目的 探讨合并腰椎退变的梨状肌综合征患者手术治疗效果.方法 分析2014年至2021年于郑州大学第一附属医院应用经椎间孔椎体间融合术(TLIF)治疗的合并腰椎退变的梨状肌综合征患者29例;根据日本矫形学会评分(JOA)、视觉模拟评分(VAS)、功能障碍指数(ODI)对患者手术前、手术后1周及末次随访进行评分.结果 本组29例患者均成功实施TLIF术;手术时间为(116.17±19.50)min;术中出血量为(310±105)ml,患者术后1周JOA评分高于术前[(20.83±2.79)分比(16.17±3.31)分,t=5.797,P＜0.05].患者末次随访VAS评分低于术前[(1.67±0.82)分 比(6.33±1.21)分,t=17.169,P＜0.05],患者末次随访ODI评分低于术前[(17.00±4.73)分比(34.67±5.35)分,t=13.325,P＜0.05].影像学检查结果显示所有患者手术节段均正常融合,椎间隙骨性愈合情况良好.27例患者接受TLIF处理后相关症状获得明显改善;2例患者接受TLIF处理后,梨状肌综合征相关症状缓解不理想,二次接受"坐骨神经松解术"处理,手术后相关症状缓解满意.结论 对于合并腰椎退变的梨状肌综合征患者,TLIF技术可有效改善患者疼痛、JOA评分及ODI指数,也能通过间接减压骶神经丛,使梨状肌综合征的相关症状得到明显的缓解.

[目的]比较寰枢椎融合与颈枕融合治疗后路齿状突游离小骨合并寰枢椎脱位的临床效果.[方法]回顾性分析2010年1月-2015年12月行后路融合术治疗的29例齿状突游离小骨合并寰枢椎脱位患者的临床资料.依据患者具体情况与术前医患沟通结果,22例行寰枢椎融合(寰枢组),7例行颈枕融合(颈枕组).比较两组患者围手术期、随访和影像资料.[结果]两组患者均顺利完成手术,术中均无严重并发症.寰枢融合组切口长度显著小于颈枕融合组(P＜0.05).两组患者术后随访均在6年以上,寰枢组恢复完全负重活动显著早于颈枕组(P＜0.05).与术前相比,术后两组颈椎前屈-后伸ROM和左右旋转ROM均显著减小(P＜0.05).术后相应时间点寰枢组颈椎前屈-后伸ROM均显著大于颈枕组(P＜0.05).随时间推移,两组的NDI评分显著下降(P＜0.05),而JOA评分显著增加(P＜0.05);相应时间点两组间NDI和JOA评分的差异均无统计学意义(P＞0.05).影像方面,与术前相比,术后两组的C0～2角显著增大(P＜0.05),而C2～7角和ADI显著减小(P＜0.05).术后寰枢组的ADI均小于颈枕组,其中,术后5年时两组间差异有统计学意义(P＜0.05).[结论]两种术式均安全有效,与颈枕融合相比,寰枢融合可减小手术创伤,更好复位寰枢椎,保留更多颈椎活动度,功能恢复更好.

目的 评估颈椎椎旁肌退变与颈椎退行性改变之间的相关性.方法 回顾性分析2019年10月至2021年6月因颈部疼痛或根性症状至郑州大学第一附属医院就诊的147例患者,其中男51例,女96例,年龄18～79[50.00(40.00,55.00)]岁.通过Image J软件测量MRI图像中C3～6椎体水平椎管的前后径(AP)、浅层颈伸肌横截面积(SEA)、深层颈伸肌横截面积(DEA)、椎体横截面积(VBA)以及脂肪浸润率(FIR).通过影像归档和通信系统(PACS)在MRI图像上评估C3～6层面椎间盘的退变分级及Modic改变.采用Spearman相关性分析对颈伸肌退变与颈椎退行性改变的关联性进行分析.结果 C3～4节段的AP与C3～6水平的DEA/VBA比值(r=0.168,r=0.216,r=0.223,r=0.232)具有相关性;Modic改变与椎旁肌参数无相关性;颈椎间盘退变在C4～5节段与C3～6水平的颈深伸肌群FIR(r=0.168,r=0.234,r=0.251,r=0.211)具有相关性,C4～5节段与 C3～6水平的颈浅伸肌群 FIR(r=0.234,r=0.273,r=0.307,r=0.209)具有相关性,C6～7节段与C3～6水平的颈浅伸肌群FIR(r=0.291,r=0.261,r=0.256,r=0.253)具有相关性.结论 颈椎椎旁肌退变与颈椎退行性改变之间存在相关性.

