Objective To summarize research progress on application of Cup-cage reconstruction in revision of chronic pelvic discontinuity (CPD) in patients undergoing total hip arthroplasty (THA). Methods Relevant literature at home and abroad in recent years was reviewed to summarize the principles of the Cup-cage reconstruction, preoperative patient assessment, intraoperative skills, clinical and radiological effectiveness, limitations, and postoperative complications. Results For the treatment of CPD, the Cup-cage reconstruction achieved long-term acetabular cup bone ingrowth, CPD healing, and biologic fixation of the prosthesis by restoring pelvic continuity. Preoperative evaluation of the surgical site and general condition is necessary. The main intraoperative objectives are to reconstruct pelvic continuity, restore the center of rotation of the hip, and avoid neurovascular injury. Current studies have demonstrated significant clinical and radiological effectiveness as well as acceptable prosthesis survival rates after operation. Nevertheless, there is a lack of evidence regarding the staging of CPD, the optimal surgical approach and internal fixation, and the factors influencing postoperative prosthesis survival remain undefined. Conclusion Cup-cage reconstruction can be an effective treatment for CPD after THA, but there is still a need to explore CPD staging, Cup-cage approach and internal fixation, and influencing factors on prosthesis survival.
Objective To analyze the therapeutic effect of the posterior pedicle screw system combined with interbody fusion cage on lumbarspondylolisthesis. Methods From February 2003 to March 2006, 37 lumbar spondylolisthesis patients were treated with this operation, including21 males and 16 females and aging 3969 years.The affected lumbars were L3(3cases)，L4(23 cases), and L5(11 cases). According to the Meyerdingevaluating system, 12 cases were lassified as degree Ⅰ, 20 cases as degree Ⅱ,and 5 cases as degree Ⅲ. Taillard index, Boxall index, slipping angle, lumbar lordosis angle and intervertebral height index were measured before operation, and 2 weeks and 3 months after operation. Results All patients were followed up 336 months. There were statistically significant differences in Taillard index, Boxall index, slipping angle, lumbar lordosis angle and intervertebral height index between before operation and 2 weeks after operation (P＜0.05),and no statistically significant differences between 2 weeks and 3 months afteroperation(P＞0.05). According to Dewei Zhou’s creterior for scoring, the results were excellent in 27 cases， good in 8 cases，and fair in 2 cases. Theexcellent and good rate was 94.6%. All of the embedded osseous were fused. Thefusing time was from 3 to 8 months (mean 3-9 months). There were no breakageof screw and rod. The position and configuration of the whole cages were good. Conclusion Applying the posterior pedicle screw system combined with interbody fusion cage may achieve synergism in the treatment of lumbar vertebral spondylolisthesis. Above procedure is served as solid internal fixationand offers a satisfactory reduction, and can improve the fusion rate of the spine. So it is an ideal procedure and worthily recommended method for treatment oflumbar vertebral spondylolisthesis.
In order to identify whether the regeneration of costal cartilage is the basis of post-surgical repair of pectus excavatum and thoracic cage remodeling, 151 cases were followed up for 0.25 to 14 years. The main procedures in treatment were 3 steps: To curve the mental strut as a bow, to repair the perichondrium as a tube, and to persist in post-operative therapy. The results showed that regeneration of the costal cartilages appeared 3 months postoperatively in the cases treated by this method. It was concluded that a satisfactory thoracic cage could be remodeled by improving the technique of repairing pectus excavatum and persisting in postoperative therapy according to the regeneration regularity.
