ObjectiveTo summarize the application and recent development of orthognathic surgery in treating syndromic craniosynostosis. MethodsThe related literature at home and abroad in recent years was extensively reviewed, and the indications, routine procedures, and protocols of orthognathic surgery in the treatment of syndromic craniosynostosis were summarized and analyzed. ResultsCraniosynostosis is a common congenital craniofacial malformation. Syndromic craniosynostosis usually involves premature fusion of multiple cranial sutures and is associated with other deformities. Orthognathic surgery is the necessary and effective means to improve the midfacial hypoplasia and malocclusion. Le Fort I osteotomy combined with sagittal split ramus osteotomy are the common surgical options. Orthognathic surgery should combine with craniofacial surgery and neurosurgery, and a comprehensive long-term evaluation should be conducted to determine the best treatment plan. Conclusion Orthognathic surgery plays an important role in the comprehensive diagnosis and treatment of syndromic craniosynostosis. The development of digital technology will further promote the application and development of orthognathic surgery in the treatment of syndromic craniosynostosis.
ObjectiveTo investigate the correlation between the effectiveness and the changes of spine-pelvic sagittal parameters for patients with spondylolisthesis before and after operation. MethodsA retrospective analysis was made on the clinical data of 32 patients with single segmental degenerative lumbar spondylolisthesis at L4 who accorded with the inclusion criteria between June 2011 and January 2014 (trial group). There were 13 males and 19 females, aged 51-67 years (mean, 59 years). According to Meyerding degree, there were 21 cases of degree I, 10 cases of degree Ⅱ, and 1 case of degree Ⅲ. All patients were treated with transforaminal lumbar interbody fusion (TLIF) surgery. Thirty-five healthy adults at the age of 46-67 years (mean, 57 years) were enrolled as normal controls (control group). The standing position lumbar lateral X-ray films (T12-S1, bilateral femoral head) were taken at pre- and post-operation to measure the pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), disc height (DH), and slip percentage (SP); the visual analogue scale (VAS) and Oswestry disability index (ODI) were recorded. Pearson correlation analysis was used to analyze the correlation between the preoperative various spine-pelvic sagittal parameters and the VAS score and the ODI. After operation, Pearson correlation analysis was used to evaluate the correlation between the changes of these parameters and the improve rates of VAS score and ODI. ResultsAll patients of trial group were followed up 15-22 months (mean, 18 months). At last follow-up, the VAS score, ODI, PT, SS, LL, SP, and DH were significantly improved when compared with preoperative values (P<0.05), except for PI (t=-1.445, P=0.158). There was no significant difference in PT, SS, LL, and DH between trial and control groups at last follow-up (P>0.05); PI was slightly bigger than that of control group (t=8.531, P=0.043). Pearson correlation analysis showed that there was a correlation between spine-pelvic sagittal parameters of PI, PT, SS, and LL (P<0.05); preoperative parameters (except for LL and DH) had correlation with ODI and VAS scores (P<0.05). Postoperative parameters (except for PI) had correlation with the improve rates of ODI and VAS scores (P<0.05), especially for the changes of PT and the improvements of ODI and VAS scores. ConclusionThere is a correlation between the changes of spine-pelvic sagittal parameters at pre- and post-operation and effectiveness in patients with lumbar spondylolisthesis. The correlation between the changes of PT and the improvement rates of ODI and VAS scores is more marked. The good effectiveness is closely related with the improved PT.
Objective To investigate the changes of low back pain (LBP) and spinal sagittal parameters in patients with unilateral Crowe type Ⅳ developmental dysplasia of the hip (DDH) after total hip arthroplasty (THA). Methods The clinical data of 30 patients who met the selection criteria between October 2018 and March 2020 were retrospectively analyzed. Patients were divided into LBP group (16 cases) and control group (14 cases) according to whether there was LBP before operation. There was no significant difference between the two groups of patients in gender, age, body mass index, affected sides, preoperative Harris score (P>0.05). Full-length lateral X-ray films of the spine were taken within 1 week before operation and at 1 year after operation, and the following imaging indicators were measured: sacral slope (SS), lumbar lordosis (LL ), spinal tilt (ST), spine-sacral angle (SSA), sagittal vertebral axis (SVA). The visual analogue scale (VAS) score, lumbar Oswestry disability index (ODI), the Harris score of the hip joint before operation and at 1 year after operation, and the occurrence of postoperative complications were collected and analysed. Results In the LBP group, LBP was relieved to varying degrees at 1 year after operation, of which 13 patients (81.3%) had complete LBP remission; VAS score decreased from 4.9±2.3 preoperatively to 0.3±0.8, ODI decreased from 33.5±22.6 preoperatively to 1.3±2.9, the differences were all significant (t=7.372, P=0.000; t=5.499, P=0.000). There was no new chronic LBP in the control group during follow-up. The Harris scores of the two groups significantly improved when compared with those before operation (P<0.05); there was no significant difference between the two groups at 1 year after operation (t=0.421, P=0.677). There was no significant difference in imaging indexes between the two groups before operation and the difference between pre- and post-operation (P>0.05). At 1 year after operation, ST and SVA in the LBP group, SSA in the control group, and SS in the two groups significantly improved when compared with those before operation (P<0.05); there was no significant difference in the other indexes between the two groups before and after operation (P>0.05). Conclusion Unilateral Crowe type Ⅳ DDH patients with LBP before operation were all relieved of LBP after THA. The relief of LBP may be related to the improvement of spinal balance, but not to lumbar lordosis and its changes.
