Endoscopic unilateral laminectomy for bilateral decompression (Endo-ULBD) is widely utilized for degenerative lumbar spinal stenosis (DLSS). However, the optimal extent of contralateral decompression in patients presenting with unilateral symptoms of DLSS (us-DLSS) remains inadequately defined. To evaluate the short- and mid-term efficacy and safety of varying degrees of contralateral decompression in us-DLSS patients. This retrospective cohort study analyzed us-DLSS patients who underwent Endo-ULBD between November 2023 and June 2025. Patients were stratified into three groups based on the degree of contralateral decompression: insufficient (Gi), moderate (Gm), and sufficient (Gs). Preoperative, postoperative, and final follow-up measurements included dural sac cross-sectional area (DSCA), dural sac expansion ratio (DSER), and Schizas grading. Clinical outcomes were assessed using Visual Analogue Scale (VAS) for back and bilateral lower limbs, Oswestry Disability Index (ODI), and modified Macnab criteria. Correlation analysis identified risk factors for outcomes at final follow-up. A total of 102 patients (117 surgical segments) were enrolled. All patients demonstrated significant improvements in back pain, symptomatic limb pain, and ODI postoperatively and at final follow-up. At final follow-up, modified Macnab outcomes were excellent in 29.41%, good in 42.16%, fair in 20.59%, and poor in 7.84%. Group comparisons revealed that patients in Gm and Gs groups were significantly older and had smaller preoperative DSCA than the Gi group. However, no significant intergroup differences were observed in postoperative or final follow-up DSCA or Schizas grading. VAS scores, ODI, and modified Macnab grades showed no significant differences among groups at any time point. Complication distribution was comparable across all groups. In patients with us-DLSS, inadequate contralateral decompression is associated with a smaller DSER, but the short- and medium-term follow-up results do not indicate worse clinical outcomes or a higher risk of complications. The long-term risks of limited decompression warrant further investigation.

ObjectiveTo investigate the technical feasibility of applying a simple suture guide device to close the annulus fibrosus (AF) of the intervertebral discs (IVD).Methods30 sheep functional discal units (FDUs) were obtained and subjected to mock discectomy. Mock sutures were performed using 3–0 non-absorbable sutures under a novel AF suture device following a suture procedure. The FDUs were compressed under axial loading at 1.8 mm/min and evaluated for Failure load (N).ResultsThe failure loads of the hand stitching group (Group H) and suture device stitching group (Group S) were significantly higher than those of the control group (Group C) (p = 0.033; p < 0.001).ConclusionThis study provides reasonable reasons to believe that the simple suture guide device described here is technically feasible for AF defect closure. It thus constitutes an encouraging proof of concept for the proposed device; however, it does not constitute a complete demonstration of the device’s feasibility in the clinical setting considering that the annulus closure operation is performed ex vivo on functional spinal units, as opposed to within an environment that mimics the clinical setting. To this end, confirmatory experiments will be conducted such as more multiaxial or dynamic mechanical testing, and notably performing the surgery on sheep models instead of on ex vivo functional spinal units.

Spinal diseases often result in compromised mobility and diminished quality of life due to the intricate anatomy surrounding the nervous system.