Objective To evaluate the surgical procedure of reinforced acetabular cage with caudal flange in reconstruction of pelvic defect after acetabular tumor resection. Methods Between June 2003 and December 2009, 25 patients with Harrington class III pelvic defect underwent reconstruction with a reinforced acetabular cage with caudal flange and total hip arthroplasty (THA). There were 13 males and 12 females with an average age of 51.2 years (range，13-73 years). The main cl inical manifestations included hip pain and buttock pain, with a median disease duration of 6 months (range, 1-96 months). Pathological findings showed 18 cases of metastasis, 3 cases of multiple myeloma, 1 case of non-Hodgkin’s lymphoma, 1 case of grade I chondrosarcoma, 1 case of giant cell tumor, and 1 case of chondroblastoma. For the patient with chondroblastoma, THA with LINK RIBBED system was used. An artificial total hip system made in China was used in 6 patients and LINK SP II system was used in the other 18 patients. Results No patients died perioperatively. Deep infection and hip dislocations occurred in 1 and 2 patients, respectively. At last follow-up, 8 of 18 patients with metastasis died of cancer and the average survival time was 11 months. The other 10 who were al ive were followed up 15 months on average. One patient with multiple myeloma died of pulmonary infection at 21 months after operation and the other 2 with multiple myeloma and 1 with lymphoma were al ive with an average follow-up of 17 months. The patient with grade I chondrosarcoma and patient with chondroblastoma were followed up 58 and 12 months, respectively, without recurrence. Recurrence occurred in the patient with giant cell tumor at 19 months afteroperation. Loosening of implant occurred in 3 patients because of local tumor recurrence. For the 23 patients at 6 months after operation, the mean Musculoskeletal Tumor Society (MSTS) 93 score was 81% (range, 57%-93%). Conclusion Reinforced acetabular cage with caudal flange could be used together with THA for reconstruction of Harrington class III pelvic defects after acetabular tumor resection, and low incidence of postoperative compl ication and good functional outcome could be expected.
Spinal fusion is a standard operation for treating moderate and severe intervertebral disc diseases. In recent years, the proportion of three-dimensional printing interbody fusion cage in spinal fusion surgery has gradually increased. In this paper, the research progress of molding technology and materials used in three-dimensional printing interbody fusion cage at present is summarized. Then, according to structure layout, three-dimensional printing interbody fusion cages are classified into five types: solid-porous-solid (SPS) type, solid-porous-frame (SPF) type, frame-porous-frame (FPF) type, whole porous cage (WPC) type and others. The optimization process of three-dimensional printing interbody fusion cage and the advantages and disadvantages of each type are analyzed and summarized in depth. The clinical application of various types of 3D printed interbody fusion cage was introduced and summarized later. Lastly, combined with the latest research progress and achievements, the future research direction of three-dimensional printing interbody fusion cage in molding technology, application materials and coating materials is prospected in order to provide some reference for scholars engaged in interbody fusion cage research and application.
Objective To assess the mid-term effectiveness of anterior decompression and fusion with nano-hydroxyapatite/polyamide 66 (n-HA/PA66) cage in treatment of cervical spondylotic myelopathy. Methods A retrospective study was made on 48 patients with cervical spondylotic myelopathy who underwent anterior decompression and fusion with n-HA/PA66 cage between August 2008 and January 2010. There were 33 males and 15 females with an average age of 54.5 years (range, 42-72 years). The disease duration was 3-12 months (mean, 6 months). The affected segments included 35 cases of single segment (C3, 4 in 7, C4, 5 in 18, and C5, 6 in 10) and 13 cases of double segments (C3-5 in 7 and C4-6 in 6). Of 48 patients, 28 was diagnosed as having intervertebral disc protrusion, 12 as having ossification of posterior longitudinal ligament, and 8 as having vertebral osteophyte; 35 patients underwent single segmental anterior corpectomy and fusion, and 13 patients underwent single segmental anterior discectomy and fusion. The pre- and post-operative radiographs (cervical anteroposterior and lateral X-ray films and three-dimensional CT scans) were taken to measure the segmental height and lordosis angle. Brantigan et al assessment standard and visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) scores were used to evaluate the graft fusion and the improvement of clinical symptoms, respectively. Results All patients were followed up for 46 months on average (range, 36-54 months). No cage breaking, displacement, or sliding was found. At last follow-up, 36 cases were rated as Brantigan grade E, 10 cases as grade D, and 2 cases as grade C; the fusion rate was 96%. Both segmental height and lordosis angle were corrected significantly at immediate and 6 months after operation and last follow-up than those before operation (P lt; 0.05), but no significant difference was found among different time points after operation (P gt; 0.05). At last follow-up, the cage subsidence was (1.3 ± 1.0) mm. The VAS and JOA scores at 6 months after operation and last follow-up were significantly improved when compared with preoperative scores (P lt; 0.05), and the scores at last follow-up were superior to ones at 6 months after operation (P lt; 0.05). Conclusion The mid-term effectiveness of anterior decompression and fusion with the n-HA/PA66 cage in patients with cervical spondylotic myelopathy is satisfactory because it can effectively restore and maintain segmental height and lordosis angle and promote osseous fusion.