Objective To elucidate the relationship between preoperative C7 slope (C7S) and sagittal parameters in anterior cervical discectomy with fusion (ACDF) by imaging. Methods A retrospective analysis of 54 patients (24 males and 30 females) with ACDF for cervical spondylosis between January 2012 and January 2017 was performed. The age ranged from 23 to 71 years (mean, 46.6 years). There were 29 cases of cervical spondylotic radiculopathy and 25 cases of cervical spondylotic myelopathy. The disease duration ranged from 3 to 48 months, with an average of 16.8 months. In the 55 patients, 44 were single-segment ACDF and 10 were double-segment ACDF. Sagittal parameters of cervical spine were measured on cervical X-ray films before operation and at last follow-up, including C2-7 Cobb angle, C2-7 sagittal vertical axis (C2-7 SVA), C7S, and segment Cobb angle (SCobb), and the changes of C2-7 Cobb angle (the difference between the last follow-up and the preoperative angle) were calculated. Pearson correlation was used to analyze the correlation between the parameters before operation and at last follow-up. According to the preoperative median value of C7S (15°), the patients were divided into group A (C7S<15°) and group B (C7S≥15°). The sagittal parameters before and after operation were compared between the two groups. Results All the 54 patients were followed up 6-45 months (mean, 15.5 months). At last follow-up, C7S, C2-7 Cobb angle, C2-7 SVA, and SCobb angle were significantly improved when compared with preoperative values (P<0.05). Correlation analysis showed that the preoperative C7S and SCobb angles were significantly correlated with C2-7 Cobb angle and C2-7 SVA (P<0.05), but there was no significant correlation between C7S and SCobb angle (r=0.049, P=0.724). There was a significant correlation between C7S, C2-7 Cobb angle, and SCobb angle at last follow-up (P<0.05), but there was no significant correlation between C7S and SCobb angles and C2-7 SVA (P>0.05). According to the median value of preoperative C7S, 28 patients in group A had C7S of (11.82±3.60)°, while 26 patients in group B had C7S of (20.77±4.09)°. There was no significant difference in gender and age between the two groups (P>0.05). The preoperative C2-7 Cobb angle and C2-7 SVA in group A were significantly lower than those in group B (P<0.05). There was no significant difference between preoperative SCobb angle and group B (t=0.234, P=0.816). There were no significant differences in C2-7 Cobb angle, C2-7 SVA, and SCobb angle between group A and group B at last follow-up (P>0.05). However, the change of C2-7 Cobb angle in group A was significantly higher than that in group B (t=2.321, P=0.024). Conclusion Preoperative C7S≥15° group has more physiological lordosis before operation, but its postoperative cervical curvature changes less, while ACDF is more conducive to correct the preoperative C7S<15 ° cervical curvature.
Objective To study the relationship between sagittal facet joint and degenerative lumber spondylolisthesis (DLS) by observing the changes of the lumbar facet joint angle. Methods Fifty-seven patients with DLS who met the inclusion criteria between January 2013 and February 2016 were collected (DLS group). There were 26 males and 31 females, with the mean age of 54.0 years (range, 34-84 years). Forty patients without DLS at same stage were collected as control group. There were 23 males and 17 females with the mean age of 55.6 years (range, 29-82 years). There was no significant difference in gender and age between 2 groups (P>0.05). The lumbar facet joint angles were measured and compared by MRI scanning images in 2 groups. In DLS group, X-ray films were used to evaluated the degree of the lumbar spondylolisthesis on the basis of the Meyerding standard, and compared the facet joint angles between patients of different DLS degree. Results Facet joint angles in the DLS group [(34.18± 4.81)°] were significantly smaller than those in control group [(45.87±1.09)°] (t=15.073, P=0.000). In DLS group, the patients were rated as degree Ⅰ in 24 cases, degree Ⅱ in 19 cases, degree Ⅲ in 14 cases. As the degree of DLS increased, the lumbar joint angle decreased gradually, and showing significantly differences between patients of different DLS degree (P<0.05). Conclusion Sagittal lumbar facet joint may be one of the main risk factors of DLS.
