RESUMO
BACKGROUND:Lumbar pedicle screw placement technique is a very mature technology in spinal surgery.There are many methods for determining the screw entry points and direction in the clinic.However,for patients with severe lumbar facet degeneration,severe osteophytosis can be found in the surgical area.Smooth and accurate screw placement has some difficulties.OBJECTIVE:To observe the effects of screw placement simulation using Mimics software on pedicle screw fixation before repair of severe lumbar facet joint degeneration.METHODS:A total of 78 cases of severe lumbar zygapophysial degeneration evaluated by CT and MR,who received single-segment lumbar pedicle screw fixation,were enroled in this study.They were randomly dividedinto two groups,including simulation screw group (n=39) and control group (n=39).Totaly 312 pedicle screws were implanted in the two groups.In the simulation screw group,Mimics software was used to perform 3D reconstruction before surgery and to simulate vertebral pedicle screw operation.In the 3D images,screw entry points and surrounding bony landmarks of pedicle screw were observed.The angle and depth of screw placement were measured.During the operation,pedicle screw placement was conducted in accordance with above results of observation and measurement.In the control group,pedicle screw was implanted according to the conventional method.After treatment,an X-ray CT examination was performed in the evaluation of the accuracy of pedicle screw placement.RESULTS AND CONCLUSION:No postoperative complication occurred in the simulation screw group.153 of 156 screws were located in vertebral pedicle in the postoperative examination.The correct rate of screw placement was significantly higher in the simulation screw group than in the control group (98.1％,88.5％,χ2=11.49,P＜0.05).The operation time,amount of bleeding and radiation exposure time were significantly shorter in the simulation screw group than in the control group (P＜0.05).These findings indicate that the lumbar facet joint degeneration accounted for a large proportion in patients with lumbar pedicle screw fixation.Facet joint degeneration increases the difficulties on distinguishing anatomical landmarks of insertion point,which brings a great difficulty for screw placement.The simulation of Mimics software in screw placement can improve accuracy in pedicle screw fixation in patients with severe lumbar facet joint degeneration,reduce complications,operation time,amount of bleeding,and radiation exposure time.
RESUMO
BACKGROUND:In traditional single open door surgery for cervical spondylosis, door shaft fixation such as suture suspension was used to maintain the open status of vertebral plate, but the fixation effect was not ideal. OBJECTIVE:To probe into the clinical application of Neulen titanium plate instrument and open-door bone grafting in patients with different types of cervical spondylosis. METHODS: A total of 32 patients were treated with Neulen titanium plate instrument and open-door bone grafting in unilateral open-door laminoplasty. RESULTS AND CONCLUSION:A total of 32 patients with cervical spondylosis were folowed up for at least 6 months. Neurological function of these patients improved significantly. JOA score improved from (8.7±3.6) to (14.6±2.4), with an improvement rate of (63.3±8.9)% (P < 0.05). In folow-up at 6 months after treatment, X-ray and CT revealed that pivot side crack had disappeared, and spinal canal expansion was satisfactory. No loose, breakage, displacement or re-closing appeared. Results suggested that Neulen titanium plate fixation or open-door side bone grafting could maintain opening state in treatment using cervical posterior single door. Fusion rate of bone graft surrounding titanium plate was 78%. Fork design of both sides of titanium plate made less screws achieve high biomechanical stability. Titanium plate fixation obtained rigid support, but not elastic fixation on the door open side, obtained immediate stability of door shaft side, and easily resulted in bone fusion.
RESUMO
[Objective]To discuss the clinical and the biological significance of the expression of residual tumor cells MTA1 in the occurrence and progression of osteosarcoma after chemotherapy,and to investigate the correlation between MTA1 expression and the prognosis in osteosarcoma patients.[Method]SP immunohistochemical technique was used to detect the expression of MTA1 in the residual tumor cells from 31 osteosarcoma patients after chemotherapy.[Result]Among 17 patients with positive MTA1 expression,6 had good prognosis(35.29%);and among 14 patients with negative MTA1 expression,11 had good prognosis(78.57%).There were significant differences between groups(P