Percutaneous pedicle screw fixation has emerged as a minimally invasive surgical approach for the treatment of thoracolumbar fractures, presenting benefits like diminished tissue trauma, minimal blood loss, and accelerated recovery. Despite these benefits, a number of patients still suffer from the occurrence of intermuscular hematoma after undergoing surgery. This hypothesis proposes that the structural characteristics of percutaneous pedicle screws, especially their hollow design, might play a role in the development of intermuscular hematoma. We explore the underlying potential mechanisms of this phenomenon and provide evidence from existing literature to support our hypothesis.

Objective:To explore the best screw path and safe screw path angle range of anterior transpedicular screws in the lower cervical spine based on 3D CT imaging by screw axial fluoroscopy.Methods:Fifty cervical CT data integral from volunteers from June 2019 to July 2020 were selected from Ningbo No. 6 Hospital and were confirmed to have no obvious defect. Among the cases, 24 were males and 26 were females aged 22-52 (31.9±5.4) years. The original data of CT scanning were imported into Mimics software in DICOM format for 3D reconstruction. On the coronal and sagittal images of the reconstructed 3D CT images, the leading edge of the C 3-7 vertebral body was divided into four parts. The MEDcap module was used for simulated screw placement in the right pedicle, and the best screw path was obtained by screw axial fluoroscopy. The best screw insertion area, the angle between the horizontal screw and the posterior edge of the vertebral body, and the angle between the sagittal screw and the anterior edge of the vertebral body were recorded. Then, the head of the screw was moved to obtain the maximum head inclination, tail inclination, inward inclination, and outward inclination of the safety screw path. The angles formed by the best screw path with the maximum head inclination, tail inclination, inward inclination, and outward inclination safety screw path were denoted respectively. The data of males and females were compared by independent sample t-test. Results:In 50 patiens, the best screw entry area in sagittal plane was zone 2 at C 3-5 (72%[36/50], 68%[34/50], 78%[39/50], respectively), zone 3 at C 6-7 (70%[35/50], 76%[38/50], respectively), and the best screw entry area in horizontal plane was zone 3 at C 3-5 (90%[45/50], 82%[41/50], 88%[44/50], respectively), zone 2 at C 6-7 (80%[40/50], 84%[42/50], respectively). The best angles for screw insertion in the sagittal and horizontal positions were 78.3°-69.9° and 46.7°-50.1° for males and 76.1°-64.9° and 44.7°-48.7° for females, respectively. The sagittal and horizontal angles between men and women had significant differences (all P values<0.001). The maximum safe angles of head inclination, tail inclination, inward inclination, and outward inclination were 8.7°-14.2°, 8.9°-13.1°, 5.4°-8.5°, and 5.3°-8.4° for males and 7.5°-13.4°, 8.4°-12.8°, 4.8°-8.0°, and 4.7°-7.8° for females, respectively. The difference was statistically significant (all P values<0.05). Conclusion:The optimal screw path and safe screw path angle of ATPS in lower cervical are obtained by screw axial fluoroscopy combined with CT three-dimensioal software to simulate screw placement and measurement, which provides imaging anatomical data support for the safety of screw placement.

Objective:To evaluate the pull-out strength on the osteoporotic vertebral body for anterior transpedicular root screw in cervical spine.Methods:9 wet specimens of normal adult osteoporotic cervical spine (C3-C7) were selected, including 5 males and 4 females. The anterior transpedicular root screw (ATPRS) , anterior transpedicular screw (ATPS) or vertebral body screw (VBS) was randomly placed on both sides of each specimen. All was divided into three groups (ATPRS vs ATPS, ATPRS vs VBS and ATPS vs VBS) with three specimens in each group. After all specimens were scanned by thin-layer CT, DICOM format data was imported into Mimics software for 3D reconstruction, then the guidance drill template of ATPS was designed and quickly printed by 3D printer. ATPS was placed under the guidance drill template, ATPRS and VBS were placed by hand. Finally, the specimens were placed on the biomechanical experimental machine, and the pull-out strength of each group of screw was tested.Results:The average maximum pull-out strength of ATPRS was (287.94±76.78) N, ATPS was (462.23±174.35) N, and VBS was (169.20±89.07) N. There was statistical difference between ATPRs and VBS, ATPRS and VBS and ATPS and VBS for pull-out strength (all P<0.05) . Conclusions:The pull-out strength of the ATPRS was better than VBS, which can provide the biomechanical support for clinical application.

