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Sample records for bioabsorbable screw fixation

  1. Magnetic resonance imaging analysis of the bioabsorbable Milagro interference screw for graft fixation in anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Frosch, K-H; Sawallich, T; Schütze, G; Losch, A; Walde, T; Balcarek, P; Konietschke, F; Stürmer, K M

    2009-10-01

    Ligament graft fixation with bioabsorbable interference screws is a standard procedure in cruciate ligament replacement. Previous screw designs may resorb incompletely, and can cause osteolysis and sterile cysts despite being implanted for several years. The aim of this study was to examine the in vivo degradation and biocompatibility of the new Milagro interference screw (Mitek, Norderstedt, Germany). The Milagro interference screw is made of 30% ss-TCP (TriCalcium phosphate) and 70% PLGA (Poly-lactic-co-glycolic acid). In the period between June 2005 and February 2006, 38 patients underwent graft fixation with Milagro screws in our hospital. Arthroscopic ACL reconstruction was performed using hamstring tendon grafts in all the patients. MR imaging was performed on 12 randomly selected patients out of the total of 38 at 3, 6 and 12 months after surgery. During the examination, the volume loss of the screw, tunnel enlargement, presence of osteolysis, fluid lines, edema and postoperative screw replacement by bone tissue were evaluated. There was no edema or signs of inflammation around the bone tunnels. At 3, 6 and 12 months, the tibial screws showed an average volume loss of 0, 8.1% (+/-7.9%) and 82.6% (+/-17.2%, P Milagro screw is closely linked to the graft healing process. The screws were rapidly resorbed after 6 months and, at 12 months, only the screw remnants were detectable. Moreover, the Milagro screw is biocompatible and osteoconductive, promoting bone ingrowth during resorption. Tunnel enlargement is not prevented in the first months but is reduced by bone ingrowth after 12 months.

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

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    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.

  3. Do Newer-Generation Bioabsorbable Screws Become Incorporated into Bone at Two Years After ACL Reconstruction with Patellar Tendon Graft?

    Science.gov (United States)

    Cox, Charles L.; Spindler, Kurt P.; Leonard, James P.; Morris, Brent J.; Dunn, Warren R.; Reinke, Emily K.

    2014-01-01

    Background: Bioabsorbable interference screws are used frequently for graft fixation in ACL (anterior cruciate ligament) reconstruction. The resorption properties of many available screws that are marketed as bioabsorbable are not well defined. The CALAXO (Smith & Nephew Endoscopy) and MILAGRO (DePuy Synthes) bioabsorbable screws contain polymers of poly(lactic-co-glycolic acid) (PLGA) plus additives to encourage osseointegration over time. The purpose of this study was to evaluate radiographic and magnetic resonance imaging (MRI) properties and compare patient-reported outcomes at a minimum of two years of follow-up after ACL reconstruction using CALAXO or MILAGRO bioabsorbable interference screws. Methods: A cohort of patients who underwent ACL reconstruction in which the fixation used was either CALAXO or MILAGRO screws returned for repeat radiographs for evaluation of tunnel widening, repeat MRI for evaluation of graft integrity and screw breakdown, and completion of the pain and symptom items of the KOOS (Knee injury and Osteoarthritis Outcome Score) questionnaire. Results: At a mean of three years (range, 2.5 to 4.0 years) after surgery, thirty-one patients with sixty-two CALAXO screws and thirty-six patients with seventy-two MILAGRO screws returned for repeat evaluation. Two blinded, independent reviewers found no significant differences between the two screw types when comparing radiographs for tibial or femoral tunnel widening or MRIs for graft integrity, tibial and femoral foreign body reactions, or femoral screw degradation. Both reviewers found a significant difference between the two screw types when comparing tibial screw degradation properties (p MILAGRO screws were more likely to be rated as intact. No significant differences were noted between the two screw types when comparing the two KOOS subscales. Conclusions: CALAXO screws in the tibial tunnel were more likely to be rated as degraded or partially degraded compared with MILAGRO screws at a mean

  4. 前路减压植骨可吸收螺钉内固定治疗颈椎病%The anterior decompression and bone grafting with bio-absorbable screw fixation for cervical spondylosis

    Institute of Scientific and Technical Information of China (English)

    王栋; 贺西京; 李浩鹏; 张健; 徐思越; 杨平林; 王国毓

    2009-01-01

    Objective:To observe the early clinical effect of the cervical spendylosis treated by the fixation with bio-absorbable screw after cervical anterior decompression and bone grafting.Method:26 cases suffered from cervical spondylosis who were treated by anterior compression,bone grafting and fixating with 2 bio-ab-serbable screws from Mar. 2007 to Sep. 2008,including 16 males and 10 females with an average age of 49.4 years (38-70 years ).There were 11 cases with cervical spondylotic myelopathy,5 with cervical spendylofic radieulopathy and 10 with mixed type of cervical spondylosis.Clinical data of these patients was analyzed ret-rospectively.One intervertebral space involvement was in 8 cases,and two spaces involvement in 18 cases.All patients underwent anterior decompression and bone grafting,in which the grafted bone was fixated by 2 bio-absorptive screws (PLLA,diameter:2.7mm) from the midline of graft bone to the bone surface of upper and lower vertebrae in 45°.Cervical collar was commonly used for 4-6 weeks after operation.All cases were fol-lowed-up every month in outpatient department to observe the improvement of symptoms and evaluate the fu-sion of bone graft.Neurological function recovery was observed by JOA score.Result:Operations of all cases were finished and screws were placed successfully.The operative incisions healed well.The excellent and good rate of symptom improvement was 84.2%,the graft fusion time was 3.3±0.6 months (range,3.2-4.6 months).No obvious complications were found.Conclusion:The cervical spendylosis with one or two-level involvement can be effectively treated by anterior decompression and bone grafting with bio-absorbable screw fixation.This operative method is safe and can avoid the complications induced by metal implants.%目的:观察颈椎前路减压植骨可吸收螺钉内同定治疗颈椎病的初步临床疗效.方法:2007年3月~2008年9月我院应用颈椎前路减压植骨可吸收螺钉

  5. Mechanical design optimization of bioabsorbable fixation devices for bone fractures.

    Science.gov (United States)

    Lovald, Scott T; Khraishi, Tariq; Wagner, Jon; Baack, Bret

    2009-03-01

    Bioabsorbable bone plates can eliminate the necessity for a permanent implant when used to fixate fractures of the human mandible. They are currently not in widespread use because of the low strength of the materials and the requisite large volume of the resulting bone plate. The aim of the current study was to discover a minimally invasive bioabsorbable bone plate design that can provide the same mechanical stability as a standard titanium bone plate. A finite element model of a mandible with a fracture in the body region is subjected to bite loads that are common to patients postsurgery. The model is used first to determine benchmark stress and strain values for a titanium plate. These values are then set as the limits within which the bioabsorbable bone plate must comply. The model is then modified to consider a bone plate made of the polymer poly-L/DL-lactide 70/30. An optimization routine is run to determine the smallest volume of bioabsorbable bone plate that can perform and a titanium bone plate when fixating fractures of this considered type. Two design parameters are varied for the bone plate design during the optimization analysis. The analysis determined that a strut style poly-L-lactide-co-DL-lactide plate of 690 mm2 can provide as much mechanical stability as a similar titanium design structure of 172 mm2. The model has determined a bioabsorbable bone plate design that is as strong as a titanium plate when fixating fractures of the load-bearing mandible. This is an intriguing outcome, considering that the polymer material has only 6% of the stiffness of titanium.

  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.

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    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?

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    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

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    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. 21 CFR 872.4880 - Intraosseous fixation screw or wire.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Intraosseous fixation screw or wire. 872.4880... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Surgical Devices § 872.4880 Intraosseous fixation screw or wire. (a) Identification. An intraosseous fixation screw or wire is a metal device intended to be...

  12. Translaminar facetal screw (magerl′s fixation

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    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.

  13. Magnesium-Based Absorbable Metal Screws for Intra-Articular Fracture Fixation

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    Roland Biber

    2016-01-01

    Full Text Available MAGNEZIX® (Syntellix AG, Hanover, Germany is a biodegradable magnesium-based alloy (MgYREZr which is currently used to manufacture bioabsorbable compression screws. To date, there are very few studies reporting on a limited number of elective foot surgeries using this innovative implant. This case report describes the application of this screw for osteochondral fracture fixation at the humeral capitulum next to a loose radial head prosthesis, which was revised at the same time. The clinical course was uneventful. Degradation of the magnesium alloy did not interfere with fracture healing. Showing an excellent clinical result and free range-of-motion, the contour of the implant was still visible in a one-year follow-up.

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

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    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.

  15. Femoral and Tibial Tunnel Diameter and Bioabsorbable Screw Findings After Double-Bundle ACL Reconstruction in 5-Year Clinical and MRI Follow-up

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    Kiekara, Tommi; Paakkala, Antti; Suomalainen, Piia; Huhtala, Heini; Järvelä, Timo

    2017-01-01

    Background: Tunnel enlargement is frequently seen in short-term follow-up after anterior cruciate ligament reconstruction (ACLR). According to new evidence, tunnel enlargement may be followed by tunnel narrowing, but the long-term evolution of the tunnels is currently unknown. Hypothesis/Purpose: The hypothesis was that tunnel enlargement is followed by tunnel narrowing caused by ossification as seen in follow-up using magnetic resonance imaging (MRI). The purpose of this study was to evaluate the ossification pattern of the tunnels, the communication of the 2 femoral and 2 tibial tunnels, and screw absorption findings in MRI. Study Design: Case series; Level of evidence, 4. Methods: Thirty-one patients underwent anatomic double-bundle ACLR with hamstring grafts and bioabsorbable interference screw fixation and were followed with MRI and clinical evaluation at 2 and 5 years postoperatively. Results: The mean tunnel enlargement at 2 years was 58% and reduced to 46% at 5 years. Tunnel ossification resulted in evenly narrowed tunnels in 44%, in conical tunnels in 48%, and fully ossified tunnels in 8%. Tunnel communication increased from 13% to 23% in the femur and from 19% to 23% in the tibia between 2 and 5 years and was not associated with knee laxity. At 5 years, 54% of the screws were not visible, with 35% of the screws replaced by a cyst and 19% fully ossified. Tunnel cysts were not associated with worse patient-reported outcomes or knee laxity. Patients with a tibial anteromedial tunnel cyst had higher Lysholm scores than patients without a cyst (93 and 84, P = .03). Conclusion: Tunnel enlargement was followed by tunnel narrowing in 5-year follow-up after double-bundle ACLR. Tunnel communication and tunnel cysts were frequent MRI findings and not associated with adverse clinical evaluation results. PMID:28203605

  16. Intermaxillary Fixation Screw Morbidity in Treatment of Mandibular Fractures

    DEFF Research Database (Denmark)

    Florescu, Vlad-Andrei; Kofod, Thomas; Pinholt, Else Marie

    2016-01-01

    PURPOSE: The aim of the present retrospective study was to investigate the morbidity of screws used for intermaxillary fixation (IMF) in the treatment of mandibular fractures. A review of the published data was also performed for a comparison of outcomes. Our hypothesis was that the use of screws...

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

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    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.

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

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    Alvis-Miranda, Hernando Raphael; Farid-Escorcia, Hector; Alcalá-Cerra, Gabriel; Castellar-Leones, Sandra Milena; Moscote-Salazar, Luis Rafael

    2014-01-01

    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. PMID:25336831

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

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    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.

  20. Odontoid screw fixation for fresh and remote fractures

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    Rao Ganesh

    2005-01-01

    Full Text Available Fractures of the odontoid process are common, accounting for 10% to 20% of all cervical spine fractures. Odontoid process fractures are classified into three types depending on the location of the fracture line. Various treatment options are available for each of these fracture types and include application of a cervical orthosis, direct anterior screw fixation, and posterior cervical fusion. If a patient requires surgical treatment of an odontoid process fracture, the timing of treatment may affect fusion rates, particularly if direct anterior odontoid screw fixation is selected as the treatment method. For example, type II odontoid fractures treated within the first 6 months of injury with direct anterior odontoid screw fixation have an 88% fusion rate, whereas fractures treated after 18 months have only a 25% fusion rate. In this review, we discuss the etiology, biomechanics, diagnosis, and treatment (including factors affecting fusion such as timing and fracture orientation options available for odontoid process fractures.

  1. Migration of polyethylene fixation screw after total knee arthroplasty.

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    Cho, Woo-Shin; Youm, Yoon-Seok

    2009-08-01

    Duracon (Howmedica, Rutherford, NJ) posterior stabilized total knee system has a snap fit locking mechanism of a tibial polyethylene, including an additional locking screw for further fixation of polyethylene. We report 13 cases of locking screw migration from tibial component after Duracon posterior stabilized primary total knee arthroplasty. Among 13 knees, screw migration in 10 asymptomatic cases was incidentally detected during regular follow-up, and they were just observed in the outpatient clinic. Only 3 knees had moderate pain, swelling, and instability, and revision was done on 2 of 3 knees.

  2. 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.

  3. Augmentation of Pedicle Screw Fixation with Calcium Phosphate Cement

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    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.

  4. Posterior atlantoaxial transpedicle screw fixation for traumatic atlatoaxial instability

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    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

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

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    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

  6. [Posterior atlantoaxial fixation using vertex multiaxial screw system].

    Science.gov (United States)

    Zhong, Dejun; Song, Yueming

    2007-06-01

    This study aims to assess the effectiveness and advantages of Vertex multiaxial screw system in use for stabilizing the atlanto-axial junction. The entry point of the atlas was located 18-20 mm lateral to the midline and 2.0 mm superior to the inferior border of posterior arch, and the direction of screw was chosen to be about 10 degrees medial to the sagittal plane and about 5 degrees cephalad to the transverse plane. In odontoid vertebra (C2), the direction of the drill bit was guided directly by the medial and superior aspect of the individual C2 pedicle. All screws were placed properly without incidence of nerve or blood vessel injury, and no complication appeared in operation and after surgery. All cases were followed up for an average of 9 months, all cases achieved well reposition and fixation of atlantoaxial joint, average JOA grade was 9.6 before preoperation and 15.9 after operation. Fixation of the atlantoaxial complex using Vertex multiaxial screw system seemed to be a reliable technique and should be considered a good alternative in atlantoaxial fusion. The technique could be used in young patiens.

  7. Pseudoaneurysm of profunda femoris artery following dynamic hip screw fixation for intertrochanteric femoral fracture

    Institute of Scientific and Technical Information of China (English)

    Shailendra Singh; Sumit Arora; Ankit Thora; Ram Mohan; Sumit Sural; Anil Dhal

    2013-01-01

    Dynamic hip screw fixation is a commonly performed procedure for internal fixation of intertrochanteric femoral fractures.Arterial injury following the operative fixation is a rare but serious event.We present a patient who developed pseudoaneurysm of profunda femoris artery after internal fixation of intertrochanteric fracture with a dynamic hip screw.The diagnosis was confirmed by angiographic study and it was successfully treated by coil embolization.

  8. Biomechanical Evaluation of Plate Versus Lag Screw Only Fixation of Distal Fibula Fractures.

    Science.gov (United States)

    Misaghi, Amirhossein; Doan, Josh; Bastrom, Tracey; Pennock, Andrew T

    2015-01-01

    Traditional fixation of unstable Orthopaedic Trauma Association type B/C ankle fractures consists of a lag screw and a lateral or posterolateral neutralization plate. Several studies have demonstrated the clinical success of lag screw only fixation; however, to date no biomechanical comparison of the different constructs has been performed. The purpose of the present study was to evaluate the biomechanical strength of these different constructs. Osteotomies were created in 40 Sawbones(®) distal fibulas and reduced using 1 bicortical 3.5-mm stainless steel lag screw, 2 bicortical 3.5-mm lag screws, 3 bicortical 3.5-mm lag screws, or a single 3.5-mm lag screw coupled with a stainless steel neutralization plate with 3 proximal cortical and 3 distal cancellous screws. The constructs were tested to determine the stiffness in lateral bending and rotation and failure torque. No significant differences in lateral bending or rotational stiffness were detected between the osteotomies fixed with 3 lag screws and a plate. Constructs fixed with 1 lag screw were weaker for both lateral bending and rotational stiffness. Osteotomies fixed with 2 lag screws were weaker in lateral bending only. No significant differences were found in the failure torque. Compared with lag screw only fixation, plate fixation requires larger incisions and increased costs and is more likely to require follow-up surgery. Despite the published clinical success of treating simple Orthopaedic Trauma Association B/C fractures with lag screw only fixation, many surgeons still have concerns about stability. For noncomminuted, long oblique distal fibula fractures, lag screw only fixation techniques offer construct stiffness similar to that of traditional plate and lag screw fixation.

  9. 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.

  10. Morphological character of cervical spine for anterior transpedicular screw fixation

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    Rong-Ping Zhou

    2013-01-01

    Full Text Available Background: Anterior cervical interbody grafts/cages combined with a plate were frequently used in multilevel discectomies/corpectomies. In order to avoid additional posterior stabilization in patients who undergo anterior reconstructive surgery, an anterior cervical transpedicular screw fixation, which offers higher stability is desirable. We investigated in this study the anatomical (morphologic characters for cervical anterior transpedicular screw fixation. Materials and Methods: Left pedicle parameters were measured on computed tomography (CT images based on 36 cervical spine CT scans from healthy subjects. The parameters included outer pedicle width (Distance from lateral to medial pedicle surface in the coronal plane, outer pedicle height (OPH (Distance from upper to lower pedicle surface in the sagittal plane, maximal pedicle axis length (MPAL, distance transverse insertion point (DIP, distance of the insertion point to the upper end plate (DIUP, pedicle sagittal transverse angle (PSTA and pedicle transverse angle (PTA at C3 to C7. Results: The values of outer pedicle width and MPAL in males were larger than in females from C3 to C7. The OPH in males was larger than in females at C3 to C6, but there was no difference at C7. The DIP and PTA were significantly greater in males than in females at C3, but there was no difference in the angle at C4-7. The PSTA was not statistically different between genders at C3, 4, 7, but this value in males was larger than females at C5, 6. The DIUP was significantly greater in males at C3, 4, 6, 7 but was non significant at C5. Conclusions: The placement of cervical anterior transpedicular screws should be individualized for each patient and based on a detailed preoperative planning.

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

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    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.

  12. Comparison between Bilateral C2 Pedicle Screwing and Unilateral C2 Pedicle Screwing, Combined with Contralateral C2 Laminar Screwing, for Atlantoaxial Posterior Fixation

    OpenAIRE

    Miyakoshi, Naohisa; HONGO, MICHIO; Kobayashi, Takashi; Suzuki, Tetsuya; Abe, Eiji; Shimada, Yoichi

    2014-01-01

    Study Design A retrospective study. Purpose To compare clinical and radiological outcomes between bilateral C2 pedicle screwing (C2PS) and unilateral C2PS, combined with contralateral C2 laminar screwing (LS), for posterior atlantoaxial fixation. Overview of Literature Posterior fixation with C1 lateral mass screwing (C1LMS) and C2PS (C1LMS-C2PS method) is an accepted procedure for rigid atlantoaxial stabilization. However, conventional bilateral C2PS is not always allowed in this method due ...

  13. 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.

  14. 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.

  15. Progressive slip after removal of screw fixation in slipped capital femoral epiphysis: two case reports

    Directory of Open Access Journals (Sweden)

    Engelsma Yde

    2012-11-01

    Full Text Available Abstract Introduction In slipped capital femoral epiphysis the femoral neck displaces relative to the head due to weakening of the epiphysis. Early recognition and adequate surgical fixation is essential for a good functional outcome. The fixation should be secured until the closure of the epiphysis to prevent further slippage. A slipped capital femoral epiphysis should not be confused with a femoral neck fracture. Case presentation Case 1 concerns a 15-year-old boy with an adequate initial screw fixation of his slipped capital femoral epiphysis. Unfortunately, it was thought that the epiphysis had healed and the screw was removed after 11 weeks. This caused new instability with a progressive slip of the femoral epiphysis and subsequently re-fixation and a subtrochanteric correction osteotomy was obligatory. Case 2 concerns a 13-year-old girl with persistent hip pain after screw fixation for slipped capital femoral epiphysis. The screw was removed as lysis was seen around the screw on the hip X-ray. This operation created a new unstable situation and the slip progressed resulting in poor hip function. A correction osteotomy with re-screw fixation was performed with a good functional result. Conclusion A slipped epiphysis of the hip is not considered ‘healed’ after a few months. Given the risk of progression of the slip the fixation material cannot be removed before closure of the growth plate.

  16. 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

  17. 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.

  18. A biomechanical study of two different pedicle screw methods for fixation in osteoporotic and nonosteoporotic vertebrae.

    Science.gov (United States)

    Higashino, Kosaku; Kim, Jin Hwan; Horton, William C; Hutton, William C

    2012-01-01

    In reconstruction of the osteoporotic spine, patients often show poor outcome because of pedicle screw failure. This study used osteoporotic and nonosteoporotic vertebrae to determine the difference in fixation strength between pedicle screws inserted straight forward and pedicle screws inserted in an upward trajectory toward the superior end plate (i.e., end-plate screws). There is some evidence to suggest that end-plate screws have a strength advantage. The particular focus was on osteoporotic vertebrae. Thirty-three vertebrae (T10-L2) were harvested. The bone mineral density (BMD) was measured: 15 vertebrae were greater than 0.8 g/cm(2) and designated as nonosteoporotic (average BMD 1.146 ± 0.186 g/cm(2)) and 18 vertebrae were designated as osteoporotic (average BMD 0.643 ± 0.088 g/cm(2)). On one pedicle the screw was inserted straight forward and on the other pedicle the screw was inserted as an end-plate screw. The torque of insertion was measured (Proto 6106 torque screwdriver). Using an MTS Mini Bionix, two types of mechanical testing were carried out on each pedicle: (a) cephalocaudad toggling was first carried out to simulate some physiological type loading: 500 cycles at 0.3 Hz, at ±50 N; and (b) then each pedicle screw was pulled out at a displacement rate of 12.5 cm/min.There was no difference in pullout force between the pedicle screws inserted straight forward and the pedicle screws inserted as end-plate screws. This result applies whether the vertebrae were osteoporotic or nonosteoporotic. For both the straight-forward screws and the end-plate screws, a statistically significant correlation was observed between torque of insertion and pullout force. The results of this experiment indicate that pedicle screws inserted as end-plate screws do not provide a strength advantage over pedicle screws inserted straight forward, whether the vertebrae are osteoporotic or not.

  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. Anatomic Study of Anterior Transdiscal Axial Screw Fixation for Subaxial Cervical Spine Injuries.

    Science.gov (United States)

    Ji, Wei; Zheng, Minghui; Qu, Dongbin; Zou, Lin; Chen, Yongquan; Chen, Jianting; Zhu, Qingan

    2016-08-01

    Anterior transdiscal axial screw (ATAS) fixation is an alternative or supplement to the plate and screw constructs for the upper cervical spine injury. However, no existing literatures clarified the anatomic feasibility of this technique for subaxial cervical spine. Therefore, the objective of this study was to evaluate the anatomical feasibility and to establish guidelines for the use of the ATAS fixation for the subaxial cervical spine injury.Fifty normal cervical spines had radiographs to determine the proposed screw trajectory (the screw length and insertion angle) and the interbody graft-related parameters (the disc height and depth, and the distance between anterior vertebral margin and the screw) for all levels of the subaxial cervical spine. Following screw insertion in 8 preserved human cadaver specimens, surgical simulation and dissection verified the feasibility and safety of the ATAS fixation.Radiographic measurements showed the mean axial screw length and cephalic incline angle of all levels were 41.2 mm and 25.2°, respectively. The suitable depth of the interbody graft was >11.7 mm (the distance between anterior vertebral margin and the screw), but C2-C3, C3-C4, C4-C5, and C5-C6 levels, but impossible at C6-C7 due to the obstacle of the sternum. All screws were placed accurately. None of the screws penetrated into the spinal canal and caused fractures determined by dissecting the specimens.The anterior transdiscal axial screw fixation, as an alternative or supplementary instrumentation for subaxial cervical spine injuries, is feasible and safe with meticulous surgical planning.

  1. Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine

    Science.gov (United States)

    Guo, Fei; Dai, Jianhao; Zhang, Junxiang; Ma, Yichuan; Zhu, Guanghui; Shen, Junjie; Niu, Guoqi

    2017-01-01

    Purpose Pedicle screw fixation in the upper cervical spine is a difficult and high-risk procedure. The screw is difficult to place rapidly and accurately, and can lead to serious injury of spinal cord or vertebral artery. The aim of this study was to design an individualized 3D printing navigation template for pedicle screw fixation in the upper cervical spine. Methods Using CT thin slices data, we employed computer software to design the navigation template for pedicle screw fixation in the upper cervical spine (atlas and axis). The upper cervical spine models and navigation templates were produced by 3D printer with equal proportion, two sets for each case. In one set (Test group), pedicle screws fixation were guided by the navigation template; in the second set (Control group), the screws were fixed under fluoroscopy. According to the degree of pedicle cortex perforation and whether the screw needed to be refitted, the fixation effects were divided into 3 types: Type I, screw is fully located within the vertebral pedicle; Type II, degree of pedicle cortex perforation is 1 mm or with the poor internal fixation stability and in need of renovation. Type I and Type II were acceptable placements; Type III placements were unacceptable. Results A total of 19 upper cervical spine and 19 navigation templates were printed, and 37 pedicle screws were fixed in each group. Type I screw-placements in the test group totaled 32; Type II totaled 3; and Type III totaled 2; with an acceptable rate of 94.60%. Type I screw placements in the control group totaled 23; Type II totaled 3; and Type III totaled 11, with an acceptable rate of 70.27%. The acceptability rate in test group was higher than the rate in control group. The operation time and fluoroscopic frequency for each screw were decreased, compared with control group. Conclusion The individualized 3D printing navigation template for pedicle screw fixation is easy and safe, with a high success rate in the upper cervical spine

  2. Calcium phosphate cement augmentation of cancellous bone screws can compensate for the absence of cortical fixation.

    Science.gov (United States)

    Stadelmann, Vincent A; Bretton, Elise; Terrier, Alexandre; Procter, Philip; Pioletti, Dominique P

    2010-11-16

    An obvious means to improve the fixation of a cancellous bone screw is to augment the surrounding bone with cement. Previous studies have shown that bone augmentation with Calcium Phosphate (CaP) cement significantly improves screw fixation. Nevertheless, quantitative data about the optimal distribution of CaP cement is not available. The present study aims to show the effect of cement distribution on the screw fixation strength for various cortical thicknesses and to determine the conditions at which cement augmentation can compensate for the absence of cortical fixation in osteoporotic bone. In this study, artificial bone materials were used to mimic osteoporotic cancellous bone and cortical bone of varying thickness. These bone constructs were used to test the fixation strength of cancellous bone screws in different cortical thicknesses and different cement augmentation depths. The cement distribution was measured with microCT. The maximum pullout force was measured experimentally. The microCT analysis revealed a pseudo-conic shape distribution of the cement around the screws. While the maximum pullout strength of the screws in the artificial bone only was 30±7N, it could increase up to approximately 1000N under optimal conditions. Cement augmentation significantly increased pullout force in all cases. The effect of cortical thickness on pullout force was reduced with increased cement augmentation depth. Indeed, cement augmentation without cortical fixation increased pullout forces over that of screws without cement augmentation but with cortical fixation. Since cement augmentation significantly increased pullout force in all cases, we conclude that the loss of cortical fixation can be compensated by cement augmentation.

  3. Posterior lumbar interbody fusion with cortical bone trajectory screw fixation versus posterior lumbar interbody fusion using traditional pedicle screw fixation for degenerative lumbar spondylolisthesis: a comparative study.

    Science.gov (United States)

    Sakaura, Hironobu; Miwa, Toshitada; Yamashita, Tomoya; Kuroda, Yusuke; Ohwada, Tetsuo

    2016-11-01

    OBJECTIVE Several biomechanical studies have demonstrated the favorable mechanical properties of the cortical bone trajectory (CBT) screw. However, no reports have examined surgical outcomes of posterior lumbar interbody fusion (PLIF) with CBT screw fixation for degenerative spondylolisthesis (DS) compared with those after PLIF using traditional pedicle screw (PS) fixation. The purposes of this study were thus to elucidate surgical outcomes after PLIF with CBT screw fixation for DS and to compare these results with those after PLIF using traditional PS fixation. METHODS Ninety-five consecutive patients underwent PLIF with CBT screw fixation for DS (CBT group; mean followup 35 months). A historical control group consisted of 82 consecutive patients who underwent PLIF with traditional PS fixation (PS group; mean follow-up 40 months). Clinical status was assessed using the Japanese Orthopaedic Association (JOA) scale score. Fusion status was assessed by dynamic plain radiographs and CT. The need for additional surgery and surgery-related complications was also evaluated. RESULTS The mean JOA score improved significantly from 13.7 points before surgery to 23.3 points at the latest follow-up in the CBT group (mean recovery rate 64.4%), compared with 14.4 points preoperatively to 22.7 points at final follow-up in the PS group (mean recovery rate 55.8%; p fusion was achieved in 84 patients from the CBT group (88.4%) and in 79 patients from the PS group (96.3%, p > 0.05). Symptomatic adjacent-segment disease developed in 3 patients from the CBT group (3.2%) compared with 9 patients from the PS group (11.0%, p fusion rate tended to be lower in the CBT group than in the PS group, although the difference was not statistically significant between the 2 groups.

  4. Monoaxial Pedicle Screws Are Superior to Polyaxial Pedicle Screws and the Two Pin External Fixator for Subcutaneous Anterior Pelvic Fixation in a Biomechanical Analysis

    Directory of Open Access Journals (Sweden)

    Rahul Vaidya

    2013-01-01

    Full Text Available Purpose. Comparison of monoaxial and polyaxial screws with the use of subcutaneous anterior pelvic fixation. Methods. Four different groups each having 5 constructs were tested in distraction within the elastic range. Once that was completed, 3 components were tested in torsion within the elastic range, 2 to torsional failure and 3 in distraction until failure. Results. The pedicle screw systems showed higher stiffness (4.008 ± 0.113 Nmm monoaxial, 3.638 ± 0.108 Nmm Click-x; 3.634 ± 0.147 Nmm Pangea than the exfix system (2.882 ± 0.054 Nmm in distraction. In failure testing, monoaxial pedicle screw system was stronger (360 N than exfixes (160 N and polyaxial devices which failed if distracted greater than 4 cm (157 N Click-x or 138 N Pangea. The exfix had higher peak torque and torsional stiffness than all pedicle systems. In torsion, the yield strengths were the same for all constructs. Conclusion. The infix device constructed with polyaxial or monoaxial pedicle screws is stiffer than the 2 pin external fixator in distraction testing. In extreme cases, the use of reinforcement or monoaxial systems which do not fail even at 360 N is a better option. In torsional testing, the 2 pin external fixator is stiffer than the pedicle screw systems.

  5. Extracapsular hip fractures: fixation with a twin hook or a lag screw?

    Science.gov (United States)

    Olsson, O; Ceder, L; Lunsjö, K; Hauggaard, A

    2000-01-01

    The twin hook, which has 2 oppositely directed apical hooks, is an alternative to the lag screw for use with a 'dynamic plate' in the fixation of trochanteric hip fractures. In this prospective study lasting 1 year, 102 consecutive patients with trochanteric hip fractures were treated by 19 surgeons with either a twin hook or a lag screw combined with a conventional sliding hip screw plate or a Medoff sliding plate. Seven intraoperative errors were made with the twin hook but postoperative migration did not differ significantly between the 2 groups. Postoperative fixation failures were equally distributed between the 2 groups. The twin hook provides adequate fixation, which is comparable to that produced by a lag screw.

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

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    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.

  7. 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.

  8. Bicortical screw fixation of distal fibula fractures with a lateral plate: an anatomic and biomechanical study of a new technique.

    Science.gov (United States)

    Milner, Brenton F; Mercer, Deana; Firoozbakhsh, Keikhosrow; Larsen, Kenna; Decoster, Thomas A; Miller, Richard A

    2007-01-01

    One of the potential drawbacks of lateral plating of distal fibula fractures is less than satisfactory fixation of unicortical screws commonly placed in the distal fragment to avoid implant penetration of the ankle joint. This study examines the anatomy of the distal fibula, proposes new techniques for bicortical screw fixation and radiographic evaluation of screw placement, and compares pullout strength of unicortical versus bicortical screws in this area. Sixteen pairs of human cadaver feet were used in this study. It was found that a large percentage of the surface area of the distal fibula is nonarticular and that the distal fibula could be divided into 3 zones with distinct anatomic features. Zone I is defined as the distal most 1.5 cm of the fibula, zone II is the next 1 cm of fibula proximal to zone I, and zone III is defined as the fibula above the ankle joint, starting at just over 2.5 cm proximal to the tip of the fibula. We determined a safe corridor for bicortical screw placement by means of a lateral plate in each zone. An improved radiographic view is described for confirmation of extraarticular screw placement. Screw pullout testing was performed on 8 pairs of fresh-frozen human cadaver fibulas. In both zone I and zone II, the bicortical screw fixation was significantly stronger than the unicortical screw fixation. In zone I, the average pullout strength for the bicortical screw fixation was 2.3 times higher than the unicortical screw fixation. In zone II, the average pullout strength for the bicortical screw fixation was 3.3 times higher than the unicortical screw fixation. This study shows that not only is bicortical screw placement in the distal fibula technically feasible, but it is also biomechanically stronger than unicortical placement in this area.

  9. 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.

  10. Outcomes of C1 and C2 posterior screw fixation for upper cervical spine fusion.

    Science.gov (United States)

    De Iure, F; Donthineni, R; Boriani, S

    2009-06-01

    To achieve stable fixation of the upper cervical spine in posterior fusions, the occiput is often included. With the newer techniques, excluding fixation to the occiput will retain the occiput-cervical motion, while still allowing a stable fixation. Harms's technique has been adapted at our institution and its effectiveness for indications such as C2 complex fractures and tumors using C1 or C2 as endpoints of a posterior fixation are reviewed. Fourteen cases were identified, consisting of one os odontoideum; four acute fractures and four non-unions of the odontoid; three tumors and two complex fractures of C2 vertebral body, and one C2-C3 post-traumatic instability. One misplaced screw without clinical consequences was the only complication recorded. Screw loosening or migration was not observed at follow-up, showing a stable fixation.

  11. Screw fixation for atlantoaxial dislocation related to Down syndrome in children younger than 5 years.

    Science.gov (United States)

    Ito, Kenyu; Imagama, Shiro; Ito, Zenya; Ando, Kei; Kobayashi, Kazuyoshi; Hida, Tetsuro; Ishikawa, Yoshimoto; Ishiguro, Naoki

    2017-01-01

    The aim of this study was to present cases of upper cervical fixation in Down syndrome patients younger than 5 years. In two cases, C1 lateral mass screws were installed. However, owing to the irreducible atlantoaxial dislocation, the screw backed out and fractured. Therefore, O-C2 fusion was performed. Furthermore, C2 bilateral lamina screws were added to the C2 pedicle screw for reinforcement. C1-C2 fusion is an option for Down syndrome patients younger than 5 years with atlantoaxial dislocation, when the dislocation is reducible. If the dislocation is irreducible, or the implant cannot be firmly secured, the fixation range should be expanded to O-C2 or below.

  12. 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.

  13. 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.

  14. Evaluation of different screw fixation techniques and screw diameters in sagittal split ramus osteotomy: finite element analysis method.

    Science.gov (United States)

    Sindel, A; Demiralp, S; Colok, G

    2014-09-01

    Sagittal split ramus osteotomy (SSRO) is used for correction of numerous congenital or acquired deformities in facial region. Several techniques have been developed and used to maintain fixation and stabilisation following SSRO application. In this study, the effects of the insertion formations of the bicortical different sized screws to the stresses generated by forces were studied. Three-dimensional finite elements analysis (FEA) and static linear analysis methods were used to investigate difference which would occur in terms of forces effecting onto the screws and transmitted to bone between different application areas. No significant difference was found between 1·5- and 2-mm screws used in SSRO fixation. Besides, it was found that 'inverted L' application was more successful compared to the others and that was followed by 'L' and 'linear' formations which showed close rates to each other. Few studies have investigated the effect of thickness and application areas of bicortical screws. This study was performed on both advanced and regressed jaws positions.

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

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    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

  16. Use of self-tapping metal screws for temporary fixation of a resorbable plate system in maxillofacial surgery.

    Science.gov (United States)

    Iwai, Toshinori; Omura, Susumu; Aoki, Noriaki; Tohnai, Iwai

    2015-05-01

    Resorbable plate systems have been used in maxillofacial surgery to obviate the need for plate removal. However, resorbable plates and screws are very costly, and refixation with additional screws may be necessary when reduction or repositioning of the bone segment is inaccurate. Here we report the use of self-tapping metal screws for temporary fixation of a resorbable plating system in maxillofacial surgery to avoid the use of additional screws following inaccurate fixation or the reuse of resorbable screws, which may result in loosening.

  17. 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.

  18. 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.

  19. 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.

  20. A biomechanical study on fixation stability with twin hook or lag screw in artificial cancellous bone.

    Science.gov (United States)

    Olsson, O; Tanner, K E; Ceder, L; Ryd, L

    2002-01-01

    The twin hook has been developed as an alternative to the conventional lag screw to be combined with a barrelled side-plate in the treatment of trochanteric hip fractures. With two oppositely directed apical hooks introduced into the subchondral bone of the femoral head, the twin hook provides different stabilising properties to the lag screw. The femoral head purchase of the twin hook and the lag screw were compared in a biomechanical study using artificial cancellous bone, and responses to axial and torsional loading was determined. A distinct yield point in load and torque was noted for the lag screw, representing failure of the laminas supporting the threads. For the twin hook, gradual increase of load and torque occurred during impaction of the bone supporting the hooks. The peak loads and torques were higher for the lag screw, but were similar for both devices after 8 mm deformation. The stiffness was higher for the lag screw, but in counter-clockwise rotation the stiffness for the lag screw was negligible. The twin hook appeared to provide fixation stability comparable to that offered by the lag screw, but with conceivable advantages in terms of a deformation response involving bone impaction and gradually increasing stability.

  1. 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.

  2. Collateral ligament reconstruction of the chronic thumb injury with bio-tenodesis screw fixation

    DEFF Research Database (Denmark)

    Gvozdenovic, Robert; Boeckstyns, Michel

    2014-01-01

    We describe a new technique for the reconstruction of chronic lesions of the collateral ligaments of the metacarpophalangeal ligaments of the thumb, using a Bio-Tenodesis screw for the fixation of a tendon graft in a triangular manner with proximal apex and allowing early mobilization, starting 2...

  3. Ergotropic effect of bone cement on pedicle screw fixation in treatment of osteoporotic thoracolumbar fracture

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    Da LIU

    2017-02-01

    Full Text Available Objective To evaluate the ergotropic effect of bone cement on pedicle screw fixation in treatment of osteopo¬rotic thoracolumbar fracture. Methods Fifty-three patients with osteoporotic thoracolumbar fracture, admitted from Jun. 2013 to Dec. 2014, were included for treatment by augmentation of pedicle screw fixation with bone cement. All patients underwent pre-operative examination of bone mineral density with T-score ≤-2.5 and augmentation of pedicle screw fixation with injection of 1.5 ml bone cement in adjacent to fractured vertebra. All patients were treated with anti-osteoporosis therapy pre- and post-operation, ob¬served and recorded with basic conditions and complications. At pre-operation, one-week post-operation and last follow-up, pain vi¬sual analogue scale (VAS and neurological function score (ASIA of all patients were recorded, and the compression rats of anterior and posterior edge of fractured vertebra, and compression rats of spinal canal and Cobb angel of all patients were measured. Results All the 53 patients were successfully undergone operation in about 90-140 min with blood loss of about 150-350 ml. No spinal cord or nerve injury, dural tear and obvious leakage of bone cement and screw loosening occurred during operation. All patients were followed up for 12 to 36 months and the neurological function obviously recovered contrasted with pre-operation. X-ray and CT examination at last follow-up showed good fractures healing, good position and non-loosening of internal fixation device and non-leakage of bone cement. At one week post-operation and last follow-up, VAS, compression rats of anterior edge and posterior edge of fractured vertebra, compression rats of spinal canal and Cobb angel were significantly lower than those at pre-operation (P0.05. Conclusions Augmentation of pedicle screw fixation with bone cement can effectively strengthen the initial stability of pedicle screw in osteo¬porosis, restore the

  4. 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.

