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Objective To analyze the death status and main causes of death among children under 5 years old in Changsha from 2016 to 2021, and to provide a scientific basis for formulating preventive measures for children's health care. Methods The data of 1 761 deaths of children under 5 years old in Changsha City from 2016 to 2021 were collected, and the mortality trend, the order of causes of death and the utilization of pre-death medical care services were retrospectively analyzed. Results The 7-day neonatal mortality, 28-day neonatal mortality, 0-1-year-old neonatal mortality, and the mortality rate of children under 5 years old (U5MR) in Changsha City from 2016 to 2021 were 0.76‰, 1.28‰, 2.41‰, and 3.86‰, respectively. All the mortality rates showed a decreasing trend (P<0.05). U5MR in males was significantly higher than that in females (P<0.05), and U5MR in rural areas was significantly higher than that in urban areas (P<0.05). The top five causes of U5MR were drowning, premature delivery or low birth weight, pneumonia, other congenital anomalies, and accidental asphyxia, respectively. The death places of children under 5 years old were mainly medical and health institutions, and 81.72% of them were treated in hospitals before death. Conclusion From 2016 to 2021, the mortality rate of children under the age of 5 in Changsha City has gradually decreased. Preventing congenital malformations, reducing preterm birth or low birth weight, improving the treatment level of pneumonia, and preventing accidents such as drowning and accidental suffocation are the key to reducing the mortality rate of children under 5 years old.
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In this paper, the current situation and existing problems of spinal surgery practice are analyzed and summarized. Combined with the review of the structure and function of spinal region, we have expounded the application and advantages of Essential Anatomy software in the clinical practice teaching of spinal surgery. This software has a friendly interface, simple operation, real content, intuitive and visual model, and it can provide videos and slice function, which makes the original complex and abstract spinal anatomy practice content become novel and vivid, and greatly deepens doctors' understanding of the structure, function, movement and the disease pathogenesis of spinal region. At the same time, it also greatly mobilizes the learning interest and initiative of the clinical practice doctors, and improves the effect of clinical practice.
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BACKGROUND: 3D printing technology provides possibility for the preparation of an ideal bone tissue engineering scaffold with high individualization, precise regulation of the porosity, pore size and inter-aperture connectivity. OBJECTIVE: To study the physical properties and biocompatibility of allogeneic bone microparticle/poly (lactic-co-glycolic acid) composite absorbable scaffolds fabricated via fused deposition modeling 3D printing. METHODS: 3D printed bone microparticle/poly (lactic-co-glycolic acid) composite absorbable scaffolds were fabricated via fused deposition modeling. The porosity, water absorption, water contact angle and in vitro degradation rate of the scaffold were measured. (1) Cytotoxicity test: Rabbit adipose-derived mesenchymal stem cells were cultured in normal medium (negative control group) and composite scaffold extract (experimental group) for 1, 3, 5, 7 days, and cell counting kit-8 was then used to detect cell proliferation. (2) Hemolysis test: Rabbit anti-clotting was added to physiological saline, distilled water and composite scaffold extract, and the hemolysis rate was detected after 50 minutes. (3) Acute toxicity test: The physiological saline and composite scaffold extracts were intraperitoneally injected into the rabbits respectively to observe the general condition of rabbits and the pathological changes of important organs. RESULTS AND CONCLUSION: (1) The porosity, water absorption and water contact angle of the composite scaffold were (60.86±2.88) ％, (53.98±2.04) ％ and (76.27±0.34) °, respectively. (2) After in vitro immersion in PBS for 4 weeks, the absorbable composite scaffold degraded relatively slowly, and the scaffold morphology remained stable, while the degradation rate accelerated after 4 weeks. The scaffold was almost completely absorbed at about 11 weeks, and it is a relatively ideal absorbable scaffold material. (3) There was no difference in cell proliferation between the experimental group and the negative control group at different time points (P> 0.05) . The cytotoxicity of the absorbable composite scaffold was grade 1. (4) The hemolysis rate of the absorbable composite scaffold was 3.8％, which met the hemolytic requirement of biomedical materials (the hemolysis rate of less than 5％) . (5) Within 72 hours after injection of absorbable scaffold extract, the rabbits showed no acute toxic reaction, as well as no pathological changes in the liver, heart and kidney were observed after 7 days of injection. (6) To conclude, the 3D printed allogeneic bone microparticle/poly (lactic-co-glycolic acid) fabricated via fused deposition modeling 3D printing has preferable physical properties and biocompatibility.
