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Objective:To investigate the clinical effect of percutaneous curved kyphoplasty in the treatment of old osteoporotic vertebral body with endplate fracture.Methods:Clinical data of 58 patients suffering from old osteoporotic vertebral bodies with endplate fractures from January 2018 to January 2020 were analyzed retrospectively. All patients had a single vertebral body fracture and were treated with bilateral injection of bone cement with percutaneous kyphoplasty (PKP). According to the shape of the puncture device, the patients were divided into a curved needle group and a ordinary group. There were 28 cases in the curved needle group, including 7 males and 21 females, aged 60-84 years old, with an average age of 71.8±7.8 years. The distribution of vertebral bodies with fractures: T 11 3 cases, T 12 5 cases, L 1 6 cases, L 2 5 cases, L 3 3 cases, L 4 4 cases, and L 5 2 cases. In the ordinary group, there were 30 cases, 8 males and 22 females, with an average age of 73.2±8.4 years (range, 61-88 years). The vertebral body distribution of fracture: T 11 3 cases, T 12 5 cases, L 1 7 cases, L 2 4 cases, L 3 4 cases, L 4 5 cases, and L 5 2 cases. The surgery time, amount of bone cement injection, and bone cement leakage rate were compared between the two groups, as well as the visual analogue scale (VAS) and Oswestry disability index (ODI) at 1 week, 6 months, and 1 year after surgery. Preoperative and postoperative vertebral midpoint height and kyphosis Cobb angle were measured. Results:All patients were followed up for 12-24 months, with an average of 14.7±2.9 months. The bone cement leakage rate in curved needle group (18%, 5/28) was lower than that in ordinary group (23%, 7/30), but there was no significant statistical difference (χ 2=0.27, P=0.607). The amount of bone cement injection and surgery time in curved needle group (5.0±0.5 ml, 55.2±6.9 min) were significantly higher than those in ordinary group (3.4±0.6 ml, 42.9±3.6 min, P<0.05) . The scores of VAS (2.3±1.0, 2.6±1.5) and ODI (27.5%±9.7%, 28.7%±11.3%) in curved needle group were lower than those in ordinary group (2.7±1.0, 4.5±1.1 and 31.8%±10.5%, 43.1%±13.4%) at 6 months after surgery and at the last follow-up after surgery. In the curved needle group, the Cobb angle was 25.5°±3.5° preoperatively, 18.4°±1.6° postoperatively, and 20.5°±4.9°at the last follow-up. The height of the vertebral body was 14.2±1.9 mm before surgery, 21.5±2.2 mm after surgery, and 20.1±3.6 mm at the last follow-up. Compared with the preoperative results, the kyphosis Cobb angle decreased and the height of the fractured vertebral body increased at the last follow-up, and the differences were statistically significant ( P<0.05). In the ordinary group, the Cobb angle was 24.4°±3.6° preoperatively, 23.1°±4.0° postoperatively, and 27.8°±2.9° at the last follow-up. The height of the vertebral body was 14.5±1.8 mm before surgery, 15.4±2.0 mm after surgery, and 12.7±1.0 mm at the last follow-up. At the last follow-up, the kyphosis Cobb angle increased and the height of the fractured vertebral body decreased compared with preoperative and postoperative 1 week, and the differences were statistically significant ( P<0.05). At 1 week after surgery, 6 months after surgery and the last follow-up, the Cobb angle of curved needle group was lower than that of ordinary group ( P<0.05), the height of vertebral body was higher than that of ordinary group ( P<0.05). Conclusion:Flexible application of percutaneous curved kyphoplasty in the treatment of old osteoporotic vertebral body with endplate fractures can effectively increase the riveting force of bone cement in the vertebral body, restore the height of endplate, and reduce the occurrence of kyphosis and chronic low back pain.
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Gastrointestinal stromal tumor (GIST) is one of the most common tumors originating from gastrointestinal mesenchymal tissues, accounting for about 0.2% of all gastrointestinal tumors. It can occur anywhere in the gastrointestinal tract. Because gastrointestinal stromal tumors have the biological characteristics of non-directional differentiation and potential malignancy, it is very important to resect them completely in time.Traditional surgical excision has a good prognosis in the past, but it has some shortcomings, such as large trauma, slow postoperative recovery and more complications. In recent years, with the continuous development of digestive endoscopy technology, many new endoscopic techniques have emerged for the treatment of gastric stromal tumors, such as endoscopic mucosal dissection (ESD), endoscopic full-thickness resection (EFTR), endoscopy and laparoscopic combined surgery, but the safety and effectiveness of endoscopic surgery for gastric stromal tumors are still controversial in the industry.