目的 研究骨质疏松与腰椎间盘退变之间的关系.方法 回顾性收集2019年10月至2021年3月于郑州大学第一附属医院骨科就诊的258例腰腿痛患者的资料.测量患者腰椎常规平扫CT及磁共振影像资料数据.根据患者L1椎体的平均CT值进行分组,CT值>160 HU为骨量正常组(85例),CT值为100～160 HU为骨量减少组(91例),CT值<100 HU为骨质疏松组(82例).使用Pfirrmann分级系统对腰椎间盘退变进行评分.用Spearman相关性分析椎体CT值与腰椎间盘退变的相关性.结果 除L2/3节段外,其余节段腰椎间盘退变评分组间比较差异有统计学意义(P<0.05);除L2/3节段外,骨质疏松组腰椎间盘退变评分高于骨量正常组和骨量减少组(P<0.05);骨量减少组腰椎间盘退变评分与骨量正常组比较,差异无统计学意义(P>0.05).L1/2、L3/4、L4/5、L5/S1及L1～S1椎间盘退变评分均与L1 CT值呈负相关(P<0.05).结论 骨质疏松与腰椎间盘退变具有正性相关的关系.

Damage and degeneration to bone and articular cartilage are the leading causes of musculoskeletal disability. Commonly used clinical and surgical methods include autologous/allogeneic bone and cartilage transplantation, vascularized bone transplantation, autologous chondrocyte implantation, mosaicplasty, and joint replacement. 3D bio printing technology to construct implants by layer-by-layer printing of biological materials, living cells, and other biologically active substances in vitro, which is expected to replace the repair mentioned above methods. Researchers use cells and biomedical materials as discrete materials. 3D bio printing has largely solved the problem of insufficient organ donors with the ability to prepare different organs and tissue structures. This paper mainly discusses the application of polymer materials, bio printing cell selection, and its application in bone and cartilage repair.

[目的]分析颈后路单开门椎板成形术后颈伸肌(neck extensor muscle,NEM)与颈椎矢状位参数变化,探讨术后NEM萎缩与颈椎矢状位参数变化的相关性.[方法]2015年1月—2019年7月于本院行颈后路单开门椎板成形术的患者共128例,于术前、术后1周,术后1、2年行影像检查,测量C2-7Cobb角、C2-7SVA、T,斜率,以及NEM的丰度(SEA/VBA和DEA/VBA)及脂肪变性率.并进行相关分析.[结果]随时间推移,C2-7SVA、C2-7Cobb角、T1S,以及SEA/VBA、DEA/VBA和脂肪含量均显曲线变化,各时间点间差异均有统计学意义(P＜0.05).Spearman相关分析表明,SEA/VBA和DEA/VBA均与C2-7 Cobb角的变化呈正相关(P＜0.05).NEM脂肪含量与C2-7Cobb角的变化呈负相关(P＜0.05).C7T1的NEM脂肪含量与T1S的变化呈正相关(P＜0.05).[结论]颈后路单开门椎板成形术后颈椎出现后凸改变的趋势,NEM萎缩与颈椎矢状位参数的变化具有相关性.

目的 探讨老年人术前营养状况与腰椎退变性侧弯术后亚综合征谵妄的关系.方法 选取2016年3月至2020年9月郑州大学第一附属医院骨科收治的因腰椎退变性侧弯接受减压矫形手术治疗的老年(≥65岁)患者62例.评估患者术前营养状况,包括微营养评分(MNA-SF评分)、体质量指数(BMI)、酒精摄入情况等;评估功能状态(巴塞尔指数);术后连续3 d进行综合征谵妄(MDAS评分)评估.Pearson相关分析用于确定年龄、MNA-SF评分、BMI、功能状态等变量和MDAS评分之间的关系;对于存在相关性的变量利用分层线性回归模型进一步评估其对MDAS评分的影响.结果 术前MNA-SF评分与术后3 d总体平均MDAS评分呈负相关(P<0.05);BMI水平与术后第1天的MDAS谵妄严重程度评分呈负相关(P<0.05);年龄与每日MDAS评分及术后3 d的平均MDAS评分均呈正相关(P<0.05);MNA-SF评分≤10时与年龄呈负相关(P<0.05);酒精摄入、巴塞尔指数功能状态评分和术前禁食时间均与亚综合症谵妄(SSD)无关(P>0.05).营养状况与SSD的关系通过分层多元线性回归分析,该模型纳入MNA-SF评分(≤10分)与年龄和BMI进行分析,解释"MDAS"的变化的贡献率(解释方差比率)是26％(R2=0.26,F=3.75,P<0.001).结论 术前营养状况与老年人腰椎术后出现SSD症状相关;应当将营养风险评估纳入老年人术前预防谵妄策略之中.

