ABSTRACT
Objective:To investigate the diagnostic efficacy of MRI-based or CT-based measurements and the combined evaluation methods for preoperative bone quality assessment in patients with cervical degenerative diseases.Methods:Patients who underwent spine surgery for cervical degenerative diseases at the Department of Orthopedics, Huashan Hospital, Fudan University from September 2020 to March 2022 with available preoperative X-ray, CT, MRI and dule energy X-Ray absorptiometry (DEXA) data were included in this study. Vertebral bone quality score (VBQ) based on MRI T1-weightedimages and CT Hounsfiled unit (HU) values of the cervical spine were measured, and a combined diagnostic formula based on the binary logistic regression was constructed. The patients were divided into normal bone mass (T≥-1.0) and osteopenia/osteoporosis groups (T<-1.0). The student's t-test and Chi-square test were performed for comparisons between groups. The Pearson correlation coefficient was also used to investigate the correlation between DEXA-T scores, cervical VBQ and CT HU values. In addition, receiver operating characteristic curve (ROC) were plotted to explore the diagnostic efficacy of VBQ, CT HU and their combined diagnosis. Meanwhile, the corresponding sensitivity and specificity were obtained. Results:A total of 71 patients were included in this study (17 in the normal group and 54 in the osteopenia/osteoporosis group). The student's t-test showed that VBQ (2.90±0.70 vs. 3.83±0.83, t=4.23, P<0.001) and CT HU values (370.26±85.38 vs. 295.20±67.96, t=3.73, P=0.002) were significantly different between the two groups. The area under the ROC curve (AUC) for VBQ and CT values of the cervical spine were 0.81 and 0.75, respectively, and the AUC for the combined diagnostic value constructed on the basis of both was 0.85. Applying VBQ scores alone had a diagnostic sensitivity of 80% and a specificity of 70%, and the combined diagnosis with VBQ and CT HU had a sensitivity of 90% and a specificity of 75%. Person correlation analysis showed a significant correlation between DEXA T value, cervical VBQ value and CT HU value. The detailed formula was: DEXA T score=-0.63×cervical VBQ+0.64 ( r=-0.55, P<0.001), CT HU value=-40.20×cervical VBQ+458.40 ( r=-0.45, P<0.001), DEXA T score=0.006×CT HU-3.47 ( r=0.45, P<0.001). Conclusion:This study confirmed the feasibility of using cervical VBQ values, CT HU values and combined diagnostics for preoperative bone density screening in patients with degenerative cervical spine diseases. This method allows surgeons to perform an initial preoperative bone density screening based on the patient's existing imaging data, and thus could aid in confirming the indication and scheme of surgery. The method could be a powerful tool for preoperative bone density assessment screening in patients with cervical degenerative diseases.
ABSTRACT
Objective To evaluate the effects of different doses of ephedrine combined with hydroxyethyl starch as a volume preload for preventing hypotension in caesarean section before combined spinal and epidural anesthesia.Methods 250 pregnant wemen undergoing cesarean section were randomly allocated into the control group (n =50) and the observation group(n =200)(group was divided into A,B,C,D group,each group 50 cases).Control group preloaded Lactated Ringer's solution 250ml before CSEA.A group preloaded hydroxyethyl starch combined with 5mg ephedrine; B group preloaded hydroxyethyl starch combined with 10mg ephedrine.C group preloaded hydroxyethyl starch combined with 15mg ephedrine; D group preloaded hydroxyethyl starch combined with 15mg ephedrine.The parturient SBP,HR and untoward reaction were monitored in five experimental groups.Results Compared with T0 A group parturient SBP was lower at T1,T2,T5 [(111.8 ± 17.18)mm Hg,(114.58 ± 19.80)mm Hg,(115.06 ± 10.39) mum Hg vs (120.88 ± 13.24) mm Hg,all P ＜ 0.05)].Compared with B,C,D group,statistical differences were found at T1,T4,T6[(111.8 ± 17.18)mm Hg vs (120.78 ± 14.47)mm Hg,(118.56 ± 14.25)mm Hg,(118.42 ± 18.71)mm Hg.(125.58 ± 14.45) mm Hg vs (120.02 ±21.15)mm Hg,(115.92 ± 17.56)mm Hg,(119.00 ±12.49)mm Hg.(118.08 ±9.09)mm Hg vs (121.52 ± 10.92) mm Hg,(116.04 ± 11.61)mm Hg,(124.98 ± 9.16) mm Hg,all P ＜ 0.05].Compared with T0 parturient HR was undulation at T1,T5 (P ＜ 0.05).Compared with C,D group,statistical differences were found at T1,T3,T4,T6 [(82.92 ± 19.55) times/min vs (98.86 ±17.82)times/min,(96.72 ± 17.91) times/min.(89.04 ± 16.68) times/min vs (92.10 ± 16.55) times/min,(98.46 ± 19.49) times/min.(87.56 ± 17.13) times/min vs (98.86 ± 16.76) times/min,(88.58 ± 19.22) times/min.(93.20 ± 14.07) times/min vs (98.80 ± 11.69) times/min,(90.98 ± 10.93) times/min.all P ＜ 0.05].In B and C group,parturient SBP and HR were steady and the untoward reaction was very few.Although parturient SBP of D group was steady,but HR obviously fast during operation (P ＜ 0.05).Compared with B,C group,statistical differences were found at T4,T6 (P ＜ 0.01).Conclusion The optimum dose is 10 ～ 15 mg of ephedrine.It combined with hydroxyethyl starch as a volume preload can keep the stable of blood circulation.