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Wang Y, Maimaiti A, Xiao Y, Tuoheti A, Zhang R, Maitusong M, Chen Q, Rexiti P. Hybrid cortical bone trajectory and modified cortical bone trajectory techniques in transforaminal lumbar interbody fusion at L4-L5 segment: A finite element analysis. Heliyon 2024; 10:e26294. [PMID: 38434416 PMCID: PMC10906328 DOI: 10.1016/j.heliyon.2024.e26294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/03/2024] [Accepted: 02/09/2024] [Indexed: 03/05/2024] Open
Abstract
Background The academia has increasingly acknowledged the superior biomechanical performance of the hybrid fixation technique in recent years. However, there is a lack of research on the hybrid fixation technique using BCS (Bilateral Cortical Screws) and BMCS (Bilateral Modified Cortical Screws). This study aims to investigate the biomechanical performance of the BCS and BMCS hybrid fixation technique in transforaminal lumbar interbody fusion (TLIF) at the L4-L5 segment in a complete lumbar-sacral finite element model. Methods Three cadaver specimens are used to construct three lumbar-sacral finite element models. The biomechanical properties of various fixation technologies (BCS-BCS, BMCS-BMCS, BMCS-BCS, and BCS-BMCS) are evaluated at the L4-5 segment with a TLIF procedure conducted, including the range of motion (ROM) of the L4-5 segment, as well as the stress experienced by the cage, screws, and rods. The testing is conducted under specific loading conditions, including a compressive load of 400 N and a torque of 7.5Nm, subjecting the model to simulate flexion, extension, lateral bending, and rotation. Results No significant variations are seen in the ROM at the L4-5 segment when comparing the four fixation procedures during flexion and extension. However, when it comes to lateral bending and rotation, the ROM is ordered in descending order as BCS-BCS, BCS-BMCS, BMCS-BMCS, and BMCS-BCS. The maximum stress experienced by the cage is observed to be highest within the BMCS-BCS technique during movements including flexion, extension, and lateral bending. Conversely, the BMCS-BMCS technique exhibits the highest cage stress levels during rotational movements. The stress applies to the screws and rods order the sequence of BCS-BCS, BCS-BMCS, BMCS-BCS, and BMCS-BMCS throughout all four working conditions. Conclusion The BMCS-BCS technique shows better biomechanical performance with less ROM and lower stress on the internal fixation system compared to other fixation techniques. BMCS-BMCS technology has similar mechanical performance to BMCS-BCS but has more contact area between screws and cortical bone, making it better for patients with severe osteoporosis.
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Affiliation(s)
- Yixi Wang
- First Clinical Medical College, Xinjiang Medical University, Urumqi, China
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yang Xiao
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abudusalamu Tuoheti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Rui Zhang
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | | | - Qihao Chen
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Key Laboratory of High Incidence Disease Research in Xinjiang (Xinjiang Medical University), Ministry of Education, Urumqi, China
- Xinjiang Clinical Research Center for Orthopedics, Urumqi, China
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Wang Y, Maimaiti A, Tuoheti A, Xiao Y, Zhang R, Kahaer A, Liu D, Rexiti P. The Method of Portal Making in Lumbar Unilateral Biportal Endoscopic Surgery with Different Operative Approaches According to the Constant Anatomical Landmarks of the Lumbar Spine: A Review of the Literature. Global Spine J 2024:21925682241230465. [PMID: 38314556 DOI: 10.1177/21925682241230465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
STUDY DESIGN Review. OBJECTIVE Unilateral Biportal Endoscopy (UBE) is a minimally invasive surgery that is gaining recognition and being employed in clinical practice. Nevertheless, the precise method for determining UBE portals' location varies depending on the originator's preferences or the anatomical structure's proximity to the portal positions. Consequently, the relationship among UBE portals' locations is messy. This study aims to elaborate on the specific portal localization and explore the positional association and commonality among different UBE approaches' portals. METHODS The following keywords are used to search in the PubMed, Ovid, Web of Science, ScienceDirect, SpringerLink, Scopus, CNKI, and Wanfang database: "Biportal endoscopic spinal surgery", "Two portal endoscopic spinal surgery", "Percutaneous biportal endoscopic decompression", "Unilateral biportal endoscopy", "Irrigation endoscopic discectomy", "UBE" and "BESS". RESULTS After screening, 29 pieces of literature are included. The study summarizes different UBE approach portal localizations, categorized by fusion or non-fusion surgery and pathological classification. The study presents an inaugural method for categorizing the lumber into four surgical intervals based on bone landmarks and assigns different UBE approaches to the appropriate intervals based on their characteristics, making the selection of UBE surgical approaches' portal locations more flexible. Additionally, the study provides an overview of the indications, complications, and distinct benefits associated with each interval, further refining the novel UBE portal interval localization method. CONCLUSION The study clarifies the interrelationship and commonality between the portals of different UBE approaches and proposes a new UBE portal interval localization method to enhance surgeons' understanding and proficiency in UBE procedures.
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Affiliation(s)
- Yixi Wang
- First Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abudusalamu Tuoheti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yang Xiao
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Rui Zhang
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Alafate Kahaer
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Dongshan Liu
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Key Laboratory of High Incidence Disease Research in Xinjiang, Xinjiang Medical University, Urumqi, China
- Key Laboratory of High Incidence Disease Research in Xinjiang, Ministry of Education, Beijing, China
- Xinjiang Clinical Research Center for Orthopaedics, Science & Technology Department of Xinjiang Uygur Autonomous Region, Urumqi, China
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Tuoheti A, Xiao Y, Wang Y, Maimaiti A, Zhang R, Kahaer A, Tuoheti A, Wu X, Rexiti P. Biomechanical evaluation of modified and traditional cortical bone trajectory technique on adjacent segment degeneration in transforaminal lumbar interbody fusion-finite element analysis. BMC Musculoskelet Disord 2024; 25:7. [PMID: 38166794 PMCID: PMC10759649 DOI: 10.1186/s12891-023-07103-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVES Modified cortical bone trajectory (MCBT) technique was proposed by our team in previous studies, but its biomechanical properties at adjacent segments have not been discussed yet. Therefore, the purpose of this study is to investigate the biomechanical properties of modified cortical bone trajectory (MCBT) technique on adjacent segment degeneration (ASD) in transforaminal intradiscal lumbar disc fusion (TLIF) compare to traditional bone trajectory (TT) technique and cortical bone trajectory (CBT) technique. METHODS The four human cadaveric lumbar specimens were provided by the anatomy teaching and research department of Xinjiang Medical University and four intact finite element models of the L1-S1 segment were generated. For each of these, three transforaminal lumbar interbody fusion procedures with three different fixation techniques were reconstructed at the L4-L5 segment, as follows: TT-TT (TT at both L4 and L5 segments), CBT-CBT (CBT at both L4 and L5 segments), MCBT-MCBT (MCBT at both L4 and L5 segments). The range of motion and von Mises stress of the intervertebral disc of the L3-L4 and L5-S1 segments were recorded with a 400N compressive load and 7.5 Nm moments in flexion, extension, left-right bending, and left-right rotation. RESULTS The peak ROM of the L3-L4 segment in the MCBT-MCBT group was reduced by 10.5%, 6.1%, 12.2%, 4.1%, and 1.5% in flexion, extension, left-right bending, and left rotation compared to the TT-TT group and reduced by 1.8%, 5.5%, 10.0%, 12.8%, and 8.8% in flexion, left-right bending, and left-right rotation compared to the CBT-CBT group, respectively. The MCBT-MCBT group has the lowest peak ROM of the L3-L4 segment in flexion, left bending, and right rotation, the lowest peak ROM of the L5-S1 segment in extension and right rotation, and the lowest peak von Mises stress of the intervertebral disc at the L5-S1 segment in right rotation compared to the TT-TT and CBT-CBT group. In addition, the peak von Mises stress at the L3-L4 segment was lowest and more dispersed in all motions, the MCBT-MCBT group exhibited lower peak ROM of the L5-S1 segment in flexion, extension, and right rotation, and showed lower peak von Mises stress of the disc at the L5-S1 segment in flexion, extension, and right rotation compared with the TT-TT group. CONCLUSION The modified cortical bone trajectory technique may have a beneficial effect on reducing the incidence of ASD in the L4-L5 TLIF model compared to the traditional bone trajectory technique and cortical bone trajectory technique.
