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Objective:To analyze the efficacy of vertebroplasty combined with posterior decompression and internal fixation in the treatment of spinal metastases with neurological symptoms.Methods:This study was a retrospective analysis of 32 cases with neurological symptoms caused by spinal metastatic tumor in the Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University from June 2016 to January 2022. All 32 patients (20 males, 12 females) aged between 39 to 85 years were enrolled in this study, with a mean age of (64.8±11.9) years. Surgery time, bleeding volume, modified Tokuhashi score, spinal instability neoplastic score (SINS) were collected. The visual analogue score (VAS), Oswestry disability index (ODI), Karnofsky performance scale (KPS) and American spinal cord injury association (ASIA) score before surgery, 1 month after surgery, 3 months after surgery and 6 months after surgery were collected and analyzed. Measurement data with normal distribution were represented as mean±standard deviation( ± s), and the comparison before and after surgery was conducted using repeated-measures analysis of variance test. Measurement data with skewed distribution were represented as M( Q1, Q3). Results:All 32 patients were followed up for 6 months. The operation time was (209.6±49.0) min, and the blood loss was (462.9±298.3) mL. 14 patients(43.8%) were treated with blood transfusion. The modified Tokuhashi score was 8.09±2.89, and the SINS was 8.81±1.97. The VAS score before surgery, postoperative 1, 3, 6 months were 7.47±0.98, 3.87±0.87, 2.91±0.73 and 2.34±0.60, respectively. ODI score before surgery, postoperative 1, 3, 6 months were 79.13±9.50, 39.14±6.31, 34.43±6.42 and 31.08±4.80, respectively. KPS score before surgery, postoperative 1, 3, 6 months were 49.69±14.70, 64.68±15.02, 71.88±12.81 and 75.63±10.76, respectively. The ASIA grading at 6 months follow-up was improved compared to preoperative baseline. Postoperative complications occurred in 4 cases, including nerve root injury (1 case), bone cement leakage in paravertebral soft tissue (1cases), bone cement leakage in paravertebral vein(1case) and acute thoracic epidural hematoma (1case).Conclusion:Vertebroplasty combined with posterior decompression and internal fixation can effectively relieve pain, relieve the compression of spinal cord and nerve, recover nerve functions, and improve the quality of life of patients with spinal metastatic tumor.
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Objective:To analyze the effect of inter-spinal distraction fusion and fixation (ISDFF) combined with limited decompression on the treatment of lumbar spinal stenosis in elderly patients.Methods:A total of 32 elderly patients with lumbar spinal stenosis, aged from 80 to 87 years old (mean age: 82.0±2.0 years) including 10 males and 22 females, in the Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University from January 2016 to January 2020 were enrolled in this retrospective study. Clinical evaluation and imaging measurement were performed before operation, after operation, 6 months and 24 months after operation. SPSS software was used for statistical analysis. Measured data of normal distribution were expressed as means±standard deviation. One way analysis of variance was used for comparison between groups. Paired t-test was used to compare between preoperative and postoperative as well as between preoperative and 24 months′ follow-up. Results:All of the 32 patients had one or more common accompanying diseases, such as hypertension, diabetes, coronary heart disease, and so on. All patients were successfully completed the operation with a total of 32 segments. VAS score was decreased from (6.22±0.91) before operation to (1.94±0.76) at 24 months( t=16.52, P<0.001). ODI score was also demonstrated the similar trend, from (54.17±10.65) preoperatively to (19.91±4.20) at 24 months follow-up( t=15.89, P<0.001). JOA score was significantly increased from (11.69±3.36) before surgery to (23.44±1.66) at the last follow-up ( t=-19.90, P<0.001). In the change of imaging, the intervertebral angle was decreased from preoperation (9.12±4.65) to (6.77±2.70) at 24 months( t=3.53, P=0.001). The posterior disk height was increased from (0.68±0.19) cm to (0.76±0.19) cm at the last follow-up( t=-2.45, P=0.020). Conclusions:As a new type of minimally invasive internal fixator, the ISDFF combined with limited decompression can relieve the pain of elderly patients with lumbar spinal stenosis and improve the quality of life. It is suitable for the treatment of elderly patients with lumbar spinal stenosis.
