ObjectiveTo explore the effectiveness of a new point contact pedicle navigation template (referred to as “new navigation template” for simplicity) in assisting screw implantation in scoliosis correction surgery. MethodsTwenty-five patients with scoliosis, who met the selection criteria between February 2020 and February 2023, were selected as the trial group. During the scoliosis correction surgery, the three-dimensional printed new navigation template was used to assist in screw implantation. Fifty patients who had undergone screw implantation with traditional free-hand implantation technique between February 2019 and February 2023 were matched according to the inclusion and exclusion criteria as the control group. There was no significant difference between the two groups (P>0.05) in terms of gender, age, disease duration, Cobb angle on the coronal plane of the main curve, Cobb angle at the Bending position of the main curve, the position of the apical vertebrae of the main curve, and the number of vertebrae with the pedicle diameter lower than 50%/75% of the national average, and the number of patients whose apical vertebrae rotation exceeded 40°. The number of fused vertebrae, the number of pedicle screws, the time of pedicle screw implantation, implant bleeding, fluoroscopy frequency, and manual diversion frequency were compared between the two groups. The occurrence of implant complications was observed. Based on the X-ray films at 2 weeks after operation, the pedicle screw grading was recorded, the accuracy of the implant and the main curvature correction rate were calculated. ResultsBoth groups successfully completed the surgeries. Among them, the trial group implanted 267 screws and fused 177 vertebrae; the control group implanted 523 screws and fused 358 vertebrae. There was no significant difference between the two groups (P>0.05) in terms of the number of fused vertebrae, the number of pedicle screws, the pedicle screw grading and accuracy, and the main curvature correction rate. However, the time of pedicle screw implantation, implant bleeding, fluoroscopy frequency, and manual diversion frequency were significantly lower in trial group than in control group (P<0.05). There was no complications related to screws implantation during or after operation in the two groups. ConclusionThe new navigation template is suitable for all kinds of deformed vertebral lamina and articular process, which not only improves the accuracy of screw implantation, but also reduces the difficulty of operation, shortens the operation time, and reduces intraoperative bleeding.
Objective To investigate the feasibility of predicting proximal junctional kyphosis (PJK) in adults after spinal deformity surgery based on back-forward Bending CT localization images and related predictive indicators. Methods A retrospective analysis was performed for 31 adult patients with spinal deformity who underwent posterior osteotomy and long-segment fusion fixation between March 2017 and March 2020. There were 5 males and 26 females with an average age of 62.5 years (range, 30-77 years). The upper instrumented vertebrae (UIV) located at T5 in 1 case, T6 in 1 case, T9 in 13 cases, T10 in 12 cases, and T11 in 4 cases. The lowest instrumented vertebrae (LIV) located at L1 in 3 cases, L2 in 3 cases, L3 in 10 cases, L4 in 7 cases, L5 in 5 cases, and S1 in 3 cases. Based on the full-length lateral X-ray film of the spine in the standing position before and after operation and back-forward Bending CT localization images before operation, the sagittal sequence of the spine was obtained, and the relevant indexes were measured, including thoracic kyphosis (TK), lumbar lordosis (LL), local kyphosis Cobb angle (LKCA) [the difference between the different positions before operation (recovery value) was calculated], kyphosis flexibility, hyperextension sagittal vertical axis (hSVA), T2-L5 hyperextension C7-vertebral sagittal offset (hC7-VSO), and pre- and post-operative proximal junctional angle (PJA). At last follow-up, the patients were divided into PJK and non-PJK groups based on PJA to determine whether they had PJK. The gender, age, body mass index (BMI), number of fusion segments, number of cases with coronal plane deformity, bone mineral density (T value), UIV position, LIV position, operation time, intraoperative blood loss, osteotomy grading, and related imaging indicators were compared between the two groups. The hC7-VSO of the vertebral body with significant differences between groups was taken, and the receiver operating characteristic curve (ROC) was used to evaluate its accuracy in predicting the occurrence of PJK. Results All 31 patients were followed up 13-52 months, with an average of 30.0 months. The patient’s PJA was 1.4°-29.0° at last follow-up, with an average of 10.4°; PJK occurred in 8 cases (25.8%). There was no significant difference in gender, age, BMI, number of fusion segments, number of cases with coronal plane deformity, bone mineral density (T value), UIV position, LIV position, operation time, intraoperative blood loss, and osteotomy grading between the two groups (P>0.05). Imaging measurements showed that the LL recovery value and T8-L3 vertebral hC7-VSO in the PJK group were significantly higher than those in the non-PJK group (P>0.05). There was no significant difference in hyperextension TK, hyperextension LL, hyperextension LKCA, TK recovery value, LL recovery value, kyphosis flexibility, hSVA, and T2-T7, L4, L5 vertebral hC7-VSO (P>0.05). T8-L3 vertebral hC7-VSO was analyzed for ROC curve, and combined with the area under curve and the comprehensive evaluation of sensitivity and specificity, the best predictive index was hC7-L2, the cut-off value was 2.54 cm, the sensitivity was 100%, and the specificity was 60.9%. Conclusion Preoperative back-forward Bending CT localization image can be used to predict the occurrence of PJK after posterior osteotomy and long-segment fusion fixation in adult spinal deformity. If the patient’s T8-L2 vertebral hC7-VSO is too large, it indicates a higher risk of postoperative PJK. The best predictive index is hC7-L2, and the cut-off value is 2.54 cm.
