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Objective:To study the correlation between the acute-phase characteristics of motor evoked potential (MEP) and severities of spinal cord injury in patients with acute cervical hyperextension injury and central cord syndrome (CCS).Methods:Retrospectively analyzed were the data of 45 patients with acute cervical hyperextension injury and CCS (observation group) who had been admitted to Department of Orthopedics, Tongji Hospital Affiliated to Tongji University from December 2018 to July 2021 and 20 healthy controls. Examination of transcranial magnetic stimulation-induced MEP was performed in patients with CCS and healthy controls using a magpro x100 magnetic stimulator, and recording was conducted in bilateral abductor pollicis brevis (APB). The characteristics of MEP waveform latency, amplitude and motor threshold were described and compared between the healthy control and observation groups; the correlations were analyzed between the MEP latency and the severity of spinal cord injury [American Spinal Injury Association (ASIA) total score and motor function of Upper Extremity Motor Subscores (UEMS)] in the observation group. According to different MEP-induced states, the patients in the observation group were divided into a resting group ( n=19), a facilitation group ( n=18), and a no-waveform group ( n=8). The severity of spinal cord injury (ASIA total score) and the functional independence of the spinal cord (SCIM-Ⅲ score) were compared among the 3 groups to analyze the correlation between the MEP-induced state and the severity of spinal cord injury (ASIA total score). Results:The observation group had a significantly longer MEP latency [(30.16±6.32) ms], a significantly smaller amplitude [(0.54±0.30) mV] and a significantly higher motor threshold [(65%±11%)] than the healthy control group (all P<0.05). The MEP latency in the observation group was significantly correlated with ASIA total score ( r=-0.730, P<0.001) and UEMS ( r=-0.740, P<0.001). The ASIA total score and SCIM-Ⅲ score were significantly different among the 3 groups ( P<0.05), and the MEP-induced state was significantly correlated with the severity of spinal cord injury (ASIA total score) ( r=0.668, P<0.001). Conclusions:In patients with acute cervical hyperextension injury and CCS, the MEP latency is prolonged, the amplitude lowered, and the motor threshold enhanced. The MEP latency is strongly correlated with the severity of spinal cord injury and upper limb motor function. The MEP-induced state is also closely related to the severity of spinal cord injury.
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Objective To improve the efficiency of blood collection in hemodialysis patients by inventing and applying new blood collection needles.Methods One hundred and eighty cases of hemodialysis patients were randomly divided into control group 1(CG1),control group 2(CG2),experimental group(EG). Comparison of the three groups in time of blood collection,the number of operation that had the risk of acupuncture injury and the number of the blood samples that had been contaminated. Results There were statistically significant difference (P<0.05)in three groups.The number of times of blood collection in the number of operations that had the risk of acupuncture injury,and the number of the blood sample that had been contaminated. CG1 had the longest blood collection time(12.55 min),EG had the shortest blood collection time(5.09 min);the risk of acupuncture injury was the highest in CG2 and the lowest in the EG.The number of contamination of blood samples and the amount of inaccurate sample in CG1 were the highest,and the lowest in the EG. Conclusions The working efficiency of transfer type anti-acupuncture needle(TTAN)during blood sample collection in hemodialysis patients is signifi-cantly better than that of traditional blood collection method,and it is helpful to reduce the risk of acupuncture injury and the risk of contamination in blood samples,which is worthy of promotion.
