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1.
Article in Chinese | WPRIM | ID: wpr-930401

ABSTRACT

Objective:To explore the clinical effect of the 3D printing pre-installed screw channel model in assisting screw placement of single complete segmented congenital hemivertebrectomy.Methods:Clinical data of 13 children treated with single complete segmented congenital hemivertebrectomy in the Department of Spine and Spinal Surgery of Henan Provincial People′s Hospital from August 2016 to January 2019 were retrospectively analyzed.Among them, there were 5 males and 8 females with the mean age of 9.9 (5-14) years.Categorized by the lesion location, 3 cases were located at T 9, 2 cases at T 10, 5 cases at T 11, 1 case at T 12, and 2 cases at L 1.During the operation, the 3D printing pre-installed screw channel model was used to assist the placement of pedicle screws.The accuracy of screw placement was assessed by the postoperative CT.All children were routinely examined by full-length anterior and lateral X-ray of spine in the standing position before and after surgery to measure the Cobb angles at the coronal and sagittal view.Furthermore, the correction rate of scoliosis and kyphosis after surgery and during follow-up was also calculated.The One-Way repeated measures ANOVA was used to compare the Cobb angle of scoliosis and kyphosis before surgery, after surgery and during follow-up. Results:A total of 85 pedicle screws were placed in 13 children, with the accuracy rate of screw placement of 95.3%.The mean surgery time and intraoperative blood loss were (216.9±28.3) min, and (478.5±132.6) mL, respectively.Scoliosis Cobb was corrected from (57.1±12.7)° to (12.7±4.7)° with a correction rate of (78.4±5.9)%, which was (14.2±7.0)° at the last follow-up.Kyphosis angle was corrected from (46.2±8.4)° to (13.2±4.4)° with a correction rate of (72.6±7.0)%, which was (14.0±3.4)° at the last follow-up.None of the children had serious complications like vascular and nerve damage.The mean postoperative follow-up was 12.3 (6-18) months.No significant loss of angle was detected during the follow-up period.There were significant differences in the lateral and kyphotic angles after surgery and during follow-up compared with preoperative ones (all P<0.05). No significant difference was detected between the postoperative lateral and kyphotic angles and those at the last follow-up (all P>0.05). Conclusion:The 3D printing pre-installed screw channel model used to assist screw placement of single complete segmented congenital hemivertebrectomy can improve the precision of screw placement and the orthopedic effect on lateral kyphosis.

2.
Article in Chinese | WPRIM | ID: wpr-884218

ABSTRACT

Objective:To evaluate the efficacy of posterior subtotal vertebrectomy in the treatment of thoracolumbar vertebral refractures after vertebroplasty.Methods:A retrospective analysis was conducted in the 28 patients with refracture after percutaneous vertebroplasty(PVP) or percutaneous kyphoplasty(PKP) who had been treated at Department of Spinal Surgery, Henan Provincial People's Hospital from June 2017 to October 2019. They were 7 males and 21 females, with an average age of 62.4 years(from 61 to 76 years). A total of 28 vertebrae were involved, including 5 T11s, 9 T12s, 11 L1s and 3 L2s. Their previous operations were PKP in 17 cases and PVP in 11. After the spinous process, vertebral plate, articular process and transverse process were resected by posterior approach, the vertebral body, bone cement and upper and lower intervertebral discs were partially resected by trans-vertebral lateral approach. At the same time, nerve decompression was performed. Finally, the inter-vertebral support was fixated followed by the posterior screw-rod orthopedic fixation. The operation time and intraoperative bleeding volume were recorded. The cobb angles of kyphosis were compared on the X-ray films of the whole spine between preoperation and the last follow-up to evaluate correction. Functional improvement of the spine was evaluated by comparison of the visual analogue scale (VAS) and JOA(Japanese Orthopedics Association) scores between preoperation and the last follow-up.Results:The operation time averaged 182.1 min and intraoperative bleeding volume 996.2 mL. All the 28 patients were followed up for 8 to 29 months (mean, 19.8 months). No obvious neurological lesions or other serious complications were observed. The cobb angle was improved from preoperative 41.3°±10.3° to 6.4°±2.5° at the last follow-up, the VAS score from preoperative 7.3±1.8 to 2.5±1.0 at the last follow-up, and the JOA score from preoperative 8.4±2.3 to 21.3±2.5 at the last follow-up, showing a significant difference in all the comparisons ( P<0.05). Conclusion:The posterior subtotal vertebrectomy is effective for thoracolumbar vertebral refractures after vertebroplasty because it can remove bone cement, decompress the spinal canal, fuse the inter-vertebral graft and reconstruct the spinal stability in one stage.

3.
Article in Chinese | WPRIM | ID: wpr-884215

ABSTRACT

Objective:To report the clinical manifestations and management of infectious spondylitis following vertebroplasty or kyphoplasty.Methods:Six cases of infectious spondylitis following vertebroplasty or kyphoplasty were analyzed retrospectively which had been treated at Department of Spinal Surgery, Henan Provincial People's Hospital between January 2014 and June 2019. They were 2 males and 4 females, aged from 64 to 81 years. Their visual analogue scale (VAS) scores ranged from 6 to 8 points; their spinal cord function was graded as C in 2 cases and E in 4 according to the American Spinal Cord Injury Association (ASIA) grading. All the patients were treated by sub-total resection of the infected vertebra, long segmental pedicle screw fixation and corresponding antibiotics therapy. The therapeutic efficacy was assessed by the inflammation indexes, imaging examinations and clinical manifestations.Results:The 6 patients were followed up for 12 to 42 months(mean 20.4 months). Their operation time ranged from 295 to 455 min (mean 370.8 min) and blood loss from 760 to 2, 250 mL (mean 1 536.7 mL). There were no such serious complications as dural tear, worsening of neurological symptoms or death. The last follow-up revealed normal body temperature and fine incision healing in all patients. Their inflammatory indexes returned to normal. Imaging examinations at the last follow-up showed no displacement of internal implants, no screw loosening or breakage of screws or rods, good bony fusion at the grafting site, and no inflammatory signals from the infected vertebra. At the last follow-up, their VAS for back pain ranged from 2 to 4 points, the ASIA grading was improved from C to D in 2 patients and maintained E in 4. Eventually, 4 patients recovered independent normal walking but 2 required a walker.Conclusions:Infectious spondylitis following vertebroplasty or kyphoplasty can lead to back pain and neurological dysfunction. Sub-total resection of the infected vertebra, long segmental pedicle screw fixation and corresponding antibiotics therapy can result in fine therapeutic outcomes.

