An anatomical study of the external bone graft axis from the pedicle to the endplate from T10 to L5 in compression healing fractures of the anterior vertebral column / 中华创伤骨科杂志

Objective:To anatomically study the external bone graft axis from the pedicle (canal) to the endplate designed for compression healing fractures of the anterior vertebral column in freshly dried vertebral specimens from T10 to L5.Methods:Eight groups of freshly dried vertebral specimens from T10 to L5 (128 vertebral bodies and 256 lateral pedicles and lateral vertebral bodies) were used to observe the vertebral axis of the pedicle (canal), the internal sagittal diameter of the pedicle (canal), and the sagittal diameter of the vertebral body, and the position of vertebral pedicle (canal) axis (f-angle) before design of the external bone graft axis from the pedicle (canal) to the endplate of the compression healing vertebral body. (1) The internal sagittal diameter of the pedicle (canal) was divided into 3 segments. The lateral segment of the vertebral plate was wide, the middle segment of the isthmus of the vertebral arch was narrow and the medial segment of the terminal segment of the vertebral arch was wide. The narrow isthmus of the middle arch (canal) was used as a transposition axis in the design of the axis of the bone graft from the vertebral arch (canal) to the endplate of the compression healing vertebral body. (2) The axis of the vertebral body of the pedicle (canal) was located medial to the transposition axis, parallel to the f-angle at 0° as described by Saillant G. (3) The compression degree of the vertebral body was measured at the outer edge of the lateral anterior column, with Ⅰ° for less than 1/4 compression of the anterior column of the vertebral body, Ⅱ° for 1/4 to 2/4, Ⅲ° for 2/4 to 3/4 and Ⅳ° for more than 3/4 of the compression. (4) The f-angle described by Salliant G at the entry end which was corresponding to the endplate of the compression healing vertebral body was used to design the pedicle (canal) to the outer implant axis of the endplate of the compression healing vertebral body.Results:At an f-angle of 8° to 10°, the bone graft axis was aligned with the Ⅱ° compression healing vertebral endplate on the superior endplate side of the vertebral body axis of the arch; at an f-angle of 16° to 18°, the bone graft axis corresponded to the superior endplate of the Ⅰ° compression healing vertebral body. At an f-angle of -10°~-8°, the bone graft axis corresponded to the Ⅲ° compression healing vertebral endplate on the inferior endplate side of the vertebral body axis of the arch; at an f-angle of -18°~-16°, the bone graft axis corresponded to the inferior endplate of the Ⅳ° compression healing vertebral body.Conclusions:The external axis from the pedicle (canal) to the endplate designed in the present anatomic study for compression healing fractures of the anterior vertebral column allows for safe and easy granular bone implantation due to the toughness of the cortical bone around the arch root (canal) in addition to the precise design of the bone graft axis from the pedicle to the endplate from T10 to L5.

Robot-assisted PVP for the treatment of osteoporotic fractures of the upper thoracic vertebra / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of "Tianji" orthopedic robot-assisted percutaneous vertebro plasty(PVP) surgery in the treatment of upper thoracic osteoporotic fracture.@*METHODS@#A retrospective analysis was performed on 32 patients with upper thoracic osteoporotic fracture who underwent PVP surgery in Shenzhen Hospital of Traditional Chinese Medicine from August 2016 to June 2022. There were 8 males and 24 females, ranging in age from 58 to 90 years old, with a mean of (67.75±12.27) years old. Fifteen patients were treated with robot-assisted PVP surgery (robot group), including 3 males and 12 females, with an average age of (68.5±10.3) years. Fracture location:1 case of T2 fracture, 1 case of T3 fracture, 3 cases of T4 fracture, 3 cases of T5 fracture, and 7 cases of T6 fracture. The follow-up period ranged from 1.0 to 3.0 months, with a mean of (1.6±0.7) months. Seventeen patients underwent routine PVP surgery (conventional group), including 5 males and 12 females, with an average age of (66.8±11.6) years old. Fracture location:1 case of T1 fracture, 5 cases of T4 fracture, 2 cases of T5 fracture and 9 cases of T6 fracture. The follow-up period ranged from 0.5 to 4.0 months, with a mean of (1.5±0.6) months. Preoperative and postoperative visual analogue scale(VAS) and Oswestry disability index(ODI) scores were compared between the two groups, and the number of punctures, perspective times, operation time, intraoperative blood loss, bone cement distribution, bone cement leakage, and intraoperative radiation dose were compared between the two groups.@*RESULTS@#Number of punctures times, perspective times, operation time, intraoperative blood loss, bone cement distribution, bone cement leakage and intraoperative radiation dose in the robot group were all significantly better than those in the conventional group(P<0.05). VAS of 2.03±0.05 and ODI of (22.16±4.03) % in the robot group were significantly better than those of the robot group before surgery, which were (8.67±0.25) score and (79.40±7.72)%(t=100.869, P<0.001;t=25.456, P<0.001). VAS of 2.17±0.13 and ODI of (23.88±6.15)% in the conventional group were significantly better than those before surgery, which were (8.73±0.18) score and (80.01±7.59)%(t=121.816, P<0.001;t=23.691, P<0.001). There was no significant difference in VAS and ODI between the two groups after operation (t=-3.917, P=0.476;t=-0.922, P=0.364).@*CONCLUSION@#Robot-assisted PVP in the treatment of upper thoracic osteoporotic fractures can further improve surgical safety, reduce bone cement leakage, and achieve satisfactory clinical efficacy.

