RESUMEN
Objective:To evaluate the feasibility of using cortical bone trajectory (CBT) screws in the osteoporotic thoracolumbar fixation by comparing the bone CT values at the bone-screw interface between traditional trajectory (TT) screws and CBT screws in patients with different bone densities.Methods:The high-resolution CT imaging data of thoracolumbar segments following thoracic or lumbar spine fractures from April 2020 to October 2022 were collected at The Second Hospital Affiliated to Wenzhou Medical University for retrospective analysis. They were divided into 3 groups: a normal bone mass group, an osteopenia group and an osteoporosis group. From each group 30 cases were chosen (90 cases in total, 36 males and 54 females). All the data were imported into Mimics 18.0 for three-dimensional bone reconstruction in which placement of TT and CBT screws was simulated on the vertebrae from T10 to L2 (non-fractured vertebrae). Regions of interest (ROI) where each simulated screw intersected the bone were segmented to measure their CT bone values. For each vertebra in each group, the relative difference percentage in average CT value of ROI between TT and CBT screws was calculated. The CT values of ROI were compared in the same group between TT and CBT screws from T10 to L2; the CT values of ROI were compared in the same screws among the 3 groups from T10 to L2; the CT values of ROI were compared between the CBT screws in the osteopenia and osteoporosis groups and the TT screws in the normal bone mass group; the relative difference percentages in average CT value of ROI between CBT and TT screws were compared between the 3 groups from T10 to L2.Results:The average CT value of ROI for CBT screws was significantly higher than that for TT screws from T10 to L2 in every group ( P< 0.001); as for the CT values of ROI for CBT and TT screws from T10 to L2, the osteoporosis group<the osteopenia group<the normal bone mass group ( P<0.001); from T10 to L2, the CT value of ROI for CBT screws in the osteopenia group was significantly higher than that for TT screws in the normal bone mass group ( P<0.001); the CT value of ROI for CBT screws in the osteoporosis group was not significantly different from that for TT screws in the normal bone mass group ( P>0.05). At T10, T12, and L1, the relative difference percentage in average CT value of ROI between CBT and TT screws was significantly higher in the osteopenia and osteoporosis groups than that in the normal bone mass group ( P<0.05), but there was no such a difference between the osteopenia and the osteoporosis groups ( P>0.05). At T11 and L2, there was no significant difference between the 3 groups in the relative difference percentage in average CT value of ROI between CBT and TT screws ( P>0.05). Conclusions:As bone mass decreases, both CBT and TT screws lead to a significant decrease in the bone density at the bone-screw interface. In patients with osteoporosis, CBT screws can still lead to a higher bone density at the bone-screw interface than TT screws, thus providing a higher strength at the bone-screw interface.
RESUMEN
The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.
RESUMEN
Objective@#To investigate the potential relationship between sensory characteristics and gray matter volumes in children with autism spectrum disorders (ASD), to provide a basis for the diagnosis and treatment of children with ASD.@*Methods@#A total of 40 ASD children who were treated or recovered in Xi an medical institutions and 16 typically developing (TD) children who were from several kindergatens in Xi an were invited for participation. Sensory characteristics were evaluated by the sensory processing and self regulation checklist, 3D structural brain images were obtained with TIWI, and gray matter volumes were analyzed by voxel based morphometry. Sensory characteristics and gray matter volumes were compared between groups and the relationship between sensory characteristics and different gray matter volumes were analyzed.@*Results@#The scores of auditory, visual, tactile, sensory processing ability and sensory under responsivity in the ASD group were lower than those in the TD group ( Z/t =-2.63, -2.57 , -3.11, -2.19, -3.83, P <0.05). Gray matter volumes in nine brain regions increased in the ASD group compared to the TD group, including the left and right posterior inferior lobe, right parahippocamal gyrus, left insula, left media frontal gyrus, left superion occipital gyrus, right superion occipital gyrus, right superion parietal lobe, and right posterion central gyrus ( t =3.53, 3.69 , 3.37, 3.86, 3.61, 3.37, 4.04, 3.38, 3.16, P <0.01). In the ASD group, the scores of visual, vestibular, proprioceptive, sensory processing ability, sensory seeking behavior and sensory over responsivity were negatively correlated with gray matter volumes of left superior occipital gyrus ( r =-0.36, -0.40, -0.39, -0.36, -0.40, -0.36), and the scores of visual, vestibular, and sensory over responsivity were negatively correlated with gray matter volumes of the right superior parietal lobule ( r =-0.36, -0.50, -0.42)( P <0.05).@*Conclusion@#The presence of paresthesia in children with ASD is associated with gray matter volumes of the left superior occipital gyrus and right superior parietal lobule.