目的:比较采用斜外侧经肌间隙入路腰椎融合术(oblique lateral interbody fusion,OLIF)与改良侧方经腰大肌入路腰椎融合术(crenel lateral interbody fusion,CLIF)联合后路经皮椎弓根螺钉内固定治疗退行性腰椎不稳的短期疗效.方法:回顾性分析2019年6月～2022年6月30例在宁波大学附属第一医院和浙江大学医学院附属邵逸夫医院因退行性腰椎不稳进行OLIF或CLIF手术的患者资料,根据手术方式分为OLIF组和CLIF组,两组患者一期术后4周均进行二期后路经皮椎弓根螺钉内固定术.OLIF组18例,男7例,女11例,年龄69.9±7.9岁,身体质量指数(body mass index,BMI)为25.67±3.05kg/m2,2节段病变6例,3节段病变12例;CLIF组12例,男4例,女8例,年龄66.5±8.6岁,BMI 24.03±2.06kg/m2,2节段病变2例,3节段病变10例.收集两组一期手术术中出血量、手术时间、住院时间、术后并发症资料,术前和一期手术术后1个月、6个月、1年时进行背部和下肢疼痛视觉模拟评分(visual analogue score,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)评估,测量手术节段椎间隙高度(disc height,DH)、腰椎前凸角(lumbar lordosis,LL),一期手术术后1年融合器沉降高度、融合器与冠状面的夹角.对两组所有数据进行统计学比较.结果:两组患者年龄、性别、BMI、病变节段数均无统计学差异(P＞0.05),有可比性.OLIF组和CLIF组一期手术手术时间、术中出血量、住院时间分别为 183.89±39.43min、55.56±27.49ml、8.39±4.804d 和 198.75±23.27min、65.00±44.62ml、8.75± 2.30d,两组间比较均无统计学差异(P＞0.05).OLIF组术后5例出现大腿前方麻木和屈髋无力,经营养神经治疗1个月后恢复正常;1例切口感染,经抗感染治疗3周后治愈.CLIF组术后4例出现大腿前方麻木和屈髋无力,经营养神经治疗1个月后恢复正常;1例患者术中出现腰椎节段动脉损伤,出血量达到200ml;1例患者腰大肌积液伴感染,经抗生素治疗6周后治愈.两组术前VAS、ODI、LL及DH比较均无显著性差异(P＞0.05),术后1个月、6个月和1年时与术前比较均有显著性改善(P＜0.05),术后两组同时间点比较均无显著性差异(P＞0.05),术后1个月和术后1年的LL差值(OLIF组12.47°±6.69°vs CLIF组6.26°±6.47°)有显著性差异(P＜0.05).术后1年随访时,OLIF组和CLIF组椎间融合率(83.33％vs 91.67％)、融合器沉降高度(1.54±0.72mm vs 1.44± 0.61mm)无统计学差异(P＞0.05),OLIF组融合器与冠状面夹角(8.94°±4.97°)显著性大于CLIF组(5.30°±3.69°)(P＜0.05).结论:OLIF与CLIF联合后路经皮椎弓根螺钉内固定治疗退行性腰椎不稳均能够获得满意的短期临床效果且疗效相当,而CLIF利用多角度融合器增加LL和维持腰椎曲度方面具有一定优势.

目的:探讨颈前路椎间盘切除植骨融合内固定术治疗因颈椎间盘突出致颈椎管狭窄患者遭受颈椎挥鞭样损伤的临床疗效.方法:回顾性分析2010年1月～2018年12月在我院行颈前路颈椎间盘切除植骨融合内固定术的50例颈椎挥鞭样损伤患者的临床资料,其中男32例,女18例,年龄35～75岁(53.6±13.6岁).根据术前颈椎MRI T2加权相中矢状位上目标节段纤维性椎管最小矢状径分为狭窄组(最小矢状径≤13mm,32例)和非狭窄组(最小矢状径＞13mm,18例),两组间年龄及性别无统计学差异.狭窄组随访25.6±7.4个月,非狭窄组27.4±8.3个月,两组随访时间差异无统计学意义.记录两组患者术前及术后1个月、1年及末次随访时ASIA评分的总分、感觉评分、运动评分,计算术后1个月、1年及末次随访时的日本骨科协会(Japanese Orthopedic Association,JOA)评分改善率和末次随访时的手术改善率,记录相关并发症的发生情况.结果:ASIA评分总分,每组术后各时间点与术前比较均有显著性增加(P＜0.05);术前和术后1个月时两组间差异均无统计学意义,但术后1年及末次随访时差异均有统计学意义(P＜0.05).ASIA上肢运动评分,每组术后各时间点与术前比较均有显著性增加(P＜0.05),术前及术后各时间点两组间比较差异均有统计学意义(P＜0.05).ASIA下肢运动评分,每组术后各时间点与术前比较均有显著性增加(P＜0.05),术前及术后各时间点两组间比较差异无统计学意义(P＞0.05).ASIA感觉评分,每组术后各时间点与术前比较均有显著性增加(P＜0.05);术前两组间差异无统计学意义(P＞0.05),术后各时间点两组间比较差异有统计学意义(P＜0.05).每组患者术后各时间点JOA评分与术前相比均明显改善(P＜0.05).术后1个月狭窄组与非狭窄组JOA评分改善率分别为37.3％和55.9％,术后1年分别为61.3％和73.6％,末次随访分别为77.3％和91.1％,上述各时间点两组间比较差异有统计学意义(P＜0.05).末次随访时,狭窄组手术改善率为88％(28/32),非狭窄组为(94％)(17/18),差异有统计学意义(P＜0.05).两组术后各出现4例颈部轴性疼痛;狭窄组13例、非狭窄组11例术后出现吞咽疼痛或吞咽异物感,行对症治疗后改善;狭窄组出现1例椎前血肿和2例C5神经根麻痹,经神经营养、消肿等对症治疗后好转.随访期间,两组患者均未发生内固定松动或摔倒等意外突发事件.结论:颈前路椎间盘切除植骨融合内固定术治疗颈椎挥鞭样损伤患者能够获得满意的疗效,但外伤前合并有颈椎间盘突出致颈椎管狭窄的患者术后短期疗效相对较差.

