Objective To investigate the surgery outcomes between patients with different recovery states measured by visual analog scores (VAS),explore the relationships among surgery outcomes,bone cement,and degrees of pain relief,and to find out the best combination of cement volume and cement distribution for Percutaneous kyphoplasty (PKP).Methods There were 220 patients with 220 vertebra,from January 2012 to January 2014,who received PKP in our hospital.Patients were divided into two groups,on the basis of different VAS.The epidemiological data,operative effect,and surgical complications were compared between two groups.Characteristic curve (ROC) was used to analyze the effect of bone cement dosage and distribution on the diagnosis of patients with different recovery state.The correlation was analyzed between the dose and distribution of bone cement and surgery outcomes.Moreover,logistic regression analysis was used to assess the safety of cement implantation.Results A total of 77 recuperators and 143 non-recuperators were included in the study.Two groups of patients in epidemiological data showed no significant difference.The surgery duration,bone cement injection dose,cement distribution,vertebral height restoration rate and improvement of kyphotic angle in the recuperator group were all significantly higher than those in the non-recuperator group.Whether small dose and large dose of bone cement volume and expanded the bone cement distribution area could significantly improve the patient of operation after the recovery rate and bone cement dose with extensive bone cement distribution area and large bone cement dose with limited bone cement distribution area had the same operation after the recovery effect (x2 =2.880,P =0.090).When the cement volume was constant,cement distribution was positively correlated with the restoration rate of vertebral height and improvement of the kyphotic angle (r2 =0.207,P ＜ 0.01;r2 =0.159,P =0.02).Conclusions The value of cement distribution is better than cement volume in relieving patient pain for diagnostic.For PKP,cement distribution above 0.49 with small cement should be suggested.

BACKGROUND:At present, humeral fractures can be mainly treated by antegrade screwed intramedul ary nail and traditional interlocking intramedul ary nail, but above methods easily induce rotator cuff injury. Results of relevant study revealed that retrograde intramedul ary nailing can solve the above problems. OBJECTIVE:To analyze biomechanical test results of retrograde improved screwed nail and to provide a basis for the further clinical use. METHODS:(1) According to the anatomical characteristics of the human humerus, specimens of humerus were subjected to biomechanical test. (2) A total of 80 cases of humeral fractures were selected from the Orthopeadic Surgery of Xi’an Red Cross Hospital Affiliated to Xi’an Jiaotong University School of Medicine from December 2013 to January 2015. Patients were randomly divided into improved nail group and prototype nail group (n=40), which were given improved nail and prototype nail, respectively. RESULTS AND CONCLUSION:(1) Anti-axial compression, anti-tension, anti-torsion, and anti-bending functions were significantly better in the improved screwed nail than in the prototype nail (P<0.05). (2) The excel ent and good rate of clinical curative effects was significantly higher in the improved nail group than in the prototype nail group. No infection, metal fracture or internal fixation loosening occurred in al patients of the two groups. These findings suggest that compared with traditional screwed nail, retrograde improved screwed nail had more advantages, more reasonable biomechanical design, more simple operation, and lower incidence of complications, so it is fit for clinical application.

