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2024 Vol. 30, No. 7
Published: 2024-07-28
 
587 Clinical Efficacy Assessment of Single-Hole Split Endoscopy Integrated with Percutaneous Pedicle Screw Fixation for Multi-Segmental Lumbar Spinal Stenosis Treatment
Hou Dongpo，Huang Weiguo*，Wang Jianguang，Cao Shuai，Ding Yi，Xu Junchuan
Objective〓To retrospectively analyzed the clinical efficacy of one-hole split endoscope (OSE) combined with percutaneous pedicle screw fixation (PPSF) in the treatment of multi-segments lumbar spinal stenosis (MLSS).Methods〓A retrospective cohort study was designed to evaluate the clinical outcomes of 52 patients undergoing surgical interventions for multi-segmental lumbar spinal stenosis (MLSS) at Beijing Civil Aviation General Hospital from January 2021 to March 2023.The OSE fusion Group (n＝30)，comprising patients with preoperative lumbar instability who underwent a combined one-hole split endoscopy (OSE) decompression and percutaneous pedicle screw fixation (PPSF) for fusion；and the OSE decompression Group (n＝22)，consisting of patients without preoperative lumbar instability who underwent OSE decompression alone.Demographic characteristics，including age and gender，were recorded.Comparative analyses were conducted for surgical parameters such as surgical duration，intraoperative blood loss，postoperative hospital stay，wound drainage volume，intraoperative fluoroscopy frequency，and surgical complications.Additionally，preoperative，1-week postoperative，and final follow-up assessments were made using the visual analogue scale (VAS) for lower back and leg pain，and the Oswestry Disability Index (ODI).Imaging parameters，namely lumbar lordosis angle (LLA) and mean disc height (MDH) of the affected segment，were also evaluated.
Results〓All patients completed the follow-up period，with the OSE fusion group having a follow-up duration ranging from 12 to 32 months，averaging at (18.36±9.45) months，and the OSE decompression group being followed up for 12 to 30 months，averaging (17.94±10.23) months.Statistically significant differences (P＜0.05) were observed between the two groups regarding surgical time，intraoperative blood loss，postoperative wound drainage volume，postoperative hospital stay，and intraoperative fluoroscopy frequency.One week postoperatively and at the final follow-up，both groups demonstrated significantly reduced VAS scores and ODI for back and lower limb pain compared to preoperative levels，with these differences being statistically significant (P＜0.05).In the OSE fusion group，the MDH and LLA were significantly higher at 1 week and the last follow-up compared to preoperative values，displaying statistically significant differences (P＜0.05).A total of 3 surgical complications occurred，all within the OSE fusion group.Two patients experienced transient exacerbation of nerve damage symptoms，attributed to intraoperative nerve root involvement.These patients underwent postoperative low-dose hormone therapy，dehydration treatment，nerve nutrition，and intensified rehabilitation exercises，resulting in gradual symptom improvement.Additionally，one patient experienced an intraoperative dural tear，which was immediately repaired during surgery.Postoperatively，the patient was instructed to remain bedridden with the head lower than the feet and a wound drainage tube was placed，leading to subsequent improvement.Conclusion〓The preliminary findings of this study suggest that both OSE decompression alone and the combined approach of OSE fusion with PPSF demonstrate promising clinical outcomes.Notably，the integration of OSE with PPSF effectively mitigates the clinical symptoms in patients with MLSS，showcasing advantages such as minimized intraoperative trauma，reduced blood loss，clear surgical visualization，procedural flexibility，and accelerated postoperative recovery.Hence，it is imperative to meticulously assess the indications and select the appropriate surgical approach tailored to the individual patient’s clinical presentation，signs，and imaging findings，thereby achieving personalized and precise minimally invasive treatment for MLSS.
