• Title/Summary/Keyword: bone screw fixation

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Posterior Cervical Fixation with Nitinol Shape Memory Loop in the Anterior-Posterior Combined Approach for the Patients with Three Column Injury of the Cervical Spine: Preliminary Report

  • Yu, Dong-Kun;Heo, Dong-Hwa;Cho, Sung-Min;Choi, Jong-Hun;Sheen, Seung-Hun;Cho, Yong-Jun
    • Journal of Korean Neurosurgical Society
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    • v.44 no.5
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    • pp.303-307
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    • 2008
  • Objective: The authors reviewed clinical and radiological outcomes in patients with three column injury of the cervical spine who had undergone posterior cervical fixation using Nitinol shape memory alloy loop in the anterior-posterior combined approach. Materials: Nine patients were surgically treated with anterior cervical fusion using an iliac bone graft and dynamic plate-screw system, and the posterior cervical fixation using Nitinol shape memory loop ($Davydov^{TM}$) at the same time. A retrospective review was performed. Clinical outcomes were assessed using the Frankel grading method. We reviewed the radiological parameters such as bony fusion rate, height of iliac bone graft strut, graft subsidence, cervical lordotic angle, and instrument related complication. Results: Single-level fusion was performed in five patients, and two-level fusion in four. Solid bone fusion was presented in all cases after surgery. The mean height of graft strut was significantly decreased from $20.46{\pm}9.97mm$ at immediate postoperative state to $18.87{\pm}8.60mm$ at the final follow-up period (p<0.05). The mean cervical lordotic angle decreased from $13.83{\pm}11.84^{\circ}$ to $11.37{\pm}6.03^{\circ}$ at the immediate postoperative state but then, increased to $24.39{\pm}9.83^{\circ}$ at the final follow-up period (p<0.05). There were no instrument related complications. Conclusion: We suggest that the posterior cervical fixation using Nitinol shape memory alloy loop may be a simple and useful method, and be one of treatment options in anterior-posterior combined approach for the patients with the three column injury of the cervical spine.

Polymethylmethacrylate-Augmented Screw Fixation for Stabilization of the Osteoporotic Spine : A Three-Year Follow-Up of 37 Patients

  • Moon, Bong-Ju;Cho, Bo-Young;Choi, Eun-Young;Zhang, Ho-Yeol
    • Journal of Korean Neurosurgical Society
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    • v.46 no.4
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    • pp.305-311
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    • 2009
  • Objective : The purpose of this study was to determine the efficacy, radiological findings, clinical outcomes and complications in patients with lumbar stenosis and osteoporosis after the use of polymethylmethacrylate (PMMA) augmentation of a cannulated pedicle screw. Methods : Thirty-seven patients with degenerative spinal stenosis and osteoporosis (T-score < -2.5) underwent lumbar fusion using the Dream Technology Pedicle Screw ($DTPS^{TM}$, Dream Spine Total Solutions, Dream STS, Seoul. Korea) between 2005 and 2007. The clinical outcomes were evaluated by using the visual analog scale (VAS) and the Prolo scale. Radiologic findings were documented through computed tomography (CT) and plain films. Results : Thirty-seven patients were evaluated and included, 2 males and 35 females with an average bone mineral density (BMD) of $0.47g/cm^2$. The average age of the patients was 68.7 (range, 57-88). The preoperative VAS for low back and leg pain ($7.87{\pm}0.95$ and $8.82{\pm}0.83$) were higher as compared with postoperative VAS ($2.30{\pm}1.61$ and $1.42{\pm}0.73$) with statistical significance (p = 0.006, p = 0.003). According to the Prolo scale, 11, 22, one and three patients were in excellent, good, fair and poor conditions, respectively. The average amount of the injected cement per one cannulated screw was $1.83{\pm}0.11\;mL$. Conclusion : The results show favorable outcome both clinically and radiographically for 37 patients who underwent lumbar fusion using $DTPS^{TM}$ and PMMA. Based on the results, the use of this surgical method can be a safe and effective option for the operation on the osteoporotic spine.