RESUMEN
Objective:To introduce a novel technique note about anterior decompression through transoral axis slide and rotation osteotomy (ASRO) and identify its imaging parameters related to osteotomy, and to explore its clinical application value.Methods:CT data of cervical spine of 90 subjects were collected, including 54 males and 36 females. The age ranged from 26 to 72 years, with an average age of 48.7 years. The Mimics software was used to reconstruct the atlantoaxial three-dimensional model. We plan to perform osteotomy on both sides of the axis of the vertebral body in the anteroposterior direction and the ASRO related anatomical parameters were measured, including the minimum osteotomy angle, the maximum osteotomy angle, the minimum and maximumdistance between the osteotomy trajectory and the inner side of the articular surface, the length of the upper articular surface of the axis side mass, the depth of osteotomy at the highest point and lowest point of the axial osteotomy surface and the minimum osteotomy depth. A 56-year-old female patient was admitted to the hospital due to atlantoaxial dislocation with failure of occipital-cervical fusion, difficulty walking, weakness and hypoaesthesia in four limbs. Imaging revealed that narrow space between the transversal walking wire and upper-posterior of the odontoid process, compressing the spinal cord from the front and the back respectively. The ASRO technique was performed on the patient under neuro-electrophysiological monitoring, and the osteotomy angle, osteotomy depth, narrowest width of the upper cervical spinal canal, the medullary, spinal cord angle were measured and Japanese Orthopaedic Association Scores (JOA) cervical myelopathy evaluation were performed after the operation to evaluate the surgical treatment effect.Results:The minimum osteotomy angle and the maximum osteotomy angle was 14.7°± 4.36° and 33.0°± 8.67°. The minimum and maximumdistance between the osteotomy trajectory and the inner side of the articular surface, and the length of the upper articular surface of the axis side mass was 6.0±1.80 mm, 12.2±3.17 mm, and 17.2±1.90 mm, the ratio of the former two to the latter was 34%±8.7% and 70%± 15.0%. The depth of osteotomy at the upper edge, lower edge and narrowest place of the axial osteotomy surface were 6.0±1.80 mm, 12.2±3.17 mm and 17.2±1.90 mm. The postoperative imaging of the patient showed that the osteotomy angle was 17.1° on left side and 16.5° on right side, and the depth of osteotomy at the upper edge, lower edge and narrowest place of the axial osteotomy surface were 17.1 mm, 13.2 mm, and 9.1 mm on left side, and 17.4 mm, 11.8 mm, 8.46 mm on right side. All measured values met the ranges which were shown in the imaging anatomical study. The narrowest width of the upper cervical spinal canal increased from 6.58 mm to 15.28 mm, the medullary spinal cord angle increased from 131.7° to 153.8°postoperatively, and the cervical spine JOA score recovered from 6 points to 14 points, suggesting that the postoperative spinal canal space is obvious increased, the compression on the front of the spinal cord was significantly reduced. The patient's symptoms improved significantly.Conclusion:ASRO technique is a good choice for salvage of failed posterior occipitocervical fusion and some irreducible atlantoaxial dislocation because of the anterior bony fusion. It could direct decompress the spinal cord anteriorly, avoid the odontoid resection, which is a safe and feasible new technique.
RESUMEN
Scoliosis is characterized by one or several segments of the spine bending sideways, accompanied by vertebral rotation and sagittal imbalance with complex etiology. Scoliosis can be caused by congenital vertebral abnormalities, asymmetry of the paraspinal muscles due to neurological lesions, and malnutrition or metabolic disorders of bone tissue. Growth hormone is a peptide hormone that plays a key role in promoting human growth and development, especially in bone growth. When the secretion of growth hormone in children or adolescents in the rapid growth stage is insufficient, it may lead to the occurrence of idiopathic short stature (ISS) and growth hormone deficiency (GHD). In clinic, ISS and GHD are mainly treated by recombinant human growth hormone (rhGH). According to some early clinical reports, in the process of rhGH treatment, many patients occur scoliosis or the original scoliosis progression is aggravated. Therefore, many scholars conclude that rhGH treatment of ISS or GHD will lead to the occurrence or development of scoliosis. However, with the increase of clinical statistics and the further progress of research, many scholars found that rhGH treatment of ISS or GHD will only increase the Cobb angle of patients with scoliosis, but will not lead to the occurrence of scoliosis, that is, rhGH treatment of ISS or GHD will not increase the prevalence of scoliosis. At present, whether rhGH treatment of ISS and GHD can lead to scoliosis and aggravation of scoliosis remains controversial. Therefore, this paper summarizes and analyzes the correlation research on the risk of scoliosis complications in children treated with rhGH, and concludes that age, gender, body mass index, and growth potential are risk factors for the development or progression of scoliosis during treatment, and discusses the balance of advantages and disadvantages of using rhGH for ISS or GHD to provide a direction for future clinical guidance.