PurposePercutaneous vertebroplasty(PVP) has been widely used in treating symptomatic Schmorl's nodes(SNs). However, there were still some patients with poor pain relief. At present, there is a lack of research to analyze the reasons for poor efficacy.MethodsReview the SNs patients treated with PVP in our hospital from November 2019 to June 2022, collect their baseline data. Reverse reconstruction software was used to calculate the filling rate of bone edema ring(R-f). NRS score was used to evaluate pain and ODI to evaluate function. The patients were divided into remission group(RG) and non remission group(n-RG) according to symptom. In addition, according to the R-f, they were divided into excellent, good and poor groups. Differences between groups were investigated.ResultsA total of 26 vertebrae were included in 24 patients. When grouped according to symptoms, patients in n-RG were older, and surgical segments were tend to locate in lower lumbar spine. The proportion of Poor distribution was significantly higher. When grouped according to the cement distribution, the preoperative NRS and ODI of the three groups were comparable, but the NRS and ODI of Poor group were significantly worse than the Excellent and Good groups postoperatively and at the last follow-up.ConclusionsThe cement distribution may significantly affect the efficacy of PVP in treating symptomatic SNs. We suggest that the bone edema ring should be filled as fully as possible to ensure the efficacy. In addition, advanced age and low lumbar lesions are also adverse factors for clinical outcomes.

Background Spinal subdural hematoma (SSH) is a rare cause of compression of the neutral elements of the spinal cord. However, little is known about the presentation of acute SSH after lumbar spine surgery. The reason for this may be that symptomatic SSH occurs rarely and is not given enough attention by spine surgeons. Currently, the decision to perform MRI postoperatively is more dependent on surgeon preference; therefore, no high-quality studies have been published. Our team reports our experience in the diagnosis and management of SSH after lumbar decompression and fusion surgery. Methods We retrospectively studied 215 patients who underwent routine MRI following minimal invasive transforaminal lumbar interbody fusion (MI-TLIF) between 2020-01-01 and 2022-06-30. The patients were divided into SSH group (17 cases) and non-SSH group (198 cases) according to the occurrence of SSH. Univariate analysis and multivariate logistic regression analysis were performed to identify relevant risk factors that increase the risk of SSH postoperatively. Results None of the patients presented with serious neurologic symptoms, such as lower extremity paralysis or cauda equina syndrome that required emergency hematoma debridement. SSH was found in 17 (7.9%) patients and non-SSH in 198 (92.1%). Factors affecting SSH were presence of hypertension, presence of diabetes and postoperative anticoagulant therapy. The significantly independent risk factor of postoperative SSH were diabetes (P = 0.008, OR: 6.988) and postoperative anticoagulant therapy (P = 0.003, OR: 8.808). Conclusions SSH after MI-TLIF is not a rare condition, with generally no requirement of emergency evacuation. Comprehensive anti-symptomatic treatment could achieve satisfactory results. Diabetes mellitus and postoperative anticoagulant therapy are independent risk factors for SSH. Spine surgeons should hold applicability of the use of anticoagulants after lumbar surgery.