Objective:To investigate the role of p53 in the angiogenesis of osteosarcoma.Methods:The human co-basement membrane capillary formation test was used to simulate angiogenesis in vivo with a 3×10 4 density. The protein level and distribution of actin fibers were observed by Western blotting and immunofluorescence. Immunohistochemistry was used to detect the expression of S2448p mammalian target of rapamycin (mTOR) in 196 clinical samples of human osteosarcoma. Results:The p53 gene had a significant inhibitory effect on the osteosarcoma MG63 cell line. When the p53 concentration was close to 100 nmol/L, it could inhibit 50% of the angiogenesis in the hFOB1.19 cell line on the artificial basement membrane, and when the concentration was greater than 200 nmol/L, p53 could almost completely inhibit angiogenesis. There were (2.37±1.56) branch points of blood vessels, which were significantly less than (26.79±3.24) in the 0 nmol/L group ( t=2.796, P<0.05). The expression of S2448P-mTOR in vascular endothelial cells was detected in 41.8% (82/196) of the samples. It has been verified that the inhibitory effect was derived from the inhibitory effect of p53 gene on the phosphorylation of phosphoinositide 3-kinase (PI3K) downstream factors including protein kinase B (Akt) and mTOR. Conclusion:These results show that p53 suppresses angiogenesis of osteosarcoma through inhibiting the PI3K/Akt/mTOR pathway.

目的:探讨经第2骶椎骶髂(S2AI)螺钉内固定在成人退变性腰椎侧后凸畸形合并骨质疏松症(OP)患者矫形术中的应用效果.方法:收集2016年1月至2019年7月收治的35例成人腰椎侧后凸畸形合并OP患者的资料,男6例,女29例.术中固定至骶2水平(S2AI组)20例,其中男4例,女16例;固定至骶1水平(S1组)15例,其中男2例,女13例.术前、术后第7天及末次随访时,测量侧凸脊柱-骨盆参数,包括侧凸Cobb角、矢状面轴向距离(SVA)、冠状面平衡(C7 PL-CSVL)、骨盆倾斜和局部后凸(RK)Cobb角;并进行疼痛视觉模拟评分(VAS)和Oswe-stry功能障碍指数(ODI)评价.结果:两组患者年龄、手术时长、出血量、随访时间差异均无统计学意义(P>0.05).S2AI组末次随访时侧凸Cobb角(18.0±7.0)°,C7PL-CSVL(6.0±1.8)mm,骨盆倾斜(2.1±1.0)°,RK Cobb角(3.6±17.4)°,SVA(16.9±14.1)mm;与术前比较,上述指标均显著降低(P<0.05).两组患者术后第7天、末次随访时VAS和ODI均较术前降低(P<0.05).两组之间上述指标改善程度比较差异无统计学意义(P>0.05).患者术中均未出现SSEP及MEP信号的改变和丢失.术后随访中未发生退钉、断棒、PJK、DJK及脊柱失代偿.S2AI组术后并发症(螺钉松动和迟发性臀部疼痛)发生率2/20,S1组为11/15,S2AI组并发症发生率低于S1组(P=0.022).结论:应用S2AI螺钉内固定治疗成人腰椎侧后凸畸形合并OP,既能满足强化固定的需要,又可获得有效的矫形效果.

