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【Objective】 To study the clinical practice and early outcome of percutaneous full-endoscopic modified posterior lumbar interbody fusion（mPLIF）combined with pedicle screw fixation through paraspinal muscle clearance. 【Methods】 A retrospective study was conducted to analyze the clinical data of patients with lower lumbar spinal diseases treated from May 2019 to April 2020. All the enrolled patients received mPLIF combined with pedicle screw fixation through paraspinal muscle clearance. The follow-up period was more than 1 year； the general parameters included age， gender， duration of disease， diagnosis of disease， surgery segment， and postoperative hospitalization time. Operation parameters included operation time and blood loss. We obtained the clinical parameters such as visual analogue scale （VAS） score for back and lower extremity， Oswestry disability index （ODI） score， and Macnab satisfaction score at the last follow-up. We evaluated the imaging parameters including intervertebral disc height， segmental lordosis angle， lumbar lordosis angle， as well as fusion outcome of patients with single segmental lumbar disease. In addition， intraoperative and postoperative complications were recorded. 【Results】 Totally 18 patients met the inclusion criteria， among whom 8 were male and 10 were female， with the average age of （53.3±8.3） years old and the average duration of disease being （28.9±36.6） months. Among them 16 patients were diagnosed as lumbar degenerative disease and the other 2 had lumbar disc infection. One patient received L3-L4 and L4-L5 intervertebral fusion； the others had one-segmental fusion， among which 11 cases were L4-L5 and 6 cases were L5-S1. The average operation time was （207.8±31.7） min， and the average blood loss was （25.6±7.8） mL， and the mean postoperative hospitalization time was （6.56±2.30） days. VAS scores of back and lower extremities at postoperative 1 week， 6 months and the last follow-up were statistically significantly improved from the preoperative scores. ODI scores at postoperative 6 months and the last follow-up were also statistically significantly improved. The rate of excellent and good according to the Macnab criteria was 94.4%. For the 17 single-level fusion patients， intervertebral height was significantly higher postoperatively and at the last follow-up compared with that of the preoperative one （P<0.05）. Segmental lordosis angle was bigger postoperatively and at the last follow-up （P>0.05）， which was not statistically significant. Lumbar lordosis angle was significantly bigger postoperatively （P<0.05） and bigger at the last follow-up， but with no statistical significance （P>0.05）. The fusion rate at the last follow-up was 88.2%. The cage broke in the process of implantation in one patient. A cage retroposition occurred in one patient at the follow-up. 【Conclusion】 Percutaneous full-endoscopic modified posterior lumbar interbody fusion combined with pedicle screw fixation through bilateral paraspinal muscle clearance by one incision showed excellent clinical outcomes in treating many kinds of lower lumbar diseases. This operation should be an excellent option for lower lumbar fusion.
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Objective To investigate the application effect of electric drill drive in the preparation of atlanto-axial posterior screw trajectory.Methods A retrospective case-control study was conducted to analyze the clinical data of 29 patients with atlanto-axial fracture and dislocation admitted to the Lanzhou University Second Hospital from February 2016 to March 2019.There were 19 male and 10 females,aged from 10 to 72 years,with an average of 44.6 years.All patients received posterior atlantoaxial screw fixation.Electric drill drive was adopted in 14 patients to prepare the screw trajectory (electric drill group),and bare hand technique was used in 15 patients (bare hand group).In the electric drill group,28 atlantal lateral screws and 28 axial pedicle screws were implanted;in the free hand group,30 atlantal lateral screws and 30 axial pedicle screws were implanted.The trajectory preparation time and intraoperative blood loss between the two groups were compared.After the operation,the X-ray films and 3D CT were taken to observe the lateral mass of atlas as well as the position,loosening or rupture,and bone healing of axial pedicle screws,and complications.Frankel grading and visual analogue scale (VAS) at the last follow-up were compared between the two groups.Results