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Objective:To test and evaluate the reliability and clinical effectiveness of osteoporotic thoracolumbar fracture (OTLF) scoring and classification system.Methods:A multicenter retrospective case series study was conducted to analyze the clinical data of 530 OTLF patients admitted to 8 hospitals including Honghui Hospital Affiliated to Xi'an Jiaotong University from January 2021 to June 2022. There were 212 males and 318 females, aged 55-90 years [(72.6±10.8)years]. There were 4 patients with grade C and 18 with grade D according to American Spinal Injury Association (ASIA) classification. According to the osteoporotic thoracolumbar injury classification and severity (OTLICS) score, all patients had an OTLICS score over 4 points and required surgical treatment. Among them, 410 patients had acute symptomatic OTLF (ASOTLF), including 24 patients with type I, 159 type IIA, 47 type IIB, 31 type IIC, 136 type IIIA, 8 type IIIB, 2 type IV (absence of neurological symptoms) and 3 type IV (presence of neurological symptoms), and 120 patients had chronic symptomatic OTLF (CSOTLF), including 62 patients with type I, 21 type II, 17 type III, 3 type IV (reducible under general anesthesia), 9 type IV (not reducible under general anesthesia), 1 type V (reducible under general anesthesia), 5 type V (presence of neurological symptoms), and 2 type V (not reducible under general anesthesia). Surgical procedures included percutaneous vertebroplasty (PVP), positional repositioning plus PVP, percutaneous kyphoplasty (PKP), posterior open reduction combined with bone graft fusion and bone cement augmented screw internal fixation, posterior open reduction combined with decompression, bone graft fusion and bone cement augmented screw internal fixation, and posterior open reduction combined with osteotomy and orthopedics, bone graft fusion and bone cement augmented screw internal fixation. A weighted Kappa was used to test the interobserver and intraobserver reliability of the OTLICS score, the ASOTLF classification, and the CSOTLF classification. The visual analog scale (VAS), Oswestry disability index (ODI), ASIA classification were compared before, at 1 month after surgery and at the last follow-up. Incidence of postoperative complications was observed.Results:The percentage of mean interobserver agreement for OTLICS staging was 93.4%, with a mean confidence Kappa value of 0.86, and the percentage of mean intraobserver agreement was 93.0%, with a mean confidence kappa value of 0.86. The percentage of mean interobserver agreement for ASOTLF staging was 94.2%, with a mean confidence Kappa value of 0.84, and the percentage of mean intraobserver agreement was 92.5%, with a mean confidence Kappa value of 0.83. The percentage of mean interobserver agreement for CSOTLF subtyping was 91.9%, with a mean confidence Kappa value of 0.80, and the percentage of mean intraobserver agreement was 91.3%, with a mean confidence Kappa value of 0.81. All the patients were followed up for 6-12 months [(9.0±2.1)months]. The VAS and ODI scores were significantly lower in patients with ASOTLF and CSOTLF classifications at 1 month after surgery and at the last follow-up than those before surgery (all P<0.05). The VAS scores in patients with ASOTLF types IIA, IIB, IIC, IIIA, and IV were significantly lower at the last follow-up than that at 1 month after surgery; the ODI scores in patients with ASOTLF types I, IIA, IIB, IIIA, IIIB and IV were significantly lower at the last follow-up than those at 1 month after surgery. The VAS scores in patients with CSOTLF types II, III, IV, and V were significantly lower at the last follow-up than those at 1 month after surgery, and the ODI scores in patients with all CSOTLF types were significantly lower at the last follow-up than those at 1 month after surgery (all P<0.05). Two patients with ASIA grade C recovered to grade D, and the rest recovered to grade E at the last follow-up ( P<0.01). No major vessel or nerve injury or internal fixation failure was found during follow-up. There were 18 patients with cement leakage, none of whom showed relevant clinical symptoms. There were 35 patients with new vertebral fractures, all of whom recovered well after symptomatic treatment. Conclusions:The OTLICS score, ASOTLF classification and CSOTLF classification have a high degree of reliability. Application of stepwise treatment for patients with different levels of injury according to the scoring and classification system can reduce pain, promote recovery of the spinal function, and reduce complications, which is of some significance in guiding the selection of clinical treatment.