目的 探讨并总结3D打印技术在脊柱肿瘤患者护理中的应用与方法.方法 选择2018年1月至2020年12月于郑州大学第一附属医院骨科应用3D打印植入物进行治疗的脊柱肿瘤患者26例,其中应用3D打印植入物治疗患者13例纳入观察组,应用常规植入物(钛笼)治疗患者13例纳入对照组.在脊柱肿瘤常规护理基础上,对观察组加强3 D打印模型的指导与并发症的观察、护理,比较2组患者视觉模拟评分法(VAS)评分、护理满意度及并发症情况.结果 观察组患者住院时间(10.68±0.95)d,明显短于对照组的(12.47±1.12)d(t=4.965,P=0.028).观察组患者术后6个月时VAS评分(2.76±1.17)分,明显低于对照组的(4.37±0.59)分(t=7.624,P=0.017).观察组患者护理满意度评分(9.57±0.41)分,明显高于对照组的(7.96±0.55)分(t=5.346,P=0.023).2组术后6个月均未见复发.观察组并发症发生率15.38％,低于对照组的30.76％,但差异无统计学意义(χ2=0.503,P=0.478).结论 通过对脊柱肿瘤患者加强3D打印模型的术前宣教与并发症的观察与护理,可有效帮助患者改善术后疼痛及预后,提高患者的满意度.

Objective:To evaluate the outcome of surgery for sympathetic cervical spondylosis with abnormal imaging.Methods:The patients with sympathetic cervical spondylosis with the abnormal imaging who received anterior cervical discectomy and fusion (ACDF) treatment from 2015-2018 were reviewed. The symptoms wee scored with somatization self-rating scale (SSS) and 20 points evaluation system before and after operation and at the last follow-up.Results:The SSS scores before, after the operation and at the last follow-up were (45.50±10.39), (27.67±3.62) and 21.50(11) respectively. The scores at postoperative week one and last follow-up were 17.83 (95% CI: 4.660-31.007, P<0.05) and 18.00 (95% CI: -0.701-36.701, P>0.05) respectively, which were lower than preoperative scores. There was no significant difference in SSS scores between the last follow-up and postoperative week one (95% CI: -17.840-18.174, P>0.05). The scores by the 20 points evaluation system were (8.50±1.87) before the operation, 1(2) at first week after operation, and 0.5(4) at the last follow-up. As compared with preoperative scores, the scores at postoperative week 1 and last follow-up decreased by 6.67 (95% CI: 3.980-9.353, P<0.05) and 6.17 (95% CI: 0.660-11.673, P<0.05) respectively. There was no significant difference between the last follow-up and one week after operation (95% CI: -4.879-5.879, P>0.05). At the last follow-up, one patient showed part of the recurrence symptoms, and the rest 25 patients recovered without relapse. Conclusion:ACDF can achieve good therapeutic effect for sympathetic cervical spondylosis with abnormal imaging.

目的:探讨合并后纵韧带退变(cervical posterior longitudinal ligament degeneration,CPLLD)的脊髓型颈椎病(cervical spon-dylotic myelopathy,CSM)的临床及影像特征.方法:选取2013年1月至2015年12月因CSM在郑州大学第一附属医院行手术治疗,且临床和影像资料完整患者的病例资料进行研究.从患者的病例资料中提取性别、年龄、身高、体质量、术前颈椎功能障碍指数(neck disability index,NDI)、术前日本骨科学会(Japanese Orthopedic Association,JOA)颈椎病评分、术前疼痛视觉模拟量表(vis-ual analogue scale,VAS)评分、有效椎管矢状径(space available for the cord,SAC)、椎管椎体矢状径比值(diameter of sagittal canal and vertebral body ratio,DSR)及合并CPLLD和颈脊髓内信号改变情况.结果:①临床数据分析结果.共纳入128例CSM患者,其中53例合并CPLLD(CPLLD组),其余75例未合并CPLLD(无CPLLD组).合并颈脊髓内信号改变者49例,其中CPLLD组29例、无CPLLD组20例,CPLLD组颈脊髓内信号改变发生率高于无CPLLD组(χ2=13.866,P=0.000).合并CPLLD的CSM患者中51～60岁患者所占比例最高,性别分布无明显差异;55个节段CPLLD呈中央型、47个节段呈偏侧型,好发部位为C 4～C6节段.术前CPLLD组患者的NDI高于无CPLLD组[(46.57±8.20)％,(36.60±7.01)％,t=1.783,P=0.000],JOA颈椎病评分低于无CPLLD组[(9.97±1.41)分,(12.60±1.25)分,t=-3.247,P=0.000];2组患者术前的疼痛VAS评分比较,差异无统计学意义[(5.47±2.12)分,(5.44±2.03)分,t=0.693,P=0.075].②影像数据分析结果.CPLLD组术前颈椎SAC和DSR均小于无CPLLD组[(4.17±1.30)mm,(5.32±1.34)mm,t=-1.327,P=0.000;0.70±0.21,0.82±0.23,t=-3.733,P=0.000].CPLLD组组内不同性别患者的术前颈椎SAC和DSR比较,差异均无统计学意义[(4.21±1.32)mm,(4.12±1.30)mm,t=0.149,P=0.795;0.67±0.15,0.75±0.19,t=0.328,P=0.602];无CPLLD组组内不同性别患者的术前颈椎SAC和DSR比较,差异均无统计学意义[(5.36±1.30)mm,(5.27±1.39)mm,t=0.187,P=0.753;0.81±0.22,0.83±0.23,t=0.739,P=0.072].③临床数据和影像数据的相关性分析结果.CPLLD和颈脊髓内信号改变呈正相关(r s=0.317,P=0.000);SAC、DSR均与JOA颈椎病评分呈正相关(r=0.321,P=0.000;r=0.795,P=0.000),均与NDI呈负相关(r=-0.309,P=0.000;r=-0.432,P=0.000).结论:CSM患者常合并CPLLD,其中以51～60岁者多见,好发于C 4～C6节段;合并CPLLD的CSM患者更容易发生颈脊髓变性、DSR和SAC更小、患者生活质量更差,建议早期手术干预.