4.
Chinese Journal of Orthopaedics ; (12): 938-946, 2021.
Article in Chinese | WPRIM | ID: wpr-910676

ABSTRACT

Objective:To explore the scheme of accurate pelvic osteotomy parameters and to analyze the feasibility and efficacy of 3D printing navigation plate in developmental dysplasia of the hip surgery.Methods:From January 2015 to December 2017, a total of 18 children with DDH underwent computer-assisted Salter pelvic osteotomy (computer-assisted osteotomy group) and 25 children with DDH who underwent conventional Salter pelvic osteotomy (conventional osteotomy group) were selected for retrospective analysis. There were 11 males and 32 females with an average age of 3.2±2.5 (range 1-11) years. According to International Hip Dysplasia Institute (IHDI) classification, there were 20 cases of type 1, 9 of type 2, 12 of type 3 and 2 of type 4. All patients were unilateral dislocation, including 18 cases on the left and 25 on the right. All children underwent pelvic CT examination before operation. Further, the proximal femur was surgically corrected during the operation. According to the acetabular rotation angle (ATA) and bony acetabular index (BAI), the computer-assisted osteotomy group simulated the operation with Mimics software made 3D printing navigation plate through which an accurate osteotomy scheme was developed. The two groups were compared in operative duration, intraoperative blood loss, Japanese Orthopaedic Association (JOA) hip joint score. Acetabular index (AI), central edge (CE) angle, and acetabulum head index (AHI) were compared between the two groups by using postoperative X-ray. The acetabular tilt angle (ATA) changes before and after operation in the computer-assisted osteotomy group were compared through 3D CT.Results:The follow-up duration was 2.3±0.2 (2.0 to 2.5) years in the computer-assisted osteotomy group and 2.8±0.15 (2.5 to 3.0) years in the conventional osteotomy group. The operative duration in the computer-assisted osteotomy group was 127±20.6 min, which was significantly longer ( t=4.657, P<0.001) than that in the conventional osteotomy group (103±13.2 min). Intraoperative bleeding was 157±17.5 ml in the computer-assisted osteotomy group and 151±15.3 ml in the conventional osteotomy group without significant difference between the two groups ( t=1.195, P=0.239). At 2 years after surgery, the JOA score of the hip joint in the computer-assisted osteotomy group (86.7±8.5 points) was like that (84.8±10.0 points) in the conventional osteotomy group ( t=0.628, P=0.533). At the last follow-up, the CE angle in the computer-assisted osteotomy group (36.8°±5.2°) was significantly larger than that (31.8°±4.4°) in the conventional osteotomy group ( t=3.414, P<0.001). There was statistically significant difference in term of AHI between the computer-assisted osteotomy group (85.8%±6.6%) and the conventional osteotomy group (80.4%±8.3%, t=2.284, P=0.028). AI was 23.5°±5.5° in the computer-assisted osteotomy group and 25.2°±4.2° in the conventional osteotomy group without significant difference ( t=-1.150, P=0.257). The ATA of the affected side was 12.3°±1.4° in the computer-assisted osteotomy group which was similar ( t=0.614, P=0.547) to that of the healthy side (11.8°±2.8°). Conclusion:Based on specific anatomical parameters, computer-assisted preoperative planning can not only directly simulate the process of osteotomy, but also produce individualized 3D printed guide plates. Compared with conventional Salter pelvic osteotomy, computer-assisted osteotomy can achieve accurate radiographic correction of the hip joint in children with DDH, resulting in a better matching relationship between the femoral head and acetabulum.

5.
Chinese Journal of Trauma ; (12): 618-627, 2021.
Article in Chinese | WPRIM | ID: wpr-909912

ABSTRACT

Objective:To analyze the incidence and epidemiological characteristics of traumatic spinal cord injury in China in 2018.Methods:Multi-stage stratified cluster sampling was used to randomly select hospitals capable of treating patients with spinal cord injury from 3 regions,9 provinces and 27 cities in China to retrospectively investigate eligible patients with traumatic spinal cord injury admitted in 2018. National and regional incidence rates were calculated. The data of cause of injury,injury level,severity of injury,segment and type of fracture,complications,death and other data were collected by medical record questionnaire,and analyzed according to geographical region,age and gender.Results:Medical records of 4,134 patients were included in this study,with a male-to-female ratio of 2.99∶1. The incidence of traumatic spinal cord injury in China in 2018 was 50.484 / 1 million (95% CI 50.122-50.846). The highest incidence in the Eastern region was 53.791 / 1 million (95% CI 53.217-54.365). In the whole country,the main causes of injury were high falls (29.58%),as well as in the Western region (40.68%),while the main causes of injury in the Eastern and Central regions were traffic injuries (31.22%,30.10%). The main injury level was cervical spinal cord in the whole country (64.49%),and the proportion of cervical spinal cord injury in the Central region was the highest (74.68%),and the proportion of lumbosacral spinal cord injury in the Western region was the highest (32.30%). The highest proportion of degree of injury was incomplete quadriplegia (55.20%),and the distribution pattern was the same in each region. A total of 65.87% of the patients were complicated with fracture or dislocation,77.95% in the Western region and only 54.77% in the Central region. In the whole country,the head was the main combined injury (37.87%),as well as in the Eastern and Central regions,while the proportion of chest combined injury in the Western region was the highest (38.57%). A total of 32.90% of the patients were complicated with respiratory complications. There were 23 patients (0.56%) died in hospital,of which 17(73.91%) died of respiratory dysfunction. Conclusions:The Eastern region of China has a high incidence of traumatic spinal cord injury. Other epidemiological features include high fall as the main cause of injury cervical spinal cord injury as the main injury level,incomplete quadriplegia as the main degree of injury,head as the main combined injury,and respiratory complications as the main complication.

