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Objective To explore the application of 3D printing technology in surgical approach choice for cervical vertebra dumbbell tumor.Methods Retrospectively analyzed the clinical data of 17 patients with cervical vertebra dumbbell tumor who were admitted into our hospital from August 2012 and February 2017 and recieved 3D model printing.Three director surgeons chosen surgical approach for each pa-tient with or without 3D printing models.The surgical approach,combined with 3D printing and chosen by most surgeons,was selected as final surgical approach for patients.All the patients were evaluated by JOA score and Frankel grade before and after operation.Results The tumor of patients who selected surgical approach with 3D printing was completely resected.Without 3D printing models in preoperation,3 surgeons selected the same surgical approach for 8 patients,2 surgeons selected the same surgical approach for 9 patients.Compared with those who se-lected surgical approach with 3D printing models in preoperation,the 3 surgeons changed surgical approach in a total of 13 times.The surgical approach of 5 patients were changed,including 2 cases changed from posterior approach to lateral approach,2 cases changed from lateral ap-proach to posterior approach,and 1 case changed from lateral approach to anterior approach.Eventually,11 cases underwent posterior ap-proach,1 case underwent anterior approach,3 cases underwent lateral approach and 2 cases underwent far lateral approach.Conclusion Ap-plied of 3D printing in treatment of cervical vertebra dumbbell tumor can rebuild and print local anatomy by digitizing method.It can excel-lently show the tumor form,relationship of tumor and vertebrae,tumor and foramen intervertebrale,tumor and vessel.3D printing technology could help surgeon precisely and directly understand the operation area and select advanced surgical approach to reduce surgical risk and in -crease the resection rate of tumor.And it has an excellent display effect especially for complex tumors and abnormal blood vessels.
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<p><b>OBJECTIVE</b>Combining K-line (the connecting line of the midpoint of C₂ and C₇ spinal canal on the cervical lateral X-ray film) to analyze the relationship between cervical range of motion of patients with ossification of posterior longitudinal ligament (OPLL) and surgical prognosis.</p><p><b>METHODS</b>A total 42 patients with ossification of cervical posterior longitudinal ligament underwent cervical posterior single open-door laminoplasty between April 2014 and March 2017 were retrospectively ananyzed. The patients were dividing into K-line (+) group and K-line (-) group according to the position realationship of OPLL and K-line. The lesion of ossification of the posterior longitudinal ligament was not over than the K-line known as K-line (+). Conversely, the lesion of ossification of the posterior longitudinal ligament crossing the K-line was called K-line (-). Preoperative and postoperative 3 months JOA scores were observed, and postoperative 3 months JOA improvement rate were computed to assess patient's neurological function recovery. Preoperation and postoperative 3 months, OPLL occupation ratio (OOR), cervical lordotic angles (CLA) and cervical lordotic value (CLV) were measured respectively. The realationship between postoperative neurologic functional recovery in patients of CLV>0 group and CLV<=0 group was evaluated in different K-line subgroups.</p><p><b>RESULTS</b>For the patients in K (+) group and K (-) group, preoperative CLA were (14.7±9.6)° and (-6.4±9.5)°(<0.05) respectively, postoperative at 3 months CLA were (14.0±8.0)° and (-1.4±10.4)°(<0.05) respectively; preoperative JOA scores were 10.9±3.2 and 11.2±2.5 (>0.05) respectively, postoperative at 3 months JOA scores were 14.2±1.8 and 12.6±2.2 (<0.05) respectively, and postoperative at 3 months JOA score improvement rate were (54.7±17.6)% and (25.5±15.7)%(<0.05) respectively. In the K-line (+) group, there were 29 patients in CLV>0 group at 3 months after operation, with improvement rate of (52.3±17.2)%, and 4 patients in CLV<=0 group, with improvement rate of (72.2±7.8)%. The improvement rate of the patients in CLV<=0 group was significantly better than that of the patients in CLV>0 group (<0.05).</p><p><b>CONCLUSIONS</b>No matter whether the ossification of cervical posterior longitudinal ligament was classified as K-line (+) or K-line (-), the cervical posterior single open-door laminoplasty can improve the neurological symptoms of patients, especially the patients in the K-line(+) group with better prognosis. The patinets in K-line(+) group, when postoperative at 3 months CLV>0, their improvement rate was lower than that of the patients with postoperative at 3 months CLV<=0.</p>
