Objective To investigate the value of intraoperative O-arm navigation in posterior hemivertebra resection for treatment of congenital kyphoscoliosis caused by fully segmented hemivertebr. Methods From January 2014 to March 2015, a total of 14 patients with congenital kyphoscoliosis caused by fully-segmented hemivertebra who had undergone hemivertebra resection surgery at the Third Hospital of Hebei Medical University were reviewed retrospectively. There were 5 males and 9 females with an average of 11. 9 years (ranged from 9 to 15 years). Among them, the hemivertebra were located at T9, L2 in each 1 patients, T10 , L1 in each 2 patients, T12 in 3 patients, T11 in 5 patients. Full-length standing radiographs were taken before surgery. The Cobb angle in the coronal and sagittal plane were measured and analyzed. All pedicle screws insertion was performed guided by intraoperative O-arm navigation. According to the comparison of intraoperative O-arm navigation in three-dimensional reconstruction of the hemivertebra, the scope of hemivertebra resection could be determined, and then individualized, thoroughly and effectively resected the hemivertebra. The screw position was observed by O-arm scan in operation and CT scan after surgery. And the pre-and post-operative changes of the Cobbs angle were analyzed in order to evaluate the correction rate of scoliosis and kyphosis. Results All the 120 screws for 14 patients were inserted exactly. The surgery time was (195. 4 ± 17. 4) min and blood loss was (611. 9 ± 173. 0) mL. All the patients were followed up from 3 to 15 months(average 9. 6 months). Scoliosis angle was corrected from 62. 8° ± 15. 8° to 10. 9° ± 5. 3° with a correction rate of 83. 34% ± 6. 08%. At the last follow-up, the scoliosis angle was 12. 1° ± 4. 8° with no significant loss of correction. Kyphosis angle was corrected from 57. 5° ± 15. 5° to 17. 0° ± 6. 6° with a correction rate of 70. 66% ± 6. 79%. At the last follow-up, the kyphosis angle was 17. 9° ± 7. 0° with no significant loss of correction. They were compared pre- and post-operative respectively, with significant differences(all P values < 0. 01). However, there were no significant differences between postoperative and the final follow-up(all P values >0. 05). No implants failure and correction lost were found during the follow-up. Conclusions In posterior approach hemivertebra resection for congenital kypho scoliosis patients caused by fully segmented hemivertebr, the use of intraoperative O-arm navigation can make screws insertion more accurate and safe. And resection of the hemivertebr is more accurate. In this way, it can reduce the complications and improve the safety of operation.

Objective To detect the effects of anterior decompression surgery on unilateral cervical spondylotic amyotrophy. Methods Thirty-five patients with unilateral cervical spondylotic amyotrophy treated by anterior decompression surgery at Spinal Surgery Department in the Third Hospital of Hebei Medical University from January 2005 to January 2014 were retrospectively studied. There were 24 males and 11 females. The mean following time after surgery was 23. 2 months, ranged from 12 to 36 months. According to the most severely atrophic muscle, patients were divided into two groups: proximal-type group (n=23) and distal-type group (n=12). Manual muscle test was used to evaluate pre- and postoperative muscle strength. The affected intervertebral level, signal intensity change in the spinal cord, impingemented position of nerve by X-ray, CT and MRI, time and grades of improvement muscle strength were recorded and compared statistically. Results The most commonly affected intervertebral level in proximal-type patients and distal-type patients were C4/5(39.1%, 9/23) and C5/6(10/12), respectively. Signal intensity change in the spinal cord on MRI T2 WI was found in 14 patients before surgery. Twenty-four pantients impingemented against the ventral nerve root and 29 patients impingemented against the anterior horn, with 18 patients having both impingemented. The muscle power improvement on manual muscle testing gained 1 or more grades was 82. 6% ( 19/23 ) in proximal-type group, whereas 5/12 in distal-type group ( P =0. 022). Fifty-six point five percent of proximal-type group had improvement of muse strength subjectively or objectively, whereas none of distal-type group had improvement, within 15 days after surgery (Z= -3. 255, P<0. 01). Conclusions Anterior decompression surgery is effective for most of patients with unilateral cervical spondylotic amyotrophy, but compared with the proximal-type patients, the distal-type patients gain inferior and slower postoperative recovery.

背景:O型臂导航系统是目前最先进的导航技术,可短时间内获得较高质量的术中三维CT图像,但其应用于脊柱外科时间尚短,应用价值需要进一步研究.目的:初步探讨O型臂导航系统在青少年特发性脊柱侧凸矫形内固定术中的应用价值.方法:回顾性分析2013年1月至2014年12月行脊柱后路侧凸矫形内固定术的青少年特发性脊柱侧凸患者42例,男7例,女35例.其中术中应用O型臂导航指导螺钉植入19例为O型臂导航组,依靠C型臂X线机透视和术者经验植入螺钉23例为C型臂引导组.分别记录两组患者的手术时间、置钉时间、术中出血量以及并发症发生情况;通过CT扫描对椎弓根螺钉位置进行分级,采用Richter方法计算两组的置钉优良率,术后通过全脊柱正侧位X线片评价矫形效果.结果:42例患者均顺利完成手术,两组患者的性别、年龄、累及节段、术前Cobb角等一般资料无统计学差异(P＞0.05).O型臂导航组患者上胸椎(T1～T4)、中胸椎(T5～T8)的置钉优良率为94.4％和95.6％,与C型臂引导组的78.9％和85.4％相比有统计学差异(P＜0.05).O型臂导航组下胸椎(T9～T12)以及腰椎(L1～L5)的置钉优良率为94.7％和95.4％,略高于C型臂引导组的88.2％和92.1％,相比无统计学差异(P＞0.05).O型臂导航组患者置钉时间为(75±20)min,显著低于C型臂引导组的(93±18)min(P＜0.05).两组手术时间、术中出血量比较无统计学差异(P＞0.05).所有患者均获得12～19个月,平均(16.5±2.1)个月的随访.两组术后1周及末次随访时主弯Cobb角均较术前显著改善(P＜0.05);术后1周与末次随访比较无统计学差异(P＞0.05).两组患者末次随访时Cobb角矫正率比较无统计学差异(P＞0.05).结论:O型臂导航技术应用于青少年特发性脊柱侧凸的手术治疗中可提高胸腰椎椎弓根螺钉植入的准确性和安全性,及时发现危险螺钉并重置,保障手术安全,近期矫形疗效确切.