ABSTRACT
Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.
ABSTRACT
Objective:To investigate the efficacy of flexion-lateral curvature-supination reduction combined with primary anterior surgery for the treatment of lower cervical dislocation with unilateral facet inter-locking.Methods:A retrospective analysis was performed in the 32 patients who had been admitted to Department of Spine Surgery, Honghui Hospital for lower cervical dislocation with unilateral facet interlocking from November 2015 to October 2018. According to their treatments, they were divided into 2 groups. In the emergency group treated by flexion-lateral curvature-supination reduction combined with primary anterior surgery, there were 13 males and 3 females, aged from 24 to 63 years. In the traction group treated by cranial traction reduction combined with secondary anterior surgery, there were 12 males and 4 females, aged from 20 to 64 years. The operation time, intraoperative blood loss, hospital stay, bone graft fusion, American Spinal Injury Association (ASIA) grade and Japanese Orthopaedic Association (JOA) score were compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, showing they were comparable ( P<0.05). All patients were followed up from 26 to 40 months. The hospital stay for the emergency group [(7.2±1.2) d] was significantly shorter than that for the traction group[(10.9±1.2) d] ( P<0.05). There was no significant difference in the operation time, blood loss, ASIA grade or JOA score between the 2 groups ( P>0.05). All patients achieved osseous fusion of intervertebral space. Conclusion:Compared with traditional methods, flexion-lateral curvature-supination reduction combined with primay anterior surgery shows no significant difference in the recovery of neurological function but leads to a shorter hospital stay.
ABSTRACT
Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.
ABSTRACT
Objective:To compare the efficacy of forceful reduction percutaneous pedicle screw and ordinary percutaneous pedicle screw in the treatment of osteoporotic thoracolumbar burst fracture with kyphosis.Methods:A retrospective cohort study was conducted to analyze the clinical data of 566 patients with osteoporotic thoracolumbar burst fracture with kyphosis admitted to Honghui Hospital, Xi ′an Jiaotong University from January 2015 to December 2018, including 191 males and 375 females, with age range of 48-79 years [(61.7±10.7)years]. Fracture segments were located at T 11 in 134 patients, T 12 in 154, L 1 in 160, and L 2 in 118. All fractures were type IIIA according to the acute symptomatic osteoporotic thoracolumbar fracture classification (ASOTLF). The thoracolumbar osteoporotic fracture severity score assessment system (TLOFSAS) score was ≥5 points. A total of 275 patients underwent forceful reduction and percutaneous pedicle screw internal fixation (forceful reduction screw group), and 291 patients underwent common percutaneous pedicle screw internal fixation (common screw group). The operation time, intraoperative blood loss, times of X-ray exposure on patients and measures documented before operation, at 3 days after operation and at 2 years after operation including anterior height ratio of the injured vertebrae, sagittal Cobb angle of the injured vertebrae, Japanese Orthopaedic Association (JOA) score and visual analog scale (VAS) were compared between the two groups. Moreover, degree of correction of Cobb angle at 3 days after operation, loss of correction of Cobb angle at 2 years after operation and postoperative complications were observed. Results:All patients were followed up for 25-34 months [(29.9±3.4)months]. The operation time, intraoperative blood loss and times of X-ray exposure on patients in forceful reduction screw group were (69.4±10.2)minutes, (60.3±13.1)ml and (26.8±3.7)times, less than (80.6±11.9)minutes, (80.7±15.4)ml and (30.4±3.4)times in common screw group (all P<0.01). There was no significant difference in anterior height ratio of the injured vertebrae between the two groups before operation and at 3 days after operation (all P>0.05). The anterior height ratio of the injured vertebrae in forceful reduction screw group was (95.5±2.3)% at 2 years after operation, significantly higher than (85.4±1.7)% in common screw group ( P<0.01). There was no significant difference in sagittal Cobb angle of the injured vertebrae between the two groups before operation ( P>0.05). The sagittal Cobb of the injured vertebrae in forceful reduction screw group at 3 days and 2 years after operation were (7.9±1.6)° and (8.8±1.5)°, lower than (10.6±1.1)° and (12.3±1.2)° in common screw group ( P<0.05 or 0.01). There were no significant difference in JOA score and VAS between the two groups before operation, at 3 days and at 2 years after operation (all P>0.05). The degree of correction of Cobb angle in forceful reduction screw group was (19.4±2.5)°, higher than (17.3±2.6)° in common screw group ( P<0.05). The loss of correction of Cobb angle in forceful reduction group was less than that in common screw group at 2 years after operation, but the difference was not statistically significant ( P>0.05). The incidence of postoperative complications in forceful reduction screw group was 12.4% (34/275), compared to 14.1% (41/291) in common screw group ( P>0.05). There were no complications such as iatrogenic nerve injury, fracture or loosening of internal fixator or leakage of bone cement in the spinal canal in both groups. Conclusions:For osteoporotic thoracolumbar burst fracture with kyphosis, forceful reduction and percutaneous pedicle screw internal fixation can significantly shorten operation time, reduce intraoperative blood loss and times of X-ray exposure on patients, restore height of the injured vertebrae, correct kyphosis and maintain reduction height of the injured vertebrae in contrast with conventional percutaneous pedicle screw internal fixation.
