BACKGROUND & AIMS: :Extranodal presentation in non-Hodgkin's lymphoma (NHL) is uncommon, and the mandible is very rarely involved. Primary NHL of the mandible, for the most part, has intermediate or high malignancy and has a much greater incidence of local recurrence compared with other sites of involvement. A 48-year-old Japanese man with NHL of the mandible received radiotherapy, followed by high-dose chemotherapy supported with peripheral blood stem cell transplantation (PBSCT). High-dose cyclophosphamide, Adriamycin, and vincristine were used for pretransplant conditioning. He achieved complete remission and has survived in continuous complete remission for more than 72 months to date. Marrow-ablative chemotherapy facilitated by PBSCT is thought to be useful as part of the primary therapy for patients with NHL who have poorer prognoses.

背景与目标： : 非霍奇金淋巴瘤 (NHL) 的结外表现并不常见，下颌骨很少涉及。与其他受累部位相比，下颌骨的原发性NHL大部分具有中等或高度恶性，并且局部复发的发生率更高。一名48岁的日本下颌骨NHL男子接受了放疗，随后接受了大剂量化疗，并伴有外周血干细胞移植 (PBSCT)。大剂量环磷酰胺，阿霉素和长春新碱用于移植前调理。迄今为止，他获得了完全缓解，并且在连续完全缓解中存活了72个月以上。PBSCT促进的骨髓消融化疗被认为是对预后较差的NHL患者的主要治疗的一部分。

BACKGROUND & AIMS: BACKGROUND:Idiopathic chronic anal fissure is believed to be a consequence of a traumatic acute anodermal tear followed by recurrent inflammation and poor healing due to relative tissue ischaemia secondary to internal sphincter spasm. This pilot trial compared the efficacy of a novel manufactured ano-coccygeal support attached to a standard toilet seat (Colorec) to the standard procedure of lateral internal sphincterotomy (LIS) for chronic anal fissure. METHODS:Fifty-three patients with confirmed chronic anal fissures were enrolled and assigned, based on their preference, to the test group and the control group. Each patient was reviewed after therapy, and follow-up was scheduled at 4, 6 and 8 weeks and at 6 months. RESULTS:The fissure healing rate was 100% in both groups. There were no statistically significant differences between the test group (n = 30, median age 42 years; range 20-71 years) and the control group (n = 22, median age 38 years; range 23-60 years) with regards to resolution of rectal bleeding at defaecation after 4 weeks (86.6 vs. 72.7%, p = 0.698), and by week 6, bleeding had resolved in 100% of patients in both groups. There was no statistically significant difference between the test group and the control group with regards to pain scores at 4, 6 and 8 weeks (4.30 ± 0.79, 2.03 ± 0.80, 0.43 ± 0.50 vs. 3.50 ± 0.74, 1.68 ± 0.56, 0.50 ± 0.51, p = 0.054) and to time until complete healing of fissures (5.60 ± 1.52 weeks vs. 5.91 ± 1.57 weeks, p = 0.479). After continuous use of the ano-coccygeal support over 6 months, no patients in the test group had recurrent fissures. No complications were observed during the trial. CONCLUSIONS:Results of both methods were comparable and demonstrated that the ano-coccygeal support is at least as effective as LIS, without any short-term complications. Larger and randomised trials on the use of ano-coccygeal support for chronic anal fissures are awaited.

背景与目标：

BACKGROUND & AIMS: We studied the roles of Notch, Delta, and Serrate in vertebrate epithelial appendage morphogenesis using feather as a model and found the following. (1) C-Notch-1, C-Delta-1, and C-Serrate-1 are not expressed at the early placode stage and are therefore not involved in the determination of bud versus interbud compartments. (2) From symmetric short buds to asymmetric long buds, C-Delta-1 and C-Serrate-1 are expressed in the posterior bud mesenchyme in a nested fashion, while C-Notch-1 is expressed as a stripe perpendicular to the anterior-posterior (A-P) axis and positioned posterior to the midpoint. (3) Epithelial-mesenchymal recombination with rotation led to the disappearance of these genes followed by their reappearance with new positions appearing to predict their new morphological orientation. (4) Conditions leading to branched buds (e.g., recombination of later buds) show polarized staining patterns before branching occurs. (5) Conditions leading to symmetrical round buds (e.g., treated with the protein kinase A agonist forskolin) suppress expression of all three genes. These results lead us to hypothesize that Notch, Delta, and Serrate are involved in establishing the A-P asymmetry of feather buds.

