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
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
Entangled Porous Titanium Alloy Metal Rubber(EPTA-MR)was used as a nucleus pulposus material in the design of non-fusion intervertebral disc prosthesis for the first time.A novel artificial lumbar intervertebral disc ...Entangled Porous Titanium Alloy Metal Rubber(EPTA-MR)was used as a nucleus pulposus material in the design of non-fusion intervertebral disc prosthesis for the first time.A novel artificial lumbar intervertebral disc prosthesis was designed by reconstructing the lumbar model with reverse engineering technology,and the biomechanical behavior of the prosthesis was simulated under varied working conditions.The nucleus pulposus size was determined by the actual size of human prosthesis.EPTA-MR samples with different densities were prepared by medical titanium alloy wire experimental studies were conducted on static stiffness,damping energy consumption,and fatigue life.The results indicated that the static stiffness of EPTA-MR could reach approximately 1500 N mm and its loss factor remained higher than 0.2,and the variation range was relatively small,with excellent vibration damping capacity and bearing capacity.Among them,the overall performance of EPTA-MR with a density of 2.5 g em 3 was closer to that of the physiologic intervertebral disc.A macro experiment of five million fatigue vibration tests combined with microstructure observation exhibited a wear rate of only 0.9396 g-MC with no noticeable change in the internal micro-morphology.Therefore,the EPTA-MR has a broad application prospect as the nucleus pulposus material of artificial intervertebral disc prosthesis.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
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
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.
基金The authors thank the National Natural Science Foundation of China(Grant Nos.51805086 and 51975123)the Fujian Provincial Natural Science Foundation(Grant No.2019J01210)Fujian Province health education joint project(Grant No.2019-WJ-01).
文摘Entangled Porous Titanium Alloy Metal Rubber(EPTA-MR)was used as a nucleus pulposus material in the design of non-fusion intervertebral disc prosthesis for the first time.A novel artificial lumbar intervertebral disc prosthesis was designed by reconstructing the lumbar model with reverse engineering technology,and the biomechanical behavior of the prosthesis was simulated under varied working conditions.The nucleus pulposus size was determined by the actual size of human prosthesis.EPTA-MR samples with different densities were prepared by medical titanium alloy wire experimental studies were conducted on static stiffness,damping energy consumption,and fatigue life.The results indicated that the static stiffness of EPTA-MR could reach approximately 1500 N mm and its loss factor remained higher than 0.2,and the variation range was relatively small,with excellent vibration damping capacity and bearing capacity.Among them,the overall performance of EPTA-MR with a density of 2.5 g em 3 was closer to that of the physiologic intervertebral disc.A macro experiment of five million fatigue vibration tests combined with microstructure observation exhibited a wear rate of only 0.9396 g-MC with no noticeable change in the internal micro-morphology.Therefore,the EPTA-MR has a broad application prospect as the nucleus pulposus material of artificial intervertebral disc prosthesis.
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。