6.
Chinese Journal of Trauma ; (12): 261-266, 2021.
Article in Chinese | WPRIM | ID: wpr-909863

ABSTRACT

Objective:To investigate the effect of Internet plus rehabilitation nursing service and continual nursing on postoperative rehabilitation of patients with osteoporotic lumbar compression fracture (OLCF).Methods:A retrospective case-control study was conducted to analyze the clinical data of 123 patients with OLCF admitted to Affiliated Hospital of Henan Medical College from May 2018 to October 2019. There were 46 males and 77 females, aged 56-74 years [(65.3±5.4)years]. The level of injury was located at L 1 in 93 patients, L 2 in 19, L 3 in 10, and L 4 in 1. The Denis fracture classification was type A in 26 patients, type B in 30, type C in 27, and type D in 40. All patients were treated by percutaneous kyphoplasty (PKP). A total of 62 patients were given Internet plus rehabilitation care services and continual care guidance (Group A), and 61 patients were given routine care health education before discharge (Group B). The Japanese orthopaedic association (JOA) score, visual analoge score (VAS), osteoporosis health confidence scale (OHBS) score, and adult health self-management ability assessment scale (AHSMSRS) score were recorded before and after intervention. The self-made questionnaires and Newcastle nursing service satisfaction scale (NSNS) were used to evaluate the compliance rate and nursing satisfaction after 3 months of intervention. Results:All patients were followed up for 3-6 months [(4.5±1.2)months]. In Group A, the JOA score was (12.1±2.1)points before intervention and (23.0±1.1)points after 3 months of intervention; the VAS was (4.4±1.3)points before intervention and (1.5±0.6)points after 3 months of intervention; the OHBS score was (81.4±4.0)points before intervention and (121.6±9.7)points after 3 months of intervention; the AHSMSRS score was (96.3±3.5)points before intervention and (143.5±11.0)points after 3 months of intervention. In Group B, the JOA score was (12.3±2.1)points before intervention and (20.4±1.2)points after 3 months of intervention; the VAS was (4.2±1.4)points before intervention and (3.6±1.1)points after 3 months of intervention; the OHBS score was (82.1±3.7)points before intervention and (108.7±9.4)points after 3 months of intervention; the AHSMSRS score was (97.1±3.8)points before intervention and (127.7±9.9)points after 3 months of intervention. The JOA score, VAS, OHBS score and AHSMSRS score in both groups were significantly improved after intervention ( P<0.01). These scores in Group A were higher than those in Group B after 3 months of intervention ( P< 0.01). The compliance rate and nursing satisfaction in Group A were 90% (56/62) and 94% (58/62) after 3 months of intervention, while those in Group B were 74% (45/61) and 75% (46/61) ( P<0.05 or 0.01). Conclusion:Compared with conventional nursing, Internet plus rehabilitation nursing service and continual nursing for OLCF patients can promote the postoperative lumbar functional recovery, reduce pain, improve self-management ability and compliance behavior, and enhance the recognition of nursing service, which is worthy of clinical application.

7.
Chinese Journal of Trauma ; (12): 63-68, 2021.
Article in Chinese | WPRIM | ID: wpr-909834

ABSTRACT

Objective:To discuss the application effect of enhance recovery after surgery (ERAS) combined with system nursing in patients with thoracolumbar fracture accompanied by nerve injury.Methods:A retrospective case-control study was conducted to analyze the clinical data of 84 patients with bilateral thoracolumbar fractures accompanied by nerve injury admitted to Henan Provincial People's Hospital from August 2017 to January 2020. All patients were treated with posterior thoracolumbar spinal canal decompression, bone grafting and internal fixation. There were 55 males and 29 females, aged 36-49 years [(43.2±5.2)years]. The injury segments were located at T 10-T 11 in 6 patients, T 11-T 12 in 38, T 12-L 1 in 31, and L 1-L 2 in 9. According to the Frankel classification of neurological function, 19 patients were rated as grade A, 22 grade B, 38 grade C, and 5 grade D. A total of 42 patients were treated by ERAS combined with system nursing (ERAS group), and 42 patients by routine rehabilitation nursing (routine nursing group). The hospitalization time, incidence of perioperative complications, and patients' satisfaction with nursing work were recorded. The visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated at postoperative 1 week and 3 months. The Frankel classification of neurological function and the MOS item short from health survey (SF-36) score were measured at postoperative 3 months. Results:All patients were followed up for 3-4 months [(3.2±1.7)months]. The hospitalization time in ERAS group was (10.9±1.6)days, significantly shorter than (14.4±1.2)days in routine nursing group ( P<0.05). The incidence of perioperative complications in ERAS group was 10%(4/42), significantly shorter than 29%(12/42) in routine nursing group ( P<0.05). The satisfaction rates in ERAS group and routine nursing group were 93%(39/42) and 76%(32/42), respectively ( P<0.05). At 1 week and 3 months after operation, the VAS in ERAS group [(1.7±0.4)points, (1.2±0.3)points]was significantly lower than those in routine nursing group [(4.8±0.9)points, (3.1±0.7)points]( P<0.05). At 1 week and 3 months after operation, the ODI in ERAS group [(13.5±1.8)points, (10.3±1.4)points] was significantly lower than those in routine nursing group [(17.9±2.0)points, (15.6±2.1)points]( P<0.05). At 3 months after operation, according to the Frankel classification, there were 2 patients with grade A, 9 with grade B, 13 with grade C, 13 with grade D and 5 with grade E in ERAS group, and there were 8 patients with grade A, 8 with grade B, 12 with grade C, 10 with grade D, and 4 with grade E in routine nursing group. The recovery rate of grade A or above in ERAS group was 95%(40/42), significantly higher than 81%(34/42) in routine nursing group ( P<0.05)]. At 3 months after operation, the SF-36 score in ERAS group was better than that in routine nursing group ( P<0.05). Conclusion:For patients with thoracolumbar fracture accompanied by nerve injury, ERAS combined system nursing can shorten the hospitalization time, reduce perioperative complications, improve patients' satisfaction, reduce pain, promote the recovery of nerve function, and improve the quality of life.