RESUMEN
The morbidity of scoliosis in adolescents in China is about 3%-5%, 80%-85% of the patients are adolescent idiopathic scoliosis (AIS), whose etiology is unknown. Scoliosis is a structural spine disease occurring during puberty or before skeletal maturation. Scoliosis has a greatly negative impacton not only the growth and development of adolescent spine, but also the mental health of adolescents. Ocular disease is a common clinical disease in which the eye ball and its accessory structures have structural abnormalitiesordys function. Ocular disease snotonly bring in convenience to patients's life, but also may induce diseases in other organs. Recent studies have shown that various ocular diseases may have a potential impact on scoliosis, and quite a fewof patients with certain ocular diseases have higher incidence rate of scoliosis. Therefore, in this article, the etiological relationship between eye diseases and scoliosis will be summarized, which provides guidance and direction for the etiological research of scoliosis and eye diseases. After sorting out, we found that the relationship between ophthalmic diseases and scoliosis mainly concentrated in the following four aspects: choroidal thickness and scoliosis, Goldenhar syndrome, gene level and strabismus. Among them, the genetic relationship is the most complex, about 40 kinds of gene or chromosome abnormalities have been found to cause ocular diseases and scoliosis; Goldenhar syndrome, also known as oculo-auriculo-vertebral spectrum, first revealed the relationship between ocular diseases and scoliosis, but the current statistical relationship is still very vague. There are few studies on choroidal thickness and strabismus at home and abroad, which are statistical studies, only revealing the relationship between choroidal thickness and scoliosis, and there are many defects in the study of choroidal thickness, which need further research.
RESUMEN
Objective:To propose a monosegment thoracic and lumbar fracture dislocation (mTLFD) classification, and to evaluate its reliability and clinical application.Methods:All of 298 cases of thoracic and lumbar fracture dislocation who received surgical management in our hospital from January 2014 to December 2019 were retrospectively analyzed. 123 cases were included in the study according to inclusion and exclusion criteria. mTLFD classification was proposed based on the imaging characteristics: type I (intervertebral disc injury mainly) and type II (vertebral burst fracture mainly). The type II was classified based on distribution of injury segment: type IIa (T 11 and above) and Ttype IIb (below T 11). Six spinal surgeons (3 residents, 3 associate chief physicians) were selected to classify the 123 cases according to preoperative imaging data, and to perform reliability test of each type. The repeatability and reliability of the classification were evaluated by ICC index. Different management strategies were performedf or each type: type I was managed with posterior decompression interbody fusion and internal fixation; type IIa underwent posterior decompression and fixation, subtotal vertebral resection and fusion was performed if bony compromise was still present through intra-operative exploration. Type IIb underwent posterior decompression, posterolateral fusion and internal fixation on the first stage, while anterior subtotal vertebral resection and reconstruction was performed on the second stage if the bony compromise was still present based on post-operative CT examination. The American Spinal Injury Association (ASIA) grading of all patients was recorded, and the visual analogue scale (VAS), Oswetry disability Iindex (ODI) and local Cobb angle of each type was compared between pre-operation and final follow-up. Results:The average follow-up time of all patients was 10.4±1.8 months. The average repeatability and reliability ICC index of mTLFD of 3 residents and 3 deputy chief physicians were 0.926 and 0.964, respectively, and 0.746 and 0.907, respectively. The reliability ICC index of type I, type IIa and type IIb was 0.918, 0.947 and 0.962, respectively, and the repeatability ICC index was 0.930, 0.940 and 0.966, respectively. The neurological function recovery was obtained in 56 patients. The preoperative VAS of type I, type IIa and type IIb were 8.5±1.0, 8.4±1.0 and 8.3±0.9, and 2.0±1.1, 1.8±1.0 and 1.8±0.9 at the final follow-up (all P<0.001). The ODI of type I, type IIa and type IIb were 97.0%±2.1%, 97.1%±1.9% and 97.3%±2.1% before surgery, and 29.5%±6.8%, 27.0%±6.0% and 29.0%±6.7% at the final follow-up (all P<0.001). The local Cobb angles of type I, type IIa and type IIb were 20.9°±7.1°, 29.0°±9.1° and 26.4°±6.9° before surgery, and 12.5°±5.4°, 18.0°±9.1° and 13.1°±5.1° at the final follow-up (all P<0.001). Conclusion:The mTLFD classification proposed in this study has strong repeatability and reliability, and management strategy of each type have achieved satisfactory clinical efficacy, indicating that the classification has certain significance for management of thoracic and lumbar spine fracture dislocation.
