Objective:To investigate the relationship between sagittal position parameters and screw loosening after unilateral biportal endoscopic (UBE) combined with percutaneous pedicle screw fixation for single-segment lumbar spinal stenosis.Methods:A total of 180 patients with single-level lumbar spinal stenosis who received UBE combined with percutaneous pedicle screw internal fixation in our hospital from June 2020 to June 2023 were enrolled. According to the postoperative follow-up, they were divided into the non-loosening group (112 cases) and the loosening group (68 cases). The demographics, operative parameters and sagittal position [pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), sagittal vertical axis (SVA)] before and after operation were compared between the two groups. The indicators with significant differences between the two groups were included in the multivariate logistic regression analysis to analyze the influencing factors of screw loosening. The dose-response relationship between sagittal position parameters and screw loosening was analyzed by restricted cubic spline model.Results:At 6 months and 1 year postoperatively, the fusion rates in the loosening group were 47.1% and 55.9%, respectively, which were significantly lower than the rates (85.7% and 100.0%) in the non-loosening group, respectively ( P<0.05). Postoperatively, the SS in the non-loosening group (36.16°±5.35°) and the loosening group (32.02°±5.54°) and the LL in the loosening group (51.26°±6.35°) were all significantly lower than preoperative values (40.51°±6.11°, 40.49°±6.08°, and 54.08°±6.21°) ( P<0.05). Meanwhile, the PT in the non-loosening group (15.24°±2.69°), TK in the non-loosening group (32.46°±7.29°), PI in the loosening group (56.82°±5.23°), PT in the loosening group (17.01°±3.64°), and TK in the loosening group (34.87°±7.21°) were all significantly higher than preoperative values (13.12°±3.19°, 30.25°±5.17°, 52.84°±5.12°, 13.15°±3.21°, and 30.26°±5.12°) ( P<0.05). Postoperatively, the loosening group had significantly lower SS (32.02°±5.54°), LL (51.26°±6.35°), and SVA (-0.87±1.06 cm) than the non-loosening group (36.16°±5.35°, 53.73°±6.27°, and -0.51±1.04 cm), respectively ( P<0.05). Conversely, the PI (56.82°±5.23°), PT (17.01°±3.64°), and TK (34.87°±7.21°) in the loosening group were significantly higher than those in the non-loosening group (53.48°±5.20°, 15.24°±2.69°, and 32.46°±7.29°), respectively ( P<0.05). Binary logistic regression analysis indicated that PT, SS, LL, and SVA were independent risk factors for screw loosening ( P<0.05). The restricted cubic spline model revealed a nonlinear dose-response relationship between sagittal parameters (PT, SS, LL, and SVA) and screw loosening ( P<0.05). With increasing PT, the odds ratio (OR) for screw loosening increased, whereas increasing SS, LL, and SVA reduced the OR for screw loosening. Conclusion:After UBE combined with percutaneous pedicle screw fixation in single-level lumbar spinal stenosis patients, sagittal position parameters PT were positively correlated with screw loosening, while SS, LL and SVA were negatively correlated with screw loosening.

Objectives:To explore the relationship between preoperative spinal-pelvic sagittal sequence and postoperative recurrence after unilateral biportal endoscopic(UBE)spinal surgery in patients with lumbar disc herniation of different ages.Methods:200 patients with lumbar disc herniation who underwent UBE surgery in our hospital from December 2018 to October 2022 were selected as the study subjects.They were divided into two groups according to ages:94 patients under 45 years old were included in the young and middle-aged group,and 106 patients at 45 years old and over were included in the middle-aged and elderly group.The spinal-pelvic sagittal sequence parameters,including thoracic kyphosis(TK),pelvic incidence(PI),pelvic tilt(PT),lumbar lordosis(LL),sacral slope(SS),were measured on preoperative lateral X-ray films of the entire spine.The relationship between spinal-pelvic sagittal parameters and age was studied using Pearson analysis.After discharge,the patients were followed up for 2 years and divided into a recurrent group(n=33)and a non-recurrent group(n=167)based on the recurrence condition during the follow-up period.Multivariate logis-tic regression analysis was conducted to identify the influencing factors of recurrence.The receiver operating characteristic curve(ROC)was adopted to evaluate the predictive value of spinal-pelvic sagittal parameters for recurrence;And the area under the ROC curve(AUC)was determined,and the 95％confidence interval(CI)was calculated.Results:The LL,PI,PT,and SS of the middle-aged and elderly group were lower than those of the young and middle-aged group(t=5.960,2.163,2.245,2.296,P＜0.05).Pearson analysis showed that LL,PI,PT,and SS were negatively correlated with age(r=-0.67,-0.72,-0.65,-0.63,P＜0.001).The proportion of patients aged ≥45 years and with a annulus fibrosus rupture＞5mm in the recurrent group was higher than that in the non-recurrent group,while LL,PI,and SS were lower than those in the non-recurrent group(P＜0.05).Multivariate logistic regression analysis showed that age ≥45 years old was an independent risk factor for recurrence(OR=2.694,95％CI:2.231-2.945,P＜0.05),while elevated LL(OR=0.623,95％CI:0.435-0.895,P＜0.05)and elevated SS were protective factors for recurrence(OR=0.687,95％CI:0.412-0.738,P＜0.05).The ROC curve results showed that the AUC for predicting patient recurrence using LL and SS were 0.743(95％CI:0.670-0.856)and 0.754(95％CI:0.669-0.872),respectively.The AUC for predicting patient recurrence us-ing both methods was 0.852(95％CI:0.769-0.903).Conclusions:The parameters of the spinal-pelvic sagittal sequence are closely related to age and postoperative recurrence risk.Age ≥45 years is an independent risk factor for postoperative recurrence,while higher LL and SS are protective factors.Preoperative evaluation of spinal-pelvic sagittal sequence,especially LL and SS,can help identify high-risk populations for UBE postop-erative recurrence and provide important references for individualized surgical strategies.

