Objective To investigate the preoperative evaluating accuracy of liver cancer using one-stop imaging quantification technique of 320 row CT and its clinical application value.Methods 42 patients with primary mass-forming liver cancers underwent one-stop imaging by 320 row CT,including enhancement imaging,perfusion quantification,liver volume quantification and angiogra-phy.After surgery,the volume of excised livers were measured.Liver function was also evaluated.Results After liver perfusion quantification,significant differences in hepatic artery flow,portal venous flow and hepatic artery perfusion index were found be-tween the 42 cases of mass-forming liver cancers and normal liver tissues (P <0.05).No significant difference was found between preoperative quantified liver volume and postoperative measured liver volume (P >0.05).The diagnostic accuracy by CT angiogra-phy was up to 40/42 cases (95.2%)through surgical verification.The diagnostic accuracy of large blood vessels and the first or sec-ond level branches were 100%.Conclusion The quantitative analysis of one-stop imaging technique by 320 rows CT can accurately evaluate the liver perfusion,angio-architecture and liver volume before surgery.

Based on a comprehensive questionnaire survey and analysis of factors which trans formation of Scientific and Technological Achievements in Medical,some strategies to accelerate transformation were proposed by this paper.

Objective To summarize the clinical features and diagnostic flow of cervical spondylosis with proximal upper extremity amyotrophy;and further analyze the clinical effect of cervical anterior decompression and fusion on cervical spondylosis with proximal upper extremity amyotrophy.Methods Twenty-two cases of cervical spondylosis with proximal upper extremity amyotrophy were analyzed retrospectively from June 2006 to December 2013.Seventeen males and 5 females with an average age of (55.73 ± 8.64) years (38 to 68 years) were included.The mean preoperative course of disease was (19.2 ± 21.86) months (1-72 months).Clinical symptoms,imaging findings and electrophysiological findings were analyzed.The muscular strength recovery of atrophic muscles was evaluated by Manual Muscle Testing (MMT).The clinical improvement rate was evaluated by the Japanese Orthopedic Association (JOA) score,and the clinical satisfaction was assessed at followed up.Results The muscles involved in patients of cervical spondylosis with proximal upper extremity amyotrophy are mainly the deltoid muscle,biceps and scapula levator muscle.Most cases of imaging findings showed multi-segmental degeneration,of which C4,5,C5,6 segments were most common.Neuroelectrophysiological examination showed that affected muscles experienced obvious denervation and decreased action potential.The average follow-up time was (44.14 ± 20.51) months (14 to 102 months).At the last follow-up,the JOA score (16.29 ±0.59) in 17 cases was higher than preoperative (15.12 ± 0.93),the difference was statistically significant (F=51.814,P=0.000),and the average improvement rate was 73.3％.MMT assessment showed that 19 patients (86.4％) in this group had muscle strength recovery for more than 1 grade at the last follow-up.The average clinical satisfaction was 83.7％.Conclusion The clinical diagnosis of cervical spondylosis with proximal upper extremity amyotrophy requires a combination of clinical symptoms,imaging findings and neurophysiological examination results for comprehensive judgment.Anterior cervical decompression and fusion in the treatment of cervical spondylosis with proximal upper extremity amyotrophy patients can achieve good clinical results.

Objective Method discussion of measuring curvature of cervical endplate based on reverse engineering software.Methods The CT scan images data (From C2 to C7) of 8 normal males were selected and inputted into Mimics 10.0 software for 3D reconstruction and separation (cervical spine is divided into C1-C7 isolated reconstructed 3D images).Another software NX Imageware 13.2 is used for further curvature measuring in lines named left,middle,right,anterior,middle,posterior which are derived from each superior and inferior endplate.In each line,15 different points which can perfectly show morphologic characters of the endplate are selected for statistic comparing between different points in the same endplate,different lines in the same endplate,different endplates in the same individual and the same endplate in different individuals.In addition,the correlation between the concavity and the width and depth of endplate is also analyzed.Results From inferior endplate of C2 to that of C6,except superior endplate of C7,there is significant difference between different points in the same line (P＜0.05),while it is opposite in the compare between lines in the same endplate,different endplates in the same individual and the same endplate (except inferior endplate of C4) in different individuals (P＞0.05).It showed significant correlation between the concavity and the width and depth of endplate.Conclusion Reverse engineering software is feasible to be used in evaluate morphologic characters of normal cervical endplate as a new method for measuring the detail parameters of them,it also explore the laws of the curvatures of cervical endplate initially and both of them will be of great use for cervical interbody cage design.