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Affiliation(s)
- Abudusalamu Tuoheti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yang Xiao
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yixi Wang
- Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Rui Zhang
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Alafate Kahaer
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | | | - Xianghui Wu
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
- Ministrv of Education, Key Laboratory of High Incidence Disease Research in Xingjiang (Xinjiang Medical University), Urumqi, China.
- Xinjiang Clinical Research Center for Orthopedics, Urumqi, China.
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Liu DS, Wang YX, Rexiti P. [Progress in minimally invasive surgery for adjacent segment disease after lumbar fusion]. Zhonghua Wai Ke Za Zhi 2023; 61:722-727. [PMID: 37400215 DOI: 10.3760/cma.j.cn112139-20230220-00074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
Adjacent segment disease (ASDis) is a common complication of posterior lumbar spine fusion and often requires surgical treatment. In the treatment of ASDis, percutaneous spinal endoscopy can be used for simple decompression without removal of the original internal fixation, or for posterior fixation and fusion under the scope or in combination with other access fixation and fusion techniques, with the advantages of less surgical trauma, less bleeding, and faster postoperative recovery. Traditional trajectory screw technique is one of the risk factors for adjacent segment degeneration because of its tendency to cause damage to the adjacent synovial joint during surgery. In contrast, the cortical tone trajectory (CBT) screw placement technique not only reduces the damage to the articular joint during the screw placement process, but also preserves the original internal fixation in the treatment of ASDis, which significantly reduces the surgical trauma. Secondly, the implantation of CBT screws with the aid of digital technologies such as three-dimentinal printed guides, CT navigation, and robotics allows for more precise "double nailing" of ASDis patients to complete the fusion of adjacent segments, and is a minimally invasive procedure to be considered for patients who meet the clinical indications for fusion. This article reviews the literature on the use of percutaneous spinal endoscopy and CBT in the surgical management of ASDis.
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Affiliation(s)
- D S Liu
- Department of Spinal Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Y X Wang
- Xinjiang Medical University, Urumqi 830054, China
| | - Paerhati Rexiti
- Department of Spinal Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
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Huang Y, Maimaiti A, Tian Y, Li Z, Kahaer A, Rexiti P. Biomechanical investigation of the hybrid lumbar fixation technique with traditional and cortical bone trajectories in transforaminal lumbar interbody fusion: finite element analysis. J Orthop Surg Res 2023; 18:549. [PMID: 37525283 PMCID: PMC10388474 DOI: 10.1186/s13018-023-04027-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE To compare the biomechanical performance of the hybrid lumbar fixation technique with the traditional and cortical bone trajectory techniques using the finite element method. METHODS Four adult wet lumbar spine specimens were provided by the Department of Anatomy and Research of Xinjiang Medical University, and four L1-S1 lumbar spine with transforaminal lumbar interbody fusion (TLIF) models at L4-L5 segment and four different fixation techniques were established: bilateral traditional trajectory screw fixation (TT-TT), bilateral cortical bone trajectory screw fixation (CBT-CBT), hybrid CBT-TT (CBT screws at L4 and TT screws at L5) and TT-CBT (TT screws at L4 and CBT screws at L5). The range of motion (ROM) of the L4-L5 segment, von Mises stress of cage, internal fixation, and rod were compared in flexion, extension, left and right bending, and left and right rotation. RESULTS Compared with the TT-TT group, the TT-CBT group exhibited lower ROM of L4-L5 segment, especially in left-sided bending; the CBT-TT group had the lowest ROM of L4-L5 segment in flexion and extension among the four fixation methods. Compared with the CBT-CBT group, the peak cage stress in the TT-CBT group was reduced by 9.9%, 18.1%, 21.5%, 23.3%, and 26.1% in flexion, left bending, right bending, left rotation, and right rotation conditions, respectively, but not statistically significant (P > 0.05). The peak stress of the internal fixation system in the TT-CBT group was significantly lower than the other three fixation methods in all five conditions except for extension, with a statistically significant difference between the CBT-TT and TT-CBT groups in the left rotation condition (P = 0.017). In addition, compared with the CBT-CBT group, the peak stress of the rod in the CBT-TT group decreased by 34.8%, 32.1%, 28.2%, 29.3%, and 43.0% under the six working conditions of flexion, extension, left bending, left rotation, and right rotation, respectively, but not statistically significant (P > 0.05). CONCLUSIONS Compared with the TT-TT and CBT-CBT fixation methods in TLIF, the hybrid lumbar fixation CBT-TT and TT-CBT techniques increase the biomechanical stability of the internal fixation structure of the lumbar fusion segment to a certain extent and provide a corresponding theoretical basis for further development in the clinic.
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Affiliation(s)
- Ying Huang
- Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | | | | | - Alafate Kahaer
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
- Key Laboratory of High Incidence Disease Research in Xingjiang (Xinjiang Medical University), Ministry of Education, Urumqi, China.
- Xinjiang Clinical Research Center for Orthopedics, Urumqi, China.
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Wang S, Aikeremu D, Kahaer A, Maimaiti A, Xiao Y, Tuoheti A, Zhang R, Maimaiti X, Guo H, Rexiti P. Anatomical and imaging measurements of the angle between the axis of the lumbar pedicle and lateral isthmus margin and its clinical significance. J Orthop Surg Res 2023; 18:509. [PMID: 37464385 DOI: 10.1186/s13018-023-03983-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND This study aims to explore the measurement of the angle between the axis of the pedicle and the lateral margin of the isthmus on the lumbar spine, and investigate its clinical significance. METHODS The angle was measured on 120 normal adults' X-ray and 25 dry anatomical specimens. 60 screws were placed by junior residents on 6 wet specimens through the freehand technique. 30 screws were placed on one side with their original experience. After learning the techniques mentioned in the study, 30 screws were placed on the other side. The specimens were examined by X-ray and CT, and the angles of the screw paths and the integrity of the pedicle were evaluated. RESULTS The angles of 120 subjects and 25 anatomical specimens show a gradually increasing trend. The differences among each segment were statistically significant (P < 0.05), but the difference in the same segment between the X-ray and the anatomical specimens was not statistically significant (P > 0.05). Furthermore, the differences in L1, L2, and L3 between the two genders were not statistically significant (P > 0.05). However, the angles were larger in female group than in male group in L4 and L5, and the differences were statistically significant (P < 0.05). The difference in the deviation rate of screw placement before and after the learning was statistically significant only in the L5 segment (P < 0.05). The difference in overall excellence rate was statistically significant (P < 0.05). CONCLUSIONS The measurement of the angle between the axis of the pedicle and the lateral margin of the isthmus on the lumbar can improve the accuracy of the lumbar sagittal screw angle.