2024 Vol. 30 (7): 587- [Abstract] ( 126 ) HTML (1 KB)  PDF (3689 KB)  ( 175 )
594  Association of Paravertebral Muscle Density with Vertebral Bone Mineral Density in OVCF Patients
Hou JunJun1，2，Hou Fushan3，CheYanjun4*，Zhang Lianyu4，Chen Qi4，Qian Zongna4，Shen Jiali4，Liu Huaqing5，Si Weibing4，Hao Yuefeng4，Yang Jing1*
Objective〓To investigated the correlation between paravertebral muscle density in the lumbosacral region and vertebral bone mineral density (vBMD) as assessed by site-specific quantitative computed tomography (QCT) in patients suffering from osteoporotic vertebral compression fracture (OVCF).Methods〓This study performed a retrospective analysis of a prospective institutional database (NCT05848167)，enrolling patients with osteoporotic spinal fractures.From January 2021 to December 2022，a total of 167 patients were included，among which 101 patients with OVCF ［(80 females and 21 males，with a mean age of 73(68.00，82.50) years for females and 71(67.00，80.00) years for males)］ possessed available examination data，specifically QCT data.Measurements of the posterior paraspinal muscle (PSM) density and area were undertaken at the superior endplate level of the L3～5 vertebral bodies，employing both manual segmentation and custom-developed software.Furthermore，measurements and calculations of vBMD were executed at the L1～2 level using QCT Pro software.All assessments were analyzed with stratification by sex and age.Results〓The analysis revealed a statistically significant correlation between PSM density and vBMD specifically within the male subject cohort.Upon implementing age and sex-specific stratification，a positive statistical association emerged between L1～2 vBMD and the density of multiple posterior paraspinal muscles，including the L3 left multifidus，L4 left erector spinae，L4 right multifidus，and both the L5 left and right bilateral multifidus muscles.In contrast，no significant correlation was detected in the female subject cohort.Conclusion〓The investigation demonstrated a pronounced positive correlation between multifidus muscle density and vBMD across various lumbar vertebral levels specifically in males.Notably，it underscores the importance of accounting for sexual dimorphism and regional variations when elucidating the intricate relationships between lumbar vertebrae and the posterior paraspinal muscles.
2024 Vol. 30 (7): 594- [Abstract] ( 130 ) HTML (1 KB)  PDF (1505 KB)  ( 79 )
600 Comparative Analysis of Cancellous Bone Mineral Density in Vertebral Bodies and Pedicle Screw Trajectories using Quantitative Computed Tomography
Yu Tongbo，Yu Hanxiao，Yao Rong，Yang Li，Zhu Xue’e
Objective〓The primary objective of this study is to assess the feasibility and accuracy of quantitative computed tomography (QCT) in analyzing the cancellous bone mineral density (BMD) of vertebral bodies and pedicle screw trajectories.Additionally，the study aims to investigate the presence and extent of any significant differences in BMD between these two anatomical regions.Methods〓This retrospective study was conducted under the approval of our institutional review board，with the requirement for informed consent waived due to the non-interventional nature of the analysis.From October 2021 to April 2022，data from 99 consecutive participants ［48 males and 51 females，aged 20 to 80 years，with a mean age of (50.90±15.80)years］ who underwent lumbar QCT examinations at The Affiliated Ben Q Hospital of Nanjing Medical University were analyzed.For each participant，the pedicle screw trajectory (designated as G) was segmented into two parts：The intrapedicular segment (R1) and the intracorporal segment (R2).Using a commercial QCT BMD analysis system，BMD measurements were obtained from the trabecular bone of lumbar vertebrae 2，3，and 4，specifically focusing on R1，R2，and the vertebral body (R3).Statistical analysis was performed using one-way ANOVA