RESUMEN
Thoracolumbar osteoporotic vertebral compression fracture（OVCF）is more common in patients with osteoporosis，which seriously affects the life quality of the elderly. Percutaneous vertebroplasty（PVP）and percutaneous kyphoplasty（PKP）are the conventionally effective strategies for treatment of OVCF，whereas quite a lot OVCF patients still sufferred from residual back pain，affecting postoperative recovery. Bone density，postoperative infection，cement leakage induced nerve injury，fascia injury and facet joint violation may be the potential factors for residual back pain. In this study，the authors review advances in the definition of residual back pain in OVCF after surgery and related risk factors including injured vertebrae，bone density，fascia injury，intravertebral vacuum cleft，cement volume and distribution，surgical related factors including facet joint violation，hoping to provide a reference for clinical treatment.
RESUMEN
Objective:To evaluate the accuracy of point-of-care ultrasound in diagnosis of guidewire tip misplacement during central venous catheterization.Methods:Ninety patients of both sexes, aged 18-90 yr, with body mass index of 15.5-44.8 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅳ, scheduled for elective surgery with general anesthesia requiring central venous catheter (CVC) insertion through bilateral internal jugular veins or subclavian veins, were enrolled.The ultrasound probe was used, and the target vessel was selected.Anesthesia was induced with propofol, sufentanil and cisatracurium, and positive pressure ventilation was applied after endotracheal intubation.After central venous puncture was successfully performed under ultrasound guidance, the guidewire was inserted to a predetermined length, and the tips of the guidewire were confirmed with X-ray film and with point-of-care ultrasound including a phased array probe and linear array probe, and the results were recorded.The CVC was inserted after confirming the guidewire tip position.Agreement between the guidewire tip misplacement confirmed with point-of-care ultrasound and with bedside X-ray film was analyzed using Kappa statistics.The sensitivity, specificity, and total coincidence rate, rate of misdiagnosis, rate of missed diagnosis, Youden index, odds product, positive predictive value and negative predictive value of the guidewire tip misplacement were calculated during central venous catheterization confirmed using point-of-care ultrasound. Results:Among the 90 patients, 17 cases had guidewire tip misplacement, and the incidence of guidewire tip misplacement was 19%.Point-of-care ultrasound and bedside X-ray film were consistent in the diagnosis of guidewire tip misplacement during CVC insertion (Kappa value 0.945, P<0.05). The sensitivity of point-of-care ultrasound in diagnosing guidewire tip misplacement during CVC insertion was 97.44 %, specificity 97.78%, total coincidence rate 97.67%, rate of misdiagnosis 2.22%, rate of missed diagnosis 2.56%, Youden index 95.22%, odds product 1 672, positive predictive value 95.00%, and negative predictive value 98.88%. Conclusion:Point-of-care ultrasound can be used to diagnose guidewire tip malposition during central venous catheterization.
RESUMEN
Objective To investigate the effect of cisternostomy on the prognosis of patients with traumatic brain injury (TBI).Methods A retrospective case control study was conducted to analyze the clinical data of 46 patients with TBI admitted to Shanxi Dayi Hospital from May 2017 to September 2018.There were 37 males and nine females,aged 24-80 years [(49.8 ± 15.7)years].The injury severity score (ISS) was 6-42 points [(25.0 ± 8.2)points],and the Glasgow Coma score (GCS) was 3-14 points [(3.4 ± 1.7) points].Twenty-three patients underwent routine surgery only (control group),and 23 patients underwent cisternostomy (cisternostomy group) on the basis of routine surgery.Intracranial pressure monitoring was performed in both groups before surgery.The postoperative intracranial pressure,intracranial pressure 1 week after operation,postoperative mechanical ventilation time,neurosurgical ICU (NICU) time,postoperative dehydration dose,decompressive craniectomy rate,postoperative infection rate,mortality rate,length of hospital stay,GCS at discharge,and Glasgow outcome score (GOS) of 3 months of follow-up were compared between the two groups.Results Compared with the control group,the cistemostomy group had lower postoperative intracranial pressure [(7.1 ± 5.7) mmHg vs.(14.2 ± 12.0) mmHg)],intracranial pressure 1 week after operation [(11.8 ± 0.5) mmHg vs.(14.0 ± 0.7) mmHg],postoperative dosage of dehydrating agent [0 (0-500.0) ml vs.1 275 (787.5-3 812.5) ml] and decompression rate (57％ ∶ 91％) (P ＜ 0.05).There were no significant differences between the cistemostomy group and control group in postoperative mechanical ventilation time [120 (42.0-225.0)hours vs.89(65.5-203.5)hours],NICU time [236(182.0-340.5)hoursvs.281 (114-400)hours],postoperative infection rate (4％ vs.0),mortality rate (13％ vs.39％) and hospital stay [32 (20.0-44.5) hours vs.25 (12.0-30.5)hours] (P ＞ 0.05).The cisternostomy group had higher GCS score at discharge than the control group [(10.7 ± 4.2) points vs.(7.9 ± 4.2) points] (P ＜ 0.05).After 3 months of follow-up,18 patients in the cisternostomy group showed good prognosis,better than that in the control group (11 patients) (P ＜ 0.05).Conclusion For TBI patients,cisternostomy can clear the blood cerebrospinal fluid,reduce harmful metabolic products in the brain,reduce intracranial pressure and hence improve the prognosis of patients.