ObjectiveTo evaluate the relief of pain and daily activities in patients with osteolytic tumor of thoracic lumbar vertebrae by percutaneous kyphoplasty (PKP).MethodsA retrospective study was conducted to review 35 cases of osteolytic tumor of vertebrae treated with PKP.All patients had a refractories back pain while CT and MRI showed osteolytic changes in their vertebrae. The operation involved percutaneously inserting inflatable vertebral body and creating a cavity filled with bone cement.The visual analogue scales (VAS),WHO standards for pain relief and owestry disability index (ODI) were recorded after the procedures.The change of height in abnormal vertebrae and status of postoperative leakage of PMMA were also recorded.These data were followed up after 1 day,1 month and 6 months and analyzed via t student test.ResultsThe total 35 operations were done successfully.All patients got a conspicuous pain relief at 24 h after operation,and no spinal injury or compression was found.The X-ray showed that the vertebrates treated were filled well by cerment.There were significant differences at pain levels[(7.52±0.81)vs(4.31±0.32)],locomotor activity scales (ODI) [(69.45±0.87) vs (54.45±0.85)] and the height of vertebral bodies [(2.0±0.5) mm vs (2.7±0.4) mm] before and after operation (t value was -7.34,-5.32 and -3.36,respectively,P ＜ 0.05).At 6 months,follow up studies showed that clinic therapeutic effects were stabled for odynolysis and locomotor activity scales.The rates of pain relief in 24 h,1 month and 6 months were 80.0 ％ (28/35),85.7 ％ (30/35),82.8 ％ (29/35),respectively.ConclusionPKP is a single safe and effective way to treat osteolytic tumor of thoracic lumbar vertebrae.It can simply,quickly,and effectively relief the pain caused by osteolytic spinal tumor,recover height of the abnormal vertebra,and improve patient's life quality safely with less complications.

Objective To summarize the complications after cervico-occipital fusion and to explore the methods of the prevention and treatment of complications. Methods Three hungred and eighteen patients were fused in cervico-occipital region from January 1985 to January 2003. Of them, 65 cases with postoperative complications were reviewed. The complications in perioperative period comprised vertebral artery injury during the operation, temporary injury of nerve root, leakage of cerebrospinal fluid, spinal cord injury or deterioration, infection and asphyxiation. The complications in mid- to long-term included bone graft nonunion or delayed fusion, vertebral body shifting, internal fixation implants breaking or loosening, slipping of screws and pseudojoint formation. The complications in bone graft donor region were haematoma, pain and infection. Two physicians were assigned to follow-up the patients. Results Three hungred cases were followed up from 18 months to 18 years with an average of 6 years and 8 months. There were 15 cases with complications after surgery in single fusion group, the incidence was 24.4%. 1 case deteriorated of spinal function after surgery, 2 with bone graft displacement, 1 with bone graft absorption, 1 with bone graft nonunion who recovered after reconstruction. 50 complications presented in internal fixation group, the incidence was 19.1%, Foramen magnum was decompressed in 1 case with vertebral displacement and fixed with Cervifix. Odontoid process was resected in 1 case with atlanto-axis dislocation and deterioration of spinal function through oral approach and cervico-occipital region was fused, the symptom was improved obviously after operation. Spinous process fracture was found in 1 case 3 months later post-fixation with Simmons wire, the atlanto-odontoid vertebra was fused again and fixed with Vetex, the bone graft was fused completely. The temporary injury of nerve root due to wrong directions of the screws, were adjusted during the operation. 4 patients who felt pain caused by screw, which were then extruded out. 2 cases with vertebral artery injury were ligated or bleeding ceased after screw fixation. Conclusion The key points to reduce the complications are familiarity with dissection and operative skills. Appropriate internal fixation also can reduce the complications. Pressure dressing was useful to eliminate the haematoma in bone graft donor region.

Objective To summary the results of fixation and fusion with lateral mass screw of atlas and vertebra dentata pedicle screw for the treatment of atlantoaxial instability. Methods From February 2002 to March 2004, 15 cases suffered with atlantoaxial instability were included in this study. There were 9 males and 6 females, with a mean age of 39.5 years old(ranged 15 to 57 years old). There were 5 cases for old odontoid fracture, 4 cases for congenital loose odontoid process, 6 cases for fresh odontoid fracture(Aderson ⅡC). 7 cases were fixed with Vertex, 3 Axis and 5 Cervifix instruments. JOA scores in preoperation were from 5.1 to 10.9, with an average of 7.6. Skull traction was performed in each patient preoperatively. The screws were placed in lateral mass of atlas beside the posterior arch of atlas about 18-20 mm and the point of intersection above 2 mm inferior boarder of posterior arch. Vertical with coronal plane, the tip of the screw made 5? to side of head in sagittal plane. The site of the screws were placed in vertebra dentate was divide equally the inferior articular process of axis, made 15? with sagittal plane and 30? with cross section. The diameter of the screw was 3.5 mm, the length of in lateral mass of atlas was from 28 to 32 mm, and from 22 to 26 mm in vertebra dentate pedicle screw. Results There were no spinal cord and vertebral artery injury after surgery. Follow-up duration was from 10 to 25 months, with average 14 months. The postoperative JOA scores were from 13.2 to 16.8, with average 14.8. The improve rate was 87.5 percent. The plant bones all fused and there were no internal fixation rupture and mobiled. Conclusion Lateral mass screw of atlas and vertebra dentata pedicle screw with three-dimension fixed virtues could be used to treat atlantoaxial instability.