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Affiliation(s)
- Shuiquan Wang
- Department of Anatomy, College of Basic Medicine, Xinjiang Medical University, Urumqi, China
| | - Dilimulati Aikeremu
- Department of 2nd Spine Surgery, People's Hospital of Xinjiang, Urumqi, China
| | - Alafate Kahaer
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maimaiti
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yang Xiao
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abudusalamu Tuoheti
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Rui Zhang
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xieraili Maimaiti
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hailong Guo
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
| | - Paerhati Rexiti
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
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Zhang R, Kahaer A, Niu H, Wang J, Jumahan A, Qiu Y, Rexiti P, Guo H. Correction: Biomechanical evaluation of the hybrid pedicle screw-cortical bone trajectory technique in transforaminal lumbar interbody fusion to adjacent segment degeneration-finite element analysis. BMC Musculoskelet Disord 2023; 24:555. [PMID: 37407970 DOI: 10.1186/s12891-023-06646-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Affiliation(s)
- Rui Zhang
- Second Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Alafate Kahaer
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, China
| | - Hanqian Niu
- Fifth Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Jingwen Wang
- Second Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Ayididaer Jumahan
- First Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Yanning Qiu
- First Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, China.
- Xinjiang Key Laboratory of High Incidence Disease Research, Xinjiang Medical University, Ministry of Education, Urumqi, China.
- Xinjiang Orthopedic Clinical Research Center, Urumqi, China.
| | - Hailong Guo
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, China.
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Wang Y, Kahaer A, Maimaiti A, Guo H, Rexiti P. Complication, fusion, and revision rate in the lumbar cortical bone trajectory and pedicle screw fixation techniques: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:382. [PMID: 37226223 DOI: 10.1186/s13018-023-03820-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/02/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND To obtain the complication rate, fusion rate, and revision rate of the lumbar cortical bone trajectory technique and pedicle screw fixation technique in lumbar interbody fusion surgery by single-arm meta-analysis and lay a basis for orthopedic surgeons to select the fixation techniques and perioperative management. METHODS PubMed, Ovid Medline, Web of Science, CNKI, and Wanfang databases were searched comprehensively. Data extraction, content analysis, and quality assessment of the literature were performed by two independent reviewers according to the Cochrane Collaboration guidelines using R and STATA software for single-arm meta-analysis. RESULTS The total complication rate of the lumbar cortical bone trajectory technique was 6%, including a hardware complication rate of 2%, ASD (adjacent segment degeneration) rate of 1%, wound infection rate of 1%, dural damage rate of 1%, hematoma rate tending to 0%, fusion rate of 94%, and revision rate of 1%. Lumbar pedicle screw fixation techniques had a total complication rate of 9%, with a hardware complication rate of 2%, ASD rate of 3%, wound infection rate of 2%, dural damage rate of 1%, hematoma rate tending to 0%, fusion rate of 94%, and revision rate of 5%. This study was registered with PROSPERO, CRD42022354550. CONCLUSION Lumbar cortical bone trajectory was associated with a lower total complication rate, ASD rate, wound infection rate, and revision rate than pedicle screw fixation. The cortical bone trajectory technique reduces the incidence of intraoperative and postoperative complications and can be an alternative in lumbar interbody fusion surgery.
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Affiliation(s)
- Yixi Wang
- First Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Alafate Kahaer
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hailong Guo
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
- Key Laboratory of High Incidence Disease Research in Xingjiang (Xinjiang Medical University), China Ministry of Education, Urumqi, China.
- Xinjiang Clinical Research Center for Orthopedics, Xinjiang Medical University, Urumqi, China.
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Zhang R, Kahaer A, Niu H, Wang J, Jumahan A, Qiu Y, Guo H, Rexiti P. Biomechanical evaluation of the hybrid pedicle screw-cortical bone trajectory technique in transforaminal lumbar interbody fusion to adjacent segment degeneration-finite element analysis. BMC Musculoskelet Disord 2023; 24:409. [PMID: 37221546 DOI: 10.1186/s12891-023-06411-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 04/07/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Transforaminal lumbar interbody fusion is an effective surgical treatment of intervertebral disk herniation. However, its clinical efficacy for adjacent segment disk degeneration (ASDD) after hybrid bilateral pedicle screw - bilateral cortical screw (pedicle screw at L4 and cortical bone trajectory screw at L5) and hybrid bilateral cortical screw - bilateral pedicle screw (bilateral cortical screw at L4 and bilateral pedicle screw at L5) remains undiscovered. Therefore, the aim of this study is to evaluate the effect of the hybrid bilateral pedicle screw - bilateral cortical screw and hybrid bilateral cortical screw - bilateral pedicle screw on the adjacent segment via a 3-dimensional (3D) finite element (FE) analysis. METHODS Four human cadaveric lumbar spine specimens were provided by the anatomy teaching and research department of Xinjiang Medical University. Four finite element models of L1-S1 lumbar spine segment were generated. For each of these, four lumbar transforaminal lumbar interbody fusion models at L4-L5 segment with the following instruments were created: hybrid bilateral pedicle screw - bilateral cortical screw, bilateral cortical screw - bilateral cortical screw (bilateral cortical screw at both L4 and L5 segments), bilateral pedicle screw - bilateral pedicle screw (bilateral pedicle screw at both L4 and L5 segments), and hybrid bilateral cortical screw - bilateral pedicle screw. A 400-N compressive load with 7.5 Nm moments was applied for the simulation of flexion, extension, lateral bending, and rotation. The range of motion of L3-L4 and L5-S1 segments and von Mises stress of the intervertebral disc at the adjacent segment were compared. RESULTS Hybrid bilateral pedicle screw - bilateral cortical screw has the lowest range of motion at L3-L4 segment in flexion, extension, and lateral bending, and the highest disc stress in all motions, while the range of motion at L5-S1 segment and disc stress was lower than bilateral pedicle screw - bilateral pedicle screw in flexion, extension, and lateral bending, and higher than bilateral cortical screw - bilateral cortical screw in all motions. The range of motion of hybrid bilateral cortical screw - bilateral pedicle screw at L3-L4 segment was lower than bilateral pedicle screw - bilateral pedicle screw and higher than bilateral cortical screw - bilateral cortical screw in flexion, extension, and lateral bending, and the range of motion at L5-S1 segment was higher than bilateral pedicle screw - bilateral pedicle screw in flexion, lateral bending, and axial rotation. The disc stress at L3-L4 segment was lowest and more dispersed in all motions, and the disc stress at L5-S1 segment was higher than bilateral pedicle screw - bilateral pedicle screw in lateral bending and axial rotation, but more dispersed. CONCLUSION Hybrid bilateral cortical screw - bilateral pedicle screw decreases the impact on adjacent segments after spinal fusion, reduces the iatrogenic injury to the paravertebral tissues, and provides throughout decompression of the lateral recess.
