Objectives:To propose a classification method of intervertebral disc annulus fibrosus injury and explore its guiding values for annulus fibrosus repair and reconstruction in lumbar spine.Methods:Based on the degree and location of annulus fibrosus injury observed during endoscopic surgery,injuries were classified into types Ⅰ-Ⅳ.Type Ⅰ,no full-thickness tear in the annulus fibrosus,requiring artificial transverse inci-sion during nucleus pulposus removal surgery;Type Ⅱ,longitudinal tear in the annulus fibrosus without de-fect,and which was further subdivided into ⅡA(≤1cm),Ⅱ B(1-1.5cm),and Ⅱ C(≥ 1.5cm)based on the tear length;Type Ⅲ,central tear in the annulus fibrosus with defect,and which was subdivided into ⅢA(≤1cm)and ⅢB(＞1cm)based on the longest diameter of the defect;Type Ⅳ,tear in the annulus fibrosus near the endplate with defect,which was subdivided into ⅣA(≤1cm)and ⅣB(＞1cm)based on the longest diameter of the defect.A retrospective analysis was conducted on 136 patients with single-segment lumbar intervertebral disc protrusion in our hospital.There were 75 male cases and 61 female cases,with an age of 36.5±10.3 years.According to the classification method,out of the 136 patients,11 cases were classified as type Ⅰ,underwent conventional single-line linear suturing;Type Ⅱ cases were treated with near-endplate bone tunnel method for suturing,with type ⅡA 26 cases using linear suturing,type ⅡB 13 cases using triangular sutur-ing,and type ⅡC 3 cases were abandoned suturing;For type ⅢA,3 cases used triangular suturing and 3 used cross suturing,while 2 type ⅢB cases were abandoned suturing;Type Ⅳ cases also used the near-endplate bone tunnel method for suturing,with 52 type ⅣA cases using triangular suturing,15 using parallel line suturing,4 cases were failed in suturing,and 4 type Ⅳ B cases were abandoned suturing.The visual analogue scale(VAS)was used to assess the pain of the patients,and the Oswestry disability index(ODI)was used to assess the lumbar function of the patients before operation,at postoperative 3 months and final fol-low-up.At final follow-up,MRI was reexamined to observe the healing of the annulus fibrosus and compare the changes from the preoperative intervertebral;The MacNab criteria were used to assess the therapeutic ef-fect.Results:All the patients successfully underwent nucleus pulposus removal and nerve root decompression surgery.There were no intraoperative complications such as nerve root injury,dural sac tear,or pseudospinal hypertension syndrome.The operation time ranged from 36min to 50min,with an average of 44.50(36.25,50.00)min.Overall,according to the classification of annulus fibrosus injury,suturing was performed in 127 cases,with a suturing rate of 93.38％,and among which 123 cases successfully completed suturing,with a success rate of 96.85％.All 136 patients were followed up for 9-24 months,averaged 13.2 months.At final follow-up,there were 6 recurrences,including 1 type ⅡC(not sutured),1 type Ⅲ A(sutured),and 4 type ⅣA(3 sutured,1 suturing failure),with a recurrence rate of 4.412％.The intervertebral space height measured at final follow-up showed no significant change compared to the preoperative height(P＞0.05),while the VAS scores for low back pain and leg pain,and ODI at 3 months postoperatively and at final follow-up were sig-nificantly improved compared to the preoperative levels(P＜0.05).According to the MacNab criteria,there were 108 excellent,14 good,8 fair,and 6 poor in outcomes,with an excellent and good rate of 89.71％.Conclu-sions:The classification of lumbar disc annulus fibrosus injury is simple and clear;Adopting corresponding annulus fibrosus suturing repair surgery that is suitable for such classification can yield a high success rate of suturing and avoid unnecessary suturing,which has certain values in guiding clinical practice.

