Objective To propose and validate a novel model to explore the potential compensatory mechanism of sacral obliquity and pelvic obliquity in coronal balance. Summary of Background Data Sacral obliquity and pelvic obliquity are common phenomena in adolescent idiopathic scoliosis (AIS). However, their compensatory mechanisms in coronal balance remain unclear. Methods A total of 569 AIS patients were recruited. Coronal pelvic and lower limb parameters, including sacral obliquity (SO), iliac obliquity (IO), and hip obliquity (HO), were measured. Coronal spinal parameters, such as coronal distance (CD), clavicle angle (CA), thoracic curve (T), thoracolumbar/lumbar curve (TL/L), and tilt angle of L2∼L5, were measured. Correlation analysis was performed. Results The mean values of SO, IO, and HO were 3.34±2.81°, 1.40±2.04°, and 0.82±1.79°, respectively. The largest correlation coefficients with SO were L5 and IO (r=0.725, 0.701). The largest correlation coefficients with IO were SO and HO (r=0.701, 0.801). The largest correlation coefficients with HO were SO and IO (r=0.566, 0.801). Conclusion SO, IO, and HO have different implications for coronal balance, and their magnitude and direction can be deduced from the novel model. These parameters could be used to evaluate the compensation of the pelvis and lower limbs in AIS. In the coronal position, the pelvis and lower limbs extend the spinal sequence, similar to vertebrae and intervertebral discs.

新型冠状病毒（SARS-CoV-2）感染引起的2019冠状病毒病（COVID-19）目前呈世界大流行趋势,中国的疫情已经得到控制,现阶段的主要任务是防止外源性输入病例及无症状感染者导致的二次爆发[1-2]。因疫情发展趋势尚不明朗,病毒可能长期存在,在抗疫常态化背景下,如何在全面复工、复产的形势下,安全开展医疗工作成为医疗行业当前关注的重点。

目的:测量脊柱畸形患者冠状位骨盆-下肢参数,探讨骨盆-下肢在脊柱畸形冠状位序列及平衡中的代偿机制.方法:收集49例以胸腰弯/腰弯为主的青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者和46例退行性腰椎侧凸(degenerative lumbar scoliosis,DLS)患者术前、术后和末次随访时的全脊柱X线片,在正位X线片上测量骨盆-下肢冠状位参数:骶骨倾斜角(sacral obliquity,SO)、髂嵴倾斜角(iliac obliquity,IO)、髋臼倾斜角(hip obliquity,HO),由两位脊柱外科主治医生分别测量,间隔1个月后重复测量,检验其信度.同时测量脊柱冠状位参数:冠状位失平衡距离(coronal decompensation,CD)、胸腰弯/腰弯(thoracolumbar/lumbar curve,TL/L)和腰骶弯(lumbosacral curve,LS)、骨盆-下肢弯(pelvis-leg curve,PL).将矫形前冠状位骨盆参数与TL/L进行相关性分析,并对比其与矫形后及末次随访时的差异.结果:AIS组SO、IO、HO的观察者间信度分别为0.986、0.979、0.989,观察者内信度为0.988、0.983、0.976;DLS组观察者间信度分别为0.863、0.979、0.996,观察者内信度为0.920、0.986、0.995.矫形前,AIS组和DLS组的TL/L与SO、IO、HO均有显著相关性(r分别为0.805、0.735、0.324和0.649、0.651、0.457,P＜0.05),SO与IO、HO亦有显著相关性(r分别为0.800、0.518和0.529、0.359,P＜0.05).AIS组矫形前、后及末次随访时的SO分别为4.5°±2.6°、2.3°±2.1°、3.3°±2.3°,IO分别为2.0°±1.6°、0.6°±1.8°、1.4°±1.6°,HO分别为0.5°±1.5°、-0.9°±1.8°、-0.1°±1.6°;DLS组SO分别为3.1°±3.4°、1.1°±4.3°、1.4°±3.2°,IO分别为1.2°±2.0°、-0.2°±3.1°、0.4°±2.1°,HO分别为0.5°±1.9°、-0.9°±2.9°、-0.5°±2.0°;与矫形前比较,两组矫形后SO、IO、HO均显著性减小(P＜0.05);AIS末次随访时SO、IO、HO有所增加(P＜0.05),DLS末次随访时SO、IO、HO均无显著性变化(P＞0.05).结论:SO、IO、HO作为简单、可靠的骨盆-下肢冠状位影像学参数可用于评价骨盆及下肢的冠状位序列;骨盆-下肢弯可延续脊柱畸形的冠状位序列并参与躯干冠状位平衡的代偿.