背景与目标： 我们以羽毛为模型研究了Notch，Delta和Serrate在脊椎动物上皮附件形态发生中的作用，发现以下内容。(1) C-Notch-1，C-Delta-1和C-Serrate-1在早期阶段不表达，因此不参与芽间隔室的确定。(2) 从对称的短芽到不对称的长芽，C-Delta-1和C-Serrate-1以嵌套方式在后芽间充质中表达，而C-Notch-1表示为垂直于前后 (a-P) 轴并位于后的条纹中点。(3) 旋转使上皮-间充质重组导致这些基因消失，然后以新的位置重新出现，以预测其新的形态方向。(4) 导致分支芽的条件 (例如，后期芽的重组) 在分支发生之前显示出极化染色模式。(5) 导致对称圆芽的条件 (例如，用蛋白激酶A激动剂forskolin处理) 抑制所有三个基因的表达。这些结果使我们假设缺口，三角洲和锯齿参与建立羽毛芽的A-P不对称性。

BACKGROUND & AIMS: We report the case of a 5-year-old girl with an enlarging suboccipital mass, a posttraumatic intraosseous arachnoid cyst. Diagnostic work-up revealed that the lesion consisted of an intradiploic arachnoid cyst and an extra-axial occipital pouch that communicated by way of an osseous and dural defect. Surgical repair was undertaken with good results. A search of the current literature has shown only seven previous reports of leptomeningeal cysts situated at the occipital bones, most of them the result of an antecedent skull fracture. A pathogenetic hypothesis is presented comparing the growth of arachnoid intraosseous cysts and the development of meningocencephaloceles.

背景与目标： 我们报告了一个5岁女孩的情况，该女孩的枕下肿块扩大，创伤性骨内蛛网膜囊肿。诊断性检查显示，病变由一个内蛛网膜囊肿和一个通过骨和硬脑膜缺损连通的轴外枕袋组成。进行了手术修复，效果良好。对当前文献的搜索显示，以前只有七个关于枕骨处的软脑膜囊肿的报道，其中大多数是先前颅骨骨折的结果。提出了一种致病假说，比较了蛛网膜骨内囊肿的生长和脑膜脑膜的发展。

BACKGROUND & AIMS: :The aim of the study was to analyze the long-term outcome (>20 years) after treatment of posterior fossa medulloblastoma (MB) in childhood. We analyzed data from patients treated for posterior fossa MB between 1974 (introduction of the first international treatment protocol in Norway) and 1987 (when use of radiotherapy was abandoned in children under 4 years of age). Out of 47 children, 24 survived >20 years. At the time of analysis, 16 patients (median age 41 years, range 32-52) were alive (median follow-up 34 years, range 30-42), while 8 patients died 22-41 years (median 31 years) after primary treatment: one late death (after 22 years) was due to tumor recurrence whilst other 7 deaths (after 23 to 41 years) were related to the detrimental effects of the treatment (secondary tumors, stroke, severe epilepsy and depression). Observed 20- and 30-year survival rates were 51% and 44%, respectively. Despite successful treatment of MB in childhood and satisfactory tumor control during the first 20 years following primary treatment, our data indicates that even long-term survivors may die from tumor recurrence. However, the main factors causing late mortality and morbidity in long-term survivors seem to be the complications related to radiotherapy given in childhood.

背景与目标： : 该研究的目的是分析儿童期后颅窝髓母细胞瘤 (MB) 治疗后的长期结果 (>20年)。我们分析了接受后颅窝MB 1974年 (在挪威引入了第一个国际治疗方案) 和1987 (在4岁以下儿童中放弃放疗时) 治疗的患者的数据。在47名儿童中，有24名存活了20年以上。在分析时，16例患者 (中位年龄41岁，范围32-52) 存活 (中位随访34年，范围30-42)，而8例患者在初次治疗后死亡22-41年 (中位31年): 1例晚期死亡 (22年后) 是由于肿瘤复发，而其他7例死亡 (23至41年后) 与治疗的有害影响 (继发性肿瘤，中风，严重癫痫和抑郁症) 有关。观察到的20年和30年生存率分别为51% 和44%。尽管在儿童时期成功治疗了MB，并且在初次治疗后的前20年中肿瘤控制令人满意，但我们的数据表明，即使是长期幸存者也可能死于肿瘤复发。然而，导致长期幸存者晚期死亡率和发病率的主要因素似乎是与儿童时期放疗有关的并发症。

