Objectives:To evaluate the clinical efficacies of robot-assisted versus C-arm fluoroscopy-guided percutaneous pedicle screw fixation for thoracolumbar burst fractures.Methods:A retrospective analysis was conducted on 46 patients(26 males,20 females;age 27-69 years)with thoracolumbar burst fractures treated between January 2022 and December 2023.The patients were divided into the observation group of 21 cases(12 males,9 females;52.1±8.8 years)receiving robot-assisted navigation,and the control group of 25 cases(14 males,11 females;50.9±13.2 years)undergoing conventional C-arm fluoroscopy guidance.No significant differences were observed in baseline characteristics(case number,sex ratio,BMI;P＞0.05).Both groups of patients underwent percutaneous pedicle screw internal fixation of the injured vertebra.Intraoperative parameters(fluoroscopy frequency,operative time,blood loss),postoperative CT scans on 3d(assessed by Gertzbein-Robbins scale for screw placement accuracy),pre-and postoperative pain VAS scores(thoracolumbar back pain before surgery and at 1d,3d,and 1 month after surgery),and radiographic parameters(Cobb angle,anterior vertebral body height ratio at preoperation,and postoperative 3d,1 month,and 6 months)were recorded and compared using t-tests and Mann-Whitney U tests.Results:The observation group demonstrated significantly shorter operative time(90.71±9.52min vs 117.62±16.63min,P＜0.05),reduced blood loss(67.14±18.75mL vs 139.52±28.01mL,P＜0.05),and fewer fluoroscopy exposures(9.14±2.27 vs 18.86±2.86,P＜0.05)than the control group.No complications occurred during follow-up in both groups.The observation group exhibited superior screw placement accuracy(98.4％vs 90.7％,P＜0.05)with 124/126 screws graded as excellent/good versus 136/150 in controls.Postoperative pain VAS scores were lower in the observation group on 1d(2.67±0.57 vs 4.00±0.70,P＜0.05)and 3d(1.19±0.68 vs 1.95±0.59,P＜0.05),but comparable at 1 month(0.76±0.43 vs 1.10±0.53,P＞0.05).The postoperative 3d,1 month and 6 months'Cobb angles(6.08°±1.49° vs 6.09°±1.05°,6.26°±1.46° vs 6.28°±1.14°,6.78°±1.38° vs 6.91°±1.31°)and anterior vertebral height ratios[(90.14±1.56)％vs(90.06±1.69)％,(89.62±1.56)％vs(89.44±2.12)％,(88.87±1.72)％vs(88.92±1.88)％]showed no significant in-tergroup differences at different time points(P＞0.05).Conclusions:Robot-assisted percutaneous pedicle screw fixation for the treatment of thoracolumbar burst fractures has significant advantages in improving surgical ac-curacy,reducing intraoperative blood loss,shortening operative time,and decreasing the number of fluoroscopic exposures.

Objectives:To evaluate the clinical efficacies of robot-assisted versus C-arm fluoroscopy-guided percutaneous pedicle screw fixation for thoracolumbar burst fractures.Methods:A retrospective analysis was conducted on 46 patients(26 males,20 females;age 27-69 years)with thoracolumbar burst fractures treated between January 2022 and December 2023.The patients were divided into the observation group of 21 cases(12 males,9 females;52.1±8.8 years)receiving robot-assisted navigation,and the control group of 25 cases(14 males,11 females;50.9±13.2 years)undergoing conventional C-arm fluoroscopy guidance.No significant differences were observed in baseline characteristics(case number,sex ratio,BMI;P＞0.05).Both groups of patients underwent percutaneous pedicle screw internal fixation of the injured vertebra.Intraoperative parameters(fluoroscopy frequency,operative time,blood loss),postoperative CT scans on 3d(assessed by Gertzbein-Robbins scale for screw placement accuracy),pre-and postoperative pain VAS scores(thoracolumbar back pain before surgery and at 1d,3d,and 1 month after surgery),and radiographic parameters(Cobb angle,anterior vertebral body height ratio at preoperation,and postoperative 3d,1 month,and 6 months)were recorded and compared using t-tests and Mann-Whitney U tests.Results:The observation group demonstrated significantly shorter operative time(90.71±9.52min vs 117.62±16.63min,P＜0.05),reduced blood loss(67.14±18.75mL vs 139.52±28.01mL,P＜0.05),and fewer fluoroscopy exposures(9.14±2.27 vs 18.86±2.86,P＜0.05)than the control group.No complications occurred during follow-up in both groups.The observation group exhibited superior screw placement accuracy(98.4％vs 90.7％,P＜0.05)with 124/126 screws graded as excellent/good versus 136/150 in controls.Postoperative pain VAS scores were lower in the observation group on 1d(2.67±0.57 vs 4.00±0.70,P＜0.05)and 3d(1.19±0.68 vs 1.95±0.59,P＜0.05),but comparable at 1 month(0.76±0.43 vs 1.10±0.53,P＞0.05).The postoperative 3d,1 month and 6 months'Cobb angles(6.08°±1.49° vs 6.09°±1.05°,6.26°±1.46° vs 6.28°±1.14°,6.78°±1.38° vs 6.91°±1.31°)and anterior vertebral height ratios[(90.14±1.56)％vs(90.06±1.69)％,(89.62±1.56)％vs(89.44±2.12)％,(88.87±1.72)％vs(88.92±1.88)％]showed no significant in-tergroup differences at different time points(P＞0.05).Conclusions:Robot-assisted percutaneous pedicle screw fixation for the treatment of thoracolumbar burst fractures has significant advantages in improving surgical ac-curacy,reducing intraoperative blood loss,shortening operative time,and decreasing the number of fluoroscopic exposures.