RESUMEN
Objective To investigate the clinical characteristics,diagnosis and treatment of pregnancy complicated with hypedipidemic pancreatitis (HLAP).Methods The clinical data of 12 patients with hyperlipidemic pancreatitis in our hospital from 2010 to 2017 were analyzed retrospectively,including general data,clinical manifestations,laboratory examinations,imaging examinations,treatment methods and prognosis.Results 12 cases of HLAP were mainly occurred in the middle and late pregnancy and often recurs.The main cause of the disease was the high fat diet.The main manifestations of the disease are abdominal pain and vomiting.It may be accompanied by gestational diabetes or hypothyroidism.Blood amylase and lipase are often not significantly elevated,with pseudohyponatremia and abnormal coagulation function.Ultrasonography and computed tomography (CT) are important methods for the diagnosis of HLAP.In 12 cases of HLAP,except for one abortion,all the other 11 cases were successfully treated.Conclusions For pregnancy complicated with hyperlipidemic pancreatitis,prevention is the first,and the key is the correct diagnosis.After combined treatment,the patients usually have a good prognosis.
RESUMEN
Objective To investigate the clinical efficacy and complications of minimally invasive transforaminal lumbar-interbody fusion (TLIF) in the treatment of lumbar spondylolisthesis. Methods Total 142 patients with single level spondylolis-thesis who treated by TLIF from 2010.01 to 2015.06 were included in this study, with 68 cases in minimally invasive TLIF (MIS-TLIF) group and 74 cases in traditional open TLIF group. The general information (age, gender, isthmic or degenerative type, per-centage of slip degree, levels), operative time, blood loss, length of postoperative hospital stay, Visual Analogue Scale (VAS) of low-back pain and leg pain, and Oswestry Disability Index (ODI) were recorded and collected. The posterior height of the interverte-bralpace and segmental lordosis, reduction of spondylolisthesis and cross-sectional area of spinal canal were measured. Results There was no statistically significant difference between the two groups in age, gender ratio, percentage of slip degree, and sur-gicallevels distribution. Total of 66 cases in MIS-TLIF group and 71 cases in Open TLIF group finished 2 years follow up, and 25 cases in MIS-TLIF group and 31 cases in Open TLIF group finished 5 years follow up. The blood loss of the MIS-TLIF group was 164.7±51.7 ml, significantly lower than the open TLIF group of 239±69.3 ml(P<0.001). The length of postoperative hospital stay was 5.9 ± 1.5 days in MIS-TLIF group, significantly shorter than the open TLIF group of 7.3 ± 3.1 days(P<0.001). The operative time of MIS-TLIF and Open TLIF was 146.3±21.9 mins, 152.0±20.4 mins, respectively, and no significant differ-ence was found between them. The VAS ofback pain, leg pain, ODI in MIS-TLIF group was 1.76±1.16, 1.91±1.36 and 23.5± 7.3 at 2 years follow up, and in Open TLIF was 1.73±1.10, 1.83±1.36 and 23.8±6.7, respectively, all of them were significant-ly different to pre-operation, however, no significant difference was found between two groups. The VAS of back pain, leg pain, ODI in MIS-TLIF group was 1.73±1.21, 1.93±1.48, and 25.4±6.8 at 5years follow up, and in Open TLIF was 1.85±1.02, 1.85± 1.33 and 26.1 ± 6.5, respectively, no significant difference between twogroups. The posterior height of the intervertebral space and segmental lordosis of MIS-TLIF was 9.52±1.67 mm and 12.11°±3.44° at 2 years follow up, while the open TLIF was 9.88± 1.54 mm and 12.98 ± 3.83° , all of them were significantly different to pre-operation,however, no significant difference between two groups. The posterior height of the intervertebral space and segmental lordosis of MIS-TLIF was 9.37 ± 1.46 mm and 11.55° ± 2.77° , while the open TLIF was 9.66 ± 1.68 mm and 12.59° ± 4.23° , no significant difference between two groups. The percentage of slip degree was reduced to 5.2％±4.6％ in MIS-TLIF and 5.6％±4.3％ in open TLIF, the cross-sectional area of spinal canal was enlarged to 139.7±19.5 mm2 and 141.7±20.7 mm2, no significant difference between two groups either. Con-clusion MIS-TLIF has less blood loss, shorter postoperative hospital stay than open TLIF, and similar clinical pain and function-al outcomes. MIS-TLIF is suggested to be a safe and effective choice in the treatment of lower grade lumbar spondylolisthesis (Grade II or less).