BACKGROUND & AIMS: OBJECTIVE:The characteristics of typical posterior canal-benign paroxysmal positional vertigo-canalolithiasis (P-BPPV-Can) are well known. We found 10 patients with a new variant of P-BPPV-Can: Reverse (Rev)-P-BPPV-Can. The characteristics and pathophysiology of Rev-P-BPPV-Can are discussed. METHODS:For 4 years and 9 months, 10 patients with Rev-P-BPPV-Can (9 women and 1 man; mean age: 73 years) visited our clinic. Within the same period, 268 patients with unilateral typical P-BPPV-Can were treated. During the Dix-Hallpike and Epley maneuvers, nystagmus was recorded using an infrared charge-coupled device camera mounted on a pair of spectacles. RESULTS:The patients exhibited entirely opposite direction of nystagmus from typical P-BPPV-Can in both the Dix-Hallpike head position and upright sitting position. The patients had typical characteristics of nystagmus due to canalolithiasis, such as latency, duration of <1 min, linear-torsional nystagmus, and fatigability. Rev-P-BPPV-Can appeared after the Epley maneuver for typical P-BPPV-Can; in other patients, Rev-P-BPPV-Can changed to typical P-BPPV-Can. The affected sides of Rev-P-BPPV-Can were decided by those of typical P-BPPV-Can. CONCLUSION:Canalolithiasis in the non-ampullary distal portion of the posterior semicircular canal may be a potential pathophysiology of Rev-P-BPPV-Can. The Epley maneuver has little effect for treating Rev-P-BPPV-Can, but spontaneous transition to typical P-BPPV-Can or spontaneous recovery is expected.

背景与目标：

BACKGROUND & AIMS: UNLABELLED:It is unclear whether using artificial cages increases fusion rates compared with use of bone chips alone in posterior lumbar interbody fusion for patients with lumbar spondylolisthesis. We hypothesized artificial cages for posterior lumbar interbody fusion would provide better clinical and radiographic outcomes than bone chips alone. We assumed solid fusion would provide good clinical outcomes. We clinically and radiographically followed 34 patients with spondylolisthesis having posterior lumbar interbody fusion with mixed autogenous and allogeneic bone chips alone and 42 patients having posterior lumbar interbody fusion with implantation of artificial cages packed with morselized bone graft. Patients with the artificial cage had better functional improvement in the Oswestry disability index than those with bone chips alone, whereas pain score, patient satisfaction, and fusion rate were similar in the two groups. Postoperative disc height ratio, slip ratio, and segmental lordosis all decreased at final followup in the patients with bone chips alone but remained unchanged in the artificial cage group. The functional outcome correlated with radiographic fusion status. We conclude artificial cages provide better functional outcomes and radiographic improvement than bone chips alone in posterior lumbar interbody fusion for lumbar spondylolisthesis, although both techniques achieved comparable fusion rates. LEVEL OF EVIDENCE:Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