ABSTRACT
Objective@#To analyze the differentially expressed microRNA (miRNA) and their target genes in peripheral blood and bone tissue of postmenopausal osteoporosis (PMOP), and provide basis for the study of pathogenesis as well as biomarkers identification of PMOP.@*Methods@#Two miRNA datasets of PMOP from the public platform NCBI-GEO DataSets were obtained, including GSE64433 (the miRNA expression profile of peripheral blood samples, including 23 PMOP patients and 25 controls) and GSE74209 (the miRNA expression profile of the femoral neck bone tissue sample, including six PMOP patients and six controls). R/Bioconductor was performed for data analysis and differentially expressed miRNA screening, and miRNAs with fold change>2 & P<0.05 between osteoporosis and controls were selected as differentially expressed miRNA. The miRNA target gene prediction was performed by combining TargetScan, miRDB and miRTarBase databases. The miRNA-target gene regulatory network was constructed and analyzed by Cytoscape.@*Results@#There were 224 differentially expressed miRNAs (75 up-regulated miRNAs and 149 down-regulated miRNAs) in the peripheral blood samples of PMOP group (GSE64433 dataset) and 132 differentially expressed miRNAs (58 up-regulated miRNAs and 74 down-regulated miRNAs) in the femoral neck bone tissue of PMOP group (GSE74209 dataset). We combined the results from the two datasets and obtained 8 miRNAs down-regulated in both datasets, and the 8 miRNAs regulated a total of 327 target genes, and 10 of these target genes were co-regulated by two miRNAs.@*Conclusions@#The core miRNAs and the target genes regulated by multiple miRNAs in the regulatory network may play important roles in the pathogenesis of PMOP and have potential application values as molecular biomarkers of disease. These findings are meaningful for the studies of PMOP pathogenesis, biomarkers screening and prevention of osteoporotic fractures.
ABSTRACT
Objective@#To determine the value of hyperextension MRI evaluation in determining whether to perform decompression therapy after reduction of reducible atlantoaxial dislocation as well as assess the decompression effect.@*Methods@#A retrospective case series study was conducted to analyze 24 patients with atlantoaxial dislocation admitted to Honghui Hospital affiliated to Xi'an Jiaotong University from May 2015 to May 2017. There were 10 males and 14 females, aged 40-74 years, with an average age of 52 years. There were 14 patients with os odontoideum, four patients with odontoid fracture, and six patients with transverse atlantal ligament rupture. Hyperextension MRI was performed to assess spinal cord compression for all patients. Eight patients with anterior spinal cord compression (Group A) underwent posterior atlantoaxial arch decompression plus atlantoaxial internal fixation reduction and bone graft fusion; 16 patients without anterior compression of the spinal cord (Group B) underwent only atlantoaxial internal fixation reduction and bone graft fusion. Intraoperative and postoperative complications were recorded. Spinal cord compression index and improvement rate of spinal cord decompression were evaluated by routine cervical spine MRI. Japanese Orthopedic Association (JOA) score was used to evaluate the clinical effect.@*Results@#All patients were followed up for 3-24 months, with an average of 9.3 months. There was no nerve or vertebral artery injury during the operation, and no screw loosening occurred after surgery. The spinal cord compression index (0.37±0.18) in Group A at the last follow-up was significantly lower than that before operation (0.73±0.22) (P<0.05), while the index in Group B (0.19±0.20) at the last follow-up was also lower than that before operation (0.61±0.25) (P<0.05). The improvement rate of spinal cord decompression was 67.11% in Group A and 70.61% in Group B. The final JOA score of Group A was (13.29±3.68)points, which was significantly better than the preoperative JOA [(5.61±2.74)points] (P<0.05). The final JOA score in Group B [(14.13±3.45)points] was also significantly better than the preoperative JOA [(7.32±2.90)points] (P<0.05). Improvement rate of JOA was 57.31% in Group A and 59.91% in Group B.@*Conclusions@#Hyperextension MRI of cervical vertebra can effectively judge whether the anterior spinal cord is compressed after reduction of atlantoaxial dislocation. It has important clinical significance for decompression treatment during reduction and internal fixation of reducible atlantoaxial dislocation. At the same time, posterior atlantoaxial arch resection and decompression can effectively relieve the compression of the spinal cord after reduction of atlantoaxial dislocation.