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Objective To investigate the operating strategies and essentials of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with tubular channel (Spotlight) to treat single-level lumbar degenerative diseases. Methods From November 2013 to December 2015, 97 patients (47 males and 50 females) underwent single-level lumbar degenerative diseases fol-lowing MIS-TLIF with Spotlight were analyzed, whose age were from 35-82 years old with the average age of 57.6±12.3 years old. The preoperative diagnosis was lumbar spinal stenosis in 63 cases, lumbar spondylolisthesis in 25 cases, and lumbar instability in 9 cases. The affected level was L3,4 in 9 cases, L4,5 in 66 cases, and L5S1 in 22 cases. According to distinct clinical manifestations and radiological characteristics, different approaches of Spotlight channels were employed. Unilateral decompression via unilateral channel was performed in 52 cases, bilateral decompression via unilateral channel was performed in 22 cases, and bilateral decom-pression via bilateral channel was performed in 23 cases. Clinical outcomes included operation duration, surgical blood loss, post-operative drainage volume and complications was recorded. Average intervertebral height, lumbar and surgical Cobb angle were utilized to evaluate the reduction of intervertebral height and lumbar lordosis. The low back and leg pain were represented as Visu-al Analogue Scale (VAS) score. The preoperative and postoperative Oswestry Disability Index (ODI) score were recorded individu-ally to evaluate patients'functional recovery. Besides, the Bridwell criterion was introduced to define the extent of the lumbar fu-sion. The MacNab criterion was used for assessment of postoperative efficacy. Results The operation duration was 189.8 ± 41.3 min, the volume of surgical blood loss was 143.9 ± 102.0 ml and the volume of postoperative drainage 75.0 ± 59.0 ml in all cases. Among them, operation time was 165.0±24.2 min, surgical blood loss was 99.5±54.1 ml and postoperative drainage was 48.4±27.6 ml in the operation group of unilateral decompression via unilateral channel. The date in the group of Bilateral decompression via unilateral channel were 208.9 ± 46.0 min, 151.4 ± 96.3 ml, 88.0 ± 51.3 ml and in the group of bilateral decompression via bilateral channel were 225.4±32.0 min, 236.0±126.3 ml, 122.8±81.7 ml. All the patients were followed up for 16-42 months, the average follow-up time was 24.9 ± 7.0 months. Low back VAS reduced from 6.10 ± 0.84 preoperatively to 1.59 ± 0.49 at the final follow-up, leg VAS decreased from 6.56±0.85 preoperatively to 1.59±0.57 at the last follow-up, and ODI reduced from 59.36％±5.52％preop-eratively to 15.89％±2.90％at the final follow-up, compared with preoperative, the differences were significant. Average interverte-bral height improved from 9.92±2.25 mm preoperatively to 12.24±1.78 mm at latest follow-up time, which had statistically signifi-cant difference. Operative segment and lumbar Cobb angle were 13.81°±6.10° and 32.32°±11.97° preoperative, at the time of lat-est follow-up improved to 14.25° ± 5.57° and 35.83° ± 9.89° , Compared with preoperative, lumbar Cobb angle was significantly in-creased but operative segment Cobb had no significant difference. According to the criteria of Bridwell, intervertebral fusion at fi-nal follow-up of I and II grades were 90 cases in total (92.8％). The MacNab criteria was used to evaluate the clinical efficacy, which 69 were excellent, 23 were good, and 5 were acceptable, the excellent and good rate was 94.8％. Conclusion The tech-nique of MIS-TLIF with the tubular channel (Spotlight) is safe and efficient for the treatment of single segment lumbar degener-ative diseases. Different strategies can be selected by different preoperative clinical manifestations and radiological features.