Objective To investigate the changes in spinal-pelvic sagittal parameters from preoperative standing to prone position in old traumatic spinal fractures with kyphosis. Methods The clinical data of 36 patients admitted between December 2016 and June 2021 for surgical treatment of old traumatic spinal fractures with kyphosis, including 7 males and 29 females, aged from 50 to 79 years (mean, 63.9 years), were retrospectively analyzed. Lesion segments included 2 cases of T11, 12 cases of T12, 2 cases of T11, 12, 4 cases of T12 and L1, 12 cases of L1, 2 cases of L2, 1 case of L2, 3, and 1 case of L3. The disease duration ranged from 4 to 120 months, with an average of 19.6 months. Surgical procedures included Smith-Petersen osteotomy in 4 cases, Ponte osteotomy in 6 cases, pedicle subtraction osteotomy in 2 cases, and improved fourth level osteotomy in 18 cases; the remaining 6 cases were not osteotomized. The bone mineral density ranged from −3.0 to 0.5 T, with a mean of −1.62 T. The spinal-pelvic sagittal parameters from preoperative standing to prone positions were measured, including local kyphosis Cobb angle (LKCA), thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and PI and LL mismatch (PI-LL). The kyphotic flexibility=(preoperative standing LKCA−preoperative prone LKCA)/preoperative standing LKCA×100%. Spinal-pelvic sagittal parameters were compared between standing position and prone position before operation, and Pearson correlation was used to judge the correlation between the parameters of standing position and prone position before operation. ResultsWhen the position changed from standing to prone, LKCA and TK decreased significantly (P<0.05), while SS, LL, PT, and PI-LL had no significant difference (P>0.05). Pearson correlation analysis showed that LL was significantly correlated with SS and PI-LL in both standing and prone positions (P<0.05), and the correlation strength between LL and SS in prone position was higher than that in standing position. In the standing position, LKCA was significantly correlated with SS and PT (P<0.05). However, when the position changed from standing to prone, the correlation between LKCA and SS and PT disappeared, while PT and PI-LL was positive correlation (P<0.05). The kyphotic flexibility was 25.13%-78.79%, with an average of 33.85%. Conclusion For the patients of old traumatic spinal fractures with kyphosis, the preoperative LKCA and TK decrease significantly from standing position to prone position, and the correlation between spinal and pelvic parameters also changed, which should be taken into account in the formulation of preoperative surgical plan.
ObjectiveTo investigate the changes and relationship of cervical spine sagittal alignment and other spinal-pelvic sagittal parameters in adolescent idiopathic scoliosis. MethodsBetween July 2011 and July 2014, 35 patients with idiopathic scoliosis who met the inclusion criteria underwent posterior pedicle screw instrumentation and fusion. There were 12 males and 23 females with a mean age of 16.2 years (range, 13-20 years), including 16 cases of Lenke type 1, 7 cases of Lenke type 2, 4 cases of Lenke type 3, 3 cases of Lenke type 4, 4 cases of Lenke type 5, and 1 case of Lenke type 6. The average follow-up time was 10.9 months (range, 5-36 months). The pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), cervical lordosis (CL), T1 slope, C2 slope, C7 sagittal vertical axis (C7 SVA), C2-7 plumbline (cSVA) were measured on pre-and post-operative standing lateral X-ray film. Based on preoperative CL, the patients were divided into kyphosis group (CL>0°) and lordosis group (CL < 0°); after operation, the patients were divided into restored lordosis (group A), decreased kyphosis (group B), and increased lordosis (group C) after operation. All data about sagittal profile changes were analyzed. The relations between CL and other spinal-pelvic parameters in the kyphosis and lordosis groups before operation were determined via Spearman correlation coefficient. ResultsStatistically significant changes were observed in PT, PI, SS, and LL between at pre-and post-operation (P < 0.05), but no significant difference was found in the other parameters (P>0.05). There were 17 patients in lordosis group and 18 in kyphosis group before operation. Intra-group comparisons showed significant changes in PT, PI, SS, C2 slope, and C7 SVA in lordosis group, and in PT, PI, SS, LL, CL, TK, T1 slope, and C2 slope in kyphosis group (P < 0.05). Subgroup comparisons showed significant changes in CL, TK, C2 slope, C7 SVA, and T1 slope before operation (P < 0.05) and T1 slope at last follow-up between 2 groups (P < 0.05). In kyphosis group, 7 cases (group A) had restored lordosis, 7 cases (group B) had decreased kyphosis, and 4 cases had increased lordosis. In lordosis group, 9 cases (group C) had increased lordosis, 3 cases had decreased lordosis, and 5 cases had kyphotic cervical alignment after operation. Significant difference was found in LL, CL, T1 slope, C2 slope, and C7 SVA of group A, in TK and CL of group B, and in CL and cSVA of group C between pre-and post-operation (P < 0.05). There were significant differences in pre-and post-operative LL between groups A and B (P < 0.05). In lordosis group, there was a strong correlation between CL and C2 slope (P < 0.05) at pre-operation. CL had strong correlation with C2 slope and T1 slope (P < 0.05) at pre-operation in kyphosis group, and CL had moderate correlation with cSVA (P < 0.05). ConclusionCervical sagittal alignment plays an important role in the balance of the spine and pelvis. The change of cervical sagittal alignment has a certain correlation with the change of thoracic kyphosis. Attention to properly maintaining or restoring cervical sagittal lordosis alignment should be considered in preoperative evaluation of adolescent indiopathic scoliosis.