To introduce a way to correct mildly and moderately inverted ni pple. Methods From May 2004 to January 2007, 16 patients (aged 18-38 years) with original bilateral inverted nipple were corrected with the double stitching of U-shape. Sixteen cases included 11 mildly inverted nipples and 5 moderately inverted nipples. Six of them received massage and vacuum aspiration, and the results were not satisfactory. After the pull ing out inverted ni pples, four microincisions about 0.1 cm on the border of areola and the basilar part of nipple were designed in each horizontal and perpendicular directions, then double stitching was performed to increase the supporting and sustaining tissue under the nipple and close the way nipple invert. Results Most cases exhibited excellent aesthetic projection and incision healed by first intention. Followup examinations were performed at 6 months to 2 years and revealed no evidence of recurring inversion, ni pple tilting or lactation disturbance. No surgical compl ications such as infection, nipple and areola of breast necrosis, permanent numbness. The scars in the local site were l imited and not conspicuous. Conclusion Double stitching of U-shape is easy and simple with few compl ications. It is an ideal method to correct mild and moderate inverted nipple.
ObjectiveTo explore the effectiveness and advantage of three-dimensional (3D) printed navigation templates assisted Ludloff osteotomy in treatment of moderate and severe hallux valgus.MethodsBetween April 2013 and February 2015, 28 patients (28 feet) with moderate and severe hallux valgus who underwent Ludloff osteotomy were randomly divided into 2 groups (n=14). In group A, the patients were treated with Ludloff osteotomy assissted with a 3D printed navigation template. In group B, the patients were treated with traditional Ludloff osteotomy. There was no significant difference in gender, age, affected side, and clinical classification between 2 groups (P>0.05). The operation time and intraoperative blood loss were recorded. The ankle function of the foot at preoperation, immediate after operation, and last follow-up were assessed by the American Orthopedic Foot and Ankle Society (AOFAS) score. Besides, the X-ray film were taken to assess the hallux valgus angle (HVA), intermetatarsal angle (IMA), and the first metatarsal length shortening.ResultsAll patients were followed up 18-40 months (mean, 26.4 months). The operation time and intraoperative blood loss in group A were significantly less than those in group B (P<0.05). The HVA, IMA, and AOFAS scores in groups A and B at immediate after operaton and last follow-up were sinificantly improved when compared with preoperative values (P<0.05); but no significant difference was found between at immediate after operation and at last follow-up (P>0.05). No significant difference was found in HVA and IMA between group A and group B at difference time points (P>0.05). There were significant differences in AOFAS score and the first metatarsal length shortening at immediate after operation and at last follow-up between 2 groups (P<0.05). Except 1 case of metastatic metatarsalgia in group B, there was no other operative complications in both groups.Conclusion3D printed navigation template assisted Ludloff osteotomy can provide accurate preoperative planning and intraoperative osteotomy. It is an ideal method for moderate and severe hallux valgus.
ObjectiveTo investigate the classification and treatment strategies of symptomatic severe osteoporotic vertebral fracture and collapse. MethodsBetween August 2010 and January 2014, 42 patients with symptomatic severe osteoporotic vertebral fracture and collapse were treated, and the clinical data were retrospectively analyzed. According to clinical symptom and imaging materials, 23 cases were classified as type I (local pain, limitation of motion, no neurological symptom, and no obvious deformity), 12 cases as type II (slight neurological symptom and kyphotic Cobb angle ≤ 30°), and 7 cases as type III (severe neurological symptom and kyphotic Cobb angle <30°). In 23 type I patients, 17 underwent percutaneous vertebral augmentation, 6 underwent posterior pedicle screw fixation strengthened with bone cement combined with percutaneous vertebral augmentation. In 12 type II patients, they were treated with local spinal decompression and internal fixation strengthened with bone cement. In 7 type III patients, 5 underwent posterior osteotomy, and 2 underwent one stage posterior approach of vertebral resection and reconstruction. The visual analogue scale (VAS), Oswestry disability index (ODI), and local kyphotic Cobb angle were used to evaluate the neurological function. The complications were recorded. ResultsThe operation was successfully completed in all patients. Wound infection and ketoacidosis secondary to stress blood glucose rise occurred in 1 case of type III patients respectively, and were cured after corresponding treatment; primary healing of wound was obtained in the other patients. The patients were followed up from 6 to 36 months (mean, 11.6 months). The nerve function was improved in 17 cases, and micturition disability was observed in 2 cases. Asymptomatic cement leakage occurred in 13 cases (30.95%) (7 cases in type I, 4 cases in type II, and 2 cases in type III). No bone cement dislocation and internal fixation failure were found during follow-up. The VAS score, ODI, and the local kyphotic Cobb angle at 1 week and last follow-up were significantly improved when compared with preoperative ones (P<0.05), but no significant difference was found between at 1 week and last follow-up (P>0.05). ConclusionIn order to improve the effectiveness and reduce the risk and complications of operation, individualized strategies should be performed according to different types of severe osteoporotic vertebral fracture and collapse.
