Anterior cervical decompression and fusion(ACDF)treatment for cervical spondylosis has been more than half a century,and achieved good clinical results.However,with the continuous extension of follow-up time,the fusio...Anterior cervical decompression and fusion(ACDF)treatment for cervical spondylosis has been more than half a century,and achieved good clinical results.However,with the continuous extension of follow-up time,the fusion segment-associated postoperative complications emerged gradually.Reserved cervical stability and activity,the concept of non-fusion was born.As a non-fusion technique,cervical artificial disc replacement(CADR)developed rapidly.With the continuous development of artificial prosthesis materials and design concepts,and specification and proficiency of surgical procedures,CADR has achieved better short and mid-term clinical efficacy than ACDF.Compared with ACDF,the main advantages of CADR are that the postoperative recovery is quick,the activity and stability of cervical vertebra are maintained,the height of cervical intervertebral space is restored,and the stress of adjacent segments and the rate of surgical renovation are reduced.In clinical work,as an emerging technology,CADR requires spine surgeons to control the surgical indications,contraindications,and patients'conditions strictly.This article reviews the research progress of CADR in order to provide new ideas for clinical treatment of cervical spondylosis.展开更多
AIM:To explore changes in the optic disc and peripapillary atrophy(PPA)in school-age children with ametropia using color fundus photography combined with artificial intelligence(AI)technology.METHODS:Based on the retr...AIM:To explore changes in the optic disc and peripapillary atrophy(PPA)in school-age children with ametropia using color fundus photography combined with artificial intelligence(AI)technology.METHODS:Based on the retrospective case-controlled study,226 eyes of 113 children aged aged 6–12y were enrolled from October 2021 to May 2022.According to the results of spherical equivalent(SE),the children were divided into four groups:low myopia group(66 eyes),moderate myopia group(60 eyes),high myopia group(50 eyes)and emmetropia control group(50 eyes).All subjects underwent un-aided visual acuity,dilated pupil optometry,best-corrected visual acuity(BCVA),intraocular pressure,ocular axis measurement and color fundus photography.RESULTS:The width of PPA,horizontal diameter ratio of PPA to the optic disc and area ratio of PPA to the optic disc were significantly different among the four groups(P<0.05).The width of the nasal and temporal neuroretinal rim,the roundness of the optic disc,the height of PPA,the vertical diameter ratio of PPA to the optic disc,and the average density of PPA in the high myopia group were significantly different compared with the other three groups(P<0.05).There were strong negative correlations between SE and area ratio of PPA to the optic disc(r=-0.812,P<0.001)and strong positive correlation between axial length(AL)and area ratio of PPA to the optic disc(r=0.736,P<0.001).CONCLUSION:In school-age children with high myopia,the nasal and temporal neuroretinal rims are narrowed and even lost,which have high sensitivity.The area ratio of the PPA to the optic disc could be used as an early predictor of myopia progression,which is of great significance for the development prevention and management of myopia.展开更多
