pullout failure. Regardless of screw design, screws with cement augmentation demonstrated significantly higher pullout strength than pedicle screws without cement augmentation (p 0.05. Taken together, our results show that pedicle screws combined with cement augmentation may greatly increase screw fixation regardless of screws with or without expansion. An increase in both the number of slits and the extent of screw expansion had little impact on the screw-anchoring strength. Cement augmentation is the most influential factor for improving screw pullout strength.

  13. Clinical Efficacy on the Treatment of Medial Malleolus Fracture by Percutaneous Hollow Screw Fixation and Tension-band Internal Fixation%经皮中空螺钉内固定与张力带内固定内踝骨折的临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    许国胜; 欧阳永宁; 苏财有; 陈小玲

    2016-01-01

    研究探讨经皮置入中空螺钉内固定治疗闭合性内踝骨折( Ashurst和Bromer分类的内翻内收型骨折Ⅰ度)的临床实用性,收集60例闭合性内踝骨折的患者,随机分为两组各30例。 A组予传统切开复位张力带内固定术治疗,B组予闭合复位经皮置入中空螺钉内固定治疗。术后采用Takakura踝关节评分系统来评价疗效,并对结果进行分析。%To study and discuss the clinical practicability of the treatment of closed medial malleolus fracture ( Varus adduction fractures I degree classified by Ashurst and Bromer ) by percutaneous hollow screw. To collect 60 cases of closed medial malleolus fracture patients and randomly divide into two groups , each group with 30 cases. A group was treated with traditional open reduction and tension-band internal fixation, and B group was treated with closed reduction and percutaneous hollow screw fixation. Use Takakura ankle scoring system to evaluate the efficacy and analyze the results after the treatment.

  14. Application of Posture Nursing Intervention in Posterior Pedicle Screw Internal Fixation%体位护理干预在脊柱后路椎弓根钉内固定术中的应用

    Institute of Scientific and Technical Information of China (English)

    马永玲

    2016-01-01

    Objective Application of posture nursing intervention in posterior pedicle screw internal fixation. Methods From October 2014 to October 2014, 100 cases of patients with posterior pedicle screw ifxation,divided into two groups:observation group (50 cases with patients treated with posture nursing intervention) and control group (50 cases of patients treated with conventional nursing intervention), compare the application effect of the two groups. Results After the intervention, the observation group nursing satisfaction is 98.0% better than the control group 86.0%(P<0.05). Conclusion The posture nursing intervention in the application of spinal posterior pedicle screw ifxation effect is good, which can improve patients' quality of life.%目的:体位护理干预在脊柱后路椎弓根钉内固定术中的应用。方法选取我院2014年10月~2015年10月收治的后路椎弓根钉内固定术患者100例,分成两组:观察组(n=50,施以体位护理干预),对照组(n=50,施以常规护理干预),对两组应用效果进行对照。结果干预后,观察组护理满意度为98.0%优于对照组86.0%(P<0.05)。结论体位护理干预在脊柱后路椎弓根钉内固定术中的应用效果良好,能提升患者生活质量。

  15. Geometric accuracy of 3D coordinates of the Leksell stereotactic skull frame in 1.5 Tesla- and 3.0 Tesla-magnetic resonance imaging. A comparison of three different fixation screw materials

    International Nuclear Information System (INIS)

    We assessed the geometric distortion of 1.5-Tesla (T) and 3.0-T magnetic resonance (MR) images with the Leksell skull frame system using three types of cranial quick fixation screws (QFSs) of different materials—aluminum, aluminum with tungsten tip, and titanium—for skull frame fixation. Two kinds of acrylic phantoms were placed on a Leksell skull frame using the three types of screws, and were scanned with computed tomography (CT), 1.5-T MR imaging and 3.0-T MR imaging. The 3D coordinates for both strengths of MR imaging were compared with those for CT. The deviations of the measured coordinates at selected points (x = 50, 100 and 150; y = 50, 100 and 150) were indicated on different axial planes (z = 50, 75, 100, 125 and 150). The errors of coordinates with QFSs of aluminum, tungsten-tipped aluminum, and titanium were <1.0, 1.0 and 2.0 mm in the entire treatable area, respectively, with 1.5 T. In the 3.0-T field, the errors with aluminum QFSs were <1.0 mm only around the center, while the errors with tungsten-tipped aluminum and titanium were >2.0 mm in most positions. The geometric accuracy of the Leksell skull frame system with 1.5-T MR imaging was high and valid for clinical use. However, the geometric errors with 3.0-T MR imaging were larger than those of 1.5-T MR imaging and were acceptable only with aluminum QFSs, and then only around the central region. (author)

  16. Screw and plate fixation for fractures of tibial shaft: three-dimensional finite element analysis%胫骨中段骨折钢板螺钉固定的有限元分析

    Institute of Scientific and Technical Information of China (English)

    胡新佳; 林博文; 王华; 张美超; 杨述华; 肖德明

    2011-01-01

    Objectives To determine biomechanical performances of limited contact-dynamic compression plate (LC-DCP) fixation with screws in different number and position for treatment of fractures of tibial shaft. Methods CT scan was performed for a fresh sample of adult tibia to construct a 3D finite element model of normal tibia using Mimics 10. 01 and Ansys 10. 0. Finite element models of oblique fractures of middle tibia were made on the basis of the normal model to be all fixed with LC-DCP of 14 holes but with screws in 5 different patterns. Model A was fixed with screws in the 1st, 2nd, 3rd, 12th, 13th and 14th holes; model B with screws in the 1st, 4th, 7th, 8th, 11th and 14th holes; model C with screws in the 1st,3rd, 6th, 9th, 12th and 14th holes; model D with screws in the 1st, 2nd, 7th, 8th, 13th and 14th holes;and model E with screws in all 14 holes. Finite element software Ansys 10. 0 was used to establish 3-D finite element models of 5 fixation models for tibial shaft fracture. Five kinds of digital loadings were simulated in computer, with 1000 N compressive load and 5 N · m torque moment for all models. Results In model A, the highest stresses were on the 3rd and 12th holes. In model B, the highest compressive stress was on the 1st hole, next by the 4th hole; the highest torsion stresses were on the 7th and 8th holes. In model C, the highest compressive stress was on the 1st hole, next by the 3rd hole; the highest torsion stresses were on the 6th and 9th holes. In models D and E, the highest compressive stress was on the 1st hole, next by the 2nd hole; the highest torsion stresses were on the 7th and 8th holes. Conclusions In treatment of tibia shaft fractures with minimally invasive percutaneous plate osteosynthesis, fixation with a 14-hole LC-DCP and 6 screws is appropriate. The appropriate fixation holes are the 1st, 2nd, 7th, 8th, 13 th and 14th holes.%目的 通过有限元分析探讨有限接触型动力加压钢板(LC-DCP)不同螺钉固定数目及

  17. 经皮空心钉固定治疗创伤性耻骨联合分离%Percutaneous cannulate screw fixation in treating the traumatic diastasis of the pubic symphysis

    Institute of Scientific and Technical Information of China (English)

    石成弟; 郭晓山; 胡炜; 余可和

    2011-01-01

    目的 探讨经皮空心钉固定治疗创伤性耻骨联合分离的手术方法及临床疗效.方法 2003年2月至2010年12月,治疗46例伴耻骨联合分离的不稳定骨盆骨折,男27例,女19例;年龄18~61岁,平均34.6岁.按Tile分型:B1.1型4例,B1.2型7例,B2型2例,B3型2例,C1.1型7例,C1.2型7例,C1.3型10例,C2型5例,C3型2例.行闭合复位经皮耻骨联合螺钉内固定后,再行后环固定,包括经皮骶髂螺钉、经皮髂骨后部螺钉固定.除4例B1.1型骨折仅固定耻骨联合外,余均同时行后环固定.结果 手术时间15~65 min,平均45 min;出血量10~50 ml,平均25 ml.46例患者均置入1枚耻骨联合螺钉,35例术后行骨盆CT检查,其中3例发现螺钉侵入盆腔,但未引起任何临床症状.术后无一例发生切口及钉道感染.46例患者均获得随访,随访时间5~48个月,平均23.5个月;随访期间未发现明显的复位丢失.根据Matta和Tornetta标准,末次随访时优43例,良3例.31例(67.39%)患者恢复原工作,6例因合并损伤而改变原工作,9例尚处于恢复期.28例患者无骶髂关节疼痛;13例仅在用力时有耻骨联合部或耻骨微痛,但不影响日常生活;5例有不同程度的骶髂关节疼痛.结论 闭合复位经皮空心钉固定治疗创伤性耻骨联合分离安全可行,操作简便,损伤小,疗效满意.%Objective To study the technique and therapeutic effect of percutaneous cannulate screw fixation to treat the traumatic diastasis of the pubic symphysis.Methods From February 2003 to December 2010,46 patients (27 men and 19 women,mean age of 34.6 years) with unstable pelvic fractures and diastasis of the pubic symphysis were admitted.All the patients were treated by closed reduction and percutaneous cannulate screw fixation of the symphysis pubis.Then to complete the fixation of posterior ring,by percutaneous screw inserted through the sacroiliac joint or posterior iliac wing.According to Tile's classification,the patients

  18. Advances in Treatment of Thoracolumbar Fractures by Using Pedicle Screw Fixation at the Level of the Fractured Vertebra%胸腰椎爆裂骨折后路伤椎椎弓根钉固定的治疗进展

    Institute of Scientific and Technical Information of China (English)

    林冬铭; 宋舟锋

    2012-01-01

    [目的]介绍胸腰椎椎弓根的解剖学特点、伤椎椎弓根钉固定的生物力学和临床应用研究进展.[方法]查阅近年来国内外有关文献,进行综合分析.[结果]伤椎椎弓根钉固定治疗胸腰椎爆裂性骨折,有助于改善骨折椎复位难、固定强度不够、复位椎体高度丢失、内置物松动断裂等缺点,但尚需进一步的理论及临床研究.[结论]伤椎椎弓根钉固定为胸腰椎爆裂性骨折的治疗提供了一种有效的内固定方法.%[Objective] To introduce the anatomic character of thoracolumbar, the progress of biomechanical & clinical study of using pedicle screw fixation at the level of the fractured vertebra. [Methods] Related literatuis concerning the treatment of thoracolumbar fractures by using pedicle screw fixation at me level of the fractured vertebra in recent years were extensively reviewed. [Results]The method of using pedicle screw fixation at the level of the fractured vertebra can well achieve outcome in reduction and stability of the posterior transpedicular fixation to treat thoracolumbar vertebra fracture patients. [Conclusion] The pedicle screw fixation at the level of the fractured vertebra is an effective internal fixation for treatment of thoracolumbar fractures.

  19. 水平方向骶髂关节螺钉固定治疗骶骨纵形骨折的安全性评价%The safety of transverse iliosacral screw fixation of longitudinal sacral fracture

    Institute of Scientific and Technical Information of China (English)

    孙旭; 李宇能; 杨明辉; 吴新宝; 赵春鹏; 王满宜

    2011-01-01

    ObjectiveTo evaluate the safety of transverse iliosacral screw fixation of longitudinal sacral fracture.MethodsWe obtained CT scan data of the pelvis from 100 adults without any bony problems from September to December 2009. They were 52 males and 48 females, aged from 15 to 91 years (average, 43. 1 years) . We then reconstructed virtual three-dimensional models of the pelvis. The three-dimensional models were re-segmented through the sacral horizontal axis to obtain standard sagittal planes of the sacrum. To identify the safe zone for transverse screw fixation, we marked off the sacral margin on each sagittal plane. In simulation of the transverse screw ipsilateral fixation and transfixation, one single virtual cylindrical implant was inserted into the safe zone. The maximum diameter of the virtual cylindrical implant was measured.ResultsA 20. 0% rate of sacral variation was observed (80 normal versus 20 deformed morphological sacrums). In ipsilateral fixation, the average screw diameter of variant S2 (14. 92 ± 2.57 mm) >normal S2 ( 12. 37 ± 1.84 mm) ( P =0. 000) > normal S1 ( 11.87 ± 3.92 mm) ( P =0. 319 ) > variant S3 (9. 30 ± 2. 00 mm) ( P =0. 000). In transfixation, the average screw diameter of variant S2 ( 13.63 ± 2. 68 mm) > normalS2 (11.48 ±1.92mm) (P=0. 002) > normal S1(10. 40 ±4.05 mm) (P=0.033) >variant S3 (7.95 ± 2. 26 mm) ( P =0. 001 ) . The maximum screw diameter of normal S2 showed a slightly negative correlation with that of normal S1, but there was no correlation between the maximum screw diameter for each sacral vertebra and the acetabulum diameter. The normal male S2 was significantly larger than the female one ( P < 0.05), but there was no significant difference in S1 between genders ( P > 0.05) .ConclusionsIn most Chinese people, the posterior pelvic ring could be fixed with 2 iliosacral screws of 6. 5 mm in diameter simultaneously in horizontal direction, but care should be taken because the safety zone is quite

  20. Absorbable screw and metal screw fixation for ankle fractures:comparison of biocompatibility and ankle function%可吸收螺钉与金属螺钉内固定修复踝关节骨折:生物相容性及踝关节功能比较

    Institute of Scientific and Technical Information of China (English)

    赵学寨; 李海军; 孟彩云; 李岩; 张仕峰; 刘明辉

    2016-01-01

    BACKGROUND:Previous ankle fracture surgery mainly uses the internal fixation materials such as metal screws or Kirschner wire, which can achieve a strong internal fixation, but al need to be taken out in the secondary surgery. In recent years, elastic modulus of biodegradable absorbable screw is identical to that of cancel ous bone, and has been widely used in clinic. OBJECTIVE:To compare the biocompatibility and functional recovery of ankle joint in the repair of ankle fractures with absorbable screws and metal screws. METHODS:100 patients with ankle fractures were selected, including 70 males and 30 females, at the age of 19 to 55 years old. Fifty patients were repaired with absorbable screws and fifty patients were repaired with metal screws. Clinical efficacy, Kofoed score, fracture healing time and adverse events were observed between the two groups after repair. RESULTS AND CONCLUSION:Patients were fol owed up for over 6 months in both groups, showing good bony cal us, good contraposition and alignment at the fracture end. No delayed union or nonunion occurred. The excel ent and good rate of clinical effect was 96%and 94%in the absorbable screw group and metal screw group, respectively, showing no significant difference. There was no significant difference in ankle Kofoed score, fracture healing time and incidence of adverse events between the two groups (P>0.05). These results suggest that absorbable screw fixation for ankle fractures had good biocompatibility and could effectively restore ankle function;its effects are similar to that of traditional metal screws.%背景:传统踝关节骨折内固定修复中使用的材料多为金属螺钉或克氏针等,虽然可达到坚强内固定的目的,但均需二次手术取出。近年来,由于生物降解可吸收螺钉的弹性模量与松质骨相当,已作为金属螺钉替代物被广泛应用于临床。目的:比较可吸收螺钉与金属螺钉置入内固定修复踝关节骨折的生物

  1. 经皮椎弓根内固定治疗胸腰椎骨折的效果及并发症分析%Therapeutic effects and complications of percutaneous pedicle screw fixation for thoracolumbar fractures

    Institute of Scientific and Technical Information of China (English)

    罗鹏; 徐良丰; 倪文飞; 王向阳; 林焱; 毛方敏; 黄其杉; 徐华梓; 池永龙

    2011-01-01

    Objective To investigate the therapeutic effects and complications of percutaneous pedicle screw fixation for thoracolumbar fractures. Methods From January 2002 to December 2008,103 patients with thoracolumbar fractures were treated with percutaneous pedicle screw fixation, including 75 males and 28 females, the average age was 45.6 years ( range, 18-72 years). All of them were of no neurological deficits. There were 65 cases of traffic injury, 23 cases of fall injury and 15 cases of smashed injury. According to the Denis classification, 64 patients were of compression fractures, and 39 patients of burst fractures. There were 5 cases had fractures in T11, 30 in T12, 42 in L1, 15 in L2, 4 in L3, 3 in L4 ,2 in T11-12, 1 in L1-2, and 1 in L2-3. Radiological examinations, including X-ray and CT examinations, and clinical examinations were carried out to evaluate the therapeutic effects. Results Twenty one patients were lost to follow up, the remaining were followed up from 10 to 48 months with an average of 27.4 months.Before the operation, the vertebral height, the kyphposis angle and the occupation of spinal canal were (54. 5 ±8. 7)%, 16. 4°±2. 9°and 1.2 ± 1. 0, and were improved to (88.6 ±6. 4)%, 11.6°± 2. 7°and 0. 5 ± 0. 6 respectively after the operation. Preoperatively the visual analogue scale and the Oswestry disability index were 8. 0 ± 1.2 and 41.2 ± 9. 3, and were improved to 1.7 ± 1.8 and 6. 7 ± 5.6 postoperatively,respectively. All of these values between pre- and post-operatively were significantly different (P <0. 01 ). Screw misplacement was found in 7 patients, superficial wound infection in 1, screw breakage in 3, screw dislodgment in 2, cement leakage in 5, transient neurological symptoms in 4, and 8 patients with low back pain remained,of which 2 patients required occasional oral analgesics. Bone fusion achieved in all cases. Conclusions The clinical efficacy of percutaneous pedicle screw fixation is similar with conventional open

  2. Comparison of headless screws used in the treatment of proximal nonunion of scaphoid bone

    OpenAIRE

    Gereli, Arel; Nalbantoglu, Ufuk; Sener, Ismail Ugur; Kocaoglu, Barıs; Turkmen, Metin

    2010-01-01

    Screws with different levels of compression force are available for scaphoid fixation and it is known that the Acutrak screw generates greater compression than the Herbert screw. We retrospectively compared two types of headless compression screw for their effectiveness in the repair of scaphoid nonunion. Twenty-nine cases of proximal scaphoid nonunion were surgically treated with non-vascularised bone graft: the Acutrak screw was used in 17 patients and the cannulated Herbert screw in 12 pat...

  3. The clinical efficacy of degenerative scoliosis treatment via posterior pedicle screw fixation%后路椎弓根钉棒固定治疗退变性脊柱侧弯的临床疗效

    Institute of Scientific and Technical Information of China (English)

    关永林; 赵学权; 王振东; 马斌祥; 孙乐伟

    2016-01-01

    Objective To explore the clinical effects of posterior pedicle screw fixation technique in the treatment of degenerative scoliosis .Methods The corrective surgery effects of 20 patients with degenerative scoliosis were ob-served.For 1 patient whose Cobb angle 20°,the surgery of spinal decom-pression, spinal fusion, long pedicle screw system fixation and bone grafting were carried out .Results All patients were followed up for 6 months, and there were not patients with postoperative infection , broken screws or broken rods and so on.All the patients′angle of thoracic lumbar segment′s kyphosis and lumbar lordosis and Cobb angle meas-ured after surgery had shown significant improvement compared with the preoperative (P<0.05),the lumbar lordosis and Cobb angle measured at 6 months after surgery had shown significant improvement compared with the postopera -tive(P<0.05); JOA score and ODI had both been significantly improved compared with the preoperative (P<0.05),the JOA score and ODI measured at 6 months after surgery had both been significantly improved compared with the postoperative(P<0.05).Conclusions On the basis of spinal decompression , which is the premise of re-ducing the pain, carrying out the surgery of posterior pedicle screw system fixation can reconstruct spine′s stability, and improve patients′life quality.%目的:探讨后路椎弓根螺钉固定技术治疗退变性脊柱侧弯的临床效果。方法对20例退变性脊柱侧弯患者进行手术矫正,对Cobb角<20°的1例患者行椎管减压、椎体融合、短节段椎弓根钉棒系统固定术;对Cobb角>20°的19例患者行椎管减压、椎体融合、长节段椎弓根钉棒系统固定并植骨融合术。结果患者均获得6个月的随访。未出现术后感染及断钉、断棒等情况。 Cobb角、腰椎前凸角和胸腰段后凸角:术后均较术前明显改善( P<0.05),术后6个月均较术后进一步改善( P<0.05)。 JOA评分及ODI评

  4. 椎弓根内固定椎体后凸成形术治疗骨质疏松性胸腰椎骨折%Pedicle Screw Fixation Kyphoplasty in Treatment of Osteoporotic Thoracolumbar Fracture

    Institute of Scientific and Technical Information of China (English)

    柯勇

    2013-01-01

    目的探讨椎弓根内固定结合椎体后凸成形术治疗骨质疏松性胸腰椎骨折的方法及临床治疗的效果。方法自2011年2月~2012年2月本院采用后路切开椎弓根内固定结合椎体后凸成形术治疗13例骨质疏松性胸腰椎压缩性骨折患者。术后随访24个月,术后复查胸腰椎正侧位片。分别于术前、术后4d、末次随访用Oswestry功能障碍指数评分(oswestry disability index,ODI),X线片上测量椎体矢状面指数(sagittal index,SI)及Cobb角(SI=椎体前缘高度/椎体后缘高度),观察内固定及伤椎稳定及功能恢复情况。结果所有患者都未发生骨水泥渗漏,无神经症状的缺失。13例患者中,12例获平均20个月随访,末次随访时患者的功能恢复良好,未发现椎弓根钉松动、断裂。结论椎弓根内固定结合椎体后凸成形术为骨质疏松性胸腰椎压缩性骨折的手术治疗提供了一种安全、可靠的方法,改善了机体的功能,提高了患者的生活质量。%Objective To investigate the pedicle screw fixation combined with kyphoplasty treatment of osteoporotic thoracolumbar fractures and clinical treatment ef ect. Methods The hospital incision posterior pedicle screw fixation combined with kyphoplasty treatment of 13 cases of osteoporotic thoracolumbar vertebral compression fracture patients from February 2011 to February 2012 The patients were fol owed up for 24 months, after review of the thoracic and lumbar lateral radiographs. Preoperative and postoperative 4D, the last fol ow-up, the Oswestry Disability Index score (oswestry disability index, ODI), X-ray measurement the vertebral sagit al index (sagit al index, SI) and the Cobb angle (SI =vertebral edge height /posterior margin height), fixed and the injured vertebra stable and function recovery observed. Results Al patients had happened leakage of bone cement, the lack of neurological symptoms. 13 patients, 12 patients were an average of 20 months fol ow

  5. 腰椎椎弓根螺钉内固定术三维可视化设计%Design of three-dimensional visualization based on the posterior lumbar pedicle screw fixation

    Institute of Scientific and Technical Information of China (English)

    徐凯; 陈春; 黄山东; 章莹; 尹庆水

    2011-01-01

    目的 建立腰椎椎弓根内固定术后的三维可视化数字模型.方法 选择1名腰椎间盘突出和1名腰椎压缩性骨折患者,在腰椎内固定术前及术后行多排螺旋CT扫描,观测术前椎体压缩程度、手术前后腰椎结构形态,术后钉棒的位置及椎板减压情况,利用Amira 4.1软件,经剪切、分割、表面重建及绘制等步骤,对腰椎结构及内植物进行三维重建,获得立体形态的腰椎手术前后改变及内置物位置结构.结果 借助数字化导航平台,重建了手术前后的腰椎和内置物形态结构.重建的三维结构可以多彩色、透明或任意组合显示.经不同角度观察,重建的三维结构显示清晰、实体感强.在三维表面重建的图像中可清楚地观察到内固定物的位置形态,特别是可以充分评估脊髓或神经根的减压程度及椎体骨折和压缩程度.术前重建图像可以清晰显示椎弓根的位置,为术中精确定位提供参考.结论腰椎椎弓根内固定术的三维重建对基础研究、临床试验及手术规划具有重要价值,应用Amira软件可为三维建模提供基础.%Objective To establish a three-dimensional visualization model of posterior lumbar pedicle screw fixation. Methods A patient with lumbar intervertebral disc hernia and another patient with compression fracture of lumbar vertebra were involved in the present study. Both patients underwent multi-slice spiral CT scan before and after lumbar pedicle screw fixation. The degree of preoperative vertebral compression, vertebral morphology before and after surgery, postoperative pedicle screw position, and decompression effects were observed. The original data of the multi-slice spiral CT were inputted into the computer. The three-dimensional reconstructed images of the lumbar and implanted screws were obtained using the software Amira 4.1 to show the three-dimensional shape of the lumbar vertebrae before and after surgery and the location of the

  6. 人工骨或自体骨移植联合椎弓根钉内固定修复脊柱结核%Artificial bone or autologous bone grafting combined with pedicle screw fixation for repair of spinal tuberculosis

    Institute of Scientific and Technical Information of China (English)

    姜棚菲; 翟文斌

    2015-01-01

    BACKGROUND:With the development of fixation materials and technology, scholars began to use artificial bone materials combined with pedicle screw fixation in the repair of spinal tuberculosis. OBJECTIVE: To summarize the characteristics of artificial bone materials combined with pedicle screw fixation in the repair of spinal tuberculosis. METHODS:The literatures about artificial bone graft materials in repair of spinal tuberculosis were retrieved from CNKI and PubMed database during 1985 to 2014 by computer. The keywords were “spinal tuberculosis, bone transplantation, internal fixation” in Chinese and English, respectively. RESULTS AND CONCLUSION:In the repair of spinal tuberculosis using artificial bone materials combined with pedicle screw fixation, autologous bone is the gold standard for bone grafting, presenting with no immune rejection. To avoid the occurrence of limited bone mass, pain and other complications, however, artificial bone materials have been extensively studied. Currently used artificial materials mainly include titanium and its aloys, hydroxyapatite composites and medical calcium sulfate, which al have good biocompatibility. But there are stil certain limitations and shortcomings.%背景:随着内固定材料和内固定技术的发展,越来越多的国内外学者开始应用人工骨材料联合椎弓根钉内固定修复脊柱结核。目的:综述人工骨修复材料联合椎弓根内固定修复脊柱结核的特点。方法:应用计算机检索CNKI和PubMed数据库1985至2014年有关人工骨移植材料修复脊椎结核方面的文献,中文关键词为“脊椎结核、骨移植、内固定”,英文关键词为“Spinal tuberculosis,Bone graft,Fixation”。结果与结论:在骨修复材料联合椎弓根内固定修复脊柱结核中,自体骨是骨移植的金标准,无免疫排斥反应,但为了避免自体骨取骨量有限、取骨后疼痛等并发症的发生,人工骨材料得到了广泛

  7. 锚钉内固定治疗后交叉韧带胫骨止点撕脱性骨折%Open reduction and internal fixation with anchor screw for tibial avulsion fracture of the posterior cruciate ligament

    Institute of Scientific and Technical Information of China (English)

    李建赤; 黄必留; 梁江声; 谭加群; 徐自强; 吴春辉

    2013-01-01

    Objective To investigate the clinical efficacy of the treatment for tibial avulsion fracture of the posterior cruciate ligament ( PCL) with open reduction and anchor screw internal fixation. Methods 32 patients of tibial avulsion fracture of the posterior cruciate ligament were treated with open reduction and anchor screw internal fixation through inverted L-shaped posterior-medial approach. All the patients were given postoperative plaster immobilization of knee at 30° flexion for about four weeks. The patients were allowed to appropriate functional exercise of knee flexion and extension after removal of the plaster. Results 30 patients were followed up for seven to 30 months with an average of (13 ±5.2) months. The bony union was achieved in all the patients after operation in two to four months, (3 ±0. 6) months in average. According to Lysholm knee score system, six months after surgery, 26 cases were excellent, three cases were good and one case was fair . The excellent rate was 96. 7%. Conclusions Inverted L-shaped posterior-medial approach and anchor screw internal fixation is a safe, effective method for tibial avulsion fracture of PCL. Reliable internal fixation may be effective in the early reconstruction of the knee stability and restoring knee function.%目的 探讨锚钉内固定治疗后交叉韧带(PCL)胫骨止点撕脱性骨折的临床疗效.方法 对32例膝关节PCL胫骨止点撕脱骨折患者,采用膝关节后内侧倒"L"形入路切开复位,以锚钉内固定治疗,术后给予石膏托固定膝关节屈曲30°约4周,拆除石膏外固定后适当行膝关节伸屈功能锻炼.结果 30例获得随访,时间7~30个月,平均(13 ± 5.2)个月.术后2~4个月均获骨性愈合,平均为(3 ± 0.6)个月.手术6个月后依据Lysholm 等膝关节评分系统评估膝关节功能,评定优26 例,良3例,可1例,优良率96.7%.结论 膝后内侧"L"形入路应用锚钉内固定治疗PCL胫骨止点撕脱骨折是安全有效、内固

  8. Clinical effect of internal fixation of screw intramedullary nail in the treatment of midshaft tibia fracture: report of 13 cases.%旋入式髓内针内固定治疗胫骨中段骨折13例

    Institute of Scientific and Technical Information of China (English)

    郭岁利

    2012-01-01

    目的 观察开放复位旋入式髓内针内固定治疗胫骨中段骨折的疗效.方法 选择2009年5月至2011年5月胫骨中段骨折患者13例,采用开放复位旋入式髓内针内固定对其进行治疗,并随访6~9个月,观察临床疗效.结果 13例均达骨性愈合,膝踝关节活动范围正常;优11例,良2例,优良率100%.无髓内针断裂、松动、变形等并发症.结论 采用开放复位旋入式髓内针内固定治疗胫骨中段骨折是一种简便易行的手术方法.%Objective To observe the clinical effect of open reduction and internal fixation of screw intramedullary nail in the treatment of midshaft tibia fracture. Methods Thirteen cases of midshaft tibia fracture were treated with open reduction and internal fixation of intramedullary nail surgery. The patients were followed up for 6 to 9 months after surgery. Results All of the 13 cases reached osseous healing. The range of knee joint motion and the range of ankle joint motion were all normal. The rate of excellent and good was 100% ( excellent in 11 cases and good in 2 cases ). Conclusion Open reduction and internal fixation of intramedullary nail is a simple and feasible operation for the treatment of midshaft tibia fracture.

  9. 石膏固定和空心螺钉内固定修复腕部舟状骨新鲜骨折:功能恢复比较%Plaster fixationversus cannulated screw internal fixation for the wrist scaphoid bone fresh fracture:comparison of functional recovery

    Institute of Scientific and Technical Information of China (English)

    卡依沙尔•买买提明; 赵岩

    2015-01-01

      结果与结论:随访3-6个月对比分析石膏组和空心螺钉组患者腕关节功能Cooney评分,空心螺钉组优9例,良1例,可1例,差0例;石膏组优1例,良5例,可3例,差2例,空心螺钉组患者治疗后优良率为91%,石膏组患者治疗后优良率为55%,空心螺钉组显著高于石膏组(t=4.817,P OBJECTIVE:To compare and analyze functional recovery of the wrist scaphoid bone fresh fracture after plaster fixation and internal fixation. METHODS: Twenty-two patients with wrist scaphoid bone fresh fracture were recruited from the First Affiliated Hospital of Xinjiang Medical University from March 2012 to March 2014, and the injury time was 2 hours to 12 days. Preoperative X-ray films revealed that, the involved patients had no wrist scaphoid bone colapses, lunate bone dislocation, ischemic necrosis of bone and osseous changes. Al the cases showed shift, unstable fractures. According to the patient’s wiling and the surgical method, the involved patients were divided into two groups, receiving plaster fixation and cannulated screw internal fixation respectively. Each group contained 11 cases. Wrist joint function was evaluated using Cooney score system. There was no significant difference in the age distribution and gender between the two groups (P > 0.05). RESULTS AND CONCLUSION: At 3-6 months of folow-up, wrist joint function of patients in the two groups was compared and analyzed with Cooney scores. According to the Cooney scores, nine cases in internal fixation group were excelent, 1 good, 1 fair and none poor; one case in plaster fixation group was excelent, 5 good, 3 fair, and 2 poor. The excelent and good rate in the internal fixation group was significantly higher than that in the plaster fixation group (91%, 55%,t=4.817,P < 0.05). Although plaster fixation has certain effects on wrist scaphoid bone fresh fracture, open reduction and canulated screw fixation has obvious effect and promotes the

  10. Percutaneous internal fixation using sacroiliac screw in dorsal position for treatment of pelvic posterior ring injuries%仰卧位经皮骶髂置钉固定术治疗骨盆后环损伤

    Institute of Scientific and Technical Information of China (English)

    王亮; 藏卫东; 甄相周; 李付彬; 徐向峰; 杨彦亭

    2009-01-01

    Objective To explore the feasibility, operative procedure and the result for the tech-nique of sacroiliac percutaneous screws fixation in dorsal position for treatment of pelvic posterior ring in-juries. Methods From October 2004 to October 2007, 14 patients with the pelvic posterior ring injuries were treated with width 7.2 mm sacroiliac cannulated screws fixation under monitoring of "C"-arm, which in-cluded 7 males and 7 females, with the mean age of 41.6 years (range, 28-75 years). According to the Tile classification, there were 4 cases for type B, 10 for type C. During the operation, the patients were kept on domal position. The inserting point was the intersection point of anterior 2 cm of superior iliac spine and posterior axillary line, or the posterior-middle 1/3 point of the line between anterior superior iliac spine and posterior superior iliac spine. The screw inclined anterior 20°~30°, 5°~15° toward foot. The pelvic preceding ring injuries and the other bone joint damages were dealt with at the same time. After the operation, screen the X-ray polished section of the pelvic A-P position and the lumbar vertebrae lateral position, and scan pelvic posterior ring by CT, watch the screw entering position in S1 centrum. Results All 14 patients were available at follow up with mean duration of 16 months (range, 6-36 months). All cases attained bone union in 3 months. Fifteen hollow titanium screws inserted into 14 patients. There were no nerve injuries and breakage or loosening of the screws, and no pelvic deformities and pain of sacroiliac. According to Majeed e-valuation, the excellent and good rate was 92.9%. Conclusion To use two ways to decide position on per-cutaneous internal fixation using sacroiliac screw in dorsal position for treatment of pelvic posterior ring in-juries is safe, convenient and feasible.%目的 探讨仰卧位经皮骶髂置钉固定术治疗骨盆后环损伤的可行性、手术方法及疗效.方法 在10

  11. Guided bone regeneration for immediate non-submerged implant placement using bioabsorbable materials in Beagle dogs.

    Science.gov (United States)

    Brunel, G; Benqué, E; Elharar, F; Sansac, C; Duffort, J F; Barthet, P; Baysse, E; Miller, N

    1998-10-01

    The aim of the present study was to evaluate the combined application of different bioabsorbable materials for healing of residual peri-implant defects after placement of non-submerged implants into fresh extraction sockets. Second and third mandibular premolars were extracted from 10 Beagle dogs, the coronal part of the distal sockets were surgically enlarged and this was followed by immediate placement of specially designed hollow-screw non-submerged dental implants. For each animal, the coronal peri-implant defects were further treated with one of the 4 following procedures: 1) no treatment, control site; 2) grafting with porous hydroxyapatite (HA); 3) collagen membrane tightly secured around the implant and over the defect and 4) grafting with HA covered with a collagen membrane. After 16 weeks of healing, specimens were removed from the mandibule and prepared for a histomorphometric evaluation. The bone-to-implant contact length (BIC) was measured and compared amongst the different treatment modalities. In the defect area, the irregular bone regeneration was similar between all the treatment procedures (P > 0.10). In the sites covered with a collagen membrane alone, the total BIC (47%) was greater than in control sites (28.7%, P < 0.05) or sites grafted with HA (22.2%, P < 0.02). Total BIC in sites treated with the HA-membrane combination (43%) was only significantly different from sites treated with HA (P < 0.05). It is concluded that the use of bioabsorbable materials results in a limited increase of osseointegration when used in conjunction with immediate placement of non-submerged implants, although the principle of the one stage surgical approach can be maintained.

  12. 单侧椎弓根螺钉置入并椎间融合对邻近椎间盘节段退变的影响%Unilateral pedicle screw fixation with lumbar interbody infusion for adjacent segment degeneration

    Institute of Scientific and Technical Information of China (English)

    邵高海; 焦春燕; 余雨; 钟斌; 李波

    2011-01-01

    背景:坚强内固定和良好融合存在严重缺陷和不足.目前还未见临床应用单侧椎弓根螺钉固定结合椎间cage植骨融合治疗腰椎退变性疾病对邻近节段退变影响的相关报道.目的:回顾分析单侧椎弓根螺钉固定结合椎间cage植骨融合治疗部分腰椎退变性疾病后对固定融合邻近上下节段退变的影响.方法:2006-03/2009-12对收治的部分腰椎管狭窄症、腰椎失稳及腰椎间盘脱出症患者22例,进行了单侧椎弓根螺钉固定加椎间cage植骨融合,术中不显露对侧.在固定融合后3,6,12,20个月及取出内固定钉棒后3,6个月,随访X射线片及MRI.针对X射线片运用角平分线法测量固定融合邻近上位椎间隙高度变化,MRI测量椎间盘髓核退变情况.结果与结论:所有病例获得随访,患者椎管狭窄症状及神经根性症状消失,并且在随访期间内没有新的临床症状出现.固定融合前、固定融合后3,6,12,20个月邻近节段上位椎间隙高度分别为(7.420±0.035 4),(7.426 6±0.036 9),(7.453 3±0.036 9),(7.516 6±0.036 9),(7.430 8±0.036 9) mm,结果表明,腰椎单侧固定融合后邻近节段椎间隙高度无明显变化(P > 0.05).MRI测量结果显示,固定融合邻近上位椎间盘髓核信号在T2加权像无明显退变.提示单侧椎弓根螺钉固定结合椎间融合治疗部分腰椎退变性疾病能有效预防固定融合邻近上下节段退变.%BACKGROUND: There are no reports add ressing effects of unilateral pedicle screw plus cage internal fixation on adjacent segment degeneration in the treatment of lumbar degenerative disease.OBJECTIVE: To review the effects of unilateral pedicle screw plus cage internal fixation on adjacent segment degeneration in the treatment of lumbar degenerative disease.METHODS: From 2006 to 2009, 22 patients with partial lumbar spinal stenosis, lumbar instability, and lumbar intervertebral disc herniation received unilateral pedicle screw plus cage

  13. 腰椎内固定中两种椎弓根钉加强技术与骨水泥的应用%Two strengthening pedicle screw techniques and bone cement in lumbar internal fixation

    Institute of Scientific and Technical Information of China (English)

    江泽华; 朱如森; 袁建军; 邵高升; 张学利

    2013-01-01

    BACKGROUND:Screw loosening and shedding may occur after osteoporosis associated with lumbar degenerative disease treated with pedicle screw fixation. Application of pedicle screw enhanced with cured materials can improve the therapeutic effect. OBJECTIVE:To compare the clinical effect of pedicle screws enhanced with poly(methyl methacrylate) and injectable calcium sulfate cement in the lumbar internal fixation of osteoporosis. METHODS:Sixty-one patients diagnosed with osteoporosis combined with lumbar spondylolisthesis, lumbar spinal instability, and severe lumbar spinal stenosis were col ected. Al patients were divided into two groups according to the treatment method:poly(methyl methacrylate) bone cement enhanced pedicle screw group and calcium sulfate bone cement enhanced pedicle screw group. RESULTS AND CONCLUSION:There were no significant differences in the operation time, blood loss, preoperative and postoperative visual analog scale score, Japanese Orthopedic Association scores and the Japanese Orthopedic Association score improvement rate between two groups (P>0.05). The results showed that two patients had bone cement leakage in poly(methyl methacrylate) group which had no neurological symptoms caused by new symptoms during fol ow-up period. The bone mineral density was not improved gradual y in poly(methyl methacrylate) group with fol ow-up time prolonging;however, in calcium sulfate group, the bone mineral density was increased significantly after treatment, and the change of bone mineral density was linearly related with Japanese Orthopaedic Association score improvement rate in calcium sulfate group. No screw loosening, pul ing out or neurological dysfunction occurred in both groups. The results indicate that like poly(methyl methacrylate), balcium sulfate bone cement can increase the stability of pedicle screws.%背景:骨质疏松伴腰椎退行性病变行椎弓根钉固定骨质疏松的椎体后可能会出现螺钉的松动、脱落,使用

  14. 缝线结合空心钉与缝线内固定治疗前交叉韧带胫骨髁间棘撕脱骨折疗效比较%Effect comparison of suture combined with cannulated screw fixation and suture fixation in treating anterior cruciate ligament tibial eminence avulsion fracture

    Institute of Scientific and Technical Information of China (English)

    罗灏; 刘君

    2014-01-01

    目的:比较缝线结合空心钉与缝线内固定治疗前交叉韧带胫骨髁间棘撕脱骨折疗效。方法将该院诊治的78例前交叉韧带胫骨髁间棘撕脱骨折患者随机分入A组与B组,A组患者接受缝线内固定,B组患者接受缝线结合空心钉内固定治疗,评估两组临床疗效。结果两组患者随访10~18个月,所有患者均骨性愈合。 B组患者术后Lysholm膝关节评分显著高于A组[(96.73±6.56) vs(91.26±6.17),P<0.05];术后B组患者Lachman试验和前抽屉试验结果显著优于A组(P<0.05);术后B组与A组IKDC2000主观膝关节评分差别具有统计学意义(P<0.05)。结论与缝线内固定相比,缝线结合空心钉内固定前交叉韧带胫骨髁间棘撕脱骨折效果更为理想,患者关节功能恢复好。%Objective To compare the effect of suture combined with cannulated screw fixation and suture fixation in treating anterior cruciate ligament tibial eminence avulsion fracture. Methods Seventy-eight cases with anterior cruciate ligament tibial eminence avul-sion fracture were randomized into group A and group B. Group A received suture fixation and group B was given suture combined with cannulated screw fixation. Clinical effects were compared between two groups. Results All the patients were followed up for 10~18 months,who obtained bony union. Postoperative Lysholm knee assessment score in group B was much higher than that in group A [(96. 73±6. 56) vs(91. 26±6. 17),P<0. 05]. Postoperative Lachman test result and anterior drawer test result in group B were su-perior to those in group A (P<0. 05). There were significant differences in IKDC2000 scores between group A and group B (P<0. 05). Conclusions Compared with suture fixation,suture combined with cannulated screw fixation has better clinical effects with ide-al recovery of joint function.

