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Objective:To investigate the clinical outcomes of anterolateral thigh flap combined with great saphenous vein transplantations for the treatment of extensive elbow soft tissue defects accompanied by brachial artery embolism.Methods:A retrospective case series study was carried out to investigate the clinical data of 19 patients with extensive elbow soft tissue defects accompanied by brachial artery embolism admitted to Fuyang People's Hospital of Anhui Medical University from March 2017 to March 2020. There were 15 males and 4 females，aged 14-59 years［（37.6±14.1）years］. The areas of elbow soft tissue defects ranged from 7 cm×3 cm to 12 cm×5 cm. Before operation，angiography test was performed to confirm brachial artery embolism of the affected upper limb. The length of embolization ranged from 5 to 12 cm［（7.3±1.6）cm］. All patients were treated using the anterolateral thigh flap combined with great saphenous vein transplantation. The operation time and intraoperative blood loss were recorded. Angiography test was re-examined one week after operation. The degree of flap swelling，elbow Broberg-Morrey functional score and scar contracture were evaluated at postoperative 3，6，and 12 months. Healing of donor site and postoperative complications were observed.Results:All patients were followed up for 12-24 months［（18.1±3.0）months］. The operation duration was 3.5-6.4 hours［（4.9±0.8）hours］，with intraoperative blood loss of 200-600 ml［（338.7±101.6）ml］. The blood flow of repaired brachial artery was unobstructed in all patients one week after operation，with all flaps survived. The degree of flap swelling was（0.9±0.3）cm at postoperative 12 months，significantly reduced from that at postoperative 3 and 6 months［（1.2±0.3）cm，（1.1±0.3）cm］（ P<0.05）. The elbow Broberg-Morrey functional score was（87.8±4.8）points，significantly higher than those at postoperative 3 and 6 months［（71.4±7.0）points，（80.2±4.8）points］（ P<0.05）. The rating of elbow function score was excellent in 9 patients，good in 8 and fair in 2 at postoperative 12 months，with the excellent and good rate of 90%. The rate of scar contracture was 63%（12/19）at postoperative 12 months，significantly higher than that at postoperative 3［11%（2/19）］（ P<0.05），while not different from that at postoperative 6 months［42%（8/19）］（ P>0.05）. The donor site was healed in all patients，without complications related to blood vessels or flaps. Conclusions:For extensive elbow soft tissue defect accompanied by brachial artery embolism，the anterolateral thigh flap combined with great saphenous vein transplantations can successfully restore the blood supply of the distal site of the affected limb with a high survival rate of the flap and well recovered limb function，and hence is a feasible method for severe elbow trauma. However，due to various factors such as elbow joint immobilization during perioperative period，scar contracture is prone to occur in the area of the flap.
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Objective:To summarize the perioperative nursing points of percutaneous kyphoplasty (PKP) in elderly patients with osteoporotic vertebral compression fractures assisted by robots, so as to provide reference for orthopedic nursing.Methods:From July 2019 to February 2021, the data of 72 patients undergoing robot-assisted PKP in the spinal surgery of the First Affiliated Hospital of Anhui Medical University were retrospectively analyzed. The perioperative nursing points were summarized, and the nursing experience was summarized. The nursing under the new measures of precise minimally invasive treatment was analyzed and discussed. The length of hospital stay, postoperative ambulation time, complications and satisfaction survey results of patients were collected and recorded. The Numerical Rating Scale(NRS) score, Self-rating Anxiety Scale(SAS) score and Oswestry Disability Index (ODI) score before and after surgery were compared. The correlation analysis of the scores of various factors was combined to comprehensively evaluate the surgical and nursing effects.Results:All patients had no complications related to machine use during and after operation, and their symptoms were improved to varying degrees. Fifty-seven cases of indwelling catheter, catheter time (19.00±14.24) h. The preoperative hospitalization time was (6.16±2.22) d, and the postoperative hospitalization time was (1.94±0.99) d. Postoperative bed time was (16.34±6.81) h. Postoperative nursing satisfaction was (98.55±2.44)%.The postoperative NRS and SAS scores were (1.00±0.55) and (32.06±5.33) points, respectively, which were lower than those before operation (3.51 ± 0.71) and (39.08±8.86) points, and the differences were statistically significant ( t values were 33.976, 8.184, P<0.01). There were statistically significant differences in six indicators of ODI scores before and after surgery, including low back pain, walking, standing, sitting, sleep and self-care ( P<0.01). Correlation analysis showed that there was a strong correlation between the six ODI score factors and the NRS score. The four factors of sitting, walking, low back pain and standing were highly correlated with SAS. Conclusions:The implementation of good perioperative nursing management for patients with PKP assisted by robot can effectively promote the rehabilitation of patients, reduce the incidence of complications and improve patient satisfaction.