Clinical Experience of Anterior Cervical Interbody Fusion with the PCB System (전방 경추 유합술에서의 PCB System의 임상적 경험)

  • Kim, Sung Han;Kim, Ho Jin;Kang, Jae Kyu;Doh, Jong Oung;Lee, Chun Dae
    • Journal of Korean Neurosurgical Society
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    • v.30 no.10
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    • pp.1170-1176
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    • 2001
  • Objective : The purpose of the study was to evaluate the clinical and radiological results after discectomy and Lubboc bone graft in the surgical management of the cervical diseases with a new titanium interbody implant and integrated screw fixation(PCB) by anterior approach. Methods : The authors retrospectively analyzed 28 cases of anterior cervical fusion with PCB system and Lubboc bone(xeno graft) from september 1998 to december 2000. Twenty-eight patients with cervical diseases underwent decompression cervical lesion and followed from 5 to 27 months with a mean follow-up of 14 months. There patients were evaluated with clinically and radiologically at immediate postoperative period and at 3, 6, 9, and 12 months. Result : The authors investigated the pre- and postoperative intervertebral disc space, clinical outcomes, radiography fusion rate, and Cobb angle in the fixed segments by anterior approach. The lordotic angles and height of disc space were increased after the operation. The clinical outcome of patients follow-up was good or excellent result based on Odom's criteria with improvement of clinical symptom in about 92.9% of the cervical diseases. Two patients showed loosening of the lower and upper cervical screw of PCB instruments, and two patients showed swallowing difficulty and wound infection Conclusion : The PCB system is a new implant for anterior cervical interbody fusion in the degenerative cervical disease and disc herniations. It provides immediate stability and segment distraction. The results of this study indicate that the PCB system is safe, easy handling of hardware, less complications, high fusion rate, and has provide the keeping the intervertebral disc space height and lordotic angles.

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COMPARATIVE STUDY OF STABILITY AND RELAPSE ACCORDING TO FIXATION METHOD AFTER BILATERAL SAGITTAL SPLIT RAMUS OSTEOTOMIES IN MANDIBULAR PROGNATHIC PATIENTS (하악전돌증 환자의 하악지시상분할골절단술 후 고정방법에 따른 안정성과 회귀율에 대한 분석)

  • Choi, Hee-Won;Kim, Kyoung-Won;Lee, Eun-Young
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.27 no.4
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    • pp.334-345
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    • 2005
  • The purpose of this study was to compare the postoperative stability and relapse according to 2 different fixation methods after bilateral sagittal split ramus osteotomies in mandibular prognathic patients. Tweenty one patients with Class III dental and skeletal malocclusion who were treated with bilateral sagittal split ramus osteotomy were selected for this retrospective study. We classfied the patients into two groups according to the fixation methods of bony segments after osteotomies. Group W (n = 10) had the bone segments fixed with nonrigid wire and Group S (n = 11) had bicortical screws inserted in the gonial area through a transcutaneous approach. Cephalometric radiographs were taken preoperatively, immediate postoperatively and more than six months postoperatively in each patient. After tracing the cephalometric radiographs, various parameters were measured. Before surgery, both groups were balanced with respect to linear and angular measurements of craniofacial morphology. Mean posterior sagittal setback amounts of the mandibular symphysis was 8.6 mm in the wire group and 6.79 mm in the rigid group, Six months postoperatively, the wire group had 33.1% relapse of the mandibular symphysis and 22.8% in the rigid group relapse. Both groups experienced changes in the orientation and configuration of the mandible. It is thought that Rigid screw fixation is a more stable method than nonrigid wire fixation for maintaining mandibular setback after sagittal split ramus osteotomy.