  15. Percutaneous compressive screw fixation for float injury to pubic symphysis%经皮加压螺钉固定治疗耻骨联合漂浮损伤

    Institute of Scientific and Technical Information of China (English)

    郭晓山; 杨雷; 池永龙

    2009-01-01

    Objective To discuss the functional results of percutaneons compressive screw fixation for float injury to the pubic symphysis. Methods From March 2003 to March 2007, 48 cases of float injury to the pubic symphysis were treated with percutaneons compressive screws, including 27 males and 21 females with an average age of 29.4 years. Of them, 39 eases were complicated with injury to the pelvic posterior ring. Emergency surgery was done for 13 cases, 27 cases were operated on within 3 to 7 days after injury and 8 within 7 to 14 days. Guided pins and screws were used during dosed reduction and percutaneous pelvic fixation was done under the guidance of intraoperative fluoroscopic imaging. Float injury to the pubic symphysis was amended by percutaneous fixation after dosed manipulation. Results The average operation time for the48 patients was 55 (31 to 100) min. The intraoperative bleeding averaged 20 to 30 mL. Satisfactory reduetian and fixation was achieved in 41 cases, but 7 cases had poor reduction. All the fractures healed 3 to 6 months postoperatively without infection, nonunion or injury to vessels, nerves or organs. All the patients could turn the body freely in bed the day after operation. Those without injury to the pelvic posterior ring could walk with crutches 3 days after operation. By the Orlando evaluation system for pelvic fractures, 37 eases were rated as excellent, 7 as good, 3 as fair and I as poor. Conclusions The percutaneous compressive screw fixation may decompress the pelvic hematoma, allowing early definitive fixation without the risk of additional hemorrhage. Complications associated with open posterior pelvic surgical procedures may be avoided by using percutaneons techniques.%目的 探讨经皮加压螺钉固定治疗耻骨联合漂浮损伤的疗效. 方法 2003年3月至2007年3月,采用经皮加压螺钉固定治疗48例耻骨联合漂浮损伤患者,男27例,女21例;平均年龄29.4岁.39例患者伴有不同程

  16. Progress of interference screw in the reconstruction of anterior cruciate ligament%界面螺钉在前十字韧带修复中的应用进展

    Institute of Scientific and Technical Information of China (English)

    程鹏飞; 柴益民

    2016-01-01

    前十字韧带损伤是常见的膝关节运动损伤.目前的常规治疗方案是在关节镜下取自体髌韧带或腘韧带植入胫骨、股骨骨隧道,用内植物加强固定,重建前十字韧带功能.界面螺钉是重建前十字韧带的常用固定器械.理想的界面螺钉材料应满足坚强的固定强度并能长时间维持,促进骨性愈合或腱骨愈合的生物活性.界面螺钉材料包括金属材料和可吸收高分子聚合物材料两类.金属界面螺钉提供的固定强度及固定刚度高,但需二次手术取出;可吸收高分子聚合物界面螺钉不用二次手术取出,但力学强度低,降解过程中可能诱发无菌性炎症反应,出现螺钉松动、骨道变宽等并发症.镁金属界面螺钉是一种新型的可降解界面螺钉,已逐渐广泛应用于前十字韧带重建的固定.镁为人体必需营养元素,镁金属材料植入体内生物相容性良好,可促进骨质长入与矿质沉积,同时激活纤维软骨止点再生,在关节腔内不会诱发严重的炎症反应;体外与动物模型研究均证实其力学强度和刚度远高于高分子聚合物材料,接近骨皮质;且体内降解速率可通过合金工艺进行调控.%The anterior cruciate ligament (ACL) injury in sports is a common knee joint injury.It is widely accepted to reconstruct ACL under arthroscopy with autologous patellar ligament or popliteal ligament fixed in tibial or femoral tunnel with interference screws.Interference screws are widely used as intra-articular fixation devices in ACL reconstruction.The ideal materials for interference screw provide rigid fixation of graft with high mechanical strength,long-lasting stiffness and the bioactivity to stimulate osteointegration and tendon-bone healing.Current interference screws are made of metals and bio-absorbable polymers.Metallic interference screws provide high mechanical strength and stiffness for tendon graft fixation,but require a second surgery for removal.Bioabsorbable

  17. The indication and preliminary clinical outcome Of atlantoaxial tri-screw-rod fixation%寰枢椎后路三点式固定的适应证与初步临床应用

    Institute of Scientific and Technical Information of China (English)

    王麓山; 王文军; 王程; 朱一平; 刘海兵; 欧阳智华

    2011-01-01

    目的:探讨寰枢椎后路经椎弓根钉棒系统"三点式"固定术式的适应证与初步临床疗效.方法:2008年6月~2010年6 月共收治21例寰椎不能进行双侧侧块置钉的寰枢椎不稳患者,其中男12例,女9例,年龄17~53岁,平均34岁.临床均表现为不同程度的颈枕部疼痛和活动受限,影像学检查均示寰椎单侧侧块骨折、寰枢椎不稳.10例合并寰枢椎半脱位者术前先给予Halo架牵引复位,所有患者均采用寰椎单侧侧块螺钉、枢椎双侧椎弓根螺钉的"三点式"内固定及植骨融合术,术后颈围固定3个月.随访患者临床与影像学结果.结果:患者均顺利完成手术,未发生脊髓和椎动脉损伤.手术时间70~140min,平均92min.所有患者均获随访,随访时间6~24个月,平均14.2个月,所有患者术后3~6个月(平均4个月)植骨块均融合,未发现螺钉松动、脱出以及断钉、断棒等现象.颈部疼痛症状均基本消失,枕颈活动度保留,对患者生活无明显影响.结论:寰枢椎"三点式"固定具有较强的三维固定作用,结合术前牵引复位与术后颈围外固定,用于不能进行寰椎双侧侧块置钉的寰枢椎不稳患者可避免枕颈融合术导致的枕颈活动丧失.%Objective:To evaluate the preliminary clinical outcome and indication of atlantoaxial tri-screwrod fixation. Method: From June 2008 to June 2010,21 patients suffering from atlantoaxial instability underwent fusion and atlantoaxial tri-screw-rod fixation.There were 12 males and 9 females,aged from 17 to 53(mean 34 years ).They all presented with cervical pain and malfunction.The radiographical fingdings indicated aflantoaxial instability together with C1 lateral mass fracture.10 cases with aflantoaxial dislocation underwent preoperative skull traction and postoperative halo-vest. Result:The operation time was 70-140 minutes (average,92 minutes).Patients were followed up for an average of 14.2 months(range,6-24 months).No spinal

  18. Biomechanical evaluation of screw and plate fixation in pelvic fractures%螺钉与钢板在骨盆骨折置入内固定应用中的生物力学评价

    Institute of Scientific and Technical Information of China (English)

    赵艳

    2011-01-01

    ofpelvic fractures and play a very important role in the final choice of treatment. Anatomic reduction and solid fixation of pelvicfractures as well as screws and plate internal fixation are very important. To develop an implant with small wound, low infectionrate, stable fixation and good compatibility is the current direction in the treatment of unstable pelvic fractures.

  19. Design and biomechanical study of a modified pedicle screw

    Institute of Scientific and Technical Information of China (English)

    LIU Tao; ZHENG Wen-jie; LI Chang-qing; LIU Guo-dong; ZHOU Yue

    2010-01-01

    Objective: In pedicle screw fixation,the heads of monoaxial screws need to be directed in the same straight line to accommodate the rod placement by backing out during operation, which decreases the insertional torque and internal fixation strength. While polyaxial screws facilitate the assembly of the connecting rod, but its ball-in-cup locking mechanism reduces the static compressive bending yield strength as compared with monoaxial screws. Our study aimed to assess the mechanical performance of a modified pedicle screw.Methods: In this study, the tail of the screw body of the modified pedicle screw was designed to be a cylindershaped structure that well matched the inner wall of the screw head and the screw head only rotated around the cyclinder. Monoaxial screws, modified screws and polyaxial screws were respectively assembled into 3 groups ofvertebrectomy models simulated by ultra high molecular weight polyethylene (UHMWPE) blocks. This model was developed according to a standard for destructive mechanical testing published by the American Society for Testing Materials (ASTM F1717-04). Each screw design had 6 subgroups, including 3 for static tension, load compression and torsion tests, and the rest for dynamic compression tests. In dynamic tests, the cyclic loads were 25%, 50%, and 75% of the compressive bending ultimate loads respectively.Yield load, yield ultimate load, yield stiffness, torsional stiffness, cycles to failure and modes of failure for the 3 types of screws were recorded. The results of modified screws were compared with those ofmonoaxial and polyaxial screws.Results: In static tests, results of bending stiffness,yield load, yield torque and torsional stiffness indicated no significant differences between the modified and monoaxial screws (P>0.05), but both differed significantly from those ofpolyaxial screws (P<0.05). In dynamic compression tests,both modified and monoaxial screws showed failures that occurred at the insertion point of screw

  20. 椎弓根钉棒系统固定治疗齿状突骨折合并寰枢关节不稳%Transpedicular Screw Fixation System for the Treatment of Dens Fracture Complicated with Atlantoaxial Instability

    Institute of Scientific and Technical Information of China (English)

    张毅; 黄象望; 沈雄杰; 常磊

    2011-01-01

    [Objective]To explore the method and efficacy of transpedicular screw fixation system for the treatment of traumatic axial dentoid process fracture complicated with atlantoaxial instability.[Methods]Twenty six adult cases of acute axial dentoid process fracture complicated with atlantoaxial instability from Dec.2005 to April 2010 were reviewed.Among all the cases, 18 cases were male and 8 cases were female.According to Anderson-D' Alonzo typing method modified by Grauer, 5 cases were type Ⅱ A, and 12 cases were type Ⅱ B, and 6 cases were type Ⅱ C, and 3 cases were type Ⅲ.Three cases were accompanied by spinal injury including 2 cases with type Ⅱ B and one case with type Ⅱ C.All cases were complicated with atlantoaxial instability.At first, all the cases underwent skull traction for atlantoaxial reduction, and then were fixed with atlantoaxial pedicle screw system by cervical posterior approach under general anesthesia.Of all cases, 19 cases underwent autologous iliac bone graft and 7 cases underwent atlantoaxial pedicle screw fixation.The surgical efficacy was assessed by JOA scores before and after operation.[Results]No vertebral artery or spinal injury occurred during operation.Mean time of follow-up was 12 months(8~25 months).Cervicobrachialgia in all patients was alleviated.Three cases with spinal injury had the recovery of neurological function to some ex tent.The imaging data of all cases showed that the atlantoaxial anatomic relationship recovered well and pedicle screws were in a proper position without postoperative loosening or breaking.The bony fusion was obtained in 19 cases undergoing bone graft at 6 months of follow up.The internal fixation system was removed in 7 ca ses without bone graft after one and a half years.Atlantoaxial rotational function was restored satisfactorily.[Conclusion]Atlantoaxial pedicle screw fixation for the treatment of traumatic axial dentoid process fracture complicated with atlantoaxial instability is a solid

  1. Pullout strength of pedicle screws with cement augmentation in severe osteoporosis: A comparative study between cannulated screws with cement injection and solid screws with cement pre-filling

    Directory of Open Access Journals (Sweden)

    Lee Yen-Chen

    2011-02-01

    Full Text Available Abstract Background Pedicle screws with PMMA cement augmentation have been shown to significantly improve the fixation strength in a severely osteoporotic spine. However, the efficacy of screw fixation for different cement augmentation techniques, namely solid screws with retrograde cement pre-filling versus cannulated screws with cement injection through perforation, remains unknown. This study aimed to determine the difference in pullout strength between conical and cylindrical screws based on the aforementioned cement augmentation techniques. The potential loss of fixation upon partial screw removal after screw insertion was also examined. Method The Taguchi method with an L8 array was employed to determine the significance of design factors. Conical and cylindrical pedicle screws with solid or cannulated designs were installed using two different screw augmentation techniques: solid screws with retrograde cement pre-filling and cannulated screws with cement injection through perforation. Uniform synthetic bones (test block simulating severe osteoporosis were used to provide a platform for each screw design and cement augmentation technique. Pedicle screws at full insertion and after a 360-degree back-out from full insertion were then tested for axial pullout failure using a mechanical testing machine. Results The results revealed the following 1 Regardless of the screw outer geometry (conical or cylindrical, solid screws with retrograde cement pre-filling exhibited significantly higher pullout strength than did cannulated screws with cement injection through perforation (p = 0.0129 for conical screws; p = 0.005 for cylindrical screws. 2 For a given cement augmentation technique (screws without cement augmentation, cannulated screws with cement injection or solid screws with cement pre-filling, no significant difference in pullout strength was found between conical and cylindrical screws (p >0.05. 3 Cement infiltration into the open cell of

  2. Biomechanics study of interal fixation with hollow compression screw and composite calcium phosphate cement of osteoporotic femoral neck%复合磷酸钙骨水泥强化骨质疏松股骨颈加压空心螺钉的生物力学研究

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    Objective To evaluate the biomechanics of hollow compression screw in the osteoporotic femoral neck with composite calcium phosphate cement (CCPC).Methods Sixteen femurs of superior segment were randomly divided into two groups: augmentation group and non augmentation group.CCPC was used in augmentation group.Result Augmentation with CCPC would improve the initial mobile force of hollow compression screw,the initial mobile force and the maximal axial pull out strength for augmentation group,non augmentation group increased from (192.7± 14.0)N and (202.8± 14.0)N to(328.5± 34.7)N and( 347.8± 31.2)N.There was significant difference of two groups(P< 0.01).Conclusion CCPC can enhance hollow compression screw fixation in osteoporotic femoral neck.

  3. Biomechanical analysis of short-segment pins Index-level screw fixation for low lumbar burst fractures%Index-level螺钉短节段固定治疗下腰椎爆裂压缩骨折的生物力学研究

    Institute of Scientific and Technical Information of China (English)

    王涛; 马剑雄; 王玉龙; 马信龙; 张晓林; 徐宝山; 杨强

    2013-01-01

    目的 通过对L4椎体爆裂骨折模型以及应用不同方法固定后的生物力学测试,探讨Index-level螺钉短节段固定方法在治疗下腰椎爆裂骨折中的意义.方法 选取10具新鲜尸体腰骶椎标本,通过截骨、切断部分韧带的方法制作L4椎体爆裂骨折模型,然后依序进行长节段固定、短节段固定以及短节段+ Index-level螺钉固定并进行生物力学测试,比较不同固定方法腰椎活动度(range of motion,ROM)的差异.结果 与短节段固定比较,短节段+Index-level螺钉固定在前屈、轴向旋转和侧屈时ROM降低,差异有统计学意义(P<0.05).在后伸位时短节段+Index-level固定稳定性提高,ROM降低32.7%,但差异无统计学意义.结论 Index-level螺钉短节段固定较单纯短节段内固定平均提高32.5%的即刻稳定性,而且比长节段固定保留更大范围ROM.%Objective To establish L4 vertebrae burst fractures and take a biomechanical test of different internal fixations so as to discuss the significance of internal fixation using short-segment plus Index-level screws in treatment of low lumbar burst fractures.Methods Ten fresh human lumbosacral vertebrae specimens were used to establish models of L4 vertebrae burst fractures by corpectomy and partial removal of ligament.Thereafter,the biomechanical test was performed in order as below:longsegment fixation,short-segment fixation and short-segment construction plus Index-level screw fixation.Differences of range of motion (ROM) of the lumbar after three different internal fixations were compared.Results Compared with short-segment fixation,short-segment plus Index-level screw fixation showed that ROM of the lumbar was decreased in front flexion,axial rotation and lateral bending (P < 0.05),but stability was improved and ROM of lumbar was decreased by 32.7% in back extension (P > 0.05).Conclusions Compared with short-segment fixation,the short-segment plus Index-level screw fixation can

  4. 3D计算机导航下经椎弓根骨水泥增强螺钉的应用%Polymethylmethacrylate-augmented thoracolumbar pedicle screw fixation guided by the three-dimensional navigation in osteoporotic patients

    Institute of Scientific and Technical Information of China (English)

    袁强; 张贵林; 吴静晔; 行勇刚; 何达; 孙宇庆; 田伟

    2014-01-01

    Objective To evaluate the safety and efficacy of polymethylmethacrylate (PMMA) -augmented thoracolumbar pedicle screw fixation guided by three-dimensional (3D) navigation in the osteoporotic patients.Methods From January 2010 to January 2012,27 osteoporotic patients with a variety of spinal disorders underwent PMMA-augmented thoracolumbar pedicle screw fixation guided by 3D navigation.They were 3 men and 24 women,aged from 51 to 92 years (average,70.1 years).Their osteoporosis was all serious.PMMA leakage was evaluated intraoperatively and postoperatively.Screw loosening and bone fusion were evaluated radiographically after operation.The Japanese Orthopaedic Association (JOA) scores of the patients were compared between preoperation and one year postoperation.Results Altogether 149 pedicle screws were implanted in the 27 patients.One patient died of postoperative pneumonia and the rest 26 patients were followed up for more than 12 months.No pedicle cortex breach or cement leakage surrounding the pedicle cortex was observed.None of the patients complained of dyspnoea showing evidence of pulmonary embolism or iatrogenic neural injury.No obvious deterioration of related symptoms or functions was observed after operation.The pre-operative JOA score (18.2 ± 2.6 points) was significantly increased (25.1 ± 2.3 points) postoperation (t =16.996,P =0.000),with a mean therapeutic improvement rate of 39.6%.None of the patients showed loosening or displacement of the implants.Lateral X-ray films showed bone fusion in 20 patients (76.9%) at the 12-month follow-up Conclusion PMMA-augmented thoracolumbar pedicle screw fixation guided by 3D navigation is safe and effective for osteoporotic patients with a variety of spinal disorders,leading to favorable outcomes both clinically and radiologically.%目的 评价在3D计算机导航下经椎弓根骨水泥增强胸腰椎椎弓根螺钉内固定术的安全性和有效性. 方法 2010年1月至2012年1月27例不同脊柱疾患

  5. Application of percutaneous pedicle screw fixation for lumbar degenerative disease%应用经皮椎弓根螺钉技术治疗腰椎退行性疾病

    Institute of Scientific and Technical Information of China (English)

    吴浩; 陈永杰; 张璨; 陈赞; 菅凤增

    2014-01-01

    目的:评估在X线透视下经皮椎弓根螺钉微创内固定技术治疗腰椎退行性病变的安全性和准确性。方法回顾性分析首都医科大学宣武医院2012年3月至2013年10月采用X线透视下经皮椎弓根螺钉微创内固定技术,结合显微镜下微创经椎间孔入路椎间盘摘除、椎体间融合术(TLIF)治疗64例腰椎退行性疾病患者的临床资料,随访3个月或以上,统计术中出血量、住院时间、并发症、术前与术后采用视觉模拟量表(VAS)和Oswestry功能障碍指数(ODI)进行疗效评估,计算患者症状改善率;术后生活质量调查(SF-36);术后复查X线及腰椎CT平扫及腰椎核磁,评估螺钉位置及融合率。结果手术平均时间(3.4±0.9)h,术中出血平均(193±100)ml,住院平均时间(7±2)d,并发症发生率7.8%(5/64)。随访3个月显示,VAS和ODI改变差异有统计学意义(P<0.01)。临床症状改善显著,ODI改善率为50.8%,SF-36平均86.2%;64例患者共植入316颗螺钉,术后X线显示306颗螺钉位置良好,10颗螺钉位置可接受,无螺钉松动;螺钉植入成功率达100%,融合率达96%。结论X线透视下微创内固定技术完全可以获得准确、理想的螺钉植入位置,结合显微镜下微创TLIF治疗腰椎退行性疾病是安全、有效的方法。%Objective To evaluate the accuracy and safety of mini-invasive and percutaneous pedicle screw fixation with fluoroscopy for lumbar degenerative disease.Methods For this retrospective study, 64 cases of lumbar degenerative disease underwent mini-invasive transforaminal lumbar interbody fusion ( TLIF) under microscope plus percutaneous pedicle screw fixation with fluoroscopy of lumbar spine from March 2012 to October 2013.The parameters of operative duration , intraoperative blood loss volume , hospital stay and complications were recorded and analyzed.The clinical outcomes were assessed

  6. Atlantoaxial transpedicle screws fixation for the treatment of atlatoaxial instability%寰枢椎椎弓根螺钉固定技术在治疗寰枢椎不稳中的应用

    Institute of Scientific and Technical Information of China (English)

    彭焰; 黄岭志; 梁安靖; 张新亮; 黄东生

    2010-01-01

    目的 探讨寰枢椎椎弓根螺钉固定技术在寰枢椎不稳中的应用疗效.方法 2004年10月2008年12月,采用寰枢椎椎弓根螺钉固定技术治疗寰枢椎不稳12例,男7例,女5例,年龄26~62岁,平均49.4岁,其中枢椎齿状凸骨折5例,均为陈旧性AdersonⅡ型骨折;寰枢椎陈旧性脱位7例.所有患者均表现为枕颈区疼痛、颈部活动障碍.4例患者合并脊髓受压,Frankel分级C级和D级各2例.术前JOA评分5~12分,平均8.5分.术前均行颅骨牵引.寰椎进钉点在后结节中点旁18~20 mm与后弓下缘以上2 mm交点处,钉道方向与冠状面垂直,矢状面上头偏约5°,枢椎进钉点为下关节突内上象限,钉道方向内斜32°,上倾28°.结果 12例患者共植入寰、枢椎左右椎弓根螺钉各24枚,无一例发生脊髓或椎动脉损伤.所有患者均获成功随访,时间为6~48个月,平均25个月,术后6月JOA评分为13.5~16.7分,平均14.9分,改善率为87.4%.结论 寰枢椎椎弓根螺钉固定技术用于寰枢椎不稳的治疗中具有稳定固定的良好临床疗效.%Objective To summarise the results of fixation with atlantoaxial transpediele screws for the treatment of atlatoaxial instability. Methods From Oct. 2004 to Dec. 2008, 12 patients with upper cervi-cal spine injury were included in this study, 7 males and 5 females, with a mean age of 49. 4 years (ranging from 26 to 62), including 5 cases of odontoid old fracture (Aderson Ⅱ ), 7 cases of atlantoaxial dislocation.Four patients suffered from neural function impairment caused by spinal cord compression ( Frankel C in 2 cases, Frankel D in 2cases). Preoprative JOA score ranged from 5 to 12, averaging 8. 5. Skull traction was performed in every case preoperatively. The screws were placed at the point of intersection beside the posteri-or arch of arias about 18-20 mm and above 2 mm inferior boarder of posterior arch. Vertical to the coronal plane, the tip of the screw was 5° sidelong to the head in

  7. Analysis the Clinical Curtive Effect of Thoracic Lumbar Spine Fractures of Posterior Pedicle Screw Fixation Combined Bone Graft Surgery%脊柱胸腰段骨折行后路椎弓根螺钉内固定联合植骨手术的临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    慕志广

    2016-01-01

    Objective To evaluate the clinical curative effect for joint posterior pedicle screw internal fixation bone graft surgery in treatment of thoracic lumbar spine fractures.Methods Selected 72 cases of thoracic lumbar spine fracture patients in our hospital, which were randomly divided into two groups, each group had 36 cases, control group with posterior pedicle screw internal fixation treatment, the observation group patients give posterior pedicle screw internal fixation with bone graft surgery therapy.ResultsAfter surgery, VAS score, Cobb Angle observation group were better than the control group (P<0.05), two groups of data difference was statistically signiifcant (P<0.05).Conclusion Posterior pedicle screw internal fixation with bone graft surgery therapy thoracic lumbar spine fracture effect is remarkable was statistically significant (P<0.05). Conclusion Posterior pedicle screw internal fixation with bone graft surgery therapy thoracic lumbar spine fracture effect is remarkable.%目的:探讨后路椎弓根螺钉内固定联合植骨手术治疗脊柱胸腰段骨折的临床疗效。方法将我院收治的72例脊柱胸腰段骨折患者随机分为两组,各36例。对照组单用后路椎弓根螺钉内固定治疗,观察组给予后路椎弓根螺钉内固定联合植骨手术治疗。结果手术后,观察组VAS评分、Cobb角均优于对照组(P<0.05),差异有统计学意义(P<0.05)。结论后路椎弓根螺钉内固定联合植骨手术治疗脊柱胸腰段骨折效果显著。

  8. 单侧椎间融合内固定治疗腰椎间盘突出症的手术效果%Surgical Effect of Unilateral Pedicle Screw Fixation and Lumbar Interbody Fusion in the Treatment of Lumbar Disc Herniation

    Institute of Scientific and Technical Information of China (English)

    李开雄; 邵玉凯; 郑晓刚; 郭金元; 肖卫; 欧艳春

    2016-01-01

    目的 分析椎间盘突出症椎间融合后单侧内固定的手术效果 .方法 随机选取2007年8月—2014年12月收治的腰椎间盘突出症患者68例,均给予椎间植骨融合术治疗,随机分为单侧内固定治疗的观察组(34例)和双侧内固定治疗的对照组(34例),观察与对比两组患者手术治疗情况. 结果 与对照组比较,观察组患者的手术时间、术中出血量 、术后引流量均低于对照组,差异有统计学意义(P<0.05);术后二组患者的椎间隙曲度、融合率以及JOA评分、MACMAB疗效评定的差异均无统计学意义. 结论 研究表明,单侧椎间融合内固定治疗手术创伤小,可取得与双侧手术相当的近远期疗效.%Objective To analyze the surgical effect of unilateral pedicle screw fixation and lumbar interbody fusion in the treatment of lumbar disc herniation. Methods 68 patients with lumbar disc herniation admitted from August 2007 to De-cember 2014 were randomly divided into the observation group and the control group with 34 cases in each. The observation group were treated by the unilateral pedicle screw fixation and lumbar interbody fusion, while the control group were treated by bilateral pedicle screw fixation and lumbar interbody fusion. And the surgical treatment effect of the two groups was ob-served and compared. Results Compared to the control group, the observation group had shorter operative time, less intra-operative blood loss and less postoperative drainage, the differences were statistically significant (P<0.05). The differences in intervertebral curvature, fusion rate, JOA score and result of MACMAB between the groups after surgery were not statistical-ly significant. Conclusion The study shows that for the treatment of lumbar disc herniation, unilateral pedicle screw fixation and lumbar interbody fusion have smaller trauma, but can obtain the same short-term and long-term effects as bilateral pedicle screw fixation and lumbar interbody fusion.

  9. 下胫腓联合螺钉治疗Maisonneuve骨折的疗效%Fixation of inferior tibiofibular syndesmosis by screw for Maisonneuve fracture

    Institute of Scientific and Technical Information of China (English)

    叶秀章; 施继飞; 敖荣广; 丁惠锋; 周成欢; 禹宝庆

    2014-01-01

    背景:Maisonneuve骨折临床上十分少见,如果处理不当可导致踝关节不稳定。目的:探讨Maisonneuve骨折的损伤机制、诊断、治疗及临床治疗效果。  方法:回顾性分析2009年8月至2012年10月,手术治疗Maisonneuve骨折19例,男15例,女4例;年龄30~68岁,平均42.2岁。骨折均为Lauge-Hansen旋前外旋型,其中Ⅱ度损伤5例,Ⅲ度损伤6例,Ⅳ度损伤8例。手术均采用2枚皮质骨位置螺钉,三层皮质平行踝关节面固定下胫腓联合韧带。随访时采用AOFAS评分评估踝关节功能恢复情况。  结果:19例患者均获随访,随访时间6~65个月,平均50个月,骨折均愈合。末次随访时AOFAS评分平均94.7分(75~97分),其中优15例,良4例。  结论:Maisonneuve骨折是一种严重的不稳定性踝关节骨折,由于其骨折的特殊性,易致误诊及漏诊。手术治疗可恢复下胫腓关节的正常解剖关系以及踝穴的匹配,对预后起决定作用。%Background:The Maisonneuve fracture is rare in clinic, and improper management can lead to instability in the ankle. Objective:To explore the injury mechanism, diagnosis and treatment of Maisonneuve fracture. Methods: A retrospective analysis was done in 19 patients who suffered from Maisonneuve fracture and were treated be-tween August 2009 and October 2012. There were 15 males and 4 females with a mean age of 42.2 years (range, 30-68 years). According to Lauge-Hansen classification, there were 5 cases with gradeⅡpronate-extorsion injury, 6 with gradeⅢpronate-extorsion injury and 8 with gradeⅣpronate-extorsion injury.All fractures were fixed with 2 cortical positioning screws. All screws engaged 3 cortices above the ankle joint and parallel to the tibial plafond. AOFAS score was used to eval-uate ankle joint function during follow up. Results:All the patients were followed up for 50 months on average (range, 6-65 months). Bony union was

  10. Finite element analysis of stress-shielding on lock internal fixation and use of unnecessary locking screws by LCP with MIPPO technology%MIPPO技术下LCP锁定固定减少锁钉个数后应力遮挡效应的有限元研究

    Institute of Scientific and Technical Information of China (English)

    钟华; 岑怡彪; 朱智敏; 孔禄生; 廖小燕; 黄艳; 刘敬东

    2012-01-01

    Objective To study the effect of stress-shielding on LCP's lock internal fixation and the use of unnecessary locking screws by comparing the changes in stress of the callus after lock internal fixation and the use of unnecessary locking screws and provide the basis of biomechatu'cs for the application of different types of plate and fixation methods in clinical MIPPO operation. Methods A three-dimensional finite element model of proximal tibia fracture with callus lock internal fixed was designed by the locking and compression of LCP,finite element was analyzed on the model,and stress of the model by different working condition and internal fixation was obtained. Results Under locking fixation,mean stress of callus through reducing two locked screws was greater than that through reducing one locked screw. According to the results of paired /-test, it had statistical signifieance.The stress shielding rate through reducing two locked screws was less than that through reducing one locked screw. Conclusion In all of the LCP locking fixation under MIPPO operation technique, the use of unnecessary locking screws should be minimized in order to reduce the effects of stress-shielding while providing a stable fixation,so as to promote formation and re-shaping of the callus and assist in fracture healing.%目的 比较经锁定固定减少锁钉个数后骨痂应力均值的变化,研究LCP锁定固定减少锁钉个数对应力遮挡效应的影响,为MIPPO术中应用不同类型的接骨板和固定方式提供生物力学依据.方法 应用有限元法根据LCP的锁定与加压结合孔,建立胫骨上端骨折LCP镇定固定后带骨痂的三维有限元模型.对模型进行力学有限元分析,得出不同工况和内固定方式下骨痂应力情况.结果 骨痂在锁定固定减少2个锁钉条件下的应力均值大于减少1个锁钉条件下的应力均值,根据配对t检验结果两者差异具有统计意义.锁定固定减少2个锁钉导致

  11. The Curative Effect Analyze of Treatment Old Displacement Type Femoral Neck Fracture by Hollow Compression Screw Internal Fixation%空心加压螺钉内固定治疗老年移位型股骨颈骨折疗效分析

    Institute of Scientific and Technical Information of China (English)

    马永成

    2016-01-01

    目的:探讨空心加压螺钉内固定治疗老年移位型股骨颈骨折疗效情况.方法分析我院骨外科2014年8月—2015年11月收治的老年移位型股骨颈骨折患者80例临床资料,依据固定方式不同进行临床分组,钢板固定组40例和空心加压螺钉内固定组40例.观察两组老年移位型股骨颈骨折患者术后功能恢复优良率和术后并发症发生率情况.结果空心加压螺钉内固定组老年移位型股骨颈骨折患者术后功能恢复优良率95%高于钢板固定组75%,空心加压螺钉内固定组老年移位型股骨颈骨折患者术后并发症发生率0低于钢板固定组10%,P<0.05,差异均有统计学意义.结论空心加压螺钉内固定治疗老年移位型股骨颈骨折患者临床疗效明显,并发症少,值得临床推广应用.%Objective To approach curative effect of treatment old displacement type femoral neck fracture by hollow com-pression screw internal fixation. Methods The 80 cases clinical data of old displacement type femoral neck fracture patients in our hospital bone surgery from 2014.8 to 2015.11 were analyzed,which was to be divided into two groups by different fixed mode,steel plate fixed group 40 cases and hollow compression screw internal fixation group 40 cases. The functional recovery excellent rate and complication rate of two groups old displacement type femoral neck fracture patients after oper-ation were detected. Result The functional recovery excellent rate 95% of hollow compression screw internal fixation group hollow compression screw internal fixation group was higher than steel plate fixed group 75%,the complication rate 0 of hollow compression screw internal fixation group hollow compression screw internal fixation group was lower than steel plate fixed group 10%,P<0.05,the difference were statistical significance. Conclusion The clinical curative effect of treatment ? old displacement type femoral neck fracture by hollow compression screw

  12. Finite element analysis of bridge combined fixation system and the locking plate-screw system on the application for femoral fractures%桥接组合式内固定系统与锁定接骨板钉系统在股骨骨折应用中的有限元分析

    Institute of Scientific and Technical Information of China (English)

    熊鹰; 李群辉; 柳百炼; 赵烽; 王大兴; 张仲子

    2012-01-01

    背景:桥接组合式内固定系统在人体骨折固定上,与锁定钢板相比效果如何,有待实验证实.目的:比较桥接组合式内固定系统与金属锁定接骨板钉系统固定股骨干骨折的生物力学特性.方法:对两种固定方式的有限元模型进行模拟加载,了解各模型中骨与内固定的应力分布和应变特点,并对结果加以分析.结果与结论:爬楼梯时接骨板锁定螺钉上的应力比步态时增48.6%,达到480 MPa,最大应力出现在中间锁定螺钉上.桥接系统中间联接棒上的最大应力比步态时大34.1%,最大值为373.9 MPa,出现在联接棒中间略远端附近;骨折区域上的应力桥接组合式内固定系统小于金属锁定接骨板钉系统.提示桥接组合式内固定系统较金属锁定接骨板钉系统具有更好的生物力学性能,固定更牢靠、利于骨折生长,是骨折内固定的一种更好选择.%BACKGROUND: The effect of the bridge combined fixation system for the fixation of bone fracture compared with locking plate system needs to be confirmed by experiment. OBJECTIVE: To compare the biomechanical properties of bridge combined fixation system and locking plate-screw system for the fixation of femoral fractures. METHODS: We used the finite element analysis method to analyze biomechanical characters of the femoral fractures fixed with the locking plate-screw system and bridge combined fixation system, such as the stress distribution and the strain characteristics of bone and fixation. RESULTS AND CONCLUSION: The stress on the locking plate screw when climbing stairs was increased for 48.6% compared with walking, the stress was 480 MPa and the maximum stress was on the middle of the locking plate-screw screws. The maximum stress on the middle of the bridge system when climbing was 34.1% larger than that when walking, the maximum stress was 373.9 MPa and occurred near the distal connection rod. The stress on the fracture area of bridge combined

  13. Mechanics research of bone cement augmentation on pedicle screw in revision of internal lumbar fixation%椎弓根螺钉骨水泥强化技术在腰椎内固定翻修手术中的力学研究

    Institute of Scientific and Technical Information of China (English)

    陈路; 廖琦; 龚玉琴

    2014-01-01

    目的:评价骨水泥强化技术在钉道扩大时对椎弓根螺钉固定强度的影响,为腰椎内固定翻修选择可靠的补救技术提供依据。方法选用成人尸体腰椎标本40个,观察组进行骨水泥强化,对照组普通方法置钉,进行生物力学检测。结果两种固定方法的最大轴向拔出力及最大旋出扭矩具有显著性差异(P<0.001),并提示弱相关。结论(1)在腰椎内固定翻修手术中,对椎弓根螺钉进行骨水泥强化可以有效提高椎弓根螺钉的固定强度。(2)钉道本身的骨质量对进行强化后的椎弓根螺钉固定强度影响有限。%Objective To evaluate the effect of bone cement augmentation technique on fixation strength of pedicle screw dur-ing trajectory expansion,to provide the basis of reliable remedial technique selection for revision of internal lumbar fixation.Methods A total of 40 lumbar vertebrae and 80 pedicles were obtained to stimulate the trajectory of pedicle needing revision after internal lumbar fixation surgery. 40 lumbar vertebrae were randomly divided into Group A and Group B ,with 20 simple fixed sides and 20 augmented fixed sides in each group. In Group A,pedicles on both sides of all the specimens were determined for the maximum axial pullout of strength;while in Group B,pedicles on both sides of all the specimens were detected for the maximum rotary torque,and differences between the two sides were compared. Results (1) There was significant difference between the two fixations,indicating a weak correlation. Conclusion (1)It was confirmed that in revision of internal lumbar fixation,bone cement augmentation on pedicle screw can effectively improve the strength of pedicle screw. (2)Maximum axial pullout of strength and maximum rotary torque in reinforced group were weakly correlated with those in the control group ,suggesting the bone quality of the trajectory had limited influence on the strength of reinforced pedicle screw

  14. Clinical Application of a Novel Open-door Laminoplasty with Internal Fixation of Lateral Mass Screw Combine with Process and Lamina Screw%下颈椎侧块螺钉结合棘突椎板螺钉在后路中的应用

    Institute of Scientific and Technical Information of China (English)

    胡勇; 徐荣明; 顾勇杰; 马维虎; 赵红勇

    2011-01-01

    Objective Laminoplasty is well described as a surgical option for treating ossification of the posterior longitudinal ligament (OPLL) and cervical stenotic myelopathy. An obstacle to the open door technique widespread use is the lack of a suitable fixation systems to adequately secure the fractured lamina to the lateral mass. Our objective was to analyse the feasibility of a novel open-door laminoplasty with internal fixation of lateral mass screw combine with process and lamina screw,and report the initial clinical effect.Methods 12 consecutive patients with cervical spondylosis between May 2008 and December 2010 were involved in this study. All cases were performed a novel open-door laminoplasty with internal fixation of lateral mass screw combine with process and lamina screw. Three cases were multiple segments cervical spondylotic myelopathy,Three cases were ossification of posterior longitudina ligament of cervical spine,Four cases were acute traumatic central cervical spinal cord syndrome,Two cases were cervical development stenosis combined with spinal cord injury. The scope of operation decompression:C3~7 3 cases,C3~6 8 cases, C3~5 1 case. 5 cases were opened door in left side,7 cases were opened door in right side. After the vertebral lamina was lift up, lateral mass screw combine with spinal process and vertebral lamina screw were fixed on the same segment of the same lateral side with polyaxial screw of the Vertex System,then there was no need to bite off the spinous process and the supraspinallig. Results All patients were followed up for about 15. 2 months(6 to 28 months). All patients.clinical symptom were improved. The average operation time prolonged 120 minutes(90 to 150 minutes), the average blood losing volume was 1 400 mL(800~4 300 mL). There are no nerve and blood vessel injury during the operation. During the follow-up period,we found 1 case have the pivotal symptom, 1 case has brief nerve root paralysis of C5,all these syndromes were

  15. 拉力螺钉辅加抗滑钢板内固定治疗Hoffa骨折%Internal fixation with lag screws plus an auxiliary anti-sliding plate for the treatment of Hoffa fractures

    Institute of Scientific and Technical Information of China (English)

    徐培; 孙杰; 袁天祥; 马宝通

    2012-01-01

    Objective To investigate the clinical efficacy of internal fixation with lag screws plus an auxiliary sliding plate for the treatment of Hoffa fractures.Methods A retrospective analysis was made for 12 patients (14 condyles) with Hoffa fracture who had been treated in our hospital from December 2007 through November 2011.They were 8 males (10 condyles) and 4 females (4 condyles),with an average age of 36.2 years (range,from 20 to 61 years).By the Hoffa classification,6 cases were medial condylar fractures,4 lateral condylar fractures and 2 bicondylar fractures.By the AO/OTA classification,10 cases were type 33B32 and 2 type 33B33.By Letenneur's classification,7 condyles were type Ⅰ,one condyle was type Ⅱ and 6 condyles were type Ⅲ.There were 2 open fractures and 10 closed ones.Femoral shaft fracture was complicated in one case,proximal tibia fracture in 3 cases,ankle fracture in one,injury to the knee extensor mechanism in 2,cruciate ligament injury in 4,medial collateral ligament injury in one,and meniscus injury in 3.The time from injury to surgery averaged 3.2 days (from 2 hours to 7 days).All fractures were reduced under direct vision and fixated with cancellous lag screws plus an additional anti-sliding plate.Results All the patients were followed for 6 to 54 months (average,20.3 months).Union was achieved in all patients after an average time of 16.6 weeks (from 11 to 23 weeks).No implant failure or fracture displacement occurred.Incision infection and incision disunion occurred in one case each,but both were cured after intensive care.According to Letenneur's functional assessment,11 cases were excellent or good and one case was fair,giving a good to excellent rate of 91.7%.Conclusions Open reduction and internal fixation with lag screws and an additional anti-sliding plate may result in excellent results for Hoffa fractures.The key to a successful surgery is an appropriate approach,anatomic reduction and rigid fixation.%目的 探讨拉力螺钉辅

  16. A finite element model of C1 lateral mass-C2 intralaminar screw-rod fixation and its biomechanical analysis%寰椎侧块-枢椎椎板螺钉固定的有限元分析

    Institute of Scientific and Technical Information of China (English)

    张凯; 刘新宇; 黄晓慧; 汪耀; 田永昊

    2011-01-01

    were analyzed when the skull was in neutral position,flexion/extension,right and left lateral bending,axial rotation and anterior-posterior (AP) translation.Result:The model of C1-C2 complex consisted of 183363 nodes and 116082 elements.The data indicated that C1 lateral mass-C2 intralaminar screwrod fixation significantly reduced the C1-C2 motion in flexion/extension,lateral bending and axial rotation compared to the intact cases.The results showed that there was concentration of stress at the upper bonescrew interface and the inferior transition area between rod and screw in extension.Stress concentration in flexion occurred in both the upper rod-screw transition area and bone-screw interface.In rotation the inferior conjunction of screw-rod presented stress convergence,the stress of the screw system was well-distributed.Conclusion:The finite element model of the atlantoaxial spine realistically simulates the atlantoaxial motion,which can simulate the natural condition and facilitate the further biomechanical research.