to evaluate and compare the differences in BMD among R1，R2，and R3.To further examine the difference between the BMD of the entire pedicle screw trajectory (G) and that of the vertebral body (R3)，a paired t-test was conducted.A statistical significance level of P<0.01 was established for all tests employed in this study.ResultsThe analysis revealed significant differences in BMD between the segments of the pedicle screw trajectory.Specifically，the mean BMD of the intrapedicular segment (R1) was (173.66±71.84)mg/cm3，which was significantly higher than that of the intracorporal segment (R2) at (113.81±48.83)mg/cm3 (P＜0.01).Comparison of the mean BMD between R1 and the vertebral body ［R3，(118.94±47.24)mg/cm3］ also showed a significant difference (P＜0.01)，whereas the difference between R2 and R3 did not reach statistical significance (P＞0.01).Additionally，no significant differences were observed in BMD measurements between left and right sides ［left，(143.14±70.06)mg/cm3；right，(144.33±66.56)mg/cm3；P＞0.01］ or among different lumbar levels ［L2，(141.25±50.32)mg/cm3；L3，(138.31±56.85)mg/cm3；L4，(151.64±58.62)mg/cm3；P＞0.01］.Similarly，the average BMD of R3 did not significantly vary among lumbar levels 2，3，and 4 ［L2，(124.28±47.04)mg/cm3；L3，(115.36±46.34)mg/cm3；L4，(117.19±48.33)mg/cm3；P＞0.01］.Notably，the global BMD of the pedicle screw trajectory ［G，(143.73±55.49)mg/cm3］ was significantly higher than that of the vertebral body(R3) (P＜0.01).ConclusionQuantitative computed tomography (QCT) provides a reliable method for assessing bone mineral density (BMD) in both vertebral bodies and pedicle screw trajectories.Our findings demonstrate that the BMD of the global pedicle screw trajectory is significantly higher than that of the corresponding segmental vertebral body，highlighting the importance of considering these differences in pre-operative planning and assessment of bone quality for spinal fixation procedures.
2024 Vol. 30 (7): 600- [Abstract] ( 118 ) HTML (1 KB)  PDF (1756 KB)  ( 57 )
604 Evaluation of the Efficacy of 3D-Printed Hemipelvic Prosthesis Replacement Surgery in the Treatment of Enneking Stage Ⅱ+Ⅲ Malignant Pelvic Tumors
Zhang Qiang，Du Junwei，Wu Junshen，Jiang Renbing
Objective〓To assess the therapeutic efficacy of 3D-printed hemipelvic endoprosthesis replacement in managing Enneking stage Ⅱ+Ⅲ pelvic malignant tumors and evaluate the safety and functional outcomes associated with preserving the anterior inferior iliac spine during the surgical procedure.Methods〓This retrospective study encompassed a cohort of 25 patients diagnosed with Enneking stage Ⅱ+Ⅲ pelvic malignant tumors who underwent 3D-printed hemipelvic endoprosthetic replacement surgery at our institution from January 2018 to January 2020.The patient demographics included 11 males and 14 females，with ages ranging from 17 to 77 years，yielding a mean age of (49.96±9.73)years.The tumor histologies comprised 11 cases of conventional osteosarcoma，6 of chondrosarcoma，3 of telangiectatic osteosarcoma，3 of Ewing’s sarcoma，1 case of metastatic paraganglioma originating from the lumbar spine，and 1 case of metastatic renal clear cell carcinoma.Based on the surgical approach adopted，patients were categorized into two groups：a study group (10 patients) where the anterior inferior iliac spine was preserved during surgery，and a control group (15 patients) where it was not retained.Intraoperative metrics，such as surgical duration and blood loss，were recorded for both groups.Prosthetic acetabular rotation center displacement was evaluated using imaging techniques.Postoperative assessments were performed utilizing the musculoskeletal tumor society(MSTS) score，Harris hip function score，and hospital for special surgery(HSS) knee function score.Furthermore，oncological outcomes，including recurrence rates and survival data，were analyzed.Complications encountered during and after