Objective:To investigate the clinical significance of a new classification system for atlas fractures based on pre- and post-treatment CT features, with a focus on diagnosis and treatment.Methods:A retrospective analysis was conducted on 75 cases of cervical vertebra fractures treated at the Sixth Hospital of Ningbo City between January 2015 and December 2020. The study included 44 males and 31 females, with an average age of 53.3±13.0 years (range: 27-81 years). The fractures were classified according to the Landells classification, resulting in 12 cases of type I, 13 cases of type II, 33 cases of type III, 9 cases that were difficult to classify due to fracture lines located at anatomical junctions, and 8 cases that could not be classified using the Landells classification due to diverse injury mechanisms. To establish a new preliminary classification for cervical vertebra fractures, the researchers considered whether the fracture line in the CT images involved the facet joint surface of the atlas, the impact on bilateral half-rings, and the displacement distance of the fracture ends. Five spinal surgeons were randomly selected to classify the CT images of the 75 patients using the new classification method. After one month, the imaging data of the 75 cases of cervical vertebra fractures were randomized and reclassified to assess the reliability and repeatability of the classification.Results:The new cervical vertebra fracture classification method comprised three types based on whether the fracture line involved the facet joint surface of the atlas: type A (no involvement of the facet joint surface of the atlas), type B (involvement of one side of the facet joint surface with intact contralateral half-ring), and type C (involvement of one side of the facet joint surface with fractured contralateral half-ring). Additionally, based on the maximum displacement distance between the fracture ends (>4 mm), six subtypes were identified: subtype 1 (≤4 mm displacement) and subtype 2 (>4 mm displacement). Consequently, the subtypes were classified as A1, A2, B1, B2, C1, and C2. According to the new classification method, the 75 patients included 17 cases of A1, 12 cases of A2, 7 cases of B1, 13 cases of B2, 12 cases of C1, and 14 cases of C2. The classification demonstrated excellent consistency, as assessed by the five doctors, with Kappa values of 0.85 and 0.91 for reliability and repeatability, respectively. At the final follow-up, all conservatively treated patients achieved bone healing, while four surgically treated patients experienced non-union of the fracture ends but exhibited good fusion between the atlas and axis. The remaining surgically treated patients achieved bony union without complications such as loosening or fracture of internal fixation.Conclusion:The new cervical vertebra fracture classification method, based on CT imaging features, comprehensively covers common clinical cases of cervical vertebra fractures and demonstrates excellent consistency. It provides valuable clinical guidance for the diagnosis and treatment of cervical vertebra fractures.

OBJECTIVE:To investigate clinical effect of sternoclavicular hook plate in treating acute proximal clavicle fracture.METHODS:The clinical of 12 patients with acute unstable proximal clavicle fracture from June 2016 to June 2019 were retrospectively analyzed. There were 8 males and 4 females, aged from 46 to 63 years old. Ten patients caused by car accident and 2 patients caused by high falling. All patients had multiple injuries;the time from injury to surgery ranged from 2 to 14 d. All patients were treated with domestic sternoclavicular joint hook plate. The operative time ranged from 40 to 115 min. The intraoperative bleeding volume ranged from 30 to 110 ml, follow-up time ranged from 10 to 36 months, the fracture healing time ranged from 8 to 18 weeks. At the latest follow-up, the efficacy was evaluated by using shoulder joint function score (Rockwood score).RESULTS:All 12 patients were followed up, with no obvious pain at the latest follow-up. The rockwood scores of the affected shoulder ranged from 13 to 14, and the healthy shoulder ranged from 14 to 15.CONCLUSION:The sternocleidoclavicular joint plate is fixed with preformed plate. The cantilever is designed to retain the motion of the sternoclavicular joint. It's safe and simple, avoid, the injury of important organs during operation, and has a good prognosis. It is an ideal fixation method for the treatment of proximal clavicle fracture.

