Objective To establish an osteoporosis screening tool for Chinese40-years-old or above women. Methods The T-score was calculated based on the mean bone mineral density(BMD) of 20-39 years women. Considering the result of dualenergy X-ray absorptiometry(DXA) as the golden criteria, the Bayes discriminant analysis was employed to explore the function. Results The formula of the screening tool for Chinese 40-years-old or above women as following:osteoporosis screenig tool for Chinese(OSTC):Weight-2×age+50. OSTC≤0was classified into high risk, OSTCgt;0 was low risk. The hit rate of OSTC was 75.78%.The sensitivity is 76.8%. The specificity is 75.1%, Kappa value was 0.51(P=0.000).That means the consistency of diagnosis result between OSTC and DXA was relatively good. Conclusion OSTC is a simple tool. Just based on age and weight, it can evaluate the osteoporosis risk of Chinese 40-years-old or above women. But the effect of OSTC has not been proved by other datasetand should be tested further.
Objective To elucidate the new development, structural features and appl ication of the lumbar interspinous process non-fusion techniques. Methods With the review of the development course and important research works in the field of the lumbar inter-spinous process non-fusion techniques, the regularity summary, science induction, and prospect were carried out. Results The lumbar inter-spinous process non-fusion technique was a part of non-fusion insertof spinal division posterior surface. According to the design, it could be divided into two major categories: dynamic and static systems. The dynamic system included Coflex and device for intervertebral assisted motion; the static system included X-STOP, ExtenSure and Wall is. The lumbar inter-spinous process non-fusion technique was a new technique of spinal division, it could reserve the integrated function of intervertebral disc and zygapophysial joint, maintain or recover the segmental movement to a normal level, and have no adverse effect on the neighboring segments. A lot of basic and cl inical researches indicated that lumbar inter-spinous process insert had extensive appl ication to curatio retrogression lumbar spinal stenosis, discogenic low back pain, articular process syndrome, lumbar intervertebral disc protrusion and lumbar instabil ity and so on. Conclusion With the matures of lumbar inter-spinous process non-fusion techniques and the increased study of various types of internal fixation devices, it will greatly facil itate the development of treatment of lumbar degenerative disease. But long-term follow-up is needed to investigating the long-term efficacy and perfect operation indication.
Objective To investigate the feasibility and clinical outcomes of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using unilateral incision and internal fixation of pedicle screws and a translaminar facet screw for dural-level lumbar degenerative disease. Methods Between January 2010 and January 2012, 19 patients with dural-level lumbar degenerative disease was treated, including 7 males and 12 females with an average age of 50.4 years (range, 22-68 years) and a median disease duration of 37 months (range, 8 months to 15 years). The operated segments included L3-5 in 6 cases and L4-S1 in 13 cases. MIS-TLIF was performed by unilateral incision, and then pedicle screws and a translaminar facet screw were used for internal fixation. Results Operations were successfully performed in all cases. The mean operation time was 158 minutes; the mean intraoperative blood loss was 156 mL; the mean length of incision was 42 mm; the mean postoperative ambulation time was 35 hours; the mean hospitalization time was 4.1 days; and the mean length of translaminar facet screw was 51 mm. All the wounds healed by first intention. No complication occurred in the others except 1 case of dural tear. The patients were followed up 12-24 months (mean, 17.1 months). The visual analogue scale (VAS) scores for back and leg pain and Oswestry disability index (ODI) scores at postoperation were significantly improved when compared with preoperative ones (P lt; 0.05). The symptom disappeared gradually. The postoperative X-ray images showed that the internal fixations were in good position; all facets screws penetrated through the base of spinous process, laminar, and facets joint; of the screws, 2 (5.3%) facets screws penetrated lateral laminar, and 1 (1.8%) pedicle screw penetrated out of pedicle of vertebral arch, but no symptom of nerve injury was seen. The CT scan and three-dimensional reconstruction at postoperative 12th month showed good interbody fusion; and based on the Bridwell’s interbody fusion grading system, 11 cases were rated as grade I, and 8 cases as grade II. Conclusions MIS-TLIF by unilateral incision and internal fixation is a safe and reliable method to treat dural-level lumbar degenerative disease, and it has the advantages of short operation time, less invasion, less blood loss, and fast recovery.
