Background and Objectives: At present, the management of comminuted distal femur fractures remains challenging for orthopedic surgeons. The aim of this study is to report a surgical treatment for comminuted distal femur fractures using supplementary medial cortical bone plate allografts in conjunction with the lateral less invasive stabilization system (LISS) plates. Materials and Methods: From January 2009 to January 2014, the records of thirty-three patients who underwent supplementary medial cortical bone plate allografts combined with lateral LISS plates fixation were reviewed. Clinical and radiographic data were collected during regular postoperative follow-up visits. Functional outcomes were determined according to the special surgery knee rating scale (HSS) used at the hospital. Results: Thirty patients were followed for 13 to 73 months after surgery, with an average follow-up time of 31.3 months. The mean time to bone union was 5.4 months (range of 3–12 months) and the mean range of knee flexion was 105.6° (range of 80–130°). Of the remaining patients, 10 had a score of “Excellent”, while 10 had a score of “Good”. Three patients had superficial or deep infections, one patient had nonunion that required bone grafting, and one patient had post-traumatic knee arthritis. Conclusions: Based on these promising results, we propose that supplementary medial cortical bone plate allografts combined with lateral LISS plate fixation may be a good treatment option for comminuted distal femur fractures. This treatment choice not only resulted in markedly improved stability on the medial side of the femur, but also satisfactory outcomes for distal femoral fractures.

OBJECTIVE:To analyze the effect of lag screw and support plate through axillary approach for the treatment of Ideberg typeⅡscapular pelvis fracture.METHODS:From January 2016 to June 2021, 26 patients with Ideberg typeⅡglenoid fractures were treated with trans-axillary lag screw combined with supporting plate, including 15 males and 11 females. The age ranged from 21 to 75 years, with an average of (43.12±6.56) years old. The Constant-Murley Shoulder joint Scale and University of California at Los Angeles (UCLA) score were used to evaluate the function and clinical efficacy of shoulder joint.RESULTS:All patients were followed up, and the duration ranged from 19 to 42 months, with an average of (30.6±10.5) months. One year after surgery, the Constant-Murley score increased from preoperative 34.9±2.5(ranged, from 28 to 47) to 87.2±6.8(ranged, from 70 to 95). The UCLA score improved from preoperative 17.9±1.7(9 to 25) to 33.1±2.3(29 to 35). Seventeen patients got an excellent result, with 7 good, and 2 fair. None of the patients had infection, screw, and plate loosening, fracture, and other complications after surgery. Two patients had different degrees of Chronic pain in the shoulder during the follow-up period.CONCLUSION:The treatment of Ideberg typeⅡscapular glenoid fractures through axillary approach with lag screws and supporting steel plates has the advantages of convenient exposure, direct visual restoration of the normal anatomical shape of the scapular glenoid, selection of suitable positions for screw and steel plate placement, achieving better treatment results, and fewer complications. It is an effective and reliable surgical method.

目的 探讨立体式皮肤牵张器治疗合并骨外露胫骨前方皮肤软组织缺损的可行性并观察其临床应用的效果.方法 回顾性分析自2019-03-2021-01手术治疗的8例胫骨前方皮肤软组织缺损并骨外露,术中采用自行研制的立体式皮肤牵张器以缓慢、可控的速度牵拉创缘,最终闭合创面,实现创面的原位修复.结果 8例均获得随访,随访时间平均12.3(6～24)个月.所有患者的软组织缺损并骨外露创面均愈合,愈合时间为4～7周,平均5.2周.7例牵拉闭合创面成功后直接缝合.1例牵张过程中克氏针切割皮肤后一端脱落,牵张失效,在股神经阻滞麻醉下再次调整穿针后继续牵拉,创面成功靠拢后再间断缝合.本组无感染复发、皮肤坏死等异常,无再手术患者.牵张后的皮肤色泽与毛发生长正常,无臃肿,皮肤触痛觉正常.结论 立体式皮肤牵张器能有效修复合并骨外露胫骨前方软组织缺损,与皮瓣转移修复手术相比创伤更小,安全性高,而且操作相对简单,学习曲线短,适合基层医院开展.