8.
Chinese Journal of Trauma ; (12): 37-43, 2021.
Article in Chinese | WPRIM | ID: wpr-909830

ABSTRACT

Objective:To investigate the effect in lumbar mobility and stress of the facet joint and end plate after implantation of the movable artificial lumbar spine so as to lay a biomechanical foundation for its clinical application.Methods:Total lumbar CT data of a healthy adult male were selected to construct a finite element analysis model and its effectiveness was validated (physiological group). Two groups were replicated after removing the L 3 vertebral body and adjacent discs of the model in physiological group. One group was placed with each component of the movable artificial lumbar spine to construct the non-fusion model (non-fusion group). The other group was placed with titanium cage, titanium plate and other to construct the fusion model (fusion group). The models in the three groups were loaded with 500 N axial load and 10 Nm axial load, and the torque load was used to simulate the movement in six directions: forward flexion, backward extension, left and right lateral bending, and left and right torsion. The lumbar mobility and stress peak and distribution of the proximal facet joints (J 1-2, J 4-5), L 2 inferior endplate and L4 superior endplate at the three model operating sites (L 2-3, L 3-4) and adjacent segments (L 1-2, L 4-5) under the same conditions were compared. Results:The range of motions of the surgical site in flexion, extension, left bending, right bending, left torsion and right torsion were L 2-3of 3.9°-8.7° and L 3-4 of 3.6°-8.4° in non-fusion group, significantly increased compared with fusion group (L 2-3 0.1°-0.2°, L 3-4 0.1°-0.1°) and slightly increased compared with physiological group (L 2-3 2.3°-6.0°, L 3-4 2.3°-7.1°). The range of motions of the adjacent segments in the above six directions were L 1-2 of 1.4°-4.3° and L 4-5 of 1.4°-6.0° in non-fusion group, smaller than those in fusion group (L 1-2 2.1°-6.1°, L 4-5 3.3°-8.6°) and similar to those in physiological group (L 2-3 2.3°-6.0°, L 3-4 2.3°-7.1°). The peak values of von Mises stress in the proximal facet joints were J 1-2 of 7.07-19.21 MPa and J 4-5of 6.12-12.99 MPa in non-fusion group, similar to those in physiological group (J 1-2 8.42-18.53 MPa, J 4-5 7.49-11.70 MPa) and smaller than those in fusion group (J 1-2 10.54-21.16 MPa, J 4-5 10.63-16.13 MPa). The maximum von Mises stress of the L 2 inferior endplate and L 4 superior endplate in the above six directions was 29.39-54.72 MPa and 32.31-47.87 MPa in non-fusion group, significantly increased compared with the L 2 inferior endplate (21.20-42.07 MPa), L 4 superior endplate (22.50-36.76 MPa) and L 2 inferior endplate (11.04-29.55 MPa) in fusion group and the L 4 superior endplate (13.12-21.32 MPa) in physiological group. Conclusion:Compared with the traditional fusion prostheses, the placement of the movable artificial lumbar spine can reconstruct the range of motion of the surgical site in the direction of flexion, extension, lateral bending and torsion, greatly reduce the impact on the stress of adjacent facet joints and the range of motion of adjacent segments, and theoretically reduce the incidence of prosthesis subsidence.

9.
Chinese Journal of Orthopaedics ; (12): 1098-1108, 2020.
Article in Chinese | WPRIM | ID: wpr-869065

ABSTRACT

Objective:To compare the effect of the new anterior cervical spine memory compression fixation device (GYZ memory alloy plate) and traditional titanium plate on the range of motion (ROM) and stress of the adjacent segment after anterior cervical discectomy and fusion.Methods:An adult male volunteer was recruited for a fee. After excluding cervical malformations, fractures, infections and other diseases, C 3-C 7 thin-layer CT scans were performed. Import the scanned data into the finite element modeling software to establish the finite element model of the physiological group and verify itseffectiveness. After C 5,6 discectomy, the intervertebral fusion device was inserted, and the anterior fixation was assisted by a conventional titanium plate or a new type of fixator. Thus, the finite element model of the traditional titanium plate group and the new fixer group was established. The three models were imported into the finite element analysis software ANSYS 16.0, and a vertical downward axial load of 73.6 N was loaded to simulate the head weight and the torque of 1.0 N·m to simulate the cervical spine flexion, extension, left lateral bending, right lateral bending, left rotation and right rotation.Compare the changes of intervertebral disc ROM and stress in adjacent segments of physiological group, traditional titanium plate group and new type fixator group. Results:The intervertebral disc ROM under six conditions was basically similar to the results of previous studies, and the model was effective. In the adjacent segment C 4,5, the three groups of activities in the flexion, extension, left lateral bending, right lateral bending, left rotation and right rotation conditions were: physiological group 3.9°, 4.2°, 3.7°, 3.7°, 2.2° and 2.2°, traditional titanium plate group 4.6°, 4.7°, 4.3°, 4.4°, 3.3° and 3.1°, and new fixture group 4.4°, 4.3°, 4.0°, 4.2°, 2.8° and 2.7°. The maximum stresses of the intervertebral discs under three different working conditions were: physiological group 1.81, 1.60, 3.99, 2.06, 3.63 and 3.41 MPa, traditional titanium plate group 1.86, 1.67, 4.21, 2.16, 3.82 and 3.63 MPa, and new fixture group 1.84, 1.64, 4.17, 2.14, 3.78 and 3.58 MPa. In the adjacent segment C 6,7, the activities of the three groups in six working conditions were: physiological group 3.1°, 3.2°, 2.5°, 2.5°, 1.2° and 1.3°, traditional titanium plate group 4.2°, 3.7°, 3.4°, 3.0°, 2.1° and 2.2°, and new fixture group 3.5°, 3.3°, 2.5°, 2.7°, 1.8° and 1.9°.The maximum stress of the intervertebral disc under three different working conditions was: physiological group 0.45, 0.66, 1.12, 0.85, 0.84 and 0.82 MPa, traditional titanium plate group 0.62, 0.93, 1.55, 1.24, 1.44 and 1.27 MPa, and new fixture group 0.61, 0.92, 1.54, 1.22, 1.07 and 1.24 MPa. The ROM and disc pressure of adjacent segments in the conventional titanium plate group were higher than those of the new fixator group. Conclusion:Compared with the traditional titanium plate, the new type of anterior cervical memory compression fixator has less effect on the ROM and stress of adjacent segments, which may slow down the process of adjacent segments degeneration to a certain extent.