  17. To investigate the clinical effect of single screw internal fixation in the treatment of mandibular condyle sagittal fracture%探讨单螺钉内固定治疗下颌骨髁突矢状骨折的临床效果

    Institute of Scientific and Technical Information of China (English)

    张文兵

    2016-01-01

    目的:分析单螺钉内固定在下颌骨髁突矢状骨折的治疗中的临床效果.方法:收治髁突矢状骨折患者 100例,分两组,各50例.观察组实施单螺钉内固定治疗,对照组实施颌间牵引复位固定治疗.结果:观察组颞下颌关节功能障碍评分和并发症的发生率显著优于对照组(P<0.05).结论:在下颌骨髁突矢状骨折的治疗中,单螺钉内固定可以有效地缓解患者的颞下颌关节功能障碍,减少并发症.%Objective:To analyse the clinical effect of single screw internal fixation in the treatment of mandibular condyle sagittal fracture.Methods:100 patients with sagittal condylar fracture were selected,they were divided into two groups,each in 50 cases.The observation group was treated with single screw internal fixation,and the control group was treated with traction reduction and fixation.Results:The score of the temporomandibular joint dysfunction score and the incidence of complications in the observation group were significantly higher than those in the control group(P<0.05).Conclusion:In the treatment of mandibular condyle sagittal fracture,single screw internal fixation can effectively relieve patients of temporomandibular joint dysfunction, reduce complications.

  18. Clinical application of augmented pedicle screw fixation with bone cement in lumber spondylolisthesis accompanied with osteoporosis%骨水泥强化椎弓根螺钉在腰椎滑脱伴骨质疏松椎体中的临床应用

    Institute of Scientific and Technical Information of China (English)

    李鹏; 毛克亚; 王岩; 肖嵩华; 张永刚; 张西峰; 张雪松; 程自申; 毛克政

    2011-01-01

    目的 探讨骨水泥强化椎弓根螺钉在腰椎滑脱伴骨质疏松患者的手术方法和疗效.方法 2008年7月至2010年11月年期间收治腰椎滑脱伴骨质疏松患者12例,平均68岁.骨质疏松按Jikei分级Ⅱ级4例,Ⅲ级8例.所有患者行经椎弓根螺钉内固定,术中采用骨水泥强化提高螺钉稳定性,植入椎弓根螺钉共26枚,观察椎弓根螺钉术中及术后的稳定性.结果 患者未发生手术并发症,腰腿痛症状改善明显,术后VAS评分较术前比较改善明显.12例患者均获得随访,随访时间8-16个月,平均14个月.12例均获得骨性融合,X线片显示内固定无松动、断裂或脱落,螺钉周围未见透亮线出现.结论 经椎弓根骨水泥强化椎弓根螺钉,固化椎体的同时增加了椎弓根螺钉界面把持力,能够满足腰椎滑脱伴骨质疏松患者脊椎后路固定手术对力学稳定的要求.%Objective To explore the surgical method and efficacy of augmented pedicle screw fixation with bone cement for the treatment of lumber spondyiolisthesis accompanied with osteoporosis. Methods Twelve lumber spondyiolisthesis patients accompanied with osteoporosis were collected and treated from July 2008 to November 2010, with an average age of 68 years old. According to Jikei scale for osteoporosis, 4 patients were in stage II and 8 patients were in stage III. All patients were treated with internal fixations of pedicle screws and the stabilities of screws were augmented by bone cement augment during operations. Twenty-six pedicle screws were instrumented in this study. The stabilities of pedicle screws during and after the operation were observed. Results There were no operative complications. The symptoms of waist and leg pain were clearly alleviated. The VAS scores after operations were clearly ameliorated compared to those before the operation. All 12 patients were followed up for 8-16 months, with a mean of 14 months. All 12 patients achieved bone unions. The X

  19. Augmentation of pedicle screw fixation with polymethylmethacrylate in the osteoporotic spine:an in vitro biomechanical study%聚甲基丙烯酸甲酯强化对骨质疏松椎弓根螺钉固定的生物力学作用

    Institute of Scientific and Technical Information of China (English)

    樊仕才; 朱青安; 王柏川; 赵卫东; 周燕莉; 金大地; 刘大庸

    2001-01-01

    Objective To ascertain whether augmentation with polymethylmethacrylate(PMMA) bone cement can enhance pedicle screw fixation in the osteoporotic spine. Methods Sixteen cadaveric thoracolumbar vertebral bodies were obtained from 6 fresh frozen old females spines(T10- L5)at random and BMD were evaluated using DEXA. One pedicle screw of 6mm diameter (CCD) was implanted (one side). The maximum torque force was measured using torque wrench. The screws were pulled out from the vertebrae at 5 mm/min. A pedicle pilot hole was created using 3.5mm drill (the other side) and vertebral body was augmented with PMMA bone cement. Two CCD screws were implanted bilaterally. The screws were pulled out two hours later and pull out force were recorded. Results Average BMD was (0.445± 0.019)g/cm2 and the maximum torque force was (0.525± 0.104)Nm. The pull out strength of pedicle screw fixation following augmentation and restoration with PMMA averaged 310% greater than that of not augmented. Conclusion Augmentation or restoration with PMMA offered a significantly increase of strength for pedicle screw fixation in the osteoporotic spine, people with osteoporosis who must use pedicle screw fixation should augment pedicle screw with PMMA bone cement.%目的探讨聚甲基丙烯酸甲酯(polymethylmethacrylate,PMMA)骨水泥强化椎弓根螺钉的方法和评价PMMA强化骨质疏松椎弓根螺钉后的生物力学性质。方法6具新鲜老年女性胸腰段骨质疏松脊柱标本(T10~L5),使用双能X线骨密度吸收仪测试每个椎体的骨密度,随机取16个椎体(32侧椎弓根),一侧椎弓根拧入CCD螺钉,测量最大旋入力偶矩后拔出螺钉作为正常对照组,用PMMA骨水泥强化椎弓根螺钉作为修复固定组,行螺钉拔出试验;另一侧经导孔直接强化椎弓根螺钉后拔出作为强化固定组,记录三组螺钉的最大轴向拔出力。结果椎体平均骨密度为(0.445±0.019)g/cm2;螺

  20. Periprosthetic fracture fixation in osteoporotic bone.

    Science.gov (United States)

    Lenz, Mark; Lehmann, Wolfgang; Wähnert, Dirk

    2016-06-01

    Fixation techniques of periprosthetic fractures are far from ideal although the number of this entity is rising. The presence of an intramedullary implant generates its own fracture characteristics since stiffness is altered along the bone shaft and certain implant combinations affect load resistance of the bone. Influencing factors are cement fixation of the implant, intramedullary locking and extramedullary or intramedullary localization of the implant and the cortical thickness of the surrounding bone. Cerclage wires are ideally suited to fix radially displaced fragments around an intramedullary implant but they are susceptible to axial and torsional load. Screws should be added if these forces have to be neutralized. Stability of the screw fixation itself can be enhanced by embracement configuration around the intramedullary implant. Poor bone stock quality, often being present in metaphyseal areas limits screw fixation. Cement augmentation is an attractive option in this field to enhance screw purchase. PMID:27338227

  1. Close reduction and percutaneous internal fixation with hollow screw in treatment of posterior malleolus fractures%闭合复位经皮空心螺钉内固定治疗后踝骨折

    Institute of Scientific and Technical Information of China (English)

    冯青; 许效坤; 苏海涛

    2011-01-01

    目的探讨闭合复位经皮空心螺钉内固定选择性治疗后踝骨折的手术方法、适应证及临床效果.方法回顾性分析2004年7月至2010年4月期间采用闭合复位经皮空心拉力螺钉内固定治疗42例成人后踝骨折的临床资料,其中旋后-外旋型28例,旋前-外旋型6例,旋前-外展型8例.采用X线片评估骨折愈合率,采用美国足踝骨科协会(AOFAS)推荐的足踝评分系统评估踝关节功能.结果平均随访22个月(6~75个月),骨折愈合时间为6~12周.按AOFAS足踝评分系统评分,平均为96分(78~100分),优41例,可1例,优良率为97.6%.结论闭合复位经皮空心螺钉内固定是一种可用于治疗后踝骨折的微创术式,具有骨折愈合快,骨折愈合率高,踝关节功能好的优点.%Objective To investigate the indication and efficacy of close reduction and percutaneous internal fixation with hollow screws in the treatment of posterior malleolus fractures. Methods The clinical data of 42 cases of posterior malleolus fracture treated by this method from July,2004 to April ,2010 were retrospectively analyzed,including 28 cases of supination-eversion fractures,6 cases of pronation-eversion fractures and 8 cases of pronation-abduction fractures. The fracture healing rate was assessed by X-ray film and the function of the ankle joint was evaluated by foot and ankle scoring system recommended by American Orthopedic Foot & Ankle Society ( AOFAS). Results The followup averaged for 22 months (6 ~75 months). The fracture healing time ranged form 6 to 12 weeks. According to the results of foot and ankle function scores, the average score was 96 points (78 ~ 100 points), including 41 cases of excellence and 1 case of fairness, the rate of excellent and good amounting to 97.6%. Conclusion With the advantage of quick recovery, high healing rate and better healing effect, close reduction and percutaneous internal fixation with hollow screws is feasible in the treatment of

  2. True anteroposterior view pedicle screw insertion technique

    Directory of Open Access Journals (Sweden)

    Bai JY

    2016-06-01

    , and efficient technique. Keywords: true AP view, MIS-TLIF, pedicle screw, internal fixation, lumbar disc herniation

  3. Iliosacral Screw Placement With Local Anesthesia Using C T Scan

    Directory of Open Access Journals (Sweden)

    Shahriar Kamrani R

    2003-07-01

    Full Text Available Ilio-sacral screw is a technique for posterior pelvic fixation. In spite of its benefits, it had not performed commonly in Iran because of its difficulties. We changed this technique to insert the screw under CT-Scan guide with lical anesthesia to increase image quality and decrease neurological complications and performed it in two patients. In both cases the screws were inserted in correct position without any complication."n"n 

  4. Biomechanical analysis on transverse tibial fixation in anterior cruciate ligament reconstructions☆

    OpenAIRE

    Edmar Stieven Filho; Mariane Henseler Damaceno Mendes; Stephanie Claudino; Filipe Baracho; Paulo César Borges; Luiz Antonio Munhoz da Cunha

    2015-01-01

    OBJECTIVE: To verify whether the combination of tibial cross pin fixation and femoral screw fixation presents biomechanical advantages when compared to femoral cross pin fixation and tibial screw fixation for the reconstruction of the anterior cruciate ligament (ACL).METHODS: Thirty-eight porcine knees and bovine extensor digitorum tendons were used as the graft materials. The tests were performed in three groups: (1) standard, used fourteen knees, and the grafts were fixated with the combina...

  5. Arthroscopic Bony Bankart Repair Using Double-Threaded Headless Screw: A Case Report

    Directory of Open Access Journals (Sweden)

    Takeshi Kokubu

    2012-01-01

    Full Text Available We present a case of arthroscopic fixation for bony Bankart lesion using a double-threaded cannulated screw. A 39-year-old man sustained a left shoulder injury from a motorcycle accident. Radiographs showed bony Bankart lesion and CT revealed 40% defect of glenoid articular surface. Arthroscopic fixation was performed using double-threaded cannulated screw after the bony fragment was reduced by suturing the labrum at the edge with a suture anchor. Arthroscopic bony Bankart repair using double-threaded cannulated screw fixation is effective because compression force could be applied between bony fragments and the screw head is not exposed in the glenohumeral joint.

  6. Bone cement-augmented pedicle screw fixation for lumbar spondylolisthesis combined with osteoporosis:1-year follow-up%骨水泥强化椎弓根螺钉置入固定骨质疏松性腰椎滑脱:1年随访

    Institute of Scientific and Technical Information of China (English)

    丁权; 陈勇

    2015-01-01

    BACKGROUND:For patients with lumbar spondylolisthesis combined with osteoporosis, appropriate fixation system for effective reset and good fixation stability is currently a hot issue of clinical concern. Pedicle screw screw-rod system after bone cement perfusion can achieve the effective fixation between pedicle screw system and the vertebral bone. OBJECTIVE:To observe the therapeutic effect of bone cement-augmented pedicle screw on patients with lumbar spondylolisthesis combined with osteoporosis. METHODS:17 cases of lumbar spondylolisthesis combined with osteoporosis were identified by bone density test. They received the posterior open reduction and internal fixation, and implanted with 68 bone cement-augmented pedicle screws. Their repair effects were observed by short-term fol ow-up. Patients were evaluated using low back pain Visual Analog Scale and lower limb Oswestry Disability Index before treatment, 1 week, 3 months and 1 year after treatment. Vertebral height, intervertebral height, screw loosening and bone cement leakage were observed using imaging. RESULTS AND CONCLUSION:Compared with pre-treatment, low back pain Visual Analog Scale score and lower limb Oswestry Disability Index were significantly improved at 1 week, 3 months and 1 year after treatment (P0.05), which indicated that clinical repair effect could be effectively maintained. At 3 months of fol ow-up, one screw loosening occurred in two patients. During fixation, mild bone cement leakage appeared in seven vertebral bodies with screw fixation, no symptoms or subsequent complications were observed. There were no significant differences in vertebral height and intervertebral height before and after treatment and during fol ow-up (P>0.05). These results suggest that bone cement-augmented pedicle screw for patients with lumbar spondylolisthesis combined with osteoporosis can effectively reset vertebral slippage, effectively provide good anti-pul-out force for a long term, and the effect was

  7. 背侧闭合Ⅴ形截骨结合可折断钉内固定治疗Freiberg病%Freiberg's disease treated with dorsal closed Ⅴ-shaped osteotomy and Charlotte breakage screw fixation

    Institute of Scientific and Technical Information of China (English)

    陈宇; 张晖; 黄富国; 方跃; 李亚星

    2016-01-01

    Objective To evaluate the clinical outcomes of treating Freiberg's disease with dorsal wedge osteotomy and Charlotte breakage screw fixation.Methods From June 2010 to June 2014,11 patients with Freiberg's disease were treated at our department.They were 5 males and 6 females at an average age of 32 years(range,from 15 to 52 years).X-ray revealed osteosclerosis and collapse of the metatarsal head.According to Smillie classification system,there were 5 cases of stage Ⅱ and 6 ones of stage Ⅲ.The duration of symptoms was from 7 to 48 months (average,23 months).The metatarsal heads were rotated to reconstruct the joint surface.After dorsal closed V-shaped osteotomy,Charlotte breakage screws were implanted.Results All wounds healed with no complications in the early postoperative period.The 11 patients were followed up for 14 to 48 months (average,19 months),showing obvious pain relief.X-ray showed that the osteotomy sites got solid union in all patients at an average time of 10 weeks (range,from 8 to 13 weeks) after operation.Average shortening of the metatarsal was 1.5 mm (range,from 1.1 to 1.8 mm).The American Orthopaedic Foot and Ankle Society(AOFAS) score,Lesser Metatarsophalangeal-Interphalangeal Scale(LMIS) score,and range of motion at one day,one month and one year after operation were significantly improved compared with the preoperative ones (P < 0.05).Significant differences were also observed between all postoperative time points (P < 0.05).No such complications happened as referred pain from the adjacent metatarsophalangeal joint,displacement,nonunion,necrosis or infection.All patients returned to sports and recreational activities at 6 months after operation,except one case of stage Ⅲ who had constant swelling in the metatarsophalangeal joint but eventually recovered at 10 months after operation.According to patients' satisfaction at the last follow-ups,including 7 cases were excellent,3 good and one poor.Conclusion Dorsal closed V

  8. Type AO-C1 thoracolumbar vertebral fracture-dislocations:four-screw two-rod single-segment reduction fixation%AO-C1型胸腰椎骨折脱位:可选择4钉2棒置入单节段复位固定

    Institute of Scientific and Technical Information of China (English)

    唐焕章; 徐皓; 董亮; 赵晓明

    2015-01-01

    BACKGROUND:The type AO-C1 thoracolumbar acute spine injury is a kind of high-energy instable injury, can cause thoracolumbar fracture-dislocation, and mainly associated with spinal nerve injury. Generaly, al needs to posterior open reduction, decompression, bone graft fusion and multiple-segmental internal fixation of pedicle screw rod system, which causes excessive loss of spinal movement segment and a large number of application of internal fixators. OBJECTIVE:To evaluate the treatment effect of posterior pedicle screw mono-segmental internal fixation for treatment of the type AO-C1 thoracolumbar vertebrae fracture-dislocations. METHODS:From January 2008 to December 2013, 17 cases of type AO-C1 thoracolumbar fracture-dislocation were folowed up. Al patients were treated with one-stage posterior open reduction and pedicle screw-rod fixation. Of them, eight cases received four screws and two rods for single-segment fixation in upper and lower vertebrae adjacent to intervertebral space after dislocation (4-screw 2-rod group). Nine cases received eight screws and two rods for multiple-segment fixation in the upper and lower vertebrae adjacent to intervertebral space after dislocation (8-screw 2-rod group). Operative time and intraoperative blood loss were compared between the two groups. The Cobb’s angle was measured on lateral X-ray film of two groups preoperatively and 1 week postoperatively and during the final folow-up. The neurological function was evaluated by Frankel classification. The visual analogue scale was adopted to assess the degree of low back pain. RESULTS AND CONCLUSION:Patients were folowed up for 1 to 5 years. Significant differences were detected in the operative time between the two groups, and operative time was better in the 4-screw 2-rod group than in the 8-screw 2-rod group (P < 0.05). No significant difference was found in intraoperative blood loss between the two groups. The deformity of fracture-dislocation had been corrected, and the

  9. Biomechanical evaluation of an expansive pedicle screw in calf vertebrae

    Institute of Scientific and Technical Information of China (English)

    雷伟; 吴子祥

    2005-01-01

    Objective: To obtain a comprehensive understanding of the effect of the improvement of fixation strength of a newly designed expansive pedicle screw through biomechanical analyses.Metheds: 100 (200 pedicles) fresh calf lumber vertebrae were used. A total of four instrumentation systems were tested including CDH (CD Horizon), USS (Universal Spine System pedicle screw), Tenor (Sofamor Denek) and expansive pedicle screw (EPS). Pullout and turning-back tests were performed to compare the holding strength of the expansive pedicle screw with conventional screws, i.e. USS, CDH and Tenor. Revision tests were performed to evaluate the mechanical properties of the expansive pedicle screw as a "rescue" revision screw. A fatigue simulation using perpendicular load up to 1 500 000 cycles was carried out.Results: The turning back torque (Tmax) and pull-out force (Fmax) of EPS were significantly greater than those of USS, Tenor and CDH screws (6.5 mm×40 mm). In revision tests, the Fmax of both kinds of EPS (6.5 mm×40 mm; 7.0 mm×40 mm) were greater than that of CDH, USS and Tenor screws significantly (P<0.05). No screws were broken or bent at the end of fatigue tests.Conclusions: EPS can significantly improve the bone purchase and the pull-out strength compared to USS, Tenor and CDH screws with similar dimensions before and after failure simulation. The fatigue characteristic of EPS is similar to that of CDH, USS and Tenor screws.

  10. A comparative study of fixation techniques for type II fractures of the odontoid process.

    Science.gov (United States)

    Graziano, G; Jaggers, C; Lee, M; Lynch, W

    1993-12-01

    Primary screw fixation of a Type II odontoid fracture or non-union is an attractive alternative to posterior atlanto-axial arthrodesis in that normal cervical motion can be maintained. Eight cervical cadaver spines, ranging in age from 17-90 years, were used for study. Type II fractures of the dens were created using an osteotome. Simulated fractures were fixed using one or two 3.5-mm bone screws. After testing each screw fixation technique, the screws were removed and a posterior C1-C2 brooks sublaminar wiring was performed using four 18-gauge wires with wooden blocks to simulate bone graft. No significant differences were found between bending and torsional stiffnesses for the one-screw and two-screw specimens. No significant differences were found between one- and two-screw fixation when compared with primary C1-C2 wiring in torsion. One- or two-screw fixation was as stiff as primary C1-C2 wiring in bending. One or two screws offers similar stability for fixation for a dens fracture. One- and two-screw fixation is at least as stiff as primary C1-C2 wiring in torsion and one- or two-screw fixation is stiffer than primary C1-C2 wiring in bending. PMID:8303437

  11. Complicações da técnica de fixação tibial com parafuso e arruela para a reconstrução ligamentar do joelho Complications of the screw/washer tibial fixation technique for knee ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Alexandre Almeida

    2010-01-01

    Full Text Available OBJETIVO: Avaliar a presença de dor ao nível da ferida operatória e a necessidade de retirada do parafuso de fixação tibial na reconstrução do ligamento cruzado anterior (LCA do joelho e com o sexo e o índice de massa corporal (IMC. MÉTODOS: Um grupo de 265 pacientes submetidos à reconstrução do LCA com enxerto ipsilateral dos tendões flexores da coxa em que o método de fixação tibial do enxerto foi o parafuso cortical com arruela metálica entre seis de julho de 2000 e 19 de novembro de 2007. RESULTADO: 176 pacientes foram avaliados com uma média de 33,3 ± 19,5 meses (mediana de 29,5 meses (IIQ: 17-45 meses - mínima de oito e máxima de 87 meses. Não houve diferença estatística ao analisar a queixa de dor no parafuso (p = 0,272 e a necessidade de retirada do mesmo (p = 0,633 entre os sexos. Não houve diferença estatística ao analisar a queixa de dor no parafuso (p = 0,08 e a necessidade de retirada do mesmo (p = 0,379 ao analisar o IMC. CONCLUSÕES: A utilização do parafuso e arruela metálica para fixação tibial na reconstrução do LCA demonstrou um índice de queixa de dor no sítio do parafuso na ordem de 25% e necessidade de sua retirada em 10,8% dos casos. Não houve predominância de queixas de dor na ferida operatória entre os sexos. Observou-se uma tendência a maior queixa de dor entre indivíduos com IMC OBJECTIVE: To evaluate the presence of pain at the site of the surgical incision and the need to remove the tibial fixation screw after arthroscopic anterior cruciate ligament (ACL reconstruction in relation to sex and body mass index (BMI. METHODS: A group of 265 patients who underwent ACL reconstruction with ipsilateral flexor tendon grafts from the thigh using a screw and washer as the tibial fixation technique between July 2000 and November 2007 . RESULTS: 176 patients were evaluated for an average of 33.3 ± 19.5 months (median of 29.5 months (IIQ: 17- 45 months - minimum of 8 and maximum of 87

  12. 金属铰链外固定支架与有限针钉置入内固定治疗肘关节"恐怖三联征"%Metal hinged elbow external fixator combined with pins and screw fixation for treatment of "terrible triad of the elbow"

    Institute of Scientific and Technical Information of China (English)

    赵王林; 杨海韵; 吴征杰

    2011-01-01

    BACKGROUND: The previous treatment of elbow dislocations associated with radial head and coronoid fractures (terrible triad of the elbow) are often poor because of recu rrent instability, stiffness and other complications from prolonged immobilization.OBJECTIVE: To observe the clinical efficacy on treatment of the terrible triad of the elbow with hinged elbow external fixator with limited internal fixation .METHODS: A total of 14 cases received the terrible triad of the elbow treatment from April 2006 to June 2010 at Foshan Hospital of Traditional Chinese Medicine, were collected. The patients were treated with metal hinged elbow external fixator combined with pin and screw fixation. All patients were followed up for ≥ 5 months, complained of illness, elbow range of motion, the forearm rotating activity, joint stability and radiographs were recorded. Mayo Elbow Performance Score (MEPS) was used to evaluate the function of elbow.RESULTS AND CONCLUSION: No patient complained pain, instability and no superficial and deep tissue infections occurred at the last follow-up. The mean fracture healing time was (11.30±3.25) weeks. The average range of elbow flexion-extension were (125.42±19.66)° (75°-145°), and forearm pronation-supination were (135.43±17.07)° (80°-150°). Two cases of brain injury occurred a small amount of ossification in anterior cubital soft tissue, did not affect the joint motion. The functional outcome was excellent in 7, good in 5 and fair in 2 according to MEPS, the fine and good rate was 86%. Hinged elbow external fixator combined with pins and screw fixation can improve the initial stability, conducive to the elbow of the center of concentric reduction and soft tissue repair and facilitate early functional exercise, eliminate the problem of secondary surgery.%背景:以往治疗肘关节后脱位伴桡骨头及尺骨冠状突骨折(肘关节恐怖三联征)的手术方法需要长期制动而常常导致肘关节复发性不稳定、

  13. The efficacy comparison between hollow screw fixation and head and tail nail fixation treatment for the elderly femoral neck fractures%空心拉力螺钉内固定与首尾钉内固定治疗老年人不同类型股骨颈骨折疗效比较

    Institute of Scientific and Technical Information of China (English)

    郝应文; 唐军伟

    2014-01-01

    Objective To analyze and compare the efficacies of internal fixation by the cancellous bone screw and by the head and tail nail in the treatment of femoral neck fracture of the elderly. Methods 103 cases of elderly femoral neck fractures who were followed up for more than one year accepted the retrospective analysis. They were divided into group A(n=55)and group B(n=48)according to the treatment they received. Group A was treated by cancellous bone screw,and group B was treated by head and tail nail. The efficacy was evaluated by Harris score. Results There was no statistical difference in the efficacy of the treatment between two groups( P >0. 05)and Harris score was improved in each type of femoral neck fracture. However,the excellent rate was higher in group A than in group B(91. 2% vs. 62. 5%)for subcapital type ( P 0. 05),and lower in group A than in group B(66. 7% vs. 95. 0%) ( P 0.05)。两组患者不同类型术后髋关节Harris评分均有不同程度的改善。头下型骨折:A组优良率为91.2%,B组优良率为62.5%,A组优良率高于B组( P 0.05);基底型骨折:A组优良率为66.7%,B组优良率为95.0%,B组优良率高于A组( P <0.05)。结论空心拉力螺钉内固定与首尾钉内固定治疗老年人股骨颈骨折,都可以达到良好的骨折复位效果,头下型骨折空心拉力螺钉内固定效果更优,基底型骨折首尾钉内固定效果更优。

  14. Vertebral and inter-vertebral screw fixation for treating thoracolumbar compression fracture:a long-term follow-up of spinal stability%经伤椎和跨伤椎螺钉置入固定胸腰椎压缩性骨折:脊柱稳定性长期随访

    Institute of Scientific and Technical Information of China (English)

    谢申; 祝少博

    2016-01-01

    BACKGROUND: Posterior pedicle screw fixation is a common method for treatment of thoracolumbar compression fractures. The fixation method contains long-segment fixation, short-segment fixation and vertebral fixation. Clinical effects of vertebral fixation and inter-vertebral short-segment fixation for treating thoracolumbar fractures remain unclear. OBJECTIVE: To compare the stability of posterior vertebral fixation and inter-vertebral pedicle screw fixation for treating thoracolumbar compression fractures. METHODS: Clinical data of 46 patients with thoracolumbar compression fractures were retrospectively analyzed. According to the fixation methods, they were divided into the vertebral fixation group (n=21) and inter-vertebral fixation group (n=25). The operation time, intraoperative bleeding, intraoperative blood transfusion, the time of lying in bed, vertebral Cobb angle, anterior vertebral height and visual analog scores were evaluated for a long time. RESULTS AND CONCLUSION: (1) During repair, in both groups, operation time, intraoperative bleeding and intraoperative blood transfusion were better in the inter-vertebral fixation group than in the vertebral fixation group (P < 0.05-0.01). The time of lying in bed was better in the vertebral fixation group than in inter-vertebral fixation group (P < 0.01). (2) No significant difference in Cobb angle and anterior vertebral height was detected before and after treatment and during repair in both groups, but final fol ow-up and fol ow-up loss were better in the vertebral fixation group than in inter-vertebral fixation group (P < 0.05-0.01). (3) No significant difference in visual analog scores was detected before and after treatment in both groups. Visual analog scores were better in the vertebral fixation group than in the inter-vertebral fixation group (P <0.01). (4) These results suggested that the two fixation methods obtained satisfactory repair effects in long-term fol ow-up. The dominance in maintaining the

  15. Gastrotomy closure using bioabsorbable plugs in a canine model.

    Science.gov (United States)

    Cios, Theodore J; Reavis, Kevin M; Renton, David R; Hazey, Jeffrey W; Mikami, Dean J; Narula, Vimal K; Allemang, Matthew T; Davis, S Scott; Melvin, W Scott

    2008-04-01

    The repair of gastric perforation commonly involves simple suture closure using an open or laparoscopic approach. An endolumenal approach using prosthetic materials may be beneficial. The role of bioprosthetics in this instance has not been thoroughly investigated, thus the authors evaluated the feasibility of gastric perforation repair using a bioabsorbable device and quantified gross and histological changes at the injury site. Twelve canines were anesthetized and underwent open gastrotomy. A 1-cm-diameter perforation was created in the anterior wall of the stomach and plugged with a bioabsorbable device. Intralumenal pH was recorded. Canines were sacrificed at one, four, six, eight, and 12 weeks. The stomach was explanted followed by gross and histological examination. The injury site was examined. The relative ability of the device to seal the perforation was recorded, as were postoperative changes. Tissue samples were analyzed for gross and microscopic tissue growth and compared to normal gastric tissue in the same animal as an internal control. A scoring system of -2 to +2 was used to measure injury site healing (-2= leak, -1= no leak and minimal ingrowth, 0= physiologic healing, +1= mild hypertrophic tissue, +2= severe hypertrophic tissue). In all canines, the bioprosthesis successfully sealed the perforation without leak under ex vivo insufflation. At one week, the device maintained its integrity but there was no tissue ingrowth. Histological healing score was -1. At 4-12 weeks, gross examination revealed a healed injury site in all animals. The lumenal portion of the plug was completely absorbed. The gross and histological healing score ranged from -1 to +1. The application of a bioabsorbable device results in durable closure of gastric perforation with physiologic healing of the injury site. This method of gastrotomy closure may aid in the evolution of advanced endoscopic approaches to perforation closure of hollow viscera.

  16. A Novel Blasted and Grooved Low Profile Pedicle Screw Able to Resist High Compression Bending Loads

    OpenAIRE

    Kuh, Sung-Uk; Kim, Young-Sung; Choi, Hong-June; Kim, Kyung-Hyun; Park, Jeong-Yoon; Jeong, Hyun-Yong; Chin, Dong-Kyu; Kim, Keun-Su; Yoon, Young-Sul; Lee, Yoon-Chul; Cho, Yong-Eun

    2012-01-01

    Objective Polyaxial pedicle screws are a safe, useful adjunct to transpedicular fixation. However, the large screw head size can cause soft tissue irritation, high rod positioning, and facet joint injury. However, the mechanical resistance provided by small and low profile pedicle screws is very limited. We therefore developed a novel, low profile pedicle screw using grooving and blasting treatment that is able to resist a high compression bending load. Methods We evaluated the compression be...

  17. 不同前路中空加压螺纹钉内固定治疗Ⅱ型齿突骨折的生物力学评价%Biomechanical evaluation of internal fixation of different anterior canulated screws for the treatment of type odontoid fracture

    Institute of Scientific and Technical Information of China (English)

    韩国伟; 刘少喻; 赵卫东; 于滨生; 梁春祥; 陈柏龄; 李浩淼; 魏福鑫

    2009-01-01

    BACKGROUND:Antedor canulated screw has been considered an ideal method to treat odontoid fracture.OBJECTIVE:To compare the biomechanical properties of different anterior screws.DESIGN,TIME AND SETTING:A randomized contrast study was performed at the Biomechanics Laboratory of Southern Medical University from March to September 2006.MATERIALS:Double-thread canulated screws and single-thread canulated screws were made of titanium alloy and provided by Shuangyang Medical Apparatus Co.,Ltd.,Suzhou.METHODS:A total of head-neck complexes (C0-C3) which were collected from 20 corpses were maintained in formaldehyde for less than 3 months;thereafter,the muscles and ligaments were removed to obtain the axis specimens so as to make type Ⅱ odontoid fracture models.The fracture samples were individually treated with double-thread and single-thread canulated screws,with 10 samples for each group.MAIN OUTCOME MEASURES:The shear stiffness and the maximum resistance of the two kinds of screw were tested in this study.RESULTS:The shear stiffness of the double-thread screw group was significantly higher than the single-thread screw group (P<0.01 );however,there was no significant different in the maximum resistance between the two groups (P>0.05).CONCLUSION:Double-thread canulated screws have a strong biomechanical stability for treating odontoid fracture;therefore,the first choice of the internal fixation should be double-thread canuiated screws for patients with osteoporosis or those who are susceptible to expanded screw pathway during surgical procedures.%背景:目前前路中空加压螺钉固定被认为是治疗齿突骨折的较理想方法.目的:比较不同前路内固定螺钉的生物力学特性.设计、时间及地点:随机分组设计,对比观察,于2006-03/09在南方医科大学生物力学实验室完成.材料:双头螺纹中空加压螺钉和单头螺纹中空加压螺钉均为钛合金材料,由苏州双羊医疗器械有限公司生产制作.方法:20

  18. 胸、腰椎椎体结核病椎置钉短节段内固定的疗效分析%Efficacy analysis of short segmental screw fixation on the decayed vertebral of thoracolumbar tuberculosis

    Institute of Scientific and Technical Information of China (English)

    王兵站; 谭洪宇; 廖文波; 刘培太; 刘屹林; 王利民

    2015-01-01

    Objective To explore the effectiveness of short segmental screw fixation and bone graft fusion on the decayed vertebral of thoracolumbar tuberculosis.Methods A total of 46 cases undergone one stage anterior debridement,interbody fusion,screw fixation on the decayed vertebral of thoracolumbar tuberculosis were retrospectively analyzed from June 2009 to November 2013.Including 25 males and 21 females,with the mean age of 39.6 years (range,13-69 years).Lesion segments:T6-L4 (segment lesions ≤ 3 segments); 3 B gradecases,6 C grade cases,4 D grade cases and 33 E grade cases assessmed by Frankel grade.The average Cobb angle of kyphosis was 16.34°±3.19° and ESR:19-81 mm/1 h preopration.CT scan and Two-dimensional reconstruction were done before operation,and the effective height of front and middle pillar of residual thoracolumbar vertebral in coronal and sagittal position were measured before operation,when the minimum effective height was higher than 10 mm,combined the intraoperative visual,the appropriate internal fixation for anterior debridement and interbody bone grafting were choosed.The cobb angle,the Frankel grade,the ESR and VAS value were compared with preoperative and postoperative.The stability and bone graft fusion were also observed.Results Fourty-six cases of patients were received followed up from 12 to 48 months,an average of 26 months.All patients with tuberculosis poisoning symptoms disappeared.The ESR:0-15 mm/1 h.Frankel rating at the end of postoperative follow-up:2 D-class cases,44 E-class cases.The VAS score (6.85± 1.22,4.49±0.95 vs.2.06±0.93) and vertebral Cobb angle (16.34°±3.19°,4.16°±2.71° vs.4.52°±1.29°) at post-operation 7 d and the last follow-up were significant lower than those at pre-operation,while the ESR (41.25±1.61 mm/1 h,17.36±6.82 mm/1 h vs.10.67±0.72 mm/1 h) was reduced to normal levelthan that of pre-operation.The comparative difference was statistically significant between pre-operative and post

  19. Posterior cervical spine arthrodesis with laminar screws: a report of two cases

    OpenAIRE

    Nakanishi, Kazuo; Tanaka, Masato; Sugimoto, Yoshihisa; Ozaki,Toshifumi

    2007-01-01

    We performed fixation using laminar screws in 2 patients in whom lateral mass screws, pedicle screws or transarticular screws could not be inserted. One was a 56-year-old woman who had anterior atlantoaxial subluxation (AAS). When a guide wire was inserted using an imaging guide, the hole bled massively. We thought the re-insertion of a guide wire or screw would thus increase the risk of vascular injury, so we used laminar screws. The other case was an 18-year-old man who had a hangman fractu...