ObjectiveTo investigate the effectiveness of limited middle and posterior column osteotomy via transvertebral space approach in treatment of old thoracolumbar compression fracture.MethodsA clinical data of 47 patients with old thoracolumbar compression fractures, who met the selection criteria between January 2010 and March 2018, was retrospectively analyzed. Twenty-five patients (group A) underwent the limited middle and posterior column osteotomy via transvertebral space approach, and 22 patients (group B) underwent the pedicle subtraction osteotomy (PSO). There was no significant difference in gender, age, cause of injury, time from injury to operation, fracture segment, and preoperative Cobb angle, sagittal vertical axis (SVA), visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, and Oswestry disability index (ODI) between the two groups (P>0.05). The operation time, intraoperative blood loss, and postoperative complications, as well as postoperative Cobb angle, SVA, VAS score, JOA score, ODI and the differences of all indexes between pre- and post-operation were recorded and compared between the two groups. The neurological function was evaluated by Frankel scale.ResultsThe operations of both groups were successfully completed. The operation time and intraoperative blood loss in group A were significant lower than those in group B (P<0.05). All incisions healed by first intetion. All patients were followed up 23-27 months (mean, 24.2 months) in group A and 24-28 months (mean, 24.8 months) in group B. At last follow-up, the VAS score, JOA score, ODI, Cobb angle, and SVA of the two groups were compared with those before operation, and the differences were significant (P<0.05). There was no significant difference between the two groups (P>0.05) in the indexes at last follow-up and the difference between pre- and post-operation. The lower extremity neurological symptoms (Frankel grade D) in 3 patients of group A before operation relieved (Frankel grade E) at last follow-up. The other patients were Frankel grade E. At last follow-up, CT showed bony fusion in the grafted area without any complications such as failure of internal fixation or pseudarthrosis.ConclusionFor patients with old thoracolumbar compression fractures, the limited middle and posterior column osteotomy via transvertebral space approach has a satisfactory effectiveness. Compared with PSO, it can reduce surgical trauma on the basis of achieving the same degree of deformity correction.
Objective To explore the failure cause of posterior approach orthopaedic operation of thoracolumbar hemivertebra, and to summary strategies of revision. Methods The cl inical data from 9 cases undergoing posterior approach orthopaedic operation failure of thoracolumbar hemivertebra between June 2003 and June 2008, were retrospectively analyzed. There were 5 males and 4 females with a median age of 12 years (range, 1 year and 10 months to 24 years). All malformations were identified as fully segmented hemivertebra from the original medical records and X-ray films, including 2 cases in thoracic vertebra, 5 cases in thoracolumbar vertebra, and 2 cases in lumbar vertebra. The preoperative scol iotic Cobb angle was (45.4 ± 17.4)°, and kyphotic Cobb angle was (29.8 ± 22.0)°. The reason of primary surgical failure were analyzed and spinal deformity was corrected again with posterior revision. Results All surgeries were finished successfully. The operation time was 3.0-6.5 hours (mean, 4.5 hours), and the perioperative bleeding was 400-2 500 mL (mean, 950 mL). All incisions healed by first intention; no infection or deep venous thrombosis occurred. Numbness occurred in unilateral lower extremity of 1 case postoperatively, and the symptom was rel ieved completely after treatment of detumescence and neural nutrition. All cases were followed up 12-30 months (mean, 18 months). No pseudoarthrosis and implant failure occurred. The X-ray films showed that the bone grafts completely fused within 8-14 months (mean, 11 months) after operation. The Cobb angles of scol iosis and kyphosis at 1 week after operation and the last follow-up were obviously improved when compared with preoperative ones, showing significant differences (P lt; 0.05). No obvious correction loss was observed either in coronal or sagittal plane. Conclusion The failure causes of posterior approach orthopaedic operation are hemivertebra processing, selection of fixation and fusion range, and selection of internal fixation. If the strategies of revision are made after the above-mentioned failure causes are considered, the cl inical results will be satisfactory.