目的 分析影响Lenke 5型青少年特发性脊柱侧弯患者术后出现近端交界性后凸(proximal junctional kyphosis,PJK)的因素.方法 回顾性分析2012年3月-2016年12月本中心脊柱外科收治的33例Lenke 5型青少年特发性脊柱侧弯(adolescent idiopathic scoliosis,AIS)患者的临床资料.末次随访时近端交界角(proximal junctional angle,PJA)较术前增加＞10°的患者纳入近端交界性后凸组(proximal junctional kyphosis,PJK),其他患者纳入非近端交界性后凸组(non-proximal junctional kyphosis,Non-PJK).分析术前及末次随访时各参数的差异性,及PJA与各参数的相关性.结果 本次研究中PJK组12人,男性3人,女性9人,平均年龄为13.58±3.2岁;Non-PJK组21人,男性5人,女性16人,平均年龄15.19±6.43岁.两组一般资料差异无统计学意义.PJK组TK、PJA、LL、LIF、PI-LL、TL/LC、TC,Non-PJK组TK、TLK、LIF、TL/LC、TC术前与末次随访时的差异有统计学意义;末次随访时PJK组与Non-PJK组TK、PJA、LL、PI-LL差异有统计学意义;末次随访时的PJA与TK(r=0.805,P=0.000)、TLK(r=0.397,P=0.022)、LUF(r=-0.357,P=0.042)、PI-LL(r=-0.528,P=0.002)、LL(r=-0.364,P=0.037)相关.结论 术后TK、PI-LL过大可能是发生PJK的因素;可以通过术中减少TLK、根据PI将LL调整在合适的范围内防止术后PJK的出现.

目的:分析Lenke 5型青少年特发性脊柱侧凸(AIS)患者颈椎矢状位曲度(CSA)在后路矫形术后改变的特点.方法:回顾性分析2011年7月～2017年7月解放军总医院脊柱外科收治的43例Lenke 5型AIS患者的临床资料.在术前、术后及末次随访时的X线片上测量颈椎前凸角(CL)、胸椎后凸角(TK)、胸腰段后凸角(TLK)、腰椎前凸角(LL)、融合节段内腰椎前凸角(LIF)、C7矢状位垂直距离(SVA).同时统计患者的基本资料,包括性别、年龄、Risser征、随访时间、融合节段椎体数目(NVF)及术前胸腰段/腰弯(TL/L Curve,TL/L C).依据患者术前CSA分为颈椎前凸组(L组,术前CL＜0°)、颈椎后凸组(K组,术前CL≥0°);依据患者末次随访时CSA较术前的改变分为颈椎前凸增加组(Ⅰ组)与颈椎前凸减少组(D组).使用t检验分析L组与K组、Ⅰ组与D组对应参数的差异性,使用LSD-t检验分析各组内术前、术后、末次随访时参数的差异.使用Pearson相关性检验分析CL与Ⅰ组和D组各参数的相关性.检验水准为双侧α=0.05.结果:43例患者中男10例,女33例;年龄15.90±4.98岁,随访时间22.84±14.10个月.L组15例,K组17例;Ⅰ组26例,D组17例.L组与K组、Ⅰ组与D组的基本资料无显著性差异.所有患者末次随访时TK较术前增加(P=-0.000);术后TLK与术前比较有显著性差异(P=0.000);CL在术前、术后及末次随访时无统计学差异.L组与K组术前CL(P=0.000)、LIF(P=0.029)、SVA (P=0.003)差异有统计学意义(P＜0.05).K组末次随访时CL较术前改善(P=0.025),TK较术前增加(P=0.000);术后TLK较术前减小(P=0.002)并维持至末次随访(P=0.002).Ⅰ组与D组术前LL(P=0.043)、CL(P=0.009)有显著性差异(P＜0.05).Ⅰ组末次随访时CL较术前改善(P=0.008),TK较术前(P=0.000)及术后(P=0.001)增加;术后TLK较术前减小(P=0.005)并维持到末次随访时(P=0.006).D组术后LL较术前增加(P=0.011)并维持到末次随访(P=0.001).Ⅰ组术前CL与TK、SVA有相关性;D组CL术前与LL、SVA,术后与TLK、SVA,末次随访时与TLK有相关性.结论:术前颈椎后凸的患者较颈椎前凸的患者在术后CSA的改善更为明显;随访中TK增加、术后TLK改善可能有助于CSA的改善;术后只有LL增加而无TK、TLK的改变则可能不会引起CSA改善.