OBJECTIVE: To study the changes of neural electrophysiology properties of cauda equina under double level compression and dynamic burdens, and to clarify the mechanisms of intermittent neurogenic claudication. METHODS: Thirty SD rats were divided into 5 groups (6 in each group). The laminectomy of L5 was performed in control group. In the experimental groups, the silicon sheets were inserted into the spinal canal of L4 and L6 to cause double level compression of cauda equina by 30%. Two hours after onset of compression, no dynamic burden was introduced in experimental group 1. Only high frequency stimulation(HFS) was introduced for 6 minutes in experimental group 2. Both HFS and additional increased compression were introduced for 6 minutes in experimental group 3. While only additional increased compression was introduced for 6 minutes in experimental group 4. After 6 minutes of dynamic burdens, all were returned to the status of static compression for another 30 minutes and then electrical examination was made. RESULTS: After 2 hours of compression, motor and sensory nerve conduction velocity (NCV) of all the four experimental groups decreased significantly (P lt; 0.05), but there was no significant difference between them. There was no significant change in the control group. There was no significant change of NCV in experimental group 1 during the last 30 minutes of experiment. NCV in the other three experimental groups decreased after introduction of dynamic burdens, especially in the experimental group 3. CONCLUSION: The above results showed that NCV of cauda equina decreased significantly under dynamic burdens during static compression. Two kinds of dynamic burdens introduced at the same time can cause more profound change than a single one.
摘要:目的:探讨联合应用激光汽化减压(percutaneous laser disc discompression,PLDD)、射频热凝靶点消融、臭氧注射治疗腰椎间盘突出症的的个体化选择。方法: 自2006年6月,在CT引导下选择性联合应用PLDD、射频和臭氧治疗腰椎间盘突出症患者267例,突出椎间盘的特点个体化选择穿刺路径和治疗方法;其中PLDD联合臭氧治疗92例(A组),射频联合臭氧治疗67例(B组),PLDD、射频和臭氧三者联合治疗108例(C组)。结果:所有患者均顺利完成手术,于术后1周、1个月,3个月及6个月随访记录VAS评分和Macanab优良率。三组患者VAS评分经方差分析,手术前、后有显著性差异(Plt;0.05),术后1周至6个月的VAS评分统计无显著性差异(Pgt;0.05);术后三组间VAS评分、Macanab优良率比较无显著性差异(Pgt;0.05)。结论: 选择性联合应用微创技术进行个体化的立体治疗,具有扩大微创手术适应症、提高手术疗效的优势,值得推广和利用。Abstract: Objective: To investigate the selectivity and individualization of using percutaneous laser disc discompression(PLDD) and ozone injection combined with radiofrequency thermocoagulation and target ablation curing lumbar intervertebral disc protrusion. Methods: From June 2006, 267 lumbar disc herniation cases were operated that guided by CT, the characteristic of the liable disc was confirmed by magnetic resonance imaging and CT before the procedure. 92 cases (A group) were treated by PLDD combined with ozone injection,67 case were treated by radiofrequency thermocoagulation and target ablation combined with ozone injection, 108 cases were treated by PLDD and ozone injection combined with radiofrequency thermocoagulation and target ablation. Results: All case been successfully operated, the theraptic effect was evaluated by comparing the value of VAS and excellent and good rate of therapy at preoperation and at 1 week, 1month,3 months, 6 months after operation. The value of VAS in three groups at postoperation were remarkably lower than preoperation (Plt;0.05). The excellent and good rate of therapy at 6 months was respectively 94.5％ in group A,94.0％ in group B and 95.4％ in group C,no significant difference was observed between the three groups(Pgt;0.05).Conclusion: The selectivity and individualization of using PLDD and ozone injection combined with radiofrequency thermocoagulation and target ablation curing lumbar intervertebral disc protrusion can enlarge the indication and improve the clinical curative effect, it should be spreaded in clinic.