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

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    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.

  6. Sol-gel derived titania coating with immobilized bisphosphonate enhances screw fixation in rat tibia.

    Science.gov (United States)

    Linderbäck, Paula; Areva, Sami; Aspenberg, Per; Tengvall, Pentti

    2010-08-01

    A variety of surface modifications have been tested for the enhancement of screw fixation in bone, and locally delivered anti-osteoporosis drugs such as bisphosphonates (BP) are then of interest. In this in vivo study, the impact of surface immobilized BP was compared with systemic BP delivery and screws with no BP. After due in vitro characterization, differently treated stainless steel (SS) screws were divided into four groups with 10 rats each. Three of the groups received screws coated with sol-gel derived TiO(2) and calcium phosphate (SS+TiO(2)+CaP). One of these had no further treatment, one had alendronate (BP) adsorbed to calcium phosphate mineral, and one received systemic BP treatment. The fourth group received uncoated SS screws and no BP (control). The screw pullout force was measured after 4 weeks of implantation in rat tibiae. The immobilized amount and release rate of alendronate could be controlled by different immersion times. The SS+TiO(2)+CaP coating did not increase the pullout force compared to SS alone. Surface delivered alendronate enhanced the pullout force by 93% [p = 0.000; 95% Confidence Interval (CI): 67-118%] compared to SS, and by 39% (p = 0.044; 95% CI: 7-71%) compared to systemic alendronate delivery. Both surface immobilized and systemically delivered alendronate improved implant fixation. Also, locally delivered, that is, surface immobilized alendronate showed a better fixation than systemically delivered. Using sol-gel derived TiO(2) as a platform, it is possible to administer controllable amounts of a variety of BPs.

  7. Transarticular screw fixation for atlantoaxial instability - modified Magerl's technique in 38 patients

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    Dhatt Saravdeep S

    2010-11-01

    Full Text Available Abstract Background Symptomatic atlantoaxial instability needs stabilization of the atlantoaxial joint. Among the various techniques described in literature for the fixation of atlantoaxial joint, Magerl's technique of transarticular screw fixation remains the gold standard. Traditionally this technique combines placement of transarticular screws and posterior wiring construct. The aim of this study is to evaluate clinical and radiological outcomes in subjects of atlantoaxial instability who were operated using transarticular screws and iliac crest bone graft, without the use of sublaminar wiring (a modification of Magerl's technique. Methods We evaluated retrospectively 38 subjects with atlantoaxial instability who were operated at our institute using transarticular screw fixation. The subjects were followed up for pain, fusion rates, neurological status and radiographic outcomes. Final outcome was graded both subjectively and objectively, using the scoring system given by Grob et al. Results Instability in 34 subjects was secondary to trauma, in 3 due to rheumatoid arthritis and 1 had tuberculosis. Neurological deficit was present in 17 subjects. Most common presenting symptom was neck pain, present in 35 of the 38 subjects. Postoperatively residual neck and occipital pain was present in 8 subjects. Neurological deficit persisted in only 7 subjects. Vertebral artery injury was seen in 3 subjects. None of these subjects had any sign of neurological deficit or vertebral insufficiency. Three cases had nonunion. At the latest follow up, subjectively, 24 subjects had good result, 6 had fair and 8 had bad result. On objective grading, 24 had good result, 11 had fair and 3 had bad result. The mean follow up duration was 41 months. Conclusions Transarticular screw fixation is an excellent technique for fusion of the atlantoaxial complex. It provides highest fusion rates, and is particularly important in subjects at risk for nonunion. Omitting the

  8. 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.

  9. 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.

  10. 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.

  11. Pectoralis Major Tear with Retracted Tendon: How to Fill the Gap? Reconstruction with Hamstring Autograft and Fixation with an Interference Screw

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    L. Baverel

    2017-01-01

    Full Text Available Rupture of the pectoralis major tendon is considered an uncommon injury and a significant number of ruptures are missed or diagnosed late, leading to a chronic tear. We report an open reconstruction technique and its outcomes in a case of chronic and retracted PM tear. At the last follow-up (12 months, the patient was pain-free, with a visual analogic scale at 0 all the time. He was very satisfied concerning the cosmetic and clinical results. The constant score was 93%, the SST value 95%, and the Quick DASH score 4.5. MRI performed one year postoperatively confirmed the continuity between PM tendon and graft, even if the aspect of the distal tendon seemed to be thinner than normal PM tendon. The excellent clinical outcomes at one-year follow-up suggest that PM tear with major tendon retraction can be reliably reconstructed with hamstring autograft, using a bioabsorbable screw to optimize the fixation device. This technique has proven its simplicity and efficiency to fill the gap.

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

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    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.

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

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    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.

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

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    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

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

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    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.

  16. Management of closed tibial plateau fractures with percutaneous cancellous screw fixation

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    Tushar Agarwal

    2013-01-01

    Full Text Available Background: Tibial plateau fractures, intra-articular in nature and caused by high-velocity trauma, constitute approximately 1% of all fractures. Primary goal in the management of proximal tibial articular fracture aims for a stable, congruous, pain-free, mobile joint. Objective: To study the technique, results, and complications of percutaneous cancellous screw fixation for tibial plateau fractures. Materials and Methods: Twenty-three men and seven women aged 18-65 years (mean = 36.8 years underwent closed reduction and percutaneous screw fixation for closed tibial plateau fractures with <5 mm depression. According to the Schatzker classification, patients were grouped as type I (n = 18, type II (n = 4, type III (n = 0, type IV (n = 8, type V (n = 2, and type VI (n = 1. Closed reduction was achieved by manual ligamentotaxis technique under image intensifier control and fixed percutaneously with two cancellous screws (6.5 mm with or without washers in a parallel fashion. Results: Functional outcome was evaluated using the Mason Hohl evaluation system. A total score of 19-24 was considered as excellent, 13-18 as good, 7-12 as fair, and <6 as poor. Outcomes were excellent in 10 patients, good in 15, fair in 4, and poor in 1 patient. Patients were allowed partial weight bearing with walker after 1 month and full weight bearing after radiological union in approximately 3-4 months. The mean period of hospital stay was 5 (range 2-15 days. All the fractures united radiologically after a mean of 3 (range 2.5- 5 months. Patients were evaluated at a mean of 3 years after injury. No patient had any complication like infection, wound dehiscence, or hardware problem. Conclusion: Percutaneous cancellous screw fixation for closed tibial plateau fractures is minimally invasive. It reduces hospital stay and cost, enables early mobilization with minimal instrumentation, and achieves satisfactory outcomes.

  17. Closed reduction with CT-guided screw fixation for unstable sacroiliac joint fracture-dislocation

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    Baskin, Kevin M.; Cahill, Ann Marie; Kaye, Robin D. [Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Born, Christopher T. [Temple University Hospital/Temple Children' s Hospital, Temple Sports Medicine, Marlton, NJ (United States); Grudziak, Jan S. [Children' s Hospital of Pittsburgh, Department of Orthopedic Surgery, Pittsburgh, PA (United States); Towbin, Richard B.

    2004-12-01

    Unstable posterior pelvic ring fractures and dislocations are uncommon but potentially life-threatening injuries in children. Early definitive management reduces risk of immediate complications as well as chronic pain and gait dysfunction. Conventional operative therapy carries substantial risk of extensive blood loss and iatrogenic neurological and vascular injury. Minimally invasive image-guided intervention may further reduce immediate risk and improve long-term outcome. To describe CT-guided closed reduction and internal fixation (CRIF) and review outcomes of unstable fracture-dislocation of the sacroiliac (SI) joint in children. Between 2000 and 2003, three children (two girls, one boy) age 8-14 years were referred to interventional radiology for treatment of unstable SI joint fracture-dislocation not adequately treated with anterior external fixation alone. The three affected SI joints (two left, one right) were treated in a combined approach by pediatric interventional radiologists and orthopedic surgeons, using a percutaneous approach under CT guidance. Over a threaded guiding pin, 7.3 mm cannulated screws were used to achieve stable reduction of the affected SI joints. One screw was removed after slight (2 mm) migration. No neurovascular or other complications occurred. All patients had satisfactory healing with near-anatomic reduction, although recovery of the youngest was delayed by associated spinal injury. Compared to open surgical alternatives, CRIF under CT guidance reduces operating time, decreases blood loss, and allows early definitive fixation and immediate non-weight-bearing mobilization with a low rate of complication for unstable posterior pelvic ring fractures. In addition, CT-guided placement of the guide pin may allow safer screw positioning and may minimize the total number of screws needed to achieve pelvic stability. (orig.)

  18. A Novel Nonpedicular Screw-Based Fixation in Lumbar Spondylolisthesis

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    Ming-Hong Chen

    2017-01-01

    Full Text Available Objective. The authors present the clinical results obtained in patients who underwent interspinous fusion device (IFD implantation following posterior lumbar interbody fusion (PLIF. The purpose of this study is investigating the feasibility of IFD with PLIF in the treatment of lumbar spondylolisthesis. Methods. Between September 2013 and November 2014, 39 patients underwent PLIF and subsequent IFD (Romeo®2 PAD, Spineart, Geneva, Switzerland implantation. Medical records of these patients were retrospectively reviewed to collect relevant data such as blood loss, operative time, and length of hospital stay. Radiographs and clinical outcome were evaluated 6 weeks and 12 months after surgery. Results. All 39 patients were followed up for more than one year. There were no major complications such as dura tear, nerve injuries, cerebrospinal fluid leakage, or deep infection. Both interbody and interspinous fusion could be observed on radiographs one year after surgery. However, there were 5 patients having early retropulsion of interbody fusion devices. Conclusion. The interspinous fusion device appears to achieve posterior fixation and facilitate lumbar fusion in selected patients. However, further study is mandatory for proposing a novel anatomic and radiological scoring system to identify patients suitable for this treatment modality and prevent postoperative complications.

  19. A Novel Nonpedicular Screw-Based Fixation in Lumbar Spondylolisthesis

    Science.gov (United States)

    2017-01-01

    Objective. The authors present the clinical results obtained in patients who underwent interspinous fusion device (IFD) implantation following posterior lumbar interbody fusion (PLIF). The purpose of this study is investigating the feasibility of IFD with PLIF in the treatment of lumbar spondylolisthesis. Methods. Between September 2013 and November 2014, 39 patients underwent PLIF and subsequent IFD (Romeo®2 PAD, Spineart, Geneva, Switzerland) implantation. Medical records of these patients were retrospectively reviewed to collect relevant data such as blood loss, operative time, and length of hospital stay. Radiographs and clinical outcome were evaluated 6 weeks and 12 months after surgery. Results. All 39 patients were followed up for more than one year. There were no major complications such as dura tear, nerve injuries, cerebrospinal fluid leakage, or deep infection. Both interbody and interspinous fusion could be observed on radiographs one year after surgery. However, there were 5 patients having early retropulsion of interbody fusion devices. Conclusion. The interspinous fusion device appears to achieve posterior fixation and facilitate lumbar fusion in selected patients. However, further study is mandatory for proposing a novel anatomic and radiological scoring system to identify patients suitable for this treatment modality and prevent postoperative complications. PMID:28164125

  20. 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.

  1. Are two retrograde 3.5 mm screws superior to one 7.3 mm screw for anterior pelvic ring fixation in bones with low bone mineral density?

    Science.gov (United States)

    Zderic, I.; Grechenig, S.; Richards, R. G.; Schmitz, P.; Gueorguiev, B.

    2017-01-01

    Objectives Osteosynthesis of anterior pubic ramus fractures using one large-diameter screw can be challenging in terms of both surgical procedure and fixation stability. Small-fragment screws have the advantage of following the pelvic cortex and being more flexible. The aim of the present study was to biomechanically compare retrograde intramedullary fixation of the superior pubic ramus using either one large- or two small-diameter screws. Materials and Methods A total of 12 human cadaveric hemipelvises were analysed in a matched pair study design. Bone mineral density of the specimens was 68 mgHA/cm3 (standard deviation (sd) 52). The anterior pelvic ring fracture was fixed with either one 7.3 mm cannulated screw (Group 1) or two 3.5 mm pelvic cortex screws (Group 2). Progressively increasing cyclic axial loading was applied through the acetabulum. Relative movements in terms of interfragmentary displacement and gap angle at the fracture site were evaluated by means of optical movement tracking. The Wilcoxon signed-rank test was applied to identify significant differences between the groups Results Initial axial construct stiffness was not significantly different between the groups (p = 0.463). Interfragmentary displacement and gap angle at the fracture site were also not statistically significantly different between the groups throughout the evaluated cycles (p ⩾ 0.249). Similarly, cycles to failure were not statistically different between Group 1 (8438, sd 6968) and Group 2 (10 213, sd 10 334), p = 0.379. Failure mode in both groups was characterised by screw cutting through the cancellous bone. Conclusion From a biomechanical point of view, pubic ramus stabilisation with either one large or two small fragment screw osteosynthesis is comparable in osteoporotic bone. However, the two-screw fixation technique is less demanding as the smaller screws deflect at the cortical margins. Cite this article: Y. P. Acklin, I. Zderic, S. Grechenig, R. G. Richards, P

  2. C1-c2 pedicle screw fixation for treatment of old odontoid fractures.

    Science.gov (United States)

    Qi, Lei; Li, Mu; Zhang, Shuai; Si, Haipeng; Xue, Jingsong

    2015-02-01

    Nonunion and C1-C2 instability of odontoid fractures usually result from delayed diagnosis and inappropriate treatment. However, the available treatment options for odontoid fractures remain controversial. The authors evaluated the effectiveness of internal screw fixation via the C1 and C2 pedicle in cases of old odontoid fractures. This retrospective study included 21 patients with old odontoid fractures (13 men and 8 women; mean age, 46.5 years; range, 24-69 years). Internal screw fixation via the C1 and C2 pedicle was performed in all patients. Fracture reduction and C1-C2 fusion were assessed with imaging. The neck pain visual analog scale score and cervical spinal cord functional Japanese Orthopaedic Association score (for those who had cervical spinal cord injury) were used to evaluate the effectiveness of treatment. Postoperative complications were recorded. Postoperative imaging showed that the C1-C2 dislocation was satisfactorily repositioned in all patients. Bone fusion was observed 1 year after surgery in all patients. No loosening or breaking of internal fixation occurred. The preoperative neck pain visual analog scale score was 5.9±1.5 and improved significantly to 1.8±0.8 after surgery (PC2 pedicle was found to be an effective and safe surgical approach for the treatment of old odontoid fractures with C1-C2 dislocation or instability.

  3. 4 mm cannulatedcancellous screws fixation in extra articular distal 1/3 radius fracture - A study

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    M.S. Patil

    2017-01-01

    Full Text Available Background: Distal radius fracture are extremely common and represents 16% of fractures treated by orthopaedic surgeons. Near anatomical reduction with restoration of radial length, radial tilt and ulnar variances are important for good functional results. Cannulated 4 mm long threaded using minimally invasive osteosynthesis technique are less aggressive towards soft tissue covering. It allows immediate range of motion of the wrist while maintaining alignment resulting in rapid and comfortable functional recovery. The objective of this study was to evaluate the clinical, radiological and functional efficacy of 4 mm cannulated screws in the management of extra articular distal radius fracture using the criteria of Gartland and Werley point system. Material & Method: 40 Patients with extra articular distal radius fracture were treated by minimally invasive osteosynthesis technique using 4 mm cannulatedcancellous screws in AL-Ameen Medical College Hospital, Bijapur between Nov 2013 to Oct 2015 which included 19 males and 21 female patients. The duration of follow-up was ranged from 12-18 months. Results: Using Demerit scoring system of Gartland and Werley, we had 45% excellent, 50% good, 0% fair and 5% poor results. As per our results, excellent to good results were found in 95% of patients. Conclusion: Cannulatedcancellous screws fixation is an effective means of fixation in distal 1/3 radius fracture, allowing immediate range of motion of the wrist, resulting in a rapid and comfortable functional recovery while maintaining alignment and bone healing. It has higher degree of purchase when treating extra articular distal radius fracture with poor bone quality. Being minimally invasive with minimal soft tissue dissection, less operative time, cost effective, cannulated screws is a good option for both young and elderly patients with extra articular distal radius fracture.

  4. 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.

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

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    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.

  6. 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 sheep.

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

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    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.

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

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    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.)

  9. Treatment of neuromuscular scoliosis with posterior-only pedicle screw fixation

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    Fernandez Harry M

    2008-06-01

    Full Text Available Abstract Background To determine whether posterior-only approach using pedicle screws in neuromuscular scoliosis population adequately addresses the correction of scoliosis and maintains the correction over time. Methods Between 2003 and 2006, 26 consecutive patients (7 cerebral palsy, 10 Duchenne muscular dystrophy, 5 spinal muscular atrophy and 4 others with neuromuscular scoliosis underwent posterior pedicle screw fixation for the deformity. Preoperative, immediate postoperative and final follow-up Cobb's angle and pelvic obliquity were analyzed on radiographs. The average age of the patients was 17.5 years (range, 8–44 years and the average follow-up was 25 months (18–52 months. Results Average Cobb's angle was 78.53° before surgery, 30.70° after surgery (60.9% correction, and 33.06° at final follow-up (57.9% correction showing significant correction (p Conclusion Results indicate that in patients with neuromuscular scoliosis, acceptable amounts of curve correction can be achieved and maintained with posterior-only pedicle screw instrumentation without anterior release procedure.

  10. 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

  11. 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.

  12. 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.

  13. Fiber-reinforced bioactive and bioabsorbable hybrid composites

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    Huttunen, Mikko; Godinho, Pedro; Kellomaeki, Minna [Tampere University of Technology, Institute of Biomaterials, Hermiankatu 12, PO Box 589, FIN-33101 Tampere (Finland); Toermaelae, Pertti [Bioretec Ltd, Hermiankatu 22, PO Box 135, FI-33721 Tampere (Finland)], E-mail: mikko.huttunen@tut.fi

    2008-09-01

    Bioabsorbable polymeric bone fracture fixation devices have been developed and used clinically in recent decades to replace metallic implants. An advantage of bioabsorbable polymeric devices is that these materials degrade in the body and the degradation products exit via metabolic routes. Additionally, the strength properties of the bioabsorbable polymeric devices decrease as the device degrades, which promotes bone regeneration (according to Wolff's law) as the remodeling bone tissue is progressively loaded. The most extensively studied bioabsorbable polymers are poly-{alpha}-hydroxy acids. The major limitation of the first generation of bioabsorbable materials and devices was their relatively low mechanical properties and brittle behavior. Therefore, several reinforcing techniques have been used to improve the mechanical properties. These include polymer chain orientation techniques and the use of fiber reinforcements. The latest innovation for bioactive and fiber-reinforced bioabsorbable composites is to use both bioactive and bioresorbable ceramic and bioabsorbable polymeric fiber reinforcement in the same composite structure. This solution of using bioactive and fiber-reinforced bioabsorbable hybrid composites is examined in this study.

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

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    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.

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

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    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.

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

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    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

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

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    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

  18. One-stage posterior C2 and C3 pedicle screw fixation or combined anterior C2-C3 fusion for the treatment of unstable hangman's fracture.

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    Liu, Jingchen; Li, Ye; Wu, Yuntao

    2013-03-01

    The present study aimed to evaluate the effect of using one-stage posterior C2 and C3 pedicle screw fixation or combined anterior C2-C3 fusion in the treatment of unstable hangman's fracture. A total of 13 patients with unstable hangman's fractures underwent C2 and C3 pedicle screw fixation, lamina interbody fusion or combined anterior C2-C3 fusion and imaging examinations to evaluate the fracture fixation and healing condition at three days and three months following surgery. Postoperative X-ray and computed tomography (CT) results showed high fracture reduction, good internal fixation position and reliable fracture fixation. The three-month postoperative CT showed good vertebral fracture healing. C2 and C3 pedicle screw fixation has a good curative effect in the treatment of unstable hangman's fracture. The direct fixation of the fracture enables early ambulation by the patients.

  19. Maxillo Mandibular Fixation in Edentulous Scenarios: Combined MMF Screws and Gunning Splints.

    Science.gov (United States)

    Chaudhary, Zainab; Sharma, Rakesh; Krishnan, Sriram

    2014-06-01

    A fracture of the maxillary or mandibular bone requires the afflicted to undergo a maxillo mandibular fixation for the establishment of pre traumatic occlusion. This process is quiet tedious and consumes a considerable period of time before any surgical procedure can commence. Such a situation can be complicated in case the individual with maxillomandibular fracture has sparse or absent dentition; for such cases a splint is fabricated or an erstwhile existing denture is used for maintaining a vertical jaw proportion. Stabilizing such splints to the jaw requires various invasive approaches that can bring into harm's way, adjacent soft tissue vital structures. We describe here an innovative technique combining the time tested method of the "gunning splint" and the advanced minimally invasive MMF screws for obtaining closed reduction in edentulous jaw fractures.

  20. 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.

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

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    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.

  2. 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.

  3. Ununited fracture neck of femur treated with closed reduction and internal fixation with cancellous screw and fibular strut graft

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    Singh Daria

    2006-01-01

    Full Text Available Background: Ununited fracture neck of femur in young adults has been tackled in various ways. Methods: Twenty five patients of ununited fracture neck of femur in age group 21-55 years were treated by closed reduction, cancellous screw fixation and fibular strut graft and followed up for 2-6 years. Time gap between injury and operation was 6 weeks to 58 weeks. Five cases were previously fixed with various fixation devices. Results: Osseous union was achieved in 24 cases with average time of 18.16 weeks. Main complication encountered in follow-up was avascular necrosis of femoral head, others were joint stiffness and shortening. Functional end results were good to excellent in 24 cases. Conclusion: Closed reduction with internal fixation by cancellous screw and fibular strut grafting is easy and useful procedure.

  4. Internal Fixation of Transverse Patella Fractures Using Cannulated Cancellous Screws with Anterior Tension Band Wiring

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    Khan I

    2016-07-01

    Full Text Available Aims: To evaluate the effectiveness and safety of anterior tension band wiring technique using two cannulated cancellous screws in patients with transverse (AO34-C1 or transverse with mildly comminuted (AO34-C2 patellar fractures. Materials and Methods: This is a prospective study of 25 patients with transverse fracture or transverse fracture with mildly comminuted patella fractures. All the patients were treated with open reduction and internal fixation using two parallel cannulated screws and 18G stainless steel wire as per the tension band principle. Results: There were eighteen males (72% and seven females (28%. The age group ranged from 24 to 58 years, with mean age of 38 years. The most common mode of injury was fall (72% followed by road traffic accident (20% and violent quadriceps contraction (8%. Transverse fracture was present in 60% and transverse fracture with mild comminution in 40% of patients. Mean time to achieve union was 10.7 weeks (range 8-12 weeks. Mean ROM at three months was 113.8 degree (90-130 and at final follow up this improved to 125.4 degrees (range 100-140. There was one case of knee stiffness and no case of implant failure was observed. Patients were evaluated using Bostman scoring, the mean score at three months being 26.04 which improved to 27.36 at the end of final follow up at one year. Conclusion: Cannulated cancellous screws with anterior tension band wiring is a safe, reliable and reproducible method in management of transverse patellar fractures, with less chances of implant failure and soft tissue irritation.

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

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    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.)

  6. Analysis of the stress and displacement distribution of inferior tibiofibular syndesmosis injuries repaired with screw fixation: a finite element study.

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    Qinghua Liu

    Full Text Available BACKGROUND: Studies of syndesmosis injuries have concentrated on cadaver models. However, they are unable to obtain exact data regarding the stress and displacement distribution of various tissues, and it is difficult to compare models. We investigated the biomechanical effects of inferior tibiofibular syndesmosis injuries (ITSIs and screw fixation on the ankle using the finite element (FE method. METHODOLOGY/PRINCIPAL FINDINGS: A three-dimensional model of a healthy ankle complex was developed using computed tomography (CT images. We established models of an ITSI and of screw fixation at the plane 2.5 cm above and parallel to the tibiotalar joint surface of the injured syndesmosis. Simulated loads were applied under three conditions: neutral position with single-foot standing and internal and external rotation of the ankle. ITSI reduced contact forces between the talus and fibula, helped periarticular ankle ligaments withstand more load-resisting movement, and increased the magnitude of displacement at the lower extreme of the tibia and fibula. ITSI fixation with a syndesmotic screw reduced contact forces in all joints, decreased the magnitude of displacement at the lower extreme of the tibia and fibula, and increased crural interosseous membrane stress. CONCLUSIONS/SIGNIFICANCE: Severe syndesmosis injuries cause stress and displacement distribution of the ankle to change multidirectional ankle instability and should be treated by internal fixation. Though the transverse syndesmotic screw effectively stabilizes syndesmotic diastasis, it also changes stress distribution around the ankle and decreases the joint's range of motion (ROM. Therefore, fixation should not be performed for a long period of time because it is not physiologically suitable for the ankle joint.

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

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    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.

  8. Both unilateral and bilateral pedicle screw fixation are effective for lumbar spinal fusion—A meta-analysis-based systematic review

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    Jiaquan Luo

    2014-04-01

    Full Text Available A series of studies have been conducted to evaluate the effectiveness of unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion, but there is still controversy about which one is more superior. We performed a meta-analysis to more accurately estimate the effectiveness of unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion. Studies on the comparison between unilateral and bilateral pedicle screw fixation in lumbar spinal fusion were identified from PubMed, SpringerLink, China National Knowledge Infrastructure (CNKI, the Wanfang database and the China Biology Medical literature database (CBM and related references were searched. The included trials were screened according to the criteria of inclusion and exclusion. The quality of included trials was evaluated. Data were extracted by two reviewers independently. RevMan 5.1.1 was used for data analysis. The fixed or random effect model was selected based on the heterogeneity test among studies evaluated using the I2 statistic. A total of nine studies involving 567 patients were included in the analyses for the effectiveness of unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion. Unilateral pedicle screw fixation was performed in 287 patients and bilateral pedicle screw fixation in 280 patients. The results of the meta-analysis indicated that statistically significant differences were observed between the two fixation procedures with regard to mean operation time and amount of bleeding. There were no differences in hospitalisation days, fusion rate, complication rate, and excellent and good rates. This meta-analysis suggested that both unilateral and bilateral pedicle screw fixation are effective in one or two segmental lumbar spinal fusion. In comparison with bilateral fixation, unilateral fixation can shorten the operation time, reduce the amount of bleeding, and reduce medical expenses. There were similar effects with regard to

  9. Efficacy of radial styloid targeting screws in volar plate fixation of intra-articular distal radial fractures: a biomechanical study in a cadaver fracture model

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    Yamashita Toshihiko

    2010-12-01

    Full Text Available Abstract Background The locking screws target the radial styloid, theoretically provide greater stability against radial styloid fragment. However, it is unknown whether the radial styloid locking screws increased the stability of the volar plating system fixation along the entire distal radius or not. In this study, we evaluated the stability of the volar plating system fixation with or without the radial styloid screws using a biomechanical study in a cadaver fracture model. Methods Six matched pairs of fresh-frozen human cadaver wrists complete from the proximal forearm to the metacarpal bones were prepared to simulate standardized 3-part intra-articular and severe comminuted fractures. Specimens were fixed using the volar plating system with or without 2 radial styloid screws. Each specimen was loaded at a constant rate of 20 mm/min to failure. Load data was recorded and, ultimate strength and change in gap between distal and proximal fragments were measured. Data for ultimate strength and screw failure after failure loading were compared between the 2 groups. Results The average ultimate strength at failure of the volar plate fixation with radial styloid screws (913.5 ± 157.1 N was significantly higher than that without them (682.2 ± 118.6 N. After failure loading, the average change in gap between the ulnar and proximal fragment was greater than that between the radial and proximal fragment. The number of bent or broken screws in ulnar fragment was higher than that in radial fragment. The number of specimens with bent or broken screws in cases with radial styloid screws was fewer than that in the fixation without radial styloid screws group. Conclusion The ulnar fragment is more intensively stressed than the radial fragment under axial loading of distal radius at full wrist extension. The radial styloid screws were effective in stable volar plate fixation of distal radial fractures.

  10. Motion-preserving reduction and fixation of C1 Jefferson fracture using a C1 lateral mass screw construct.

    Science.gov (United States)

    Jo, Kwang-Wook; Park, Ik-Seong; Hong, Jae Taek

    2011-05-01

    The treatment of C1 Jefferson fractures is controversial. Non-surgical treatment with halo fixation always bears the risk of insufficient healing with further instability and increasing neck pain. However, a C1-2 fusion can markedly decrease the rotatory motion of the neck. The aim of this report is to describe a new treatment for C1 Jefferson fractures. We used open reduction and C1 fixation using a bilateral C1 lateral mass screw construct. The screws were connected with a rod and nuts to reduce lateral spread of the lateral masses. This method is an alternative surgical option for C1 Jefferson fractures in select patients and can maintain important C1-2 joint motion.

  11. 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.

  12. 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.

  13. Analysis of the Stress and Displacement Distribution of Inferior Tibiofibular Syndesmosis Injuries Repaired with Screw Fixation: A Finite Element Study

    OpenAIRE

    Qinghua Liu; Kun Zhang; Yan Zhuang; Zhong Li; Bin Yu; Guoxian Pei

    2013-01-01

    BACKGROUND: Studies of syndesmosis injuries have concentrated on cadaver models. However, they are unable to obtain exact data regarding the stress and displacement distribution of various tissues, and it is difficult to compare models. We investigated the biomechanical effects of inferior tibiofibular syndesmosis injuries (ITSIs) and screw fixation on the ankle using the finite element (FE) method. METHODOLOGY/PRINCIPAL FINDINGS: A three-dimensional model of a healthy ankle complex was devel...

  14. Treatment of Displaced Sacroiliac Fracture Using the Lateral Window for Short Plate Buttress Reduction and Percutaneous Sacroiliac Screw Fixation.

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    Colin Murphy

    2016-04-01

    Full Text Available Fractures through the sacroiliac joint are very challenging to treat, technically difficult to reduce through closed methods on account of the multiaxial displacement of fractures fragments, frequently occur in very unwell patients, and have poor outcomes if malreduction is present. We describe a technique utilising the lateral window and a short buttress plate to reduce and stabilize the fragments prior to percutaneous fixation with sacroiliac screws.

  15. Subtrochanteric fracture: a rare but severe complication after screw fixation of femoral neck fractures in the elderly.

    Science.gov (United States)

    Jansen, Hendrik; Frey, Soenke P; Meffert, Rainer H

    2010-12-01

    Cannulated screw fixation is a minimal invasive technique to treat undisplaced femoral neck fractures. It is the preferred method in elderly patients who often suffer co-morbidities. There is scarce literature on subtrochanteric femoral fracture as a complication of cannulated screw fixation of a femoral neck fracture. This complication occurred, without an adequate trauma, in two of 35 patients (5.7%) in this retrospective study of patients older than 65 years (mean age: 77 years) who were treated with cannulated screws for an undisplaced femoral neck fracture between 2004 and 2009. We reviewed the literature for the incidence of this complication and possible predisposing factors. The overall incidence reported in literature is 2.4-4.4% (mean: 2.97%). Despite a broad use of this type of osteosynthesis, the literature does not provide clear biomechanical or clinical indications for optimal screw placement to avoid this complication. Considering the literature and our personal results, surgeons should be aware of this severe complication; they may opt for a different implant in the very old, osteoporotic patient with an undisplaced femoral neck fracture.

  16. Laminoplasty with lateral mass screw fixation for cervical spondylotic myelopathy in patients with athetoid cerebral palsy: A retrospective study.

    Science.gov (United States)

    Zhou, Hua; Liu, Zhong-Jun; Wang, Shao-Bo; Pan, Sheng-Fa; Yan, Ming; Zhang, Feng-Shan; Sun, Yu

    2016-09-01

    Although several studies report various treatment solutions for cervical spondylotic myelopathy in patients with athetoid cerebral palsy, long-term follow-up studies are very rare. None of the reported treatment solutions represent a gold standard for this disease owing to the small number of cases and lack of long-term follow-up. This study aimed to evaluate the outcomes of laminoplasty with lateral mass screw fixation to treat cervical spondylotic myelopathy in patients with athetoid cerebral palsy from a single center.This retrospective study included 15 patients (9 male patients and 6 female patients) with athetoid cerebral palsy who underwent laminoplasty with lateral mass screw fixation for cervical spondylotic myelopathy at our hospital between March 2006 and June 2010. Demographic variables, radiographic parameters, and pre- and postoperative clinical outcomes determined by the modified Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), and visual analog scale (VAS) scores were assessed.The mean follow-up time was 80.5 months. Developmental cervical spinal canal stenosis (P = 0.02) and cervical lordosis (P = 0.04) were significantly correlated with lower preoperative modified JOA scores. The mean modified JOA scores increased from 7.97 preoperatively to 12.1 postoperatively (P cerebral palsy. Laminoplasty with lateral mass screw fixation is an effective treatment for cervical spondylotic myelopathy in patients with athetoid cerebral palsy and developmental cervical spinal canal stenosis.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. 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

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

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    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.

  3. Minimally invasive transforaminal lumbar interbody fusion with unilateral pedicle screw fixation: comparison between primary and revision surgery.

    Science.gov (United States)

    Kang, Moo Sung; Park, Jeong Yoon; Kim, Kyung Hyun; Kuh, Sung Uk; Chin, Dong Kyu; Kim, Keun Su; Cho, Yong Eun

    2014-01-01

    Minimally invasive surgery with a transforaminal lumbar interbody fusion (MIS TLIF) is an important minimally invasive fusion technique for the lumbar spine. Lumbar spine reoperation is challenging and is thought to have greater complication risks. The purpose of this study was to compare MIS TLIF with unilateral screw fixation perioperative results between primary and revision surgeries. This was a prospective study that included 46 patients who underwent MIS TLIF with unilateral pedicle screw. The patients were divided into two groups, primary and revision MIS TLIF, to compare perioperative results and complications. The two groups were similar in age, sex, and level of operation, and were not significantly different in the length of follow-up or clinical results. Although dural tears were more common with the revision group (primary 1; revision 4), operation time, blood loss, total perioperative complication, and fusion rates were not significantly different between the two groups. Both groups showed substantial improvements in VAS and ODI scores one year after surgical treatment. Revision MIS TLIF performed by an experienced surgeon does not necessarily increase the risk of perioperative complication compared with primary surgery. MIS TLIF with unilateral pedicle screw fixation is a valuable option for revision lumbar surgery.

  4. Minimally Invasive Transforaminal Lumbar Interbody Fusion with Unilateral Pedicle Screw Fixation: Comparison between Primary and Revision Surgery

    Directory of Open Access Journals (Sweden)

    Moo Sung Kang

    2014-01-01

    Full Text Available Minimally invasive surgery with a transforaminal lumbar interbody fusion (MIS TLIF is an important minimally invasive fusion technique for the lumbar spine. Lumbar spine reoperation is challenging and is thought to have greater complication risks. The purpose of this study was to compare MIS TLIF with unilateral screw fixation perioperative results between primary and revision surgeries. This was a prospective study that included 46 patients who underwent MIS TLIF with unilateral pedicle screw. The patients were divided into two groups, primary and revision MIS TLIF, to compare perioperative results and complications. The two groups were similar in age, sex, and level of operation, and were not significantly different in the length of follow-up or clinical results. Although dural tears were more common with the revision group (primary 1; revision 4, operation time, blood loss, total perioperative complication, and fusion rates were not significantly different between the two groups. Both groups showed substantial improvements in VAS and ODI scores one year after surgical treatment. Revision MIS TLIF performed by an experienced surgeon does not necessarily increase the risk of perioperative complication compared with primary surgery. MIS TLIF with unilateral pedicle screw fixation is a valuable option for revision lumbar surgery.

  5. Atlantoaxial screw fixation for the treatment of isolated and combined unstable jefferson fractures - experiences with 8 patients.

    Science.gov (United States)

    Hein, C; Richter, H-P; Rath, S A

    2002-11-01

    The unstable atlas burst fracture ("Jefferson fracture") is a fracture of the anterior and posterior atlantal arch with rupture of the transverse atlantal ligament and an incongruence of the atlanto-occipital and the atlanto-axial joint facets. The question whether it has to be treated surgically or nonsurgically is still discussed and remains controversial. During the last decade 8 patients with unstable atlas burst fractures were examined and treated in our department. Five of the eight patients were first treated conservatively by external immobilization. Because of continuing instability due to insufficient bony fusion of the atlantal fracture all five patients underwent atlanto-axial transarticular screw fixation and fusion - as described by Magerl - with good results. In all 8 patients a good bony fusion of the atlanto-axial segment was achieved. None of the patients exhibited neurological deficits after surgical treatment. Although immobilization with a halo vest is recommended by most authors, from our view primary transarticular C1-C2 screw fixation has to be discussed as an alternative for unstable atlas burst fractures. Nonsurgical treatment with halo extension always bears the risk of insufficient healing with further instability and a fixated incongruence of the atlanto-occipital and the atlanto-axial joints, leading to arthrosis, immobility and increasing neck pain. After 10 weeks of insufficient immobilization secondary pre- and intra-operative reposition manoeuvres and surgical fixation hardly can reverse this fixated incongruence. Moreover, halo-extension needs an immobilization of the cervical spine for about 10 weeks and more, which is very uncomfortable and leads to further complications especially in elderly patients.

  6. Effect of heparin on hemorheology and inflammatory cytokines in patients with spinal trauma after PCS pedicle screw fixation

    Institute of Scientific and Technical Information of China (English)

    Nan-Xiang Huang; Hong Lin; Wei Li

    2016-01-01

    Objective:To explore the effect of low molecular weight heparin (LMWH) on the hemorheology, inflammatory cytokines, and coagulation funtion in patients with spinal trauma after PCS pedicle screw fixation.Methods: A total of 80 patients with spinal trauma who were admitted in our hospital were included in the study and randomized into the treatment group and the control group with 40 cases in each group. The patients in the two groups were performed with PCS pedicle screw fixation. The patients in the treatment group were given subcutaneous injection of LMWH after operation. The hemorheology indicators, inflammatory cytokines levels, and coagulation function change before and after operation in the two groups were compared.Results: The difference of RBV (low shear, middle shear, and high shear) (mPa•s), PAR, and PAR (1 min) (%) before operation between the two groups was not statistically significant (P>0.05), the above indicators 24 h after operation in the two groups were significantly elevated when compared with before operation (P<0.05), and the above indicators 24 h after operation in the treatment group were significantly lower than those in the control group (P<0.05). The above indicators 48 h and 1 week after operation in the control group were significantly elevated, while those in the treatment group were significantly reduced when compared with before treatment (P<0.05). CRP, IL-6, and IL-10 levels after operation in the treatment group were significantly lower than those in the control group (P<0.05). PT, APTT, and FIB after operation in the treatment group were significantly lower than those in the control group (P<0.05).Conclusions:LMWH can effectively reduce the blood viscosity, inhibit the inflammatory reaction, and contribute to postoperative rehabilitation in patients with spinal trauma after PCS pedicle screw fixation.

  7. Totally absorbable screws in fixation of subtalar extra articular arthrodesis in children with spastic neuromuscular disease: preliminary report of a randomized prospective study of fourteen arthrodeses fixed with absorbable or metallic screws.

    Science.gov (United States)

    Partio, E K; Merikanto, J; Heikkilä, J T; Ylinen, P; Mäkelä, E A; Vainio, J; Törmälä, P; Rokkanen, P

    1992-01-01

    Seven patients with spastic neuromuscular disease and severe hindfoot valgus deformity were treated by subtalar arthrodesis. Arthrodesis was performed in both feet at the same operation and fixed on one side with a self-reinforced poly-L-lactide (SR-PLLA) screw, and with a standard AO screw on the other side. The functional status state was improved, and radiographic union of the arthrodesis occurred in all feet. The radiograph showed better solid fusion in five feet treated with PLLA screws, similar fusion in both sides in one patient, and one slower fusion in the side treated initially with a PLLA screw. Totally absorbable SR-PLLA screws appear to be firm enough for fixation of subtalar extraarticular arthrodesis in children.