RESUMEN
Objective To reduce the risk of cervical spinal cord injury,the most medial point of the cervical intervertebral disc that the posterior percutaneous endoscopic sheath could reach was evaluated.And that could help to determine the indication of posterior percutaneous endoscopic cervical discectomy for cervical intervertebral disc herniation.Methods Cervical MRI images for 50 randomly selected patients,21 males and 29 females with ages from 20 to 60(average 33.5± 10.03 years),were analysed.All 50 patients underwent MRI examination at our institution between January 2014 and December 2017.As 50％ of the zygapophyseal joint was preserved,on the cross-section T2-weighted MRI images,when the sheath just touched the spinal cord,the intersection point of the medial wall of sheath and cervical spinal cord (Point L) was the most medial point of the posterior percutaneous endoscopy could get.The distance between Point L and the line through and tangent to the most lateral point of cervical disc border was the length of the line section DL.The distance between the middle sagittal line of the cervical disc and the line through and tangent to the most lateral point of cervical disc border was the length of the line section D.D1/D was the most medial distance ratio of the posterior percutaneous endoscopic cervical discectomy when 50％ of the lateral zygapophyseal joint was preserved.In the same way,D'1/D was the most medial distance ratio of the posterior percutaneous endoscopic cervical discectomy when 75％ of the lateral zygapophyseal joint was preserved.Results When 50％ of the lateral zygapophyseal joint was preserved,the upper limit of 95％ confidence intervals of the most medial distance ratio that the posterior percutaneous endoscopy could get were 78％,76％,81％,93％ in C3,4,C4,5,C5,6,C6,7 respectively.This meant that the most medial distance the posterior percutaneous endoscopy could get were the 78％,76％,81％,0.93％ of the length of the line section D in C3,4,C4,5,C5,6,C6,7 respectively.The most medial distance the posterior percutaneous endoscopy could get in C5,6 or C6,7 was longer than that in C3,4,C4,5.Conclusion When 50％ of the lateral zygapophyseal joint was preserved,the upper limit of the most medial distance ratio that the posterior percutaneous endoscopy should get were 78％,76％,81％,93％ in C3,4,C4,5,C5,6,C6,7 respectively.This meant that the most medial distance the posterior percutaneous endoscopy could get were the 78％,76％,81％,93％ of the length of line section D in C3,4,C4,5,C5,6,C6,7 respectively.If the resected disc was beyond this range,the cervical spinal cord should be in the risk of being injured.
RESUMEN
Objective To investigate the effects of aspirin on the morphology and wall structure of the intracranial aneurysm induced by hemodynamics.Methods Twenty-six SD rats were randomly divided into three groups:a control group,a model group,and an aspirin group.The right common carotid artery,left external carotid artery,and pterygopalatine artery were ligated in order to change the hemodynamics of left internal carotid artery.After 3-month induction,the anterior communicating artery complex were harvested after heart perfusion.The aneurysm-like structure was observed using a scanning electron microscope and was graded.The changes of elastic hyer and smooth muscle cells in the tunica media were detected by pathological examination.Results Aneurysm-like remodeling was observed both in the model group and in the aspirin group,and there was no statistical differences in morphological grade between the 2 groups (P =0.054).Pathological examination showed the folds or loss of the internal elastic lamina and thinned media smooth muscle layer both in the model group and in the aspirin group.The length of thinned media in the model group was significantly higher than that in the aspirin group (173.50 ± 17.62 μm vs.153.50 ± 12.04 μ,m;t=2.964,P=0.008).Conclusions Aspirin can slow down the pathological remodeling of intracranial aneurysm wall,but it cannot completely inhibit the formation of intracranial aneurysm.