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Objective:To analyze the clinical efficacy of inter-spinal distraction fusion and fixation and Posterior lumbar interbody fusion in the treatment of lumbar disc herniation with stenosis, and to evaluate the health economics of the two surgical methods.Methods:Retrospectivly analyzed the clinical data of 400 patients with lumbar disc herniation with stenosis, who were enrolled in Beijing Friendship Hospital, Capital Medical University from Jan. 2015 to Jan. 2019, including 190 male cases and 210 female cases, aged from 50 to 87 years old, with the average age of 67.97. All patients were divided into two groups according to different surgical methods. Among them, 200 patients used interspinous process fusion and distraction fixation (ISDFF group), the other 200 cases used posterior lumbar decompression and pedicle internal fixation (PLIF group). All patients completed the follow-up time of more than 1 year after operation. The basic information of patients′ age, gender, total number of days in hospital, intraoperative bleeding, operation time, surgical incision length and other basic information were observed. The Oswestry dysfunction index (ODI), the Japanese Orthopaedic Association Score (JOA) and the visual analog scale (VAS) were used to evaluate the relief of symptoms before and after the two groups of patients. Total medical expenses, anesthesia expenses, surgical expenses and other expenses were analysed. The software of SPSS 20.0 were conducted to analyze data.Results:The patients in the ISDFF group were (70.84±8.93) years old, and the PLIF group was (65.10±10.23) years old ( t=5.98, P=0.008). The operation time in the ISDFF group was (59.21±16.22) min, and the operation time in the PLIF group was (81.31±17.24) min( t=13.20, P<0.001). The bleeding volume of the ISDFF group was (33.24±11.31) mL, and the bleeding volume of the PLIF group was (67.30±17.61) mL ( t=23.02, P<0.001). The length of the surgical incision in the ISDFF group was (8.27±2.53) cm, and the length of the surgical incision in the PLIF group was (11.15±1.91) cm ( t=11.848, P<0.001). The total hospitalization time in the ISDFF group was (15.15±0.54) days, and the total hospitalization time in the PLIF group was (19.86±0.97) days( t=4.26, P<0.001). There was no significant difference in preoperative ODI, JOA and VAS between the two groups ( P>0.05). Symptoms of postoperative patients were significantly improved compared with preoperative. There were statistical differences in ODI, JOA and VAS between the two groups before and after operation ( P<0.05). However, ODI, JOA and VAS were no statistical difference between the two groups after operation. Complications occurred in 5 cases of the two groups of patients, including two cases of superficial infection in the PLIF group, two cases of dural tear in the PLIF group, one case of spinous process fracture in the ISDFF group. The total hospitalization fee for ISDFF was (57 450±8 670) (yuan), and the total hospitalization fee for PLIF was (75 770±1 640) (yuan), with statistical differences ( t=9.92, P<0.001). The cost of ISDFF operation was 1864±38.19 (yuan), and the cost of PLIF operation was 2352±41.39 (yuan) ( t=8.65, P<0.001). ISDFF antibacterial drug usage fee was 635.5±64.69 (yuan), PLIF antibacterial drug usage fee was 1449±307.1 (yuan) ( t=2.59, P<0.001). The one-time medical material cost during the ISDFF operation was (38 990±300) (yuan), and the one-time medical material cost during the PLIF operation was (52 110±150) (yuan) ( t=5.88, P<0.001). The excellent and good rate of ISDFF group was 92%, and that of PLIF group was 86%. In this study, the total cost of hospitalization was used as an indicator to measure the cost, and further cost-effectiveness evaluation was made. For every good patient, the cost of the ISDFF group was 62 450 yuan, and the cost of the PLIF group was 88, 100 yuan. Conclusions:ISDFF is beneficial to reduce the cost of medical insurance in China, which is in line with the direction of national reform to reduce medical expenditure. It is a surgical method worthy of wide promotion and has a good application prospect.
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Objective:To study the efficacy and safety of bone-filling mesh container plasty in the treatment of posterior wall fracture of vertebra caused by spinal metastases.Methods:This study is a retrospective analysis of 65 patients with pathological fractures of the vertebra caused by vertebral metastases treated with bone-filling mesh container plasty from January 2015 to December 2019. There were 21 males and 44 females, 70.3±10.8 (46-90) (years). According to primary tumor, there were 25 cases of lung cancer, 14 cases of breast cancer, 11 cases of digestive system cancer, 13 cases of urinary system cancer, 1 case of lymphoma and 1 case of ovarian cancer. In the segment of vertebral metastases, there were 2 cases of T 2 vertebra, 1 case of T 5 vertebra, 1 case of T 6 vertebra, 2 cases of T 8 vertebra, 1 case of T 9 vertebra, 5 cases of T 10 vertebra, 4 cases of T 11 vertebra, 15 cases of T 12 vertebra, 12 cases of L 1 vertebra, 8 cases of L 2 vertebra, 8 cases of L 3 vertebra, 4 cases of L 4 vertebra, and 2 cases of L 5 vertebra. According to the CT images of the patient's vertebra before operation, the area of the damaged posterior wall of the vertebra is measured as s, and the area of the posterior wall of the intact vertebra is measured as S. The ratio of posterior wall damage is calculated as R= s/ S, and the value of R represents the degree of damage to the posterior wall of the vertebra. According to the size of the R value, the patients were divided into four groups, typeⅠ( R≤25%, 21 cases), typeⅡ(25%< R≤50%, 22 cases), typeⅢ (50%< R≤75%, 14 cases), typeⅣ( R>75%, 8 cases). The visual analog scale (VAS), Oswestry disability index (ODI) and activity of daily living (ADL) before and 1 day after surgery, 1 month after surgery, and 3 months after surgery were analyzed and compared to evaluate the efficacy of bone-filling mesh container plasty. Pairwise comparisons were performed to verify whether there is a difference in efficacy, bone cement leakage and postoperative complications. Results:All 65 patients were followed up for 3-6 months, with an average of 3.8 months. The VAS scores before surgery, postoperative day 1, postoperative 1, 3 months were 7.32±0.99, 4.14±1.06, 4.11±0.97, and 4.34±1.11, respectively, with a statistically significant difference ( F=149.20, P<0.001). ODI of preoperative, postoperative day 1, postoperative 1, and 3 months were 69.45%±4.15%, 36.65%±3.72%, 36.84%± 3.38%, 37.78%±3.45%, respectively, with a statistically significant difference ( F=840.88, P<0.001). ADL score of preoperative, postoperative day 1, postoperative 1, and 3 months were 71.31±12.81, 79.85±9.14, 78.92±8.95, and 78.31±8.67, respectively, with a statistically significant difference ( F=149.20, P<0.001). There was no significant difference in VAS, ODI and ADL scores between types I and IV (all P>0.05), but with the increase of R value, the leakage rate of intraspinal bone cement would increase correspondingly. Eleven cases occurred bone cement leakage with the rate of 17%. The leakage rate of type I and II was 0, type III was 7.1% (1/14), and type IV was 37.5% (3/8). All patients did not have systemic complications such as allergies, shock, decreased oxygen saturation, etc., and there were no bleeding, infection, nerve root symptoms or cement insertion syndrome after surgery. Conclusion:Bone-filling mesh container plasty can significantly improve the pain symptoms of patients with spinal metastases and recovery functions. The degree of damage to the posterior vertebra has no effect on the efficacy of the surgery. As the degree of damage to the posterior wall of the vertebra increases, the risk of complications of bone cement leakage in the spinal canal will increase.
