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Objective:To investigate the degenerative characteristics and biomechanical effects of paravertebral muscles in patients with degenerative lumbar scoliosis.Methods:The clinical data of 236 patients with degenerative lumbar scoliosis from January 2016 to January 2020 in Yuncheng Central Hospital of Shanxi Province were retrospectively analyzed. All patients underwent lumbar X-ray and MRI measurement, and the indexes included coronal scoliosis Cobb angle, rotation classification of apical vertebra, cross-sectional area (CSA) of the apical vertebra upper and lower intercalated disc plane, fatty infiltration rate (FIR) of psoas major and back extensor muscle group (including erector spinae and multifidus muscle), cross-sectional area difference index (CDI) and fatty infiltration difference (FID). The correlation between paravertebral muscle degeneration and coronal scoliosis Cobb angle was evaluated.Results:The coronal scoliosis Cobb angle of 236 patients was 10.4° to 57.8° (18.72 ± 6.44)°; there were no statistical differences in coronal scoliosis Cobb angle and rotation classification of apical vertebra between different sex, scoliosis direction and apical vertebra position ( P>0.05). In the apical vertebra upper intercalated disc plane, the concave side CSA of psoas major muscle was significantly higher than convex side: (3.82 ± 1.06) cm 2 vs. (3.68 ± 1.01) cm 2, the concave side CSA of multifidus muscle, back extensor muscle group and paraspinal muscle group (including psoas major muscle, quadratus lumborum, erector spinae and multifidus muscle) was significantly lower than convex side: (9.80 ± 2.14) cm 2 vs. (10.46 ± 2.60) cm 2, (18.18 ± 3.03) cm 2 vs. (19.79 ± 3.22) cm 2 and (25.25 ± 5.06) cm 2 vs. (27.86 ± 6.90) cm 2, and there were statistical differences ( P<0.05 or <0.01); there were no statistical differences in CSA of quadratus lumborum and erector spinae between concave side and convex side ( P>0.05). In the apical vertebra lower intercalated disc plane, the concave side CSA of psoas major muscle and quadratus lumborum was significantly higher than convex side: (6.62 ± 3.09) cm 2 vs. (6.40 ± 3.23) cm 2 and (4.58 ± 0.57) cm 2 vs. (4.45 ± 0.64) cm 2, the concave side CSA of multifidus muscle and back extensor muscle group was significantly lower than concave side: (9.49 ± 3.10) cm 2 vs. (10.32 ± 4.06) cm 2 and (19.31 ± 4.36) cm 2 vs. (20.54 ± 5.60) cm 2, and there were statistical differences ( P<0.01 or <0.05); there was no statistical difference in CSA of erector spinae and paraspinal muscle group between concave side and convex side ( P>0.05). In apical vertebra upper and lower intercalated disc plane, the concave side FIR of back extensor muscle group was significantly higher than convex side: (31.83 ± 11.04)% vs. (24.37 ± 12.76)% and (38.62 ± 10.09)% vs. (31.80 ± 8.23)%, and there was statistical difference ( P<0.01); there was no statistical difference in FIR of psoas major muscle between concave side and convex side ( P>0.05). Pearson linear correlation analysis result showed that CDI of multifidus muscle, back extensor muscle group, paraspinal muscle group and FID of back extensor muscle group were positively correlated with coronal scoliosis Cobb angle (apical vertebra upper intercalated disc plane: r = 0.94, 0.70, 0.86 and 0.90, P<0.01; apical vertebra lower intercalated disc plane: r = 0.92, 0.94, 0.81 and 0.66, P<0.01); the CDI of psoas major muscle in apical vertebra lower intercalated disc plane was positively correlated with coronal scoliosis Cobb angle ( r = 0.73, P<0.01); there was no correlation between CDI of psoas major muscle in apical vertebra upper intercalated disc plane and coronal scoliosis Cobb angle ( r = 0.17, P>0.05). In patients with apical vertebra located in L 2 and L 3, the CSA of psoas major muscle and quadratus lumborum in apical vertebra lower intercalated disc plane was significantly higher than that in apical vertebra upper intercalated disc plane, and there was statistical difference ( P<0.01); in patients with apical vertebra located in L 2, the concave side CSA of erector spinae in apical vertebra lower intercalated disc plane was significantly higher than that in apical vertebra upper intercalated disc plane, and there was statistical difference ( P<0.01). Conclusions:The biomechanical effects of lumbar flexion/ back extensor muscle group should be different in the process of disease progression in patients with degenerative lumbar scoliosis, in which the back extensor muscle group can effectively inhibit the degenerative disease. The protection of paravertebral muscle group function should be placed in an important role in degenerative lumbar scoliosis treatment.