  8. 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.

  9. Posterior Titanium Screw Fixation without Debridement of Infected Tissue for the Treatment of Thoracolumbar Spontaneous Pyogenic Spondylodiscitis

    Science.gov (United States)

    Iacoangeli, Maurizio; Nasi, Davide; Nocchi, Niccolo; Di Rienzo, Alessandro; di Somma, Lucia; Colasanti, Roberto; Vaira, Carmela; Benigni, Roberta; Liverotti, Valentina; Scerrati, Massimo

    2016-01-01

    Study Design Retrospective study. Purpose The aim of our study was to analyze the safety and effectiveness of posterior pedicle screw fixation for treatment of pyogenic spondylodiscitis (PSD) without formal debridement of the infected tissue. Overview of Literature Posterior titanium screw fixation without formal debridement of the infected tissue and anterior column reconstruction for the treatment of PSD is still controversial. Methods From March 2008 to June 2013, 18 patients with PSD underwent posterior titanium fixation with or without decompression, according to their neurological deficit. Postero-lateral fusion with allograft transplantation alone or bone graft with both the allogenic bone and the autologous bone was also performed. The outcome was assessed using the visual analogue scale (VAS) for pain and the Frankel grading system for neurological status. Normalization both of C-reactive protein (CRP) and erythrocyte sedimentation rate was adopted as criterion for discontinuation of antibiotic therapy and infection healing. Segmental instability and fusion were also analyzed. Results At the mean follow-up time of 30.16 months (range, 24–53 months), resolution of spinal infection was achieved in all patients. The mean CRP before surgery was 14.32±7.9 mg/dL, and at the final follow-up, the mean CRP decreased to 0.5±0.33 mg/dL (p <0.005). Follow-up computed tomography scan at 12 months after surgery revealed solid fusion in all patients. The VAS before surgery was 9.16±1.29 and at the final follow-up, it improved to 1.38±2.03, which was statistically significant (p <0.05). Eleven patients out of eighteen (61.11%) with initial neurological impairment had an average improvement of 1.27 grades at the final follow-up documented with the Frankel grading system. Conclusions Posterior screw fixation with titanium instrumentation was safe and effective in terms of stability and restoration of neurological impairment. Fixation also rapidly reduced back pain

  10. 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.

  11. 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.

  12. 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

  13. A comparative study on cervical biomechanical stability of lateral fixation piece and pedicle screws of screw fixation%颈椎侧块螺钉内固定和椎弓根螺钉内固定的生力学稳定性比较研究

    Institute of Scientific and Technical Information of China (English)

    冯灿林; 黄海珊; 黎霭云; 刘庆浩; 雷明; 祝城华; 许国增

    2014-01-01

    目的 比较颈椎侧块螺钉内固定和椎弓根螺钉内固定的生物力学稳定性.方法 取12具成人尸体的颈椎作为标本,于C4~C5处切断,造成颈椎不稳定模型.对标本依次行非内固定、侧块螺钉内固定和椎弓根螺钉内固定三种方式.然后进行柔韧性以及左右旋转扭矩和刚度测试,评价两种内固定术的稳定性效果.结果 在三维运动范围方面,侧块螺钉内固定比椎弓根螺钉内固定的三维运动范围有不同程度减小(P<0.05);侧块螺钉左右旋转的刚度比椎弓根螺钉内固定强(P<0.05).结论 从生物力学稳定性的角度来看,下颈椎不稳采用侧块螺钉内固定的生物力学稳定性较好.%Objective To compare the cervical biomechanical stability of lateral fixation piece and pedicle screws of screw fixation.Methods The 12 cervical vertebras as experimental sample,and from C4 to C5 were cut off and caused cervical instability model.Three ways of non fixation,lateral mass screw fixation and pedicle screw fixation were implemented.Then flexibility and rotation torque and stiffness were tested.Stability of two kinds of internal fixation was evaluated.Results In the 3-D range of movement,lateral mass screw fixation was notably smaller than that of pedicle screws fixation (P < 0.05).The lateral mass screw fixation had more strength than pedicle screws fixation (P < 0.05).Conclusion The instability of lower cervical spine patients may use lateral mass screw fixation,and its biomechanical stability is better.

  14. 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.

  15. 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.

  16. Correlation Between Residual Displacement and Osteonecrosis of the Femoral Head Following Cannulated Screw Fixation of Femoral Neck Fractures.

    Science.gov (United States)

    Wang, Chen; Xu, Gui-Jun; Han, Zhe; Jiang, Xuan; Zhang, Cheng-Bao; Dong, Qiang; Ma, Jian-Xiong; Ma, Xin-Long

    2015-11-01

    The aim of the study was to introduce a new method for measuring the residual displacement of the femoral head after internal fixation and explore the relationship between residual displacement and osteonecrosis with femoral head, and to evaluate the risk factors associated with osteonecrosis of the femoral head in patients with femoral neck fractures treated by closed reduction and percutaneous cannulated screw fixation.One hundred and fifty patients who sustained intracapsular femoral neck fractures between January 2011 and April 2013 were enrolled in the study. All were treated with closed reduction and percutaneous cannulated screw internal fixation. The residual displacement of the femoral head after surgery was measured by 3-dimensional reconstruction that evaluated the quality of the reduction. Other data that might affect prognosis were also obtained from outpatient follow-up, telephone calls, or case reviews. Multivariate logistic regression analysis was applied to assess the intrinsic relationship between the risk factors and the osteonecrosis of the femoral head.Osteonecrosis of the femoral head occurred in 27 patients (18%). Significant differences were observed regarding the residual displacement of the femoral head and the preoperative Garden classification. Moreover, we found more or less residual displacement of femoral head in all patients with high quality of reduction based on x-ray by the new technique. There was a close relationship between residual displacement and ONFH.There exists limitation to evaluate the quality of reduction by x-ray. Three-dimensional reconstruction and digital measurement, as a new method, is a more accurate method to assess the quality of reduction. Residual displacement of the femoral head and the preoperative Garden classification were risk factors for osteonecrosis of the femoral head. High-quality reduction was necessary to avoid complications.

  17. 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.

  18. 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

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, Sebastian, E-mail: sebastian.fischer@kgu.de [Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Vogl, Thomas J. [Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Marzi, Ingo [Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Zangos, Stephan; Wichmann, Julian L.; Scholtz, Jan-Erik; Mack, Martin G. [Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Schmidt, Sven [Orthopaedic University Hospital Friedrichsheim, Marienburgstraße, 260528 Frankfurt (Germany); Eichler, Katrin [Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany)

    2015-02-15

    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.

  19. Malposition and revision rates of different imaging modalities for percutaneous iliosacral screw fixation following pelvic fractures

    DEFF Research Database (Denmark)

    Zwingmann, Jörn; Hauschild, Oliver; Bode, Gerrit;

    2013-01-01

    INTRODUCTION: Percutaneous iliosacral screw placement following pelvic trauma is associated with high rates of revisions, screw malpositioning, the risk of neurological damage and inefficient stability. The correct entry point and the small target corridor may be difficult to visualize using only...... an image intensifier. Therefore, 2D and 3D image-based navigation and reconstruction techniques could be helpful tools. The aim of this systematic review and meta-analysis was to evaluate the best available evidence regarding the rate of malpositioning and revisions using different techniques for screw...... implantation, i.e., conventional, 2D and 3D image-based navigation and reconstruction techniques, CT navigation. METHODS: A systematic review and meta-analysis were performed using the data available on Ovid Medline. 430 studies published between 1/1948 and 2/2011 were identified by two independent...

  20. 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

  1. 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.

  2. Iatrogenic Injury of Profunda Femoris Artery Branches after Intertrochanteric Hip Screw Fixation for Intertrochanteric Femoral Fracture: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Nikolaos Patelis

    2014-01-01

    Full Text Available A case of arterial rupture of the profunda femoris arterial branches, following dynamic hip screw (DHS fixation for an intertrochanteric femoral fracture, is presented. Bleeding is controlled by coil embolization, but, later on, the patient underwent orthopedic material removal due to an infection of a large femoral hematoma.

  3. 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.

  4. 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

  5. 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

  6. 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.

  7. 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.

  8. 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

  9. Application of C2 Transpedicular Screw Fixation Combined with C3 Lateral Mass Screw Plate Fixation in Posterior Treatment of Old Hangman's Fracture%经后路C2椎弓根C3侧块短节段固定治疗陈旧性枢椎椎弓骨折

    Institute of Scientific and Technical Information of China (English)

    曹成刚; 梁益建; 何睿; 石化洋; 曾勇; 陈伶

    2012-01-01

    Objective To approach the therapeutic effect of C2 transpedicular screw fixation combined with C3 lateral mass screw plate fixation on old Hangman' s fracture. Methods Nine patients with old Hangman' s fracture were treated with C2 transpedicular screw fixation combined with C3 lateral mass screw plate fixation as well as bone gr'aft fusion in our hospital from 2002. Results A mean follow-up time was 8 months(6 to 15 months). All cases got bony union. No infection, neurological deficits, or other complications were found. Conclusion It can be an effective and simple way to treat old Hangman' s fracture with C2 transpedicular screw fixation combined with C3 lateral mass screw plate fixation, which can ultimately preserve the cervical function.%目的 探讨经后路C2椎弓根C3侧块短节段内固定治疗陈旧性枢椎椎弓骨折(Hangman骨折)的疗效.方法 2002年以来9例陈旧性Hangman骨折采用经后路C2椎弓根C3侧块短节段固定,植骨融合治疗.结果 所有患者随访6~15个月,平均8个月.所有患者均骨性愈合,未出现感染、神经损伤等并发症.结论 经后路C2椎弓根C3侧块短节段内固定治疗陈旧性Hangman骨折是一种安全有效并能最大程度保留患者颈部功能的方法.

  10. Feasibility study of patient-specific surgical templates for the fixation of pedicle screws.

    Science.gov (United States)

    Salako, F; Aubin, C-E; Fortin, C; Labelle, H

    2002-01-01

    Surgery for scoliosis, as well as other posterior spinal surgeries, frequently uses pedicle screws to fix an instrumentation on the spine. Misplacement of a screw can lead to intra- and post-operative complications. The objective of this study is to design patient-specific surgical templates to guide the drilling operation. From the CT-scan of a vertebra, the optimal drilling direction and limit angles are computed from an inverse projection of the pedicle limits. The first template design uses a surface-to-surface registration method and was constructed in a CAD system by subtracting the vertebra from a rectangular prism and a cylinder with the optimal orientation. This template and the vertebra were built using rapid prototyping. The second design uses a point-to-surface registration method and has 6 adjustable screws to adjust the orientation and length of the drilling support device. A mechanism was designed to hold it in place on the spinal process. A virtual prototype was build with CATIA software. During the operation, the surgeon places either template on patient's vertebra until a perfect match is obtained before drilling. The second design seems better than the first one because it can be reused on different vertebra and is less sensible to registration errors. The next step is to build the second design and make experimental and simulations tests to evaluate the benefits of this template during a scoliosis operation.

  11. 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

  12. 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

  13. Biomechanical comparison of dynamic condylar screw and locking compression plate fixation in unstable distal femoral fractures: An in vitro study

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    Ashutosh Kumar Singh

    2013-01-01

    Full Text Available Background: Distal femur fractures are difficult to manage and the selection of implant for internal fixation remains controversial. The objective of this study is to establish the relative strength of fixation of a distal femoral locking plate (DFLP compared with the dynamic condylar screw (DCS in the distal femur fractures. Materials and Methods: Study was conducted on 16 freshly harvested cadaveric distal femoral specimens, eight implanted with DCS and other eight with DFLP. The construct was made unstable by removing a standard sized medial wedge of 1 cm base (gap-osteotomy beginning 6 cm proximal to the lateral joint line in distal metaphyseal region with the loss of medial buttress. Fatigue test was conducted under load control mode at the frequency of I Hz. Specimens were subjected to cyclic loading of 2 kN, under observation for 50,000 cycles or until failure/cutout, which ever occurred earlier. Results: In DFLP group, there was no implant failure and the average number of cycles sustained was 50,000. Six out of eight specimens completed 50,000 cycles and two failed in DCS group. The average number of cycles sustained by DCS was 46150. Though the bone quality as assessed by dual energy X-ray absorptiometry DEXA was comparable in both DFLP and DCS group ( P = 0.06, none failed in DFLP group and subsidence was 1.02 ± 0.34 mm (range: 0.60-1.32 mm, which was significantly 43% lower ( P = 0.006 than subsidence in DCS group (1.82 ± 0.58; range: 1.20-3.08 mm. The average stiffness of DCS group was 52.8 ± 4.2 N/mm, which was significantly lower than average stiffness of locked condylar plate group (71.2 ± 5.1 N/mm ( P = 0.02. Conclusions: DFLP fixation of the distal femur fractures resulted in stronger construct than the DCS fixation in both cyclic loading and ultimate strength in biomechanical testing of a simulated A3 distal femur fracture.

  14. POST TRAUMATIC INSTABILITY OF SUB - AXIAL CERVICAL SPINE - REDUCTION AND INTERNAL FIXATION BY LATERAL MASS SCREWS : A LONG TERM FOLLOW - UP STUDY

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    Godagu

    2015-10-01

    Full Text Available AIM: We present here the clinical results of 24 patients who were operated for cervical instability following trauma by lateral mass fixation at our institution between July 2010 and Dec 2013 and to assess the stability of the construct at 2yr follow - up study. MATERIALS AND METHODS: Between July 2010 and Dec 2013 a total of 24 pts. Were operated by lateral mass fixation for cervical spine instability following trauma to subaxial cervical spine between C3 - C6. Presenting with posterior element injury like facet locking and subluxation injuries were included in the study. Al l these patients were evaluated postoperatively for neurologic improvement , complications and Results were analyzed. RESULTS: A total of 104 screws were placed in to the lateral masses during the study. There were 8(33.3% deaths in this series not related to the surgical procedure. There were no immediate complications related to the procedure. There was no evidence of neurovascular injury either during the procedure or immediately following the surgery. There was CSF leak in one case of badly traumatized cord injury during the procedure. Neurological improvement was seen in 13(81.2% out of surviving 16 cases of trauma at the end of 3m to the extent of self - ambulation and the rest three did not show any improvement and remained quadriplegic. CONCLUSION: In this study we report good long term stability achieved by the lateral mass fixation with rods and screws with least morbidity and the safety of the procedure compared to other methods of posterier elements fixations. Both Roy Camille and Magerl technique can be followed for screw placement, where in Magerl technique has slight advantage of avoiding the nerve root injury and a longer screw can be placed to achieve a good bony purchase. Over all it is very safe and efficacious procedure in the hands of an ex perienced surgeon

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

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    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.

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

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    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.

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

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    Hyeun-Sung Kim

    2016-01-01

    Full Text Available 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<0.05. Further, restored vertebral height was maintained during the 2 or more years of postoperative follow-up. Compared to the PVP group the postoperative compression ratio and kyphotic angle were significantly 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.

  18. CT morphometric analysis to determine the anatomical basis for the use of transpedicular screws during reconstruction and fixations of anterior cervical vertebrae.

    Directory of Open Access Journals (Sweden)

    Chun Chen

    Full Text Available BACKGROUND: Accurate placement of pedicle screw during Anterior Transpedicular Screw fixation (ATPS in cervical spine depends on accurate anatomical knowledge of the vertebrae. However, little is known of the morphometric characteristics of cervical vertebrae in Chinese population. METHODS: Three-dimensional reconstructions of CT images were performed for 80 cases. The anatomic data and screw fixation parameters for ATPS fixation were measured using the Mimics software. FINDINGS: The overall mean OPW, OPH and PAL ranged from 5.81 to 7.49 mm, 7.77 to 8.69 mm, and 33.40 to 31.13 mm separately, and SPA was 93.54 to 109.36 degrees from C3 to C6, 104.99 degrees at C7, whereas, 49.00 to 32.26 degrees from C4 to C7, 46.79 degrees at C3 (TPA. Dl/rSIP had an increasing trend away from upper endplate with mean value from 1.87 to 5.83 mm. Dl/rTIP was located at the lateral portion of the anterior cortex of vertebrae for C3 to C5 and ipsilateral for C6 to C7 with mean value from -2.70 to -3.00 mm, and 0.17 to 3.18 mm. The entrance points for pedicular screw insertion for C3 to C5 and C6 to C7 were recommended -2∼-3 mm and 0-4 mm from the median sagittal plane, respectively, 1-4 mm and 5-6 mm from the upper endplate, with TPA being 46.79-49.00 degrees and 40.89-32.26 degrees, respectively, and SPA being 93.54-106.69 degrees and 109.36-104.99 degrees, respectively. The pedicle screw insertion diameter was recommended 3.5 mm (C3 and C4, 4.0 mm (C5 to C7, and the pedicle axial length was 21-24 mm for C3 to C7 for both genders. However, the ATPS insertion in C3 should be individualized given its relatively small anatomical dimensions. CONCLUSIONS: The data provided a morphometric basis for the ATPS fixation technique in lower cervical fixation. It will help in preoperative planning and execution of this surgery.

  19. The Treatment of Sacroiliac Joint Dislocation by Fixation Using Pedicle Screws Combined with Iliac Screws%髂骨置钉联合同侧椎弓根钉复位固定治疗骶髂关节脱位

    Institute of Scientific and Technical Information of China (English)

    孙海浪; 朱国太; 郝跃东; 唐晓明

    2012-01-01

    To explore the clinical effect of the treatment of sacroiliac joint dislocation by fixation using pedicle screws combined with iliac screws, total of 9 patients (3 female, 6 male) diagnosed as sacroiliac joint dislocation treated with the fixation using pedicle screws combined with iliac screws were studied. The mean age was 36. 4 years(range 21 - 55). The reason for trauma was traffic accident in 5, fall in 4. The type was 6C1, 2C2, 1C3, according to the Tile. Of the 9 patients, 5 had femur fracture, 2 had lung contusion, 2 had separation symphysis pubis, 7 had fracture of all 4 public. All patients were followed-up for 6 ~ 30 months (average 16 months). X-rays after operation showed that all the dislocations were replaced satisfied and sacroiliac joint fused. There was no screw loose and break. No re-dislocation of sacroiliac joint happened. It was safety and perfect surgical procedure that using pedicle screws combined with iliac screws to treat sacroiliac joint dislocation.%探讨髂骨置钉联合同侧椎弓根钉复位固定治疗骶髂关节脱位方法及效果.收治9例骶髂关节脱位患者,男6例,女3例,年龄21岁~55岁,平均36.4岁.5例为交通事故伤,4例为高处坠落伤,C1型6例,C2型2例,C3型1例.其中3例患者合并有股骨干骨折,2例合并有肺挫伤,2例合并有耻骨联合分离,7例伴耻骨支骨折.结果,术后9例患者均获得随访,随访6个月~30个月,平均16月,术后X线片复查示骶髂关节脱位复位满意,骶髂关节均获融合.内固定无松动断裂,骶髂关节无再脱位.应用髂骨置钉联合同侧椎弓根钉复位固定治疗技术是治疗骶髂关节脱位的一种直接而可靠的固定方法.

  20. 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.

  1. One-stage posterior C2 and C3 pedicle screw fixation or combined anterior C2-C3 fusion for the treatment of unstable hangman’s fracture

    OpenAIRE

    Liu, Jingchen; Li, Ye; Wu, Yuntao

    2013-01-01

    The present study aimed to evaluate the effect of using one-stage posterior C2 and C3 pedicle screw fixation or combined anterior C2-C3 fusion in the treatment of unstable hangman’s fracture. A total of 13 patients with unstable hangman’s fractures underwent C2 and C3 pedicle screw fixation, lamina interbody fusion or combined anterior C2-C3 fusion and imaging examinations to evaluate the fracture fixation and healing condition at three days and three months following surgery. Postoperative X...

  2. Advances in cervical anterior transpedicular screw fixation technique%颈椎前路椎弓根螺钉内固定技术的研究进展

    Institute of Scientific and Technical Information of China (English)

    欧阳钧; 吴卫东

    2013-01-01

    Cervical posterior transpedicular screw technique was first introduced to clinic in 1994. Due to its good biomechanical stability and satisfactory fusion effect,it has become a major solution to some cervical spine diseases.However,most of the diseases involved in vertebral body and posterior transpedicular screw technique is complex and difficult,these factors prevent the technique be widely used in cervical spine surgery.In 2008,a new concept of cervical anterior transpedicular screw fixation technique was first proposed.This new technique inherited advantages of posterior transpedicular screw fixation,and of course,it also overcomes drawbacks of conventional anterior vertebral body screw fixa-tion.This review presents an overview of anterior transpedicular screw fixation technique on anatomical and biomechanical field.%颈椎后路椎弓根螺钉固定技术于1994年首次应用于临床,鉴于其稳定的固定融合效果,已成为多种颈椎疾病的主要治疗手段。然而,由于颈椎病灶的好发部位多位于前部,且颈椎后路椎弓根螺钉操作难度较大,在一定程度上限制了该技术的发展。2008年颈椎前路椎弓根螺钉固定技术的概念被首次提出,此技术继承了后路椎弓根螺钉生物力学性能卓越的优点,且克服传统颈椎前路椎体螺钉稳定性较差的缺点。本文主要就颈椎前路椎弓根螺钉固定技术的解剖学及生物力学研究进展进行综述。

  3. 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

  4. Functionality Evaluation of a Novel Smart Expandable Pedicle Screw to Mitigate Osteoporosis Effect in Bone Fixation: Modeling and Experimentation

    Directory of Open Access Journals (Sweden)

    Ahmadreza Eshghinejad

    2013-01-01

    Full Text Available This paper proposes a novel expandable-retractable pedicle screw and analyzes its functionality. A specially designed pedicle screw is described which has the ability to expand and retract using nitinol elements. The screw is designed to expand in body temperature and retract by cooling the screw. This expansion-retraction function is verified in an experiment designed in larger scale using a nitinol antagonistic assembly. The results of this experiment are compared to the results of a finite element model developed in Abaqus in combination with a user material subroutine (UMAT. This code has been developed to analyze the nonlinear thermomechanical behavior of shape memory alloy materials. The functionality of the proposed screw is evaluated with simulation and experimentation in a pullout test as well. The pullout force of a normal screw inserted in a normal bone was simulated, and the result is compared with the results of the expandable screw in osteoporotic bone. Lastly, strength of the designed pedicle screw in a foam block is also verified with experiment. The reported finite element simulations and experiments are the proof for the concept of nitinol expandable-retractable elements on a pedicle screw which validate the functionality in a pullout test.

  5. 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

  6. Anterior subaxial cervical spine fixation using a plate with single screw per vertebral body: A simple and efficient construct - Clinical series and a cadaver study

    Directory of Open Access Journals (Sweden)

    Vannemreddy Prasad

    2009-01-01

    Full Text Available Objective: To report our experience with a novel construct for traumatic and nontraumatic cervical spine lesions that was validated by biomechanical studies of cadaver cervical spine. Study Design: Consecutive cases of anterior cervical spine fixation performed over six years reviewed for stability offered by a construct comprising of a plate fixed by a single screw to each vertebral body. Setting: A university hospital and a biomechanical lab. Materials and Methods: Data were coded and entered into a statistical worksheet for multivariate analysis. Cadaver spine models applied for biomechanical study of stability. Results: Total of 103 cases reviewed; 86 with single-level disease; traumatic in 66 (64% cases and degenerative in 33 (32% cases, including hard disks, OPLL, and spondylitis (4% with other causes. Fixation was with diskectomy in 59 and with corpectomy in 40. A bone graft was utilized for fusion in 87 and a bone-filled titanium spacer in 13. A single screw was placed in each vertebral body with a locking plate (having linear arrangement of holes. This construct remained strong in 95% of cases at the end of 6-24 months. Five cases failed requiring reoperation. Five patients with cervical spinal cord injury (SCI died. On statistical analysis, construct was stronger with diskectomy compared with corpectomy. Construct used on cadavers confirmed the biomechanical stability in short segment fixation (C5-6. Conclusion: A conservative construct utilizing a single screw per vertebral body and a one-holed plate system appears to be strong enough to afford stability in both traumatic and nontraumatic lesions of subaxial cervical spine, comparable to others.

  7. 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

  8. 寰枢椎椎弓根螺钉置钉技术的临床应用%Clinical application of atlantoaxial pedicle screw system fixation

    Institute of Scientific and Technical Information of China (English)

    吴长沙; 李攀; 李恩贤; 李让贤; 夏兴平; 刘超; 涂国能

    2015-01-01

    Objective To investigate the effect of atlantoaxial pedicle screw system fixation to treat upper cervical in-juries.Methods Patients with upper cervical injuries were treated with atlantoaxial pedicle screw system fixation, which included 5 cases of Jefferson fractures,11 odontoid fractures and 9 Hangman fractures.Results No patient had the injury of spinal cord,nerve root and vertebral artery.There was 1 case with vertebral vein injury,which had been controlled by compression.1 case with Jefferson fracture showed incomplete reduction.All patients were followed up from 1 year to 2 years.All fusion bone got union from CT scan and X-ray a year after surgeries.The clinical symp-toms were improved and the screws were verified to be in a proper position without breakage or loosening.Conclusions The atlantoaxial pedicle screw system fixation is an effective method,which provide stable fixation and high fusion rate for fracture to treat upper cervical injuries.%目的:探讨寰枢椎椎弓根螺钉置钉技术在上颈椎损伤临床应用的效果。方法选择性应用寰枢椎椎弓根螺钉固定技术治疗 Jefferson 骨折5例,齿状突骨折11例,Hangman 骨折9例。结果术中无椎动脉、脊髓及神经根损伤发生。1例暴露时损伤静脉丛,予以压迫即能止血;1例寰枢椎骨折不完全复位。患者均获随访,时间1~2年。患者临床症状明显改善,术后1年行 X 线及 CT 检查,显示所有骨折均骨性愈合,螺钉位置良好,无松动、断钉。结论寰枢椎椎弓根螺钉内固定技术具有固定可靠及骨折愈合率高等特点,为上颈椎损伤提供了坚固的稳定性。

  9. 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

  10. Advances of pedicle screw fixation for thoracolumbar fractures%椎弓根螺钉内固定术治疗胸腰椎骨折的进展

    Institute of Scientific and Technical Information of China (English)

    丁浩洋; 柯珍勇

    2014-01-01

    0BJECTIVE:To systemic il ustrate advances of pedicle screw internal fixation in treating thoracolumbar fracture. METHODS:A computer-based online search(1993-01/2014-01) of PubMed database(http://www. ncbi.nlm.nih.gov/pubmed/) and WANFANG database (http://www.wanfangdata.com.cn/) was performed for related articles with keywords“pedicular screw,internal fixation,thoracolumbar fracture”in English and in Chinese.A total of 65 articles were col ected,and 28 were included according to inclusion and exclusion criteria. RESULTS:Pedicle screws have a good biomechanical characteristic.Cooperated with different ways of operation,pedicle screws can be used for reconstructing the stability of vertebral fracture,providing three-dimensional correction,restoring the hight of vertebral body and physiological bending of the spine,and decompressing spinal canal.With the technological development in recent years,the application of intermediate screw and percutaneous pedicle screw fixation optimized the surgical approach, reduced the trauma and postoperative adverse reactions. CONCLUSION:With the application of various kinds of techniques,pedicle screw fixation can be used for the treatment of various types of thoracolumbar fractures.%目的:系统阐述椎弓根螺钉内固定术应用于胸腰椎骨折治疗的进展。方法使用计算机及因特网检索(1993-01/2014-01) PubMed数据库(http://www.ncbi.nlm.nih.gov/pubmed/)、中国万方数据库(http://www.wanfangdata.com.cn/)中相关文章,英文关键词为“pedicular screw,internal fixation,thoracolumbar fracture”,中文关键词为“椎弓根螺钉,内固定,胸腰椎骨折”。共检索到65篇文献,根据纳入及排除标准,共纳入28篇文章。结果椎弓根螺钉具有良好生物力学特性,配合不同的手术方式,可重建骨折椎稳定性,提供三维矫正,恢复椎体高度及脊柱的生理弯曲,行椎管减压。而近年来随技术发展,伤椎内固定

  11. 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

  12. 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.

  13. 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 .

  14. Biomechanical study on the posterior screw fixation in the lower cervical spine%下颈椎后路螺钉固定的生物力学研究进展

    Institute of Scientific and Technical Information of China (English)

    林华杰; 徐荣明; 刘观燚

    2011-01-01

    So far,the fixation in the lower cervical spine through posterior approach technology has commonly been used,besides the lateral screw and pedicle screw techniques,transarticular screw and laminar screw techniques have being paid more attention recently. This article introduced four screw fixation ways in the lower cervical spine through posterior approach and reviewed the recent biomechanics studies of four screw fixation techniques. The biomechanics study includes stabilization,pollout strength, insertion technique, and screw characteristic and so on. Lateral screw and pedicle screw techniques have become an effective internal fixation way for the lower cervical spine instability because of their superior stabilization and higher pollout strength. Transarticular screw fixation has become a new way to fix the lower cervical spine through posterior approach,which has widely surgical indications. Besides, this technique is relatively safe, simple and has achieved favorable curative effect in clinic. Laminar screw fixation technique is rarely used in clinic, but the study of anatomy and biomechanics confirmed that this technique can be applied as a salvage technique in clinic. Above four techniques of the screw fixation in the lower cervical spine through posterior approach have advantages and disadvantages, respectively, and the application in clinic is different. Through the biomechanics study of these techniques will contribute to the development of the techniques of the screw fixation in the lower cervical spine through posterior approach and guide the clinical work effectively.%目前,下颈椎后路螺钉固定除侧块螺钉和椎弓根螺钉技术已普遍应用外,经关节螺钉和经椎板螺钉固定技术也逐渐被重视.本文就此介绍下颈椎后路4种螺钉固定方式,并对各自固定技术的生物力学研究现状进行综述.生物力学研究内容包括三维稳定性、抗拔出力、置钉技术和螺钉特点等.侧块螺钉和椎

  15. Biomechanical comparison of cervical transfacet pedicle screws versus pedicle screws

    Institute of Scientific and Technical Information of China (English)

    LIU Guan-yi; XU Rong-ming; MA Wei-hu; SUN Shao-hua; HUANG Lei; YING Jiang-wei; JIANG Wei-yu

    2008-01-01

    Background Transfacet pedicle screws provide another alternative for standard pedicle screw placement for plate fixation in the Iumbar spine. However, few studies looking at transfacet pedicle screw fixation in the cervical spine are available. Therefore, cervical transfacet pedicle screw fixation and standard pedicle screw fixation techniques were biomechanically compared in this study.Methods Ten fresh human cadaveric cervical spines were harvested. On one side, transfacet pedicle screws were placed at the C3-4, C5-6, and C7-T1 levels. On the other side, pedicle screws were placed at the C3, C5, and C7 levels. The screw insertion technique at each level was randomized for right or left. The starting point for the transfacet pedicle screw insertion was located at the midpoint of the inferolateral quadrant of the lateral mass and the direction of the screw was about 50° caudally in the sagittal plane and about 45° toward the midline in the axial plane. Screws were placed from the inferior articular process, across the facet complex and the pedicle into the body of the caudal vertebra. The entry point for the pedicle screw was located at the midpoint of the superolateral quadrant of the lateral mass, and the direction of the screw was about 45° toward the midline in the axial plane and toward the upper third of the vertebral body in the sagittal plane. After screw placement we performed axial pullout testing.Results All the cervical transfacet pedicle screws and the pedicle screws were inserted successfully. The mean pullout strength for the transfacet pedicle screws was 694 N, while for the pedicle screws 670 N (P=-0.013). In all but six instances (10%), the pedicle screw pullout values exceeded the values for the transfacet pedicle screws; this occurred three times at the C3/C4 level, twice at the C5/C6 level and once at the C7/T1 level. The greatest pullout strength difference at a single level was observed at the C5/C6 level, with a mean difference of 38 N (t

  16. 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.

  17. 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

  18. 三维重建虚拟置钉指导前路寰枢椎侧方关节螺钉内固定和齿状突螺钉内固定:3D打印模型的实验研究%Using simulated screw trajectories in three dimensional reconstruction to guide anterior C1-C2 transarticular screw fixation and odontoid screw fixation in 3D printed models

    Institute of Scientific and Technical Information of China (English)

    翁万青; 田乃锋; 王鉴顺; 王胜; 王向阳; 徐华梓; 吴爱悯; 池永龙

    2016-01-01

    目的 探讨术前运用3D打印模型进行三维重建虚拟置钉指导前路寰枢椎侧方关节螺钉和齿状突螺钉内固定的可行性. 方法 对30例正常成人的寰枢椎CT数据进行三维重建并打印骨骼模型.首先模拟前路寰枢椎侧方关节螺钉内固定术,测量最内侧方角度、最外侧方角度,取平均值为侧偏角;最小向后角度、最大向后角度,取平均值为后偏角.再次模拟齿状突螺钉内固定术,测量侧偏角、后偏角.以三维虚拟置钉结果为参考,指导三维打印模型实验置钉,分别测量前路寰枢椎侧方关节螺钉、齿状突螺钉的侧偏角和后偏角,侧偏角和后偏角,与对应的影像学数据进行对比. 结果 前路寰枢椎侧方关节螺钉内固定术三维重建虚拟置钉测得左、右侧侧偏角平均分别为21.80°±3.97°、21.54°±4.04°,后偏角平均分别为29.34°±4.48°、28.90°±4.49°.在3D打印模型中实验置钉测得左、右侧侧偏角分别为21.18°±4.95°、20.69°±4.40°,后偏角平均分别为28.88°±4.84°、28.22°±4.48°.齿状突螺钉内固定术三维虚拟置钉测得侧偏角和后偏角平均分别为0.40°±0.86°、27.16°±3.38°.在3D打印模型中实验置钉测得侧偏角和后偏角平均分别为0.24°±0.85°、27.52°±3.64°.对比分析发现三维重建模型置钉数据与相应的3D打印模型实验置钉数据基本相近,差异均无统计学意义(P>0.05). 结论 术前运用3D打印模型可以进行CT三维重建模拟精确置钉指导前路寰枢椎相应的螺钉和齿状突螺钉内固定.这种术前模拟实验手术可以作为教学和临床应用参考.%Objective To provide a preoperative protocol for surgeons by investigating the optimal screw trajectories in 3D images to guide the internal fixation with anterior atlantoaxial transarticular screws and anterior odontoid screws in 3D printed models of upper cervical spine.Methods Computed tomography (CT) scans of 30 adult

  19. 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.

  20. Intra- and postoperative complications of navigated and conventional techniques in percutaneous iliosacral screw fixation after pelvic fractures

    DEFF Research Database (Denmark)

    Zwingmann, Jörn; Südkamp, Norbert P; König, Benjamin;

    2013-01-01

    and the small target corridor for the iliosacral screw may be difficult to visualise using an image intensifier. 2D and 3D navigation techniques may therefore be helpful tools. The aim of this multicentre study was to evaluate the intra- and postoperative complications after percutaneous screw implantation...... by classifying the fractures using data from a prospective pelvic trauma registry. The a priori hypothesis was that the navigation techniques have lower rates of intraoperative and postoperative complications. METHODS: This study is based on data from the prospective pelvic trauma registry introduced...... were identified. Out of these a further analysis was performed in 597 patients suffering injuries of the SI joint (187×with surgical interventions) and 597 patients with sacral fractures (334×with surgical interventions). The rate of intraoperative complications was not significantly different, with 10...

  1. Clinical effects of posterior pedicle screw fixation on spinal deformity in growing period: a report of 360 cases

    Directory of Open Access Journals (Sweden)

    Zheng-lei WANG

    2011-08-01

    Full Text Available Objective To observe the effect of a new kind of pedicle screw frame system with sliding terminus and locked middle segment on spinal deformity in growing period.Methods Three hundred and sixty patients in growing period were involved in the present study,and among them 82 were suffering from congenital scoliosis,218 idiopathic scoliosis and 60 kyphosis.All the patients were treated with the pedicle screw frame system with sliding terminus and locked middle segment.The treatment effects and postoperative complications were observed,and the Cobb angle before and after the operation was compared.Results The Cobb angle of 300 scoliosis patients was corrected from 53°±3° to 8°±2°,and the Cobb angle of 60 kyphosis patients was corrected from 60°±2° to 25°±3°,and the corrective effect was satisfactory.The correction rate of patients with Cobb angle ≤50° was 80%.Two hundred and ten patients were followed-up for 1 to 6 years,and the longitudinal growth of spine was 1.5-4.0cm.No severe complication,such as screw fracture,rod fracture or nerve injury,occurred.Conclusion The pedicle screw frame system with sliding terminus had a favorable three-dimensional correction effect,and the spine growth would not be restricted,and there was no stiffness,vertebral rotation,or distortion of shaft after operation.

  2. 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.

  3. 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.

  4. Biomechanical changes and clinical characteristics of cervical pedicle screws internal fixation%颈椎椎弓根螺钉置入内固定的生物力学变化及其临床特性

    Institute of Scientific and Technical Information of China (English)

    王华刚; 杨飞

    2011-01-01

    背景:颈椎椎弓根钉由于其独特的三维稳定性,越来越多的学者对其进行更加广泛的研究.目的:综述颈椎椎弓根解剖特点及椎弓根螺钉置钉的安全性和临床应用.方法:应用计算机检索1994-01/2010-09 CNKI及PubMed数据库相关文章,中文检索词为"颈椎弓根螺钉",英文检索词为"cervical pedicle screws",共检索到文献292篇,最终纳入符合标准的文献43篇.结果与结论:通过文献检索获得目前一致的观点认为颈椎弓根内固定由于是三维固定,因此可以获得良好的生物力学.但是,由于颈椎弓根周围毗邻部特殊的解剖结构,潜在血管、神经根和颈髓损伤的危险性,置入内固定风险及难度大,所以临床应用要做到个体化置钉.%BACKGROUND: More and more scholars have focused on cervical pedicle screws because of their unique three-dimensional stability.OBJECTIVE: To review the anatomic characteristics of the cervical pedicle, and to investigate the safety and clinical application of cervical pedicle screws.METHODS: The literature concerning the cervical pedicle screw internal fixation in recent years were extensively searched from CNKl and PubMed databases (1994-01/2010-09) using the keywords of "cervical pedicle screws" in Chinese and English. Forty-three articles of 292 were included in the result analysis.RESULTS AND CONCLUSION: Cervical pedicle screw fixation can obtain a good biomechanics based on its three-dimensional fixation. However, due to the special anatomic structures of the cervical pedicle adjacent to the surrounding, potential risks of blood vessel, nerve root and cervical spinal cord injuries, it is difficult to the internal fixation of cervical pedicle screws with a certain risk. The clinical application of pedicle screws should be individualized.

  5. 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

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

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    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

  7. C2椎弓根 C3侧块螺钉固定治疗不稳定性 Hangman 骨折%C2 Pedicle Screw C3 Lateral Mass Screw Fixation for Treatment of Unstable Hangman Fracture

    Institute of Scientific and Technical Information of China (English)

    吴磊磊; 邱玉金; 李攀

    2012-01-01

      Objective To evaluate the clinical effect of unstable Hangman fracture treated with C 2 pedicle screw C3 lateral mass screw fixation.Methods From July 2003 to July 2011,32 cases of patients with unstable Hangman fracture were treated in our hospital . Based on Levine-Edwards classification,typeⅡ-14 cases,typeⅡA -15 cases,type Ⅲ -3 cases.All the cases were treated with C 2 pedicle screw C3 lateral mass screw fixation.Results There was no spinal cord and vertebral artery injury or other complications during the opera -tion.All the patients were followed up from 3th to 24th months,average of 13.7months and got bony fusion.The preoperative displacement of C2 ~3 vertebral bodies was (5.7 ±1.3)mm,the postoperative displacement of C 2 ~3 vertebral bodies followed up for 6 months was(2.3 ±1.7) mm,P <0.05;The preoperative angulation of C 2 ~3 vertebral bodies was 12.6°±1.4°,the postoperative angulation of C 2 ~3 vertebral bodies followed up for 6 months was 7.3°±1.7°,P <0.05;based on JOA 17 scores for assessment of spinal cord function ,the preoperative score was 6.3 ±0.3,the postoperative score followed up for 6 months was 13.5 ±1.1,the recovery rate of nervous function was 67%.Conclusion For treatment of unstable Hangman fracture ,C2 pedicle screw C3 lateral mass screw fixation is an effective method .