随着导航技术和微创技术的进步,脊柱微创手术得到了持续的发展.传统的术中影像系统 ( 如 C 型臂透视系统 ) 目前在脊柱手术中应用广泛,而更为先进的影像系统如三维 X 线透视、锥体束 CT、术中 CT / MRI 等,则被研究证实具有更为安全和准确的内植物置入水平,同时还可以显著减少医护人员的放射线暴露剂量 [1].这些先进的导航技术的应用对比传统的术中 C 型臂透视技术,可以提供更为准确和清晰的解剖图像,对于脊柱微创手术显得更为适用 [2-3],笔者将近年来脊柱微创手术中导航系统的应用现状及研究进展综述如下.

Objective:To explore the clinical value of intraoperative CT navigation for pedicle screws placement in surgical correction of spinal deformity with vertebral rotation.Methods:A total of 100 patients with spinal deformity and vertebral rotation in our hospital from 2009 to 2012 were retrospectively analyzed.All patients were divided into navigation group(n =37) and non-navigation group (n--63).Each group were divided into 4 subgroups (G1,G2,G3,G4 group).After all screws placement completed,CT scan was taken three dimensional reconstruction,and was given assess accuracy of each screw.Broken screws rate,malposition and revision rate of each group were calculated and analyzed.Results:Broken screws rate,mollposition and revision rate in navigation group were lower than those in non-navigation group(P＜0.01).Accuracy rates of G3,G4 sub groups in navigation group were higher than those in non-natigation group(P ＜0.01).Conclusion:Intraoperative CT navigation can improve the accuracy of pedicle screws placement when degree of vertebral rotation exceed 10°.

Objective To study the protective effects of oral sodium pyruvate on microstructural changes of L5 dorsal root ganglion in rats subjected to simulated weightlessness.Methods Forty male Sprague-Dawley rats were randomly divided into groups of normal control drinking regular water (group CON),tail-suspension drinking regular water (group SUS),tail-suspension drinking normal saline (group SAL) and tail-suspension drinking pyruvate saline (group PYR).After the microgravity for 8 weeks,both sides of L5 dorsal root ganglion were taken out.Cell morphology with hematoxylin eosin staining and Nissl body shape with toluidine blue staining examined by light microscopy and mitochondria observed by electron microscopy were carried out with dorsal root ganglion.Glial cell line-derived neurotrophic factor and glial fibrillary acidic protein protein expressions were measured by Western-blot.ATP contents and ATPase activities were also detected.Four groups of samples were compared using analysis of variance.Results Compared with groups SUS and SAL,dorsal root ganglion cells showed no obvious swelling and gap widened.Their Nissl bodies were staining darker and mitochondrial structure was integral in group PYR.Western-blot determinations revealed that the glial cell line-derived neurotrophic factor expression in group PYR was increased with 223％ and 212％,compared with group SUS and group SAL,respectively;the glial fibrillary acidic protein level was decreased in both group SUS and group SAL by 28％ and 24％ in comparison with group PYR,respectively,the differences were statistically significant (with P values below 0.05).In metabolic parameters,ATP contents in group PYR were enhanced by 35％ and 38％,relative to groups SUS and SAL,respectively.ATPase activities in group PYR were improved with 42％ and 51％,relative to groups SUS and SAL,respectively,the differences were statistically significant (with P values below 0.05).ATP contents and ATPase activities in group PYR were all preserved.All the parameters in group PYR were not statistically significant different from those in group CON (with P values above 0.05).Conclusions The dorsal root ganglion and its organelles in both structure and function were injured in rats subjected with 8-week simulated weightlessness;oral pyruvate could alleviate damage of dorsal root ganglion in the early stage of microgravity.

Objective To evaluate the efficacy and safety of SURGIFLO,a hemostatic material,when used to stop active bleeding in anterior cervical operations.Methods Eighty-six patients who had received one-level anterior cervical operation between October 2015 and May 2016 were divided into two groups using the randomized method.SURGIFLO was used for hemostasis in the study group,while the traditional method was used in the control group.Operation time,intraoperative blood loss,postoperative drainage were recorded and compared between the two groups to evaluate the hemostatic effect.Results In anterior cervical operations,the intraoperative blood loss was (39.4 ± 16.9) ml and operation time was (73.8 ± 13.9) mins in the study group,compared with (46.7 ± 15.9) ml and (86.3 ± 18.5) mins in the control group.There was significant difference between the two groups (P ＜ 0.05),butthere was no significant difference between the study group (6.1 ± 4.2) ml and the control group (9.3 ± 8.9) ml in postoperative drainage (P ＞ 0.05).Conclusions In one-level anterior cervical operations,the use of SURGIFLO can shorten the operation time and reduce the intraoperative blood loss and surgical complications.SURGIFLO is a safe and effective hemostatic material in spine surgery.

