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Objective To investigate the guiding significance of Daping orthopedics operative risk scoring system for senile patient (DORSSSP) for stratified treatment of elderly patients with severe hip fractures.Methods A retrospectively case-control study was performed for data of 440 elderly patients with hip fracture admitted to Second Affiliated Hospital of Soochow University from January 2014 to January 2018,including 130 male and 310 female patients aged 60-98 years [(79.3 ± 6.3) years].According to the DORSSSP scoring system,the patients were divided into low risk group (Group A,n =208),medium risk group (Group B,n =157) and high risk group without SICU transfer after operation (Group C,n =23) and high risk group with SICU transfer after operation (Group D,n =52).The risk prediction results of each group were recorded and compared with the actual complications and mortality.Results (1)According to the prediction of DORSSSP,the number of postoperative complications in Groups A,B,C and D were 52,60,14 and 31,respectively,while the number of actual complications after operation was 45,55,13 and 16.There was significant difference between the predicted value and the actual value of postoperative complications in Group D (P ＜ 0.01),which was not found in other three groups (P ＞ 0.05).The incidence of postoperative complications in Group D was lower than that in Group C (P ＜0.05).(2) According to the prediction of DORSSSP,the number of postoperative death in Groups A,B,C and D were 0,three,two and four,respectively,while the number of actual death after operation was 0,one,two and one,respectively.The predicted value and the actual value of death were significantly different in Group D (P ＜ 0.05),but were not in other three groups (P ＞ 0.05).The incidence of postoperative death in Group D was lower than that in Group C (P ＞ 0.05).Conclusions There is a good correlation between DORSSSP score and postoperative complications and mortality.Based on DORSSSP score for stratified treatment,the interventional treatment of elderly patients with severe hip fracture after operation into SICU can better reduce the incidence of complications.
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Objective@#To investigate the guiding significance of Daping orthopedics operative risk scoring system for senile patient (DORSSSP) for stratified treatment of elderly patients with severe hip fractures.@*Methods@#A retrospectively case-control study was performed for data of 440 elderly patients with hip fracture admitted to Second Affiliated Hospital of Soochow University from January 2014 to January 2018, including 130 male and 310 female patients aged 60-98 years [(79.3±6.3)years]. According to the DORSSSP scoring system, the patients were divided into low risk group (Group A, n=208), medium risk group (Group B, n=157) and high risk group without SICU transfer after operation (Group C, n=23) and high risk group with SICU transfer after operation (Group D, n=52). The risk prediction results of each group were recorded and compared with the actual complications and mortality.@*Results@#(1)According to the prediction of DORSSSP, the number of postoperative complications in Groups A, B, C and D were 52, 60, 14 and 31, respectively, while the number of actual complications after operation was 45, 55, 13 and 16. There was significant difference between the predicted value and the actual value of postoperative complications in Group D (P<0.01), which was not found in other three groups (P>0.05). The incidence of postoperative complications in Group D was lower than that in Group C (P<0.05). (2) According to the prediction of DORSSSP, the number of postoperative death in Groups A, B, C and D were 0, three, two and four, respectively, while the number of actual death after operation was 0, one, two and one, respectively. The predicted value and the actual value of death were significantly different in Group D (P<0.05), but were not in other three groups (P>0.05). The incidence of postoperative death in Group D was lower than that in Group C (P>0.05).@*Conclusions@#There is a good correlation between DORSSSP score and postoperative complications and mortality. Based on DORSSSP score for stratified treatment, the interventional treatment of elderly patients with severe hip fracture after operation into SICU can better reduce the incidence of complications.
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BACKGROUND:Lower cervical anterior transpedicular screw technology combines the advantages of the anterior and posterior surgery;therefore, the pressure releasing and reconstruction problems can be solved via one time anterior surgery, whereas, the difficulty and risk of the operation are increased. However, the three-dimensional (3D) printing assembly navigation template improves the safety and accuracy of screw placement. OBJECTIVE:To explore the feasibility and accuracy of 3D printing assembly navigation template in lower cervical anterior transpedicular screws and compare it with free hand pedicle screw placement. METHODS:Lower cervical spine specimens of six adult (2 males, 4 females, average age 58.5 years old ranged from 53 to 64 years) corpses were equal y and randomly divided into two groups. Group A underwent free hand pedicle screw placement. Groups B (lower cervical anterior transpedicular screws assisted by personalized 3D printing combined navigation template):Three cadaveric lower cervical spines were examined using CT and data in DICOM format were recorded. After data were processed using software Mimics for 3D model reconstruction, computer-assisted design of optimum trajactory for lower cervical (C3-C7) anterior transpedicular screws placement was worked out and made into a dril template, where the surface was created as the inverse of anterior surface of cervical vertebra. The dril template was materialized in a 3D printing and used to place the screws. Subsequently, CT scan was performed to evaluate the screw orientation and acceptability. RESULTS AND CONCLUSION:(1) Thirty screws were inserted in Group A. The pedicle perforation was classified by CT, Grade 1:22 screws, Grade 2:6 screws, Grade 3:2 screws;insertion rate was acceptable (Grades 1-2):28 (93%). Thirty screws were inserted in Group B. The pedicle perforation was classified by CT, Grade 1:25 screws, Grade 2:4 screws, Grade 3:1 screw;insertion rate was acceptable (Grades 1-2):29 (97%). There were no statistical y significant differences in the rate of acceptable insertion and orientation between two groups (P>0.05). (2) These results suggested that 3D printing combined navigation template consisted with dril hole cap and screw hole, with functions of double direction. Compared with the traditional method, personalized 3D printing combined navigation template can be used simply.