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Objective To compare the clinical efficacy of posterior pedicle screw fixation through Wiltse paraspinal approach and posterior traditional open approach in the treatment of thoracolumbar fracture and dislocation.Methods A retrospective case control study was performed based on the clinical data of 40 patients with thoracolumbar fracture and dislocation admitted between January 2013 and January 2016.All the surgeries were performed through posterior midline incision,and they were divided into two groups according to different approaches.Patients in Group A received pedicle screw fixation through Wiltse paraspinal approach while Group B received fixed pedicle screw through open surgery.Group A was composed of 12 males and 8 females,aged 21-60 years [(41.5 ±9.6)years].Group B was composed of 13 males and 7 females,aged 18-58 years [(39.1 ± 13.1) years].The same surgical procedures were adopted in spinal decompression,reduction,and the spinal vertebral interbody bone graft and fusion surgery in the two groups.Operation duration,intraoperative blood loss,postoperative drainage volume,visual analogue scale (VAS),spinal canal patency at the last follow-up,percentage of postoperative injury of vertebral height recovery,and Cobb angle were compared.CT and MRI were used to evaluate postoperative paravertebral muscle atrophy,and American spinal injury association (ASIA) impairment scale was used to evaluate neurological function assessment.Results All patients were followed up for 9-33 months,with (19.3 ± 5.6) months for Group A and (22.5 ± 4.9) months for Group B (P ＞ 0.05).The operation duration was (240.5 ± 38.3) min in Group A and (258.5 ± 43.7) min in Group B (P ＞ 0.05).The intraoperative blood loss was (525.0 ± 168.2) ml in Group A,less than (770.0 ± 269.2) ml in Group B (P ＜ 0.05).Postoperative drainage volume was (190.1 ± 78.9) ml in Group A,less than (281.7 ± 122.3) ml in Group B (P ＜ 0.05).VAS score 24 hours after operation and at the last follow-up in Group A was (6.4 ± 1.0) points and (1.6 ± 0.5) points,respectively,better than those in Group B [(7.8 ± 0.7) points and (2.2 ± 0.4) points] (P ＜ 0.05).No significant differences were observed in terms of spinal canal patency at the last follow-up,percentage of postoperative injury of vertebral height recovery,and Cobb angle [Group A:(85.3 ± 3.7) ％,(85.5 ± 2.7) ％,and (4.7 ± 1.2)°;GroupB:(85.8±1.8)％,(88.8 ±1.3)％,and (5.3 ±1.5)°] (P＞0.05).In terms of MRI evaluation score of postoperative paravertebral muscle atrophy,Group A reported better results than Group B [(2.1 ± 0.6) points vs.(1.2 ± 0.6) points] (P ＜ 0.05).At the last follow-up,there were 7,5,6,1 and 1 patients in Group A,while 6,6,5,2 and 1 patients in Group B at ASIA grades A,B,C,D and E (P ＞ 0.05).Within the same group,significant difference was observed between the preoperative data and that at the last follow-up in terms of postoperative VAS score,spinal canal patency,percentage of injury of vertebral height,Cobb angle,and ASIA impairment scale (P ＜ 0.05).Conclusion For thoracolumbar fracture and dislocation,compared with traditional open approach,posterior pedicle screw fixation through Wiltse paraspinal approach can effectively restore the vertebral body height and spinal canal patency and can reduce the intraoperative bleeding,postoperative drainage,postoperative back pain,and paravertebral lesion.
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Orthopedic,as an important subject of medical system,is complementary and common progress with young orthopedic surgeon.So,strengthening the standardized training of clinical and scientific research ability for young orthopedic is the primary task in department of orthopedics in our country.Unfortunately,the development of the professional career of Chinese young orthopedic surgeon is presently entrapped in a dilemma due to the diverse contents of the orthopedic subject and the abstract structure of the bone science,and the short time for college education and practice training.In practice,we focus on the ability cultivation based on problem oriented clinical practice,and integrate reasonable and standardized assessment mechanism referring to the international excellent physician training mode.We also integrate the comprehensive development of medicine,teaching and research to promote the improvement of the professional ability of the young doctors in the department of orthopedics.