背景与目标：

BACKGROUND & AIMS: PURPOSE:To evaluate the reparability of the posterior horn of the medial meniscus with root ligament tear by measuring the actual pullout failure strength of a simple vertical suture of an arthroscopic subtotal meniscectomized posterior horn of the medial meniscus. METHODS:From November 2009 to May 2010, nine posterior horns of the medial meniscus specimens were collected from arthroscopic subtotal meniscectomy performed as a treatment for root ligament rupture of the posterior horn of the medial meniscus. Simple vertical sutures were performed on the specimens, and pullout failure load was tested with a biaxial servohydraulic testing machine (Model 8874; Instron Corp., Norwood, MA, USA). The degree of degeneration, extrusion, and medial displacement of the medial meniscus were evaluated with magnetic resonance imaging (MRI). The Kellgren-Lawrence classification was used in standing plain radiography, and mechanical alignment was measured using orthoroentgenography. Tear morphology was classified into ligament proper type or meniscoligamentous junctional type according to the site of the torn root ligament of the posterior horn of the medial meniscus during arthroscopy. RESULTS:The mean pullout failure strength of the posterior horn of the medial meniscus was 71.6 ± 23.2 N (range, 41.4-107.7 N). The degree of degeneration of the posterior horn of the medial meniscus on MRI showed statistically significant correlation with pullout failure strength and Kellgren-Lawrence classification. Pullout failure strength showed correlation with mechanical alignment and Kellgren-Lawrence classification (P < 0.05). CONCLUSIONS:The measurement of pullout failure strength of the posterior horn of the medial meniscus with root ligament tear showed a degree of repairability. The degree of degeneration of the posterior horn of the medial meniscus on MRI showed a significant correlation with the pullout failure strength. The pullout failure strength was also not only correlated with the degree of degeneration of the posterior horn of the medial meniscus, but also with mechanical alignment and Kellgren-Lawrence classification, which represent bony degenerative change.

背景与目标：

BACKGROUND & AIMS: :The connections between nuclei of the septum-diagonal band complex and the clusters of histaminergic neurons in the posterior hypothalamic region were studied with a dual-labeling procedure in which anterograde neuroanatomical tracing with Phaseolus vulgaris-leucoagglutinin was combined with immunohistochemistry of histidine decarboxylase. Phaseolus vulgaris-leucoagglutinin was injected in the medial and lateral septal nuclei, and in various parts of the nuclei of the diagonal band of Broca. The fibers arising from the medial and lateral septal nuclei traverse the vertical limb of the diagonal band and, in part, join the medial forebrain bundle in the preoptic area. Other fibers descend diffusely through the lateral hypothalamus to the posterior hypothalamus, or course in a bundle of fibers ensheathing the fornix. The nuclei of the diagonal band project via the medial forebrain bundle and the diffuse pathway to the posterior hypothalamic region. All the nuclei of the septum-diagonal band complex, with the exception of the medial and lateral parts of the nucleus of the horizontal limb of the diagonal band, project to clusters of histaminergic neurons. These projections exhibit the following arrangement: along the axis lateral septal nucleus-medial septal nucleus-vertical limb of the diagonal band-medial part of the horizontal limb of the diagonal band, the septohypothalamic fibers decrease in density and distribute to fewer clusters of histaminergic neurons. Varicosities on the labeled fibers are formed in close proximity to the cell bodies and dendrites of the histaminergic neurons.

背景与目标： : 通过双重标记程序研究了隔-对角带复合体的核与下丘脑后部组胺能神经元簇之间的联系，其中将菜豆-白细胞凝集素的顺行神经解剖示踪与组氨酸脱羧酶的免疫组织化学相结合。将菜豆-白细胞凝集素注入内侧和外侧间隔核以及Broca对角线带核的各个部分。由内侧和外侧中隔核产生的纤维横穿对角线带的垂直肢体，并部分连接视前区的内侧前脑束。其他纤维通过下丘脑外侧扩散到下丘脑后部，或以一束纤维的方式延伸到穹窿。对角带的核通过内侧前脑束和弥散途径投射到下丘脑后部区域。隔膜-对角线带复合体的所有核，除了对角线带水平肢核的内侧和外侧部分外，都投射到组胺能神经元簇。这些投影表现出以下排列: 沿着轴外侧间隔核-内侧间隔核-对角线带的垂直肢体-对角线带的水平肢体的内侧部分，下丘脑隔膜纤维的密度降低并分布到更少的组胺能神经元簇。标记纤维上的静脉曲张形成于组胺能神经元的细胞体和树突附近。

BACKGROUND & AIMS: :The aim of this study was to demonstrate the incidence of absence of the posterior root of the first cervical nerve, and the relation between the accessory nerve and the posterior root of the first cervical nerve in Turkish population. Dissections of the accessory nerve and the posterior root of the first cervical nerve were performed in 49 specimens from 27 formalin fixed cadavers (25 male and 2 female). The type of the connections between the accessory nerve and the posterior root of the first cervical nerve was classified into four types. Type III was the most common type in present study (30.6%). There was a connection between the accessory nerve and the posterior root of the first cervical nerve in this type. The connections demonstrated in this study are important in the etiology and surgical treatment of the spasmodic torticollis.