Objective To investigate the clinical effect of different surgical approaches on multi-level cervical spondylosis in elderly patients.Methods A total of 53 aged patients with multi-level cervical spondylosis (≥70 years old) who received operation in our department during May 2007 to May 2014 were retrospectively studied, and divided into anterior cervical surgical group (n=22) and posterior cervical group (n=31), according to the surgical approach.The operation duration, intraoperative blood loss, hospitalization time, postoperative complications, Japanese orthopedics association (JOA) scores, Neck disability index (NDI), postoperative subjective improvement of clinical symptoms and spinal fusion of the two groups were evaluated and compared respectively.Results The mean operative time was longer in the anterior surgical group than in the posterior surgical group [(2.7±0.5)h vs.(1.9±0.3) h, P＜0.05].The average blood loss of the anterior surgical group was less than that of posterior surgical group [(90.0±50.4) ml vs.(160.7±40.5)ml, P＜0.05].The hospitalization time of the anterior surgical group was less than that of posterior surgical group [(10.3±2.5) d vs.(15.7±3.6) d, P＜0.05].Postoperative JOA score of anterior surgical group was higher than that of posterior surgical group 6 months after surgery [(14.7 ±0.8)vs.(13.8±1.2), P＜0.05], while there was no significant difference in JOA score between the two groups up to the last follow-up [(14.8±1.2) vs.(14.7±1.8), P＞0.05].NDI score was lower in anterior surgical group than in posterior surgical group 3, 6, 12 months after operation and at the last follow-up.Among the 41 patients, radiographic outcomes showed that there were 16 cases of anterior surgical group with no bony fusion at the follow-up 3 months after operation, and all the 16 patients achieved bony fusion at the follow-up 1 year after operation, and there were 4 cases with titanium mesh subsidence (＜ 3 mm).Conclusions Both anterior cervical decompression and fusion and posterior cervical single open-door laminoplasty have good efficacy in the treatment of multilevel cervical spondylosis in elderly patients, which have advantages on the limb functional recovery time and cervical function assessment.When anterior cervical surgical contraindications were excluded, the anterior cervical decompression and fusion may be a good choice for the treatment of multilevel cervical spondylosis in aged patients.

Objective To explore the electrophysiological charaterstics of upper extremities nerves on the patients with Hirayama disease (HD),amyotrophic lateral sclerosis (ALS),and distal cervical spondylotic amyotrophy (DCSA).Methods The data of electrophysiological examination of the upper limbs of 87 patients with HD,83 with ALS and 28 with DCSA were reviewed retrospectively.Seventy-two patients with HD among 87 had unilateral upper limb's amyotrophy and the other 15 ones had bilateral amyotrophy.There were 30 patients had unilater upper limb's amyotrophy and 53 ones had bilateral amyotrophy from the group of patients with ALS; 20 patients with DSCA were affected unilaterally and 8 ones were bilaterally affected.Results Compound muscle action potential (CMAP) evoked by ulnar stimulation had a lower ampititude compared with that evoked by median stimulation in HD patients.In ALS cases that was just the opposite.However,the CMAPs were similar in DCSA cases.The mean ratio of CMAP amplitude by ulnar stimulation to by median stimulation was 0.58±0.40 in HD group; 2.28±1.25 in ALS and 1.31±0.63 in DCSA.The differences in the three groups were statistical significance.The U/M CMAP ratio was less than 0.6in 62 patients with HD,3 with ALS and 1 with DCSA,and more than 1.7 in 73 cases (57 ALS,12 HD and 4 DCSA).Conduction velocities (CV) of the sensory and motor nerves,the amplitude of the sensory nerve action potential in bilateral limbs,and the CMAP amplitude of the unaffected limb were normal in all cases.Conclusion This study could concluded that the severity of amyotropy in hypothenar mucles were higher than that in thenal muscles in patients with HD; there was just opposite in ALS cases and similar in DSCA.