Objective:To compare the clinical effects of discectomy combined with transpedicular dynamic stabilization and transforaminal lumbar interbody fusion (TLIF) in treating single-level lumbar disc herniation.Methods:From November 2012 to November 2015, a total of 96 patients with single-level lumbar disc herniation (disc height decreased more than 1/3, the width of the basilar part of the herniated disc >6 mm, massive disc herniation or Modic type I endplate changes) treated by discectomy combined with Dynesys dynamic stabilization (Dynesys group, n=48) or TLIF (fusion group, n=48) were enrolled. Clinical assessments included operation duration, intraoperative blood loss, MacNab score, visual analogue scale (VAS), Oswestry disability index (ODI) and rate of complications. Radiographs were evaluated for lumbar mobility, intervertebral height, etc. Results:A total of 86 patients were included in the final analysis (44 in Dynesys group and 42 in fusion group) and were evaluated after 5 years follow-up. The operation duration of Dynesys group (159.61±37.29 min) was less than that of the fusion group (177.42±39.90 min) significantly ( t=2.140, P=0.035). Intraoperative blood loss in Dynesys group (151.78±50.88 ml) was less than that in fusion group (197.74±76.55 ml) with significant difference ( t=3.293, P=0.001). At 5 years follow-up, there were 2 cases with screw loosening and 5 cases with adjacent segmental degeneration in Dynesys group without symptom. In fusion group, there were 12 cases with adjacent segmental degeneration and two of them with symptom. There were significant differences in the incidence of adjacent segment degeneration between the two groups ( χ2=4.012, P=0.045). According to the MacNab criteria, excellent or good cases accounted for 95% in Dynesys group and 93% in fusion group without significant differences ( Z=0.425, P=0.671). VAS back, VAS leg and ODI scores were improved significantly in both groups after 2 years and 5 years ( P<0.05). However, there were no significant differences between the two groups ( P<0.05). The activity of the surgical segment was 4.59°±0.48° in Dynesys group and 1.00°±0.42° in fusion group at 5 years after surgery. The height of intervertebral space in Dynesys group decreased from 11.19±2.07 mm before surgery to 9.98±2.02 mm at 2 years after surgery and to 9.86±1.64 mm at 5 years after surgery ( F=6.462, P=0.002). However, there was no statistically significant difference between the 2 and 5 years follow-up ( q=0.415, P>0.05). At 5 years after surgery, the activity of the first proximal segment in the two groups was 9.74°±3.29° and 11.69°±3.89°, respectively ( t=2.514, P=0.014). Conclusion:Both discectomy combined with dynamic stabilization and TLIF can achieve satisfied clinical effects in treating single-level lumbar disc herniation. Dynamic stabilization preserves the intervertebral activity of surgical segments and results in a lower incidence of adjacent segment degeneration compared with that in fusion surgery. Furthermore, discectomy combined with dynamic stabilization is a less invasive intervention with shorter operation duration and less blood loss compared with TLIF.

Objective To study the expression and effect of macrophage inflammatory protein-2(MIP-2) in liver injury induced by ischemia/reperfusion(I/R). Methods Thirty-two rats were randomly divided into 4 groups(8 rats in each group):false operation (control) group and 3, 9, 24 hours reperfusion group.The expression of MIP-2 mRNA in hepatic tissue, MIP-2 protein in plasma, the neutrophil infiltration in liver tissue and serum ALT were measured. Results The expression of MIP-2 mRNA in the ischemic tissue was significantly higher than that in nonischemic tissue (P