  8. Bony healing of unstable thoracolumbar burst fractures in the elderly using percutaneously applied titanium mesh cages and a transpedicular fixation system with expandable screws.

    Directory of Open Access Journals (Sweden)

    Anica Eschler

    Full Text Available There is a high incidence of vertebral burst fractures following low velocity trauma in the elderly. Treatment of unstable vertebral burst fractures using the same principles like in stable vertebral burst fractures may show less favourable results in terms of fracture reduction, maintenance of reduction and cement leakage. In order to address these shortcomings this study introduces cementless fixation of unstable vertebral burst fractures using internal fixators and expandable intravertebral titanium mesh cages in a one-stage procedure via minimum-invasive techniques.A total of 16 consecutive patients (median age 76 years, range 58-94 with unstable thoracolumbar burst fractures and concomitant osteoporosis were treated by an internal fixator inserted via minimum invasive technique one level above and below the fractured vertebra. Fracture reduction was achieved and maintained by transpedicular placement of two titanium mesh cages into the fractured vertebral body during the same procedure. Intra- and postoperative safety of the procedure as well as analysis of reduction quality was analysed by 3D C-arm imaging or CT, respectively. Clinical and radiographic follow-up averaged 10.4 months (range 4.5-24.5.Stabilization of the collapsed vertebral body was achieved in all 16 cases without any intraoperative complication. Surgical time averaged 102 ± 6.6 minutes (71-194. The postoperative kyphotic angle (KA and Cobb angle revealed significant improvements (KA 13.7° to 7.4°, p < 0.001; Cobb 9.6° to 6.0°, p < 0.002 with partial loss of reduction at final follow-up (KA 8.3°, Cobb 8.7°. VAS (Visual Analogue Scale improved from 7.6 to 2.6 (p < 0.001. Adjacent fractures were not observed. One minor (malposition of pedicle screw complication was encountered.Cementless fixation of osteoporotic burst fractures revealed substantial pain relief, adequate maintenance of reduction and a low complication rate. Bony healing after unstable osteoporotic burst

  9. 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。

  10. 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

  11. 螺钉置入内固定修复后踝骨折的适应证%Indications for screw fixation of posterior malleolas fractures

    Institute of Scientific and Technical Information of China (English)

    程渊; 高仕长; 倪卫东; 梁安霖

    2015-01-01

    BACKGROUND:Posterior maleolar fractures are often accompanied by ankle joint instability,if the stability of ankle joint is not recovered,it is prone to traumatic arthritis of the ankle.However,the indications of internal fixation of posterior maleolar fractures remain controversial.OBJECTIVE:To explore the indications for internal fixation of posterior maleolar fractures by comparing the clinical effects of posterior maleolar fractures treated with internal fixation or not.METHODS:42 patients with maleolar fractures involving posterior ankle were recruited from the First Affiliated Hospital of Chongqing Medical University from January 2007 to January 2012.According to preoperative CT scans of ankle joint,42 cases were divided into the internal fixation group and the non-fixation group.27 cases in the fixation group had posterior maleolar fractures in more than 10%of the distal tibial articular surface and/or dislocation of the posterior maleolar fractures greater than 2 mm,and were treated with screws.15 cases in the non-fixation group had posterior maleolar fractures in less than 10%of the distal tibial articular surface anddislocation of the posterior maleolar fractures less than 2 mm,and were treated with non-operation.The average healing time of posterior maleolar fractures,postoperative complications,ankle-hindfoot scores of American Orthopedic Foot and Ankle Society were compared during the folow-up postoperatively.RESULTS AND CONCLUSION:Al of 42 patients with ankle fractures achieved bony union within 6 months.In the fixation group,1 case had postoperative superficial infection of the wounds in the medial ankle and lateral ankle,and the wound got healed completely with anti-infection therapy.One case in each group had postoperative superficial necrosis in the incisional edges,and got healed by dress changing.For the other cases,there was no wound infection,internal fixation loosening,breakage or failure and other adverse events during the folow

  12. 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.

  13. 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。

  14. 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.

  15. 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.

  16. 中青年胸腰椎骨折经皮椎弓根钉棒系统短节段内固定术后螺钉断裂浅析%Analysis on Percutaneous Pedicle Screw Rod System With Short Segment Fixation After Screw Fracture in Young Thoracolumbar Fractures

    Institute of Scientific and Technical Information of China (English)

    高飞; 阿日奔吉日嘎啦; 姜富祥; 王兴; 张弘来; 王高强

    2016-01-01

    Objective TTo explore the causes of percutaneous pedicle screw rod system with short segment ifxation after screw fracture in young thoracolumbar fractures.Methods54 cases of thoracolumbar vertebral fracture percutaneous pedicle nail stick system short segment internal fixation in young patients, 4 cases of postoperative screw fracture, the clinical data were retrospectively analyzed.Results in this group of patients appear screw breakage was 7.40%. The main cause of the fracture of the screw for pedicle screw insertion angle deviation, connecting rod camber is too large.Conclusion The mechanical stability and gravity load of the percutaneous pedicle screw rod system are important reasons for the screw breakage.%目的:探讨中青年胸腰椎骨折经皮椎弓根钉棒系统短节段内固定术后螺钉断裂的原因。方法54例行胸腰段椎体骨折经皮椎弓根钉棒系统短节段内固定术的中青年患者中,4例术后发生螺钉断裂,将其临床资料进行回顾性分析。结果本组病例出现螺钉断裂为7.40%,原因为椎弓根钉置入角度不适,连接棒弯度过大。对比剩余50例螺钉未出现断裂病例(P<0.05)。结论经皮椎弓根钉棒系统自身的力学稳定性和重力负荷是导致螺钉断裂的重要原因。

  17. Biomechanics and stability of the spine after implantation with pedicle screw and cervical vertebral screw fixation%椎弓根螺钉及颈椎体螺钉置入内固定后的生物力学及稳定性比较

    Institute of Scientific and Technical Information of China (English)

    刘淼; 尚显文; 宁旭; 庄勇; 许顺恩

    2016-01-01

    BACKGROUND:From the point of view of human anatomy, the load of the spine is more. When the body moves, the range of activities, and activity are relatively large. After screws were implanted in the spine, if biomechanical properties and stability are not up to the standard, it easily leads to lack of grip force of screw and screw loosening so as to increase the incidence of complications after treatment. OBJECTIVE:To compare biomechanical properties and stability of the spine after insertion of pedicle screw and cervical vertebral screw into the spine. METHODS:100 vertebrae under human cervical spine specimens were analyzed and randomly divided into cervical vertebral screw fixation group and pedicle screw fixation group. Cervical vertebral screws and pedicle screws were implanted in lower cervical spine specimens. Electro Force 3510 material testing machine was used to test axial pul-out force, axial pul-out strength after the fatigue loading, and fixed stability. The biomechanical properties and stability were compared after two kinds of screws were implanted in the spine. RESULTS AND CONCLUSION:(1) Instantaneous pul out force and immediate pul out stiffness were significantly higher in the pedicle screw fixation group than in the cervical vertebral screw fixation group (P  目的:对比内固定椎弓根螺钉与颈椎体螺钉置入脊柱后的生物力学性能及其稳定性。  方法:选取100个人体下颈椎椎体标本进行分析,随机分为颈椎体螺钉组与内固定椎弓根螺钉组。分别将内固定椎弓根螺钉与颈椎体螺钉置入人体下颈椎标本中,采用Electro Force 3510材料试验机对标本进行轴向拔出力、疲劳加载后轴向拔出力、固定稳定性等生物力学测试,比较2种螺钉置入脊柱后的生物力学性能及其稳定性。  结果与结论:①内固定椎弓根螺钉组即时拔出力、即时拔出刚度均显著高于颈椎体螺钉组(P<0.05);②2组虽然疲劳

  18. 创伤性颈椎不稳后路钉棒固定重建稳定%Stability reconstruction of traumatic cervical vertebra by screw-rod fixation through posterior approach

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    周章彦; 朱轶; 谢彬; 林义文

    2012-01-01

    Objective To explore the therapeutic effect on treatment of traumatic instability of cervical vertebra by pedicel screw through posterior approach or screw-rod fixation in lateral mass. Methods 30 patients of traumatic cervical vertebra instability were treated with grafting in cervical spinal lamina or between small joints by posterior transpedicular screw through posterior approach or screw-rod fixation in lateral mass. Results All cervical symptoms disappeared after operation and the damaged neurological function of cervical spinal cord were significantly improved. No complication was found in the follow up visits for 3 ~ 52 ( 10 ± 3. 2 ) months. The recovered cervical vertebra of all patients was of well fused and stable without looseness, fracture of interior fixation or displacement of grafting bone; the fracture was well healing and grafting bone was gradually fused with flexion range of extensible i05°±i0.5°, lateral 80° ±7. 2°, and axial rotation 96° ±9. 3°. Conclusions The treatment of the traumatic cervical vertebra by posterior transpedicular screw through posterior approach or screw-rod fixation in lateral mass reveals good reconstructed stability.%目的 探讨颈后路椎弓根钉或侧块螺钉-棒内固定治疗颈椎创伤性不稳临床效果.方法 对30例创伤性颈椎不稳患者行后路椎弓根钉或侧块螺钉-棒内固定,椎板或小关节间植骨.结果 术后颈部症状完全消失,受损颈髓神经功能明显改善.30例均获随访,时间3~52(10±3.2)个月,未发生并发症.颈椎复位良好,序列稳定;无内固定松动、断裂、植骨块移位;骨折愈合好,植骨渐进融合.颈椎伸屈角度105°±10.5°,侧屈角度80°±7.2°,轴向旋转功能96°±9.3°.结论 颈椎创伤性不稳采用经后路椎弓根钉或侧块螺钉-棒内固定治疗能够达到良好的稳定效果.

  19. 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。

  20. 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.

  1. 三种置钉方法在下颈椎经椎弓根螺钉置入过程中的比较%A comparative study on pedicle screw internal fixation to the lower cervical vertebra by three screw place methods

    Institute of Scientific and Technical Information of China (English)

    尹华; 赵银必

    2011-01-01

    背景:目前各种下颈椎椎弓根置钉方法的准确率报道不一,特别是国内常用的椎板部分切除置钉法、Abumi法、管道疏通法缺乏比较.目的:探讨下颈椎(C3~7)经椎弓根螺钉内固定的可行性,比较椎板部分切除置钉法、Abumi法、管道疏通法在置钉满意率、出血量、置钉时间、并发症等方面的差异.方法:选择60例需颈后路经椎弓根螺钉内固定治疗的下颈椎疾患病例,随机分成3组,各置入椎弓根螺钉80枚,分别采用椎板部分切除置钉法、Abumi法及管道疏通法.术中计算各方法置钉时间、出血量;出院前观察置钉满意率及在颈椎椎弓根四壁损伤例数的构成比;比较C3~7每一节段的椎弓根外侧壁损伤发生率.结果与结论:椎板部分切除组、Abumi组及管道疏通组置钉时间依次递减(P 0.05),椎弓根损伤好发生于外壁.C4、C5节段外壁损伤发生率明显高于C3、C6、C7.提示管道疏通法在经颈后路椎弓根螺钉内固定常规置钉法中优势明显.%BACKGROUND: Nowadays there are so many screw place methods in lower cervical vertebra. But they have different accuracy.There was no comparative study on the pedicle screw internal fixation in lower cervical vertebra by three screw place methods such as vertebral plate partial resection screw place method, Abumi place screw method and pipeline dredge method.OBJECTIVE: To explore the feasibility of the pedicle screw internal fixation in lower cervical vertebra (C3-7), and to compare the differences in screw satisfaction rate, blood loss, screw placing time, complications among vertebral plate partial resection screw place method, Abumi screw place method, and pipeline dredge method.METHODS: Totally 60 patients with lower cervical spine disease who needed the pedicle screw internal fixation through cervical posterior approach were chosen and divided into three groups each with 80 pedicle screws by vertebral plate partial resection

  2. A clinical comparative analysis of the treatment between open short-segment pedicle screw fixation and percutaneous short-segment pedicle screw fixation for thoracolumbar fractures%伤椎置钉和经皮短节段固定治疗胸腰段椎体骨折的疗效比较

    Institute of Scientific and Technical Information of China (English)

    杨晓明; 徐宏光; 刘平; 王弘

    2016-01-01

    目的:对比开放伤椎置钉和经皮微创短节段固定治疗胸腰段椎体骨折的近期临床疗效。方法回顾性分析35例胸腰段椎体骨折患者,分为开放伤椎置钉短节段固定组(A 组)和经皮微创短节段固定组(B 组),测量手术前后骨折椎体压缩程度,椎体后凸畸形角度,疼痛视觉模拟评分(VAS)以及术后腰椎功能障碍指数(ODI),统计两组患者住院时间,手术失血和手术时间,并对以上参数进行对比分析。结果两组患者一般资料,术前骨折椎体压缩程度和 VAS 评分差异无统计学意义(P >0.05)。两组患者术后骨折椎体高度均有效恢复(P <0.05),且良好维持,术后 VAS 和 ODI 评分均较术前改善(P <0.05),且 B 组术后 ODI 评分优于 A 组。B 组在手术时间,失血量和住院时间上较 A 组缩短。结论两种手术方式均能有效恢复骨折椎体高度,改善术后功能,但经皮微创短节段固定在手术时间,失血量,住院时间和功能上要优于伤椎置钉短节段固定组。%Objective To comparatively analyze the clinical efficacies of the treatment between open short-segment pedicle screw fixa-tion including the fractured vertebra and percutaneous short-segment pedicle screw fixation for thoracolumbar fractures.Methods A retrospective analysis was made of 35 cases of thoracolumbar fractures which were assigned into open short-segment pedicle screw fixa-tion including the fractured vertebra(group A)and minimally invasive percutaneous short-segment pedicle screw fixation group(group B).The compression percentage of the fractured vertebra,vertebral kyphosis angle,visual analogue scale(VAS)of back pain and Oswe-stry Disability Index(ODI)were measured before and after surgery.Hospitalized time,blood loss and surgical time were also compara-tively analyzed between the two groups.Results The demographic data,compression percentage of vertebral

  3. 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

  4. 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.

  5. 距骨颈骨折螺钉固定的三维有限元分析%Three dimensional finite element analysis of talar neck fracture with screw fixations

    Institute of Scientific and Technical Information of China (English)

    田文; 王富明; 黄俭; 陈璐瑶; 杨芳梅

    2013-01-01

    目的 通过三维有限元法对距骨颈骨折不同螺钉内固定方式进行对比评价,比较不同内固定方式生物力学稳定性,为临床应用提供理论依据.方法 利用CT扫描数据,根据距骨颈骨折不同的内固定方式,建立距骨颈骨折内固定三维有限元模型,研究不同内固定von Mises应力分布和骨折面接触压力及张开位移,分析骨折固定后生物力学稳定性.结果 获得距骨颈骨折不同内固定固定有限元模型,静止站立和踝关节背伸时,不同内固定生物力学稳定性不同,双螺钉由前向后固定螺钉的应力及骨折面张开位移较小,骨折面压力较大.结论 利用双螺钉由前向后固定距骨颈骨折,可以取得较好的生物力学稳定性.%Objective To explore the biomechanical properties of different internal fixations for talar neck fracture through three dimensional finite element ( FE ) analysis and therefore to provide scientific foundation for clinic application. Methods CT scan data were used to develop FE models of the talar neck fracture with different fixations. The different fixations were compared for stress and strain, the fracture surface contact pressure and contact gap were also compared for analysing the biological mechanical stability of different internal fixations. Results The FE models of the talar neck fracture with different fixations were developed. Finite element simulation showed differences between the different fixations with regard to the distributions of stress and contact gap at the fracture surfaces and the von Mises stress in the implant. Anterior to posterior fixation using two screws were shown maximum von Mises stress in the implants, maximum contact press and minimum contact gap in contact surface. Conclusions Anterior to posterior fixation using two screws exhibits fine fixation stability for talar neck fracture.

  6. Simultaneous anterior and posterior screw fixations confined to the axis for stabilization of a 3-part fracture of the axis (odontoid, dens, and hangman fractures): report of 2 cases.

    Science.gov (United States)

    Shinbo, Jun; Sameda, Hiroaki; Ikenoue, Sumio; Takase, Kan; Yamaguchi, Takeshi; Hashimoto, Eiko; Enomoto, Takahiro; Kanazuka, Aya; Mimura, Masaya

    2014-03-01

    Fractures of the axis are considered to be one of the most common injuries to the cervical spine, accounting for more than 20% of all cervical spine fractures. Multiple fractures of the axis are much rarer, accounting for 1% of all cervical fractures. Management of such complex fractures is still challenging, and there is no strong consensus for the treatment. The authors describe the cases of 2 patients who presented with 3-part fractures of the axis consisting of an odontoid Type II fracture and a Levine-Edwards Type IA fracture, which were treated with concurrent insertion of an anterior odontoid screw and bilateral posterior pedicle screws. The cases presented were characterized by 1) a Type II odontoid fracture; 2) a Type IA traumatic spondylolisthesis with no or a little translation and angulation of C-2 on C-3 in a ring fracture of the axis; and 3) no disorders at the C2-3 disc on MR images. Therefore, the authors performed surgery confined to the axis by concurrently inserting an anterior odontoid screw and posterior bilateral pedicle screws without arthrodesis of C2-3. This was followed with cervical soft collar fixation for only 1-2 weeks. The outcomes were favorable, including good osteosynthesis, high primary stability, early patient mobilization, and preserved range of motion of the cervical spine at C2-3 as well as at C1-2.

  7. 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

  8. 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。

  9. Treatment of pedicle screw rod system internal fixation on sacroiliac joint fracture and dislocation%椎弓根钉棒系统固定治疗骶髂关节骨折及脱位分析

    Institute of Scientific and Technical Information of China (English)

    唐理英

    2013-01-01

    Objective To analyze the treatment effects of the iliac screw and pedicle screw rod internal fixation on sacroiliac joint fracture and dislocation and discuss the clinical application value of the pedicle screw rod system in fixation of sacroiliac joint. Methods The double plates fixation via posterior approach was adopted for the patients with sacroiliac joint fracture and dislocation in the control group (n=24),while the iliac screw and pedicle screw rod system internal fixation was adopted for the patients with sacroiliac joint fracture and dislocation in the treatment group (n=24).The clinical effects of the surgeries and the postoperative follow-up of the two groups were compared. Results There were no significant differences (P < 0.05) of the operation time,intraoperative blood loss and fracture healing time between the two groups; All the patients were followed up for 12-18 months. The Majeed score of the treatment group was 95.8%(23/24), which was better than the control group (70.8%(17/24))with significant difference (P<0.05). Conclusion The treatment effect of the iliac screw and pedicle screw rod internal fixation on sacroiliac joint fracture and dislocation is good,which can recover the normal function of joint to the greatest degree and improve the patient’s quality of life.%  目的分析应用髂骨钉与椎弓根钉棒内固定治疗骶髂关节骨折、脱位的治疗效果,探讨椎弓根钉棒系统固定骶髂关节的临床应用价值。方法对照组(n=24)骶髂关节骨折、脱位采用后路双钢板固定治疗,治疗组(n=24)为骶髂关节骨折、脱位患者采用髂骨钉与椎弓根钉棒系统固定术治疗,对比两组的手术临床效果及术后随访情况。结果两组的手术时间、术中出血量、骨折愈合时间均无显著性差异(P<0.05);所有患者均随访12~18个月, Majeed评分治疗组优良率为95.8%(23/24),明显优于对照组的70.8%(17/24),两

  10. 齿状突螺钉钢板内固定系统的生物力学研究%A biomechanical evaluation of odontoid screw plate fixation system

    Institute of Scientific and Technical Information of China (English)

    胡勇; 董伟鑫; 孙肖阳; 袁振山; 张蛟; 谢辉; 邬春晖

    2016-01-01

    目的 评价自行设计的齿状突螺钉钢板内固定系统在治疗Ⅰ型Hangman骨折伴Ⅱ型齿状突骨折联合C2~C3椎间盘损伤时的生物力学性能.方法 选取8具新鲜尸体颈椎标本(包括C1~C3颈椎节段),在生物力学试验机上依次测试以下各组C1~C2及C2~C3节段的三维运动范围(ROM)值及中性区值:完整标本状态(A组);失稳状态:Hangman Ⅰ型骨折+Ⅱ型齿状突骨折+C2~C3椎间盘切除(B组);颈椎前路钢板+齿状突螺钉+ cage固定组(C组);齿状突螺钉钢板固定组(D组);后路C2~C3椎弓根侧块螺钉+齿状突螺钉固定组(E组)和后路C1~C3椎弓根侧块螺钉固定组(F组),并对结果进行统计学分析.结果 在C1~C2节段,D组和F组的ROMC1~c2值在各个方向上差异均有统计学意义(P<0.05).在C2~C3节段,D组与C组相比,ROMC2~c3值在各个方向上均较小,且差异有统计学意义(P<0.05);D组与E、F组相比,ROMC2~C3值在前屈、后伸方向上较小,且差异有统计学意义(P<0.05).结论 齿状突螺钉钢板内固定系统在治疗Hangman Ⅰ型骨折伴Ⅱ型齿状突骨折联合C2~ C3椎间盘损伤时具有良好的生物力学性能,可以作为治疗此类合并伤的一种补充方法.%Objective To evaluate the biomechanical stability of anterior odontoid screw plate (AOSP).Methods Eight fresh-frozen cadaveric cervical spine specimens were subjected to stepwise destabilization of the C1-Ca complex,simulating a type Ⅰ Hangman fracture,type Ⅱ odontoid fracture,and the C2-3 disc injury.Intact specimens,fractured specimens,and fractured specimens with posterior,anterior fixation techniques were divided into six groups:control group (intact),injury group of type Ⅱ odontoid fracture and type Ⅰ Hangman fracture combined with C2-3 disk injury,after anterior cervical plate + odontoid screw + cage (ACP + OS + cage) group,after anterior odontoid screw plate (AOSP) fixation system group,after affixing rods from

  11. 经皮内固定术与传统后路开放内固定术治疗胸腰椎骨折不良事件比较的Me ta分析%Comparison of the adverse events of percutaneous pedicle screw fixation and traditional open pedicle screw fixation for thoracolumbar fractures:a Meta-analysis

    Institute of Scientific and Technical Information of China (English)

    孙祥耀; 海涌; 张希诺

    2016-01-01

    常差异无统计学意义(OR=1.04,95%CI:0.43~2.56,P=0.92),术后感染差异无统计学意义(OR=0.39,95%CI:0.12~1.26,P=0.12)。结论 PPSF能够缩短手术时间、减少手术出血量、减小手术创伤等,能够达到与TOPSF相似的置钉准确度,保证手术安全性,有效的保护周围软组织,减少术后Cobb角矫正度的丢失,降低术后疼痛及功能恢复异常等不良事件的发生率。%Objective To systematically review the adverse events of percutaneous pedicle screw fixation (PPSF)and traditional open pedicle screw fixation (TOPSF)for thoracolumbar fracture,in order to provide more evidence for the effective treatment of thoracolumbar fracture.Methods Databases including Pubmed,Cochrane Central Register of Controlled Trails (CENTRAL),and Embase were retrieved with computer.Journal ofBone and Joint Surgery,Spine, and European Spine Journal were manually searched.The searching terms were thoracolumbar fracture,lumbar frac-ture,percutaneous pedicle screw fixation,open fixation,posterior surgery,sextant,traditional fixation,conventional fixation,minimally invasive surgery,comparative study,randomized controlled trail,and clinical trail.Data were then screened,extracted,assessed,and analyzed with RevMan 5.3 software.Results A total of 18 studies including 4 ran-domized controlled trials,3 prospective comparative studies,1 1 retrospective comparative studies were enrolled,invol-ving 1 ,034 patients.Meta-analysis showed that the PPSF group,compared with the TOPSF group,had shorter surgery time (WMD= -0.95,95%CI:-1.33--0.57,P<0.001),less intraoperative blood loss (WMD= -2.97,95%CI:-3.69--2.25,P<0.001),less postoperative drainage amount (WMD= -2.43,95%CI:-3.04--1.83,P<0.001),shorter hospital stay (WMD= -5.37,95%CI:-6.69--4.05,P<0.001),less time from surgery to walk-ing (WMD= -2.51,95%CI:-3.66--1.36,P<0.001),less overall postoperative visual analogue scale (WMD=-1.14,95%CI:-1

  12. 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.

  13. 应用皮质支撑原理固定股骨颈骨折的生物力学研究%Biomechanical study on femoral neck fracture fixation based on cortical screw support theory

    Institute of Scientific and Technical Information of China (English)

    王立江; 魏海强; 郭连江; 黎宁; 彭阿钦

    2009-01-01

    Objective To evaluate the biomechanical effect of cortical screw support technique in fixation of the femoral neck fractures. Methods The models of subcapital femoral neck fracture were made in eight matched pairs of embamled cadaver femurs and decided into experiment group and control group (four pairs per group). The side of experiment group was fixed using three cannulated compression screws with cortical screw support and that of control group with conventional screw placement. The speci-mens in two groups were tested in aspects of torsion and axial loading. Results In axial load test at load of 600 N and 800 N, the displacements in cortical screw support group were (0.677±0.135) mm and (0.907±0.132) mm respectively, while those of femoral head in conventional screw placement group were (0.899±0.160) mm and (1.202±0.152) nun respectively (P <0.05). There was signifi-cant difference between the two groups (P < 0.05). The maximal vertical loading for failure of the fixa-tion was (2 782±228) N in cortical screw support group and (1 950±281) N in conventional screw placement group (P < 0.01). In torsibility test at 4° and 6° torsibility, the torque-moments of cortical screw support group were (10.406±1.515) Nm and (15.328 ±1.471) Nm respectively and those of conventional screw placement group (6.628±1.163) Nm and (9.072±1.570) Nm respectively, with statistical difference between two groups (P <0.01). The maximal torque-moment for failure of the fixa-tion was (25.437±5.213) Nm in cortical screw support group and (13.235±3.012) Nm in conven-tional screw placement group (P < 0.01). Conclusion Fixation of femoral neck fractures by using cortical screw support can significantly enhance anti-torsion and anti-compression of internal fixation.%目的 根据皮质支撑的方法 ,探讨应用空心螺钉固定股骨颈骨折的生物力学效果.方法 选择8具成人防腐股骨标本,用随机数字表法分成两组,每组4具,制成股

  14. 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.

  15. 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.

  16. 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

  17. 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.

  18. 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

    2014-01-01

    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. PMID:25034732

  19. 镁合金中空螺钉内固定齿状突ⅡA型骨折生物力学研究%Biomechanical study of magnesium alloy hollow screws in fixation of type Ⅱ A odontoid process fracture

    Institute of Scientific and Technical Information of China (English)

    王志坤; 夏虹; 谢文伟; 曾兴栋; 马立敏; 张余

    2013-01-01

    Objective To develop a new magnesium alloy hollow screw for anterior fixation of the type Ⅱ A odontoid process fracture and peffor a biomechanical study.Methods Thirty fresh human atlas specimens,according to age,gender,dentate size pairs were divided into 2 groups:magnesium alloy,titanium alloy screws screws group.Two groups of axis odontoid fractures type Ⅱ A were cut by sawing,causing uniform odontoid fracture model.Magnesium alloy titanium alloy screws were used for fixation.On the biomechanics machine the load-displacement relationship of odontoid process,torque and pullout force-displacement relationship in different vertical load were measured.Results Loaded with different vertical loads acting on the odontoid sagittal plane,when the load was <400 N,no significant displacement difference between the two groups (P >0.05),when the displacement difference load >500 N fracture had statistical significance (P <0.05).No statistical significance when the neck by <100 N/mm torque of two materials screw fixation of odontoid displacement difference (P >0.05),but the difference was statistically significant when the torque of the >200 N/mm (P <0.05).Conclusion Magnesium alloy hollow screw fixation of odontoid process fracture of type Ⅱ A in the end is enough to prevent a before and after the shift occurred,but the anti-torsion ability is poor,suggest that postoperative neck support brake.%目的 研制应用于齿状突ⅡA型骨折前路内固定的新型镁合金中空螺钉,并进行生物力学研究.方法 将30个新鲜人体枢椎标本,根据年龄、性别、齿状突大小配对分为2组:镁合金螺钉组、钛合金螺钉组.将2组枢椎按齿状突ⅡA型骨折锯断,造成统一齿状突骨折模型,分别用镁合金螺钉、钛合金螺钉固定,在生物力学机上测量不同垂直负荷下齿状突载荷-位移关系、扭矩-位移关系及最大拔出力.结果 分别加载不同垂直负荷作用于齿状

  20. Treatment of sacroiliac joint dislocation with percutaneous sacroiliac screw internal fixation%经皮骶髂螺钉内固定治疗骶髂关节脱位

    Institute of Scientific and Technical Information of China (English)

    陈红卫; 赵品益; 楼舒畅; 赵胜春; 陈欣; 赵钢生; 叶招明; 潘骏

    2008-01-01

    Objective To analyze the clinical effect of percutaneous sacroiliac screw internal fixation in treatment of sacroiliac joint dislocation. Methods From June 2002 to August 2006,16 patients with sacroiliac joint dislocation were treated with percutaneous sacroiliac screw internal fixation under C-arm X-ray tomography.There were 10 males and 6 females at age range of 10-58 years(mean 34.3 years).Results The operation lasted for 30-90 minutes(average 50.5 minutes).All patients were followed up for 12-36 months(average 18.3 months).The results of postoperative normotopia,lateral,ingate and egress Xray and CT scanning showed that all the screws were located within S1 and S2 of all,14 patients obtained satisfactory result of reduction,with no infection,nerve injuries,loosening or breakage of the screw fixation.The function and the sensation of the sacroiliac ioint and low extremities recovered to normal. Conclusions Percutaneous sacroiliac screw intemal fixation is an ideally safe and effective way to treat sacroiliac joint dislocation,for it has many advantages such as minimal invasion,reliable fixation,less complication and quick recovery.It is also very necessary to take caudad and cephalad view under an image intensifier during the operation to assure the accuracy of implantation.%目的 分析经皮骶髂螺钉内固定治疗骶髂关节脱位的临床疗效.方法 对2002年6月-2006年8月16例骶髂关节脱位患者的临床资料进行回顾性分析,其中男10例,女6例;年龄10~58岁,平均34.3岁.所有患者均在C形臂X线机监测下经皮骶髂螺钉内固定.结果 手术时间为30~90 min,平均50.5 min.术后行骨盆正位、侧位、人口位、出口位X线片和CT扫描,螺钉均位于S1、S2椎体内.16例均获得12~36个月(平均18.3个月)随访.14例骨折复位良好,无切口感染,无术中血管神经损伤,无内固定松动及断裂,腰骶及下肢活动、感觉均正常.结论 经皮骶髂螺钉内固定治疗骶髂关节脱

  1. Dynamic Hip Screw Fixation Combined of Oral Medicine Treating Intertrochanteric Fracture%动力髋螺钉固定术配合口服中药治疗高龄股骨粗隆间骨折

    Institute of Scientific and Technical Information of China (English)

    徐爱民

    2012-01-01

    目的:探讨采用动力髋螺钉(DHS)固定术配合口服中药治疗高龄股骨粗隆间骨折的方法和疗效.方法:对2004年1月—2009年1月收治的股骨粗隆间骨折患者进行手术治疗.其中男25例,女21例,年龄65~83岁,平均年龄73岁,采用动力髋螺钉(DHS)固定术.结果:1例病人术后3天出现患肢深静脉血栓,经活血、溶栓治疗后恢复.2例因其他疾病死亡,43例骨折均全部愈合,已恢复原来生活能力,无内固定物松动及髋内翻畸形等并发症.结论:动力髋螺钉(DHS)固定术配合口服中药治疗高龄股骨粗隆间骨折具有操作简单、时间短、固定可靠、损伤小、出血少、骨折愈合率高、并发症少等优点,是值得推广应用的手术方法[1].%Objective:To investigate the method and effect of the dynamic hip screw ( DHS )fixation of intertrochanteric fracture. Methods; During January 2004-January 2009, patients admitted because of intertrochanteric fractures were treated surgically, including 25 males and 21 females, aged 65 to 83 years old, mean age was 73, using dynamic hip screw ( DHS ) fixation. Results: 3 days after surgery, 1 case limb deep vein thrombosis occurs, the blood circulation restored after thrombolytic therapy. 2 patients died due to other diseases,43 cases of fracture were all healed and returned to the original capacity, no loosening of internal fixation, or complications such as varus deformity. Conclusion: The dynamic hip screw ( DHS ) fixation combined with oral medicine treatment of intertrochanteric fracture is simple, treatment course is short, fixed and reliable, with less damage, less bleeding, high fracture healing rate, fewer complications, and is worthy of promoting application for the surgical method[1].

  2. 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.].

  3. A 10-year follow-up of transpedicular screw fixation and intervertebral autogenous posterior iliac crest bone graft or intervertebral B-Twin system in failed back surgery syndrome

    Science.gov (United States)

    Cincu, Rafael; Lorente, Francisco de Asis; Gomez, Joaquin; Eiras, Jose; Agrawal, Amit

    2015-01-01

    Background: The spine surgeons have been combining anterior and posterolateral fusion (circumferential fusion) as the final solution to treat spinal disorders and many have been using it to treat failed back surgery syndrome (FBSS). In present study, we analyzed and compared the clinical and radiological outcomes in patients with transpedicular screw fixation and intervertebral autogenous posterior iliac crest bone graft or in patients with transpedicular screw fixation and intervertebral B-Twin system for FBSS with a follow-up period of 10 years after the surgery. Materials and Methods: This study was a retrospective case study performed on 55 patients with FBSS. Clinical and radiological changes were compared between the two groups of patients on the basis of improvement of back pain, radicular pain, and work capacity. Outcome was measured in terms of Oswestry Low Back Pain Disability Index, and the changes in pain and function were documented every year from before surgery until 2012. We analyzed the evolution of 55 cases of FBSS those underwent segmental circumferential posterior fusions from June 2001 to February 2003, operated by a single surgeon and followed up during 10 years until February 2012. The patients were divided into 2 groups: In 25 patients, posterolateral fusions with Legacy™ (Medtronic, Inc. NYSE: MDT) screws and intersomatic autogenous posterior iliac crest bone graft was performed, and, in 30 patients, posterolateral fusions with the same screws and intersomatic fusion B-Twin (Biomet Spain Orthopaedics, S.L.) system was performed. In all cases, we used posterior lumbar interbody fusion (PLIF)/transforaminal lumbar interbody fusion (TLIF) approach for intervertebral graft, and the artrodesis was supplemented at intertransverse level with Autologus Growth Factor (AGF-MBA INCORPORADO, S.A.). The outcome was measured in terms of Oswestry Low Back Pain Disability Index, and the changes in pain and function were documented every year and compared

  4. 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.

  5. Atlantoaxial stabilization using multiaxial C-1 posterior arch screws.

    Science.gov (United States)

    Donnellan, Michael B; Sergides, Ioannis G; Sears, William R

    2008-12-01

    The authors present a novel technique of atlantoaxial fixation using multiaxial C-1 posterior arch screws. The technique involves the insertion of bilateral multiaxial C-1 posterior arch screws, which are connected by crosslinked rods to bilateral multiaxial C-2 pars screws. The clinical results are presented in 3 patients in whom anomalies of the vertebral arteries, C-1 lateral masses, and/or posterior arch of C-1 presented difficulty using existing fixation techniques with transarticular screws, C-1 lateral mass screws, or posterior wiring. The C-1 posterior arch screws achieved solid fixation and their insertion appeared to be technically less demanding than that of transarticular or C-1 lateral mass screws. This technique may reduce the risk of complications compared with existing techniques, especially in patients with anatomical variants of the vertebral artery, C-1 lateral masses, or C-1 posterior arch. This technique may prove to be an attractive fixation option in patients with normal anatomy.

  6. 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

  7. "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

  8. 骨水泥并椎弓根螺钉脊柱内固定的力学效应%Biomechanics Effect of Pedicle Screw with PMMA in Internal Fixation of Spine

    Institute of Scientific and Technical Information of China (English)

    吉浩宇; 霍洪军

    2011-01-01

    Objective To evaluate the effect of the strength of pedicle screw fixation with PMMA in human spine,to observe effect of pedicle screw with PMMA and revision with PMMA so as to provide basis for clinic.Methods Thirty fresh frozen adult vertebras were used,and were randomly divided into 2 groups,each which have 15 ones, and each which have 4 sides vertebral pedicle,which was named “A” side、“B”side、“C” side、and “D” side.All vertebras were good.One track was made in each “A”and “B” vertebral pedicle,then was drilled with tap.Before pedicle screw fixation,each track of “A” side was augmented with PMMA as testing side,then,“A” and “B” sides were served as contral with the pedicle screws ,which were size of 5.5 mm/40 mm.The vertebral pedicles of “C” side,which were drilled with tap,which were size of 5.5 mm、6.25 mm、and 7.0 mm,were augmented by PMMA,and finally, the 5.5 mm/40 mm screws were implanted in it.The vertebral pedicles of “D” side weredrilled with tap,which were size of 5.5 mm、6.25 mm、and 7.0 mm、then,the 7.0 mm/55 mm screws were implanted in it.The specimens were examined,and were good.Maximum incision strength was tested on both sides of eath vertebral body through electronical borer.Finally,data obtained in experiment was analyzed.Results Maximum strength was (805±64) N in “A” side, (1 198± 122) N in “B” side, (1 175±203) N in “C” side,and (953±97) N in “D” side.The differences between “A” side and “B” side were significant(P<0.05,the differences between “C” side and “D” side were significant(P<0.05),that showed that the effect of revision with PMMA was better than with the bigger screw,and that the effect of augmentation with PMMA was better than fixation with only screw.Conclusion Inner fixation through vertebral pedicle following augmentation and restoration with PMMA were the more firm,that had the effect of preventing from screw destroying vertebras, and

  9. 经后路寰枢椎椎弓根螺钉固定融合术治疗寰枢椎失稳%Atlanto-axial pedicle screw fixation through posterior approach for treatment of atlanto-axial joint instability

    Institute of Scientific and Technical Information of China (English)

    左春光; 刘夏君; 王新虎; 王建顺

    2013-01-01

    Objective:To discuss the therapeutic effects of the atlantoaxial pedicle screw system fixation in treatment of atlantoaxial instability. Methods:From June 2003 to March 2010,32 patients with atlantoaxial instability were treated by atlantoaxial pedicle screw system fixation, included 21 males and 11 females wiht an average age of 42.5 years old ranging from 28 to 66 years. Among them, 18 cases were odontoid process fractures,7 were congenital dissociate odontoid process,4 were Jefferson fracture combined with odontoid fracture, 3 were rheumatic arthritis causing atlantoaxial instability. All patients suffered from the atlantoaxial subluxation and atlantoaxial instability. The JOA score ranged from 4 to 14 (means 9.1±0.3) before operation. The patients had some image examination including the X-ray of cervical vertebrae (include of dynamic position film) ,spiral CT 3D reconstruction and/or MRI. The position of pedicle screw system implantation,the angle of pedicle screw system implantation and screw length were measured. Operating skull traction. Operation undewent general anesthesia, implanted the pedicle screw, reduction and bone fusion under direct vision. The bone was fixated between posterior arch of atlas and lamina of axis by the lateral combination bended to posterior. Results:One hundred and twenty-eight atlantoaxial pedicle screws were implanted in 32 patients. No patient had the injure of spinal cord,nerve root and vertebral artery. All patients were followed-up from 6 to 48 months (averaged 16 months). After operation,the JOA score ranged from 11 to 17 (averaged 15.9± 0.2) ,improvement rate was 86.1%. The fracture of odontoid process were healing completely. All fusion bone were combinated. The internal fixation wasn't loosening and breaking. Conclussion:The atlantoaxial pedicle screw system fixation was effective method to treat atlantoaxial instability. The method had many advantages, such as provide rigid and short segment fixation, safe and simple

  10. 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.