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Osteoporotic vertebral compression fracture (OVCF) is a kind of fragility fracture, and osteoporotic thoracolumbar fracture (OTLF) is the most common type. At present, OTLF has gradually been a common disease in the elderly, among which improper treatments may cause serious complications and even death, bringing a heavy burden to the family and society. Accordingly, in-depth researches on the prevention and treatment of this disease is significant to improve the quality of life for the elderly and reduce social burden. Accurate choices of treatments depend on fracture classifications. A variety of OTLF classifications have been proposed by domestic and foreign scholars, but each has its own defects, and to distinguish their differences may be problematic. Therefore, it is difficult to apply each classification. In this study, the authors review the research progress in different classification and scoring sytems for OTLF to provide a reference for clinical diagnosis and treatment.
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Objective:To evaluate the efficacy of unilateral and bilateral percutaneous kyphoplasty (PKP) in the treatment of type IIIA acute symptomatic osteoporotic lumbar fracture (ASOLF).Methods:A retrospective cohort study was conducted to analyze the clinical data of 117 patients with type IIIA ASOLF admitted to Honghui Hospital of Xi′an Jiaotong University from April 2016 to February 2018, including 32 males and 85 females, aged 60 to 88 years [(68.3±5.7)years]. Injury segments were located at L 1 in 35 patients, at L 2 in 38, at L 3 in 26 and at L 4 in 18. All patients were treated with PKP. A total of 61 patients were treated using the midpoint of the transverse process-articular process displacement as the puncture point (unilateral puncture group) and 56 patients were treated using the traditional "2" point and "10" point as the puncture point (bilateral puncture group). The operation time, amount of radiation exposure of patients and surgeons and bone cement injection volume were compared between the two groups. The Cobb angle, height of anterior edge of injured vertebrae, visual analogue scale (VAS) and Oswestry disability index (ODI) were compared before operation, at day 1 after operation and at the final follow-up. Intraoperative and postoperative complications were observed. Results:All patients were followed up for 24-35 months [(26.3±4.7)months]. The operation time and amount of radiation exposure of patients were (20.4±5.6)minutes and (1.08±0.44)mSv in unilateral puncture group, significantly different from (37.5±9.2)minutes and (2.24±0.58)mSv in bilateral puncture group (all P<0.01). There were no significant differences in amount of radiation exposure of surgeons and bone cement injection volume between the two groups (all P>0.05). In unilateral puncture group and bilateral puncture group, the Cobb angle of fractured vertebrae at day 1 after operation [(22.4±10.7)°, (23.4±11.1)°] and at the final follow-up [(24.3±8.3)°, (23.5±9.5)°] was significantly decreased from that before operation [(29.6±9.7)°, (30.6±12.9)°] (all P<0.01); the height of anterior edge of injured vertebrae at day 1 after operation [(80.4±12.6)%, (78.8±11.9)%] and at the final follow-up [(79.3±10.7)%, (77.4±11.2)%] was significantly increased from that before operation [(65.7±6.3)%, (66.4±9.7)%] (all P<0.01); the VAS at day 1 after operation [(2.1±0.5)points, (2.3±1.1)points] and at the final follow-up [(1.9±0.8)points, (2.0±0.6)points] was significantly decreased from that before operation [(7.1±0.7)points, (7.2±0.9)points] (all P<0.01); the ODI at day 1 after operation (21.1±9.7, 22.9±7.9) and at the final follow-up (18.5±4.6, 19.8±9.4) was significantly decreased from that before operation (72.7±4.5, 73.1±3.7) (all P<0.01). While the above four parameters between the two groups had no significant differences at each time point, with no significant differences within each group at day 1 after operation and at the final follow-up (all P>0.05). There were 13 patients [21% (13/61)] with cement leakage in unilateral puncture group as compared to 18 patients [29% (18/56)] in bilateral puncture group ( P<0.05). There were 4 patients [7% (4/61)] with adjacent vertebral fracture in unilateral puncture group, similar to 5 patients [9% (5/56)] in bilateral puncture group ( P>0.05). The lower back pain caused by facet injury were noted in 8 patients [14% (8/56)] in bilateral puncture group who were relieved after 1 month of non-surgical treatment, but none occurred in unilateral puncture group ( P<0.01). Conclusions:Unilateral and bilateral PKP can obtain satisfactory clinical efficacy in the treatment of type IIIA ASOLF, but the former has advantages of shorter operation time, less radiation exposure and lower incidence of bone cement leakage and facet injury.