目的 分析模拟失重雌、雄性大鼠模型骨密度及骨代谢生化指标和生物力学之间的相关性,与骨折风险建立联系,探讨航天医疗基础工作.方法 3个月龄雌、雄性SD大鼠各20只,按照性别及是否失重分为4组.采用尾部悬吊模拟失重方法,实验4周后处死SD大鼠,双能X线吸收法(dual-energy X-ray absorption,DEXA)测定L4椎体、股骨髁部骨密度,骨组织切片染色,ELISA法检测骨代谢生化标志物:骨碱性磷酸酶(bone alkaline phosphatase,BALP)、抗酒石酸酸性磷酸酶(tartrateresistant acid phosphatase,TRAP),生物力学测试骨强度.结果 悬吊组大鼠较对照组大鼠BMD均显著下降,雌性悬吊组较雄性组下降明显;组织切片悬吊组较对照组骨组织及骨细胞间隙明显增宽,细胞肿胀;BALP、TRAP雄性悬吊组分别较对照组升高3.09和1.72倍,雌性悬吊组分别较对照组升高3.43和2.14倍;悬吊组椎体的最大压缩载荷(N)、最大压缩压力(MPa)、股骨最大抗弯曲载荷(N)悬吊组较对照组显著下降.骨密度(bone mineral density,BMD)、BALP、TRAP与椎体最大力学强度Fmax相关性系数r值,雄性组分别为0.985、-0.949、-0.970,雌性组分别为0.908、-0.858、-0.921.结论 失重4周后大鼠出现明显的骨质疏松、骨小梁结构破坏、力学强度显著下降.雌性大鼠骨质疏松较雄性组明显加重.最大力学强度Fmax与骨密度成正相关,与BALP、TRAP成负相关,未来精准、便捷的骨代谢指标可能成为航天医学预测骨折风险的手段之一.

Objective To explore the impact of the ratio between pelvic tilt (PT) and sacral slope (SS) on the life quality of patients with ankylosing spndylitis (AS) after kyphosis correction. Methods From November 2008 to May 2011, 33 AS pa?tients were reviewed, including 31 males and 2 females, aged from 19 to 58 years old (average, 36 years old). The thoracolumbar kyphosis angle was 35.23° ± 13.98° (range, 15.12°-74.37° ) and the lumbar lordosis angle was 8.68° ± 18.27° (range,-23.70°-62.15°). The Scoliosis Research Society (SRS)?22 questionnaire was used to evaluate the quality of life and the Oswestry disability index (ODI) was used to evaluate the condition of pain. The pelvic incidence (PI), PT, SS, sagittal vertical axis (SVA) and osteoto?my angle were obtained from standing lateral full?spine radiographs. The correlations were analyzed from the subjective grading and the sagittal parameters in AS patients. Results The osteotomy site was in L1 (5 cases, 21.00°-54.59° , average 32.59° ± 13.44° ), L2 (19 cases, 28.63°-66.24° , average 37.89° ± 9.26° ), L3 (9 cases, 31.78°-60.90° , average 47.05° ± 9.20° ), respectively. The range of osteotomy angle was 39.59°±10.82° (range, 21.00°-66.24°). The subjective grading and spino?pelvic parameters were improved significantly after operation except PI, only postoperative PT/SS (0.93±0.65) and ODI standing (0.60±0.75)(r=0.681, P<0.05), osteotomy angle (39.59°±10.82°) and satisfaction of management (3.33±0.49)(r=0.478, P<0.05)had correlation with the subjective grading. Conclusion Compared with the change of PT, SS and SVA, the change of PT/SS is more closely related to the quality of life after operation in AS patients with kyphosis, which should be pay attention to by surgeon when designing operative schemes.