10.
Chinese Journal of Trauma ; (12): 885-891, 2020.
Article in Chinese | WPRIM | ID: wpr-867800

ABSTRACT

Objective:To investigate the processing accuracy and biomechanical properties of 3D printed artificial bone trabeculae with different porosity generated by the Voronoi Tessellation algorithm, and to provide a reference for improving the biomechanical properties of titanium alloy implants in orthopedics.Methods:A healthy adult male volunteer (aged: 30 years, tall: 175 cm and weight: 70 kg) was selected to collect CT scan data of the lumbar spine. Five kinds of biomimetic artificial bone trabeculae with different porosity were generated using the Voronoi Tessellation algorithm, and divided into Tra_A (73.7%), Tra_B (74.1%), Tra_C (80.0%), Tra_D (80.2%) and Tra_E (85.7%) groups according to the porosity. Selective laser melting (SLM) 3D printing technology was used to process trabecular bone structures with different porosity into titanium alloy prosthesis with a diameter of 18 mm and a height of 20 mm. Each group had 3 samples. The internal structure of each sample was observed by industrial microscope, and the actual porosity of artificial bone trabecular of each group was calculated and compared with the theoretical porosity to evaluate the machining accuracy of artificial bone trabecular with different porosity. Finally, the ultimate load, yield strength and elastic modulus of each sample were evaluated by in vitro mechanical test, and the biomechanical properties of artificial bone trabeculae with different porosity were evaluated.Results:There were no cracks, fracture of connecting rod or accumulation of titanium alloy powder in all specimens. The average actual porosity of the five groups of artificial bone trabecular specimens was 66.0%, 65.5%, 71.8%, 72.5% and 78.1%, respectively. Compared with the theoretical porosity, it was smaller by 10.5%, 11.6%, 10.2%, 9.7% and 8.8%, respectively. In the in vitro mechanical tests for the five groups of artificial bone trabecular specimens, the mean value of ultimate load was 23.6 kN, 18.9 kN, 17.0 kN, 16.3 kN, 10.7 kN, respectively; the mean value of yield strength was 72.2 MPa, 58.7 MPa, 54.9 MPa, 52.2 MPa, and 36.1 MPa, respectively; the mean value of the actual elastic modulus was 7.5 GPa, 6.3 GPa, 4.5 GPa, 4.3 GPa and 2.4 GPa, respectively. With the increase of the porosity of artificial bone trabeculae, all three indicators above showed a decreasing trend. Conclusions:The artificial bone trabeculae generated by the Voronoi Tessellation algorithm and printed by SLM 3D have better machining quality. With the increase of porosity, the processing precision of the titanium alloy artificial bone tray specimens is better. Limit load, yield light and elastic modulus of artificial bone trabecula decrease with the increase of porosity.

11.
Chinese Journal of Trauma ; (12): 577-586, 2020.
Article in Chinese | WPRIM | ID: wpr-867755

ABSTRACT

According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.

12.
Chinese Journal of Trauma ; (12): 496-502, 2020.
Article in Chinese | WPRIM | ID: wpr-867745

ABSTRACT

Objective:To investigate the clinical efficacy of locking proximal femur plates (LPFP) revision and artificial hip joint revision after failure of proximal femoral nail antirotation (PFNA) internal fixation in elderly patients with intertrochanteric fracture.Methods:A retrospective case control study was conducted on the clinical data of 43 patients with PFNA internal fixation failure in the elderly admitted to Henan Provincial People's Hospital between March 2014 and October 2018. There were 23 males and 20 females, aged 65-83 years [(71.2±2.0)years]. The course of disease was 60-267 days [(83.1±3.6)days]. According to Evans classification, there were 11 patients with type II fractures, 13 with type III and 19 with type IV. There were 23 patients in artificial hip joint revision group and 20 patients in LPFP revision group. The operation time, intraoperative blood loss, postoperative hospitalization time, total hospitalization time, Harris score and complications were recorded and evaluated in two groups.Results:All patients were followed up for 12-28 months, with an average of 13.6 months. Between artificial joint revision group and LPFP revision group, the operation time and intraoperative blood loss were similar ( P>0.05), but there were significant difference in postoperative hospitalization time [(7.1±3.2)days vs. (13.2±2.9)days] and total hospitalization time [(10.2±2.8)days vs. (16.4±3.4)days] ( P<0.05). In artificial joint revision group, the Harris hip score was (21.1±3.7)points preoperatively, and was respective (70.7±4.8)points, (74.6±4.1)points, (78.6±3.3)points, (82.9±5.2)points, (83.8±5.8)points and (84.9±6.4)points at postoperative 1, 2, 3, 6, 9, 12 months. In LPFP revision group, the Harris score was (21.7±3.2)points preoperatively, and was respective (59.9±2.1)points, (64.79±3.4)points, (70.1±4.2)points, (73.9±4.2)points, (76.2±6.3)points and (77.9±6.8)points at postoperative 1, 2, 3, 6, 9, 12 months. The Harris score in artificial joint revision group was gradually improved compared with LPFP revision group ( P<0.05). One patient with superficial wound infection occurred in each group, and the wound healed after frequent dressing changes. Distal femoral fractures occurred in one patient of artificial joint revision group and distal femoral fractures in three patients of LPFP revision group, but all patients were healed after being fixed with wire. Conclusion:For elderly patients with PFNA internal fixation failure of intertrochanteric fracture, artificial hip revision has shorter hospital stay and better hip joint function recovery than LPFP internal fixation, although the effect in operation time and intraoperative blood loss are similar.

13.
Chinese Journal of Trauma ; (12): 309-314, 2020.
Article in Chinese | WPRIM | ID: wpr-867717

ABSTRACT

Objective:To compare the application value of prefabricated path with an awl for guiding pin and traditional screw placement during anterior odontoid screw fixation.Methods:A retrospective case-control study was conducted to analyze 35 patients with fresh odontoid fractures treated from January 2010 to August 2017 in Henan Provincial People's Hospital, including 25 males and 10 females with age range of 19-55 years (mean, 36.9 years). The preoperative odontoid fractures were classified into type IIA in 15 patients, type IIB in 20 patients according to Anderson and D'Alonzo classification. Among them, 16 patients in Group A were treated with prefabricated path by an awl for guiding pin during anterior odontoid screw fixation, and 19 patients in Group B were implanted screws according to traditional experience in anterior odontoid screw fixation. Operation time, intraoperative fluoroscopy time, success rate of first-time guiding pin implantation, intraoperative blood loss, fracture healing outcomes and American Spinal Injury Association (ASIA) grade at the latest follow-up were collected and compared between the two groups.Results:All patients were followed up for 13-20 months [(16.8±1.5)months]. Two groups had significant differences in operation time [Group A: (73.5±12.9)minutes; Group B: (82.6±13.6)minutes], intraoperative fluoroscopy time [Group A: (3.1±0.6)minutes, Group B: (7.0±0.9)minutes], and success rate of first-time guiding pin implantation (Group A: 94%, Group B: 58%) ( P<0.05), but not in intraoperative blood loss [Group A: (129.4±40.6)ml; Group B: (135.8±38.4)ml] and fracture healing rate (Group A: 94%, Group B: 95%) and ASIA grade at the latest follow-up (Group A: grade C in 1 patient, grade D in 3, grade E in 12; Group B: grade C in 2 patients, grade D in 2, grade E in 15) ( P>0.05). All patients were successfully operated without occurrence of cerebrospinal fluid leakage, neurovascular injury or incision infection. Conclusions:Prefabricated path with an awl for guiding pin during anterior odontoid screw fixation is superior to traditional experience, which can reduce operation time, intraoperative fluoroscopy time and improve the success rate of first-time guiding pin implantation. Meanwhile, there is no effect on intraoperative blood loss or fracture healing outcomes.

