Objective To analyze the fracture characteristics, operative indicators, complications and treatment results of intertrochanteric fractures of femur in over 80 years old cases. Methods A total of 87 cases (90 hips) of intertrochanteric fractures with mean age over 80 years treated with operative methods from October 1996 to October 2004 were reviewed upon fracture types, preoperative primary diseases, operative methods and postoperative complications. Results The average age was 83.5 years. Of all, 74 cases had different physical diseases included cardiovascular, cerebrovascular, respiratory, digestive system and others (average 2.4 diseases per person). Treatment methods included DHS and intramedullary interlocking nail such as Gamma nail, PFN and reconstructive nails. A follow up for six months in 63 cases showed that excellence rate of functional evaluation was 84%(53/63). Conclusions The full evaluation and treatment of preoperative diseases are the prerequisite for the intertrochanteric fractures in the elderly, for the intertrochanteric fractures in the elderly have high incidence and many preoperative diseases and severe complications.

Objective To evaluate the clinical results and safety of pedicle screw fixation for the treatment of spinal disorders. Methods From January 1988 to December 1999, 475 patients (216 males amd 259 females) with an average age of 49.1 years old in the male and an average age of 48.7 years old in the female, underwent pedicle screw fixation for spinal disorders. Diagnoses included 217 cases of spondylolisthesis, 76 lumbar stenosis, 32 degenerative lumbar spine instability, 72 thoracic or lumbar spine fractures, 60 scoliosis, and 18 others. The instrumentations were as follows: Dick 55 cases, Steffee 79 cases, CD 54 cases, RF 82 cases, DRFS 59 cases, TSRH 29 cases, USS 19 cases, SOCON 44 cases, Dynalock 24 cases, Diapson 22 cases, Tenor 5 cases, and CDH 3 cases. The fusion ranges involved one segment in 310 cases, two segments in 96 cases, and three segments in 9 cases. Hooks were applied in 60 cases. Results Four hundreds and twenty eight patients(90.l%) were followed up for (6.0?3.7)years. In the patients of degenerative spondylolisthesis, spondylolysis, lumbar stenosis, degenerative lumbar instability and thoracolumbar fracture, the amelioration of nerve function was 79.9%, 87.9%, 77.0%, 89.3%and 62.7%; the improvement of spinal motion was 90.5%, 90.9%, 83.6%, 92.9%and 52.5%; the amelioration of low back pain was 89.9%, 87.9%, 85.2%, 89.3%and 84.8%; and the amelioration of leg pain was 93.9%, 90.9%, 93.4%, 92.9%and 79.7%respectively. The mean reduction rate of degenerative spondylolisthesis, spondylolysis and spinal fracture was 90.5%, 87.9%and 91.5%respectively. The SOCON technique showed the highest reduction rate of an average of 92.3%, followed by RF of 90.8%, and Dick, Steffee and DRFS of 81.2%, while other instrumentations showed no satisfactory result in reduction. Complications occurred in 90 cases, in which 26 cases occurred during operation with the incidence of 6.1%, while 64 occurred after operation with the incidence of 15.0%. Conclusion Pedicle screws provide fixation of short segments with satisfactory clinical results and relatively high fusion rate. Perfect surgical technique is the key to reduce the incidence of complications.