Objective:To investigate the efficacy of a novel self-designed skin-stretching device for skin-soft tissue defects and bone exposure after internal fixation of calcaneal fracture.Methods:From July 2018 to January 2021, 9 patients were treated at Orthopedic Hospital, Southeast Hospital Affiliated to Xiamen University for skin-soft tissue defects and bone exposure after internal fixation of calcaneal fracture. They were 6 males and 3 females, aged from 19 to 61 years (mean, 42.6 years). The interval between their initial internal fixation and the present operation ranged from 14 to 75 days (average, 47.3 days). Of them, one developed wound dehiscence due to fat liquefaction, 2 necrosis of skin and soft tissue along the wound edges, and 6 incision infection. Their fusiform skin and soft tissue defects had formed after routine expansion of the wound, with an area of 5.0 cm×2.0 cm to 7.0 cm×3.5 cm, and all their wounds were positive by Pinch test. After a Kirschner wire with a diameter of 2.0 was placed on both sides of the wound, our novel self-designed skin-stretching device was installed. Intraoperatively, depending on the soft tissue conditions on both sides, the wound was closed acutely by about 5 mm in width. The threaded rod of the skin-stretching device was adjusted every day after operation to gradually reduce the wound surface until the wound edge was closed and sutured without tension. During wound stretch, the visual analogue scale (VAS), wound approaching time, stretch speed, wound healing time, complications and the Vancouver Scar Scale (VSS) for the wound scar at the last follow-up were recorded.Results:All the 9 patients were followed up for 8 to 18 months (average, 12.5 months). The wounds were successfully closed in all the patients. The time for wound closure (till the suture) ranged from 8 to 15 d, averaging 12.1 d; the stretch rate from 1 to 3 mm/d, averaging 2 mm/d; the time for complete wound healing (to the suture removal) from 22 to 30 d, averaging 26.8 d; the VAS score during the stretch from 3 to 7 points, averaging 4.9 points; the VSS score from 2 to 7 points, averaging 4.1 points. There was no recurrence of surgical site infection, skin re-necrosis or reoperation in the patients.Conclusions:In the treatment of skin-soft tissue defects and bone exposure caused by various reasons after internal fixation of calcaneal fracture, our novel self-designed skin-stretching device is an effective in situ wound repair instrument, showing advantages of simple operation, less trauma and high safety. It is suggested that the stretch speed should average 2 mm/d, which is well tolerated by patients.

目的 探讨胫骨平台骨折术后不同程度感染性骨缺损治疗策略的选择.方法 回顾性分析2014年7月至2018年2月我院收治的45例胫骨平台骨折术后感染性骨缺损病人的临床资料,其中男32例,女13例,年龄为(39.42±12.09)岁(20～66岁).腔洞性骨缺损16例,节段性骨缺损16例,波及关节面的缺损13例.Ⅰ型为胫骨平台内腔洞性骨缺损;Ⅱa型为胫骨平台下节段性(<4 cm)并平台内腔洞性骨缺损;Ⅱb型胫骨平台下节段性(≥4 cm)并平台内腔洞性骨缺损;Ⅲa型胫骨平台波及关节面的缺损,但节段性缺损<4 cm;Ⅲb型为胫骨平台波及关节面的缺损,但节段性缺损≥4 cm.所有病人一期彻底扩创取出内固定,二期按照胫骨平台骨缺损情况进行分型治疗.记录病人一期手术前、二期手术后3个月的炎性指标(白细胞计数、C-反应蛋白、红细胞沉降率和降钙素原)、膝关节活动度、美国特种外科医院(Hospital for Special Surgery,HSS)膝关节评分,及术后并发症、骨折愈合情况.结果 病人随访时间为(25.25±3.32)个月(17～56个月),骨折愈合时间为(11.21±4.43)个月(8～17个月),伤口愈合较满意,其中8例行腓肠肌肌瓣转移术覆盖伤口,10例行同侧大腿取皮局部植皮术,1例节段性骨缺损术后10个月骨折未见明显愈合,再次手术植骨后6个月得到愈合.随访2年未见伤口破溃及感染复发.在观察期间未见固定失败、再骨折、神经损伤、下肢深静脉血栓、肺栓塞等并发症的发生.二期术后3个月各炎性指标、膝关节活动度、HSS评分与一期术前比较,差异均有统计学意义(P均<0.05).末次随访时,病人患膝HSS评分为(89.23±5.35)分(82～94分).结论 根据胫骨平台术后感染性骨缺损进行分型治疗,临床疗效良好,为胫骨平台术后感染性骨缺损诊疗提供了策略.