Objectives:To propose a classification method of intervertebral disc annulus fibrosus injury and explore its guiding values for annulus fibrosus repair and reconstruction in lumbar spine.Methods:Based on the degree and location of annulus fibrosus injury observed during endoscopic surgery,injuries were classified into types Ⅰ-Ⅳ.Type Ⅰ,no full-thickness tear in the annulus fibrosus,requiring artificial transverse inci-sion during nucleus pulposus removal surgery;Type Ⅱ,longitudinal tear in the annulus fibrosus without de-fect,and which was further subdivided into ⅡA(≤1cm),Ⅱ B(1-1.5cm),and Ⅱ C(≥ 1.5cm)based on the tear length;Type Ⅲ,central tear in the annulus fibrosus with defect,and which was subdivided into ⅢA(≤1cm)and ⅢB(＞1cm)based on the longest diameter of the defect;Type Ⅳ,tear in the annulus fibrosus near the endplate with defect,which was subdivided into ⅣA(≤1cm)and ⅣB(＞1cm)based on the longest diameter of the defect.A retrospective analysis was conducted on 136 patients with single-segment lumbar intervertebral disc protrusion in our hospital.There were 75 male cases and 61 female cases,with an age of 36.5±10.3 years.According to the classification method,out of the 136 patients,11 cases were classified as type Ⅰ,underwent conventional single-line linear suturing;Type Ⅱ cases were treated with near-endplate bone tunnel method for suturing,with type ⅡA 26 cases using linear suturing,type ⅡB 13 cases using triangular sutur-ing,and type ⅡC 3 cases were abandoned suturing;For type ⅢA,3 cases used triangular suturing and 3 used cross suturing,while 2 type ⅢB cases were abandoned suturing;Type Ⅳ cases also used the near-endplate bone tunnel method for suturing,with 52 type ⅣA cases using triangular suturing,15 using parallel line suturing,4 cases were failed in suturing,and 4 type Ⅳ B cases were abandoned suturing.The visual analogue scale(VAS)was used to assess the pain of the patients,and the Oswestry disability index(ODI)was used to assess the lumbar function of the patients before operation,at postoperative 3 months and final fol-low-up.At final follow-up,MRI was reexamined to observe the healing of the annulus fibrosus and compare the changes from the preoperative intervertebral;The MacNab criteria were used to assess the therapeutic ef-fect.Results:All the patients successfully underwent nucleus pulposus removal and nerve root decompression surgery.There were no intraoperative complications such as nerve root injury,dural sac tear,or pseudospinal hypertension syndrome.The operation time ranged from 36min to 50min,with an average of 44.50(36.25,50.00)min.Overall,according to the classification of annulus fibrosus injury,suturing was performed in 127 cases,with a suturing rate of 93.38％,and among which 123 cases successfully completed suturing,with a success rate of 96.85％.All 136 patients were followed up for 9-24 months,averaged 13.2 months.At final follow-up,there were 6 recurrences,including 1 type ⅡC(not sutured),1 type Ⅲ A(sutured),and 4 type ⅣA(3 sutured,1 suturing failure),with a recurrence rate of 4.412％.The intervertebral space height measured at final follow-up showed no significant change compared to the preoperative height(P＞0.05),while the VAS scores for low back pain and leg pain,and ODI at 3 months postoperatively and at final follow-up were sig-nificantly improved compared to the preoperative levels(P＜0.05).According to the MacNab criteria,there were 108 excellent,14 good,8 fair,and 6 poor in outcomes,with an excellent and good rate of 89.71％.Conclu-sions:The classification of lumbar disc annulus fibrosus injury is simple and clear;Adopting corresponding annulus fibrosus suturing repair surgery that is suitable for such classification can yield a high success rate of suturing and avoid unnecessary suturing,which has certain values in guiding clinical practice.

Objective:To investigate the risk factors of bone cement leakage after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF).Methods:A multi-center, large-sample, case-control study was carried out to analyze the clinical data of 2 273 OVCF patients (2 689 vertebrae) undergone PVP at four hospitals between May 2018 and October 2021, including 994 males and 1 279 females, with the age of 52-91 years [(69.1±3.1)years]. Of all, 581 patients (604 vertebrae) were allocated to leakage group and 1 692 patients (2 085 vertebrae) to no leakage group according to the occurrence of bone cement leakage. The gender, age, fracture sites, vertebral compression degree, endplate integrity of fractured vertebrae, surgical segments, surgical approaches and bone cement injection volume were recorded. Univariate analysis was used to investigate the correlation between those indicators with bone cement leakage. Multivariate Logistic regression analysis was used to identify the independent risk factors for bone cement leakage.Results:Univariate analysis showed that gender, age, fracture sites, vertebral compression degree, bone cement injection volume were related to bone cement leakage after PVP ( P<0.05 or 0.01), but no correlation was found in the endplate integrity of fractured vertebrae, surgical segments and surgical approaches (all P>0.05). Multivariate Logistic regression analysis showed that fracture sites ( OR=1.68, 95% CI 1.11-2.55, P<0.05), vertebral compression degree more than 40% ( OR=1.98, 95% CI 1.29-3.02, P<0.01), bone cement injection volume greater than or equal to 5.5 ml ( OR=1.55, 95% CI 1.07-2.26, P<0.05) were significantly associated with bone cement leakage after PVP. Conclusion:Thoracic vertebral fracture, vertebral compression degree more than 40% and bone cement injection volume greater than or equal to 5.5 ml are independent risk factors for bone cement leakage after PVP in OVCF.