ObjectiveTo evaluate the surgical techniques and 2-year follow-up results of Mast Quadrant-assisted modified transforaminal lumbar interbody fusion (TLIF).MethodsFrom September 2006 to October 2008,54 patients with single-level lumbar degeneration disease were treated by Mast Quadrantassisted modified TLIF.Under the guidance of C-arm,the Mast Quadrant's retractor was placed and the lower articular process of the upper vertebrae and 1/2-2/3 of the lamina,flavum ligament and hyperplastic cohesive part of the lower articular process were removed,the nerve roots and the central canal were decompressed.After cleaning up intervertebral disc space,bone grafting and pedicle screw fixation were achieved.Visual analogue scale(VAS) and Oswestry disability index(ODI) results,as well as the fusion rate at the last follow-up were analyzed.ResultsAll patients were treated by Mast Quadrant-assisted modified TLIF,in which 51 patients were followed up for 2 years.An average operating time was(178.7±63.2) min,and an average blood loss was (224.2±136.5) ml; an average postoperative drainage loss was (117.2±91.4) ml,and an average postoperative stay was(5.8±3.6) d.There were statistic significances between pre- and post-operative ODI and VAS scores,respectively.At last follow-up,51 patients were achieved radiographic fusion without internal fixation failure and other complications.ConclusionMast Quadrant-assisted modified TLIF had a good vision,was relatively safe and easy to be acceptable by surgeons,and which had a good clinical results for the patients with single-level lumbar degenerative disease.

Objective To determine anatomic parameters related to the surgery of lumbar cortical bone trajectory of normal adults and the feasibility of screw application in cortical bone and its specification and dimension.Methods Lumbar 3D image data of 80 adults between 18 and 40 years old (40 for each gender) were randomly selected as subjects of our research.With the help of the imaging software for 3D interactive viewing,the ideal starting point was supposed to be the junction of the center of the superior articular process and 1 mm below the inferior border of the transverse process.The diameter,length,lateral angle to the vertebral horizontal plane,cephalad angle to the vertebral sagittal plane of the trajectory and the horizontal distance from the insertion point to the lateral edge of the vertebral plate were measured.Differences of anatomic parameters for each gender,side and segment were analyzed.Results Differences of anatomic parameters on both sides of each segment had no statistical significance.At the ideal trajectory,the mean screw length was 37.56±2.41 mm at L1,38.72±2.36 mm at L2,39.51 ±2.51 mm at L3,39.78± 2.87 mm at L4 and 38.83±2.74 mm at L5.The mean screw diameters from L1 to L5 were 6.04±1.23 mm,6.17±1.24 mm,7.15±1.22 mm,8.02± 1.41 mm and 8.68± 1.42 mm respectively.However,differences of ideal entry angle of L1 to L5 had no statistical significance.The mean lateral angle from L1 to L5 were 8.46°±2.11°,9.37°±2.84°,9.62°±2.16°,9.53°± 1.98°,9.04°± 1.97°,while the mean cephalad angle to the vertebral sagittal plane from L1 to L5 were 26.49°±4.97°,25.94°±4.56°,26.42°±4.42°,26.29°±3.48°,26.89°±3.69°.The mean distance from the insertion point to the lateral edge of the vertebral plate gradually increased from L1 to L5,which were 1.19±0.75 mm,1.54±1.08 mm,2.01±1.45 mm,3.49±1.52 mm,4.47±1.32 mm respectively.The screw diameters of each segment for men were greater than those for women.Conclusion The common length of screw for lumbar cortical bone trajectory of normal adults might be from 35 mm to 40 mm.The safe upper limits of the screw diameter were 5.5 mm at L1,5.5-6.0 mm at L2,6.5-7.0 mm at L3,7.5 mm at L4 and 8 mm at L5.The average lateral angle of all 5 lumbar segments was 9.20°± 2.11° and the average cephalad angle was about 26.41°±4.22°.