Objective To explore the clinical application value of the spinal robot-assisted surgical system in mild to moderate lumbar spondylolisthesis and evaluate the accuracy of its implantation. Methods The clinical data of 56 patients with Meyerding grade Ⅰ or Ⅱ lumbar spondylolisthesis who underwent minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) between January 2017 and December 2017 were retrospectively analysed. Among them, 28 cases were preoperatively planned with robotic arm and percutaneous pedicle screw placement according to preoperative planning (group A); the other 28 cases underwent fluoroscopy-guided percutaneous pedicle screw placement (group B). There was no significant difference in gender, age, body mass index, slippage type, Meyerding grade, and surgical segmental distribution between the two groups (P>0.05). The screw insertion angle was measured by CT, the accuracy of screw implantation was evaluated by Neo’s criteria, and the invasion of superior articular process was evaluated by Babu’s method. Results One hundred and twelve screws were implanted in the two groups respectively, 5 screws (4.5%) in group A and 26 screws (23.2%) in group B penetrated the lateral wall of pedicle, and the difference was significant (χ2=9.157, P=0.002); the accuracy of nail implantation was assessed according to Neo’s criteria, the results were 107 screws of degree 0, 3 of degree 1, 2 of degree 2 in group A, and 86 screws of degree 0, 16 of degree 1, 6 of degree 2, 4 of degree 3 in group B, showing significant difference between the two groups (Z=4.915, P=0.031). In group B, 20 (17.9%) screws penetrated the superior articular process, while in group A, 80 screws were removed from the decompression side, and only 3 (3.8%) screws penetrated the superior articular process. According to Babu’s method, the degree of screw penetration into the facet joint was assessed. The results were 77 screws of grade 0, 2 of grade 1, 1 of grade 2 in group A, and 92 screws of grade 0, 13 of grade 1, 4 of grade 2, 3 of grade 3 in group B, showing significant difference between the two groups (Z=7.814, P=0.029). The screw insertion angles of groups A and B were (23.5±6.6)° and (18.1±7.5)° respectively, showing significant difference (t=3.100, P=0.003). Conclusion Compared to fluoroscopy-guided percutaneous pedicle screw placement, robot-assisted percutaneous pedicle screw placement has the advantages such as greater accuracy, lower incidence of screw penetration of the pedicle wall and invasion of the facet joints, and has a better screw insertion angle. Combined with MIS-TLIF, robot-assisted percutaneous pedicle screw placement is an effective minimally invasive treatment for lumbar spondylolisthesis.
Objective To compare the effectiveness between three-dimensional (3D) printed porous titanium alloy cage (3D Cage) and poly-ether-ether-ketone cage (PEEK Cage) in the posterior lumbar interbody fusion (PLIF). Methods A total of 66 patients who were scheduled to undergo PLIF between January 2018 and June 2019 were selected as the research subjects, and were divided into the trial group (implantation of 3D Cage, n=33) and the control group (implantation of PEEK Cage, n=33) according to the random number table method. Among them, 1 case in the trial group did not complete the follow-up exclusion study, and finally 32 cases in the trial group and 33 cases in the control group were included in the statistical analysis. There was no significant difference in gender, age, etiology, disease duration, surgical segment, and preoperative Japanese Orthopaedic Association (JOA) score between the two groups (P>0.05). The operation time, intraoperative blood loss, complications, JOA score, intervertebral height loss, and interbody fusion were recorded and compared between the two groups. Results The operations of two groups were completed successfully. There was 1 case of dural rupture complicated with cerebrospinal fluid leakage during operation in the trial group, and no complication occurred in the other patients of the two groups. All incisions healed by first intention. There was no significant difference in operation time and intraoperative blood loss between groups (P>0.05). All patients were followed up 12-24 months (mean, 16.7 months). The JOA scores at 1 year after operation in both groups significantly improved when compared with those before operation (P<0.05); there was no significant difference between groups (P>0.05) in the difference between pre- and post-operation and the improvement rate of JOA score at 1 year after operation. X-ray film reexamination showed that there was no screw loosening, screw rod fracture, Cage collapse, or immune rejection in the two groups during follow-up. At 3 months and 1 year after operation, the rate of intervertebral height loss was significantly lower in the trial group than in the control group (P<0.05). At 3 and 6 months after operation, the interbody fusion rating of trial group was significantly better in the trial group than in the control group (P<0.05); and at 1 year after operation, there was no significant difference between groups (P>0.05). ConclusionThere is no significant difference between 3D Cage and PEEK Cage in PLIF, in terms of operation time, intraoperative blood loss, complications, postoperative neurological recovery, and final intervertebral fusion. But the former can effectively reduce vertebral body subsidence and accelerate intervertebral fusion.