Effectiveness of TiRobot-assisted and free-hand percutaneous kyphoplasty via pedicle of vertebra in treatment of osteoporotic vertebral compression fracture of thoracic vertebra / 中国修复重建外科杂志

OBJECTIVE@#To compare the effectiveness of TiRobot-assisted and C-arm X-ray fluoroscopy assisted percutaneous kyphoplasty (PKP) via pedicle of vertebra in the treatment of osteoporotic vertebral compression fracture (OVCF) of thoracic vertebrae.@*METHODS@#The clinical data of 85 patients with OVCF of thoracic vertebrae who were admitted between January 2020 and March 2023 and met the selection criteria was retrospectively analyzed including 40 patients (50 vertebrae) undergoing PKP assisted by TiRobot (group A) and 45 patients (50 vertebrae) undergoing PKP assisted by C-arm X-ray fluoroscopy (group B). There was no significant difference in the comparison of baseline data such as gender, age, body mass index, bone mineral density T-value, fracture segment, trauma history, and preoperative numerical rating scale (NRS) score, Oswestry disability index (ODI), and Cobb angle of injured vertebra between the two groups ( P>0.05). The effectiveness evaluation indexes of the two groups, including the operation time, the volume of injected cement, the times of fluoroscopies, the length of hospital stay, and the occurrence of postoperative complications were collected and compared. Anteroposterior and lateral X-ray films and CT of the injured vertebra were reviewed at 1 day after operation to observe whether there was cement leakage and to evaluate the distribution of cement in the injured vertebra. Before and after operation, pain was assessed using the NRS score, dysfunction was assessed using the ODI, and vertebral height recovery was assessed by measuring the Cobb angle of the injured vertebrae by X-ray films.@*RESULTS@#Both groups of patients successfully completed the operation, the operation time, the volume of injected cement, the times of fluoroscopies, and the length of hospital stay in group A were significantly less than those in group B ( P<0.05). The patients in two groups were followed up 4-12 months (mean, 9.6 months). Bone cement leakage occurred in 5 vertebrae in group A and 15 vertebrae in group B after operation, all of which leaked to the intervertebral space and around the vertebral body, and the patients had no obvious clinical symptoms. The difference of bone cement leakage between the two groups was significant ( P<0.05). No severe complication such as intraspinal leakage, infection, or vascular embolism was found in the two groups. At 1 day after operation, the distribution index of bone cement in group A was mostly grade Ⅴ, which was well dispersed; while in group B, it was mostly grade Ⅱ and grade Ⅴ; the difference of bone cement distribution index between the two groups was significant ( P<0.05). The NRS score, ODI, and Cobb angle of injured vertebra in both groups were significantly improved at 1 day after operation when compared with preoperative ones ( P<0.05). There was no significant difference in the difference of the above indexes between the two groups before and after operation ( P>0.05).@*CONCLUSION@#TiRobot-assisted unilateral PKP in the treatment of OVCF of thoracic vertebrae is safe and effective, which can reduce the X-ray transmission times during operation, shorten the operation time, reduce the volume of bone cement injection, and thus decrease incidence of bone cement leakage.

Percutaneous endoscopic visualization trephine for thoracic spinal stenosis / 西安交通大学学报(医学版)

【Objective】 To explore the surgical characteristics and clinical efficacy of percutaneous endoscopic visualization trephine for thoracic spinal stenosis. 【Methods】 We made a retrospective analysis of 37 patients with single-segment thoracic spinal stenosis treated with percutaneous endoscopic visualization trephine from January 2019 to June 2020. Among them， there were 14 males and 23 females； their age ranged from 31 to 82 years old， with an average of （57.6±11.8） years old. Their posture， length of hospital stay， length of operation and blood loss were recorded. The visual analogue scale （VAS）， Oswestry disability index （ODI） and the modified Japanese Orthopaedic Association （JOA） score were used to evaluate the preoperative and final conditions of patients and calculate the improvement rate. 【Results】 The operation was successfully completed in all the patients， and no patients developed epidural hematoma， incision infection or postoperative paralysis. Among the 37 patients， 24 ones with ossification of ligamentum flavum （OLF） were in the prone position， and 13 patients had lateral surgery. Among them， thoracic disc herniation （TDH） occurred in 3 cases， OPLL in 5 cases and OLF+OPLL in 5 cases. The hospital stay was （7.2±1.6） days， the operation time was （96.5±20.0） min， and the blood loss was （41.9±10.8） mL. VAS score decreased from （7.0±0.9） to （1.9±0.8）； ODI improved from （41.7±2.1） to （16.1±1.7）； and JOA score increased from （5.8±1.4） to （8.6±1.4）. The preoperative and postoperative differences were statistically significant （P<0.05）. 【Conclusion】 Percutaneous endoscopic visualization of thoracic spinal stenosis is treated by choosing different positions according to the type of compression. The spinal canal is fully decompressed. The surgical method is safe and minimally invasive， and the postoperative effect is satisfactory.

