Objective:To compare the therapeutic efficacy of the dual anteromedial and anterolateral approaches versus that of the anterior midline approach in the treatment of Wahlquist type C medial tibial plateau fractures accompanied by posterior column collapse.Methods:A retrospective study was conducted to analyze the 21 patients who had been treated for Wahlquist type C medial tibial plateau fractures plus posterior column collapse at The Fourth Orthopedic Ward, The 72nd Group Army Hospital of PLA between January 2019 and August 2023. The cohort included 13 males and 8 females, with an age of (43.3±6.7) years. The left side was involved in 14 fractures and the right side in 7 ones. The patients were divided into 2 groups based on their surgical approaches: a dual-approach group ( n=13) undergoing fixation via the dual anteromedial and anterolateral approaches, and a single-approach group ( n=8) undergoing fixation via the anterior midline approach. Comparative parameters included operative time, intraoperative blood loss, fracture healing time, quality of fracture reduction, medial proximal tibial angle (MPTA), incision complications, postoperative bone mass reduction quality (evaluated according to the Rasmussen anatomical criteria for tibial condyle fracture reduction), lateral tibial plateau instability, incidence of genu varum, and post-traumatic arthritis. Functional recovery of the lower limb joints was assessed at the final follow-up using the Merchant criteria. Results:No statistically significant differences were observed in the baseline characteristics between the 2 groups preoperatively, indicating comparability ( P>0.05). All patients were followed up for a mean duration of (38.1±11.3) months. The postoperative MPTA in the dual-approach group (86.8°±0.8°) was significantly larger than that in the single-approach group (85.5°±0.9°) ( P<0.05). Genu varum occurred in 1 patient in the dual-approach group and in 4 patients in the single-approach group, while lateral tibial plateau instability was observed in 1 patient in the dual-approach group and in 4 patients in the single-approach group, showing statistically significant differences between the 2 groups ( P<0.05). No statistically significant differences were found between the 2 groups regarding operative time, intraoperative blood loss, fracture healing time, quality of fracture reduction, incidence of incision complications, or incidence of post-traumatic arthritis ( P>0.05). At the final follow-up, no statistically significant difference was observed in the functional recovery of the lower limb joints assessed by the Merchant criteria between the 2 groups ( P>0.05). Conclusion:In the treatment of Wahlquist type C medial tibial plateau fractures accompanied by posterior column collapse, compared with the single anterior midline approach, the dual anteromedial and anterolateral approaches can restore more effectively the MPTA, and reduce the incidences of genu varum and lateral tibial plateau instability.

Objective:To compare the efficacy of O-arm navigation versus C-arm guidance for anterior internal fixation in the management of Anderson-D′Alonzo type II odontoid fractures.Methods:A retrospective cohort study was conducted to analyze the clinical data of 58 patients with Anderson-D′Alonzo type II odontoid fractures admitted to Zhengzhou Orthopedic Hospital between January 2017 and September 2024, including 35 males and 23 females, aged 18-57 years [(39.3±9.0)years]. Anderson-D′Alonzo type II fractures were further classified as type IIA in 25 patients and type IIB in 33. Twenty-seven patients underwent O-arm assisted anterior internal fixation (O-arm navigation group), while 31 received C-arm guided anterior internal fixation (C-arm guidance group). The two groups were compared in terms of the operative duration, intraoperative blood loss, success rate for one-time guidewire placement, and intraoperative radiation exposure (anteroposterior and lateral views). At 3 days postoperatively, screw placement accuracy was evaluated via CT in both groups. Additionally, neck disability index (NDI) and visual analogue scale (VAS) scores were assessed preoperatively, at 1 week, 3 months postoperatively, and at the last follow-up. Bone union time and complication rate were also analyzed.Results:All the patients were followed up for 6-20 months [(13.1±3.4)months]. The O-arm navigation group exhibited significantly shorter operative duration [(91.1± 8.9)minutes] and less intraoperative blood loss [(38.9±8.2)ml], compared with (103.3±14.5)minutes and (47.3±9.1)ml in the C-arm guidance group ( P<0.01). The success rate for one-time guidewire placement was 100% (27/27) in the O-arm navigation group, significantly higher than 52% (16/31) in the C-arm guidance group ( P<0.01). Intraoperative radiation exposure for patients in the O-arm navigation group was lower in both anteroposterior view [(11 612.6±1 603.6)μSv] and lateral views [(29 738.2±6 602.5)μSv], compared with (40 638.0±9 431.9)μSv and (47 152.0±11 759.3)μSv in the C-arm guidance group ( P<0.01). CT scans at 3 days postoperatively revealed a 100% (27/27) screw placement accuracy in the O-arm navigation group, compared with 65% (20/31) in the C-arm guidance