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PURPOSE@#Posttraumatic stress disorder (PTSD) is a significant global mental health concern, especially in the military. This study aims to estimate the efficacy of mindfulness meditation in the treatment of military-related PTSD, by synthesizing evidences from randomized controlled trials.@*METHODS@#Five electronic databases (Pubmed, EBSCO Medline, Embase, PsychINFO and Cochrane Library) were searched for randomized controlled trials focusing on the treatment effect of mindfulness meditation on military-related PTSD. The selection of eligible studies was based on identical inclusion and exclusion criteria. Information about study characteristics, participant characteristics, intervention details, PTSD outcomes, as well as potential adverse effects was extracted from the included studies. Risk of bias of all the included studies was critically assessed using the Cochrane Collaboration's tool. R Statistical software was performed for data analysis.@*RESULTS@#A total of 1902 records were initially identified and screened. After duplicates removal and title & abstract review, finally, 19 articles in English language with 1326 participants were included through strict inclusion and exclusion criteria. The results revealed that mindfulness meditation had a significantly larger effect on alleviating military-related PTSD symptoms compared with control conditions, such as treatment as usual, present-centered group therapy and PTSD health education (standardized mean difference (SMD) = -0.33; 95% CI [-0.45, -0.21]; p < 0.0001). Mindfulness interventions with different control conditions (active or non-active control, SMD = -0.33, 95% CI [-0.46, -0.19]; SMD = -0.49, 95% CI [-0.88, -0.10], respectively), formats of delivery (group-based or individual-based, SMD = -0.30, 95% CI [-0.42, -0.17], SMD = -0.49, 95% CI [-0.90, -0.08], respectively) and intervention durations (short-term or standard duration, SMD = -0.27, 95% CI [-0.46, -0.08], SMD = -0.40, 95% CI [-0.58, -0.21], respectively) were equally effective in improving military-related PTSD symptoms.@*CONCLUSION@#Findings from this meta-analysis consolidate the efficacy and feasibility of mindfulness meditation in the treatment of military-related PTSD. Further evidence with higher quality and more rigorous design is needed in the future.
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There has been a long history since human beings began to realize the existence of post-traumatic symptoms. Posttraumatic stress disorder (PTSD), a diagnostic category adopted in 1980 in the Diagnostic and Statistical Manual of Mental Disorders-Ⅲ, described typical clusters of psychiatric symptoms occurring after traumatic events. Abundant researches have helped deepen the understanding of PTSD in terms of epidemiological features, biological mechanisms, and treatment options. The prevalence of PTSD in general population ranged from 6.4% to 7.8% and was significantly higher among groups who underwent major public traumatic events. There has been a long way in the studies of animal models and genetic characteristics of PTSD. However, the high comorbidity with other stress-related psychiatric disorders and complexity in the pathogenesis of PTSD hindered the effort to find specific biological targets for PTSD. Neuroimage was widely used to elucidate the underlying neurophysiological mechanisms of PTSD. Functional MRI studies have showed that PTSD was linked to medial prefrontal cortex, anterior cingulate cortex and sub-cortical structures like amygdala and hippocampus, and to explore the functional connectivity among these brain areas which might reveal the possible neurobiological mechanism related to PTSD symptoms. For now, cognitive behavior therapy-based psychotherapy, including combination with adjunctive medication, showed evident treatment effects on PTSD. The emergence of more effective PTSD pharmacotherapies awaits novel biomarkers from further fundamental research. Several natural disasters and emergencies have inevitably increased the possibility of suffering from PTSD in the last two decades, making it critical to strengthen PTSD research in China. To boost PTSD study in China, the following suggestions might be helpful: (1) establishing a national psychological trauma recover project, and (2) exploring the mechanisms of PTSD with joint effort and strengthening the indigenized treatment of PTSD.