Objective:To explore the clinical effect of 3D printing assisted the SRS-Schwab Ⅳ osteotomy for senile kyphosis.Methods:A retrospective analysis of 48 elderly patients with kyphosis who were hospitalized for surgery in the First Affiliated Hospital of Zhengzhou University from June 2018 to December 2019. According to the random number table method, they were divided into experimental group and control group with 24 cases each. The experimental group used 3D printing model to assist SRS-Schwab Ⅳ osteotomy and the control group underwent SRS-Schwab Ⅳ osteotomy based on preoperative imaging data. The operation time, C arm perspective time, intraoperative blood loss, kyphosis Cobb angle, Cobb angle correction rate, lumbar lordosis correction degree, lumbar lordosis correction loss rate. The pain visual analog scale (VAS) and Oswestry dysfunction index (ODI) were used to assess the degree of improvement in both methods. Chi-square test was used for comparison of counting data between the two groups. The comparison between different time points in the measurement data group adopts one-way analysis of variance, and independent-samples t test was used for comparison between two groups at the same time point. Results:All patients underwent surgery successfully. The operative time [(171.1±50.9) min]and the perspective of time [(9.2±1.9) s] and the intraoperative blood loss [(321.5±76.8) ml]in the 3D group were significantly reduced as compared with those in the control group [operative time (264.2±44.2) min, t=6.767, P<0.05, the perspective of time (13.6±4.0) s, t=4.856, P<0.05, the intraoperative blood loss (472.9±86.2) ml, t=6.422, P<0.05], and the difference was statistically significant. The correction rate of Cobb angle (73.7%), LL correction degree (34.4°) in the 3D group was significantly higher than that in the control group [Cobb angle correction rate (51.9%), χ2=10.382, P<0.05, LL correction degree (30.1°), t=4.949, P<0.05], and the difference was statistically significant. The LL correction loss rate (11.9%) in the 3D group was slightly lower than that in the control group (13.6%), but there was no statistically significant difference between the two groups during the last follow-up ( χ2=0.177, P>0.05). VAS score and ODI index showed similar improvement at each time point during postoperative follow-up in both groups. Conclusion:3D printing assisted SRS-Schwab Ⅳ osteotomy is feasible for the treatment of senile kyphosis, which can reduce the operation time, intraoperative blood loss and radiation exposure time, as well as the satisfactory clinical effect.