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Facet joint is the important part of spinal biomechanical structures. The damage of facet joint will destroy the stability of spinal motion segments and accelerate the adjacent segments degeneration (ASD). The violation of cranial facet joint based on various screw insertion techniques is a common but easily overlooked factor in clinical application. The reduction of intra-operative cranial facet joint violation is essential for reduction of postoperative ASD. The rates of facet violation are related to screw insertion techniques. The insertion techniques, including robot-assisted guidance, computer-assistant navigation, and cortical bone trajectory, are used successfully well in protecting cranial facet joints, compared with the freehand pedicle screw placement technique, which has been widely utilized in clinical practice. However, the conventional X-ray guided screw insertion technique is associated with a higher rate of facet violation. The main reasons why different techniques lead to various rates of facet violation include various anatomical referenced landmarks during screw insertion, selection of assisted equipment for instruments, and resistance of soft tissues of the spine. In addition, the related risk factors, such as facet angle, screw insertion segments, lumbar degeneration, and learning curve effect, can also affect the rates of facet violation. In the present study, we compared the differences of facet joint violation when using various screw techniques, and summarized the causes of violations and related risk factor. The present review might provide references for surgeons regarding the decrease of cranial facet joint violation, optimization of insertion techniques and reduction of ASD.
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Objective:To evaluate the clinical efficacy of percutaneous channel screwing assisted by the robot navigation positioning system combined with pelvic unlocking reduction frame for pelvic fractures.Methods:A retrospective analysis was conducted of the 12 patients with pelvic fracture who had been admitted to Department of Orthopaedics, The First Affiliated Hospital to Anhui Medical University from January to October 2018. They were 7 men and 5 women with an average age of 42.3 years (from 25 to 62 years). The time from injury to operation averaged 5.1 days (from 2 to 10 days). There were 2 cases of type B1, 5 ones of type B2 and 5 ones of type C1 according to the Tile classification. After closed reduction using the pelvic unlocking reduction frame, the orthopedics robot navigation positioning system was used to guide the placement of percutaneous screws. The posterior rings were fixated with sacroiliac screws, and the anterior rings with pubis screws, pubic symphysis screws or external fixation. The placement time for each screw, fluoroscopy frequency, reduction quality, fracture union time, function of the affected hip and complications at the final follow-up were recorded.Results:A total of 25 percutaneous screws were inserted in the 12 patients with a mean fluoroscopic frequency of 4.7 times (from 3 to 8 times) and a mean placement time of 14.9 min (from 12 to 20 min). According to the Matta rating system, the fracture reduction was rated as excellent in 7 cases, as good in 4 and as fair in one. The average follow-up time was 11.3 months (from 6 to 16 months). All fractures healed after an average period of 11.8 weeks (from 10 to 14 weeks). By the Majeed scoring, the pelvic function at the final follow-up was excellent in 8 cases and good in 4. The follow-ups observed no infection, nerve injury, deep vein thrombosis, heterotopic ossification, implant looseningor traumatic arthritis in these patients.Conclusion:Percutaneous channel screwing assisted by the robot navigation positioning system combined with pelvic unlocking reduction frame can reduce operative time and risks and lead to minimal invasion for pelvic fractures.