  11. 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

  12. 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.)

  13. 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.

  14. Anatomical parameters for percutaneous lag screw fixation of the sacroiliac joint%骶髂关节经皮拉力螺钉固定钉道参数的解剖学测量

    Institute of Scientific and Technical Information of China (English)

    游景扬; 王钢; 黎润光; 陈滨; 任高宏; 杨建涛; 刘善宇

    2010-01-01

    Objective To provide anatomic evidence for iliosacral screw fixation at the pedicle level of the first sacral vertebra(S1).Methods Virtual three-dimensional models were reconstructed on the basis of computed tomography(CT)scans obtained from 50 adult patients without any bony problem.The percutaneous lag screw fixation of the sacroiliac joint was simulated.The width and height of the S1 pedicle,the optimal entry points for iliosacral screws on the outer posterolateral ilium,the directions of screws,and the distances from the entry point to the contrary anterior cortex of the S1 vertebral body and to the posterior superior lilac spine were measured.Results The width and height of the S1 pedicle were(20.43 ±1.63)mm and(20.26±0.99)mm,respectively.The optimal entry points of the 2 iliosacral screws were on both above the line between the anterior superior iliac spine and the posterior superior iliac spine.The distances to the posterior superior lilac spine were(49.87 ± 6.80)mm and(51.11 ± 7.15)mm,respectively.Iliosacral screws got into the S1 pedicle in parallel,perpendicular to the outer posterolateral ilium,with 18.35°± 5.20°to the coronal plane and 77.62°± 3.98° to the sagittal plane.The distances from the entry points of 2 iliosacral screws to the contrary anterior cortex of S1 vertebral body were(76.08 ± 4.32)mm and(77.62 ± 3.98)mm,respectively.Differences in length,the width and height of the S1 pedicle,distance to the posterior superior iliac spine and angle to the coronal plane of the iliosacral screws between men and women were of statistical significance(P <0.05).Conclusions Two iliosacral screws of 6.5 mm in diameter can be implanted at the level of the first sacral vertebra in healthy adults.The anatomic parameters measured can be applied in design of the surgical navigation template for percutaneous lag screw fixation of the sacroiliac joint.%目的 为经S_1椎弓根水平骶髂关节拉力螺钉固定术提供应用解剖学依据.方法 2008

  15. Optimum Configuration of Cannulated Lag Screws for the Fixation of Femoral Neck Fractures:A Biomechanical Study%空心钉在股骨颈中构型的生物力学研究

    Institute of Scientific and Technical Information of China (English)

    王世坤; 王志义; 刘振宇

    2011-01-01

    Objective To determine which of configurations,a inverse triangular configuration and an upright triangular configuration,provide significantly improved fixation strength for fixation of femoral neck fractures with three cannulated lag screws. Methods Eight pairs of femurs were selected. A osteotomy was made. One femur of each pair was randomly selected for stabilization using cannulated lag screws in either an inverse triangular configuration or an upright triangular configuration. An Universal Material Testing Machine was used to apply vertical loads directly onto the femoral head. At each applied load, the inferior femoral head displacement reading and shearing displacement of the osteotomy were recorded. Results The inverse triangular configuration group sustained a higher (P<0. 05) average ultimate load to failure (3375 N) than did specimens in the upright triangular configuration (2725 N). At a load of 8 0 0 N , the average shearing displacement was less for specimens stabilized in the inverse triangular configuration (39. 1 μm) than for those stabilized in the upright triangular configuration (93. 1 μm;P<0. 05). Conclusion Three cannulated lag screws placed in the inverse triangular configuration provide significantly improved fixation strength compared with three screws placed in the upright triangular configuration for fixation of femoral neck fractures without posterior comminution.%目的 通过生物力学实验探讨空心钉固定股骨颈骨折时,3枚螺钉的构型对固定强度和稳定性的影响.方法 选取25~70岁尸体股骨8对,左右股骨随机分成两组.倾角50°截骨,3枚空心钉分别呈正三角和倒三角构型固定股骨颈骨折.生物力学实验机对股骨-螺钉复合体进行线性递增的加载,同时测量股骨头的位移和沿截骨面的剪切化移.结果 倒三角形构型的空心固定组较正三角形组具有更高的极限负荷和抗剪切能力,差异有统计学意义(P<0.05).结论 对于无

  16. Transpedicular screw fixation system for treatment of unstable fractures of arias vertebra%经后路单纯寰椎椎弓根螺钉内固定治疗不稳定性寰椎骨折

    Institute of Scientific and Technical Information of China (English)

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

    2011-01-01

    目的 探讨经后路单纯寰椎椎弓根螺钉内固定治疗不稳定性寰椎骨折的临床疗效.方法 2007年3月~2010年4月,采用经后路寰椎椎弓根螺钉内固定治疗不稳定性寰椎骨折患者23例,其中8例为后3/4 Jefferson骨折;12例患者为半环Jefferson骨折;3例患者为后1/2 Jefferson骨折.患者均有不同程度的颈枕区疼痛,活动受限;日本骨科协会(Japanese Orthopaedic Association,JOA)评分为7~12分,平均9.5分.结果 所有患者随访12~39个月,平均18.8个月.手术时间为30~60 min,出血量为50~200 mL.术后X 线片及CT 示1例一侧寰椎椎弓根螺钉部分进入椎动脉孔,1例螺钉一侧偏内致椎弓根内侧皮质破裂,但均无神经症状,其余螺钉位置良好.术后JOA评分13~17分,平均14.7分.未发生与螺钉相关的神经血管并发症,无内固定松动或断钉现象,所有患者术后随访时均已达到骨性融合,寰枢关节旋转功能良好.结论 寰椎后路椎弓根螺钉技术是治疗不稳定性寰椎骨折的有效方法.%Objective To study the clinical outcomes of transpedicular screw fixation system for treatment of unstable fractures of the atlas vertebra. Methods From March 2007 to April 2010, transpedicular fixation was employed to treat 23 patients with unstable fractures of the atlas vertebra; the patients included l5 males and 8 females. Eight patients had posterior 3/4 Jefferson fracture, 12 had 1/2 ring Jefferson fracture and 3 had posterior 1/2 Jefferson fracture. The preoperative Japanese Orthopaedic Association(JOA) score was 7-12, with an average of 9.5. All patients were treated by single transpedicular fixation via the posterior approach. Results The patients were followed up for 12-39 months, with a mean of 18.8 months. The operative time ranged 30-60 min. Intraoperative blood loss ranged from 50-200 mL. Postoperative roentgenoghaph and CT scan showed that 1 screw was inserted so medially and penetrated the spinal canal, and 1

  17. 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。

  18. Complicaciones de los tornillos de bloqueo intermaxilar en el tratamiento de las fracturas mandibulares Complications of self-tapping bone screws for maxillomandibular fixation in the treatment of jaw fracture

    Directory of Open Access Journals (Sweden)

    J. Molina Montes

    2008-08-01

    Full Text Available Durante la última década se ha introducido el tornillo de bloqueo intermaxilar como método de fijación maxilomandibular en el tratamiento de las fracturas de mandíbula. El propósito del estudio es evaluar las complicaciones de la técnica y la yatrogenia dental que derivan de su aplicación durante un periodo de 4 años. Se han revisado un total de 62 pacientes y 272 tornillos y, aunque han aparecido complicaciones, su incidencia es baja.In the last decade, self-tapping bone screws have been used widely as a temporary maxillomandibular fixation method in the treatment of jaw fractures. The purpose of the present study was to evaluate the complications of the technique and potential dental iatrogenesis over a period of 4 years. We reviewed a total of 62 patients and 272 screws. Although complications appeared, the complication rate was low.

  19. Pedicle screw fixation and posterior lumbar interbody fusion in treatment of lumbar spondylolisthesis%椎弓根固定加椎间植骨治疗腰椎滑脱症

    Institute of Scientific and Technical Information of China (English)

    李源

    2008-01-01

    目的 探讨经后路椎弓根螺钉复位固定加椎体间植骨融合治疗腰椎滑脱的疗效.方法 采用椎弓根内固定系统,手术复位固定后,从两侧进入椎间隙取出椎间盘及纤维环,取髂骨块植骨融合.结果 29例患者获得随访,平均随访时间16个月(9~26个月).26例症状完全消失或缓解,优良率89.6%.结论 椎弓根固定系统加椎间植骨治疗腰椎滑脱症效果满意.%Objective To discuss the efficacy of reduction and fixation by pedicle screw system and iliac dowel graft placement in the treatment of lumbar spondylolisthesis.Methods From January 2003 to Decmber 2006.29 cases with lumbar spondylolisthesis were treated with pedicle screw system and iliac dowel graft placement.Results Twenty-nine patients were followed up from 9-26 months(16 months On average).26 cases were healed or alleviated.The excellent rate was 89.6%.Conclusion This technique has been found to be a safe,rapid effective procedure for lumbar spondylolisthesis and satisfaction.

  20. 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

  1. 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.

  2. Multiaxial inter-vertebral and vertebral pedicle pedicle screw fixation for spinal fractures: a biomechanical comparative study%经伤椎与跨伤椎万向钉置钉固定脊柱骨折的生物力学对比研究

    Institute of Scientific and Technical Information of China (English)

    王洪伟; 周跃; 李长青; 刘涛; 赵卫东

    2010-01-01

    Objective To compare the biomechanical stability of the multiaxial inter-vertebral and vertebral pedicle screw fixation in vertebral fracture fixation of the spinal fracture model. Methods Six lumbar fracture models were made on fresh calf lumbar spine specimens at L1 -L5 to compare the stability of four transpedicular multiaxial screws and six transpedicular multiaxial screws by examining the range of motion (ROM) in flexion, extension, lateral bending and torsion. Results Biomechanical experiment found that four multiaxial screws transpedicular fixation specimen exhibited a significantly larger ROM in flexion and extension than the intact specimens; while six multiaxial transpedicular screw fixation specimen exhibited a smaller ROM than the intact specimens (t =4. 844,P <0. 01 ;t =3. 722,P <0.05 ). The ROM of six multiaxial transpedicular screw fixation specimen was significantly smaller than that of four multiaxial transpedicular screw fixation specimen in flexion, extension, lateral bending and rotation ( P < 0. 01 ). Conclusions Compared with four multiaxial transpedicular screw fixation, six multiaxial transpedicular screw fixation exhibits a significantly larger stability in flexion, extension, lateral bending and rotation, as provides theoretical basis for treatment of thoracolumbar fractures with pedicular screw fixation.%目的 对比评估经伤椎6钉与跨伤椎4钉固定脊柱骨折的生物力学稳定性.方法 6具新鲜冰冻小牛腰椎标本L1~L5节段,制备成腰椎前中柱损伤模型.比较4钉固定组与6钉固定组的三维6个方向的运动范围.结果 生物力学试验证实,4钉固定组在屈曲、后伸运动方向上的稳定性都较对照组小,但差异无统计学意义.6钉固定组在屈曲、后伸运动方向上的稳定性均较完整对照组大,且差异有统计学意义(t=4.844,P<0.01;t=3.722,P<0.05).6钉固定组在各个方向的运动范围均小于4钉固定组,且两组在屈曲、后伸、侧屈

  3. 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

  4. 髂骨螺钉在成人腰椎骨盆固定术中的置钉路径及参数分析%Pelvic fixation paths and nailing parameter analysis on iliac screws in the adult lumbar spine

    Institute of Scientific and Technical Information of China (English)

    臧振华; 金昌洙; 张平

    2015-01-01

    ObjectiveToexplore the approach of iliac screw in lumbar vertebra pelvis arthrodesis. Methods Randomly selected 20 pelvic CT scan images of male and female separately, by reconstruction of 64 row spiral CT thin layer scanning image converted into 3D images. Firstly, you can select the nail screws O as entry point. Respectively from point O to the anterior superior, anterior inferior and upper edge of the acetabulum of the pelvis 3.5 mm cut, three cutting plane (OX, OY, OZ) were obtained, measured the length and width of each screw channel plane.ResultsThe narrowest diameter of three cutting plane (OX, OY, OZ) were more than 7 mm, all can be implanted iliac screw. Nail length range: Male OX plane (101.0±22)mm, OY plane (122.3±6.5)mm, OZ plane (110.8±9.0)mm; women OX plane (92.9±23.9)mm, OY plane (113.0±11.7)mm, OZ plane (110.6±11.2)mm. Statistical results also showed that there were no significance in the deflection angle of tailward and outward declination angle of screw channel between females and males (P>0.05).ConclusionThrough the pelvis three cutting plane (OX, OY, OZ) are permitted to implant screw. Through anterior inferior iliac spine (OY) is theoretically better iliac screw inserted position in the fixation of lumbar sacral vertebra pelvis.%目的:探讨腰椎骨盆融合术中髂骨螺钉入路。方法随机抽调进行过CT骨盆扫描的男女成年患者图像各20份,将其64排CT薄层图像重建转换为三维立体图像。选取可以进钉的螺钉入点O,从O点分别向髂前上棘、髂前下棘、髋臼上缘最高点处切割骨盆,得出3个切割平面(OX、OY、OZ),测量每个平面的钉道长度及宽度。结果3个切割平面(OX、OY、OZ)在最窄横径超过7 mm的条件下,均可以置入髂骨钉。钉长范围为:男性OX平面为(101.0±22)mm,OY平面为(122.3±6.5)mm,OZ平面为(110.8±9.0)mm;女性OX平面为(92.9±23.9)mm,OY平面为(113.0±11.7)mm,OZ

  5. Minimally Invasive Posterior Trans-muscular C1-C2 Screw Fixation Through an Anatomical Corridor to Preserve Occipitocervical Tension Band: Surgical Anatomy and Clinical Experience.

    Science.gov (United States)

    Díaz, Roberto; Berbeo, Miguel E; Villalobos, Luis M; Vergara, Manuel F; Osorio, Enrique

    2014-01-01

    The C1-C2 joint is affected by multiple entities that may produce biomechanical instability. Optimal management for atlantoaxial instability has been searched by ways of different surgical techniques with different results, generating discussion between second effects of a particular treatment. Lateral dissections can place the axial neck musculature and ligaments at risk of neural denervations or vascular compromise. Either of these entities may result in significant postoperative atrophy, pain, and instability. Minimally invasive techniques for the treatment of spinal disorders allow to our patients less morbid procedures with equal or better results compared to conventional surgery. In the following paper, we review the anatomy of the atlantoaxial joint and propose a minimally invasive trans-muscular C1-C2 fusion technique using C1 lateral-mass screws and C2 pedicular screws. We describe cases with surgical, clinical, and radiographic follow-up.

  6. Morphometric evaluation of subaxial cervical spine using multi-detector computerized tomography (MD-CT) scan: the consideration for cervical pedicle screws fixation

    OpenAIRE

    Chanplakorn, Pongsthorn; Kraiwattanapong, Chaiwat; Aroonjarattham, Kitti; Leelapattana, Pittavat; Keorochana, Gun; Jaovisidha, Suphaneewan; Wajanavisit, Wiwat

    2014-01-01

    Background Cervical pedicle screw (CPS) insertion is a technically demanding procedure. The quantitative understanding of cervical pedicle morphology, especially the narrowest part of cervical pedicle or isthmus, would minimize the risk of catastrophic damage to surrounding neurovascular structures and improve surgical outcome. The aim of this study was to investigate morphology and quantify cortical thickness of the cervical isthmus by using Multi-detector Computerized Tomography (MD-CT) sca...

  7. 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

  8. Clinical pedicle screw accuracy and deviation from planning in robot-guided spine surgery: robot-guided pedicle screw accuracy

    NARCIS (Netherlands)

    Dijk, van Joris D.; Ende, Roy P.J.; Stramigioli, Stefano; Köchling, Matthias; Höss, Norbert

    2015-01-01

    STUDY DESIGN: A retrospective chart review was performed for 112 consecutive minimally invasive spinal surgery patients who underwent pedicular screw fixation in a community hospital setting. OBJECTIVE: To assess the clinical accuracy and deviation in screw positions in robot-assisted pedicle screw

  9. Efficacy of three methods of internal fixation on femoralneck fracture

    Institute of Scientific and Technical Information of China (English)

    闫洪印; 陈扬; 肖建德; 李振宇; 龚敏; 马若凡; 刘尚礼

    2002-01-01

    @@ From 1990 to 2000, we used Hansson pin, AOhollow-pulling screw, and bendable screw to treat150 cases of fresh femoral neck fracture and theresult was analysed to compare the efficacy of the threemethods of internal fixation.

  10. Effect of sustentaculum tali screw placement after open reduction and internal fixation of intraarticular calcaneal fractures%切开复位内固定跟骨关节内骨折后载距突固定效果

    Institute of Scientific and Technical Information of China (English)

    强敏菲; 陈雁西; 张坤; 李浩博; 戴号

    2014-01-01

    Objective To investigate the effect of sustentaculum tali screw placement on outcomes following open reduction and internal fixation (ORIF) of intraarticular calcaneal fractures.Methods A retrospective analysis was made on 139 patients with intraarticular calcaneal fractures treated by ORIF from April 2008 to January 2012.According to Sanders classification,there were 9 patients with type Ⅱ fractures,87 with type Ⅲ fractures and 43 with type Ⅳ fractures.Fracture reduction followed by placement of calcaneal anatomic plate or anatomic locking plate was performed via calcaneal lateral L-shape incision.All the patients received X-rays and CT scans within postoperative 2 weeks.Placement of screws in sustentaculum tail was detected by CT volume rendering to visualize implants combined with multiplanar reconstruction imaging (MPR).Patients were divided into accurate fixation group (Group A,n =28),marginal fixation group (Group B,n =58),and non-fixation group (Group C,n =53) based on radiological results.Intra-and peri-operative parameters,time to partial weight-bearing,time to full weight-bearing,fracture healing time,and clinical outcome were compared among groups.Functional outcome was assessed using American Orthopedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale.Results Postoperative X-rays indicated accurate fixation of sustentaculum tail in 64 patients,marginal fixation in 22,and non-fixation in 53,but CT images manifested accurate fixation in 28 patients,marginal fixation in 58,and non-fixation in 53.Group A had operation duration of (93 ±11) min and intraoperative blood loss of (252 ± 27) ml,longer or higher than those in Group B [(85 ±8) min,(194±16) ml] and Group C [(57±6) min,(136 ±13) ml] (P<O.05).There was no significant difference in mean hospital stay among the three groups (P > 0.05).Ninety-two patients were followed-up for 12-38 months (mean 18.5 months) and 85 patients completed foot and ankle exercise as planned

  11. 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

  12. 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

  13. C2~3椎弓根-侧块螺钉系统治疗不稳定型Hangman骨折%Transpedicular with Pedicle Screw Fixation for the Treatment of Hangman's Fractures

    Institute of Scientific and Technical Information of China (English)

    王磊; 刘海龙; 徐卫松; 仇志学; 韩国栋

    2011-01-01

    目的 探讨C2~3椎弓根-侧块螺钉系统治疗Hangman骨折的疗效及临床效果.方法 我院2007年4月至2010年10月收治的11例Hangman骨折患者进行回顾性研究,男4例,女7例;年龄22~61岁,平均42.5岁.患者均表现为颈痛、颈部活动受限,2例单侧上肢,1例双侧上肢麻木无力.所有患者入院后均行X线、三维CT及MRI检查,并测量Cz~3椎体移位和成角,其中Levine- Edwards分型,Ⅰ型3例,Ⅰ型4例,Ⅰa型2倒,Ⅲ型2例.人院后常规行颅骨牵引,Ⅰ型患者予以halo-vest架外固定治疗,Ⅱ型、Ⅱa型、Ⅲ型患者行后路C2~3椎弓根侧块螺钉内固定术,术后用费城颈托保护6周.结果 随访2~44个月,平均20.6个月.平均6个月时骨折端愈合,颈痛、肢体麻木等症状消失,但颈部活动度较正常略有下降,无内固定失败及感染等并发症发生.结论 经后路C2~3椎弓根侧块螺钉系统是治疗Hangman骨折的良好手术方式.%Objective To determine the treatment efficacy of transpedicular with pedicle screw fixation for the treatment of Hangman's fracture. Methods A retrospective review of 11 cases,including 4 males and 7 females,with Hangman's fractures was performed. The age of the patients were 22~61 years, average 42. 5 years. All the patients complained neck pain and limitation of movement of the neck. Numbness and weakness appeard in unilateral upper limb in 2 cases, biliater upper limbs in 1 case. All patients received anterior-posterior and lateral X-rays,MRI andthree dimensional CT scans. Initial and final radiographs were measured for translation and angilation of C2~J. According to the Levine-Edwards classification,there were 3 cases for type I ,4 for type H ,2 for type JI a and 2 for type I . Skull tractions under extension position were used in all patients after admission. Halo-vest treatment option for type Ⅰ ,Then type Ⅱ ,Ⅱla, Ⅲ transpedicular with pedicle screw fixation were performed. Philadelphia collars

  14. 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.

  15. 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

  16. Treatment of craniovertebral anormalies through occipitocervical fusion by inter-diploe screw fixation%枕骨板障间螺钉固定枕颈融合术治疗颅颈部畸形

    Institute of Scientific and Technical Information of China (English)

    姚女兆; 王文军; 王麓山; 晏怡果; 王程; 朱一平

    2014-01-01

    Objective To explore the clinical outcome of the treatment of craniovertebral anormalies through occipitocervical fusion by inter-diploe screw fixation.Methods From January 2010 to January 2013,15 patients (9 males,6 females) in the First Affiliated Hospital of University of South China were diagnosed with craniovertebral anormalies.The age ranged from 29 to 60 years (40.4 ± 8.2) years.Eight patients had Arnold-Chiari deformitory,5 patients had basilar invagination with os odontoidem,2 patients had Klippel-Feil deformitory.All the patients had symptoms of spinal medulla compression.The Japanese orthopaedic association(JOA) score of preoperation ranged from 6 to 10 (8.1 ± 1.7).All the patients received head-shoulders traction through modified Halo-vest for 1-2 weeks.All cases received occipitocervical fusion by inter-diploe screw-rod-pedicel screw system.Results All patients underwent this technique operation successfully.The mean operation time was 100-220 min (140.2 ± 30.5) min,and blood loose was 190-710 ml(272.2 ±73.4) ml.There was no neurological function worsen and severely complications.The JOA after operation 3 days was 9-14 (11.0 ± 2.1),there was statistical differences compared to preoperation (t =0.003,P < 0.05).The postoperatively radological films indicated all the inter-diploe screw locations were satisfactory,there was no screw penetrating the medial occipital plate.All cases were followed up for 12-36 months(22.0 ± 6.3) months.Bone graft fusion was obtained in 3-9 months (5.1 ± 2.7) months.There was no internal fixation breakage and loosening.The JOA score of last follow-up was 12-16 (14.1 ± 1.6),there was statistical differences compared to preoperation(t =0.002,P < 0.05).All patients with limb numbness,muscle weakness and other symptoms were obviously improved than preoperation.Conclusions Occipitocervical fusion using inter-diploe screw-rod-pedicel screw system,is an effective method for the treatment of craniovertebral anormalies with

  17. 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

  18. 经皮骶髂螺钉和骶髂关节前路钢板内固定治疗不稳定骨盆骨折的临床疗效比较%Clinical curative effect comparison on percutaneous sacroiliac screws internal fixation and sacroiliac joint anterior plate fixation in the treatment of unstable pelvic fractures

    Institute of Scientific and Technical Information of China (English)

    蔺广生

    2016-01-01

    目的:探讨经皮骶髂螺钉和骶髂关节前路钢板内固定治疗不稳定骨盆骨折的临床疗效。方法选取2012年1月~2014年1月收治的149例不稳定骨盆骨折患者,根据治疗方法将其分成骶髂钢板组和骶髂螺钉组。其中骶髂钢板组74例,给予骶髂关节前路钢板内固定治疗;骶髂螺钉组75例,给予经皮骶髂螺钉治疗。比较两组患者临床资料、手术相关指标、临床疗效以及术后并发症。结果两组患者性别、年龄、致伤原因、合并伤以及Tile分类等资料数据比较差异无统计学意义( P>0.05);骶髂螺钉组患者手术时间、出血量、切口长度以及住院时间[(86.1±11.2)min,(16.7±8.5)mL,(1.7±0.6)cm和(8.7±2.7)d]均显著低于骶髂钢板组患者[(122.3±20.5)min,(516.3±118.7)mL,(15.7±1.5)cm和(17.7±4.8)d,P<0.05];骶髂螺钉组患者骨折复位优良率和功能恢复优良率(97.3%和96.0%)均显著高于骶髂钢板组患者(79.7%和73.0%,P<0.05);骶髂螺钉组患者术后并发症发生率(4.0%)显著低于骶髂钢板组患者(24.3%,P<0.05)。结论经皮骶髂螺钉治疗不稳定骨盆骨折临床疗效显著,且具有出血量小、创伤小、恢复快、术后并发症少等优点,值得临床推广应用。%Objective To investigate clinical efficacy of percutaneous sacroiliac screws internal fixation and sacroiliac joint anterior plate fixation in the treatment of unstable pelvic fractures.Methods From Jan.2012 to Jan.2014,149 cases of unstable pelvic fracture were selected to study.According to the treatment method,all the patients were divided into sacroiliac plate group and sacroiliac screw group.There were 74 patients in the sacroiliac plate group treated with the sacroiliac joint anterior plate internal fixation and 75 patients in the sacroiliac screw group treated with percutaneous sacroiliac screw fixation

  19. Clinical comparative analysis on percutaneous sacroiliac screws internal fixation and sacroiliac joint anterior plate fixation in the treatment of unstable pelvic fractures%经皮骶髂螺钉与骶髂关节前方钢板固定治疗不稳定性骨盆骨折的临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    杨雷; 王洪飞; 王中海

    2012-01-01

    目的 探讨经皮骶髂螺钉与骶髂关节前方钢板固定治疗不稳定性骨盆骨折的临床疗效.方法 选取本院2008年1月至2011年6月收治的不稳定性骨盆骨折患者64例,随机分为两组,采用骶髂关节前方钢板固定治疗的患者32例为对照组,采用经皮骶髂螺钉内固定治疗的患者32例为观察组,比较两组患者围术期临床指标、术后Matta评分、术后Majeed功能评分.结果 观察组手术时间、术中出血量、伤口总长度、术后发热时间、住院时间均明显少于对照组,观察组并发症发生率(3.1%)明显低于对照组(21.9%),观察组术后Matta评分总优良率(96.9%)明显高于对照组(81.2%),观察组术后Majeed功能评分总优良率(93.8%)明显高于对照组(75.0%),差异均有统计学意义(P<0.05).结论 经皮骶髂螺钉内固定治疗不稳定性骨盆骨折具有损伤小、出血少、疼痛轻、恢复快等优点,是一种安全有效的微创手术方法,临床疗效明显好于骶髂关节前方钢板固定,术前充分准备及患者积极配合可以大幅降低并发症的发生率,值得临床推广使用.%Objective To investigate clinical efficacy of percutaneous sacroiliac screws internal fixation and sacroiliac joint anterior plate fixation in the treatment of unstable pelvic fractures. Methods Sixty-four patients with unstable pelvic fractures were selected in the hospital from January 2008 to June 2011, which were randomly divided into two groups. The control group (n=32) used sacroiliac joint anterior plate fixation, while the study group (n=32) used percutaneous sacroiliac screw internal fixation for treatment. The perioperative clinical indicators, postoperative Matta score, postoperative Majeed function score of all patients were compared. Results The operation time, intraop-erative blood loss, wound total length, postoperative fever time, duration of hospitalization in the study group were significantly less than those

  20. 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.

  1. Percutaneous triple anterior screw fixation of acute combined atlas-axis fractures in elderly patients:a primary report%前路经皮三钉固定治疗老年寰枢椎联合骨折

    Institute of Scientific and Technical Information of China (English)

    王向阳; 徐华梓; 池永龙; 林焱; 黄其杉; 倪文飞; 王胜; 徐晖

    2011-01-01

    目的 探讨经皮内固定技术治疗老年(特别是合并颅脑损伤)患者急性寰枢椎联合骨折的方法及其疗效.方法 2006年3月至2011年2月,共7例老年急性寰枢椎联合骨折患者.男6例,女1例;年龄64~84岁,平均72.4岁.寰椎骨折:Jefferson骨折2例,前弓骨折2例,前后弓两处骨折2例,前后弓骨折+侧块骨折1例.枢椎齿状突骨折:AndersonⅡ型骨折6例,浅Ⅲ型骨折1例.颅脑损伤5例,均合并不同程度意识朦胧、谵妄或昏迷.对所有患者均在“C”型臂X线机监视下行经皮前路枢椎齿状突和两侧寰枢关节螺钉内固定术治疗,并分析其治疗效果.结果 手术时间36~78 min,平均56 min.同时行植骨术的患者出血20~50 ml,未行植骨术者无明显出血.7例患者均获得满意治疗效果,螺钉位置正确.无神经根、脊髓、椎动脉和食管损伤等并发症发生.全组病例平均随访10.7个月,无脱钉、弯钉及断钉发生,枢椎齿状突骨折均骨性愈合,无寰枢关节不稳.结论 对于老年特别是合并颅脑损伤患者的急性寰枢椎联合骨折,经皮前路三钉固定技术是一种简单、安全和有效的方法,有利于对患者临床护理和早期功能训练,减少并发症的发生.%Objective To evaluate the clinical effect of the percutaneous fixation for atlas-axis combined fractures in the elderly patients,especially with brain injury.Methods From March 2006 to February 2011,a total of 7 cases with C1,2 combined fractures entered the study,including 5 males and 1 female with an average age of 72.4 years (range,64-84 years).Fracture combinations included two Jefferson/type Ⅱ odontoid,two anterior ring/type Ⅱ odontoid,two anterior and posterior ring/type Ⅱ odontoid,and one anterior and posterior ring+lateral mass/type Ⅲ odontoid.There were 5 patients with head injuries in varying degrees of coma.All patients underwent percutaneous placement of odontoid screw and anterior C1,2 transarticular screws

  2. 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

  3. 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.

  4. 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

  5. Basis椎弓根螺钉固定加环形植骨融合治疗腰椎滑脱%Basis pedicle screw fixation and posterior instrumented circumferential fusion for the treatment of lumbar spondylolisthesis

    Institute of Scientific and Technical Information of China (English)

    董福龙; 申才良; 张建湘; 汤健; 杨庆国; 江曙

    2011-01-01

    Objective To summarize curative effects of the decompressive laminectomy by posterior approach, reduc tion of spondylolisthesis fixed with Basis pedicle screw and posterior instrumented circumferential fusion in the treat ment of lumbar spondylolisthesis. Methods Thirty-two patients with lumbar spondylolisthesis treated with posterior instrumented circumferential fusion were studied retrospectively. Results All the patients received follow-up for 4 ~ 25 months. Symptoms were disappeared after operations in all the patients. The postoperative X-ray films showed that 29 patients obtained complete reduction,3 partly reduction. This surgical methods produced satisfactory outcomes with the 100% osseous fusion. All the bone grafts were fusion, without screws loosening or breakage or internal fixation loosing was found. Based on Hou Shu-xun Criteria for therapeutical evalution, the efficacy was as follows: excellent in 23 cases,good in 7,and fair in 2,the rate of excellent and good was 94%. Conclusions Posterior instrumented cir cumferential fusion with Basis pedicle screw is an effective method for treating severe lumbar spondylolisthesis.%目的 探讨后路腰椎管减压、Basis椎弓根螺钉系统复位固定加环形植骨融合治疗腰椎滑脱症的疗效.方法 对32例腰椎滑脱症患者行后路腰椎管减压Basis椎弓根螺钉复位固定加环形植骨融合术.结果 32例均获随访,时间4~25个月.患者术后症状均消失,X线片示29例滑脱完全复位,3例部分复位.所有患者均达骨性融合,无椎弓根钉松动、断裂及再滑脱现象.根据侯树勋等疗效评定标准评定:优23例,良7例,可2例,优良率94%.结论 Basis椎弓根固定系统复位固定加环形植骨融合治疗腰椎滑脱症临床疗效满意,可作为治疗严重腰椎滑脱的首选方法.

  6. Clinical Effect of Percutaneous Sacroiliac Screws Fixation and Plate Fixation in Front of Sacroiliac Joints in Treating ;Unstable Pelvic Fractures%经皮骶髂螺钉与骶髂关节前方钢板固定治疗不稳定性骨盆骨折的临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    刘洪; 唐长友; 贺健军

    2015-01-01

    Objective To investigate the clinical effect of plate fixation in front of sacroiliac joints and percutaneous sacroiliac screws fixation in treating unstable pelvic fractures. Methods 82 patients with unstable pelvic fractures treated in our hospital from March 2011 to March 2014 were selected and randomly divided into two groups. The control group (41 cases) was treated with plate fixation in front of sacroiliac joints, the observation group (41 cases) was treated with percutaneous sacroiliac screws fixation. The operation time, length of incision, bleeding volume during operation, hospitalization time, the treatment effects and complications were compared between two groups. Results The length of incision, operation time and hospitalization time of observation group were significantly shorter than those of control group, the bleeding volume during operation was significantly less than that of control group;the excellent and good rate of fracture reduction in observation group was 95.12%, significantly higher than 75.61%of control group;the incidence of complications of observation group was 4.88%, significantly lower than 19.51%of control group;all the difference was statistical (P<0.05). Conclusions In the treatment of unstable pelvic fractures, percutaneous sacroiliac screws fixation has the advantages of small trauma, quick recovery, better clinical effect and higher safety, which is worthy of promotion.%目的:探讨不稳定性骨盆骨折分别采用骶髂关节前方钢板固定与经皮骶髂螺钉固定治疗的临床效果。方法选取2011年3月至2014年3月我院收治的不稳定性骨盆骨折患者82例,随机分为两组各41例。对照组采用骶髂关节前方钢板固定治疗,观察组采用经皮骶髂螺钉固定治疗。比较两组的手术时间、切口长度、术中出血量、住院时间、治疗效果及并发症发生情况。结果观察组切口长度、手术时间及住院时间均明显短于对照组,术中出

  7. 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

  8. 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.

  9. 可吸收螺钉结合外固定架治疗复杂性胫腓骨骨折%ABSORBABLE SCREWS WITH EXTERNAL TRESTLE FIXATION IN TREATING COMPLICATED FRACTURE OF TIBIA AND FIBULA

    Institute of Scientific and Technical Information of China (English)

    王占军; 吴洪增

    2011-01-01

    Objective To introduce a technique for treating the complicated fracture of tibia and fibula. Methods Fifty - four cases of opened and/or comminuted fracture of tibia and fibula were treated by internal absorbable screws fixation with external skeletal trestle fixation,at the same time underwent the conventional bone graft. Results There were 44 cases ( 81. 5% ) having anatomic reduction,and the others having approximately anatomic reduction,All the bone fracture healed good, the clinical healing time of bone fracture was 4 ~ 14 months( average time of 6. 5 months) . Fifty - four cases were followed - up for 10 ~ 24 months ( average time of 13 months). Accerding to Johner - Wruhs standard,51 cases were excellent,3 cases were good. Conclusion The method has many advantages such as mininal damage ,reliable effect, safety and low cost ,and it is worth promoting the application.%目的 介绍一种适合复杂性胫腓骨骨折的治疗方法.方法 本组54例开放性和(或)粉碎性胫腓骨骨折的病例,采用可吸收螺钉加外固定支架固定的方法治疗,同时常规行植骨术.结果 44例(81.5%)达到解剖复位,其余达到功能复位,骨折全部愈合,临床愈合时间4~14个月,平均6.5个月.随访10~24个月,平均13个月.按Johner-Wruhs评分标准,优51例,良3例.结论 该方法创伤小,固定可靠,安全经济,值得推广应用.