Objective:To construct an adenovirus containing bone morphogenetic protein (BMP)-4 and use its characteristic of ectopic bone formation in skeletal muscle to explore the in vivo effect of transplanting heterotopic autologous bone for bone defect repair. Methods:The BMP4 gene was constructed into AAV vector, and AAV-BMP4 was purified. AAV-BMP4 was adsorbed in Gelfoam and implanted into the femoral muscle pocket of SCID mice raised in the SPF breeding room of the Experimental Animal Center of Zhengzhou University. The activity of AAV-BMP4 was determined 4 weeks post operation. Apply AAV-BMP4 subcutaneously on the back of the mouse to observe the skeletal muscle induced ectopic bone formation. While the bone tissue is stable, the bone tissue is taken out and transplanted into the pre-prepared mouse skull defect model to observe the bone defect repair effect.Results:The purified AAV-BMP-4 virus particles with a concentration of 5×10 12 vp/ml were successfully constructed. The purified AAV-BMP-4 virus particles implanted into the femoral muscle pocket of mice can successfully induce the formation of ectopic bone tissue. A small amount of new bone tissue appeared 4 weeks after the AAV-BMP-4+ Gelfoam complex was implanted subcutaneously on the back of the mouse with an amount of 1 cm×2 cm×2 cm. Both X-ray and MicroCT examinations confirmed the formation of subcutaneous bone tissue on the back of the mouse. The bone tissue that was trimmed and transplanted into the mouse skull defect model did not show abnormal proliferation after being implanted in the defect, but continued to undergo slight changes in appearance over time, and the skull defect was well repaired. Conclusion:The AAV-BMP-4 constructed in vitro has good biological activity. AAV-BMP-4+ Gelfoam can effectively induce bone formation in skeletal muscle. The new bone tissue can successfully repair the animal model of skull defect. After the transplanted bone tissue was implanted into the skull defect, there was no overgrowth, and it was well integrated with the host bone.

目的 探讨3D打印导航模板辅助经后路第2骶椎髂骨(S2AI)螺钉置入的可行性与准确性.方法 回顾性分析2017年9月至2019年9月接受初次S2AI置钉患者30例.其中男14例,女16例;年龄42～74岁.根据治疗方法的不同将其分为导板组和徒手组,每组15例.导板组患者术前行骨盆CT三维重建,设计导航模板并在术中使用,徒手组采用常规手术徒手置钉.所有患者术后复查骨盆CT,三维重建后观察螺钉与皮质的关系,并对比两组患者术后CT在矢状面上尾向偏角(SA)、横断面与正中线夹角(TA)、进钉点与骶正中嵴的距离(HD)以及与第1骶后孔下缘的垂直距离(VD).记录并比较两组手术S2AI置钉时间、术中置钉所需透视C型臂次数.结果 导板组15例患者共置入S2AI钉30枚,所有螺钉均穿过骶髂关节,无侵犯及穿出皮质.徒手组15例患者共置入S2AI钉30枚,所有螺钉均穿过骶髂关节,无侵犯及穿出皮质.导板组患者术后SA(30.00±3.49)°、TA(40.43±2.10)°、HD(19.44±0.85)mm、VD(4.97±0.43)mm,与徒手组患者术后SA(30.72±3.34)°、TA(39.71±2.12)°、HD(19.15±1.31)mm、VD(5.02±0.53)mm比较,差异无统计学意义(均P>0.05).导板组测量置钉时间(19.60±1.30)min、透视次数(4.20±0.41)次低于徒手组测量置钉时间[(52.93±9.22)min]、透视次数[(13.80±2.81)次],差异有统计学意义(均P<0.05).结论 成人骨盆固定中,应用3D打印导板与徒手置钉的准确性无明显差异,但3D导板组手术时间更短,术中透视次数也更少.