背景与目标： : 这项研究的目的是证明土耳其人群中第一颈神经后根缺失的发生率，以及副神经与第一颈神经后根之间的关系。在来自27例福尔马林固定尸体 (25例男性和2例女性) 的49个标本中进行了副神经和第一颈神经的后根解剖。副神经与第一颈神经后根之间的连接类型分为四种类型。III型是目前研究中最常见的类型 (30.6%)。在这种类型中，副神经和第一颈神经的后根之间存在连接。在这项研究中证明的联系在痉挛性斜颈的病因和手术治疗中很重要。

BACKGROUND & AIMS: :We report a case of compression fracture of anterior margin of medial tibial plateau and medial femoral condyle combined with the posterior cruciate ligament and posterolateral corner disruption. A thirty-seven-year old male had undergone the left knee injury 6 months before. The physical examination revealed positive posterior drawer test and tibial dial test, which evidenced the posterior cruciate ligament and posterolateral corner insufficiency. The plain lateral knee radiographs showed a marginal fracture of the anteromedial tibial plateau and a dimpling on the adjacent part of the medial femoral condyle. On arthroscopy, there were no gross tear of the cruciates, but the posterolateral capsule disclosed stigmata of stretching injury with multiple petechiae and scarring. The compression fracture on the anteromedial side and the stretching injury on the posterolateral side altogether support the mechanism of hyperextension pivoting on the anteromedial side of the knee joint. A small bony lesion around the knee joint should be inspected rigorously with an assumed mechanism of injury for it may herald major ligamentous injury.

背景与目标： : 我们报告了一例胫骨内侧平台前缘和股骨内侧con合并后交叉韧带和后外侧角断裂的压缩性骨折。一名37岁的男性在6个月前遭受了左膝受伤。体格检查显示后抽屉试验和胫骨表盘试验阳性，证明后交叉韧带和后外侧角功能不全。膝关节外侧x线平片显示胫骨前内侧平台的边缘骨折和股骨内侧con的相邻部分凹陷。在关节镜检查中，十字形没有明显的撕裂，但后外侧囊显示出有多处瘀点和疤痕的拉伸损伤的柱头。前内侧的压缩性骨折和后外侧的拉伸损伤共同支持了膝关节前内侧过度伸展枢转的机制。应严格检查膝关节周围的小骨病变，并假定其损伤机制，因为它可能预示着严重的韧带损伤。

BACKGROUND & AIMS: BACKGROUND CONTEXT:Posterior three-column spinal osteotomies were shown to be effective to treat severe and stiff kyphoscoliosis. Translations at the site of osteotomy after deformity correction were commonly seen intraoperatively, which might cause potential neurologic deficits. However, this phenomenon was not thoroughly discussed in the current literature. PURPOSE:This study aimed to evaluate the three-dimensional (3D) translations at the three-column osteotomy site and their effects on neurologic outcome in the surgical correction of severe and stiff kyphoscoliosis. STUDY DESIGN/SETTING:A retrospective study was carried out. PATIENT SAMPLE:Sixty-nine patients treated by posterior three-column spinal osteotomy for severe kyphoscoliosis of idiopathic, congenital, neuromuscular, neurofibromatosis, and tuberculosis origin were included. OUTCOME MEASURES:General, coronal, and sagittal translations were graded three-dimensionally according to the theory of Meyerding. METHODS:The charts of 69 clinical patients with severe and stiff kyphoscoliosis treated by posterior three-column osteotomy from January 2013 to June 2015 were reviewed. There were 35 male patients with an average age of 21.5 years and 34 female patients with an average age of 22.5 years. The etiologies of these spinal deformities were idiopathic, congenital, neuromuscular, neurofibromatosis, and tuberculosis. According to our classification system of spinal cord neurologic function, there were 41 type A, 13 type B, and 15 type C cases. The 3D spine models were reconstructed from thin-sliced computed tomography (CT) scan, and the 3D translations at the three-column osteotomy site were graded and analyzed. RESULTS:The incidences of general translation (GT), frontal translation (FT), and sagittal translation (ST) were 62.3%, 52.2%, and 26.1%. The incidence of evoked potential (EP) change in cases with GT/FT being or more than grade II (GT, 42.9%; FT, 50.0%) was significantly higher than that with GT/FT being less than grade II (GT, 16.7%; FT, 18.2%), whereas the incidence of EP change in cases with ST being or more than grade I (33.3%) was significantly higher than that with ST being less than grade I (9.8%). No linear correlations were found between spine shortening distance, deformity correction rate, and the degree of translation. CONCLUSIONS:The 3D translations are common in posterior three-column spinal osteotomies regardless of anterior strut graft placement. The increase of translation will increase neurologic risks, with GT or FT less than grade II and ST less than grade I being relatively safe.