Objective:This study investigates the accuracy and safety of pars interarticularis screw placement of axial screw internal fixation in patients with high riding vertebral artery.Methods:A retrospective case control study was performed on 74 patients with high riding vertebral artery who received axial screw internal fixation in the Spinal Surgery Department of The Ningbo No.6 Hospital from January 2013 to June 2020. The patients were composed of 51 males and 23 females aged 29-71 (53.2±7.6) years. The patients were divided into the isthmus screw group ( n=38) and laminar screw group ( n=36), and the baseline data of the two groups were compared and observed. Screw placement time, operation time, intraoperative X-ray frequency, intraoperative blood loss, incidence of complications, and hospital stay were observed and compared between the two groups. The visual analog scale (VAS) was used in evaluating the degree of neck pain before operation, 3 months post-operation, and at the last follow-up, and the modified Japanese Orthopaedic Association (mJOA) score was used in evaluating neurological function. At the last follow-up, the Odom criteria were used in evaluating clinical efficacy. The accuracy of axial pars and lamina screw placement was evaluated according to the screw grading criteria proposed by Upendra et al. These criteria were based on postoperative cervical CT scan and 3D reconstruction. Results:No significant differences in age, gender, body mass index, disease type, and other general information was found between the two groups (all P values >0.05). Likewise, no significant differences in screw placement time, intraoperative X-ray frequency, intraoperative blood loss, and hospital stay were found (all P values >0.05). The operation time of the isthmus screw group (125.75 min±13.64 min) was shorter than that in the lamina screw group (145.53 min±20.25 min), and the differences were statistically significant ( t=-4.90, P<0.001). The screw length in the isthmus screw group was (16.24±2.35) mm, which was shorter than that in the lamina screw group (20.67±2.62) mm, and the difference was statistically significant ( t=-7.67, P<0.001). Two patients in the isthmus screw group penetrated the posterior wall of the vertebral artery foramen during operation, and four cases in the lamina screw group penetrated the lamina cortex, but none of them had angioneurotic symptoms. In the laminar screw group, two patients with atlantoaxial dislocation had laminar screw loosening and prolapse during follow-up, and two patients had superficial incision infection after occipitocervical fusion. The incidence of complications in the isthmus screw group was 5.26% (2/38), lower than that in the lamina screw group (22.22%, 8/36), and the difference was statistically significant (χ 2=4.55, P=0.033). All patients in both groups were followed up for 10-96 months, with an average of 30.8 months. The VAS and mJOA scores in both groups significantly improved 3 months after operation and at the last follow-up (all P values <0.05), and no statistical difference was found between the groups (all P values >0.05). A total of 55 screws were inserted in the isthmus screw group, and 50 screws were inserted in the lamina group. The accuracy of screw placement (Ⅰ+Ⅱa+Ⅱb) was 96.4% (53/55) and 94.0% (47/50), respectively, and no significant difference was found between the groups (χ 2=0.56, P=0.906). In patients in the isthmus screw group, no complications, such as screw loosening and prolapse, occurred during follow-up. The clinical efficacy was evaluated according to the Odom score at the last follow-up, and 65.8% (25/38), 21.1% (8/38), and 13.2% (5/38) were superior, good, and acceptable in the isthmus screw group, respectively, and 63.9% (23/36), 19.4% (7/36), and 16.7% (6/36) were superior, good, and acceptable in the lamina screw group, respectively. No significant difference was found between the groups ( Z=0.25, P=0.803). Conclusion:In patients with HRVA, isthmus and lamina screws provide similar clinical results, but in terms of the accuracy of screw placement, the isthmus screw is superior, and it can significantly shorten the time of operation and reduce the complications of operation.

