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Feng D, Duan Y, Chen J, Wu Y, Li T, Wang Y, Jiang L, Huang Y. Posterior Pedicle Screw Fixation With Indirect Decompression Versus Direct Decompression in Treating Thoracolumbar Burst Fracture: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 186:27-34. [PMID: 38493890 DOI: 10.1016/j.wneu.2024.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE To compare the safety and efficacy between posterior pedicle screw fixation with direct versus indirect decompression in treating patients with thoracolumbar burst fracture. METHODS This study was conducted on the basis of PRISMA statement. We systematically searched the PubMed and Embase databases up to July 3, 2023. Relevant studies comparing indirect decompression and direct decompression were recruited. Weighted mean differences (WMDs), odds ratios (ORs) and 95% confidence intervals (CIs) were analyzed for continuous and dichotomous data, respectively. P < 0.05 was considered statistically significant. RESULTS The operation time (WMD: -37.14, 95% CI: [-42.64, 31.64], P < 0.00001, I2 = 0%) and intraoperative blood loss (WMD: -316.82, 95% CI: [-469.80, -163.85], P < 0.0001, I2 = 99%) of indirect decompression group were significantly lower. Percentage of anterior vertebral body height (WMD: 3.98, 95% CI: [2.36, 5.60], P < 0.00001, I2 = 32%) and encroachment rate of the spinal canal (WMD: 1.48, 95% CI: [0.56, 2.40], P = 0.002, I2 = 35%) of indirect decompression group were significantly higher. No statistical difference was identified in grades of neurologic recovery and Cobb angle. CONCLUSIONS Posterior pedicle screw fixation with indirect decompression was safe and effective for thoracolumbar burst fracture with or without neurologic deficits when posterior longitudinal ligament was intact.
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Affiliation(s)
- Dagang Feng
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yuchen Duan
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Jun Chen
- Department of Critical Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yamei Wu
- Sichuan Academy of Chinese Medicine Sciences, Chengdu, China
| | - Tong Li
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yiran Wang
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P.R. China
| | - Leiming Jiang
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yong Huang
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China.
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Cirillo JI, Farias I, Del Pino C, Gimbernat M, Urzúa A, Tapia C, Zamorano JJ. Surgical timing prevails as the main factor over morphologic characteristics in the reduction by ligamentotaxis of thoracolumbar burst fractures. BMC Surg 2023; 23:166. [PMID: 37340380 DOI: 10.1186/s12893-023-02061-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/29/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND thoracolumbar burst fractures are associated with spinal canal occupation. The indirect decompression of the spinal canal and reduction of the fragment can be achieved with the distraction of the middle column and ligamentotaxis. Nevertheless, the factors that influence the effectiveness of this procedure and its temporality are controversial. METHODS The aim of this observational, cross-sectional study was to evaluate the effectiveness of indirect reduction by ligamentotaxis in thoracolumbar burst fractures according to the fracture's radiologic characteristics and the procedure's temporality. Patients diagnosed with a thoracolumbar burst fracture between 2010 and 2021 were submitted to indirect reduction by distraction and ligamentotaxis. A retrospective analysis of radiologic characteristics and temporality of the procedure was performed with an independent sample t-test or Pearson's correlation coefficient, as required. RESULTS A total of 58 patients were included in the analysis. Postoperatively, ligamentotaxis significantly improved all radiologic parameters (canal occupation, endplates distance, and vertebra height). Still, none of the radiological characteristics of the fracture (width, height, position, sagittal angle) were associated with the postoperative change in canal occupation. The endplates distance and the temporality of ligamentotaxis significantly predicted the reduction of the fracture. CONCLUSION Fragment reduction effectiveness is more significant when performed as early as possible and adequate distraction is achieved using the internal fixator system. The radiologic characteristics of the fractured fragment do not determine its reduction capacity.
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Affiliation(s)
- Juan Ignacio Cirillo
- Hospital del Trabajador, Santiago, Chile
- Clínica Universidad de los Andes, Santiago, Chile
- Universidad Andrés Bello, Hospital del Trabajador, Facultad de Medicina, Santiago, Chile, 8370035, República 239
| | - Ignacio Farias
- Hospital San José, Santiago, Chile
- Clínica Dávila Vespucio, Santiago, Chile
| | - Cristóbal Del Pino
- Hospital del Trabajador, Santiago, Chile.