All patients were followed up for 3 to 36 months,with an average of 21 months.The electric drill group took significantly shorter time in preparing both atlantal and axial pedicle screw trajectories than the bare hand group [(8.8 ±4.2)minutes ∶ (16.5 _±9.7)minutes;(4.1 ± 1.2)minutes∶ (6.1 ±3.2)minutes] (P＜0.05).There was no significant difference in intraoperative blood loss between the electric drill group and the bare hand group [(54.2 ± 32.0) ml ∶ (58.0 ± 28.4) ml] (P ＞ 0.05).In the electric drill group,the penetration rate of atlantal screws was 0,the complete position rate was 96％ (27/28),and the good rate of screw placement was 100％ (28/28),superior to 23％ (7/30),73％ (22/30) and 73％(22/30) in the bare hand group (P ＜ 0.05).In terms of the axial screws,in the electric drill group,the panetration rate was 4％ (1/28),the complete position rate was 82％ (23/28),and the good rate of screw placement was 96％ (27/28),superior to 10％ (3/30),70％ (21/30) and 93％ (28/30) in the bare hand group (P ＞ 0.05).There were no complications such as cerebrospinal fluid leakage,spinal cord injury,cerebellar infarction,loosening and fracture of internal fixation,and nonunion of bone.At the last follow-up,Frankel grading and VAS of the two groups were improved to different degrees (P ＜0.05),but there was no significant difference between the two groups (P ＞ 0.05).Conclusion For atlantoaxial fracture and dislocation,preparation of atlantoaxial internal fixation screw trajectories by electric power can significantly shorten the operation time and improve the accuracy of atlas screw placement.
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Objective@#To investigate the application effect of electric drill drive in the preparation of atlanto-axial posterior screw trajectory.@*Methods@#A retrospective case-control study was conducted to analyze the clinical data of 29 patients with atlanto-axial fracture and dislocation admitted to the Lanzhou University Second Hospital from February 2016 to March 2019. There were 19 male and 10 females, aged from 10 to 72 years, with an average of 44.6 years. All patients received posterior atlantoaxial screw fixation. Electric drill drive was adopted in 14 patients to prepare the screw trajectory (electric drill group), and bare hand technique was used in 15 patients (bare hand group). In the electric drill group, 28 atlantal lateral screws and 28 axial pedicle screws were implanted; in the free hand group, 30 atlantal lateral screws and 30 axial pedicle screws were implanted. The trajectory preparation time and intraoperative blood loss between the two groups were compared. After the operation, the X-ray films and 3D CT were taken to observe the lateral mass of atlas as well as the position, loosening or rupture, and bone healing of axial pedicle screws, and complications. Frankel grading and visual analogue scale (VAS) at the last follow-up were compared between the two groups.@*Results@#All patients were followed up for 3 to 36 months, with an average of 21 months. The electric drill group took significantly shorter time in preparing both atlantal and axial pedicle screw trajectories than the bare hand group [(8.8±4.2)minutes ∶(16.5±9.7)minutes; (4.1±1.2)minutes∶ (6.1±3.2)minutes] (P<0.05). There was no significant difference in intraoperative blood loss between the electric drill group and the bare hand group [(54.2±32.0)ml ∶ (58.0±28.4)ml] (P>0.05). In the electric drill group, the penetration rate of atlantal screws was 0, the complete position rate was 96% (27/28), and the good rate of screw placement was 100% (28/28), superior to 23% (7/30), 73% (22/30) and 73%(22/30) in the bare hand group (P<0.05). In terms of the axial screws, in the electric drill group, the panetration rate was 4% (1/28), the complete position rate was 82% (23/28), and the good rate of screw placement was 96% (27/28), superior to 10% (3/30), 70% (21/30) and 93% (28/30) in the bare hand group (P>0.05). There were no complications such as cerebrospinal fluid leakage, spinal cord injury, cerebellar infarction, loosening and fracture of internal fixation, and nonunion of bone. At the last follow-up, Frankel grading and VAS of the two groups were improved to different degrees (P<0.05), but there was no significant difference between the two groups (P>0.05).@*Conclusion@#For atlantoaxial fracture and dislocation, preparation of atlantoaxial internal fixation screw trajectories by electric power can significantly shorten the operation time and improve the accuracy of atlas screw placement.