背景与目标：

BACKGROUND & AIMS: INTRODUCTION:The purpose of this study was to analyze explanted PEEK rod spinal systems in the context of their clinical indications. We evaluated damage to the implant and histological changes in explanted periprosthetic tissues. METHODS:12 patients implanted with 23 PEEK rods were revised between 2008 and 2012. PEEK rods were of the same design (CD Horizon Legacy, Medtronic, Memphis TN, USA). Retrieved components were assessed for surface damage mechanisms, including plastic deformation, scratching, burnishing, and fracture. Patient history and indications for PEEK rod implantation were obtained from analysis of the medical records. RESULTS:11/12 PEEK rod systems were employed for fusion at one level, and motion preservation at the adjacent level. Surgical complications in the PEEK cohort included a small dural tear in one case that was immediately repaired. There were no cases of PEEK rod fracture or pedicle screw fracture. Retrieved PEEK rods exhibited scratching, as well as impressions from the set screws and pedicle screw saddles. PEEK debris was observed in two patient tissues, which were located adjacent to PEEK rods with evidence of scratching and burnishing. CONCLUSION:This study documents the surface changes and tissue reactions for retrieved PEEK rod stabilization systems. Permanent indentations by the set screws and pedicle screws were the most prevalent observations on the surface of explanted PEEK rods.

背景与目标：

BACKGROUND & AIMS: :OBJECTIVE Spinal navigation techniques for surgical fixation of unstable C1-2 pathologies are challenged by complex osseous and neurovascular anatomy, instability of the pathology, and unreliable preoperative registration techniques. An intraoperative CT scanner with autoregistration of C-1 and C-2 promises sufficient accuracy of spinal navigation without the need for further registration procedures. The aim of this study was to analyze the accuracy and reliability of posterior C1-2 fixation using intraoperative mobile CT scanner-guided navigation. METHODS In the period from July 2014 to February 2016, 10 consecutive patients with instability of C1-2 underwent posterior fixation using C-2 pedicle screws and C-1 lateral mass screws, and 2 patients underwent posterior fixation from C-1 to C-3. Spinal navigation was performed using intraoperative mobile CT. Following navigated screw insertion in C-1 and C-2, intraoperative CT was repeated to check for the accuracy of screw placement. In this study, the accuracy of screw positioning was retrospectively analyzed and graded by an independent observer. RESULTS The authors retrospectively analyzed the records of 10 females and 2 males, with a mean age of 80.7 ± 4.95 years (range 42-90 years). Unstable pathologies, which were verified by fracture dislocation or by flexion/extension radiographs, included 8 Anderson Type II fractures, 1 unstable Anderson Type III fracture, 1 hangman fracture Levine Effendi Ia, 1 complex hangman-Anderson Type III fracture, and 1 destructive rheumatoid arthritis of C1-2. In 4 patients, critical anatomy was observed: high-riding vertebral artery (3 patients) and arthritis-induced partial osseous destruction of the C-1 lateral mass (1 patient). A total of 48 navigated screws were placed. Correct screw positioning was observed in 47 screws (97.9%). Minor pedicle breach was observed in 1 screw (2.1%). No screw displacement occurred (accuracy rate 97.9%). CONCLUSION Spinal navigation using intraoperative mobile CT scanning was reliable and safe for posterior fixation in unstable C1-2 pathologies with high accuracy in this patient series.

