Objective To investigating the safety and accuracy of artificial intelligence (AI) assisted automatic planning of pedicle screws parallel to sagittal plane for C1. Methods The subjects who completed cervical CT scan in Zigong Fourth People’s Hospital btween January 2020 and December 2023 were selected. The subjects who completed cervical CT scan were randomly divided into two groups using a random number table method. Among them, 80% were used as the training model (training group), and 20% were used as the validation model (validation group). The original cervical CT data of the training group were imported into ITK-SNAP software to mark the feature points. Four feature points were selected. In order to obtain the weighted function model of the four feature points, training group were trained with the spatial key point location algorithm. pedicle trajectory based on the four key points obtained. Finally, the algorithm was compiled to form a visual interface, and imported into the verification group of annular vertebral CT data to calculate the pedicle screw trajectory. Results A total of 500 patients were included. Among them, there were 400 cases in the training group and 100 cases in the validation group. The average positioning error of spatial key points is (0.47±0.16) mm. The average distance between the planned pedicle screw center line and the internal edge of the pedicle was (2.86±0.12) mm. Pedicle screw placement parallel to the sagittal plane and 3D display can be safely performed for the C1 pedicle that is large enough to accommodate a 3.5 mm diameter screw without cortical breakthrough. Conclusions For pedicle screw planning parallel to the sagittal plane in C1, training based on the spatial positioning algorithm of anterior and posterior tubercles and bilateral tangential points can obtain a safe and accurate pedicle screw trajectory. It provides theoretical basis for orthopedic robot automatic screw placement. For vertebral bodies with narrow or deformed pedicles, further expansion of the training data is needed to expand the adaptive range and improve the accuracy of the algorithm.
Objective To explore the feasibilities, methods, outcomes and indications of atlas pedicle screw system fixation and fusion for the treatment of upper cervical diseases. Methods From October 2004 to January 2006, 17 patients with upper cervical diseases were treated with atlas pedicle screw system fixation and fusion. There were 13 males and 4 females, ageing 19 to 52 years. Of 17 cases, there were 14 cases of atlantoaxial dislocation(including 3 cases of congenital odontoid disconnection，4 cases of old odontoid fracture，2 cases of new odontoid fracture(typeⅡC), 3 cases of rupture of the transverse ligament, and 2 cases of atlas fracture； 2 cases of tumor of C2; 1case of giant neurilemoma of C2,3 with instability after the resection oftumors. JOA score before operation was 8.3±3.0. Results The mean operative time and bleeding amount were 2.7 hours (2.1-3.4 hours) and 490 ml (300-750 ml) respectively. No injuries to the vertebral artery and spinal cord were observed. The medial-superior cortex of lateral mass was penetrated by 1 C1 screw approximately 3 mmwithout affecting occipito-atlantal motions. All patients were followed up 3-18 months. The clinical symptoms were improved in some extents and the screws were verified to be in a proper position, no breakage or loosening of screw and rob occurred. All patients achieved a solid bone fusion after 3-6 months. JOA score 3 months after operation was14.6±2.2. JOA improvement rates were 73%-91%(mean 82%). Conclusion The atlas pedicle screw system fixation and fusion is feasible for the treatment of upper cervical diseases and has betteroutcomes, wider indications if conducted properly.
ObjectiveTo investigate reliability and short-term effectiveness of axis laminar screws for reducible atlantoaxial dislocation (RAAD).MethodsA clinical data of 41 patients with RAAD who were admitted between February 2013 and February 2018 and met the inclusion criteria was retrospectively analyzed. The atlases in all patients were fixated by lateral mass screws, and the axes were fixed by laminar screws in 13 cases (LS group) and by pedicle screws in 28 cases (PS group). There was no significant difference in gender, age, and preoperative Japanese Orthopedic Association (JOA) score between the two groups (P>0.05). The effectiveness was estimated by post-operative JOA score; and the accuracy of the axis screw, atlantoaxial bone graft fusion, and the fixation stability were examined by X-ray film and CT.ResultsAll incisions healed by first intention. All patients were followed up 12-17 months (mean, 13.8 months) in LS group and 12-20 months (mean 14.1 months) in PS group, and the difference in follow-up time was not significant (Z=−0.704, P=0.482). At last follow-up, JOA scores were 13.9±1.6 in LS group and 14.3±1.8 in PS group, which significantly improved when compared with the pre-operative scores in the two groups (t=−9.033, P=0.000; t=−15.835, P=0.000); while no significant difference was found between the two groups (t=−0.630, P=0.532). Twenty-five screws of 26 screws in LS group and 54 screws of 56 screws in PS group were implanted accurately, with no significant difference in the accuracy of the axis screw between the two groups (Z=−0.061, P=0.951). All patients obtained atlantoaxial bone graft fusion, except 1 case in PS group. There was no significant difference in the atlantoaxial bone graft fusion between the two groups (Z=−0.681, P=0.496).ConclusionFor RAAD, Axis laminar screws can maintain the atlantoaxial primary stability and had a good short-term effectiveness. So, it could be an alternative and reliable technique for axis screw.