OBJECTIVE:To compare the clinical effecty of Wiltse approach combined with contralateral transforaminal lumbar interbody fusion (TLIF) and traditional TLIF in the treatment of lumbar disc herniation and its affect on injury of multifidus muscle. METHODS:From June 2014 to September 2017, 90 patients with lumbar disc herniation combined with lumbar spine instability were divided into two groups (Wiltse approach group and traditional group) depend on the procedure of operation. Wiltse approach group was treated with Wiltse approach screw placement in one side combined with contralateral TLIF. There were 50 patients in Wiltse approach group, including 36 males and 14 females, aged 45 to 72 yearswith an average of (60.4± 3.1) years. The traditional group was treated with traditional TLIF operation. There were 40 patients in the traditional group, including 25 males and 15 females, aged 45 to 74 years with an average of (62.1±3.4) years. The operative time, intraoperative blood loss, accuracy of screw implantation, postoperative drainage volume and drainage tube removal time were recorded in two groups. Visual analogue scale (VAS) and Oswestry Disability Index (ODI)were observed before and 12 months after operation. All patients underwent CT examination preoperative and 12 months postoperative, and the CT values of bilateral multifidus muscle were measured. RESULTS:All the patients were followed up, 40 patients in traditional group were 12 to 18 months with an average of (15.3±4.3) months; and 50 patients in Wiltse approach group were 13 to 24 months with an average of (16.5± 4.1) months. There were no statistically significant differences in operative time and intraoperative blood loss between two groups (P>0.05). The accuracy of screw implantation in Wiltse approach group was higher than traditional group (P<0.05).There was no significant difference in preoperative VAS score and ODI between two groups, and 12 months after operation, VAS score and ODI in Wiltse approach group was significantly lower than traditional group (P <0.05). The postoperative drainage and drainage tube placement time in Wiltse approach group were lower than the traditional group(P<0.05). There was no statistically significant difference in CT value of multifidus muscle before operation between two groups (P>0.05), while there was statistically significant difference after operation (P<0.05). Postoperative CT values of multifidus muscles on decompression and non-decompression side were obviously reduced in traditional group (P<0.05). The CT value of the multifidus muscle on the decompression side of the Wiltse approach group was significantly lower than that before operation(P<0.05), and there was no significant difference before and after the operation on the non-decompression side (P>0.05). CONCLUSION:Compared with traditional surgical procedures, the Wiltse approach nail placement combined with contralateral TLIF has the advantage of accurate nail placement, reducing multifidus muscle damage, and reducing the incidence of postoperative intractable low back pain.

Objective:To evaluate the radiological parameters of the anatomical morphology of atlantoaxial lateral mass articular surface and support the design of clinical atlantoaxial lateral mass fusion cage.Methods:A retrospective study. From January 2019 to June 2020, 100 healthy adults who underwent cervical CT examination in Ningbo No. 6 Hospital were selected retrospectively, including 57 males and 43 females, aged 26-61 years with an average age of (40.9±6.4) years. Philips 64-slice multislice spiral CT was used to scan C 1-C 7 and reconstruct 2D images. The curvature, length, and height of intervertebral space were measured and compared in the sagittal and coronal planes. The shape of the atlantoaxial lateral mass articular surface and the distribution of the vertex position of the concave or convex vertices were observed. Results:No significant differences were observed in the curvature, length, and height of the intervertebral space between the left and right sides in the sagittal and coronal planes of atlantoaxial lateral mass (all P values>0.05). The curvatures of the sagittal atlantoaxial lateral mass articular surface were 171.16°±6.21° and 166.37°±8.50°. The curvatures of the coronal were 159.83°±8.22° and 167.22°±10.40°. The lengths of the sagittal atlantoaxial lateral mass articular surface were (16.38±1.61) and (16.59±1.63) mm. The lengths of the coronal were (16.75±1.71) and (17.14±1.69) mm. The anterior, middle, and posterior intervertebral space heights of the sagittal atlantoaxial lateral mass articular were (2.87±0.80), (2.22±0.63), and (3.25±1.00) mm, respectively. The inside, middle, and outside intervertebral space heights of the coronal were (1.94±0.74), (3.39±0.57), and (1.64±0.62) mm, respectively. The sagittal articular surface shape of atlantoaxial lateral mass was mostly double convex and convex flat. The coronal was mostly double concave and concave flat. In the sagittal and coronal plane, the vertex of the atlantoaxial lateral mass were more in 1/3 of the center. Conclusions:The curvature of the atlantoaxial lateral mass surface and the position of the vertex should be considered to optimize the shape of the cage.

