ABSTRACT
OBJECTIVE@#To compare the safety and nail placement accuracy of fluoroscopy-assisted and robot-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of single-space lumbar disc herniation.@*METHODS@#The clinical data of 52 patients with single-space lumbar disc herniation treated by MIS-TLIF from March 2019 to February 2020 were retrospectively analyzed. Among them, 24 patients were treated by robot-assisted MIS-TLIF(group A) and 28 patients were treated by fluoroscopy-assisted MIS-TLIF (group B). The intraoperative blood loss, operation time, intraoperative fluoroscopy times, preoperative and postoperative visual analogue scale(VAS), Japanese Orthopaedic Association(JOA) scores and operation-related complications were recorded in two groups. Gertzbein-Robbins grade according to CT scan was used to evaluate the nail placement after operation. Grade A and B were evaluated as satisfactory nail placement, and grade C, D, and E were evaluated as error placement. Babu's method was used to evaluate the screw's invasion to the superior articular process.@*RESULTS@#The operation time, intraoperative blood loss and intraoperative fluoroscopy times in group A were less than those in group B(P<0.05).VAS and JOA scores of all patients at the final follow-up were significantly improved compared with those before operation(P<0.05), but there was no statistically significant difference between the groups(P>0.05). There were 96 and 112 screws in group A and group B, respectively. Three days after operation, according to the Gertzbein-Robbins grade to evaluate the nail placement accuracy, there were 90 screws of grade A, 5 of grade B, 1 of grade C, no grade D and E in group A;there were 84 screws of grade A, 16 of grade B, 8 of grade C, 4 of grade D, no grade E in group B;the difference between two groups was statistically significant(Z=-3.709, P=0.000). The satisfactory rate of screw placement in group A was 98.96% (95/96), and that of group B was 89.29% (100/112), the difference between two groups was statistically significant (χ2=8.254, P=0.004). Three days after operation, the invasion of superior facet joints by pedicle screws was evaluated according to Babu's method, including 90 screws in grade 0, 4 in grade 1, 2 in grade 2, and 0 in grade 3 in group A;86 in grade 0, 12 in grade 1, 10 in grade 2 and 4 in grade 3 in group B, and the difference was statistically significant(Z=-3.433, P=0.001). There were no serious spinal cord, nerve and vascular injuries and other operation-related complications caused by screw implantation failure in both groups. All patients were followed up from 6 to 12(9.06±1.60) months. The neurological symptoms improved well after operation. During the follow-up period, there was no recurrence of symptoms, loosening or breakage of the internal fixation.@*CONCLUSION@#Compared with the traditional fluoroscopy-assisted MIS-TLIF, the spinal robot-assisted MIS-TLIF not only has more minimally invasive and safer, but also has higher accuracy in nail placement, lower incidence of upper articular process invasion, and more accurate decompression targets, which can be used for minimally invasive treatment of single-space lumbar disc herniation.
Subject(s)
Humans , Case-Control Studies , Fluoroscopy , Intervertebral Disc Displacement/surgery , Lumbar Vertebrae/surgery , Minimally Invasive Surgical Procedures/methods , Pedicle Screws , Retrospective Studies , Robotics , Spinal Fusion/methods , Treatment OutcomeABSTRACT
Objective To investigate the structure and biomechanical property differences in different regions of the femoral head for elderly patients with femoral neck fractures, and to study its influence on internal fixation for fracture. Methods Twenty femoral head specimens were collected from elderly patients with femoral neck fracture after joint replacement. The femoral head was divided into 3 parts (lateral, inferior and medial region) with reference to anatomical markers on surface of the femoral head. After the position and drilling direction of the ring drill were determined, a circular drill was used to obtain the cylindrical cancellous bone columns with 10 mm in diameter and 10 mm in height. The data of cancellous bone columns in different regions were analyzed by Micro-CT scanning system, including bone volume fraction (BVF), trabecular space (Tb.Sp), trabecular thickness (Tb.Th), the number of trabecular number (Tb.N), the bone surface volume ratio (bone surface/bone volume, BS/BV), structural model index (SMI). Mechanical property differences of bone tissues in different regions were calculated by micro-finite element analysis. ResultsBone mass in the elderly osteoporotic femoral head decreased, and there were significant differences in bone microstructure and mechanical properties in different regions of the femoral head. Bone microstructure and mechanical properties in medial region were obviously superior to those in lateral and interior region. Conclusions The bone structure and mechanical strength in medial region of the femoral head are obvious superior to those in lateral and inferior regions. The position for internal fixation should be fully considered during treatment of osteoporotic femoral neck fracture in clinic.
