OBJECTIVE To study the methods and preliminary clinical efficacy of posterior lumbar minimally invasive surgery assisted by 3D-Viewer system under a direct vision and provide rationales for further clinical applications. METHODS From September 2008 to September 2009, a total of 84 lumbar degenerative disease patients were enrolled and randomly divided into 2 groups (n = 42 each). One group was treated operatively by 3D-Viewer system under a direct vision while another treated with conventional operations. The lumbar paraspinal muscle approach was employed. Surgery was assisted by 3D-Viewer system under a direct vision. The operative duration, intra-operative blood loss volume, CK (creatine kinase) levels at Days 1 & 7 post-operation, atrophic rates of cross-sectional areas of bilateral multifidus muscles on MRI (magnetic resonance imaging) at 12 months post-operation were recorded. At Month 12 post-operation, the therapeutic efficacy was evaluated by Oswestry disability index (ODI) and the post-operative clinical effects assessed. RESULTS The operative duration, intra-operative blood loss volume and CK level at Days 1 & 7 post-operation were statistically different (P < 0.05); there was significant difference in the atrophic rates of cross-sectional areas of bilateral multifidus muscles on MRI and the improvement rates of ODI (P < 0.001); the therapeutic efficacy of the invasive group was significantly better than that of the group treated with traditional operations (P < 0.05). CONCLUSION The 3D-Viewer technique reduces the risk of damage. As an ideal minimally invasive procedure, it may achieve satisfactory outcomes for spinal diseases.
Background: Accurate diagnosis of osteoporosis relies on precise measurement of bone mass and assessment of bone micro-architecture. However, the application of Bone Mineral Density (BMD) as the sole criterion of osteoporosis may not reflect all fractions of the bones. In this study, we retrospectively analysed the association between the mean CT value of different bone fractions and ages, and discussed the quantitative diagnosis of osteoporosis.
Methods: The thin-slice Computed Tomography (CT) scans of the lumbar vertebrae of 862 patients were retrospectively reviewed. The patients were divided into the Pathological Fracture (PF) group (n=107) and the Non-Pathological Fracture (NPF) group (n=755). The NPF group was further divided into 7 subgroups with a 10-year-increment. The vertebral bodies were divided into the overall vertebral bodies (Min-Max HU), the cancellous bone (Min-661HU) and the compact bone (662-Max HU) to investigate their mean CT values. The correlation between these parameters and age were analysed. The parameters of the PF group and the NPF subgroups were compared using the ANOVA analysis.
Results: The mean CT values of the overall vertebral bodies (R2, 0.76-0.79) and the cancellous bone (R2, 0.84-0.85) were negatively correlated with patient’s age, while that of the compact bone was only 0.25-0.36. There were significant differences in the mean CT values between PF group and the NPF subgroups (P<0.05).
Conclusion: The mean CT value of the cancellous bone, which reflect the true bone density, correlate well with the age, and might be promising candidates in the quantitative and differential diagnosis of osteoporosis and the bone fracture risk assessment.
Osteosarcoma (OS) patients with metastasis have very dismal prognoses, and lack effective target therapies. Overexpression of cytosolic phospholipase A2 (cPLA2) has been shown to promote progression in several types of cancers, but its functions in OS have not been investigated.In our study, the expression of cPLA2a was detected with immunohistochemistry in 102 cases of OS. The clinical significance of cPLA2a was evaluated by analyzing its correlation with clinicopathological factors. The prognostic significance of cPLA2a was estimated by univariate and multivariate analysis. The oncogenic functions of cPLA2a on cell proliferation and invasion were investigated by MTT assay and tranwell assay respectively. Western blotting was applied to detect the markers of epithelial-mesenchymal transition (EMT) after silencing cPLA2a expression or inhibiting its activity by a specific antagonist.In our study, high expression of cPLA2a was significantly associated with metastasis and advanced Enneking stage. High cPLA2a expression was significantly associated with poor prognosis and it was an independent prognostic biomarker of OS. By silencing cPLA2a or inhibiting its activity by a specific antagonist, we demonstrated that cPLA2a promoted cell invasion of OS cells via inducing the EMT process.High cPLA2a expression was an independent prognostic biomarker of OS, and cPLA2a could promote OS cell invasion via inducing the EMT process, indicating that cPLA2a was an independent prognostic biomarker and may be an effective drug target for OS.
Objective To study surgical methods and clinical efficacy on treatment of lumbar disc herniation by microendoscopic discectomy. Methods A total of 60 patients with the lumbar disc herniation were enrolled in the study.The microscope endoscopic tubular retractor system was used to access the interlaminar space. The nerve root was retracted medially with a nerve root retractor to expose the herniated lumbar disc for performing the discectomy. The dissociative ligament was restored anatomically after disc removal and the decompression of the nerve root. Results The operation was completed smoothly in all the 60 patients, without conversions to open surgery.The operation time was(50±12)min(range,40~80 min).The wound healed by first intention in all the patients. No complications were observed. A follow-up was carried out for 9-16 months(mean,12.8 months).According to the Nakai classification, excellent results were achieved in 38 patients, good in 18 patients, fair in 4 ,and poor in 0, the rate of excellent or good outcomes being 93. 33% . Conclusions The treatment of lumbar disc herniation by microendoscopic discectomy is safe, with little organization damages,simultaneously maintained spinal columns stability. It is an effective way of preventing the scar after the operation of disc herniation, the clinical effect is good.