Morphometric description of thoracic vertebral pedicles in adult Malawian cadavers and implications for transpedicula spine fixation / Descripción morfometrica de los pedículos vertebrales torácicos en cadáveres de Malawi adultos e implicaciones para la fijación transpedicular de la columna

SUMMARY: Thoracic pedicles are important during the surgical repair of the thoracic spine deformities. Individuals show considerable differences in the asymmetric dimensions of the thoracic pedicles across populations. The purpose of this study was to determine the thoracic pedicle size and angle in adult Malawian cadavers and to suggest the clinical implications associated particularly the transpedicular fixation of spinal deformities. Adult thoracic vertebra from undetermined sex specimens (n=227) from the skeletal collection in the Anatomy Division, Biomedical Sciences Department, College of Medicine, University of Malawi were measured to assess the pedicle width, pedicle height, chord length, transverse diameter, interpedicular distance, transverse and sagittal pedicle angles. The mean pedicle width was 4.71 ± 1.83 mm (left side) and 4.82 ± 1.77 mm (right side) and the mean pedicle height was 12.63 ± 2.61 mm (left side) and 12.60 ± 2.54 mm (right side). The mean transverse pedicle angle was 12.22 ± 2.30 degrees (left side) and 12.46 ± 2.34 degrees (right side). The mean sagittal pedicle angle was 9.24 ± 2.67 degrees (left side) and 9.40 ± 2.76 degrees (right side). The mean interpedicular distance was 16.67 ± 2.23 mm. Our sample population generally showed smaller thoracic pedicle dimensions than those reported in other populations. Prior knowledge of the variations regarding the thoracic pedicle dimensions is vital for the determination of the pedicle screw size and design. Most importantly the information helps surgeons during preoperative planning of the transpedicular thoracic spine fixation and radiological interpretation.

RESUMEN: Los pedículos de las vértebras torácicas son importantes durante la reparación quirúrgica de las deformidades de la columna torácica. Los individuos muestran diferencias considerables en las dimensiones asimétricas de las vértebras torácicas entre poblaciones. El propósito de este estudio fue determinar el tamaño y el ángulo los pedículos de las vértebras torácicas en cadáveres de Malawi adultos y sugerir las implicaciones clínicas asociadas a la fijación transpedicular de las deformidades espinales. Se midieron 227 vértebras torácicas de muestras de individuos de sexo indeterminado de la colección esquelética en la División de Anatomía, Departamento de Ciencias Biomédicas, Facultad de Medicina, Universidad de Malawi para evaluar el ancho del pedículo, la altura del pedículo, la longitud, el diámetro transversal, distancia interpedicular y ángulos pediculares transversales y sagitales. El ancho medio del pedículo fue de 4,71 ± 1,83 mm (lado izquierdo) y 4,82 ± 1,77 mm (lado derecho) y la altura media del pedículo fue de 12,63 ± 2,61 mm (lado izquierdo) y 12,60 ± 2,54 mm (lado derecho). El ángulo pedicular transverso medio fue de 12,22 ± 2,3 grados (lado izquierdo) y 12,46 ± 2,34 grados (lado derecho). El ángulo pedicular sagital medio fue de 9,24 ± 2,67 grados (lado izquierdo) y 9,40 ± 2,76 grados (lado derecho). La distancia interpedicular media fue de 16,67 ± 2,23 mm. La población de esta muestra mostró dimensiones de los pedículos de las vértebras torácicas generalmente más pequeñas que las informadas en otras poblaciones. El conocimiento previo de las variaciones con respecto a las dimensiones de los pedículos de las vértebras torácicas es vital para la determinación del tamaño y diseño del tornillo pedicular. Lo más importante es que la información ayuda a los cirujanos durante la planificación preoperatoria para la fijación transpedicular de la columna torácica y su interpretación radiológica.

Anatomic measurement and clinical significance of the middle and lower thoracic segments in normal adults / Medición anatómica e importancia clínica de los segmentos torácico medio e inferior en adultos normales

Thoracic disc herniation (TDH) has high technical difficulty and serious complications, and the clinical anatomy of thoracic intervertebral foramen is less. Collecting 10 adult male cadavers, measuring the longitudinal diameter of the dorsal root ganglion (D1), the transverse diameter of the dorsal root ganglion (D2), horizontal sagittal diameter of the upper edge of the intervertebral disc (S1), the high of intervertebral foramen (H1), the height of articulationes costovertebrales (H2), the height of intervertebral disk (H3), the angel of the dorsal root ganglion (a). The aim of this study is to explore the safe area of middle and lower thoracic section and provide anatomical basis for the selection of operative cannula. Mastering the certain rules of the anatomical structure of the middle and lower thoracic segments, and referring to the above parameters in clinical, is conducive to the selection of the working casing during surgery.