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Objective:To evaluate the clinical effect of interspinous process fusion (BacFuse) in the treatment of lumbar disc herniation (LDH) with rheumatoid arthritis (RA).Methods:A retrospective analysis of the clinical data of 50 patients with RA and LDH from May 2013 to June 2018 in department of orthopedics, Beijing Friendship Hospital, Capital Medical University was conducted. Among them, there were 9 males and 41 females, aged (66.60±4.23) years, with an age ranging from 54 to 84 years. According to different surgical methods, the patients were divided into posterior lumbar interbody fusion (PLIF) group ( n=26) and BacFuse group ( n=24). Operative time, intraoperative blood loss and operative complications of the two groups were observed. Oswestry disability index (ODI) and Japanese Orthopaedic Association (JOA) scores were used to evaluate the clinical effect at preoperative, 3 days of postoperative and the last follow-up. The measurement data were expressed as mean±standard deviation( Mean± SD), comparison between groups used t test and the count data were expressed as percentage(%), the chi-square test was used for comparison between the two groups. The clinical effect of the two groups were compared by repeated analysis of variance. Results:In the PLIF group, the operation time and bleeding volume were (174.62±55.59) min, (309.62±30.26) mL, respectively. In the BacFuse group, the operation time and bleeding volume were (71.25±12.96) min, (57.92±9.32) mL, respectively. The differences between the two groups were statistically significant ( P<0.05). The operative complications in the PLIF group (8 cases) was significantly higher than that in the BacFuse group (2 cases) , the difference between the two groups was statistically significant ( χ2 = 3.926, P=0.048). There were significant differences between every two scores among the preoperative, 3 days of postoperative and last follow-up in ODI of the PLIF group( F=760.231, P<0.001). The preoperative, 3 days of postoperative and last follow-up ODI scores of the BacFuse group were significant differences between every two scores ( F= 952.525, P<0.001). There were no significant differences in ODI scores between the two groups [( t=-1.13, P=0.263), ( t=0.706, P=0.483), ( t=0.389, P=0.699)]. There were significant differences between every two scores among the preoperative, 3 days of postoperative and last follow-up in JOA of the PLIF group( F=406.012, P<0.001). The preoperative, 3 days of postoperative and last follow-up in JOA scores of the BacFuse group were significant difference between every two scores ( F=457.760, P<0.001). There were no significant differences in JOA scores between the two groups [( t=0.825, P=0.414), ( t=1.909, P=0.062), ( t=1.086, P=0.283). Conclusions:Compared with PLIF, BacFuse has a similar clinical effect in the treatment of LDH with RA, but BacFuse is less invasive and has fewer postoperative complications. BacFuse is an effective minimally surgical method for the treatment of LDH with RA.
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Objective:To compare the clinical outcomes of percutaneous vertebroplasty (PVP) and the Vesselplasty for kümmell′s disease.Methods:A retrospective case-control study was used.The clinical data of 62 patients with kümmell′s disease were selected in Beijing Friendship Hospital, Capital Medical University, from January 2017 to January 2019. There were 19 males and 43 females, aged (70.94±7.69) years, with range from 60 to 85 years. The patients were divided into two groups according to different operation methods. The 36 patients treated by PVP and 26 patients treated by Vesselplasty were followed up at least one year after operation. The follow-up time was (17.55±4.22) months. The operation time, incidence of cement leakage, preoperative and postoperative Cobb′s angle, visual analogue score (VAS) 1 week and 1 year after operation were observed. The measurement data were expressed as mean±standard deviation ( Mean± SD), independent sample t-test was used for comparison between groups. The count data were expressed as percentage (%), chi-square test was used for comparison between groups. Results:All the operation was successfully completed. No serious complications such as paraplegia, bone cement allergy, pulmonary embolism were occurred. The operation time was no significant difference between the two groups ( P< 0.05). The incidence of cement leakag was 41.67% (15/36) in PVP group and 11.54% (3/26) in Vesselplasty group. The latter was significantly lower than the former, with statistically significant differences between the two groups ( P< 0.05). In PVP group, the Cobb′s angles of preoperation, postoperation 1 year and difference were (26.23 ± 5.62)°, (17.46 ± 3.01)° and (8.78 ± 4.62)°, respectively, in Vesselplasty group, they were (28.74 ± 6.68)°, (16.68 ± 2.79)° and (12.07 ± 5.72)°, respectively. Cobb′s angle of the two groups was significantly improved after operation. In the comparison between the groups, the improvement of the Cobb′s angle in the Vesseplasty group was better than that of the PVP group, and the difference was statistically significant ( P< 0.05). The VAS score in PVP group was (8.42±1.03) scores in preoperation, (3.06±1.01) scores in 1 week, (0.81±0.75) scores in 1 year. The VAS score in Vesselplasty group was (8.35±1.02) scores in preoperation, (2.88±1.11) scores in 1 week and (1.04±0.87) scores in 1 year. Compared with pre-operation, the VAS scores of the two groups decreased significantly at 1 week and 1 year after operation, and the difference was statistically significant ( P<0.05). There was no significant difference in VAS between groups 1 week after operation and 1 year after operation ( P>0.05). Conclusion:Vesselplasty can effectively control the flow and distribution of bone cement in the vertebral body, effectively reduce the leakage of bone cement, and better correct kyphosis.
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Objective:To investigate the effect of ultrasonic debridement machine for postoperative cleaning of perianal abscess.Methods:77 patients with perianal abscess were enrolled in this study.They were divided into control group (38 cases) and observation group (39 cases) by random sampling.The control group was implemented routine treatment post operation and the observation group was implemented routine dressing combined with ultrasonic cleaning machine to clean the crissum.And the visual analogue scale (VAS) was adopted to analyze the pain level of postoperative wound.And the postoperative clearance rate of bacteria, wound healing time, controlled time of infection and cleaning effect of wound between two groups were compared.Results:The VAS score of the observation group on the 1st, 3rd, 5th and 9th day after operation were significantly lower than those of control group (t=8.031, ■on wound of observation group was significantly higher than that of control group while the length stay in hospital of■healing time and controlled time of infection of observation group were significantly lower than those of control group■machine to clean wounds after perianal abscess surgery can effectively remove bacteria of wound, and improve cleaning effect, alleviate pain level of wound, and promote the rapid repair of wounds.