ABSTRACT
Objective To analyze the differentially expressed microRNA (miRNA) and their target genes in peripheral blood and bone tissue of postmenopausal osteoporosis (PMOP),and provide basis for the study of pathogenesis as well as biomarkers identification of PMOP.Methods Two miRNA datasets of PMOP from the public platform NCBI-GEO DataSets were obtained,including GSE64433 (the miRNA expression profile of peripheral blood samples,including 23 PMOP patients and 25 controls) and GSE74209 (the miRNA expression profile of the femoral neck bone tissue sample,including six PMOP patients and six controls).R/Bioconductor was performed for data analysis and differentially expressed miRNA screening,and miRNAs with fold change ＞ 2 & P ＜ 0.05 between osteoporosis and controls were selected as differentially expressed miRNA.The miRNA target gene prediction was performed by combining TargetScan,miRDB and miRTarBase databases.The miRNA-target gene regulatory network was constructed and analyzed by Cytoscape.Results There were 224 differentially expressed miRNAs (75 up-regulated miRNAs and 149 down-regulated miRNAs) in the peripheral blood samples of PMOP group (GSE64433 dataset) and 132 differentially expressed miRNAs (58 up-regulated miRNAs and 74 down-regulated miRNAs) in the femoral neck bone tissue of PMOP group (GSE74209 dataset).We combined the results from the two datasets and obtained 8 miRNAs down-regulated in both datasets,and the 8 miRNAs regulated a total of 327 target genes,and 10 of these target genes were co-regulated by two miRNAs.Conclusions The core miRNAs and the target genes regulated by multiple miRNAs in the regulatory network may play important roles in the pathogenesis of PMOP and have potential application values as molecular biomarkers of disease.These findings are meaningful for the studies of PMOP pathogenesis,biomarkers screening and prevention of osteoporotic fractures.