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<p><b>OBJECTIVE</b>To observe the disease course of chronic renal failure (CRF) intervened by Qudu Granule (QG) and to explore its possible mechanism.</p><p><b>METHODS</b>Totally 166 phase 3 and 4 chronic kidney disease (CKD) patients of Pi-Shen deficiency and phlegm-turbidity obstruction syndrome were randomly assigned to two groups, the experimental group (83 cases, completed in 77 cases) and the control group (83 cases, completed in 75 cases). Based on the routine treatment, patients in the experimental group orally took QG, while those in the control group orally took niaoduqing granule (NG), 5 g each time, 3 times a day in both groups. The total therapeutic course was over 12 months for all. The changes of serum creatinine (SCr) were observed in the two groups. The reciprocal of SCr was taken as the vertical coordinate, and the course of disease (months) as the horizontal coordinate. The oblique rate and the return coefficient (value b) were compared between the two groups. Meanwhile, the changes of blood pressure, 24-h urinary protein quantitative amount, plasma albumin (Alb), and hemoglobin (Hb) were also observed.</p><p><b>RESULTS</b>The average treatment time was longer in the experimental group [(42.8 +/- 18.5) months] than in the control group [(34.2 +/- 12.7) months, P < 0.01]. In the experimental group 35 patients didn't reach the endpoint at the 48th month, accounting for 45.45%, while 24 patients didn't reach the endpoint in the control group, accounting for 32.00%, showing statistical difference (P < 0.01). The b value was -0.00258 +/- 0.00132 in the experimental group and -0.00386 +/- 0.00167 in the control group. The absolute value of the slope rate was obviously smaller in the experimental group than in the control group (P < 0.01). The 48-month blood pressure was obviously lower in the experimental group than in the control group. The 24-h urinary protein at the 12th, 24th, 36th, and 48th month were obviously lower in the experimental group than in the control group at the same time point (P < 0.05). The plasma Alb was obviously higher in the experimental group than in the control group at the same time point with statistical difference (P < 0.05). There was no statistical difference in the Hb level between the two groups at each time point (P > 0.05).</p><p><b>CONCLUSIONS</b>The course of CRF could be postponed by QG. Its mechanisms might possibly be correlated with lowering blood pressure, reducing the excretion of urinary protein, and increasing plasma Alb.</p>
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Adult , Female , Humans , Male , Middle Aged , Disease Progression , Drugs, Chinese Herbal , Therapeutic Uses , Kidney Failure, Chronic , Drug Therapy , PhytotherapyABSTRACT
objective Microbial limit test(MLT)for Dahuang Zhechong pill was established and verified to supply scientific foundation for the establishment of MLT for antibacterial and anti-inflammatory Chinese patent medicine,and to supply principle guidance for the verification of the method issued in Chinese pharmacopoeia(2005 edition);meanwhile the antibiogram of Dahuang Zhechong pill was probed,which can provide evidence for its clinical administration.Methods With centrifugal sedimentation method and culture medium diluted method,the recovery test was done on each tested bacterial strain to validate the accuracy and feasibility of MLT.Results Dahuang Zhechong pill had a stronger inhibitory effect on staphylococcus aureus and bacillus subtilis,had a weak inhibitory effect on escherichia coli,and had no effect on candida albicans and aspergillus niger,indicating that the antimicrobial spectrum of Dahuang Zhechong pill is Gram-positive bacteria.Conclusion Centrifugal sedimentation method combined with culture medium diluted method can eliminate the anti-bacterial effect of Dahuang Zhechong pill during the experiment,thus the microorganisms in the polluted pill can be detected successfully.