Objective To evaluate the treatment of ilioinguinal approach surgery associated acute iatrogenic deep venous thrombosis (DVT).Methods The clinical data and treatment of 11 patients with ilioinguinal approach surgery associated acute iatrogenic DVT were analyzed.Results These 11 patients initially suffered from complicated acetabulum fracture,7 cases were treated by single ilioinguinal approach surgery and the other 4 cases were combined with Kocher-Langenbeck approach.In 3 days after surgery,DVTs were found by Doppler sonography,and all the DVTs were proved having closed relationships with ilioinguinal approach through digital subtraction angiography(DSA):iliac-femoral veins appeared stenosis at ilioinguinal segment in all the 11 cases,DVTs were found distal to the stenosis in 9 cases,both sides in 2 cases (1 case combined extensive iliac vein emphraxis and the other case combined extensive femoral vein emphraxis).After retrievable inferior vena cava filters were implanted,11 patients received catheter-directed thrombolysis for 5-12 days.Complete thrombolysis was achieved in 8 cases and thrombi residual left in 3 cases.The iliac-femoral veins were recanalized completely.After (10 ± 4) month fellow-up,no DVT recurred and no PTS appeared.Conclusions Ilioinguinal approach surgery seriously effects iliac-femoral veins,and is a important precipitating factor of DVT.Early catheter-directed thrombolysis under the protection of inferior vena cava filter is an effective treatment.

In the past few years, many techniques were used to study brain perfusion imaging;each of them has its own advantages and disadvantages. The principle, specification, clinical application, contradistinction and the current research situation of these techniques were reviewed in this article.

Objective To explore the value of imaging diagnosis of nerve-root-type cervical spondylosis(NRTCS)and to study the relative factors to the nerve root disturbance.Methods 188 cases of NRTCS clinically proved and with complete imaging data were retrospectively analyzed.The imaging characteristics of CR,CT and MRI of NRTCS were compared and the relative factors to the nerve root disturbance were analyzed in combination with the clinical characteristics.Results ①CR films in six-position could show the whole expression of the cervical spine.The anterior-posterior and functional position CR showed the physiological curvature change in 122(64.9%),narrowing of intervertebral space in 96(51.2%)and vertebral-body unstability or slide in 49(26.1%).The oblique CR showed the intervertebral-foramen lessening or narrowing in(26.1%)and Luschka-or intervertebral-joint osteophyte in 82(43.2%);②CT scans showed Luschka-or intervertebral-joint osteophyte in 76(40.4%),disc herniation and calcification of cartilage nodus in 80(42.6%)and hypertrophy or calcification of ligamenlum flavum in 66(39.8%);③MRI showed intervertebral-disk degeneration and protrusion in 105(55.8%),hypertrophy or calcification of ligamentum flavum in 51(27.1%),the nerve root and spinal cord compressed in 69(36.7%)and edema or degeneration of spinal cord in 23(12.2%).Conclusion The nerve root disturbance is closely correlated with the imaging appearances in NRTCS.It is of importance in early diagnosis and treatment for NRTCS to analyse synthetically the imaging data and clinical characteristics.

Objective To study the diagnostic value of imageology(CR,CT and MRI) for sacraoiliac pathological changes(SIPC) in ankylosing spondylitis(AS).Methods A retrospective analysis was made on the manifestations of CR,CT and MRI of the sacraoiliac joints in 98 cases of clinically-proved AS,including the grading,site and number,calcification,joint-space and sub-articular-surface-bone changes.Results The characteristics of AS in sacraoiliac joint on CR were: joint-space narrowing(67),articular-surface sclerosis(22),cystic change(15) and joint stiffness(17) and calcification(38).CT features were:the lesions involving iliac-side synovium of the sacraoiliac joint mainly,chondral calcification(55),joint-space narrowing(42),cystic change(43) and sclerosis(65) of the articular surface and sub-surface bone structure,and calcification of sacraoiliac-ligament(52).MRI showed: articular-cartilage damage(40),edema around the lesion(57) and intrabony fat sedimentation(15).Conclusion For sacraoiliac joint in AS,CR examination is the basic imaging method,CT in grading lesions is more accurate,while SIPC in AS can be early diagnosed by MRI.