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Objective To study cerebral cortical activation preoperatively and postoperatively in patients with cervical spondylotic myelopathy (CSM), and discuss effect of the surgery on cortical reorganization in functional recovery.Methods 19 cases with CSM intrial group underwent cervical vertebra canal decompression surgery according to clinical routine.Cases in trial group completed clinical assessment using the modified Japanese Orthopaedic Association Scores (mJOA) prior to decompression and 12 months following surgery, and underwent cerebral functional MRI and conventional MRI in the same time.19 controls also carried out cerebral functional MRI and conventional MRI.All subjects performed a finger-tapping paradigm with right hand during processing functional MRI.The imagings and data of trial group were divided into preoperative group and postoperative group in accordance with the time of completed and than analysed.Results The mJOA score of postoperative group was increased significantly (P<0.001).Cortical volume of activation (VOA) of preoperative group was significantly higher than the control group (P<0.05).VOA was lower in the postoperative group, but still significantly higher than the control group (P<0.05).The preoperative group was able to detect and activate the signal only in the left precentral gyrus.The postoperative group was able to detect and activate the signal in the l left postcentral gyrus, the premotor area and the supplementary motor area, and the right cerebral cortex could also detect a small amount of activation signal.Conclusion CSM patients undergo cerebral cortical remodeling, causing sensory and motor function activation areas to expand and shift.The changes of cortical reorganization after cervical vertebra canal decompression surgery are associated with functional recovery.The surgical treatment may promote the compensating cortical reorganization.
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Objectives:To evaluate the long-term complications of percutaneous kyphoplasty(PKP) for osteoporotic vertebral compression fractures (OVCF),and to provide evidence for clinical procedure.Methods:Databases including CNK1,CBM,PubMed,The Cochrane Library(lssue 2,2017),Wiley Online Library,ELSEVIER Science Direct(SDOS) were used to collect the randomized controlled trials(RCTs) which compared PKP with conservative treatment in the treatment of OVCF from inception to February 2017.The diagnosis of thoracolumbar vertebral compression fracture was confirmed by X-ray,CT and MRI.The presence of thoracolumbar osteoporotic T which was less than or equal to-2.5,was confirmed by bone mineral density measurement.All the patients were 50 years or older,and disease duration was less than 6 months;postoperative outcomes included at least one of the following indicators:new vertebral fractures,adjacent fractures,serious adverse events,visual analogue score.Cochrane system evaluation manual 5.0.1 was referred to evaluate the quality of the included literatures.Results:Five RCT studies included four English literatures and one Chinese literature.Methodological quality assessment of 4 articles were more than or equal to 4 points,one article scored 3 points.PKP group consisted of 417 cases,conservative treatment group of 458 cases.The results of meta-analysis showed that there was statistical difference in VAS between the two groups after 3 to 6 months' treatment(mean difference=-0.36;95％CI-0.07 to-0.65;P=0.02).However,there was no statistical difference in new vertebral fractures,adjacent fractures or serious adverse events.Conclusions:Application of PKP in OVCF can reduce the patients' long-term (3-6 months) VAS pain score and does not increase the risks of new vertebral fractures,adjacent fractures and serious adverse events.