Objective:To explore The feasibility of digital guidance drill templates assisted expansive open-door laminoplasty.Methods:Ten specimens of normal adult cervical spine (C 3-7) were selected, including six males and four females. The specimens aged 42-67 years, with an average age of (43.6±4.2) years. After CT scanning, the date was imported into Mimics software in DICOM format. 3D models were reconstructed and the position and depth of troughs on the open side and hinge side were selected for expansive open-door laminoplasty. Drill templates were designed and exported in STL, manufactured by 3D printing finally. Then drill templates were attached to the posterior part of cervical lamina and spinous process. Under guidance of templates, troughs of both sides were conducted by using a high-speed drill. Then the lamina is elevated and instrumentations were implanted. Postoperative CT scanning was conducted to record the fracture of trough on the hinge side. 3D reconstruction was performed again to compare the position and depth between theory and actual trough on both sides by paired t test. Results:A total of 50 drill templates were designed and manufactured. There was no occurrence of hinge fracture after operation. In C 3-7, the distance range between the theory position of troughs on the open side and the midline was 11.8-14.4 mm, while in actual it was 11.4-14.0 mm. The distance range between the theory position of troughs on the hinge side and the midline was 11.6-14.3 mm; in actual, it was 10.9-14.0 mm. The theory depth range of trough on the hinge side was 3.0-3.8 mm, while the actual depth was 3.1-3.8 mm. According to the statistical analysis, the difference in the position of trough on the open side, the position of trough on the hinge side and the depth of trough on the hinge side between theory and actual were not statistically significant (all P>0.05). Conclusion:Digital guided template assisted open-door laminoplasty is a feasible technique, which can improve the accuracy and safety of the position and depth of the trough, and has clinical application value.

Objective: To evaluate the best entry region and trajectory of anterior transpedicular root screws (ATPRS). Methods: From January 2018 to May 2019, 50 cervical CT date integral of healthy people were selected from Ningbo No. 6 Hospital and were confirmed no obvious defect. Of these, 24 cases were males and 26 were females, aged 20-49 (32±5) years. The CT data was imported into Mimics by DICOM format, then 3D reconstruction was performed. In the coronal plane, the area from the centreline of the anterior of C(3-7) to the left Z-line(marked a line through the intersection of the anterior of the luschak joint and upper endplates, parallel to the centralline of the anterior of the vertebral body) was divided into nine areas. Then virtual screw with diameter of 3.5 mm was inserted. Record the length of screw of each area (L), the angle between screw and the posterior of the vertebral body in horizontal plane(α), the angle between screw and the anterior of the vertebral body in sagittal plane (β), individually. The data between groups were compared by independent sample t test. Results: The best regions were zone 9 of C(3), C(4); zone 8, 9 of C(5); zone 2-3, 5-9 of C(6); zone 1-9 of C(7) in men. And these were zone 9 of C(3); zone 3, 6, 8 and 9 of C(4), C(5); zone 2-3, 5-9 of C(6); zone 1-9 of C(7) in women. The distribution of best region was almost the same in men and women, zone 9 of each segment was the best region, and the screw length was the longest. It increased gradually from C(3) to C(7). C(3) had the least region, C(4) and C(5) had less, while C(6) and C(7) had the most. The horizontal angle of C(3-7) in men and women were 44.0°-47.2°, 40.2°-45.3° in zone 1, 4 and 7, respectively; 35.1°-41.4°, 34.6°-38.7° in zone 2, 5 and 8, respectively; 30.0°-37.2°, 30.2°-34.5° in zone 3, 6 and 9, respectively; and it demonstrated a gradually decreased trend. The sagittal angle of C(3-7) in men and women was 85.3°-97.4°, 80.5°-88.9° in zone 1-3, respectively; 101.2°-113.7°, 101.0°-109.3° in zone 4-6, respectively; 116.6°-128.8°, 119.9°-125.3° in zone 7-9, respectively; and it demonstrated a gradually increased trend. There was no significant difference in the horizontal and sagittal angle between men and women (both P>0.05). Conclusions: Anterior transpedicular root screw is a feasible internal fixation technique. It has wide region and the Z-line can be used as a reference for screw placement.

