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Objective:To investigate the anatomical safety and feasibility ofposterior occipitocervical fixation with atlan-tooccipital-clivus screw.Methods:Data of 60 patients who treated in the spinal department of our hospital with upper cervical computed tomographic scans from February 2017 to November 2019 were retrospectively collected. Occipitocervical infection, injury, tumor and deformity were excluded. The Mimics software was used to reconstruct the occiput, atlas and measure the anatomical parameters, including the height and width of the anterior edge of the clivus, the height and width of the middle part of the clivus, the thinnest distance of the soft tissue in front of the clivus, the anteroposterior diameter, transverse diameter, the angle of inside tilting in coronary plane of the occipital condyle, the distance from the hypoglossal canal to the atlantooccipital articular surface, the anteroposterior diameter and transverse diameter of the superior joint of atlas, the height of the lateral mass, and the height and transverse diameter of the inferior articular process of the superior atlas joint. The three-dimensional digital modeling was performed and the screw diameter of 3.5mm was simulated. 3-Matic software were used to measure the screw placement parameters, including the inside tilting angle in coronary plane of screw, and the angle of upper tilting in sagittal plane and length of screw. The atlanto-occipital junction was exposed at the rear of 8 cadavers. According to the above parameters, the titanium alloy screws with a diameter of 3.5 mm were transferred from the inferior articular process and posterior arch of the atlas to the clivus through the atlantooccipital. Finally, the screw path was cut along the nail path with a pendulum saw, and the track of the screw was observed to confirm the safety and effectiveness of the screw.Results:The leading edge height and width of male clivus was 16.8±2.5 mm and 20.1±3.1 mm. The middle part of the clivus was 9.7±2.3 mm and 22.4±3.7 mm. The thinnest soft tissue in front of the clivus was 5.8±1.48 mm. The anteroposterior diameter of the occipital condyle was 19.1±1.9 mm, the transverse diameter was 12.6±2.0 mm, the inside tilting angle was 33.7°±4.5°, and the vertical distance from the lowest point of the neural tube to the articular surface of the occipital condyle was 9.6±1.1 mm. The height of the lateral mass of atlas was 12.9±2.4 mm, the anteroposterior diameter of the upper joint of atlas was 21.7±1.9 mm, and the transverse diameter was 11.7±1.4 mm. The width of the inferior facet was 14.9±1.4 mm and the height of the inferior facet was 5.7±0.85 mm. The distance from the screw entry point to the vertical line of the lateral mass migration midpoint was 2.5±0.6 mm; The distance from the screw entry point to the horizontal line of the midpoint was 2.3±0.7 mm.The inside titling angle of screw was 18.4°±1.6°, the upper tilting angle was 55.6°±3.1°, the length of the screw track was 53.0±2.8 mm, the adjustment range of upper tilting angle was 15.0±2.8 mm, the adjustment range of inside tilting angle was 10.4±2.4 mm. The anatomical parameters of females were slightly smaller than those of males, and the difference was statistically significant, but there was no significant difference between left and right parameters. The screws of 8 specimens could be inserted safely and effectively.Conclusion:Atlan-tooccipital-clivus screw can be implanted without damaging the nerve and vascular structure, and it can be used as a choice for occipitocervical fixation.
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Objective:To provide a theoretical basis for the clinical application of the posterior route through atlas occipital articular slope screw internal fixation system through the biomechanical study.Methods:Eight cadavers of healthy adults aged 35-60 years and 155-180 cm in height were selected. The specimens with complete anatomical structure and without surgical operation were established as normal models. The model of occipito-atlantoaxial complex was established by breaking the articular capsule, ligament and other connecting structures and cutting the dentate process. The device was established as an internal fixation model through the specimen of atlantooccipital joint slope screw internal fixation system. Given normal model and internal fixation of 1.5 N·m in the moment of flexion, lateral bending and axial rotation and to measure the specimen C 0-C 1 and C 0-C 2 segment of the range (range of motion, ROM), comparative analysis of pillow neck area within the normal model and fixed model changes the range of movement, after the evaluation through the slope between atlas and the occipital screw internal fixation system of mechanical properties. Results:In the normal model, the flexion, flexion and extension, lateral bend and axial rotation ranges of C 0-C 1 segments were 23.85°±2.43°, 4.74°±0.55°, 5.77°±0.75°, respectively; the corresponding activity ranges of C 0-C 2 segments were 30.66°±3.05°, 9.09°±1.37°, 70.97°±9.48°, respectively; in the internal fixation model, the flexion and extension, lateral bend and axial rotation ranges of C 0-C 1 segments were 0.71°±0.24°, 0.24°±0.06°, 0.34°±0.09°, respectively. The corresponding activity range of C 0-C 2 segment was 3.09°±0.82°, 0.74°±0.07°, 1.22°±0.10°, respectively. Compared with the normal model, the range of activity of the internal fixation model in all directions was significantly reduced (<3°), and the reduction ratio of activity was more than 90%. Conclusion:The posterior route through pillow slope screw internal fixation system can effectively reduce the range of motion of the occipital neck in flexion, extension, lateral bending and rotation, and has safe and reliable biomechanical stability.
