ABSTRACT
Objective:To analyze the incidence and epidemiological characteristics of traumatic spinal cord injury in China in 2018.Methods:Multi-stage stratified cluster sampling was used to randomly select hospitals capable of treating patients with spinal cord injury from 3 regions，9 provinces and 27 cities in China to retrospectively investigate eligible patients with traumatic spinal cord injury admitted in 2018. National and regional incidence rates were calculated. The data of cause of injury，injury level，severity of injury，segment and type of fracture，complications，death and other data were collected by medical record questionnaire，and analyzed according to geographical region，age and gender.Results:Medical records of 4，134 patients were included in this study，with a male-to-female ratio of 2.99∶1. The incidence of traumatic spinal cord injury in China in 2018 was 50.484 / 1 million （95% CI 50.122-50.846）. The highest incidence in the Eastern region was 53.791 / 1 million （95% CI 53.217-54.365）. In the whole country，the main causes of injury were high falls （29.58%），as well as in the Western region （40.68%），while the main causes of injury in the Eastern and Central regions were traffic injuries （31.22%，30.10%）. The main injury level was cervical spinal cord in the whole country （64.49%），and the proportion of cervical spinal cord injury in the Central region was the highest （74.68%），and the proportion of lumbosacral spinal cord injury in the Western region was the highest （32.30%）. The highest proportion of degree of injury was incomplete quadriplegia （55.20%），and the distribution pattern was the same in each region. A total of 65.87% of the patients were complicated with fracture or dislocation，77.95% in the Western region and only 54.77% in the Central region. In the whole country，the head was the main combined injury （37.87%），as well as in the Eastern and Central regions，while the proportion of chest combined injury in the Western region was the highest （38.57%）. A total of 32.90% of the patients were complicated with respiratory complications. There were 23 patients （0.56%） died in hospital，of which 17（73.91%） died of respiratory dysfunction. Conclusions:The Eastern region of China has a high incidence of traumatic spinal cord injury. Other epidemiological features include high fall as the main cause of injury cervical spinal cord injury as the main injury level，incomplete quadriplegia as the main degree of injury，head as the main combined injury，and respiratory complications as the main complication.
ABSTRACT
Osteoporosis is a type of chronic disease characterized by increased bone fragility caused by destruction of bone microstructure and high risk of vertebral compression fractures. Previous researches show hyperactive bone resorption caused by abnormal activity of osteoclasts is highly related to osteoporosis. Icariin, a traditional Chinese medicine monomer, has been reported to have a biological effect in regulating osteoclast signaling pathway RANK/RANKL/OPG. It also can participate in the regulation of multiple stages of osteoclast differentiation. These results suggest icariin has an important role in regulating osteoclast differentiation and bone erosion. The authors systematically review the related researches on the mechanism of icariin in regulating osteoclast differentiation, in order to provide new ideas for osteoporosis-targeted treatment for osteoporosis.
ABSTRACT
Objective To investigate the effect of graded surgical treatment according to injury classification on old thoracolumbar vertebral compression fractures ( OVCFs) . Methods A retrospective case series study was conducted to analyze the clinical data of 238 patients with old thoracolumbar OVCFs admitted to the Honghui Hospital affiliated to the College of Medicine, Xi'an Jiaotong University from February 2013 to November 2016. There were 49 males and 189 females, aged 63-78 years, with an average age of 66. 8 years. The bone density T value was ( -3. 8 ± 0. 3)SD. The injured segments were located at T7-T9 in 35 patients, T10-L2 in 171, and L3-L4 in 32. A total of 16 patients had neurological injury, including 14 with grade C and two with grade D according to the American Spinal Injury Association ( ASIA) neurological function classification. According to the patient's clinical manifestations and imaging complexity, the patients were assigned with I to V grades for individualized surgical treatment. Among them, 86 patients with grade I were treated with vertebral augmentation; 60 patients with grade II received posterior reduction and internal fixation combined with vertebral augmentation when necessary;44 patients with grade III were treated with posterior decompression and reduction and internal fixation;30 patients with grade IV received posterior osteotomy and orthopedic fusion; 18 patients with grade V were treated based on the major symptoms. The visual analogue score ( VAS ) , Oswestry dysfunction index ( ODI) , vertebral sagittal index, and the American Spinal Injury Association ( ASIA) grading before operation and at the last follow-up as well as the postoperative complications were recorded. Results All patients were followed up for 12-38 months with an average of 18. 5 months. The VAS of patients with grade I to V improved from preoperative (8. 0 ± 0. 7)points, (8. 1 ± 0. 7)points, (8. 3 ± 0.89)points,(8.1±0.7)points,(8.2±0.2)pointsto(2.1±0.8)points,(2.0±0.8)points,(2.2± 0. 8)points, (2. 3 ± 0. 8)points, (2. 2 ± 0. 8)points at the last follow-up (P<0. 05);ODI was improved from preoperative 69. 5 ± 3. 0, 70. 1 ± 2. 0, 70. 3 ± 2. 1, 69. 9 ± 1. 9, 70. 0 ± 2. 2 to 39. 8 ± 2. 2, 39. 1 ± 2. 4, 40. 1 ± 2. 1, 39. 0 ± 2. 3, 39. 5 ± 2. 3 at the last follow-up (P<0. 05);the vertebral sagittal index improved from (89. 7 ± 2. 1)％, (74. 4 ± 8. 3)％, (75. 0 ± 6. 7)％, (72. 3 ± 5. 2)％, (71. 1 ± 2. 1)％to (85.2 ±7.4)％, (84.2 ±5.5)％, (85.1 ±4.4)％, (86.2 ±3.5)％, (83.4 ±1.7)％ (P<0.05). For 16 patients with nerve injury, the ASIA grading was improved from preoperative grade C in 14 patients and grade D in two patients to grade D in four patients and grade E in 12 patients at the last follow-up. A total of 11 patients ( seven patients with grade I, one with grade II, two with grade IV, and one patient with grade V) had vertebral height loss in the later stage, but only two patients underwent secondary surgery for severe low back pain. Conclusions For obsolete thoracolumbar OVCFs, the concept of graded surgery can effectively guide the treatment strategies of these patients. Different surgical schemes for patients with different conditions can effectively alleviate the pain, restore spinal stability, correct kyphosis deformity, relieve nerve compression and promote functional recovery.