ABSTRACT
Objective To determine the value of hyperextension MRI evaluation in determining whether to perform decompression therapy after reduction of reducible atlantoaxial dislocation as well as assess the decompression effect. Methods A retrospective case series study was conducted to analyze 24 patients with atlantoaxial dislocation admitted to Honghui Hospital affiliated to Xi'an Jiaotong University from May 2015 to May 2017. There were 10 males and 14 females, aged 40-74 years, with an average age of 52 years. There were 14 patients with os odontoideum, four patients with odontoid fracture, and six patients with transverse atlantal ligament rupture. Hyperextension MRI was performed to assess spinal cord compression for all patients. Eight patients with anterior spinal cord compression ( Group A ) underwent posterior atlantoaxial arch decompression plus atlantoaxial internal fixation reduction and bone graft fusion; 16 patients without anterior compression of the spinal cord ( Group B ) underwent only atlantoaxial internal fixation reduction and bone graft fusion. Intraoperative and postoperative complications were recorded. Spinal cord compression index and improvement rate of spinal cord decompression were evaluated by routine cervical spine MRI. Japanese Orthopedic Association ( JOA) score was used to evaluate the clinical effect. Results All patients were followed up for 3-24 months, with an average of 9. 3 months. There was no nerve or vertebral artery injury during the operation, and no screw loosening occurred after surgery. The spinal cord compression index (0. 37 ± 0. 18) in Group A at the last follow-up was significantly lower than that before operation (0. 73 ± 0. 22) (P<0. 05), while the index in Group B (0. 19 ± 0. 20) at the last follow-up was also lower than that before operation (0. 61 ± 0. 25) (P<0. 05). The improvement rate of spinal cord decompression was 67. 11％ in Group A and 70. 61％ in Group B. The final JOA score of Group A was ( 13. 29 ± 3. 68 ) points, which was significantlybetterthanthepreoperativeJOA[(5.61±2.74)points] (P <0.05). ThefinalJOA score in Group B [(14. 13 ± 3. 45) points] was also significantly better than the preoperative JOA [(7. 32 ± 2. 90)points] (P<0. 05). Improvement rate of JOA was 57. 31％ in Group A and 59. 91％in Group B. Conclusions Hyperextension MRI of cervical vertebra can effectively judge whether the anterior spinal cord is compressed after reduction of atlantoaxial dislocation. It has important clinical significance for decompression treatment during reduction and internal fixation of reducible atlantoaxial dislocation. At the same time, posterior atlantoaxial arch resection and decompression can effectively relieve the compression of the spinal cord after reduction of atlantoaxial dislocation.
ABSTRACT
Objective To compare minimally invasive percutaneous pedicle screw fixation and open pedicle screw fixation for neurologically intact thoracolumbar fractures.Methods A retrospective study was conducted in the 180 patients who had been treated for thoracolumbar fractures without neurological deficits from January 2016 to December 2016.Of them,93 were treated by minimally invasive percutaneous pedicle screw fixation and 87 by open pedicle screw fixation.The 2 groups were compared in terms of blood loss,radiological parameters,visual analogue scale (VAS) and Oswestry disability index (ODI).Results Compared with the open surgery group,the minimally invasive surgery group had significantly shorter operating time (95.8 ±33.4 min versus 106.3 ±30.9 min),significantly less intraoperative blood loss (65.8 ±40.3 mL versus 183.1 ± 77.5 mL),significantly less total blood loss in theory 24 hours after surgery (374.7 ± 160.6 mL versus 614.8 ± 242.6 mL) and significantly shorter hospital stay (5.2 ± 2.0 d versus 6.7 ± 2.7 d),but significantly longer C-arm exposure time (23.6 ±4.2 min versus 12.4 ±4.1 min) and significantly more hidden blood loss 24 hours after surgery (308.9 ± 159.0 mL versus 243.5 ± 195.5 mL) (P ＜ 0.05).Compared with preoperation,significant improvements were observed at one week postoperation and the last follow-up in the 2 groups regarding the percentage of anterior height of the fractured vertebral body and cobb angle (P ＜ 0.05),but there were no significant differences in the percentage of anterior height of the fractured vertebral body or cobb angle between the 2 groups at one week postoperation or at the last follow-up (P ＞ 0.05).At 3 days postoperation,significant better pain relief was observed in the minimally invasive surgery group than in the open surgery group (P ＜ 0.01),but at the last follow-up no obvious pain was reported in either group.At the last follow-up,there was no significant difference between the 2 groups in ODI (6.2 ± 1.1 versus 6.0 ± 1.4) (P =0.320).Conclusions In the treatment of neurologically intact thoracolumbar fractures,minimally invasive percutaneous pedicle screw fixation may lead to shorter operating time,less blood loss and shorter hospital stay but no poorer radiological outcomes or long-term patient-reported outcomes than the open pedicle screw fixation.However,it should be noted that the former may lead to a higher volume of hidden blood loss.