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Objective:To explore the difference in properties of anterior occipital condyle plate screws compared with common anterior occipitalcervical fusion internal fixation.Methods:A 28-year-old healthy adult male volunteer's CT data of the occiput and neck was selected to establish finite element models：including the normal model，simple artificial vertebral fixation model（special-shaped titanium cage+clival screws），anterior occipital condyle plate and screw fixation model，and clival plate and screw fixation model，then a 50 N gravity and a torque of 1.5 N m were exerted upon the upper surface of the occipital bone to make the model produce flexion and extension，lateral bending and rotation. The motion range，internal fixation stress distribution and occipital bone stress distribution of each model under varying conditions were compared.Results:Under the conditions of flexion，extension，lateral bending and rotation，the range of motion of the normal model was 18.65°，15.35°，9.82° and 34.68°，respectively；that of the simple artificial vertebral fixation model was 3.20°，3.63°，2.94° and 3.92°，respectively；that of the clival plate and screw fixation model was 0.40°，0.50°，0.35° and 0.89°，respectively；that of the anterior occipital condylar plate and screw fixation model was 0.27°，0.33°，0.13° and 0.30°，respectively. Compared with the simple artificial vertebral fixation model，the range of motion of the clival plate and screw fixation model decreased by 87.5%，86.2%，88.1% and 77.3% in flexion，extension，lateral bending and rotation. The range of motion of the anterior occipital condylar plate and screw fixation model decreased by 91.5%，90.1%，95.6% and 92.3%，respectively. Under the conditions of flexion and extension，lateral bending and rotation，the stress peak of the simple artificial vertebral fixation model was 52.3 MPa，51.9 MPa，52.6 MPa，respectively；that of the clival plate and screw fixation was 100.1 MPa，158.1 MPa，170.6 MPa，respectively；that of the anterior occipital condylar plate and screw fixation was 114.2 MPa，62.9 MPa，132.9 MPa，respectively. Under the condition of flexion and extension，lateral bending and rotation，the stress peak of the occipital bone in the simple artificial vertebral body internal fixation model was 52.9 MPa，50.9 MPa and 62.3 MPa，respectively；that of the clival plate and screw fixation model was 19.7 MPa，55.9 MPa and 38.3 MPa，respectively；that of the anterior occipital condylar plate and screw fixation model was 37.8 MPa，15.0 MPa and 16.3 MPa，respectively. The stress in bone near the hypoglossal canal was close to 0 MPa，much smaller than the stress peak in occipital bone.Conclusion:Anterior occipital condylar plate and screw fixation in front of the special-shaped titanium cage can improve the stability of occipitocervical fusion with little effect on the occipital bone and hypoglossal canal or without obvious stress concentration，and hence is a safe and reliable anterior fixation method for upper cervical spine instability.
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Objective:To investigate the safety of posterior atlantoaxial transarticular screw combined with atlas pedicle screw fixation in Chinese.Methods:CT data of upper cervical spine in 48 patients were collected from Ningbo No.6 Hospital, including 26 males and 22 females aged 26-58 years [(37.3±13.5)years]. All CT data was transformed into 3D dimensional model and inserted with virtual screws by Mimics 19.0. Firstly, the vertical plane P 1 and the horizontal plane P 2 of the atlas were built in those atlantoaxial models, secondly the atlantoaxial transarticular screw S 0 was inserted by Margel method, and it's insertion point was located at 3 mm lateral and 2 mm cephalad in the C 2 inferior articular process. Finally, four atlas pedicle screws were inserted at the midline of atlas lateral mass. The four screws are inserted as follows. S 1: the screw was tangent to the lateral side of the S 0 or the medial of the atlas pedicle. S 2: the screw was tangent to the lateral wall of the atlas pedicle. S 3: the screw was tangent to the upper wall of the atlas pedicle. S 4: the screw was tangent to the inferior wall of the atlas pedicle. The angles between S 1, S 2 and P 1 as the camber angle, and the angle between S 3, S 4 and P 2 as the gantry angle were measured. Then the safety range of camber angle and gantry angle were calculated, and the screw length of S 1, S 2, S 3 and S 4 was measured. In all models, the camber angle and gantry angle of the screws were adjusted an interval of 2°, the number of successful cases was calculated and the success rate of insertion was calculated. Results:All 3D models were inserted successfully. The minimum value, maximum value and safety range of the camber angle of atlas pedicle screws were (-6.7±5.2)°, (10.4± 4.3)°, (17.1±3.7)°, respectively; and of the gantry angle were (-0.5±3.5)°, (11.0±5.8)°, (11.5±4.9)°, respectively. The length of screw placement was S 1: (31.1±2.4)mm, S 2: (28.3±2.5)mm, S 3: (29.2±3.8)mm, S 4: (29.6±3.0)mm, respectively ( P<0.05). When the camber angle was from -1°to 5°, the success rate of screw placement was 87.5%; when inserting with 2° camber angle, the success rate was 100%; when the gantry angle was 5°, the success rate was 93.8%. Conclusion:The posterior atlantoaxial transarticular screw combined with atlas pedicle screw can achieve satisfy insertion length and success rate.