目的 作为阶梯式治疗方法之一,评价选择性神经根阻滞术(selective nerve root block,SNRB)对腰椎椎间孔狭窄症(1umbar foraminal stenosis,LFS)的疗效.方法 选取我科收治的LFS患者56例,Wildermuth分级:1级30例,2级26例,根据症状、体征及影像学表现,明确责任间隙,局麻下行SNRB术,术前术后随访患者VAS和JOA评分,Nakai分级标准评价术后疗效.结果 随访3-15个月,平均12.8个月,5例后期行椎间孔微创手术,4例行开放融合手术,SNRB手术短期优良率达80％,VAS评分术前腰痛、腿痛评分分别为(6.5±1.9)、(7.2±1.3),术后1d分别为(3.1±1.2)、(2.5±0.8),末次随访分别为(3.5±0.8)、(2.8±1.2)分,JOA评分术前、术后、末次随访分别为(13.8±4.2)、(24.5±3.8)、(23.1±2.6)分.VAS、JOA术后和末次随访较术前差异均有明显统计学意义,术后1d和末次随访评分无统计学差异.结论 SNRB作为阶梯治疗方式在腰椎椎间孔狭窄症中疗效确切,SNRB不仅是一种诊断方式,也是一种行之有效的治疗方式.

目的 研究尾吊模拟失重对雌、雄性大鼠第5腰椎背根神经节(dorsal root ganglion,DRG)微观结构的影响.方法 成年雌、雄性大鼠各20只,按性别和是否模拟失重随机分为4组.实验组尾部悬吊建模.4周后取第5腰椎双侧DRG,HE和甲苯胺蓝染色观察细胞和尼氏体形态,电镜观测髓鞘板层结构,免疫组化检测髓鞘碱性蛋白(myelin basic protein,MBP)含量.结果 模拟失重组DRG细胞间隙轻度增宽,部分节细胞与卫星细胞分离;尼氏体结构蓬松、肿胀,染色不均匀.电镜下模拟失重组髓鞘板层结构紊乱、松散;免疫组化结果显示,尾吊组MBP染色减轻,积分光密度(integral optical density,IOD)值较对照组降低(P＜0.01);不同性别间差异显著(P＜0.05).结论 模拟失重导致背根神经节细胞、细胞器及MBP的改变,雌性组DRG的损伤较雄性组更严重,提示航天医疗应个性化对待此种差异.

目的:探讨不使用传统钛网支撑植骨的后路脊柱去松质骨截骨术(posterior vertebral column decancellation,PVCD)治疗Pott's角状后凸畸形的安全性及有效性.方法:回顾性分析2010年8月～2014年5月于我院行PVCD治疗且资料完整的26例Pott's角状后凸畸形患者的临床资料,其中男11例,女15例,年龄24.8±7.6岁(14～46岁).后凸顶点位于胸椎6例,胸腰段18例,腰椎2例.术前ASIA分级C级1例,D级4例,E级21例.记录并分析手术前后及末次随访时的后凸Cobb角、顶椎区域前柱和后柱长度变化、手术时间、术中出血量、手术并发症.结果:手术时间为306.2±59.5min (200～420min),术中出血量为2046.2±742.4ml(1000～4000ml).5例患者围手术期出现并发症,其中一过性神经症状2例,脑脊液漏3例.术前后凸Cobb角为91.3°±17.5° (66°～140°),术后为17.1 °±6.2°(4°～30°),矫正74.2°±18.1 °,矫正率为(80.9±6.6)％.截骨部位前柱增加3.6±3.1 cm (0～8.4cm),后柱短缩2.7±1.1cm(1.3～4.8cm).所有患者均获随访,随访时间为30.8± 16.5个月(12～60个月).末次随访时后凸Cobb角为20.3°±6.1°(9°～33°),矫正平均丢失3％.末次随访ASIA分级C级患者恢复为D级,3例D级患者恢复为E级,l例D级患者无恢复.结论:不使用传统钛网支撑植骨的PVCD技术是治疗Pott's后凸畸形的一种安全有效的方法.

