Morphometric measurement of lower lumbar intervertebral foramina based on digital three-dimensional simulation.

AIM: This study aimed to investigate the morphology of the lower lumbar intervertebral foramina through use of a digital three-dimensional (3D) simulation model to guide the endoscope through the intervertebral foramina. MATERIAL AND METHODS: Individuals without disease affecting the lumbar vertebrae underwent computed tomography (CT) scanning in the supine position. The CT images obtained were imported to medical software to reconstruct a 3D model of the lumbar vertebrae. The stereoscopic longitudinal and transverse diameters of the lumbar intervertebral foramina were measured directly on the established simulation model. Comparisons in terms of sex and age were performed using t-test or analysis of variance. RESULTS: In total, 100 individuals were included in the study. Average longitudinal and transverse diameters of the lower lumbar intervertebral foramen decreased moving inferiorly. The longitudinal and transverse diameters of the lower lumbar intervertebral foramina were similar between sexes and between age groups. However, longitudinal diameter decreased with age (P 0.05). CONCLUSION: The reconstructed lumbar vertebrae simulation model presented in this study has high fidelity to the structure of the human lumbar spine. This approach provides individualized, accurate, standardized, and detailed guidance for endoscopic surgery through the lumbar intervertebral foramen.

Proximal humeral internal locking plate combined with a custom neutral-position shoulder and elbow sling for proximal humerus fractures: A randomized study.

OBJECTIVES: The aim of this study was to investigate the effectiveness of the proximal humeral internal locking system (PHILOS) plate combined with a custom neutral-position shoulder and elbow sling for proximal humerus fractures. METHODS: A total of 112 patients with proximal humerus fractures were assigned randomly into 2 groups. Group A (n = 56) was treated by open reduction and internal fixation (ORIF) with a PHILOS plate; group B (n = 56) was treated by ORIF with a PHILOS plate in combination with the use of a custom neutral-position shoulder and elbow sling for 30 days after surgery. The incidence of internal fixation failure, the Constant-Murley shoulder assessment, and Visual Analogue Scale (VAS) score were recorded and analyzed. RESULTS: Patients included were followed up for an average of 15 months (range, 6-24 months). No significant differences were observed in mean VAS scores and mean Constant-Murley shoulder assessment scores at 1-day preoperative and postoperative day 3 between groups A and B. However, mean VAS scores and mean Constant-Murley shoulder assessment in group B were significantly improved when compared with group A at postoperative day 30 and the final follow-up. No cases of postoperative infection, loss of reduction, PHILOS break, or vascular nerve injury occurred in either group. CONCLUSIONS: Proximal humerus fractures treated with the combination of the PHILOS and custom neutral-position shoulder and elbow sling for 30 days after operation was associated with a lower incidence of internal fixation failure. There was no increase in adverse events compared with open reduction and internal fixation with a PHILOS plate alone.