Objective To evaluate the clinical outcomes of the hybrid technique of posterior osteotomy with short segmental fusion and dual growing rod technique for severe rigid congenital scoliosis.Methods Seven patients (2males,5 females) undergoing this hybrid technique for severe rigid congenital scoliosis in our hospital from 2006 to 2011 were retrospectively studied.The average age was 5.9 years (range,2-10).The Risser sign of all the patients was 0.The follow-up time was 59.4 months (range,36-83 months).The patients' charts were reviewed.The analysis included age at initial surgery and the latest follow-up,number and frequency of lengthening,and complications.Radiographic evaluation included measured changes in scoliosis Cobb angle,thoracic kyphosis,lumbar lordosis,trunk shift,length of T1-S1 and instrumentation.Results All patients were treated with posterior osteotomy with short segmental fusion and dual growing rod technique.There were 48 total surgeries,41 of which were lengthening procedures,for 7 patients.The average lengthening was 5.9 per patient.The mean scoliosis improved from 81.4° to 40.1 ° after initial surgery and was 41.1 ° at the final follow-up.The average T1-S1 length was of 1.12 cm per year.The Campbell's space available for lung ratio increased from 0.87 to 0.97.Conclusion Osteotomy with short fusion could help to improve the correction of the growing rod and eliminate the large asymmetric growth potential around the apex,with little influence to the length of the spine.Dual growing rod technique could maintain correction achieved at initial surgery while allowing spinal growth to continue.However,this technique is relatively more aggressive and technique demanding.And the patients need numbers of surgeries.

Objective To investigate the perioperative complications and risk factors of one-stage posterior vertebral column resection (VCR) for severe spinal deformity.Methods From September 2004 to July 2012,39 patients with severe and fixed spinal deformity underwent one-stage posterior VCR,including 15 males and 24 females,aged from 3 to 53 years (average,16.9 years).There were 24 cases of kyphoscoliosis (mean coronal Cobb angle:85.1°,mean sagittal Cobb angle:92.9°),7 cases of scoliosis (mean coronal Cobb angle:81.1°),and 8 cases of kyphosis (mean sagittal Cobb angle:94.4°).Eleven patients had neurological compromise.The perioperative complications and related risk factors of 39 patients were retrospectively analyzed.Results All patients were followed up for 3 to 72 months (average,29.4 months).There were 15cases (13 patients) of perioperative complications.Neurological complications occurred in 6 patients (15.4％),among whom one patient presented complete paraplegia after surgery and 5 patients presented transient paresthesia or muscle weakness.Adults had a significantly higher incidence of neurological complications than teenagers.The incidence rate of neurological complications was 36.4％ in patients with preoperative neurological compromise,while 7.1％ in patients without preoperative neurological compromise.All patients with postoperative neurological complications had kyphosis before operation,and the incidence of neurological complications increased significantly in patients with severe kyphosis (Cobb angle ≥90°).Prolonged respiratory support was conducted in 4 cases.Rupture of the parietal pleura occurred in 3 cases (7.7％),cerebrospinal fluid leak in 1 case (2.6％),and pulmonary infection in 1 case (2.6％).Conclusion One-stage posterior VCR is effective in the treatment of severe and rigid spinal deformity.However,the perioperative complications,especially the neurological complications are common.The risk factors of neurological complications include preoperative neurological compromise,degree of kyphosis and the age of patients.

Objective To assess the relationship between reconstruction of coronal trunk shift and changes of unfused segments after selective posterior thoracolumbar/lumbar curves fusion for idiopathic scoliosis.Methods Radiographic data of patients with thoracolumbar/lumbar idiopathic scoliosis who underwent selective posterior correction at our hospital from October 2005 to October 2011 with a minimum of 2 year follow-up period was retrospectively analyzed.Posteroanterior and lateral radiographs of the whole spine before surgery,after surgery and at the last follow-up were performed.Changes of coronal trunk shift during follow-up period were observed and multiple linear regression analysis was performed to determine its relationship with changes of upper thoracic curve,main thoracic curve,lumbar curve,distal unfused segments and coronal sacral inclination.Results Thirty-seven patients with 4 males and 33 females were included in this study.The average age was 14.6±2.0 years (range,12-20 years).The mean follow-up period was 3.6 years (range,2-8.9 years).The mean preoperative Cobb angles of lumbar and thoracic curve were 44.2° and 25.2°,respectively.At the last follow-up,they were corrected to 10.3° and 13.6°,indicating 75.7％ and 44.9％ correction rate,respectively.The pre-and post-operative mean trunk shifts were 2.2 cm and 2.0 cm with no significant differences.At the last follow-up,it compensated to 0.9 cm,which showed significant differences compared with that of postoperation.Linear regression analysis suggested that trunk shift changes during follow-up period were only correlated with changes of distal unfused segments.The regression equation could be described as Changes of trunk shift (cm) =1.248 7+0.137 8×Changes of distal unfused segments (°).Conclusion The reconstruction of coronal trunk balance is mainly compensated by distal unfused segments after selective posterior correction for thoracolumbar/lumbar idiopathic scoliosis.Although preserved most of its levels,unfused thoracic segments do not play an important role in the reconstruction of trunk shift.