Objective To compare the clinical effect of minimally invasive surgery transforaminal lumbar inter-body fusion (MIS-TLIF) and posterior lumbar interbody fusion (PLIF) in treatment of L5~S1 degenerative lumbar spine disease. Methods A total of 84 patients with L5~S1 degenerative lumbar spine disease (38 patients for MIS-TLIF, 46 pa-tients for PLIF), who admitted to Department of Spinal Surgery in our hospital from December 2012 to August 2014, were selected as the subjects. The average follow-up time for these patients was 15.8 months (range, 12~20 months). The time of surgery, blood loss, time of standing recovery, hospital time, X-ray exposure, postoperative drainage volume, vi-sual analogue score (VAS) and Japanese Orthopedic Association (JOA) scores of MIS-TLIF group and PLIF group were compared. Results There were no differences between the MIS-TLIF group and PLIF group in age, gender and clinical diagnosis (P>0.05). Compared with PLIF group, MIS-TLIF group had significantly shorter operative time (122 h vs 136 h), less blood loss (115 mL vs 151 mL), less postoperative drainage volume (0 mL vs 140 mL), shorter postoperative bed time (3.6 d vs 5.2 d) and longer X-ray exposure time (15 s vs 11.6 s), all with P<0.05. After discharged from hospital, the VAS scores of low back pain in MIS-TLIF group [(3.8 ± 2.3) points] was significantly shorter than that in PLIF group [(4.9±4.2) points] (P<0.05). After 3 months of surgery and final follow-up, there were no significant differences between MIS-TLIF group and PLIF group in VAS scores [3 months post operation:2.1 points vs 2.5 points;Final follow-up:1.3 points vs 1.5 points) (P>0.05) and JOA scores (3 months post operation:19.2 points vs 18.9 points;Final follow-up:24.6 points vs 25.1 points) (P>0.05), while which were significantly better than preoperative scores in two groups (P<0.05). There was no significant difference between MIS-TLIF group (92.1%) and PLIF group (91.3%) in the clinical curative effects of final follow-up. Conclusion MIS-TLIF has the advantages of surgery in L5~S1 lumbar degenerative disease, so we can choose the reasonable surgical procedure according to individual skill levels and instruments.

Objective To observe the effect of simulated weightlessness on DRG in female rat model.Method 80 female Sprague-Dawley rats were randomly designated as HU groups (n=40) and normal control(NC) groups (n=40).Four weeks later, the L5 DRG was excised, lumbar 5 DRG were stained with HE staining, the myelin of DRG was observed by using immunohistochemis-try.TEM method aimed to observe the DRG myelin and mitochondria.Results HE staining showed that, in HU groups, the arrange-ment between cells in DRG were slightly loose, some ganglion cells and satellite cells were separated.IOD in NC groups was 0.573 ± 0.007, which was lower than in HU groups (0.802 ±0.009)(P<0.05).In HU group, the structure of myelin was disorderly and twisted.Mitochondria in HU group were swollen and deformed obviously.Conclusions Stimulated weightlessness can cause the dam-age changes in the DRG myelin and mitochondria.These suggests that simulated weightlessness can cause damage in female rat DRG.

Objective To investigate health-related quality of life ( HRQOL ) after personalized kyphosis correction in ankylosing spondylitis ( AS ).Methods Forty AS patients with fixed thoracolumbar kyphosis were treated with pedicle subtraction osteotomies ( PSO ) in our hospital from January 2007 to November 2011. All patients with no spinal cord neurological signs and good hip range of motion in both sides were divided into two groups under randomized method. Closing wedge osteotomy correction and pedical screw fixation of single segment or double segments from posterior approach were performed in both groups. Group A was treated with personalized PSO and group B was treated with traditional PSO. Pre- and post-operative pelvic incidence ( PI ), pelvic tilt ( PT ) were measured. The scoliosis research society-22 ( SRS-22 ) questionnaire and Oswestry disability index ( ODI ) were used to evaluate clinical results. Analyses of assessing scores and the relationship between PI and PT preoperatively and postoperatively were conducted.Results There were no signiifcant differences between group A and group B in pre-operative PI, PT, ODI and SRS-22 (P>0.01 ). All of the patients experienced improvement in appearance, psychology, pain, function and satisfaction, especially ODI. There were no signiifcant differences between A and B in post-operative ODI, SRS-psychology, pain, function and satisfaction (P>0.01 ) but SRS-appearance (P=0.0020 ), which were ( 4.6±0.3 ), ( 4.3±0.3 ) respectively.Conclusions Personalized kyphosis correction can improve the quality of life for AS patients after the operation. It also has better controllability on the correct angle of the chin-brow. Mastering of the personalized method can signiifcantly simplify discussions and controversies of the operation plan to achieve similar even better effects compared with traditional method.