【Abstract】 Objective To evaluate the effectiveness of percutaneous fixation of pelvic fracture by Acutrak full thread headless hollow compression screw. Methods Between March 2008 and April 2010, 31 patients with pelvic fracture underwent percutaneous fixation surgery with Acutrak full thread headless hollow compression screw (surgical group). The effectivenss was compared with those of 14 patients with pelvic fracture treated conservatively (control group). There was no significant difference in age and sex between 2 groups (P gt; 0.05). The injury was more severe in surgical group than in control group. The standard of short-term recovery was active turning over and walking for 5 steps with walking aids. The standard of long-term recovery was pain, gait, fracture healing, and function recovery. Results In surgical group, the other patients reached the standard of short-term recovery at 1-4 days after injury except 1 patient who had sacral plexus injury; in control group, the patients could turn over at 9-13 days (Tile type A2) and 17-25 days (Tile type B2) respectively, and could walk at 17-21 days (Tile type A2) and at 45-57 days (Tile type B2) respectively. The patients of 2 groups were followed up 6-19 months. The time of fracture healing was 2-6 months. The long-term results were excellent in 29 cases and good in 2 cases in surgical group, and were excellent in 8 cases and good in 6 cases in control group, showing significant difference between 2 groups (χ2=6.636, P=0.017).Conclusion Percutaneous internal fixation combined with Acutrak full thread headless hollow compression screw can provide more effective treatment. It can alleviate patients, pain quickly, improve life quality, and has better long-term effectiveness.
To analyze the effectiveness of posterior pedicle screw system combined with interbodyfusion in treating lumbar spondylol isthesis. Methods Between January 2005 and January 2009, 26 patients with lumbar spondylol isthesis underwent posterior pedicle screw system combined with interbody fusion, including 11 males and 15 females with an average age of 56.8 years (range, 36-73 years). The disease duration was 7 months to 11 years. The affected lumbars were L3 in 3 cases, L4 in 12 cases, and L5 in 11 cases. According to the Meyerding evaluating system, 21 cases were classified as degree III, 5 cases as degree III-IV, and 1 case as degree IV. The cl inical results were investigated by measuring radiographic measurements, including Taillard index, Boxall index, sl i pping angle, lumbar lordosis angle,and intervertebral height index preoperatively, immediately, 2 weeks and 3 months postoperatively, respectively. SUK’s criteria was used to judge bone graft fusion. Results Primary heal ing of the incisions was achieved in all cases. Allpatients were followed up 25.8 months on average (range, 10-51 months). There were significant differences in Taillardindex, Boxall index, sl i pping angle, lumbar lordosis angle, and intervertebral height index between preoperatively andimmediately, 2 weeks, 3 months after operation (P lt; 0.05). Bone graft fusion was achieved at 3-8 months after operation(mean, 3.5 months); and the fusion rate was 100%. According to Japanese Orthopedic Association (JOA) scoring, theresults were excellent in 17 cases, good in 7 cases, fair in 1 case, and poor in 1 case; and the excellent and good rate was 92.3%. Compl ications occurred in 2 cases, including nail or rod breakage and nerve injury, and they were cured aftertreatment. Conclusion Posterior pedicle screw system combined with interbody fusion treating lumbar vertebralspondylol isthesis can afford sol id internal fixation and achieve a satisfactory reduction, so it maybe an ideal procedure and a worthy recommended method for treating lumbar spondylol isthesis.