背景与目标： : 目的脊柱导航技术用于手术固定不稳定的C1-2病理受到复杂的骨和神经血管解剖，病理的不稳定性以及不可靠的术前配准技术的挑战。具有C-1和C-2自动注册的术中CT扫描仪保证了脊柱导航的足够准确性，而无需进一步的注册程序。这项研究的目的是分析使用术中移动CT扫描仪引导的导航进行后路C1-2固定的准确性和可靠性。方法2014年7月至2016年2月连续10例C1-2不稳患者采用C-2椎弓根螺钉和C-1侧块螺钉进行后路固定，C-1至C-3 2例后路固定。使用术中移动CT进行脊柱导航。在C-1和C-2中导航螺钉插入后，重复术中CT以检查螺钉放置的准确性。在这项研究中，由独立的观察者对螺钉定位的准确性进行了回顾性分析和评分。结果作者回顾性分析了10名女性和2名男性的记录，平均年龄为80.7 ± 4.95岁 (42-90岁)。通过骨折脱位或屈伸x线片证实的不稳定病理包括8例安德森II型骨折，1例不稳定安德森III型骨折，1例hangman骨折Levine Effendi Ia，1例复杂hangman-Anderson III型骨折和1例破坏性C1-2类风湿性关节炎。在4例患者中，观察到重要的解剖结构: 高位椎动脉 (3例) 和关节炎引起的C-1侧块的部分骨性破坏 (1例)。总共放置了48个导航螺钉。在47个螺钉 (97.9%) 中观察到正确的螺钉定位。在1个螺钉 (2.1%) 中观察到轻微的椎弓根破裂。没有螺杆位移发生 (准确率97.9%)。结论在不稳定的C1-2病变中，使用术中移动ct扫描进行脊柱导航是可靠且安全的，在该系列患者中准确性较高。

BACKGROUND & AIMS: BACKGROUND:Previous studies have shown that increasing tibial slope can shift the resting position of the tibia anteriorly. As a result, sagittal osteotomies that alter slope have recently been proposed for treatment of posterior cruciate ligament (PCL) injuries. HYPOTHESES:Increasing tibial slope with an osteotomy shifts the resting position anteriorly in a PCL-deficient knee, thereby partially reducing the posterior tibial "sag" associated with PCL injury. This shift in resting position from the increased slope causes a decrease in posterior tibial translation compared with the PCL-deficient knee in response to posterior tibial and axial compressive loads. STUDY DESIGN:Controlled laboratory study. METHODS:Three knee conditions were tested with a robotic universal force-moment sensor testing system: intact, PCL-deficient, and PCL-deficient with increased tibial slope. Tibial slope was increased via a 5-mm anterior opening wedge osteotomy. Three external loading conditions were applied to each knee condition at 0 degrees, 30 degrees, 60 degrees, 90 degrees, and 120 degrees of knee flexion: (1) 134-N anterior-posterior (A-P) tibial load, (2) 200-N axial compressive load, and (3) combined 134-N A-P and 200-N axial loads. For each loading condition, kinematics of the intact knee were recorded for the remaining 5 degrees of freedom (ie, A-P, medial-lateral, and proximal-distal translations, internal-external and varus-valgus rotations). RESULTS:Posterior cruciate ligament deficiency resulted in a posterior shift of the tibial resting position to 8.4 +/- 2.6 mm at 90 degrees compared with the intact knee. After osteotomy, tibial slope increased from 9.2 degrees +/- 1.0 degrees in the intact knee to 13.8 degrees +/- 0.9 degrees. This increase in slope reduced the posterior sag of the PCL-deficient knee, shifting the resting position anteriorly to 4.0 +/- 2.0 mm at 90 degrees. Under a 200-N axial compressive load with the osteotomy, an additional increase in anterior tibial translation to 2.7 +/- 1.7 mm at 30 degrees was observed. Under a 134-N A-P load, the osteotomy did not significantly affect total A-P translation when compared with the PCL-deficient knee. However, because of the anterior shift in resting position, there was a relative decrease in posterior tibial translation and increase in anterior tibial translation. CONCLUSION:Increasing tibial slope in a PCL-deficient knee reduces tibial sag by shifting the resting position of the tibia anteriorly. This sag is even further reduced when the knee is subjected to axial compressive loads. CLINICAL RELEVANCE:These data suggest that increasing tibial slope may be beneficial for patients with PCL-deficient knees.

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