BACKGROUND Total cervical artificial disc replacement(TDR)has been considered a safe and effective alternative surgical treatment for cervical spondylosis and degenerative disc disease that have failed to improve with...BACKGROUND Total cervical artificial disc replacement(TDR)has been considered a safe and effective alternative surgical treatment for cervical spondylosis and degenerative disc disease that have failed to improve with conservative methods.Positioning the surgical patient is a critical part of the procedure.Appropriate patient positioning is crucial not only for the safety of the patient but also for optimizing surgical exposure,ensuring adequate and safe anesthesia,and allowing the surgeon to operate comfortably during lengthy procedures.The surgical posture is the traditional position used in anterior cervical approach;in general,patients are in a supine position with a pad under their shoulders and a ring-shaped pillow under their head.AIM To investigate the clinical outcomes of the use of a modified surgical position versus the traditional surgical position in anterior approach for TDR.METHODS In the modified position group,the patients had a soft pillow under their neck,and their jaw and both shoulders were fixed with wide tape.The analyzed data included intraoperative blood loss,position setting time,total operation time,and perioperative blood pressure and heart rate.RESULTS Blood pressure and heart rate were not significantly different before and after body positioning in both groups(P>0.05).Compared with the traditional position group,the modified position group showed a statistically significantly longer position setting time(P<0.05).However,the total operation time and intraoperative blood loss were significantly reduced in the modified position group compared with the traditional position group(P<0.05).CONCLUSION The clinical outcomes indicated that total operation time and intraoperative blood loss were relatively lower in the modified position group than in the traditional position group,thus reducing the risks of surgery while increasing the position setting time.The modified surgical position is a safe and effective method to be used in anterior approach for TDR surgery.展开更多
As a new choice for the treatment of degenerative lumbar disease, artificial lumbar disc replacement has been widely used in clinical surgery. The finite element is a very effective method to predict and simulate the ...As a new choice for the treatment of degenerative lumbar disease, artificial lumbar disc replacement has been widely used in clinical surgery. The finite element is a very effective method to predict and simulate the surgery effect. The purpose of this paper is to review the applications of finite element in artificial lumbar disc replacement, such as design of artificial lumbar disc prosthesis, risk and effect evaluation of artificial lumbar disc replacement, and assessment of operation methods. Lastly, we discuss the future development of finite element method applied in this field, including personalized design of the prosthesis, postoperative behavior guide, and artificial lumbar disc replacement combined with fusion surgery. In conclusion, as an invaluable complement to biomechanical experiments and clinical studies, the finite element method makes important contributions to our understanding of biomechanics of intervertebral disc, and plays an important role in the field of artificial lumbar disc replacement.展开更多