Objective To explore some operative problems of correcting paralytic scoliosis(PS) by using vertebral pedicle screwsrods system. Methods From May 2000 to May 2005, 18 patients with PS were corrected by screwsrods system which were made of titanium alloy.There were 10 males and 8 females, aging from 11 to 26 years. The primary disease included poliomyelitis in 13 patients and myelodysplasia (MS) in 5 patients (2 cases for second correction) with scoliosis of an average 85° Cobb angle (55-125°). The pelvic obliquity was found in all patients with an average 24° angle (355°).Of the 18 patients,3 cases were given perioperative halo-pelvic traction, 2 cases were given vertebral wedge osteotomy and correction and fixation, the other patients were purely underwent the treatment of pedicle screwrods system implants. Fusion segment at operation ranged from 6 to 15 sections, applied screws the most was 16,the fewest was 6. Results There were no wound infections and neurologic complications, all wounds healed by the first intention. Allscoliosis obtained obvious correction (P＜0.001), the correction rate averaged 52.95% (44%-81%); the majority of lumbar kyphosis and pelvic obliquity were apparently corrected. The average clinical follow-up (16 cases) was 21 months(6-36 months),there was no implants failure. One patient with MS had a worse Cobb magnitude, the other patients had no curve progression (P＞0.05). Conclusion The use of vertebral pedicle screwsrods fixation to multiple vertebral bodys and short segment fusion for PS, the treatment method is reliable and the outcome is satisfactory. While performing the correcting operative procedures, the spinal, pelvic and lower extremity deformities and functions should be all considered as a whole.
Objective To investigate the effectiveness of compression screw combined with Buttress plate through direct axillary approach for Ideberg typeⅡ scapular glenoid fractures. MethodsA retrospective analysis was conducted on 11 patients with Ideberg type Ⅱ scapular glenoid fractures treated with compression screws combined with Buttress plate fixation through the direct axillary approach between January 2014 and June 2022. There were 7 males and 4 females, aged from 34 to 75 years, with an average of 56.0 years. The causes of injury included 4 cases of falling from height injury, 4 cases of heavy object injury, and 3 cases of traffic accident injury. The time from injury to operation was 2-5 days, with an average of 3.8 days. The operation time, intraoperative blood loss, hospital stay, complications, and fracture healing time were recorded. The Constant-Murley score, American Society of Shoulder and Elbow Surgeons (ASES) score, and shoulder joint flexion, abduction, external rotation (neutral position), and internal rotation (neutral position) range of motion were used to evaluate shoulder joint pain and function. ResultsThe operation time was 45-105 minutes, with an average of 79.0 minutes; the intraoperative blood loss was 80-200 mL, with an average of 99.2 mL; the hospital stay was 3-8 days, with an average of 5.8 days. One patient had poor wound healing after operation, and the wound healed after strengthening dressing change; the rest wounds had primary healing, and no axillary nerve paralysis occurred. Except for 1 patient lost follow-up, the remaining 10 patients were followed up 10-54 months, with an average of 26.4 months. The postoperative X-ray film examination showed that the fractures healed well within 8-15 weeks, with an average of 11.0 weeks. There was no complication such as fracture displacement, internal fixator failure or fracture during follow-up. At last follow-up, the patient’s shoulder joint flexion, abduction, external rotation (neutral position), and internal rotation (neutral position) range of motion, Constant-Murley score, and ASES score significantly improved when compared with those before operation (P<0.05). ConclusionCompression screw combined with Buttress plate through direct axillary approach is an effective way to treat Ideberg typeⅡ scapular glenoid fracture, with advantages of small trauma, concealed incision, and good effectiveness.