Objective To review the process of radiographic measurements of sagittal balance and offer reference for the clinical practice. Methods The related literature of spino-pelvic sagittal parameters and their clinical application was reviewed and analyzed from the aspects such as the clinical application, the advantages and disadvantages, and how to use them effectively. Results All parameters have their advantages and disadvantages, and they are influenced by age and race. Sagittal vertical axis can only reflect the global balance, and T1 pelvic angle which accounts for both spinal inclination and pelvic tilt can’t be controlled in the surgery. The correction goal for western people may be not suitable for Chinese. Conclusion The parameters should be used wisely when evaluating the sagittal balance, the global balance and local balance should be considered together and the different groups of people need different correction goals.
ObjectiveTo investigate the relationship between lumbar facet joint degeneration of each segment and spine-pelvic sagittal balance parameters. MethodsA retrospective analysis was made the clinical data of 120 patients with lumbar degenerative disease, who accorded with the inclusion criteria between June and November 2014. There were 58 males and 62 females with an average age of 53 years (range, 24-77 years). The disease duration ranged from 3 to 96 months (mean, 6.6 months). Affected segments included L3, 4 in 32 cases, L4, 5 in 47 cases, and L5, S1 in 52 cases. The CT and X-ray films of the lumbar vertebrae were taken. The facet joint degeneration was graded based on the grading system of Pathria. The spine-pelvic sagittal balance parameters were measured, including lumbar lordosis (LL), upper lumbar lordosis (ULL), lower lumbar lordosis (LLL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). According to normal range of PI, the patients were divided into 3 groups: group A (PI was 1ess than normal range), group B (PI was within normal range), and group C (PI was more than normal range). The facet joint degeneration was compared;according to the facet joint degeneration degree, the patients were divided into group N (mild degeneration group) and group M (serious degeneration group) to observe the relationship of lumbar facet joint degeneration of each segment and spine-pelvic sagittal balance parameters. ResultsAt L4, 5 and L5, S1, facet joint degeneration showed significant difference among groups A, B, and C (P<0.05), more serious facet joint degeneration was observed in group C;no significant difference was found in facet joint degeneration at L3, 4 (P>0.05). There was no significant difference in the other spine-pelvic sagittal balance parameters between groups N and M at each segment (P>0.05) except for PT (P<0.05). ConclusionPI of more than normal range may lead to or aggravate lumbar facet joint degeneration at L4, 5 and L5, S1;PT and PI are significantly associated with facet joint degeneration at the lower lumbar spine.
ObjectiveTo investigate the effectiveness of posterior sagittal anorectoplasty (PSARP) and total urogenital mobilization in treatment of cloacal malformation. MethodsThree girls with cloacal malformation were admitted between June 2010 and June 2013. The age was 2 years, 5 months, and 4 months, respectively. All patients received previous separated sigmoid colostomy. PSARP and total urogenital mobilization were performed to correct the malformation. Colostomy stoma was closed after confirming the patent of rectum and anus. Dilation of anus was sustained for 6 months after anorectoplasty. ResultsOperations were successfully completed in 3 cases. The durations of operation were 3 hours and 40 minutes, 4 hours and 20 minutes, and 3 hours and 50 minutes; the blood loss was 10, 20, and 10 mL; and the time of colostomy stoma closure was 3, 5, and 3 months, respectively. Three cases were followed up 13, 18, and 4 months, respectively; no anal stenosis or rectal prolapse occurred. They had normal micturition; the B ultrasonic examination showed that the residual urine volume was less than 10 mL. At 12 months after anorectoplasty, the Wexner scores were 1 and 5 in 2 cases followed up 13 and 18 months; according to Krickenbeck postoperative effect, 2 cases had defecation and no constipation; 1 case had soiling (grade 1). ConclusionPSARP and total urogenital mobilization should be the first choice in treatment of cloacal malformation with common channel less than 3 cm.