背景:基于机器学习的不同算法,如何借助各种算法模型开展腰椎间盘突出症的临床研究已成为目前智能化医学发展的趋势和热点。目的:综述机器学习不同算法模型在腰椎间盘突出症诊治中的特点,归纳相同用途的算法模型各自优势和应用策略。方...背景:基于机器学习的不同算法,如何借助各种算法模型开展腰椎间盘突出症的临床研究已成为目前智能化医学发展的趋势和热点。目的:综述机器学习不同算法模型在腰椎间盘突出症诊治中的特点,归纳相同用途的算法模型各自优势和应用策略。方法:计算机检索PubMed、Web of Science、EMBASE、中国知网、万方数据、维普及中国生物医学数据库中与机器学习在腰椎间盘突出症诊治中的相关应用文献,按入组标准筛选后最终纳入96篇文献进行综述。结果与结论:①机器学习的不同算法模型为腰椎间盘突出症的临床诊治提供了智能化、精准化的应用策略。②监督学习中的传统统计学方法和决策树在探究危险因素,制定诊断、预后模型方面简单高效;支持向量机适用于高维特征的小数据集,作为非线性分类器可应用于正常或退变椎间盘的识别、分割、分类,制定诊断、预后模型;集成学习可相互弥补单一模型的不足,具有处理高维数据的能力,提高临床预测模型的精度和准确性;人工神经网络提高了模型的学习能力,可应用于椎间盘识别和分类,制作临床预测模型;深度学习在具有以上用途的基础上,还能优化图像,辅助手术操作,是目前腰椎间盘突出症诊治中应用最广泛、性能最佳的模型;无监督学习中的聚类算法主要用于椎间盘分割和不同突出节段的分类;而半监督学习方式临床应用相对较少。③目前,机器学习在腰椎间盘的识别、分割,退变椎间盘的分类和分级,自动化临床诊断和分类,构建临床预测模型以及辅助术中操作方面具有一定临床优势。④近年来,机器学习的研究策略已向神经网络和深度学习方向转变,具有更强学习能力的深度学习算法将会是未来实现智能化医疗的关键。展开更多
目的：探讨Mobi-C颈椎人工间盘置换治疗单节段颈椎间盘突出症的近期效果。方法：对应用Mobi-C颈椎人工间盘置换治疗的12例单节段颈椎间盘突出症患者于术前、术后（1～2 d ）及末次随访时进行全面的影像学和临床评价，并进行问卷调查。...目的：探讨Mobi-C颈椎人工间盘置换治疗单节段颈椎间盘突出症的近期效果。方法：对应用Mobi-C颈椎人工间盘置换治疗的12例单节段颈椎间盘突出症患者于术前、术后（1～2 d ）及末次随访时进行全面的影像学和临床评价，并进行问卷调查。结果：本组病例随访6～24月，平均13个月。 Odom临床疗效评价优10例，良2例。患者的颈部及上肢疼痛明显缓解，VAS评分术后下降了5．8分（P＜0．05），末次随访时下降了5．5分（P＜0．05）。颈椎功能障碍指数（NDI）和SF-36生活质量量表评分明显改善，患者的生活质量明显提高。除3例患者发生异位骨化外，未发现相邻节段退变加速。结论：保留颈椎活动度的Mobi-C颈椎人工间盘置换对颈椎间盘突出症的患者近期疗效确切，可明显提高患者的生活质量。展开更多
目的比较Mobi-C人工颈椎间盘置换术与ROI-C辅助的颈椎前路减压融合术治疗单节段颈椎病的效果。方法回顾性分析2016年3月至2017年9月在我院治疗的单节段颈椎病患者,对符合标准的35例患者资料进行分组,其中Mobi-C人工颈椎间盘置换术15例,R...目的比较Mobi-C人工颈椎间盘置换术与ROI-C辅助的颈椎前路减压融合术治疗单节段颈椎病的效果。方法回顾性分析2016年3月至2017年9月在我院治疗的单节段颈椎病患者,对符合标准的35例患者资料进行分组,其中Mobi-C人工颈椎间盘置换术15例,ROI-C辅助的颈椎前路减压融合术20例,术后随访12个月以上。记录手术时间、术中出血量和手术相关并发症。采用日本矫形外科协会(Japanese orthopedic association,JOA)评分、颈部残障功能指数(neck disability index,NDI)及疼痛视觉模拟评分法(visual analogue scale,VAS)评价临床疗效。颈椎侧位X线片测量手术节段局部前凸椎间盘Cobb角和颈椎整体前凸C 2~7 Cobb角,过伸过屈位X线片测量颈椎整体活动度(range of motion,ROM),对术前及随访时的数据进行比较。结果35例患者均完成随访。两组患者末次随访的JOA评分、NDI评分及VAS评分均较术前有明显改善,两组术前的JOA评分、NDI评分及VAS评分组间比较差异无统计学意义( P >0.05),两组末次随访的JOA评分、NDI评分及VAS评分组间比较差异无统计学意义( P >0.05)。Mobi-C人工颈椎间盘置换术组末次随访椎间盘Cobb角、C 2~7 Cobb角、颈椎整体活动度与术前相比差异无统计学意义( P >0.05);ROI-C辅助的颈椎前路减压融合术末次随访椎间盘Cobb角及C 2~7 Cobb角与术前相比差异无统计学意义( P >0.05),末次随访颈椎整体活动度与术前相比差异有统计学意义( P <0.05)。两组术前椎间盘Cobb角、C 2~7 Cobb角、颈椎整体活动度的组间比较差异无统计学意义( P >0.05);两组末次随访时椎间盘Cobb角、C 2~7 Cobb角、颈椎整体活动度的组间比较差异有统计学意义( P <0.05)。结论相比于ROI-C辅助的颈椎前路减压融合术,Mobi-C人工颈椎间盘置换术可以取得与前路减压融合内固定术相同的临床效果,而且更好地保持了颈椎活动度,可以作为颈椎病的有效治疗方法.展开更多
目的观察单节段Discover人工颈椎间盘置换术及颈椎前路减压融合术后颈椎整体曲度和置换节段活动度的变化情况,分析其临床效果。方法回顾性分析2008年3月至2013年3月治疗的48例颈椎病及颈椎间盘突出症患者,其中18例行Discover人工颈椎间...目的观察单节段Discover人工颈椎间盘置换术及颈椎前路减压融合术后颈椎整体曲度和置换节段活动度的变化情况,分析其临床效果。方法回顾性分析2008年3月至2013年3月治疗的48例颈椎病及颈椎间盘突出症患者,其中18例行Discover人工颈椎间盘置换术（置换组）,男8例,女10例,年龄31-58岁,平均44.2岁;30例行颈椎前路减压融合术（融合组）,男13例,女17例,年龄35-68岁,平均49.8岁。测量手术前后和末次随访时置换节段活动度（range of motion,ROM）,置换节段脊柱功能单位（functional spinal unit,FSU）Cobb角和颈椎整体曲度（C2-7Cobb角）。结果两组患者均获得12个月以上随访,末次随访置换节段屈伸活动度置换组较术前稍增加,左右侧屈活动度无明显变化,而融合组屈伸及左右侧屈活动度较术前明显减小,差异有统计学意义（P〈0.05）;两组间末次随访相比较,融合组屈伸及左右侧屈活动度明显减小,差异有统计学意义（P〈0.05）。末次随访FSU置换组较术前明显增加,差异有统计学意义（P〈0.05）,而融合组无明显变化;两组间末次随访相比较,置换组明显增加,差异有统计学意义（P〈0.05）。末次随访颈椎曲度置换组较术前稍增加,而融合组较术前明显减小,差异有统计学意义（P〈0.05）;两组间末次随访相比较,融合组明显减小,差异有统计学意义（P〈0.05）。结论单节段Discover人工颈椎间盘置换术后对颈椎整体曲度及置换节段活动度的影响小,与传统前路减压融合术相比,可以较好发挥其对颈椎的保护作用。展开更多
