Application of back-forward Bending CT localization image in the prediction of proximal junctional kyphosis after spinal deformity surgery in adults / 中国修复重建外科杂志

OBJECTIVE@#To investigate the feasibility of predicting proximal junctional kyphosis (PJK) in adults after spinal deformity surgery based on back-forward Bending CT localization images and related predictive indicators.@*METHODS@#A retrospective analysis was performed for 31 adult patients with spinal deformity who underwent posterior osteotomy and long-segment fusion fixation between March 2017 and March 2020. There were 5 males and 26 females with an average age of 62.5 years (range, 30-77 years). The upper instrumented vertebrae (UIV) located at T 5 in 1 case, T 6 in 1 case, T 9 in 13 cases, T 10 in 12 cases, and T 11 in 4 cases. The lowest instrumented vertebrae (LIV) located at L 1 in 3 cases, L 2 in 3 cases, L 3 in 10 cases, L 4 in 7 cases, L 5 in 5 cases, and S 1 in 3 cases. Based on the full-length lateral X-ray film of the spine in the standing position before and after operation and back-forward Bending CT localization images before operation, the sagittal sequence of the spine was obtained, and the relevant indexes were measured, including thoracic kyphosis (TK), lumbar lordosis (LL), local kyphosis Cobb angle (LKCA) [the difference between the different positions before operation (recovery value) was calculated], kyphosis flexibility, hyperextension sagittal vertical axis (hSVA), T 2-L 5 hyperextension C 7-vertebral sagittal offset (hC 7-VSO), and pre- and post-operative proximal junctional angle (PJA). At last follow-up, the patients were divided into PJK and non-PJK groups based on PJA to determine whether they had PJK. The gender, age, body mass index (BMI), number of fusion segments, number of cases with coronal plane deformity, bone mineral density (T value), UIV position, LIV position, operation time, intraoperative blood loss, osteotomy grading, and related imaging indicators were compared between the two groups. The hC 7-VSO of the vertebral body with significant differences between groups was taken, and the receiver operating characteristic curve (ROC) was used to evaluate its accuracy in predicting the occurrence of PJK.@*RESULTS@#All 31 patients were followed up 13-52 months, with an average of 30.0 months. The patient's PJA was 1.4°-29.0° at last follow-up, with an average of 10.4°; PJK occurred in 8 cases (25.8%). There was no significant difference in gender, age, BMI, number of fusion segments, number of cases with coronal plane deformity, bone mineral density (T value), UIV position, LIV position, operation time, intraoperative blood loss, and osteotomy grading between the two groups ( P>0.05). Imaging measurements showed that the LL recovery value and T 8-L 3 vertebral hC 7-VSO in the PJK group were significantly higher than those in the non-PJK group ( P>0.05). There was no significant difference in hyperextension TK, hyperextension LL, hyperextension LKCA, TK recovery value, LL recovery value, kyphosis flexibility, hSVA, and T 2-T 7, L 4, L 5 vertebral hC 7-VSO ( P>0.05). T 8-L 3 vertebral hC 7-VSO was analyzed for ROC curve, and combined with the area under curve and the comprehensive evaluation of sensitivity and specificity, the best predictive index was hC 7-L 2, the cut-off value was 2.54 cm, the sensitivity was 100%, and the specificity was 60.9%.@*CONCLUSION@#Preoperative back-forward Bending CT localization image can be used to predict the occurrence of PJK after posterior osteotomy and long-segment fusion fixation in adult spinal deformity. If the patient's T 8-L 2 vertebral hC 7-VSO is too large, it indicates a higher risk of postoperative PJK. The best predictive index is hC 7-L 2, and the cut-off value is 2.54 cm.

CT localization on suprascapular nerve and clinical application value in arthroscopic Bristow-Latarjet / 中国组织工程研究

BACKGROUND: The Bristow-Lataijet technique is a reliable treatment for recurrent anterior shoulder instability. However, it as been reported 1.6% of patients suffering nerve injury. Thereafter, the all-arthroscopic Latarjet procedure has been gaining popularity, but the surgeon is unable to palpate the nerves, and their localization, so protection is a difficulty. OBJECTIVE: To investigate the CT localization of suprascapular nerve on the posterosuperior scapular neck, and to improve the safety and quality in Bristow-Latarjet surgery. METHODS: This study was carried out on 12 normal formalin fixed adult cadaveric upper limb specimens (8 males and 4 females). The study was in accordance with the ethical requirements of Dongguan Hospital of Traditional Chinese Medicine. The nerve trunk and branches were marked with developing lines to examine the position and course of nerve on the posterosuperior scapular neck. CT localization was used to measure the distance, angle and height ratio to glenoid from the superior pole of scapula, spinoglenoid notch, the entry point of outermost nerve branch to anterior and posterior margin of the glenoid, through internally and externally rotating 45 degrees of should joints. The data were statistically analyzed. RESULTS AND CONCLUSION: (1) Pearson correlation analysis: The height of glenoid was positively correlated with the distance from the spinoglenoid notch and entrance point to the articular surface. (2) Comparison between internal and external rotation 45 degrees: Distance of superior pole of scapula and angles showed no significant difference (all P > 0.05). There were significant differences in the distance and angle in the spinoglenoid notch (all P 0.05). There were significant differences in distance, angle, and height ratio at entrance point (all P < 0.01), suggesting that external rotation had larger angle and safer range of distance than internal rotation. In the position of internal and external rotation 45 degrees, the distance, angle and height ratio of spinoglenoid notch and entrance point showed significant differences (P < 0.01), indicating that compared with spinoglenoid notch, the angle between entrance point and articular surface was smaller, the distance from entrance point to articular surface was shorter, and the height ratio was higher. (4) Therefore, external rotation is recommended in the case of internal fixation of the bony tunnel for the posterior glenoid so as to reduce the incidence of nerve injury.

Reasoning and discussion of spiral CT localization formula / 医疗卫生装备

Using geometry principle of the spiral CT localization , functional relation was deduced between the bed coordinates and the diagram layers coordinates, i.e.when gantry angle is zero degree, the function relation type is Twm= S190/Cos? + M; Otherwise, it is Twm= S190/Cos? +M. Combined with the actual operation of CT localization, the formula of the CT localization is:Twm=S190/Cos?+M. Finally, the physical meaning and the simplified condition of the formula were discussed.