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Objective To study the relationship between degenerative lumbar spondylolisthesis and degeneration of cartilage endplate by magnetic resonance imaging.Methods The median sagittal scanning of LA/L5 and L5/S1 intervertebral discs of all subjects were performed by magnetic resonance imaging with T2.Measureed the inclination angle of the front half of the endplate and the inclination angle of the posterior half of the endplate,then the ratio of the anterior horn and the posterior horn was calculated as the change rate of the endplate.The differences of the rate of cartilage endplate in the corresponding stage of spondylolisthesis group and normal group were compared.Results In L4 lumbar spondylolisthesis group,both upper and lower endplate of L4/L5 intervertebral disc have significant differences between the lumbar spondylolisthesis group and the normal group (t =11.280,-3.765,P =0.000).In L5 lumbar spondylolisthesis group,there are significant differences between the lumbar spondylolisthesis group and the normal group (t =11.280,-3.765,P =0.000),both upper and lower endplate of L5/S1 intervertebral disc;and significant differences were found among the upper and lower endplates of the L5/S1 (t =4.633,P =0.000).Among all the subjects,between the upper and lower endplate of L4/L5,significant differences were found,too(t =17.377,3.137,2.199,P =0.000,0.005,0.035).In addition to the above,the differences were not statistically significant.Therefore,lumbar spondylolisthesis can lead to degenerative in cartilage endplate of Slippage stage.Conclusion The degree of degeneration of the anterior and the posterior half of the same cartilage endplate is asymmetrical,for example,the degeneration of the posterior half of the upper endplate is worse than that of the anterior half of the plate,but the degeneration of the anterior half of the lower endplate is worse than that of the posterior half endplate.The degenerative degree of cartilage endplate was less affected by lumbar spondylolisthesis in the non slip stage.
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Objective To assess the efficacy of radiofrequency therapy combined with ozone injection in the treatment of lumbar disc protrusion. Methods A total of 202 patients with lumbar disk protrusion were included and divided into three groups:radiofrequency (RF) group, ozone (Oz) group, and combination (Co) group. The efficacy was evaluated by visual analogue scale (VAS), Macnab curative effect evaluation, and oswestry disability index (ODI) at 1d, 1m and 6m after treat?ment. Results There were no significant differences in gender, age, the course of disease, preoperative VAS scores and ODI scores (P>0.05). All patients were operated successfully. There were no infection of the intervertebral disc, no compli?cations of spinal cord, nerve and no blood vessel injury. There were no significant differences in preoperative VAS and ODI scores between three groups. The VAS and ODI scores were significantly lower at 6 month and 12 month after operation in Co group combined with those of RF group and Oz group. There were no significant differences in these two scores between RF group and Oz group (P>0.05). There were no significant differences in effective rates at 1d, 6 month and 12 month after operation between three groups (P>0.05). But the excellent and good effective rates were higher in Co group than those of RF and Oz groups. There were no significant differences in excellent and good effective rates between RF group and Oz group. Conclusion The therapy of radiofrequency combined with ozone injection is an efficient and mini-invasive tech?nique for the treatment of lumbar disc protrusion and worth promoting.
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Objective To explore the association between C677T polymorphism of methylenetetrahydrofolate reductase (MTHFR) gene and susceptibility to hyperuricemia and gout.Methods The case-control studies from Chinese Biomedical Database,Chinese National Knowledge Infrastructure,Wanfang,Weipu,PubMed,Cochrane Library,OvidSP,Wiley Online Library,EBSCO,Elsevier Science Direct,Springer Link and Google scholar databases for the association of C677T polymorphism of MTHFR gene with hyperuricemia and gout.The pooled odds ratios (OR) with 95％ confidence intervals (CI) were appropriately derived from randomeffects or fixed-effects models to assess the association strength by RevMan 5.3 and Stata 12.0 software.Results Ten references enrolled 1 899 hyperuricemia patients and 5 403 controls,and 3 references enrolled 209 gout patients and 194 controls in total.The meta analysis showed that carriers of genotype CC [OR=0.42,95％CI (0.29,0.63),P＜0.01] and allele C [OR=0.54,95％CI (0.42,0.71),P＜0.01] had lower risk of hyperuricemia;genotype TT [OR=1.55,95％CI (1.32,1.83),P＜0.01] and allele T [OR=1.84,95％CI (1.38,2.45),P＜0.01] had higher risk of hyperuricemia,carriers of genotype CC [OR=0.32,95％CI (0.15,0.68),P=0.003] and allele C [OR=0.35,95％CI (0.17,0.70),P=0.003] hadlower risk of gout;genotype TT [OR=2.92,95％CI (1.74,4.92),P＜0.01] allele T [OR=2.69,95％CI(1.50,4.84),P=0.0009] had higher risk of gout.Conclusion The meta analysis reveals that C677T polymorphism of MTHFR gene is associated with the susceptibility to hyperuricemia and gout.
