ObjectiveTo measure L1-L5 lumbar isthmus thickness and to construct Chinese adult male lumbar (L1-L5) 3D model by Micro CT 3D reconstruction technique, in order to provide micro-anatomical data for clinical treatment of L1-L5 lumbar spondylolysis. MethodsDry, non-damaged specimens of L1-L5 lumbar isthmus from 60 Chinese adult males were randomly selected from September 2013 to January 2014. Micro CT scanning was carried out, followed by corresponding 3D model construction. The microscopic anatomical parameters such as superior, inferior, inner and outer edge thickness of left and right L1-L5 lumbar isthmus were measured. ResultsL1-L5 lumbar isthmus superior edge thickness was in the order of L1> L2> L3> L5> L4, with the variation ranging from (4.31±0.95) mm to (4.88±0.75) mm. L1-L5 lumbar isthmus inferior edge thickness was in the order of L1< L2< L3< L4< L5, gradually thickened with the variation ranging from (6.03±1.01) mm to (7.27±1.27) mm. L1-L5 lumbar isthmus inner edge thickness amplitude was not obvious, ranging from (6.33±1.21) mm to (6.57±1.27) mm. L1-L5 lumbar isthmus outer edge thickness was in the order of L1< L2< L3< L4< L5, gradually thickened with the variation ranging from (8.44±1.21) mm to (10.27±1.28) mm. ConclusionThere are certain rules within superior, inferior, inner and outer edge thickness of adult L1-L5 lumbar isthmus:the inferior and outer edge thickness of L1-L5 lumbar isthmus gradually becomes thicker, while superior edge gradually becomes thinner. From L1 to L5 lumbar isthmus, the outer edge of the lumbar isthmus is the thickest, followed by inner and inferior edge, and the upper edge is the thinnest.
目的 探討雙源CT腰椎檢查中低劑量掃描方法及其臨床應用價值。 方法 將2011年8月－2012年5月行雙源CT腰椎檢查的714例患者隨機分為7組。均采用管電壓120 kV，分別依次采用常規參考管電流量250 mAs和低管電流量240、230、220、210、200、190 mAs，且均采用CARE DOSE技術采集數據。掃描參數：準直器64 mm×0.6 mm，重建層厚0.75 mm，重建間隔0.7 mm，FOV 180～200 mm。采集圖像后，測量腰3椎體的CT值及同層面的脊髓的CT值、背脊肌的CT值及噪聲；腰5椎體的CT值及同層面的脊髓的CT值、背脊肌的CT值及噪聲，并計算腰3、腰5椎體及相應層面脊髓的信噪比(SNR)和其相對于背脊肌的對比噪聲比（CNR）。應用統計學軟件對不同管電流下的CNR、SNR、盲法評分的數值以及射線劑量指數（CTDI）、劑量長度乘積（DLP）、有效劑量（ED）進行分析。 結果 第1組和第2組比較，圖像的背脊肌SD值；腰3、腰5椎體和脊髓的SNR值進行比較，差異無統計學意義（P＞0.05）。第1組與第3、4、5、6、7組比較，腰3、腰5低管電流量各組間圖像的背脊肌SD值；腰3、腰5椎體和脊髓的SNR值與常規管電流量組間比較差異均有統計學意義（P＜0.05）。腰3和腰5各組圖像的椎體-背脊肌和脊髓-背脊肌CNR值分別行單因素方差分析，結果差異均無統計學意義（P＞0.05）。 結論 雙源CT腰椎檢查時，通過階段性逐步降低管電流量的方法，使診斷醫生逐漸適應低劑量圖像質量，從而實現現有設備的低劑量掃描的方法是可行的。對于體質量指數（BMI）≤25 kg/m2的患者，可以采用190 mAs的參考管電流量進行腰椎掃描，不僅降低了患者接受的輻射劑量，同時也能獲得滿足臨床診斷的合格圖像，并且保護患者和減小設備損耗。
Objective To evaluate the effectiveness of pedicle subtraction osteotomy (PSO) and non-osteotomy techniques in treatment of medium-to-severe kyphoscoliosis by retrospective studies. Methods Between January 2005 and January 2009, 99 patients with medium-to-severe kyphoscoliosis were treated by PSO (PSO group, n=46) and non-osteotomytechnique (non-osteotomy group, n=53) separately. There was no significant difference in sex, age, Cobb angle of scol iosis on coronal plane, and Cobb angle of kyphosis on saggital plane between 2 groups (P gt; 0.05). The operation time and blood loss were recorded; the Cobb angle of scol iosis on coronal plane and kyphosis on sagittal plane were measured at pre- and postoperation to caculate the rates of correction on both planes. Results The operation was successfully completed in all the patients. The operation time and blood loss of the patients in PSO group were significantly greater than those of the patients in non-osteotomy group (P lt; 0.05). All patients were followed up 12-56 months (mean, 22.4 months); no spinal cord injury occurred, and bone fusion was achieved at last follow-up. The Cobb angles of scol iosis and kyphosis at 2 weeks and last follow-up were significantly improved when compared with the preoperative angles in the patients of 2 groups (P lt; 0.05). There was no significant difference in Cobb angle of scol iosis and the rate of correction between 2 groups (P gt; 0.05), but the correction loss of PSO group was significantly smaller than that of non-osteotomy group (P lt; 0.05) at last follow-up. At 2 weeks and last follow-up, the Cobb angle of kyphosis, the rate of correction, and correction loss were significantly better in PSO group than in non-osteotomy group (P lt; 0.05). Conclusion There is no signifcant difference in scol iosis correction between PSO and non-osteotomy techniques.PSO can get better corrective effect in kyphosis correction than non-osteotomy technique, but the operation time and blood losswould increase greatly.