surgery were also documented and analyzed.Results〓The follow-up period for all patients ranged from 16 to 27 months，averaging at (21.92±3.40)months.Analysis revealed no statistically significant differences in surgical duration or intraoperative blood loss between the study group (with preserved anterior inferior iliac spine) and the control group (without preservation) (P＞0.05).However，at both postoperative and final follow-up assessments，the study group demonstrated significantly higher MSTS functional scores，Harris hip scores，and HSS knee scores compared to the control group，with statistically significant differences observed (P＜0.05).Notably，the comparison of acetabular prosthetic rotation center offset between the two groups at the last follow-up did not yield statistically significant differences (P＞0.05).Postoperative complications included 3 cases of surgical site infections and 2 instances of fat liquefaction necrosis around the incision site，all of which resolved with appropriate treatment.During the last follow-up，one patient with pelvic metastatic tumor was diagnosed with liver metastasis one year after surgery.This patient was managed with targeted therapy and remained alive with the tumor under control.No instances of tumor recurrence or metastasis were observed in the remaining patients.Conclusion〓Our study concludes that 3D-printed hemipelvic prosthesis surgery represents a safe and effective therapeutic approach for managing Enneking stage Ⅱ+Ⅲ pelvic malignant tumors.Furthermore，the preservation of the anterior inferior iliac spine and associated muscle attachment points during surgery is pivotal in facilitating optimal functional recovery of the hip and knee joints，as evidenced by the superior functional outcomes observed in the study group.This surgical technique offers a promising option for improving both oncological outcomes and quality of life for patients with complex pelvic malignancies.
2024 Vol. 30 (7): 604- [Abstract] ( 114 ) HTML (1 KB)  PDF (5366 KB)  ( 112 )
611 Comparison of the Efficacy of Two Internal Fixation Methods in the Treatment of Unstable Femoral Neck Fracture in Young and Middle-Aged Patients
Wang Qiufei1，Tao Huaqiang2*，Gu Ye1*，Peng Yuqin1，Ju Rong1，Huang Mengna1，Zhu Zhihong1，Zhu Feng2，Wang Yijun2，Geng Dechun2，Xu Yaozeng2
Objective〓To compare the short and medium term efficacy and prognosis of femoral neck dynamic cross napping system and multiple hollow compression screws in the treatment of young and middle-aged unstable femoral neck fractures.
Methods〓A retrospective analysis was conducted on data from 112 patients who sustained femoral neck fractures and met the inclusion criteria between October 2020 and October 2023.The patients were divided into two treatment groups based on the surgical approach：femoral neck system (FNS) and multiple cannulated screws (MCS).The FNS group comprised 55 patients，including 21 males and 34 females，with a mean age of (56.05±7.53)years (ranging from 33 to 65 years).The MCS group included 57 patients，comprising 24 males and 33 females，with a mean age of (55.04±8.32)years (ranging from 29 to 65 years).Initially，baseline characteristics of both groups were compared.Subsequently，perioperative indicators，such as surgical incision length，operative time，intraoperative blood loss，fluoroscopy time，and the need for assisted reduction，were analyzed to identify differences in surgical data between the FNS and MCS groups.Additionally，follow-up outcomes，including hospital stay，time to weight-bearing，Harris hip scores，visual analogue scale (VAS) pain scores，and postoperative complications，were evaluated.Finally，changes in femoral neck shortening at 3 and 6 months post-surgery were assessed to determine the effectiveness of each treatment modality.Statistical comparisons were made to evaluate the differences in outcomes between the FNS and MCS groups.