Posterior Thoracic Cage Interbody Fusion Offers Solid Bone Fusion with Sagittal Alignment Preservation for Decompression and Fusion Surgery in Lower Thoracic and Thoracolumbar Spine

  • Shin, Hong Kyung;Kim, Moinay;Oh, Sun Kyu;Choi, Il;Seo, Dong Kwang;Park, Jin Hoon;Roh, Sung Woo;Jeon, Sang Ryong
    • Journal of Korean Neurosurgical Society
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    • v.64 no.6
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    • pp.922-932
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    • 2021
  • Objective : It is challenging to make solid fusion by posterior screw fixation and laminectomy with posterolateral fusion (PLF) in thoracic and thoracolumbar (TL) diseases. In this study, we report our experience and follow-up results with a new surgical technique entitled posterior thoracic cage interbody fusion (PTCIF) for thoracic and TL spine in comparison with conventional PLF. Methods : After institutional review board approval, a total of 57 patients who underwent PTCIF (n=30) and conventional PLF (n=27) for decompression and fusion in thoracic and TL spine between 2004 and 2019 were analyzed. Clinical outcomes and radiological parameters, including bone fusion, regional Cobb angle, and proximal junctional Cobb angle, were evaluated. Results : In PTCIF and conventional PLF, the mean age was 61.2 and 58.2 years (p=0.46), and the numbers of levels fused were 2.8 and 3.1 (p=0.46), respectively. Every patient showed functional improvement except one case of PTCIF. Postoperative hematoma as a perioperative complication occurred in one and three cases, respectively. The mean difference in the regional Cobb angle immediately after surgery compared with that of the last follow-up was 1.4° in PTCIF and 7.6° in conventional PLF (p=0.003), respectively. The mean durations of postoperative follow-up were 35.6 months in PTCIF and 37.3 months in conventional PLF (p=0.86). Conclusion : PTCIF is an effective fusion method in decompression and fixation surgery with good clinical outcomes for various spinal diseases in the thoracic and TL spine. It provides more stable bone fusion than conventional PLF by anterior column support.

One-Stage Treatment of Chronic Calcaneal Osteomyelitis with Bone Morphogenetic Protein 2 and Local Antibiotic Delivery in a Cat

  • Kim, Hyungkyoo;Jeong, Heejun;Park, Chul;So, Kyung-Min;Park, Jiyoung;Jeong, Seong Mok;Lee, Haebeom
    • Journal of Veterinary Clinics
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    • v.33 no.5
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    • pp.300-303
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    • 2016
  • An age-unknown, 4.8 kg, male, wild, domestic short-hair cat was presented for left hindlimb lameness. A physical examination revealed a draining tract which was suspected of bite on left calcaneal bone. The left tarsal joint was markedly swollen and exudates were observed around the draining tract. Sequestrum at left calcaneus bone, and osteolysis were identified by radiography. The sequestrum and its surrounding exudative tissue were debrided during surgery and the tissue was submitted for bacterial culture and sensitivity test. The debridement caused a bone defect ($1.5cm{\times}0.5cm{\times}0.5cm$) on the medial left calcaneal bone. Plate and screw fixation was performed to the calcaneus bone as buttress plate. Recombinant human bone morphogenetic protein-2 (rhBMP-2) loaded hydroxyapatite was implanted in the bone defect. Furthermore, Amikacin-impregnated collagen sponges were also placed around bone plate to deliver local antibiotics. A systemic antibiotic treatment regimen based on bacterial culture and sensitivity test results was administered for 4 weeks. The wound properly healed without any signs of infection, and the bone healing was confirmed by radiography. The patient showed normal weight bearing ambulation at 18 weeks after surgery. The use of rhBMP-2 and local antibiotic delivery system is a good surgical option for the one-stage treatment of chronic osteomyelitis.