目的 探讨肩袖损伤经肩关节镜下修复手术治疗后分阶段康复锻炼结合优化熏蒸康复疗法的临床疗效.方法 回顾性分析自2018-07-2019-12采用肩关节镜下修复手术治疗的98例肩袖损伤,50例术后行分阶段康复锻炼结合优化熏蒸康复疗法治疗(观察组),48例术后单纯行分阶段康复锻炼(对照组).比较2组术后1、6、12周肩关节功能Con-stant-Murley评分、疼痛VAS评分.结果 2组均顺利完成手术并获得至少12个月的随访.术后1、6、12周观察组肩关节功能Constant-Murley评分高于对照组,疼痛VAS评分低于对照组,差异有统计学意义(P＞0.05).结论 分优化熏蒸康复疗法具有便捷、操作简单等优点,结合分阶段康复锻炼可有效改善患者肩关节功能及疼痛情况,值得临床推广.

目的 比较经皮椎体成形术(Percutaneous vertebroplasty,PVP)与经皮椎体后凸成形术(Percutaneous kyphoplasty,PKP)治疗Kümmell病的临床疗效.方法 回顾性分析自2016-01-2019-12诊治的27例Kümmell病,15例采用PVP治疗(PVP组),12例采用PKP治疗(PKP组),比较2组手术时间、术中出血量、骨水泥渗漏数,比较2组术后1d与末次随访时疼痛VAS评分、ODI指数、伤椎Cobb角.结果 27例均顺利完成手术并获得完整随访,随访时间3～12个月,平均6.5个月.PVP组手术时间、术中出血量较PKP组少,差异有统计学意义(P＜0.05).PVP组术后出现3例骨水泥渗漏,PKP组术后出现2例骨水泥渗漏,2组骨水泥渗漏数比较差异无统计学意义(P＞0.05).术后1 d与末次随访时2组疼痛VAS评分、ODI指数比较差异无统计学意义(P＞0.05);PVP组伤椎Cobb角较PKP组大,差异有统计学意义(P＜0.05).结论 PKP和PVP治疗早期Kümmell病均可有效缓解疼痛症状,但PVP手术时间更短,术中出血量更少,在临床推荐优先采用PVP进行治疗.

背景:近年报道,腓骨长肌腱可作为重建前交叉韧带新的移植材料,且能取得与腘绳肌腱同等效果,有必要对这2种重建前交叉韧带的移植材料进行系统评价。目的:采用Meta分析方法评价腓骨长肌腱和腘绳肌腱重建前交叉韧带的临床疗效。方法:采用中英文分别在中文数据库（万方医学、中国知网、维普医药、中国生物医学）、英文数据库（Ovid、Pub Med、Web of Science、Embase、Cochrane library）检索腓骨长肌腱和腘绳肌腱重建前交叉韧带的临床对照试验,检索时限从自建库至2019年3月,并由2名评价员通过筛选文献、文献评价、提取数据,并在Revman5.3软件进行Meta分析。结果与结论:（1）通过制定的检索式共检索出中英文文献413篇,最终符合纳入标准10篇,包括647例重建前交叉韧带患者,其中271例使用腓骨长肌腱重建,376例采用腘绳肌腱重建;（2）Meta分析显示:腓骨长肌腱组术后12个月的Lysholm评分、术后6个月的IKDC评分高于腘绳肌腱组（MD=1.23,95%CI[0.31,2.51],P=0.0009;MD=3.19,95%CI[0.07,6.31],P=0.02）,术后并发症发生率低于腘绳肌腱组（OR=0.15,95%CI[0.03,0.69],P=0.01）;两组术后6,12个月的Tegner评分、关节活动度、关节松弛程度,以及术后6个月的Lysholm评分、术后12个月的IKDC评分比较差异均无显著性意义（P＞ 0.05）;（3）结果表明,腓骨长肌腱重建前交叉韧带的临床效果与腘绳肌腱相当,术后12个月的Lysholm评分、术后6个月的IKDC评分优于腘绳肌腱组,并且可减少术后并发症。临床上可推荐腓骨长肌腱代替腘绳肌腱重建前交叉韧带,但是纳入文献质量限制,需要更高级别的证据。