The intervertebral disc (IVD) is a load-bearing, avascular tissue that cushions pressure and increases flexibility in the spine. Under the influence of obesity, injury, and reduced nutrient supply, it develops pathological changes such as fibular annulus (AF) injury, disc herniation, and inflammation, eventually leading to intervertebral disc degeneration (IDD). Lower back pain (LBP) caused by IDD is a severe chronic disorder that severely affects patients’ quality of life and has a substantial socioeconomic impact. Patients may consider surgical treatment after conservative treatment has failed. However, the broken AF cannot be repaired after surgery, and the incidence of re-protrusion and reoccurring pain is high, possibly leading to a degeneration of the adjacent vertebrae. Therefore, effective treatment strategies must be explored to repair and prevent IDD. This paper systematically reviews recent advances in repairing IVD, describes its advantages and shortcomings, and explores the future direction of repair technology.

Percutaneous vertebral augmentation (PVA) and percutaneous cement discoplasty (PCD) are two relatively new minimally invasive surgeries for symptomatic Schmorl's reported in recent decade. However, the clinical evidence for the effectiveness of these two surgeries is insufficient. The purpose of this study was to compare the biomechanical benefits and risks of the two surgeries in order to analyze their biomechanical differences and effectiveness. We reconstructed Five lumbar finite element models via computed tomography data, including control model, PVA-ideal model, PVA-nonideal model, PCD-ideal model, and PCD-nonideal model. The stress and strain of Schmorl's nodes, bone marrow edema zone (BMEZ), affected endplate, and the overall stability of segment were analyzed and compared. The validity of our models was confirmed. As a result, the PVA-ideal model can significantly reduce the stress of Schmorl's node and the strain of BMEZ, while this effect is inappreciable in PVA-nonideal model. The PCD-ideal model significantly reduced the strain of Schmorl's nodes and BMEZ, and significantly improve segmental stability, but also resulted in a significant increase in the stress of Schmorl's nodes, BMEZ and endplates. The PCD-nonideal model not only lacks blocking effect, but also sharply increases the strain of Schmorl's nodes and BMEZ. Thus, We recommend that both PVA and PCD surgeries in ideal distribution facilitated a more stable paranodular biomechanical microenvironment. However, due to the possibility of poor biomechanical outcomes caused by the non-ideal cement distribution, the non-ideal distribution of bone cement needs to be remedied in practice.

目的 观察风险主动自查与超前自纠管理模式在骨科手术安全管理中的应用效果.方法 该院2019年7—9月开展风险主动自查与超前自纠管理活动,开展前后各抽取骨科手术患者100例,开展期间无护理人员变动,比较护理人员风险管理能力评分、护理缺陷事件发生率及患者护理满意度评分.结果 活动开展后骨科手术室护理人员各项风险管理评分和患者各项护理满意度评分高于开展前,差异均有统计学意义(P<0.05);活动开展后护理缺陷事件发生率(2.0％)低于开展前(7.0％),但差异无统计学意义.结论 将风险主动自查与超前自纠管理模式应用于骨科手术室安全管理中,可提升护理人员风险管理能力,降低护理缺陷事件发生率,提高患者护理满意度.