Objective To assess the risk of sympathetic nerve injury in oblique lumbar interbody fusion (OLIF) in different lumbar spine segments based on anatomical study.Methods Twenty-four healthy adult volunteers (12 male and female) were selected and routine lumbar spine scanning was performed with MAG MAGOMOM Verio 3.0 T.The anatomical structures of left lumbar sympathetic trunk,abdominal aorta and left psoas muscle were identified on T2 images of L2,3,L3,4,L4,5 intervertebral space.And the anatomical parameters of the OLIF operation approach and the anatomical parameters of the left sympathetic trunk and adjacent structures were measured.The t-test was used to compare the parameters between the different sexes.The comparison of the data between the different segments was performed by the least significant difference (LSD) single factor analysis of variance.Results From the L2,3 to L4,5 segments,the anatomical parameters of the OLIF operation approach and the anatomical parameters of the left sympathetic trunk and the adjacent structures showed regular changes.The distances between the anterior margin of the left psoas muscle and the abdominal aorta from L2,3 to L4,5 were 13.65±4.10 mm to 9.42 ± 4.00 mm in adult healthy male individuals,and 13.89±3.18 mm to 8.38 ± 3.33 mm in female individuals,showing a significant downward trend.The distances between the left sympathetic trunk and the abdominal aorta from L2,3 to L4,5 were 10.76±3.89 mm to 6.68±3.39 mm in adult healthy male individuals,and 11.52±3.02 mm to 6.12±2.95 mm in female individuals,also showing a significant downward trend.There were significant differences in the operation area of OLIF surgery between different segments.The operation area of OLIF surgery was relatively large in L 2,3 segment,and the risk of sympathetic nerve injury was relatively small.The left lumbar sympathetic trunk in the L3,4 intervertebral space was walking front and inside,and there was a greater risk of injury in the OLIF surgery.Conclusion The left lumbar sympathetic trunk located in or close to OLIF surgery operation field in L2-L5 segments.There was a certain risk of sympathetic nerve injury in OLIF surgery,and the risk of sympathetic nerve injury was different in L2,3,L3,4,L4,5 segments.

Objective To measure the related anatomical parameters of lumbosacral nerve root and adjacent structures by magnetic resonance neurography,and to analyze operative safety of transforaminal lumbar interbody fusion in Chinese people.Methods A total of 12 healthy volunteers,including 6 males and 6 females,underwent magnetic resonance neurography of lumbosacral nerve root using a Siemens 3.0T MRI machine.The Osirix software was used to reconstruct the three-dimensional imaging and measure the following anatomic parameters: 1) the distance between the nerve root and the superior pedicle; 2) the distance between the nerve root and the inferior pedicle; 3) the angle between the nerve root and the sagittal plane; 4) the distance between the superior and inferior nerve roots; 5) the distance between the superior and inferior pedicles.Results L1-L5 nerve roots got a good imaging by magnetic resonance neurography in all 12 volunteers.The distance between the nerve root and the superior pedicle and the angle between the nerve root and the sagittal plane gradually became smaller from L1 to L5.But the variation in the distance between the nerve root and the inferior pedicle and the distance between the superior and inferior pedicles was not obvious.The distance between the nerve root and the inferior pedicles,which was closely related to the operating space of TLIF,ranged from (8.99±0.88) mm to (10.72±1.01) mm for males and from (7.76±0.46) mm to (8.54±0.65) mm for females; it was less than 10 mm in each segments in the majority of subjects,and the data of females was significantly smaller than that of males.No significant differences were found in parameters between the left and right sides in the same segment.Conclusion Based on the above anatomical study and measurement analysis,we believe that there is some harassment to the upper nerve root in TLIF for Chinese patients,and for some patients there is a certain injury risk.