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Objective To explore the effect of spinal sagittal balance on secondary vertebral fracture after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCF).Methods The data were reviewed of the patients with single segmental OVCF who had undergone PKP at Department of Spine Surgery,Second Hospital of Lanzhou University from March 2014 to December 2015.Of them,21 had secondary vertebral fracture after PKP.As an observational group,they were matched with another 21 patients without secondary vertebral fracture after PKP as a control group (ratio:1:1) for age,gender,body mass index (BMI) and bone mineral density (BMD).Their standard standing plain radiographs of the whole spine were used to measure the parameters of spine-pelvis sagittal balance.The 2 groups were compared in sagittal balance parameters.Results The sagittal vertical axis (26.86 ± 33.55 mm) and thoracic kyphosis (47.62° ± 10.73°) in the observational group were significantly larger than those (4.05 ± 31.93 mm and 41.10 °±8.17°) in the control group (P ＜0.05);the lumbar lordosis (35.29°±8.77 °),sacral slope (22.71 ° ± 5.80°) and pelvic incidence (45.38° ± 7.49°) in the former were significantly smaller than those in the control group (41.71°±9.19°,27.43°±5.29° and 51.19°±8.44°) (P ＜0.05);there were no significant differences between the 2 groups in pelvic tilt or thoracolumbar kyphosis (P ＞ 0.05).Conclusions The OVCF patients with larger sagittal vertical axis,larger thoracic kyphosis and smaller lumbar lordosis may be more likely to suffer secondary vertebral fracture after PKP.A larger pelvic incidence may be a protective factor against secondary vertebral fracture after PKP for OVCF patients.
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Objective To investigate a new selection criteria for lower instrumentation vertebrae (LIV) in thoracolumbar adolescent idiopathic scoliosis (AIS).Methods Fifty-two cases of fusion thoracolumbar bend and more than 1.5 years follow up were included.The cases conformed to the AIS selection criteria,i.e.,the first vertebral body touched at the scoliosis distal end in the central sacral vertical line (CSVL) of erect orthotopic X-ray film served as the touch vertebrae (TV),moreover which should meet the following requirements:the Nash-Moe rotation ≤ degree Ⅱ;CSVL located between bilateral vertebral pedicle in the concave side Bending image;no kyphosis of thoracolumbar and lumbar segments existed;the patients with the distance 3-4 mm from CSVL to TV were also included into the study.The operation of each case was carried out by an experienced spine surgeon team.The internal fixation orthopedic fusion of total pedicle screws was adopted by posterior approach.The spine full length of the anterior-posterior and lateral X-ray film and left and right sides Bending images at clinostatism were taken before operation,instantly after operation and at final follow up.The Cobb angle of main bending,trunk shift (TS) at coronal plane,LIV tilting (LIVT) and LIV distal disc angulation (LIVA) were measured.The positions of TV and stable spine were observed,recorded and performed the statistical analysis.Results All cases were followed up for more than 18 months,with an average follow-up period of (23 ± 3) months.The main bending Cobb angles before operation,instantly after operation and at final follow up were (49.32±11.37)°,(9.08 ± 6.78)°and (10.65±6.68)°respectively,LIVT were (21.76±4.68)°,(5.17±4.09)° and (5.16±3.08)° respectively and LIVA were (7.19±5.16)°,(3.16±2.78)° and (4.17±3.28)° respectively;the above indicators had statistical differences between before operation with instantly after operation and at final follow up (P＜0.05).Twenty seven cases were preoperative trunk decompensation,and 5 cases were complicating trunk decompensation at final follow up,which were not increased compared with those before operation.Comparing TV as LIV with adopting stable vertebrae as LIV,the former could save (1.42 ±0.45) fusion segments.Conclusion Adopting the new criteria to conduct thoracolumbar AIS operation saves the fusion segments as compared with commonly used method in clinic.