  20. Arthroscopic fixation with screws versus sutures for anterior cruciate ligament tibial avulsion fractures%关节镜下螺钉与缝线固定前交叉韧带胫骨止点撕脱骨折的疗效比较

    Institute of Scientific and Technical Information of China (English)

    王庆; 黄华扬; 张涛; 沈洪园; 郑小飞; 李凭跃; 区永亮

    2015-01-01

    Objective To compare the curative effects between arthroscopic screw and suture fixations for anterior cruciate ligament (ACL) tibial avulsion fractures.Methods From November 2007 to November 2012,41 patients with ACL tibial avulsion fracture underwent arthroscopy at our department.They were 32 males and 9 females,8 to 43 years of age (average,18.3 years).By the Meyers-McKeever-Zaricznyj classification,12 cases were type Ⅱ and 29 type Ⅲ.There were 19 cases in the screw fixation group,including 14 males and 5 females,9 to 42 years of age (average,18.9 years).The suture fixation group had 22cases,including 16 males and 6 females,8 to 43 years of age (average,17.8 years).Operation time,knee range of motion (ROM),case of flexion contracture,Lysholm score,international knee documentation committee (IKDC) score,and side-to-side mobile difference by KT-2000 were evaluated.The 2 groups were similar in age,gender,fracture type and time from injury to surgery (P > 0.05).Results The operation time for the suture fixation group (58.9 ±6.7 min) was significantly longer than that for the screw fixation group (51.6±6.2 min) (P < 0.05).There were no significant differences between the 2 groups regarding the Lysholm score (96.2 ± 2.83 for the screw fixation group versus 95.5 ± 2.6 for the suture fixation group),the IKDC score (91.4 ± 6.4 for the screw fixation group versus 88.1 ± 7.5 for the suture fixation group),the side-to-side mobile difference by KT-2000 (2.7 ± 2.6 mm for the screw fixation group versus 2.8 ± 2.7 mm for the suture fixation group (P < 0.05).Flexion contracture of ≥ 5° occurred in 3 cases in the screw fixation group and 2 cases in the suture fixation group,showing no significant difference (P > 0.05).Conclusions In treatment of ACL tibial avulsion fractures of types Ⅱ and Ⅲ,there is no significant difference between arthroscopic screw fixation and suture fixation,because both methods can achieve good stability and functional recovery

  1. 一期韧带修复联合拉力螺钉固定治疗踝关节不稳的疗效观察%Efficacy of phase Ⅰ ligament repair combined with lag screw fixation for ankle instability

    Institute of Scientific and Technical Information of China (English)

    罗静涛; 韩铭

    2015-01-01

    Objective To evaluate the clinical efficacy of phase Ⅰ ligament repair combined with lag screw fixation for ankle instability. Methods From Jan. 2011 to Jun. 2013, 34 patients with acute ankle sprain, including 18 males and 16 females, aged 28. 0 to 69. 0 years (mean 49. 3 years), were randomly divid-ed into external fixation group and screw fixation group (n=17 each), given external fixation with plaster or brace, and phase Ⅰ line of rivets in-situ repair combined with lag screw, respectively. All lesion limbs were not weight-bearing and followed up for 3 months. Hospital costs and complications were observed. Therapeutic effect was evaluated by AOFAS and VAS score. Results The cost of hospitalization was (1. 72±0. 30) ten thousand yuan in screw fixation group, and (0. 68±0. 20) ten thousand yuan in external fixation group (P<0. 05). AOFAS scores at 1st, 2nd, and 3rd month during the followed-up period were (66. 2±1. 3), (88. 5±2. 1) and (97. 2 ±1. 9) in screw fixation group, and (46. 8±1. 6), (53. 5±2. 7) and (75. 6±1. 2) in external fixation group (P<0. 05), respectively. VAS scores at 1st, 2nd, and 3rd month during the followed-up period were (3. 2 ± 0. 8), (2. 5±0. 6) and (1. 2±0. 2) in screw fixation group, and (4. 0±0. 7), (3. 1±0. 6) and (2. 6±0. 4) in external fixation group (P<0. 05), respectively. There was no screw cut out, nails broken, traumatic arthritis, inferior tibiofibular instability and other complications in screw fixation group. In external fixation group, 2 patients complained of ankle stiffness that eased after exercise and physiotherapy, and 4 patients administered phase Ⅱ ankle ligament reconstruction due to pain and instability in the knee. Conclusion Phase Ⅰ ligament repair combined with lag screw fixation for acute ankle instability manifests excellent postop-erative ankle function and fewer complications, although the cost of hospitalization is higher. It is a practicable procedure for ankle sprains.%目的:

  2. Lumbar pedicle cortical bone trajectory screw

    Institute of Scientific and Technical Information of China (English)

    Song Tengfei; Wellington K Hsu; Ye Tianwen

    2014-01-01

    Objective The purpose of this study was to demonstrate the lumbar pedicle cortical bone trajectory (CBT) screw fixation technique,a new fixation technique for lumbar surgery.Data sources The data analyzed in this review are mainly from articles reported in PubMed published from 1994 to 2014.Study selection Original articles and critical reviews relevant to CBT technique and lumbar pedicle fixation were selected.Results CBT technique was firstly introduced as a new fixation method for lumbar pedicle surgery in 2009.The concepts,morphometric study,biomechanical characteristics and clinical applications of CBT technique were reviewed.The insertional point of CBT screw is located at the lateral point of the pars interarticularis,and its trajectory follows a caudocephalad path sagittally and a laterally directed path in the transverse plane.CBT technique can be used for posterior fixation during lumbar fusion procedures.This technique is a minimally invasive surgery,which affords better biomechanical stability,fixation strength and surgical safety.Therefore,CBT technique has the greatest benefit in lumbar pedicle surgery for patients with osteoporosis and obesity.Conclusion CBT technique is a better alternative option of lumbar pedicle fixation,especially for patients with osteoporosis and obesity.

  3. Effect of Different Distal Fixation Augmentation Methods on the Pullout Strength of Fassier-Duval Telescoping Rods.

    Science.gov (United States)

    Mansour, Alfred; Barsi, James; Baldini, Todd; Georgopoulos, Gaia

    2016-01-01

    Antegrade telescoping rods have been introduced for use in pediatric patients with osteogenesis imperfecta (OI) to decrease the incidence of long-bone fractures and to correct and prevent deformities. Recent studies have documented failures of telescoping intramedullary rods due to inadequate distal fixation. The purpose of this study was to evaluate the pullout strength of distal fixation of the telescoping rod with and without synthetic calcium phosphate or polymethylmethacrylate (PMMA) augmentation. Four sets of 6 telescoping distal fixation rods were fixed according to standard insertion technique into an open-cell rigid-foam synthetic bone block simulating OI bone. The groups tested were as follows: control (no augmentation), 0.75 mL of PMMA-augmented, 0.75 mL of PMMA-rescued (stripped distal fixation, then resecured after PMMA augmentation), and 0.75 mL of bioabsorbable-calcium phosphate (CP)-augmented. All rods were tested to failure. The peak load was recorded. Average pullout strengths were as follows: control, 20±6.6 N; PMMA, 125±16.8 N; PMMA-rescued, 137±11.9 N; bioabsorbable-CP, 81±10.3 N. All augmented groups had significantly higher pullout strength compared with the control (P<.001). The PMMA and PMMA-rescued groups failed at the PMMA/bone interface, whereas the bioabsorbable-CP group failed at the cement/rod interface. All augmented constructs improved pullout strength by at least 400% compared with the control. Bioabsorbable cement may be less detrimental to the physis if pullout still occurs despite augmentation due to its mode of failure. This study provides biomechanical evidence to support the further in vivo investigation of either PMMA or bioabsorbable cement augmentation to improve pullout strength of distal telescoping rod fixation.

  4. The use of rigid internal fixation in the surgical management of cervical spondylosis.

    Science.gov (United States)

    Kwon, Brian K; Vaccaro, Alexander R; Grauer, Jonathan N; Beiner, John M

    2007-01-01

    In the surgical management of cervical spondylosis, the application of rigid internal fixation can enhance the immediate stability of the cervical spine. The sophistication of such internal fixation systems and the indications for their use are continuously evolving. A sound understanding of regional anatomy, biomechanics, and kinematics within the cervical spine is essential for the safe and effective application of internal fixation. Numerous options currently exist for anterior cervical plating systems; some lock the screws to the plate rigidly (constrained), whereas others allow for some rotational or translational motion between the screw and plate (semiconstrained). The role of anterior fixation in single and multilevel fusions is still the subject of some controversy. Long anterior cervical reconstructions may require additional posterior fixation to reliably promote fusion. Rigid fixation in the posterior cervical spine can be achieved with lateral mass screws or pedicle screws. Although lateral mass screws provide excellent fixation within the subaxial cervical spine, the regional anatomy of C2 and C7 often make it difficult to place such screws, and pedicle screws at these levels are advocated. Pedicle screws achieve fixation into both the anterior and posterior column and are arguably the most stable form of rigid internal fixation within the cervical spine. Familiarity with these internal fixation techniques can be an extremely valuable tool for the spine surgeon managing these degenerative disorders of the cervical spine.

  5. 椎弓根螺钉置入内固定与单纯椎管减压治疗退行性腰椎滑脱的比较%Comparison of pedicle screw fixation and simple vertebral canal decompression in the treatment of lumbar degenerative spondylolisthesis

    Institute of Scientific and Technical Information of China (English)

    刘保华; 王沛; 夏群; 冯世庆; 郑永发; 李冰

    2011-01-01

    of pedicle screw fixation and fusion in treatment of degenerative spondylolisthesis, and to compare with simple vertebral canal compression.METHODS: A total of 38 patients with lumbar degenerative spondylolisthesis received treatment at the Department of Orthopaedics, General Hospital of Tianjin Medical University were selected, and 3 patients were lost in follow-up. Of the remaining 35 cases, 21 cases underwent pedicle screw fixation posterolateral fusion and 14 cases underwent simple vertebral canal decompression. Simple vertebral canal compression group treated with the rongeur bite yellow ligament and lamina to relieve nerve root compression, forward vertebral slippage of adjacent vertebral body with posterior inferior formation relative prominence was chiseled with osteotome. According to Wein-stein method pedicle screw into the needle localization, then screw into the pedicle screw and undergo vertebral plate decompression on the basis of compression condition in pedicle screw fixation and fusion group. The clinical effect underwent comprehensive evaluation of oswestry dysfunction index; horizontal displacement and angular displacement were observed at hyperextension and flexion time. Degenerative condition of adjacent segment was evaluated by UCLA system.RESULTS AN D CONCLUSION : A total of 35 patients were followed up for 1 year. The excellent rate in pedicle screw fixation and fusion group was significantly higher than that in simple vertebral canal compression group (P < 0.05). Pedicle screw fixation and fusion has little effect on the stability of lumbar. There was no significant change in adjacent segment before degenerative insertion and 1 year after insertion. Simple vertebral canal compression had a significant effect on the stability of lumbar, and there was no significant change in adjacent segment degeneration before treatment and 1 year after treatment. It is indicated that pedicle screw fixation and fusion has satisfying effects in treatment of

  6. The Curative Effect of Pedicle Screw Fixation by Wiltse Approach on Lumbar Disc Herniation%Wiltse入路椎弓根螺钉固定治疗腰椎间盘突出症的疗效观察

    Institute of Scientific and Technical Information of China (English)

    杨剑; 康建平; 王松; 雷飞

    2014-01-01

    Objective To compare the clinical curative effect of pedicle screw fixation by Wiltse approach with that of traditional lumbar interbody fusion by posterior median approachon lumbar disc herniation(LDH). Methods 285 cases with lumbar disc hernia-tion received surgical treatment and were randomly divided into 2 groups:group A(Wiltse approach)(n=120)and group B(posterior median approach)(n=165); a comparative study was made between the 2 groups in bleeding in operation, time length of operation, postoperative complications, postoperative time in bed,the fusion rate;Visual Analogue Pain Score(VAS), Oswestry Disability Index (ODI)and Japanese Orthopaedic Association(JOA)were applied in the follow-up before and after operation and the results were statis-tically analyzed. Results Group A was superior to group B in bleeding in operation, time length of operation, postoperative complica-tions, postoperative time in bed,the scores of VAS and ODI in the last follow-up(P0.05);the VAS scores, ODI scores and JOA scores of both group in the last follow-up were more improved than those before operation. Conclusions Pedicle screw fixation by Wiltse approach and tradi-tional lumbar interbody fusion by posterior median approach both are effective on LDH while the former is of such advantages as less bleeding, small wound, shorter operation time, lower occurrence of complications and lower residual rate of low back pain.%目的:比较Wiltse入路(肌间隙入路)椎弓根螺钉固定融合术(A组)与传统腰椎后正中入路椎间融合术(B组)治疗腰椎间盘突出症(Lumbar disc herniation, LDH)的临床疗效。方法285例腰椎间盘突出症接受手术治疗的患者分为两组,A组120例,B组165例。比较两种手术入路术中出血量、手术时间、术后并发症,术后卧床时间、融合率,术前、术后随访均应用腰痛和腿痛视觉模拟(Visual analogue pain score,VAS)评

  7. 颈后路多节段椎弓根螺钉内固定术与颈前路钢板内固定术治疗Hangman骨折疗效对比分析%The Efficacy Comparison of Internal Fixation by Multilevel Pedicle Screw in Posterior and Internal Fixation by Steel Plate in Anterior on Treating ;Hangman Fracture

    Institute of Scientific and Technical Information of China (English)

    李军

    2014-01-01

    目的:观察比较Hangman骨折采用颈后路多节段椎弓根螺钉内固定术与颈前路钢板内固定术的疗效。方法:选取笔者所在医院2010年6月-2013年6月收治的Hangman骨折患者45例,按照随机数字表法分成颈后路组23例和颈前路组22例。比较两组患者手术时间及术中出血量,手术治疗产生的并发症,术后骨折的痊愈程度及恢复脊髓功能的情况。结果:两组患者手术时间、术中出血量、术后骨折痊愈的程度及恢复脊髓功能的情况比较差异均无统计学意义(P>0.05)。颈后路组的并发症总发生率(4.35%)明显低于颈前路组的并发症总发生率(31.82%),两组比较差异有统计学意义(P0.05).The overall incidence of complications in posterior group(4.35%) was significantly lower than anterior group(31.82%),and the difference between the two groups was statistically significant(P<0.05).Conclusion:The ideal method for treating Hangman fracture is internal fixation by multilevel pedicle screw in posterior.

  8. Reinforcement of osteosynthesis screws with brushite cement.

    Science.gov (United States)

    Van Landuyt, P; Peter, B; Beluze, L; Lemaître, J

    1999-08-01

    The fixation of osteosynthesis screws remains a severe problem for fracture repair among osteoporotic patients. Polymethyl-methacrylate (PMMA) is routinely used to improve screw fixation, but this material has well-known drawbacks such as monomer toxicity, exothermic polymerization, and nonresorbability. Calcium phosphate cements have been developed for several years. Among these new bone substitution materials, brushite cements have the advantage of being injectable and resorbable. The aim of this study is to assess the reinforcement of osteosynthesis screws with brushite cement. Polyurethane foams, whose density is close to that of cancellous bone, were used as bone model. A hole was tapped in a foam sample, then brushite cement was injected. Trabecular osteosynthesis screws were inserted. After 24 h of aging in water, the stripping force was measured by a pull-out test. Screws (4.0 and 6.5 mm diameter) and two foam densities (0.14 and 0.28 g/cm3) were compared. Cements with varying solid/liquid ratios and xanthan contents were used in order to obtain the best screw reinforcement. During the pull-out test, the stripping force first increases to a maximum, then drops to a steady-state value until complete screw extraction. Both maximum force and plateau value increase drastically in the presence of cement. The highest stripping force is observed for 6.5-mm screws reinforced with cement in low-density foams. In this case, the stripping force is multiplied by 3.3 in the presence of cement. In a second experiment, cements with solid/liquid ratio ranging from 2.0 to 3.5 g/mL were used with 6.5-mm diameter screws. In some compositions, xanthan was added to improve injectability. The best results were obtained with 2.5 g/mL cement containing xanthan and with 3.0 g/mL cements without xanthan. A 0.9-kN maximal stripping force was observed with nonreinforced screws, while 1.9 kN was reached with reinforced screws. These first results are very promising regarding screw

  9. 颈后路全椎板减压侧块螺钉内固定治疗颈椎后纵韧带骨化症的疗效观察%The efficacy of posterior laminectomy and lateral mass screw fixation on cervical ossification of the posterior longitudinal ligament

    Institute of Scientific and Technical Information of China (English)

    郑华伟

    2013-01-01

    目的对比观察后路单开门椎管扩大成形术和全椎板减压侧块螺钉内固定术治疗颈椎后纵韧带骨化症(OPLL)的疗效,评价后者的临床应用价值。方法纳入2008年6月至2012年3月间本院收治的颈椎后纵韧带骨化症患者28例,其中男19例,女9例,年龄41~79岁,平均56.5岁,病程12~35个月,平均22.5个月。所有患者随机分为两组:Ⅰ组14例,行颈后路单开门椎管扩大成形术;Ⅱ组14例,行全椎板减压侧块螺钉内固定术。术后随访,观察并比较两组患者术后神经功能恢复及颈部轴性症状发生情况。结果所有患者均获得随访,随访时间12~36个月,平均25.2个月。Ⅰ组、Ⅱ组神经功能改善率分别为(58.3±18.4)%、(62.9±15.4)%,差异无统计学意义(P>0.05)。Ⅱ组患者颈部轴性症状的发生率21.4%(3/14)明显低于Ⅰ组64.3%(9/14),差异有统计学意义(P<0.05)。结论颈后路全椎板减压侧块螺钉内固定治疗颈椎后纵韧带骨化症疗效肯定,能明显降低术后轴性症状的发生率。%Objective To compare the efficacy of posterior unilateral open-door laminoplasty versus posterior laminectomy and lateral mass screw fixation for cervical ossification of the posterior longitudinal ligament(OPLL). Methods From June 2008 to March 2012, 28 patients with cervical OPLL including 19 males and 9 females were randomly divided into two groups: patients in open-door laminoplasty group were treated with posterior unilateral open-door laminoplasty, those in lateral mass screw group were treated with posterior laminectomy and lateral mass screw fixation. Nerve function recovery and incidence of axial symptoms during the follow-up were evaluated and compared between the two groups. Results All patients were followed up for 12 to 36 months with the mean of 25.2 months. There was no significant difference in the improvement rate of nerve function recovery JOA score between the two

  10. 改良MI-TLIF联合经皮椎弓根钉固定治疗退行性腰椎侧弯%Treatment of degenerative lumbar scoliosis by using modified MI-TLIF and percutaneous pedicle screw fixation

    Institute of Scientific and Technical Information of China (English)

    尹知训; 何二兴; 崔基浩; 吴梅祥; 石中玉; 刘超杰

    2014-01-01

    治疗的有效方法。%Objective To discuss the operative essentials and therapeutic effects of modified minimally invasive-transforaminal lumbar interbody fusion (MI-TLIF) combined with percutaneous pedicle screw fixation for degenerative lumbar scoliosis (DLS). Methods From march 2012 to march 2014, 32 DLS patients were treated by modified MI-TLIF (concave-side distraction step by step, cage insertion into the curved side of intervertebral space, and bone graft fusion) and percutaneous pedicle screw fixation in the First and Fouth Affiliated Hospital of Guangzhou Medical College. Incision length, operative time, intraoperative estimate blood loss and hospital stay were recorded, Cobb's angle, lordosis angle and spinal imbalance distances on coronal and sagittal plane were measured according to preoperative and postoperative spinal full-length radiographs, postoperative improvement of low back and leg pain were evaluated by visual analogue scale (VAS) and Oswestry disability index (ODI) scoring, clinical effects were assessed according to Nakai standard. Results Incision length was 4.2-5.3 cm with the average of 4.5 cm, operative time was 85-165 min with the average of 110 min, intraoperative estimate blood loss was 120 mL (90-300 mL) and the hospital stay was 14.5 d (11-17 d). Thirty patients were followed-up for 12.5 months (4-23 months). No pedicle screw-rod breakage or cage displacement were found. Compared with preoperative and the last follow-up, the following results had statistical differences (P<0.05):VAS of low back pain and leg pain decreased from (6.8 ± 2.3), (7.5 ± 2.2) to (1.9 ± 1.3), (2.4 ± 1.5) respectively, ODI improved from (41.4 ± 2.7)% to (13.6 ± 2.5)%; Cobb's angle decreased from (33.7 ± 3.5)° to (10.1 ± 2.3)°, lordosis angle deviation decreased from (22.6 ± 8.0)° to (3.3 ± 1.4)°; Imbalance distance on sagittal plane and coronal plane improved from (46.8 ± 9.8), (29.3 ± 7.8) mm to (19.7 ± 7.6), (10.7 ± 6.3) mm respectively. According to Macnab standard, there

  11. Posterior pedicle screw fixation and interbody fusion in the treatment of recurrent lumbar disc herniation:an evaluation of vertebral stability%后路钉棒内固定椎间融合治疗复发性腰椎间盘突出症:椎体稳定性评价

    Institute of Scientific and Technical Information of China (English)

    刘凤松; 王凯; 景成伟; 张亮; 刘宾; 杨亚林

    2014-01-01

    BACKGROUND:Discectomy is an important therapy for lumbar disc herniation, but a smal number of patients undergoing discectomy wil relapse. OBJECTIVE:To investigate the spinal stability fol owing posterior pedicle screw fixation combined with interbody fusion cage for treatment of recurrent lumbar disc herniation. METHODS:Twenty-six patients with recurrent lumbar disc herniation from January 2007 to December 2011 were enrol ed and subjected to posterior pedicle screw fixation combined with interbody fusion cage. Pain relief and lumbar stability were observed postoperatively. We analyzed the spinal stability in recurrent lumbar disc herniation patients after posterior pedicle screw fixation combined with interbody fusion cage depending on literature search. RESULTS AND CONCLUSION:Al the 26 patients were fol owed up for 12-36 months. After treatment, al patients effectively al eviated the symptoms of low back pain, and lumbar interbody fusion was good, with a good rate of 96.2%. There was no pedicle screw loosening, broken, non-fusion phenomenon. Posterior decompression and interbody fusion cage combined with posterior pedicle screw fixation for recurrent lumbar disc herniation, characterized as fast symptom relief, strong fixation, exact interbody fusion exact, is an ideal treatment for recurrent lumbar disc herniation.%背景:腰椎间盘突出症治疗的重要方法是椎间盘切除,但有少部分患者会出现复发现象。  目的:探讨后路椎弓根钉棒内固定联合cage植入椎间融合治疗复发性腰椎间盘突出症后的脊柱稳定性。  方法:选择2007年1月至2011年12月复发性腰椎间盘突出症患者26例,应用后路减压cage植入椎间融合加钉棒系统内固定治疗复发性腰椎间盘突出症进行再手术治疗,观察患者治疗后疼痛症状缓解情况以及腰椎稳定性。通过数据库文献检索的方法分析后路钉棒内固定椎间融合治疗复发性腰椎间盘突出症的椎

  12. The treatment of trans-scaphoid perilunate fracture dislocation:open reduction and internal fixation withcompression hollow screw%切开复位加压空心螺钉内固定治疗经舟骨月骨周围骨折-脱位

    Institute of Scientific and Technical Information of China (English)

    朱小弟; 王利; 李文庆; 毛仁群; 杨涛

    2012-01-01

    目的 探讨切开复位加压空心螺钉和克氏针内固定治疗经舟骨月骨周围骨折-脱位的临床效果.方法 对25例患者采用切开复位、克氏针固定腕骨关节,舟骨骨折复位加压空心螺钉内固定,同时修复关节囊和韧带,术后进行康复治疗. 结果 术后随访7~24个月,平均15个月,根据Cooney 腕关节评分标准,本组优8例、良10例、可5例,差2例,平均评分值82分.X线片检杳舟状骨骨折一期愈合,腕关节达解剖复位,腕骨间隙正常.结论 应用切开复位加压空心螺钉和克氏针内固定,修复关节囊和重要韧带,有利于腕关节功能的恢复,是治疗经舟骨月骨周围骨折-脱位的较好方法.%Objective To investigate the clinical effects of open reduction, internal fixation with pressure hollow screw and Kirschner wire on trans-scaphoid perilunate fracture-dislocation. Methods 25 cases of trans-scaphoid perilunate fracture-dislocation were treated with open reduction, compression hollow screw fixation of the scaphoid, Kirschner wire fixation of intercarpal joints, followed by the repair of the joint capsule and special ligaments. The postoperative rehabilitation was performed. Results All cases were followed up about 7~24 months with an average of 15 months. The wrist function was evaluated by Cooney scores, with the mean value of 82. 8 cases were excellent, 10 cases good, 5 cases fair and 2 case poor. X-ray displayed that the fractures of scaphoid were healing by first intention and intercarpal joints were reduced. The gap between carpal bones was normal. Conclusions It is helpful for the recovery of wrist function using open reduction, internal fixation with pressure hollow screw and Kirschner wire, and the repair of the joint capsule and ligaments, during the treatment of trans-scaphoid perilunate fracture dislocation.

  13. 寰枢椎椎弓根螺钉内固定治疗Ⅱ型齿突骨折合并寰枢椎脱位%Atlantoaxial pedicle screw internal fixation in treatment of typeⅡodontoid fracture combined with atlantoaxial dislo-cation

    Institute of Scientific and Technical Information of China (English)

    窦以宝; 罗学勤; 尹玉荣; 卞博; 高孟亮

    2014-01-01

    Objective To evaluate the clinical effect of posterior atlantoaxial pedicle screw internal fixation for the treat -ment of type Ⅱodontoid process fracture combined with atlantoaxial dislocation .Methods From 2010 October to 2012 Sep-tember , the clinical data of 20 cases of typeⅡ( Anderson classification ) odontoid fracture combined with atlantoaxial disloca-tion were retrospectively analyzed , all patients underwent the posterior operation of atlantoaxial pedicle screw internal fixation . All the patients were associated with atlantoaxial dislocation or subluxation , and had no symptoms of spinal cord injury , but neck pain significantly .Preoperative conventional skull traction for an average time of 3.5 d.Results All patients received a mean follow-up of 16 months, all patients with neck pain was relieved ,reliable fixation.Conclusion Atlantoaxial pedicle screw system fixation technique is an effective operation method to treat the odontoid type Ⅱfractures with atlantoaxial disloca-tion.%目的:探讨经后路寰枢椎椎弓根螺钉内固定治疗Ⅱ型齿突骨折合并寰枢椎脱位的临床疗效。方法对2010年10月~2012年9月收治的20例Ⅱ型( Anderson分型)齿突骨折合并寰枢椎脱位的患者行后路寰枢椎椎弓根螺钉内固定术治疗的临床资料进行回顾性分析,所有患者伴有寰枢椎的脱位或半脱位,所有患者无明显脊髓损伤症状,枕颈部疼痛明显,术前常规采用颅骨牵引,平均3.5 d。结果20例患者术后平均随访16个月,所有患者颈部疼痛缓解明显,骨折固定可靠。结论寰枢椎椎弓根螺钉系统三维固定技术是治疗Ⅱ型齿突骨折并寰枢椎脱位患者一种有效的手术方法。

  14. A feasibility study of upper thoracic vertebral plate screw fixation through posterior approach%上胸椎后路椎板螺钉固定的可行性研究

    Institute of Scientific and Technical Information of China (English)

    钟熙强; 何少奇; 董伊隆; 刘良乐; 黄益奖; 戴鸣海; 汤呈宣

    2016-01-01

    Objective:To study the anatomical parameters of upper thoracic vertebral plate of Chinese adults and explore the feasibility of upper thoracic vertebral plate screw fixation through posterior approach in Chinese adults.Methods:The cadaveric T1 -4 specimens of 40 Chinese adults were selected and the anatomical parameters that related to the upper thoracic vertebral plate screw fixation technique were measured by using vernier caliper and conimeter.The anatomical parameters included the thickness of upper,middle and lower part of vertebral plate,the height of vertebral plate,the screw path length and the included angle between vertebral plate axis and sagittal plane. Results:There was no statistical difference in the thickness of the middle part of T4 vertebral plate and the included angle between T1 -4 vertebral plate axis and sagittal plane axis between 20 females and 20 males(5.94 +/-0.1 3 vs 6.00 +/-0.22 mm,t =1 .609,P =0.1 1 2;46.00 +/-1 .1 0 vs 46.50 +/-1 .1 0 degrees,t =1 .955,P =0.054;46.30 +/-0.80 vs 46.60 +/-1 .1 0 degrees,t =1 .383,P =0.1 71 ;45.40 +/-1 .40 vs 45.30 +/-1 .40 degrees,t =0.404,P =0.688;45.20 +/-1 .40 vs 45.30 +/-1 .40 degrees,t =0.41 0,P =0.683).The thickness of the middle part of T1 -3 vertebral plate were less in adult female cadavers compared to adult male cadavers(5.86 +/-0.1 0 vs 5.93 +/-0.1 8 mm,t =2.083,P =0.040;5.88 +/-0.1 1 vs 5.97 +/-0.20 mm,t =2.581 ,P =0.01 2;5.90 +/-0.09 vs 6.00 +/-0.1 9 mm,t =2.885,P =0.006).Such parameters of T1 -4 were less in adult female cadavers compared to adult female cadavers as thick-ness of upper part of vertebral plate(5.39 +/-0.1 2 vs 5.51 +/-0.1 3 mm,t =4.202,P =0.000;5.43 +/-0.09 vs 5.52 +/-0.1 1 mm,t =4.1 84,P =0.000;5.43 +/-0.1 0 vs 5.53 +/-0.1 0 mm,t =4.279,P =0.000;5.41 +/-0.08 vs 5.53 +/-0.07 mm,t =7.557,P =0.000),thickness of lower part of vertebral plate(5.43 +/-0.1 2 vs 5.55 +/-0.1 2 mm,t =4.51 3,P =0.000;5.43 +/-0.07 vs 5.57 +/-0.1 0 mm,t =7.068,P =0.000;5.44 +/-0.08 vs 5.57 +/-0.1 1 mm

  15. Quantitative Anatomy of C7 Vertebra in Southern Chinese for Insertion of Lateral Mass Screws and Pedicle Screws

    Science.gov (United States)

    Chan, Chi Hin; Wong, Kam Kwong; Wong, Wing Cheung

    2016-01-01

    Study Design Retrospective study. Purpose To analyze the quantitative anatomy of C7 vertebra for insertion of lateral mass screws and pedicle screws in Southern Chinese patients. Overview of Literature C7 lateral mass is smaller when compared to other subaxial cervical levels, which limits the length of lateral mass screws that can be used. Some studies have suggested pedicle screws for better fixation. But, this option is limited by the narrow pedicle width. Methods We have obtained computed tomography (CT) cervical spine data in 0.625 mm slices from our radiology department. The patients were adults. CTs were from May to August, 2015. The lateral mass screw length was measured using Margerl's technique and pedicle width and pedicle screw trajectory were determined in three-dimensional reformated images. Results CT scans of cervical spines of 94 patients were obtained and 188 lateral masses and pedicles of C7 vertebrae were measured. The mean lateral mass screw length was 13.2 mm (standard deviation [SD] 1.6 mm), mean outer pedicle width was 5.9 mm (SD 1.0 mm) and mean pedicle screw trajectory was 29.4 degrees (SD 3.6 degrees). Most (91.0%) of the pedicles had an outer diameter ≥4.5 mm. Conclusions The mean lateral mass screw length was longer when compared with other similar studies, while the mean outer pedicle width was narrower. Nearly 10% of the pedicles were unable to accommodate 3.5 mm screws. These findings favor the use of lateral mass screws to provide a safe and stable fixation for C7 vertebrae in Southern Chinese patients, while the final choice of fixation method should only be confirmed after careful preoperative planning with CT scan. PMID:27559451

  16. One-wayversusuniversal pedicle screw fixation for lumbar fractures:biomechanics%椎弓根单向螺钉及万向螺钉置入内固定修复腰椎骨折的生物力学比较

    Institute of Scientific and Technical Information of China (English)

    吕胜江; 付丽娟; 李红梅

    2016-01-01

    BACKGROUND:Previous studies have performed three-dimensional finite element analysis on lumbar fracture fixation. However, a few studies concerned three-dimensional finite element analysis of lumbar spinal pedicle screw fixation. OBJECTIVE:To analyze the biomechanical characteristics of one-way screw and universal screw fixation for lumbar fractures using finite element method. METHODS:Models of lumbar fractures treated with one-way screw and universal screw fixation were established. Three-dimensional finite element method was used to analyze and compare the maximum axial displacement, maximum bending degree, maximum stress on thepedicle screw fixation system and maximum stress of intervertebral disc in normal vertebral fracture model, one-way and universal pedicle screw fixation models. RESULTS AND CONCLUSION:(1) The maximum axial displacement at anteflexion, posterior extension, left lateral curvature and right lateral curvature was significantly lower in the one-way fixation group and universal fixation group than in the normal group (P  目的:以有限元法分析腰椎椎弓根单向螺钉及万向螺钉置入内固定修复腰椎骨折的生物力学特点。  方法:建立腰椎骨折椎弓根单向螺钉及万向螺钉内固定模型,以三维有限元法分析正常腰椎模型、腰椎骨折椎弓根单向螺钉及万向螺钉内固定模型的最大轴向位移、最大弯曲度、椎弓根螺钉固定系统上的最大应力以及椎间盘的最大应力,并进行对比分析。  结果与结论:①单向钉固定组和万向钉固定组在前屈、后伸、左侧弯和右侧弯时的最大轴向位移均明显低于正常腰椎组(P<0.05-0.01),万向钉固定组在以上各方位的最大轴向位移均低于单向钉固定组;②单向钉固定组和万向钉固定组在各方位的最大弯曲度均明显低于正常腰椎组(P<0.05-0.01),万向钉固定组在各方位时的最大弯曲度均低于单向钉固定组;

  17. Double insurance transfacetal screws for lumbar spinal stabilization

    Directory of Open Access Journals (Sweden)

    Atul Goel

    2014-01-01

    Full Text Available Aim: The authors report experience with 14 cases where two screws or ′′double insurance′′ screws were used for transfacetal fixation of each joint for stabilization of the lumbar spinal segment. The anatomical subtleties of the technique of insertion of screws are elaborated. Materials and Methods: During the period March 2011 to June 2014, 14 patients having lumbar spinal segmental instability related to lumbar canal stenosis were treated by insertion of two screws into each articular assembly by transfacetal technique. After a wide surgical exposure, the articular cartilage was denuded and bone chips were impacted into the joint cavity. For screw insertion in an appropriate angulation, the spinous process was sectioned at its base. The screws (2.8 mm in diameter and 18 mm in length were inserted into the substance of the medial or inferior articular facet of the rostral vertebra via the lateral limit of the lamina approximately 6-8 mm away from the edge of the articular cavity. The screws were inserted 3 mm below the superior edge and 5 mm above the inferior edge of the medial (inferior facets and directed laterally and traversed through the articular cavity into the lateral (superior articular facet of the caudal vertebra toward and into the region of junction of base of transverse process and of the pedicle. During the period of follow-up all treated spinal levels showed firm bone fusion. There was no complication related to insertion of the screws. There was no incidence of screw misplacement, displacementor implant rejection. Conclusions: Screw insertion into the firm and largely cortical bones of facets of lumbar spine can provide robust fixation and firm stabilization of the spinal segment. The large size of the facets provides an opportunity to insert two screws at each spinal segment. The firm and cortical bone material and absence on any neural or vascular structure in the course of the screw traverse provides strength and

  18. 骨水泥和纳米骨浆强化椎弓根螺钉植入固定骨质疏松椎体的生物力学特点%Bone cement and nano bone putty strengthen pedicle screw implantation in the fixation of osteoporotic vertebral body:biomechanical characteristics

    Institute of Scientific and Technical Information of China (English)

    卢小兵; 孟祥翔

    2015-01-01

    BACKGROUND:Nano bone putty and bone cement injection are two common methods to strengthen the fixation of pedicle screws, but there are relatively few reports on the comparison of their strengthening effects. OBJECTIVE:To compare the biomechanical characteristics of bone cement and nano bone putty strengthening pedicle screw implantation in the fixation of osteoporotic vertebral body. METHODS: Totaly 24 human cadaveric pedicles were obtained, which were al in line with osteoporosis standards, and randomly divided into 3 groups: control group (only implanted pedicle screws), bone cement group (first injected bone cement in the nail channel, and then implanted pedicle screws) and nano bone putty group (first injected nano bone putty in the nail channel, and then implanted pedicle screws). After 2 hours of implantation, the maximum axial pulout strength and the maximum rotation torque of specimens in each group were determined. RESULTS AND CONCLUSION:The maximum axial pulout strength and maximum rotation torque of the bone cement and the nano bone putty groups were greater than those of the control group (P < 0.05), and the maximum axial pulout strength and the maximum rotation torque of the bone cement group were greater than those of the nano bone putty group (P < 0.05). These results demonstrate that the maximum axial pulout strength and the maximum rotation torque of pedicle screw implantation in the fixation of osteoporotic vertebral body can be effectively improved by injection of bone cement and nano bone putty, and the strengthening effect of bone cement is more obvious. %背景:纳米骨浆和骨水泥注入是强化椎弓根螺钉固定的两种常用方法,但目前关于两种加强方法的强化效果比较的报道相对较少。目的:对比骨水泥或纳米骨浆强化椎弓根螺钉植入固定骨质疏松椎体的生物力学特点。方法:取24个人尸体椎弓根,均符合骨质疏松标准,随机均分为3组,对照组仅植

  19. Application of individualization percutaneous cannulated screws fixation with the help of com-puter-assisted design in carpal scaphoid fracture%计算机辅助设计个体化经皮空心螺钉内固定治疗腕舟骨骨折的应用

    Institute of Scientific and Technical Information of China (English)

    曾俊; 林旭; 郭勇; 钟泽莅; 曹林虎; 谭伦

    2014-01-01

    目的:利用Mimics软件设计一种腕舟骨骨折个体化掌侧经皮空心螺钉置钉技术。方法将24例成人腕舟骨骨折腕关节CT扫描数据导入Mimics软件,在Mimics软件中进行腕关节三维重建,模拟舟骨手术,制定舟骨个体化置钉参数并模拟置钉,据此参数在腕舟骨上经皮置钉。术后行腕关节CT扫描,验证置钉准确性。结果 Mimics重建图像和CT扫描的腕舟骨参数差异无统计学意义,能准确反映舟骨三维立体结构。用该方法对24例成人腕舟骨骨折行经皮空心螺钉固定,术后CT显示螺钉位置良好,随访腕关节功能良好。结论用Mimics软件对腕关节进行三维重建,模拟手术,测量、制订详细合理的个体化置钉参数,可优化手术方案与方式,减少并发症,降低手术风险,提高临床治疗效果。%Objective To provide a individualization volar percutaneous cannulated screws fixation with the help of Mimics-assisted design in carpal scaphoid fracture surgery. Methods Three-dimensional reconstruction of 24 CT scanned adult carpal scaphoid fractures were performed by using Mimics software. The operations were analogued in Mimics software and then individual fixation parameters were designed. Based on which percutaneous cannulated screws fixation of carpal scaphoid fracture were performed under Mimics individual fixation parameters. The accuracy of postoperation was assessed by CT scanning. Results There was no statistical difference in parameters of the CT scan and Mimics reconstruction images, which could reflect carpal scaphoid accurate three dimensional structure. Postoperation CT scanning showed that the cannulated screws were fixed successfully in 24 adult carpal scaphoid frac-tures. The function of wrists were well in follow-up. Conclusions Three-dimensional reconstruction of the carpal scaphoid by using mimics software, sham operated,measurement and design individual screw fixation parameters

  20. Optimizing Stability in Femoral Neck Fracture Fixation.

    Science.gov (United States)

    Ye, Ye; Hao, Jiandong; Mauffrey, Cyril; Hammerberg, E Mark; Stahel, Philip F; Hak, David J

    2015-10-01

    Optimizing stability of femoral neck fracture fixation is important in obtaining a successful outcome. The mechanical problems and strategies for achieving optimal stability differ depending on patients' age and degree of osteoporosis. Femoral neck fractures in younger adults usually result from high-energy trauma and have a vertical fracture pattern. Strategies for optimizing fixation stability in this group include placing additional screws at right angles to the fracture plane and medial buttress plate augmentation. In elderly patients, screw position relative to the intact cortical femoral neck bone is of critical importance. Additional strategies for optimizing fixation stability in this group include the concept of length stable fixation, use of adjunctive calcium phosphate cement, and use of novel fixed angle fixation implants. PMID:26488776

  1. 后路椎间融合加椎弓根螺钉固定术治疗退行性腰椎间盘病变%Posterior lumbar interbody fusion combined with pedicle screw fixation in treatment of degenerative diseases of lumbar intervertebral disc

    Institute of Scientific and Technical Information of China (English)

    黄占柱; 仇小华; 张如意

    2011-01-01

    Objective To investigate the clinical effect of treating the patients suffering from degenerative diseases of lumbar intervertebral disc with posterior lumbar interbody fusion (PLIF) combined with pedicle screw fixation.Methods This study was based on 100 cases suffering from degenerative diseases of lumbar intervertebral disc who underwent PLIF combined with pedicle screw fixation.All the patients were followed by 1 - 2 years.The shape and the function of spinal column were both estimated before and after the operation,and they were also estimated during the following of the patients after the operation.The datas in the formal 3 stages were multiply compared.Results Between the preoperative and postoperative datas,there were statistically significant differences in the JOA scores and the angle of scoliosis and kyphosis (P < 0.05 ).And so do the preoperative datas and the datas during the following (P <0.05).But no similar result was detected between the postoperative data and the data during the following (P > 0.05).Conclusions Posterior lumbar interbody fusion (PLIF) combined with pedicle screw fixation has a significant effect in treating degenerative diseases of lumbar intervertebral disc,deserving further study and clinical popularization.%目的 探讨后路椎间融合加椎弓根螺钉固定术治疗退行性腰椎间盘病变的临床疗效.方法 对100例退行性腰椎间盘病变患者采取后路椎间融合加椎弓根螺钉固定术,术后予1~2年随访,并比较术前、术后及随访时脊柱形态、功能恢复情况(JOA评分).结果 术后与术前患者脊柱后凸、侧凸角度和JOA评分比较差异均有统计学意义(P均<0.05),随访时与术前比较差异也有统计学意义(P<0.05),随访时与术后比较差异无统计学意义(P>0.05).结论 后路椎体间融合术治疗退行性腰椎间盘病变效果显著,有进一步研究和推广价值.