ABSTRACT
Objective To investigate the structure and biomechanical property differences in different regions of the femoral head for elderly patients with femoral neck fractures,and to study its influence on internal fixation for fracture.Methods Twenty femoral head specimens were collected from elderly patients with femoral neck fracture after joint replacement.The femoral head was divided into 3 parts (lateral,inferior and medial region) with reference to anatomical markers on surface of the femoral head.After the position and drilling direction of the ring drill were determined,a circular drill was used to obtain the cylindrical cancellous bone columns with 10 mm in diameter and 10 mm in height.The data of cancellous bone columns in different regions were analyzed by Micro-CT scanning system,including bone volume fraction (BVF),trabecular space (Tb.Sp),trabecular thickness (Tb.Th),the number of trabecular number (Tb.N),the bone surface volume ratio (bone surface/bone volume,BS/BV),structural model index (SMI).Mechanical property differences of bone tissues in different regions were calculated by micro-finite element analysis.Results Bone mass in the elderly osteoporotic femoral head decreased,and there were significant differences in bone microstructure and mechanical properties in different regions of the femoral head.Bone microstructure and mechanical properties in medial region were obviously superior to those in lateral and interior region.Conclusions The bone structure and mechanical strength in medial region of the femoral head are obvious superior to those in lateral and inferior regions.The position for internal fixation should be fully considered during treatment of osteoporotic femoral neck fracture in clinic.
ABSTRACT
Objective To investigate the structure and biomechanical property differences in different regions of the femoral head for elderly patients with femoral neck fractures,and to study its influence on internal fixation for fracture.Methods Twenty femoral head specimens were collected from elderly patients with femoral neck fracture after joint replacement.The femoral head was divided into 3 parts (lateral,inferior and medial region) with reference to anatomical markers on surface of the femoral head.After the position and drilling direction of the ring drill were determined,a circular drill was used to obtain the cylindrical cancellous bone columns with 10 mm in diameter and 10 mm in height.The data of cancellous bone columns in different regions were analyzed by Micro-CT scanning system,including bone volume fraction (BVF),trabecular space (Tb.Sp),trabecular thickness (Tb.Th),the number of trabecular number (Tb.N),the bone surface volume ratio (bone surface/bone volume,BS/BV),structural model index (SMI).Mechanical property differences of bone tissues in different regions were calculated by micro-finite element analysis.Results Bone mass in the elderly osteoporotic femoral head decreased,and there were significant differences in bone microstructure and mechanical properties in different regions of the femoral head.Bone microstructure and mechanical properties in medial region were obviously superior to those in lateral and interior region.Conclusions The bone structure and mechanical strength in medial region of the femoral head are obvious superior to those in lateral and inferior regions.The position for internal fixation should be fully considered during treatment of osteoporotic femoral neck fracture in clinic.
ABSTRACT
<p><b>OBJECTIVE</b>To explore the optimal method for the treatment of the elbow joint stiffness accompanied with neural injury after electrical injury.</p><p><b>METHODS</b>Thirty adult cadaver elbows were fixed and dissected to observe the attachments of the ligaments and the muscles around the joint, and its relationship with the major nerves. Ten patients with electric burns with stiffness of the elbow joint were treated by means of loosening the anterior and posterior fascicles of radial and ulnar collateral ligaments, at the same time down shifting the insertion of flexor muscles, replacing the ulnar nerve anteriorly, in order to reconstruct flexor and extension functions of the elbow. The effect was evaluated with biomechanics criteria.</p><p><b>RESULTS</b>Through anatomical study, it was revealed that contracture of the posterior fascicles of the radial and ulnar collateral ligaments and triceps brachii muscle would result in stiffness of the elbow joint, and contracture due to disuse of the two anterior fascicles of the radial and ulnar collateral ligaments and M.biceps brachii would produce flexion deformity of the elbow joint. Postoperatively, the functions of the elbow joints of all the 10 patients recovered satisfactorily. Follow-up from 1 to 3 years showed no change in the range of flexion and extension movements of the elbows, and on the contrary, mobility of the elbow joints was improved.</p><p><b>CONCLUSION</b>Loosening of the anterior and posterior fascicles of the two collateral ligaments and replacement of insertions of biceps and triceps are pivotal in the treatment of stiffness of the elbow joint. Meanwhile lowering the origins of forearm flexor muscles on epicondylus and replacing anteriorly the ulnar nerve can further improve the flexion, function of the joint and relieve compression of the nerve.</p>