Objective To provide evidence-based therapeutic schedule for an adult patient with Lumber Isthmic Spondylolisthesis grading II. Methods Based on fully assessing the patient’s conditions, the clinical problems were put forward according to PICO principles. Such database as The Cochrane Library (2005 to April 2011), DARE (April 2011), CENTRAL (April 2011), MEDLINE (April 2011), EMbase and CBM were searched to collect high quality clinical evidence, and then we told a patient information about treatment plans. The plan was chosen by the patient for she knew her conditions and the plans. Results We included 1 meta-analysis, 3 randomized controlled trials, 5 systematic reviews and 1 prospective study on the natural course of isthmic spondylolisthesis were included. Literature evidence indicated that the prognosis of isthmic spondylolisthesis was good. Surgery should be selected when there was neither no remission of symptom, nor progression of lumber olisthy with conservative treatment. The long-term effect of surgery may be good, but it cannot change the natural course of the disease. Based on literature evidence, the patient chose the conservative treatment. After one year’s treatment the patient recovered, her sciatica relieved, and CT showed no progression of lumber olisthy. Conclusion Patient with low grand isthmic spondylolisthesis chose conservative treatment may achieves good effects, whereas on the process of the treatment, regular follow-up to monitor the progression of lumber olisthy should be conducted.
Objective To summarize the efficacy of percutaneous endoscopic transforaminal unilateral decompression for the treatment of lumbar spinal stenosis, and to investigate the incidence and possible reasons for lower extremity symptoms of non-surgical side after surgery. Methods The clinical data of 46 patients who underwent percutaneous endoscopic transforaminal unilateral decompression for lumbar lateral recess stenosis between February 2016 and March 2018 were retrospectively analysed. There were 22 males and 24 females with an average age of 56.9 years (range, 21-90 years). The disease duration was 6 months to 12 years (mean, 4.8 years). There were 37 cases of single-segment lumbar lateral recess stenosis and 9 cases of multi-segment stenosis. All patients underwent single-segment surgery, including 2 cases of L3, 4, 35 cases of L4, 5, and 9 cases of L5, S1. For patients with multi-segment lumbar lateral recess stenosis, the single segment consistent with radicular symptom was selected for surgery. The visual analogue scale (VAS) scores of low back pain and sciatica and Oswestry disability index (ODI) scores were recorded preoperatively and at last follow-up to evaluate the relief of symptoms. Postoperative symptoms on non-surgical side of lower extremity including new or aggravated radiation pain and numbness were recorded. The surgical effectiveness was evaluated according to modified MacNab score at last follow-up. Results All the 46 patients underwent successful operations without postoperative complications such as wound infection, permanent nerve root injury, and deep vein thrombosis. The patients were followed up 12-37 months (mean, 23.8 months). Four patients suffered from radioactive pain and numbness for the non-surgical side of lower extremities at 1-3 months postoperatively, and the symptoms were improved after conservative treatment without revision surgery. VAS scores of low back pain and sciatica and the ODI scores were significantly improved at last follow-up when compared with preoperative ones (P<0.01). According to the criteria of modified MacNab scores, 25 cases were excellent, 17 cases were good, 3 cases were fair, and 1 case was poor. The excellent and good rate was 91.3%. Conclusion Percutaneous endoscopic transforaminal unilateral decompression for lumbar spinal stenosis would be able to relieve pain effectively and achieve good results. Lower extremity symptoms of non-surgical side may be observed postoperatively. Although the symptoms can be relieved by conservative treatment, further investigation should be carried out for the long-term result of those cases.