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Objective@#To evaluate the clinical effectiveness of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for single-level lumbar spondylolisthesis treatment with bilateral Spotlight tubular channels.@*Methods@#A total of 21 patients with lumbar spondylolisthesis whom underwent MIS-TLIF via bilateral Spotlight tubular channels were retrospectively analyzed from October 2014 to November 2015. The 21 patients included 11 males and 10 females ranged from 35 to 82 years (average aged 60.7 years). In term of spondylolisthesis category, there were 18 cases of degenerative spondylolisthesis and 3 cases of isthmic spondylolisthesis. With respect to spondylolisthesis degree, 17 cases were grade Ⅰ° and 4 cases were grade Ⅱ°. Besides, 17 cases at L4-5 and 4 cases at L5-S1were categorized by spondylolisthesis levels. Operation duration, blood loss, postoperative drainage and intraoperative exposure time were recorded, functional improvement was defined as an improvement in the Oswestry Disability Index (ODI), Visual Analog Scale (VAS) was also employed at pre and post-operation (3 months and the last follow-up), to evaluate low back and leg pain. Furthermore, to evaluate the recovery of the intervertebral foramen and of lumbar sagittal curvature, average height of intervertebral space, Cobb angles of lumbar vertebrae and operative segments, spondylolisthesis index were measured. At the last follow-up, intervertebral fusion was assessed using Siepe evaluation criteria and the clinical outcome was assessed using the MacNab scale. Radiographic and functional outcomes were compared pre- and post-operation using the paired T test to determine the effectiveness of MIS-TLIF. Statistical significance was defined as P<0.05.@*Results@#All patients underwent a successful MIS-TLIF surgery. The operation time (235.2±30.2) mins, intraoperative blood loss (238.1±130.3) ml, postoperative drainage (95.7±57.1) ml and intraoperative radiation exposure (47.1±8.8) were recorded. Different significance between 3 months post-operative follow-up and pre-operation was exhibited (P<0.01) in respects of lumbar VAS (t=11.1, P<0.01) and leg VAS (t=17.8, P<0.01). Moreover, final follow-up compared with pre-operation, and final follow-up compared with 3 months post-operative follow-up, VAS scores were also statistical difference (P<0.01). At the final follow-up, there were significant differences compared with pre-operation in ODI scores (t=30.1, P<0.01). Comparison between 3 months post-operative follow-up and pre-operation, statistical distinctions were demonstrated (P<0.05) in terms of mean height of intervertebral space (t=-10.9, P<0.01), the Cobb angles of lumbar vertebrae (t=-2.4, P<0.05), operative segments Cobb angles (t=-5.2, P<0.01) and Lumbar spondylolisthesis incidence (t=17.1, P<0.01). In addition, there was statistical difference between final follow-up and pre-operation (P<0.05) as well. For instance, mean height of intervertebral space (t=-10.5, P<0.01), the Cobb angles of lumbar vertebrae (t=-2.7, P<0.05), operative segments Cobb angles (t=-4.2, P<0.01) and Lumbar spondylolisthesis incidence (t=18.6, P<0.01) were involved. All spondylolisthesis vertebrae were restored completely. Lastly, at the last follow-up, 12 cases of grade 1 and 7 cases of grade 2 fusion were present as determined by the Siepe evaluation criteria. McNab scale assessment classified 17 patients having excellent clinical outcome, 3 patients in good and 1 patient having a better clinical outcome.@*Conclusion@#MIS-TLIF with bilateral Spotlight tubular channels is a safe and effective approach for single segment lumbar spondylolisthesis.
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BACKGROUND:Screw fixation of the fractured vertebral body can share the stress of implant, increase fixing strength, and help to maintain the stability of late fracture. However, whether it can assist reduction using fracture vertebral screw, but no relevant clinical reports were found at present. OBJECTIVE:To explore the effectiveness of self-designed screw-assisted reduction of fractured vertebrae. METHODS:161 cases of thoracolumbar fracture who had been hospitalized between June 2001 and June 2009 were enrol ed in this study, including 101 males and 60 females, at the age of 22-67 years, averagely 36 years. By Denis classification, 64 cases affected burst fractures and 97 flexion-compression fractures. Fracture levels involved T11 (9 cases), T12 (63 cases), L1 (74 cases) and L2 (15 cases). The self-designed method of reduction assisted with screw insertion was used. The efficacy of this reduction method was evaluated by operation time, intraoperative bleeding, fracture union time, height ratio of anterior borders of injured and normal vertebrae, sagittal Cobb’s angle, and reduction of fragments. RESULTS AND CONCLUSION:The operation time ranged from 60 to 150 minutes, averaging 80 minutes. The intraoperative bleeding ranged from 67 to 750 mL, averaging 98 mL. The fol ow-up time ranged from 16 to 42 months in 161 patients. Fracture union time ranged from 10 to 18 weeks, averaging 12.6 weeks. The ratio of anterior heights and sagittal Cobb’s angle of fractured vertebrae were significantly improved from (54.39±9.60)%and (22.55±7.90)° respectively preoperati on to (82.80±6.63)%and (8.91°±5.85)° 12 months postoperation (P<0.05). The size of spinal canal was increased by (46.5±2.6)%postoperatively. CT scan revealed satisfactory fragment reduction and no deep infection appeared. These findings suggest that our self-designed screw-assisted reduction of the fractured vertebrae can improve the reduction quality in the treatment of thoracolumbar fractures.