ABSTRACT
Objective To investigate the effect of intravenous tranexamic acid (TXA) on perioperative hidden blood loss in percutaneous pedicle screw fixation for thoracolumbar fractures.Methods A prospective study was conducted in the 113 patients who would be subjected to percutaneous pedicle screw fixation for thoracolumbar fracture from January 2017 to December 2017.They were randomly assigned into an observation group (n =58) receiving intravenous drip of 15 mg/kg TXA 30 minutes preoperation or a control group (n =55) receiving intravenous drip of normal saline solution 30 minutes preoperation.The total blood loss and hidden blood loss 24 hours postoperation,D-dimer volume,incidences of deep vein thrombosis and other complications were recorded and compared between the 2 groups.Results There were 54 patients in the observation group and 50 patients in the control group for statistic analysis.The observation group had significantly less total blood loss (319.0 ± 140.5 mL) and hidden blood loss (242.0 ± 143.4 mL) 24 hours postoperation than the control group (418.7 ± 188.1 mL and 354.7 ± 181.9 mL,respectively) (P ＜ 0.05).There were no significant differences between the 2 groups in operation time or intraoperative blood loss (P ＞ 0.05).The volume of postoperative D-dimer was significantly higher than the preoperative value in both groups (P ＜ 0.05).No thromboembolic events occurred in either group.Conclusion Intravenous TXA may significantly reduce intraoperative hidden blood loss with no increased rik of thromboembolic events in percutaneous pedicle screw fixation for thoracolumbar fractures.
ABSTRACT
Clinical practice is the critical stage of training medical students in basic clinical quality.For the current major issues,such as lack of clinical case resources,lack of teaching conditions,and less chances of practice for students,cases library combined with medical human patient simulator is used in extern's teaching.Through this teaching,the students can touch numerous and comprehensive clinical cases,grasp clinical techniques proficiently,predominate diagnosis and treatment of common diseases in Orthopaedics efficiently by using medical human patient simulator.The effect of clinical practice teaching is improved greatly.The practice of related teaching means and methods provides a new way for the reform of the practice teaching.
ABSTRACT
This study was aimed to observe clinical efficacy of Bushen Huoxue Kaiqiao (BSHXKQ) treatment of diabetes-induced vascular mild cognitive impairment . A total of 30 cases of diabetes-induced vascular mild cognitive impairment were randomly divided into the treatment group ( 15 cases ) and the control group ( 15 cas-es). The treatment group received free-fried BSHXKQ prescription (Cistanche 10 g, Shichangpu 5 g, Sanqi 2 . 5 g ) for treatment 3 times a day , and in combination of 30 mg of nimodipine , 3 times a day . In the con-trol group , 30 mg of nimodipine was orally administrated 3 times a day . The treatment was continued for 6 months. Clinical Dementia Rating (CDR), Activity of Daily Living Scale (ADL), Montreal Cognitive Assessment Beijing Edition ( MoCA ) and TCM Syndrome Score were used in the evaluation before and after the treatment . The results showed that the rate of progress was in both groups after treatment . In the treatment group , the rate was 86 . 70%, and in the control group the rate was 33 . 33%. The total effective rate in the treatment group was superior to the control group ( P < 0 . 05 ) . There were statistical significances in the MoCa Scale , ADL Scale and TCM Syndrome Score before and after treatment in each group ( P < 0 . 05 ) . The treatment ef-fect in the treatment group was superior to the control group ( P < 0 . 05 ) . There was no statistical significance in the incidence of adverse events in both groups . It was concluded that the effect of BSHXKQ prescription in the treatment of diabetes-induced vascular mild cognitive impairment was superior to nimodipine in improving activities of daily living , cognitive function , degree of dementia and TCM syndrome score . There was no differ-ence in the incidence of adverse events compared with nimodipine .
ABSTRACT
@#Objective To explore effect of Axis internal fixation system while decompression and fusion for the treatment of timeworn atlantoaxial dislocation with incomplete spinal cord injury.Methods 29 cases of timeworn atlanto-axial dislocation with incomplete spinal cord injury underwent decompression fusion and Axis internal fixation with a 7～46 months (mean 20 months) flowing-up.ResultsAfter treatment, all patients got completed fusion, there was no deterioration of neurofunction, and rate of JOA scores increased was 78.6%.ConclusionAxis internal fixation system can provide immediately a rigid stability and maintain axial correction for the segment ahile decompression and fusion for the treatment of timeworn atlantoaxial deslocation with incomplete spinal cord injury.