RESUMEN
Objective To analyze the incidence and risk factors of contralateral radiculopathy in patients after unilateral transforaminal lumbar interbody fusion (TLIF) surgery.Methods A retrospective study was conducted within 587 patients (average age 57.1 years,range 19-71 years) who underwent unilateral TILF from January 2010 to January 2014 in our hospital,including 334 males and 253 females.Patients were divided into a symptomatic group and an asymptomatic group.The causes of contralateral neurological symptom were evaluated according to the radiological data.The difference of pre-and post-operative contralateral foramen area (CFA),segmental angle (SA) and the clinical treatment outcomes (VAS,JOA score) were compared between two groups.Results Patients were followed up for 9-21 months,average 15.1 months.Post-operative contralateral radiculopathy occurred in 28 (4.8％) of the patients who underwent unilateral TLIF,including contralateral foraminal stenosis in 16 (57.1％,16/28),screw malposition in 5 (17.9％,5/28),contralateral lateral recess stenosis and/or newly developed disc herniation in 3 (10.7％,3/28),hematoma in 1 (3.6％,1/28),cement compression in 1 (3.6％,1/28),and unknown origin in 2 patients (7.1％,2/28).Nineteen (3.2％,19/587) of the 28 patients received revision surgery because of ineffective conservative treatment.Compared with the asymptomatic group,the difference of pre-and post-operative CFA was significantly smaller (-13.8±13.2 mm2) in symptomatic group,while the SA was significantly greater (7.0°±9.8°) in symptomatic group.The JOA score at 3 months after the surgery was significantly improved in asymptomatic group (63.0％±18.1％,P＜0.05).Conclusion The incidence rate of contralateral neurological symptom was 4.8％ in the present study.The potential risk factors associated with contralateral radiculopathy were predominantly contralateral foraminal stenosis and screw malposition.The excessive restoration of SA might have an effect on contralateral nerve compression,which should arouse the attention of the surgeon.
RESUMEN
The sagittal balance of the body is jointly maintained the by spine,pelvis and lower limb.Spino-pelvic alignment plays an important role on body sagittal balance,it is also involved in the pathogenesis of lumbar spondylolisthesis,adolescent idiopathic scoliosis,lumbar degeneration and other diseases.In addition,the sagittal spino-pelvic alignments are also related closely to the surgery strategy formulation of spinal deformity and clinical outcome.Coronal and sagittal parameters of the spine and pelvis are numerical representations of the spino-pelvic alignment which are usually obtained by imaging data.For the reason that X-ray radiography is economical,convenient and avaiable auxiliary examination to perform direct visualization of spine in the standing position.It provides an important way for the study of spino-pelvic alignment.But in the lateral pelvis X-ray films,arms at sides in relaxed standing position prevents adequate visualization of the spine on a lateral radiograph,resulting in difficulty measuring the relevant parameters.Thus,flexion of shoulders is required to bring the upper limbs forward by the early researchers to obtain a clearer lateral spino-pelvic radiograph.The variation in position has been confirmed to have significant effects on the sagittal spinal alignment.Even in the same position,slight variations in positioning may also mask or increase the difference between multiple radiographs.For example,in spine surgery,the erroneous judgment of the degree of correction when comparing radiographs before and after operation.Therefore,the important influence by the various standing position on our clinical treatment and research can not be ignored.In summary,providing an accurate,consistent and representative position is urgently significant.Some scholars propounded proper positioning of the subjects during lateral radiographs of the spine to yield and evaluate sagittal spinal alignment.The body position includes the passive upper body support position and unsupported active position,involving varying degrees of flexion about shoulders and knees.This paper summarize the related literature to make a review.
RESUMEN
Objective To investigate the efficacy of Atorvastatin in reducing the recurrence rate of chronic subdural hematoma (CSDH) after single burr hole drainage and irrigation.Methods Between January 2000 and May 2005 and between January 2013 and December 2015,122 patients with CSDH admitted to the Neurosurgery Department,Lanzhou General Hospital were treated with single burr hole drainage and irrigation under local anesthesia.All patients were classified into two groups.Patients in the treatment group (n=67) took Atorvastatin after operation and those in the control group (n=55) did not take Atorvastatin.Patient demographics,clinical characteristics,imaging data,Markwalder's Grading Scale (MGS) and recurrence rates were assessed.Results Preoperative clinical characteristics and MGS levels at discharge were similar between the two groups (all P＞0.05).The recovery rate of CSDH was 98.5％ in the treatment group,without recurrence or death.The recovery rate of CSDH was 96.4％ in the control group,with four cases of relapse,making up a recurrence rate of 7.3 ％ (4/55).As a result,the recurrence rates were statistically significantly different between the two groups (x2 =5.038,P =0.039).Conclusions Atorvastatin can significantly reduce the recurrence rate of CSDH after single burr hole drainage and irrigation.
