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Objective:To evaluate the mid- and long-term outcomes of Dynesys hybrid surgery (in some segments act as a non-fusion device, in other segments act as an alternative of rigid fixation in combination with interbody fusion) in the treatment of multi-segmental lumbar degenerative disease (LDD).Methods:The data of 27 patients who received Dynesys hybrid surgery (hybrid group) for the treatment of LDD from May 2011 to September 2016 and completed the follow-up were retrospectively analyzed. Among them, there were 8 males and 19 females; their average age was 59.1±11.9 years (23-78 years). Main diagnosis: 13 cases of lumbar spinal stenosis, 14 cases of lumbar disc herniation; 4 cases of combined lumbar dynamic position instability, 7 cases of combined lumbar spondylolisthesis. There were 15 cases of two-segment disease, 11 cases of three-segment disease, and 1 case of four-segment disease. Segments distribution: 9 cases of L 3-L 5, 6 cases of L 4-S 1, 7 cases of L 3-S 1, 4 cases of L 2-L 5, and 1 case of L 2-S 1. Midline incision was used to exposure, followed by bilateral pedicle screws implantation, and interbody fusion cage with bone grafting were performed at the fusion level. Twenty-seven patients who underwent TLIF+rigid internal fixation during the same period were included as the control group. Clinical outcomes were measured by visual analog scale (VAS) for low back pain and leg pain, and Oswestry disability index (ODI). Radiological outcomes included fusion rate, intervertebral disc height (DH) of surgical segments and the proximal adjacent segment, range of motion (ROM) of non-fusion segments and the proximal adjacent segment. At the same time, the occurrence of complications was observed. Results:Patients of Hybrid group and control group were followed up for an average of 83.8±20.9 months (48-112 months) and 87.3±16.2 months (53-114 months), respectively. Baseline data of the two groups (average follow-up time, age, gender, surgical level, diagnosis) showed no significant difference. The operation time (183.0±27.8 min) and intraoperative blood loss (301.9±178.9 ml) in the hybrid group were significantly lower than those in the control group (operation time t=2.337, P=0.023; blood loss t=2.706, P=0.01). At the final follow-up, the VAS scores of low back pain and leg pain (low back pain t=12.164, P<0.001; leg pain t=20.603, P<0.001), as well as ODI were significantly improved ( t=22.827, P<0.001). A total of 32 segments received TLIF+Dynesys stabilization and 35 segments received Dynesys non-fusion stabilization in the hybrid group, with 28 segments (87.5%) achieved solid fusion at 1-year follow-up. There were 67 fusion segments in the control group, and the fusion rate at 1-year follow-up was 85.1%. DH of non-fusion segments were lower than that before surgery with statistical significance at final follow-up ( t=2.647, P=0.012), while DH of the fusion segments in the hybrid group and the surgical segments in the control group increased compared with that before surgery at the final follow-up. A certain degree of ROM (2.4°±1.5°) was retained of the non-fusion segments at the final follow-up; the ROM of proximal adjacent segments of non-fused segments was significantly smaller than that of proximal adjacent segments of fused segments ( t=2.126, P=0.044). In the hybrid group, screw loosening occurred in 4 patients (8 screws) and adjacent segment degeneration (ASD) occurred in 5 patients. In the control group, screw loosening occurred in 3 patients (6 screws), while ASD occurred in 8 patients. No screw fracture was observed during the follow-up period and no patients received reoperation. Conclusion:Hybrid surgery of Dynesys stabilization combined with interbody fusion is a safe and effective method for the treatment of multi-segmental LDD. Compared with multi-segmental fusion, this lumbar hybrid surgery has the advantages of less trauma and retaining partial segmental ROM.