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Affiliation(s)
- Rui Zhang
- Second Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Alafate Kahaer
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, China
| | - Hanqian Niu
- Fifth Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Jingwen Wang
- Second Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Ayididaer Jumahan
- First Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Yanning Qiu
- First Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Hailong Guo
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, China.
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, China.
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Kahaer A, Zhang R, Wang Y, Luan H, Maimaiti A, Liu D, Shi W, Zhang T, Guo H, Rexiti P. Hybrid pedicle screw and modified cortical bone trajectory technique in transforaminal lumbar interbody fusion at L4-L5 segment: finite element analysis. BMC Musculoskelet Disord 2023; 24:288. [PMID: 37055739 PMCID: PMC10099636 DOI: 10.1186/s12891-023-06385-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/30/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Investigate the biomechanical properties of the hybrid fixation technique with bilateral pedicle screw (BPS) and bilateral modified cortical bone trajectory screw (BMCS) in L4-L5 transforaminal lumbar interbody fusion (TLIF). METHODS Three finite element (FE) models of the L1-S1 lumbar spine were established according to the three human cadaveric lumbar specimens. BPS-BMCS (BPS at L4 and BMCS at L5), BMCS-BPS (BMCS at L4 and BPS at L5), BPS-BPS (BPS at L4 and L5), and BMCS-BMCS (BMCS at L4 and L5) were implanted into the L4-L5 segment of each FE model. The range of motion (ROM) of the L4-L5 segment, von Mises stress of the fixation, intervertebral cage, and rod were compared under a 400-N compressive load with 7.5 Nm moments in flexion, extension, bending, and rotation. RESULTS BPS-BMCS technique has the lowest ROM in extension and rotation, and BMCS-BMCS technique has the lowest ROM in flexion and lateral bending. The BMCS-BMCS technique showed maximal cage stress in flexion and lateral bending, and the BPS-BPS technique in extension and rotation. Compared to the BPS-BPS and BMCS-BMCS technique, BPS-BMCS technique presented a lower risk of screw breakage and BMCS-BPS technique presented a lower risk of rod breakage. CONCLUSION The results of this study support that the use of the BPS-BMCS and BMCS-BPS techniques in TLIF surgery for offering the superior stability and a lower risk of cage subsidence and instrument-related complication.
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Affiliation(s)
- Alafate Kahaer
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Road, Urumqi, China
| | - Rui Zhang
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Road, Urumqi, China
| | - Yixi Wang
- First Clinical Medical Institution, Xinjiang Medical University, Urumqi, China
| | - Haopeng Luan
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Road, Urumqi, China
| | - Abulikemu Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Road, Urumqi, China
| | - Dongshan Liu
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Road, Urumqi, China
| | - Wenjie Shi
- First Clinical Medical Institution, Xinjiang Medical University, Urumqi, China
| | - Tao Zhang
- Digital Orthopaedic Center of Xinjiang Medical University, Urumqi, China
| | - Hailong Guo
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Road, Urumqi, China
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Road, Urumqi, China.
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Wang Y, Kahaer A, Shi W, Guo H, Rexiti P. Morphometric measurement of lumbar pedicle in different regions: a systematic review. J Orthop Surg Res 2023; 18:30. [PMID: 36631862 PMCID: PMC9832728 DOI: 10.1186/s13018-023-03499-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/01/2023] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To collect the data of pedicle width and height in different areas, and to investigate the difference and variation rule of pedicle width and height. METHODS Comprehensive search of PubMed, Ovid Medline, and Web of science databases was performed. Collected data were imported into SPSS, and one-way ANOVA test and post hoc test were used to determine whether there were statistical differences in pedicle width and height between the different regions. RESULTS Oceania had the largest pedicle width and height, followed by Americans. West Asian had the largest pedicle width in Asia, followed by East and Southeast Asian, and Chinese and South Asian had similar pedicle width. Different from the variation pattern of pedicle width, the pedicle height of Chinese, East and Southeast Asian and West Asian in Asian range is similar, but the pedicle height of South Asian is significantly smaller than the first three, and has statistical significance. CONCLUSIONS People in different regions have similar patterns of variation in pedicle width and height even though they belong to different ethnic groups. This phenomenon is particularly prominent and pronounced in populations in geographically close areas, which may be related to inter-ethnic integration due to population movement between adjacent areas. There is a relationship between the morphological characteristics of the human lumbar pedicle and geographical location.
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Affiliation(s)
- Yixi Wang
- grid.13394.3c0000 0004 1799 3993First Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Alafate Kahaer
- grid.412631.3Departments of Spine Surgery, Xinjiang Uygur Autonomous Region, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 China
| | - Wenjie Shi
- grid.13394.3c0000 0004 1799 3993First Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Hailong Guo
- grid.412631.3Departments of Spine Surgery, Xinjiang Uygur Autonomous Region, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 China
| | - Paerhati Rexiti
- grid.412631.3Departments of Spine Surgery, Xinjiang Uygur Autonomous Region, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 China
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12
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Liu D, Kahaer A, Wang Y, Zhang R, Maiaiti A, Maimaiti X, Zhou Z, Shi W, Cui Z, Zhang T, Li L, Rexiti P. Comparison of CT values in traditional trajectory, traditional cortical bone trajectory, and modified cortical bone trajectory. BMC Surg 2022; 22:441. [PMID: 36575417 PMCID: PMC9795663 DOI: 10.1186/s12893-022-01893-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND To compare the CT values and length of the screw tracks of traditional trajectory (TT), cortical bone trajectory (CBT), and modified cortical bone trajectory (MCBT) screws and investigate the effects on the biomechanics of lumbar fixation. METHODS CT scan data of 60 L4 and L5 lumbar spine were retrieved and divided into 4 groups (10 male and 10 female cases in the 20-30 years old group and 20 male and 20 female cases in the 30-40 years old group). 3-dimentional (3D) model were established using Mimics 19.0 for each group and the placement of three techniques was simulated on the L4 and L5, and the part of the bone occupied by the screw track was set as the region of interest (ROI). The mean CT value and the actual length of the screw track were measured by Mimics 19.0. RESULTS The CT values of ROI for the three techniques were significantly different between the same gander in each age group (P < 0.05). The difference of screw track lengths for CBT and MCBT in the male and female is significant (P < 0.05). CONCLUSIONS According to the CT values of the three screw tracks: MCBT > CBT > TT, the MCBT screw track has greater bone-screw surface strength and longer screw tracks than CBT, which is easier to reach the anterior column of the vertebral body contributing to superior biomechanical properties.