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Objective To observe effect of muscle basal lamina containing neural stem cells (NSCs) in repair of spinal cord injury.Methods Thirty-six SD rats from the same nest were used in the study and spinal cord hemisection models were induced.The animals were classified to blank control group (clearance of the lesion edge only with isotonic saline),NSCs group (transplantation of NSCs to the edge),NSCs + muscle basal lamina group (transplantation of complex of NSCs and muscle basal lamina to the edge) according to random number table,with 12 rats per group.At weeks 4 and 8,survival and migration of the transplanted cells and compatibility of muscle basal lamina with the host were detected.At weeks 2,4,and 8,the hindlimb function was assayed using BBB scoring system.Results NSCs in NSCs + muscle basal lamina group grew at the lesion edge,migrated to both sides of the edge,and integrated with peripheral tissues.Whereas,few NSCs survived at the lesion edge in NSCs group and inflammatory cell infiltration was notable.At week 2,there was no statistical difference of BBB score among the three groups.At weeks 4 and 8,BBB score in NSCs + muscle basal lamina group (7.92 ± 1.00,11.38 ± 1.51) was significantly higher than that in blank control group (3.82 ± 0.75,3.71 ± 0.76) and NSCs group (6.25 ±1.06,8.25 ± 1.83) (P＜0.05).Conclusion Muscle basal lamina orients growth of NSCs along its lumen,facilitates migration of host cells to ground substance within its lumen,and reduces local inflammatory reaction.
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Objective To investigate effects of exogenous sonic hedgehog (Shh) on proliferation of neural stem cells (NSCs) in ependymal area and recovery of motor function after spinal cord injury (SCI) in adult rats.Methods Fifty-five female SD rats were involved in the study:five were selected as normal control group and fifty as Shh group (n =25) and SCI group (n =25) after being subjected to SCI at T10 segment using the modified Allen' s method according to the random number table.At 1,3,7,14,and 28 days after operation,restoration of hindlimb motor function of SD rats was assessed with modified Tarlov scale and changes of double positive cells of Brdu and Nestin with double-stained immunofluorescence.Results Tarlov scale revealed statistical difference between Shh and SCI groups since days 7 postoperatively (P ＜ 0.05).In the double-staining test,number of double positive cells of Brdu and Nestin was greater in Shh Group than in SCI Group since day 3 postoperatively [(97.20 ± 18.23) vs (72.60± 15.60),(153.60 ±25.76) vs (112.20 ±23.63),(133.80 ±21.02) vs (94.20± 18.70),(89.80 ± 15.42) vs (43.40 ± 10.62),P ＜ 0.05].Conclusion Exogenous Shh is conducive to the proliferation of ependymal NSCs and the recovery of motor function in SCI rats.
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Objective To discuss the selection and clinical efficacy of operative methods for subaxial cervical dislocation without spinal cord injury. Methods A retrospective study was performed on 11 patients with subaxial cervical dislocation without spinal cord injury treated from January 2004 to June 2009. According to Allen' s classification, all patients suffered from retracted flexion injuries, including seven patients with Ⅰ degree dislocation, one with Ⅱ degree dislocation and three with Ⅲ degree dislocation. There were eighth patients with old dislocation and three with fresh dislocation, both of which were simple cervical trauma without other organ injuries. Open reduction, internal fixation and iliac bone graft spinal fusion were performed in seven patients and combined posterior and anterior open reduction,internal fixation and iliac bone graft spinal fusion in four. All the patients were followed up for observation of clinical effect. Results All operations were completed successfully. There were 11 patients at Frankel grade E preoperatively and 11 at grade E postoperatively. X-ray photographs showed that the sequence and curvature of the cervical spine recovered to normal after operation. All patients were followed up for 3-31 months postoperatively, which showed no redislocation or symptoms of spinal cord injury.Conclusion For lower cervical dislocation combined with locked facet, one-stage combined anterior and posterior reduction and internal fixation should be performed. While for those without locked facet, simple anterior reduction and bone graft spinal fusion is needed. Open reduction, internal fixation and bone graft spinal fusion are effective method for treatment of subaxial cervical dislocation without spinal cord injury.
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Objective To study the expression of cyclooxypenase-2(COX-2),prognosis of patients and the correlation between COX-2 and CD_(105)in osteosarcoma.Methods The expression of COX-2 and CD_(105)in human osteosarcoma was detected with immunohistochemistry.Then to count the microvessl density (MVD)were marked with CD_(105),The prognosis of the patients with osteosarcoma was analyzed by Cox multi- variate survival analysis.Results The positive rate of COX-2 expression was 77.5 %,The expression of COX-2 was positively correlated with surgical grade and metastasis of osteosarcoma;There were significant difference between surgical grade Ⅰ and Ⅱ b、grade Ⅰ and Ⅲ(P0.05);Metastatic cases had higher MVD than those without metastasis(P