[Show abstract][Hide abstract] ABSTRACT: To compare the radiographic outcome of three different fusion methods in maintenance of intervertebral height after cervical anterior corpectomy.
From May 2005 to November 2009, a total of 77 patients with cervical spondylotic myelopathy who underwent anterior cervical corpectomy and fusion were reviewed in the study. Fusion methods included autogenous iliac bone grafting in 22 patients (group 1), titanium mesh cages without end caps in 21 patients (group 2) and titanium mesh cages with modular end caps in 34 patients (group 3). No significant differences were found in age, gender or level of corpectomy among the three groups (P > 0.05). The height of anterior border (HAB) and the height of posterior border (HPB) of the fused segment were measured on lateral radiographs pre-operatively, post-operatively and at final follow-up to evaluate the outcome. The incidence of subsidence of titanium mesh cage and iliac bone was also reviewed retrospectively. The statistical analysis included One-way variation analysis and chi-square test.
All cases obtained the follow-up with an average of (30 ± 5) months (range 24 to 46 months). At final follow-up, the loss of the height of anterior border (HAB) of the fused segment in group 3 ((0.4 ± 0.4) mm) was less than that in the other two groups ((0.9 ± 0.6) mm in group 1 and (1.1 ± 0.8) mm in group 2) (mean difference = -0.45 mm and -0.70 mm, P < 0.05), but the difference was not statistically significant between group 1 and group 2 (P > 0.05); the loss of HPB of the fused segment in group 3((0.6 ± 0.5) mm) was less than that in the other two groups ((1.1 ± 0.7) mm in group 1 and (1.6 ± 0.8) mm in group 2) (mean difference = -0.52 mm and -0.98 mm, P < 0.05), but the difference was not statistically significant between group 1 and group 2 (P > 0.05). Iliac bone subsidence occurred in 10 cases (45.5%) in group 1, including mild subsidence (1 - 3 mm) in 9 cases (40.9%) and severe subsidence (> 3 mm) in 1 case (4.5%), and titanium mesh cage subsidence occurred in 11 cases (52.4%) in group 2, including mild subsidence in 9 cases (42.9%) and severe subsidence in 2 cases (9.5%), and 2 cases (5.9%) in group 3 showed mild subsidence of titanium mesh cages. The incidence of titanium mesh cage subsidence in group 3 was less than that in the other two groups (χ(2) = 12.423 and 15.551, P < 0.05), but the difference was not statistically significant between group 1 and 2 (P > 0.05).
Titanium mesh cage with modular end cap is superior to both titanium mesh cage without end cap and auto iliac bone graft in maintenance of the cervical intervertebral height postoperatively. The usage of modular end cap can efficiently reduce postoperative subsidence rate of titanium mesh cage.
No preview · Article · Nov 2012 · Zhonghua wai ke za zhi [Chinese journal of surgery]
[Show abstract][Hide abstract] ABSTRACT: Initial results for the use of single and dual growing rod techniques in the treatment of early onset scoliosis (EOS) has been seldom documented. The aim of this research was to investigate the initial efficacy of single and dual growing rods in treatment of EOS.
A retrospective study of 25 early onset scoliosis cases treated with growing rod technique between November 2002 and May 2010 was performed, including six cases in the single growing rod group and 19 cases in the dual growing rod group. Operation time, intra-operative bleeding, correction rate, changes in C7-S1 distance, and incidence of complications of the first operation were compared for the two techniques.
The average post-operative follow-up duration was 31.9 months. There was no statistical difference observed between operation time, intra-operative bleeding, and complication incidence between the single and dual growing rod groups. In addition, no statistical difference was observed in the pre-operative coronal Cobb's angle (P > 0.05), or in the pre-operative sagittal Cobb's angle between both groups (P > 0.05). The correction rate of the dual growing rod group was significantly superior to that of the single growing rod group in the coronal plane (P < 0.01), but not in the sagittal plane (P > 0.05). The C7-S1 distance in the dual growing rod group was significantly larger than that in the single growing rod group (P < 0.05).
The growing rod technique is an effective option for surgical treatment of EOS. The dual growing rod technique shows relative superiority in the correction outcome as compared to the single growing rod technique.