Objective:To investigate the relationship between sagittal position parameters and screw loosening after unilateral biportal endoscopic (UBE) combined with percutaneous pedicle screw fixation for single-segment lumbar spinal stenosis.Methods:A total of 180 patients with single-level lumbar spinal stenosis who received UBE combined with percutaneous pedicle screw internal fixation in our hospital from June 2020 to June 2023 were enrolled. According to the postoperative follow-up, they were divided into the non-loosening group (112 cases) and the loosening group (68 cases). The demographics, operative parameters and sagittal position [pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), sagittal vertical axis (SVA)] before and after operation were compared between the two groups. The indicators with significant differences between the two groups were included in the multivariate logistic regression analysis to analyze the influencing factors of screw loosening. The dose-response relationship between sagittal position parameters and screw loosening was analyzed by restricted cubic spline model.Results:At 6 months and 1 year postoperatively, the fusion rates in the loosening group were 47.1% and 55.9%, respectively, which were significantly lower than the rates (85.7% and 100.0%) in the non-loosening group, respectively ( P<0.05). Postoperatively, the SS in the non-loosening group (36.16°±5.35°) and the loosening group (32.02°±5.54°) and the LL in the loosening group (51.26°±6.35°) were all significantly lower than preoperative values (40.51°±6.11°, 40.49°±6.08°, and 54.08°±6.21°) ( P<0.05). Meanwhile, the PT in the non-loosening group (15.24°±2.69°), TK in the non-loosening group (32.46°±7.29°), PI in the loosening group (56.82°±5.23°), PT in the loosening group (17.01°±3.64°), and TK in the loosening group (34.87°±7.21°) were all significantly higher than preoperative values (13.12°±3.19°, 30.25°±5.17°, 52.84°±5.12°, 13.15°±3.21°, and 30.26°±5.12°) ( P<0.05). Postoperatively, the loosening group had significantly lower SS (32.02°±5.54°), LL (51.26°±6.35°), and SVA (-0.87±1.06 cm) than the non-loosening group (36.16°±5.35°, 53.73°±6.27°, and -0.51±1.04 cm), respectively ( P<0.05). Conversely, the PI (56.82°±5.23°), PT (17.01°±3.64°), and TK (34.87°±7.21°) in the loosening group were significantly higher than those in the non-loosening group (53.48°±5.20°, 15.24°±2.69°, and 32.46°±7.29°), respectively ( P<0.05). Binary logistic regression analysis indicated that PT, SS, LL, and SVA were independent risk factors for screw loosening ( P<0.05). The restricted cubic spline model revealed a nonlinear dose-response relationship between sagittal parameters (PT, SS, LL, and SVA) and screw loosening ( P<0.05). With increasing PT, the odds ratio (OR) for screw loosening increased, whereas increasing SS, LL, and SVA reduced the OR for screw loosening. Conclusion:After UBE combined with percutaneous pedicle screw fixation in single-level lumbar spinal stenosis patients, sagittal position parameters PT were positively correlated with screw loosening, while SS, LL and SVA were negatively correlated with screw loosening.