group ( P<0.01). Before operation, at 1 weeks and 3 months postoperatively, and at the last follow-up, NDI scores were (48.4±7.8)%, (21.0±3.1)%, (14.4±2.4)%, and (13.9±2.3)% in the O-arm navigation group, while they were (47.4±7.6)%, (20.9±3.2)%, (14.1±2.0)%, and (13.8±1.4)% in the C-arm guidance group ( P>0.05); VAS scores were 6.0(6.0, 7.0)points, 4.0(3.0, 4.0)points, 2.0(1.0, 2.0)points, and 2.0(1.0, 2.0)points in the O-arm navigation group, while they were 7.0(6.0, 7.0)points, 4.0(3.0, 5.0)points, 2.0(1.0, 3.0)points, and 2.0(2.0, 2.0)points in the C-arm guidance group ( P>0.05). The NDI and VAS scores in both groups were significantly improved at 1 weeks and 3 months postoperatively, and at the last follow-up compared to those preoperatively ( P<0.05), and were furtherly improved at 3 months postoperatively and at the last follow-up compared to those at 1 weeks postoperatively ( P<0.05), with no significant differences between those at 3 months postoperatively and at the last follow-up ( P>0.05). No significant difference was found in bone union time between the two groups ( P>0.05). The complication rate in the O-arm navigation group was 4% (1/27), lower than 29% (9/31) in the C-arm guidance group ( P<0.05). Conclusions:Compared with C-arm guidance, O-arm assisted anterior internal fixation for Anderson-D′Alonzo type II odontoid fractures can reduce operative duration and intraoperative blood loss, improve the success rate for one-time guidewire placement and screw accuracy, and decrease radiation exposure and complication rate.

Objective:To compare the efficacy of whole-process visualization system-assisted pedicle screw internal fixation and free-hand pedicle screw internal fixation in the treatment of thoracolumbar burst fracture (TLBF) without neurologic symptoms.Methods:A retrospective cohort study was conducted to analyze the clinical data of 64 patients with TLBF without neurologic symptoms admitted to Zhengzhou Orthopedic Hospital from December 2020 to October 2022, including 41 males and 23 females, aged 23-52 years [(42.1±6.6)years]. The injured vertebrae involved T 11 in 26 patients, T 12 in 17, L 1 in 12, and L 2 in 9. The Wiltse approach was used in all the patients, 31 of whom were treated with pedicle screw internal fixation assisted by the whole-process visualization system (visualization system-assisted screw placement group) and 33 of whom were treated with free-hand pedicle screw internal fixation (free-hand screw placement group). The two groups were compared in terms of operation time, single screw placement time, intraoperative blood loss, intraoperative total radiation dose and total length of hospital stay. The accuracy of pedicle screw placement and penetration rate of the pedicle cortex were evaluated in the two groups. The Cobb angle and lumbar visual analogue scale (VAS) before surgery, at 1 week, 3 months after surgery and at the last follow-up were compared between the two groups. The incidence of postoperative complications was also investigated. Results:All the patients were followed up for 10-33 months [(17.5±4.8)months]. The operation time was (106.9±11.8)minutes in the visualization system-assisted screw placement group, shorter than (121.3±11.4)minutes in the free-hand screw placement group ( P<0.01). The single screw placement time was (9.1±1.0)minutes in the visualization system-assisted screw placement group, shorter than (11.7±1.5)minutes in the free-hand screw placement group ( P<0.01). The total radiation dose was (10.4±2.4)mGy in the visualization system-assisted screw placement group, lower than (51.8±7.2)mGy in the screw placement group ( P<0.01). There was no significant difference in intraoperative blood loss or total length of hospital stay between the two groups ( P>0.05). The accuracy of pedicle screw placement was 96.6% (197/204) in the visualization system-assisted screw placement group, significantly higher than 89.3% (191/214) in the free-hand screw placement group ( P<0.01). Both groups showed significant improvements in Cobb angle and VAS scores at 1 week, 3 months after surgery, and at the last follow-up ( P<0.05). There were no significant differences in Cobb angle or VAS scores between the two groups at each time point ( P>0.05). In the visualization system-assisted screw placement group, one patient had incision infection at 4 days after operation, which was cured with antibiotics. One patient in the free-hand screw placement group developed the symptoms of nerve root irritation at 2 days after surgery, which disappeared at 7 days after revision. There was no significant difference in the incidence of complications between the two groups ( P>0.05). During the follow-up, no patients had broken screws, loosening of internal fixation, or loss of correction in either group. Conclusions:Compared with free-hand pedicle screw internal fixation, the whole-process visualization system-assisted pedicle screw internal fixation in the treatment of TLBF without neurologic symptoms can shorten the time of operation and screw placement, reduce the radiation dose, and improve the accuracy of pedicle screw placement, suggesting that it is a safer and more effective auxiliary method for pedicle screw placement.