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Objective To investigate incision pathogenic bacteria after spinal surgery, and observe clinical effects of therapeutic methods. Methods A total of 30 cases of early surgical incision infection (7 cases of superficial infection and 23 cases of deep infection) after spinal surgery were retrospectively analyzed. The basic data including clinical manifes-tations, diagnosis, treatment, etiology and follow-up results were analyzed. Results It was found that the mean infection time after operation was 2-15 days in 30 patients. Thirty-three strains were isolated including 18 gram-positive cocci (54.5%, and Staphylococcus aureus account for 13, 39.4%), 15 gram-negative bacteria (45.5%, and Coli communior account for 6, 18.2%). The drug susceptibility test showed that gram-positive cocci were highly sensitive to vancomycin, rifampin, tei-coplanin and cotrimoxazole. No vancomycin-resistant Staphylococcus aureus were found. Gram negative bacteria were high-ly sensitive to imipenem (100%). Seven cases of superficial infection were cured after dressing. Twenty-three cases of deep incision wound infection were no recurrence of infection after treatment by deep wound debridement, and postoperative cathe-terization. Conclusion The early wound infection after spinal surgery is usually due to Staphylococcus aureus. It is good to perform wound debridement, continuous perfusion drainage, and treatment with vancomycin for deep wound infection.
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Objectives: To explore the association between the polymorphism in -857 site of tumor necrosis factor (TNF)-α promoter region and the susceptibility to ankylosing spondylitis (AS). Methods: Case-control studies Pubmed, Cochrane Library, Ovid, Chinese Biomedical Database(CBM), Chinese National Knowledge In-frastructure(CNKI), Wanfang and Weipu data bases from inception to October 2013 for the association between TNF-α-857 C/T polymorphism and the susceptibility to AS were collected. Meta-analysis was performed by Revman 5.2 and Stata 12.0 software. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were de-rived from random-effects or fixed-effects models to assess the strength of the association. Results: Nine case-control studies were included in the final meta-analysis, including a total of 933 AS patients and 1094 controls. Statistically significant differences between AS and control groups were observed in the susceptibility to AS and TNF-α-857 genotype CC [OR=0.46, 95%CI (0.26, 0.81), P=0.007], allele C [OR=0.61, 95%CI (0.41, 0.91), P=0.02] and T [OR=1.64, 95%CI (1.10, 2.43), P=0.02]. But, no statistical difference in the fre-quency of genotype TT [OR=1.49, 95%CI (0.95, 2.34), P=0.08] was observed between AS and control groups. There were obvious heterogeneities among the studies of genotype CC(P<0.00001, I2=87%), allele C(P<0.00001, I2=84%) and allele T(P<0.00001, I2 =84%), except genotype TT(P=0.09, I2=42%). Sensitivity analysis was per-formed by leaving out one study at a time, but the heterogeneity remained obvious. It was symmetric of the funnel plots of genotype CC, allele C and T with AS, but genotype TT. There was no statistical significance in genotype CC[Begg′s test(z=0.52, P=0.602), Egger′s test(t=0.23, P=0.825)], genotype TT[Begg′s test(z=0.94, P=0.348), Egger′s test(t=1.26, P=0.248)], allele C[Begg′s test(z=0.31, P=0.754), Egger′s test(t=0.72, P=0.494)] or allele T[Begg′s test(z=0.31, P=0.754), Egger′s test(t=-0.72, P=0.494)]. Conclusions: Genotype CC, allele C and T of TNF-α-857 are associated with the susceptibility to AS, and T-allele carriers have higher risk of AS.
