ABSTRACT
SUMMARY OBJECTIVE: To reduce surgical exposure and improve accuracy, this study evaluated the anatomical distance parameter D (including D1, D2, and D3) of the lumbar isthmus for cortical bone screw insertion. METHODS: A total of 25 structurally complete lumbar dry specimens were used for lumbar anatomy measurements. The six cadaver specimens were divided into upper and lower parts on the plane of the T11-T12 vertebrae, and we use the lower parts. Therefore, six lumbar wet specimens and another four complete lumbar dry specimens were selected. The lumbar isthmus tangent point was considered a coordinate origin, and the insertion point was determined through translating the distance of D1 value to the midline of the vertebral body horizontally and then vertically moved toward inferior board of the transverse process with the distance of D3 value. RESULTS: In four dry and six wet intact lumbar specimens, cortical bone screws were placed according to the average value of the isthmus parameter D. A total of 100 trajectories were verified in specimens by X-ray and computed topography scan to evaluate the safety, accuracy, and feasibility of the surgical use of isthmus parameter D. Using this parameter, the rates of excellent screw placement were 95% (38/40) in four dry specimens and 88.7% (53/60) in six wet specimens. CONCLUSION: The isthmus parameter D is easier to use by the operator, which can improve surgical accuracy and reduce operation time. LEVEL OF EVIDENCE: Level IV, prospective study.
ABSTRACT
Objective:To explore the effect of mobile C-arm X-ray system in the surgical treatment of thoracolumbar spine fractures.Methods:The clinical data of 120 patients with thoracolumbar spine fractures admitted to People′s Hospital of Xinjiang Uygur Autonomous Region from July 2018 to July 2020 were retrospectively analyzed. According to different surgical methods, they were divided into control group and experimental group, with 60 cases in each group. The control group adopted the traditional posterior median approach lumbar fusion, and the experimental group adopted the percutaneous pedicle screw internal fixation guided by the C-arm system. The operation time, bleeding, operation cost, visual analog score (VAS) and activities of daily living (ADL) and complication rate were compared and analyzed between the two groups. Measurement data with normally distribution were expressed as mean±standard deviation( ± s), and the comparison between groups was performed by two independent samples t test. The comparison between groups of count data was performed by chi-square test. Results:The operation time, the blood loss, the cost, VAS, ADL score, the complication rate of the control group were (119.83 ± 10.96) min, (90.56±30.52) mL, (4.90±0.75) ten thousand yuan, (4.17±0.64) scores, (78.11±12.78) scores and 30%, while the experimental group were (103.50±13.76) min, (73.88±40.35) mL, (4.06 ± 0.97) ten thousand yuan, (2.40±0.49) scores, (86.00±8.86) scores and 5%, respectively, showing a significant difference between the two groups ( P<0.05). Conclusions:Application of mobile C-arm X-ray system in thoracolumbar spine minimally invasive surgery can reduce the probability of complications, improve the quality of life of patients, and accelerate the rehabilitation. It is valuable for popularization.