Objective To analyze the therapeutic effect of the posterior pedicle screw system combined with interbody fusion cage on lumbarspondylolisthesis. Methods From February 2003 to March 2006, 37 lumbar spondylolisthesis patients were treated with this operation, including21 males and 16 females and aging 3969 years.The affected lumbars were L3(3cases)，L4(23 cases), and L5(11 cases). According to the Meyerdingevaluating system, 12 cases were lassified as degree Ⅰ, 20 cases as degree Ⅱ,and 5 cases as degree Ⅲ. Taillard index, Boxall index, slipping angle, lumbar lordosis angle and intervertebral height index were measured before operation, and 2 weeks and 3 months after operation. Results All patients were followed up 336 months. There were statistically significant differences in Taillard index, Boxall index, slipping angle, lumbar lordosis angle and intervertebral height index between before operation and 2 weeks after operation (P＜0.05),and no statistically significant differences between 2 weeks and 3 months afteroperation(P＞0.05). According to Dewei Zhou’s creterior for scoring, the results were excellent in 27 cases， good in 8 cases，and fair in 2 cases. Theexcellent and good rate was 94.6%. All of the embedded osseous were fused. Thefusing time was from 3 to 8 months (mean 3-9 months). There were no breakageof screw and rod. The position and configuration of the whole cages were good. Conclusion Applying the posterior pedicle screw system combined with interbody fusion cage may achieve synergism in the treatment of lumbar vertebral spondylolisthesis. Above procedure is served as solid internal fixationand offers a satisfactory reduction, and can improve the fusion rate of the spine. So it is an ideal procedure and worthily recommended method for treatment oflumbar vertebral spondylolisthesis.
Objective To explore the effectiveness of the percutaneous parallel screw fixation via the posterolateral “safe zone” for Hawkins type Ⅰ-Ⅲ talar neck fractures. Methods A retrospective analysis was conducted on the clinical data from 35 patients who met the selection criteria of talar neck fractures between January 2019 and June 2021. According to the surgical method, they were divided into a study group (14 cases, using percutaneous posterolateral “safe zone” parallel screw fixation) and a control group (21 cases, using traditional open reduction and anterior cross screw internal fixation). There was no significant difference in gender, age, affected side, Hawkins classification, and time from injury to operation between the two groups (P>0.05). The operation time, bone healing time, complications, and Hawkins sign were recorded, and the improvement of pain and ankle-foot function were evaluated by visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score at last follow-up. The overall quality of life was assessed by the short form of 12-item health survey (SF-12), which was divided into physical and psychological scores; and the satisfaction of patients was evaluated by the 5-point Likert scale. Results The operation time in the study group was significantly shorter than that in the control group (P<0.05). All patients werefollowed up 13-35 months, with an average of 20.6 months; there was no significant difference in the follow-up time between the two groups (P>0.05). The time of bone healing in the study group was shorter than that in the control group, and the positive rate of Hawkins sign (83.33%) was higher than that in the control group (33.33%), and the differences were significant (P<0.05). In the control group, there were 2 cases of incision delayed healing, 7 cases of avascular necrosis of bone, 3 cases of joint degeneration, 1 case of bone nonunion, and 3 cases of internal fixation irritation; while in the study group, there were only 2 cases of joint degeneration, and there was a significant difference in the incidence of complications between the two groups (P<0.05). At last follow-up, there was no significant difference in VAS score between the two groups (P>0.05), but the SF-12 physical and psychological scores, AOFAS ankle and hindfoot scores, and patients’ satisfaction in the study group were significantly better than those in the control group (P<0.05). ConclusionThe treatment of Hawkins type Ⅰ-Ⅲ talar neck fractures with percutaneous parallel screw fixation via the posterolateral “safe zone” can achieve better effectiveness than traditional open surgery, with the advantages of less trauma, fewer complications, faster recovery, and higher patient satisfaction.
Objective To study the application and the curative effect of compressed screw and sartorius bone flap in treating femoral neck fractures in youth or middle age. Methods From February 1996 to December 2004, 86 patients with femoral neck fracture were treated by open reduction compressed screw and sartorius bone flap, aging from 21 to 49 years. Fracture was caused by traffic accident in 35 cases, fall from height in 27 cases and fall in 24 cases. Accoding to Garden classification, 23 cases were type Ⅱ, 25 cases were type Ⅲ, and 15 cases were type Ⅳ. We analyzed fracture healing and evaluate function by observation of the postoperative X-ray films. Results Of the 86 patients, 62 were followed up 6 months to 7 years (2 years and 5 months on average). According to Weijie’s criterion for nonunion and necrosis offemoral head, nonunion occurred in 4 cases; the healing rate of fracture was 93.5%. In healed patients, necrosis of femoral head occurred in 7 cases (11.3%) after 3 years. The results of hip joint function evaluation were excellent in 44 cases, good in 8 cases, fair in 6 cases and poor in 4 cases; and the excellent and good rate was 83.9%. Conclusion Compressed screw and sartorius bone flap was simple and effective for femoral neck fractures in youth or middle age.