- Universidad Andrés Bello, Hospital del Trabajador, Facultad de Medicina, Santiago, Chile, 8370035, República 239.
| | | | | | - Carlos Tapia
- Hospital del Trabajador, Santiago, Chile
- Instituto Traumatológico, Santiago, Chile
| | - Juan José Zamorano
- Hospital del Trabajador, Santiago, Chile
- Clínica Alemana, Santiago, Chile
- Universidad del Desarrollo, Santiago, Chile
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Liu ZZ, Shi L, Yan ZJ, Ran JH, Xu XY, Deng ZL. The anatomic study and surgical technique for canal decompression with "pedicle-plasty" strategy in lumbar burst fractures with pedicle rupture. Biotechnol Genet Eng Rev 2023:1-22. [PMID: 37018456 DOI: 10.1080/02648725.2023.2199241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
In the treatment of lumbar burst fractures with nerve injury, fusion is often required to rebuild spinal stability, but it can lead to the loss of motor units and increase the occurrence of adjacent segment diseases. Thus, a novel approach of lumbar canal decompression with "pedicle-plasty" strategy (DDP) was needed in clincal treatment. Firstly, image measurement analysis, the images of 60 patients with lumbar spine CT examinations were selected to measure osteotomy angle (OA), distance from the intersection of osteotomy plane and skin to the posterior midline (DM),transverse length of the osteotomy plane (TLOP), and sagittal diameter of the outer edge of superior articular process (SD). Secondary, cadaver study, distance between the intermuscular space and midline (DMSM), anterior and posterior diameters of the decompression (APDD), and lateral traction distance of the lumbosacral plexus (TDLP) were measured on 10 cadaveric specimens. Finally, procedure of DDP was demonstrated on cadaver specimens. OA ranged from 27.68°+4.59° to 38.34°+5.97°, DM ranged from 43.44+6.29 to 68.33+12.06 mm, TLOP ranged from 16.84+2.19 to 19.64+2.36 mm, and SD ranged from 22.49+1.74 to 25.53+2.21 mm. DMSM ranged from 45.53+5.73 to 65.46+6.43 mm. APDD were between 10.51+3.59 and 12.12+4.54 mm, and TDLP were between 3.28+0.81 and 6.27+0.62 mm.DDP was successfully performed on cadaveric specimens. DDP, as a novel approach of decompression of burst fractures with pedicle rupture, can fully relieve the occupation and at the same time preserve the spinal motor unit because of no resection of intervertebral discs and no destruction of facet joints,and has certain developmental significance.
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Affiliation(s)
- Zuo-Zhong Liu
- Department of Orthopedics, Yongchuan Hospital of Chongqing Medical University, Chongqing, PR China
| | - Lei Shi
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Zheng-Jian Yan
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Jian-Hua Ran
- Department of Anatomy, and Laboratory of Neuroscience and Tissue Engineering, Basic Medical College, Chongqing Medical University, Chongqing, PR China
| | - Xi-Yan Xu
- Chongqing Fifth People's Hospital, Department of Orthopedics, Chongqing, PR China
| | - Zhong-Liang Deng
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
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Xia C, Yang S, Liu J, Lu J, Shang D, Fu D, Zhao Z, Wang X. Finite element study on whether posterior upper wall fracture is a risk factor for the failure of short-segment pedicle screw fixation in the treatment of L1 burst fracture. Injury 2021; 52:3253-3260. [PMID: 34521540 DOI: 10.1016/j.injury.2021.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/04/2021] [Accepted: 08/13/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To establish the finite element model of T12 and L2 (T12-L2) pedicle screw fixation for severe L1 burst fracture, and quantitatively simulate and analyze the screw stress and vertebral displacement in different degrees of L1 posterior upper wall fracture (PUWF), and evaluate whether PUWF degree is a risk factor for fixation failure. METHODS The data of 6 healthy volunteers were used to establish a finite element model of T12-L2 pedicle screw fixation for type A severe burst fractures. The stress and displacement of the conventional and Schanz pedicle screws for the different degrees of PUWF (including the anterior upper wall of the vertebral canal and the bipedicle) were evaluated. RESULTS The maximum stress and L1 displacement of conventional and Schanz pedicle screws were positively correlated with the severity of the PUWF (P<0.05). During anterior flexion, the maximum stress of conventional pedicle screws for 70% type I were 538.3±59.75MPa and the maximum stress of Schanz pedicle screws for 90% type Ⅱ, 90% type Ⅲ and 70% type IV fractures were close to the fatigue threshold. The maximum stress during anterior flexion were significantly higher than those during posterior extension, bending and rotation (P<0.05). CONCLUSION The posterior upper wall fracture of vertebral body (VB) of type A burst fracture is not an independent risk factor for the failure of short-segment pedicle screw fixation (SSPSF). Anterior flexion of type A fractures combined with severe PUWF of VB was a risk factor for the failure of SSPSF.
