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Objective:To compare the clinical efficacies of robot-assisted and free-hand long segment screw fixation combined with wedge osteotomy in the treatment of type IV chronic symptomatic osteoporotic thoracolumbar fractures (CSOVCFs).Methods:A retrospective cohort study was conducted to analyze the clinical data of 72 patients with type IV CSOVCFs who were admitted to Honghui Hospital of Xi′an Jiaotong University from May 2019 to December 2021, including 22 males and 46 females; aged 61-82 years [(71.2±12.3)years]. Fracture segments were located at T 11-T 12 in 37 patients and at L 1-L 2 in 31. A total of 32 patients were treated with robot-assisted long segment screw fixation combined with wedge osteotomy (robot group) and 36 with free-hand long segment screw fixation combined with wedge osteotomy (free-hand group). The operation time, intraoperative bleeding volume, dosage of radiation exposure, intraoperative needle adjustment, time of single pedicle screw placement and accuracy of pedicle screw placement were compared between the two groups. The kyphotic Cobb angle, sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar kyphosis (LL), visual analogue scale (VAS) and Oswestry disability index (ODI) were measured preoperatively, at 3 days postoperatively and at the last follow-up. The incidences of facet joint violation, deviation in guide needle placement, cerebrospinal leak and proximal junctional kyphosis (PJK) were observed. Results:All patients were followed up for 12-26 months [(18.2±5.1)months]. The operation time and time of single pedicle screw placement showed no significant differences between the two groups (all P>0.05). The intraoperative bleeding volume was (502.5±58.3)ml in the robot group, less than that in the free-hand group [(690.2±45.9)ml]. The dosage of radiation exposure was (32.6±10.8)μSv in the robot group, lower than that in the free-hand group [(48.6±15.2)μSv]. The intraoperative needle adjustment was (2.1±0.3)times in the robot group, higher than that in the free-hand group [(20.7±5.8)times], and the accuracy of pedicle screw placement was 99.7% in the robot group, less than that in the free-hand group (91.8%) (all P<0.01). Compared with pre-operation, the kyphotic Cobb angle, SVA, TK and LL were significantly improved in both groups at postoperative 3 days and at the last follow-up (all P<0.05). Compared with postoperative 3 days, the kyphotic Cobb angle, SVA and TK were increased at the last follow-up within the two groups, but with no significant differences (all P>0.05). Compared with postoperative 3 days, the LL was decreased within the two groups at the last follow-up, but with no significant differences (all P>0.05). The VAS and ODI in the two groups were significantly lower at postoperative 3 days and at the last follow-up when compared with those before operation (all P<0.05), and both values were significantly lower at the last follow-up than those at postoperative 3 days (all P<0.05). There were no significant differences in the VAS or ODI at all time points between the two groups (all P>0.05). The incidence of facet joint violation in the robot group was 1.6%, markedly lower than that in the free-hand group (9.6%) ( P<0.01). The incidences of deviation in guide needle placement, cerebrospinal leak and PJK showed no differences between the two groups (all P>0.05). Conclusion:For type IV CSOVCFs, the robot-assisted long segment screw fixation combined with wedge osteotomy can better reduce intraoperative blood loss, decrease radiation exposure, improve accuracy of pedicle screw placement, and reduce facet joint violation when compared with free-hand long segment screw fixation combined with wedge osteotomy.
