Outcomes of cervical degenerative disc disease treated by anterior cervical discectomy and fusion with self-locking fusion cage

BACKGROUND Cervical degenerative disc(CDD)disease is a common type of spondylosis.Although anterior cervical discectomy and fusion(ACDF)is the preferred treatment for CDD disease,internal fixation with a titanium plate may cause various complications.The invention of the ACDF with a self-locking fusion cage(ROI-C)has effectively decreased the incidence of postoperative complications.AIM To observe the outcomes of CDD disease treated by ACDF with a ROI-C.METHODS Ninety patients with CDD disease treated at our hospital from March 2019 to March 2021 were included.They were divided into two groups(control group and observation group,n=45 in each)using a random number table.Patients in the control group received ACDF plus internal fixation with a titanium plate.Those in the observation group received ACDF+ROI-C placement.The two groups of patients were compared in terms of surgical parameters,pain,cervical spine function,range of motion,and complications.RESULTS The two groups of patients showed no significant differences in surgical time,blood loss,drainage volume,and length of hospital stay(P>0.05).No significant differences in the visual analogue scale(VAS),Japanese Orthopedic Association(JOA),and neck disability index(NDI)scores were observed between the two groups before surgery(P>0.05).The VAS and NDI scores in the observation group were considerably lower than those in the control group after surgery;however,the JOA scores in the observation group were significantly higher than those in the control group(P<0.05).No significant differences were observed in cervical disc height and the range of motion of the superior or inferior adjacent vertebrae between the two groups before surgery(P>0.05).The disc height in the observation group was larger than that in the control group after surgery.The range of motion of both the superior and inferior adjacent vertebrae was significantly smaller in the observation group than in the control group(P<0.05).The incidence of complications was only 2.22% in the observation group compared to 15.56% in the control group,and the difference was statistically significant(P<0.05).CONCLUSION Cervical spine function restoration was better with ROI-C with internal fixation in ACDF than with conventional titanium plates in ACDF for CDD disease.

A 3D shell-like approach using element-free Galerkin method for analysis of thin and thick plate structures

A new efficient meshless method based on the element-free Galerkin method is proposed to analyze the static deformation of thin and thick plate structures in this paper. Using the new 3D shell-like kinematics in analogy to the solid-shell concept of the finite element method, discretization is carried out by the nodes located on the upper and lower surfaces of the structures. The approximation of all unknown field variables is carried out by using the moving least squares （MLS） approximation scheme in the in-plane directions, while the linear interpolation is applied through the thickness direction. Thus, different boundary conditions are defined only using displacements and penalty method is used to enforce the essential boundary conditions. The constrained Galerkin weak form, which incorporates only dis- placement degrees of freedom （d.o.f.s）, is derived. A modified 3D constitutive relationship is adopted in order to avoid or eliminate some self-locking effects. The numeric efficiency of the proposed meshless formulation is illustrated by the numeric examples.

A novel anatomical self-locking plate fixation for both-column acetabular fractures

Purpose:To compare the stability of the posterior anatomic self-locking plate(PASP)with two types of popular reconstruction plate fixation,i.e.double reconstruction plate(DRP)and cross reconstruction plate(CRP),and to explore the influence of sitting and turning right/left on implants.Methods:PASP,DRP and CRP were assembled on a finite element model of both-column fractures of the left acetabulum.A load of 600 N and a torque of 8 N·m were loaded on the S1 vertebral body to detect the change of stress and displacement when sitting and turning right/left.Results:The peak stress and displacement of the three kinds of fixation methods under all loading conditions were CRP>DRP>PASP.The peak stress and displacement of PASP are 313.5 MPa and 1.15 mm respectively when turning right;and the minimal was 234.0 Mpa and 0.619 mm when turning left.Conclusion:PASP can provide higher stability than DRP and CRP for both-column acetabular fractures.The rational movement after posterior DRP and PASP fixation for acetabular fracture is to turn to the ipsilateral side,which can avoid implant failure.