  2. 关节镜下缝线“8”字打结空心钉固定治疗前交叉韧带胫骨止点撕脱性骨折%The Research about Figure of 8 Suture Fixation with Cannulated Screw and washer Under Arthroscopic in the Treatment of Anterior Cruciate Ligament Tibial Avulsion Fracture

    Institute of Scientific and Technical Information of China (English)

    吴健

    2015-01-01

    Objective to analyze the value of figure of 8 suture fixation with cannulated screw and washer under arthroscopic in the treatment of anterior cruciate ligament tibial avulsion fracture. Methods the Lysholm knee score and the Lachman test negative rate of 68 cases of patients before and after surgical operation were compared to evaluate the value of the 8 suture fixation with cannulated screw and washer under arthroscopic. Results all fractures were healed well. Postoperative Lysholm score was (92.84+1.65),which was significantly higher than that before operation with score (28.46±1.37)(t=33.486,P=0.000). Postoperative Lachman negative rate was 0%,which was significantly lower than that before operation with 100.00% (χ2=36.942, P=0.000).Conclusion figure of 8 suture fixation with cannulated screw and washer under arthroscopic has good effect in the treatment of anterior cruciate ligament tibial avulsion fracture.%目的:分析关节镜下缝线“8”字打结空心钉固定治疗前交叉韧带胫骨止点撕脱性骨折的价值。方法以68例患者为对象,比较患者术前、后Lysholm膝关节功能评分和Lachman试验阴性率。结果:所有患者骨折均愈合良好。术后Lysholm评分为(92.84±1.65)分,显著高于术前(28.46±1.37)的评分(t=33.486,P=0.000)。术后Lachman阴性率为0.00%,显著低于术前100.00%的阳性率(χ2=36.942,P=0.000)。结论关节镜下缝线“8”字打结空心钉固定治疗前交叉韧带胫骨止点撕脱性骨折具有较好的近期疗效。

  3. 关节镜下缝线“8”字打结空心钉固定治疗前交叉韧带胫骨止点撕脱性骨折%The Research about Figure of 8 Suture Fixation with Cannulated Screw and Washer Under Arthroscopic in the Treatment of Anterior Cruciate Ligament Tibial Avulsion Fracture

    Institute of Scientific and Technical Information of China (English)

    吴健

    2015-01-01

    目的:分析关节镜下缝线“8”字打结空心钉固定治疗前交叉韧带胫骨止点撕脱性骨折的价值。方法以68例患者为对象,比较患者术前、后Lysholm膝关节功能评分和Lachman试验阴性率。结果所有患者骨折均愈合良好。术后Lysholm评分为(92.84±1.65)分,显著高于术前(28.46±1.37)的评分(t=33.486,P=0.000)。术后Lachman阴性率为0.00%,显著低于术前100.00%的阳性率(c2=36.942,P=0.000)。结论关节镜下缝线“8”字打结空心钉固定治疗前交叉韧带胫骨止点撕脱性骨折具有较好的近期疗效。%Objective to analyze the value of figure of 8 suture fixation with cannulated screw and washer under arthroscopic in the treatment of anterior cruciate ligament tibial avulsion fracture.Methods The Lysholm knee score and the Lachman test negative rate of 68 cases of patients before and after surgical operation were compared to evaluate the value of the 8 suture fixation with cannulated screw and washer under arthroscopic.Results all fractures were healed well. Postoperative Lysholm score was (92.84 +1.65), which was significantly higher than that before operation with score (28.46±1.37)(t=33.486,P=0.000). Postoperative Lachman negative rate was 0%, which was significantly lower than that before operation with 100.00% (c2=36.942,P=0.000).Conclusion figure of 8 suture fixation with cannulated screw and washer under arthroscopic has good effect in the treatment of anterior cruciate ligament tibial avulsion fracture.

  4. 腓骨解剖型钢板联合可吸收拉力螺钉内固定治疗腓骨远端骨折合并下胫腓韧带损伤的疗效%Therapeutic Efficacy of Fibular Anatomical Plate and Absorbable Screw Joint Fixation for Distal Fibular Fracture Complicated by Inferior Tibiofibular Ligament Damage

    Institute of Scientific and Technical Information of China (English)

    尤涛

    2011-01-01

    Objective To study the therapeutic effect of fibular anatomical plate and absorbable screw joint fixation on distal fibular fracture complicated by inferior tibiofibular ligament damage.Methods Twenty patients with distal fibular fractures and inferior tibiofibular ligament injury were treated by fibular anatomical plate combined with absorbable screw joint fixation.Results Postoperative healing time was 13 to 16 weeks.According to Baird and Jackson improved subjective and objective evaluation and X- rating: 17 cases were excellent and 3 cases were good, with the excellent rate of 100%.Moreover, all the incisions were healed by first intention, no infection and no local adverse reactions were found in the 20 cases.Conclusions Fibular anatomical plate combined with absorbable screw joint fixation is an effective method in the treatment of distal fibular fracture complicated by inferior tibiofibular ligament damage.%目的 探讨腓骨解剖型钢板联合可吸收拉力螺钉内固定治疗腓骨远端骨折合并下胫腓韧带损伤的疗效.方法 对20例腓骨远端骨折合并下胫腓韧带损伤患者采用腓骨解剖型钢板联合可吸收拉力螺钉内固定治疗.结果 患者术后骨折愈合时间为13-16周,根据改良Baird和Jackson的主、客观和X线评价:优17例,良3例.其优良率为100%.而且伤口均一期愈合,无一例感染,无局部不良反应.结论 腓骨解剖型钢板联合可吸收拉力螺钉内固定是治疗腓骨远端骨折合并下胫腓韧带损伤的有效方法.

  5. Osteosynthesis-screw augmentation by ultrasound-activated biopolymer - an ovine in vivo study assessing biocompatibility and bone-to-implant contact

    OpenAIRE

    Neumann, Hanjo; Breer, Stefan; Reimers, Nils; Kasch, Richard; Schulz, Arndt-Peter; Kienast, Benjamin

    2015-01-01

    Objectives Screw fixation and fragment anchoring in osteoporotic bones is often difficult. Problems like the cut out phenomenon and implant migration in osteoporotic bones have been reported. One possibility of improving the anchoring force of screws is augmentation of the screw. Cement-augmented screws in spinal surgery could exhibit a better anchoring in osteoporotic bones. Methods The purpose of this study was to examine the effect of screw augmentation using a resorbable polymer. Ultrasou...

  6. Evaluation the treatment outcomes of intracapsular femoral neck fractures with closed or open reduction and internal fixation by screw in 18-50-year-old patients in Isfahan from Nov 2010 to Nov 2011

    Directory of Open Access Journals (Sweden)

    Mohammad Javdan

    2013-01-01

    Conclusion: This study showed that femoral neck fracture is associated with several complications, especially if open reduction was necessary. So, the surgical method and necessary equipments such as radiolucent bed, C-ARM machine, and implant cannulated screw set should be considered.

  7. 经伤椎置钉治疗胸腰椎骨折的临床运用及疗效分析%Posterior pedicle screw fixation at injured level for treatment of thoracolumbar spine fracture: analysis of clinical application and curative effect

    Institute of Scientific and Technical Information of China (English)

    袁志峰; 邵斌; 曾景平

    2013-01-01

    目的 探讨运用经伤椎置钉治疗胸腰椎骨折的效果.方法 2008年6月~2011年12月,50例胸腰椎骨折患者分别采用传统伤椎上下邻椎置钉(A组)及上下邻椎置钉加经伤椎置钉(B组)治疗,每组25例.以切口长度、手术时间、术中出血量、术前与术后伤椎椎体高度、术前与术后的侧位Cobb角、腰背部疼痛发生情况、内固定失败率等方面对比2组治疗效果.结果 切口长度、手术时间、术中出血量2组差异无统计学意义(P>0.05).2组患者术前、术后1周、术后6个月在椎体高度及Cobb角方面差异无统计学意义(P>0.05);在术后12个月及内固定取出后上述2项评价指标差异有显著的统计学意义(P<0.05).结论 经伤椎置钉治疗胸腰椎骨折术后椎体高度保持良好,腰背痛发生率低,切口长度、术中出血及手术时间无明显增加,是一种安全可靠、切实有效的治疗方法.%Objective To investigate the curative effect of posterior pedicle screw fixation at the injured level for the treatment of thoracolumbar spine fractures. Methods From June 2008 to December 2011 , a total of 50 patients with thoracolumbar spine fractures were equally randomized to Group A( treated with classic pedicle screw fixation ) and Group B( treated with pedicle screw fixation at the injured level )based on fixation methods( n = 25 ). The incision length, operation time, amount of bleeding in operation, preoperative and postoperative fractured vertebral body height, segmental lordosis ( Cobb' s angle ), visual analogue scale ( VAS ) score of lumbar pain and failure rate of internal fixation were assessed and compared clinically. Results There were no statistical significance in incision length, operation time and amount of bleeding( P >0. 05 ). Also, there were no statistical significance in fractured vertebral body height and Cobb' s angle at pre-operation, postoperative 1 week and postoperative 6 months( P >0. 05 ), But it had

  8. 特发性脊柱侧弯后路钉棒置入内固定:谁是影响效果的因素?%Posterior screw-rod fixation for idiopathic scoliosis:factors affecting the results

    Institute of Scientific and Technical Information of China (English)

    毕中普; 夏磊; 徐静磊; 周亚旗; 柯广水; 桑亮

    2014-01-01

    背景:特发性脊柱侧弯在脊柱侧弯中最常见,有时还伴有神经、内分泌系统以及营养代谢的异常,但保守治疗效果欠佳,通常需要进行手术治疗。畸形矫正是一个极其复杂的过程,对特发性脊柱侧弯治疗、转归等进行深入研究意义巨大,但目前缺少相近研究。  目的:观察后路钉棒内固定置入治疗特发性脊柱侧弯的矫正效果,探讨影响其效果的相关因素。  方法:回顾性分析近4年80例接受后路钉棒内固定置入治疗的特发性脊柱侧弯患者的病例资料,记录研究患者年龄、性别、病程、治疗前后X射线平片测量的冠状面Cobb's角、躯干偏移度等观察指标,并进行统计学分析。  结果与结论:单因素分析显示患者性别和患者病程均与内固定后矫正效果无明显相关(P>0.05);而患者年龄分布、侧凸的位置、侧凸的柔韧性均与内固定疗效相关(P OBJECTIVE:To observe the correction effect of posterior screw-rod fixation for idiopathic scoliosis, and explore the relevant factors influencing its effectiveness. METHODS:We retrospectively analyzed 80 cases receiving pedicle screw fixation in the treatment of idiopathic scoliosis in the latest four years. Age, gender, disease duration, preoperative and postoperative X-ray measurement of coronal Cobb’s angle, and trunk deviation were recorded, and statistical y analyzed. RESULTS AND CONCLUSION:Univariate analysis showed that gender and disease duration were not significantly correlated with postoperative correction results (P>0.05). However, the age distribution of patients, the location of scoliosis, and scoliosis flexibility were associated with curative effects of internal fixation (P<0.05). Posterior screw-rod fixation for idiopathic scoliosis can achieve significant effects. The patient’s age, location and flexibility of scoliosis have a significant effect on the effects of fixation. The

  9. 伤椎椎弓根植骨加短节段椎弓根螺钉置入内固定治疗老年人胸腰椎骨折%Transpedicular bone graft combined with short-segment pedicle screw internal fixation for senile thoracolumbar fracture

    Institute of Scientific and Technical Information of China (English)

    王宏伟; 王宇; 王军辉; 穆尚强; 姜波; 潘锋

    2011-01-01

    BACKGROUND: Traditional pedicle screw internal fixation combined with posterolateral lumbar fusion in the treatment of senilethoracolumbar burst fracture are easily to occur reset angle, high loss, delayed nerve damage and internal fixation loosening.OBJECTIVE: To investigate the method and effect of transpedicular bone graft combined with pedicle screw internal fixation onthe treatment of senile thoracolumbar fracture.METHODS: Totally 32 patients who were more than 60 years old with thoracolumbar burst fracture were treated by posteriorpedicle fixation combined with grafting through the injured pedicle. Height of fractured vertebrae, Cobb angle, occupying of spinalcanal, neuropathic function, lumbar and back pain were measured and analyzed preoperatively, postoperatively and during thefollow up period.RESULTS AND CONCLUSION: All the patients were followed-up over 6 months. The internal fixation was not break or loose, theheight of fractured vertebrae, the Cobb angle, the occupying of spinal canal, the neuropathic function, lumbar and back painimproved obviously, and the height of fractured vertebrae, the Cobb angle and the occupying of spinal canal were not obviouslylose. It is indicated that application of transpedicular bone graft combined with posterior pedicle screw internal fixation is aneffective method in treatment of senile thoracolumbar burst fracture, it can restore the height and strength of the vertebral body,and immediately increase vertebral bone content and the stability of the spine, and reduce the possibility of breaking nail, breakingrod, the loss of height and other complications, which are caused by stress.%背景:传统椎弓根内固定系统加后外侧植骨融合治疗老年胸腰椎爆裂性骨折易发生复位角度、高度丢失,迟发性神经损伤,内固定松动.目的:观察经骨折椎椎弓根植骨联合椎弓根内固定治疗老年胸腰椎爆裂性骨折的方法和效果.方法:采用经骨折椎椎弓根植骨结合短

  10. Femoral neck shortening after internal fixation

    OpenAIRE

    LIU, YUE; AI, Zi Sheng; Shao, Jin; Yang, Tieyi

    2014-01-01

    Objective: The aim of this study was to assess the factors affecting femoral neck shortening after internal fixation of femoral neck fractures. Methods: Eighty-six patients with femoral neck fractures were treated using three parallel cannulated screws between May 2004 and January 2011. The shortening of the femoral neck in the horizontal (X), vertical (Y), and along the resultant along the (Z) vector (XÆ, YÆ, ZÆ) was measured on anteroposterior radiographs corrected by screw diameter and ...

  11. GSS pedicle screw fixation combined with two-stage bone cement perfusion for thoracolumbar fractures%GSS椎弓根螺钉内固定并二期伤椎骨水泥灌注治疗胸腰椎骨折

    Institute of Scientific and Technical Information of China (English)

    宋洁富; 李利军; 常峰; 荆志振

    2012-01-01

    Objective To explore the efficacy and safety of surgical treatment of thoracolumbar fractures by GSS pedicle screw fixation combined with two-stage bone cement perfusion. Methods From March 2005 to October 2010, 31 patients with thoracolumbar bursting fractures were treated with posterior GSS pedicle screw fixation. The patients were reviewed by X-ray and CT scan 3-18 months postoperatively. Once "eggshell phenomenon" appeared, bone cement was used in the injured vertebral body before removing the fixators. Injured vertebral height and Cobb' s angle were measured preoperatively, postoperatively and at the final follow-up. Results No leakage of bone cement happened in all the patients. The internal fixators were removed 12-18 months postoperatively. Then the patients were followed up for 1-3 years. Fractured vertebral height and Cobb' s angle were significantly improved after surgery. Conclusion GSS combined with two-stage bone cement perfusion for thoracolumbar fractures can achieve a good therapeutic effect. It can be taken as an attempt at the treatment of thoracolumbar fractures.%目的 探讨GSS椎弓根螺钉内固定结合二期伤椎骨水泥灌注治疗胸腰椎骨折的有效性和安全性.方法 2005年3月~2010年10月共31例胸腰椎爆裂性骨折患者行后路GSS椎弓根螺钉内固定治疗,术后3~18个月根据X线及CT复查情况,出现"蛋壳现象"的患者在取出内固定前行伤椎骨水泥灌注,记录术前、术后及末次随访时的伤椎高度及X线片测量的Cobb角角度.结果 本组患者均未出现骨水泥渗漏,术后12~18个月取出内固定后再随访1~3年.术后伤椎椎体高度及Cobb角与术前相比有明显改善.结论 GSS椎弓根螺钉内固定结合二期伤椎骨水泥灌注治疗胸腰椎骨折可达到良好的治疗效果,可作为治疗胸腰椎骨折的新的尝试.

  12. 枕颈融合内固定治疗颅颈交界区不稳的疗效分析%Clinical effects of the treatment of atlantoaxial dislocation by posterior occipitocervical fixation with C2 pedicle screws and occipitocervical plate systems

    Institute of Scientific and Technical Information of China (English)

    廖文胜; 张威; 王利民; 鲍恒

    2013-01-01

    Objective To observe the clinical effect of posterior occipitocervical fixation using C2 pedicle screws and occipitocervical plate systems.Methods Totally 47 patients with atlantoaxial dislocation were treated with posterior occipitocervical fixation using C2 pedicle screws and occipitocervical plate systems.The clinical effect was evaluated with JOA scores、Frankel system and image examination.Results All the patients were followed up for 12-33 months,average 24.6 months.Frankle classification of postoperative neurofunctional recovery:2 cases recovered from grade B to grade C,3 cases of 4 patients recovered from grade C to grade D,27 cases of 29 patients recovered from grade D to grade E and 3 cases had no improved.JOA scores after operation was from 7-15 scores,average13.4 scores.The improving rate of neurological function was 77.3%.The excellent cases were 27(57.4%),good cases were 16(34.0%) and effective cases were 4(8.5%).Image examination showed all patients exhibited a stiff bone fusion.There were no internal fixation loosing、rupture、mobiled and screw pulled out.Conclusion Posterior occipitocervical fixation using C2 pedicle screws and occipitocervical plate systems has a definite therapeutic effect on atlantoaxial dislocation.%目的 观察枕骨板联合枢椎椎弓根螺钉治疗颅颈交界区不稳的疗效.方法 对47例颅颈交界区不稳患者行枕骨钛板联合枢椎椎弓根螺钉治疗,采用JOA评分、Frankel分级及影像学检查评价手术效果.结果 所有患者随访12 ~ 33个月,平均24.6个月.随访结束时Frankel分级:B级中2例均改善到C级,C级4例中有3例改善到D级,D级29例中27例改善到E级,其余3例改善不明显.术后JOA评分法评分7~15分,平均13.4分.脊髓功能改善率平均为77.3%;其中优27(57.4%)例,良16(34.0%)例,有效4(8.5%)例.影像学复查45例患者成功获得骨性融合,2例经再次植骨后获得骨性融合.X线片观察未发

  13. Comparison of biomechanical property on Suture-Button and conventional screw fixating the distal tibiofibular syndesmosis injury%Suture-Button与常规螺钉固定下胫腓联合对胫距关节的力学影响比较

    Institute of Scientific and Technical Information of China (English)

    肖刚; 徐亚林; 汪宗保; 匡光志; 陈朝晖; 姚长风

    2014-01-01

    目的 比较Suture-Button与常规螺钉固定下胫腓联合对胫距关节的力学影响.方法 8具新鲜冷冻尸体小腿,切断下胫腓联合韧带及三角韧带后,每组4具分别以Suture-Button(Suture-Button组)与常规螺钉(螺钉组)固定下胫腓联合,运用生物力学测试方法和应力应变传感技术,测量两组内固定胫距关节内的接触面积和峰值压力变化.结果 两组在矢状面上不同屈伸角度下所测得的接触面积(t=3.52、4.49、5.93、4.75)、峰值压力(t=3.61、3.97、4.68、2.41)差异均无统计学意义(均P>0.05),但指标呈改善趋势.结论 Suture-Button与常规螺钉固定在力学上具有相似作用,而且下胫腓联合损伤固定后的效果比不固定有好转趋势.%Objective To explore the biomechanical property on Suture-Button and conventional screw fixating the distal tibiofibular syndesmosis injury.Methods The distal tibiofibular syndesmosis injury models were made by cutting the anteroinferior tibiofibular ligaments,posteroinferior tibiofibular ligaments,interosseous tibiofibular ligaments or deltoid ligaments of 8 fresh frozen calves.These models were randomly and equally divided into the two groups.The two groups were respectively fixed by Suture-Button and conventional screw.The contact area and peak intra-articular pressure of tibiatalar joint were measured by biomechanical testing methods and the stress and strain sensing technology.Results The maximal contact area and peak intra-articular pressure of Suture-Button fixation group had no significant differences with the conventional screw group by the four kinds of ankle flexion-extension angles in the sagittal plane (t =3.52,4.49,5.93,4.75,all P > 0.05),peak intra-articular pressure was also similarly improved (t =3.61,3.97,4.68,2.41,all P > 0.05).But biomechanical markers of two fixation groups had an improvement trend.Conclusion Suture-Button fixing the distal tibiofibular syndesmosis injury had similar

  14. 聚甲基丙烯酸甲酯和自体骨加强的椎弓根螺钉技术治疗退变性脊柱侧凸的临床疗效比较%Autogenous bone and polymethylmethacrylate augmentation of screw fixation for degenerative scoliosis

    Institute of Scientific and Technical Information of China (English)

    谢杨; 傅强; 陈自强; 石志才; 朱晓东; 孙晓飞; 李明

    2012-01-01

    Objective To compare the clinical effect of autogenous bone and polymethylmethacrylate (PMMA) augmentation of screw fixation in degenerative scoliosis with osteoporosis. Methods A retrospective analysis was conducted on 31 consecutive patients with degenerative scoliosis combined with osteoporosis who accepted pedicle screw fixation from December 2000 to December 2006. Fourteen of them underwent fixation with pedicle screw by augmentation with PMMA and the other 17 patients with autogenous bone. Peri-operative data were recorded. Preoperative, postoperative and final follow up corrective effects were compared. Results No significant difference was found in clinical data except for administration time of oral pain relief medicines and surgery cost between the two surgical strategies. Cement leakage was observed in 2 patients in PMMA augmentation group, but there was no evidence of nerve damage. Conclusion There is no difference in surgical effect between two surgery strategies on degenerative scoliosis combined with osteoporosis. Less oral pain medicines are taken in the polymethylmethacrylate-augmented pedicle screw fixation and fusion, but with much more cost and danger of cement leakage.%目的 比较应用聚甲基丙烯酸甲酯( PMMA)和自体骨加强的椎弓根螺钉技术治疗合并骨质疏松的退变性脊柱侧凸的临床疗效.方法 回顾性分析2000年12月至2006年12月手术治疗的31例伴骨质疏松的退变性脊柱侧凸患者,其中14例采用PMMA加强钉道,17例采用自体骨加强钉道.记录并发症等围手术期情况,比较手术前后及随访期间侧凸的矫正效果.结果 两种手术除口服止痛药使用时间和手术费用外,其他临床数据差异无统计学意义,PMMA加强组中2例出现骨水泥渗漏,但未出现神经损伤的症状.结论 两种手术对伴骨质疏松的退变性脊柱侧凸的临床疗效无明显差异,PMMA加强的椎弓根螺钉内固定融合术可减少口服止痛药的用量,

  15. 后路漂浮法减压内固定治疗严重黄韧带骨化型胸椎管狭窄症%Treatment of Thoracic Spine Stenosis by Laminectomy Using “Lamina Floating” Technique and Internal Fixation with Severe Ossification of the Ligamentum Flavum by Pedicle Screw

    Institute of Scientific and Technical Information of China (English)

    陈建梅; 姚晓东; 黄丽花; 李金泉; 徐皓

    2012-01-01

    Objective To evaluate the effect of laminectomy using "lamina floating" technique and internal fixation by pedicle screw to thoracic spine stenosis with severe ossification of the ligamentum flavum (OLF-TSS). Methods From January 2007 to October 2010,15 patients of OLF-TSS in the hospital treated with laminectomy using "lamina floating" technique and internal fixation by pedicle screw were retrospectively analyzed according to Japanese Orthopaedic Association (JOA) scoring system and complications. Results The mean follow-up period was 10. 3 months (ranging from 5 months to 3 years). According to the JOA scoring system,excellent in 10 cases,good in 3 cases, the excellent and good rate was 86. 7%. 2 cases with cerebrospinal fluid leakage were recovered after repaired with back fascia. Conclusion Laminectomy using "lamina floating" technique is a safe and effective method for decompression of OLF-TSS, and internal fixation by pedicle screw can effectively rebuild spinal stability post-operation. So laminectomy using "lamina floating" technique and internal fixation by pedicle screw is a good choice for severe ossification of the ligamentum flavum thoracic spine stenosis.%目的 探讨经后路漂浮法减压及内固定术治疗严重黄韧带骨化型胸椎管狭窄症的疗效.方法 2007年1月至2010年10月,我科收治严重黄韧带骨化型胸椎管狭窄症15例,根据Miyakoshit分型均为融合型,其中男7例,女8例;年龄40~67岁,平均56岁.所有患者术前均行X线、CT、MRI检查,并采用后路漂浮法减压+椎弓根钉内固定术.通过JOA评分、并发症发生情况评估疗效.结果 术后15例均获得随访,随访5个月~3年,平均10.3个月.根据JOA评分进行疗效评价,优10例,良3例,可2例,优良率86.7%.其中2例出现硬脊膜撕裂,经腰背筋膜修复后痊愈.结论 后路漂浮法可以安全有效地对受压胸髓实现减压,椎弓根钉内固定可以提供脊柱稳定,是治疗黄韧带骨化型胸椎管狭窄症的良好术式.

  16. 3D 打印模型辅助后路内固定治疗儿童颈椎畸形%Individualized 3D printing model-assisted posterior screw fixation for the treatment of the cervical de-formity of children

    Institute of Scientific and Technical Information of China (English)

    李浩; 李承鑫; 张学军; 郭东; 范敬一; 刘虎; 孙记航; 潘少川

    2016-01-01

    Objetive To study the method and effect of individualized 3D printing model—assisted pos-terior screw fixation for the treatment of the cervical deformity of children.Methods 22 patients with cervical deformity associated with upper cervical instability diagnosed by CT were retrospectively analyzed in Department of Orthopedics at Beijing Children’s Hospital.First,a 3D printing model of cervical was made with 3D printing technology,then simulated screw insertion and fixation operation on the model to obtain the individual screw in-sertion data to assist the real operation.At last implemented one-stage posterior orthomorphia combined with in-ternal fixation.Results 22 patients with cervical deformity successfully underwent the posterior screw fixation operation assisted by individual 3D printing models,without injury to the vertebral artery and nerve root,without internal fixation loosening and fracture,postoperative follow-up time ranged from 3 to 23 months,average 13.5 months.Postoperative ADI was significantly reduced,CMA increased significantly,the medulla oblongata ventral compression significantly reduced or disappeared,no death in operation,1 case with two times the fusion of bone graft,1 case underwent sternocleidomastoid muscle amputation lysis,1 case of foramen magnum decompression, 1 cases of posterior arch of atlas decompression. Conclusions Posterior screw fixation operation assisted by individualized 3D printing model can improve the success rate and safety of screw insertion,and effectively pro-tect the vertebral artery and nerve root avoiding damage,especially is of great help to the treatment of children with cervical deformity.%目的:研究个体化3D 打印模型辅助后路内固定治疗儿童颈椎畸形的方法和效果。方法对北京儿童医院骨科 CT 确诊的22例颈椎畸形伴上颈椎不稳患儿进行回顾性分析。采用3D 打印技术建立颈椎个体化3D 打印模型,在模型上进行模拟置钉及内固定手

  17. 空心拉力螺钉加镍钛聚髌器置入内固定重建骨折髌骨的生物力学条件%Biomechanical requirement for the reconstruction of patellar fracture treated with cancellous bone screw and nickel-titanium-patellar concentrator internal fixation

    Institute of Scientific and Technical Information of China (English)

    高振巢; 刘德昌; 蔡国平

    2013-01-01

    BACKGROUND: There are various internal fixation methods for the clinical treatment of patel ar fractures, but each method has advantages and disadvantages, respectively. The selection of proper internal fixation method wil directly affect the healing time and recovery of knee joint function. OBJECTIVE: To investigate the biomechanical reconstruction effect on patel ar fracture treated with cancel ous bone screw and nickel-titanium-patel ar concentrator internal fixation. METHODS: A retrospective analysis was performed on 27 cases of acute patel ar fracture patients from January 2011 to January 2012 in the Department of Orthopedics, Jinshan Hospital, Fudan University, including 13 cases of transverse fracture, 11 cases of comminuted fracture and three cases of upper or lower pole fracture. Al the 27 patients received cancel ous bone screw and nickel-titanium-patel ar concentrator internal fixation without plaster external fixation, and then the quadriceps active contraction training was performed from the 2nd day after internal fixation, and bed knee flexion and extension exercises were performed at 1 week after internal fixation. The knee joint function was evaluated with Böstman score system. RESULTS AND CONCLUSION: Al the 27 patients were fol owed-up for 4-14 months. Incisions obtained stage Ⅰ healing, and there was no fracture fixation or shedding, wound infection, skin necrosis or other complications. The average healing time was 8.5 weeks without delayed healing. According to clinical grading scale of Böstman score system, the mean score was 27.9, included 27 cases of excel ent (81%), four cases of good (15%), one case of poor (4%), and the excel ent and good rate was 96%. The results suggest that cancel ous bone screw combined with nickel-titanium-patel ar concentrator internal fixation can maintain the advantages of traditional internal fixation method, and can avoid the disadvantages of the traditional internal fixation method.%  背景:目前

  18. Research and application of absorbable screw in orthopedics: a clinical review comparing PDLLA screw with metal screw in patients with simple medial malleolus fracture

    Institute of Scientific and Technical Information of China (English)

    TANG Jin; HU Jin-feng; GUO Wei-chun; YU Ling; ZHAO Sheng-hao

    2013-01-01

    Objective:To observe the therapeutic effect of absorbable screw in medial malleolus fracture and discuss its clinical application in orthopedics.Methods:A total of 129 patients with simple medial malleolus fracture were studied.Among them,64 patients were treated with poly-D,L-lactic acid (PDLLA) absorbable screws,while the others were treated with metal screws.All the patients were followed up for 12-20 months (averaged 18.4 months) and the therapeutic effect was evaluated according to the American Orthopaedic Foot and Ankle Society clinical rating systems.Results:In absorbable screw group,we obtained excellent and good results in 62 cases (96.88%); in steel screw group,61 cases (93.85%) achieved excellent and good results.There was no significant difference between the two groups.Conclusion:In the treatment of malleolus fracture,absorbable screw can achieve the same result compared with metal screw fixation.Absorbable screw is preferred due to its advantages of safety,cleanliness and avoiding the removal procedure associated with metallic implants.

  19. Decompressive cervical laminectomy and lateral mass screw-rod arthrodesis. Surgical analysis and outcome

    OpenAIRE

    Obaidat Mouness H; Dabbas Waleed F; Qudsieh Tareq M; Obeidat Moutasem M; Audat Ziad A; Al Barbarawi Moh'd M; Malkawi Anas A

    2011-01-01

    Abstract Background This study evaluates the outcome and complications of decompressive cervical Laminectomy and lateral mass screw fixation in 110 cases treated for variable cervical spine pathologies that included; degenerative disease, trauma, neoplasms, metabolic-inflammatory disorders and congenital anomalies. Methods A retrospective review of total 785 lateral mass screws were placed in patients ages 16-68 years (40 females and 70 males). All cases were performed with a polyaxial screw-...

  20. 经寰枢椎椎弓根螺钉固定治疗Jefferson 骨折合并寰枢椎不稳%Treatment of Jefferson fracture combined with atlantoaxial instability with C1-C2 pedicle screw fixation

    Institute of Scientific and Technical Information of China (English)

    陈建明; 张成程; 许天明; 文景; 李勇; 周艳

    2011-01-01

    Objective To discuss the clinical outcomes of C1-C2 pedicle screw fixation in treatment of Jefferson fracture combined with aflantoaxial instability.Methods Eleven adult patients with Jefferson fracture combined with atlantoaxial instability were treated with C1-C2 pedicle screw fixation in our department from January 2006 to December 2009.There were eight males and three females at age range of 20-52 years(mean 36 years).There were eight patients with fresh fractures,three with old fracture and three complicated with odontoid process fracture.The main preoperative clinical symptoms were the limitation of head torsion and pain in the occiput and neck,with no spinal dysfunction in all patients.X-ray,CT scan,three-dimensional reconstruction,MRI scan and skull traction were performed in all patients before operation.Then,the patients were treated with C1-C2 pedicle screw fixation without fusion between C1-C2 under general anesthesia.Results The atlantoaxial dislocation was reduced completely and the patients could move from bed,wearing the neck collar.There was no injury of vertebral artery,spinal cord or nerve roots during operation,but one patient suffered the venous plexus bleeding which was packed with the hemostatic gauze.Eleven patients were followed up for 6-24 months(average 15 months),which showed bone union,with no internal fixation breakage,loosening or dislocation.The internal fixation was removed from seven patients 15 months after operation,with mild limitation of the cervical vertebra torsion(90°-135°,average 115°)but with no limitation of obvious extension-flexion motion.Conclusion C1-C2 pedicle screw fixation has features of simple operation,short segment fixation,solid fixation and high rate of bone healing for treatment of Jefferson fracture combined with atlantoaxial instability.%目的 探讨经寰枢椎椎弓根螺钉内固定治疗Jefferson骨折合并寰枢椎不稳的临床疗效.方法 选择2006年1月-2009年12月采用经寰枢椎椎

  1. Pedicle screw reduction and fixation combined with calcium sulfate cement vertebroplasty in the treatment of thoracolumbar fractures%椎弓根钉复位固定结合注射型硫酸钙椎体成形术治疗胸腰椎骨折

    Institute of Scientific and Technical Information of China (English)

    魏力今; 周业金; 刘艺明; 潘良春; 李春; 何高

    2011-01-01

    目的 总结椎弓根钉复位固定结合注射型硫酸钙(CSC) 椎体成形术治疗胸腰椎骨折的方法与疗效.方法 对23 例(25椎)胸腰椎骨折采用切开复位椎弓根钉固定,用特定注射器经伤椎椎弓根穿刺注入CSC进行椎体成形术治疗,影像学评估术前、术后及取钉12个月后矢状位指数(SI)及椎体前、后缘高度压缩率变化.结果 平均每个椎体注入CSC 5.34 ml,6例术中发生椎旁渗漏,无椎管内渗漏,术后患者神经功能Frankel分级较术前提高1~2级(P<0.05).术后8~12周影像学结果 提示,硫酸钙在椎体内完全消失,被正常骨组织吸收.术后及取钉12个月后SI角及椎体前、后缘高度压缩率均较术前有明显改善(P<0.01),术后至取钉12个月后椎体前缘无明显丢失,但椎体后缘有少量丢失(P<0.05).本组无椎弓根钉失败病例.结论 椎弓根钉复位固定结合CSC椎体成形术治疗胸腰椎骨折,能使复位后的伤椎恢复其完整形态及椎体强度,提高胸腰椎骨折的临床疗效,其方法简便、安全,近期疗效满意.%Objective To investigate the method and effect of pedicle screw reduction and fixation combined with calcium sulfate cement ( CSC ) vertebroplasty in the treatment of thoracolumbar fractures. Methods 23 cases ( 25 vertebrae ) with thoracolumbar fractures were treated with pedicle screw sagittal index( SI ) angle reduction and fixation combined with CSC vertebroplasty. According to imaging, we evaluated the change SI angle and compression ratio of vertebral body at the time of preoperation, postoperation and 12 months later. Results Each vertebra was injected with 5. 34 ml CSC on average. 6 cases got paravertebral leakage. No vertebral canal leakage was found.Frankel grading of neural function was improved. CSC disappeared in 8 ~12 weeks and substituted by bone. In the postoperative and 12 months films, the SI angle, vertebral height were improved ( P <0. 01 ). The anterior height did not

  2. Effects of the internal fixation for lower cervical fracture-dislocation combined with locked ;facet with pedicle screw%椎弓根钉棒治疗下颈椎骨折脱位合并小关节绞锁的疗效

    Institute of Scientific and Technical Information of China (English)

    杨子斌; 赵伟; 吕乔; 阮安培

    2015-01-01

    目的:探讨后路切开复位、椎弓根螺钉固定、椎板植骨治疗下颈椎骨折脱位伴关节突绞锁的疗效。方法26例下颈椎关节突绞锁中,单侧小关节绞锁者9例,双侧小关节绞锁者17例。患者入院后行颅骨牵引,3~5 d后行后路切开复位、椎弓根螺钉固定、椎板植骨术。对患者脊髓损伤ASIA神经功能评级,测量脱位程度,评价治疗效果。结果26例均获随访,时间12~36个月。术中无脊髓、血管、神经系统损伤;术后无螺钉松动,复位良好;颈椎椎间高度和生理曲度恢复。脊髓神经功能ASIA分级:2例A级、2例B级及1例C级患者无明显改善,其余病例较术前好转。结论后路切开复位、椎弓根螺钉固定、椎板植骨术是治疗下颈椎骨折脱位合并小关节绞锁的可行方法。%Objective To explore the clinical effects of the posterior open reduction and internal fixation for fracture and dislocation of cervical spine with cervical pedicle screws and vertebral plate bone graft and fusion. Methods 26 patients′clinical data with lower cervical facet fracture and dislocation locking were retrospectively analyzed. There were unilateral facet interlocking in 9 cases, bilateral locking in 17 cases. The skull traction-reduction was performed for 3~5 days,then all patients were treated by posterior open reduction,internal fixation with cervical pedicle screws, and laminar bone graft;Before the beginning of the treatment all patients were taken American Spinal Injury Associa-tion ( ASIA) neurological function grade and measured the degree of dislocation. Results The follow-up time of 26 cases ranged from 12 months to 36 months. There was no severe complication such as vertebral artery nerve root or spinal cord injuries or aggravation of spinal cord injury, and no screw loosening;All patients got good reduction, and restoration of intervertebral height. Neurofunction recovery was achieved in all cases except 2 cases with

  3. Short-segment versus long-segment pedicle screw fixation for repair of thoracolumbar fracture:one-year follow-up of vertebral compression rate%短节段与长节段椎弓根螺钉置入修复胸腰椎骨折比较:椎体压缩率1年随访

    Institute of Scientific and Technical Information of China (English)

    苏伟坤; 叶少腾

    2015-01-01

    背景:后路减压内固定修复胸腰椎骨折效果肯定,又根据处理方法的不同分为短节段与长节段椎弓根螺钉内固定。目前临床上关于两种修复方案的疗效,存在较大争议。目的:对比观察经后路短节段与长节段椎弓根螺钉置入内固定修复胸腰椎骨折患者的伤椎前缘压缩率及Cobb角变化率。方法:纳入胸腰椎骨折患者120例,根据内固定方案分为两组,研究组采用经后路短节段椎弓根螺钉内固定,对照组采用经后路长节段椎弓根螺钉内固定。观察两组患者内固定前、内固定后即刻、内固定后12个月伤椎前缘压缩率以及Cobb角变化率。结果与结论:内固定前两组患者伤椎前缘压缩率、Cobb角变化率差异均无显著性意义(P >0.05)。内固定后即刻及内固定后12个月,可见研究组伤椎前缘压缩率、Cobb角变化率均明显小于对照组,差异均有显著性意义(P 0.05). Anterior vertebral compression rate and Cobb angle were significantly smal er in the study group than in the control group immediately and 12 months after fixation (P<0.05). Besides, surgical time and blood loss volume were less in the study group than in the control group (P<0.05). These results indicated that posterior short-segment pedicle screw fixation for treatment of thoracolumbar fracture can effectively improve kyphosis, recover vertebral compression degree, and its surgical time is short and blood loss volume during surgery is little, so it is better than posterior long-segment pedicle screw fixation.