Objective:To compare the efficacy of three-dimensional visualization-assisted intermuscular versus conventional intermuscular cervical expansive open-door laminoplasty (CEOL) in the treatment of cervical spinal cord injury without fracture or dislocation (CSCIWFD).Methods:A retrospective cohort study was conducted to analyze the clinical data of 58 patients with CSCIWFD admitted to Zhengzhou Orthopedic Hospital from October 2021 to January 2024, including 39 males and 19 females, aged 36-77 years [(52.9±8.9)years]. Among them, 26 patients were treated with three-dimensional visualization-assisted intermuscular CEOL (three-dimensional visualization group), while 32 patients were treated with conventional intermuscular CEOL (conventional intermuscular group). All patients were treated with CEOL in 4 segments (C 3-C 6), comprising 104 surgical segments in the three-dimensional visualization group and 128 in the conventional intermuscular group. The following outcomes were compared between the two groups, including the operative duration, intraoperative blood loss, accuracy rate of open-door and hinge placement at the surgical levels, visual analogue scale (VAS) of the neck and shoulder and Japanese Orthopedic Association (JOA) score preoperatively, at 1 week, 1 month, 3 months, 6 months postoperatively and at the last follow-up, American Spinal Injury Association (ASIA) impairment scale preoperatively and at the last follow-up, and postoperative complication rate. Results:All patients were followed up for 12-24 months [(17.5±3.1)months]. The operative duration and intraoperative blood loss were (117.0±12.3)minutes and (151.3±30.9)ml in the three-dimensional visualization group, which were shorter or less than (131.9±15.0)minutes and (184.7±42.9)ml in the conventional intermuscular group ( P<0.01). The accuracy rate of open-door and hinge placement at the surgical levels was 94.2% (98/104) in the three-dimensional visualization group, significantly higher than 83.6% (107/128) in the conventional intermuscular group ( P<0.05). The VAS scores of the neck and shoulder preoperatively, at 1 week, 1 month, 3 months, 6 months postoperatively, and at the last follow-up were 6.0(5.0, 7.0)points, 3.5(3.0, 4.0)points, 3.0(2.0, 3.0)points, 2.0(1.0, 3.0)points, 2.0(1.0, 2.3)points, and 2.0(1.0, 2.0)points in the three-dimensional visualization group, which were not statistically different from 5.0(4.3, 6.8)points, 4.0(3.0, 4.0)points, 3.0(2.0, 3.0)points, 2.0(1.3, 2.0)points, 2.0(1.0, 2.8)points, and 2.0(1.0, 2.0)points in the conventional intermuscular group ( P>0.05). The VAS scores of the neck and shoulder in the two groups were significantly decreased at 1 week, 1 month and 3 months postoperatively from the preoperative values ( P<0.05), while they were stabilized at 6 months postoperatively and at the last follow-up compared with those at 3 months postoperatively, with no significant difference among them ( P>0.05). The JOA scores were (8.1±2.8)points, (10.0±2.6)points, (10.5±2.6)points, (11.6±2.3)points, (12.7±2.3)points, and (13.7±2.4)points in the three-dimensional visualization group, which were not statistically different from (8.8±2.2)points, (10.3±2.1)points, (10.8±2.0)points, (12.0±2.0)points, (12.9±2.0)points, and (13.8±2.1)points in the conventional intermuscular group ( P>0.05). The JOA scores of the two groups showed continuous improvement at 1 week, 1 month, 3 months, 6 months postoperatively and at the last follow-up in comparison with the preoperatively values ( P<0.05). Although no significant difference was observed between the two groups in ASIA grade preoperatively and at the last follow-up ( P>0.05), the ASIA grade at the last follow-up was significantly improved compared with that before surgery in both groups ( P<0.05). The postoperative complication rate was 12% (3/26) in the three-dimensional visualization group, significantly lower than 38% (12/32) in the conventional intermuscular group ( P<0.05). Conclusion:Compared with the conventional intermuscular approach, the three-dimensional visualization-assisted intermuscular CEOL offers advantages in reducing surgical trauma, improving surgical precision, and lowering the postoperative complication rate in the treatment of CSCIWFD.