Objectives:To explore the relationship between preoperative spinal-pelvic sagittal sequence and postoperative recurrence after unilateral biportal endoscopic(UBE)spinal surgery in patients with lumbar disc herniation of different ages.Methods:200 patients with lumbar disc herniation who underwent UBE surgery in our hospital from December 2018 to October 2022 were selected as the study subjects.They were divided into two groups according to ages:94 patients under 45 years old were included in the young and middle-aged group,and 106 patients at 45 years old and over were included in the middle-aged and elderly group.The spinal-pelvic sagittal sequence parameters,including thoracic kyphosis(TK),pelvic incidence(PI),pelvic tilt(PT),lumbar lordosis(LL),sacral slope(SS),were measured on preoperative lateral X-ray films of the entire spine.The relationship between spinal-pelvic sagittal parameters and age was studied using Pearson analysis.After discharge,the patients were followed up for 2 years and divided into a recurrent group(n=33)and a non-recurrent group(n=167)based on the recurrence condition during the follow-up period.Multivariate logis-tic regression analysis was conducted to identify the influencing factors of recurrence.The receiver operating characteristic curve(ROC)was adopted to evaluate the predictive value of spinal-pelvic sagittal parameters for recurrence;And the area under the ROC curve(AUC)was determined,and the 95％confidence interval(CI)was calculated.Results:The LL,PI,PT,and SS of the middle-aged and elderly group were lower than those of the young and middle-aged group(t=5.960,2.163,2.245,2.296,P＜0.05).Pearson analysis showed that LL,PI,PT,and SS were negatively correlated with age(r=-0.67,-0.72,-0.65,-0.63,P＜0.001).The proportion of patients aged ≥45 years and with a annulus fibrosus rupture＞5mm in the recurrent group was higher than that in the non-recurrent group,while LL,PI,and SS were lower than those in the non-recurrent group(P＜0.05).Multivariate logistic regression analysis showed that age ≥45 years old was an independent risk factor for recurrence(OR=2.694,95％CI:2.231-2.945,P＜0.05),while elevated LL(OR=0.623,95％CI:0.435-0.895,P＜0.05)and elevated SS were protective factors for recurrence(OR=0.687,95％CI:0.412-0.738,P＜0.05).The ROC curve results showed that the AUC for predicting patient recurrence using LL and SS were 0.743(95％CI:0.670-0.856)and 0.754(95％CI:0.669-0.872),respectively.The AUC for predicting patient recurrence us-ing both methods was 0.852(95％CI:0.769-0.903).Conclusions:The parameters of the spinal-pelvic sagittal sequence are closely related to age and postoperative recurrence risk.Age ≥45 years is an independent risk factor for postoperative recurrence,while higher LL and SS are protective factors.Preoperative evaluation of spinal-pelvic sagittal sequence,especially LL and SS,can help identify high-risk populations for UBE postop-erative recurrence and provide important references for individualized surgical strategies.

[Objective] To analyze the clinical curative effect of 20G and 23G vitrectomy for posterior segment intraocular foreign bodies,to explore the differences of their efficacy and safety.[Methods] This was a retrospective case study.Select 71 patients (71 eyes) who suffered from posterior segment intraocular foreign bodies and underwent different ways of vitrectomy,according to the way of vitrectomy,the patients were enrolled into 20G vitrectomy group (20G group,37 patients,37 eyes) and 23G vitrectomy group (23G group,34 patients,34 eyes).All patients were given wound suture,and patients complicated traumatic cataract should underwent cataract surgery;then were given 20G/23G vitrectomy and extraction of intraction foreign bodies,and (or) be given retinal laser photocoagulation,cryocoagulation,and endotamponade during the procedure.Extraction of intraction foreign bodies and the location of retinal,surgical time,postoperative inflammation and stimulus syndrome,length of hospital stay,the best corrected acuity (BCVA) and other complications after surgery were registered.Minimum follow-up was 6 months.[Results] The rate of extraction of intraction foreign bodies and early retinal reattachment rate were 100％ of the two groups.Comparing the complications after surgery between the two groups,the differences had no statistical significance (all P ＞ 0.05) except the incidence of postoperative ocular hypotenison.The significant difference was found in the comparison of surgical time,average hospitalizcd days,postoperative inflammation score and stimulus syndrome between the two groups,and there were significant differences when the vision distribution before and after surgery in two groups were self-compared (P ＜ 0.05).At lastest follow up,the differences had no statistical significance when comparing the cases of unplanned surgical reoperation,the location of retinal and the vision distribution between the two groups (P ＞ 0.05).[Conclusion] 20G and 23G vitrectomy are both safely and effectively performed in patients with posterior segment intraocular foreign bodies,the efficacy and safety of them are comparable.There is higher incidence of postoperative ocular hypotension in 23G group,and it has an ascendant than 20G group in shorter surgical time and length of hospital stay,lighter postoperative inflamnation and stimulus syndrome.