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OBJECTIVE：To e stablish a method for simultaneous determination of 7 constituents in Xiao ’er jinqiao granules . METHODS：QAMS method was adopted. The determination was performed on Lubex Kromasil C 18 column with mobile phase consisted of acetonitrile- 0.1％ phosphoric acid solution （gradient elution ）. The detection wavelength was set at 326 nm，the flow rate was 1.0 mL/min. The column temperature was 40 ℃，and sample size was 10 µL. Using chlorogenic acid as the internal reference，the relative correction factors （RCF）of neochlorogenic acid ，cryptochlorogenic acid ，forsythiaside A ，isochlorogenic acid B ，isochlorogenic acid A and isochlorogenic acid C were calculated. The effects of different chromatogram system ， chromatogram column ，the ratio of mobile phase ，flow rate and column temperature on RCF were investigaten. According to the two-point correction method combined with the relative retention time correction of the components to be tested ，the peak location was carried out. The contents of 7 components were determined by QAMS and SCM respectively and then compared. RESULTS： The linear range of neochlorogenic acid ，chlorogenic acid ，cryptochlorogenic acid ，forsythoside A ，isochlorogenic acid B ，isochlorogenic acid A ，isochlorogenic acid C were 9.27-92.70，37.36-373.60，13.02-130.20，7.15-71.50，4.56-45.60，6.32-63.20，14.69-146.90 µg/mL （r≥0.999 7）. The limits of quantification were 1.38，1.41，1.40，1.99，1.10，1.17，1.10 ng，respectively；and the limits of detection were 0.41，0.42，0.42，0.60，0.33，0.35，0.33 ng，respectively. RSDs of precision ，repeatability and stability tests were all less than 2％；average recoveries were 98.28％-99.15％ （RSD＜2.0％ ， n＝9）. RCFs of neochlorogenic acid ， （No.2013LZLY-K61） cryptochlorogenic acid ，forsythiaside A ，isochlorogenic acid B，isochlorogenic acid A and isochlorogenic acid C relative to xinyuliang@stu.cqmu.edu.cn chlorogenic acid were 0.995，1.007，0.580，1.243，1.252 and 1.247，respectively. RSDs of RCFs were all lower than 3％ under different chromatogram conditions. Absolute value of relative error between the relative retention time of components to be tested predicted by two-point correction combined with relative retention time correction and measured value was less than 2％. The contents measured by QAMS were 2.790-3.416， 14.526-17.907，3.763-4.531，1.625-1.982，1.087-1.523，1.434-2.219，3.631-5.078 mg/g；the contents measured by SCM method were 2.811-3.438，14.512-17.893，3.739-4.508，1.656-2.012，1.108-1.544，1.460-2.245，3.597-5.045 mg/g；relative errors of the two methods were within ±2％. CONCLUSIONS ：Two-point correction method combined with relative retention time correction can accurately locate the peaks of each constituent ；established QAMS method is simple ，rapid，accurate and reliable ，it can be used for simultaneous determination of 7 constituents in Xiao ’er jinqiao granules.
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Objective@#To evaluate the effects of physical activity interventions based on social ecology model, and to explore promising approach for increasing physical activity of students in large cities.@*Methods@#A quasi-experimental design with parallel control was implemented. Students from grade 4 in 20 primary schools in 3 districts of Shanghai were recruited. Based on social ecology model, physical activity interventions were carried out in three levels: personal, social-and physical environment. The interventions lasted for 6 months. Questionnaires, physical examinations and physical fitness tests were carried out. Rank sum test, chi-square test and logistic stepwise regression was used to analyze the intervention effects.@*Results@#In the intervention group, the proportion of students who favored physical activity increased from 47.9% to 50.7%. Time spent in moderate to vigorous intensity physical activity (MVPA) increased from 64 min/d to 70 min/d, mainly during the weekend. The interventions showed significant effects, especially for girls. In the intervention group, the proportion of students spent 1 h/d in MVPA increased from 53.7% to 57.7%(χ2=4.95, P<0.05). Multivariate analysis showed that after intervention, the proportion of students spent more than 1 h/d in MVPA in the intervention group was higher than that in the control group (OR=1.22, 95%CI=1.02-1.48, P=0.03).@*Conclusion@#Physical activity interventions based on social ecology model can increase uptake of physical activity among school students.