Objective To compare clinical outcomes of the minimally invasive transforaminal lumbar interbody fusion ( MIS-TLIF ) with intraoperative computed tomography ( iCT ) navigation system, minimally invasive transforaminal lumbar interbody fusion ( MIS-TLIF ) and conventional open transforaminal lumbar interbody fusion ( COTLIF ) for single-level lumbar fusion surgery, by which to evaluate clinical effects and feasibility of the MIS-TLIF by assistance of iCT navigation system.Methods From April, 2009 to September, 2011, 45 patients diagnosed as lumbar disc herniation ( LDH ) were treated by one team of surgeons at a single institution. Minimally invasive transforaminal lumbar interbody fusion with intraoperative computed tomography ( iCT-MIS-TLIF )was conducted in 11 cases. MIS-TLIF was conducted in 15 cases. COTLIF was conducted in 19 cases. Patient’s condition was considered and the treatment was voluntarily chosen by patients. Detailed procedures, preoperative and intraoperative images were illustrated. Operation time, intraoperative blood loss, postoperative blood loss ( drain ), mean hospital stay and postoperative ambulation period in 3 groups were compared. Oswestry disability index ( ODI ), visual analogue scale ( VAS ) and X-ray 3 days, 1.5, 3, 6, 12, 24 months postoperatively were applied to evaluate clinical effects. Considering the influence of CT guidance on the operation time, the time cost in scanning and registration were recorded.Results The mean follow-up period was 24 months. There were no signiifcant differences in routine clinical data, VAS and ODI. No complications occurred in all 45 patients. The operation time in iCT-MIS-TLIF group was signiifcantly higher than MIS-TLIF group and COTLIF group (P<0.05 ). No signiifcant differences existed in mean operative blood loss, mean postoperative blood loss ( drain ), mean postoperative hospital stay and mean postoperative ambulation time (P>0.05 ) in iCT-MIS-TLIF group and MIS-TLIF group, which were signiifcantly lower than COTLIF group (P<0.05 ). VAS and ODI results in the follow-up were signiifcantly improved postoperatively in 3 groups. VAS results of iCT-MIS-TLIF group and MIS-TLIF group 3days postoperatively and ODI results postoperatively were signiifcantly lower than COTLIF group. There were no signiifcant differences at other time points. No signiifcant VAS or ODI differences existed in iCT-MIS-TLIF group and MIS-TLIF group at different time points. There were no signiifcant differences in the evaluation of fusion rate by X-ray. The mean automatic image registration time was 45.5 seconds, the mean CT scanning time was 9 seconds, the mean time-out for intraoperative scanning was 5.8 minutes, and the mean total number of CT scans per patient was 3.1 times.Conclusions Minimally invasive approach causes less change in multiifdus, less postoperative back pain and functional disability than conventional open approach. Preliminary experience with the ifrst 11 patients conifrms the feasibility of iCT scanning and integrated navigation system in the minimally invasive lumbar instrumentation. iCT-MIS-TLIF and MIS-TLIF have similar good long-term clinical outcomes and high fusion rates compared with COTLIF with the additional beneifts of less early postoperative back pain and functional disability, early rehabilitation, and shorter hospitalization. No signiifcant differences exist in iCT-MIS-TLIF and MIS-TLIF although with radiation exposure. However, for complicated anatomical structure, iCT navigation system provides better accuracy and safety for posterior spinal instrumentation.