Objective:To analyze the clinical efficacy of asymmetric T 1 transpedicular wedge resection Smith-Petersen osteotomy (T 1 SPO) in the treatment of stiff cervical thoracic lateral kyphosis deformity. Methods:This is a retrospective case series study. The clinical data of nine patients with stiff cervical thoracic kyphosis who underwent asymmetric T 1 SPO corrective treatment from June 2012 to October 2022 were collected. There were 7 males and 2 females, aged 45 to 68 years. The surgery time, intraoperative blood loss, and complications were recorded. The chin brow vertical angle (CBVA), cervical thoracic kyphosis Cobb angle, cervical thoracic scoliosis Cobb angle, and cervical thoracic sagittal axis (C 2-T 1 sagittal vertical axis, SVA) before surgery, after surgery, and at the last follow-up were measured and the correction rates were calculate. Results:All 9 patients successfully completed the surgery. The operation time ranged from 245 to 320 minutes, and the intraoperative blood loss was 1 400 to 2 200 ml. All patients were followed up for 24 to 48 months. The preoperative CBVA was 93.7° to 112.0°, which improved to 25.2° to 31.7° at the last follow-up, with an correction rate of 73.4%. The preoperative cervicothoracic kyphosis Cobb angle was -57.0° to -16.6°, which improved to 10.3° to 18.5° at the last follow-up, with an correction rate of 166.7%. The preoperative scoliosis Cobb angle was 13.0° to 16.5°, which improved to 2.2° to 3.8° at the last follow-up, with an correction rate of 84.9%. The preoperative SVA was 7.8 to 12.5 cm, which improved to 4.5 to 6.8 cm at the last follow-up, with an correction rate of 42.3%. One patient experienced numbness and weakness in the left hand after surgery, which recovered after 3 months. One patient had poor healing of the surgical incision, which healed after symptomatic treatment. During the follow-up, the coronal and sagittal balance of all patients was maintained, and no other neurological complications occurred. There were no cases of screw loosening, broken screws, or broken rods, or other internal fixation failures.Conclusion:The application of asymmetric T 1 SPO technique in the treatment of stiff cervical thoracic lateral kyphosis deformity can achieve relatively satisfactory correction effects.

Objective:To compare the efficacy of O-arm navigation-assisted and conventional posterior cervical expansive open-door laminoplasty (CEOL) via the intermuscular approach in the treatment of cervical spinal cord injury without fracture-dislocation (CSCIWFD).Methods:A prospective cohort study was conducted to analyze the clinical data of 60 CSCIWFD patients who were admitted to Zhengzhou Orthopedic Hospital from May 2021 to May 2023, with compression at C3-C6. Patients were randomly divided into two groups: 30 patients underwent O-arm navigation-assisted intermuscular approach CEOL (navigation-assisted group) and 30 patients underwent conventional intermuscular approach CEOL (conventional surgery group). Surgical duration, intraoperative blood loss, postoperative drainage volume, and total surgical blood loss were compared between the two groups. At 2 weeks postoperatively, CT scan was performed to evaluate the accuracy of hinge or open-door position preparation of the surgical segments. Visual analogue scale (VAS) for neck and shoulder pain and Japanese Orthopedic Association (JOA) scores were compared between the two groups preoperatively, at 2 weeks, 6 months postoperatively, and at the last follow-up. Complication rates were also evaluated.Results:A total of 60 patients with CSCIWFD were included, comprising 35 males and 25 females, aged 35-77 years [(50.9±8.6)years]. All the patients were followed up for 12-24 months [(16.9±3.1)months]. The surgical duration and intraoperative blood loss were (121.6±17.9)minutes and (144.7±44.2)ml in the navigation-assisted group, shorter or less than (132.3±14.6)minutes and (178.7±48.7)ml in the conventional surgery group ( P<0.05). There were no statistically significant differences in postoperative drainage volume and total surgical blood loss between the two groups ( P>0.05). CT scan reviewed at 2 weeks postoperatively revealed that the accuracy rate of hinge and open-door position preparation of the surgical segments in the navigation-assisted group was 99.2% (119/120), significantly higher than 86.7% (104/120) in