Objective To observe the effect of threaded titanium cage and transpedical screw for the treatment of lumbar spondylolisthesis. Methods Eighteen patients with lumbar spondylolisthesis were adopted in this study. Among them, there were 8 males and 10 females, aged from 43 to 62 years old .Roentgenogramshowed that there were 6 cases of Ⅰ° spondylolisthesis, 11 cases of Ⅱ° and 1 case of Ⅲ°. All patients were treated with cages for intervertebral fusion after total laminectomy and pedicle screws for the reduction. Results The cases were followed up from 6 to 12 months with an average of 11 months. The clinical results were excellent in 13 cases and good in 5 cases. All patients achieved successful fusion and bony union . There were no pedicle screw loosening or broken or peripheral nerve dysfunction in this series. Conclusion This method has been proved to be an effective and reliable procedure for treatment of lumbar spondylolithesis. It produces a high fusion rate and clinical success.
Objective To evaluate the effectiveness of using titanium alloy trabecular bone three-dimensional (3D) printed artificial vertebral body in treating cervical ossification of the posterior longitudinal ligament (OPLL). Methods A retrospective analysis was conducted on clinical data from 45 patients with cervical OPLL admitted between September 2019 and August 2021 and meeting the selection criteria. All patients underwent anterior cervical corpectomy and decompression, interbody bone graft fusion, and titanium plate internal fixation. During operation, 21 patients in the study group received titanium alloy trabecular bone 3D printed artificial vertebral bodies, while 24 patients in the control group received titanium cages. There was no significant difference in baseline data such as gender, age, disease duration, affected segments, or preoperative pain visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), vertebral height, and C2-7 Cobb angle (P>0.05). Operation time, intraoperative blood loss, and occurrence of complications were recorded for both groups. Preoperatively and at 3 and 12 months postoperatively, the functionality and symptom relief were assessed using JOA scores, VAS scores, and NDI evaluations. The vertebral height and C2-7 Cobb angle were detected by imaging examinations and the implant subsidence and intervertebral fusion were observed. Results The operation time and incidence of complications were significantly lower in the study group than in the control group (P<0.05), while the difference in intraoperative blood loss between the two groups was not significant (P>0.05). All patients were followed up 12-18 months, with the follow-up time of (14.28±4.34) months in the study group and (15.23±3.54) months in the control group, showing no significant difference (t=0.809, P=0.423). The JOA score, VAS score, and NDI of the two groups improved after operation, and further improved at 12 months compared to 3 months, with significant differences (P<0.05). At each time point, the study group exhibited significantly higher JOA scores and improvement rate compared to the control group (P<0.05); but there was no significantly difference in VAS score and NDI between the two groups (P>0.05). Imaging re-examination showed that the vertebral height and C2-7 Cobb angle of the two groups significantly increased at 3 and 12 months after operation (P<0.05), and there was no significant difference between 3 and 12 months after operation (P>0.05). At each time point, the vertebral height and C2-7 Cobb angle of the study group were significantly higher than those of the control group (P<0.05), and the implant subsidence rate was significantly lower than that of the control group (P<0.05). However, there was no significant difference in intervertebral fusion rate between the two groups (P>0.05). Conclusion Compared to traditional titanium cages, the use of titanium alloy trabecular bone 3D-printed artificial vertebral bodies for treating cervical OPLL results in shorter operative time, fewer postoperative complications, and lower implant subsidence rates, making it superior in vertebral reconstruction.