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Affiliation(s)
- Chunyang Xia
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, 6 Jiefang Street, Dalian, Liaoning 116001, China.
| | - Sheng Yang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, 6 Jiefang Street, Dalian, Liaoning 116001, China.
| | - Jifeng Liu
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, 6 Jiefang Street, Dalian, Liaoning 116001, China; Department of Orthopaedics, Yantai Hospital of Shandong Wendeng Orthrpaedics & Traumatology, Shanhai South Road, Laishan district, Yantai 264003, Shandong Province, China.
| | - Jianmin Lu
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, 6 Jiefang Street, Dalian, Liaoning 116001, China.
| | - Depeng Shang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, 6 Jiefang Street, Dalian, Liaoning 116001, China.
| | - Dapeng Fu
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, 6 Jiefang Street, Dalian, Liaoning 116001, China.
| | - Zhenhua Zhao
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, 6 Jiefang Street, Dalian, Liaoning 116001, China.
| | - Xiahua Wang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, 6 Jiefang Street, Dalian, Liaoning 116001, China.
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Pourabbas Tahvildari B, Safari R, Pouralimohammadi MA. Analysis of the Effect and Prognostic Factors Associated with Postural and Instrumental Reduction in Thoracolumbar Burst Fractures. J Biomed Phys Eng 2021; 11:337-344. [PMID: 34189122 PMCID: PMC8236101 DOI: 10.31661/jbpe.v0i0.2012-1245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/05/2021] [Indexed: 12/03/2022]
Abstract
Background: Axial load on thoracolumbar junction, both mechanical and anatomical transitional zone, causes the compression and flexion of the spine, and consequently thoracolumbar burst fractures. Objective: This study aimed to investigate the effect and prognostic factors associated with the postural and instrumented reduction on the restoration of vertebral height and kyphosis angle in thoracolumbar burst fractures. Material and Methods: This retrospective cohort study was conducted on 41 patients with A3, A4, and B type thoracolumbar burst fractures, subjected to postural and instrumented reduction for the restoration of vertebral height and kyphosis angle. The magnitude and correction of kyphotic deformity and percentage of vertebral body collapse were measured before and after postural reduction, and after instrumental insertion to find if they were affected by fracture type and level, time-to-surgery, and use of pedicular screws at the fractured level. Results: Postural and instrumental reduction significantly improved both the kyphosis angle and the percentage of vertebral body height, regardless of AO types (p.value <0.001 and p.value <0.001, respectively). AO type A3, and A4 comparing to type B, has better restoration of kyphosis angle by postural (p-value=0.013, p-value=0.007, respectively) and instrumental reduction. (p-value=0.006, p-value=0.014, respectively). Evaluation of time to surgery showed that performing operation during the first four days would result in better correction of kyphosis angle (p-value 0.015). Conclusion: AO type A3, and A4, time to surgery before 4 days, and fracture level at L2 were favorable prognostic factors to better restoration of kyphosis angle using both postural and instrumented reduction.
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Affiliation(s)
- Babak Pourabbas Tahvildari
- MD, Bone and joint research center, Department of Orthopedic surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rasool Safari
- MD, Bone and joint research center, Department of Orthopedic surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Amin Pouralimohammadi
- MD, Bone and joint research center, Department of Orthopedic surgery, Shiraz University of Medical Sciences, Shiraz, Iran
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Yuan L, Yang S, Luo Y, Song D, Yan Q, Wu C, Yang H, Zou J. Surgical consideration for thoracolumbar burst fractures with spinal canal compromise without neurological deficit. J Orthop Translat 2020; 21:8-12. [PMID: 32042591 PMCID: PMC6997615 DOI: 10.1016/j.jot.2019.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 11/16/2019] [Accepted: 12/03/2019] [Indexed: 11/29/2022] Open
Abstract
Background For thoracolumbar burst fractures with spinal canal compromise but no neurological deficit, is it necessary to perform additional laminectomy decompression after the currently accepted posterior pedicle-screw internal fixation? Methods Patients were divided into two groups: decompression group (Group A) and nondecompression group (Group B). A retrospective analysis of the posterior vertebral body height of the fractured vertebral body, the ratio of the volume of the spinal canal, and the change of the Cobb angle, relative to the corresponding preoperative values, was conducted to analyse the reasons for choosing different surgical methods. Results Compared the intraoperative findings after fixation with the preoperative data, in Group A, the posterior vertebral body height of the fractured vertebral body was not significantly restored, the volume ratio of the spinal canal was not significantly improved, and the Cobb angle was not significantly reduced (p > 0.05). In comparison, in Group B, the posterior vertebral body height of the fractured vertebral body was significantly restored, the volume ratio of spinal canal was significantly increased, and the Cobb angle was significantly reduced (p < 0.001). Conclusion For patients with thoracolumbar burst fractures with spinal canal compromise but no neurological deficit, if when the posterior intraoperative fixation is performed, the spinal canal fracture is partially recovered, the posterior vertebral body height of the injured vertebrae is significantly restored, the spinal canal volume ratio is significantly increased, and the large kyphosis is corrected, then the indirect decompression without the posterior laminectomy can be performed. The translational potential of this article This study contributes to offer treatment consideration for patients with thoracolumbar burst fracture without neurological symptoms.