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Objective To explore the clinical characteristics and prognostic factors of primary gastric lymphoma.Methods Clinical data of 78 primary gastric lymphoma patients treated between September 2012 and January 2017 in our hospital were analyzed retrospectively.Results 1-year and 3-year survival rate were 86％ and 68％ respectively.Univariate analysis showed that the four factors including the level of serum lactate dehydrogenase (x2 =35.088,P =0.000),Musshoff stage (x2 =29.930,P =0.000),pathology types (x2 =6.077,P =0.014),IPI score (x2 =21.337,P =0.000) were associated with the prognosis.Multivariate analysis showed that Musshoff stage was an independent risk factor for the prognosis when stage Ⅰ,stage Ⅱ (OR =1.075,95％ CI:0.060-19.107,P =0.961) were compared with stageⅢ (OR =11.994,95％ CI:1.042-138.083,P =0.046),or stage Ⅳ (OR =13.165,95％ CI:1.476-117.417,P =0.021).Conclusions Musshoff stage is an independent factor for the prognosis,surgical treatment can not prolong survival and chemotherapy is the therapy of choice.
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Objective To investigate the risk factors of postoperative complications in spinal tuberculosis surgery,and try to find a way to improve the results of perioperative management and reduce or avoid the postoperative complications.Methods All of 172 cases of spinal tuberculosis who were treated by surgery from February 2005 to January 2013 in orthopedic department of Zhongshan hospital,Fudan University were retrospectively analyzed.There were 88 males and 84 females,whose average age was 50.9± 18.7y (18-84y).Among them 98 cases got cold abscess,and 56 cases had tuberculosis poisoning symptoms.The lesions located mostly in thoracic spine (112/172,65.1％) and lumbar spine (40/172,23.3％),while rarely in cervical or sacral spine.2 intervertebral spaces were involved in 116 cases (67.4％),more than 2 intervertebral spaces were involved in 32 cases (18.6％),and single intervertebral space were involved in the rest cases (14.0％).38 cases were treated through single anterior approach,54 cases were treated by anterior-posterior surgical approach,and single posterior approach was performed in 80 cases.58 cases were suffered from neurological dysfunction.All the postoperative complications and related clinical parameters during hospitalization period were collected and analyzed with SPSS software.Each clinical parameter was analyzed with univariate analysis to find the factors related to postoperative complications,and then the related factors were analyzed by multivariate regression analysis.Results All of 172 patients were included and 41.9％ (72/172) of the patients suffered from postoperative complications.System complications were the most common (33.7％,58/172).The rates of local complications were 10.5％ (18/172).Univariate analysis showed that the lesion site,value of hemoglobin,electrolyte disturbances,postoperative ASIA score and blood loss were related with postoperative complications.Posterior approach related with local complications.Multivariate regression analysis showed that preoperative hemoglobin ＜100 g/L,poor postoperative ASIA scores and long period of preoperative anti-TB treatment (＞28 days) were related with the system or local postoperative complications.Conclusion Patients with anemia (hemoglobin ＜ 100g/L),poor postoperative neurological function and long period of preoperative anti-TB treatment could take more risks of the postoperative complications.