Objective To evaluate the effectiveness of lumbopelvic fixation using the combination of closed multi-axial screws (CMAS) iliosacral fixation system and the posterior segmental spinal fixation for unstable sacral fractures. Methods Between January 2013 and November 2014, 25 patients (39 sides) with unstable sacral fractures were treated with lumbopelvic fixation using the combination of CMAS iliosacral fixation system and the posterior segmental spinal fixation. There were 17 males and 8 females, aged 19-55 years (mean, 33.9 years). The causes were traffic accident injury in 15 cases, falling injury from height in 8 cases, and crushing injury in 2 cases. The interval of injury and operation was 1-13 days (mean, 3.5 days). Fracture was classified as Denis type I in 2 sides, type II in 20 sides, and type III in 17 sides; nerve injury was rated as Gibbons grade I in 2 cases, grade II in 2 cases, grade III in 7 cases, and grade IV in 9 cases. The reduction quality was evaluated by Matta criterion, the clinical function outcome by Majeed, and nerve function by Gibbons criterion. Results The average operation time was 110 minutes (range, 80-150 minutes). The average blood loss was 570 mL (range, 250-1 400 mL). Superficial wound infection occurred in 2 patients, and was cured after debridement and antibiotic therapy. All patients were followed up for an average of 18 months (range, 15-22 months). Postoperative X-ray and CT examination showed clinical healing of sacral fractures at 8-12 weeks after operation (mean, 10 weeks). The mean removal time of internal fixation was 13 months (range, 12-20 months). No screw loosening and fracture, adhesion of internal fixation to surrounding tissue, and obvious electrolysis phenomenon occurred. According to Matta criterion, reduction was rated as excellent in 32 sides, good in 6 sides, fair in 1 side, and the excellent and good rate was 97.5%. According to Majeed functional scoring at last follow-up, the mean score was 84.7 (range, 64-98); the results were excellent in 18 cases, good in 5 cases, and fair in 2 cases, and the excellent and good rate was 92.0%. The nerve function was significantly improved when compared with preoperative one; nerve injury was rated as Gibbons grade I in 8 cases, grade II in 8 cases, grade III in 3 cases, and grade IV in 1 case. Conclusion Lumbopelvic fixation using the combination of CMAS iliosacral fixation system and the posterior segmental spinal fixation is a relatively effective fixation for unstable sacral fractures. Not only is the fracture fixation rigid for early full weight-bearing, but also nerve decompression can be performed which facilitates nerve function recovery.