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Objective@#To compare the clinical outcomes of unilateral extreme extrapedicular puncture versus bilateral transpedicular puncture in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture.@*Methods@#A prospective cohort study was performed. Ninety-seven patients of osteoporotic vertebral compression fractures treated were selected from January 2016 to January 2018 in Beijing Friendship Hospital, Capital Medical University. There were 36 males and 61 females, aged (72.19±7.41) years, with an age range of 60-80 years. All the patients underwent PVP with different puncture methods were divided into unilateral puncture group(n=52) and bilateral puncture group(n=45). PVP was performed in the unilateral extreme extrapedicular puncture group by unilateral puncture of the pedicle, and PVP was performed by bilateral puncture of the pedicle in the bilateral transpedicular puncture group. All patients completed at least one year of follow-up after operation. The operation time, fluoroscopy times, cement volume, incidence of cement leakage, visual analogue score (VAS) of 1 week and 1 year after operation were observed. The measurement data were expressed as mean±standard deviation (Mean±SD), count data were expressed as percentage, the independent sample t test and the χ2 test were used for comparison between groups, and the paired t test was used for comparison within the group.@*Results@#The operation was successfully completed in both groups. No serious complications such as paraplegia, bone cement allergy, pulmonary embolism were occurred. In the unilateral puncture group, the operation time were (21.90±3.16) min, the fluoroscopy times were (15.46±2.86) times, the cement volume were (3.47±0.41) ml and the incidence of cement leakage was 44.23% (23/52), in the bilateral puncture group, the operation time were (31.64±6.90) min, the fluoroscopy times were (23.31±2.39) times, the cement volume were (4.66±0.61) ml and the incidence of cement leakage was 68.89% (31/45). The operation time, fluoroscopy times, cement volume and incidence of cement leakage of unilateral puncture group were significantly less than those of bilateral puncture group. The difference was statistically significant (P< 0.05). The VAS score in unilateral puncture group was (8.18±0.77) scores in preoperation, (3.39±0.69) scores in 1 week, (1.07±0.90) scores in 1 year. The VAS score in bilateral puncture group was (7.93±0.92) scores in preoperation, (3.14±0.83) scores in 1 week and (0.90±0.82) scores in 1 year. Compared with pre-operation, the VAS scores of the two groups decreased significantly at 1 week and 1 year after operation, and the difference was statistically significant (P<0.05). However, there was no significant difference in VAS between groups at 1 week after operation and 1 year after operation (P>0.05).@*Conclusions@#Compared with bilateral transpedicular puncture, PVP through unilateral extrapedicular puncture can achieve the same clinical effect. However, the latter can significantly reduce the operation time, the cement volume, fluoroscopy times and the incidence of cement leakage.
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Objective To compare the clinical outcomes of unilateral extreme extrapedicular puncture versus bilateral transpedicular puncture in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture.Methods A prospective cohort study was performed.Ninety-seven patients of osteoporotic vertebral compression fractures treated were selected from January 2016 to January 2018 in Beijing Friendship Hospital,Capital Medical University.There were 36 males and 61 females,aged (72.19 ±7.41) years,with an age range of 60-80 years.All the patients underwent PVP with different puncture methods were divided into unilateral puncture group(n =52) and bilateral puncture group(n =45).PVP was performed in the unilateral extreme extrapedicular puncture group by unilateral puncture of the pedicle,and PVP was performed by bilateral puncture of the pedicle in the bilateral transpedicular puncture group.All patients completed at least one year of follow-up after operation.The operation time,fluoroscopy times,cement volume,incidence of cement leakage,visual analogue score (VAS) of 1 week and 1 year after operation were observed.The measurement data were expressed as mean ± standard deviation (Mean ± SD),count data were expressed as percentage,the independent sample t test and the x2 test were used for comparison between groups,and the paired t test was used for comparison within the group.Results The operation was successfully completed in both groups.No serious complications such as paraplegia,bone cement allergy,pulmonary embolism were occurred.In the unilateral puncture group,the operation time were (21.90 ± 3.16) min,the fluoroscopy times were (15.46 ± 2.86) times,the cement volume were (3.47 ± 0.41) ml and the incidence of cement leakage was 44.23％ (23/52),in the bilateral puncture group,the operation time were (31.64±6.90) min,the fluoroscopy times were (23.31 ± 2.39) times,the cement volume were (4.66 ± 0.61) ml and the incidence of cement leakage was 68.89％ (31/45).The operation time,fluoroscopy times,cement volume and incidence of cement leakage of unilateral puncture group were significantly less than those of bilateral puncture group.The difference was statistically significant (P ＜ 0.05).The VAS score in unilateral puncture group was (8.18 ± 0.77) scores in preoperation,(3.39 ± 0.69) scores in 1 week,(1.07 ± 0.90) scores in 1 year.The VAS score in bilateral puncture group was (7.93 ± 0.92) scores in preoperation,(3.14 ±0.83) scores in 1 week and (0.90 ±0.82) scores in 1 year.Compared with pre-operation,the VAS scores of the two groups decreased significantly at 1 week and 1 year after operation,and the difference was statistically significant (P ＜ 0.05).However,there was no significant difference in VAS between groups at 1 week after operation and 1 year after operation (P ＞ 0.05).Conclusions Compared with bilateral transpedicular puncture,PVP through unilateral extrapedicular puncture can achieve the same clinical effect.However,the latter can significantly reduce the operation time,the cement volume,fluoroscopy times and the incidence of cement leakage.