La hernia de disco torácico (TDH) tiene una alta dificultad técnica y complicaciones graves, y la anatomía clínica del agujero intervertebral torácico es menor. Recolectando 10 cadáveres machos adultos, midiendo el diámetro longitudinal del ganglio de la raíz dorsal (D1), el diámetro transversal del ganglio de la raíz dorsal (D2), el diámetro sagital horizontal del borde superior del disco intervertebral (S1), el colmo del intervertebral agujero (H1), la altura de las articulaciones costovertebrales (H2), la altura del disco intervertebral (H3), el ángel del ganglio de la raíz dorsal (α). El objetivo de este estudio es explorar el área segura de la sección torácica media y baja y proporcionar una base anatómica para la selección de la cánula operatoria. Dominar ciertas reglas de la estructura anatómica de los segmentos torácicos medio e inferior, y referirse a los parámetros anteriores en clínica, es propicio para la selección de la carcasa de trabajo durante la cirugía.

Digital measurements of the anatomical parameters of pedicle-rib unit screw fixation in thoracic vertebrae of preschoolers / 中国组织工程研究

BACKGROUND: Pedicle screw internal fixation has been widely used in the lumbar spine, and fixed application in thoracic vertebra has gradually been accepted. Considering the narrow thoracic pedicle, especially at T3-T9, pedicle screw always punctures the cortex and important adjacent structures. To avoid serious complications, researchers developed the external pedicle approach from the costal transverse process joint and the costal vertebra joint to the vertebral body, and then others designed a similar screw entry method, which can provide enough safe paths as long as the ribs are not penetrated. At present, the existing studies mainly focus on the upper and middle thoracic vertebrae in adults. OBJECTIVE: To measure the anatomical parameters of pedicle-rib unit screw fixation in thoracic vertebrae of preschoolers, and to explore their developmental regularity and morphological characteristics at different age groups and sexes, so as to provide theoretical basis for clinical practice. METHODS: Sixty-seven preschoolers aged 7-12 years old without bone destruction, tumor, deformity, degeneration or fractures at the spine and no history of spine related surgery were selected. Three-dimensional reconstruction was conducted after spiral CT scanning. The morphological structure of pedicle-rib unit was observed. The transverse diameter, length, inclination angle and safety angle range of pedicle-rib unit screw were measured and analyzed statistically to investigate the feasibility of screw on anatomy. All guardians of the children signed the informed consents, and the study was approved by the hospital ethical committee. RESULTS AND CONCLUSION: (1) The transverse diameter of the thoracic pedicle-rib unit was increased with age, and decreased first and then increased with the increase of vertebral sequence. The transverse diameter in males was larger than in females at the same age. (2) The length of pedicle-rib screw channel was significantly different in different age groups (P < 0.05), which showed a significant increase with age and a trend of first increase and then decrease with the increase of vertebral sequence. (3) Pedicle-rib unit screw placement showed that safety angle range was 18°-25°, including maximum safety scope in T1, followed by T|0, minimum in T4 and T5. (4) Thus, security angle range of pedicle-rib unit screw in children is narrower than that in adults. Compliance with the adult standards in screw placement may cause severe nerve damage to the nerves and blood vessels, so preoperative individualized screw placement should be carried out according to the CT results.

Comparative analysis on biomechanical stability of the lateral fixation of the upper thoracic vertebrae through the middle Axillary approach and the traditional anterior plate fixation / 中国组织工程研究

BACKGROUND: With the comprehensive promotion of spinal internal fixation technology, the remodeling of spinal mechanical stability has attracted more and more attention. Lateral internal fixation via axillary midline transthoracic approach for the treatment of upper thoracic vertebra lesion is a new surgical approach. Currently, the research on the biomechanics of upper thoracic vertebra after fixation is relatively rare. OBJECTIVE: To evaluate whether the reconstruction of upper thoracic vertebrae via axillary midline transthoracic approach can achieve the requirements of biomechanical stability by biomechanical analysis of three-dimensional motion stability and load-bearing strength of upper thoracic vertebrae in lateral and anterior internal fixation models. METHODS: The C7-T6 spine and bilateral rib cage joint specimens were obtained from 12 human cadaveric bodies, and the three-dimensional motion stability test of the complete upper thoracic vertebrae model was performed and recorded as a complete vertebral body group. Subsequently, the specimens were randomly divided into two groups, and the traditional front plate internal fixation (front internal fixation group) and the axillary line into the thoracic cavity side plate internal fixation models (lateral internal fixation group) were established, respectively, with six specimens in each group. Three-dimensional motion test, vertical pressure test and vertical pressure failure test were performed. This study was approved by the Ethics Committee of Second Affiliated Hospital of Guangxi Medical University (approval No. 2017(KY-0080)). RESULTS AND CONCLUSION: (1) The load of left vertebral body group under left/right flexion, flexion/posterior extension and left/right rotational motion was smaller than that of lateral internal fixation group and anterior internal fixation group (P 0.05). (2) When the load reached 600 N, the vertebral body sinking displacement of the front internal fixation group was smaller than in the lateral internal fixation group [(1.39±0.20), (2.15±0.17) mm, P< 0.01]. (3) There was no significant difference in the maximum intensity load between the anterior internal fixation group and the lateral internal fixation group [(1 839.70±122.45), (1 798.65±120.21) N, P=0.571], (4) Results showed that the axillary midline transthoracic approach was in the lateral steel plate. The fixation is stable and meets the biomechanical needs of spinal reconstruction.