  4. 单侧椎弓根螺钉内固定椎间融合治疗腰椎退行性病变临床研究%Unilateral pedicle screw fixation with transforaminal lumbar interbody fusion for the treatment of lumbar degenerative disease

    Institute of Scientific and Technical Information of China (English)

    徐海栋; 陈勇; 许斌; 赵建宁

    2011-01-01

    Objective This study aimed to investigate the clinical outcome of unilateral pedicle screw (Ups) fixation and transforaminal lumbar interbody fusion (TLJF) in the treatment of lumbar degenerative disease. Methods Forty-two patients with lumbar degenerative disease were assigned to two groups on a voluntary basis to receive Ups + TLJF ( n = 24 ) and bilateral pedicle screw fixation combined with fusion between vertebra (n = 18). Pre-and post-operative back pains were compared using the visual analog scale (VAS) system, the clinical outcomes assessed by the Kim method, and the fusion status evaluated by the Schulte method. Results The clinical symptoms of all the patients were improved post-operatively, with no complications. The Ups + TL1F group showed higher VAS and Kim scores than the bilateral fixation group, but no significant differences were observed in the bone graft fusion between the two groups. The patients were followed up for6 to 18 (mean 12.8) months. Conclusion Ups + TLJF, characterized by minimal invasiveness, is a reliable and effective option for the management of lumbar degenerative disease. However, its indications should be well considered.%目的 评估单侧椎弓根螺钉内固定(unilateral pedicle screw fixation,Ups)结合经椎间孔椎间融合(transforaminallumbar interbody fusio,TLIE)治疗腰椎退行性疾病的临床疗效. 方法 2009年12月至2010年12月,共收治不同类型腰椎退行性疾病患者42例,按照自愿的原则,采用Ups结合TLIF治疗24例和双侧椎弓根螺钉内固定术结合椎间融合术治疗18例.应用视觉模拟评分系统(Visual Analog Scale,VAS)评估患者术前、术后疼痛情况,应用Kim方法评价临床效果,应用Schulte方法观察植骨融合情况. 结果 所有患者术后临床症状较术前明显改善、临床疗效良好,无并发症的发生.VAS评分、Kim评分单侧固定优于双侧固定,Schulte方法观察植骨融合2组无显著差异.随访时间6~18个月,平均12

  5. 单侧椎弓根螺钉内固定联合单枚融合器治疗极外侧腰椎间盘突出症%Unilateral pedicle screw fixation combined with single cage interbody fusion for far lateral lumbar disc herniation

    Institute of Scientific and Technical Information of China (English)

    王佳; 周耀; 李伟; 杨方

    2013-01-01

    Objective To evaluate the surgical results of treating far lateral lumbar disc herniations by lumbar inter-body fusion with unilateral pedicle screw fixation and single cage. Methods 26 cases of far lateral lumbar disc herniations were received the treatment of lumbar interbody fusion with unilateral pedicle screw fixation and single cage via a posterior approach. X-ray or CT examinations were taken in the regular follow-up to observe the fusion rates and complications, and the outcome of the surgery was assessed by Japanese Orthopaedic Association ( JOA ) low back pain scores. Results There were no wound infection or nerve complications after operation. All patients were followed up for 18 ~27 months. The fusion rate was 96. 2%( 25/26 ). The average JOA scores of preoperation and final followed-up were 12. 43 2. 16 and 24. 53 2. 97 respectively, which showed significant difference ( P <0. 05 ) between the two observations. The mean improvement rate was 81. 6% , and 19 cases got excellent results,5 good and 2 fair. The excellent and good rate was 92. 3%( 24/26 ). Conclusions Lumbar interbody fusion with unilateral pedicle screw fixation combined with single cage can provide simple procedure, little trauma, reliable fixation, high fusion rate, and satisfactory clinical results.%目的 评估单侧椎弓根螺钉内固定联合单枚融合器治疗极外侧腰椎间盘突出症的疗效.方法 对26例极外侧腰椎间盘突出症患者经腰椎后路行单侧椎弓根螺钉内固定联合单枚cage的融合手术.术后定期复查X线片或CT片,观察融合率及并发症情况;采用JOA腰腿痛评分法评估疗效.结果 术后均无伤口感染、神经损伤.患者均获随访,时间18~27个月.临床融合率96.2%(25/26).JOA评分:术前为12.43分±2.16分,末次随访时为24.53分±2.97分,差异有统计学意义(P<0.05),平均改善率为81.6%.疗效评定:优19例,良5例,中2例,优良率92.3%(24/26).结论 单侧椎弓根螺钉内固定联合单

  6. Transforaminal lumbar interbody fusion combined with unilateral pedicle screw fixation for upper lumbar disc hernia-tion%经椎间孔行腰椎间融合联合单侧椎弓根螺钉固定术治疗高位腰椎间盘突出症疗效分析

    Institute of Scientific and Technical Information of China (English)

    谭健; 李平元; 欧军; 苏小桃; 卢政好

    2014-01-01

    Objective To investigate the clinical effect of transforaminal lumbar interbody fusion (TLIF) combined with unilateral pedicle screw fixation for upper lumbar disc herniation. Methods Retrospectively analysed the clinical data of 16 patients with upper lumbar disc herniation from Jun 2009 to Feb 2013 in our hospital, who were treated with transforaminal lumbar interbody fusion combined with unilateral pedicle screw fixation;using the visual analogue scale assessed the pain degree of patients at admission and after operation; assessed the clinical efficacy at last follow-up according to the modified MacNab criteria and observed intervertebral fusion. Results 16 patients were followed up 12 to 52 months (average 24.2 months) after surgery. All the patients had no nerve damage and leakage of cerebrospinal fluid complications. VAS score at different postopera-tive periods had significant difference compared with the VAS score before operation (P<0.01). According to the modified Mac-Nab criteria,the excellent and good rate was 93.75%. X-ray examination showed that there were no internal fixation failure and lumbar interbody non-fusion at the last follow-up. Conclusion Transforaminal lumbar interbody fusion combined with uni-lateral pedicle screw fixation has satisfied effect in the treatment of upper lumbar disc herniation,and has the advantages of small trauma,less complications,low cost.%目的:探讨经椎间孔行腰椎间融合(transforaminal lumbar interbody fusion,TLIF)联合单侧椎弓根螺钉固定术治疗高位腰椎间盘突出症的临床疗效。方法回顾性分析2009年6月~2013年2月本院16例高位腰椎间盘突出症患者临床资料,均采用TLIF联合单侧椎弓根螺钉固定术治疗;采用腰腿痛视觉模拟评分测评入院时和TLIF联合单侧椎弓根螺钉固定术后(术后1周、1个月、3个月及末次随访)患者疼痛情况,末次随访采用改良MacNab标准评定临床疗效,并了解椎间融合

  7. 腓骨远端解剖型钢板与空心螺钉置入内固定修复Danis-Weber B型双踝骨折%The distal fibula anatomic plate combined with hollow screw fixation for Danis-Weber B double ankle fractures

    Institute of Scientific and Technical Information of China (English)

    马运宏

    2015-01-01

    背景:踝关节骨折是临床上常见的骨折,Danis-Weber B型骨折所占比例较大,对外踝的解剖复位以及选择适合的内固定物是修复成败的关键。  目的:观察解剖型钢板和空心螺钉联合内固定修复踝关节内外侧面骨折的解剖复位效果。  方法:对2010年3月至2013年10月收治的32例Danis-Weber B型踝关节骨折患者进行回顾性研究,内固定方式外踝均选用钢板螺钉固定,内踝骨块均选用双螺纹加压螺钉固定。采用美国足踝外科协会(AOFAS)的踝与后足评分系统及Kofoed踝关节评分对患者踝关节功能进行评估,以目测类比评分评定修复后疼痛程度的改善,根据影像学结果分析内固定后对线对位的生物力学水平。  结果与结论:所有患者均获得6-24个月随访,所有病例均骨性愈合。治疗后随访6个月患者踝关节AOFAS评分、Kofoed评分及目测类比评分均显著优于治疗前,差异有显著性意义(P <0.05)。影像学结果显示,内固定后对线对位良好。有1例感染患者,其他无不良反应。提示应用解剖型钢板和空心螺钉置入内固定修复踝关节内、外踝双踝骨折,可发挥解剖钢板与空心螺钉各自的特点及生物力学优势,使骨折达到踝关节的解剖复位。%BACKGROUND:Ankle joint fracture is a common fracture in the clinic. Proportion of Danis-Weber B fracture was large. Anatomic reduction and suitable internal fixator of lateral mal eolus are the key for successful repair. OBJECTIVE:To analyze the anatomic reduction effect of anatomic plate combined with hol ow screw fixation for inner and outer side fracture of the ankle joint. METHODS:A total of 32 patients with Danis-Weber B ankle fracture, who were treated from March 2010 to October 2013, were retrospectively analyzed. Plate and screw were used for internal fixation of lateral mal eolus. Double thread compression screw was used for fixation

  8. Dynamic hip screw combined with trochanter stabilizing plate versus Gamma nail fixation in repair of intertrochanteric fracture%动力髋结合转子稳定钢板与Gamma钉内固定治疗股骨转子间骨折的比较

    Institute of Scientific and Technical Information of China (English)

    周强; 陆骅; 俞思明; 王占朝; 茅宇仑; 姚兵; 张天浩

    2014-01-01

    背景:股骨转子间骨折患者在早期积极有效的内固定治疗可以获得良好的疗效。  目的:探讨动力髋螺钉+转子稳定钢板与Gamma钉置入内固定治疗Evans ⅢB型、IV型股骨转子间骨折的比较。  方法:选取上海交通大学医学院附属新华医院崇明分院2009年2月至2012年11月收治的67例Evans ⅢB型、IV型股骨转子间骨折患者,其中动力髋螺钉+转子稳定钢板治疗28例,Gamma钉治疗39例。所有患者治疗后常规使用抗生素和功能锻炼。回顾性分析两组患者治疗时间、治疗中出血量、骨折愈合时间以及Harris髋关节功能评分。  结果与结论:所有患者随访6-45个月,平均随访21个月。①动力髋螺钉+转子稳定钢板组出现感染1例,经换药半年后拔除内固定治愈,Gamma钉1例肥胖患者治疗后3周下床活动时再次受伤,出现远端锁钉处骨折,经更换长Gamma钉后愈合,Gamma钉组有4例患者因大转子固定欠稳定,卧床时间超过6周出现重症肺炎,经转内科治疗后治愈。②动力髋螺钉+转子稳定钢板组治疗后出现髋内翻畸形2例,Gamma钉组3例,所有患者骨折均愈合。③动力髋螺钉+转子稳定钢板组较Gamma钉组治疗时间更长,治疗中出血量明显增多(P0.05)。动力髋螺钉+转子稳定钢板和Gamma钉均是治疗Evans ⅢB型、IV型股骨转子间骨折的有效方法,选择合适的内固定物要根据骨折的稳定性、骨折愈合状况、骨质疏松程度等综合分析。%BACKGROUND:Intertrochanteric fracture can obtain good curative effects after active effective internal fixation in early stage. OBJECTIVE:To compare dynamic hip screw+trochanter stabilizing plate and Gamma nail fixation for treatment of Evans type IIIB and type IV intertrochanteric fracture. METHODS:A total of 67 patients with Evans type IIIB and type IV intertrochanteric fracture, including 28 cases undergoing dynamic

  9. 三种单纯腰椎椎间融合并双侧椎弓根螺钉内固定后即刻稳定性的比较%Initial stability of lumbar spine following three types of interbody fusion and bilateral pedicle screw fixation

    Institute of Scientific and Technical Information of China (English)

    张烽; 陈兵乾; 居建文; 王素春; 段广超; 王以进

    2008-01-01

    BACKGROUND:Operative approaches of lumbar interbody fusion include anterior (ALIF),posterior (PLIF) and transforaminal lumbar interbody fusion (TLIF).The resected structures and cage implantation sites are different,and the initial stability of lumbar spine is varied.OBJECTIVE:To compare the initial stability of lumbar spine following ALIF,PLIF or TLIF in combination with bilateral pedicle screw fixation.DESIGN:Comparative observation.MATERIALS:Fifteen samples of fresh calf lumbar spine were used.METHODS:Models ofALIE PLIF and TLIF were simulated.After examination as normal group,the samples were randomly divided into three groups (n=5).Besides anterior,posterior and transforaminal lumbar interbody fusion include anterior,bilateral pedicle screw fixation was performed.MAIN OUTCOME MEASURES:Biomechanical characteristics of the lumbar spine before and after ALIF,PLIF or TLIF in combination with bilateral pedicle screw fixation.RESULTS:Following three approaches of lumbar interbody fusion,the stability of lumbar spine was significantly reduced,which was enhanced after bilateral pedicle screw fixation (torsion indexes were also increased).In addition,rigidity of the lumbar spine was enhanced.The stability indexes of lumbar spine following TLIF were significantly greater than the other approaches,indicating the initial stability of TLIF was the best.The rigidity,stress,and swain of lumbar spine following PLIF were greater than ALIE but torsion indexes were smaller than ALIE CONCLUSION:The stability of lumbar spine following lumbar interbody fusion was significantly reduced compared with normal sample.But bilateral pedicle screw fixation greatly increases the stability.Among three types of lumbar interbody fusion,the initial stability of lumbar spine following TLIF is the best.%背景:椎间融合术按照手术入路主要有前路椎间融合术、后路椎间融合术和椎间孔入路椎问融合术.3种融合术术中切除的结构不同,融合器置入的部位

  10. 单侧椎弓根钉固定加单枚Cage植骨融合治疗腰椎退行性疾病的临床观察%Unilateral Pedicle Screw Fixation with Single Cage Interbody Fusion Clinical Observation on the Treatment of Lumbar De-generative Disease

    Institute of Scientific and Technical Information of China (English)

    李辉

    2015-01-01

    Objective:To investigate the unilateral pedicle screw fixation with single Cage implantation clinical curative effect of the treatment of degenerative disease of lumbar spine bone fusion .Methods:From March 2007 to March 2011 hospitalized in department of orthopedics in our hospital treatment of 48 cases of lesions caused by degenerative lumbar disease were randomly divided into 2 groups ,respectively using unilateral pedicle screw fixation with single Cage inter‐body fusion in the treatment of 22 cases of the treatment group is unilateral ,bilateral pedicle screw fixation and inter‐body fusion in the treatment of single Cage 26 cases were bilateral treatment group .Comparative analysis of 2 groups of patients before and after operation of Japanese Orthopedic Association (JOA ) score and visual analogue scale (VAS) ,improvement rate ,operation time ,amount of bleeding ,hospitalization days ,cost of hospitalization and postop‐erative follow‐up of Cage bone graft fusion .Results:48 patients were followed up ,followed up for 12~24 months ,aver‐age 18 months ,two groups of patients with JOA score of VAS and compares their differences had no statistical signifi‐cance (P>0 .05)before operation ,no statistical significance at the end of the follow‐up JOA score of VAS and compares their differences (P>0 .05) ,but the patients in the 2 groups compared with the preoperative JOA score of VAS and the comparison was statistically significant (P<0 .01) .The operation time ,hemorrhage volume ,length of hospitalization , cost of hospitalization ,unilateral treatment group was significantly better than the bilateral treatment group (P<0.01) .Conclusion:Unilateral pedicle screw fixation and bone grafting with single cage spine surgery is effective opera‐tion technology ,and achieve the same clinical efficacy of bilateral pedicle screw fixation of the same in the treatment of lumbar degenerative disease .And this technique has short operation time ,intraoperative

  11. Polymethylmethacrylate-augmented transpedicular screw fixation for stabilization of the lumbar degenerative disease accompanied with osteoporosis%骨水泥加强椎弓根螺钉内固定治疗伴骨质疏松症的腰椎退行性病变

    Institute of Scientific and Technical Information of China (English)

    薛海滨; 马远征; 王亮; 李大伟; 顾苏熙

    2011-01-01

    Objective To explore the clinical efficacy of the use of polymethylmethacrylate (PMMA)-augmented transpedicular screw fixation for the treatment of lumbar degenerative disease accompanied with osteoporosis.Methods Thirty-eight patients of lumbar degenerative disease accompanied with osteoporosis from Jun 2004 to Jan 2009 were selected with intact follow-up data.They were 16 males and 22 females with average age of 62.5 years, including lumbar degenerative stenosis 16 cases, lumbar intervertebral disc herniation combined with segmental instability 12 cases, lumbar degenerative spondylolisthesis 6 cases, and lumbar degenerative scoliosis 4 cases.The patients were treated with lumbar canal decompression, or fusion,or transpedicular screw fixation by augmentation with PMMA in the screw tract, according to their clinical feature and imaging results.The postoperative outcomes were evaluated using Oswestry Disability Index (ODI) scale, visual analog scale (VAS), and radiological findings.Results All cases were followed up for 18-48months (36.5 months in average).Low back pain and leg pain were released apparently.There were no loosens and dislocations of the screw postoperatively according to X-ray scan.No bright lines appeared around the screws.Upon the last follow-up time, the VAS for low back pain decreased from 7.46 ± 2.24 preoperatively to 3.15 ± 1.47 postoperatively ( P < 0.01 ).The VAS for leg pain decreased from 7.24 ±2.32.preoperatively to 2.11 ±0.84 postoperatively (P <0.01 ).ODI score decreased from 43.15 ±5.72 preoperatively to 15.41 ± 6.42 postoperatively ( P < 0.01 ).The intraoperative and postoperative complications occurred in 16 cases.The complications did not cause any delayed damage.Conclusion For patients suffering from lumbar degenerative disease accompanied with osteoporosis, PMMA in the screw tract was helpful for increasing the stabilization of transpedicular screw and preventing from loosen and dislocation of the screws, therefore

  12. Posterior cervical spine arthrodesis with laminar screws: a report of two cases

    Directory of Open Access Journals (Sweden)

    Sugimoto,Yoshihisa

    2007-04-01

    Full Text Available We performed fixation using laminar screws in 2 patients in whom lateral mass screws, pedicle screws or transarticular screws could not be inserted. One was a 56-year-old woman who had anterior atlantoaxial subluxation (AAS. When a guide wire was inserted using an imaging guide, the hole bled massively. We thought the re-insertion of a guide wire or screw would thus increase the risk of vascular injury, so we used laminar screws. The other case was an 18-year-old man who had a hangman fracture. Preoperative magnetic resonance angiography showed occlusion of the left vertebral artery. A laminar screw was inserted into the patent side (i.e., the right side of C2. Cervical pedicle screws are the most biomechanically stable screws. However, their use carries a high risk of neurovascular complications during screw insertion, because the cervical pedicle is small and is adjacent laterally to the vertebral artery, medially to the spinal cord, and vertically to the nerve roots. Lateral mass screws are also reported to involve a risk of neurovascular injuries. The laminar screw method was thus thought to be useful, since arterial injuries could thus be avoided and it could also be used as a salvage modality for the previous misinsertion.

  13. Cement leakage in pedicle screw augmentation: a prospective analysis of 98 patients and 474 augmented pedicle screws.

    Science.gov (United States)

    Mueller, Jan U; Baldauf, Joerg; Marx, Sascha; Kirsch, Michael; Schroeder, Henry W S; Pillich, Dirk T

    2016-07-01

    OBJECTIVE Loosening and pullout of pedicle screws are well-known problems in pedicle screw fixation surgery. Augmentation of pedicle screws with bone cement, first described as early as 1975, increases the pedicle-screw interface and pullout force in osteoporotic vertebrae. The aim of the present study was to identify cement leakage and pulmonary embolism rates in a large prospective single-center series of pedicle screw augmentations. METHODS All patients who underwent cement-augmented pedicle screw placement between May 2006 and October 2010 at the authors' institution were included in this prospective cohort study. Perivertebral cement leakage and pulmonary cement embolism were evaluated with a CT scan of the area of operation and with a radiograph of the chest, respectively. RESULTS A total of 98 patients underwent placement of cement-augmented pedicle screws; 474 augmented screws were inserted in 237 vertebrae. No symptomatic perivertebral cement leakage or symptomatic pulmonary cement embolism was observed, but asymptomatic perivertebral cement leakage was seen in 88 patients (93.6%) and in 165 augmented vertebrae (73.3%). Cement leakage most often occurred in the perivertebral venous system. Clinically asymptomatic pulmonary cement embolism was found in 4 patients (4.1%). CONCLUSIONS Perivertebral cement leakage often occurs in pedicle screw augmentation, but in most cases, it is clinically asymptomatic. Cement augmentation should be performed under continuous fluoroscopy to avoid high-volume leakage. Alternative strategies, such as use of expandable screws, should be examined in more detail for patients at high risk of screw loosening. PMID:26943258

  14. Internal Fixation with Absorbable Screws for Femoral Head Fractures Combined with Posterior Hip Dislocation%可吸收钉内固定治疗股骨头骨折并髋关节后脱位的临床体会

    Institute of Scientific and Technical Information of China (English)

    贾斌; 张勇; 曹国庆; 马雪峰; 郑杰; 高迪; 刘彦勋

    2012-01-01

    Objective To summarize the clinical experiences in internal fixation with absorbable screws for femoral head fractures with posterior dislocation of the hip. Methods There were 7 cases of femoral head fractures with posterior dislocation of hip were treated with the absorbable screw fixation. The fractures of the femoral head were scored by the Pipkin ' s fracture classifications with 2 of type I , 3 of type II , 1 of type HI and 1 of type IV. The size of the femoral head fracture mass was minimum 2. 0 cm x 2. 0 cm x 2. 5 cm and maximum 4.5cm x 3.5 cm x4. Ocm. 5 cases of type I and type II were operated by Smith-Peterson approach and the others were operated by Kocher-Langenbeck approach. The absorbable screws of 4. 5mm diameter and 35 ~ 55mm length were used to fix the femoral heads. Results All the 7 cases were followed up in average 31.7 (14 ~ 57) months. According to the Thompson-Epstein standard, there were 3 cases of excellent, 2 of fine, 1 of fair and 1 of worth. The total good rate was 71. 4%. 1 patient with type IV occurred femoral neck fracture nonunion followed by the necrosis of the femoral head, which converted to total hip arthroplasty 2. 5 years later. Conclusions It is recommended of the absorbable screw in the treatment of femoral head fractures combined with posterior dislocation of hip with adventures of no secondary surgery, conveniently obtained material and extensive clinical application.%目的 总结可吸收钉内固定治疗股骨头骨折并髋关节后脱位的临床体会. 方法 采用可吸收钉内固定治疗股骨头骨折并髋关节后脱位患者7例.股骨头骨折按照Pipkin's骨折分型:Ⅰ型2例,Ⅱ型3例,Ⅲ型1例,Ⅳ型1例.股骨头骨折块最小2.0 cm×2.0 cm×2.5 cm,最大4.5 cm×3.5 cm×4.0 cm.受伤至就诊时间为1 h~12d.Ⅰ型2例和Ⅱ型3例经Smith-Peterson入路,Ⅲ型1例和Ⅳ型1例采用Kocher-Langenbeck入路,以直径4.5 mm,长度35~55mm的可吸收螺钉内固定股骨头骨折块.结果

  15. 单侧椎弓根钉固定结合单枚融合器治疗腰椎不稳症%Treatment of lumbar instability with transforaminal lumbar interbody fusion (with single cage) combined with uni-lateral pedicle screw fixation

    Institute of Scientific and Technical Information of China (English)

    华永均; 王人彦; 郭志辉; 朱利民; 陆建阳

    2014-01-01

    Objective:To explore the clinical effect of transforaminal lumbar interbody fusion (with single cage) combined with unilateral pedicle screw fixation in treating lumbar instability. Methods:The clinical data of 50 patients with lumbar in-stability were retrospectively analyzed. They underwent treatment and obtained following up more than 8 months from 2009 to 2012. All patients complicated with refractory or recurrent lower back pain ,and unilateral primarily or unilateral lower limb ra-diation pain,X ray and CT films showed lumbar instability. The patients were respectively treated with transforaminal lumbar interbody fusion (with single cage) combined with unilateral or bilateral pedicle screw fixation. According to different fixation methods,they divided into unilateral fixation group and bilateral fixation group. There were 20 patients with 22 intervertebral spaces in unilateral fixation group,8 males and 12 females,aged from 26 to 66 years old,2 cases with isthmic spondylolisthesis of degreeⅠ,8 cases with degenerative spondylolisthesis,10 cases with lumbar disc herniation;fusion location with L3,4 was in 1 case,L4,5 was in 12 cases,L5S1 was in 9 cases. There were 30 patients with 30 intervertebral spaces in bilateral fixation group,14 males and 16 females,aged from 41 to 62 years old,4 cases with isthmic spondylolisthesis of degree Ⅰ,14 cases with degenerative spondylolisthesis,12 cases with lumbar disc herniation;fusion location with L3,4 was in 3 cases,L4,5 was in 15 case,L5S1 was in 12 cases. Operation time,intraoperative blood loss,postoperative drainage,complications were analyzed and intervertebral height,lordosis angle changes,fusion rate and clinical effect were compared between two groups. Results:All incisions obtained primary healing,lower limb radiation pain and low back pain disappeared basically,no infection,endo-rachis injury was found. Foot drop occurred in one case of bilateral fixation group and no iatrogenic neurological symptom was

  16. Omni - posterior decompression and transpedicular screw fixation in thoracic spine for thoracic ossification of ligamentum flavum%后路全椎板减压+胸椎弓根钉内固定术治疗胸椎黄韧带骨化的疗效分析

    Institute of Scientific and Technical Information of China (English)

    施清选; 叶志明; 林文武; 朱志侠

    2011-01-01

    Objective To examine the clinical efficacy of omni - posterior decompression and transpedicular screw fixation in thoracic spine in the treatment of thoracic ossification of ligamentum flavum.Methods The clinical data of 27 patients with thoracic ossification of flavum who underwent omni -posterior decompression and transpedicular screw fixation in thoracic spine in our hospital from January 2002 to January 2008 were retrospectively analyzed.The patients included 18 males and 9 females at age of 47 to 71 years with an average of 58 years.All of them were given routine X - ray,CT and MRI examinations preoperatively.The improved Macnab standard and VAS scoring system were used to evaluate the surgical effects.Results According to the Macnab standard,the excellent and good rate was 77.8% in this cohort within one year after operation and the effective rate was 85.1%.The excellent and good rate reached 85.1% one year after operation.VAS scoring revealed that the satisfactory degree was 66.6%within a year and 75% a year later.The mean follow - up duration was 2.5 year( 1.5 to 5 years).Conclusion Omni - posterior decompression and transpedicular screw fixation in thoracic spine is a safe and effective operation method for thoracic ossification of ligamentum flavum.%目的 探讨后路全椎板减压+胸椎弓根钉内固定术治疗胸椎黄韧带骨化的疗效.方法 回顾性总结2002年至2008年间胸椎黄韧带骨化病例27例.患者术前均常规给予X线、CT及MRI检查.手术采用后路全椎板减压+椎弓根钉内固定术.术后采用改良Macnab疗效评定标准及VAS评分,评价治疗效果.结果 术后改良Macnab疗效评定标准,27例患者术后1年内优良率77.8%,手术总有效率85.2%,1年后优良率85.1%.VAS评分应用专用评分尺,患者总满意度为66.6%,1年后总满意度为75%.结论 后路全椎板减压+胸椎弓根钉内固定术为治疗胸椎黄韧带骨化安全有效的手术方式.

  17. Treatment of posterior malleolar fractures by means of limited open reduction, poking reduction and QWIX cannulated screw internal fixation%有限切开、撬拨复位、QWIX空心钉内固定治疗后踝骨折

    Institute of Scientific and Technical Information of China (English)

    孟纯阳; 蒋电明; 卢旻鹏; 安洪

    2009-01-01

    Objective To evaluate the clinical effect of limited open reduction, poking reduction and QWIX cannulated screw internal fixation in treatment of posterior malleolar fracture. Methods A total of 14 patients with posterior malleolar fracture were treated by limited open reduction, poking reduction and QWIX cannulated screw internal fixation. Injury causes included traffic accidents in five patients, fall from height injury in four and inversion sprain in five. According to fracture type classification methods of Weber and Danis, there were two patients with type A3, seven with type B3 and five with type C3. Func-tional exercise was carried out based on postoperative exercise plan. Regular follow-up was performed to e-valuate the functional recovery of the ankle joint. Results All patients were followed up for 6-18 months (average 9.5 months). One patient with sural nerve injury returned to normal after six months. Twelve pa-tients showed excellent range of motion of the ankle joint and normal gait three months after operation. In 12 patients, dorsiflexion of the ankle joint was > 20° and plantar flexion > 40° six months after operation, which was approximately similar to contralateral normal ankle joint. The ankle joint function of all patients returned to normal six months after operation. According to Baird-Jackson ankle joint function evaluation, the result was excellent in 12 patients, good in one and fair in one, with excellence rate of 93%. Con-clusion The limited open reduction, poking reduction and internal fixation of QWIX caunulated screw are effective method for treatment of posterior malleolar fractures.%目的 探讨有限切开、撬拨复位、QWIX空心钉内固定治疗后踝骨折的临床疗效.方法 14例后踝骨折患者,男3例,女11例;年龄23~69岁,平均43.6岁.其中交通伤5例,坠落伤4例,行走扭伤3例,滑旱冰扭伤2例.按Weber和Danis踝关节骨折分型方法:A3型2例,B3型7例,C3型5例,进行

  18. Open Reduction and Internal Fixation with DHS Combined with Anti-rotation Screw to Treat Pauwels Type Ⅲ Femoral Neck Fracture in Young Adults%切开复位DHS联合抗旋螺钉固定治疗青壮年股骨颈PauwelsⅢ型骨折

    Institute of Scientific and Technical Information of China (English)

    曲国胜; 刘建华; 马英; 杨国良; 冯世斌

    2011-01-01

    目的:评价切开复位DHS 联合抗旋螺钉固定治疗青壮年股骨颈Pauwels Ⅲ型骨折的临床效果.方法:采用回顾性分析的方法,总结2005 年2月~2009 年4月,我院手术治疗的Pauwels Ⅲ型骨折患者26 例.其中,男22 例,女4例,年龄19~47 岁,平均38.4 岁.骨折按Pauwels 型均为Ⅲ型,采用切开复位DHS 联合空心钉固定.结果:本组患者随访时间20~70 个月,平均31.2 个月.除3例发生股骨头缺血性坏死外,其余23名患者骨折均得到愈合.根据Harris 髋关节功能评分系统评估疗效,优18 例,良5例,差3例.结论:切开复位DHS 联合抗旋螺钉固定治疗青壮年股骨颈Pauwels Ⅲ型骨折的疗效肯定,解剖复位、坚强固定是获得满意疗效的关键.%Objective:To evaluate the result of Pauwels type Ⅲ femoral neck fracture in young adults treated with open reduction and internal fixation with DHS combined with anti-rotation screw.Methods:A retrospective analysis was done on the clinical date of 16 cases of young Pauwels type Ⅲ fracture,which were surgically treated in our hospital from February 2005 to April 2009.There were 15 males and 1 females,with an average of 38.4 years old (ranged from l9 to 47 years old).All were Pauwels type Ⅲ fracture and treated with the method of open reduction and fixed with DHS combined with anti-ration screw.Results: The average period of follow-up of these 16 cases was 20~70 months.l4 patients got fracture union,and 2 cases suffered from osteonecrosis of femoral neck.According to Harris criterion,the results of the treatment was evaluated as excellent in 11 cases,good in 3 cases,bad in 2 cases.Conclusion:Effect of the open reduction and internal fixation with DHS combine with anti-rotation screw to treat young Pauwels type Ⅲ fracture is definite,anatomic reduction and rigid fixation of operation can lower the rate of complications effectively.

  19. 修复与不修复下胫腓前韧带在下胫腓联合损伤治疗中的疗效比较%Comparison of curative effects of repairing anterior tibiofibular ligament or not after fixation with metal screw for treatment of distal tibiofibular syndesmosis injury

    Institute of Scientific and Technical Information of China (English)

    吴少科; 郑鸿; 陈航; 谭宏昌; 曾荣; 孙欣; 魏波; 钟环; 刘浩; 康毅

    2013-01-01

    Objective To compare the therapeutic effects between repairing anterior tibiofibular ligament or not after fixation with metal screw in the treatment of distal tibiofibular syndesmosis injury. Methods Thirty eight patients with distal tibiofibular syndesmosis injury were randomly divided into two groups. Seventeen patients were treated by repairing anterior tibiofibular ligament and 21 patients were not repaired after fixation with metal screw. The lasting time of operation,blood loss during operation and postoperative curative effects were compared between two groups. Results All the patients were followed up for 11 to 20 months (average of 15.4 months). The intraoperative blood loss in repair group were significantly more than those in not repair group(P 0.05). According to AOFAS effective evaluation criteria,the repairing ligament group's excellent and good rate was 94.1%, and in the not repair group's 95.2% ,but there was no statistically significant difference between two groups (P >0.05). Conclusion It is unnecessary to repair the anterior tibiofibular ligament after fixation with metal screw in distal tibiofibular syndesmosis injury.%目的 比较下胫腓联合损伤复位固定后修复与不修复下胫腓前韧带两种手术方法的疗效.方法 38例下胫腓联合损伤随机分为2组,修复组17例采用皮质骨螺钉固定并修复下胫腓韧带;不修复组21例单纯采用皮质骨螺钉固定后不修复下胫腓前韧带.比较两组在手术时间、术后疗效、术后下胫腓联合重叠距离等方面的差异.结果 38例均获随访11~20个月,平均15.4个月.修复组手术时间较不修复组长,差异有统计学意义(P<0.05).术后两组下胫腓联合重叠距离比较,差异无统计学意义(P>0.05).疗效按AOFAS评定标准,修复组和不修复组的优良率分别为94.1%、95.2%,差异无统计学意义(P>0.05).结论 下胫腓联合损伤采用皮质骨螺钉内固定后下胫腓前韧带可不予以修复.