Objective:To investigate the operative and clinical performance of an improved 3D printed navigation guiding template to develop patient specific solutions for posterior atlantoaxial pedicle screw fixation surgery.Methods:Thirty-eight patients with atlantoaxial dislocation admitted between January 2015 to December 2018 were divided into a template navigation group ( n=18) and a traditional group ( n=20). The template navigation group was assisted by the improved digital guide board, and the traditional group was guided by the C-arm fluoroscopy. The operative time, C-arm fluoroscopy times, blood loss and other intraoperative indicators were compared between two groups. Kawaguchi method was used to evaluate the satisfaction of screw placement. The accuracy and safety of the screw insertion were evaluated using preoperative and postoperative computed tomographic scan by calculation of screw deviation from the preplanned trajectory and evaluation of screw entry point location. Japanese Orthopedic Association scale (JOA) score and Neck Disability Index (NDI) were used to evaluate the improvement of postoperative symptoms in the two groups. Independent sample t test was used for evaluation of intergroup patient age, follow-up time, efficacy. Chi-square test was used for comparison of counting data between the two groups, and paired t test was used for comparison of measurement data within the group. Results:All patients underwent surgery successfully. A total of 70 pedicle screws were inserted in the template navigation group, while 75 pedicle screws were inserted in the traditional group. The operative time (87.6±35.4) and frequency of fluoroscopy (3.9±1.9) in the template navigation group were significantly reduced as compared with those in the traditional group [Operative time (124.3±56.6) min ( χ2=3.734, P<0.05), fluoroscopy frequency (12.4±4.7) ( χ2=4.327, P<0.05)]. The amount of bleeding [(84.5±55.2) ml] in the template navigation group was slightly les than that in the traditional group [(96.1±69.4) ml], but the difference between the two groups was not statistically significant ( χ2=0.875, P>0.05). JOA scores and NDI scores in both groups were improved similarly at each time point during the follow-up period. However, postoperative CT showed that the total accuracy rate of Kawaguchi 0-grade in template navigation group was 95.7% (67/70), significantly higher than that in the traditional group [77.3% (58/75), χ2=2.628, P<0.05]. In the template navigation group, there were no statistically significant differences in the actual measured inclination angle, head inclination angle, and the coordinate position of the nailing point before and after surgery, while there were statistically significant differences in the traditional group. Conclusion:The improved digital navigation template is simple and safe to be applied in placement of atlantoaxial pedicle screws, and it can significantly shorten the operative time and reduce radiation exposure. Furthermore, the clinical effect of these patients is satisfactory.

Objective:Study the ideal entry point and angle of children atlas pedicle screw.Methods:Select children aged 2-6 years who underwent 64-slice CT scan of cervical spine at the First Affiliated Hospital of Zhengzhou University from January 2017 to June 2020. A total of 153 children meet the standard, 23-45 in each age group, an average of 30, children who meet the requirements are divided into two groups according to gender, male ( n=100), female n=53). The clearance width of atlas pedicle screw on both sides was measured at different inclination angles. The length of the pedicle screw path, the horizontal distance from the entry point to the intersection of the lateral mass and the inner edge of the posterior arch, and the Angle of inclination were measured when the clearance width was used to the maximum. Student T test was used to analyze whether the gender difference was statistically significant. Results:When the Angle of the screw path is parallel to the straight line where the bow intersects the front and rear, the clearance width of the screw can be maximum (8.02±1.06) mm. The length of the nail path is (24.75±3.34) mm when the path is parallel with the connecting line between the side block and the intersection point of the front and rear arches. The distance between the entry point and the intersection point of the side block and the inner edge of the rear arch was (5.70±1.10) mm, and the optimal Angle of inclination was (20.93±3.07)°. There is no statistical difference in the measurement of atlas parameters of children of different genders( P>0.05). Conclusion:Atlas pedicle screw in children under 6 years of age. It is safe and feasible to select the point (5.70±1.10) mm outwards from the intersection point of the lateral block and the inner edge of the posterior arch as the vertical line, and the point of intersection with the horizontal midline of the posterior arch as the entry point. When the Angle of the entry passage was parallel to the straight line of the intersection point of the anterior and posterior arches (20.93±3.07)°, it was the best Angle for children to be fixed with atlas pedicle screw.