OBJECTIVE:To investigate the influence of posterior osteotomy on spinopelvic parameters in lumbar degenerative kyphosis (LDK) patients.METHODS:The clinical data of 21 patients with lumbar degenerative kyphosis who underwent osteotomy from January 2012 to December 2015 were retrospectively analyzed. There were 5 males and 16 females, aged from 55 to 76 years with an average of (66.24±5.13) years. All patients had taken preoperative and postoperative full length spinal X-ray, analyzing the spinopelvic parameters as thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS).RESULTS:All operations were successful, the average operative time was 190 min (160 to 220 min) and intraoperative blood loss was 1 000 ml (800 to 1900 ml). Parameters of the patients between preoperative and period 1-year follow-up were as follows : preoperative TK increased from (31.67±21.13) ° to (34.67±11.60) °, LL corrected from (4.76±3.17) ° to (37.41±6.28) °, PT reduced from (33.94±5.01) ° to (20.12±5.36) °, and SS improved from (18.47±2.60) ° to (31.71±4.30) °, SVA restored from (13.24±3.60) cm to (2.82±1.33) cm. There were significant differences of spinopelvic parameters between preoperation and postoperation (P<0.05).CONCLUSION:Posterior osteotomy can effectively reconstruct the sagittal balance of spinopelvis in patients with lumbar degenerative kyphosis. The recovery of lumbar lordosis and sacral slope is closely related to the reconstruction of sagittal balance.

OBJECTIVE:To evaluate effectiveness of regular and modified drill templates used to guide cervical anterior transpedicular screw (ATPS) placement. METHODS:This study included 15 adult cadaveric specimens. Computed tomography images were imported into Mimics software. Three-dimensional modeling of all cervical vertebrae was done, and the ideal trajectories were designed for ATPSs. Models of regular and modified templates were designed for every level on the left or right side randomly. After three-dimensional printing, 2 types of templates were used to guide the insertion. Postoperative computed tomography scans were used to measure deviations between real and ideal trajectories in the direction and positioning of entry points. The deviations in the 2 groups were compared using paired t test. RESULTS:There were 120 templates and ATPSs fabricated and placed. Postoperative images showed that 7 screws perforated pedicles in the regular group, with an accuracy rate of 88.3%. Deviations between real and ideal trajectories in cranially inclined angles and extroversive angles were 1.13° ± 0.61° and 0.97° ± 0.60°, respectively, and deviations of entry point position in the x-axis and y-axis were 0.72 ± 0.38 mm and 0.95 ± 0.47 mm, respectively. In the modified group, there were 2 malposition screws with accuracy rate of 96.7%. Deviations in cranially inclined angles were 0.66° ± 0.53° and 0.66° ± 0.55° in extroversive angles, respectively, and deviations in entry point positions in the x-axis and y-axis were 0.45 ± 0.37 mm and 0.51 ± 0.34 mm, respectively. The differences in deviations between groups were statistically significant. CONCLUSIONS:Compared with regular drill templates, modified drill templates can provide higher accuracy and stronger trajectory control in ATPS insertions.

PURPOSE:To investigate the surgical effects of modified kyphoplasty with controllable balloon dilatation for treatment of thoracolumbar osteoporotic vertebral compression fractures (OVCF). METHODS:From April 2013 to October 2017, a total of 53 patients with thoracolumbar OVCF were treated with controllable balloon percutaneous kyphoplasty (C-PKP). Peri-operative parameters including days from injury to operation, operation time, injected cement volume, cement leakage and complications were collected. Visual analogue scale (VAS) and Cobb angle before and after operation were applied to evaluate surgical effects. Moreover, a total of 53 cases treated with traditional balloon of percutaneous kyphoplasty were retrospectively analyzed and compared with C-PKP in above parameters. RESULTS:C-PKP achieved significant fewer events of cement leakage (type C) than that of traditional PKP (5/53 vs 13/53, p < 0.01). The patients were followed up for 10.8 ± 4.2 months; VAS and Cobb angle of the injured vertebra in both two groups at three days and final follow-up were significantly improved compared with that before surgery (p < 0.05), while there were no significant differences between the two groups regarding the VAS and Cobb angle at corresponding time points (p > 0.05). CONCLUSIONS:C-PKP technology is a safe and efficient way for the treatment of thoracolumbar OVCF, and it can reduce cement leakage.