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BACKGROUND:At present, the main purpose of treatment for degenerative scoliosis is to relieve symptoms, surgicaly correct scoliosis, restore balance and function of the spine, but what kind of techniques is superior has been controversial. OBJECTIVE:To systematicaly assess the clinical effectiveness and safety of short fusion versus long fusion for degenerative scoliosis. METHODS:The databases such as China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Scientific Journals Database, WanFang Database, The Cochrane Library, PubMed, and EMbase published before May 2015 were electronicaly searched to colect the trials about the short fusion versus long fusion for degenerative scoliosis. Meta-analysis was performed by using RevMan 5.3.4 software. RESULTS AND CONCLUSION: Eleven studies were included, with 533 patients, including 272 cases in the short fusion group and 261 cases in the long fusion group. Meta-analysis results showed that: compare with short fusion group, long fusion group had better improvement of spine Cobb angle (P < 0.000 01) and lordosis angle (P < 0.000 01). No differences were found in the coronal imbalance (P=0.06) and lateral slippage (P=0.24) between the two groups. No significant difference was detected in Japanese Orthopaedic Association score (P=0.93), Visual analogue scale score (P=0.22), and Oswestry Disability Index score (P=0.13) between the two groups. The postoperative complications (P=0.000 6) and the rate of reoperation (P=0.03) were higher in the long fusion group than those in the short fusion group. The incidence of adjacent segment disease has no difference between the two groups (P=0.81). These findings suggest that long fusion is better than short fusion in improvement of the deformity of spine, but incidence of postoperative complications and the rate of reoperation are higher than those in the short fusion group. Comprehensive consideration should be given to the selection of a fixed fusion scheme.
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BACKGROUND:Periosteal cel s have been used in bone repair, but whether nucleus puplousus cel s co-cultured with autologous periosteal cel s can differentiate into osteoblasts in spinal fusion is rarely reported. OBJECTIVE:To isolate nucleus puplousus cel s and periosteal cel s so as to observe the osteogenic ability of nucleus puplousus cel s co-cultured with periosteal cel s or not. METHODS:Type II col agenase digestion method was used to isolate and purify nucleus pulposus cel s, which were confirmed by toluidine blue and immunohistochemical staining. Periosteal cel s were isolated histological y and cultured in complete medium, and cel surface antigens CD90, CD105 were identified by immunofluorescence staining. According to the experimental needs, the cel s were assigned into two groups. Nucleus pulposus cel s and periosteal cel s were co-cultured by osteogenic induction medium in the experimental group. Nucleus pulposus cel s in the control group were cultured alone in osteogenic induction medium. Cel morphology was observed by inverted microscopy, and cel proliferation was detected by cel counting kit-8. The osteogenic differentiation indexes of cel s in each group were measured using alkaline phosphatase staining, alizarin red staining, and type I col agen immunohistoehemical staining. The expression of osteopontin was tested by western blot assay. RESULTS AND CONCLUSION:CD105 and CD90 expressions of the periosteal cel s were positive. Nucleus puplousus cel s were positive for toluidine blue and col agen type II immunohistochemical staining. The proliferative ability of nucleus puplousus cel s was significantly higher in the experimental group than the control group at days 1, 3, 5, 7, 9. After 2 weeks of induction, the cel s were positive for alkaline phosphatase staining, alizarin red staining, and type I col agen immunohistoehemical staining, but the experimental group showed higher positive expressions than the control group (P<0.05). The expression of osteopontin was also higher in the experimental group than the control group. These findings indicate that nucleus puplousus cel s possess osteogenic ability, but have lower proliferative ability in vitro. After co-culture with periosteal cel s, the proliferative ability of nucleus puplousus cel s can be increased. Under osteogenic induction, nucleus puplousus cel s co-cultured with periosteal cel s have good compatibility and adhere with each other, which have stronger osteogenic ability than cel s cultured alone.
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Objective To investigate the value of nerve conduction studies (NCSs),F wave analysis,somatosensory evoked potential (SEP) and skin sympathetic response (SSR) in the early diagnosis of diabetic peripheral neuropathy (DPN).Methods A total of 110 patients with diabetes mellitus were recruited as the diabetic group and another 50 well-matched healthy volunteers as the normal controls.Sensory and motor NCSs of the median,ulnar,posterior tibial and common peroneal nerves were performed.F waves were recorded from the median and posterior tibial nerves.SEPs elicited by stimulation to nerves of both the upper and lower limbs as well as SSRs were measured,all in both the diabetic group and the normal controls.Results The total rate of nerve conduction abnormality was 74.5％ in the diabetic group,with sensory nerve conduction abnormalities more frequent and more severe among motor nerves in the extremities.The total rate of F wave abnormalities was 57.3％ in the diabetic group.The rate in patients with normal distal motor conduction in their median and posterior tibial nerves was 50.7％.The total SEP abnormality rate was 70.0％ with regard to the proximal peripheral nerve potentials in the diabetic group,but there was no obvious abnormality of the supraclavicular electrical potential in the upper limbs for those with normal sensory nerve conduction in the median nerve.The rate of occurrence of abnormality in the gluteus point potential in the lower limbs of those with normal posterior tibial sensory conduction was 62.5％.The total rate of SSR abnormalities was 80.0％ in the diabetic group but 72％ among those with normal nerve conduction in their extremities.Combining the NCS,SSR,SEP and F wave results,the total abnormality rate was 90.9％ in the diabetic group,which was much higher than with any single test used alone.Conclusion NCS is essential for diagnosing DPN.Early diagnosis of subclinical diabetic neuropathy will be significantly enhanced when nerve conduction,SSRs,SEPs and F waves are tested together.