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<p><b>OBJECTIVE</b>To explore the feature of primary light chain amyloidosis patients treated with high-dose melphalan with auto peripheral blood stem cell transplantation (auto-PBSCT) and bortezomib plus dexamethasone (VD).</p><p><b>METHODS</b>Thirty-eight patients diagnosed from September 2004 to September 2012 were analyzed retrospectively, including 15 cases received auto-PBSCT, 23 cases exposed with VD.</p><p><b>RESULTS</b>The median follow-up duration for the patients was 34 months (range, 1-112 months), including auto-PBSCT group of 38 months (range, 5-112 months) and VD group of 31 months (range, 1-108 months). The organ response rate in all the patients was 39.5% (15/38), and the organ response rate between these two groups has no significant difference [33.3% (5/15) vs 43.5% (10/23), P=0.532]. However, the median time of organ response was significant difference [6 (3-10) months vs 3 (1-6) months, respectively (P=0.032)]. The 3-year overall survival (OS) rates in the two groups were 72.0% and 66.9%, and their average survival were 84.7 months and 75.9 months, respectively (P=0.683). In the patients with auto-PBSCT, the occurrence of III-IV grade of bone marrow suppression (P<0.001), fever (P<0.001), nausea and infection (P=0.006) were obviously higher than those with VD, but there was no statistically significant difference in pulmonary infection (P=0.069) and bloodstream infection (P=0.059).</p><p><b>CONCLUSIONS</b>The preliminary results have presented that primary light chain amyloidosis patients treated with auto-PBSCT or VD had similar organ response rate and survival. However, more adverse events occurred in the group of auto-PBSCT.</p>
Subject(s)
Humans , Amyloidosis , Therapeutics , Bortezomib , Therapeutic Uses , Dexamethasone , Therapeutic Uses , Immunoglobulin Light-chain Amyloidosis , Melphalan , Therapeutic Uses , Myeloablative Agonists , Therapeutic Uses , Peripheral Blood Stem Cell Transplantation , Retrospective StudiesABSTRACT
Objective To investigate a therapeutic method which could provide sustained-release delivery and local longlasting anti-TB treatment after debridement of thoracic and lumbar spine tuberculosis.Methods Data of 18 patients (including 2 revised cases),who were diagnosed of thoracic and lumbar tuberculosis and required surgery treatment from October 2008 to January 2011 were retrospectively analyzed.There were 12 males and 6 females,with an average age of 48.7± 13.3 years (range,22 to 67 years).Affected spinal segments in these patients spanned from T8 to S1.fourteen patients were treated with posterior surgical procedure alone while the other 4 were treated with one-stage combined anterior-posterior surgery.Combined with autogenous bone,OSTEOSET RBK drug carrier-type artificial bone mixed with isoniazid and streptomycin was used after debridement.Chlinical parameters including clinical symptoms,laboratory results,and imaging data were evaluated during follow-up.Results Incisions of all patients achieved primary healing.The duration of patient follow-up ranged from 29 to 56 months (average,39.5months).No liver and kidney function abnormalities,ototoxicity,or local nerve irritations were found perioperatively.Improvements in clinical symptoms were observed in all patients.One patient with L2a tuberculosis recurred 18 months after the initial surgery.At 6-month follow-up,intervertebral body fusion was achieved without complications of internal fixation or significant angle loss of kyphosis correction.Conclusion OSTEOSET RBK dmg carrier-type artificial bone mixed with isoniazid,streptomycin for treatment of thoracic and lumbar spine tuberculosis is a safe and effective way to control local infection and recurrence.Combined with autologous bone could contribute to bone fusion.
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Objective To study the influence of splenectomy on the surgical efficacy in the patients with gastric cancer in the up-per and middle portion and entire stomach .Methods 86 patients with gastric cancer in the upper and middle portion and entire stomach receiving the gastric cancer D 2 radical operation in the two hospitals from April 2003 to January 2008 were selected and di-vided into the observation group(47 cases) and the control group(39 cases) .The observation group accepted the modified lymph-adenectomy with spleen-preserving ,while the control group accepted the D2 total radical gastrectomy with splenectomy .The long-term effects were compared between the two groups .Results The total hospitalization time and the occurrence rate of postoperative complications were(20 .62 ± 7 .93)d and 10 .64% in the observation group ,which were less than (27 .51 ± 12 .44)d and 30 .77% in the control group ,and the differences between the two groups showed the statistical significance (t=3 .128 ,χ2 =5 .446 ,P=0 .000) . The 5-year survival rate in different TNM stages had no statistical difference between the two groups (P>0 .05) .Conclusion For the patients with gastric cancer in the upper and middle portion and entire stomach without spleen or splenogastric ligament metas-tasis ,the modified spleen-preserving lymphadenectomy could make the patients to get the same prognosis as the gastrectomy com-bined with splenectomy ,which reduces the occurrence rate of complications and is worth promoting clinically.