文摘Anterior cervical decompression and fusion(ACDF)treatment for cervical spondylosis has been more than half a century,and achieved good clinical results.However,with the continuous extension of follow-up time,the fusion segment-associated postoperative complications emerged gradually.Reserved cervical stability and activity,the concept of non-fusion was born.As a non-fusion technique,cervical artificial disc replacement(CADR)developed rapidly.With the continuous development of artificial prosthesis materials and design concepts,and specification and proficiency of surgical procedures,CADR has achieved better short and mid-term clinical efficacy than ACDF.Compared with ACDF,the main advantages of CADR are that the postoperative recovery is quick,the activity and stability of cervical vertebra are maintained,the height of cervical intervertebral space is restored,and the stress of adjacent segments and the rate of surgical renovation are reduced.In clinical work,as an emerging technology,CADR requires spine surgeons to control the surgical indications,contraindications,and patients'conditions strictly.This article reviews the research progress of CADR in order to provide new ideas for clinical treatment of cervical spondylosis.
文摘AIM:To explore changes in the optic disc and peripapillary atrophy(PPA)in school-age children with ametropia using color fundus photography combined with artificial intelligence(AI)technology.METHODS:Based on the retrospective case-controlled study,226 eyes of 113 children aged aged 6–12y were enrolled from October 2021 to May 2022.According to the results of spherical equivalent(SE),the children were divided into four groups:low myopia group(66 eyes),moderate myopia group(60 eyes),high myopia group(50 eyes)and emmetropia control group(50 eyes).All subjects underwent un-aided visual acuity,dilated pupil optometry,best-corrected visual acuity(BCVA),intraocular pressure,ocular axis measurement and color fundus photography.RESULTS:The width of PPA,horizontal diameter ratio of PPA to the optic disc and area ratio of PPA to the optic disc were significantly different among the four groups(P<0.05).The width of the nasal and temporal neuroretinal rim,the roundness of the optic disc,the height of PPA,the vertical diameter ratio of PPA to the optic disc,and the average density of PPA in the high myopia group were significantly different compared with the other three groups(P<0.05).There were strong negative correlations between SE and area ratio of PPA to the optic disc(r=-0.812,P<0.001)and strong positive correlation between axial length(AL)and area ratio of PPA to the optic disc(r=0.736,P<0.001).CONCLUSION:In school-age children with high myopia,the nasal and temporal neuroretinal rims are narrowed and even lost,which have high sensitivity.The area ratio of the PPA to the optic disc could be used as an early predictor of myopia progression,which is of great significance for the development prevention and management of myopia.