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Objective To summarize the experience of anterolateral percutaneous vertebroplasty (PVP) in the treatment of cervical metastases in advanced lung cancer,and to evaluate its therapeutic effect on patients with cervical metastases in advanced lung cancer.Methods A total of 27 patients with advanced cervical spine metastases were enrolled from July 2009 to September 2018 in Department of Orthopaedics,Beijing Friendship Hospital,Capital Medical University.A retrospective analysis was performed on 20 patients who underwent PVP and had complete follow-up data.There were 12 males and 8 females,aged (59.15±7.55) years.A total of 32 cervical metastases were performed.Bone cement leakage was observed by X-ray and CT after operation,and complications were recorded during and after operation.Follow-up visits were made by outpatient or telephone until the 3rd month after the operation.By comparing visual analogue scale (VAS),analgesic use score,cervical dysfunction index (NDI) and KPS before and after operation,the improvement of the quality of life of patients after operation was comprehensively evaluated.The measurement data were expressed as (Mean ± SD).The paired t test was used to test the normal distribution of the paired difference before and after the operation,and the paired rank sum test was used to test the difference before and after the operation which did not conform to the normal distribution.Results The preoperative Tokuhashi correction score was (7.15 ± 2.87) score in 20 patients and the Tomita score was (7.55 ± 2.21) score.The single-segment cervical vertebrae cement injection volume was (1.17 ± 0.25) ml.The postoperative cement leakage rate was 53.13％ (17/32),but no serious complications.VAS before surgery and 3 months after surgery [preoperative (8.30 ± 1.08) score,postoperative (3.60 ± 1.67) score,P =0.000)],analgesic use score [preoperative (3.35 ± 0.59) score,postoperative (1.70 ± 0.80) score,P =0.000],cervical dysfunction index [preoperative (63.10 ± 7.94) score,postoperative (42.55 ± 15.69) score,P =0.000)] and KPS [Preoperative (54.50 ± 6.86) score,postoperative (61.67 ± 12.95) score,P =0.011] were significantly improved,and the difference was statistically significant.Conclusion PVP via anterolateral approach is effective in the treatment of advanced cervical metastases of lung cancer,and can effectively improve the quality of life of patients with advanced cervical metastases,but the surgical leakage rate is high and needs attention.
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Objective@#To investigate the protective effect and potential mechanism of tanshinol borneol ester (TBE) on homocysteine(Hcy) induced rat bone marrow mesenchymal stem cells (BMSCs) damage.@*Methods@#BMSCs were isolated and cultured in vitro by density gradient centrifugation and adherent culture method. BMSCs were divided into the control (normal isolation and culture), TBE-1(10 μmol/L TBE-1 solution with 100 μl), TBE-2 (10 μmol/L TBE-2 solution with 100 μl), Hcy (0.5 mmol/L Hcy solution with 100 μl), Hcy + TBE-1(0.5 mmol/L Hcy solution with 100 μl, and 10 μmol/L TBE-1 solution with 100 μl), Hcy + TBE-2 (0.5 mmol/L Hcy solution with 100 μl, and 10 μmol/L TBE-2 solution with 100 μl), Hcy+ TBE-1+ inhibitor group(0.5 mmol/L Hcy solution with 100 μl, 10 μmol/L TBE-1 solution with 100 μl, and 25 μmol/L LY294002(specific blocker of phosphatidylinositol 3 kinase) solution with 100 μl), Hcy+ TBE-2+ inhibitor group(0.5 mmol/L Hcy solution with 100 μl, 10 μmol/L TBE-2 solution with 100 μl, and 25 μmol/L LY294002 solution with 100 μl). Cell proliferation activity was detected by MTT assay. The T-SOD activity and malonaldehyde level of cells were measured by anthineoxidase method and TBA method, respectively, to evaluate cell oxidative and antioxidative activities. The ultrastructure of cells was observed under transmission electron microscope. The expression level of PKB and NF-κB of cells in various groups were detected with the immunocytochemical method.@*Results@#(1)Cell proliferation activity in TBE-1 group and TBE-2 group was significantly increased compared with the control group (both P<0.01), and was similar between TBE-1 group and TBE-2 groups after 1, 12, 24 and 48 hours treatment.