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Objective To explore the association between the polymorphism in-308 site of tumor necrosis factor (TNF)-α promoter region and ankylosing spondylitis (AS).Methods The case-control studies from PubMed,Cochrane Library,Ovid,Chinese Biomedical Database,Chinese National Knowledge Infrastructure,Wanfang and Weipu databases for the association polymorphism in-308 site of TNF-α promoter region with AS.The pooled odds ratios (OR) with 95％ confidence intervals (CI) were appropriately derived from random-effects models or fixed-effects models to assess the association strength by RevMan 5.2 and Stata 12.0 software.Results Nineteen references enrolled 2 155 AS patients and 2 367 controls in total.The meta analysis showed that the frequencies of GG vs (AA +GA) genotypes was not statistically different between AS group and the control group in total populations [OR=1.20,95％CI (0.85,1.70),P=0.30],in the populations of Asian origin [OR=1.29,,95％CI (0.66,2.52),P=0.45] and in the populations of non-Asian origin [OR=1.16,95％CI (0.78,1.72),P=0.46].The analysis also showed that the frequencies of AA vs (GG +GA) genotypes was not statisticalLY differenT between AS group and the control group in total populations[OR=0.78,95％CI (0.53,1.15),P=0.21],in the populations of Asian origin [OR=1.15,95％CI (0.33,4.00),P=0.82] and in the populations of non-Asian origin[OR=0.69,95％CI (0.42,1.13),P=0.14].The analysis also showed that the frequencies of allele G vs A was not statistically different between AS group and the control group in total populations [OR=1.09,95％CI (0.79,1.50),P=0.61],in the populations of Asian origin [OR=1.17,95％CI (0.65,2.09),P=0.60] and in the populations of non-Asian origin [OR=1.05,95％CI (0.71,1.54),P=0.81].Conclusion The Meta-analysis reveales that all genotypes and alleles of-308 site of TNF-α promoter region may not be associated with AS.
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BACKGROUND:Cervical kyphosis post laminectomy is a common iatrogenic,and progressive abnormality of the curvature of cervical spine,and can influence the function of cervical spine of children and adults.OBJECTIVE:To explore the effect of multiple levels of laminectomies on the curvature of cervical spine,and analyze the role of the elastic modulus of cervical intervertebral disc and ligaments on maintaining curvature of postlaminectomy cervical spine.DESIGN,TIME AND SETTING:Three-dimensional finite element analysis was performed in Changzheng Hospital,Second Military Medical University of Chinese PLA between January 2003 and January 2004.MATERIALS:The highly resolution pictures of the cross-section of cervical spine(interval distance of layer 1 mm) were came from male cross-section of cervical spinal of American visible human project,which was freely downloaded from The Visible Human Project.METHODS:The highly resolution pictures of cervical spinal cross-section were used as data to reconstruct the three-dimensional multiple levels postlaminectomy cervical spine models including all structure of spine from cranial base to the first thoracic vertebrae except the vertebral lamina,spinous process,ligamentum flavum,interspinous and supraspinous ligament from the second to the seventh cervical spine.The finite element and elastic modulus of the structures of cervical spine were defined according to previous reports.With this model and Ansys6.1 finite element analysis software,the effect of laminectomy on the curvature of cervical spine and impact of the elastic modulus of intervertebral disc and ligament to the curvature of postlaminectoy cervical spine were analyzed.MAIN OUTCOME MEASURES:The influence of the elastic modulus of cervical intervertebral disc and ligament(anterior and posterior longitudinal ligaments) on the curvature of the postlaminectomy cervical spine.RESULTS:The physical lordosis of multiple levels postlaminectomy cervical spine was reduced after multi-level loading,and the physical lordosis of the superior cervical spine disappeared with only slightly kyphosis.The kyphosis was aggravated after reducing the elastic modulus of intervertebral disc and ligament(anterior and posterior longitudinal ligaments).Following increased elastic modulus of intervertebral disc and ligament,the kyphosis of cervical spine was reduced even disappeared,and gradually regained the normal lordosis of cervical spine.CONCLUSION:Multiple levels cervical laminectomy can significant reduce the physical lordosis of cervical spine,and convert the physical cervical lordosis to cervical kyphosis.The elastic modulus increase of cervical intervertebral disc and ligament can inhibit kyphosis formation post laminectomy.
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hyperflexion,and the differentiation was significant(P