ObjectiveTo review the research progress of total endoscopic minimally invasive technique in treating cervical nerve root canal stenosis (CNRCS).MethodsThe related literature at home and abroad was extensively reviewed. The research history, current situation, research progress, advantages and disadvantages of minimally invasive treatment of CNRCS under total endoscope were summarized.ResultsIn recent years, with the continuous development of minimally invasive technique of total endoscope in spine surgery, the surgical treatment methods are also constantly innovated. Compared with the traditional open surgery, minimally invasive treatment of CNRCS under total endoscope can obtain better effectiveness, keep the stability of the cervical segment to the maximum extent, reduce the impact on the activity of the cervical spine and the occurrence of related surgical complications, which is an effective minimally invasive technology.ConclusionThe minimally invasive treatment of CNRCS under total endoscope has achieved some results, which is expected to be one of the indispensable means to treat CNRCS, but it still needs to be improved.
ObjectiveTo develop a new type of internal fixation device which can be used to treat the minor avulsion fracture of the medial malleolus, lateral malleolus, the base of the fifth metatarsal, and the ulnar styloid process, and investigate the reliability and effectiveness of the device through biomechanical test.MethodsEighty human’s bone specimens with complete medial malleolus, lateral malleolus, the base of the fifth metatarsal, and the ulnar styloid process were selected and measured the anatomic indexes (the height, width, and thickness of medial malleolus, lateral malleolus, the base of the fifth metatarsal, and the ulnar styloid process). The CT three-dimensional reconstruction data of 200 healthy adults which including medial malleolus, lateral malleolus, the base of the fifth metatarsal, and the ulnar styloid process was also selected and measured the anatomic indexes by Mimics software. The plastic rod-hook plate was designed according to the measured results and prepared. Forty fresh porcine lower limb specimens were randomly divided into groups A and B (20 in each group), and 8 adult lower limb specimens including 4 left and 4 right were also randomly divided into groups A and B (4 in each group). All specimens were prepared for avulsion fracture of medial malleolus. Then, the fractures were fixed with plastic rod-hook plate in group A and wire anchor in group B. The load and axial torsion test of ankle joint were carried out by universal biomechanical testing machine.ResultsAccording to the anatomical characteristics, a plastic rod-hook plate was designed successfully. The biomechanical test results between animal and human specimens were consistent. There was a linear relationship between load and displacement in the ankle distal load test. The displacement when loaded to the maximum load was significantly lower in group A than in group B (P<0.05). The torsion angle and torque were significantly higher in group A than in group B when the internal fixation failed in the axial torsion test of the ankle joint (P<0.05), and the torsion angle was significantly smaller in group A than in group B when the torque was 1 N·m (P<0.05), and the maximum torque was also significantly higher in group A than in group B (P<0.05). However, there was no significant difference in torsion angle between the two groups in the maximum torque (P>0.05).ConclusionThe biomechanical properties of plastic rod-hook plate is obviously better than wire anchor, and the fixation of avulsion fracture with plastic rod-hook plate is easy to operate, which is expected to be used in the clinical treatment of minor avulsion fractures such as medial malleolus, lateral malleolus, base of the fifth metatarsal, and ulna styloid process.