the conventional surgery group ( P<0.01). Before operation and at 2 weeks, 6 months postoperatively, and at the last follow-up, the VAS scores for neck and shoulder pain and JOA scores in the navigation-assisted group were 5.0(4.0, 7.0)points and (8.7±2.8)points, 3.0(2.0, 4.0)points and (10.2±2.5)points, 2.0(1.0, 2.0)points and (1 3.0±1.8)points, and 1.0(1.0, 2.0)points and (13.9±1.5)points respectively, while in the conventional surgery group, the VAS scores and JOA scores were 5.5(5.0, 6.3)points and (8.8±2.6)points, 4.0(3.0, 4.0)points and (10.4±2.5)points, 2.0(1.0, 3.0)points and (12.9±2.2)points, and 2.0(1.0, 2.0)points and (13.8±2.0)points ( P>0.05). Both groups showed improvement in neck and shoulder VAS scores and JOA scores at 2 weeks, 6 months postoperatively, and at the last follow-up, compared to preoperative scores ( P<0.05); further improvement was observed at 6 months postoperatively and at the last follow-up compared to that at 2 weeks postoperatively ( P<0.05). There were no significant differences between neck and shoulder VAS scores or JOA scores at 6 months postoperatively and at the last follow-up ( P>0.05). In the navigation-assisted group, 2 patients had axial neck-shoulder pain postoperatively, with a complication rate of 7% (2/30); while in the conventional surgery group, 7 patients had axial neck-shoulder pain and one patient developed cerebrospinal fluid leakage and low-pressure headache, with a complication rate of 27% (8/30) ( P<0.05). Conclusion:Compared to the conventional intermuscular approach, O-arm navigation-assisted intermuscular approach CEOL for CSCIWFD reduces surgical duration and intraoperative blood loss, improves the accuracy of hinge and open-door position preparation, and lowers complication rates.

Objective:To compare the efficacy of O-arm navigation-assisted and conventional posterior cervical expansive open-door laminoplasty (CEOL) via the intermuscular approach in the treatment of cervical spinal cord injury without fracture-dislocation (CSCIWFD).Methods:A prospective cohort study was conducted to analyze the clinical data of 60 CSCIWFD patients who were admitted to Zhengzhou Orthopedic Hospital from May 2021 to May 2023, with compression at C3-C6. Patients were randomly divided into two groups: 30 patients underwent O-arm navigation-assisted intermuscular approach CEOL (navigation-assisted group) and 30 patients underwent conventional intermuscular approach CEOL (conventional surgery group). Surgical duration, intraoperative blood loss, postoperative drainage volume, and total surgical blood loss were compared between the two groups. At 2 weeks postoperatively, CT scan was performed to evaluate the accuracy of hinge or open-door position preparation of the surgical segments. Visual analogue scale (VAS) for neck and shoulder pain and Japanese Orthopedic Association (JOA) scores were compared between the two groups preoperatively, at 2 weeks, 6 months postoperatively, and at the last follow-up. Complication rates were also evaluated.Results:A total of 60 patients with CSCIWFD were included, comprising 35 males and 25 females, aged 35-77 years [(50.9±8.6)years]. All the patients were followed up for 12-24 months [(16.9±3.1)months]. The surgical duration and intraoperative blood loss were (121.6±17.9)minutes and (144.7±44.2)ml in the navigation-assisted group, shorter or less than (132.3±14.6)minutes and (178.7±48.7)ml in the conventional surgery group ( P<0.05). There were no statistically significant differences in postoperative drainage volume and total surgical blood loss between the two groups ( P>0.05). CT scan reviewed at 2 weeks postoperatively revealed that the accuracy rate of hinge and open-door position preparation of the surgical segments in the navigation-assisted group was 99.2% (119/120), significantly higher than 86.7% (104/120) in the conventional surgery group ( P<0.01). Before operation and at 2 weeks, 6 months postoperatively, and at the last follow-up, the VAS scores for neck and shoulder pain and JOA scores in the navigation-assisted group were 5.0(4.0, 7.0)points and (8.7±2.8)points, 3.0(2.0, 4.0)points and (10.2±2.5)points, 2.0(1.0, 2.0)points and (1 3.0±1.8)points, and 1.0(1.0, 2.0)points and (13.9±1.5)points respectively, while in the conventional surgery group, the VAS scores and JOA scores were 5.5(5.0, 6.3)points and (8.8±2.6)points, 4.0(3.0, 4.0)points and (10.4±2.5)points, 2.0(1.0, 3.0)points and (12.9±2.2)points, and 2.0(1.0, 2.0)points and (13.8±2.0)points ( P>0.05). Both groups showed improvement in neck and shoulder VAS scores and JOA scores at 2 weeks, 6 months postoperatively, and at the last follow-up, compared to preoperative scores ( P<0.05); further improvement was observed at 6 months postoperatively and at the last follow-up compared to that at 2 weeks postoperatively ( P<0.05). There were no significant differences between neck and shoulder VAS scores or JOA scores at 6 months postoperatively and at the last follow-up ( P>0.05). In the navigation-assisted group, 2 patients had axial neck-shoulder pain postoperatively, with a complication rate of 7% (2/30); while in the conventional surgery group, 7 patients had axial neck-shoulder pain and one patient developed cerebrospinal fluid leakage and low-pressure headache, with a complication rate of 27% (8/30) ( P<0.05). Conclusion:Compared to the conventional intermuscular approach, O-arm navigation-assisted intermuscular approach CEOL for CSCIWFD reduces surgical duration and intraoperative blood loss, improves the accuracy of hinge and open-door position preparation, and lowers complication rates.

Objective:To compare the efficacy of O-arm navigation versus C-arm guidance for anterior internal fixation in the management of Anderson-D′Alonzo type II odontoid fractures.Methods:A retrospective cohort study was conducted to analyze the clinical data of 58 patients with Anderson-D′Alonzo type II odontoid fractures admitted to Zhengzhou Orthopedic Hospital between January 2017 and September 2024, including 35 males and 23 females, aged 18-57 years [(39.3±9.0)years]. Anderson-D′Alonzo type II fractures were further classified as type IIA in 25 patients and type IIB in 33. Twenty-seven patients underwent O-arm assisted anterior internal fixation (O-arm navigation group), while 31 received C-arm guided anterior internal fixation (C-arm guidance group). The two groups were compared in terms of the operative duration, intraoperative blood loss, success rate for one-time guidewire placement, and intraoperative radiation exposure (anteroposterior and lateral views). At 3 days postoperatively, screw placement accuracy was evaluated via CT in both groups. Additionally, neck disability index (NDI) and visual analogue scale (VAS) scores were assessed preoperatively, at 1 week, 3 months postoperatively, and at the last follow-up. Bone union time and complication rate were also analyzed.Results:All the patients were followed up for 6-20 months [(13.1±3.4)months]. The O-arm navigation group exhibited significantly shorter operative duration [(91.1± 8.9)minutes] and less intraoperative blood loss [(38.9±8.2)ml], compared with (103.3±14.5)minutes and (47.3±9.1)ml in the C-arm guidance group ( P<0.01). The success rate for one-time guidewire placement was 100% (27/27) in the O-arm navigation group, significantly higher than 52% (16/31) in the C-arm guidance group ( P<0.01). Intraoperative radiation exposure for patients in the O-arm navigation group was lower in both anteroposterior view [(11 612.6±1 603.6)μSv] and lateral views [(29 738.2±6 602.5)μSv], compared with (40 638.0±9 431.9)μSv and (47 152.0±11 759.3)μSv in the C-arm guidance group ( P<0.01). CT scans at 3 days postoperatively revealed a 100% (27/27) screw placement accuracy in the O-arm navigation group, compared with 65% (20/31) in the C-arm guidance group ( P<0.01). Before operation, at 1 weeks and 3 months postoperatively, and at the last follow-up, NDI scores were (48.4±7.8)%, (21.0±3.1)%, (14.4±2.4)%, and (13.9±2.3)% in the O-arm navigation group, while they were (47.4±7.6)%, (20.9±3.2)%, (14.1±2.0)%, and (13.8±1.4)% in the C-arm guidance group ( P>0.05); VAS scores were 6.0(6.0, 7.0)points, 4.0(3.0, 4.0)points, 2.0(1.0, 2.0)points, and 2.0(1.0, 2.0)points in the O-arm navigation group, while they were 7.0(6.0, 7.0)points, 4.0(3.0, 5.0)points, 2.0(1.0, 3.0)points, and 2.0(2.0, 2.0)points in the C-arm guidance group ( P>0.05). The NDI and VAS scores in both groups were significantly improved at 1 weeks and 3 months postoperatively, and at the last follow-up compared to those preoperatively ( P<0.05), and were furtherly improved at 3 months postoperatively and at the last follow-up compared to those at 1 weeks