  20. 骨水泥强化椎弓根钉固定联合椎体成形术治疗重度骨质疏松性脊柱骨折%Pedicle screw fixation strengthened with bone cement combined with vertebroplasty for the treatment of severe osteoporotic fractures

    Institute of Scientific and Technical Information of China (English)

    胡明; 李大伟; 黄凤山; 刘玉川; 杨达宇; 马远征

    2011-01-01

    Objective To explore the peri-operative treatment and clinical efficacy of pedicle screw fixation strengthened with bone cement combined with vertebroplasty for the treatment of severe osteoporotic fractures. Methods The clinical data of 15 patients with severe vertebral osteoporotic compression fractures were retrospectively analyzed from August 2005 to April 2009. The average age of the patients was 63. 1 years old. They had no severe basal diseases. They were all treated with posterior pedicle screw fixation strengthened with bone cement combined with vertebroplasty. All patients were followed up for 10-38 months (21 months in average) after the operation. Results All patients could tolerate the surgery and the average operating time was 106. 7 ±5. 3 min. The average bleeding volume was 370 ± 6. 1 ml. The twist and back pain were significantly ameliorated after the surgery. The height of vertebral body recovered back to 90% after operation. The height loss was not obvious during the following up. Conclusion The efficacy of pedicle screw fixation strengthened with bone cement combined with vertebroplasty for the treatment of severe osteoporotic fractures is good at correcting fracture and maintaining the recovering effect of the vertebra. The key point of this therapy is the surgical indication and osteoporotic medicine treatment.%目的 探讨骨水泥强化椎弓根钉固定联合椎体成形术治疗严重骨质疏松性椎体压缩骨折的围术期处理和临床疗效.方法 回顾分析2005年8月~ 2009年4月收治的15例严重骨质疏松性椎体压缩骨折患者的临床资料,平均63.1岁,无重大基础病存在,经脊柱后入路椎弓根钉撑开复位,钉道采用骨水泥灌注加强并行经伤椎椎体成形术.术后随访10~ 38个月,平均21月.结果 均耐受手术,平均手术时间为106.7±5.3min;平均失血量为370±6.1ml,术后腰背痛明显改善,椎体高度恢复至90%左右,随访椎体高度

  1. 单双侧椎弓根钉内固定结合椎间融合术治疗腰椎椎间盘突出症初期疗效比较%Early clinical effects of internal fixation with unilateral versus bilateral transpedicle screws combined with intervtebral fusion in lumbar disc herniation

    Institute of Scientific and Technical Information of China (English)

    夏才伟; 王生介; 厉晓龙; 刘伟峰; 刘俊; 杨雷; 蒋小军

    2011-01-01

    Objective To compare the early clinical effects of internal fixation with unilateral versus bilateral transpedicle screws combined with intervertebral fusion in lumbar disc herniation. Methods From March 2008 to June 2009, 40 patients with L4/L5 disc herniation were treated by internal fixation with unilateral ( n = 16 ) or bilateral ( n = 24) transpedicle screws combined with intervertebral fusion. The pre- and postoperative data of patients were compared between the 2 techniques, such as visual analog scale (VAS) and Oswestry disability index (ODI) scores, operation time, blood loss, hospital days, cost of hospitalization, fusion rate and incidence rate of complications. Results The differences of the preoperative VAS and ODI scores between patients with different operation had no statistic significance ( P > 0. 05 ), and neither had the differences of VAS and ODI scores, fusion rate, and incidence rate of complications at the last follow-up (P>0. 05). The postoperative data of all patients were better than those before surgery. The operation time, blood loss and cost of hospitalization of patients with unilateral instruments were better than those of patients with bilateral instruments. Conclusion The internal fixation with unilateral transpedicle screws combined with intervertebral fusion is as effective as with bilateral instruments in L4/L5 disc herniation, which is lower cost, less operation time and blood loss during the operation.%目的 探讨单侧椎弓根钉内固定结合椎间融合术治疗L4/L5椎间盘突出症的初期临床疗效及优势.方法 2008年3月~2009年6月行内固定椎体间融合术治疗L4/L5椎间盘突出症患者40例,其中单侧内固定16例,平均随访22.1个月;双侧内固定24例,平均随访20.8个月.比较2种手术患者术前疼痛视觉模拟量表(visual analog scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI)评分、手术时间、术中出血量、术后住院天数、住院费用

  2. Effects of C arm X-ray perspective computer auxiliary surgery navigation system on screw fixation in the elderly lumbar vertebrae pedicle%C臂透视计算机辅助导航对老年人腰椎椎弓根螺钉置入术及手术疗效的影响

    Institute of Scientific and Technical Information of China (English)

    张良; 孙常太; 徐宏兵; 张华俦; 王英民

    2012-01-01

    Objective To investigate the influence of C arm X- ray perspective computer auxiliary surgery navigation system on lumbar vertebral pedicle screw fixation in the elderly.Methods 286 patients(aged≥65 years) treated by lumbar spine post decompress and pedicle screw fixation for lumbar vertebral degeneration were divided into navigation (n=153) or non-navigation (n=133) groups.The amount of blood loss,surgery duration and time of beginning to walk after surgery were measured and compared, the improvement grading was determined by Oswestry disability index (ODI) before surgery and at the last follow-up. Results The surgery duration [(27.6+6.3)ain vs.(33.8±9.9)min],the volume of blood loss[(135.7±21.1)ml vs.(165.4±32.1)ml] and the time of beginning to walk after surgery[(134.6± 12.3)h vs.(169.0±23.9)h] were obviously reduced in navigation group as compared with non-navigation group (P < 0.05). The grading improvement rate by ODI[(76.6±±3.7)%vs.(69.8+6.6)%] was higher in navigation group than in non navigation group (P<0.05). Conclusions Using C arm X-ray perspective computer auxiliary surgery navigation system to lumbar pedicle screws fixation is helpful in the elderly for improving clinical efficacy.%目的 探讨C型臂透视计算机辅助手术导航系统对于老年人腰椎椎弓根螺钉置入术的影响. 方法 对286例65岁及以上行腰椎后路减压内固定的腰椎退行性疾病患者分为导航(153例)和未导航(133例)两组,比较两组患者的术中失血量、手术时问和术后下地时间.应用Oswestry功能障碍指数问卷表(ODI)对所有患者的术前和末次随访评分,计算2次评分的ODI评分改善率. 结果 导航组与未导航组相比,椎弓根手术时间[ (27.6±6.3)min、(33.8±9.9)min]和出血量[(135.7±21.1)ml、(165.4±32.1)ml]减少,术后下地时间[(134.6±12.3)h、(169.0=23.9)h]缩短;ODI评分改善率[(76.6±3.7)%、(69.8±6.6)%]提高. 结论 C型臂透视计算机辅助手术导

  3. 钉棒置入与椎间融合修复极外侧型腰椎间盘突出症:远期腰椎稳定性随访%Extreme lateral lumbar disc herniation after pedicle screw fixation and interbody fusion cage:lumbar stability at long-tem follow-up

    Institute of Scientific and Technical Information of China (English)

    史瑞明; 李国胜; 张义峰; 黄震源; 孙利; 王存

    2014-01-01

    BACKGROUND:Extreme lateral lumbar disc herniation is a rare type of lumbar disc herniation, there are a variety of treatment methods, but the therapeutic efficacy and recurrence rate are controversial. OBJECTIVE:To investigate the availability of lumbar pedicle screw fixation combined with interbody fusion cage for treating extreme lateral lumbar disc herniation. METHODWe retrospectively analyzed 19 patients with extreme lateral lumbar disc herniation after treatment with lumbar pedicle screw fixation combining with interbody fusion cage from March 2006 to January 2009. The outcomes were evaluated depending on VAS scoring standard and Macnab scoring standard, lumbar stability were observed postoperatively. We analyzed the spinal stability in recurrent lumbar disc herniation patients after lumbar pedicle screw fixation combined with interbody fusion cage depending on literature search. RESULTS AND CONCLUSION:Al the 19 patients were fol owed up for 13 months to 3 years, the leg and lumbar pain of al the patients were relieved to varying degrees. Preoperative VAS score was 7.3±1.28 points and postoperative VAS score was 2.1±0.8 points, showing significant difference between two groups (P  目的:探讨应用腰椎椎弓根钉棒内固定联合椎间融合器置入椎间融合修复极外侧型腰椎间盘突出症的临床效果。  方法:回顾性分析2006年3月至2009年1月行腰椎椎弓根钉棒系统联合椎间融合器置入椎间融合治疗的19例极外侧型腰椎间盘突出症患者的临床资料,根据目测类比评分标准及Macnab评价标准进行疗效判定,观察治疗后腰椎稳定性,通过数据库文献检索方法评估腰椎椎弓根钉棒内固定联合椎间融合器置入椎间融合修复极外侧型腰椎间盘突出症的效果。  结果与结论:19例患者均得到随访,随访时间13个月-3年。所有患者治疗后即有下肢及腰部疼痛不同程度的缓解,治

  4. 接骨药丸联合桡骨茎突切除植骨螺钉内固定治疗腕舟骨骨不连研究%Study of Jiegu Pill Combined with Excision of Processus Styloideus Radii and Screw Fixation Treating Scaphoid Nonunion

    Institute of Scientific and Technical Information of China (English)

    王涛

    2015-01-01

    目的:探讨接骨药丸联合桡骨茎突切除植骨螺钉内固定术对腕舟骨骨不连的临床疗效.方法:40例腕舟骨骨不连患者随机平分为对照组及实验组,对照组采取桡骨茎突切除植骨螺钉内固定术,实验组予接骨药丸联合桡骨茎突切除植骨螺钉内固定术治疗,比较两组患者的屈伸活动范围、尺桡偏活动范围改善情况及腕关节恢复情况.结果:两组患者术后6月屈伸活动范围与尺桡偏活动范围改善情况均明显高于术后3月(P<0.01),实验组术后3、6月屈伸活动范围与尺桡偏活动范围改善情况均高于对照组(P<0.01);实验组腕关节功能优良率明显高于对照组(P=0.0416<0.05).结论:接骨药丸联合桡骨茎突切除植骨螺钉内固定术对腕舟骨骨不连临床疗效显著,值得借鉴.%Objective:To investigate the clinical efficacy of Jiegu pill combined with excision of processus styloideus radii and screw fixation on scaphoid nonunion. Methods:40 cases of scaphoid nonunion were divided equally into control group and experimental group, both adopted excision of processus styloideus radii and screw fixation, experimental group added Jiegu pill, flexion and extension scope, improvement of radioulnar partial scope and wrist joint recovery of the two groups were compared. Results:Flexion and extension scope and improvement of radioulnar partial scope of two groups after operation of 6 months were significantly higher than those after operation of 3 months (P<0.01), flexion and extension scope and improvement of radioulnar partial scope of experimental group after operation of 3 and 6 months were higher than those of control group (P<0.01);the excellent and good rate of wrist joint function of experimental group was higher than that of control group (P=0.0416<0.05). Conclusion:Jiegu pill combined with excision of processus styloideus radii and screw fixation on scaphoid nonunion is significantly clinically effective, being worth

  5. 肱骨近端锁定内固定系统治疗肱骨近端骨折中肱骨头螺钉分布分析%Analysis of Screw Distribution in the Humerus Head in Proximal Humerus Fracture Treated with Proximal Humerus Internal Fixation Locking System

    Institute of Scientific and Technical Information of China (English)

    周靖; 黄伟; 林维成; 王天兵

    2015-01-01

    Background Proximal humerus fracture is one of the fractures that easily occur in human body .It is a fracture around joints so there are specific treatment ways .As the aggravation of aging society ,the osteoporosis population is getting larger .Osteoporosis has become an important issue in the traumatic orthopedics treatment .How to increase the stability of fixation in osteoporosis fracture and how to make sure stability of the bony union in fracture are becoming challenges for traumatic orthopedists .Proximal humerus fracture is one kind of osteoporosis fractures .Proximal Humerus Internal Locking System (PHILOS) has a stable angulation of screws locking as well as assembly of multi‐directions of screws inside the humerus heads .These characteristics increase the stability of fixation and lead to the wide clinical application .This research analyze the humerus head screws distribution in proximal humerus fracture treated by PHILOS .Methods General data:inclusion criteria of cases :(1 ) proximal humerus fracture;(2 ) CT on the shoulder joints before operation;(3) accept the PHILOS operation .From December 2007 to August 2014 ,41 patients who reached the above‐mentioned criteria were selected as the study subjectives .They were patients with fresh fractures and 15 were males and 26 were females .And their average age was 67 .7 years old (from 42‐89 years old) .All patients should have CT of the shoulder joints before the operation .They will get general anesthesia and the operation position is beach chair position .The incision will be performed from the deltopectoral approach .PHILOS from Synthes is selected as the internal fixation device .Date measurements :The contralateral shoulder joint cross section on the CT was selected as the measurement data .The measurement index was the included angle α between the ideal center distribution lines in the humeus head screw s (mark as"a") and the real center distribution line (mark as "a′") .Line a is the

  6. Treatment of unstable pelvic fractures with an external fixator and combined screwing at iliac crests and pubic symphysis%髂嵴-耻骨联合置钉外固定支架治疗不稳定型骨盆骨折

    Institute of Scientific and Technical Information of China (English)

    张伟; 宋世锋; 刘立柱; 李超艺; 李强; 唐捷; 张丕军

    2016-01-01

    目的 探讨髂嵴-耻骨联合置钉外固定支架治疗不稳定型骨盆骨折的临床疗效. 方法 回顾性分析2013年1月至2014年2月收治的12例不稳定型骨盆骨折患者资料,男8例,女4例;年龄为32 ~57岁,平均42.5岁.致伤原因:交通伤7例,高处坠落伤5例.骨折按Tile分型:B型8例,其中B1型3例,B2型3例,B3型2例;C1型4例.合并伤:休克7例,膀胱损伤1例,四肢长骨骨折6例,关节损伤3例,胸腰椎损伤4例.受伤至手术时间为12h至7d,平均4d.B型骨折采用髂嵴-耻骨联合置钉外固定支架治疗,C1型骨折采用髂嵴-耻骨联合置钉外固定支架加经皮S1骶髂关节螺钉内固定治疗. 结果 12例患者术后获5 ~12个月(平均9个月)随访.无一例患者死亡.本组患者骨折愈合时间为8~13周,平均11.3周.所有患者恢复正常行走,7例患者发生针道浅表感染,无针道深部感染.1例患者出现螺钉松动,无复位丢失、神经损伤及尿道损伤等并发症发生.末次随访时根据Majeed评分标准评定疗效:优10例,良1例,中1例. 结论 髂嵴-耻骨联合置钉外固定支架治疗不稳定型骨盆骨折可恢复骨盆前环的稳定性,临床疗效良好.%Objective To study the clinical efficacy of external fixator and combined screwing at iliac crests and pubic symphysis for the treatment of unstable pelvic fractures.Methods From January 2013 to February 2014,12 cases of unstable pelvic fracture were treated at our department.They were 8 men and 4 women,from 32 to 57 years of age (average,42.5 years).Seven cases were caused by a traffic accident,and 5 by falling from a height.By Tile classification,8 cases were type B (including type B1 in 3 cases,type B2 in 3 and type B3 in 2),and 4 cases type C1.Associated injury included shock in 7 cases,bladder injury in one,limb long bone fracture in 6,joint injury in 3,and thoracic and lumbar injury in 4.The interval from injury to operation averaged 4 days,ranging from 12 hours to 7 days

  7. Biomechanical analysis on transverse tibial fixation in anterior cruciate ligament reconstructions

    Directory of Open Access Journals (Sweden)

    Edmar Stieven Filho

    2015-04-01

    Full Text Available OBJECTIVE: To verify whether the combination of tibial cross pin fixation and femoral screw fixation presents biomechanical advantages when compared to femoral cross pin fixation and tibial screw fixation for the reconstruction of the anterior cruciate ligament (ACL.METHODS: Thirty-eight porcine knees and bovine extensor digitorum tendons were used as the graft materials. The tests were performed in three groups: (1 standard, used fourteen knees, and the grafts were fixated with the combination of femoral cross pin and a tibial screw; (2 inverted, used fourteen knees with an inverted combination of tibial cross pin and a femoral screw; (3 control, ten control tests performed with intact ACL. After the grafts fixation, all the knees were subjected to tensile testing to determine yield strength and ultimate strength.RESULTS: There was no statistically significant difference in survival techniques in regard to strength, yield load and tension. There was a higher survival compared in the standard curves of yield stress (p < 0.05.CONCLUSION: There is no biomechanical advantage, observed in animal models testing, in the combination of tibial cross pin fixation and femoral screw when compared to femoral cross pin fixation and tibial screw.

  8. 单侧椎弓根钉固定结合椎间融合治疗腰椎间盘突出症30例临床回顾报道%Unilateral Pedicle Screw Fixation Combined With Lumbar Disc Herniation in 30 Cases of Lumbar Disc Herniation

    Institute of Scientific and Technical Information of China (English)

    李加立

    2015-01-01

    Objective Discussion with unilateral pedicle screw ifxation and clinical efifcacy of the treatment of lumbar disc herniation of intervertebral fusion, and to evaluate its clinical value. Methods 30 cases of lumbar disc herniation underwent unilateral pedicle screw fixation combined with interbody fusion for treatment from March 2012~March 2013 in our hospital, surgery in 6 months, 12 months, 18 month, 24 month follow-up, follow-up observations of bone fusion, clinical symptoms as well as occurrence of complications. Results Clinical symptoms of all patients have received varying degrees of ease, clinical after 6 months, 12 months, 18 months, 24 months recovery rates were 76.7%, 83.3%, 90%and 86.7%. Perioperative complication rate was 23.3%, after treatment, symptoms were controlled and improved. Conclusion Clinical unilateral pedicle screw ifxation combined with interbody fusion for lumbar disc herniation is remarkable, worth promoting.%目的:探讨研究单侧椎弓根钉固定结合椎间融合治疗腰椎间盘突出症临床疗效,并评价其临床应用价值。方法给予2012年3月~2013年3月于我院就诊的30例腰椎间盘突出症患者行单侧椎弓根钉固定结合椎间融合术进行治疗,术后于6个月、12个月、18个月、24个月随访,随访观察记录骨融合情况、临床症状缓解情况以及并发症发生情况。结果所有病患的临床症状均得到了不同程度的缓解,临床术后6个月、12个月、18个月、24个月恢复率分别为76.7%、83.3%、90%、86.7%。围手术期并发症发生率为23.3%,经过治疗后症状均得到控制及改善。结论临床采用单侧椎弓根钉固定结合椎间融合术治疗腰椎间盘突出症疗效显著。

  9. Estudo químico, macroscópico e da resistência à flexão de placas e parafusos de titânio usados na fixação interna rígida Chemical, macroscopical and bending resistance study of titanium plates and screws used in internal rigid fixation

    Directory of Open Access Journals (Sweden)

    Alexandre Elias TRIVELLATO

    2000-12-01

    Full Text Available O objetivo deste estudo foi comparar quatro sistemas de placas e parafusos de titânio de 2,0 mm de diâmetro utilizados em fixação interna rígida, sendo duas marcas nacionais (Engimplan e Bucomax e duas importadas (Synthes e W. Lorenz. Foram realizadas as seguintes análises: composição química, através de espectrometria por dispersão de energia (EDS e espectrometria de emissão atômica (AES, macroscópica, por meio de medidas padronizadas e de resistência à flexão. Os resultados obtidos permitem concluir que as marcas nacionais apresentaram um comportamento inferior, em relação a padronização das dimensões das placas e parafusos avaliados, influenciando nos resultados dos testes de flexão, para os quais estas se comportaram da mesma maneira. Entretanto, a marca comercial W. Lorenz utiliza liga de titânio-6alumínio-4vanádio para a confecção dos parafusos, fato responsável pelo melhor resultado no teste de flexão que qualquer outra marca. Os demais parafusos e placas apresentaram-se constituídos de titânio comercialmente puro, de acordo com a EDS e posteriormente confirmados pela AES.The aim of this study was to compare four systems of titanium plates and screws (diameter of 2.0 mm used for internal rigid fixation. From them, two were made in Brazil (Engimplan and Bucomax, one in Switzerland (Synthes, and the other, in Germany (W. Lorenz. The following analyses were done: chemical analysis using Energy Dispersive Spectroscopy (EDS and Atomic Emission Spectroscopy (AES, measurement of dimensions and bending resistance test. The obtained results allow to conclude that both Brazilian systems showed inferior behavior regarding dimensional standards. The bending assay showed that the Brazilian systems are similar to each other. However, the W. Lorenz screws are made of titanium-6aluminum-4vanadium alloy, which can be the reason for their better performance in the bending assay, when compared with that of the other three

  10. QWIX螺钉置入内固定修复髌骨骨折:骨折断端的持续动静态加压作用%QWIX screw fixation in repair of patellar fractures:continuous dynamic and static pressure in the broken ends of the bones

    Institute of Scientific and Technical Information of China (English)

    刘杰; 高仕长; 梁安霖

    2014-01-01

    extension apparatus continuity and potential uncoordination of patel ofemoral joint. The aim of patel ar fracture surgery is to restore the smoothness of patel ar articular surface and to maintain the continuity of knee extension apparatus, to provide stable effective fixation, so as to do early functional exercises. OBJECTIVE:To evaluate the clinical effectiveness of a fixation technique for patel ar fractures using QWIX combined with Kirschner wire and wire. METHODS:From September 2011 to September 2012, 30 patients with patel ar fractures were treated using QWIX screws combined with Kirschner wire and wire in the First Affiliated Hospital of Chongqing Medical University, China. There were 17 males and 13 females, at the age of 47.7 years on average. In accordance with the situation of comminuted fracture and the degree of displacement, QWIX screws or QWIX screws+tension band wire or QWIX screws+Kirschner wire+tension band wire were used for fixation. Active and passive knee motion exercises began at 1 day after surgery, without any external fixation. At 6 weeks, 3, 6, 12 months, and 1 year after surgery, the patients were fol owed up in out-patient clinic to identify fracture healing and to make sure whether complications appeared or not. The range of flexion and extension of bilateral knee was measured. The knee function of the affected side was evaluated using Bostman score at 1 year postoperatively. RESULTS AND CONCLUSION:Al patients were fol owed up for 12 to 24 months. 24 cases were healed within 3 months after surgery, and 6 cases were healed within 4 months after surgery, with an average healing time of 3.2 months. With time prolonged, the range of flexion and extension of bilateral knee gradual y increased. The knee function of patients recovered to the level before injury at 1 year after surgery. During fol ow-up, one patient experienced knee pain due to Kirschner wire loosening. No infection, knee pain, fixation failure, or flexion dysfunction occurred in the

  11. In vitro release of doxycycline from bioabsorbable materials and acrylic strips

    DEFF Research Database (Denmark)

    Larsen, T

    1990-01-01

    Treatment of marginal periodontitis may include use of local antibiotics. In the present in vitro study the bioabsorbable materials Surgicel, Tissell, and CollaCote and acrylic strips were examined for release of doxycycline into liquids and residual antibacterial activity of the materials. Piece...

  12. Bioabsorbable Suture Anchor Migration to the Acromioclavicular Joint: How Far Can These Implants Go?

    Directory of Open Access Journals (Sweden)

    Giovanna Medina

    2014-01-01

    Full Text Available Few complications regarding the use of bioabsorbable suture anchors in the shoulder have been reported. What motivated this case report was the unusual location of the anchor, found in the acromioclavicular joint which, to our knowledge, has never been reported so far. A 53-year old male with previous rotator cuff (RC repair using bioabsorbable suture anchors presented with pain and weakness after 2 years of surgery. A suspicion of retear of the RC led to request of a magnetic resonance image, in which the implant was found located in the acromioclavicular joint. The complications reported with the use of metallic implants around the shoulder led to the development of bioabsorbable anchors. Advantages are their absorption over time, minimizing the risk of migration or interference with revision surgery, less artifacts with magnetic resonance imaging, and tendon-to-bone repair strength similar to metallic anchors. Since the use of bioabsorbable suture anchors is increasing, it is important to know the possible complications associated with these devices.

  13. A simplified in vivo approach for evaluating the bioabsorbable behavior of candidate stent materials.

    Science.gov (United States)

    Pierson, Daniel; Edick, Jacob; Tauscher, Aaron; Pokorney, Ellen; Bowen, Patrick; Gelbaugh, Jesse; Stinson, Jon; Getty, Heather; Lee, Chee Huei; Drelich, Jaroslaw; Goldman, Jeremy

    2012-01-01

    Metal stents are commonly used to revascularize occluded arteries. A bioabsorbable metal stent that harmlessly erodes away over time may minimize the normal chronic risks associated with permanent implants. However, there is no simple, low-cost method of introducing candidate materials into the arterial environment. Here, we developed a novel experimental model where a biomaterial wire is implanted into a rat artery lumen (simulating bioabsorbable stent blood contact) or artery wall (simulating bioabsorbable stent matrix contact). We use this model to clarify the corrosion mechanism of iron (≥99.5 wt %), which is a candidate bioabsorbable stent material due to its biocompatibility and mechanical strength. We found that iron wire encapsulation within the arterial wall extracellular matrix resulted in substantial biocorrosion by 22 days, with a voluminous corrosion product retained within the vessel wall at 9 months. In contrast, the blood-contacting luminal implant experienced minimal biocorrosion at 9 months. The importance of arterial blood versus arterial wall contact for regulating biocorrosion was confirmed with magnesium wires. We found that magnesium was highly corroded when placed in the arterial wall but was not corroded when exposed to blood in the arterial lumen for 3 weeks. The results demonstrate the capability of the vascular implantation model to conduct rapid in vivo assessments of vascular biomaterial corrosion behavior and to predict long-term biocorrosion behavior from material analyses. The results also highlight the critical role of the arterial environment (blood vs. matrix contact) in directing the corrosion behavior of biodegradable metals.

  14. EFFECT OF THE SCREW TORQUE LEVEL ON THE INTERFRAGMENTARY STRAIN AND THE INTERFRAGMENTARY MODULUS

    Directory of Open Access Journals (Sweden)

    Boonthum Wongchai

    2013-01-01

    Full Text Available The screw torque is applied at the screw head to fix the plate and the bone. It generates the compressive force between the plate and the bone to stabilize them. The interfragmentary strain is the main factor for healing the bone fractured. The screw torque level affects the interfragmentary strain and the stability of the fixation between the plates an the bone. The interfragmentary modulus is the new factor of the plate fixation stability and it is affected by the torque level. This research is proposed to study the effect of the screw torque level on the interfragmentary strain and the interfragmentary modulus. The interfragmentary strain and the interfragmentary modulus decrease by increasing the screw torque level.

  15. Early curative effect of transpedicular screw fixation in treatment of thoracolumbar fracture combined with posterior ligamentous complex injuries%经椎弓根钉内固定治疗合并后方韧带复合体损伤胸腰椎骨折早期疗效观察

    Institute of Scientific and Technical Information of China (English)

    曹贵君; 孟纯阳; 张卫红; 孔祥清; 高峰; 吴同申; 陈国武

    2015-01-01

    目的 探讨后路经椎弓根钉内固定治疗合并后方韧带复合体(PLC)损伤的胸腰椎骨折早期临床疗效.方法 回顾性分析2008年7月-2013年3月行手术治疗的合并PLC损伤胸腰椎屈曲分离型骨折患者22例,其中男16例,女6例;年龄23 ~62岁,平均39岁.所有患者病情稳定后,在静吸复合麻醉下行后路椎弓根螺钉内固定术.根据骨折移位的程度及韧带损伤的类型行后外侧和(或)椎体间自体植骨.观察术前、术后3d、随访末期的椎体高度恢复率、Cobb角矫正率、美国脊髓损伤协会(ASIA)分级.结果 所有患者手术顺利,术中未发生手术并发症;患者均获得随访5~51个月(平均26.5个月).骨折复位满意,分离的后部结构闭合.椎体前缘高度术后较术前平均改善20.6% (P <0.01);Cobb角术后较术前平均改善10.60°(P<0.01).术前有神经损伤的8例术后均有不同程度恢复;术后感觉评分较术前平均改善20.7% (P <0.05),运动功能评分较术前改善30.9% (P <0.01).CT三维重建示植骨全部骨性愈合;患者无局部疼痛及内固定物断裂.结论 后路经椎弓根钉内固定手术治疗合并PLC损伤的胸腰椎屈曲分离型骨折短期疗效满意,钉棒固定可以达到满意复位、骨折失稳脊柱的三柱即刻稳定;充分植骨是获得永久性稳定的保障.%Objective To investigate the preliminary clinical result of thoracolumbar fracture combined with posterior ligamentous complex injuries repaired by posterior transpedicular screw fixation.Methods A retrospective review was performed on 22 patients with thoracolumbar flexion-distraction fracture combined with posterior ligamentous complex injuries treated with transpedicular screw fixation from July 2008 to March 2013.There were 16 males and 6 females with mean age of 39 years (range,23-62 years).After medically stable,posterior pedicle screw fixation was performed under intravenousinhalational anesthesia

  16. 综合康复护理对股骨粗隆间骨折行DHS内固定术患者预后的影响%Effect of comprehensive rehabilitation interventions on the patients with intertrochanteric fracture of femur treated by dynamic hip screw internal fixation

    Institute of Scientific and Technical Information of China (English)

    钟巧艺; 陈思颖; 赵洁莲; 区海云; 何惠兰

    2011-01-01

    目的:探讨综合康复护理对股骨粗隆间骨折行动力髋螺钉(dynamic hip screw,DHS)内固定术患者预后的影响.方法:选择2008年9月-2009年9月本院收治的股骨粗隆间骨折行DHS内固定术的49例患者为对照组,选择2009年10月-2010年10月收治的58例患者为实验组.对照组给予常规护理,实验组采用综合康复护理,比较两组患者骨折愈合时间、住院时间、疗效及并发症的发生率.结果:实验组骨折愈合时间及住院时间短于对照组、疗效优于对照组、并发症的发生率低于对照组(均P<0.05).结论:股骨粗隆间骨折患者行DHS内固定术后采用综合康复护理,有利于缩短骨折愈合时间及住院时间,提高治疗效果,降低术后并发症的发生率,值得临床推广应用.%Objective To explore the influence of comprehenaive rehabilitation interventions on patients with intertrochanteric fracture of femur treated by DHS (dynamic hip screw) intemal fixation. Methods Forty-nine patients with intertrochanteric fracture of femur treated by DHS intemal fixation from September 2008 to September 2009 were selected as the control group. Fifty-eight patients with intertrochanteric fracture of femur treated by DHS intemal fixation from October 2009 to October 2010 were selected as the experimental group. The control group received conventional nuraing intervention, and the experimental group received comprehensive rehabilitation nursing interventions. Healing time, hospitalization time, clinical effect and incidence of complications were compared in the two groups. Results Hospitalization time, clinical effect in the experimental group was shorter than thoae in the control group; the clinical effect was better than that in the control Sroup; the incidence of complications was lower than that in the control group. Conclusion Comprehengive nursing intervention shortens healing time and hospitalization time, increases the therapy efficacy, and decreases the

  17. Posterior lumbar inter-body fusion (PLIF) using autogenous bone and cage with pedicle screw instrumentation versus PLIF using cage with pedicle screw instrumentation in adult spondylolisthesis

    Institute of Scientific and Technical Information of China (English)

    Dou Yusheng; Hao Dingjun; Wen Shiming

    2005-01-01

    Objective: To compare the clinical outcomes of PLIF using autogenous bone and cage with pedicle screw fixation (group 2) and simple cage fusion with pedicle screw fixation (group 1) in adult spondylolisthesis.Methods: 27 patients with minimum follow-up of 24 months, treated by inter-body fusion with pedicle screw fixation were prospectively studied. Disc space height, degree of slippage and fusion rate had been compared before and after operation between the two groups. Results: After minimum 24 month's follow-up, there was no significant difference between the two groups in terms of the amount of blood loss, duration of hospital stay, back pain,radiating pain, fusion rate, or complication (P>0.05). however, there was a significant difference between the two groups in terms of disc space height and percentage of slippage (P<0.05). Conclusion: PLIF using autogenous bone and cage with pedicle screw fixation more beneifical to improve fusion rate and prevent long-term instabilities than simple cage fusion with pedicle screw fixation in adult spondylolisthesis.

  18. MRI辅助髓核容积测定评价单侧椎弓螺钉置入并椎间融合对邻近节段的影响%MRI measurement of nucleus pulposus volume to assess the influence of unilateral pedicle screw fixation with an interbody fusion cage on adjacent segment

    Institute of Scientific and Technical Information of China (English)

    张红军; 王群波; 黄文强; 李波; 余雨; 邵高海

    2016-01-01

    隙高度均较治疗前略有减少,但差异无显著性意义(P>0.05)。⑤提示应用单侧单节段椎弓根螺钉置入内固定结合cage椎间植骨融合修复部分腰椎退性性疾病,可对固定融合邻近节段椎间盘退变起有一定的预防作用。%BACKGROUND:A large number of biomechanical studies and clinical application research showed that unilateral pedicle screw fixation with a single cage can not only make the spine to obtain immediate stability, and also reduces the fixed segment stiffness. However, there is not related research on the change of adjacent segment disc nucleus pulposus volume with unilateral pedicle screw. OBJECTIVE:To evaluate the effects of unilateral pedicle screw fixation with a single cage on adjacent segment degeneration for treating lumbar degenerative disease with MRI measurement of lumbar nucleus pulposus volume. METHODS:A total of 34 patients with lumbar disc herniation were treated by posterior lumbar interbody fusion with unilateral pedicle screw fixation with a single cage insertion. There were L4-5 segment in 16 patients (9 males and 7 females) and L5-S1segment in 18 patients (10 males and 8 females). The fixator was taken out at 18 months after surgery. They were folowed up for 24 to 36 months. With MRI, the transverse diameter and sagittal diameter of the nucleus pulposus were measured by using T2-weighted images at 6, 12, 18, 30 months after treatment, while the nucleus pulposus height was measured by middle sagittal position. Cephalic intervertebral height was measured with angular bisector method on X-ray films. Effects of unilateral pedicle screw fixation on cephalic intervertebral disc degeneration were evaluated according to nucleus pulposus volume and the intervertebral space height. RESULTS AND CONCLUSION:(1) Nucleus pulposus volume at cephalic L3-4 on the fixed L4-5segment was reduced in male patients after 30 months of treatment compared with pre-treatment (P=0.139), but increased in female

  19. 钉-棒系统与外固定支架固定骨盆不稳定损伤模型的生物力学比较%Biomechanical comparison of pedicle screw-rod system and pelvic external fixator in models of rotatory unstable pelvic injury

    Institute of Scientific and Technical Information of China (English)

    李尚政; 苏伟; 赵劲民; 谢能峰

    2013-01-01

    Objective To compare the biomechanical performances of pedicle screw-rod system versus pelvic ala ilium external fixator in cadaveric models of rotatory unstable pelvic injury.Methods Seven cadaveric specimens of normal adult pelvis were used for the test,retaining intact spines from the fifth lumbar vertebra to the proximal 20 centimeters of both femurs,intact pubic symphysis,bilateral hip joints,bilateral sacroiliac joints,bilateral sacrotuberous ligaments,bilateral sacrospinous ligaments,bilateral anterior sacroiliac ligaments and bilateral posterior sacroiliac ligaments.The pelvic specimens were put in an AGX biomechanical testing machine at a standing neutral posture and subjected to a vertical load of up to 500 N downward from the L5 body.The displacements of the symphysis pubis were recorded sequentially in the following 4 conditions:1.intact pelvis; 2.pelvic Tile B1 injury in simulation of rotatory unstable injury of the pelvis in which the symphysis pubis was cut off and accompanied with ruptures of ipsilateral sacrospinous and sacrotuberous ligaments; 3.pelvic Tile B1 injury fixated with the pedicle screw-rod system; 4.pelvic Tile B1 injury fixated with the pelvic ala ilium external fixator.Results Under the vertical load of 500 N,displacements of the symphysis pubis increased significantly from condition 1 (0.121 ± 0.025 mm),to condition 3 (0.656 ±0.103 mm),to condition 4 (1.512 ±0.101 mm) and last to condition 2 (4.512 ±0.391 mm).The difference between any two conditions was significant (P < 0.05).Conclusion Fixation by the pedicle screw-rod system is significantly better than that by the pelvic ala ilium external fixator for rotatory unstable pelvic injury,because the former can more effectively restore the biomechanical stability of the pelvic ring.%目的 通过对钉-棒系统和骨盆髂骨翼外固定支架固定骨盆水平旋转不稳定损伤模型的生物力学进行测试,对比两者固定骨盆的力学稳定性,为

  20. Análise biomecânica de variáveis relacionadas à resistência ao arrancamento dos parafusos do sistema de fixação vertebral Biomechanical analysis of the variables related to the pullout strength of screws in the vertebral fixation system

    Directory of Open Access Journals (Sweden)

    Rodrigo César Rosa

    2008-07-01

    screws with different diameters. METHODS: Screws of 5, 6, and 7 mm were inserted in the bovine bone test samples. The pilot hole was made with the dull-tipped probe, the cutting-tip probe, and burr. The perforation diameter was smaller, equal, and larger than the inner diameter of the screw. Mechanical pullout assays were performed in the three diameters for each manner of preparation of the pilot hole after inserting the implant. The mechanical assays were performed in an Emic®, Software Tesc 3.13 universal machine with load cell of 2000 N, load application speed of 2 mm/min, pre-load of 5 N, and accommodation time of 10 seconds. The property evaluated in the mechanical assays was the maximum pullout strength. RESULTS: In the group with 5 mm and 6 mm screws, and increase was observed in the pullout strength when the pilot hole diameter was smaller than the inner diameter of the screw in all manners of preparation (dull-tipped probe, cutting-tip probe, and burr. No statistical difference was seen in the seven millimeter screw group for all perforation diameters and manners of preparing the pilot hole. CONCLUSION: The pilot hole diameter has an influence upon the pullout strength of the screws in the vertebral fixation system. The making of a pilot hole with diameter larger than the inner diameter of the screw reduces the pullout strength of the implant, irrespective of the manner of preparation of the pilot hole.

  1. The date measurement of atlas lateral mass screw fixation by use of the virtual surgery system%虚拟手术系统支持下寰椎侧块螺钉固定相关数据的测量

    Institute of Scientific and Technical Information of China (English)

    何建荣; 李超; 杨会武; 何飞; 黄河

    2012-01-01

    [目的]通过结合当前虚拟手术系统辅助手术的优势,测量寰椎侧块螺钉固定通道的相关数据.[方法]选取8例16侧无破损和畸形的寰椎(C1)防腐头颈标本,先行CT扫描,后将数据导入虚拟手术系统进行重建,测量寰椎侧块数据:选择侧块与后弓根部下方交界区和横突孔的内侧缘与寰椎后弓内侧壁中点为进钉点,测最,L1:横突孔的内侧缘与寰椎后弓内侧壁的距离,L2:进钉点与侧块前缘最高点的距离,L3:进钉点与侧块前缘的垂直距离,α:进钉点的垂线与寰椎侧块上缘切线的角度,β:进钉点垂线与横突孔内侧缘切线的角度,γ:进钉点垂线与侧块内侧缘切线的角度,内斜角度δ:(β+γ) /2-β.左右两侧均测量3次,取其均值,进行统计学分析.[结果]虚拟手术系统测量寰椎侧块相关参数L1、L2、L3、α、β、γ、δ,经统计学分析,左右侧测量值均无统计学差异(P>0.05).[结论]选择侧块与后弓根部下方交界区处寰椎后弓内壁外约5 mm为进钉点,侧块螺钉进钉深度在18~22 mm,上倾斜约18°~20°,在矢状位上可内收6°.%[Objective]To measure the data related to screw fixation passage of atlas lateral mass,combining with the advantages of current virtual surgery system. [ Method] Eight cases ( 16 sides) of anticorrosive atlas ( Cl ) without damage or malformation underwent CT scans,then the CT data was transferred to the virtual surgery system and reconstructed to measure the data of atlas lateral mass. The junctional zone of lateral mass and underside of posterior arch pedical and midpoint of inner border of transverse foramen and inner wall of the posterior arch of atlas was selected as screw insertion point. The following parameters were measured; the distance between the inner border of transverse foramen and the inner wall of the posterior arch of atlas ( L1) , the distance between screw insertion point and highest point of front border of lateral mass ( L2

  2. Laparoscopic sleeve gastrectomy using a synthetic bioabsorbable staple line reinforcement material: Post-operative complications and 6 year outcomes

    Directory of Open Access Journals (Sweden)

    Mahdi Saleh

    2016-09-01

    Conclusion: The synthetic bioabsorbable reinforcement material shows no staple line leaks making it safe to use. LSG as a procedure had a high resolution of obesity-related comorbidities as well as sustainable long-term weight loss.

  3. Fixation with percutaneous cannulated screws assisted by robot navigation for femoral neck fractures%机器人导航定位系统辅助下经皮空心螺钉内固定治疗股骨颈骨折

    Institute of Scientific and Technical Information of China (English)

    刘建全; 刘黎军; 黄俊锋; 尤微; 王大平

    2015-01-01

    目的 探讨机器人导航定位系统辅助下经皮空心螺钉内固定治疗股骨颈骨折的疗效.方法 回顾性分析2012年10月至2014年6月采用机器人导航定位系统辅助下经皮空心螺钉内固定治疗的21例股骨颈骨折患者资料(导航组),男8例,女13例;年龄为20 ~ 85岁,平均(65.2±4.2)岁;骨折按Garden分型:Ⅰ型2例,Ⅱ型5例,Ⅲ型9例,Ⅳ型5例.选择同期采用传统徒手定位方法手术治疗的25例股骨颈骨折患者作为对照组.比较两组患者的手术时间、术中透视次数、术中出血量、总钻孔次数、骨折愈合时间及末次随访时髋关节Harris评分等. 结果 导航组患者的手术时间[(75.2±10.6) min]和骨折愈合时间[(5.3±2.5)个月]短于对照组[(85.1±11.3) min、(6.1±3.0)个月],但差异均无统计学意义(P>0.05).导航组患者的术中透视次数[(28.5±9.8)次]、术中出血量[(9.4±7.6)mL]及总钻孔次数[(9.2±4.5)次]显著少于对照组[(48.6±8.1)次、(40.2±10.3)mL、(17.5±8.5)次],差异均有统计学意义(P<0.05).导航组患者末次随访时髋关节Harris评分平均为(87.6±3.1)分,对照组患者平均为(86.9±4.7)分,差异无统计学意义(P>0.05).随访期间导航组无一例患者发生伤口感染、内固定物松动、骨折再移位及股骨头缺血性坏死等并发症. 结论 与传统徒手定位方法相比,机器人导航定位系统辅助下经皮空心螺钉内固定治疗股骨颈骨折具有设备操作相对简单、术中螺钉置入更加精准和规范等优点,实现了手术的微创化,减少了放射线的接触时间.%Objective To discuss clinical efficacy of fixation with percutaneous cannulated screws assisted by robot navigation for femoral neck fractures.Methods From October 2012 to June 2014,21 patients with femoral neck fracture were treated by internal fixation with percutaneous cannulated screws assisted by robot navigation.They were 8 men and 13 women,20 to 85 years of age

  4. Atlantoaxial Pedicle Screw via Posterior Fixation and Fusion for the Treatment of Jefferson Fracture%寰枢椎椎弓根螺钉经后路固定融合治疗 Jefferson 骨折伴齿状突骨折

    Institute of Scientific and Technical Information of China (English)

    洪波; 向铁城; 黄象望; 刘向阳; 盛斌; 邓化龙; 熊伟

    2014-01-01

    [Objective] To explore clinical outcome of atlantoaxial pedicle screw via posterior fixation and infusion for the treatment of Jefferson fracture associated with odontoid fracture .[Methods] A total of 12 pa-tients with Jefferson fracture and odontoid fracture from March 2009 to May 2012 underwent atlantoaxial pedi-cle screw via posterior fixation and infusion .All patients were 8 males and 4 females with a mean age of 40 .3 years old(ranged 25 to 62 years old) .According to Anderson classification ,there were 9 patients with type II odontoid fracture and 3 patients with type III odontoid fracture .Preoperative JOA score of neurological func-tion were from 5~13(means 9 .6 ± 0 .2) .Before the operation ,the imaging examinations such as X-ray ,spiral 3-dimension CT and MRI and skull traction were performed .JOA scores were compared between before and one year after operation .The improvement rate was calculated .[Results]Atlantoaxial fracture dislocation a-chieved basic reduction .No vertebral artery injury ,spinal and nerve root injury occurred during the operation . No deterioration of spinal cord injury was observed after operation .All patients were followed up for 6~18 months(mean 13 months) .Clinical symptoms were improved significantly .Reexamination of X-ray and spiral CT 6 months after operation showed that all fractures were bone union .The screw position was good .No loosening ,defluxion and breaking occurred .JOA scores of neurological function one year after operation were 14~17(mean 16 .1 ± 0 .2) .The average improvement rate was 85 .8% .[Conclusion]Atlantoaxial pedicle screw via posterior fixation and infusion for the treatment of Jefferson fracture associated with odontoid fracture has significant efficacy .It is advantages such as stable fixation and high bone union rate .%[目的]探讨寰枢椎椎弓根螺钉经后路固定融合治疗 Jefferson 骨折伴齿状突骨折的临床疗效。[方法]自2009年3月至2012年5月对12例Jefferson骨折

  5. Biomechanical testing of implant free wedge shaped bone block fixation for bone patellar tendon bone anterior cruciate ligament reconstruction in a bovine model

    Directory of Open Access Journals (Sweden)

    Willis-Owen Charles A

    2010-09-01

    Full Text Available Abstract Background The use of an interference fit wedged bone plug to provide fixation in the tibial tunnel when using bone-patellar tendon-bone autograft for anterior cruciate ligament reconstruction offers many theoretic advantages including the potential to offer a more economical and biological alternative to screw fixation. This technique has not been subjected to biomechanical testing. We hypothesised that a wedged bone plug fixation technique provides equivalent tensile load to failure as titanium interference screw fixation. Methods In a controlled laboratory setting, anterior cruciate ligament reconstruction was performed in 36 bovine knees using bone-patella-bone autograft. In 20 knees tibial fixation relied upon a standard cuboid bone block and interference screw. In eight knees a wedge shaped bone block with an 11 mm by 10 mm base without a screw was used. In a further eight knees a similar wedge with a 13 mm by 10 mm base was used. Each specimen used a standard 10 mm tibial tunnel. The reconstructions were tested biomechanically in a physiological environment using an Instron machine to compare ultimate failure loads and modes of failure. Results Statistical analysis revealed no significant difference between wedge fixation and screw fixation (p = 0.16, or between individual groups (interference screw versus 11 mm versus 13 mm wedge fixation (P = 0.35. Conclusions Tibial tunnel fixation using an impacted wedge shaped bone block in anterior cruciate ligament reconstruction has comparable ultimate tensile strength to titanium interference screw fixation.