文摘BACKGROUND Total cervical artificial disc replacement(TDR)has been considered a safe and effective alternative surgical treatment for cervical spondylosis and degenerative disc disease that have failed to improve with conservative methods.Positioning the surgical patient is a critical part of the procedure.Appropriate patient positioning is crucial not only for the safety of the patient but also for optimizing surgical exposure,ensuring adequate and safe anesthesia,and allowing the surgeon to operate comfortably during lengthy procedures.The surgical posture is the traditional position used in anterior cervical approach;in general,patients are in a supine position with a pad under their shoulders and a ring-shaped pillow under their head.AIM To investigate the clinical outcomes of the use of a modified surgical position versus the traditional surgical position in anterior approach for TDR.METHODS In the modified position group,the patients had a soft pillow under their neck,and their jaw and both shoulders were fixed with wide tape.The analyzed data included intraoperative blood loss,position setting time,total operation time,and perioperative blood pressure and heart rate.RESULTS Blood pressure and heart rate were not significantly different before and after body positioning in both groups(P>0.05).Compared with the traditional position group,the modified position group showed a statistically significantly longer position setting time(P<0.05).However,the total operation time and intraoperative blood loss were significantly reduced in the modified position group compared with the traditional position group(P<0.05).CONCLUSION The clinical outcomes indicated that total operation time and intraoperative blood loss were relatively lower in the modified position group than in the traditional position group,thus reducing the risks of surgery while increasing the position setting time.The modified surgical position is a safe and effective method to be used in anterior approach for TDR surgery.
文摘As a new choice for the treatment of degenerative lumbar disease, artificial lumbar disc replacement has been widely used in clinical surgery. The finite element is a very effective method to predict and simulate the surgery effect. The purpose of this paper is to review the applications of finite element in artificial lumbar disc replacement, such as design of artificial lumbar disc prosthesis, risk and effect evaluation of artificial lumbar disc replacement, and assessment of operation methods. Lastly, we discuss the future development of finite element method applied in this field, including personalized design of the prosthesis, postoperative behavior guide, and artificial lumbar disc replacement combined with fusion surgery. In conclusion, as an invaluable complement to biomechanical experiments and clinical studies, the finite element method makes important contributions to our understanding of biomechanics of intervertebral disc, and plays an important role in the field of artificial lumbar disc replacement.