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Objective To evaluate clinical effect of accurate pedicle subtraction osteotomy (PSO) using osteotomes in the treatment of thoracolumbar kyphosis (TLK).Methods From June 2007 to October 2010,18 patients with TLK underwent accurate PSO using osteotomes under X-ray fluoroscopy,including 13 males and 5 females,with an average age of 48.6 years.The primary causes of TLK included old fracture (11cases),chronic tuberculosis (4 cases) and hemivertebra (3 cases).Deformity apex occurred at T12 (5 cases),L1 (9 cases),and L2 (4 cases).Radiological assessment for sagittal balance was performed by measuring Cobb angle.The Frankel grade,visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate pre-and post-operative neurological status,back pain and function.Results The mean operative time,mean blood loss and mean postoperative drainage volume were 247.0±29.3 minutes,708.5±34.5 ml and 337.3±74.6 ml,respectively.All patients were followed up for 1 to 4.5 years (average,2.8 years).Solid fusion was achieved in all patients.Cobb angle was corrected from preoperative 42.3°±5.7° to 2.2°±1.9° three months postoperatively and 2.7°±2.1 ° at final follow-up.VAS and ODI scores decreased from preoperative 8.5±1.0 and 72.8％±8.3％ to 2.1±0.7 and 21.6％±9.2％ three months postoperatively,and 1.9±0.6 and 19.3％±8.6％ at final follow-up,respectively.With regard to Frankel grade,a 1-grade and 2-grade improvement was observed in 7 cases and 2 cases 3 months postoperatively,respectively.At final follow-up,a 1-grade and 2-grade improvement was observed in 5 cases and 4 cases,respectively.Two patients had transient neurological symptoms postoperatively,which recovered after drug treatment for 2 weeks.No other complications occurred.Conclusion It is safe and effective to correct TLK through accurate PSO using osteotomes,which has some advantages,such as less blood loss,higher fusion rate and fewer complications.
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Objective To investigate the feasibility,safety and therapeutic effects of minimally invasive percutaneous mono-segment pedicle instrumentation in treating thoracolumbar burst fractures ( AO classification:A 3.1 and A 3.2 ).Methods Twenty-four inpatients with thoracolumbar burst fractures (AO classification:A 3.1 and A 3.2) treated with percutaneous mono-segment pedicle instrumentation from March 2010 to December 2010 were retrospectively studied.The operation time,blood loss,pre-and post-operative visual analogue scale ( VAS),ratio of anterior height between compressed vertebral body and normal vertebral body and vertebral kyphotic Cobb' s angle were evaluated.Results The operation lasted for (90 ± 25) minutes,with intraoperative blood loss of (20 ± 10) ml.The rate of anterior body height rose from pre-operative (56.5 ± 10.1 ) to (92.3 ± 12.2) one week post-operatively and to (90.2 ± 11.l)at the follow-up one year later.The vertebral kyphotic Cobb' s angle was pre-operative ( 16.5 ± 5.2) °,which was reduced to ( 7.3 ± 2.4 )° at oneweek after surgery and ( 7.9 ± 3.5 )° at the follow-up one year later respectively.The VAS scored ( 7.0 ± 1.2) points before surgery,( 1.2 ±0.7) points at one week after surgery and ( 1.1 ± 6..5) points at the follow-up one year later.The ratio of anterior body height at one week after surgery and at the follow-up one year later were both obviously higher than that before surgery (P ＜ 0.05 ),but the ratio one week postoperatively showed no significant difference in comparison with that one year postoperatively (P ＞0.05).The kyphotic Cobb' s angle had significant decrease at one week after surgery and at the follow-up one year later,as compared with that before operation (P ＜0.0 5).Also,the VAS score showed marked improvement at one week after surgery and at the follow-up one year later.Conclusions Minimally invasive percutaneous mono-segmental pedicle instrumentation is effective and safe for thoracolumbar burst fractures (AO classification:A 3.1and A 3.2),but it is not suitable for thoracolumbar burst fracture with severely compressed vertebra.