No preview · Article · Aug 2012 · Chinese medical journal
[Show abstract][Hide abstract] ABSTRACT: To determine the efficacy of imaging patients in a state of traction ("traction imaging") for selection of upper and lower vertebrae to undergo instrumentation (UIV and LIV, respectively) to correct moderate to severe, rigid scoliosis.
Twenty-seven patients aged 11-21 years (average, 15.5 years) who had been treated at our institution for scoliosis of the thoracic spine between 2004 and 2008 were retrospectively analyzed. All patients were treated with the third multiple hook-screw and rod instrumentation system. Standardized radiographic measurements (anteroposterior, sagittal, bending, fulcrum, traction) were taken and Cobb's angles, apical vertebra translation (AVT), and traction-stable vertebrae determined.
All patients were followed for 6-36 months (average, 14.7 months). The Cobb's angles under preoperative vertical traction correlated positively with those measured postoperatively in standing anteroposterior film (P < 0.01). Preoperative AVT under vertical traction was significantly different from that measured postoperatively in standing anteroposterior film (P < 0.01). The traction radiography-determined UIV slant angles were significantly different from those preoperatively without traction and the postoperative values, whereas traction radiography-determined LIV values were not significantly different from those found preoperatively without traction (P > 0.05).
Traction radiographic imaging is an effective, feasible preoperative assessment for determining which vertebrae are stable, designing the surgical strategy and choosing the UIV and LIV for correcting moderate to severe, rigid scoliosis.
No preview · Article · Feb 2012 · Orthopaedic Surgery
[Show abstract][Hide abstract] ABSTRACT: Pulmonary problems often occur in patients with early-onset scoliosis (EOS). However, lung function in patients with EOS after growing rod surgery has not been documented. The aim of this study was to investigate lung function after the treatment for EOS with growing rod and its possible correlative factors.
Eight patients with EOS were treated with growing rod surgery at Peking Union Medical College Hospital from September 2002 to September 2009. Four patients had finished the final fusion surgery (group 1), and the other 4 (group 2) were in the process of periodic lengthening. Preoperative forced vital capacity (FVC), ratio of FVC to predicted FVC, forced expiratory volume in 1 second (FEV1), ratio of FEV1 to predicted FEV1, and radiographic measurements of Cobb's angle and C7-S1 distance were recorded. Lung function changes and correlations between lung function changes and radiographic changes (Cobb's angle and C7-S1 distance) were analyzed.
In group 1, FVC and FEV1 both increased. FVC showed a significant difference (P = 0.01), but FEV1 did not (P = 0.05). In group 2, FVC and FEV1 also increased, and both showed a significant difference (P = 0.04 and P = 0.02, respectively). Ratio of FVC to predicted FVC and ratio of FEV1 to predicted FEV1 changed similarly and did not show statistical differences in the 2 groups. There were no significant correlations between lung function changes and radiographic changes (Cobb's angle and C7-S1 distance) (P = 0.10 and P = 0.41, respectively).
Lung function increases after growing rod surgery in patients with EOS. Lung function changes do not correlate with Cobb's angle changes or C7-S1 distance changes.
No preview · Article · Dec 2011 · Chinese medical journal
[Show abstract][Hide abstract] ABSTRACT: To investigate and compare the analgesic effect of a periarticular multimodal drug injection and patient-controlled epidural analgesia (PCEA) in total knee arthroplasty (TKA).
Thirty-six patients undergoing unilateral TKA were randomly divided into two groups (A and B). Group A received a periarticular injection of ropivacaine, morphine and epinephrine at operation and Group B did not. All patients received postoperative patient-controlled epidural analgesia (PCEA). Preoperative baseline data, surgery-related conditions, postoperative VAS (visual analog score), range of motion (ROM), time of opening PCEA, drug dosage in PCEA and side effects were recorded respectively.
At 6, 12 hour VAS in Group A was lower than Group B (P < 0.05). The time of opening PCEA in Group A was longer than Group B (P < 0.05). The drug dosage in PCEA in Group A was less than Group B (P < 0.05). There was no difference of surgical conditions, ROM, 24/48 hour VAS and side effects between two groups (P > 0.05).
Periarticular drug injection during TKA can relieve pain early after TKA, prolong the time of opening PCEA and reduce the drug dosage in PCEA.
No preview · Article · Oct 2010 · Zhonghua yi xue za zhi