Antedisplacement and fixation of thoracic vertebra-ossification of posterior longitudinal ligament complex for treatment of severe multi-level thoracic ossification of posterior longitudinal ligament / 第二军医大学学报

Objective: To introduce a technical innovation for the treatment of severe multi-level thoracic ossification of posterior longitudinal ligament (OPLL). Methods: The detailed surgical procedure included isolation of vertebra-OPLL complex (VOC), implantation of screws and rods, and antedisplacement of the VOC. A patient diagnosed as multi-level thoracic OPLL with myelopathy was treated by this technique and the outcomes were reported. Results: Neurological outcomes achieved an evident improvement, with the recovery rate of modified-Japanese Orthopaedic Association score being 75%. The operation took 480 min and the intraoperative bleeding was 1 000 mL. Postoperative computed tomography and magnetic resonance imaging showed sufficient decompression of spinal cord. The occupation ratio of spinal canal improved from 86.6% to 58.8% in T2/3, and from 68.2% to 45.9% in T3/4. Conclusion: Posterior thoracic vertebra-OPLL complex antedisplacement and fixation is a feasible, theoretically safe and effective surgical option for the treatment of severe multi-level thoracic OPLL with myelopathy. The operation is simple and performed outside the spinal canal, and no ossified mass is removed. However, further studies with large-scale cases and control groups are required to reveal the applicability and safety of this technique.

Sex Estimation of Typical Adult Vertebrae Morphology in Central China Based on CT Technique / 法医学杂志

Objective The morphological data of the second thoracic vertebra and the third lumbar vertebra were measured by computerized tomography （CT）. The sex differences were analyzed and the discrimination equation was obtained. Methods The data of 274 adults （203 cases from experimental group and 69 cases from validation group） from central China were collected. Four linear data （maximum transverse length of vertebral body, maximum longitudinal length of vertebral body, maximum transverse length of vertebral foramen, maximum longitudinal length of vertebral foramen）, one angle data （angle between spinous processes） and two area （vertebral foramen area, total cross-sectional area of vertebral body） data of the second thoracic vertebra and the third lumbar vertebra were collected, respectively. Then three ratios ［maximum transverse length/　maximum longitudinal length of vertebral body, maximum transverse length/ maximum longitudinal length of vertebral foramen, vertebral foramen area/ （total cross-sectional area of vertebral body-vertebral foramen area）］ and one angle （angle between spinous processes） were obtained. The discriminant equation was established for sexual discriminant analysis. Results The morphology of the second thoracic vertebra and the third lumbar vertebra was related with gender. Four single index discriminant formulae and eleven multi-index discriminant formulae were established. The 69 validation group samples were substituted into the formula for testing, and the maximum discriminant accuracy rate of the single-index discriminant formula was 75%. The maximum discriminant accuracy rate of multi-index discriminant formula was 83%. Conclusion It is feasible to conduct individual sex analysis by the morphological indexes of second thoracic vertebra and the third lumbar vertebra. The indexes have important application values in practice.

Feasibility of bone mineral density of T12 measured with quantitative CT for replacing abnormal lumbar vertebrae for diagnosis of osteoporosis / 中国医学影像技术

Objective: To explore the feasibility of bone mineral density (BMD) of T12 for replacing abnormal L1 or L2 for diagnosis of osteoporosis during lung cancer screening with low-dose CT and bone mineral density examination with quantitative CT. Methods: Totally 1 298 healthy individuals who underwent lung cancer screening with low-dose CT and BMD examination with quantitative CT were enrolled. BMD of T12 to L2 vertebrae were measured, and the calibrated BMD of T12 was calculated and recorded as T12*. Taking L1+L2 as diagnostic criteria, the consistencies in bone mass assessment and the differences in diagnosis of osteoporosis among vertebral combinations of T12+L1, T12+L2, T12*+L1, T12*+L2 and L1+L2 were analyzed, respectively. Results: There were good consistencies between vertebral combinations and L1+L2 in bone mass assessment (all Kappa>0.75, all P98%. The sensitivities of T12+L1 and T12+L2 in osteoporosis diagnosis were 73.33% (143/195) and 77.95% (152/195), respectively, whereas of T12*+L1 and T12*+L2 in osteoporosis diagnosis were 83.08% (162/195) and 90.26% (176/195), respectively. Conclusion: BMD of T12 for replacing abnormal L1 or L2 during quantitative CT can reduce the sensitivity in diagnosis of osteoporosis, therefore BMD of T12 should be calibrated in measurement.