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Affiliation(s)
- Dongshan Liu
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang Uygur Autonomous Region China
| | - Alafate Kahaer
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang Uygur Autonomous Region China
| | - Yixi Wang
- grid.13394.3c0000 0004 1799 3993Xinjiang Medical University, Urumqi, China
| | - Rui Zhang
- grid.13394.3c0000 0004 1799 3993Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maiaiti
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang Uygur Autonomous Region China
| | - Xieraili Maimaiti
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang Uygur Autonomous Region China
| | - Zhihao Zhou
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang Uygur Autonomous Region China
| | - Wenjie Shi
- grid.13394.3c0000 0004 1799 3993Xinjiang Medical University, Urumqi, China
| | - Zihao Cui
- grid.13394.3c0000 0004 1799 3993Digital Orthopaedic Center, Xinjiang Medical University, Urumqi, China
| | - Tao Zhang
- grid.13394.3c0000 0004 1799 3993Digital Orthopaedic Center, Xinjiang Medical University, Urumqi, China
| | - Longfei Li
- grid.13394.3c0000 0004 1799 3993Digital Orthopaedic Center, Xinjiang Medical University, Urumqi, China
| | - Paerhati Rexiti
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang Uygur Autonomous Region China
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Kahaer A, Chen R, Maitusong M, Mijiti P, Rexiti P. Zero-profile implant versus conventional cage-plate construct in anterior cervical discectomy and fusion for the treatment of single-level degenerative cervical spondylosis: a systematic review and meta-analysis. J Orthop Surg Res 2022; 17:506. [PMID: 36434694 PMCID: PMC9694547 DOI: 10.1186/s13018-022-03387-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/05/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The clinical outcomes of single-level anterior cervical discectomy and fusion (ACDF) with the Zero-profile (Zero-p) were evaluated in comparison with the anterior cervical cage-plate construct (CPC). METHODS We performed a systematic search covering PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, Medline, China National Knowledge Infrastructure (NCKI), Wan Fang Database, and Wei Pu Database. Articles focused on single-level ACDF or data of the single - level that can be extracted were included, and articles that did not directly compare Zero-p and CPC were excluded. Twenty-seven studies were included with a total of 1866 patients, 931 in the Zero-p group and 935 in the CPC group. All outcomes were analyzed using Review Manager 5.4. RESULTS The meta-analysis outcomes indicated that operative time (WMD = - 12.47, 95% CI (- 16.89, - 8.05), P < 0.00001), intraoperative blood loss (WMD = - 13.30, 95% CI (- 18.83, - 7.78), P < 0.00001), risk of adjacent segment degeneration (ASD) (OR 0.31, 95% CI (0.20, 0.48), P < 0.0001), risk of dysphagia of short-term (OR 0.40, 95% CI (0.30, 0.54), P < 0.0001), medium-term (OR 0.31, 95% CI (0.20, 0.49), P < 0.0001), and long-term (OR 0.29, 95% CI (0.17, 0.51), P < 0.0001) of Zero-p group were significantly lower. The JOA score of Zero-p group at the final follow-up was significantly higher (WMD = - 0.17, 95% CI (- 0.32, - 0.03), P = 0.02). There were no significant differences in length of stay (LOS), Neck Disability Index (NDI), Visual Analogue Score (VAS), fusion rate, segmental Cobb angle, cervical Cobb angle, prevertebral soft tissue thickness (PSTT), SF-36, subsidence, implant failure, and hoarseness between the two groups. This study was registered with PROSPERO, CRD42022347146. CONCLUSION Zero-p group reduced operative time, intraoperative blood loss, JOA score at follow-up and reduced the incidence of dysphagia and postoperative ASD, but the two devices had the same efficacy in restoring the cervical curvature, preventing the cage subsidence, and in postoperative VAS, NDI, LOS, PSTT, SF-36, fusion rate, implant failure, and hoarseness in single-level ACDF. The use of Zero-p in single-level ACDF was recommended.
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Affiliation(s)
- Alafate Kahaer
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang Uygur Autonomous Region China
| | - Ruilin Chen
- grid.13394.3c0000 0004 1799 3993Xinjiang Medical University, Urumqi, China
| | | | - Peierdun Mijiti
- grid.13394.3c0000 0004 1799 3993School of Public Health, Xinjiang Medical University, Urumqi, 830054 Xinjiang Uygur Autonomous Region China
| | - Paerhati Rexiti
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang Uygur Autonomous Region China
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Shi W, Aini M, Dang L, Kahaer A, Zhou Z, Wang Y, Maimaiti A, Wang S, Guo H, Rexiti P. Feasibility and improvement of a three-dimensional printed navigation template for modified cortical bone trajectory screw placement in the lumbar spine. Front Surg 2022; 9:1028276. [PMID: 36406344 PMCID: PMC9666697 DOI: 10.3389/fsurg.2022.1028276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/05/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Compared with traditional pedicle screw trajectory, cortical bone trajectory (CBT) increases the contact surface between the screw and cortical bone where the screw is surrounded by dense cortical bone, which does not deform remarkably due to degeneration. We aimed to provide detailed information about the improvement of three-dimensional (3D)-printed navigation templates for modified CBT screw placement in the lumbar spine and evaluate the safety and accuracy thereof. METHODS Four human cadaveric lumbar spine specimens were selected. After CT scanning data were reconstructed to 3D models, either the left or right side of each specimen was randomly selected to establish a 3D-navigation template, mutually complemented with the surface anatomical structure of the lateral margin of the lumbar isthmus, vertebral plate, and spinous process. The corresponding 3D centrum was printed according to the CT scanning data, and a navigation template of supporting design was made according to modified cortical bone technique. The same template was used to insert CBT screws into 3D printed and cadaveric specimens. After the screws were inserted, the screw path of the 3D printed specimens was directly observed, and that of the anatomical specimens was scanned by CT, to determine the position and direction of the screws to analyze the success rate of screw placement. RESULTS Twenty cortical bone screws were placed in each of the 3D printed and anatomical specimens, with excellent rates of screw placement of 100% and 95%, respectively. CONCLUSIONS We report the easy, safe, accurate, and reliable use of a 3D-printed navigation template to carry out screw placement by modified cortical bone technique in the lumbar spine.