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Objective To evaluate the diagnostic and therapeutic significance of serum free light chain (sFLC) in primary systemic(AL) amyloidosis. Methods Twenty-five patients with AL amyloidosis,including 18 men and 7 women with a mean age of 54(47-77) years old, were enrolled from October, 2005to May, 2010. sFLC was measured by immunoturbidimetric assay. The type of monoclonal light chain was judged upon sFLC κ/λ and its sensibility was compared with serum immunofixation and immunohistochemical analysis. Four patients were treated with M (T)D (melphalan/thalidomideand, dexamethasone), one with VD (velcade and dexamethasone) and four with high-dose melphalan followed by autologous stem cell support. The changes of sFLC were serially determined before and after treatment. Results Among the 25 patients with AL amyloidosis, two were κ light chains of precursor protein and 23 were λ light chains. Mean plasma cell in bone marrow was 3.5% (0-15%). Nineteen (76%) patients had abnormal elevated sFLC and abnormal κ/λ ratios, and 17(68% ) patients with immunofixation positive. The sFLC test had similar sensitivity as serum immunofixation (P = 0. 727 ). Twenty-one (84%) patients were shown to have either κor λ immunoreactive amyloid deposits on biopsied tissues. The sFLC test combined with serum immunofixation allowed the M protein to be detected in 22 (88%) patients. The positive rates of immunohistochemical analysis combined with sFLC test and/or serum immunofixation were 96%. Four patients with hematologic response showed obvious improvement in visceral organ involvement, but illness of 5 patients without hematologic response kept stable or progressed. Conclusions sFLC test is a sensitive qualitative and quantitative method to detect M protein. Preliminary data show the patients with obvious sFLC level decrease and/or κ/λ recovery to normal may have a high percentage of improved organs function. sFLC is critical index in diagnosing AL amyloidosis, which might help efficacy assessment.
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Objective To compare the treatment effectiveness of AO/ASIF proximal femoral nail (PFN) and proximal femoral nail antirotation (PFNA) in treatment of intertrochanterie fractures. Methods A retrospective study was done on 233 patients with intertroehanteric fractures treated from August 2004 to December 2006. The patients were divided into PFN group (188 patients) and PFNA group (45 patients) for comparing operative procedures and postoperative functional recovery. Results There was statistical difference in aspects of incision length, blood loss and operation time between two groups. The follow-up for 22.8 months showed excellence rate of 89.9% in PFN group and 91.1% in PFNA group, with statistical difference (X2 = 0.06, P > 0.05). There occurred hip varus in one patient and antirotation nail cutting-out in two in PFN group, which was not found in PFNA group. Conclusion PFN and PFNA are both good choices for treatment of intertrochanteric fractures. Compared with PFN, PFNA has more advantages in reducing operation time and blood loss especially for the eider patients with osteoporosis.
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Objective To evaluate the clinical use of delayed open reduction and internal fixation technique in the treatment of Rud?i Ⅲ Pilon fractures. Methods From May 1997 to June 2003, 38 patients with Rud?i Ⅲ Pilon fractures underwent immediate calcaneal traction as well as treatment with methylprednisolone and mannitol. After 5-8 days, all patients underwent regular open reduction and internal fixation with cloverleaf buttress plates. One week after the operation, ankle joint began to exercise with no weight bearing. Results All patients were followed up for average 18 months and evaluated subjectively and objectively by using systems of Teeny and Wiss, which showed good results for 74 %, mild for 21% and poor for 5%. All fractures healed within an average of 5.7 months except for two cases of infections and one soft tissue complication. Conclusion Delayed open reduction and internal fixation offers acceptable way for treatment of severe Pilon fractures.