Anatomical study of the technique of the axis laminar screws and development of guide.

PURPOSE: To develop a bidirectional slide guide to assist screw placement in the axial lamina and to preliminarily discuss the accuracy and feasibility of auxiliary screw placement. METHODS: CT data from 40 randomly selected patients were imported into the software for modelling, and cross-pinning was used to simulate pinning. According to the different crossing methods of the upper and lower laminar screws, they are divided into two groups. In the software, the position of the needlepoint of each screw is accurately measured, and the needle point is kept unchanged to simulate the movable range of the screw tail under the condition that the body does not penetrate the cortical bone. The data were compared by grouping and gender. Finally, the guide was designed by combining the screw exit point and fine adjustment angle data of all patients with the centripetal principle of the slide rail. RESULTS: The needle exit data L1/L2/L3/L4 were 6.44 ± 0.52 mm, 7.05 ± 0.48 mm, 3.55 ± 0.75 mm and 5.09 ± 0.74 mm, respectively, and the fine adjustment angle of the slide rail was 10.51° ± 0.87°. There was no significant difference between the two groups or between men and women (p > 0.05). CONCLUSION: In this experiment, using the data obtained from the simulation of screw insertion, a two-way slide guide was designed to assist the insertion of axial laminar screws. The guide locks the screw outlet point to position and guides the screw inlet point, which improves the accuracy and safety of screw placement.

Application of the combination of three-dimensional visualization with a problem-based learning mode of teaching to spinal surgery teaching.

OBJECTIVE: To explore the application of the combination of three-dimensional visualization technology with a problem-based learning mode of teaching in clinical teaching related to spinal surgery. METHODS: A total of 106 5-year undergraduate students who majored in clinical medicine were selected as research subjects, and practiced in the Orthopaedics Department of the Affiliated Hospital of Xuzhou Medical University in 2021. These students were randomly divided into an experimental group and a control group, with 53 students in each group. The experimental group received a combination of three-dimensional visualization technology with the PBL teaching mode, while the control group was treated with the traditional teaching method. The teaching effects exhibited by these two groups were compared using tests and questionnaires that were administered after the teaching was completed. RESULTS: The theoretical test total scores of students in the experimental group were higher than those of students in the control group. The students in the two groups self-rated their classroom achievements, and the results attained by students in the experimental group were higher than those obtained by students in the control group (P < 0.05). The scores reported by students in the experimental group for interest in learning, classroom atmosphere, classroom interaction and teaching satisfaction were higher than those reported by students in the control group (P < 0.05). CONCLUSION: The application of a combination of 3D visualization technology with the PBL teaching mode to spinal surgery teaching can improve students' learning efficiency and interest and is conducive to cultivating students' clinical thinking.

Low-Frequency Repetitive Transcranial Magnetic Stimulation for the Treatment of Chronic Tinnitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Chronic tinnitus affects approximately 10-15% of the population. Low-frequency repetitive transcranial magnetic stimulation (rTMS) has been considered as a promising and well-tolerated therapeutic strategy for chronic tinnitus. However, a recent large-scale multicenter clinical trial showed a negative result. OBJECTIVE: This systematic review is aimed at assessing the efficacy and safety of low-frequency rTMS in chronic tinnitus. METHODS: We searched PubMed, Embase, and Cochrane Library for randomized controlled studies of rTMS treatment of chronic tinnitus. A pooled analysis of standardized mean difference (SMD) was performed with 95% confidence intervals (CI). RESULTS: Ten RCTs involving 567 participants were included in this review. Compared with sham stimulation, rTMS showed no significant efficacy in tinnitus severity and disability measured by Tinnitus Handicap Inventory (THI) in short-term (SMD = -0.04, 95% CI -0.23 to 0.16, P = 0.72), medium-term (SMD = -0.13, 95% CI -0.43 to 0.17, P = 0.41), and long-term (SMD = -0.16, 95% CI -0.38 to 0.05, P = 0.14) follow-up. Tinnitus severity and disability measured by Tinnitus Questionnaire (TQ) also showed no significant improvement in short-term (SMD = -0.11, 95% CI -0.31 to 0.10, P = 0.30), medium-term (SMD = -0.10, 95% CI -0.37 to 0.16, P = 0.44), and long-term (SMD = -0.20, 95% CI -0.40 to 0.01, P = 0.06) follow-up. Additionally, no statistically significant difference was shown in the changes of tinnitus loudness assessed by a visual analogue scale (VAS) between rTMS and sham groups in the short-term (SMD = -0.28, 95% CI -0.59 to 0.02, P = 0.07), medium-term (SMD = -0.26, 95% CI -0.59 to 0.07, P = 0.13), and long-term (SMD = -0.20, 95% CI -0.53 to 0.13, P = 0.24) follow-up. Few mild or moderate adverse events were observed in both the rTMS and sham groups. CONCLUSION: Low-frequency rTMS is well tolerated but not effective in treating chronic tinnitus based on the current analysis of pooled data. Further studies with modified and uniform protocols are required to investigate the potential benefit of rTMS in chronic tinnitus.