Clinical application of vertebral arch-transverse pathway in pedicle screw implantation / 中国修复重建外科杂志

Objective: To investigate the safety and effectiveness of pedicle screw implantation via vertebral arch-transverse pathway in clinical application by a prospective randomized controlled trial. Methods: Twenty-four patients who were admitted between May 2015 and June 2017 and met the selection criteria for thoracic pedicle screw fixation were included in the study. According to the random number table method, they were divided into the trial group (screw implantation via vertebral arch-transverse pathway) and the control group (traditional screw implantation technology), with 12 patients in each group. There was no significant difference between the two groups in age, gender, cause of injury, injured segment, and the interval between injury and operation (P>0.05). The time of screw implantation was recorded and compared between the two groups. The acceptable rate of screw implantation and the penetration rate of pedicle wall were calculated after operation. Results: The time of screw implantation of trial group was (5.08±1.74) minutes, which was significantly shorter than that of control group [(5.92±1.66) minutes], and the difference was significant (t=4.258, P=0.023). Patients in both groups were followed up 1-2 years, with an average of 1.5 years. During the follow-up, no failure of internal fixation occurred. At 1 week after operation, the screw implantation in trial group was rated as gradeⅠin 54 screws, gradeⅡ in 3 screws, and grade Ⅲ in 2 screws, with the acceptable rate of 93.61%. The screw implantation in control group was rated as gradeⅠin 40 screws, grade Ⅱin 10 screws, grade Ⅲ in 8 screws, and grade Ⅳ in 1 screw, with the acceptable rate of 84.75%. There was significant difference in the acceptable rate of screw implantation between the two groups (χ2=3.875, P=0.037). The penetration rate of pedicle wall in trial group was 8.47% (5/59), which was significantly lower than that in the control group [32.20% (19/59); χ2=4.125, P=0.021]. Conclusion: Compared with the traditional technique, the pedicle screw implantation via vertebral arch-transverse pathway can obtain a good position of the screw canal with higher accuracy and simpler operation.

Gender determination by Morphometry measuring of the 12th thoracic vertebra three-dimensional reconstruction image / 中国法医学杂志

Objective This article aims to investigate the effect of gender determination for measuring the 12th Thoracic Vertebra by using computed tomography (CT) and explore the feasibility for the research of human skeleton measuring by CT technique in the ifeld of forensic anthropology.Methods After ascertaining 11 radial line indicators,we measured Multi-planner Reformation (MPR)image of the 12th Thoracic Vertebra. Four ratio indicators were calculated after eliminating measurement uncertainty of results. We inspected the effect of gender determination for measuring the 12th Thoracic Vertebra by using computed tomography (CT) on account of statistical measurement data.Results Gender determination of 12 indicators is remarkable after eliminating 3 unstable indicators. Sevene quations were established. The equation established by centrum indicators predicted sex up to 91.6% accuracy.Conclusion The morphometry indicators of 12th Thoracic Vertebra have gender difference. CT technology can accurately measure skeleton and is valuale for study of human skeleton measuring research in the ifeld of forensic anthropology.

Effects of thinned cap uncovering technique on treatment for thoracic ossification of ligamentum flavum / 西安交通大学学报(医学版)

Objective To summarize the outcome of treatment for thoracic vertebra ossification of ligamentum flavum (OLF)with en-bloc removal of the spinal canal’s posterior wall termed as the “thinned cap uncovering”technique.Methods From 2003 to 2013,56 patients with OLF were treated with thinned cap uncovering technique.In this group,there were 40 male patients and 1 6 female ones,with the average age of 45 years (range of 30-65 years)and the average history of 3 years.The 56 patients were followed up for an average duration of 2 years and 7 months (1-5 years).Results According to WANG’s evaluation,45 cases (about 80%) had excellent results,9 cases (about 1 6%)had good results,and 3 cases had improved symptoms,the excellence to good rates being 96%.Conclusion Removal of the posterior wall of the spinal canal via “thinned cap uncovering”technique is a reliable and effective treatment for thoracic OLF.The strategy for successful operation is to use high speed drill to cut bone accurately,which allows discectomy for thoracic vertebra and to diminish faults and complications during the surgical procedure.