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Affiliation(s)
- Wenjie Shi
- Xinjiang Uygur Autonomous Region, Xinjiang Medical University, Urumqi, China
| | - Mijiti Aini
- Department of Orthopedics Second People's Hospital Kashgar District, Xinjiang Uygur Autonomous Region, Kashgar City, China
| | - Limin Dang
- Xinjiang Uygur Autonomous Region, Xinjiang Medical University, Urumqi, China
| | - Alafate Kahaer
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Zhihao Zhou
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Yixi Wang
- Xinjiang Uygur Autonomous Region, Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Shuiquan Wang
- Department of Anatomy, College of Basic Medicine, Xinjiang Medical University, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Hailong Guo
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Uygur Autonomous Region, Urumqi, China,Correspondence: Paerhati Rexiti Hailong Guo
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Uygur Autonomous Region, Urumqi, China,Correspondence: Paerhati Rexiti Hailong Guo
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Kahaer A, Maimaiti X, Maitirouzi J, Wang S, Shi W, Abuduwaili N, Zhou Z, Liu D, Maimaiti A, Rexiti P. Biomechanical investigation of the hybrid modified cortical bone screw–pedicle screw fixation technique: Finite-element analysis. Front Surg 2022; 9:911742. [PMID: 35923441 PMCID: PMC9339714 DOI: 10.3389/fsurg.2022.911742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundHybrid fixation techniques including the both modified cortical bone trajectory (MCBT) and traditional trajectory (TT) at the L4 and L5 lumbar segment are firstly proposed by our team. Therefore, the purpose of this study is to evaluate and provide specific biomechanical data of the hybrid fixation techniques including the MCBT and TT.MethodsFour human cadaveric specimens were from the anatomy laboratory of Xinjiang Medical University. Four finite-element (FE) models of the L4–L5 lumbar spine were generated. For each of them, four implanted models with the following fixations were established: TT-TT (TT screw at the cranial and caudal level), MCBT-MCBT (MCBT screw at the cranial and caudal level), hybrid MCBT-TT (MCBT screw at the cranial level and TT screw at the caudal level), and TT-MCBT (TT screw at the cranial level and MCBT screw at the caudal level). A 400-N compressive load with 7.5 N/m moments was applied to simulate flexion, extension, lateral bending, and rotation, respectively. The range of motion (ROM) of the L4–L5 segment and the posterior fixation, the von Mises stress of the intervertebral disc, and the posterior fixation were compared.ResultsCompared to the TT-TT group, the MCBT-TT showed a significant lower ROM of the L4–L5 segment (p ≤ 0.009), lower ROM of the posterior fixation (p < 0.001), lower intervertebral disc stress (p < 0.001), and lower posterior fixation stress (p ≤ 0.041). TT-MCBT groups showed a significant lower ROM of the L4–L5 segment (p ≤ 0.012), lower ROM of the posterior fixation (p < 0.001), lower intervertebral disc stress (p < 0.001), and lower posterior fixation stress (p ≤ 0.038).ConclusionsThe biomechanical properties of the hybrid MCBT-TT and TT-MCBT techniques at the L4–L5 segment are superior to that of stability MCBT-MCBT and TT-TT techniques, and feasibility needs further cadaveric study to verify.
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Affiliation(s)
- Alafate Kahaer
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xieraili Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | | | - Shuiquan Wang
- Department of Anatomy, College of Basic Medicine, Xinjiang Medical University, Urumqi, China
| | - Wenjie Shi
- First Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Nueraihemaiti Abuduwaili
- Department of Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Zhihao Zhou
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Dongshan Liu
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Correspondence: Paerhati Rexiti
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Rexiti P, Aikeremu D, Wang S, Abuduwali N, Kahaer A, Sheng W. Cadaveric study of anatomical measurement of isthmus parameters of lumbar spine to guide cortical bone screw placement. Rev Assoc Med Bras (1992) 2022; 68:754-758. [PMID: 35766687 PMCID: PMC9575907 DOI: 10.1590/1806-9282.20210729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/11/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To reduce surgical exposure and improve accuracy, this study evaluated the anatomical distance parameter D (including D1, D2, and D3) of the lumbar isthmus for cortical bone screw insertion. METHODS A total of 25 structurally complete lumbar dry specimens were used for lumbar anatomy measurements. The six cadaver specimens were divided into upper and lower parts on the plane of the T11-T12 vertebrae, and we use the lower parts. Therefore, six lumbar wet specimens and another four complete lumbar dry specimens were selected. The lumbar isthmus tangent point was considered a coordinate origin, and the insertion point was determined through translating the distance of D1 value to the midline of the vertebral body horizontally and then vertically moved toward inferior board of the transverse process with the distance of D3 value. RESULTS In four dry and six wet intact lumbar specimens, cortical bone screws were placed according to the average value of the isthmus parameter D. A total of 100 trajectories were verified in specimens by X-ray and computed topography scan to evaluate the safety, accuracy, and feasibility of the surgical use of isthmus parameter D. Using this parameter, the rates of excellent screw placement were 95% (38/40) in four dry specimens and 88.7% (53/60) in six wet specimens. CONCLUSION The isthmus parameter D is easier to use by the operator, which can improve surgical accuracy and reduce operation time. LEVEL OF EVIDENCE Level IV, prospective study.
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Affiliation(s)
- Paerhati Rexiti
- The First Affiliated Hospital of Xinjiang Medical University, Department of Spine Surgery - Ürümqi, China
| | - Dilimulati Aikeremu
- People's Hospital of Xinjiang Uygur Autonomous Region, Orthopedic Center, Department of 2nd Spine Surgery - Ürümqi, China
| | - Shuiquan Wang
- Xinjiang Medical University, College of Basic Medicine, Department of Anatomy - Ürümqi, China
| | - Nueraihemaiti Abuduwali
- The First Affiliated Hospital of Xinjiang Medical University, Department of Imaging Center - Ürümqi, China
| | - Alafate Kahaer
- The First Affiliated Hospital of Xinjiang Medical University, Department of Spine Surgery - Ürümqi, China
| | - Weibin Sheng
- The First Affiliated Hospital of Xinjiang Medical University, Department of Spine Surgery - Ürümqi, China
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Maitirouzi J, Luo H, Zhou Z, Ren H, Rexiti P. Finite element analysis of human lumbar vertebrae in internal fixation system model with different bone density trajectories. Int J Artif Organs 2022; 45:478-487. [PMID: 35441547 DOI: 10.1177/03913988221088613] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE To evaluate the biomechanics effect of modified cortical bone screw technique (MCBT) with other traditional internal fixation systems on lumbar osteoporotic wet specimen. METHODS Four different finite element models were established using CT data: (1) lumbar osteoporosis model without internal fixation system; (2) traditional pedicle screw technology (TT) model; (3) traditional cortical bone screw technology (CBT) model; (4) MCBT model. The changes of global displacement, intervertebral disc displacement of all models and internal fixation system Von Mises stress among the three models were compared under the same physiological load. RESULTS Compared with the other three models, the total displacement of the modified CBT screw model was the smallest, with the maximum displacement of 0.216 mm; The intervertebral disc displacement of the modified CBT screw model was the smallest, with the maximum displacement of 0.149 mm; the internal fixation system Von Mises stress of the modified CBT screw technique model was the largest compared with the other three models, The maximum Von Mises stress is 232.73 MPa. CONCLUSION Compared to traditional pedicle screw and traditional CBT, MCBT has better mechanical stability, and it is of certain clinical application value.