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Objective@#To investigate the influence of low viscosity and high viscosity bone cement in PVP on active function, anatomical index and leakage rate of patients with severe osteoporotic vertebral compression fractures (OVCF).@*Methods@#From October 2015 to June 2017, 136 patients with severe OVCF were chosen in the Central Hospital of Yuncheng and randomly divided into two groups according to the digital table, with 68 patients in each group.The control group was given low viscosity bone cement by PVP scheme, and the observation group was given high viscosity bone cement by PVP.The VAS score, ODI score, SF-36 score and kyphosis Cobb angle before and after operation, the recovery rate of injured vertebrae, bone cement injection volume and postoperative cement leakage rate of the two groups were compared.@*Results@#There were no statistically significant differences in the VAS score, ODI score and SF-36 score before operation between the two groups(all P>0.05). The VAS score, ODI score and SF-36 score after operation of the control group were (1.90±0.32)points, (30.38±3.52)points, (76.07±9.38)points, respectively, which of the observation group were (1.94±0.34)points, (29.72±3.34)points, (77.10±9.60)points, respectively, which were significantly better than those before operation(control group: t=4.27, 5.01, 4.02; observation group: t=4.21, 4.89, 3.87, all P<0.05). There were no statistically significant differences in the VAS score, ODI score and SF-36 score after operation between the two groups(all P>0.05). The kyphosis Cobb angle after operation of the observation group was (14.02±2.59)°, which was significantly lower than (16.83±3.31)° of the control group and (27.78±4.09)° before operation (t=4.99, 2.64, all P<0.05). The recovery rate of injured vertebrae of the observation group was (28.34±5.70)%, which was statistically significantly higher than (22.72±4.16)% of the control group (t=3.42, P<0.05). There was no statistically significant difference in the bone cement injection volume between the two groups(P>0.05). The incidence rate of bone cement leakage in the observation group was 10.29%(7/68), which was significantly lower than that in the control group [30.88%(21/68)](χ2=12.15, P<0.05).@*Conclusion@#Low viscosity and high viscosity bone cement in PVP in the treatment of patients with severe OVCF possess the same clinical effects on relieve pain and improve activity and quality of life; but high viscosity bone cement application can efficiently improve the anatomical index of injured vertebrae and avoid postoperative cement leakage.
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Objective To investigate the influence of low viscosity and high viscosity bone cement in PVP on active function,anatomical index and leakage rate of patients with severe osteoporotic vertebral compression fractures (OVCF).Methods From October 2015 to June 2017,136 patients with severe OVCF were chosen in the Central Hospital of Yuncheng and randomly divided into two groups according to the digital table,with 68 patients in each group.The control group was given low viscosity bone cement by PVP scheme,and the observation group was given high viscosity bone cement by PVP.The VAS score,ODI score,SF-36 score and kyphosis Cobb angle before and after operation,the recovery rate of injured vertebrae,bone cement injection volume and postoperative cement leakage rate of the two groups were compared.Results There were no statistically significant differences in the VAS score,ODI score and SF-36 score before operation between the two groups(all P ＞0.05).The VAS score,ODI score and SF-36 score after operation of the control group were (1.90 ± 0.32) points,(30.38 ± 3.52) points,(76.07 ±9.38) points,respectively,which of the observation group were (1.94 ± 0.34) points,(29.72 ± 3.34) points,(77.10 ±9.60) points,respectively,which were significantly better than those before operation (control group:t =4.27,5.01,4.02;observation group:t =4.21,4.89,3.87,all P ＜ 0.05).There were no statistically significant differences in the VAS score,ODI score and SF-36 score after operation between the two groups (all P ＞ 0.05).The kyphosis Cobb angle after operation of the observation group was (14.02 ± 2.59) °,which was significantly lower than (16.83 ±3.31) ° of the control group and (27.78 ± 4.09) ° before operation (t =4.99,2.64,all P ＜ 0.05).The recovery rate of injured vertebrae of the observation group was (28.34 ± 5.70) ％,which was statistically significantly higher than (22.72 ± 4.16) ％ of the control group (t =3.42,P ＜ 0.05).There was no statistically significant difference in the bone cement injection volume between the two groups(P ＞ 0.05).The incidence rate of bone cement leakage in the observation group was 10.29％ (7/68),which was significantly lower than that in the control group [30.88％ (21/68)] (x2 =12.15,P ＜ 0.05).Conclusion Low viscosity and high viscosity bone cement in PVP in the treatment of patients with severe OVCF possess the same clinical effects on relieve pain and improve activity and quality of life;but high viscosity bone cement application can efficiently improve the anatomical index of injured vertebrae and avoid postoperative cement leakage.
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ObjectiveTo investigate the value of endoscopic ultrasound (EUS) versus magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of obstructive jaundice. MethodsA total of 31 patients with obstructive jaundice who visited Beijing Tiantan Hospital, Capital Medical University, from January 2015 to March 2016 were enrolled, and all the patients underwent EUS and MRCP. The sensitivity, specificity, accuracy, and Youden index of EUS and MRCP in the diagnosis of obstructive jaundice were compared. ResultsOf all patients, 16 (51.61%) were diagnosed with common bile duct stones, 1 (3.23%) was diagnosed with ampullary tumor, 6 (19.35%) were diagnosed with duodenal papillary tumor, 3 (9.68%) were diagnosed with tumor of the head of the pancreas, 2 (6.45%) were diagnosed with bile duct tumor, 2 (6.45%) were diagnosed with bile duct inflammation, and 1 had no stones or space-occupying lesions observed by endoscopic retrograde cholangiopancreatography, EUS, or MRCP. The coincidence rate of EUS in the diagnosis of ampullary tumor, duodenal papillary tumor, and tumor of the head of the pancreas was 100%, and MRCP had a lower coincidence rate in the diagnosis of common bile duct stones and a lower overall coincidence rate of diagnosis than EUS (81.25%/76.67% vs 93.75%/90.00%). In the diagnosis of obstructive jaundice, EUS and MRCP had sensitivities of 90.00% and 76.70%, specificities of 100%, accuracy rates of 90.30% and 7740%, and Youden indices of 0.90 and 0.77. ConclusionEUS has a higher value in the diagnosis of obstructive jaundice than MRCP.