ObjectiveTo investigate the effectiveness of the Ilizarov technique for the treatment of traumatic talipes equinovarus so as to provide the evidence for the clinical practice. MethodsBetween February 2011 and April 2012,42 patients with traumatic talipes equinovarus received treatment by Ilizarov technique,including 29 males and 13 females aged 17-55 years (mean,34.3 years).The left side was involved in 24 cases,and the right side in 18 cases.The disease duration was 6 months to 6 years (mean,2.7 years).According to the principles of Ilizarov,a ring external fixator was applied on the affected foot and lower leg.The threaded rods and screw nuts were revolved according to the tolerance of patients at 3-7 days after fixation.At first,forefoot varus or foot inversion was corrected,and then drooping feet deformity was corrected.The patients were encouraged to begin weight-bearing walking after correction.X-ray films were taken regularly to observe the ankle joint and avoid its dislocation.The external fixator was maintained in neutral position for 8-12 weeks after achieving satisfactory correction.An walking ankle-foot orthosis and a sleeping ankle-foot orthosis were used for more than 16 weeks after removal of the fixator.The outcome was assessed with American Orthopaedic Foot and Ankle Society (AOFAS) comprehensive scoring system and visual analogue scale (VAS) pain score. ResultsForty-two patients were followed up 14.3 months on average (range,10-24 months).All the patients achieved 0° dorsiflexion at 4-13 weeks (mean,6.8 weeks) after treatment with Ilizarov apparatus.The fixator was maintained for 10.7 weeks on average (range,10-16 weeks) after correction.No dislocation of the ankle joint and no damage to nerves and blood vessels occurred.The deformity of plantar flexion (10°) was found in 3 patients.At last follow-up,the patients could walk normally.AOFAS score was significantly increased to 93.4±8.0 from 52.7±10.1 at preoperation (t=-7.035,P=0.008);according to AOFAS scoring system,24 cases were grades as excellent,14 as good,2 as moderate,and 2 as poor,and the excellent and good rate was 90.5%.The VAS score of the foot significantly decreased to 3.51±1.44 from 7.55±1.39 at preoperation (t=-0.564,P=0.025). ConclusionIlizarov technique combined with non-fusion has satisfactory effectiveness in correction of traumatic talipes equinovarus.It is a safe,effective,and minimally invasive method.
【Abstract】 Objective To explore the clinical application and outcomes of preoperative second measurement of three-dimensional (3-D) CT reconstruction data for scoliosis orthopedic surgery. Methods Between August 2006 and March 2008, 11 patients with severe rigid scoliosis received surgery treatment, including 4 males and 7 females with an average age of 17.2 years (range, 15-19 years). Preoperative second measurement of 3-D CT reconstruction data was conducted to guide the surgery， including the angle and width of pedicle, the entry point, and the choice of screws whose lengths and diameters were suitable. A total of 197 pedicle screws were implanted. The operation time， blood loss， postoperative nerve function，and Cobb’s angles at sagittal and coronal view were all recorded， and the postoperative CT scan was performed to assess the accuracy of pedicle screw insertion according to Andrew classification. Results Pedicle screws were implanted within 1-11 minutes (mean, 5.8 minutes), and the blood loss was 450-2 300 mL (mean, 1 520 mL). The postoperative X-ray films showed the correction rates of Cobb’s angle were 68.5% in coronal view and 55.5% in sagittal view. The accuracy of pedicle screw insertion was rated as grade I in 77 screws (39.1%)，grade II in 116 screws (58.9%)， and grade III in 4 screws (2.0%) according to postoperative CT scan. All 11 cases were followed up 14 months to 2 years without any complications. Conclusion Preoperative second measurement of 3-D CT reconstruction data can make the surgery process easy and accurate in treatment of severe scoliosis.
ObjectiveTo review the advances in the application of tranexamic acid (TXA) in adolescent spinal corrective surgery.MethodsThe mechanism of action and pharmacokinetic, effectiveness, dosage, safety as well as methods of administration were comprehensively summarized by consulting domestic and overseas related literature about the application of TXA in adolescent spinal corrective surgery in recent years.ResultsTXA efficaciously reduce intraoperative blood loss, transfusion rate and volume, postoperative drainage volume in adolescent spinal corrective surgery. At present, the most common method of administration in adolescent spinal corrective surgery is that a loading dose is given intravenously before skin incision or induction of anesthesia, followed by a maintenance dose until the end of the surgery. The range of loading dose and maintenance dose is 10-100 mg/kg and 1-10 mg/(kg·h), respectively. No drug related adverse event has been reported in this range.ConclusionThe effectiveness and safety of TXA in adolescent spinal surgery have been basically confirmed. However, further studies are needed to determine the optimal dosage, method of administration as well as whether it could reduce blood loss after surgery.