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Affiliation(s)
- Julaiti Maitirouzi
- College of Mechanical Engineering, Xin jiang University, Urumqi, Xin jiang, China
| | - Huiqing Luo
- College of Mechanical Engineering, Xin jiang University, Urumqi, Xin jiang, China
| | - Zhihao Zhou
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hangning Ren
- College of Mechanical Engineering, Xin jiang University, Urumqi, Xin jiang, China
| | - Paerhati Rexiti
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Shi W, Aierken G, Wang S, Abuduwali N, Xia Y, Rezhake R, Zhao S, Zhou M, Jianabuli, Sheng W, Rexiti P. Application study of three-dimensional printed navigation template between traditional and novel cortical bone trajectory on osteoporosis lumbar spine. J Clin Neurosci 2021; 85:41-48. [PMID: 33581788 DOI: 10.1016/j.jocn.2020.11.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 08/08/2020] [Accepted: 11/23/2020] [Indexed: 01/02/2023]
Abstract
To investigate the safety, accuracy and indications of traditional and novel cortical bone screws placement for osteoporosis lumbar spine, 4 lumbar vertebra specimens (2 males and 2 females) were used for this study. After the computed tomography scanning data of the above anatomical specimens were three-dimensional (3D) reconstructed, one side of each anatomical specimen was randomly chosen to place traditional cortical bone screws, and the other side received novel technical placement. The safety screw trajectory was designed, and a 3D navigation template complementary to the surface anatomical structure of lumbar isthmus lateral margin-vertebral plate-spinous process part was established. The designed supporting navigation template was substantialized, and the navigation template replicated different cortical bone screw trajectory at different sides of the same one lumbar vertebra. Forty cortical bone screws were firstly placed in 3D printed vertebra and then 40 were placed in real anatomical specimens. In 3D printed specimens, the success rates of screw placement with navigation template using traditional and novel techniques were both 100%. While in anatomical specimens, the success rate of screw placement using traditional and novel navigation template was 97.5% (one out of 40 went wrong). Therefore, it is safe, accurate and reliable to place traditional and novel cortical bone screws on osteoporosis lumbar spine using 3D printed navigation template. Traditional and novel screw placement methods should be flexibly applied or combined according to specific sequence and form of vertebra.
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Affiliation(s)
- Wenjie Shi
- Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Gulixian Aierken
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Shuiquan Wang
- Department of Anatomy, College of Basic Medicine, Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Nueraihemaiti Abuduwali
- Department of Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Yudong Xia
- Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Reyazuli Rezhake
- Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Shuwen Zhao
- Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Mingbin Zhou
- Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Jianabuli
- Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Weibin Sheng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China.
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China.
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Rexiti P, Aierken A, Sadeer A, Wang S, Abuduwali N, Deng Q, Sheng WB, Guo HL. Anatomy and Imaging Studies on Cortical Bone Screw Freehand Placement Applying Anatomical Targeting Technology. Orthop Surg 2020; 12:1954-1962. [PMID: 32896100 PMCID: PMC7767784 DOI: 10.1111/os.12775] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/11/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES A series of constant anatomical structures were used as guide targets for screw placement to improve the accuracy of cortical screw placement and reduce surgical injury and fluoroscopy radiation. The most commonly used angles and distances between the cortical bone screw insertion point and the lateral margins of the isthmus were selected as the contents of the questionnaire. METHODS A total of 40 physicians were selected to determine the specific values for each angle and distance. Screw placements were performed on four dry and six wet lumbar spine specimens according to the proposed anatomical target guidance technique. A total of 100 cortical bone trajectories were evaluated using X-ray and CT scanning of the specimens to verify the practicability, accuracy, and safety of the anatomical target guidance technique in screw placement. RESULTS The average deviation rates for angle and distance determination were 105.5% and 14.33%, respectively, indicating a significant difference between the estimated and actual values from other angles (P < 0.05). Based on visual inspection, probe penetration, X-ray, and CT examination of 100 cortical bone trajectories, the excellent rate of 40 trajectories on four dry specimens was 95%, while that of 60 trajectories on six wet specimens was 88.7%. CONCLUSION Use of lumbar constant anatomical structures as targeting guidance could assist cortical bone screw placement and reduce surgical damage.
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Affiliation(s)
- Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Ailixier Aierken
- Department of Spine Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Aierken Sadeer
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Shuiquan Wang
- Department of Anatomy, College of Basic Medicine, Xinjiang Medical University, Ürümqi, China
| | - Nueraihemaiti Abuduwali
- Department of Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Qiang Deng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Wei-Bin Sheng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Hai-Long Guo
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
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20
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Rexiti P, Zhang TC, Batuer C, Cao L. Orthopedic treatment for open fracture of lower extremities and soft tissue defects in young children and rapid rehabilitation after operation. PHYSICIAN SPORTSMED 2020; 48:161-164. [PMID: 31317807 DOI: 10.1080/00913847.2019.1642810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: This study aims to explore the clinical features of open fracture of lower extremities with soft tissue injury in young children, and its surgical and postoperative rehabilitation methods.Methods: A total of 32 children with open fracture of lower extremities and soft tissue injury treated in our department from January 2010 to December 2016 were included into this study. An individualized treatment plan was established according to the characteristics of each patient's condition, and rapid rehabilitation procedures were carried out after the operation to promote the healing of the wound, and shape and function recovery.Results: In the present study, four children developed superficial infection after the operation, and healed after proper management. Furthermore, two children were found to have osteomyelitis during follow-up after discharge, and healed after they returned to the hospital for debridement. All patients were followed up until fracture healing, and the follow-up duration ranged within 6-15 months, with an average duration of 8.5 months. All patients achieved bony union, and none of the patients had bone exposure. In the curative effect assessment, 24 children were classified as excellent, six children were classified as good, one child was classified as moderate, and one child was classified as poor. The excellent and good rate was 93.75%.Conclusions: Open fracture of the lower extremities commonly occur in the middle and lower segment of the tibia and fibula in children, and is usually combined with soft tissue injury. The correct treatment of fractures, and skin and soft tissue injuries, as well as the rapid rehabilitation of children, are the keys to achieving a good clinical effect.
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Affiliation(s)
- Paerhati Rexiti
- Center of orthopedics, The First Teaching Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Tie-Cheng Zhang
- Department of health rehabilitation medicine, The First Teaching Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Chugulike Batuer
- Center of orthopedics, The First Teaching Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Li Cao
- Center of orthopedics, The First Teaching Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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21
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Rexiti P, Aierken G, Wang S, Abudurexiti T, Abuduwali N, Deng Q, Guo H, Sheng W. Anatomical research on strength of screw track fixation in novel cortical bone trajectory for osteoporosis lumbar spine. Am J Transl Res 2019; 11:6850-6859. [PMID: 31814892 PMCID: PMC6895526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 10/18/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The cortical bone screw has good internal fixation effect on osteoporotic bone. In order to further increase the strength of screw track fixation in cortical bone trajectory, this study introduced a modified technique with novel insertion point and angle for cortical bone screw placement. METHODS Cortical bone screws were placed in four dry and six wet and intact lumbar specimens according to the modified technique. A total of 100 trajectories in specimens were confirmed by X-ray and CT scan to evaluate the safety, accuracy and practicability of screw fixation. The successful rate was 95% (38/40) in four dry specimens, and 88.7% (53/60) in six wet specimens. CONCLUSION This study showed that the novel trajectory could be fixed more closely with cortical bone compared to traditional cortical bone trajectory technique, and thus it may reduce the surgical exposure to the elders and help them to recover quickly after the operation.