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Objective To compare and explore the curative effects of elective operation and emergency operation in treating atlantoaxial vertebral segmental spinal canal space-occupying lesions.Methods Thirty-two patients suffering from atlanto-axial vertebral segmental spinal canal space-occupying lesions treated in our hospital from May 2010 to April 2015 were selected and divided into the emergency operation group (group A,n =14) and elective operation group (group B,n =18).The emergency and elective operations were adopted respectively.Then the operation time,intraoperative blood loss,JOA score,ODI index,VAS score,postoperative imaging(MRI) and effect satisfaction degree were compared between the two groups.Results After treatment,the JOA score in the group A was (25.23±4.47) points,which was higher than (22.10±3.56) points in the group B,and the difference was statistically significant (t=3.67,P＜0.05).The ODI index and VAS score of the two groups all were decreased.The ODI index in the group A was (18.56±3.10) points,which in the group B was (21.56±4.37) points,and there was statistically significant difference between the two groups (t=3.76,P＜0.05).The VAS score in the group A was (1.89 ±-0.53)points,which in the group B was (3.16±0.89)points,the difference was statistically significant between the two groups (t=3.76,P＜0.05).Before surgery and at postoperative 1 month,the spinal cord function classification(Frankel grade) of the two groups had no statistically significant difference between the two groups(Z=-0.18,P=0.85＞0.05,Z=-0.52,P=0.60＞0.05).The operation time had no statistical difference between the group A and B[(120.23±9.02)min vs.(126.25±12.12)min,P＞0.05].The intraoperative bleeding volume had had no statistical difference between the group A and B [(211.26±12.25)mL vs.(220.43±17.58)mL,P＞ 0.05].After one month of treatment,the satisfaction degree in the group A was 92.56 ％,which was higher than 72.22％ in the group B,and the difference was statistically significant (Z=-2.13,P＜0.05).Conclusion Emergency operation in treating atlantoaxial segment spinal space occupying lesions can effectively improve the therapeutic effect,and has higher patients satisfaction after treatment.Therefore which is worth promoting and applying.
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BACKGROUND: The choice of suitable bone graft substitute is vital for spinal fusion treatment, which can solve some limitations caused by autogenous bone graft and other materials. OBJECTIVE: To investigate properties of different bone graft fusion materials, and to explore their application in dog spinal fusion of lumbar vertebral body. METHODS: Forty-five Chinese rural dogs were enrol ed to prepare lumbar interbody fusion models, and then were randomized into three groups transplanted with autogenous ilium, recombinant human bone morphogenetic protein-2 composite or al ograft ilium, respectively. Afterwards, effects of different materials in the lumbar interbody fusion were analyzed. RESULTS AND CONCLUSION: The fusion rate of the composite group was significantly higher than those of the other groups (P < 0.05). Oswestry dysfunction index of the composite group was significantly lower than those of the other groups after surgery (P < 0.05). Hematoxylin-eosin staining showed that dogs achieved complete bony fusion, continuous bone trabecula gradual y formed, and there was no gap between the transplanted bone and the bone surface in the composite group compared with the other groups at 12 weeks after surgery. These results demonstrate that recombinant human bone morphogenetic protein-2 composites can significantly promote the spinal fusion superior to autologous and al ogeneic bone grafts.
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BACKGROUND:Knee cartilage injury is difficult to heal, which is an urgent clinical problem to solve. OBJECTIVE:To summarize the advantages of synovial mesenchymal stem cel s in the treatment of knee cartilage injury. METHODS:A computer-based search of PubMed was performed for articles related to synovial mesenchymal stem cel s for knee cartilage injury using the keywords of“knee joint, cartilage, synovial membrane, tissues, injuries and repair”. A total of 48 articles were retrieved initial y, and 35 articles were included in result analysis. RESULTS AND CONCLUSION:Synovial mesenchymal stem cel s for treatment of knee cartilage injury can achieve more ideal outcomes. Mesenchymal stem cel s inherent in the damaged tissue are the optimal seed cel s for tissue repair.