患者,男,67 岁,7 年前无明显诱因情况下出现右肩关节反复疼痛,肿胀伴活动受限,经自行服药治疗后无改善.随病程进展,肩关节肿胀、疼痛发作逐渐频繁且程度加重,活动明显受限,1周前自觉上述症状进行性加重,于2019年8月8日入普安县人民医院骨外科就诊.患者自诉无明确外伤病史.查体:右肩部膨隆、饱满,关节明显肿胀伴活动明显受限,外展80°,内收15°,前屈40°,后伸20°,局部皮温不高,肩关节周围散在压痛点.

目的 探索同步热疗改善肩峰下撞击综合征患者术后肩关节功能的方法.方法 选取2017年6月-2019年6月我院收治的82例肩峰下撞击综合征术后患者,随机分为三组:对照组A(n=27),采用传统热疗20 min后再进行康复训练40 min;对照组B(n=27),采用便携式温热肩部理疗仪热疗20 min后再进行康复训练40 min;实验组(n=28),采用便携式温热肩部理疗仪热疗同时康复训练40 min.在术前、术后6周、术后12周,采用视觉模拟评分(visual analog scale,VAS)、Constant-Murley肩关节功能评分(Constant-Murley score,CMS)进行评估,并记录不良反应.结果 术前三组VAS评分及CMS评分无统计学差异(P均>0.05).所有研究对象均随访至少12周.三组VAS及CMS评分在治疗过程中均显著改善(P均<0.05).术后6周、术后12周随访时,实验组VAS评分显著优于对照组A和对照组B(6周:2.4±0.49 vs 3.9±0.50和3.4±0.52;12周:1.3±0.52 vs 1.5±0.47和1.6±0.51;P均<0.05);实验组CMS评分显著高于对照组A(6周:59.37±1.69 vs 57.35±2.22;12周:72.76±2.65 vs 73.44±3.01;P均<0.05),但与对照组B差异无统计学意义.结论 在肩峰下撞击综合征术后的康复训练中采用同步热疗,较传统热疗后康复训练的效果更好.

目的 比较锁定钢板和交锁髓内钉内固定治疗胫骨多节段骨折的临床疗效.方法 将94例胫骨多节段骨折患者按固定方式不同分为交锁髓内钉组(采用交锁髓内钉内固定治疗,46例)和锁定钢板组(采用锁定钢板内固定治疗,48例).比较两组手术时间、骨折愈合时间及并发症发生情况.结果 患者均获得随访,时间13～48个月.骨折均愈合,时间28～66周.手术时间锁定钢板组短于交锁髓内钉组(P<0.05).锁定钢板组和交锁髓内钉组各有1例出现伤口感染,锁定钢板组有1例出现钢板内置物断裂.末次随访时根据Joh-ner-Wruhs评分标准评价疗效:交锁髓内钉组优良率89.1％,锁定钢板组优良率91.7％,两组比较差异无统计学意义(P>0.05).结论 交锁髓内钉和锁定钢板内固定均能达到治愈胫骨多节段骨折的目的,交锁髓内钉固定具有中轴固定、不占据软组织容量的优点,锁定钢板固定具有操作相对简单的优点.

目的 观察外跨外旋体位切开复位支撑钢板内固定治疗内后髁塌陷型胫骨平台骨折的临床疗效.方法 回顾性分析自2017-01-2019-02诊治的36例内后髁塌陷型胫骨平台骨折,采用外跨外旋体位,作膝关节后内侧倒L形切口,骨折复位后采用胫骨后内侧钢板进行支撑固定.结果 36例均获得随访,随访时间平均18(12～26)个月.随访期间未出现下肢深静脉血栓形成、感染、骨折不愈合、内固定失败、膝关节屈伸功能受限等并发症.骨折愈合时间平均13.6(10～19)个月.末次随访时膝关节功能HSS评分为(88.6±3.2)分,较术前(29.7±7.2)分明显提高,差异有统计学意义(P＜0.05).结论 外跨外旋体位下倒L形切口可以很好地显露胫骨平台内后髁,同时对合并外侧髁或累及干骺端的Schatzker V、Ⅵ型骨折可在同一个体位下进行处理,该体位可作为仰卧位的一个补充,当前内侧切口对后方显露不足时可切换至外跨外旋体位来增加内后方的显露,同时联合支撑钢板固定维持骨折复位质量与保证骨折愈合的稳定环境.