Study design : A retrospective cohort study. Objective : To detect the boundary of indications of fixation in OLIF surgery. Methods : Review patients undergoing stand-alone or combined OLIF. Measure the disc height increment (ΔDH), foraminal height (FH), cage subsidence (CS). VAS and the ODI was used to evaluate low back pain and functionality. Multiple linear regression were used to determine the risk factors of CS. Results : A totle of 66 consecutive patients included. The BMD in combined group was significantly lower than that of stand-alone group(p=0.005). The combined group showed better FH maintenance at 6 months (p= 0.049) and last follow-up (p= 0.019). In combined group, tCS was significantly lower at all post-operation point (p≤0.001). BMD was a mild negative correlated factor for CS in combined group (r= -0.602, p= 0.001)and a strongly negative correlated factor in stand-alone group (r= -0.797, p< 0.001). Greater mCS significantly associated with worse VAS (r=0.685, p<0.001) and ODI (r=0.616, p<0.001) in stand-alone group, and this effect was significantly weakened in the combined group as VAS (r=0.427, p=0.033) and ODI (r=0.594, p=0.002). Patients with stand-alone OLIF were at risk of severe CS when BMD <-1.38, while those with combined OLIF had an equal risk when BMD < -4.77. Conclusions : The long-term fusion rates and functionality improvements of OLIF with or without fixation are comparable. Patients with BMD < -1.38 may not suitable for stand-alone procedure due to higher risk of severe CS and worse clinical outcomes. Additional fixation can extends the applicable boundary to a BMD = -4.77.

Study design : Finite element simulation study. Objective : To compare the biomechanical effects of percutaneous vertebral augmentation (PVA) and percutaneous cement discoplasty (PCD) in patients with symptomatic Schmorl’s node combined with Modic change. Methods : CT data from a single patient was assembled into finite element models, from which we constructed four distinct surgical models, including PVA-ideal, PVA-nonideal, PCD-ideal, and PCD-nonideal, to compare the stress and strain differences of parapodular tissues. Results : The validity of our model was confirmed. PVA-ideal model showed a moderate reduction in the stress peak of the Schmorl’s node (0.48 vs. 0.81–0.89 Mpa) in the erect position. In the PCD-ideal model, the stress peak of the Schmorl’s node increased significantly when the spine was moved toward the lesion (3.99Mpa). Both PVA-ideal and PCD-ideal models showed global strain inhibition at the Schmorl’s node and BMEZ, which was attenuated in the non-ideal models. The PCD-ideal model significantly reduced segmental ROM (-76.8% to -59.3%) and significantly increases endplate stress (up to 220.8%), with no such effects seen in the PVA-ideal model. Conclusions : Both PVA-ideal and PCD-ideal models facilitated a more stable parapodular biomechanical microenvironment. The PVA-ideal model yielded minimal stress disturbance on the augmented or adjacent vertebral endplate but offered no improvement to segment stability. The PCD-ideal model provides adequate segment stability, but also carries a greater risk for adjacent vertebral fracture. As nonideal implementations of both surgeries can result in poor biomechanical outcomes, the surgical indications of PVA or PCD need to be carefully selected.

目的 探讨医疗失效模式与效应分析(HFMEA)管理模式对脊柱后路手术患者压疮的预防作用.方法 2019年1月至2020年12月在该院行脊柱后路手术的患者65例,按入院时间先后顺序分为对照组33例与观察组32例.对照组实施常规护理,观察组采用HFMEA管理模式的护理.比较两组压疮发生率及压疮分期、压疮恢复时间、术后72h压疮恢复程度、患者满意度.结果 观察组压疮发生率(6.3％)低于对照组(27.3％),压疮程度轻于对照组,压疮恢复时间短于对照组,术后72h压疮恢复评分高于对照组,整体满意率(100％)明显高于对照组(78.8％),差异均有统计学意义(P<0.05).结论 HFMEA管理模式可有效预防脊柱后路手术患者压疮发生,加快压疮患者的恢复,并提高患者满意度.