14.
Chinese Journal of Trauma ; (12): 117-123, 2020.
Article in Chinese | WPRIM | ID: wpr-867690

ABSTRACT

Since December 2019, the corona virus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (2019-nCoV) has been reported in Wuhan, Hubei Province. Almost 70% of patients susceptible to 2019-nCoV are over age of 50 years, with extremely large proportion of critical illness and death of the elderly patients. Meanwhile, the elderly patients are at high risk of osteoporotic fractures especially osteoporotic vertebral compression fractures (OVCF). During the prevention and control of COVID-19 epidemic, the orthopedists are confronted with the following difficulties including how to screen and protect OVCF patients, how to accurately diagnose and assess the condition of suspected or confirmed COVID-19 patients, and how to develop reasonable treatment plans and comprehensive protective measures in emergency and outpatient clinics. In order to standardize the diagnosis and treatment of OVCF patients diagnosed with COVID-19, the authors jointly develop this expert consensus to systematically recommend the standardized emergency and outpatient screening and confirmation procedures for OVCF patients with suspected or confirmed COVID-19 and protective measures for emergency and outpatient clinics. Moreover, the consensus describes the grading and classification of OVCF patients diagnosed with COVID-19 according to the severity of illness and recommends different treatment plans and corresponding protective measures.

15.
Chinese Journal of Trauma ; (12): 117-123, 2020.
Article in Chinese | WPRIM | ID: wpr-811517

ABSTRACT

Since December 2019, the corona virus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (2019-nCoV) has been reported in Wuhan, Hubei Province. Almost 70% of patients susceptible to 2019-nCoV are over age of 50 years, with extremely large proportion of critical illness and death of the elderly patients. Meanwhile, the elderly patients are at high risk of osteoporotic fractures especially osteoporotic vertebral compression fractures (OVCF). During the prevention and control of COVID-19 epidemic, orthopedists are confronted with the following difficulties including how to screen and protect OVCF patients, how to accurately diagnose and assess the condition of OVCF patients with suspected or confirmed COVID-19, and how to develop reasonable treatment plans and comprehensive protective measures in emergency and outpatient clinics. In order to standardize the diagnosis and treatment of patients with OVCF diagnosed with COVID-19, the authors jointly develop this expert consensus. The consensus systematically recommends the standardized emergency and outpatient screening and confirmation procedures for OVCF patients with suspected or confirmed COVID-19 and protective measures for emergency and outpatient clinics. Moreover, the consensus describes the grading and classification of OVCF patients diagnosed with COVID-19 according to the severity of illness and recommends different treatment plans and corresponding protective measures based on the different types and epidemic prevention and control requirements.

16.
Chinese Journal of Trauma ; (12): 1068-1074, 2019.
Article in Chinese | WPRIM | ID: wpr-824390

ABSTRACT

Objective To investigate the clinical efficacy of percutaneous fixation assisted by O-arm-based navigation for thoracolumbar fractures without neurologic deficits.Methods A retrospective case control study was conducted analyze the clinical data of 35 thoracolumbar fracture patients without neurologic deficits admitted to Henan Provincial People's Hospital from January 2018 10 December 2018.There were 26 males and 9 females,aged 17-51 years,with an average age of 30.4 years.The injured segments were distributed at T11 in 10 patients,T12 in 15,L1 in 11,and L2 in 4 patients.A total of 19 patients(22 vertebrae,98 pedicle screws)were treated with O-arm guided navigation assisted percutaneous internal fixation(Group A),and 16 patients(18 vertebrae,82 pedicle screws)were treated with C-arm guided percutaneous internal fixation(Group B).The operation time,accuracy rate of nail placement,complications,Cobb angle of fracture vertebral body,visual analogue score(VAS)and Japanese Orthopaedic Association(JOA)score were recorded and compared before operation,7 days after operation and at the last follow-up.Results The patients were followed up for 2-12 months [(7.2 ±2.9)months] in Group A and 3-13 months [(7.1±3.3)months] in Group B.The operation time was(70.5±11.2)minutes in Group A and(81.3±10.9)minutes in Group B(P<0.01).A total of 93 screws were completely placed in the pedicle in Group A(accuracy rate of 95%),and 74 screws in Group B(accuracy rate of 90%)(P<0.01).There were no complications such as infection,pulmonary embolism,spinal cord,nerve injury or lower extremity deep vein thrombosis in either group.The Cobb angle of the fractured vertebral body at day 7 after operation in Group A and Group B was(9.4±2.1)° and(10.4±2.5)° respectively,while the Cobb angle of the fractured vertebral body at the final follow-up in Group A and Group B was(9.7±2.3)°and(11.4±2.9)° respectively.The postoperative Cobb angle was significantly increased compared with the preoperative Cobb angle(P<0.05),but there was no significant difference between the two groups(P>0.05).The V AS at day 7 after operation was(2.3±1.1)points and(2.8±1.0)points in Group A and Group B,respectively,while the VAS at the final follow-up was(0.7±0.7)points and(0.8±0.7)points in Group A and Group B respectively.The postoperative VAS was significantly decreased compared with the preoperative VAS(P<0.05),but there was no significant difference between the two groups(P >0.05).The JOA at day 7 after operation was(21.1±2.2)points and(21.8±2.5)points in Group A and Group B respectively,while the JOA at the final follow-up was(24.9±2.2)points and(23.8±1.9)points in Group A and Group B respectively.The postoperative JOA was significantly increased compared with the preoperative JOA(P<0.05),but there was no significant difference between the two groups(P>0.05).Conclusion For thoracolumbar fractures without neurologic deficits,percutaneous fixation assisted by O-arm-based navigation can shorten the operation time and deliver a higher accuracy rate in the placement of pedicle screws,in addition to the similar effects with percutaneous fixation assisted by C-arm in pain relief,function improvement and correction of fracture vertebral kyphosis.