目的:总结斜外侧腰椎椎间融合术(oblique lateral interbody fusion,OLIF)治疗退行性腰椎疾病的并发症及防治策略.方法:回顾性分析我院2016年7月～2018年2月采用OLIF治疗的退行性腰椎疾病患者共78例,男37例,女41例,年龄45～78岁,平均54.2±7.9岁,随访13～36个月,平均18.3±4.1个月.其中退行性腰椎管狭窄症25例(32.1％),退行性腰椎侧凸23例(29.5％),退行性腰椎滑脱18例(23.1％),椎间盘源性腰痛12例(15.4％).手术节段L2/3 31例,L3/4 47例,L4/5 37例;单节段融合52例,双节段融合15例,三节段融合11例.其中6例一期或二期行后路椎弓根钉棒内固定术,72例未行后路椎弓根钉棒内固定术.统计手术时间、出血量、术中与术后并发症发生情况等.结果:所有患者均顺利完成手术,手术时间45～351min,平均130±55min.术中出血量为50～2500ml,平均为118±76ml.共有18例(23.1％)患者出现并发症,其中术中并发症5例,包括终板损伤2例,术中一期给予后路钉棒内固定处理,至末次随访时未出现其他并发症;节段动脉损伤1例,术中给予结扎止血,术后未出现进一步失血;左髂总静脉损伤1例,术中予修补、止血材料止血及输血,术后患者出现下肢肿胀,抬高患肢、抗凝等处理后肿胀消退;腹膜损伤1例,术中予腹膜修补,术后次日患者肠道功能恢复.出现术后并发症13例,包括融合器沉降2例,融合器移位2例,均二期及时给予后路钉棒内固定治疗;大腿前方麻木3例,术后予神经营养药治疗,1周左右患者麻木症状明显改善;下肢皮温感觉异常2例,予营养神经治疗,随访4个月时患者症状恢复;假关节形成2例,但无临床症状,未予特殊处理;术后不完全性肠梗阻1例,禁食、肛门排气及服用通便药物后好转;术后切口浅表感染1例,经清创换药及抗感染治疗后痊愈.结论:OLIF手术治疗退行性腰椎疾病存在一定程度的术中/后并发症发生率,积极地对症处理可以获得良好的预后.

显微外科技术是临床医师在手术显微镜下用显微器械进行的精细手术操作,可以超越人类视野的自然限制,提高组织的鉴别能力,为外科医疗技术开创了新纪元.新中国显微外科技术始于20世纪60年代,经过50多年的发展,已经形成了较为完整、系统的理论体系,极大地推动了骨科、整形外科、颅脑外科、颌面外科等学科的发展.我国学者在世界显微外科领域也具有重要的里程碑贡献,特别是在再植再造、组织修复重建领域处于国际前沿地位.笔者回顾新中国成立以来显微外科技术的发展历程,以及该技术在骨外科领域中的应用进展,报道如下.

2013年11月～2016年11月,我科采用胫骨远段前外侧L形锁定钢板外置固定治疗16 例少年儿童胫骨远端近踝关节骨折患者,疗效满意,报道如下. 1 材料与方法 1. 1 病例资料 本组16 例,男11 例,女5 例,年龄 6 ～16 岁. 新鲜骨折 13例,其中闭合骨折8例(5例局部皮肤软组织严重挫伤、大量水疱形成甚至皮肤破溃,3例为闭合复位失败) ,开放骨折5例( Gustilo Ⅰ型 3 例, Gustilo Ⅱ型 2例);陈旧骨折3例. 骨折波及骺板3例( Salter-Harris 分型:Ⅱ型 2 例,Ⅴ型 1例). 开放骨折患者给予急诊手术治疗;其余患者待肿胀大部分消退、局部软组织稳定后手术. 患者伤后至手术时间为2～25 d.