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Objective To evaluate biomechanical properties of internal fixation after C3 corpectomy and C2-4 anterior fusion with Zephir plate in reconstructing stability of the upper cervical vertebra, and compare them with conventionally used anterior internal fixation after C2-3 intervertebral fusion and posterior internal fixation by C2 transpedicle screws. MethodsSix fresh human upper cervical vertebra specimens (including C2-4) were divided into five groups: the intact specimen group(control group), the incision of the C2-3 group (Hangman group), the posterior internal fixation by C2 transpedicle screw group (posterior fixation group), the anterior internal fixation after C2-3 intervertebral fusion with Zephir plate group (anterior fixation group), and the internal fixation after C3 corpectomy and C2-4 anterior fusion with Zephir plate group (C2-4 incision +internal fixation group). Range of motion (ROM) of the C2-3 and C3-4 segments was tested respectively under 0.5, 1.5 and 2.5 N•m moment by measurement system for three-dimensional spinal movement, and the statistical analysis was also conducted. Results(1) C2-3 segment: ROM of anterior fixation group and C2-4 incision +internal fixation group was significantly smaller than that of Hangman group and posterior fixation group in all six directions under various loading conditions (P<0.05); there was no significant difference between anterior fixation group and C2-4 incision +internal fixation group. ROM of posterior fixation group was larger than that of intact group in all six directions under various loading conditions (P<0.05); There was no significant difference in flexion and extension direction under all loading conditions between posterior fixation group and Hangman group, but significant difference was found in left/right and right/left axial rotation and under 2.5 N•m moment between posterior fixation group and Hangman group (P<0.05). (2) C3-4 segment: there was no significant difference in ROM in six directions under various loading conditions among all groups except for C2-4 incision +internal fixation group. ROM of C2-4 incision +internal fixation group was significantly smaller than that of other groups in all six direction (P<0.05). Although ROM of anterior fixation group was slightly larger than that of Hangman group and posterior fixation group, the difference was not statistically significant. Conclusions From the view of biomechanics, internal fixation after C3 corpectomy and C2-4 anterior fusion with Zephir plate is a better surgical option for stabilizing the fracture than that of posterior internal fixation by C2 transpedicle screws to treat type II Hangman fracture with C2-3 intervertebral disc injury.
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<p><b>OBJECTIVE</b>To study on thyroid bilateral gland lobe disease with endoscopic monolateral anterior chest approach.</p><p><b>METHODS</b>Twenty patients experienced thyroid bilateral gland lobe surgery with endoscopic monolateral anterior chest approach; 24 experienced conventional surgery simultaneously and were enrolled in control group. Two groups were compared at surgical style, complications, surgical time, length of stay in hospital, incision cosmetic result and incision pain etc. Criteria of patients selected for thyroid bilateral gland lobe surgery with endoscopic monolateralanterior chest approach:with no surgical history of thyroid or other neck-related diseases and no chemotherapy; diagnosed with benign tumor according to presurgery CT result and thyroid functional examination. Diameter of tumor on both sides should be smaller than 4 cm, one side smaller than 2 cm, located at lower middle part of gland lobe and near to gland surface.</p><p><b>RESULTS</b>Patients in both groups matched in age and sex; scorings on surgical style, hospital stay, postoperative drainage, and postoperative pain were not significantly distinctive. Endoscopic group had less bleeding volumn than conventional group during surgery, better cosmetic results, but longer surgical duration and higher cost of hospitalization. Both groups occurred no permanent glottic paralysis and hypocalcemia, no recurrence. Endoscopic group had one case ecchymoma; one case temporary glottic paralysis; both recovered in one month. Complication incidence in both groups was not significantly distinctive (chi(2) = 2.514, P = 0.201).</p><p><b>CONCLUSIONS</b>Gasless endoscopic monolateral anterior chest approach can well treat selected thyroid bilateral gland lobe disease and with a better cosmetic result than conventional surgery.</p>