Objective:To compare the clinical and radiological outcomes in smoking patients after cervical disc replacement (CDR) with those of non-smoking patients.Methods:A retrospective analysis was performed on 119 patients with single-segmental or two-segmental cervical spondylosis treated by CDR between February 2015 and February 2017. Finally, 78 patients with complete data were included. All patients were divided into smoking(27 cases) and non-smoking(51 cases) groups based on whether they had smoked in the six months prior to surgery. The visual analogue scale (VAS), neck dysfunction index (NDI), Japanese orthopaedic association scale (JOA), Nurick scale, and Bazaz scores for dysphagia were compared and evaluated at different time points before and after operation. All patients were evaluated by these radiological parameters, such as range of motion (ROM) on the surgical segment, neutral cervical lordosis (C 2-7 Cobb), and the presence of heterotopic ossification (HO). Chi-square test was used for comparison of counting data between the two groups, and paired t test was used for comparison of measurement data within the group. Independent sample t test was used for evaluation of intergroup data. Results:A total of 78 patients were followed up for at least 3 years (mean follow-up period of 51.2 months). There were 51 cases in non-smoking group and 27 cases in smoking group. The age in the smoking group (42.3±9.6) was younger than in non-smoking group (50.4±11.1) ( t=-21.737, P<0.05). The percentage of males in the smoking group (92.6%) was significantly higher than in the non-smoking group (31.4%; χ2=9.625, P<0.05). There were no statistically significant differences between the two groups in operative segment distribution (single-segmental ratio %) (70.4, 62.7, χ2=0.761, P>0.05), intraoperative blood loss (ml) (22.7±10.5, 24.3±11.2, t=-0.716, P>0.05), operative time (min) (65.4±11.5, 63.9±12.1, t=0.832, P>0.05), and follow-up time (month) (52.5±12.7, 50.9±13.5, t=0.661, P>0.05). Both groups showed similar improvements in all clinical outcomes before and after CDR treatment. In the smoking group, ROM on the surgical segment after CDR [preoperative: (7.3±4.2)°; postoperative: (7.8±4.6)°] was preserved well ( t=0.639, P>0.05). However, in the non-smoking group, the ROM on the surgical segment was significantly reduced after CDR surgery [before surgery: (8.1±4.9)°; after surgery: (6.9±3.2)°, t=18.564, P<0.05]. The occurrence trend of HO in the non-smoking group was higher than that in the smoking group, but the difference was not statistically significant (37.0% vs. 33.3%, χ2=0.798, P>0.05). Other radiological assessments for patients in both groups yielded similar results. Conclusion:CDR can maintain good ROM in smoking group, which may be a reasonable choice for smoking patients with cervical spondylosis.

目的 分析脊髓型颈椎病患者颈椎矢状位序列在站立位与平卧位测定中的差异及临床意义.方法 回顾性分析2017年1月-2018年5月因脊髓型颈椎病在郑州大学第一附属医院脊柱外科行手术治疗的患者术前颈椎影像资料;测量站立位颈椎侧位X线断层融合图像、仰卧位CT及MRI正中矢状面图像上颈椎前凸角(CobbC2 ～7)、颈2～7矢状位轴(SVAC2 ～7)、胸1椎体倾斜角(T1 slope,T1S)、颈倾斜角(neck tilt,NT)、胸廓人口角(thoracic inlet angle,TIA),采用配对t检验比较三种不同测量方式两两间的差异性,并说明各自的临床意义.结果 X线断层融合图像与CT图像上测量的TIA无显著性差异(P＞0.05),SVAC2 ～7、CobbC2～7、T1S、NK有显著性差异(P＜0.05);断层融合图像与MRI图像上测量的SVAC2 ～7、CobbC2 ～7、T1S、NK、TIA均有显著性差异(P＜0.05);CT图像上与MRI图像上测量的数据均无显著性差异(P＞0.05).结论 颈椎矢状位参数在站立位与仰卧位时差异较大,站立位可以准确的反映患者术前颈椎曲度情况,并且对术中重建颈椎矢状位序列有较好的指导作用;因此术前拍摄清晰的站立位颈椎侧位片是必不可少的.

目的 对比分析脊髓型颈椎病患者与正常人颈椎侧位X线断层融合图像上颈椎矢状位参数.方法 选取2017年7月至2018年7月在郑州大学第一附属医院诊断为脊髓型颈椎病的70例患者作为观察组,选取同期70例无症状正常人作为对照组,分析两组颈椎侧位X线断层融合图像资料.在颈椎侧位X线断层融合图像上分别测量T1倾斜角(T1 S)、胸廓入口角(TIA)、颈倾斜角(NT)、颈椎前凸角(Cobb角)、枕颈角(OC2 A)及C2～C7矢状位轴向距离(C2～C7 SVA).采用t检验比较两组颈椎矢状位参数,采用Pearson相关系数分析各组内颈椎矢状位参数间的相关性.结果 两组TIA比较,差异无统计学意义(P>0.05).两组Cobb角、T1 S、NT、OC2 A及C2～C7 SVA比较,差异有统计学意义(P<0.05).对照组T1S与C2～C7 SVA呈负相关(r=-0.272,P<0.05),其余各参数间无相关性(P>0.05).观察组C2～C7 SVA与Cobb角呈负相关(r=-0.246,P<0.05),其余各参数间无相关性(P>0.05).结论 脊髓型颈椎病患者与无症状正常人颈椎矢状位参数存在明显差异,正常人较脊髓型颈椎病患者颈椎前凸程度更大,从而更有力地维持颈椎生理曲度.