Surgical Results of Patients with Isthmic Spondylolisthesis with Transpedicular Screw Fixation and Posterior Lumbar Interbody Fusion Using Posterior Movable Segment (협부형 척추전방전위증에 대한 후방가동관절 이용한 골유합술 및 척추경나사못 고정술의 수술적 결과)

  • Kim, Chan;Lee, Seung Myung;Shin, Ho
    • Journal of Korean Neurosurgical Society
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    • v.30 no.sup1
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    • pp.108-114
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    • 2001
  • Objective : Posterior lumbar interbody fusion(PLIF) provides the favorable outcome to degenerative lumbar disease, especially isthmic spondylolisthesis. To determine the long-term effect of PLIF using psterior movable segment, we analysed the results of follow-up radiologic changes and surgical outcome retrospectively Patients and Method : During the past 11 years(1989. 1.-1999. 9.), 148 patients with symptomatic lumbar spondylolisthesis were managed at our department and the clinical wants were throughly recieved and final outcome is determined at last follow up. PLIF using antogenous bone(posterior movable segment, iliac bone and rib) were performed in 106 case. Results : After an average follow-up period of 33 months(range ; 15-58 months), the results were excellent in 66 cases, good in 37 cases, fair in 2 cases and poor in 1 cases. And the satisfactory results were 103 cases(98.2%) in PLIF,. Conclusion : In conclusion, patients who underwent PLIF with autologous bone graft had good clinical and radiological outcomes without significant neurological complications.

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Surgical Treatment of Talar Chondroblastoma via Partial Posterior Medial Malleolar Osteotomy: A Case Report (내과의 부분후방절골술을 통한 거골연골모세포종의 수술적 치료: 증례 보고)

  • Oh Jun Yu;Jin Soo Suh;Han Sung Kim;Jun Young Choi
    • Journal of Korean Foot and Ankle Society
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    • v.27 no.2
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    • pp.75-78
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    • 2023
  • During bone tumor resection, many cases require medial malleolar osteotomy to achieve adequate access to the operative field. Various osteotomy methods have been developed to address this issue, including oblique, transverse, reverse V-shape, and step-cut osteotomies. However, medial malleolar osteotomy has several drawbacks, such as the excessive disruption of the joint surface, unstable screw fixation when fixing the medial malleolus, and iatrogenic medial ankle joint arthritis due to articular displacement during the reduction of the osteotomy site. In addition, there is a possibility of injury to the posterior tibial artery, tibial nerve, or posterior tibialis tendon if the osteotomy range is too aggressive. Therefore, the authors propose a new osteotomy method, which has shown promising clinical results, namely, partial posterior medial malleolar osteotomy. This method minimizes articular involvement and provides adequate access to the operative field during talar body bone tumor resection.

HISTOLOGICAL CHANGES IN THE ELONGATED BONE AFFECTED BY OSTEODISTRACTION OF THE MANDIBLE IN THE DOG (성견 하악골 절단 후 기계적 골 견인에 의해 형성된 골 신장부에 대한 시기별 조직학적 변화)