目的:探讨倒退旋转法穿刺技术辅助的经皮球囊扩张椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs)患者的临床疗效.方法:回顾性分析2015年1月至2016年12月采取经皮穿刺球囊撑开扩张椎体后凸成形术穿刺位置不良的100例OVCFs患者,均为单节段骨折,受伤或出现明显腰痛时间＜1个月,伴有局部压痛、叩击痛,胸腰部活动受限.根据术中穿刺方法的不同分为倒退旋转法穿刺组及传统穿刺组,每组各50例.分析两组的手术时间、放射透视次数、手术并发症和手术前后的视觉模拟评分(visual analogue scale,VAS)评价手术效果.结果:100例患者均完成手术,术后随访均超过1年.倒退旋转法穿刺组手术时间(21.5±5.9) min,术中穿刺C形臂X线透视(7.7±1.3)次,每椎骨水泥注入量(4.6:±0.8) ml;术前VAS评分为8.3±0.9,术后1年为2.3:±0.8.传统穿刺组手术时间(30.2±7.5) min,术中穿刺C形臂X线透视(14.3±2.0)次,骨水泥注入量(4.3±1.0) ml;术前VAS评分为8.1±1.0,术后1年为2.6±0.5.两组骨水泥注入量及术后1年的VAS评分差异无统计学意义(P＞0.05),而两组手术时间及术中穿刺C形臂X线透视次数差异有统计学意义(P＜0.05).结论:在PKP手术中对于首次穿刺位置不良者,运用倒退旋转法穿刺技术可以快速改变穿刺针的进针点和进针方向,达到理想穿刺靶点,可减少手术时间和术中X线透视次数.

In recent years,the surgical treatment of thoracolumbar fractures has made great progress.The thoracolumbar injury classification and severity score (TLICS) of thoracolumbar injuries and the new AO classification,as the most widely used classification score in clinical application,have a clear guiding significance for clinical treatment and scientific research.With the extensive application of CT and MRI,the divergence in the diagnosis of posterior ligament complex (PLC) injury in scoring systems has been narrowed.With the wide application of pedicle screw and the deeper understanding of the anatomical and mechanical characteristics of spine,posterior pedicle screw fixation has been gradually adopted as the major method,while anterior or posterior pedicle screw fixation is only used in special cases.Because of the in-depth study of pedicle screw mechanics,more and more attention has been paid to the fixation of injured vertebrae.Moreover,with the intensive study of sagittal balance of the spine,the reconstruction of injured vertebrae has been proposed as a new concept and further investigated.The author discusses thoracolumbar fracture scoring system,surgical approach,surgical fixation segment,bone graft reconstruction and minimally invasive treatment so as to provide some reference.

Objective To investigate the clinical effect of the reserve-flow anterolateral thigh perforator flap based on aesthetics concept to repair soft tissue defect around the knee joint.Methods From June 2016 to April 2017, 10 patients with skin and soft tissue defects around the knee joint were admitted to Mingzhou Hospital of Zhejiang University. The area of the soft tissue defects around the ankle were ranged from 5. 0 cm × 3. 0 cm to 11. 0 cm × 7. 5 cm after debridement. The anterolateral thigh perforator flaps were designed on the ipsilateral lateral thigh, according to the results of preoperative perforator detection . The reserve-flow anterolateral thigh perforator flaps based on aesthetic concept were used to repair the wound through the subcutaneous tunnel. The flaps were 5. 5 cm × 3. 5 cm to 12. 0 cm × 8. 0 cm in size. The donor sites were directly closed. Results The flaps of 9 patients completely survived, however, epidermal necrosis occurred to 1 patient, at the distal end of the flap, about 1 cm × 1 cm in size. It completely healed after dressing change for 1 week. The follow up time was from 8 to 15 months ( mean 12 months) . The flaps were satisfactory in appearance, good in the elasticity, nearly normal in color, and had protective sensation. The two-point discrimination perception ranged from 9 to 13 mm( mean 10 mm) . The donor and recipient sites only remained linear scars, with no depression deformity. The lower limb functions were normal. Conclusions The reverse-flow anterolateral thigh flap based on aesthetic concept, is an alternative method to repair the soft tissue defect around the knee joint, and protect the donor site to the maximum extent.