[目的]前瞻性比较经皮椎体成形术(PVP)和经皮椎体后凸成形术(PKP)治疗单节段骨质疏松性椎体压缩骨折(OVCF)伴椎管狭窄但无神经症状的临床疗效.[方法]2014年7月～2016年6月87例单节段骨质疏松性椎体压缩骨折伴椎管狭窄但无神经症状的患者纳入本研究,按随机数字法分为PVP组43例和PKP组44例,分别行PVP和PKP治疗.比较分析两组手术时间、骨水泥注入量、X线曝光次数、术后住院时间、并发症和VAS和ODI评分.影像测量并比较椎体平均高度、后突骨块长度、后凸角.[结果] PKP组手术时间和骨水泥注入量显著大于PVP组(P＜0.05),但两组X线曝光次数和住院时间差异无统计学意义(P＞0.05),两组术后相关并发症发生率差异也无明显统计学意义(P＞0.05).所有患者均获得24～36个月的随访,两组末次随访的VAS及ODI评分较术前均明显减少(P＜0.05),但相应时间点两组间VAS和ODI评分差异无统计学意义(P＞0.05).影像测量方面,PKP组的椎体高度恢复及后凸角矫正显著优于PVP组(P＜0.05),此外PKP组后突骨块矫正也明显优于PVP组(P＜0.05).[结论] PVP与PKP治疗伴椎管狭窄但无神经症状的单节段骨质疏松性椎体压缩骨折的临床疗效基本相近,均能取得良好临床效果,但PKP椎体高度恢复、术后后凸矫正优于PVP.

目的:总结全脊椎整块切除术(total enbloc spondylectomy,TES)治疗原发性胸腰椎肿瘤的术中及术后并发症,并探讨其处理策略.方法:2005年1月～2014年12月采用全脊椎整块切除术治疗原发性胸腰椎肿瘤41例,其中男23例,女18例,年龄27～60岁(41.7±3.5岁).病变节段:T7 1例,T11 3例,T12 6例,L1 10例,L2 10例,L3 7例,L44例.病理诊断:骨巨细胞瘤18例,骨肉瘤10例,骨母细胞瘤4例,组织细胞肉瘤7例,脊索瘤2例.Tomita分型均为3～5型,WBB分型累及4～8区或5～9区29例,4～9区12例.其中30例行单一后路全脊椎整块切除术,11例行前后联合人路全脊椎整块切除术.肿瘤切除后均一期行脊柱稳定性重建,前方采用钛网或人工椎体重建,后方在病椎上下各两个节段行椎弓根螺钉固定.统计术中与术后并发症发生情况.结果:所有患者均顺利完成手术,手术时间为150～350min (215±49min).术中出血量为1900～3600ml (2800±340ml).随访15～120个月(42.0±7.1个月),共有12例(12/41)患者出现17例次手术并发症,术中出现9例次并发症,包括1例一侧髂血管损伤,术中予缝合;2例大出血,术中予结扎、止血材料止血及输血;1例脊髓损伤、2例神经根牵拉伤,术中予大剂量激素冲击治疗,术后予神经营养药,脊髓损伤患者末次随访时Frankel分级由B级转为C级,神经根牵拉患者1个月随访时神经根放射痛逐渐缓解;2例硬膜撕裂、1例淋巴管破裂,术中予以修补并加压包扎.术后发生8例次并发症,包括1例浅层伤口感染,经清创及抗感染治疗后愈合;1例胸腔积液,经胸腔闭式引流及抗感染后积液完全吸收;1例脑脊液漏并淋巴管漏、1例脑脊液漏,采用头高脚低位平压引流后切口愈合;2例钛网下沉松动并内固定断裂,行翻修手术;2例复发,未行二次手术.结论:原发性胸腰椎肿瘤一期行全脊椎切除术并发症发生率较高,早期积极对症处理能够获得满意疗效.