(2)The T-SOD activity in TBE-1 group and TBE-2 group was significantly higher than in control group (both P<0.01), while it was significantly lower in Hcy group, Hcy+ TBE-1 group, and Hcy+ TBE-2 group than in control group(all P<0.01), and was similar between control group, Hcy+ TBE-1+ inhibitor group, and Hcy+ TBE-2+ inhibitor group(all P>0.05). The T-SOD activity was higher in Hcy+ TBE-1 group and Hcy+ TBE-2 group than in Hcy group(both P<0.01), and was higher in Hcy+ TBE-1+ inhibitor group than in Hcy+ TBE-1 group(P<0.05) and was higher in Hcy+ TBE-2+ inhibitor group than in Hcy+ TBE-2 group(P<0.05). The malonaldehyde level was lower in TBE-1 group and TBE-2 group than in control group(both P<0.01), was higher in Hcy group, Hcy+ TBE-1 group, Hcy+ TBE-2 group, Hcy+ TBE-1+ inhibitor group, and Hcy+ TBE-2+ inhibitor group than in control group(all P<0.01), was lower in Hcy+ TBE-1 group and Hcy+ TBE-2 group than in Hcy group(both P<0.01), was higher in Hcy+ TBE-1+ inhibitor group than in Hcy+ TBE-1 group(P<0.05), was higher in Hcy+ TBE-2+ inhibitor group than in Hcy+ TBE-2 group(P<0.05). (3)Under electron microscope, BMSCs showed profound swelling, senescence and apoptosis of cells increased significantly in Hcy group, Hcy+ TBE-1+ inhibitor group, and Hcy+ TBE-2+ inhibitor group when compared with control group. BMSCs in the TBE-1 and TBE-2 groups presented with abundant rough endoplasmic reticulum, and very active cell metabolism signs. Compared with Hcy group, BMSCs edema, the number of aging and apoptotic cells, and cell injury severity were significantly less in TBE-1+ Hcy group and TBE-2+ Hcy. (4)The PKB level was higher in TBE-1 group and TBE-2 group than in control group(both P<0.01), was lower in Hcy group, Hcy+ TBE-2 group, Hcy+ TBE-1+ inhibitor group, and Hcy+ TBE-2+ inhibitor group than in control group(all P<0.01), was similar between control group and Hcy+ TBE-1 group(P>0.05), was higher in Hcy+ TBE-1 group and Hcy+ TBE-2 group than in Hcy group(both P<0.05), was lower in Hcy+ TBE-1+ inhibitor group than in Hcy+ TBE-1 group(P<0.05), and was lower in Hcy+ TBE-2+ inhibitor group than in Hcy+ TBE-2 group(P<0.05). The NF-κB level was higher in TBE-1 group and TBE-2 group than in control group(both P<0.01), was lower in Hcy group, Hcy+ TBE-1 group, Hcy+ TBE-2 group, Hcy+ TBE-1+ inhibitor group, and Hcy+ TBE-2+ inhibitor group than in control group(P<0.01 or 0.05), was higher in Hcy+ TBE-1 group and Hcy+ TBE-2 group than in Hcy group(both P<0.05), was lower in Hcy+ TBE-1+ inhibitor group than in Hcy+ TBE-1 group(P<0.05) and was lower in Hcy+ TBE-2+ inhibitor group than in Hcy+ TBE-2 group(P<0.05).@*Conclusion@#Tanshinol borneol ester can promote the proliferation of BMSC, and attenuate the homocysteine induced rat BMSCs damage possibly through activation of phosphatidylinositol 3 kinase/PKB signal transduction and its downstream signal pathway protein NF-κB.
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Objective To study the clinical effect of the BacFuse for the lumbar disc herniation(LDH) and to discuss the affect for symptom of patients and structure of spine.Methods Collected the patients suffered from LDH retrospectively who had been implanted the BacFuse.There were 25 patients (29 surgical levels) included in the study.The clinical and X-ray assessment have been done on preoperation,postoperation,3 month,6 month and 12 month.Clinical index used visual analogue scale (VAS) score,oswestry disability index (ODI) score and Japanese Orthopaedic Association (JOA) score assessed clinical symptom and physical function.The intervertebral angle,posterior disk height and foraminal height were measured in X-ray.The patients were taken CT at preoperation and postoperation.The area and distance of herniated disc were measured in CT scan.Results In the aspect of clinical effect,25 cases were finished operation successly.The VAS score decreased from (6.61±1.29) points on preoperation to (2.78±1.00) points on the last follow-up,the ODI score decreased from (31.9±8.3) points to (15.9±6.4) points,the JOA score increased from (9.6± 3.0) points to (18.8± 3.2) points.In the aspect of spine structure,the intervertebral angle decreased from 10.1°±5.4° on preoperation to 8.4°±4.9° on the last follow-up,the posterior disk height increased from (0.65±0.29) cm on preoperation to (0.78±0.27) cm on the last follow-up and the foraminal height increased from (2.01±0.35) cm on preoperation to (2.16±0.37)cm.There was significant difference on posterior disk height and foraminal height between preoperation and postoperation,while the posterior disk height lost (0.07±0.12) cm (9.3％) and foraminal height lost (0.06±0.19) cm (2.7％).The CT showed that area of herniated disc decreased from (4.10±0.78) mm to (3.72±0.66) mm (9.3％) and distance of herniated disc decreased from (96.4±37.8) mm2 to (83.8±31.1) mm2 (7.4％).Conclusion BacFuse can relieve symptom and affect the biomechanics of the spine,makes the herniated disc retract partially,playing a Internal Retractor role in spine,and it is a new effective therapy for LDH.