下肢骨折在骨伤科中极为常见,因骨的连续性和完整性中断,导致周围软组织损伤,增加了局部张力,阻碍血运及静脉回流,患者会出现局部疼痛、肿胀、畸形及功能障碍,严重影响患者的正常生活,若不及时治疗易使局部肌肉及神经组织等缺血缺氧,将影响骨折折愈合和肢体功能恢复[1 - 2].中医药治疗骨折方法多,效果好,优势明显[ 3].本文观察了中药外敷治疗下肢闭合性骨折的疗效,现将结果报告如下.

Ankylosing spondylitis (AS) is a common chronic inflammatory autoimmune disease. Toll-like receptors (TLRs) are involved in non-specific immunity. In the present study, the roles of TLRs in AS were investigated. The levels of inflammatory cytokines were detected by ELISA and reverse transcription-quantitative polymerase chain reaction (RT-qPCR). The expression levels of TLRs and nuclear factor-kappa B (NF-kappa B) signaling-associated factors were determined via RT-qPCR and western blot analyses. It was observed that the levels of interleukin (IL)-6, tumor necrosis factor-alpha (TNF-alpha), C-reactive protein, TLR4 and TLR5 were increased in patients with AS, whereas those of IL-10 and TLR3 were decreased. Pomalidomide, a TNF-alpha release inhibitor, reduced the expression of IL-6, TNF-alpha, TLR4, TLR5 and phosphorylated-p65, and upregulated that of IL-10, TLR3 and p65 in peripheral blood mononuclear cells from patients with AS. Treatment of patients with infliximab, an anti-TNF-alpha monoclonal antibody, induced similar effects in vivo. In conclusion, it was revealed that inhibition of TNF-alpha suppressed inflammatory responses in patients with AS, increased the expression of TLR3 and decreased NF-kappa B signaling, and the expression of TLR4 and TLR5. The results indicated that TLRs and the NF-kappa B signaling pathway were involved in the regulation of inflammatory responses in AS. These findings provided insight into the mechanisms underlying the development of AS and potential novel therapeutic approaches.

OBJECTIVE The 3D model of lumbar spine was established by using Mimics software. To observe the applicability and needling parameters of lumbar vertebral kyphoplasty with unilateral puncture by backward rotation method using simulated puncture. METHODS Twenty-four patients (12 males and 12 females) with osteoporotic thoracic fracture in the first time and no signs of lumbar misalignment and bone destruction were scanned by spiral CT on the lumbar spine. The original DICOM file was modeled in 3D with Mimics software, and the vertebral bodies were separated. After being imported into 3-matic software, the posterior wall of the vertebral body was restrained for standardized measurement. A sketch perpendicular to the mid-section of the pedicle and the posterior wall of the vertebral body was drawn. The simulated puncture was performed on the sketch. The angle and distance parameters of the range of motion of the puncture needle were recorded, and the puncture needle was recorded at the top. The crossing points of the anterior, middle and posterior zones of the tangential line of the vertebral body were located at the high extraversion angle, and the results were compared and analyzed. RESULTS All the data in the left and right sides had no significantly differences(P>0.05). Data of different segments in different gender were significantly differences(P<0.05). The maximal extraversion angle in lumbar spine increased gradually from (33.41±1.31) degree to (56.53±4.71) degree in males, as same as in females from(28.58±2.55) to (53.86±2.68) degree. There was no crossing point in area A, 3.3% of males and 26.67% of females in area B, rest in area C. The distribution areas on gender showed statistically significance (P<0.05). CONCLUSIONS Backward rotation method can theoretically meet the requirements of puncture point for vertebral compression fracture, especially for males and lower lumbar spine. The determination of the maximum inclination angle is of guiding significance to the backward rotation method.

Transient osteoporosis of the hip(TOH) is classified as a type of bone marrow edema syndrome. TOH is lack of previous study and there is still controversy about his pathogenesis. In recent years, with the development of multi-discipline, such as imaging, pathology, molecular biology, the study has found that the pathological mechanism is complex, while its mechanism is still not clear, which need further research. This paper summarizes the research progress on the pathogenesis of TOH from neurogenic, osteonecrosis, abnormal vascular function, subchondral fracture, heredity and regional acceleration and son on.