ObjectiveTo analyze the prognosis of the new occurred proximal thoracic(PT) curve after posterior correction surgery in adolescent idiopathic scoliosis (AIS) patients.MethodsThe radiographs of 21 AIS patients,who had a primary main thoracic (MT) curve and suffered from a new PT curve after posterior correction surgery,were retrospectively reviewed.All patients were followed up for an average of 19.8 months.Imaging parameters including coronal Cobb angle,T1 tilt and radiographic shoulder height,were measured and analyzed.ResultsThe average coronal Cobb angle of the MT curve was 54.3° preoperatively,14.1° at the final follow-up,with an average correction rate of 74.6％.Before operation,5 patients had negative T1 tilt and 16 without T1 tilt.After operation,all the 21 patients had positive T1 tilt and new PT curves;the average T1 tilt was 6.0° and the average coronal Cobb angle of the PT curve was 16.0°.At the final follow-up,the average T1 tilt and coronal Cobb angle of the PT curve were 4.0° and 13.2°,respectively; eighteen patients still had positive T1 tilt and 17 patients still had PT curves larger than 10°.As for the radiographic shoulder height,5 patients had equal shoulders and 16 patients had right shoulder elevation before operation; after operation,19 patients had left shoulder elevation and 6 patients had unbalanced shoulders; at the final follow-up,14 patients still had left shoulder elevation and 5 patients had unbalanced shoulders.At the final follow-up,T1 tilt and coronal Cobb angle of the PT curve were better than those postoperatively immediately,while the incidences of the new PT curve,left shoulder elevation,unbalanced shoulders were all not significantly different from those postoperatively immediately.ConclusionThe new occurred PT curves after posterior correction surgery in AIS patients are difficult to be compensated and could cause shoulder imbalance,thus great attention should be paid to prevent the occurrence of the PT curve.

Objective. To evaluate the results of operative treatment of spinal fracture-dislocation without neurologic deficits. Methods. Eighteen patients with spinal fracture-dislocation were neurologically intact at the time of injury, and all were treated operatively. The fracture sites were:8 cases in cervical spine, 3 cases in thoracic spine, and 7 cases in lumbar spine. Eight patients with cervical injuries had variant degrees of forward slide and kyphotic deformity. Of the 10 thoracic and lumbar fracttwes, one had lateral dislocation, 4 cases with kyphotic deformities, 5 cases with spinal canal compromise averaged 50% (ranging from 40% to 70%). Results. The average period of follow-up was 4.4 years with a range of 11 months to 13 years. All the patientsretumed to full-time work. No patient developed neurologic deterioration. Kyphotic deformity was corrected in the 4cases, and no progressive kyphosis was noted. There was no operation-related complication. The averaged post-opera-tive hospitalization time was 13 days. Conelusions. Despite the rare incidence of spinal fracture-dislocation without neumlogic deficits, we suggested that kind of fracture be considered unstable fracture because of its potential risk of delayed neurologic deterioration and kyphotic deformity, and be treated operatively to restore the sagittal ali~ment and the stability of the spine.