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Affiliation(s)
- Lijie Yuan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.,Department of Orthopaedic Surgery, Taicang Affiliated Hospital of Soochow University, Taicang, Jiangsu, China
| | - Shaofeng Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yuan Luo
- Department of Orthopaedic Surgery, Taicang Affiliated Hospital of Soochow University, Taicang, Jiangsu, China
| | - Dawei Song
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Qi Yan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Cenhao Wu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Huilin Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jun Zou
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Zhang B, Zhou F, Wang L, Wang H, Jiang J, Guo Q, Lu X. A new decompression technique for upper lumbar fracture with neurologic deficit-comparison with traditional open posterior surgery. BMC Musculoskelet Disord 2019; 20:580. [PMID: 31787080 PMCID: PMC6886208 DOI: 10.1186/s12891-019-2897-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 10/14/2019] [Indexed: 12/25/2022] Open
Abstract
Background Surgery is usually recommended for thoracolumbar fracture with neurologic deficit. However, traditional open posterior approach requires massive paraspinal muscles stripping, and the canal decompression may be limited and incomplete. We aimed to investigate a new approach via the Wiltse approach and the Kambin’s Triangle. Methods Twenty-one consecutive patients with traumatic upper lumbar fracture who received this new approach surgery between January 2015 and January 2016 constituted the new approach group. Twenty-nine patients received the traditional open posterior surgery between January 2014 and January 2015 were classified as the traditional posterior surgery group. Surgical informations including operative time, blood loss, drainage volume, hospitalization days were collected and compared among the two groups. The American Spinal Injury Association (ASIA) impairment scale and Visual Analog Score (VAS) were evaluated preoperatively, postoperatively and at 12 months follow-up. Results Patients in the new approach group had fewer operation time (128.3 ± 25.1 vs 151 ± 32.2 min, P = 0.01), less blood loss (243.8 ± 135.5 vs 437.8 ± 224.9 ml, P = 0.001) and drainage volume (70.7 ± 57.2 vs 271.7 ± 95.5 ml, P < 0.001), as well as shorter hospitalization stay than the traditional posterior surgery group (6.6 ± 1.8 vs 8.5 ± 2.4 d, P = 0.004). Similar neurologic recovery according to ASIA grade was achieved in both groups (Recovery index: 0.90 ± 0.53 vs 0.86 ± 0.51, P = 0.778). While the pain level was significantly lower in the new approach group postoperatively (2.6 ± 0.7 vs 3.5 ± 0.9, P < 0.001) and at 12 months follow-up (1.4 ± 0.9 vs 2.4 ± 0.8, P < 0.001). Conclusion The present new approach was successfully applied in the treatment of upper lumbar fracture with neurologic deficit. It can reduce iatrogenic trauma and achieve similar or better outcomes compared to the traditional posterior surgery.