Objective:To evaluate the clinical efficacy and changes between Dynesys and Posterior lumbar interbody fusion (PLIF) in the treatment of two-level lumbar degenerative disease.Methods:43 consecutive patients with lumbar degenerative disease were treated using the Dynesys or PLIF between June 2010 and June 2012. In all patients, 23patients were implanted Dynesys and other patients for PLIF. The follow-up period was at least 60 months. Used the Visual analogue scale (VAS) and Oswestry disability index (ODI) to evaluate the clinical outcomes. And during the follow-up period, collected the data for the intervertebral height and the range of motion (ROM), for the operation section and the upper adjacent vertebral. MRI and Grading Scale from the University of California at Los Angeles (UCLA) were used to define the change of intervertebral disc signal.Results:The ODI index and VAS score both improved significantly at the final follow-up evaluation ( P<0.05), as compared to the basal line values. And in terms of imaging, there were no significant difference in the vertebral height of the operation section and the upper adjacent vertebral. The range of motion (ROM) for the operative section in the group of PLIF was significantly lower than that in Dynesys group ( P<0.05). And when it comes to the upper adjacent vertebral space, it was higher at the same time ( P<0.05). According to the UCLA Grading Scale, there were 3 cases in the Dynesys group and 11 in the PLIF group had radiological adjacent degeneration, the difference was significant between two groups ( P<0.05). And when it comes to the second intension, there were 3 patients in PLIF groups (TLIF 1; PLIF 2) but only 1 in Dynesys groups. Conclusion:Dynesys and PLIF are both effective for lumbar degenerative disease and show good medium and long-term clinical and radiographic results. But when it comes the risks in developing ASD and the ROM of adjacent segments, Dynesys stabilization can be the better choice.

Background: Annular fiber closure techniques have been proven effective in reducing short-term recurrence after discectomy. However, annular fiber closure devices are expensive and still fail at a low rate. We present a novel suture method, needle-guided annular closure suture (NGACS) that does not require a special device and can be performed for annular fiber closure following microendoscopic discectomy.Material/Methods: Twenty-five patients who underwent treatment with NGACS were reviewed by analysis of the medical records. The clinical outcomes were assessed and compared preoperatively and immediately, 1, 6, and 12 months postoperatively. The parameters included the Visual Analog Scale (VAS)-back and VAS-leg scores and the Oswestry Disability Index (ODI). Midsagittal T2WI images were obtained to evaluate lumbar disc degeneration using the Pfirrmann grade. Additional adverse events were also recorded and tracked.Results: The VAS-back and VAS-leg scores and the ODI were significantly different at each follow-up time point (P<0.001), and improvements in pain and disability were maintained well during the follow-up period. Lumbar disc reherniation or other serious adverse events were not observed in this series. There was no significant difference between the initial and final Pfirrmann grades (Z=-1.414, P=0.157). The preoperative average disc height was 9.94 +/- 1.97 mm, and the disc height at 12 months after surgery was 9.14 +/- 1.88 mm. The average decrease in disc height was 8.11 +/- 3.36%.Conclusions: This study demonstrates the feasibility and superior clinical outcomes of the NGACS technique. This method can be a good substitution when annular fiber closure devices are not available. Moreover, this technique can be easily popularized due to its low cost and few restrictions.

OBJECTIVE:To evaluate the clinical effects of percutaneous endoscopic foraminoplasty for simple lumbar spinal lateral exit zone stenosis. METHODS:A total of 36 patients with simple lumbar spinal lateral exit zone stenosis were admitted to our hospital from January 2013 to June 2018, and received selective nerve root canal radiography and radicular block. According to the symptoms and patients' personal wills, 22 cases underwent the one-stage percutaneous foraminal surgery(the one-stage operation group), and the other 14 patients were re-admitted to the hospital for operation(the delayed operation group) because of the recurrence of symptoms after discharge. The visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the clinical effects before therapy, 1 day after the radicular block, and 1 day, 3 months and 6 months after the operation. RESULTS:VAS and ODI of all 36 cases were obviously improved (P<0.05) at various stages after the surgery and maintained well and showed a continuous downward trend. The VAS at 6 months after the operation was improved significantly compared with that at 1 day after the operation (P<0.05).When comparing the postoperative ODI between 1 day and 3 months after the surgery, 1 day and 6 months after the surgery, 3 months and 6 months after the surgery, the differences were statistically significant (P<0.05). The VAS and ODI of the one-stage operation group at 1 day after radicular block were better than those of delayed operation group. The VAS and ODI of delayed operation group before readmission were significantly higher than those at 1 day after radicular block. There were no significant differences in VAS and ODI at each stage after operation between two groups(P>0.05), but when compared with its own pretherapy andbefore readmission results, the difference was significant (P<0.05). There was no nerve injury in all cases. Only 2 cases were presented with the outlet root stimulation symptoms, and the symptoms relieved after short term conservative treatment. CONCLUSION:The clinical effects of radicular block may be unsustainable for patients with simple lumbar spinal lateral exit zone stenosis. Instead, percutaneous endoscopic foraminoplasty was simple, safe and effective.