postoperatively ( P<0.05), with no significant differences between those at 3 months postoperatively and at the last follow-up ( P>0.05). No significant difference was found in bone union time between the two groups ( P>0.05). The complication rate in the O-arm navigation group was 4% (1/27), lower than 29% (9/31) in the C-arm guidance group ( P<0.05). Conclusions:Compared with C-arm guidance, O-arm assisted anterior internal fixation for Anderson-D′Alonzo type II odontoid fractures can reduce operative duration and intraoperative blood loss, improve the success rate for one-time guidewire placement and screw accuracy, and decrease radiation exposure and complication rate.

Objective:To compare the efficacy of whole-process visualization system-assisted pedicle screw internal fixation and free-hand pedicle screw internal fixation in the treatment of thoracolumbar burst fracture (TLBF) without neurologic symptoms.Methods:A retrospective cohort study was conducted to analyze the clinical data of 64 patients with TLBF without neurologic symptoms admitted to Zhengzhou Orthopedic Hospital from December 2020 to October 2022, including 41 males and 23 females, aged 23-52 years [(42.1±6.6)years]. The injured vertebrae involved T 11 in 26 patients, T 12 in 17, L 1 in 12, and L 2 in 9. The Wiltse approach was used in all the patients, 31 of whom were treated with pedicle screw internal fixation assisted by the whole-process visualization system (visualization system-assisted screw placement group) and 33 of whom were treated with free-hand pedicle screw internal fixation (free-hand screw placement group). The two groups were compared in terms of operation time, single screw placement time, intraoperative blood loss, intraoperative total radiation dose and total length of hospital stay. The accuracy of pedicle screw placement and penetration rate of the pedicle cortex were evaluated in the two groups. The Cobb angle and lumbar visual analogue scale (VAS) before surgery, at 1 week, 3 months after surgery and at the last follow-up were compared between the two groups. The incidence of postoperative complications was also investigated. Results:All the patients were followed up for 10-33 months [(17.5±4.8)months]. The operation time was (106.9±11.8)minutes in the visualization system-assisted screw placement group, shorter than (121.3±11.4)minutes in the free-hand screw placement group ( P<0.01). The single screw placement time was (9.1±1.0)minutes in the visualization system-assisted screw placement group, shorter than (11.7±1.5)minutes in the free-hand screw placement group ( P<0.01). The total radiation dose was (10.4±2.4)mGy in the visualization system-assisted screw placement group, lower than (51.8±7.2)mGy in the screw placement group ( P<0.01). There was no significant difference in intraoperative blood loss or total length of hospital stay between the two groups ( P>0.05). The accuracy of pedicle screw placement was 96.6% (197/204) in the visualization system-assisted screw placement group, significantly higher than 89.3% (191/214) in the free-hand screw placement group ( P<0.01). Both groups showed significant improvements in Cobb angle and VAS scores at 1 week, 3 months after surgery, and at the last follow-up ( P<0.05). There were no significant differences in Cobb angle or VAS scores between the two groups at each time point ( P>0.05). In the visualization system-assisted screw placement group, one patient had incision infection at 4 days after operation, which was cured with antibiotics. One patient in the free-hand screw placement group developed the symptoms of nerve root irritation at 2 days after surgery, which disappeared at 7 days after revision. There was no significant difference in the incidence of complications between the two groups ( P>0.05). During the follow-up, no patients had broken screws, loosening of internal fixation, or loss of correction in either group. Conclusions:Compared with free-hand pedicle screw internal fixation, the whole-process visualization system-assisted pedicle screw internal fixation in the treatment of TLBF without neurologic symptoms can shorten the time of operation and screw placement, reduce the radiation dose, and improve the accuracy of pedicle screw placement, suggesting that it is a safer and more effective auxiliary method for pedicle screw placement.