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OBJECTIVES@#Sleep disorders directly affect health-related quality of life, so it is of great significance to investigate the risk factors of sleep disorders and to actively intervene. This study aims to investigate the relationship between dietary patterns and associated factors and sleep disorders among the health screening populations in Changsha.@*METHODS@#A cross-sectional study was carried out in 86 073 subjects aged 18-70 years old who underwent the health screening. The association between dietary patterns and sleep disorders was analyzed. The associated factors for sleep disorders were identified via by principal component analysis and classification tree model.@*RESULTS@#The overall prevalence of reporting sleep disorders was 18.64%. Four major dietary patterns (healthy, snacks, whole-grain, and fried food patterns) were identified. In logistic regression, snacks and fried food patterns had higher risk of sleep disorders. The whole-grain pattern was a protective factor for sleep disorders. Nine associated factors including age, susceptibility to anxiety, snacking parterns, feelings of depression, chronic pain, physical activity, educational level, gender, and weight, and 9 groups at high risk for sleep disorders were identified by classification tree model.@*CONCLUSIONS@#Sleep disorders are prevalent in the health screening population of Changsha. There is a close association between snacks dietary patterns and sleep disorders. It is necessary to promote healthy and reasonable diet, and keep good lifestyle for the prevention and control of sleep disorders. Health management after physical examination should take different health interventions for high-risk groups with different characteristics of sleep disorders.
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Adolescent , Adult , Aged , Humans , Middle Aged , Young Adult , Cross-Sectional Studies , Diet , Feeding Behavior , Health , Mass Screening , Quality of Life , Sleep Wake Disorders/epidemiologyABSTRACT
Objective@#To compare the clinical efficacy of posterior atlantoaxial screw-rod fixation combined with spinous process muscle-vessel complex bone graft or iliac bone graft for atlantoaxial instability.@*Methods@#A retrospective case-control study was conducted to analyze the clinical data of 56 patients with atlantoaxial instability admitted to the Sixth Hospital of Ningbo from September 2014 to October 2016. There were 35 males and 21 females, with the age range from 9 to 59 years [(50.3±3.2)years]. A total of 26 patients were treated with posterior atlantoaxial screw-rod fixation combined with spinous process muscle-vessel complex bone graft (complex group), while 30 patients were treated with iliac bone graft (ilium group). Patients showed different degrees of neck pain and limited neck activity preoperatively. X-ray films and three-dimensional CT examination of the cervical spine were taken before and after operation for evaluating the atlantoaxial reduction, bone graft fusion and internal fixation. The operation time, intraoperative bleeding, bone fusion time, visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) score, atlantodental interval (ADI) and axial symptoms were compared between the two groups, and the complications were recorded.@*Results@#Both groups were followed up for 24-30 months, with an average of 27.4 months. In the complex group and the ilium group, the operation time was (2.21±0.25)hours and (2.72±0.26)hours (P<0.01); the intraoperative blood loss was (227.3±45.4)ml and (277.7±43.4)ml, respectively (P<0.05); the bone fusion time was (6.9±0.5)months and (8.1±1.8)months (P>0.05), respectively. In the complex group, the VAS was (5.45±0.69)points before operation, (2.64±0.51)points at the follow-up one month after operation, (0.91±0.7)points at the follow-up 12 months after operation, and (0.45±0.16)points at the follow-up 24 months after operation; and in the ilium group, the VAS was (5.18±0.75)points, (2.45±0.52)points, (1.27±0.19)points and (0.41±0.18)points correspondingly. In terms of VAS, there were significant differences before and after operation within each group (P<0.01), while there were no significant differences between the two groups at different time points (P>0.05). In the complex group, the JOA score was (10.82±0.35)points before operation, (12.73±0.65)points at the follow-up one month after operation, (15.18±0.61)points at the follow-up 12 months after operation, and (15.64±0.15)points at the follow-up 24 months after operation; and in the ilium group, the JOA score was (10.73±1.19)points, (13.01±0.63)points, (14.73±0.91)points and (15.55±0.51)points correspondingly. In