目的 探究微创侧方入路腰椎椎间融合术(extreme lateral interbody fusion,XLIF)与微创侧前方入路腰椎椎间融合术(oblique lateral lumbar interbody fusion,OLIF)对退变性脊柱侧凸患者功能恢复的影响,为临床上退变性脊柱侧凸的治疗方式选择提供参考.方法 选取2016年1月-2019年1月宁波大学医学院附属医院收治的行手术治疗的退变性脊柱侧凸患者100例,按术式分为XLIF组(56例)、OLIF组(44例).XLIF组行XLIF术,OLIF组行OLIF术.对比2组临床指标、脊柱侧凸Cobb's角、PI-LL、功能恢复、疼痛、并发症发生情况.结果 OLIF组术后6个月侧凸Cobb's角、PI-LL分别为(5.00±1.10)°、(13.52±2.13)°,低于XLIF组的(5.12±1.09)°、(13.68±2.15)°,差异无统计学意义(t=0.544、0.371,P=0.587、0.712).OLIF组术后6个月DOI、NRS评分分别为(8.00±0.50)分、(1.13 ±0.02)分,低于XHF组的(11.27±0.68)分、(2.49±0.10)分(t=26.710、99.277,均P＜0.001);OLIF组术后6个月JOA评分为(25.66±3.58)分,高于XLIF组的(19.68±2.46)分(t=9.884,P＜0.001).OLIF组患者手术并发症发生率为2.27％,低于XLIF组的17.86％(x2=4.625,P=0.032).结论 与XLIF术相比,OLIF术可减轻退变性脊柱侧凸患者腰椎疼痛症状,促进功能恢复,且安全性较高,值得临床推广应用.

To examine the clinical effects of a new bone cement composed of poly(methyl methacrylate) (PMMA) and mineralized collagen (MC) compared with pure PMMA bone cement in treating osteoporotic vertebral compression fractures (OVCFs) in patients aged over 80. In all, 32 cases using pure PMMA bone cement and 31 cases using MC-modified PMMA (MC-PMMA) bone cement for OVCFs between June 2014 and March 2016 were screened as PMMA group and MC-PMMA group, respectively, with an average age of over 80. The operation duration, intraoperative blood loss, hospital stay, oswestry disability index (ODI), visual analogue scale (VAS), anterior vertebral height (AVH), intermediate vertebral height (IVH) and posterior vertebral height (PVH) of injured vertebrae, vertebral computed tomography value, re-fracture rate of adjacent vertebrae, correction rate of spinal kyphotic angle and wedge-shaped vertebra angle and surgical complications were compared between the two groups. In the early post-operative period, the VAS, ODI, AVH and IVH in MC-PMMA group were comparable to those in the traditional PMMA group. Moreover, the MC-PMMA group showed better effects compared with the PMMA group 12 months after surgery. Thus, this new bone cement has superior clinic effects in the long term.