Objective To study the changes of bone mineral density ( BMD ) of cancellous bone, trabecular bone structure, bone tissue morphology, bone metabolic biochemical markers and mechanical properties in tail-suspended female rats under simulated weightlessness, so as to provide certain theoretical support for the research on bone mass changes in female astronauts after the lfight and aerospace medicine.Methods Twenty 3-month-old female Sprague-Dawley ( SD ) rats were randomly divided into 2 groups. The tails of the rats in group A (n=10 ) were suspended for 4 weeks, and the other rates were taken as blank control group (n=10 ). All the rates were continuously fed for 4 weeks, and their general conditions were recorded, including activities, eating and drinking,defecation, weight, unhairing or not, death and tail falling off. All the rats were sacrificed at predetermined time points. The BMD of the L4 vertebral body and femoral condyle was evaluated by dual-energy X-ray absorption ( DEXA ). Micro computed tomography ( Micro-CT ) was applied to analyze the trabecular bone. Bone tissue slice staining was conducted by using ponceau. Serum bone metabolic biochemical markers were detected by Enzyme-linked immunosorbent assay ( ELISA ), and biochemical properties were investigated.Results At 4 weeks after the establishment of osteoporosis models, the activities, eating and drinking and defecation of the rats in group A were normal, and the differences in weight gain were not statistically significant between the 2 groups (P>0.05 ). No unhairing, death or tail falling off was noticed in either group. When compared with that in blank control group, the BMD of the L4 vertebral body and femoral condyle in group A was reduced by 29% and 30% (P<0.05 ). The bone volume / total volume ( BV/TV ), bone surface/bone volume ( BS/BV ), trabecular thickness ( Tb.Th ) and trabecular number ( Tb.N ) of the L4 vertebral body in group A was reduced by 40%, 15%, 30% and 33% when compared with that in blank control group (P<0.05 ). The BV/TV, BS/BV, Tb.Th and Tb.N of the femoral condyle in group A was reduced by 21%, 25%, 50% and 19% when compared with that in blank control group (P<0.05 ). The trabecular separation ( Tb.Sp ) of the L4 vertebral body and femoral condyle in group A was increased by 92% and 33% respectively (P<0.05 ) when compared with that in blank control group (P<0.05 ). The 3-dimensional ( 3 D ) reconstruction of the trabecular bone in region of interest ( ROI ) of lumbar cancellous bone showed group A was not as good as blank control group in the intensity, real volume, size and continuity of the trabecular bone in the lumbar vertebral body. Honeycomb-like structure was detected and obvious osteoporosis and 3D structural damage were noticed. The osteoporotic bone changes and incontinuity, diminution and enlarged space of the trabecular bone were observed in group A under the microscope ( 50X ). The human bone alkaline phosphatase ( BALP ) and tartrate resistant acid phosphatase ( TRAP ) in group A was 4.5 and 3.1 times higher than that in blank control group (P<0.05 ). The maximal compressive load and maximal compressive stress of the lumbar vertebral body and the maximal lfexural load of the femur in group A were decreased by 36%, 33% and 34% when compared with that of blank control group (P<0.05 ).Conclusions The significant decrease of the BMD of cancellous bone, 3 D structural damage of the trabecular bone, morphological destruction of bone tissues, bone metabolism imbalance and obvious reduction of mechanical strength of the vertebral body and femur are detected in the tail-suspended rats at 4 weeks after the establishment of osteoporosis models. The visible signs of osteoporosis are observed, and the risk of fracture is increased theoretically. A full understanding of bone mass loss and fracture risk in female astronauts should be developed.

Objective By analyzing the changes of bone microstructure, biochemical metabolism and mechanical properties of male and female rats in a tail-suspending osteoporosis model simulating weightlessness, to provide experimental evidence for bone mass change of astronauts and aerospace medicine.Methods Twenty male and 20 female 3-month-old SD rats were selected and randomly divided into 2 groups, tail-suspending ( TS) model group and control group.After 4-week experiment, the rats were killed.Bone mineral density ( BMD) of L4 lumbar vertebrae and the femurs was measured using dual-energy X-ray absorptiometry ( DEXA) .The trabeculae were analyzed using micro-CT.Ponceau staining was used for the bone tissue slices.Bone biochemical markers were detected using ELISA method.The biomechanical indexes were tested using a biomechanical testing machine. Results The BMD of L4 and the femurs in the TS groups was obviously lower than that in control groups.The bone volume fraction (BV/TV), the thickness (Tb.Th) and number of the trabeculae (TB.N) of were also lower (P<0.05).However, the bone surface to bone volume ( BS/BV) and trabecular separation ( Tb.Sp) in TS group were significantly higher than those in control group (P<0.05).The bone metabolic biochemical markers BLAP and TRAP in the TS groups were remarkably higher than those in control groups, which were 4.1 and 2.7 times in male groups and 4.5 and 3.1 times in female groups, respectively. Biomechanical testing showed that the maximum compressive load ( N) , maximal compressive stress ( MPs) of lumbar vertebrae, flexural load of the femurs decreased in male TS group by 27.5%, 26.4%, and 24.8%, respectively, and in female TS group by 36.6%, 33%, and 34%, respectively, comparing to the control group.BMD of L4 and the femurs, BV/TV, Tb.Th, TB.N, N, and MPa in female TS groups decreased significantly comparing to those in male TS groups. BALP and TRAP increased significantly in male TS groups comparing to those in male TS groups ( P <0.05).Conclusion After 4 weeks, obvious osteoporosis, destruction of the 3-dimensional microstructure , decrease of the mechanical strength in the vertebrae and thigh , and imbalance of the bone metabolism have been found in both male and female TS groups .In theory it increases the fracture risk , and this is most obviously in female rats than in male rats in TS groups .The risk of bone loss and fracture in different gender of astronauts should be recognized , and the results can guide us in personal intervention in the aerospace medical work .