  10. 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

  11. 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

  12. Platelet-rich plasma combined with closed reduction and hollow screw internal fixation for femoral neck fracture%PRP联合闭合复位空心螺钉内固定治疗股骨颈骨折

    Institute of Scientific and Technical Information of China (English)

    陈志军; 杨彪; 张大华

    2016-01-01

    目的:分析自体富血小板血浆( PRP)联合闭合复位空心螺钉内固定治疗股骨颈骨折的临床效果。方法回顾性分析2010年5月至2014年8月在我院治疗的200例股骨颈骨折患者的临床资料,分为PRP组和对照组,各100例。 PRP组采用PRP联合闭合复位空心螺钉内固定治疗,对照组单纯采用闭合复位空心螺钉内固定治疗,记录2组患者住院时间、骨折愈合时间、切口愈合情况、术后并发症、Harris评分及髋关节功能恢复情况。结果 PRP组住院时间、骨折愈合时间明显短于对照组,切口甲级愈合率高于对照组,术后合并股骨头坏死及骨折不愈合率明显低于对照组,差异均具有统计学意义(P<0.05)。 PRP组患者术后6个月、12个月Harris评分分别为87.35、90.82分,均高于对照组的81.37、84.32分,术后6个月、12个月髋关节功能优良率分别为86%、90%,高于对照组的67%和76%,差异均具有统计学意义(P<0.05)。结论 PRP联合闭合复位空心螺钉内固定治疗股骨颈骨折能明显缩短骨折愈合时间,减少术后并发症,提高患者髋关节功能及术后生活质量,安全性和有效性较高。%Objective To explore the clinical effect of autologous platelet-rich plasma ( PRP) combined with closed reduction and hol-low screw internal fixation for femoral neck fracture .Methods Totally 200 cases of femoral neck fracture were collected from May 2010 to August 2014 in our hospital .Randomly divided them into two groups , namely the PRP group and the control group , with 100 patients in each group.The PRP group were given autologous platelet-rich plasma ( PRP) combined with closed reduction and hollow screw internal fixation , while the control group were given closed reduction and hollow screw internal fixation merely .The length of stay , time of fracture healing , wound healing state , postoperative complications rate

  13. Cage Pedicle Screw Fixation for the Treatment of Lumbar Spondylolisthesis%Cage加椎弓根螺钉固定治疗腰椎滑脱症的临床疗效

    Institute of Scientific and Technical Information of China (English)

    桂曙光; 袁凌伟; 李得彬; 王建; 胡小东

    2015-01-01

    Objective:To research the clinical efficacy of posterior decompression and interbody cage fusion in the treatment of lumbar spondylolisthesis.Methods:From march 2009 to june 2013,I applied interbody fusion and pedicle screw in the treatment of 22 patients with lumbar spondylolisthesis, including 13 males and 9 females, aged 41-67 years, mean 48years old, type I spondylolisthesis 14cases t,ype II spondylolisthesis 7 cases, and III spondylolisthesis patients. All patients were followed up for 3 months to 32months , with an average of 28 months.Results:All the cases slippage were reseted. ,the fusion rate was 100%, the vertebral height and symptoms after operation improved significantly, the cage remain the normal position and the pedicle screw not be loosening and fracture. The excellent rate is 95.46%, ac-cording to the Zou Dewei rating criteria. Conclusion:The fixation with cage and pedicle screw in the treatment of lumbar spondylolisthesis is one of the good methods have the advantages of more safety , interbody fusion rate fixation , without fracture and loosening.%目的:评价后路减压固定加椎间cage融合术治疗腰椎滑脱症的临床疗效。方法:自2009年3月~2013年6月应用椎间cage加椎弓根螺钉固定技术治疗腰椎滑脱症患者22例,其中男13例,女9例,年龄41~67岁,平均48岁。其中Ⅰ度滑脱14例,Ⅱ度滑脱7例,Ⅲ度滑脱1例。对所有患者术后随访3个月~32个月,平均28个月。结果:所有滑脱基本复位,融合率100%,椎体间高度恢复,症状明显改善, cage位置正常,椎弓根螺钉无松动及断裂。根据邹德威等评分标准,优良率达95.46%。结论:采用cage加椎弓根螺钉固定治疗腰椎滑脱症临床效果好、安全,椎间融合率高,内固定物无断裂、松动,是较为理想的手术方法之一。

  14. CT引导经皮置钉治疗病理性骶髂关节疼痛%Percutaneous CT-guided fixation of sacroiliac joint with cannulated lag screw for treating pathologic pain of sacroiliac joint

    Institute of Scientific and Technical Information of China (English)

    胡勇; Ebraheim NA; 徐荣明; 薛波

    2005-01-01

    BACKGROUND: Most patients with posterior pelvic and sacroiliac metastasis are terminally ill. Their treatment is usually palliative and directed toward relieving pain and improving the quality of life with the least possible intervention.OBJECTIVE: To investigate the possibility of percutaneous CT-guided fixation of sacroiliac joint with cannulated lag screw treatment for pathologic pain of sacroiliac joint.DESIGN: Preoperative and postoperative auto-control clinical trial was conducted.SETTING and PARTICIPANTS: The study was completed in Ningbo Sixth Hospital. Eight patients(4 males and 4 females, aged 12 years to 83 years)with metastatic tumor of sacroiliac joint were selected for our study.METHODS: After treatment with percutaneous CT-guided fixation of sacroiliac joint with cannulated lag screw, the sacroiliac joint of the 8 patients became pathologically unstable. Enneking pain scale was obtained preoperatively and postoperatively.MAIN OUTCOME MEASURES: Pain recovery was assessed preoperatively and postoperatively.RESULTS: After 2. 5 years' follow-up, pain of the patients was relieved with a range of 0 to 5(mean 3.2).CONCLUSION: Percutaneous cannulated lag screws with CT guidance help alleviate the patients' pain due to pathologically unstable sacroiliac joint.%背景:大多数后路骨盆和骶髂关节转移肿瘤患者为临终患者,其治疗目的主要是姑息治疗和减轻疼痛,提高患者生活质量.目的:探讨在CT引导下经皮微创技术置入空心拉力螺钉治疗病理性骶髂关节疼痛.设计:前后对照的临床试验.地点和对象:在浙江省宁波市第六医院完成.8例骶髂关节转移肿瘤患者,男4例,女4例;年龄12~83岁.方法:对8例骶髂关节转移肿瘤患者试行在CT引导下经皮微创技术置入空心拉力螺钉稳定病理性骶髂关节不稳.术前和术后进行Enneking疼痛评分.主要观察指标:手术前后疼痛恢复情况.结果:经2年5个月随访,患者疼痛减轻,平均3.2

  15. Comparison of the effects on percutaneous sacroiliac joint screw fixation and anterior sacroiliac joint plate fixation in the treatment of unstable pelvic fractures%经皮骶髂关节螺钉与骶髂关节前方钢板固定治疗不稳定型骨盆骨折的效果比较

    Institute of Scientific and Technical Information of China (English)

    丁涛

    2016-01-01

    Objective To investigate the efficacy of percutaneous sacroiliac joint screw fixation and anterior sacroiliac joint plate fixation in the treatment of unstable pelvic fractures. Methods Forty cases of patients with unstable pelvic fractures were divided into two groups according to odd and even numbers. The control group (odd numbers, 20 cases) was given anterior sacroiliac joint plated fixation, while the observation group (20 cases) was given percutaneous sacroiliac joint screw. The efficacy of the two groups were evaluated with perioperative indexes, Majeed scores and complications during 6 months follow-up. Results The operative time, blood loss and hospitalization time of the observation group were significantly superior to those of the control group (P<0.05); the excellent rate of the observation group was significantly higher than that of the control group (P<0.05); during follow-up, the complication rate of the observation group was lower than that of the control group (P<0.05). Conclusion Percutaneous sacroiliac joint screw fixation has a good therapeutic effect on unstable pelvic fracture, with less operation time and fewer complications, so as to promote the recovery of patients, which is worthy of clinical application.%目的:探讨经皮骶髂关节螺钉与骶髂关节前方钢板固定治疗不稳定型骨盆骨折的疗效。方法选取40例不稳定型骨盆骨折患者,按住院单双号分为两组。对照组(20例)给予骶髂关节前方钢板固定治疗,观察组(20例)给予经皮骶髂关节螺钉治疗,观察并记录两组围手术期指标、Majeed评分及随访6个月期间并发症发生情况。结果观察组手术时间、术中出血量、住院时间均明显优于对照组( P<0.05);观察组患者手术治疗的优良率明显高于对照组( P<0.05),随访期间,观察组患者并发症发生率明显低于对照组( P<0.05)。结论经皮骶髂关节螺钉手术对不稳定型骨盆骨折

  16. Pedicle screw placement in the lumbar spine: effect of trajectory and screw design on acute biomechanical purchase.

    Science.gov (United States)

    Wray, Steven; Mimran, Ronnie; Vadapalli, Sasidhar; Shetye, Snehal S; McGilvray, Kirk C; Puttlitz, Christian M

    2015-05-01

    testing were statistically significant between the 3 screw/trajectory combinations. The incidence of cortical wall breach with the cortical or traditional pedicle screw trajectories was not significantly different. CONCLUSIONS The data demonstrated that the cortical trajectory provides denser bone that allows for utilization of smaller screws to obtain mechanical purchase that is equivalent to long pedicle screws placed in traditional pedicle screw trajectories for both normal- and low-quality bone. Overall, this biomechanical study in cadavers provides evidence that the cortical screw trajectory represents a good option to obtain fixation for the lumbar spine with low-quality bone.

  17. 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

  18. 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

  19. Are bio-absorbable stents the future of SFA treatment?

    Science.gov (United States)

    Peeters, P; Keirse, K; Verbist, J; Deloose, K; Bosiers, M

    2010-02-01

    Several limitations inherent to the implantation of a metallic device, such as the occurrence of in-stent re-stenosis, in an arterial lumen intuitively explain the interest for developing bio-absorbable stents. Two main types of bio-absorbable stents currently exist: polymer stents and metallic stents. To date, no studies with bio-absorbable stents have been conducted in the superficial femoral artery (SFA). Because of their strut thickness and lack of radial force, polymer stents are no good candidates for endovascular use. Absorbable metal stents (AMS) do have the potential to perform well for artery treatment, although current evidence from in-human coronary and infrapopliteal studies yield unsatisfactory results. Drastic technological improvements are mandatory before AMS can be considered for every day practice. Yet, it is our belief that further development of other metal and non-metal bio-absorbable stents, with or without drug-coating, may lead to the creation of the ultimate SFA stent.

  20. 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

  1. 后路椎弓根螺钉内固定融合术治疗创伤性寰枢椎不稳%Treatment of traumatic atlantoaxial instability via posterior internal fixation and fusion plus atlantoaxial pedicle screw

    Institute of Scientific and Technical Information of China (English)

    王守国; 徐用亿; 谢跃; 费昊东; 季峰; 赵庆华; 田纪伟

    2011-01-01

    [ Objective ] To study the therapeutic effect of posterior fixation and fusion plus pedicle screw in treatment of traumatic atlantoaxial instability. [ Method] A retrospective analysis was done on twenty patients (14 male and 6 female,mean age of 39.6 years old) with traumatic atlantoaxial instability treated via atlantoaxial pedicle screw system from March 2008 to October 2010,included 4 cases with Jefferson fracture,5 cases with type- II Dens fracture,3 cases with Dens fracture combined with atlantoaxial dislocation, 1 case with Jefferson fracture combined with Dens fracture,7 cases with atlantoaxial dislocation. The post-operative effect was evaluated with JOA (Japanese Orthopaedic Association)scores and VAS( visual analogue scale). [ Result]Operative time were 138.75 ±20.06 min,and blood loss were 338. 80 ± 100. 10 ml. All patients received the follow-up( range from 12 to 25 months,mean 15.6 months). All atlantoaxial joint came to bony fusion by the last follow-up without complication due to instrumentation. There was significant difference on VAS scores between pre-operation(7. 25 ± 1. 52) and post-operation (2. 13 ± 1.75) (P<0.01). There was significant difference on JOA scores between pre-operation( 8.65 ±3.49) and post-operation (13. 05 ±4. 88) (P <0. 01), and improvement rate was 58. 01 ± 20. 15%. [ Conclusion] Posterior fixation and fusion plus pedicle screw has the advantages of strong fixation,direct screw placement,and high fusion rate in traumatic atlantoaxial instability. So it is a better alternative for traumatic atlantoaxial instability.%[目的]探讨经后路椎弓根螺钉系统内固定融合术治疗创伤性寰枢椎不稳的临床疗效.[方法]回顾2008年3月~2010年10月,采用后路椎弓根钉系统固定融合治疗创伤性寰枢椎不稳20例,男14例,女6例;平均年龄39.6岁;Jefferson骨折4例,Ⅱ型齿状突骨折5例,齿状突骨折合并寰枢椎脱位3例,Jefferson骨折合并齿状突骨折1例,寰枢椎脱位7

  2. MINIMALLY INVASIVE ANTERIOR TRANSARTICULAR SCREW FIXATION AND FUSION FOR ATLANTOAXIAL INSTABILITY%微创前路经寰枢椎关节突固定融合治疗寰枢椎不稳

    Institute of Scientific and Technical Information of China (English)

    陆焱; 王建; 郑文杰; 刘杰; 黄博

    2012-01-01

    Objective To investigate the clinical results and compl ications of minimally invasive anterior transarticular screw fixation and fusion for atlantoaxial instability. Methods Between May 2007 and December 2010, 13 patients with atlantoaxial instability were treated with minimally invasive anterior transarticular screw fixation and fusion under endoscope. There were 11 males and 2 females, aged 17-61 years (mean, 41.3 years). The time between injury and operation was 5-14 days (mean, 7.4 days). All cases included 6 patients with Jefferson fracture, 5 with odontoid fracture, and 2 with os odontoideum. According to Frankel classification of nerve functions, 2 cases were rated as grade D and 11 cases as graed E. The operation time, intra-operative blood loss, radiation exposure time, and complications were recorded and analyzed. The stability was observed by X-ray films. The clinical outcome was assessed using the Frankel scale, and the fusion rates were determined by CT scan three-dimensional reconstruction at last follow-up. Results The mean operation time was 124 minutes (range, 95-156 minutes); the mean intra-operative blood loss was 65 mL (range, 30-105 mL); and the mean radiation exposure time was 41 seconds (range, 30-64 seconds). Thirteen patients were followed up 12-47 months (mean, 25.9 months). No blood vessel and nerve injuries or internal fixator failure occurred. The bone fusion time was 6 months, and the dynamic cervical radiography showed no instability occured. At last follow-up, the neurological function was grade Ein all patients. The fusion rate was 84.6% (11/13). No continuous bone bridge was seen in the joint space of 2 patients, but they achieved stability. Conclusion Minimally invasive anterior transarticular screw fixation and fusion is a safe and effective procedure for treatment of atlantoaxial instability.%目的 探讨微创前路经寰枢椎关节突固定融合治疗寰枢椎不稳的临床效果和并发症.方法 2007年5月-2010年12

  3. Surgical treatment of thoracolumbar fractures by using the posterior short segment pedicle screw fixation%后路短节段固定联合伤椎置钉治疗胸腰椎骨折

    Institute of Scientific and Technical Information of China (English)

    胡力丰; 张志成; 王晓凯; 孙天胜

    2012-01-01

    Objective To evaluate the efficacy,indications and clinical outcomes of the treatment of thoracolumbar fractures by short segmental pedicle screws fixation at the level of the fracture.Methods Thirtytwo patients with thoracolumbar fracture,who underwent surgical procedure of short segmental pedicle screws fixation at the level of the fracture from 2007 to 2010,were followed up.X rays were performed preoperatively and postoperatively to locate the injured vertebral segment height and fractured kyphosis vertebral (Cobb angle).Frankel standard was used to assess the spinal cord function.Results All patients were followed up for 12 to 20 months and were in satisfying condition in the reduction of fracture.After surgery,the height of fractured vertebral body leading edge recovered from preoperative (32.4% ~69.3%,averaged (51.6 ± 17.8)% ) to (85.6% ~99.2%,averaged (92.8 ±6.2)% ) after two weeks and (90.6% ~97.8%,averaged (93.8 ±3.6)% ) at the last follow-up.Fractured vertebral Cobb angle was recovered from the preoperative ( 12.8 ° ~ 30.5 °,averaged [20.8±9.1] °) to (0° ~7.8 °,averaged [4.9 ±3.2] °) two weeks later and (2.0° ~ 12.0°,averaged [ 6.2 ± 4.6 ] o at the last follow-up.Cobb angle of the injured vertebral segment and the extend of vertebral compression were significantly improved after the angle was corrected ( P <0.01 ).Conclusion Using reduction and short segment pedicle screw fixation at the fracture level would be helpful to correct kyphotic vertebral compression and restore the height of injured vertebrate,which was also of benefit to increase the stability of short-segment posterior fixation system and reduce the loss of correction in a long run.%目的 观察经伤椎椎弓根置钉复位固定治疗胸腰椎骨折的可行性、适应证及临床疗效.方法 我院2007年1月至2010年1月收治的胸腰椎骨折采用经伤椎椎弓根置钉复位固定治疗,共随访32例,对患者术前及术后伤椎

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

    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.

  5. The comparison of clinical effects of arthroscopic fixation with sutures versus screws for posterior cruciate ligament tibial avulsion fractures%关节镜下缝线与螺钉固定后十字韧带胫骨止点撕脱骨折的疗效比较

    Institute of Scientific and Technical Information of China (English)

    李亦丞; 孙学斌; 刘阳; 李纲; 尼加提; 张克远

    2017-01-01

    Objective To compare the clinical effects between arthroscopic suture and screw fixation for posterior cruciate ligament (PCL)tibial avulsion fractures.Methods From February 2013 to January 2016,29 cases with PCL tibial avulsion fracture diagnosed at our department were selected,in which 15 cases of the suture fixation group and 14 cases of the screw fixation group were separated.Operation time, Lysholm score,IKDC score and knee range of motion (ROM)were compared after operation.Results The operation time for the suture fixation group (48.3±1.5)min was significantly longer than that for the screw fixation group (36.4±1.5)min (P<0.05).During the follow-up period,there were no incision in-fection and loosening of the fixation device.The X-ray films showed that all fractures were healed in the first post-operative year.There was a case with synarthrophysis in each group,and the knee function of them returned to normal after rehabilitation training.There were no significant differences between the two groups regarding the Lysholm score (89.9±1.3)for the suture fixation group vs (88.9±1.5)for the screw fixation group),the IKDC score (89.2±1.6)for the suture fixation group vs (89.8±1.5)for the screw fixation group),and the ROM (129.6°±2.8°)for the suture fixation group vs (127.7°±3.2°)for the screw fixation group.Conclusion Arthroscopic fixation with suture vs screw for posterior cruciate ligament tibial avulsion fractures can achieve satisfactory effects,but the operation time of screw fixation has more advantages.%目的:比较关节镜下缝线与螺钉固定后十字韧带(PCL)胫骨止点撕脱性骨折的疗效。方法选择2013年2月—2016年1月新疆医科大学第一附属医院收治的29例PCL胫骨止点撕脱骨折患者,其中术中采用缝线固定15例(缝线固定组)、螺钉固定14例(螺钉固定组),比较两组患者的手术时间、Lysholm评分、IKDC评分及膝关节活动度(ROM)情况。结果缝线

  6. 同种异体肌腱与螺钉固定修复Lisfranc关节韧带损伤的生物力学比较研究%Comparison Between Allogeneic Tendon Fixation and Screw Fixation in Ligamentous Lisfranc Injury: a Biomechanical Analysis

    Institute of Scientific and Technical Information of China (English)

    文艺; 冯品; 张晖; 屠重棋

    2013-01-01

    Objective To compare the stability provided by a allogeneic tendon with a screw for the treatment of ligamentous Lisfranc injury. Methods Six fresh-frozen, paired cadaveric feet were loaded in the condition of Lisfranc ligament intact, injury and fixation models. With axial or abduction stress, the distance between medial cuneiform and second metatarsal was recorded. Results With both two types of stress, there were statistically significant differences in motion detected between the intact and post-injury conditions (all P = 0. 000), and the magnitudes were greater with abduction [ (4. 14 ± 1. 02) mm] than axial load C (1. 60 ± 0. 64) mm]. In screw fixation group, the mean position changes under axial load and abduction load were (1. 53±0. 62) mm and (4. 06 ± 1.05) mm in post-injury model respectively, while the changes were (0. 76 ± 0. 35) mm and (1. 20 ± 0. 53) mm in the fixation model (all P=0. 000) which were not statistical different to that in the intact model. In allogeneic tendon fixation group, the mean position changes were (1. 66 ± 0. 65) mm and (4. 21 ± 1. 00) mm in the post-injury model, while were (0. 90 ± 0. 41) mm and (1. 33 ± 0. 61) mm in the fixation model (all P = 0. 000) which also were not statistical different to that in the intact model. Conclusion Under abduction stress, a significantly greater difference was found between pre- and post-injury, which may be valuable for diagnosing and testing ligamentous Lisfranc injury. Allogeneic tendon fixation can provide similar stability as screw fixation in ligamentous Lisfranc injury.%目的 分别比较螺钉和同种异体肌腱固定修复Lisfranc关节韧带损伤的生物力学强度.方法 6对新鲜冷冻尸体足部标本,分别制备Lisfranc关节韧带完整模型、损伤模型及损伤后的螺钉或同种异体肌腱固定模型,并分别给予轴向和外展负荷加载,数码显微摄像头记录内侧楔骨和第2跖骨底间的位移变化.结果 ①在轴向和外展加

  7. Comparative study of safety and efficacy of electrocautery blade with cold scalpel blade for skin opening during fixation of fracture of forearm bone with plate and screws

    Directory of Open Access Journals (Sweden)

    K T Madhukar

    2012-01-01

    Full Text Available Introduction: The art of performing surgeries have improved in recent years with the development of various electrosurgical devices assisting surgeons in performing safer surgeries with better outcomes. Skin incision has traditionally been made with a standard scalpel blade with good primary healing end results of the wound. The electrocautery has been used safely in performing deeper dissections. Use of electrocautery in skin incision has been discouraged in the past for the fear of cutaneous scarring, wound dehiscence, and infections particularly in orthopedic surgeries using internal implants. A review of the literature shows not many studies have been conducted to evaluate the safety and efficacy of electrocautery in skin incisions during orthopedic surgeries using internal implants. Aim: A prospective study was conducted in a tertiary care hospital with the aim to determine whether an electrocautery blade can be used safely for skin incisions. Materials and Methods: Sixty-two patients with single-bone fracture of the forearm undergoing open reduction and internal fixation received one-half of the incision with a standard scalpel blade and another half with electrocautery in pure cutting mode randomly. Analysis: Wounds were compared on operating day for any physical changes and on days 3, 5, and 12, and again on 3 rd and 6 weeks follow-up to know any difference in skin healing between the incised wounds of the two halves. Results: No evidence of any difference in healing of the two halves of skin incision was noted. There was also no increased risk of wound scarring, dehiscence, or infection with electrocautery incision when compared with standard scalpel incision. The time taken for skin incision with electrocautery was significantly less when compared with cold scalpel incision. Conclusion: We propose that electrocautery can be safely used for performing skin incision, with comparable results to that of a standard scalpel skin incision.

  8. Dynamic hip screw and Gamma nail fixation repair unstable intertrochanteric fracture:a three-dimensional finite element analysis%动力髋螺钉和Gamma钉置入固定不稳定股骨转子间骨折的三维有限元分析

    Institute of Scientific and Technical Information of China (English)

    黄晓微; 禹宝庆; 李泽湘; 敖荣广

    2015-01-01

    BACKGROUND:For unstable intertrochanteric fracture repair, there are two views:extramedul ary fixation or intramedul ary fixation. Theoretical y, intramedul ary fixation is in line with the principles of minimal y invasive, more mechanical and biological advantages. However, evidence-based medicine and related studies have shown that compared with the extramedul ary fixation, intramedul ary fixation did not reflect the proper theoretical advantage. OBJECTIVE:To compare the biomechanical performance of two kinds of internal fixation systems:dynamic hip screw and Gamma nail which commonly used in repair of intertrochanteric fractures by finite element method, and to evaluate the advantages and disadvantages of dynamic hip screw and Gamma nail in treatment of unstable intertrochanteric fracture. METHODS:Three-dimensional finite element model of human femur unstable intertrochanteric fractures (31-A2;AO fracture classification), and the three-dimensional finite element models of dynamic hip screw and Gamma nail were established respectively, and were fixed according to the requirement of orthopedic surgery. The reference load which the joint bearing was at the peak time in adult step state period with the body mass of 700 N was stimulated. The stress distribution of bone, bone-internal fixation model, nail or screw, the strain and deformation of fracture location on the surface of the bone and bone-internal fixation model, the stress distribution along the femur and the loading transfer condition along the internal fixator and the like were analyzed. RESULTS AND CONCLUSION:Dynamic hip screw and Gamma nail have good sliding compression features which could make the continuous and dynamical y axial compression of the fractured section. Under the load conditions, the displacement value of dynamic hip screw was larger. In the treatment of unstable intertrochanteric fracture, Gamma nail was stronger than dynamic hip screw. Two kinds of internal fixations al make the

  9. 双中空螺钉顺-逆行反向固定治疗距骨颈骨折%Double opposing lag screws for internal fixation of talar neck fracture

    Institute of Scientific and Technical Information of China (English)

    黎清波; 谢鸣; 黄若昆; 赵晶晶; 刘丰; 雷波; 潘昊; 肖凯; 勘武生

    2016-01-01

    目的 探讨采用2枚中空螺钉顺-逆行反向固定治疗距骨颈骨折的方法与疗效. 方法 对2005年10月至2012年10月收治的13例距骨颈骨折患者资料进行回顾性分析,男8例,女5例;年龄26 ~ 56岁,平均37.9岁;骨折根据Hawkins分型:Ⅰ型2例,Ⅱ型9例,Ⅲ型2例;4例合并内踝骨折,均为闭合性骨折;均予直径为3.5 mm的中空螺钉经距骨前、后路顺-逆行反向固定术.术后采用美国足踝外科协会(AOFAS)的踝-后足评分和视觉模拟评分(VAS)评价疗效. 结果 所有患者术后获12 ~ 84个月(平均43.3个月)随访,骨折愈合时间9~12周(平均10.2周).术后均无骨不愈合或愈合不良发生.AOFAS的踝-后足评分由术前平均(5.4±4.1)分(0~12分)改善为术后(89.7±8.1)分(72 ~ 98分),差异有统计学意义(f=54.984,P<0.001);其中优9例,良3例,可1例.VAS评分由术前平均(9.4±0.8)分(8~10分)改善为术后(1.1±0.8)分(0~3分),差异有统计学意义(t=20.679,P<0.001).结论 采用2枚中空螺钉顺-逆行反向固定治疗斜行的距骨颈骨折,既保护了距骨的血供,也更好地达到了最好生物力学固定的目的,是一种较好的手术方式.%Objective To report the process and clinical efficacy of internal fixation with double opposing lag screws for talar neck fractures.Methods From October 2005 to October 2012,we treated 13 patients with talar neck fracture.They were 8 males and 5 females,with a mean age of 37.9 years (range,from 26 to 56 years).According to the Hawkins classification of talar neck fractures,2 had type Ⅰ,9 type Ⅱ,and 2 type Ⅲ.The right foot was involved in 9 of them.None of them sustained bilateral talar neck fractures.A concomitant medial malleolar fracture occurred in 4 of them.All the fractures were closed injury.All the patients received internal fixation with 2 opposing hollow screws of 3.5 mm in diameter which were inserted via the talus anterior or posterior approach and antegradely or

  10. Intramedullary screw fixation through Wiltse paraspinal approach to treat thoracolumbar spine fracture%Wiltse肌间隙入路联合伤椎置钉治疗胸腰段骨折

    Institute of Scientific and Technical Information of China (English)

    王根林; 张福占; 谢计乐; 张彬; 陈洁; 汪恒; 姜为民; 杨惠林

    2015-01-01

    目的 探讨经Wiltse肌间隙入路联合伤椎置钉短节段椎弓根螺钉固定治疗无神经损伤胸腰段骨折的疗效. 方法 回顾性研究2013年11月至2015年1月采用Wiltse肌间隙入路与传统剥离椎旁肌入路分别联合伤椎置钉治疗胸腰段骨折的48例患者资料,Wiltse肌间隙入路的患者为A组(24例),传统剥离椎旁肌入路的患者为B组(24例).两组患者术前一般资料比较差异无统计学意义(P>0.05),具有可比性.比较两组患者的手术时间、手术出血量、术后下地时间,术前及术后不同时间点腰背部疼痛视觉模拟评分(VAS),术前、术后下地前和末次随访时伤椎前缘高度比值的变化.结果 两组患者均无切口并发症、螺钉松动及断钉发生.A组手术时间、出血量与术后下地时间均少于B组,差异有统计学意义(P<0.001).两组患者术后VAS评分均较术前明显恢复,差异有统计学意义(P<0.05),术后1d、3d、1周、2周VAS评分两组间比较差异均有统计学意义(P <0.001),A组低于B组;术后6个月VAS评分两组间比较差异无统计学意义(P=0.328).两组患者术后伤椎前缘高度均较术前明显恢复,差异有统计学意义(P<0.05);两组间椎体高度恢复率比较差异无统计学意义(P>0.05). 结论 两种手术入路联合伤椎置钉治疗胸腰段脊柱骨折均能使椎体骨折获得良好复位,但Wiltse肌间隙入路手术时间短、创伤更小、术后恢复更快.%Objective To demonstrate the efficacy of fixation with short-segment thoracolumbar pedicle screws through Wiltse paraspinal approach in treatment of the thoracolumbar spine fracture without neurotrosis.Methods A retrospective analysis was conducted of the 48 patients with thoracolumbar spine fracture who had undergone intramedullary screw fixation from November 2013 to January 2015.The Wiltse paraspinal approach was adopted in 24 patients (group A), 12 males and 12 females, with a mean age of 48.1

  11. Reliability of predictors for screw cutout in intertrochanteric hip fractures

    NARCIS (Netherlands)

    K.M.J. de Bruijn (Kirstin); D. den Hartog (Dennis); W.E. Tuinebreijer (Wim); G.R. Roukema (Gert)

    2012-01-01

    textabstractBackground: Following internal fixation of intertrochanteric hip fractures, tip apex distance, fracture classification, position of the screw in the femoral head, and fracture reduction are known predictors for screw cutout, but the reliability of these measurements is unknown. We invest

  12. Robot assisted navigated drilling for percutaneous pedicle screw placement: A preliminary animal study

    Directory of Open Access Journals (Sweden)

    Hongwei Wang

    2015-01-01

    Conclusions: The preliminary study supports the view that computer assisted pedicle screw fixation using spinal robot is feasible and the robot can decrease the intraoperative fluoroscopy time during the minimally invasive pedicle screw fixation surgery. As spine robotic surgery is still in its infancy, further research in this field is worthwhile especially the accuracy of spine robot system should be improved.

  13. 探讨后路椎间盘摘除椎弓根钉内固定结合Cage植骨治疗腰椎间盘突出症的临床效果%Clinical Effect of Posterior Lumbar Interbody Fusion and Pedicle Screw Fixation Combined With Cage Bone Graft in the Treatment of Lumbar Disc Herniation

    Institute of Scientific and Technical Information of China (English)

    梁涛

    2016-01-01

    Objective To explore the feasibility of posterior lumbar interbody fusion and pedicle screw fixation combined with Cage bone graft in the treatment of lumbar disc herniation. Methods 86 patients with lumbar disc herniation were col ected. The patients in the study group were treated with posterior lumbar interbody fusion and pedicle screw fixation combined with Cage bone graft. The control group was treated with simple bone graft. Results There were significant differences in the treatment effect of the two groups after 6 months. Conclusion The treatment of lumbar disc herniation by posterior lumbar interbody fusion with pedicle screw fixation combined with Cage bone graft is effective and safe.%目的:探究腰椎间盘突出症使用后路椎间盘摘除椎弓根钉内固定结合 Cage 植骨治疗的可行性。方法收集腰椎间盘突出症患者86名,研究组使用后路椎间盘摘除椎弓根钉内固定结合 Cage 植骨治疗方案,对照组使用单纯植骨治疗方案。结果术后6个月两组患者治疗效果的差异具有统计学意义。结论腰椎间盘突出症使用后路椎间盘摘除椎弓根钉内固定结合 Cage 植骨治疗,具有较高的有效率和安全性。

  14. Design of bioabsorbable, amorphous polymer networks and composites

    Energy Technology Data Exchange (ETDEWEB)

    Wiggins, J.S.

    1992-01-01

    Amorphous, crosslinked, bioabsorbable polymers have been developed as an alternative to conventional linear, semi-crystalline thermoplastic bioabsorbable polymers, and as matrix resins for totally bioabsorbable composites. Bioabsorbable composites have been fabricated, consisting of poly(glycolic acid) surgical mesh embedded in polyester and polyester-urethane based matrices. Low-molecular weight precursors used in the matrices of the composites were based on D, L-lactide and [epsilon]-caprolactone polyols, which were synthesized by coordination ring-opening polymerization using glycol initiators and stannous octoate as catalyst. Polymers initiated with diols were chain extended with fumaric acid for use as unsaturated polyester prepolymers, and were crosslinked using peroxide initiation. Polyester triols synthesized from glycerol initiation were crosslinked with L-lysine diisocyanate (LDI). Networks synthesized from D, L-lactide based precursors were more rigid with higher tensile strengths and moduli, while networks synthesized from [epsilon]-caprolactone were more flexible and elastomeric. Copolymer network properties were influenced by the relative amounts of each monomer incorporated into the copolymers. A composite based on neat poly(D, L-lactide-co-[epsilon]-caprolactone) fumarate displayed a tensile strength of 37 MPa and modulus of 107 MPa; addition of 25 wt% styrene yielded tensile strength and modulus of 64 MPa and 689 MPa, respectively. A silane coupling agent was shown to dramatically improve the fiber-matrix interfacial adhesion; tensile strength of a poly(D, L-lactide-co-glycolic acid) fumarate composite was increased from 84 to 92 MPa upon fiber pretreatment. Improved adhesion was also demonstrated using SEM. DSC revealed that if the glass transitions for the matrices was maintained at [approximately]60[degrees]C, the composites were easily shaped above this temperature, yet remained rigid at biological temperatures.

  15. 下颈椎前路内固定联合后路经关节金属螺钉置入固定的生物力学稳定性%Biomechanical stability of the lower cervical spine inter-fixation by anterior approach combined with posterior articular screws

    Institute of Scientific and Technical Information of China (English)

    康建平; 冯大雄; 王清; 钟德君; 李骏; 叶飞; 王松

    2011-01-01

    BACKGROUND: A simple anterior corpectomy or discectomy, or simple posterior open canal to expand a single trip cannot fully complete three-column spinal cord decompression and spinal stabilization in patients with degenerative cervical stenosis.OBJECTIVE: To study the biomechanical stability of the lower cervical spine inter-fixation by anterior approach combined with posterior srticular screws.METHODS: Ten cervical spine specimens were gained from cadavers. Every specimen was managed via two methods sequentially: The first method was by posterior C3-C7 open-door laminoplasty combined with posterior articular screw fixation andby anterior C5 subtotal corpectomy with bone granule graft in the titanium mesh and ORION fixation (test group); The second method was by posterior C3-C7 open-door laminoplasty and by anterior C5 subtotal corpectomy with bone granule graft in thetitanium mesh and ORION fixation (control group).RESULTS AND CONCLUSION: Compared with the control group, displacement angles of flexion, extension, left/right lateroflexion left/right rotation in the test group were lower (P < 0.001). The findings indicated that: ①The lower spine gained the excellent biomechanical stability in flexion, extension, lateroflexion and rotation via the treatment of anterior fixation combined posterior articular screw fixation. ②The treatment of anterior fixation combined with posterior articular screw fixation provided significant biomechanical stability to the lower cervi cal spine in flexion position.%背景:对退变性颈椎管狭窄单纯采用前路椎体次全切除或椎间盘切除或单纯后路单开门椎管扩大成行均不能彻底完成脊髓减压和脊柱三柱稳定.目的:探讨下颈椎前路固定联合后路经关节螺钉固定的生物力学稳定性.方法:正常成人尸体颈椎标本,每具分别制作以下两种模型:①经后路C3~C7单开门和下颈椎前路C5椎体次全切除钛网支撑植骨、ORION内固定

  16. 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.

  17. The main cause and countermeasure of internal fixation loosening and disruption in the treatment of thoracolumbar fracture with vertebra pedicle screw-rod system%椎弓根钉棒系统治疗胸腰段椎体骨折术后松动断裂的原因及防治

    Institute of Scientific and Technical Information of China (English)

    蒲川成; 冉学军; 邓长青; 覃勇志; 周勇

    2012-01-01

    目的 分析脊柱后路椎弓根钉棒系统内固定治疗胸腰段椎体骨折术后松动、断裂的原因,探讨防治对策.方法 426例行后路椎弓根钉棒系统内固定治疗的胸腰椎骨折患者中,术后21例发生内固定松动、断裂,其中11例进行手术翻修,10例采取保守观察治疗.结果 21例均获随访,时间8~36个月.患者均骨性愈合,未再次发生内固定物松动及断钉、断棒.结论 经后路椎弓根钉棒系统内固定术治疗胸腰段椎体骨折,撑开复位后致骨折椎体"蛋壳样"变,未植骨填充所导致的前柱不实、后柱植骨融合不良、椎弓根钉棒系统安置不当内部自身产生较大的应力及术后脊柱负重过早是钉棒松动、断裂的主要原因.通过对伤椎前后柱进行充分植骨,提高椎体的骨性愈合速度和质量,及尽可能保留后柱小关节结构,增加脊柱稳定性,可明显降低内固定物松动、断裂的发生率.%Objective To explore the main cause and countenneasure of internal fixation loosening and disruption in the treatment of thoracolumbar fracture with pedicle screw-rod system. Methods A retrospective review was made in 426 patients with thoracolumbar fractures who fixed with pedicle screw-rod system. There were 2f cases with internal fixation loosening and disruption, f f cases were undergone revisions and the other fO cases were treated conservatively. Results 2f cases were followed up for 8~36 months. All of these cases recovered without fixation loosening and disruption. Conclusions The " shell-like change after vertebral fractures distraction reduction without bone graft leads to anterior column weakness. No posterior bone graft, and wrong pedicle screw-rod system insertion leads to excessive stress force on internal fixator itself, and premature vertebral column weight-bearing were the main reasons of pedicle screw-rod system loosening and disruption in the treatment of thoracolumbar vertebral fracture with the

  18. 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、

  19. One stage atlantoaxial pedicle screw fixation for unstable atlas burst fracture%一期后路寰枢椎固定治疗不稳定寰椎爆裂性骨折

    Institute of Scientific and Technical Information of China (English)

    蒋伟宇; 马维虎; 赵刘军; 顾勇杰; 胡旭栋; 于亮; 李国庆; 阮超越; 洪锦炯

    2015-01-01

    Objective To assess the clinical results of one stage posterior atlanloaxial pedicle screw fixation and fusion for unstable atlas burst fracture.Methods A retrospective analysis of clinical data including 32 cases,which were admitted according to the inclusion and exclusion criteria between May 2010 and December 2013.There were 11 females and 21 males whose age ranged from 22 to 59 years (mean 41.8 years).X-ray,CT scan reconstruction and MRI were done before operation to evaluate the injury of ligament and fracture.There were 17 cases of unstable atlas burst fracture,including 5 cases Jefferson fracture,8 cases untypical Jefferson fracture,and 4 cases lateral mass fracture combined with anterior arch or posterior arch fracture.There were 15 cases combined with axial fracture,9 cases combined with dens fracture,4 cases with axial body fracture,and 2 cases with Hangman fracture.The patients had various degrees of occipital neck pain,limited mobility and neurological dysfunction.Degree C in 1 case and degree D in 5 cases were assessed by the American Spinal Cord Injury Association (ASIA) impairment scale.All patients were treated with one stage posterior atlantoaxial pedicle screw fixation and fusion.All patients were assessed clinically by neurologic recovery,atlantoaxial reduction and bone graft fusion.The preoperative and postoperative atlanto-dens interval (ADI),lateral mass distance (LMD) and VAS were measured and statistically analyzed.Complications were observed.Clinical outcome of last follow-up was evaluated by dynamic X-ray and CT scan.Results All patients were followed up.The follow-up time ranged from 10 to 24 months (mean 15.6 months).The healing time of bone fusion ranged from 5 to 10 months with an average follow-up time of 6.9 months.The average preoperative VAS score was 5.0± 1.4 while the score of last follow-up was 1.0±0.7,with statistically significant differences.Neurological status improved in all patients but one.Four cases with grade D

  20. 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。

  1. 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.

  2. 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

  3. 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:

  4. 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

  5. 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.

  6. 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.

  7. 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

  8. 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.

  9. 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

  10. Biomechanical evaluation on the stability of anterior cervical pedicle screw fixation for osteoporosis%生物力学评价颈椎前路椎弓根螺钉植入骨质疏松椎骨内的稳定性

    Institute of Scientific and Technical Information of China (English)

    李振伟; 向阳明

    2015-01-01

    segments, the stability of fixator and bone graft is poor due to big bone graft span, which may easily cause fusion failure and pseudarthrosis, and impact curative effects. OBJECTIVE:To investigate biomechanical stability of anterior cervical pedicle screw implantation for osteoporosis in the vertebra. METHODS:A total of 12 human cervical vertebrae were col ected, including 6 vertebrae with normal bone density and 6 vertebrae with osteoporosis. Data of 60 vertebra specimens were analyzed. 30 osteoporotic specimens implanted in anterior cervical pedicle screw were set as anterior cervical pedicle screw group. 30 normal specimens implanted in anterior cervical pedicle screw were set as anterior vertebral screw group. According to bone density, 40 vertebrae were col ected in above two groups, and were considered as normal bone mineral density group, instant osteoporosis group, fatigue normal bone mineral density group, and fatigue osteoporosis group (n=10). Bone mineral density of each vertebra was detected using dual-energy X-ray absorptiometry. Biomechanical index of two kinds of screws was detected using ElectroForce 3510 material testing machine. RESULTS AND CONCLUSION:Bone mineral content, vertebral screw pul-out strength, vertebral screw pul-out stiffness, pedicle screw pul-out strength, and pedicle screw pul-out stiffness were significantly higher in the anterior cervical pedicle screw group than in the anterior vertebral screw group (P<0.05). The maximum axial pul-out strength of normal bone mineral density group, instant osteoporosis group, fatigue normal bone mineral density group, and fatigue osteoporosis group was significantly higher than in the anterior vertebral screw group (P<0.05). The results confirmed that osteoporotic vertebral biomechanical performance is more stable in anterior pedicle screws compared with the anterior vertebral screw.

  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. Anterior cervical plating plus axial screw fixation for treating cervical flexion-distraction injury: anatomic study%颈椎前路钢板并轴向螺钉固定治疗屈曲牵张型损伤的解剖学研究

    Institute of Scientific and Technical Information of China (English)

    瞿东滨; 邹琳; 杨勇; 徐准; 程勇泉

    2012-01-01

    Objective To study the anatomical flexibility of anterior cervical plating plus axial screw fixation for treating cervical flexion-distraction. Methods Fifty cases of digital lateral X-ray films from adult healthy volunteers aged 24-48 years, with mean 28 years, were measured directly in the JW-PACS picture system. Measuring parameters included vertebral body height, intervertebral disc height and disc depth. The line started from anteroinferior point of the inferior vertebrae to posterosuperior point of the superior vertebrae was drawn to mimic the axial screw fixation in the lateral film. The maximal screw length, screw cephalic inclination angle and the distance between screw and anterior vertebral margin at disc level was recorded. Simulated anterior cervical plating and axial screw fixation was carried out in one preserved human specimen under the guidance of C-arm X-ray fluoroscope. Results The maximal length of anterior cervical axial screw was (41.18+3.92 )mm, and the axial screw inclination angle (25.21±3.58)°. The suitable depth of interbody graft was more than (11.69±1.63)mm, but less than (17.09±1.50)mm of disc depth. Simulated procedure in the preserved specimen demonstrated that axial screw fixation could be successfully completed at C2/3, C3/4, C4/5, and C5/6 levels, but difficult be performed at C6/7 due to obstacle of sternum. Conclusions The flexibility of axial screw fixation plus anterior cervical plating is confirmed from this study for managing of cervical flexion-distraction injuries.%目的 提出一种联合颈椎前路钢板固定治疗屈曲牵张型颈椎损伤的新术式—颈椎轴向螺钉固定术,进行解剖学可行性研究.方法 随机调取50例正常成年志愿者的颈椎侧位片.年龄22~48岁,平均28岁.通过JW-PACS图像系统,测量C2~6椎体高度;C2/3~C5/6椎间盘高度以及椎间盘矢径;并模拟轴向螺钉固定,即下位椎体前下缘至上位椎体后上缘的连线,测量轴向螺钉最大

  13. 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.