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<p><b>BACKGROUND</b>The cross-section of thoracolumbar vertebral body is kidney-shaped with depressed posterior boundary. The anterior wall of the vertebral canal is separated from the posterior wall of the vertebral body on the lateral X-ray image. This study was designed to determine the sagittal distance between the anterior border of the vertebral canal and the posterior border of the vertebral body (DBCV) and to analyze the potential role of DBCV in the estimation of cement leakage during percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP).</p><p><b>METHODS</b>We retrospectively recruited 233 patients who had osteoporotic vertebral compression fractures and were treated with PVP or PKP. Computed tomography images of T11-L2 normal vertebrae were measured to obtain DBCV. The distance from cement to the posterior wall of the vertebral body (DCPW) of thoracolumbar vertebrae was measured from C-arm images. The selected vertebrae were divided into two groups according to DCPW, with the fracture levels, fracture grades and leakage rates of the two groups compared. A relative operating characteristic (ROC) curve was applied to determine whether the DCPW difference can be used to estimate the degree of cement leakage. The data were processed by statistical software SPSS version 21.0 using independent sample t-test and Chi-square tests.</p><p><b>RESULTS</b>The maximum DBCV was 6.40 mm and the average DBCV was 3.74 ± 0.95 mm. DBCV appeared to be longer in males than in females, but the difference was not statistically significant. The average DCPW of type-B leakage vertebrae (2.59 ± 1.20 mm) was shorter than that of other vertebrae (7.83 ± 2.38 mm, P < 0.001). The leakage rate of group DCPW ≤6.40 mm was lower than that of group DCPW >6.40 mm for type-C and type-S, but much higher for type-B. ROC curve revealed that DCPW only has a predictive value for type-B leakage (area under the curve: 0.98, 95% confidence interval: 0.95-0.99, P < 0.001), and when the cut-off value was 4.05 mm, the diagnostic sensitivity and the specificity were 94.87% and 93.02%, respectively.</p><p><b>CONCLUSIONS</b>Depression of the thoracolumbar posterior vertebral body may be informative for the estimation of cement location on C-arm images. To reduce type-B leakage, DCPW should be made longer than DBCV on C-arm images for safety during PVP or PKP.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Fractures, Compression , General Surgery , Kyphoplasty , Methods , Osteoporotic Fractures , General Surgery , Retrospective Studies , Spinal Fractures , General Surgery , Vertebroplasty , MethodsABSTRACT
Objective To evaluate the feasibility and therapeutic effect of kyphoplasty in treating severe osteoporotic vertebral compressive fractures. Methods Thirty-five patients (48 vertebral bodies) with severe osteoporotic compressive fractures were included. There were 33 females and 2 males with the mean age of 74.2 years. The average compressive rate of the affected vertebral bodies was 77.0%. The thoracolumbar vertebrae were treated with kyphoplasties. Percutaneous puncture direction was adjusted according to compressive rate and shape of the vertebral bodies. The inflatable bone tamp was inserted into the fractured vertebral body. The balloon was inflated with low pressure and dilate-relieve-dilate method was applied. The balloon was deflated and withdrawn, leaving a cavity within the vertebral body, which then fulfilled with visualized bone cement. Preoperative and postoperative symptom level, complications and radiographic findings were recorded. Results All 35 patients tolerated procedure well. The mean heights of the anterior, mid and posterior vertebral body had improved from (0.8±0.1) cm, (0.8±0.2) cm, (2.1 ±0.8) cm preoperatively to (1.2±0.3) cm, (1.3±0.2) cm, (2.3±1.0) cm respectively after operation (P ＜0.05). There was significance difference between preoperative and postoperative heights of the anterior and mid vertebral body. The mean kyphosis was improved from 28.2°±5.2° before operation to 19.1°±4.9° after operation. Conclusion Kyphoplasty is feasible and effective for severe osteoporotic vertebral compressive fractures.
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<p><b>OBJECTIVE</b>To compare the reactogenicity and serology between influenza subunit vaccine and split vaccine.</p><p><b>METHODS</b>A randomized, double-blind study was carried out among children (age 6 - 12 years) in order to compare the safety and immunogenicity of an influenza inactivated subunit vaccine (Agrippal, Chiron Vaccines) with that of a split vaccine (Flurix, GSK).</p><p><b>RESULTS</b>A total of 499 subjects were vaccinated and included in the safety analysis. A total of 249 subjects received Agrippal and 250 received Flurix. All subjects were kept under medical observation for 30 minutes in order to check the evidence of having any immediate local and systemic reaction. Daily observation records were collected during the 3-day follow-up after vaccination. 6.4% of the cases with fever >or= 37.5 degrees C was reported in the Flurix group, but 2.4% in Agrippal group which was significantly less than the former group (P > 0.05). Blood samples (the D0 pre- and D23 post-vaccination sera) were collected from 224 of Agrippal group and 223 of Flurix group and analysed by the haemagglutination inhibition (HI) assay. Agrippal and Flurix induced similar seroprotection (HI titer >or= 1:40, H1N1 99.6% vs 100.0%; H3N2 99.1% vs 99.1%) and seroconversion (4-fold increase, 95.1% vs 97.8%; H3N2 74.5% vs 79.8%) rates and geometric mean titer (GMT) increase (16.0 vs 21.0; 5.4 vs 6.4) against the two A subtypes. A similar seroprotection rate (94.2% vs 96.4%) and GMT increase (21.2 vs 18.2) against the influenza B strain were also noticed in both vaccines. No significant difference was found in the results of immunological assay between the two vaccines (P < 0.05). A lower seroconversion rate against B strain was observed in Agrippal group than in Flurix group (91.1% vs 97.3%).</p><p><b>CONCLUSION</b>In terms of safety, both vaccines were generally well tolerated. The fever reaction was less frequently seen in the Agrippal group. Both vaccines induced an effective immune response in the vaccines.</p>