文摘背景:基于机器学习的不同算法,如何借助各种算法模型开展腰椎间盘突出症的临床研究已成为目前智能化医学发展的趋势和热点。目的:综述机器学习不同算法模型在腰椎间盘突出症诊治中的特点,归纳相同用途的算法模型各自优势和应用策略。方法:计算机检索PubMed、Web of Science、EMBASE、中国知网、万方数据、维普及中国生物医学数据库中与机器学习在腰椎间盘突出症诊治中的相关应用文献,按入组标准筛选后最终纳入96篇文献进行综述。结果与结论:①机器学习的不同算法模型为腰椎间盘突出症的临床诊治提供了智能化、精准化的应用策略。②监督学习中的传统统计学方法和决策树在探究危险因素,制定诊断、预后模型方面简单高效;支持向量机适用于高维特征的小数据集,作为非线性分类器可应用于正常或退变椎间盘的识别、分割、分类,制定诊断、预后模型;集成学习可相互弥补单一模型的不足,具有处理高维数据的能力,提高临床预测模型的精度和准确性;人工神经网络提高了模型的学习能力,可应用于椎间盘识别和分类,制作临床预测模型;深度学习在具有以上用途的基础上,还能优化图像,辅助手术操作,是目前腰椎间盘突出症诊治中应用最广泛、性能最佳的模型;无监督学习中的聚类算法主要用于椎间盘分割和不同突出节段的分类;而半监督学习方式临床应用相对较少。③目前,机器学习在腰椎间盘的识别、分割,退变椎间盘的分类和分级,自动化临床诊断和分类,构建临床预测模型以及辅助术中操作方面具有一定临床优势。④近年来,机器学习的研究策略已向神经网络和深度学习方向转变,具有更强学习能力的深度学习算法将会是未来实现智能化医疗的关键。
文摘目的：探讨Mobi-C颈椎人工间盘置换治疗单节段颈椎间盘突出症的近期效果。方法：对应用Mobi-C颈椎人工间盘置换治疗的12例单节段颈椎间盘突出症患者于术前、术后（1～2 d ）及末次随访时进行全面的影像学和临床评价，并进行问卷调查。结果：本组病例随访6～24月，平均13个月。 Odom临床疗效评价优10例，良2例。患者的颈部及上肢疼痛明显缓解，VAS评分术后下降了5．8分（P＜0．05），末次随访时下降了5．5分（P＜0．05）。颈椎功能障碍指数（NDI）和SF-36生活质量量表评分明显改善，患者的生活质量明显提高。除3例患者发生异位骨化外，未发现相邻节段退变加速。结论：保留颈椎活动度的Mobi-C颈椎人工间盘置换对颈椎间盘突出症的患者近期疗效确切，可明显提高患者的生活质量。
文摘目的比较Mobi-C人工颈椎间盘置换术与ROI-C辅助的颈椎前路减压融合术治疗单节段颈椎病的效果。方法回顾性分析2016年3月至2017年9月在我院治疗的单节段颈椎病患者,对符合标准的35例患者资料进行分组,其中Mobi-C人工颈椎间盘置换术15例,ROI-C辅助的颈椎前路减压融合术20例,术后随访12个月以上。记录手术时间、术中出血量和手术相关并发症。采用日本矫形外科协会(Japanese orthopedic association,JOA)评分、颈部残障功能指数(neck disability index,NDI)及疼痛视觉模拟评分法(visual analogue scale,VAS)评价临床疗效。颈椎侧位X线片测量手术节段局部前凸椎间盘Cobb角和颈椎整体前凸C 2~7 Cobb角,过伸过屈位X线片测量颈椎整体活动度(range of motion,ROM),对术前及随访时的数据进行比较。结果35例患者均完成随访。两组患者末次随访的JOA评分、NDI评分及VAS评分均较术前有明显改善,两组术前的JOA评分、NDI评分及VAS评分组间比较差异无统计学意义( P >0.05),两组末次随访的JOA评分、NDI评分及VAS评分组间比较差异无统计学意义( P >0.05)。Mobi-C人工颈椎间盘置换术组末次随访椎间盘Cobb角、C 2~7 Cobb角、颈椎整体活动度与术前相比差异无统计学意义( P >0.05);ROI-C辅助的颈椎前路减压融合术末次随访椎间盘Cobb角及C 2~7 Cobb角与术前相比差异无统计学意义( P >0.05),末次随访颈椎整体活动度与术前相比差异有统计学意义( P <0.05)。两组术前椎间盘Cobb角、C 2~7 Cobb角、颈椎整体活动度的组间比较差异无统计学意义( P >0.05);两组末次随访时椎间盘Cobb角、C 2~7 Cobb角、颈椎整体活动度的组间比较差异有统计学意义( P <0.05)。结论相比于ROI-C辅助的颈椎前路减压融合术,Mobi-C人工颈椎间盘置换术可以取得与前路减压融合内固定术相同的临床效果,而且更好地保持了颈椎活动度,可以作为颈椎病的有效治疗方法.
文摘目的观察单节段Discover人工颈椎间盘置换术及颈椎前路减压融合术后颈椎整体曲度和置换节段活动度的变化情况,分析其临床效果。方法回顾性分析2008年3月至2013年3月治疗的48例颈椎病及颈椎间盘突出症患者,其中18例行Discover人工颈椎间盘置换术（置换组）,男8例,女10例,年龄31-58岁,平均44.2岁;30例行颈椎前路减压融合术（融合组）,男13例,女17例,年龄35-68岁,平均49.8岁。测量手术前后和末次随访时置换节段活动度（range of motion,ROM）,置换节段脊柱功能单位（functional spinal unit,FSU）Cobb角和颈椎整体曲度（C2-7Cobb角）。结果两组患者均获得12个月以上随访,末次随访置换节段屈伸活动度置换组较术前稍增加,左右侧屈活动度无明显变化,而融合组屈伸及左右侧屈活动度较术前明显减小,差异有统计学意义（P〈0.05）;两组间末次随访相比较,融合组屈伸及左右侧屈活动度明显减小,差异有统计学意义（P〈0.05）。末次随访FSU置换组较术前明显增加,差异有统计学意义（P〈0.05）,而融合组无明显变化;两组间末次随访相比较,置换组明显增加,差异有统计学意义（P〈0.05）。末次随访颈椎曲度置换组较术前稍增加,而融合组较术前明显减小,差异有统计学意义（P〈0.05）;两组间末次随访相比较,融合组明显减小,差异有统计学意义（P〈0.05）。结论单节段Discover人工颈椎间盘置换术后对颈椎整体曲度及置换节段活动度的影响小,与传统前路减压融合术相比,可以较好发挥其对颈椎的保护作用。