  14. Flexible fixation and fracture healing

    DEFF Research Database (Denmark)

    Schmal, Hagen; Strohm, Peter C; Jaeger, Martin

    2011-01-01

    , noncomminuted fractures. External fixation uses external bars for stabilization, whereas internal fixation is realized by subcutaneous placement of locking plates. Both of these "biologic" osteosynthesis methods allow a minimally invasive approach and do not compromise fracture hematoma and periosteal blood...... of articular fractures. They allow for subchondral stabilization using small-diameter angular stable screws as well as buttressing of the joint and the metaphyseal component of a fracture. Biomechanically, they can be far stiffer than external fixators, because subcutaneous plates are located much closer...... to the bone surface than external fixator bars. External fixators have the advantage of being less expensive, highly flexible, and technically less demanding. They remain an integral part of orthopaedic surgery for emergent stabilization, for pediatric fractures, for definitive osteosynthesis in certain...

  15. 脊柱前路内固定器系统与脊柱后路椎弓根钉棒系统治疗腰椎爆裂性骨折的疗效比较%Effect of anterior internal fixation and posterior pedicle screw fixation in the treatment of lumbar burst fractures

    Institute of Scientific and Technical Information of China (English)

    张建新; 李玉明; 张苏斌; 吕曦

    2016-01-01

    Objective To compare the effect of anterior internal fixation and posterior pedicle screw fixa-tion in the treatment of lumbar burst fractures.Methods Thirty-three patients( the anterior group) with burst frac-ture of lumbar spine treated by anterior internal fixation system in our hospital from Feb.2012 to Dec.2013 were se-lected.Fifty-four patients ( the posterior group) treated by posterior pedicle screw rod system fixation were also ret-rospectively analyzed.The differences in operation time, intraoperative blood loss,loss of Cobb' s angle,Japanese Orthopaedic Association ( JOA) Scores,anterior height ratio of the vertebral body and score by American Spinal In-jury Association (ASIA) between the two groups were compared.Results The operation time of (178.8 ±55.2) min and the intraoperative blood loss of ( 750.9 ± 85.2 ) mL in the anterior group were both significantly higher than those of the posterior group[(149.3 ±38.6)min,(414.3 ±67.8)mL] and the difference was statistically sig-nificant(P0.05).After 1 year of operation,the JOA scores of the two groups were significantly improved and the difference was statistically significant(P0.05) .Conclusion The results of the two methods in the treatment of lumbar burst frac-ture are both satisfactory.The disadvantage of the posterior group is the large loss of Cobb angle correction and the disadvantage of the anterior group is the surgical trauma.Individualized consideration should be given to the factors such as patients' surgical tolerance.%目的 研究对比脊柱前路内固定器系统内固定及脊柱后路椎弓根钉棒系统内固定治疗腰椎爆裂性骨折的效果差异.方法 笔者选取2012年2月~2013年12月采用前路内固定器系统内固定治疗的33例腰椎爆裂性骨折患者(前路组)、后路椎弓根钉棒系统内固定治疗的54例患者(后路组)进行回顾性分析,对比两组患者的手术时间、术中出血量、Cobb角丢失、日本矫形外科协会(JOA)评分

  16. 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

  17. Bioabsorbable materials for use in vena cava filters

    DEFF Research Database (Denmark)

    Løvdal, Alexandra Liv Vest; Klausen, Kasper

    ⁄2 weeks using three sheep. Two stent-bases were implanted per sheep, one cranially and one caudually. After merely 2 weeks the stent-bases showed multiple fractures in the circumferential direction caused by the continuous cyclic compression. The fragments from the caudal device remained in the caval wall...... the adequate flexibility in such a filter design to withstand the cyclic compression of the vein over the course of 2 weeks. To achieve the goal of creating a bioabsorbable IVC filter, the stent-base must be made from a different polymer....

  18. The effect of screw insertion torque on tendons fixed with spiked washers.

    Science.gov (United States)

    Beynnon, B D; Meriam, C M; Ryder, S H; Fleming, B C; Johnson, R J

    1998-01-01

    The long-term success of a hamstring tendon graft depends not only on the type of device that is used for fixation but also on the mechanical interlocking of the soft tissue between the fixation device and bone. The purpose of this study was to evaluate the effect of screw insertion torque on the structural properties of soft tissue fixed to bone with a spiked metal washer. Two bovine tendons, one similar in size to a human semitendinosus tendon and the other similar in size to a human gracilis tendon, were secured to a bovine femur using a figure-of-8 technique with screws and metal spiked washers. A single load to failure was applied at 25 mm/sec. A significant positive linear correlation was observed between fixation screw insertion torque magnitude and the ultimate failure load value. An increase in the fixation screw insertion torque produced an increase in the ultimate failure load value. Similarly, there was a significant positive linear correlation between fixation screw insertion torque magnitude and the average maximum linear load value. No relationship was detected between screw insertion torque magnitude and the linear stiffness values of the tendon-fixation construct, indicating that a reproducible model was used. This study demonstrates that screw insertion torque is an important variable that controls the initial strength of soft tissue fixation to bone.

  19. ANALYSIS OF CLINICAL CURATIVE EFFECT OF THE TREATMENT OF PRESSURIZED STEEL SCREWS INTERNAL FIXATION FOR 106 PATIENTS WITH NONUNION OF HUMERUS BACKBONE FRACTURE%加压钢板螺钉内固定用于106例肱骨干骨折术后骨不愈合治疗的临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    吐尔洪江·阿不拉; 吐尔松·热合曼; 邓龙君

    2011-01-01

    [Objective] To explore the clinical curative effect of the treatment of pressurized steel screws internal fixation for patients with nonunion of humerus backbone fracture. [ Methods] 106 patients with brachial backbone fracture nonunion (observation group) were treated by the application of pressurized steel screws internal fixation, analyzed its therapeutic effect, and compared with clinical curative effect of 72 cases (control group) of nun-steel screws adopted the pressure of internal fixation for brachial backbone fracture nonunion. [Results] 106 patients were performed successfully, all were followed up 9 months to 24 months effectively, the average time was 17 months. The line of force was good, 92 cases reached anatomicalreattachment, 14 cases reached the function restoration. The time of X-ray examination for osteoarthritis was 2-11 months, the average was 4.9 months, no one nonunion. 4 patients happened postoperative wound infection, after in time antibiotic treatment, all healed. All patients were without elbows, shoulders, activity function limitation. The excellent and good rates were 100%, and significantly higher than those in the control group. [Conclusion] Pressurized steel screws internal fixation in the treatment of postoperative nonunion after screw humerus fracture has good curative effect, can acquire satisfactory results, and widely used and promoted in clinic.%[目的]探讨加压钢板螺钉内固定在治疗肱骨干骨折术后不愈合方面的临床意义.[方法]对某院经治的106例肱骨干骨折术后不愈合的患者(观察组),应用加压钢板螺钉内固定术,分析其治疗效果,并与72例以往采用非加压钢板螺钉内固定治疗的肱骨干骨折术后不愈合患者(对照组)的临床疗效比较.[结果]106例患者手术均顺利完成,均进行有效随访,随访时闻9~24个月,平均17个月.上肢的力线良好,106例中92例达到了解剖复位,余14例均达到了功能复位.X线检查结

  20. 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

  1. Anatomic security of applying different numbers of screws at the sacrum sides in the anterior double plate fixation of the sacroiliac joint%骶髂关节前路双钢板固定骶骨侧不同螺钉数量的解剖安全性研究

    Institute of Scientific and Technical Information of China (English)

    刘佳; 高仕长; 倪卫东; 蒋电明; 周程鹏

    2012-01-01

    0bjective: To compare the anatomic security of applying different numbers of screws at the sacrum sides in the anterior double plates fixation of the sacruiliac joint and to clarify which is safer when the stability of the fixation is considered. Methods: (1) Totally 15 normal cadavers pelvis were scanned by CT. Thin-section CT scan data were saved and analyzed by the software Materi-alise's interactive medical image control system (MIMICS 10.0). The virtual operations of the anterior double plates approach for fixation of the sacroiliac joint were performed in the same software. (2)The left sides of the sacroiliac joint were named as group A,in which two screws were placed into the sacrum sides. The right sides of the sacroiliac joint were named as group B,in which one screw was placed into the sacrum sides. The distances from the medial edge of the plates to the lateral sides of the anterior branches of lumbar nerves 4,5 were measured. The relationship of the screws and the sacroiliac joint was checked by radiograph. Results: (1 )In the virtual operations,the sacrum sides can accommodate two screws safely- (2)In group A,the distances from the medial edge of the upper and lower plates to the lateral sides of the anterior branches of lumbar nerve 5 were (3.0 ± 1.4) mm and (1.5 ± 1.0) mm respectively. The upper and lower plates can be placed below the anterior branches of lumbar nerve 4 safely. In group B,the distances from the medial edge of the upper plates to the lateral sides of the anterior branches of lumbar nerves 4,5 were (5.0 ± 1.1) mm and (10.3 ±1.3) mm respectively and those from the medial edge of the lower plates were (2.7 ± 0.5) mm and (5.1 ±0.9) nun respectively. (3)ln X-ray examination,no screw of the left upper plates was found in the sacroiliac joint in group A and 4 screws of the left lower plates were observed. On the other hand, no screw of the right plates (lower and upper) in the group B was found in the sacroiliac joint. Conclusions

  2. Correção da cifose de Scheuermann: estudo comparativo da fixação híbrida com ganchos e parafusos versus fixação apenas com parafusos Corrección de la cifosis de Scheuermann: estudio comparativo de la fijación híbrida con ganchos y tornillos versus fijación solo con tornillos Correction of Scheuermann kyphosis: comparative study of hybrid fixation using hooks and screws versus screw-only fixation

    Directory of Open Access Journals (Sweden)

    Enguer Beraldo Garcia

    2009-12-01

    fijación solo con tornillos.OBJECTIVE: to evaluate the degree of correction of Sheuermann kyphosis, in 6 patients who were submitted to surgery using hybrid instrumentation comprised of hooks and screws (H, and 17 patients undergoing screw-only fixation (P. METHODS: 23 patients with Scheuermann kyphosis were submitted to surgical treatment using anterior and posterior approach. In the present study, we indicated surgical treatment for rigid kyphosis, varying between 60º and 105º. All patients presented a Risser signal above 4. Liberation and Fusion were realized through anterior approach, followed by fixation, deformity correction, and arthrodesis through posterior approach. RESULTS: in Group H, a preoperative kyphosis of 84.17º and a postoperative of 47.5º were observed. In Group P, a preoperative kyphosis of 80.35º and postoperative of 33.53º were observed. CONCLUSION: it was concluded that both types of fixation presented very satisfactory results, with screw only fixation being superior.

  3. 实时三维导航技术应用于先天性脊柱侧凸矫形的近期疗效%SHORT-TERM EFFECTIVENESS OF SPINAL NAVIGATION WITH INTRA-OPERATIVE THREE-DIMENSIONAL-IMAGING MODALITY IN PEDICLE SCREW FIXATION FOR CONGENITAL SCOLIOSIS

    Institute of Scientific and Technical Information of China (English)

    孙麟; 宋跃明; 龚全; 刘立岷; 周春光; 周忠杰

    2013-01-01

    Objective To investigate short-term effectiveness of spinal navigation with the intra-operative three-dimensional (3D)-imaging modality in pedicle screw fixation for congenital scoliosis (CS). Methods Between July 2010 and December 2011, 26 patients with CS were treated. Of 26 patients, 13 patients underwent pedicle screw fixation using the spinal navigation with the intra-operative 3D-imaging modality (navigation group), while 13 patients underwent the conventional technique with C-arm X-ray machine (control group). There was no significant difference in gender, age, hemivertebra number and location, major curve Cobb angle, and Risser grade between 2 groups (P > 0.05). Operation time, operative blood loss, frequency of the screw re-insertion, and postoperative complication were observed. The pedicle screw position was assessed by CT postoperatively with the Richter's standard and the correction of Cobb angle was assessed by X-ray films. Results All patients underwent the surgery successfully without major neurovascular complication. There was no significant difference in operation time, operative blood loss, and pedicle screw location between 2 groups (P > 0.05). A total of 58 screws were inserted in navigation group, and 3 screws (5.2%) were re-inserted. A total of 60 screws were inserted in control group, and 10 screws (16.7%) were re-inserted. There was significant difference in the rate of pedicle screw re-insertion between 2 groups (χ2 =3.975, P=0.046). Patients of navigation group were followed up 6-24 months, and 6-23 months in control group. According to Richter's standard, the results were excellent in 52 screws and good in 6 screws in navigation group; the results were excellent in 51 screws, good in 5 screws, and poor in 4 screws in control group. Significant difference was found in the pedicle screw position between 2 groups (Z=-1.992, P=0.046). The major curve Cobb angle of 2 groups at 1 week and last follow-up were significantly improved when

  4. 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

  5. Computational investigations of mechanical failures of internal plate fixation.

    Science.gov (United States)

    Chen, G; Schmutz, B; Wullschleger, M; Pearcy, M J; Schuetz, M A

    2010-01-01

    This paper investigated the biomechanics of two clinical cases of bone fracture treatments. Both fractures were treated with the same locking compression plate but with different numbers of screws as well as different plate materials. The fracture treated with 12 screws (rigid fixation) failed at 7 weeks with the plate breaking; the fracture with six screws (flexible fixation) endured the entire healing process. It was hypothesized that the plate failure in the unsuccessful case was due to the material fatigue induced by stress concentration in the plate. As the two clinical cases had different fracture locations and different plate materials, finite element simulations were undertaken for each fractured bone fixed by both a rigid and a flexible method. This enabled comparisons to be made between the rigid and flexible fixation methods. The fatigue life was assessed for each fixation method. The results showed that the stress in the rigid fixation methods could be significantly higher than that in flexible fixation methods. The fatigue analyses showed that, with the stress level in flexible fixation (i.e. with fewer screws), the plate was able to endure 2000 days, and that the plate in rigid fixation could fail by fatigue fracture in 20 days. The paper concludes that the rigid fixation method resulted in serious stress concentrations in the plate, which induced fatigue failure. The flexible fixation gave sufficient stability and was better for fracture healing.

  6. Clinical evaluation of locking compression plate fixation for comminuted olecranon fractures

    NARCIS (Netherlands)

    Buijze, G.; Kloen, P.

    2009-01-01

    BACKGROUND: In patients managed with plate fixation for the treatment of an olecranon fracture, the placement of an axial intramedullary screw may obstruct the placement of bicortical screws in the ulnar shaft. To overcome this problem, unicortical screws can be applied with use of a contoured locki

  7. 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.

  8. Clinical Analysis of Tension Band Internal Fixation Screw Combined with Cannulated Titanium Wire Treatment of Patella Fracture%空心加压螺纹钉结合钛丝张力带法内固定治疗髌骨骨折临床探讨

    Institute of Scientific and Technical Information of China (English)

    陈哲

    2015-01-01

    Objective To hol ow compression screw nail combining with titanium wire internal fixation treatment of patel a fracture with tension band method shal be discussed in this paper.Methods Selected from October 2011to October 2014 were 31 cases of patel ar fracture patients,using hol ow compression screw nails with internal fixation with titanium wire tension band method to treatment, the treatment ef ect analysis.Results Al patients were successful y completed surgery,no looseness or breakage implants,knee function and basic returned to normal.Conclusion The treatment in patients with patel ar fracture,hol ow compression screw nails in combination with the use of internal fixation with titanium wire tension band method,fixed ef ect is good,can be as early as possible for knee joint function in patients with postoperative exercise,is a bet er treatment method.%目的对空心加压螺纹钉结合钛丝张力带法内固定治疗髌骨骨折予以探讨。方法选取我院2011年10月~2014年10月收治的31例髌骨骨折患者,采用空心加压螺纹钉结合钛丝张力带法内固定予以治疗,对治疗效果予以分析。结果所有患者均顺利完成手术,植入物无松动或断裂,膝关节功能也基本恢复正常。结论对髌骨骨折患者予以治疗时,空心加压螺纹钉结合钛丝张力带法内固定的运用,固定效果较好,术后患者可以尽早进行膝关节功能锻炼,是一种较好的治疗方法。

  9. Clinical Application of Single-side Pedicle Screw Fixation for Lumbar Posterior Fusion under Quad-rant System%可扩张通道单侧椎弓根内固定在腰椎融合术中的临床应用

    Institute of Scientific and Technical Information of China (English)

    张帅; 徐皓; 尹承慧; 黄小金

    2016-01-01

    目的:探讨经肌间隙可扩张通道单侧椎弓根内固定在单节段腰椎融合术中的临床应用价值。方法2012年8月至2014年6月,随机选取我院具有完整临床资料和随访信息的经肌间隙可扩张通道单侧椎弓根螺钉固定的患者45例。观察末次随访 Oswestry 功能障碍指数评分(oswestry disability index,ODI)和腰腿痛视觉模拟评分(visual an-alogue scale,VAS),术后1年 X 线片/ CT 观察测量椎间隙高度及观察椎间融合情况。结果术后末次随访 ODI、VAS评分及椎间隙高度较术前差异均有统计学意义(P <0.05),末次随访植骨融合率为100%。结论可扩张通道单侧椎弓根内固定在腰椎融合术中具有创伤小的优点,且疗效肯定,为腰椎退行性疾病的患者提供了一种简单、有效的治疗方法。%Objective To assess the clinical value of minimally invasive single-side pedicle screw fixation for lumbar pos-terior fusion. Methods A consecutive series of 45 patients who had undergone lumbar spinal fusion of 1 segment to treat de-generative lumbar disease was analyzed,which underwent TLIF with unilateral pedicle screw fixation under Quadrant system. More than 1 year all the patients were followed up with VAS scores and Oswestry disability questionnaire. All the patients ac-cepted X-line/ CT evaluation to compare the intervertebral height/ fusion rates at the operative level pre-operation with post-op-eration. Results The ODI score,VAS score and intervertebral height were significantly improved when compared with preop-erative one. The fusion rate were 100% . Conclusion Single-side pedicle screw fixation assisted by under Quadrant system caused less iatrogenic injury and had positive efforts post-operation. It can provide a simple and reliable choice in degenerative lumbar disease.

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

    Directory of Open Access Journals (Sweden)

    TANG Jin

    2013-02-01

    Full Text Available 【Abstract】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 ac-cording to the American Orthopaedic Foot and Ankle Soci-ety clinical rating systems. Results: In absorbable screw group, we obtained excel-lent 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. Key words: Ankle; Bone screws; Fractures, bone

  11. 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

  12. 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.

  13. 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.

  14. Usefulness of absorbable screws in the Sauvé-Kapandji procedure for rheumatoid wrist reconstruction.

    Science.gov (United States)

    Nakamura, K; Oda, H; Tanaka, S; Kuga, Y; Yamamoto, M; Nishikawa, T; Juji, T; Shimizu, M

    2002-06-01

    Abstract  In the Sauvé-Kapandji (S-K) procedure for rheumatoid wrist reconstruction, the distal end of the ulna is fixed to the radius with screws. Recently, absorbable screws have increasingly been used instead of metal ones. However, the clinical usefulness of absorbable screws in S-K procedures for rheumatoid patients is still unknown. The purpose of this article is to evaluate the effect of absorbable screws in this procedure by comparing their clinical results with those of metal screws. Poly-l-lactic acid (PLLA) absorbable screws were used in 23 wrists, and metal screws were used in 20 wrists. We evaluated the presence of general or local reactions to PLLA, the stability of the ulnar head, the time to bone union, changes in the shape of the distal ulna, and the presence of bone resorption around the screws. There were no complications with the use of PLLA screws, and their fixation stability was adequate to form sufficient bone union. In five cases in the metal screw group, bone resorption around the screws occurred between 1 and 2 years after surgery. Bone resorption around the PLLA screws was not observed. We conclude that absorbable screws may be more useful than metal screws in the S-K procedure for rheumatoid wrist reconstruction.

  15. Biomechanical comparison of reconstruction plate versus pedicle screw-rod system in fixation of the models of Tile B1 pelvic injury%钢板与钉棒系统固定骨盆Tile B1型损伤模型的生物力学比较

    Institute of Scientific and Technical Information of China (English)

    李尚政; 苏伟; 庄小强; 白宇; 陆生林

    2014-01-01

    Objective To compare the biomechanical properties of reconstruction plate and pedicle screw-rod system in fixation of the models of Tile B1 pelvic injury.Methods We used 7 cadaveric specimens of normal adult pelvis from 2 males and 5 females with an average death age of 42.1 years.The cadaveric pelvis preserved an intact spine from the fifth lumbar vertebra to 20 centimeters above the proximal ends of both femurs,intact pubic symphysis,bilateral hip joints,bilateral sacroiliac joints,and major pelvic ligaments.After the pelvic specimens were put in an AGS-X biomechanical testing machine at a simulated standing neutral posture,they were subjected to a vertical load of up to 500 N downward from the L5 vertebral body.The displacements of the symphysis pubis were recorded sequentially in the following 4 conditions:1.intact pelvis (the intact group); 2.models of Tile B1 pelvic injury simulating rotatory unstable injury of the pelvis in which the symphysis pubis was cut apart in combination with ruptures of ipsilateral sacrospinous and sacrotuberous ligaments (the injury group); 3.Tile B1 pelvic injury fixated with a reconstruction plate (the plate group).4.Tile B1 pelvic injury fixated with the pedicle screw-rod system (the screw-rod group).Results Under the vertical load of 500 N,the displacements of the symphysis pubis in the intact,injury,plate and screw-rod groups were respectively 0.121 ±0.025 mm,4.512 ±0.391 mm,0.358 ±0.051 mm,and 0.656 ±0.103 mm.There were significant differences between the 4 groups (F =725.707,P =0.000).The displacement increased from the intact group,the plate group,the screw-rod group to the injury group.The differences between any 2 groups were significant (P < 0.05).Conclusions In fixation of the models of Tile B1 pelvic injury,the reconstruction plate and the pedicle screw-rod system can both effectively restore the biomechanical stability of the injured pelvis.However,internal fixation with the reconstruction plate may yield better

  16. Strain-stress analysis of lower limb with applied fixator

    Directory of Open Access Journals (Sweden)

    Mrázek M.

    2010-07-01

    Full Text Available This paper compares physiological state of tibia before and after application of an external fixator. The fixator systems’ models but also model of tibia are loaded in the direction of body axis. The paper is focused on the examination of differences in stiffness before and after the application of fixation. Two types of axial external fixators are compared. Both fixators differ in their construction. The first fixator is two-frame and fixation rods are used for fixing the bone tissue (variant I. The second one is fixed into tibia with screws (variant II. We have found out that the two-frame external fixator has much bigger stiffness during limb fixation than the fixator with one body. Much higher deformations compared to physiological state of tibia occur in the variant II.

  17. 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

  18. Three-dimensional navigation for placement of percutaneous sacroiliac joint screws in internal fixation of sacroiliac complex injury%3D导航技术下经皮骶髂关节螺钉内固定治疗骶髂关节复合体损伤

    Institute of Scientific and Technical Information of China (English)

    王小阵; 孟乘飞; 汪国栋; 吴刚; 王锋; 刘曦明; 蔡贤华

    2016-01-01

    目的 探讨3D导航技术下经皮骶髂关节螺钉内固定治疗骶髂关节复合体损伤的临床疗效. 方法 回顾性分析2015年3月至2016年1月收治且获得随访的30例骶髂关节复合体损伤患者资料.男22例,女8例;年龄为25~63岁,平均44.2岁.骨折按Tile分型:B型14例,其中B1型6例,B2型6例,B3型2例;C型16例,其中C1型9例,C2型5例,C3型2例.3例术前合并腰骶干损伤患者采用前路钢板联合3D导航技术下经皮骶髂关节螺钉内固定,其余27例患者采用3D导航技术下经皮骶髂关节螺钉内固定.记录每枚螺钉置入时间、X线暴露时间,术后应用Matta放射学标准评定骨折复位质量,末次随访时采用Majeed评分标准评定骨盆功能. 结果 30例患者在3D导航系统辅助下共置入36枚骶髂关节螺钉.术中每枚螺钉置入时间为28~ 40 min(平均33.2 min),术中X线暴露时间为1.2~2.5 min(平均1.4 min).置钉处手术切口均未发生感染.术后骨折复位质量依据Matta评分标准评定:优16例,良11例,可3例,优良率为90.0%.术后X线片、CT三维重建示内固定均稳定,置入螺钉无断裂、松动及脱出.30例患者术后获6~ 12个月(平均10.6个月)随访.末次随访时根据Majeed评分标准评定骨盆功能:优17例,良8例,可4例,差1例,优良率为83.3%.结论 3D导航技术下经皮骶髂关节螺钉内固定治疗骶髂关节复合体损伤的疗效良好,具有手术创伤小、简便、快速等优点.%Objective To investigate the clinical results of three-dimensional navigation for placement of percutaneous sacroiliac joint screws in the intemal fixation of sacroiliac complex injury.Methods A retrospective study was conducted of the 30 patients who had been treated for sacroiliac complex injury from March 2015 to January 2016 and fully followed up.They were 22 males and 8 females,aged from 25 to 63 years (average,44.2 years).According to Tile classification for pelvic fractures,there were 14 cases

  19. The clinical research of posterior transpedicular screw fixation combined with intervertebral bone grafting fusion in the treatment of Ⅱ degree and Ⅲ degree lumbar spondylolisthesis%后路椎弓根螺钉内固定联合椎间植骨融合治疗Ⅱ、Ⅲ度腰椎滑脱的临床研究

    Institute of Scientific and Technical Information of China (English)

    宁凯; 车立新; 王志刚; 李坤; 吉喆

    2012-01-01

    目的 探讨后路椎弓根螺钉内固定联合椎间植骨融合治疗Ⅱ、Ⅲ度腰椎滑脱临床疗效.方法 回顾性分析我院2009年1月~2011年1月收治入院的30例腰椎滑脱症患者临床资料,所有病例均为Ⅱ、Ⅲ度腰椎滑脱.患者均采用后路椎弓根螺钉内固定联合椎间植骨融合治疗,观察手术前后临床症状及滑脱恢复情况、术后复位、疗效评价、材料生物相容性、术后椎间隙高度及BFS评分.结果 30例患者术前均为Ⅱ、Ⅲ度腰椎滑脱,其中,19例行椎管、神经根管减压、复位固定、植骨融合治疗,11例只行复位固定、植骨融合治疗.获得随访30例,均超过12个月.30例椎间植骨全部融合,融合率为100%.BFS评分优良率达90.0%.结论 后路椎弓根螺钉内固定联合椎间植骨融合治疗Ⅱ、Ⅲ度腰椎滑脱,操作简便、固定可靠,是临床治疗中的一种值得推广的方法.%Objective To explore the curative effect of posterior transpedicular screw fixation combined with intervertebral bone grafting fusion in the treatment of Ⅱ degree and Ⅲ degree lumbar spondylolisthesis. Methods The clinical data of 30 patients with lumbar spondylolisthesis from January 2009 to January 2011 in our hospital were analyzed retrospectively. All cases were suffered with Ⅱ degree or Ⅲ degree lumbar spondylolisthesis. All patients were adopted posterior transpedicular screw fixation combined with intervertebral bone grafting fusion treatment. The clinical symptoms, slippage recovery condition before and after operation, postoperative restoration, therapeutic effect evaluation, material biocompatibility, postoperative intervertebral height and BFS score were observed. Results 30 patients all suffered with Ⅱ degree or Ⅲ degree lumbar spondylolisthesis before surgery, among whom 19 cases were treated with canalis vertebralis and nerve root canal decompression, reduction and fixation and bone graft fusion. Other 11 cases were

  20. 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

  1. 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.

  2. 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

  3. Treatment of fractures of the condylar head with resorbable pins or titanium screws: an experimental study.

    Science.gov (United States)

    Schneider, Matthias; Loukota, Richard; Kuchta, Anne; Stadlinger, Bernd; Jung, Roland; Speckl, Katrin; Schmiedekampf, Robert; Eckelt, Uwe

    2013-07-01

    We aimed to compare in vivo the stability of fixation of condylar fractures in sheep using sonic bone welding and standard titanium screws. We assessed stability of the osteosynthesis and maintenance of the height of the mandibular ramus. Height decreased slightly in both groups compared with the opposite side. The volume of the condyle increased considerably in both groups mainly because callus had formed. The results showed no significant disadvantages for pin fixation compared with osteosynthesis using titanium screws.

  4. Accuracy and complications of transpedicular C2 screw placement without the use of spinal navigation.

    Science.gov (United States)

    Mueller, Christian-Andreas; Roesseler, Lukas; Podlogar, Martin; Kovacs, Attlila; Kristof, Rudolf Andreas

    2010-05-01

    The objective of the study was to describe the technique, accuracy of placement and complications of transpedicular C2 screw fixation without spinal navigation. Patients treated by C2 pedicle screw fixations were identified from the surgical log book of the department. Clinical data were extracted retrospectively from the patients' charts. Pedicle screw placement accuracy was assessed on postoperative CT scans according to Gertzbein and Robbins (GRGr). A total of 27 patients were included in the study. The mean age of the patients was 56 +/- 22.0 years; 51.9% of them were female. As much as 17 patients suffered from trauma, 5 of degenerative disease, 3 of inflammations and 2 of metastatic disease. A total of 47 C2 transpedicular screw fixations were performed. The canulated screws were inserted under visual control following the preparation of the superior surface of the isthmus and of the medial surface of the pedicles of the C2. Intraoperative fluoroscopy was additionally used. The postoperative CT findings showed in 55.3% GRGr 1, in 27.7% GRGr 2, in 10.6% GRGr 3, and in 6.3% GRGr 4 pedicle screw insertion accuracy. Screw insertions GRGr 5 were not observed. Screw malpositioning (i.e., GRGr 3 and 4) was significantly associated with thin (C2 fractures. In the three patients with screw insertions GRGr 4, postoperative angiographies were performed to exclude vertebral artery affections. In one of these three cases, the screw caused a clinically asymptomatic vertebral artery compression. Hardware failures did not occur. In one patient, postoperative pneumonia resulted in the death of the patient. Careful patient selection and surgical technique is necessary to avoid vertebral artery injury in C2 pedicle screw fixation without spinal navigation. A slight opening of the vertebral artery canal (Gertzbein and Robbins grade C2 pedicle screw insertions.

  5. Complications of pedicle screws in lumbar and lumbosacral fusions in 105 consecutive primary operations

    NARCIS (Netherlands)

    Jutte, PC

    2002-01-01

    Pedicle screw fixation is technically demanding and associated with high complication rates. The aim of this study was to identify and quantify the pedicle screw-related complications in 105 consecutive operations. We retrospectively analysed 105 consecutive primary operations. We found complication

  6. 全髋关节置换与空心螺钉置入内固定修复中老年股骨颈骨折:髋关节功能比较%Total hip arthroplasty versus hollow screw fixation for the repair of femoral neck fractures in the middle-aged and elder patients:hip function

    Institute of Scientific and Technical Information of China (English)

    林庆波

    2015-01-01

    BACKGROUND:The repair method of femoral neck fractures included internal fixation and hip arthroplasty. The selection of repair methods is affected by many factors, such as age, condition of patients, and own physical condition. The selection of repair methods for femoral neck fractures is always controversial. OBJECTIVE:To compare the hip function and prognosis of elderly patients with femoral neck fractures after total hip arthroplasty and hol ow screw fixation. METHODS:140 patients aged less than 60 years, who accepted treatment in Rizhao Hospital of Traditional Chinese Medicine from April 2012 to February 2014, were selected. They were randomly divided into replacement group and fixation group (n=70). Patients in the replacement group received total hip arthroplasty, and patients in the fixation group received hol ow compression screw fixation. Harris score of the hip, complications and satisfactions of the hip were observed, compared and analyzed between the two groups at 1 month post surgery. RESULTS AND CONCLUSION:The excel ent and good rate of Harris score at 1 month post surgery was significantly higher in the replacement group (90%) than in the fixation group (63%) (P  目的:对比中老年股骨颈骨折患者行全髋关节置换与空心螺钉置入内固定治疗后的髋关节功能及预后。  方法:选取2012年4月至2014年2月日照市中医医院收治的140例股骨颈骨折患者,年龄小于60岁,随机分为置换组和内固定组,每组70例。置换组采用全髋关节置换治疗,内固定组患者采取空心加压螺钉置入内固定治疗。观察两组患者治疗后1个月的髋关节功能Harris评分、并发症发生情况及关节功能满意度,并进行对比分析。  结果与结论:治疗后1个月,置换组Harris评分的优良率为90%,明显高于内固定组63%,差异有显著性意义(P<0.05);置换组并发症发生率为6%,明显低于内固定组29%

  7. Preliminary report of C1-C2 pedicle screw fixation for pediatric atlantoaxial dislocation%寰枢椎椎弓根螺钉内固定术治疗儿童寰枢椎脱位的初步报告

    Institute of Scientific and Technical Information of China (English)

    谭明生; 唐向盛; 王文军; 张恩中; 移平; 杨峰; 蒋欣; 郝庆英

    2012-01-01

    Objectives: To investigate the surgical feasibility and short-term clinical outcome of C1-C2 pedicle screw fixation for pediatric atlantoaxial dislocation. Methods: Between September 2005 and March 2011, 16 cases suffering from pediatric atlantoaxial dislocation undergoing atlantoaxial pedicle screw instrumentation were reviewed retrospectively. There were 9 males and 7 females with the age at time of surgery ranging from 5 to 13 years (mean, 9.1 years). All patients presented with pain at craniocervical junction and neck stiffness. 3 cases were complicated with medulla compression, and according to ASIA classification, there were 2 grade D and 1 grade C. Standard anterior-posterior, lateral and flexion-extension radiographs, computed tomography and MRI of cervical spine were obtained in all patients before operation. All patients presented with atlantoaxial dislocation, and the pathogenesis included disruption of transverse ligament(n=l), atlantoaxial fracture and dislocation(n=l), congenital odontoid malfromation(n=12), atlantoaxial rotatory subluxation(n=2). Cervical spinal cord compression was identified in 5 cases. The height of Cl posterior arch was 2.5-3.8mm (average, 3.0mm). The atlanto-dental interval(ADI) was 6-14mm(average, 9mm). Preoperative skull traction wasperformed rou-tinely on all cases for 1-2 weeks, and complete reduction was achieved in 7 cases, incomplete reduction in 5 cases, and no reduction in 4 cases. All patients had Cl pedicle screws placed as part of a fixation construct with pedicle exposure method(PEM). C1-C2 pedicle screw placement under direct vision in-traoperativeiy, reduction and fixation, bone graft and fusion were administered in all cases. The neurological function and CT scan were used to evaluate the surgical outcome. Results: All 16 patients underwent bilateral atlantoaxial pedicle screw fixation. All operations were completed successfully. A total of 64 screws were successfully placed. Reduction and fixation were

  8. 后路单侧椎弓根钉固定联合椎间融合术治疗退行性腰椎失稳%POSTERIOR UNILATERAL PEDICLE SCREW FIXATION PLUS LUMBAR INTERBODY FUSION FOR TREATMENT OF DEGENERATIVE LUMBAR INSTABILITY

    Institute of Scientific and Technical Information of China (English)

    魏富鑫; 刘少喻; 崔尚斌; 王乐; 梁春祥; 龙厚清; 黄阳亮

    2013-01-01

    Objective To evaluate the effectiveness of posterior unilateral pedicle screw fixation plus lumbar interbody fusion in treatment of degenerative lumbar instability.Methods Between February 2008 and December 2011,33 patients with degenerative lumbar instability were treated with posterior unilateral pedicle screw fixation plus lumbar interbody fusion,including 14 cases of lumbar disc protrusion with instability,15 cases of lumbar spinal stenosis with instability,3 recurrent cases of lumbar disc protrusion at 1 year after discectomy,and 1 case of extreme lateral lumbar disc protrusion.There were 20 males and 13 females with an average age of 47.2 years (range,39-75 years).The average disease duration was 12.8 months (range,6-25 months).Single-segment-fixation was performed in 28 cases (L4,5 in 21 cases,L5,S1 in 6 cases,and L5,6 in 1 case),and double-segment-fixation was performed in 5 cases (L3.4 and L4,5).The clinical results were evaluated by using Oswestry disability index (ODI) and modified Japanese Orthopaedic Association (JOA) score for low back pain.Results Infection occurred in 1 case,and was cured after dressing change; primary healing was obtained in the other patients.Thirty-one patients were followed up 32.3 months on average (range,15-53 months).Cage displacement occurred in 1 case who received bilateral pedicle screw fixation plus lumbar interbody fusion; no screw breaking,Cage displacement,or pseudoarthrosis was observed in the others.X-ray films showed bone fusion in the other patients except 1 case of bone fusion failure.ODI and JOA score at last follow-up were significantly improved when compared with the ones before operation and at 2 weeks after operation (P <0.05); the improvement rates were 74.0% ± 10.1% and 83.6% ± 9.4%,respectively.Conclusion Posterior unilateral pedicle screw fixation plus lumbar interbody fusion is an effective and reliable method for patients with degenerative lumbar instability because it has the advantages of

  9. C2 laminar screw and C1-2 transarticular screw combined with C1 laminar hooks for atlantoaxial instability with unilateral vertebral artery injury.

    Science.gov (United States)

    Guo, Qunfeng; Liu, Jun; Ni, Bin; Lu, Xuhua; Zhou, Fengjin

    2011-09-01

    Transarticular screw fixation (TASF) is technically demanding, with high risk of vertebral artery (VA) injury. How to manage intraoperative VA injury and choose optimal alternative fixation becomes a concern of spinal surgeons. In this study, the management strategy for a patient with suspected intraoperative VA injury was analyzed. A 53-year-old woman developed type II odontoid fracture and brain stem injury due to a motor vehicle accident 3 months earlier. After conservative treatments, the brain stem injury improved, but with residual ocular motility defect in the right eye. The odontoid fracture did not achieve fusion with displacement and absorption of fracture fragments. After admission, atlantoaxial fixation using bilateral C1-2 transarticular screws (TASs) combined with C1 laminar hooks was planed. The first TAS was inserted successfully. Unfortunately, suspected VA injury developed during tapping the tract for the second TAS. Considering the previous brain stem injury and that directly inserting the screw to tamponade the hemorrhage might cause VA stenosis or occlusion, we blocked the screw trajectory with bone wax. C2 laminar screw was implanted instead of intended TAS on the injured side. The management strategy for suspected VA injury should depend on intraoperative circumstances and be tailored to patients. Blocking screw trajectory with bone wax is a useful method to stop bleeding. Atlantoaxial fixation using C2 laminar screw and C1-2 TAS combined with C1 laminar hooks is an ideal alternative procedure.