terms of JOA score, there were significant differences between before and after operation within each group (P<0.01), while there were no significant differences between the two groups at different time points (P>0.05). In the complex group, the ADI was (2.28±0.59)mm before operation, (1.83±0.56)mm at the follow-up one month after operation, (1.71±0.56)mm at the follow-up 12 months after operation, and (1.59±0.67)mm at the follow-up 24 months after operation; and in the ilium group, the ADI was (2.23±0.60)mm, (1.80±0.18)mm, (1.67±0.69)mm and (1.62±0.53)mm correspondingly. In terms of ADI, there were significant differences between before and after operation within each group (P<0.01), while there were no significant differences between the two groups at different time points (P>0.05). The axial symptom scores were graded as excellent in 23 patients and good in three patients of the complex group while excellent in 21 patients and good in nine patients in the ilium group (P>0.05). There were no patients with spinal nerve injury caused by pedicle screw placement after operation. One patient in the ilium group had incision errhysis and recovered after dressing change, and other patients had no incision infection.@*Conclusions@#For atlantoaxial instability, posterior atlantoaxial screw-rod fixation combined with spinous process muscle-vessel complex bone graft or autogenous iliac bone graft can both achieve satisfactory clinical results. The spinous process-muscle-vascellum complex graft has less operation time and intraoperative bleeding than the autogenous iliac bone graft, which can be a feasible alternative operation.
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Objective To compare the clinical efficacy of posterior atlantoaxial screw-rod fixation combined with spinous process muscle-vessel complex bone graft or iliac bone graft for atlantoaxial instability.Methods A retrospective case-control study was conducted to analyze the clinical data of 56 patients with atlantoaxial instability admitted to the Sixth Hospital of Ningbo from September 2014 to October 2016.There were 35 males and 21 females,with the age range from 9 to 59 years [(50.3 ±3.2) years].A total of 26 patients were treated with posterior atlantoaxial screw-rod fixation combined with spinous process muscle-vessel complex bone graft (complex group),while 30 patients were treated with iliac bone graft (ilium group).Patients showed different degrees of neck pain and limited neck activity preoperatively.X-ray films and three-dimensional CT examination of the cervical spine were taken before and after operation for evaluating the atlantoaxial reduction,bone graft fusion and internal fixation.The operation time,intraoperative bleeding,bone fusion time,visual analogue scale (VAS),Japanese Orthopaedic Association (JOA) score,atlantodental interval (ADI) and axial symptoms were compared between the two groups,and the complications were recorded.Results Both groups were followed up for 24-30 months,with an average of 27.4 months.In the complex group and the ilium group,the operation time was (2.21 ±0.25) hours and (2.72 ±0.26) hours (P ＜0.01);the intraoperative blood loss was (227.3 ± 45.4) ml and (277.7 ± 43.4) ml,respectively (P ＜ 0.05);the bone fusion time was (6.9 ±0.5) months and (8.1 ± 1.8) months (P ＞ 0.05),respectively.In the complex group,the VAS was (5.45 ± 0.69)points before operation,(2.64 ± 0.51)points at the follow-up one month after operation,(0.91 ± 0.7) points at the follow-up 12 months after operation,and (0.45 ± 0.16) points at the follow-up 24 months after operation;and in the ilium group,the VAS was (5.18 ± 0.75) points,(2.45 ± 0.52)points,(1.27 ± 0.19) points and (0.41 ± 0.18) points correspondingly.In terms of VAS,there were significant differences before and after operation within each group (P ＜ 0.01),while there were no significant differences between the two groups at different time points (P ＞ 0.05).In the complex group,the JOA score was (10.82 ± 0.35) points before operation,(12.73 ± 0.65) points at the follow-up one month after operation,(15.18 ±0.61) points at the follow-up 12 months after operation,and (15.64 ±0.15) points at the follow-up 24 months after operation;and in the ilium group,the JOA score was (10.73 ± 1.19) points,(13.01 ± 0.63) points,(14.73 ± 0.91) points and (15.55 ± 0.51) points correspondingly.In terms of JOA score,there were significant differences between before and after operation within each group (P ＜ 0.01),while there were no significant differences between the two groups at different time points (P ＞ 0.05).In the complex group,the ADI was (2.28 ± 0.59) mm before operation,(1.83 ± 0.56)mm at the follow-up one month after