  6. Ankle fusion stability: a biomechanical comparison of external versus internal fixation.

    Science.gov (United States)

    Hoover, Justin R; Santrock, Robert D; James, William C

    2011-04-11

    This biomechanical study compares bimalleolar external fixation to conventional crossed-screw construct in terms of stability and compression for ankle arthrodesis. The goals of the study were to determine which construct is more stable with bending and torsional forces, and to determine which construct achieves more compression.Fourth-generation bone composite tibia and talocalcaneal models were made to 50th percentile anatomic specifications. Fourteen ankle fusion constructs were created with bimalleolar external fixators and 14 with crossed-screw constructs. Ultimate bend, torque, and compression testing were completed on the external fixator and crossed-screw constructs using a multidirectional Materials Testing Machine (MTS Systems Corp, Eden Prairie, Minnesota). Ultimate bend testing revealed a statistically significant difference (P=.0022) with the mean peak load to failure for the external fixator constructs of 973.2 N compared to 612.5 N for the crossed-screw constructs. Ultimate torque testing revealed the mean peak torque to failure for the external fixator construct was 80.2 Nm and 28.1 Nm for the crossed-screw construct, also a statistically significant difference (P=.0001). The compression testing yielded no statistically significant difference (P=.9268) between the average failure force of the external fixator construct (81.6 kg) and the crossed-screw construct (81.2 kg).With increased stiffness in both bending and torsion and comparable compressive strengths, bimalleolar external fixation is an excellent option for tibiotalar ankle arthrodesis.

  7. Hollow-Bone-Graft Dynamic Hip Screw Can Fix and Promote Bone Union after Femoral Neck Fracture: an Experimental Research

    OpenAIRE

    SHEN, Jia-zuo; YAO, Jian-fei; LIN, Da-sheng; Lian, Ke-jian; Ding, Zhen-qi; Lin, Bin; GUO, Zhi-min; Zhang, Ming-Hua; Li, Qiang; LI, Lin; Qi, Peng

    2012-01-01

    Background: Delayed bone union, nonunion or osteonecrosis often occur after femoral neck fractures in young adults. Secondary bone healing requires strong internal fixation, intramedullary pressure reduction and early functional exercise. Objective: To compare bone healing of femoral neck fractures treated with hollow-bone-graft dynamic hip screws (Hb-DHS) and standard dynamic hip screws (DHS) in an animal model. Design: Testing of specifically designed fixation devices in a pig animal model....

  8. Hollow-Bone-Graft Dynamic Hip Screw Can Fix and Promote Bone Union after Femoral Neck Fracture: an Experimental Research

    OpenAIRE

    Jia-zuo SHEN, Jian-fei YAO, Da-sheng LIN, Ke-jian LIAN, Zhen-qi DING, Bin LIN, Zhi-min GUO, Ming-hua ZHANG, Qiang LI, Lin LI, Peng QI

    2012-01-01

    Background: Delayed bone union, nonunion or osteonecrosis often occur after femoral neck fractures in young adults. Secondary bone healing requires strong internal fixation, intramedullary pressure reduction and early functional exercise.Objective: To compare bone healing of femoral neck fractures treated with hollow-bone-graft dynamic hip screws (Hb-DHS) and standard dynamic hip screws (DHS) in an animal model.Design: Testing of specifically designed fixation devices in a pig animal model.In...

  9. 下腰椎病变椎弓根螺钉系统内固定术后急性感染的临床治疗%Clinical treatment of acute infection of lower lumbar spine under pedicle screw fixation system

    Institute of Scientific and Technical Information of China (English)

    许建柱; 胡文跃

    2011-01-01

    OBJECTIVE To investigate the effect of the clinical treatment of acute infection under the lumbar spine after pedicle screw system. METHODS A total of 38 patients were treated under the lumbar spine in patients with pedicle screw system during the course of acute infection caused by the gap from Jan 2009 to Apr 2010. Towards the infected groupi according to the time of infection, the different clinical treatment methods were given. 57 cases treated in the same period under the lumbar pedicle screw system variable line fixed after a good recovery in patients were set as non-infected group. The patient's clinical manifestations. Diagnosis, treatment and prognosis of non-infected group of the indicators were analyzed. RESULTS After treatment, patients with acute infection, the patient showed better wound healing degrees, no recurrence of swelling, leaking and other adverse symptoms, and other discomfort. 38 patients, 1 patient lost, its 37 patients were followed up for 1 year, infection rate was 91. 89% good, the fine non-infected group was 92. 98% , two groups had no significant difference. CONCLUSION The lesions incision and drainage, lesion debridement, internal fixation removal surgery combined with intravenous antibiotics) sensitive treatment of lumbar pedicle screw system for acute postoperative infection is a more effective clinical treatment.%目的 探讨椎弓螺钉系统内固定术治疗下腰椎病变后急性感染的临床治疗效果.方法选择2009年1月-2010年4月收治的38例下腰椎病变行椎弓螺钉系统内固定过程中引发间隙急性感染患者,作为感染组,同一时期收治的57例下腰椎病变行椎弓螺钉系统内固定术后恢复良好的患者为非感染组,将两组患者的临床表现、诊断依据、治疗方法以及预后各项指标进行对比分析.结果急性感染患者经治疗后,患者的伤口均呈较好愈合度,未再次出现红肿、渗出等症状;38例患者,除有1

  10. Parafuso de massa lateral do atlas para fixação da coluna cervical superior: resultados cirúrgicos Tornillos de masa lateral del atlas para la fijación de la columna cervical superior: resultados quirúrgicos Lateral mass screws of the atlas for upper cervical spine fixation: surgical results

    Directory of Open Access Journals (Sweden)

    Enrico Ghizoni

    2011-01-01

    alcanzar la fusión y la estabilidad de la columna cervical, y con el conocimiento de la anatomía y de la técnica quirúrgica es posible obtenerse excelentes resultados.OBJECTIVE: To present the surgical results of a case series of upper cervical spine stabilization with the use of lateral mass screws of the atlas. METHODS: Retrospective review of the surgical results of patients submitted to upper cervical spine stabilization with the use of lateral mass screws of the atlas. RESULTS: Six patients were operated in the period between January 2009 to April 2010, four men and two women. There was no permanent morbidity or mortality in the presented series. The main cause of atlanto-axial instability was trauma and there was just one case of odontoid pathologic fracture from a prostate metastasis. Axis fixation was achieved with the use of three different screw techniques (pars, pedicle and laminar, with equal distribution among the patients. CONCLUSIONS: The use of lateral mass screws of the atlas is an important technique to achieve fusion and stability of the upper cervical spine and with the knowledge of the anatomy and of the surgical technique good results can be achieved.

  11. 后路经椎弓根内固定联合椎体成形术对高龄胸腰段脊椎骨折的疗效研究%Effects of in Elderly Patients of Thoracolumbar Vertebral Fractures by Posterior Pedicle Screw Internal Fixation Combined with Vertebral Angioplasty

    Institute of Scientific and Technical Information of China (English)

    冉仁国; 王齐兵

    2016-01-01

    , mean intraoperative blood loss, postoperative Cobb's angle, stenosis rate, vertebral compression ratio compared to preoperative have greatly improved (P0.05). Occurred in 2 cases of spinal canal leakage of bone cement, internal ifxation nail breakage of 3 cases did not occur abdominal parenchymal organs injury and screw withdrawal and so on complications. Conclusion:Through the posterior transpedicular screw system internal fixation, vertebral body plasty combination in the treatment of thoracolumbar spine with excellent biomechanical properties and improve the injured vertebral morphological integrity and strength, postoperative complications and prognosis of the patients with good effect, the effect is signiifcant.

  12. Preliminary results in anterior cervical discectomy and fusion with an experimental bioabsorbable cage – clinical and radiological findings in an ovine animal model

    OpenAIRE

    Daentzer, Dorothea; Floerkemeier, Thilo; Bartsch, Ivonne; Masalha, Waseem; Welke, Bastian; Hurschler, Christof; Kauth, Theresa; Kaltbeitzel, Daniel; HOPMANN, Christian; Kujat, Bernd; Kalla, Katharina

    2013-01-01

    Background Bioabsorbable implants are not widely used in spine surgery. This study investigated the clinical and radiological findings after anterior cervical discectomy and fusion (ACDF) in an ovine animal model with an experimental bioabsorbable cage consisting of magnesium and polymer (poly-ϵ-caprolactone, PCL) in comparison to a tricortical bone graft as the gold standard procedure. Materials and Methods 24 full-grown sheep had ACDF of C3/4 and C5/6 with an experimental bioabsorbable impl...

  13. 后路一期病灶清除结合内固定治疗多节段脊柱结核%Surgical Treatment with Posterior Pedicle Screw Fixation,Focal Cleaning,Titanium Mesh and Bone Graft Fusion for Multi-segmental Spinal Tuberculosis

    Institute of Scientific and Technical Information of China (English)

    杨启远; 冯敬; 杨雯栋; 罗小丽; 李英博; 雷超; 冯志; 赖显金

    2016-01-01

    Objective To study the clinical effect of Surgical treatment with posterior pedicle screw fixation,focal clean-ing,titanium mesh and bone graft fusion for multi-segmental spinal tuberculosis. Methods The clinical data from 16 patients with multi-segmental spinal tuberculosis from January 2009 to December 2014 were retrospectively analyzed. There were 7 males and 9 females,ranging in age from 19 to 56 years with an average of 36. 5 years old. 2 vertebral bodies involved in 6 ca-ses,3 vertebral bodies in 7 cases,4 vertebral bodies in 2 eases,and 5 vertebral bodies in 1case. Among these cases,there were 9 cases of thoracic vertebra,5 cases of thoracolumbar vertebra,2 cases of lumbar vertebra. The kyphosis angel of diseased seg-ments was 28° to 53°,37. 6° in average. According to the Frankel classification before operation,there were Frankel A in 0 case,Frankel B in 1 cases,Frankel C in 2 cases,Frankel D in 6 cases,Frankel E in 7 cases. After intensive anti-tuberculosis medication(HRSZ)for 2 to 4 weeks before operation,all patients were treated with posterior pedicle screw fixation,focal clean-ing,titanium mesh and bone graft fusion. After operation,the anti-tuberculosis medication was continued for 12 ~ 18 months. Results The operation time ranged from 160 mins to 290 mins,215 mins in average. The blood loss ranged from 400 to 1 800 mL,780 mL in average. All the cases were followed up for 6 months to 2 years with the average of 1 year and 7 months. 1 cases was complicated with CSF leakage. No wound infection and sinus tract formation were noted. All the cases showed excellent bone graft fusion,all internal fixation had good position without looseness,displacement and breakage. The Mean kyphosis angle was 28. 2°(range,8°to 27°)after operation,with an average correction rate of 75% . Neurologic status of all patients with pre-opertative neurologic deficit was :1 with grade B recovered to grade C;2 with grade C,1 recovered to grade D and 1 recovered to grade E;6

  14. Minimally invasive percutanuous cannulated pedicle screw system fixation for the treatment of thoracolumbar flexion-distraction fracture without neurologic impairment%微创经皮空心椎弓根固定系统治疗无神经功能障碍的屈曲牵张型胸腰椎骨折

    Institute of Scientific and Technical Information of China (English)

    张志成; 孙天胜; 刘智; 郭永智; 李连华

    2011-01-01

    Objective:To explore the feasibility and effect of percutanuous cannulated pedicle screw AF system fixation for the treatment of thoracolumbar flexion - distraction fracture without neurologic impairment. Methods: From June 2008 to June 2010,21 patients with thoracolumbar flexion-distraction fracture were treated with percutanuous cannulated pedicle screw fixation. There were 16 males and 5 females with the mean age of 32.7 years ranging from 23 to 55 years. Injured levels 5 cases was in T12,13 was in L1;3 was in L;. According to classification of AO,B1 was in 13 cases,B2 was in 8 cases. ASIA grade of all the patients were grade E. The mean operative time, bleeding volume, lengths of stay were evaluated. All the patients took the X -ray and three-dimensional CT reconstruction to observe the fracture healing and to measure the height of the anterior border of fracture vertebral body and the Cobb angle of kyphosis. The visual analogue scales (VAS) were compared preoperation and postoperation. The clinical effects were analyzed according to Oswestry Disability Index (ODI) from 10 aspects,including pain intensity .personal care, lifting, walking, sitting, standing, sleeping, sex life, social life, traveling. Results-.All the operations were successful and the mean time was (109.0±16.0) min,blood loss was (90.0±15.0) ml,lengths of stay was (7.7±2.3) d. No postoperative neurological deficits or wound infection occurred. One case occurred subcutaneous fluid of incision and 1 case occurred delayed healing of incision. Fifteen patients were followed up with an average of 16.7 months (12-33 months). The VAS score improved from preoperative 8.3±1.7 to 1.8±1.2 at final follow up (P0.05).There were satisfactory fracture reduction and good position of internal fixation, and no loss of reduction within 12 months and no fixation failure in follow-up. Conclusion: The minimally invasive percutaneous cannulated pedicle screw fixation technique is feasible in treatment of

  15. 经皮撬拨复位轴向结合横向多枚中空钉内固定治疗SandersⅡ、Ⅲ型跟骨骨折的临床疗效%An analysis of the clinical effects of percutaneous fracture reduction followed by internal fixation with multiple axial and horizontal cannulated screws in the treatment of Sanders type II and III calcaneal fracture

    Institute of Scientific and Technical Information of China (English)

    林文琛; 许耀明; 颜峻; 李超颖; 郑烽礼

    2014-01-01

    ObjectiveTo explore and compare the curative effects of percutaneous fracture reduction followed by internal fixation with cannulated screws and open reduction followed by internal fixation with titanium plate in the treatment of Sanders typeⅡ andⅢ calcaneal fracture at early stage.Methods 60 patients with calcaneal fracture from February 2010 to September 2013 were selected. They all belonged to Sanders typeⅡ andⅢ fracture, in which 34 patients were typeⅡ and 26 typeⅢ. All patients were randomly assigned to two groups and received surgeries of percutaneous fracture reduction followed by internal fixation with cannulated screws and open reduction followed by internal fixation with titanium plate. They were observed in the follow-ups, and functional evaluation was carried out via Marryland evaluation system. Excellent and good rate of the two methods was calculated, and differences between the two groups were analyzed through statistics. Results Follow-ups were carried out for 60 patients, and the follow-up time was 4-38 months (average 18 months). Clinical effects: among 31 patients who received percutaneous fracture reduction followed by internal fixation with cannulated screws, 18 patients showed excellent foot functions, 6 good, 3 average and 2 unsatisfactory. The excellent and good rate was 83.8%; among 29 patients who received open reduction followed by internal fixation with titanium plate, 18 patients showed excellent foot functions, 6 good, 3 average and 2 unsatisfactory. The excellent and good rate was 82.8%. The differences of the excellent and good rate between the two methods were not statistically significant (x2=0.617,P =0.971>0.05).Conclusion Percutaneous fracture reduction followed by internal fixation with cannulated screws and open reduction followed by internal fixation with titanium plate in the treatment of calcaneal fracture can both achieve favorable effects. Percutaneous fracture reduction followed by internal fixation with

  16. A Technique of Superficial Medial Collateral Ligament Reconstruction Using an Adjustable-Loop Suspensory Fixation Device

    OpenAIRE

    Deo, Shaneel; Getgood, Alan

    2015-01-01

    This report describes superficial medial collateral ligament reconstruction of the knee using a novel method of graft fixation with the ACL Tightrope RT (Arthrex, Naples, FL). After tibial fixation with either a standard interference screw or staple, femoral fixation of the semitendinosus tendon is performed with the adjustable-loop suspensory fixation device, which allows for both initial graft tensioning and re-tensioning after cyclical knee range of motion. This provides the ability for th...

  17. Locking plate fixation for proximal humerus fractures.

    LENUS (Irish Health Repository)

    Burke, Neil G

    2012-02-01

    Locking plates are increasingly used to surgically treat proximal humerus fractures. Knowledge of the bone quality of the proximal humerus is important. Studies have shown the medial and dorsal aspects of the proximal humeral head to have the highest bone strength, and this should be exploited by fixation techniques, particularly in elderly patients with osteoporosis. The goals of surgery for proximal humeral fractures should involve minimal soft tissue dissection and achieve anatomic reduction of the head complex with sufficient stability to allow for early shoulder mobilization. This article reviews various treatment options, in particular locking plate fixation. Locking plate fixation is associated with a high complication rate, such as avascular necrosis (7.9%), screw cutout (11.6%), and revision surgery (13.7%). These complications are frequently due to the varus deformation of the humeral head. Strategic screw placement in the humeral head would minimize the possibility of loss of fracture reduction and potential hardware complications. Locking plate fixation is a good surgical option for the management of proximal humerus fractures. Complications can be avoided by using better bone stock and by careful screw placement in the humeral head.

  18. Introduction to Lumbosacral and Sacropelvic Fixation Strategies.

    Science.gov (United States)

    Hsieh, Patrick C; Mummaneni, Praveen V

    2016-07-01

    We are pleased to present this Neurosurgical Focus video supplement on lumbosacral and sacropelvic fixation strategies. Despite advancement in surgical techniques and technologies in spine, achieving consistent solid fusion across the lumbosacral junction remains a major challenge. The anatomy of the lumbosacral junction allows for a higher range of motion compared to other areas of the thoracolumbar spine. The L5-S1 interspace is exposed to significant shear forces. As a result, complications such as pseudoarthrosis, screw pull-out, implant fracture, or sacral fractures can occur. Complications are particularly seen in long fusion constructs ending across the lumbosacral junction. To reduce these complications, various lumbosacral and sacropelvic fixation techniques have been developed and utilized. The current supplement is intended to provide instructional videos that illustrate several current techniques for lumbosacral and sacropelvic fixation. The collection includes techniques for anterior L5-S1 interbody fusion, minimally invasive L5-S1 interbody fusions, lumbosacral pedicle screw placement, sacroiliac fusion, and sacro-alar-iliac screw placement. The authors of the videos in the supplement have provided detailed narration and video illustration to describe the nuances of the various open and minimally invasive techniques for lumbosacral and sacral-pelvic fixation. We are pleased to have such a collection of quality video illustration from experts in the field. It's been our privilege to serve as guest editors for this supplement and we believe that you will enjoy the contents of this supplement. PMID:27364425

  19. 持续闭式引流(VSD)结合骨水泥抗生素链珠治疗腰椎骨折椎弓根钉棒系统内固定术后早期感染%Treatment of early postoperative infection of lumbar fracture internal fixation of pedicle screw rod system with vacuum sealing drainage(VSD)combined with antibiotic bone cement chain

    Institute of Scientific and Technical Information of China (English)

    朱余龙; 朱海涛; 丁德刚; 徐亮

    2014-01-01

    目的:探讨持续闭式引流(VSD)结合骨水泥抗生素链珠治疗腰椎骨折椎弓根钉棒系统内固定术后早期感染的临床疗效。方法2010年3月一2014年3月,使用持续闭式引流(VSD)结合骨水泥抗生素链珠治疗腰椎骨折椎弓根钉棒系统内固定术后早期感染11例,随访其临床效果。结果11例患者均得到随访,随访时间8—12月,平均10.5月。手术后感染治愈,无一例需取出原内固定物重新或者更换固定材料。结论持续闭式引流(VSD)结合骨水泥抗生素链珠治疗腰椎骨折椎弓根钉棒系统内固定术后早期感染操作简单、安全有效,可以作为治疗腰椎骨折椎弓根钉棒系统内固定术后早期感染手段之一。%Objective: To investigate the efficacy of the treatment of early postoperative infection of umbar fracture internal fixation of pedicle screw rod system with VSD combined with antibiotic bone cement chain. Methods: from 2010 March to 2014 March, the use of continuous closed drainage (VSD) combined with antibiotic bone cement bead chain, lumbar fracture internal fixation of pedicle screw rod system treatment of early postoperative infection in 11 cases, folow-up clinical results. Results: 11 patients were folowed up from 8-12 months, with an average of 8.5 months. Cured of infection after surgery, no case of need to remove or replace the original re-fixed within the implant material. Conclusion: The continuous closed drainage (VSD) combined with antibiotic bone cement beads chain to treat early infection is simple, safe and effective treatment of lumbar fracture internal fixation of pedicle screw rod system can be used as a means of early postoperative infection.

  20. 强化螺钉治疗老年腰椎管狭窄近中期疗效%The short and midterm clinical effect of pedicle screw fixation with bone cement augmentation in the treatment of senile lumbar spinal stenosis

    Institute of Scientific and Technical Information of China (English)

    瞿岱彪; 黄圣升; 吴华; 刘礼金

    2015-01-01

    目的:评价骨水泥强化椎弓根螺钉内固定治疗伴老年腰椎管狭窄症的近中期临床疗效。方法2012年6月至2014年6月间应用骨水泥强化椎弓根螺钉治疗老年性腰椎管狭窄患者24例,所有患者术前均行骨密度测定诊断为骨质疏松症。采用VAS、JOA下腰痛评分及Oswestry功能障碍指数问卷表(ODI)评分标准评价临床疗效。结果24例患者随访6-24个月,平均(11.50±2.11)个月,不适症状均得到一定改善。 VAS评分术前(7.55±1.30)、术后3个月为(3.65±0.87)、术后6个月为(3.15±0.71)、末次为(2.83±2.04);JOA评分术前为(8.66±7.01)、术后3个月为(14.09±2.07)、术后6个月为(16.88±1.95)、末次随访为(17.33±1.74);ODI评分术前为(0.71±0.31)、术后3个月为(0.44±0.12)、术后6个月为(0.31±0.11)、末次随访为(0.29±0.07)。术后3个月、6个月、末次随访所有评价指标分别与术前对比,差异均有统计学意义(P<0.05)。随访时复查相关影像学资料示只有1例因外伤出现椎弓根螺钉松动,末次随访椎间融合率高达87%。结论对于老年性合并骨质疏松的腰椎管狭窄症患者,应用骨水泥强化椎弓根螺钉技术临床疗效确切,有术后椎间融合率高、发生内固定松动率低、二次手术风险低等优势。%Objective To observe the short and midterm clinical effect of pedicle screw fixation with bone cement augmenta-tion in the treatment of senile lumbar spinal stenosis. Methods From June 2012 to June 2014,24 patients with Lumbar Spinal Stenosis and osteoporosis were treated by posterior decompression,intervertebral fusion with pedicle screw fixation with bone ce-ment augmentation. Osteoporosis was diagnosed by dual-energy X-ray absorptiometry (DEXA) examination in all cases preopera-tively. The clinical results were investigated by measuring VAS and JOA and ODI scoring. Results 24 patients were followed up from 6 to 24 months (average 11.50

  1. 经皮椎体成形术结合椎弓根螺钉内固定治疗胸腰段骨质疏松性爆裂性骨折%A combination of percutaneous vertebroplasty and pedicle screw fixation for thoracolumbar osteoporotic burst fractures

    Institute of Scientific and Technical Information of China (English)

    赵国辉; 陈孜; 金丹杰; 徐南伟; 张云坤

    2015-01-01

    背景:椎体成形术是治疗骨质疏松性骨折的有效方法,但是对于伴有椎体后壁破裂、椎管内存在压迫的骨折,单纯采用椎体成形并不能够达到满意的治疗效果。目的:探讨经皮椎体成形术(PVP)结合后路椎弓根螺钉内固定术治疗后壁破裂伴椎管内有骨片移位(AO分型:A3/A4)的骨质疏松性椎体骨折(OVCF)的临床疗效。方法:回顾分析2011年5月至2014年9月经CT证实为后壁破裂伴椎管内有骨片移位的椎体骨折患者11例的病例资料。男2例,女9例,年龄55~69岁,平均60.6岁。所有患者均接受PVP+椎弓根螺钉内固定手术,损伤节段:T111例, T124例,L14例,L22例。记录患者术前、术后1周和末次随访的疼痛视觉评分(VAS),Cobb角,椎体前缘、后缘高度。结果:手术均获得成功,2例出现骨水泥泄漏(1例前方泄漏、1例上方泄漏),无经后壁向椎管内泄漏病例。本组患者全部获得随访,时间6~36个月,平均20个月。1例损伤椎上方左侧椎弓根螺钉移位至椎间隙。术前VAS评分,椎体前柱、后柱高度,Cobb角,与术后1周、末次随访时比较,差异均有统计学意义(P<0.01)。结论:对于有后壁破裂伴椎管内有骨片移位的骨质疏松性椎体骨折,PVP+椎弓根螺钉内固定是一种值得选择的治疗方案。%Background: Percutancons vertebroplasty (PVP) is an effective treatment for osteoporotic vertebral compression fracture (OVCF). But when the OVCF combined with posterior wall rupture accompanied by bone fragment displacement with ver-tebral canal, it is not suitable to use PVP only. Objective:To evaluate therapeutic effects of a combination of PVP and posterior pedicle screw internal fixation for the treat-ment of OVCF with posterior wall rupture accompanied by bone fragment displacement within vertebral canal (AO type:A3/A4). Methods: Eleven patients with OVCF with posterior

  2. Treatment of Lumbar Degenerative Disease with Unilateral Decompression,Bone Graft Fusion and Unilateral Pedicle Screw Fixation%经单侧减压融合、单边椎弓根螺钉内固定治疗腰椎退变性疾病

    Institute of Scientific and Technical Information of China (English)

    宋晋刚; 崔易坤; 苗艳; 尹振宇; 羊刚毅; 黄海锋

    2016-01-01

    目的:探讨经单侧行病变节段椎管减压、椎间植骨融合、单边椎弓根螺钉内固定治疗腰椎退变性疾病的临床疗效。方法我院2010年1月~2013年12月对35例腰椎退变性疾病采用经单侧减压、椎间植骨融合、单边椎弓根螺钉固定手术治疗。根据 JOA 评分法评估术后腰椎功能改善情况,采用视觉模拟评分(visual analog scale,VAS)评估术后疼痛缓解情况,腰椎正侧位 X 线片及 CT 扫描了解植骨融合情况。结果随访12~18个月,平均15个月。术前 JOA 评分(8.2±2.1)分,显著低于术后3个月(20.8±3.8)分(q =22.123,P <0.05)和术后12个月(21.7±3.9)分(q =23.703,P <0.05);VAS 评分术前(7.9±2.1)分,显著高于术后3个月(2.4±0.4)分(q =26.107,P <0.05)和12个月(2.3±0.3)分(q =26.582,P <0.05);JOA 评分和 VAS 评分随访期间无显著变化(P >0.05)。1年后椎间植骨融合率100%,未发现椎弓根螺钉松动、断裂、拔钉等异常。结论经单侧减压、椎间植骨融合联合单边椎弓根螺钉内固定治疗腰椎退变性疾病疗效满意,可在合适病例中推广应用。%Objective To investigate the clinical effects of unilateral vertebral canal decompression,intervertebral bone graft fusion,and unilateral pedicle screw fixation in the treatment of lumbar degenerative disease. Methods From January 2010 to December 2013,a total of 35 cases of lumbar degenerative disease were treated with unilateral decompression,intervertebral bone graft fusion,and unilateral pedicle screw fixation.The postoperative spine functions were evaluated with the JOA scores,the postoperative pain relief was evaluated with the VAS scores,and bone graft fusion was reviewed with lumbar X-ray and CT scanning. Results The patients were followed up for 12 -18 months (mean,15 months).The preoperative JOA scores (8.2 ±2

  3. 腰椎滑脱椎弓根螺钉内固定融合术后邻近节段椎间隙变化的相关研究%Related study on adjacent segments intervertebral space change after spondylolishesis pedicle screw internal fixation and fusion operation

    Institute of Scientific and Technical Information of China (English)

    贾鹏; 赵文国; 王勇贵

    2013-01-01

    目的 探讨腰椎内固定融合术后邻近椎间隙高度的变化及其与螺钉角度的关系.方法 回顾性分析31例行腰椎内固定融合术的腰椎滑脱患者的临床资料,观察术后固定融合区邻近椎间隙的变化;对是否“悬浮固定”对邻近椎间隙高度变化的影响及不同邻近节段椎间隙高度变化进行对比;分析邻近椎间隙高度变化与螺钉角度的关系.结果 L5~S1固定组其上方的L4/L5椎间隙术后1 a高度与术后即时比较虽有一定程度的降低,但差异无统计学意义(P>0.05);L4~L5固定组其上方的L3/L4椎间隙及下方的L5/S1椎间隙术后1 a高度与术后即时比较虽有一定程度的降低,但差异亦无统计学意义(P>0.05);L5~S1固定组其上方的L4/L5椎间隙高度变化与L4~L5固定组其上方的L3/L4椎间隙高度变化比较,差异无统计学意义(P>0.05);L4~L5固定后,固定融合区上方邻近椎间隙(L3/L4)高度变化与下方邻近椎间隙(L5/S1)高度变化比较,差异无统计学意义(P>0.05);螺钉角度<6°组与螺钉角度≥6.组比较,固定融合区上方邻近椎间隙高度变化差异无统计学意义(P>0.05);固定融合区上方椎间隙高度变化与螺钉角度呈正线性相关关系(r =0.373,P=0.039).结论 是否“悬浮固定”对固定融合区邻近节段椎间隙无影响,固定融合区上、下方邻近节段椎间隙变化无差异;螺钉角度的大小与固定融合区上方邻近节段椎间隙存在正相关关系,即螺钉角度越大,椎间隙变小越明显.%Objective To observe the change of the height of the adjacent segments intervertebral space after internal fixation and fusion operation of lumbar vertebrae and the relation between the change of height of intervetebral space in the adjacent segments and the angle of the pedicle screw.Methods Thirty-one patients who had undergone an internal fixation and fusion operation of lumbar vertebrae were analyzed

  4. Decompressive cervical laminectomy and lateral mass screw-rod arthrodesis. Surgical analysis and outcome

    Directory of Open Access Journals (Sweden)

    Obaidat Mouness H

    2011-05-01

    Full Text Available Abstract Background This study evaluates the outcome and complications of decompressive cervical Laminectomy and lateral mass screw fixation in 110 cases treated for variable cervical spine pathologies that included; degenerative disease, trauma, neoplasms, metabolic-inflammatory disorders and congenital anomalies. Methods A retrospective review of total 785 lateral mass screws were placed in patients ages 16-68 years (40 females and 70 males. All cases were performed with a polyaxial screw-rod construct and screws were placed by using Anderson-Sekhon trajectory. Most patients had 12-14-mm length and 3.5 mm diameter screws placed for subaxial and 28-30 for C1 lateral mass. Screw location was assessed by post operative plain x-ray and computed tomography can (CT, besides that; the facet joint, nerve root foramen and foramen transversarium violation were also appraised. Results No patients experienced neural or vascular injury as a result of screw position. Only one patient needed screw repositioning. Six patients experienced superficial wound infection. Fifteen patients had pain around the shoulder of C5 distribution that subsided over the time. No patients developed screw pullouts or symptomatic adjacent segment disease within the period of follow up. Conclusion decompressive cervical spine laminectomy and Lateral mass screw stabilization is a technique that can be used for a variety of cervical spine pathologies with safety and efficiency.

  5. Effect of different radial hole designs on pullout and structural strength of cannulated pedicle screws.

    Science.gov (United States)

    Chen, Hsin-Chang; Lai, Yu-Shu; Chen, Wen-Chuan; Chen, Jou-Wen; Chang, Chia-Ming; Chen, Yi-Long; Wang, Shih-Tien; Cheng, Cheng-Kung

    2015-08-01

    Cannulated pedicle screws are designed for bone cement injection to enhance fixation strength in severely osteoporotic spines. However, the screws commonly fracture during insertion. This study aims to evaluate how different positions/designs of radial holes may affect the pullout and structural strength of cannulated pedicle screws using finite element analysis. Three different screw hole designs were evaluated under torsion and bending conditions. The pullout strength for each screw was determined by axial pullout failure testing. The results showed that when the Von Mises stress reached the yield stress of titanium alloy the screw with four radial holes required a greater torque or bending moment than the nine and twelve hole screws. In the pullout test, the strength and stiffness of each screw with cement augmentation showed no significant differences, but the screw with four radial holes had a greater average pullout strength, which probably resulted from the significantly greater mean maximum lengths of cement augmentation. Superior biomechanical responses, with lower stress around the radial holes and greater pullout strength, represented by cannulated pedicle screw with four radial holes may worth recommending for clinical application. PMID:26054806

  6. Retrospective comparison of percutaneous fixation and volar internal fixation of distal radius fractures.

    Science.gov (United States)

    Lozano-Calderón, Santiago A; Doornberg, Job N; Ring, David

    2008-06-01

    A change in the practice of a single surgeon provided an opportunity for retrospective comparison of comparable cohorts treated with percutaneous fixation (17 patients) or a volar plate and screws (23 patients) an average of 30 months after surgery. The final evaluation was performed according to the Gartland and Werley and Mayo rating systems and the DASH questionnaire. There were no significant differences on the average scores for the percutaneous and volar plating groups, respectively: Gartland and Werley, 4 vs 5; Mayo, 82 vs 83; and DASH score 13 for both cohorts. Motion, grip, and radiographical parameters were likewise comparable. Volar internal plate and screw fixation can achieve results comparable to percutaneous fixation techniques in the treatment of fractures of the distal radius.

  7. Application of the Orthopedics Robot Navigation Positioning System in Assistance of Hollow Screw Internal Fixation for Femoral Neck Fractures%骨科机器人导航定位系统辅助股骨颈骨折空心螺钉内固定术的应用

    Institute of Scientific and Technical Information of China (English)

    曾田勇

    2015-01-01

    目的 探讨骨科机器人导航定位系统辅助股骨颈骨折空心螺钉内固定术的应用效果.方法 机器人主控系统首先建立股骨颈骨折经皮空心钉内固定的有限元模型,医生在定位执行系统的引导下完成手术操作.结果 23例手术均达到骨折解剖复位,直径3 mm的导针最大平行度偏差值<1.2 mm; C臂透视时间15.7 s,平均照射次数23.1次.结论 机器人辅助创伤骨科手术定位精确、固定可靠、操作安全,同时极大地减少术中患者及医护人员X线照射时间,有效地减小了辐射伤害.%Objective To explore the effectiveness of application of the orthopedics robot navigation positioning system in assistance of hollow screw internal ifxation for femoral neck fractures.Methods Firstly, the main control system of the robot would establish a FEA (Finite Element Analysis) model of percutaneous hollow screw internal fixation for femoral neck fractures. Then, physicians could perform the surgeries under the guidance of the positioning implementation system.Results Anatomical reduction of fractures was achieved in all the 23 cases of surgeries. The deviation of the maximum degree of parallelism was less than 1.2 mm for the guide pin (diameter: 3 mm). The C-arm lfuoroscopy time was 15.7 s; while, the average number of radiation times was 23.1.Conclusion The robot-assisted trauma orthopedics surgery proven its advantages of accurate positioning, reliable ifxation and safe operation, which could greatly and effectively reduce the intra-operative X-ray exposure time and radiation harm for patients and medical staff.

  8. 加压钢板及螺钉前外侧与内侧入路修复肱骨中下段骨折:疗效及安全性评价%Anterolateral and medial approach fixation with compression plate and screw for middle and inferior humeral fractures:efficacy and safety

    Institute of Scientific and Technical Information of China (English)

    吴畏; 汪海波

    2015-01-01

    BACKGROUND:Reduction and fixation are presently used for middle and inferior humeral fractures. The methods of fixation approach include anterolateral (including modified upper arm anterolateral), posterior and medial approaches. The repair approach of middle and inferior humeral fractures remains controversial. OBJECTIVE:To compare efficiency and safety of anterolateral and medial approach fixation with compression plate and screw for middle and inferior humeral fractures. METHODS:A total of 90 cases of middle and inferior humeral fractures treated in Chongqing Red Cross Hospital were equaly and randomly divided into experimental group and control group. In the control group, patients were subjected to compression plate and screw through anterolateral approach. In the experimental group, patients were subjected to compression plate and screw through medial approach. Operation time, intraoperative blood loss, complications and the recovery of shoulder joint and elbow joint function were compared in patients of both groups. RESULTS AND CONCLUSION:Intraoperative blood loss was significantly lower in the experimental group than in the control group (P 0.05). During 6 months of folow-up, no significant difference in shoulder joint function Neer score and elbow joint function Mayo score was detected between the two groups (P > 0.05). During the folow-up period, no wound infection, bone nonunion or chronic osteomyelitis appeared in both groups. These data confirm that the effects of medial approach and anterolateral approach for middle and inferior humeral fractures are similar. Medial approach leads to less blood loss, can effectively make up for the defects of the traditional repair scheme, and can be considered as one of fixation approach for middle and inferior humeral fractures.%背景:目前对肱骨中下段骨折主要采用复位内固定治疗,内固定入路方式主要有3种:前外侧入路(包括改良上臂前外侧入路)、后侧入路以及内

  9. En bloc open-door laminectomy and pedicle screw fixation for extremely severe cervical ossification of posterior longitudinal ligament%“单开门”揭开式椎板整块切除、椎弓根螺钉固定治疗极重度颈椎后纵韧带骨化症

    Institute of Scientific and Technical Information of China (English)

    张继东; 夏群; 胡永成; 吉宁; 韩岳; 宁尚龙

    2013-01-01

    目的 观察“单开门”揭开式椎板整块切除、椎弓根螺钉固定治疗极重度颈椎后纵韧带骨化症(ossification of posterior longitudinal ligament,OPLL)的临床疗效.方法 回顾性分析2007年1月至2011