17.
Chinese Journal of Trauma ; (12): 977-985, 2019.
Article in Chinese | WPRIM | ID: wpr-824376

ABSTRACT

Objective To investigate the efficacy of posterior atlantoaxial joint axial release,bone grafting and internal fixation for the treatment of irreducible atlantoaxial dislocation (IAAD) with partial reduction.Methods A retrospective case-control study was conducted to analyze the clinical data of 42 patients with IAAD admitted to Henan Provincial People's Hospital from January 2014 to October 2017.There were 17 males and 25 females,aged from 12 to 72 years [(47.2 ± 11.3) years].After more than 50% reduction by high weight skull traction,18 patients underwent posterior atlantoaxial joint axial release,reduction,bone grafting and fusion with internal fixation (Group A),and 24 patients underwent anterior transoral or retropharyngeal release,reduction,posterior bone grafting and fusion with internal fixation (Group B).The operation time,intraoperative blood loss,preoperative and postoperative anterior atlantodental interval (ADI),clivus-canal angle (CCA),cervicomedullary angle (CMA),and Japanese Orthopaedic Association (JOA) scores between the two groups were compared.The improvement rate of JOA scores at the last follow-up of the two groups and the atlantoaxial joint fusion rate at 3 months and 6 months after surgery were calculated and compared.The complications were recorded.Results All patients were followed up for 12 to 40 months with an average of 24.6 months.Group A had significant decreases in operation time [(138.1 ±25.6) minutes ∶ (242.8 ± 38.1) minutes] and intraoperative blood loss [(179.3 ± 48.7) ml ∶ (218.2 ± 42.6) ml] compared with Group B (P <0.05).There were significant differences between the ADI,CCA,CMA and JOA scores before operation and during the last follow-up in both Group A and Group B (P < 0.05),but there was no significant difference between the two groups in terms of these scores (P > 0.05).The JOA scores in Group A were excdlent in eight patients,good in eight patients,and fair in two patients,with the improvement rate of 89%.The JOA scores in Group B were excellent in 13 patients,good in eight patients,and fair in three patients,with the improvement rate of 87% (P >0.05).In Group A,the atlanto-axial joint fusion rate was 83% at 3 months and 100% at 6 months postoperatively;in Group B,the fusion rate was 79% at 3 months and 100% at 6 months postoperatively (P > 0.05).There was no failure of internal fixation or loss of reduction in both groups.Conclusion Posterior atlantoaxial joint axial release,bone grafting and fusion with intemal fixation can be used to treat the partially reducible IAAD through a single approach.The reduction effect was comparable to that of anterior transoral or retropharyngeal release,bone grafting and fusion,with less operation time and intraoperative blood loss.

18.
Chinese Journal of Trauma ; (12): 977-985, 2019.
Article in Chinese | WPRIM | ID: wpr-800775

ABSTRACT

Objective@#To investigate the efficacy of posterior atlantoaxial joint axial release, bone grafting and internal fixation for the treatment of irreducible atlantoaxial dislocation (IAAD) with partial reduction.@*Methods@#A retrospective case-control study was conducted to analyze the clinical data of 42 patients with IAAD admitted to Henan Provincial People's Hospital from January 2014 to October 2017. There were 17 males and 25 females, aged from 12 to 72 years [(47.2±11.3) years]. After more than 50% reduction by high weight skull traction, 18 patients underwent posterior atlantoaxial joint axial release, reduction, bone grafting and fusion with internal fixation (Group A), and 24 patients underwent anterior transoral or retropharyngeal release, reduction, posterior bone grafting and fusion with internal fixation (Group B). The operation time, intraoperative blood loss, preoperative and postoperative anterior atlantodental interval (ADI), clivus-canal angle (CCA), cervicomedullary angle (CMA), and Japanese Orthopaedic Association (JOA) scores between the two groups were compared. The improvement rate of JOA scores at the last follow-up of the two groups and the atlantoaxial joint fusion rate at 3 months and 6 months after surgery were calculated and compared. The complications were recorded.@*Results@#All patients were followed up for 12 to 40 months with an average of 24.6 months. Group A had significant decreases in operation time [(138.1±25.6) minutes ∶(242.8±38.1) minutes] and intraoperative blood loss [(179.3±48.7)ml ∶(218.2±42.6)ml] compared with Group B (P<0.05). There were significant differences between the ADI, CCA, CMA and JOA scores before operation and during the last follow-up in both Group A and Group B (P<0.05), but there was no significant difference between the two groups in terms of these scores (P>0.05). The JOA scores in Group A were excellent in eight patients, good in eight patients, and fair in two patients, with the improvement rate of 89%. The JOA scores in Group B were excellent in 13 patients, good in eight patients, and fair in three patients, with the improvement rate of 87% (P>0.05). In Group A, the atlanto-axial joint fusion rate was 83% at 3 months and 100% at 6 months postoperatively; in Group B, the fusion rate was 79% at 3 months and 100% at 6 months postoperatively (P > 0.05). There was no failure of internal fixation or loss of reduction in both groups.@*Conclusion@#Posterior atlantoaxial joint axial release, bone grafting and fusion with internal fixation can be used to treat the partially reducible IAAD through a single approach. The reduction effect was comparable to that of anterior transoral or retropharyngeal release, bone grafting and fusion, with less operation time and intraoperative blood loss.