operation,(1.71 ± 0.56)mm at the follow-up 12 months after operation,and (1.59 ± 0.67)mm at the follow-up 24 months after operation;and in the ilium group,the ADI was (2.23 ± 0.60) mm,(1.80 ± 0.18) mm,(1.67 ± 0.69) mm and (1.62 ± 0.53) mm correspondingly.In terms of ADI,there were significant differences between before and after operation within each group (P ＜ 0.01),while there were no significant differences between the two groups at different time points (P ＞ 0.05).The axial symptom scores were graded as excellent in 23 patients and good in three patients of the complex group while excellent in 21 patients and good in nine patients in the ilium group (P ＞ 0.05).There were no patients with spinal nerve injury caused by pedicle screw placement after operation.One patient in the ilium group had incision errhysis and recovered after dressing change,and other patients had no incision infection.Conclusions For atlantoaxial instability,posterior atlantoaxial screw-rod fixation combined with spinous process muscle-vessel complex bone graft or autogenous iliac bone graft can both achieve satisfactory clinical results.The spinous process-muscle-vascellum complex graft has less operation time and intraoperative bleeding than the autogenous iliac bone graft,which can be a feasible alternative operation.
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Objective To study the trends in surgical treatment and the outcomes of critical acute pancreatitis (CAP).Methods The clinical data of 76 patients with CAP who were treated in the Department of Biliopancreatic Surgery of the Xiangya Hospital,Central South University from January 2010 to December 2017 were retrospectively reviewed.Data which included demographics,micro-organisms,surgical interventions and mortality were compared between the time periods of 2010 to 2013 and 2014 to 2017.Results Before 2014,19 patients with CAP were treated in the Department of Biliopancreatic Surgery of the Xiangya Hospital,Central South University.The percentage of multidrug resistant organisms (MDRO) in pancreatic drainage was 5.3％ (1/19).In the latter 4 years,57 patients with CAP were treated.The percentage of MDRO was 50.9％ (29/57),which was significandy higher than the initial 4 years (P＜0.001).For surgical treatment,the proportion of minimally invasive surgery in the latter 4 years was significantly higher than that in the initial 4 years.The percentage of percutaneous catheter drainage (PCD) increased from 63.2％ in the initial 4 years to 86.0％ in the latter 4 years.The proportion of minimal access retroperitoneal pancreatic necrosectomy (MARPN) increased from zero in the initial 4 years to 59.6％,while the proportion of open pancreatic necrosectomy (OPN) decreased from 68.4％ in the initial 4 years to 24.6％.The mortality rate of patients with CAP dropped from 52.6％ (10/19) in the initial 4 years to 24.6％ (14/57) in the latter four years.Conclusions In the center which specializes in treating pancreatitis,although the problem of bacterial resistance had become increasingly prominent,the mortality rate of CAP had shown a significant downward trend due to the development of various minimally invasive techniques.
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Objective To investigate prognosis and related factors of infectious pancreatic necrosis(IPN) caused by multidrug-resistant organisms(MDROs).Methods Clinical data of 53 IPN patients admitted to a hospital between October 2010 and March 2016 were analyzed retrospectively,patients were divided into MDRO infection group and common bacterial infection group according to antimicrobial resistance of pathogens isolated from peripancreatic drainge fluid,prognosis and related factors of two groups were compared.Results Among 53 IPN patients with confirmed evidence for pathogenicity,33(62.3％)were in MDRO infection group,and 20(37.7％)were in common bacterial infection group,the most common MDROs isolated from peripancreatic drainage was multidrug-resistant Acinetobacter baumannii (MDRO-AB) (37.5％,18/48).The mortality of IPN patients was 30.2％ (16/53),mortality of MDRO infection group was higher than common bacterial infection group(39.4％ [13/33] vs 15.0％ [3/ 20],P＜0.05);the severity score,length of intensive care unit (ICU) stay,and hospitalization expenses in MDRO infection group were all higher than common bacterial infection group(all P＜0.05).The mortality of IPN patients were closely associated with MDRO infection and severity score of acute pancreatitis (all P ＜ 0.05).Conclusion Prognosis of patients with MDRO infection is poor,treatment is difficult,MDRO infection has become one of the most important challenge to the treatment of severe acute pancreatitis.