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Affiliation(s)
- Bangke Zhang
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Fengjin Zhou
- Department of Spinal Surgery, Xi'an Zhongde Orthopedics Hospital, Xi'an, China
| | - Liang Wang
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Haibin Wang
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jiayao Jiang
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Qunfeng Guo
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | - Xuhua Lu
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
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Chen F, Shi T, Li Y, Wang H, Luo F, Hou T. Multiple parameters for evaluating posterior longitudinal ligaments in thoracolumbar burst fractures. DER ORTHOPADE 2018; 48:420-425. [PMID: 30578443 DOI: 10.1007/s00132-018-03679-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The posterior longitudinal ligament plays a key role in spinal stability. The purpose of this study was to determine the injuries of the posterior longitudinal ligament (PLL) in thoracolumbar burst fractures. PATIENTS AND METHODS Patients suffering a thoracolumbar burst fracture from January 2011 to December 2015 were divided into an intact group and a disrupted group according to the status of the PLL. Mid-sagittal canal diameter, width and height of bone fragments, inversion angle and horizontal rotation angle of bone fragments and local kyphosis angle were measured. Anterior, middle and posterior vertebrae compression ratio, mid-sagittal diameter compression ratio, ratio of height of bone fragments occupying the posterior wall of the injured vertebral body and ratio of the width of bone fragment occupying the transverse canal diameter were calculated. RESULTS A total of 95 patients were included in the study including 52 patients in the intact group and 43 patients in the disrupted group. There were significant differences on anterior and posterior vertebrae compression ratio, mid-sagittal diameter compression ratio, inversion angle and horizontal rotation angle of bone fragment (P 0.05) between the two groups. Injury of the PLL showed a positive correlation with the mid-sagittal diameter compression ratio and inversion angle of bone fragment (P 0.05). CONCLUSION The mid-sagittal diameter compression ratio and inversion angle of bone fragment can be used to assess the status of the PLL in thoracolumbar burst fractures. When the mid-sagittal diameter compression ratio was 52% and the inversion angle of the bone fragment was 33° the PLL was likely to be disrupted.
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Affiliation(s)
- Fei Chen
- Department of Orthopedics, Bozhou District People's Hospital, Zunyi City, Guizhou Province, China
| | - Tao Shi
- Center for Orthopedics and Trauma, TheThird Affiliated Hospital, Chongqing Medical University, No. 1, Shuanghu branch Road, 401120, Chongqing, Yubei District, China.
| | - Yang Li
- Center for Orthopedics and Trauma, TheThird Affiliated Hospital, Chongqing Medical University, No. 1, Shuanghu branch Road, 401120, Chongqing, Yubei District, China
| | - Han Wang
- Center for Orthopedics and Trauma, TheThird Affiliated Hospital, Chongqing Medical University, No. 1, Shuanghu branch Road, 401120, Chongqing, Yubei District, China
| | - Fei Luo
- Department of Orthopedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Tianyong Hou
- Department of Orthopedics, Southwest Hospital, Third Military Medical University, Chongqing, China
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Zhang Q, Zhang W, Zhang Z, Zhang L, Chen H, Hao M, Deng J, Tang P. Femoral nonunion with segmental bone defect treated by distraction osteogenesis with monolateral external fixation. J Orthop Surg Res 2017; 12:183. [PMID: 29178906 PMCID: PMC5702156 DOI: 10.1186/s13018-017-0684-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 11/09/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Currently, the common treatment for femoral nonunion with large segmental bone defect is difficult and complex. The effective surgical methods are rare, include vascularized bone grafting, Masquelet technique and Ilizarov distraction osteogenesis. The objective of this study is to investigate the outcomes of segmental femoral defects treated with monolateral external fixation using the distraction osteogenesis. METHODS We retrospectively analyzed patients with femoral nonunion with segmental bone defects (> 6 cm) between January 2010 and January 2014 in our single trauma center. All patients were treated by distraction osteogenesis with monolateral external fixation. All surgeries were performed by the same surgeon. Bone union, duration of distraction osteogenesis in days, time to consolidation in months, external fixation index (EFI), complications, and additional surgical interventions were recorded postoperatively. The modified Application of Methods of Illizarov (ASAMI) criteria were used to evaluate the operative effectiveness. RESULTS Forty-one patients were enrolled in this study for analysis. The length of the bone defect ranged from 6 to 17 cm. All patients eventually achieved healing, and no patient experienced recurrence of infection or newly developed infection. The average time needed for healing was 13 months. In terms of the incidence of complications, 3 cases axial deviations, 5 cases docking site nonunion, 23 cases pin-tract infection, 14 cases knee joint stiffness or their joint mobility declined, 2 cases osteogenesis insufficient in the distraction area,1 case refracture, and 2 cases loose external fixation pins. In terms of the evaluations of fracture healing and function, 30 patients excellent, 6 patients good, 5 patients fair, and 0 patient poor. In terms of postoperative function evaluations, 21 patients excellent, 9 patients good, 7 patients fair, and 4 patients poor. CONCLUSION For patients with femoral nonunion with large segmental bone defects, the monolateral external fixation can provide effective stability, improve compliance, and reduce complications.
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Affiliation(s)
- Qun Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853 People’s Republic of China
| | - Wei Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853 People’s Republic of China
| | - Zhuo Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853 People’s Republic of China
| | - Licheng Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853 People’s Republic of China
| | - Hua Chen
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853 People’s Republic of China
| | - Ming Hao
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853 People’s Republic of China
| | - Junhao Deng
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853 People’s Republic of China
| | - Peifu Tang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853 People’s Republic of China
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