RESUMEN
Objective To measure anatomic data related to the thyroid cartilage and cricoid cartilage and to analyze their implications for anterior spine surgery.Methods From January 2015 to February 2017,Cervical spine CT image data of 309 normal adults (195 males,114 females) in our department were retrospectively analyzed.The transverse diameters of the thyroid cartilage and the cricoid cartilage was measured at three different levels as follows:the superior border of the thyroid cartilage(SBTC),the inferior border of the thyroid cartilage(IBTC),and the inferior border of the cricoid cartilage(IBCC).At those levels,the corresponding level and transverse diameter of the cervical vertebra or intervertebral disc were also determined.Differences of anatomic parameters for each gender and level,and the relationship between the transverse diameter and height and weight were analyzed.Results The transverse diameters of the thyroid cartilage or cricoid cartilage and the corresponding cervical vertebra or intervertebral disc were associated significantly with height and weight.The transverse diameters of the thyroid cartilage or cricoid cartilage gradually decreased from the level of SBTC (44.30±4.97 mm) to the level of IBTC (41.39±4.62 mm),and the latter to the level of IBCC (26.36±3.79 mm),but increased from the level of SBTC (27.47±2.66 mm) to the level of IBTC (29.00±3.15 mm),and the latter to the level of IBCC (31.48±3.49 mm) for the cervical vertebra or intervertebral disc.Differences of the transverse diameters of the thyroid cartilage or cricoid cartilage and the cervical vertebra or intervertebral disc on three levels had statistical significance.The transverse diameters of each level had individual differences,while men were greater than those for women.The thyroid cartilage was routinely located above the C5 (56.9％ for male,86.0％ for female).Differences of the frequency between men and women on three levels had statistical significance.Conclusion The Individual and sex differences in the location of the thyroid cartilage and the size of the thyroid cartilage and the cricoid cartilage provided anatomical basis for predicting the difficulty of intraoperative exposure,incidence of esophageal injuries and early postoperative dysphagia.
RESUMEN
Pedicle screw fixation is widely used in spine surgery, which allows 3?dimensional fixation with a more rigid construct and permits a shorter fusion length. However, conventional pedicle screw fixation has some drawbacks, including signifi?cant muscle dissection for the exposure of bone marks. Although percutaneous pedicle screw technique can compensate for above defects, it requires an additional approach for decompression and bone graft insertion. Besides, the percutaneous pedicle screw technique depends on intraoperative multiplanar fluoroscopy, which results in high risk of radiation exposure of the surgeons and patients. Screw loosening is a well?known complication, especially in osteoporosis patients. Several methods can enhance screw stability, for example, modifying screw design and augmenting vertebral bodies with reinforcing materials that can improve the structural capacity of the deteriorated tissue, however, they also have some disadvantages. Although we can enhance bone?screw by modifying screw design, it is not useful in severe osteoporosis patients. At the same time, bone cement can increase pedicle screw axial pullout strength and fatigue resistance, however, it is associated with a number of inherent disadvantages such as its high exothermic polymerizing temperature, toxicity of the monomer, and risk of leakage to the spinal canal. Santoni et al. intro?duced cortical bone trajectory (CBT) for lumbar pedicle screw with a new screw design that is shorter and smaller in diameter which has been proposed to maximize the thread contact with this higher density bone surface. In addition, the CBT technique fol?lows a caudocephalad path sagittally and a laterally directed path in the transverse plane, engaging only cortical bone in the pedi?cle without the involvement of the vertebral body trabecular space. Finally, the screw insertion point of this technique locates around lateral pars, enabling less tissue dissection. Therefore, it can be an alternative approach to enhance screw fixation strength, and it may rescue failed pedicle screw and be used in minimally invasive spine surgery.
RESUMEN
Sagittal spinal deformity is one of the common reasons of sagittal disequilibrium which can cause torso forward,cardiopulmonary dysfunction,fiat back syndrome,intractable low back pain and a series of cases,affecting the patients' life quality and increasing huge economic burden on society.The treatment of sagittal spinal deformity has been a hot spot in the field of clinical spinal surgery and its main purpose is to reconstruct the overall balance of the body,which would relieve pain and improve life quality.Pedicle subtraction osteotomy is considered to be one of the most effective and safe method for correcting spinal deformity with excellent reconstruction of sagittal plane balance.However,the calculation of the angle required during surgery is still a problem,because insufficient or excessive correction will lead to the secondary sagittal disequilibrium.Therefore,an accurate calculation of the angle required during pedicle subtraction osteotomy is particularly important.In recent years,scholars believe that the sagittal equilibrium depends on a fragile balance among spinal curvature,pelvic shape and position of the lower limbs.Scholars have developed a standard of sagittal equilibrium based on their own research,and proposed a variety of quantitative analysis methods to calculate the angle required during pedicle subtraction osteotomy:trigonometric method,exact angle calculation method,overall balance method,spine femoral angle measurement method,digital virtual method,graphic method,acoustic meati to hip axis method and hilus pulmonis to hip axis method,which provide important theoretical bases for the treatment of sagittal spinal deformity.