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Objective To explore the effectiveness of short segmental screw fixation and bone graft fusion on the decayed vertebral of thoracolumbar tuberculosis.Methods A total of 46 cases undergone one stage anterior debridement,interbody fusion,screw fixation on the decayed vertebral of thoracolumbar tuberculosis were retrospectively analyzed from June 2009 to November 2013.Including 25 males and 21 females,with the mean age of 39.6 years (range,13-69 years).Lesion segments:T6-L4 (segment lesions ≤ 3 segments); 3 B gradecases,6 C grade cases,4 D grade cases and 33 E grade cases assessmed by Frankel grade.The average Cobb angle of kyphosis was 16.34°±3.19° and ESR:19-81 mm/1 h preopration.CT scan and Two-dimensional reconstruction were done before operation,and the effective height of front and middle pillar of residual thoracolumbar vertebral in coronal and sagittal position were measured before operation,when the minimum effective height was higher than 10 mm,combined the intraoperative visual,the appropriate internal fixation for anterior debridement and interbody bone grafting were choosed.The cobb angle,the Frankel grade,the ESR and VAS value were compared with preoperative and postoperative.The stability and bone graft fusion were also observed.Results Fourty-six cases of patients were received followed up from 12 to 48 months,an average of 26 months.All patients with tuberculosis poisoning symptoms disappeared.The ESR:0-15 mm/1 h.Frankel rating at the end of postoperative follow-up:2 D-class cases,44 E-class cases.The VAS score (6.85± 1.22,4.49±0.95 vs.2.06±0.93) and vertebral Cobb angle (16.34°±3.19°,4.16°±2.71° vs.4.52°±1.29°) at post-operation 7 d and the last follow-up were significant lower than those at pre-operation,while the ESR (41.25±1.61 mm/1 h,17.36±6.82 mm/1 h vs.10.67±0.72 mm/1 h) was reduced to normal levelthan that of pre-operation.The comparative difference was statistically significant between pre-operative and post-operative.The fusion rate at the end of post-operative follow-up:44 excellent cases,2 good cases.Conclusion When the effective height of front and middle pillar of residual thoracolumbar vertebral in coronal and sagittal position in vertebral tuberculosis was higherthan 10mm,reliable stability and treatment efficiency were achieved with anteriorinternal fixation.
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BACKGROUND: Poly-lactic glycolic acid (PLGA) is a promising cell scaffold material. However, its hydrophilicity and cellular affinity is poor, so it is necessary to modify its performance.OBJECTIVE: To explore the hydrophilic ability of the modified PLGA scaffold compounded with type Ⅰ collagen, and the cellular biocompatibility with chondrocyte of rabbit ear.METHODS: PLGA scaffold was modified with Poly-L-Lysine and compounded with type I collagen. The gross structure of scaffold was observed by inverted microscopy. The modified PLGNtype-Ⅰ collagen scaffold (experimental) and PLGA scaffold (control) were immerged in distilled water for 0.5, 1, 2, 4, 8, 12 and 24 hours. Chondrocytes were cultured by enzyme digestion method, and the second passage cells were seeded on surfaces of two scaffolds. Cell morphology was observed by phase contrast microscopy; cell attachment rate 24 hours after seeding was calculated, and the cell proliferation was determined by MTT assay at 1, 2, 4 and 6 days.RESULTS AND CONCLUSION: Modified composite scaffold exhibited high porosity and increased surface roughness compared with control group. Water uptake of two scaffolds displayed statistically significance at the same time point (P < 0.01), indicating the modification improved the hydrophilicity. The attachment rate of chondrocytes was 0.908 0+0.019 2 in modified compound scaffolds and 0.733 2±0.047 5 in control scaffold after 24 hours (P < 0.05), indicating the improved cellular affinity following modification. After 1, 2, 4 and 6 days, the absorbance between two groups was significantly different (P < 0.05), indicating the modified scaffold improved cell proliferation.