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Affiliation(s)
- Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi, China
| | - Gulixian Aierken
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi, China
| | - Shuiquan Wang
- Basic Medical Department, Xinjiang Medical UniversityUrumqi, China
| | - Tuerhongjiang Abudurexiti
- Department of Minimally Invasive Spine Surgery, The Sixth Affiliated Hospital of Xinjiang Medical UniversityUrumqi, China
| | | | - Qiang Deng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi, China
| | - Hailong Guo
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi, China
| | - Weibin Sheng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi, China
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22
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Rexiti P, Wutiku M, Wulamu W, Bai F, Cao L. Pulmonary hypertension could be a risk for deep vein thrombosis in lower extremities after joint replacement surgery. Rev Assoc Med Bras (1992) 2019; 65:946-950. [PMID: 31389502 DOI: 10.1590/1806-9282.65.7.946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/10/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE A background of Pulmonary Hypertension (PH) indicates a progressive elevation of pulmonary vascular resistance, leading to overfilling, elevation of venous pressure, congestion in various organs, and edema in the venous system. This study aimed to investigate whether PH is a risk factor for deep vein thrombosis (DVT) of the lower extremities after hip and knee replacement surgery. METHODS A total of 238 patients who received joint replacement of lower extremities in our department of orthopedics from January 2009 to January 2012 were examined by echocardiography and Color Doppler flow imaging (CDFI) of the lower extremities. Based on pulmonary artery pressure (PAP), the patients were divided into a normal PAP group (n=214) and PH group (n=24). All the patients were re-examined by CDFI during post-operative care. RESULTS Among the 238 patients, 18 had DVT in the lower extremities after the operation. DVT total incidence rate was 7.56% (18/238). In the PH group, 11 patients had DVT (45.83%, 11/24), but in the normal PAP group, only 7 had DVT (3.27%, 7/214). The incidence of DVT was significantly lower in the normal PAP group than in the PH group (P<0.01). In addition, there was a positive correlation between PAP and the incidence of DVT. CONCLUSION PH could be a high-risk factor for the occurrence of DVT in patient's lower extremities after joint replacement surgeries.
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Affiliation(s)
- Paerhati Rexiti
- Department of Orthopaedics, The First Affiliation Hospital of Xinjiang Medical University, Urumqi, China
| | - Minawaer Wutiku
- Department of Sonography, Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Wuhuzi Wulamu
- Department of Orthopaedics, The First Affiliation Hospital of Xinjiang Medical University, Urumqi, China
| | - FengZhou Bai
- Department of Orthopaedics, The First Affiliation Hospital of Xinjiang Medical University, Urumqi, China
| | - Li Cao
- Department of Orthopaedics, The First Affiliation Hospital of Xinjiang Medical University, Urumqi, China
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Rexiti P, Abudurexiti T, Abuduwali N, Deng Q, Guo H. Debridement and Internal Fixation from a Single Posterior Approach for the Treatment of Lumbosacral Tuberculosis. World Neurosurg 2018; 120:e392-e399. [DOI: 10.1016/j.wneu.2018.08.081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/10/2018] [Accepted: 08/11/2018] [Indexed: 10/28/2022]
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Rexiti P, Abudurexiti T, Abuduwali N, Wang S, Sheng W. Measurement of lumbar isthmus parameters for novel starting points for cortical bone trajectory screws using computed radiography. Am J Transl Res 2018; 10:2413-2423. [PMID: 30210680 PMCID: PMC6129534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 07/25/2018] [Indexed: 06/08/2023]
Abstract
The current study aims to measure distance parameters in lumbar isthmus to develop new references for lumbar pedicle screw insertion. Using computed radiography, the distance between the median pedicle tangent and the isthmus lateral tangent (D1) and the isometric distance between the isthmus lateral tangent and the inferior border of transverse process (D2) were measured on 120 spine X-ray images. A derived distance D3 (equal to D2 minus 1 mm) was calculated. These parameters were used to define the starting points for pedicle screws. Cortical bone trajectory (CBT) fixations were carried out on six wet (including 3 male and 3 female) and 4 dry lumbar specimens using the new system, and were evaluated for accuracy and safety of screw insertion. Measurements showed that D1 (mm) was 2.1±0.13 (L1), 2.3±0.13 (L2), 3.6±0.33 (L3), 4.4±0.36 (L4), 5.7±0.36 (L1); D2 was 5±0.83 (L1), 6.19±0.84 (L2), 5.38±0.86 (L3), 3.66±0.42 (L4) and 2.30±0.37 (L5). A total of 100 CBTs were evaluated. Among them, 7 out of the 60 screws in the 6 wet specimens penetrated into the lateral pedicle bone, the successful rate was 88.7%; 2 out of the 40 screws in the 4 dry specimens penetrated through the lateral or median pedicle bone, the successful rate was of 95%. With our new system, CBT screws can be placed based on these parameters, which can be obtained less invasively, and irrespective of articular degeneration in lumbar facet and morphological variation in the transverse process. Our data show that the technique is safer, less invasive, and easier to operate. It would help reduce bleeding, intraoperative X-ray exposure and surgical time.
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Affiliation(s)
- Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi, China
| | - Tuerhongjiang Abudurexiti
- Department of Spine Surgery, The Sixth Affiliated Hospital of Xinjiang Medical UniversityUrumqi, China
| | | | - Shuiquan Wang
- Basic Medical Department, Xinjiang Medical UniversityUrumqi, China
| | - Weibin Sheng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi, China
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Rexiti P, Abulizi Y, Muheremu A, Wang S, Maimaiti M, Guo H, Sheng W. Anatomical and radiologic characteristics of isthmus parameters in guiding pedicle screw placement. J Int Med Res 2018; 46:2386-2397. [PMID: 29619849 PMCID: PMC6023064 DOI: 10.1177/0300060518762986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To study the clinical application of lumbar isthmus parameters in guiding pedicle screw placement. Methods Lumbar isthmus parameters were measured in normal lumbar x-rays and cadaveric specimens from a Chinese Han population. Distance between the medial pedicle border and lateral isthmus border was recorded as a 'D' value and was compared between X-rays and cadavers. Orthopaedic surgeons estimated different distances (2-6 mm) and angles (5-20°), and bias ratios between estimated and real values were compared. Orthopaedic residents placed pedicle screws on cadaveric specimens before and after application of the 'D' value, and screw placement accuracy was compared. Results Except for L4 vertebrae, significant differences in the 'D' value were found between 25 cadaveric specimens and x-ray films from 120 patients. Distances and angles estimated by 40 surgeons were significantly different from all real values, except 2 mm distance. Accuracy of pedicle screw placement by six orthopaedic residents was significantly improved by applying the 'D' value. Conclusions Surgeon estimates of distance were more accurate than angle estimates. Addition of a 'D' value to conventional parameters may significantly improve pedicle screw placement accuracy in lumbar spine surgery.
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Affiliation(s)
- Paerhati Rexiti
- 1 Department of Spine Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yakufu Abulizi
- 1 Department of Spine Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Aikeremujiang Muheremu
- 2 Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Shuiquan Wang
- 1 Department of Spine Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Maierdan Maimaiti
- 1 Department of Spine Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Hailong Guo
- 1 Department of Spine Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Weibin Sheng
- 1 Department of Spine Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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