Analysis of 150 cases from measuring sternal angle corresponded to thoracic plane by three-dimensional recon-struction of spiral CT / 局解手术学杂志

Objective To measure the sternal angle corresponded to thoracic plane by three-dimensional reconstruction of spiral CT , and to explore the accurate positioning methods and the preoperative assessment of cervicothoracic junction lesions .Methods Selected 42 cases of normal bone mass , 48 cases with bone loss , and 60 cases of osteoporosis who were diagnosed by dual-energy X-ray absorptiometry , and measured the location of thoracic sternal angle corresponded to the thoracic spine and thoracic kyphosis angle through the volume recon -struction data of the 16-slice spiral CT chest examinations .Results The range of sternal angle corresponded to thoracic plane was measure-ment units ⅢtoⅥ.The measure unit Ⅳwas the most, accounting for about 55%.There was no statistical significance between the position of sternal angle corresponded to thoracic plane and the relationship of bone mass , which required further study .The position of sternal angle corresponded to thoracic plane was associated with the thoracic kyphosis angle .The larger the thoracic kyphosis angle , the lower the corre-sponding position was .Conclusion The thoracic segment corresponded to the sternal angle is not a constant or accurate plane , which is not properly concerned as an accurate positioning mark to the thoracic segment .The measurement of the thoracic sternal angle was corresponded to the thoracic spine location , and its co-relationship evaluation between the thoracic kyphosis angle was vital for the accurately positioning of cervico-thoracic junction area lesions , the pre-assessment methods of surgical treatment , approach selection , and different methods for ster-num and other such contents .This research was of important clinical significance .

Short-term currative effect of horizontal osteotomy across injured vertebral forⅤdegree old fracture-disloca-tions of thoracolumbar spine / 局解手术学杂志

Objective To discuss the short-term currative effect of horizontal osteotomy across injured vertebral forⅤdegree old frac-ture-dislocations of thoracolumbar spine.Methods The data of 4 patients who received horizontal osteotomy across injured vertebral internal fixation in our hospital from April 2010 to October 2012 were retrospectively analyzed,of which 1 case with T8-9 fracture dislocation,2 cases with T10-11 fracture dislocation,1 case with T11-12 fracture dislocation.The Franke1 classification of all patients were grade A.Results All 4 cases were achieved completely fracture reduction and followed-up for 2-14 months(an average of 7.4 months),who could get sitting posi-tion with the support of brace 1 week after operation.The postoperative follow-up indicated that all 4 cases got fusion,but there was no improve-ment for Franke1 classification.Conclusion The method of horizontal osteotomy across injured vertebral forⅤdegree old fracture-dislocations of thoracolumbar spine has good short-term clinical effect,with the advantages of shorter operation time,less bleeding and good reduction effect.

A Rare Case of Monostotic Spinal Fibrous Dysplasia Mimicking Solitary Metastatic Lesion of Thyroid Carcinoma

Monostotic fibrous dysplasia of the vertebra is a rare entity. A case of a 53-year-old lady who presented with an 8 months history of pain in the thoracic spine region with paraparesis is discussed. She had a history of papillary thyroid carcinoma and had undergone total thyroidectomy one year prior to her current problem. Magnetic resonance imaging revealed isolated osteolytic lesion over the posterior element of the T12 vertebra with narrowing of the spinal canal causing compression of the cord. The diagnosis of fibrous dysplasia was made histologically. Fibrous dysplasia rarely occurs in axial bones compared with peripheral bones. This case illustrates that osteolytic lesion of the vertebrae should be evaluated with detailed radiological and histopathological examination before an empirical diagnosis of spinal metastasis is made in an adult with a background history of primary malignancy well-known to spread to the bone.

Damage control in thoracic and lumbar unstable fractures in polytrauma. Systematic review / Controle de danos em fraturas instáveis torácica e lombar em politraumatizados. Revisão sistemática / Control de daños en fracturas torácicas y lumbares inestables en politraumatizados. Revisión sistemática

The objective of this systematic review was to integrate the information from existing studies to determine the level of evidence and grade of recommendation of the implementation of damage control in unstable thoracic and lumbar fractures in polytraumatized patients. Eighteen papers were collected from different databases by keywords and Mesh terms; the level of evidence and grade of recommendation, the characteristics of the participants, the time of fracture fixation, the type of approach and technique used, the length of stay in the intensive care unit, the days of dependence on mechanical ventilator, and the incidence of complications in patients were assessed. The largest proportion of the studies were classified as level 4 evidence and grade C of recommendation which is favorable to the implementation of damage control in unstable thoracic and lumbar fractures in polytraumatized patients as a positive recommendation, although not conclusive. Most papers advocate fracture stabilization within 72 hours of the injury which is associated with a lower incidence of complications, hospital stay, stay in the intensive care unit and lower mortality.

O objetivo desta revisão sistemática foi integrar as informações dos estudos existentes para determinar o nível de evidência e grau de recomendação da aplicação do controle de danos em fraturas torácica e lombar instáveis em pacientes com politraumatismo. Foram incluídos 18 artigos encontrados em diferentes bancos de dados, usando-se palavras-chave e termos do MeSH; avaliaram-se: nível de evidência e grau de recomendação, características dos participantes, momento em que se realizou a fixação da fratura, tipo de acesso e a técnica utilizada, dias de permanência na unidade de terapia intensiva, os dias de dependência de ventilação mecânica e a incidência de complicações dos pacientes. A maior proporção de artigos foi classificada como nível 4 de evidência, com predomínio do grau C de recomendação, o que torna favorável à implementação do controle de danos em fraturas torácicas e lombares instáveis em pacientes com politraumatismo, não sendo, contudo, concludente. A maioria dos artigos preconiza a estabilização da fratura nas primeiras 72 horas da lesão, o que está associado a menor incidência de complicações, permanência hospitalar, permanência na unidade de terapia intensiva e a menor mortalidade.