Objective． An internal fixation apparatus— — distraction reduction fixation system(DRFS) was designed to satisfy the clinical needs for spondylolisthesis. Methods. Since 1996, 53 patients were treated with DRFS. Among them, 35 had spondylolisthesis, 12 had lumbar canal stenosis accompanied with instability, 2 had vertebral tumors and 4 suffered from spinal fracture. The average age was 53.6 years old (ranged 24～ 72yrs). The mean time for follow-up was 30.6 months (16 ～ 44 months). Results． The slip rate was 0.15± 0.10 before operation, and decreased to 0.09± 0.07 after operation. Entire slip reposition was achieved in 19 cases (54.3％ ). The change in height of the intervertebral space within the fixation segments was 0.7± 0.17. Conclusion． DRFS achieved better results for spondylolisthesis less II degree and no other adverse effects were found. Compared with other foreign and domestic techniques, it had advantages in less implants, less operation gears required and ease to utilize in operation. It was proved to be an ideal internal fixation apparatus.

Objective: To evaluate the feasibility of the Estimation of Physiologic Ability and Surgical Stress (E-PASS) system to predict peri-operative risk in degenerative scoliosis patients scheduled for spinal surgery. Methods: Clinical data of 227 cases with degenerative scoliosis (Male∶Female=57∶170, Mean age=66.2±7.7 years), who accepted the operation of instrumentation and fusion in our hospital from January 2013 to July 2017, were retrospectively reviewed according to the E-PASS system, including peri-operative complications. Both hospital stayand post-operative hospital staywere compared between the groups with and withoutthe complications using t test. All E-PASS scores, including Preoperative Risk Score (PRS), Surgical Stress Score (SSS) and Comprehensive Risk Score (CRS), were analyzed between the two groups using Mann-Whitney Utest.The relationship between complications and PRS, SSS and CRS were analyzed using Spearmancorrelation analysis. The predictiveaccuracy of PRS, SSS and CRS were analyzed using the area under the receiver operating characteristic (ROC) curve (AUC). Results: There were a total of 47 patients (20.7%) suffering peri-operative complications, including 27 cases (11.9%) with complications at surgical sites and 23 cases (10.1%) with complications at non-surgical sites. Both hospital stay (t=-4.722, P<0.001)and post-operative hospital stay (t= -4.867, P<0.001) were increased because of the complications. All E-PASS scores, including PRS (P=0.005), SSS (P=0.003) and CRS (P<0.001) were significantly higher in patients with peri-operative complications and they were linearly correlated with the overall incidence of the complications(ρ=0.185-0.259). In particular, PRS was correlated with complications at non-surgical sites (ρ=0.162) and SSS with surgical site complications(ρ=0.162). The area under the receiver operating characteristic curve (AUC) for PRS and SSS was higher in patients with complications at non-surgical and surgical sites (AUC=0.655 and 0.650), respectively.The AUC for CRS exhibited good predictive power for both types of complications (AUC=0.662 and 0.631). Conclusion The peri-operative morbidity of spinal surgery for degenerative scoliosis was relatively higher. The E-PASS system could correctly predict the morbidity.

Objective To retrospectively analyze the application of single and dual growing rod techniques in treatment of early onset scoliosis,and compare the early results of two techniques.Methods Retrospective study was done on 18 cases of early onset scoliosis treated with growing rod technique from November 2002 to March 2009.Single growing rod group included 5 cases and dual growing rod group included 13 cases.We compared the operation time,intra-operative bleeding,correction rate,changes in distance between C7-S1 and incidence of complications of the first operation between two techniques.Results The average post-operative follow-up duration was 39.9 months (14-89).There was no difference in operation time,intra-operative bleeding and incidence of complications between two techniques.There was no difference in preoperative coronal Cobb angle and preoperative sagittal Cobb angle between single growing rod group and dual growing rod group.Correction rate of dual growing rod group was significantly superior to single growing rod group in coronal plane (P＜0.01),but not in sagittal plane.Increase of the distance between C7-S1 dual growing rod group was significantly larger than the single growing rod group (P＜0.05).Conclusion Growing rod technique is an effective option for early onset scoliosis.Dual growing rod technique is relatively superior to single growing rod technique in correction outcomes.