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Objective To investigate the clinical efficacy of bone filling mesh bag combined with pedicle anchoring for the treatment of Stage Ⅲ reducible Kummell disease.Method The 35 paients with Stage Ⅲ reducible Kummell disease were treated with bone filling mesh bag combined with pedicle anchoring from January 2018 to December 2022.The operation Time,intraoperative blood lose,bone cement injection volume and surgical complications were recorded.The VAS score,ODI value,kyphosis Cobb angle and midline height of the injured vertebral were compared at preoperative,postoperative 1 day and last follow-up.Results All patients were followed up for 12-24 months[(15±3.5)months].Operation time was 35-63 min[(45±5.8)min],intraoperative blood loss was 10-35 ml[(20±5)ml],bone cement injection volume was 4.5-7.8 ml[(5.5±1.8)ml].There were 4 cases of bone cement leakage,there were 1 case of intervertebral leakage,2 cases of lateral leakage,1 case of anterior leakage and no patient with intracanal leakage.All bone cement leakage did not lead to clinical symptoms,bone cement poisoning and pulmonary embolism.No cement mass slip.All patients were followed up for 12 to 24 months[(15±3.5)months].VAS scores and Oswestry Disability Index(ODI)values were significantly lower on the first day after surgery than before surgery,with statistical significance(P＜0.05).The 3-month follow-up was slightly higher than that on the first day after surgery,and the difference was not statistically significant(P＞0.05).The midline height and Cobb Angle of the injured vertebra were measured by imaging.The height of the injured vertebra recovered significantly on the first day after operation,and the Cobb Angle decreased significantly,the difference was statistically significant(P＜0.05).The midline height of the injured vertebrae decreased and the Cobb Angle increased slightly at 3 months after the operation,but the difference was not statistically significant(P＞0.05).Conclusion In the the treatment of Stage Ⅲ reducible Kummell disease,Bone filling mesh bag combined with Pedicle anchoring have good clinical efficacy,which can significantly reduce the pain of patients,relieve clinical symptoms,improve spinal function,improve quality of life,and reduce the incidence of bone cement leakage and slippage.
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Based on the development and application of new technology,as a new interdisciplinary subject,digital orthopedics becomes an important development direction of modern medicine in the past years.Using digital orthopedics technology,such as 3D digital printing technology,mixed reality technology,provides new impetus of orthopedic surgery and indicates its great potential of precision medicine and personalized therapy for orthopedic disorders.In 2017,Hubei Branch of China Digital Orthopaedic Society of Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) was founded.It is an important milestone and academic event for the development of digital orthopedics in Hubei.After that,Hubei's digital orthopedics professionals have made great progress in clinical,scientific research,conference and social activities.The development of 5G technologies in China will provide more opportunities and challenges for global digital orthopedics in the near future.
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Objective To investigate the clinical efficacy of modified open-door laminoplasty with preservation ofthe unilateral paraspinal muscle ligament complex in treating ossification of posterior longitudinal ligament (OPLL) of the cervical spine.Methods From June 2015 to July 2017,thirty-two patients with OPLL of the cervical spine who underwent modified open-door laminoplasty with preservation of the unilateral paraspinal muscle ligament complex were retrospectively analyzed(modified group).There were 20 males and 12 females with the average age of 61.72±8.41 years (range 46-75 years).The decompression segment range included three cases of C2-C6,seven cases of C2-C7,eight cases of C3-C6,and fourteen cases of C3-C7.Moreover,twenty-three patients with OPLL of the cervical spine who underwent traditional unilateral open-door laminoplasty at the same time were included as controls (control group).The demographics,operation duration,and blood loss volume was recorded.The visual analogue scale (VAS),Japanese Orthopaedic Association scores (JOA),improvement rate of JOA score and neck disability index (NDI) were recorded and analyzed at preoperation,three months after operation,six months after operation and at the final follow-up.The cervical curvature,cervical curvature index (CCI),range of motion (ROM) were measured and statistically analyzed on the lateral X-ray film of the cervical spine.The union rate of the lamina hinge and that of spinous process-lamina was measured on the cross section of the CT scan.Bilateral cervical posterior muscle volume was recorded and analyzed at cross-section plane on MRI.Axial symptoms,C5 nerve root palsy and other complications were also recorded.Results All the patients were followed-up for 6 to 18 months (mean,13.04±4.67 months in control group,11.81±4.93 months in modified group).At the final follow-up,the JOA,VAS and NDI scores improved from preoperatively 6.09±0.79 to 13.43± 1.53,4.22±1.04 to 2.83±1.15 and 25.48％±3.20％ to 8.83％±5.41％ in the control group,versus 6.28±1.05 to 13.88±1.48,4.09± 1.00 to 1.16±0.57 and 25.06％±3.24％ to 5.66％±2.46％ in the modified group.The postoperative JOA score and recovery rate of the two groups was not significantly different,whereas the VAS and NDI scores were significantly reduced in the modified group compared to the control group.The maximum cervical flexion angle,cervical curvature,ROM and CCI of control group were 6.26°± 3.31°,30.17°±4.56°,11.39°±1.95° and 9.74％±4.05％ at the final follow-up,which were reduced significantly compared to pre-operation.The maximum cervical flexion angle,cervical curvature,ROM and CCI of modified group were 10.06°± 1.93°,35.03°± 5.01°,17.03°±2.86° and 14.22％±5.00％,and there were no significant differences compared to pre-operation.There were significant differences among two groups.At the final follow-up,the posterior muscle volume of the two groups at open side was decreased compared to preoperation,but there was no significant difference between the two groups.At the last follow-up,the posterior muscle volume at hinge side was not changed compared to preoperation in modified open-door laminoplasty group,while the volume of the posterior muscle at hinge side in the traditional control group decreased compared to preoperation.The difference was statistically significant.A total of eight patients with axial symptom were present after operation.There were two patients (6％,2/ 32) in the modified group and six patients (26％,6/23) in the control group.The difference of axial symptoms incidence was statistically significant between the two groups.Conclusion Modified open-door laminoplasty with preservation of the unilateral paraspinal muscle ligament complex is an effective technique in treating OPLL of the cervical spine.The technique not only guaranteed to have good recovery of neurological function and to maintain cervical curvature and range of motion,but also contributed to decrease the occurrence of postoperative axial symptoms.
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Objective To evaluate the individualized 3D) printed drilling guide we developed and used for placement of C1/2 pedicle screws in the clinical treatment of fracture and dislocation of the atlantoaxial joint.Methods From January 2014 to June 2016,we treated a total of 17 patients with fracture and dislocation of the atlantoaxial joint.All the cervical CT data of the patients were imported into the digital orthopaedic workstation for 3D reconstruction,data modeling and 3D printing to design and manufacture individualized atlantoaxial vertebral guide templates.Intraoperatively,C1 and C2 pedicle screws were placed under the guide of individualized 3D printed drilling template.Cervical short-segment fixation and fusion were conducted for the patients.Postoperatively,regular clinical and radiographic follow-ups were carried out.Results No serious complications like injury to spinal cord and vertebral artery happened due to failed placement of C1/2 pedicle screws.The operation time ranged from 136 to 222 min (average,168.0 rmin);the intraoperative blood loss ranged from 260 to 556 mL (average,356.0 mL).The 17 patients were followed up for 6 to 36 months (average,13.5 months).The patients obtained bony union after 4 to 6 months (average,4.8 months).At the final follow-up,according to ASIA92 scoring system,the average sensory score was improved significantly from preoperative 7.4 + 3.2 to postoperative 13.1 + 5.9,and the average motor score was improved significantly from preoperative 5.3 + 3.1 to postoperative 11.7 + 5.1 (P ＜ 0.05).No such complications as infection or implant failure occurred after operation.Conclusion Individualized 3D printed drilling guide for implantation of atlantoaxial pedicle screws can make the complicate and risky placement become accurate,safe and simple.
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[Objective]To introduce the surgical technique and its rationale and to evaluate the early and mid-term clinical outcome of routine core decompression and insertion of a biomaterial loaded allograft threaded cage(ATC)in the treatment of necrotic femoral head．[Methods]Seventy-six patients(78 hips)with femoral head necrosis were allocated to a program of either core decompression or core decompression and implantation of ATC．[Results]At review all patients had a minimum follow-up of 24-months(24 to 68 months)．In the control group，no significant improvement in Harris hip score(HHS)was found，and 13 of the 22 hips had deteriorated to stageⅢ．In the treatment group．the mean HHS was improved from 62．8 to 81．6．Collapse was seen in 1 hip，and this collapse Was progressive in 3 hips．[Conclusion]It，s thus evident that the technique is attractive as a salvage procedure．which shows encouraging Success rates and early clinical results.
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Objective To optimize the processing technology of Radix Achyranthis Bidentatae prepared with salt. Methods With the amount of the oleanolic acid as the parameter,the processing technology was optimized through orthogonal exper iments design L9(34). Results The optimal processing technology of Radix Achyran this Bidentatae prepared with salt was:the thickness of the medicinal pieces be ing 5～10 mm,baking 20 min with 3.00 %salt at 100 ℃. Conclusion The chosen pr ocessing technology is reasonable.