  10. 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

  11. 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

  12. Merits Difference of Percutaneous Pedicle Screw Internal Fixation and Tra-ditional Surgery in Treatment of Thoracolumbar Fracture%经皮椎弓根螺钉内固定术和传统手术治疗胸腰椎骨折的优劣差异

    Institute of Scientific and Technical Information of China (English)

    刘军; 张陆; 高松明

    2016-01-01

    目的:研究比较经皮微创椎弓根螺钉内固定和传统的开放手术治疗胸腰椎骨折临床优劣差异。方法整群选取2012年12月—2015年6月期间在该院治疗的胸腰椎骨折患者44例,采用随机分组将其均分成微创组和开放组,每组患者22例。开放组采用传统的开放性椎弓根螺钉内固定手术治疗;微创组实施Sextant系统下经皮微创内固定手术治疗。记录两组患者的围手术期相关指标、胸腰椎术后矫正情况,并随访观察并发症情况。结果微创组在手术时间、切口大小、出血量等围手术期指标均要明显优于开放组(P﹤0.05);治疗后,两组在椎前缘高度差异有统计学意义(P﹤0.05)。开放组并发症发生例数明显高于微创组(P﹤0.05)。结论经皮椎弓根螺钉内固定术治疗胸腰椎骨折具有出血少、安全性高、临床效果好等优点。%Objective To research and compare the merits difference of percutaneous pedicle screw fixation and traditional surgery in treatment of thoracolumbar fracture. Methods 44 cases of patients with thoracolumbar fracture treated in our hos-pital from December 2012 to June 2015 were selected and randomly divided into the mini-invasive group and the open group with 22 cases in each, the open group were treated with traditional open?pedicle screw internal fixation, the mini-in-vasive group were treated with minimally invasive percutaneous internal fixation under the Sextant system, the related index-es in the perioperative period and rectification condition after thoracolumbar surgery of the two groups were recorded , the complication condition was followed up and observed. Results The indexes in the perioperative period such as operation time, cut size and blood loss were obviously higher than those in the open group, (P﹤0.05), after treatment, the difference in the anterior vertebral body height between the two groups was statistically significant (P﹤0.05), the

  13. A review of locking compression plate biomechanics and their advantages as internal fixators in fracture healing.

    Science.gov (United States)

    Miller, Danielle L; Goswami, Tarun

    2007-12-01

    Metallic implants are often involved in the open reduction and internal fixation of fractures. Open reduction and internal fixation is commonly used in cases of trauma when the bone cannot be healed using external methods such as casting. The locking compression plate combines the conventional screw hole, which uses non-locking screws, with a locking screw hole, which uses locking head screws. This allows for more versatility in the application of the plate. There are many factors which affect the functionality of the plate (e.g., screw placement, screw choice, length of plate, distance from bone, etc.). This paper presents a review of the literature related to the biomechanics of locking compression plates and their use as internal fixators in fracture healing. Furthermore, this paper also addresses the materials used for locking compression plates and their mechanical behavior, parameters that control the overall success, as well as inherent bone quality results.

  14. Two I.CO.S.s and general cannulated compression screw in femoral neck fracture fixation: a biomechanical comparison of 2 different configurations%2种构型2枚I.CO.S.固定股骨颈骨折的生物力学比较

    Institute of Scientific and Technical Information of China (English)

    陆慧; 吴元勇; 朱明; 倪卫东

    2011-01-01

    目的:探讨双重空心加压螺钉(Ideal compression screw,I.CO.S.)在治疗股骨颈骨折中的生物力学作用,并为临床上选择合适空间构型的2枚此类螺钉治疗股骨颈骨折提供一定的理论依据.方法:采集20具尸体股骨标本,模拟股骨颈头下型骨折,随机分为I.CO.S.组(实验组)和普通空心加压螺钉组(对照组),每组各10个标本,分别随机采用2枚水平位(2枚螺钉前后平行位于股骨颈轴心上方)和垂直位(2枚螺钉上下平行位于股骨颈轴心上下方)固定各5个.测定各组载荷下的应变值、股骨头的水平和垂直位移、并进行屈服力学性能测试.结果:在生物力学稳定性方面,I.CO.S.在水平位移和屈服载荷方面较普通空心加压螺钉好,螺钉水平位固定在应变、水平位移和屈服载荷方面较垂直位好.结论:I.C0.S.固定股骨颈骨折的稳定性较好,且2枚I.CO.S.水平位固定有较高的稳定性可应用于临床.%Objective : To explore the hiomechanical stability for treatment of femoral neck fracture with ideal compression screw ( I.CO. s. ) and to provide theoretical basis for choosing appropriate geometric configurations of two I.CO.S.s in clinical application. Methods : 20 cadaveric human femurs were selected and divided randomly into two groups : experiment group and control group, 10 in each one which was then divided equally into two sub-groups. The model of subcapital femoral neck fracture was made , then given anatomical reduction and fixed with I.CO.S. ( experiment group ) and general cannulated compression screw ( control group)separately with two different configurations : horizontal one ( parallel screws in superior aspect of femoral neck ) and vertical one( parallel screws in sagittal plane of femoral neck ) . The different biomechanical performances were evaluated through experimental stress analysis. Results : In hiomechanical stahility aspect,I.CO.S.was better than general screw in the horizontal

  15. Complicaciones de los tornillos de bloqueo intermaxilar en el tratamiento de las fracturas mandibulares Complications of self-tapping bone screws for maxillomandibular fixation in the treatment of jaw fracture

    OpenAIRE

    J. Molina Montes; J. González-Lagunas; J. Mareque Bueno; J.A. Hueto Madrid; G. Raspall Martí

    2008-01-01

    Durante la última década se ha introducido el tornillo de bloqueo intermaxilar como método de fijación maxilomandibular en el tratamiento de las fracturas de mandíbula. El propósito del estudio es evaluar las complicaciones de la técnica y la yatrogenia dental que derivan de su aplicación durante un periodo de 4 años. Se han revisado un total de 62 pacientes y 272 tornillos y, aunque han aparecido complicaciones, su incidencia es baja.In the last decade, self-tapping bone screws have been use...

  16. 前路钛板结合方形区螺钉内固定治疗涉及方形区的髋臼骨折%Quadrilateral plate fractures of the acetabulum treated by internal fixation with reconstruction titanium plate combined with trans-plate quadrilateral screws via the ilioinguinal approach

    Institute of Scientific and Technical Information of China (English)

    蔡贤华; 刘曦明; 汪国栋; 徐峰; 王华松; 李世梁; 黄大伟; 徐洲发

    2013-01-01

    目的 探讨前路钛板结合方形区螺钉内固定治疗涉及方形区的髋臼骨折的疗效. 方法 2005年1月至2011年5月共收治52例涉及方形区的髋臼骨折患者,其中36例获得随访,男21例,女15例;年龄21~59岁,平均43.5岁.骨折按Letournel分型:双柱骨折15例,横形骨折4例,前柱伴后半横形骨折8例,T形骨折9例.所有患者均采用髂腹股沟入路,复位后行重建钛板及经钛板3 ~5枚皮质骨螺钉(方形区螺钉)部分经骨表面内固定.术后应用Matta放射学标准评估骨折复位质量,末次随访时采用改良Merle d'Aubigné和Postel评分标准评定髋关节功能. 结果 36例患者术后获12 ~ 72个月(平均41.7个月)随访.术后骨折复位质量按Matta放射学标准评定:解剖复位19例,良好复位12例,不满意复位5例,复位优良率为86.1%.所有患者骨折均获临床愈合,愈合时间为2~4个月,平均3个月.末次随访时采用改良Merle d'Aubigné和Postel评分标准评定髋关节功能:优16例,良13例,可5例,差2例,优良率为80.6%.本组患者功能优良率与骨折复位质量呈明显正相关(r=0.513,P=0.001).无一例患者发生方形区螺钉松脱、断裂.结论 前路钛板结合方形区螺钉内固定可靠,无进入髋关节腔之虞,是治疗以前柱损伤为主的双柱骨折、向前移位的横形骨折、部分前柱合并后半横形骨折及部分T形骨折的有效方法之一.%Objective To explore the clinical efficacy of internal fixation using reconstruction titanium plate combined with trans-plate quadrilateral screws in treatment of quadrilateral plate fractures of the acetabulum via the ilioinguinal approach.Methods Of the 52 quadrilateral plate fractures of the acetabulum which had been treated between January 2005 and May 2011,36 cases were followed up.They were 21 males and 15 females,with an average age of 43.5 years (from 21 to 59 years).By Letournel's classification,there were 15 double

  17. 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

  18. 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

  19. Biomechanical impact of C2 pedicle screw length in an atlantoaxial fusion construct

    Directory of Open Access Journals (Sweden)

    Risheng Xu

    2014-01-01

    Full Text Available Background: Posterior, atlantoaxial (AA fusions of the cervical spine may include either standard (26 mm or short (16 mm C2 pedicle screws. This manuscript focused on an in vitro biomechanical comparison of standard versus short C2 pedicle screws to perform posterior C1-C2 AA fusions. Methods: Twelve human cadaveric spines underwent C1 lateral mass screw and standard C2 pedicle screw (n = 6 versus short C2 pedicle screw (n = 6 fixation. Six additional controls were not instrumented. The peak torque, peak rotational interval, and peak stiffness of the constructs were analyzed to failure levels. Results: The peak torque to construct failure was not statistically significantly different among the control spine (12.2 Nm, short pedicle fixation (15.5 Nm, or the standard pedicle fixation (11.6 Nm, P = 0.79. While the angle at the peak rotation statistically significantly differed between the control specimens (47.7° of relative motion and the overall instrumented specimens (P < 0.001, the 20.7° of relative rotation in the short C2 pedicle screw specimens was not statistically significantly higher than the 13.7° of relative rotation in the standard C2 pedicle screw specimens (P = 0.39. Similarly, although the average stiffness was statistically significantly lower in control group (0.026 Nm/degree versus the overall instrumented specimens (P = 0.001, the standard C2 pedicle screws (2.54 Nm/degree did not differ from the short C2 pedicle screws (1.69 Nm/degree (P = 0.30. Conclusions: Both standard and short C2 pedicle screws allow for equally rigid fixation of C1 lateral mass-C2 AA fusions. Usage of a short C2 pedicle screw may be an acceptable method of stabilization in carefully selected patient populations.

  20. 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.

  1. 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.

  2. Effect of the bio-absorbent on the microwave absorption property of the flaky CIPs/rubber absorbers

    Energy Technology Data Exchange (ETDEWEB)

    Cheng, Yang; Xu, Yonggang, E-mail: xuyonggang221@163.com; Cai, Jun; Yuan, Liming; Zhang, Deyuan

    2015-09-01

    Microwave absorbing composites filled with flaky carbonyl iron particles (CIPs) and the bio-absorbent were prepared by using a two-roll mixer and a vulcanizing machine. The electromagnetic (EM) parameters were measured by a vector network analyzer and the reflection loss (RL) was measured by the arch method in the frequency range of 1–4 GHz. The uniform dispersion of the absorbents was verified by comparing the calculated RL with the measured one. The results confirm that as the bio-absorbent was added, the permittivity was increased due to the volume content of absorbents, and the permeability was enlarged owing to the volume content of CIPs and interactions between the two absorbents. The composite filled with bio-absorbents achieved an excellent absorption property at a thickness of 1 mm (minimum RL reaches −7.8 dB), and as the RL was less than −10 dB the absorption band was widest (2.1–3.8 GHz) at a thickness of 2 mm. Therefore, the bio-absorbent is a promising additive candidate on fabricating microwave absorbing composites with a thinner thickness and wider absorption band. - Graphical abstract: Morphology of composites filled with flaky CIPs and the bio-absorbent. The enhancement of bio-absorbent on the electromagnetic absorption property of composites filled with flaky carbonyl iron particles (CIPs) is attributed to the interaction of the two absorbents. The volume content of the FCMPs with the larger shape CIPs play an important role in this effects, the composites filled with irons and bio-absorbents can achieve wider-band and thinner-thickness absorbing materials. - Highlights: • Absorbers filled with bio-absorbents and CIPs was fabricated. • Bio-absorbents enhanced the permittivity and permeability of the composites. • The absorbent interactions play a key role in the enhancement mechanism. • Bio-absorbents enhanced the composite RL in 1–4 GHz.

  3. A comparison of navigation template and traditional dynamic screw fixations for subtrochanteric fracture%应用动力髋螺钉治疗股骨转子下骨折导航模板与传统方法的效果比较

    Institute of Scientific and Technical Information of China (English)

    黄若昆; 谢鸣; 余嘉; 潘浩; 陈明; 任义军; 勘武生

    2013-01-01

    [目的]比较导航模板下与传统方法应用动力髋螺钉(DHS)内固定治疗股骨转子下骨折的效果.[方法]选择2009年2月~ 2010年12月期间接受导航模板与传统方法应用DHS治疗的16例股骨转子下骨折患者资料.随机分成常规手术组及导航模板组,两组均采用动力髋螺钉内固定.导航模板组通过数字化重建技术得到了基于动力髋螺钉个体化导航模板,重建的导航模板有较好的匹配性.采用Harris评分标准对术后随访1年手术效果进行评估.[结果]与传统组比较,导航模板组缩短了手术时间,减少了手术出血量,术后复查X线片见骨折端复位良好,内固定位置良好,应用Harris髋关节评分患者恢复良好,显著提高了手术的有效性,均达到了术前的预期效果.[结论]导航模板下DHS内固定具有缩短手术时间、术中出血量少、安全准确等优点,有其临床应用价值.%[Objective]To compare the navigation template and traditional method using dynamic hip screw(DHS)fixation in the treatment of subtrochanteric fractures. [ Method] Sixteen patients with subtrochanteric fracture were treated in our department from April 2009 to April 2010 and their clinical data were completed. All cases were randomly divided into two groups: the routine Operation and navigation template. In the navigation template group, subtrochanteric fracture mode was constructed by computer-aided design. Operation reposition on femoral subtrochanteric iracture was simulated, the module match with greater trochanter of femur,as well as the screw patch was designed. The post-surgury effect was evaluated by using Harris scores after 1 year follow-up. [Result]Compared to the routine group,the effect of navigation template group decreased operation duration and bleeding amount with excellent reposition. Harris scores for hip joint showed that the patients recovered well after operation. [ Conclusion] Computer-assisted preoperative design is

  4. Transforaminal lumbar interbody fusion combined unilateral pedicle screw fixation for upper lumbar disc herniation%经椎间孔融合联合单侧椎弓根钉内固定治疗高位腰椎椎间盘突出症

    Institute of Scientific and Technical Information of China (English)

    付松; 邵诗泽; 荣晓玲; 侯海涛; 孙秀琛; 刘海军; 王龙强; 王欢; 黄相鹏

    2013-01-01

    Objective To evaluate the clinical effect of unilateral transforaminal lumbar interbody fusion (TLIF) combined unilateral pedicle screw fixation for the treatment of upper lumbar disc herniation.Methods From Mar 2006 to December 2008,23 cases with upper lumbar disc herniation undewent laminectomy,transforamina discectomy and lumbar interbody fusion were reviewed retrospectively.The involved level included L1/L2 in 5 cases,L2/L3 in 8 cases and L3/L4 in 10 cases.All cases were treated by single cage combined unilateral pedicle screw placement.Japanese Orthopaedic Association (JOA) scores (29 scores) were used to assesse the clinical outcome and the excellent rate,improve rate and fusion status were reviewed retrospectively.Results Complications included dural tear(1 cases) and pedicle screw deviating(1 cases).The mean follow-up time was 40.2 months(24 ~ 52 months).The preoperative JOA score was 10.04 ± 2.12,and 24.13 ± 3.39 at 23 months postoperative.excellent rate was 91.3%.Bone fusion rate was 95.8%.Conclusion Unilateral transforaminal lumbar interbody fusion combined unilateral pedicle screw fixation has the advantages of small incision,little bleeding,no destruction of the contralateral structure,short operating time or hospital stay,low medical device expenses and good recovery.%目的 观察经椎间孔融合(transforaminal lumbar interbody fusion,TLIF)联合单侧椎弓根钉内固定治疗高位腰椎椎间盘突出症的临床疗效.方法 2006年3月~2008年12月收治且获得随访的单间隙高位腰椎椎间盘突出症患者23例,其中L1/L2 5例,L2/L3 8例,L3/L4 10例.均采用经椎间孔单枚Cage植骨融合并单侧椎弓根螺钉内固定术治疗.根据日本骨科学会(Japanese Orthopaedic Association,JOA)(29分)评分法评估术后疗效,计算改善率和优良率,观察植骨融合情况.结果 1例硬脊膜撕裂,1例椎弓根螺钉位置偏斜.随访23~52个月,平均40.2个月,JOA评分由术前10.04±2.12提高到随访23

  5. Effect of Salmon calcitonin combined with expandable pedicle screw internal fixation system in the treatment of senile osteoporotic thoracolumbar fractures%鲑鱼降钙素联合EPS治疗骨质疏松性胸腰椎骨折的疗效

    Institute of Scientific and Technical Information of China (English)

    樊勇; 桑宏勋; 漆伟; 贺伍儿; 张扬; 雷伟

    2013-01-01

    Objective To investigate the clinical effect of salmon calcitonin combined with expandable pedicle screw ( EPS) internal fixation system in the treatment of senile osteoporotic thoracolumbar fractures. Methods A retrospective analysis was earned out in 78 cases of senile osteoporotic thoracolumbar fractures treating with salmon calcitonin combined expandable pedicle screw internal fixation system from January 2008 to January 2010. Patients were observed before and after treatment. Results The anterior and posterior height of vertebral body after operation were significantly higher than the preoperative ones, respectively ( P < 0. 05 ). The postoperative Cobb ' s angle was significantly lower than the preoperative one ( P < 0. 05 ). Postoperative VAS score and JOA score and BMD were significantly better than preoperative ones (P < 0. 05 ). Conclusion For senile osteoporotic thoracolumbar fractures, the salmon calcitonin combined with expandable pedicle screw internal fixation system has a good clinical effect. The method has the advantages of simple operation, rapid postoperative recovery, high stability, promote bone healing, and the clinical application.%目的 探讨鲑鱼降钙素联合膨胀式椎弓根螺钉(EPS)内固定系统治疗老年骨质疏松性胸腰椎骨折的临床疗效.方法 2008年1月~2010年1月,78例老年骨质疏松性胸腰椎骨折患者在我院采用鲑鱼降钙素联合膨胀式椎弓根螺钉内固定系统进行治疗.观察治疗前后的患者情况.结果 通过治疗后的分析,患者术后的椎体前缘高度和椎体后缘高度均明显的高于术前的患者的椎体前缘高度和椎体后缘高度,数据比较具有显著的差异(P<0.05);术后的Cobb's角度明显的低于术前的Cobb's角度,数据的比较具有显著性的差异(P<0.05).术后的VAS评分和JOA评分以及BMD均明显的优于手术治疗前,数据比较具有显著的差异(P<0.05).结论 对于老年骨质疏松性胸腰椎骨折

  6. 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

  7. 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

  8. Design of digitized anterior approach screw fixation program:Clinical application in the treatment of type Ⅱ odontoid fractures%数字化颈前路螺钉内固定方案设计:Ⅱ型齿状突骨折的临床应用

    Institute of Scientific and Technical Information of China (English)

    陈宣煌; 张国栋; 吴长福; 林海滨

    2013-01-01

      BACKGROUND: The treatment of type Ⅱ odontoid fractures has the difficulties of difficult, high risk and the choice between cervical spine stability and cervical activity. OBJECTIVE: To investigate the method and clinical application of computer in the three-dimensional construction of type Ⅱ odontoid fractures, reduction and design of digitized fixation. METHODS: One cervical specimen was used to prepare the type Ⅱ odontoid fractures model for high-speed thin CT scan. The model was reconstructed and reseted in the Mimics. The Solidworks was used to design the screw and performed virtual simulation on the three-dimensional model of fracture reduction in order to guide the clinical application. RESULTS AND CONCLUSION: Three-dimensional reconstruction and reduction were performed on the fracture model, and the virtual screw fixation was completed according to the three-dimensional measurement data thus guiding the clinical surgery successful y. The results show that digitized screw fixation that used in the treatment of type Ⅱ odontoid fractures can be designed on the computer with Mimics and Solidworks, which has good reference value to the clinical surgery.%  背景:Ⅱ型齿状突骨折的治疗存在难度大、风险高以及颈椎稳定性和颈椎活动度之间的选择难点。目的:探讨计算机软件应用于Ⅱ型齿状突骨折三维重建、复位以及数字化内固定设计的方法和临床应用。方法:将1具颈椎标本制作成Ⅱ型齿状突骨折类型,进行高速CT薄层扫描,在Mimics中对骨折模型进行重建、复位,以 Solidworks 进行螺钉的设计,并在骨折复位三维模型上进行虚拟内固定,以此指导临床。结果与结论:对骨折标本模型进行了三维重建、复位,根据三维模型测量数据,完成虚拟螺钉内固定,并成功指导临床手术。结果显示,应用Mimics及Solidworks可在计算机上设计出用于治疗Ⅱ型齿状突骨折的数

  9. Fixação de fraturas ilíacas em cães com parafusos, fios de aço e cimento ósseo de polimetilmetacrilato Canine iliac fracture fixation with screws, orthopedic wire and polymethylmethacrylate bone cement

    Directory of Open Access Journals (Sweden)

    Claudio Roehsig

    2008-09-01

    Full Text Available O presente trabalho teve como objetivo verificar a recuperação da locomoção e o tempo para cicatrização óssea de fraturas ilíacas fixadas com parafusos, fios de aço e cimento ósseo de polimetilmetacrilato. Dezesseis cães de ambos os sexos, com peso de 1,8 a 16kg e idade entre sete meses e 11 anos, foram submetidos à osteossíntese da fratura de ílio, provocadas por acidente automobilístico. Em dois animais, realizou-se osteossíntese bilateral, totalizando 18 ossos ilíacos operados. A abordagem ao ílio foi lateral e quando necessária estendida caudalmente através da osteotomia do trocanter maior. As fraturas foram reduzidas e, em cada segmento ósseo, foram implantados dois a três parafusos e banda de tensão com fio de aço entre os parafusos adjacentes à linha de fratura. Sobre esses implantes aplicou-se cimento ósseo misturado com cefazolina sódica e após o endurecimento prosseguiu-se com a síntese dos tecidos moles com suturas rotineiramente utilizadas na clinica cirúrgica. No período pós-operatório, foram realizadas avaliações até 90 dias após a osteossíntese e observou-se locomoção apropriada em 15 animais. Avaliações radiográficas demonstraram sinais de completa consolidação óssea entre 60 e 90 dias. Falha da estabilização ocorreu em dois casos, obrigando a reintervenção cirúrgica em um deles. A partir dos resultados obtidos, é possível concluir que, em cães com até 16kg de peso, a fixação de fraturas ilíacas utilizando parafusos cimentados com PMMA constitui uma eficiente técnica, que proporciona adequada estabilidade, precoce recuperação funcional e cicatrização óssea.The present study aimed to verify the time for locomotion recovery and bone healing in canine iliac fractures fixated with screws, orthopedic wires and methylmetacrylate bone cement. Sixteen dogs from both genders accidentally hit by a car and showing iliac fractures were included. Dogs aged from 7 months to 11

  10. Minimally Invasive Percutaneous Injured Vertebra Pedicle Screw Fixation for Treatment of Thoracolumbar Fracture:15 Cases for Clinical Effect Observation%经皮后路单节段椎弓根钉内固定治疗胸腰椎骨折15例临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    杨文宇; 卢光辉

    2015-01-01

    Objective To evaluate the clinical outcome of percutaneous injured vertebra pedicle screw fixation for thoracolumbar fracture. Methods 15 compression fracture and mild burst fracture patients treated by minimal yInvasive percutaneous injured vertebra pedicle screw fixation were fol owed up for 6to 24 months (average 16 months). The Denis pain scale, anterior vertebral height cor ection rate, kyphosis Cobb's angle cor ection rate and patients' satisfaction were recorded.Results Al patients were fol owed up and had a high level of satisfaction with surgery. According to Denis pain grading, 12 patients had no pain, 3 patients with occasional pain but no medication. X-ray evaluation revealed satisfactory recovery of vertebral body height, the anterior vertebral height cor ection rate was 95%, and the kyphosis Cobb's angle correction rate was 98%. No implant break, and no signs of pseudoarthrosis were observed.Conclusion The treatment for thoracolumbar fracture by percutaneous injured vertebra pedicle screw fixation isef ective with a proper indication.%目的:探讨胸腰椎骨折应用经皮后路单节段椎弓根钉内固定治疗的临床效果。方法对15例压缩性骨折和轻度暴力骨折采用经皮后路单节段椎弓根钉内固定。患者随访6~24(平均16)个月,进行临床Denis疼痛评分、椎体前缘高度矫正率、后凸Cobb's角矫正率,调查患者手术满意度。结果所有患者均得到随访,所有患者均对手术表示满意。按照Denis疼痛分级,P1级有12例患者无疼痛,P2级有3例患者有轻微疼痛,无需服药治疗,神经功能均恢复至正常;X线检查术后椎体高度恢复满意,术后伤椎高度矫正率为95%、后凸Cobb's角矫正率为98%。无内固定物断裂、松动、脱出,所有病例均获得骨性愈合。结论选择好适应证,经皮后路单节段椎弓根钉内固定治疗胸腰段骨折能达到理想的疗效。

  11. 腰椎短节段椎弓根螺钉固定术后近端邻近节段前凸原因分析%Pathogenesis analysis of proximal junctional lordosis after short-level posterior pedicle screw fixation in lumbar spine

    Institute of Scientific and Technical Information of China (English)

    刘海鹰; 王波; 王会民; 缪克难; 金朝晖

    2008-01-01

    Objective To analyze the possible reasons for proximal junctional lordosis(PJL)after short-segment posterior pedicle screw fixation in lumbar spine and discuss its proper management.Methods From December 2001 to August 2005,345 patients were treated by short-segment pedicle screw fixation and these patients were reviewed.Clinical outcome was evaluated according to Oswestry Disability Index(ODI).Proximal junctional lordosis was assessed evaluated on radiographs,by measuring lumbar lordosis angle,segmental angle at proximal level and lumbar-sacral angle.Risk factors of proximal junctional lordosis were analyzed.Resuits All patients were followed-up for 2 to 6 years(average 3.8 years).ODI after lumbar surgery was 9.7-46.2(average 19.6±10.7).PJL was noted in 78 patients(22.6%),37(10.7%)of whom were symptomatic and 21(6.1%)received revision surgery.PJL was more commonly occurred in patients over 60 years old,with reduced lumbar lordosis or veaical sacrum.The number of fusion-segment was not correlated to the occurrence of PJL.Conclusions Short-segment posterior pediele screw fixation can not improve lumbar sagittal alignment.Age over of 60 years,reduced lumbar lordosis and vertical sacrum are possible risk factors of PJL sacrum.%目的 分析腰椎后路椎弓根螺钉固定术后近端邻近节段前凸的可能原因,探讨合理的应对措施.方法 回顾分析2001年12月至2005年8月345例进行腰椎后路椎弓根螺钉患者,根据Oswestry功能障碍指数评价患者的临床效果,影像学检查观察近端邻近节段前凸情况,测量邻近节段椎间角、腰前凸角、腰骶角,并分析年龄、融合节段范围、腰骶力线对近端邻近节段前凸形成的影响.结果 全部患者随访2~6年(平均3.8年),术后Oswestry功能障碍指数为9.7~46.2(平均19.6±10.7).78例(22.6%)术后出现近端邻近节段前凸,37例(10.7%)出现临床症状,21例(6.1%)接受再次手术.年龄大于60岁、术后腰前凸减小、垂直骶骨的

  12. Treatment of linguiform calcaneus fracture by close nail-pry reduction and internal fixation with hollow screws%闭合撬拨复位经皮空心螺钉内固定治疗跟骨舌形骨折

    Institute of Scientific and Technical Information of China (English)

    涂淑强; 黄科棣; 帅永明; 徐南云; 袁秋文; 郭剑

    2012-01-01

    Objective: To study the curative effects of close nail-pry reduction and internal fixation with hollow screws for treatment of linguiform calcaneus fracture. Methods: From May 2006 to October 2009,32 patients (35 feel) with linguiform calcaneus fracture were treated by close nail-pry reduction and internal fixation with hollow screws, including 23 males and 9 females ranging in age from 25 to 46 years, with a mean of 37.6 years. According to Paley classification, 3 cases were Paley II a, and 29 cases were Paley II b. All cases were close fractures. The time from injury to operation was 3 to 10 days after most swelling subsided. BBhler angle and Gissane angle were measured by X-ray before and after operation. The therapeutic effect was assessed according to ZHANG Tie-liang's foot score. Results:All the patients were followed-up for 6 to 18 months,with a mean of 12 months. All fractures gained bone healing. The time of fracture healing averaged 12 months. The fractures healed completely and no infection occurred. According to ZHANG Tie-liang's foot scale,the postoperative function was excellent in 18 feet,good in 10 feet, moderate in 5 feet and poor in 2 feet. The Bohler angle and Gissane angle were significant improved after treatment (P<0.01 ). Conclusion: The surgical method of close nail-pry reduction and internal fixation with hollow screws for treatment of linguiform calcaneus fracture can regain the foot function, with minimal injury, fewer complications, earlier recovery and lower costs.%目的:探讨闭合撬拨复位经皮空心螺钉内固定治疗跟骨舌形骨折的手术疗效.方法:自2006年5月至2009年10月共收治32例(35足)跟骨舌形骨折,男23例,女9例;年龄25~46岁,平均37.6岁.根据Paley分类法:PaleyⅡa型3例,PaleyⅡb型29例,均为闭合性骨折.手术时间为伤后3~10d,均等局部肿胀消退至中、轻度后手术.通过X线片测量手术前后B(o)hler角及Gissane角,并按张铁良足部综

  13. 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.

  14. Clinical Analysis of Enhanced Pedicle Screw Fixation for Spinal Stenosis Caused by Osteoporosis%椎体强化椎弓根螺钉固定治疗骨质疏松性椎管狭窄的临床分析

    Institute of Scientific and Technical Information of China (English)

    官建中; 王照东; 吴敏; 周建生; 肖玉周

    2012-01-01

    目的 观察探讨老年骨质疏松性椎管狭窄行后路椎管减压、椎体强化推弓根螺钉内固定并椎间后外侧植骨的治疗效果.方法 对15例老年骨质疏松性椎管狭窄患者行经后路椎管探查减压植骨椎体强化椎弓根螺钉内固定术治疗,患者年龄为55 -75岁,平均66.5岁,术后随访12个月,观察术后并发症及症状缓解情况,回顾性分析临床资料,按照Oswesty功能障碍指数(Oswestry disabilityindex,ODI)设计问卷调查随访,对临床治疗效果进行评分并行统计学分析(P<0.05).结果 15例患者术后间歇性跛行、腰腿痛等相关神经压迫症状均有明显缓解,该术式总体优良率100%.结论 老年骨质疏松性腰椎椎管狭窄患者非手术治疗无效,经过术前相关检查及身体状况的严格评估后,无手术禁忌证者可以考虑手术治疗.经后路椎管探查减压植骨椎体强化椎弓根螺钉内固定术能有效缓解患者临床症状,提高临床疗效,是治疗老年骨质疏松性椎管狭窄的一种安全、有效的方法.%Objective To observe and investigate the effects of posterior spinal canal decompression,vertebral strengthening, pedicle screws fixation and poslerolaleral grafting in elderly patients with spinal stenosis caused by osteoporosis. Methods All 15 aged patients aged between 55 to 75 years old (average 66.5 ) with spinal stenosis caused by osteoporosis were treated with posterior spinal canal decompression,vertebral strengthening and pedicle screws fixation. A questionnaire survey was conducted to follow up the complications and conditions of the patients after surgery according to Oawestry disability index. The clinical date and scoTe of the effect were analyzed after the survey. Results The sign of neurotbltpsis such as internment ciaudicaiion, lumbago and scelalgia pain were apparently eased and the total rate of excellent or good was 100%. Conclusion The physical therapy is invalid in elderly patients with

  15. 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

  16. Biodegradable and bioabsorbable polymers. Seitai bunkaiter dot kyushu sei kobunshi

    Energy Technology Data Exchange (ETDEWEB)

    Kimura, Y. (Kyoto Inst. of Technology, Kyoto (Japan). Faculty of Textile Science)

    1991-08-20

    The relationship between biodegradability with the layout and structure of high polymers which are degraded and disintegrated by the contact with organism is investigated. Description is made also on a new polyurethane which is decomposed by the action of E. Coli. Vinyl polymers formed by carbon-carbon bonding is hard to be made biodegradable with a few exceptions. If the chemical structures are similar, the rates of the decomposition are in the order of crystalline high polymer < glass state high polymer < rubber state high polymer. Bioabsorbable polymers disappear in a short time even implanted in body, and are used ideally as temporary mending materials during the period of body{prime}s self recovery and as the carriers for slow release drugs. Development of biodegradable polymers which can be decomposed by microbes in soil and sea water are expected to be most likely. Non-absorbable degradable polymers which are decomposed, with the decomposed products remaining in body for a long time, can function well in dischargeable portions. 38 refs., 3 tabs.

  17. 内窥镜辅助下前路经寰枢关节螺钉固定植骨融合术治疗上颈椎不稳%Endoscopy-assisted anterior transarticular screw fixation and bone grafting for upper cervical instability

    Institute of Scientific and Technical Information of China (English)

    姚女兆; 王文军; 王麓山; 晏怡果; 李学林; 欧阳智华

    2012-01-01

    目的:探讨内窥镜辅助下前路经寰枢关节螺钉固定植骨融合术治疗上颈椎不稳的临床可行性及其疗效.方法:2006年1月至2009年12月采用内窥镜辅助下前路经寰枢关节螺钉固定植骨融合术治疗上颈椎不稳患者13例,男8例,女5例;年龄17~65岁,平均46.8岁.JeffersonⅡ型骨折6例,JeffersonⅢ型骨折1例,寰枢椎脱位3例,陈旧性齿状突骨折3例.患者均有枕颈部不适和活动受限,术前VAS评分为3.2~4.1分,平均3.8分;2例伴有不同程度脊髓功能损害者,按Frankel分级C级1例,D级1例.随访患者临床症状改善和植骨融合情况.结果:均在内镜辅助下顺利完成手术,13例患者共置入26枚螺钉;手术时间60~130min,平均80min;术中出血110~290ml,平均190ml.术中无脊髓、椎动脉损伤等并发症.术后复查CT显示1枚螺钉位置欠佳,螺钉外斜角偏小且上斜角偏大,螺钉部分进入椎管,但未损伤脊髓,未做处理;25枚位置良好.寰枢关节基本复位,固定可靠.术后随访12~60个月,平均18个月,末次随访时VAS评分降至1.0~2.0分,平均1.3分,与术前比较有统计学差异(P<0.05).2例伴颈髓损伤患者的症状均有改善,Frankel分级C级者恢复到D级,D级者恢复到E级.12例患者术后3个月开始出现植骨融合,末次随访时寰枢关节间隙植骨均达到融合;1例患者未见明显植骨融合,但寰枢关节稳定性良好,未出现断钉等并发症.结论:内窥镜辅助下前路经寰枢关节螺钉固定植骨融合术治疗上颈椎不稳是可行的,能取得较好的治疗效果,且在一定程度上克服了传统手术显露困难的缺点,从而减少手术并发症.%Objectives: To evaluate the operation method and clinical outcome of atlantoaxial joint fusion using endoscopy-assisted anterior transarticular screw fixation and bone grafting for upper cervical instability. Methods: 13 cases with upper cervical instability who underwent anterior release

  18. 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

  19. 颈前路单枚空心螺钉治疗Ⅱ型齿状突骨折失误15例分析%Intraoperative mismanagement in anterior single-screw fixation of odontoid fractures: an analysis of 15 cases

    Institute of Scientific and Technical Information of China (English)

    吴玉杰; 贾连顺; 傅智轶; 金文杰; 胡小鹏

    2011-01-01

    Objective To analyze intraoperative mismanagements in anterior single-screw fixation of odontoid fractures.Methods From April 2002 to July 2010, intraoperative mismanagements happened in the treatment of 15 cases of fresh odontoid fracture with anterior single-screw fixation under C-arm fluoroscopy.They were 10 men and 5 women, aged from 22 to 65 years (average, 37 years).All the fractures were Anderson-D' Alonzo type Ⅱ.The mismanagements were characterized to find out their reasons.Results The mean follow-up time was 13.4 months (range, 6 to 47 months).All the fractures healed in an average of 14.5 week (range, 12 to 34 weeks) after operation, no severe complications were found.The intraoperative mismanagements could be elassified into 3 kinds.In the first kind, the guide pin was driven through the odontoid bone into the cranial cavity in 3 cases, resulting in one death due to serious injury to the medullary bulb.In the second kind, malreduction happened in 5 cases due to intraoperative displacement of the fracture.In the third kind, poor position and fixation of the screw happened in 7 cases because of enlargement of the screw canal after repeated correction of the guide pin direction.Conclusions The intraoperative mismanagements in anterior single-screw fixation of odontoid fractures were mostly caused by careless surgeons who made their operative assessments and plans before they read the X radiographs of their patients carefully or before they had been familiar with the operative instruments.Secondly, some mismanagements were caused by intraoperative accidents, most of which, however, could have been avoided by careful preoperative preparation and meticulous operative maneuvers.%目的 分析颈前路加压螺钉内固定治疗Ⅱ型齿状突骨折失误的原因及对策.方法 分析2002年4月至2010年7月在C型臂X线机监视下行前路加压螺钉内固定治疗中出现失误的15例新鲜Ⅱ型齿状突骨折患者资料,男10例,女5例;年龄22

  20. 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

  1. 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.

  2. 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

  3. 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.

  4. Stability of unicortical locked fixation versus bicortical non-locked fixation for forearm fractures

    Institute of Scientific and Technical Information of China (English)

    Timothy J.Pater; Steve I Grindel; Gregory J.Schmeling; Mei Wang

    2014-01-01

    Locking plate fixation is being widely applied for fixation of forearm fractures and has many potential advantages, such as fixed angle fixation and improved construct stability, especially in osteoporotic bone. Biomechanical data comparing locking devices to commonly used Low Contact Dynamic Compression (LCDCP) plates for the fixation of forearm fractures has been lacking. The purpose of this study was to compare the fixation stability of a 3.5-mm unicortical locked plate with bicortical non-locked LCDCP plates. Six matched pairs of fresh frozen cadaveric forearms were randomly assigned to unicortical locked and bicortical unlocked groups. Non-destructive four-point bending and torsional test was performed on the ulna and radius separately, using a servohydraulic testing system to obtain construct stiffness of the intact specimens and specimens after osteotomy and plating. The specimens were then loaded to failure to test the fixation strength. The locked unicortical fixation showed significantly higher bending stiffness than the unlocked bicortical fixation, but with significantly lower stiffness and strength in torsion. Fixation strength was comparable between the two groups under bending, but significantly greater in the bicortical non-locked group under torsion. Findings from this study suggest that postoperative rehabilitation protocols may need modification to limit torsional loading in the early stage when using locked unicortical fixation. The study also points out the potential advantage of a hybrid fixation that combines locked unicortical and unlocked bicortical screws.

  5. Percutaneous Anterior Column Fixation for Acetabulum Fractures, Does It Have to Be Difficult?-The New Axial Pedicle View of the Anterior Column for Percutaneous Fixation.

    Science.gov (United States)

    Zhang, Lihai; Zhang, Wei; Mullis, Brian; Liu, Daohong; Xiong, Qi; Lv, Houchen; Ji, Xinran; Peng, Ye; Tang, Peifu

    2016-01-01

    Anterior column percutaneous screw fixation can be challenging. The purpose of this new technique is to offer a rapid, simple, and safe method to place an anterior screw. The authors used a 3-dimensional reconstruction simulation, cadaver study, and a clinical case series to demonstrate this new alternative to standard previously described techniques.

  6. 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

  7. Surgical Revision after Sacroiliac Joint Fixation or Fusion

    Science.gov (United States)

    Holt, Timothy

    2017-01-01

    Background Minimally invasive sacroiliac joint (SIJ) fusion has been shown to be safe and effective for the treatment of SIJ dysfunction. Multiple devices are available to perform SIJ fixation or fusion. Surgical revision rates after these procedures have not been directly compared. Methods We retrospectively identified all patients in our practice who underwent SIJ fixation or fusion between 2003 and 2015. Using both chart review and focused contact with individual patients, we determined the likelihood of surgical revision. Revision rates were compared using Kaplan-Meier survival analysis. Results Thirty-eight patients underwent SIJ fixation with screws and 274 patients underwent SIJ fusion using triangular titanium implants. Four-year cumulative revision rates were 30.8% for fixation and 5.7% for fusion. Conclusions In our study, SIJ fixation with screws had a much higher revision rate compared to SIJ fusion with triangular titanium implants designed for bone adherence.

  8. 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

  9. 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.