[Objective]To discuss the methods of insertion the pedicle screws of thoracic vertebrae and sum the results of correction of idiopathic scoliosis.[Method]Bone of entrance was removed with rongeur forceps.According to the depth and rotation preoperative,to drill using 1.5 mm and 2.5 mm Kirschner wire.If the resistance was increasing and Kirschner wire was bending,it needs to adjust the direction.Stop to drill whenachieve the depth,after checking the hole using special probe then strike awl in the hole.Checking the hole using specillum again then insert the screws.[Result]97% were successful inserted by one time.There were no patients with spinal cord injury and leakage of cerebrospinal fluid and no infection of incisionsl wound.The correction rate in coronal plane was 73% after surgery.The Cobb's angle in sagittal plane was from 6? to 30?,with average of 23?.Rotation deformity was corrected Ⅰ to Ⅱ degree.There were 103 patients.Follow-up duration was with average 4.9 years.Trunk balance was good and no flat back was happen.Bone graft fused well.The correction lost 3.7% in coronal plane at final follow up.One case was with late infection and 2 patients were with screws broken.The internal fixations were removed out.[Conclusion]Using Kirschner wire to made screw hole is a good way to insert thoracic vertebrace pedicle screw.Screw-rod system had favourable three diamensions correct control force.Fully pedicle screw to correct idiopathic scoliosis has good results.

0.05).There were no pseudoarthrosis and internal fixation failure.The incidence of proximal junction kyphosis was higher in group B(P

[Objective]To investigate the methods of surgical treatment of complicated lumbar spinal stenosis. [Methods]Totally 176 patients who were diagnosed as having complicated lumbar spinal stenosis,operated by back decompression,fused by bone graft and internal fixed by pedicle screws from January 1997 to January 2001 were retrospectively analyzed.Ninety-eight were males and 78 were females,with an average age of 58.5 years.Patient history was from 2 to 31 years.Thirty-five patients had a previous surgery on lumbar vertebrae,and 19 patients had two or more.Forty patients were complicated with one degree degenerated olisthe,42 were complicated with lumbar scoliosis and Cobb's angle more than 20?,21 had lumbar unsteadiness after surgery,19 patients had spinal stenosis in juncture after surgery.One ore two segments intervertebral discs were removed and vertebral plate were closed together,fused by bone graft and fused articular process.To the patients with more than two segments affection,processus articularis and processus transverses were fused to the patients need not remove intervertebral disk or remove less than half of processus articularis and interbody vertebral were fused to the patient need remove intervertebral disk.Patients with scoliolosis were decompressed and inserted pedicle screws.Revolve rod combined with compression and brace technique was used to correct scoliolosis,fuse the disk and articular process to the patient with severe intervertebral disk hernia and others were fused post-lateraly.[Results]Operation time was from 80 to 250 minutes.Blood loss was from 450ml to 1600ml and no patient died.The follow-up duration averaged 5.6 years.Fused disks had good to excellent rate of 87.4%,and multi-segments had good to excellent rate of 86.1%,and combined with scoliolosis good to excellent rate of 89.8%.The Cobb's angle was average 6.7? and correct rate was 73.8%.The fused rate of post-lateral was 92%(60/65),while the interbody vertebral fused rate was 97.9%(139/142).[Conclusion]The operation of complicated lumbar spinal stenosis is difficult to operate and has high risk.Back decompression,fused by bone graft and internal fixation by pedicle screws is a good method.