To evaluate the appl ication value of internal fixation of spinal column by posterior approach and extraperitioneal bilateral focal debridement for the treatment of tuberculosis of lumbosacral vertebral body. Methods From March 2000 to February 2005, 16 cases of spinal tuberculosis in L3-S1 were treated with internal fixation of spinal column by posterior approach and extraperitioneal bilateral focal debridement. Sixteen cases included 11 males and 5 females, and the age was 21-56 years. The locations of spinal tuberculosis were L3 in 4 cases, L4 in 6, L5 in 4, and S1 in 2. The course of disease averaged 13 monthes (range 6 monthes to 6 years). The ESR of all cases was greater than 20 mm/h (average40 mm/h); WBC was normal in 14 cases, and a l ittle high in 2 cases. The X-ray picture showed narrow intervertebral space in 5 cases, compressed body of vertebra in 7 cases, and destroyed 2 consecutive vertebra and its sclerotin was condupl icate in 1 case. All cases were abscess in major psoas muscle. The CT showed destruction of bone, abscess-formation and dead bone in body of vertebra of 16 cases. The abscess were found in vertebral canal in 5 cases and dura mater of spinal cord and spinal nerve root crushed in 2 cases. The MRI showed destruction of bone, abscess-formation and hibateral abscess in major psoas muscle in 11 cases. The abscess were found in vertebral canal and dura mater of spinal cord and spinal nerve root crushed in 6 cases. The therapy of pasid was treated after operation in all the cases. Results Incision healed by first intention in 16 cases; and disruption of wound occurred and heal ing was achieved after symptomatic treatment in 1 case. Sixteen cases were followed up 2-5 years (29 months on average). Among all the cases, anaesthesia in double thigh was found in 3 cases, adynamia of dorsiflexion in foot in 1 case, gatism in 1 case; after 2 weeks the symptoms were vanished. Indirect hernia of fold inguen were found in 1 case after 2 years, and the patient refused operation for age and was no longer followed up. Fuzzy, exsic and acerb in eyes were foundin 6 cases, hearing disturbance were found in 2 cases, and symptoms were vanished after medication adjustment. Low-grade fever and lumbar myalgia were found in 1 case and cured after staying in bed and medication adjustment. All ESR were normal, synostosis of lumbosacral vertebral body was found in 13 cases, kyphosis in 1 case. Conclusion Internal fixation of spinal column by posterior approach and extraperitioneal bilateral focal debridement is safe and available way for the treatment of tuberculosis of lumbosacral vertebral body, it can save the times of operation, shorten period and enhance effect of treatment.
目的 觀察比較鹽酸氨基葡萄糖單獨使用及與硫酸軟骨素聯合使用治療腰椎小關節骨關節炎（LFOA） 的臨床療效。 方法 2009年1月－2011年1月，將80例LFOA患者隨機分成兩組，A組口服鹽酸氨基葡萄糖，B組口服鹽酸氨基葡萄糖和硫酸軟骨素兩種藥物，6周為1個療程，間斷治療4個療程。分別比較用藥前與用藥后3、6周及5、8、11個月時的日本骨科協會（JOA）評分、晨僵和壓痛程度變化。 結果 治療后，兩組的JOA評分在各觀察時點均增加，與治療前比較差異有統計學意義（P＜0.05）。組間行JOA評分治療改善率的比較，在各觀察時點差異均有統計學意義（P＜0.05），B組JOA評分改善率優于A組。治療3周后，兩組晨僵和壓痛評分均降低，與本組治療前比較差異有統計學意義（P＜0.05）；組間比較，差異亦有統計學意義（P＜0.05），B組晨僵和壓痛程度均低于A組。第6周，第5、8、11個月，兩組組間比較晨僵和壓痛程度差異均無統計學意義（P＞0.05），但各療程結束后兩組晨僵和壓痛程度均呈持續降低趨勢。 結論 單獨應用鹽酸氨基葡萄糖及鹽酸氨基葡萄糖與硫酸軟骨素的聯合應用治療LFOA療效確切，聯合用藥優于單獨應用鹽酸氨基葡萄糖。
ObjectiveTo compare the biomechanical differences between the kidney-shaped nano-hydroxyapatite/polyamide 66 (n-HA/PA66) Cage and the bullet-shaped n-HA/PA66 Cage. MethodsL2-L5 spinal specimens were selected from 10 adult male pigs. L2, L3 and L4, L5 served as a motor unit respectively, 20 motor units altogether. They were divided into 4 groups (n=5):no treatment was given as control group (group A); nucleus pulposus resection was performed (group B); bullet-shaped Cage (group C), and kidney-shaped Cage (group D) were used in transforaminal lumbar interbody fusion (TLIF) through left intervertebral foramen and supplemented by posterior pedicle screw fixation. The intervertebral height (IH) and the position of Cages were observed on the X-ray films. The range of motion (ROM) was measured. ResultsThere was no significant difference in the preoperative IH among 4 groups (F=0.166, P=0.917). No significant change was found in IH between at pre- and post-operation in group B (P>0.05); it increased after operation in groups C and D, but difference was not statistically significant (P>0.05). There was no significant difference in the postoperative IH among groups B, C, and D (P>0.05). The distance from Cage to the left margin was (3.06±0.51) mm in group C (close to the left) and (5.68±0.69) mm in group D (close to the middle), showing significant difference (t=6.787, P=0.000). The ROM in all directions were significantly lower in groups C and D than in groups A and B (P<0.05), and in group A than in group B (P<0.05). The right bending and compression ROM of group C were significantly higher than those of group D (P<0.05), but no statistically significant difference was found in the other direction ROM (P>0.05). ConclusionThe bullet-shaped and kidney-shaped Cages have similar results in restoring IH and maintaining the stability of the spine assisted by internal fixation. Kidney-shaped Cage is more stable than bullet-shaped Cage in the axial compression and the bending load opposite implant, it can be placed in the middle and back of the vertebral body more ideally.