Key words:
Microendoscopic discectomy; Lumbar disc herniation; Surgery
Criticality pathways and genes related to osteoporosis were identified. We downloaded the expression data of osteoclasts treated with or without bisphosphonates and all human pathways from the public database. Gibbs sampling and Markov chain were performed to identify the disturbed pathways and the hub genes in the disturbed pathways. Pathways and genes with adjusted probability (αadj ) ≥0.75 were considered as the disturbed pathways and hub genes. We identified four disturbed pathways (Maturity onset diabetes of the young, Olfactory transduction, Cyanoamino acid metabolism, Taurine and hypotaurine metabolism) and two hub genes (OR2A4 and NKX2-2) with αadj ≥0.75. The expression levels of these disturbed pathways and hub genes were downregulated in bisphosphonates group. In conclusion, four disturbed pathways and two hub genes related to osteoporosis were identified. These results give us a better understanding of the potential mechanism of bisphosphonate treatment and the pathogenesis of osteoporosis.
The objective is to investigate the biomechanical conditions of the Posterior Vertebral Column Resection (PVCR) of the constructed scoliosis 3D finite element model.A patient with scoliosis was selected; before the PVCR orthopaedy, the patient was submitted to the radiography of normal and lateral full-length vertebral column scans and the total magnetic resonance imaging (MRI) scans; then, the idiopathic scoliosis model was constructed by the 3D finite element method, and the 3D finite element software utilized in the process of model construction included Mimics software, Geomagic Studio 12 software, and Unigraphic 8.0 (UG 8.0) software; in addition, PVCR orthopaedy was utilized to correct the scoliosis of the patient, and the biomechanical parameters, such as orthodontic force, vertebral body displacement, orthopedic rod stress, stress on the pin-bone interface of the vertebral body surface, and the stress on the intervertebral disc, were studied.The 3D effective finite element model of scoliosis was successfully constructed by the Mimics software, the Geomagic Studio 12 software, and the UG 8.0 software, and the effectiveness was tested. PVCR orthopaedy could effectively solve the problem of scoliosis. The magnitude of the orthodontic force that a patient needed depended on the physical conditions and the personal orthodontic requirements of the patient. The maximum vertebral body displacement on the X-axis was the vertebral body L1, the maximum displacement on the Y-axis was the vertebral body T3, the maximum displacement on the Z-axis was the vertebral body T1, and the rang of orthopedic rod stress was 0.0050214e7 MPa to 0.045217e7 MPa, in which the maximum stress of 2 vertebral bodies in, above, and below the osteotomy area reached 0.045217e7 MPa, the stress on the pin-bone interface of the T10 vertebral body surface reached 11.83 MPa, and the stress of T8/T9 intervertebral disc reached 13.84 MPa.The 3D finite element model based on 3D finite element software was highly efficient, and its numerical simulation was accurate, which was important for the subsequent biomechanical analysis of PVCR orthopaedy. In addition, the vertebral stress of PVCR orthopaedy was different in each body part, which was mainly affected by the applied orthodontic force and the sites of the orthodontic area.
In this experimental study, we evaluated the use of digital 3D navigation printing in minimizing complications arising from sacroiliac screw misplacement.A total of 13 adult pelvic specimens were studied using 3D navigation printing. Mimics software was used for preoperative planning and for obtaining sacrum median sagittal resection and long axis resection of the S1 pedicle center by 3D segmentation. The ideal screw path had its origin at the post-median part of the auricular surface of the sacroiliac joint, the midpoint at the mid-position of the lateral recess and outlet of the anterior sacral foramina; and the endpoint at the S1 sagittal resection. A sacroiliac screw fixed the pelvic specimens with the assistance of the navigation module. The distance between the start point (ilium surface) and endpoint (sacral median sagittal resection) of the screw path was measured after the pre- and postoperative 3D pelvis module was 3D-registered according to the standard precision range. The origin/endpoint qualified rates of the postoperative (n/26) and preoperative (26/26) screw paths were analyzed by the chi-square test.No screw misplacement occurred in the screw paths of any of the 13 pelvic specimens. The mean distance between the preoperative and postoperative origin of the screw path was 1.5415±0.6806 mm, and the mean distance between the preoperative and postoperative endpoint was 2.2809±0.4855 mm. The qualified rate of origin was 23/26 when the precision grade was 2.4 mm (P>0.05, χ2=1.41), while the qualified rate of endpoint was 21/26 when the precision grade was 2.7 mm (P>0.05, χ2=3.54).In this experimental study, using a 3D printing navigation module helped attain an accurate and safe sacroiliac screw implantation.
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