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ObjectiveTo evaluate the efficacy of short-segment transpedicular fixation combined with augmentation vertebroplasty in treatment of thoracolumbar burst fractures. MethodsFrom November 2006 to September 2009, 37 patients with thoracolumbar burst fracture were admitted and received transpedicular fixation combined with calcium sulfate cement augmentation vertebroplasty, and the clinical data including fracture types, complications and following-up results were collected for analysis. The multimethod evaluation strategies involved the anterior vertebral body height, the sagittal Cobb's angle, the restoration of nervous function, internal fixation failure, visual analogue scale (VAS) and Oswestry disability index (ODI) were retrospective analyzed. Results All patients were followed up for average 19 months (range, 14-37). There were no internal fixation failure, loss of reduction, neurological complications in all the patients. In 16 patients with partial neurologic deficits, 14 initially improved at the final follow-up, with no deterioration of neurologic functions. The mean time of calcium sulfate cement obvious absorption and union was 3 months and 5 months postoperatively, respectively. The anterior vertebral body height was 55.40％before surgery and 85.46％ after surgery on average, ended up with 82.35％. The sagittai Cobb's angle was improved from 22.45° to 6.86°, ended up with 9.66° on average. The mean VAS and ODI at the final followup were respectively 1.2 and 20.4 on average. ConclusionShort-segment transpedicular fixation combined with augmentation vertebroplasty appears to be effective in achieving stable biomechanics with high security,which seems to be a feasible option in the management of thoracolumbar burst fractures.
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[Objective]To investigate the curative effect and methods of distal tibial fracture by operation.[Method]From May 2004 to Feb.2005,30 cases of distal tibial fracture were treated in the department.All cases were treated with open reduction,internal fixation with medial anatomic plates,and with bone-grafting prophylacticly in all cases.The operation would be done on 10~14 days after fracture.They were followed up and analyzed retrospectively.[Result]All cases were followed up for 8～17 months(average 13.9 months).All wounds were primary healing and all fractures obtained bone-union.Twenty-two cases were the excellent,6 cases were the good according to Mazur's criteria.The excellent and good rate was 93.3%.All cases had no severe complication,such as wound infection,cutaneous necrosis and bone non-union.[Conclusion]Anatomic plate of distal tibia is a perfect choice for treatment of distal tibial fracture.Operative juncture and prophylactic bone grafting were very important to obtain satisfactory effect.
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Objective: To investigate the effects of the cooperative actions of isoflavone, vitamin C and E on the expression of acute C reactive protein (CRP) and interleukin 6 (IL-6) in the patients with typeⅡdiabetic mellitus (DM). Method: Ninety six patients with DM were divided randomly into 4 groups, DM control group(B), and groups receiving low(C), medium (D) , and high (E) dose of the compound antioxidant of isoflavone, vitamin C and E respectively. Another 24 healthy subjects served as normal control group (A). Observe the changes of the levels of CRP and IL-6 during oral glucose tolerance test (OGTT). Results: The peak of serum levels of CRP and IL-6 in the patients of DM control group and lower dosage group appeared 1 h after OGTT and were significantly higher than the 0 h value (P