多向自锁钛板内固定一期前路治疗腰骶段结核的临床研究

目的探讨采用自主研发的多向自锁钛板内固定行一期前路病灶清除、植骨融合术治疗腰骶段结核的安全性和有效性。方法 2010-2015年我科采用一期前路病灶清除、植骨融合与多向自锁钛板内固定术治疗腰骶段结核共35例。术前常规支持及抗结核治疗,采用CT血管造影技术评估髂血管走行与腰骶段结核病灶的关系及骨质破坏情况。术中采用多向自锁钛板选择骨质结构相对完整的区域进行固定。术后定期随访,评估结核活动、植骨融合、矫形维持、神经功能恢复及并发症等情况。结果 35例患者均获随访,随访时间18~36(26.06±6.16)个月。手术时间(148.57±17.68)min,术中失血量(257.14±29.66)m L。术中无大血管、神经及输尿管损伤。术后腰腿痛症状均获明显缓解,无结核复发、下肢深静脉血栓、逆行射精及勃起功能障碍等并发症,术后12个月椎间植骨均达Ⅰ级骨愈合。术前、末次随访红细胞沉降率分别为(32.14±9.87)、(5.34±2.30)mm/h,术前、末次随访C反应蛋白分别为(23.66±9.98)、(1.26±0.55)mg/L,术前、末次随访平均VAS评分分别为(4.80±1.02)、(0.83±0.71)分,术前、末次随访平均ODI评分分别为(27.47±6.79)%、(4.31±1.49)%,术前、术后及末次随访平均腰骶角分别为(23.09±3.21)°、(29.21±1.16)°和(26.71±1.57)°。结论一期前路结核病灶清除、植骨融合与多向自锁钛板内固定术治疗腰骶段结核安全且有效,多向自锁钛板是适合腰骶段结核前路手术的有效内固定装置。

桡骨远端掌侧钢板螺钉固定方向对关节面稳定性的影响

目的桡骨远端锁定钢板是桡骨远端经关节面骨折公认有效的治疗方法,但随着万向螺钉的出现,远端螺钉置入方向与其所能提供的支撑效果之间的关系缺少足够重视,本研究旨在探讨远端螺钉置入方向对腕关节功能的影响。方法本研究采用临床随机对照试验方式,纳入100例C型桡骨远端骨折随机分为A组和B组,每组各50例。采用SF-36评分、PRWE评分、DASH评分作为评价指标。A组垂直桡骨干方向排布桡骨远端锁定螺钉,B组按照掌倾角方向平行关节面置入远端螺钉。随访时间为术后2周、3个月、12个月。3次重复测量减少偏倚。计数资料采用personχ2分析检验,方差齐的计量资料组采用两组独立样本t检验,方差不齐的采用u检验,α值取双尾0.05。结果 100例均按照试验设计进行手术,术前组间一般情况差异无统计学意义。术后并发症组间差异无统计学意义。术后2周、3个月、12个月SF-36评分、DASH评分、PRWE评分差异没有统计学意义。对14例严重骨质疏松出现腕关节解剖角度异常患者进行亚组分析,术后12个月的SF-36评分A组为(36.4±12.8)分、B组为(56.4±20.0)分,差异有统计学意义;术后3个月、12个月的DASH评分组间差异有统计学意义;术后3个月、12个月的PRWE评分差异有统计学意义。结论掌侧万向锁定钢板治疗C型桡骨远端骨折,能提高手术自由度,疗效确切,螺钉锁定的方向影响支撑强度。腕关节对线畸形与关节功能不相关,但合并严重骨质疏松者即使术中解剖复位,关节面再塌陷概率依然较高,建议尽可能平行关节面竹排样支撑置入远端螺钉,以便获得更好的腕关节功能。

MiPPo与多向髓内钉技术在胫骨远端骨折中的对比研究

目的:研究胫骨远端骨折患者分别接受经皮微创胫骨钢板固定(MIPPO)与多向髓内钉技术(TTMLIIN)的临床治疗效果。方法:2019年2月-2020年1月收治胫骨远端骨折患者124例,随机分为两组,各62例。对照组接受MIPPO治疗,观察组接受TTMLIIN治疗。比较两组术后治疗效果和并发症情况。结果:观察组手术时间短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);观察组术后并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:两种不同的治疗方案均能取得理想治疗效果,但TTMLIIN应用后,发生的并发症较少。

基于弹性薄板理论的矿壁稳定性分析模型及应用

为了研究矿壁在复杂荷载作用下的稳定性,根据矿壁-充填体的联合承载机理,并基于受纵横荷载共同作用的弹性薄板小挠度弯曲理论,建立矿壁稳定性分析模型。将模型运用于冬瓜山铜矿54线隔离矿柱采场矿壁稳定性分析,分析结果与实际工程探测情况一致,验证了模型在工程中的实用性和可靠性;研究充填体弹性模量E2、黏聚力c和矿壁结构参数对矿壁内部极限应力的影响,以及矿壁临界宽度随壁面尺寸和充填体力学参数的变化规律。研究表明:随着E2增大,σmax与σmin均逐渐增大,随着c增大,σmax减小,σmin增大;随着长高比值由小增大,矿壁从趋向于受拉破坏转变为趋向于受压破坏,临界宽度由主要受长度控制过渡为主要受高度控制;临界宽度随c增大而迅速减小,随E2增大而缓慢增大。研究结论为冬瓜山铜矿及类似开采条件的矿山提供了隔离矿柱开采设计优化的新方法、新思路。