Objective:To compare the efficacy of three-dimensional visualization-assisted intermuscular versus conventional intermuscular cervical expansive open-door laminoplasty (CEOL) in the treatment of cervical spinal cord injury without fracture or dislocation (CSCIWFD).Methods:A retrospective cohort study was conducted to analyze the clinical data of 58 patients with CSCIWFD admitted to Zhengzhou Orthopedic Hospital from October 2021 to January 2024, including 39 males and 19 females, aged 36-77 years [(52.9±8.9)years]. Among them, 26 patients were treated with three-dimensional visualization-assisted intermuscular CEOL (three-dimensional visualization group), while 32 patients were treated with conventional intermuscular CEOL (conventional intermuscular group). All patients were treated with CEOL in 4 segments (C 3-C 6), comprising 104 surgical segments in the three-dimensional visualization group and 128 in the conventional intermuscular group. The following outcomes were compared between the two groups, including the operative duration, intraoperative blood loss, accuracy rate of open-door and hinge placement at the surgical levels, visual analogue scale (VAS) of the neck and shoulder and Japanese Orthopedic Association (JOA) score preoperatively, at 1 week, 1 month, 3 months, 6 months postoperatively and at the last follow-up, American Spinal Injury Association (ASIA) impairment scale preoperatively and at the last follow-up, and postoperative complication rate. Results:All patients were followed up for 12-24 months [(17.5±3.1)months]. The operative duration and intraoperative blood loss were (117.0±12.3)minutes and (151.3±30.9)ml in the three-dimensional visualization group, which were shorter or less than (131.9±15.0)minutes and (184.7±42.9)ml in the conventional intermuscular group ( P<0.01). The accuracy rate of open-door and hinge placement at the surgical levels was 94.2% (98/104) in the three-dimensional visualization group, significantly higher than 83.6% (107/128) in the conventional intermuscular group ( P<0.05). The VAS scores of the neck and shoulder preoperatively, at 1 week, 1 month, 3 months, 6 months postoperatively, and at the last follow-up were 6.0(5.0, 7.0)points, 3.5(3.0, 4.0)points, 3.0(2.0, 3.0)points, 2.0(1.0, 3.0)points, 2.0(1.0, 2.3)points, and 2.0(1.0, 2.0)points in the three-dimensional visualization group, which were not statistically different from 5.0(4.3, 6.8)points, 4.0(3.0, 4.0)points, 3.0(2.0, 3.0)points, 2.0(1.3, 2.0)points, 2.0(1.0, 2.8)points, and 2.0(1.0, 2.0)points in the conventional intermuscular group ( P>0.05). The VAS scores of the neck and shoulder in the two groups were significantly decreased at 1 week, 1 month and 3 months postoperatively from the preoperative values ( P<0.05), while they were stabilized at 6 months postoperatively and at the last follow-up compared with those at 3 months postoperatively, with no significant difference among them ( P>0.05). The JOA scores were (8.1±2.8)points, (10.0±2.6)points, (10.5±2.6)points, (11.6±2.3)points, (12.7±2.3)points, and (13.7±2.4)points in the three-dimensional visualization group, which were not statistically different from (8.8±2.2)points, (10.3±2.1)points, (10.8±2.0)points, (12.0±2.0)points, (12.9±2.0)points, and (13.8±2.1)points in the conventional intermuscular group ( P>0.05). The JOA scores of the two groups showed continuous improvement at 1 week, 1 month, 3 months, 6 months postoperatively and at the last follow-up in comparison with the preoperatively values ( P<0.05). Although no significant difference was observed between the two groups in ASIA grade preoperatively and at the last follow-up ( P>0.05), the ASIA grade at the last follow-up was significantly improved compared with that before surgery in both groups ( P<0.05). The postoperative complication rate was 12% (3/26) in the three-dimensional visualization group, significantly lower than 38% (12/32) in the conventional intermuscular group ( P<0.05). Conclusion:Compared with the conventional intermuscular approach, the three-dimensional visualization-assisted intermuscular CEOL offers advantages in reducing surgical trauma, improving surgical precision, and lowering the postoperative complication rate in the treatment of CSCIWFD.