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Objective:To evaluate the efficacy of unilateral puncture techniques in high-viscosity cement percutanueous vertebroplasty (PVP) in treatment of type I chronic symptomatic osteoporotic vertebral compression fracture (CSOVCF).Methods:A retrospective case control study was conducted to analyze the clinical data of 119 patients with type I CSOVCF admitted to Honghui Hospital affiliated to Xi'an Jiaotong University School of Medicine from December 2013 to December 2016. There were 42 males and 77 females, aged 58-95 years [(79.2±15.6)years]. All patients had bone mineral density of -4.5--2.5 SD [(-3.9±0.2)SD] (T score). The fractured segments included L 1-L 2 in 56 patients and L 3-L 5 in 63. All patients were treated by high-viscosity cement PVP with the unilateral puncture of transverse process and superior articular process in unilateral group ( n=60) and by the bilateral puncture approach with the Magerl method in bilaleral group ( n=59). The operation time, cement injection volume, and intraoperative fluoroscopy frequency were recorded. The visual analogue scale (VAS), Oswestry dysfunction index (ODI), anterior height ratio of injured vertebrae and Cobb angle were measured before operation, at postoperative 1 day and at the last follow-up. The adjacent vertebral fracture, cement leakage and other complications were recorded. Results:All patients were followed up for 12-48 months [(24.1±5.6)months]. The operation time in unilateral group [(21.5±6.5)minutes] was significantly shorter than that in bilateral group [(37.8±7.4)minutes] ( P<0.05). The cement injection volume in unilateral group [(4.2±0.7)ml] was less than that in bilateral group [(6.5±1.1)ml]( P<0.05). The intraoperative fluoroscopy frequency in unilateral group [(14.2±3.0)times] was less than that in bilateral group [(31.4±6.4)times] ( P<0.05). Both groups showed significant improvements in VAS, ODI, anterior height ratio of injured vertebrae and Cobb angle at postoperative 1 day and at the last follow-up compared with these before operation ( P<0.05), but there were no significant differences after operation between the two groups ( P>0.05). The incidence of adjacent vertebral fracture was 5%(3/60) in unilateral group and 8% (5/59) in bilaleral group ( P>0.05). Four patients (7%) had cement leakage in unilateral group and 11 patients (19%) in bilateral group ( P<0.05). No complications of wound infection, nerve injury or pulmonary embolism occurred. Conclusion:Compared with Magerl bilateral puncture approach, high-viscosity cement PVP with unilateral puncture of transverse process and superior articular process in treatment of type I CSOVCF has advantages of shorter operation time, less trauma, less radiation exposure and lower cement leakage rate.
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Objective To investigate the status of the readiness for hospital discharge and pain degree in inpatients with thoracolumbar osteoporotic fractures, and the correlation between them.Methods A cross-sectional analysis of survey data from a sample of 252 patients with thoracolumbar osteoporotic fractures was conducted in a grade A tertiary hospital in Xi′an from January 1st, 2016 to June 30th, 2016. The status of the readiness for hospital discharge and pain level were investigated through the Readiness for Hospital Discharge Scale and Numerical Rating Scale (NRS) respectively. Pearson correlation coefficient method was used to detect the correlation between the two target factors. Results The average score of readiness for hospital discharge was 7.71±1.55. The mean NRS score decreased from 7.8 ± 0.8 at baseline to 2.7 ± 0.6 before discharge. The scores of each dimensions of readiness for hospital discharge from high to low were expected support, personal status, and coping capacity. There was a negative correlation between discharge readiness and pain degree in patients with thoracolumbar osteoporotic fractures (r =-0.537, P<0.05). Conclusions The status of the readiness for hospital discharge among the patients with thoracolumbar osteoporotic fractures is in a medium to high level before discharge. The pain degree is significantly decreased to a lower level. There is a negative correlation between the readiness for hospital discharge and the pain degree.