Results〓Among the 112 patients，111 patients completed follow-up for a period ranging from 24 to 144 weeks.The mean follow-up time was (74.17±36.76)weeks in the FNS group and (77.75±32.49)weeks in the MCS group.Comparative analysis revealed that the fracture healing time in the FNS group (13.20±2.13)weeks was significantly shorter than that in the MCS group (15.39±4.42)weeks (P＜0.05).Similarly，the complete weight-bearing time in the FNS group (11.76±4.22)weeks was earlier than that in the MCS group (19.39±4.42)weeks (P＜0.05).Furthermore，the femoral neck shortening length and hip function scores，as assessed by the Harris hip score，were significantly better in the FNS group compared to the MCS group (P＜0.05).In terms of postoperative complications，the FNS group exhibited a lower rate of internal fixation failure (1.82%)，although this difference did not reach statistical significance when compared to the MCS group.Notably，no statistically significant differences were observed between the two groups in terms of other perioperative parameters，postoperative outcomes，or the overall incidence of complications (P＞0.05).Conclusion〓When compared to the conventional MCS technique，the FNS technique offers several advantages in the treatment of unstable femoral neck fractures in middle-aged and young adults.Specifically，it embodies the technical merits of minimally invasive surgery，providing both better static stability and a dynamic compression effect.These attributes enable patients to commence early weight-bearing and rehabilitation exercises，thereby potentially reducing the incidence of postoperative complications.
2024 Vol. 30 (7): 611- [Abstract] ( 115 ) HTML (1 KB)  PDF (2108 KB)  ( 96 )
617 Morphological Analysis of Sagittal Viewing of Complete Discoid Meniscus Based on Magnetic Resonance Imaging
Dai Zhu，Chen Yuxi*，Wu He，Liao Ying，Wu Biao，Huang Wen，Ming Yu
Objective〓The primary objective of this study is to delineate the morphological disparities between complete lateral discoid meniscus (CDLM) and the standard lateral meniscus on sagittal magnetic resonance imaging (MRI) views.Additionally，the study aims to elucidate the underlying mechanisms leading to CDLM rupture by comparing anatomical features among ruptured，unruptured CDLM，and normal lateral meniscus cases.Methods〓A retrospective analysis was conducted on the records of patients who underwent knee arthroscopic meniscus surgery at The First Affiliated Hospital of University of South China from January 2017 to December 2020.A total of 99 knees from 95 patients (36 males with 38 knees and 59 females with 61 knees) fulfilling the inclusion criteria were included in the study.The patient age range was 18~55 years，with a mean age of (45.63±6.81)years.These knees were classified into three groups：30 knees (from 29 patients) with ruptured CDLM (Group A)，16 knees (from 16 patients) with unruptured CDLM (Group B)，and 53 knees (from 51 patients) with normal lateral meniscus (Group C).MRI scans were utilized to measure two key parameters：The anteroposterior diameter (APD) of the meniscus and the proximal anteroposterior tibia diameter (TD).The intraclass correlation coefficient (ICC) was employed to assess inter-observer reliability，and the average of two measurements was recorded for analysis.Statistical comparisons were performed among the three groups for APD，TD，and the ratio of APD to TD (APD/TD)，with the intention of identifying significant differences that might elucidate the mechanisms behind CDLM rupture.Results〓The inter-observer reliability for measuring the APD and proximal anteroposterior TD was high，with ICC values of 0.782 and 0.972 respectively.Comparing the three groups，there was no statistically significant difference in APD between ruptured (Group A) and unruptured CDLM (Group B) (P＞0.05).However，both Group A and Group B had significantly smaller APDs compared to the normal lateral meniscus group (Group C) (P＜0.05).Similarly，TD did not differ significantly between Group A and Group B (P＞0.05)，but Group A had a lower TD than Group C (P＜0.05).Notably，the APD/TD ratio was significantly higher in Group A compared to Group B (P＜0.05)，indicating an increase in relative APD post-rupture，while Group B had a significantly lower APD/TD ratio compared to Group C (P＜0.05).Conclusion〓The study demonstrates that complete lateral discoid meniscus (CDLM) exhibits smaller anteroposterior (APD) and proximal tibial (TD) dimensions compared to normal lateral meniscus.Furthermore，CDLM rupture is associated with an increase in the relative APD (APD/TD ratio)，suggesting morphological alterations that may contribute to its susceptibility to rupture.
2024 Vol. 30 (7): 617- [Abstract] ( 106 ) HTML (1 KB)  PDF (1745 KB)  ( 50 )
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