目的 比较动态中和固定系统(Dynesys)及腰椎椎间融合内固定术(椎间融合术)治疗老年腰椎退行性疾病的疗效.方法 采用Dynesys治疗65例老年腰椎退行性疾病患者(Dynesys组),并与同期接受单节段椎间融合术的70例同类患者(融合组)作比较,比较2组手术时间、术中出血量、住院日数以及手术疗效、术后Oswestry功能障碍指数(ODI)、疼痛视觉模拟评分(VAS)、术后手术节段和上位节段活动度的差异.结果 Dynesys组手术时间、术中出血量、住院日数均短/少于融合组(P均<0.05),而术后ODI和VAS 2组比较差异均无统计学意义(P均>0.05).2组随访时间为48～100个月.至末次随访时,Dynesys组和融合组患者的疼痛症状和神经功能均得到了明显改善,均未出现螺钉松动、断裂或腰椎移位.Dynesys组和融合组术后4年的优良率分别为93.15％和90.67％.Dynesys组术后手术节段活动度大于融合组(P<0.05),但2组术后上位节段活动度比较差异无统计学意义(P>0.05).融合组患者术后2例(2.9％)出现邻椎病,而Dynesys组患者均无出现邻椎病.结论 术前严格把握手术适应证,Dynesys系统治疗老年腰椎退行性疾病的创伤较椎间融合术更小,术后并发症更少,恢复更快.

Objective Finite element method was used to clarify the biomechanics effect of cement intervertebral leakage during vertebral augmentation.Present a novel classification of bone cement intervertebral leakage.Analyze the effect of stress changing of bone cement intervertebral leakage on adjacent endplate by finite element method.Methods Based on Churojana's classification method,we redefined diverse kinds of intervertebral leakage:as the Type Ⅰ (intervertebral-extradiscal leakage),Type Ⅱ (intradiscal leakage) and Type Ⅲ (combined leakage).Type Ⅱ was also been divided into Ⅱa (anterior),Ⅱb (central),Ⅱc(posterior),Ⅱd (lateral) and Ⅱe (cross-region) due to the location of the leaked bone cement.All the Type Ⅱ cases were divided into 1 or 2 two subtypes according to whether the cement had reached the adjacent vertebral endplate.We established 3D reconstruction of volunteer thoracolumbar spine using Mimics 17.0 software,and using Geomagic 2015 to generate L1 vertebral compression fracture model.In the Ansys 17.0 software,we simulated the L1 bone cement leakage into the T12/L1 intervertebral space model.After validating the validity of the model,calculate the solution of the intact model,non-leakage model and various leakage models,the stress distribution of the caudal endplate of T12 was analyzed in neutral,flexion,extension,lateral bending and torsion.Results The maximum stress of inferior endplate of T12 vertebra of intact model is 11.476 MPa,19.517 MPa,16.879 MPa,42.346 MPa,43.033 MPa,6.568 MPa,6.568 MPa in neutral,flexion,extension,left bending,right bending,left rotation,right rotation respectively.For the non-leakage model,the maximal stress of adjacent vertebral endplate was 12.967 MPa (112.99％),23.134 MPa (118.53％) and 20.403 MPa (120.88％) in neutral,flexion and extension compared to the intact model.No significant increasing can be found in other conditions.Compared to the non-leakage model,the stress of adjacent vertebral endplate is similar when type Ⅰ leakage occurs.In type Ⅱ leakage,the Ⅱa1 was 28.506 MPa (123.40％) in the flexion;the Ⅱa2 was 84.791 MPa (366.52％) in the flexion;the Ⅱb2 was 14.138 MPa (122.82％) in the neutral and 27.313 MPa (118.06％) in the flexion;the Ⅱc1 was 19.695 MPa (128.50％) in the extension;the Ⅱc2 was 67.740 MPa (441.97％) in the extension,and the Ⅱd2(right) was 123.940 MPa (285.83％) in the right bending.In the left/right rotation motions,the stress values are small,ranging from 5.095-15.585 MPa.Conclusion After vertebral augmentation,the stress of adjacent vertebral endplate increased slightly.Type Ⅰ leakage did not further increase the stress of adjacent vertebral endplates.Type Ⅱ leakage increases the stress of adjacent endplates in the direction of leaked cement.Subtype 2 of Type Ⅱ offer more stress than subtype 1.When the peripheral type of leakage (Ⅱa,Ⅱc and Ⅱd) occurred,if the spine flexes in the direction of leakage,then the stress increase of adjacent endplates will increase further.