19.
Chinese Journal of Trauma ; (12): 1068-1074, 2019.
Article in Chinese | WPRIM | ID: wpr-799881

ABSTRACT

Objective@#To investigate the clinical efficacy of percutaneous fixation assisted by O-arm-based navigation for thoracolumbar fractures without neurologic deficits.@*Methods@#A retrospective case control study was conducted to analyze the clinical data of 35 thoracolumbar fracture patients without neurologic deficits admitted to Henan Provincial People's Hospital from January 2018 to December 2018. There were 26 males and 9 females, aged 17-51 years, with an average age of 30.4 years. The injured segments were distributed at T11 in 10 patients, T12 in 15, L1 in 11, and L2 in 4 patients. A total of 19 patients (22 vertebrae, 98 pedicle screws) were treated with O-arm guided navigation assisted percutaneous internal fixation (Group A), and 16 patients (18 vertebrae, 82 pedicle screws) were treated with C-arm guided percutaneous internal fixation (Group B). The operation time, accuracy rate of nail placement, complications, Cobb angle of fracture vertebral body, visual analogue score (VAS) and Japanese Orthopaedic Association (JOA) score were recorded and compared before operation, 7 days after operation and at the last follow-up.@*Results@#The patients were followed up for 2-12 months [(7.2±2.9)months] in Group A and 3-13 months [(7.1±3.3)months] in Group B. The operation time was (70.5±11.2)minutes in Group A and (81.3±10.9)minutes in Group B (P<0.01). A total of 93 screws were completely placed in the pedicle in Group A (accuracy rate of 95%), and 74 screws in Group B (accuracy rate of 90%) (P<0.01). There were no complications such as infection, pulmonary embolism, spinal cord, nerve injury or lower extremity deep vein thrombosis in either group. The Cobb angle of the fractured vertebral body at day 7 after operation in Group A and Group B was (9.4±2.1)° and (10.4±2.5)° respectively, while the Cobb angle of the fractured vertebral body at the final follow-up in Group A and Group B was (9.7±2.3)° and (11.4±2.9)° respectively. The postoperative Cobb angle was significantly increased compared with the preoperative Cobb angle (P<0.05), but there was no significant difference between the two groups (P>0.05). The VAS at day 7 after operation was (2.3±1.1)points and (2.8±1.0)points in Group A and Group B, respectively, while the VAS at the final follow-up was (0.7±0.7)points and (0.8±0.7)points in Group A and Group B respectively. The postoperative VAS was significantly decreased compared with the preoperative VAS (P<0.05), but there was no significant difference between the two groups (P>0.05). The JOA at day 7 after operation was (21.1±2.2)points and (21.8±2.5)points in Group A and Group B respectively, while the JOA at the final follow-up was (24.9±2.2)points and (23.8±1.9)points in Group A and Group B respectively. The postoperative JOA was significantly increased compared with the preoperative JOA (P<0.05), but there was no significant difference between the two groups (P>0.05).@*Conclusion@#For thoracolumbar fractures without neurologic deficits, percutaneous fixation assisted by O-arm-based navigation can shorten the operation time and deliver a higher accuracy rate in the placement of pedicle screws, in addition to the similar effects with percutaneous fixation assisted by C-arm in pain relief, function improvement and correction of fracture vertebral kyphosis.

20.
Chinese Journal of Orthopaedics ; (12): 152-159, 2019.
Article in Chinese | WPRIM | ID: wpr-734425

ABSTRACT

Objective To develop a new type of lumbar prosthesis,movable artificial lumbar vertebral body (MALV) and evaluate the stability and activity of the prosthesis by in vitro biomechanical test.Methods Fifteen adult fresh lumbar spine specimens were randomly divided into three groups:intact group,fusion group and non-fusion group.The anatomical parameters of L2 vertebral body and adjacent intervertebral discs were collected by software (Mimics 16.0,Materialise Company,USA) and the new prosthesis was personalized by 3D printing and mechanical processing.All specimens in fusion group and in non-fusion group were implanted with titanium cage,titanium plate and MALV respectively after partial resection of L2 vertebra and adjacent intervertebral disc.No other intervention was conducted on physiological specimens.All specimens were examined by imaging to determine the position of the prosthesis and the condition of the spinal cord.Specimens in all groups were subjected to a 7.5 N · m load biomechanical test in flexion,extension,left and right lateral bending,left and right rotation aiming to evaluate the mobility of operative site and adjacent discs.Results The new prosthesis consists of three parts,vertebral body,intervertebral disc and composite material ball.All 15 cadavers were free of spinal deformity,fracture and osteoporosis.Postoperative radiographic examination indicated no prosthesis displacement and spinal compression without adverse phenomena.The results in vitro mechanical test were as followed.There was no statistical difference in ROM of the T12L1 intervertebral in non-fusion group (3.68°±0.86°,3.52°± 0.86°,2.64°±0.93°,2.58°±0.76° respectively) and in intact group (3.98°±0.90°,3.74°±0.91°,2.94°±1.10°,2.96°±0.86° respectively) in flexion,extension,left and right lateral bending (P>0.05).The ROM of the T12L1 intervertebral in fusion group (5.28°±0.83°,5.32°±0.42°,4.72°±1.10°,4.94°±1.17° respectively) was significantly larger than that in intact group and non-fusion group (P<0.05).There was no statistically significant difference between the ROM of L1.2 and L2.3 intervertebral in flexion,extension and left and rightlateral bending in the non-fusion group (ROM of L1.2 were 4.62°±0.51 °,4.34°±0.67°,3.16°±0.55°,3.28°±0.41 ° respectively;ROM of L2.3 were 4.54°±0.58°,4.36°±0.65°,3.26°±0.21°,3.42°±0.37° respectively) and the intact group (ROM of L1.2 were 4.10°±0.53°,3.72°±0.42°,2.74°±0.50°,3.04°±0.40° respectively;ROM of L2.3 were 4.26°±0.72°,4.08°±0.77°,3.00°±0.36°,3.20°±0.31° respectively) (P>0.05).The ROM of L1.2 and L2.3 in intact group and in non-fusion group were significantly greater than those in the fusion group (ROM of L1.2 were 1.10°± 0.35°,1.28°±0.31°,0.84°±0.34°,0.80°± 0.43° respectively;ROM of L2.3 were 1.14°±0.30°,1.18°±0.28°,0.94°± 0.36°,1.06°±0.32°) (P<0.05).There was no statistically significant difference in the ROM of the T12-L3 full segment in the left and right rotation of the three groups (Intact group:4.47°± 0.99°,4.40°±0.70°;Non-fusion group:4.60°±0.90°,4.50°±0.77°;Fusion group:3.85°±0.50°,3.72°±0.70°)(P>0.05).Conclusion The MALV can retain the mobility of the operative site in flexion,extension,lateral bending and rotation.Furthermore,it can effectively avoid the increased mobility of adjacent segment intervertebral.After implantation,the prosthesis can obtain satisfied immediate stability.

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