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Objective To investigate plasma level of soluble intercellular adhesion molecule-1 (sICAM-1)and soluble E-slectin (sES) in patients with Keshan disease (KD) accompanied by hypertension,and to further their relation to systolic blood pressure (SBP),diastolic blood pressure (DBP) and ejection fraction (EF) of left ventricle.Methods Patients with Keshan disease investigated in 2007 in Fuyu County,Heilongjiang Province were divided into two groups according to whether they were accompanied by hypertension or not:KDP group (n =17),the patients were diagnosed as Keshan disease accompanied by hypertension;KDN group (n =14),the patients were only diagnosed as Keshan disease.Healthy volunteers lived in the same area as the patients were included in the control group (CON group,n =10).The clinical data (such as age,sex and past medical history),SBP and DBP were recorded.EF was detected by echocardiography.Plasma sICAM-1 and sES concentrations were measured by ABC-enzyme-linked immunosorbent assay technique.Results Plasma level of sICAM-1 in the subjects was significantly elevated in KDP group as compared with that in CON group and KDN group [(399.84 ± 99.06) vs (323.06 ± 61.27) μg/L,P ＜0.05;(399.84 ± 99.06) vs (268.27 ± 72.88) μg/L,P ＜ 0.01].However,there was no statistical significance in plasma sICAM-1 between the KDN group and control group (P ＞ 0.05).The difference of plasma sES between the control group,KDN group and KDP group did not reach statistical significance [(76.31 ± 23.17),(72.26 ± 20.15) and (90.21 ± 19.21) μg/L,F =3.236,P ＞ 0.05].As compared with the KDN group,SBP and DBP were obviously higher in KDP group [(169 ± 27) and (121 ± 10) mmHg,(102 ± 17) and (81 ± 6) mmHg,1 mmHg =0.133 kPa,F =6.376,4.300,all P ＜ 0.01],and EF was not significantly increased [(58 ± 14)％ and (55 ± 14)％,F =0.789,P ＞ 0.05].Furthermore,correlation analysis showed plasma sICAM-1 was positively correlated with SBP (r =0.540 6,P ＜ 0.01)and DBP (r =0.461 2,P ＜ 0.01),but not with EF of left ventricle in subjects whir Keshan disease (r =0.073 4,P ＞0.05).Conclusion These data shows slCAM-1 may play a role in the development of Keshan disease accompanied by hypertension,providing an potential index for its risk assessment.
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BACKGROUND:The monocyte chemoattactant protein-1 gene polymorphism is associated with spinal tuberculosis susceptibility. OBJECTIVE:To investigate the association between serum monocyte chemoattactant protein-1 expression level and spinal tuberculosis susceptibility in Han population of Hunan province. METHODS:The patients with spinal tuberculosis and the healthy volunteers were recruited in Xiangya Hospital of Central South University from December 2004 to December 2010. The empty peripheral venous blood 2 mL were col ected from the subjects in early morning, then the monocyte chemoattactant protein-1-362 genotypes were detected by polymerase chain reaction and DNA sequencing technology. And the serum monocyte chemoattactant protein-1 level was detected by enzyme linked immunosorbent assay technology. The ROC curve was used for diagnostic tests to calculate diagnostic threshold value of serum monocyte chemoattactant protein-1 level to spinal tuberculosis susceptibility, and to analyze the diagnostic titer. RESULTS AND CONCLUSION:208 patients with spinal tuberculosis and 210 healthy volunteers were included. The serum monocyte chemoattactant protein-1 level of the spinal tuberculosis patients was significantly higher than that of the healthy volunteers [(134.58±51.63) ng/L vs. (39.18±17.45) ng/L, P<0.01]. The serum monocyte chemoattactant protein-1 level could not be affected by gender, but over-expressed in patients with monocyte chemoattactant protein-1-362-CC genotypes. The serum monocyte chemoattactant protein-1 level higher than 101.65 ng/L indicated that the patients might suffered from spinal tuberculosis (sensitivity:85.5%, specificity:94.3%, Youden index:0.799, area under curve of ROC:0.946, 95%confidence interval:0.916-0.975, P<0.01). The serum monocyte chemoattactant protein-1 level may be associated with spinal tuberculosis susceptibility in Han population of Hunan province, highly expressed serum monocyte chemoattactant protein-1 can be used as one of the indicators for the diagnosis of spinal tuberculosis.
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0.05). No procedure related complications and malignant arrhythmia were found during 6-12 months follow-up. Conclusion Intracoronary transplantation of ABMMNCs is safe and may improve the heart function.