目的:针对现有的肩部理疗仪的缺点,研制一种便携式温控肩部理疗仪.方法:该装置由控制器、锂电池、电源适配器、电热板及肩部固定带等主要部件和附加部件载药敷料组成.该装置研制的重点和难点在于控制加热系统,由供电、主控微控制单元(microcontroller unit,MCU)、操作按键、控制加热、温度检测、显示和提示等部分组成.结果:该装置具有热敏实时测温、报警保护功能,在理疗的同时可进行功能锻炼,配合专用的载药敷料还可进行中药熏蒸,有助于肩关节功能恢复,提高治疗效率,缩短治疗时间.结论:该装置质量轻、携带方便、操作简易、安全性高、舒适性好,具有一定的临床应用价值,值得推广.

Objective: To investigate the clinical curative effect of C(1)-C(2) pedicle screw fixation for pediatric atlantoaxial dislocation after a long-term follow-up. Methods: From March 2005 to April 2011, a total of 12 male and 9 female patients were included, with age from 3 to 9 years old (mean, 6.1 years old). Among them, 14 cases (67%) had typeⅠinstability atlantoaxial dislocation, 7 cases (33%) had type Ⅱ reducible atlantoaxial dislocation. All 21 pediatric patients with atlantoaxial dislocation underwent posterior pedicle screw fixations. Frankel Grade was used to evaluate function before and after treatment. Furthermore, the information of C(1)-C(2) bony fusion, cervical spine alignment, angle of sagittal curvature, and instability of the subaxial spine were collected from all patients preoperatively, immediately postoperatively and during follow-up period. Results: All 21 patients had regular follow-up with an average duration of 96.4 months (range, 65 to 127 months). All children had good bony fusion within 6 months after treatment. There were 9 patients with lordotic alignment and 12 patients with straight alignment before surgery. After surgery, there were 12 patients with lordotic alignment and 9 patients with straight alignment. At the time of the last follow-up, 17 patients had lordotic alignment and 4 patients had straight alignment. No difference was found between pre- and post-operation (P=0.354). The same result was found between post-operation and last follow-up (P=0.095). Neither kyphotic nor swan-neck deformity was found in any of the 21 patients. The mean angle of sagittal curvature decreased from 31.7°±4.3°preoperatively to 15.5°±2.5°postoperatively (P<0.001). The mean angle of sagittal curvature increased from 15.5°±2.5°postoperatively to 19.1°±2.7°at the final follow-up (P=0.343). No spinal deformities or subaxial instabilities were found. Of the four patients with preoperative neurological defects, Frankel Grade was significantly improved at 3 months follow-up compared with pretreatment values. None of the patients experienced worsening neurological symptoms or injury to the vertebral artery. Conclusion: The results demonstrate that C(1)-C(2) pedicle screw fixation could achieve satisfactory clinical effects for the management of pediatric atlantoaxial dislocation with long-term follow-up.

Objective To compare the clinical efficacy of modified minimally invasive transforam-inal lumbar interbody fusion (TLIF) under Quadrant channel and conventional minimally invasive TLIF in the treatment of single-level lumbar disc herniation. Methods Eighty patients with single-level lumber disc herniation were randomly divided into the modified group and the conventional group, and they were treated by modified minimally invasive TLIF under Quadrant channel and conventional mini-mally invasive TLIF, respectively. Perioperative indicators, complications, changes in visual analogue scale (VAS) scores and Oswestry dysfunction index (ODI) before and after operation were compared be-tween the two groups. The clinical efficacy was evaluated at 12 months after operation according to the modified Macnab criteria. Results The operation time and length of incision of the modified group were significantly shorter than those of the conventional group (P＜0.05). There were no significant dif-ferences between the two groups in the intraoperative blood loss, postoperative drainage volume, post-operative ambulation time, length of hospital stay and incidence of complications (P＞0.05). VAS scores in the two groups at 1 week and 12 months after operation were significantly lower than at 24 h before operation, while ODI scores were significantly higher than at 24h before operation (P＜0.05). The VAS score in modified group at 1 week after operation was significantly lower than that in conventional group (P＜0.05). There were no significant differences between the two groups in VAS scores, ODI scores and the excellent and good rate of modified Macnab evaluation at 12 months after operation (P＞0.05). Conclusion Compared with conventional minimally invasive TLIF, the modified minimally in-vasive TLIF under Quadrant channel can obviously shorten the operation time, the incision is smaller, and the postoperative short-term pain is milder.