Objective To investigate the effectiveness of trans-intervertebral space osteotomy (TIO) combined with cage implantation in treatment of old thoracolumbar compression fracture with kyphosis. Methods A clinical data of 59 patients with old thoracolumbar compression fracture and kyphosis, who met the selection criteria between January 2010 and August 2020, was retrospectively analyzed. Among them, 20 cases underwent TIO combined with cage implantation (group A), 21 patients underwent TIO (group B), and 18 patients underwent pedicle subtraction osteotomy (PSO; group C). There was no significant difference in gender, age, time from injury to operation, fracture segment, and preoperative Cobb angle, average height of functional spinal unit (FSU), sagittal vertical axis (SVA), visual analogue scale (VAS) score, Japanese Orthopedic Association (JOA) score, and Oswestry disability index (ODI) between groups (P>0.05). The operation time, intraoperative blood loss, and postoperative complications were recorded. Imaging review was performed to observe the fusion of the bone graft. Cobb angle, average height of FSU, and SVA were measured. VAS score, JOA score, and ODI were used to evaluate the degree of low back pain and lumbar function. Frankel grading was used to evaluate neurological function. Results The operations of 3 groups were successfully completed. The operation time and intraoperative blood loss were significantly lower in groups A and B than in group C (P<0.05); there was no significant difference between group A and group B (P>0.05). All incisions healed by first intention. Patients in all groups were followed up 23-27 months, with an average of 24.8 months. There was no significant difference in follow-up time between groups (P>0.05). At last follow-up, VAS score, JOA score, ODI, and SVA of 3 groups significantly improved when compared with those before operation (P<0.05), there was no significant difference in the differences of pre- and post-operation between groups (P>0.05). The neurological function grading of 3 groups was Frankel grade E. The Cobb angle and the average height of FSU in 3 groups at immediate and last follow-up significantly improved when compared with preoperative ones (P<0.05), there was no significant difference between immediately after operation and last follow-up (P>0.05). And there were significant differences in above indexes between groups at each time point (P<0.05). At last follow-up, the osteotomy site fused without internal fixation failure or pseudarthrosis formation were observed in 3 groups. ConclusionFor patients with old thoracolumbar compression fractures with kyphosis, the effectiveness of TIO combined with cage implantation is satisfactory. Compared with TIO and PSO, it can obtain more deformity correction degree and less invasive.
Objective To compare the clinical effects of treating prolapse of the cervical intervertebral disc by the Solis cage fusion, the titanium cage fusion or the autogenous iliac crest graft combined with the titanium plate fixation. Methods Sixty-four patients with prolapse of the cervical intervertebral discadmitted to hospital from February 2002 to May 2005 were retrospectively analyzed. In Group A, 20 patients (15 males and 5 females, aged 38.76 years, 30 intervertebral spaces) were treated with the Solis cage fusion, and the preoperative JOAscores were 9-16, averaged 11.4; in Group B, 21 patients (15 males and 6 females,aged 37-78 years, 23 intervertebral spaces) were treated with the titanium cagefusion, and the preoperative JOA scores were 8-13, averaged 10.1; in Group C, 23 patients (18 males and 5 females, aged 32-76 years, 28 intervertebral spaces)were treated with the autogenous iliac crest graft combined with the titanium plate fixation, and the preoperative JOA scores were 9-14, averaged 10.6. The comparative analysis was made among the 3 groups in the following aspects: X-ray exposure time, time working on the iliac bone, operation time, hemorrhage amount，complication incidence after operation, cervical vertebral fusion rate, symptom relief rate, and recovery rate of the JOA score. Results According to the follow-upfor 2-15 months averaged 12 months, the time working on the iliac bone was longer in Group C than in Groups A and B (11.5±2.4 vs 4.1±1.7 minand 4.2±1.9 min, P＜0.05); the operation time was longer in Group C than in Groups A and B (98.3±14.7 min vs 55.5±10.3 min and 56.8±12.6 min, P＜0.05); and the X-ray exposure time was longer in Group C than in Groups A and B (7.8±1.8 min vs 4.3±1.2 min and 4.2±1.3 min, P＜0.05). Also, the hemorrhage amount in Group C was much greater than in Groups A and B (145.8±19.3 ml vs 65.8±10.2 ml and 67.2±12.3 ml,P＜0.05). The postoperative complication rate was lower in Groups A and Bthan in Group C (P＜0.05). There was a significant difference in the complication rate in the cervical region between Group A (5.0%±1.8%) and Group B (14.3%±2.6%,Plt;0.05）. The fusion rate in Groups A and B was 100% 3-4 monthsafteroperation, and there was no difference when compared with that in Group C. The recovery rates of the JOA scores in the three groups were 81.9%±3.2%，78.9%±7.3%, and 76.3%±9.4%, respectively, and there was no significant difference among the three groups. Conclusion The Solis cage fusion has a better therapeutic effect in treating prolapse of the cervical intervertebral disc than the titanium cage fusion and the autogenous iliac crest graft combined with the titanium plate fixation. The Solis cage fusion also makes the operation easier, with a more rapid recovery rate and fewer postoperative complications in the patient.