  • Baek, Sun-Ho;Ahn, Byoung-Keun;Park, Young-Ju;Park, Hee-Geon;Park, Jun-Woo;Rhee, Gun-Joo;Lee, Yong-Chan;Cho, Byoung-Ouck
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.27 no.5
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    • pp.404-416
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    • 2001
  • Purpose : Traditionally, the treatement of choice has been a bone grafting procedure to increase the length of bone in case of actual length discrepancy. But, bone grafting procedure has many disadvantages, for example, graft resorption, donor site morbidity, and so on. So, many trials have been performed to avert the use of autogenous bone graft via introducing new materials or methods. And, one of those trials has been realized by the development of a technique inducing bone lengthening by osteotomy (or corticotomy) and slow gradual distraction of the osteotomized segments. This new technique of bone lengthening dates back to the early 20th century. But, the majority of information concerning the biology of new bone formation during bone lengthening and technical details of the procedure were produced by extensive clinical and experimental studies performed by Ilizarov, a Russian surgeon. According to Ilizarov, with adequate blood supply, preservation of periosteum, rigid fixation of the osteotomized segments, and proper rate and rhythm of distraction, intramembranous bone rapidly develops within the distraction gap in the limb lengthening procedure. In the limb lengthening, many orthopedic surgeons try to observe the biologic and clinical principles recommended by Ilizarov. In the oral and maxillofacial region, however, not a few studies must be performed to apply this surgical technique in the clinical cases. Besides, the mechanism of bone formation in the distraction gap is not clear, yet. The purpose of this experiment was to scrutinize serially the histological changes in the elongated bone affected by osteodistraction of the mandibular body in an adult canine model. In addition, it was performed to confirm the presence of specific region(s) which was important in the bone formation in the gap through the observation of the expression pattern of osteocalcin and osteonectin with the immunohistochemical examination. Materials and Methods : The experimental and control specimens were obtained from seven adult male mongrel dogs weighing over 20kg. The distractors were custom-made linear extraoral devices and bicortical fixation screws were 2.3mm in diameter, 50mm in total length, 15mm in screw length. The distractors were devised to produce a linear gap of 0.75mm between two bony segments every $360^{\circ}$ turn of the rotation rod of the device. The mandibular body of the right side of each animal was corticotomized perpendicular to the occlusal plane and then two bony segments were separated completely by careful manipulation of the segments with bone forceps. The left side of each animal was left intact. This side was served as control. At sixth day after osteotomy and fixation of the segments were performed, distraction of the segments was commenced with a rate of 1.1mm/day and a rhythm of two/day for ensuing 7 days. The animals were euthanized at the 16th. 29th, and 44th day after the osteotomy. The bony specimens were decalcified, embedded in paraffin, sectioned $5{\mu}m$ thick and stained with H&E. The prepared specimens were examined under the light microscope. And, immunohistochemical examinations using anti-osteocalcin antibody (OC1, Biodesign, USA) and anti-osteonectin antibody (Haematologic Technologies Inc., Essex, VT) to locate the expressions of osteocalcin and osteonectin, respectively, were performed. Results : 1. New bone was observed already at the 16th. day after osteotomy. This suggests that new bone formation in osteodistraction was commenced at an early stage of the regenerative process. But, radiologically and microscopically, bony union was not completed in the distraction gap at the 44th. day after osteotomy. Therefore, rigid fixation must be maintained between the bony fragments till the complete bony union is confirmed clinically rather than one month or so after the completion of distraction.

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Treatment of Carpal Scaphoid Fracture (주상골 골절의 수술적 치험례)

  • Beck, Won-Jin;Seo, Jae-Sung;Ahn, Jong-Chul;Ihn, Joo-Chul
    • Journal of Yeungnam Medical Science
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    • v.3 no.1
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    • pp.361-366
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    • 1986
  • Fracture of the carpal scaphoid bone is the most common fracture of the carpus. Unfortunately. nonunion are common since the symptoms do not alert patients to seek early medical treatment and the diagnosis is easily missed. Fracture of the scaphoid is a common condition whose management remains controversial. The conservative treatment has many complications, these include inability to work while in plaster, stiffness of the wrist afterwards, muscle wasting, weakness and malunion. So various operative treatments of scaphoid fracture have been developed. Open reduction by use of screws suggested by Maclaughlin first in 1954. In 1984 a new and simple operative technique has been developed to provide rigid internal fixation for all types of fractures of the scaphoid by T.J. Herbert. This involves the use of a double-treaded bone screw which provides good fixation that, after operation, a plaster cast is rarely required and most patients are able to return to work within a few weeks. Authors have experienced 10 cases of scaphoid fracture and accomplished good result in all cases by internal fixation using Herbert screw. The results are as follows : Of these 10 fractures, 2 were fresh fractures and 8 were non unions of scaphoid fracture. In nonunion cases, the time interval between fracture and operation was from 5 months to 5 years. The postoperative immobilization period was average of 4 weeks. Short period of immobilization achieved early functional recovery of the wrist. The bony unions in roentgenogram were seen from 3 months to 9 months after operation. In 2 cases the fracture gap was seen after 9 months. But in these cases the symptoms such as pain and range of motion of wrist were improved.

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