El objetivo de esta revisión sistemática fue integrar la información de los estudios existentes para determinar el nivel de evidencia y grado de recomendación de la aplicación del control de daños en fracturas torácicas y lumbares inestables en pacientes politraumatizados. Se incluyeron 18 artículos localizados en diferentes bases de datos a través de palabras clave y términos del MeSH; se valoró el nivel de evidencia y grado de recomendación, las características de los participantes, el momento en que se realizó la fijación de la fractura, el tipo de abordaje y técnica utilizada, los días de estancia en la unidad de terapia intensiva, los días dependientes de ventilador mecánico y la incidencia de complicaciones de los pacientes. La mayor proporción de los estudios se catalogaron como nivel de evidencia 4 y se obtuvo un grado C de recomendación como predominante lo cual coloca la aplicación de control de daños a fracturas torácicas y lumbares inestables en pacientes politraumatizados como una recomendación favorable pero no concluyente. La mayoría de los artículos abogan por una estabilización de la fractura en las primeras 72 horas de la lesión lo cual se asocia a menor incidencia de complicaciones, estancia hospitalaria, estancia en la unidad de cuidados intensivos y menor mortalidad.

Treatment for thoracolumbar spine infection without removing internal fixation / 中国组织工程研究

BACKGROUND:Surgical site infection of instrumented thoracolumbar spine is not rare and may induce serious consequences. There’s controversy about whether to remove the internal fixation in the treatment of infection. OBJECTIVE: To evaluate the safety of the treatment for surgical site infection of thoracolumbar spine without removing internal fixation. METHODS:A total of 358 patients underwent thoracolumbar internal fixation in Department of Orthopedics, the Fourth People’s Hospital of Zigong City, between March 2008 and December 2012. Among them, 13 cases appeared surgical site infection of instrumented thoracolumbar spine, including 5 males and 8 females. The average age of the 13 cases was 54.5 years (31-65 years). After patients were treated with aggressive debridement, irrigation and anti-infective therapy, the wound healings were evaluated. The hemanalysis, erythrocyte sedimentation rate, C-reactive protein and visual analogous scale score were analyzed and compared before debridement and 6 months after debridement. RESULTS AND CONCLUSION: The 13 patients had surgical site infection of instrumented thoracolumbar spine during 1 to 13 months post-operation. After timely diagnosis, aggressive debridement and irrigation, as wel as sensitive antibiotic therapy, 12 patients succeeded in curing infection and retaining implants. 1 patient with T12 fracture removed the fixation and cured infection. The folow-up time was 8-40 months, no case recurred. The hemanalysis, erythrocyte sedimentation rate, C-reactive protein and visual analogous scale score showed significant difference before debridement and 6 months after debridement (P < 0.05). Postoperative infection after thoracolumbar internal fixation should be timely diagnosis and receive surgical treatment. Through aggressive debridement, irrigation and sensitive antibiotic therapy, most patients can be cured without removing internal fixation.

Comparison of risk of tumor invasion and metastasis under paravertebral block combined with general anesthesia versus general anesthesia in the patients undergoing radical lung cancer resection performed via video-assisted thoracoscope:plasma VEGF and M / 中华麻醉学杂志

Objective To compare the risk of tumor invasion and metastasis under paravertebral block (PVB) combined with general anesthesia versus general anesthesia in the patients undergoing radical resection for lung cancer performed via video-assisted thoracoscope in terms of plasma concentrations of vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9).Methods Forty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 30-64 yr,with body mass index of 18-25 kg/m2,scheduled for elective radical resection for lung cancer performed via video-assisted thoracoscope,were randomly divided into 2 groups (n =20 each) using a random number table:general anesthesia group (group G) and PVB combined with general anesthesia (group PG).PVB of T4-7 was performed successfully with local injection of 0.375％ ropivacaine 5 ml before induction of anesthesia.Double-lumen endotracheal tube was placed after induction of anesthesia,and the patients were mechanically ventilated.Anesthesia was maintained with inhalation of sevoflurane (end-tidal concentration 1％-2％),and intravenous infusion of remifentanil 0.2-0.3 μg · kg-1 · min-1,and intermittent intravenous boluses of atracurium.Before anesthesia and at 24 h after surgery,the venous blood samples were collected for measurement of plasma concentrations of VEGF and MMP-9.Results The plasma VEGF and MMP-9 concentrations were significantly lower after surgery in group PG than in group G.Conclusion PVB combined with general anesthesia significantly decreases the risk of tumor invasion and metastasis in the patients undergoing radical lung cancer resection performed via video-assisted thoracoscope in comparison to general anesthesia.