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Objective@#To systematically evaluate the clinical efficacies of Helmet non-invasive ventilation and oxygen therapy on patients with hypoxemic respiratory failure.@*Methods@#The randomized controlled trials (RCTs) for comparison of efficacy between Helmet non-invasive ventilation and oxygen therapy for treatment of patients with hypoxemic respiratory failure published by Wanfang database, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), PubMed, Embase, Cochrane Library and Web of Science were retrieved. The retrieval time was from the establishment of database to February 1st, 2019. The indexes of the study outcomes included oxygenation index, arterial partial pressure of carbon dioxide (PaCO2), endotracheal intubation rate, hospital mortality and intolerance rate. Literature search and data extraction was performed separately by two researchers. Quality assessment of literature was conducted according to the risk of bias criterion provided by Cochrane collaboration net. The extractive data were Meta-analyzed by RevMan 5.1.0. Funnel plot and Egger regression analysis was employed to detect publication bias.@*Results@#Six RCTs including 5 English studies and 1 Chinese study were selected. Finally, 547 patients were enrolled, with 270 patients in Helmet non-invasive ventilation group and 277 in oxygen therapy group. The study quality assessment revealed that the overall risk of bias was low, and no publication bias was detected by the funnel plot and Egger regression analysis. Meta-analysis showed that the oxygenation index in Helmet non-invasive ventilation group was significantly higher than that in oxygen therapy group [mean difference (MD) = 73.47, 95% confidence interval (95%CI) was 52.01 to 94.92, P = 0.000 01], and PaCO2 (MD = -2.46, 95%CI was -4.54 to -0.39, P = 0.02), endotracheal intubation rate [relative risk ratio (RR) = 0.38, 95%CI was 0.20 to 0.73, P = 0.004] and hospital mortality (RR = 0.35, 95%CI was 0.19 to 0.65, P = 0.000 8) in Helmet non-invasive ventilation group were significantly lower than those in oxygen therapy group. There was no significant difference in patient's intolerance between the two groups (RR = 2.38, 95%CI was 0.74 to 7.67, P = 0.15).@*Conclusion@#Compared with oxygen therapy, the Helmet non-invasive ventilation used for treatment of patients with hypoxemic respiratory failure can effectively improve the oxygenation index, decrease the PaCO2, reduce the endotracheal intubation rate and hospital mortality, and the patients are well tolerated to the Helmet method.
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Gastrointestinal stromal tumor (GIST) is one of the most common tumors originating from gastrointestinal mesenchymal tissues,accounting for about 0.2％ of all gastrointestinal tumors.It can occur anywhere in the gastrointestinal tract.Because gastrointestinal stromal tumors have the biological characteristics of non-directional differentiation and potential malignancy,it is very important to resect them completely in time.Traditional surgical excision has a good prognosis in the past,but it has some shortcomings,such as large trauma,slow postoperative recovery and more complications.In recent years,with the continuous development of digestive endoscopy technology,many new endoscopic techniques have emerged for the treatment of gastric stromal tumors,such as endoscopic mucosal dissection (ESD),endoscopic fullthickness resection (EFTR),endoscopy and laparoscopic combined surgery,but the safety and effectiveness of endoscopic surgery for gastric stromal tumors are still controversial in the industry.
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Objective To systematically evaluate the clinical efficacies of Helmet non-invasive ventilation and oxygen therapy on patients with hypoxemic respiratory failure. Methods The randomized controlled trials (RCTs) for comparison of efficacy between Helmet non-invasive ventilation and oxygen therapy for treatment of patients with hypoxemic respiratory failure published by Wanfang database, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), PubMed, Embase, Cochrane Library and Web of Science were retrieved. The retrieval time was from the establishment of database to February 1st, 2019. The indexes of the study outcomes included oxygenation index, arterial partial pressure of carbon dioxide (PaCO2), endotracheal intubation rate, hospital mortality and intolerance rate. Literature search and data extraction was performed separately by two researchers. Quality assessment of literature was conducted according to the risk of bias criterion provided by Cochrane collaboration net. The extractive data were Meta-analyzed by RevMan 5.1.0. Funnel plot and Egger regression analysis was employed to detect publication bias. Results Six RCTs including 5 English studies and 1 Chinese study were selected. Finally, 547 patients were enrolled, with 270 patients in Helmet non-invasive ventilation group and 277 in oxygen therapy group. The study quality assessment revealed that the overall risk of bias was low, and no publication bias was detected by the funnel plot and Egger regression analysis. Meta-analysis showed that the oxygenation index in Helmet non-invasive ventilation group was significantly higher than that in oxygen therapy group [mean difference (MD) = 73.47, 95% confidence interval (95%CI) was 52.01 to 94.92, P = 0.000 01], and PaCO2 (MD = -2.46, 95%CI was -4.54 to -0.39, P = 0.02), endotracheal intubation rate [relative risk ratio (RR) = 0.38, 95%CI was 0.20 to 0.73, P = 0.004] and hospital mortality (RR = 0.35, 95%CI was 0.19 to 0.65, P = 0.000 8) in Helmet non-invasive ventilation group were significantly lower than those in oxygen therapy group. There was no significant difference in patient's intolerance between the two groups (RR = 2.38, 95%CI was 0.74 to 7.67, P = 0.15). Conclusion Compared with oxygen therapy, the Helmet non-invasive ventilation used for treatment of patients with hypoxemic respiratory failure can effectively improve the oxygenation index, decrease the PaCO2, reduce the endotracheal intubation rate and hospital mortality, and the patients are well tolerated to the Helmet method.
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Objective To evaluate the effect of percutaneous transforaminal endoscopic discectomy (PTED) using tar?get puncture and 2-stage procedures in treating lumbar disc hernia. Methods Patients present in our clinic from January 2014 to June 2014 with lumbar disc hernia who were treated with PTED were collected (n=36). Lower back and leg pain were evaluated by visual analog scale (VAS) while clinic outcome were assessed by Oswestry disability index (ODI) and modified Macnab criteria. Results All surgeries were carried out successfully. On average, operation time was(125±31)min, blood loss was(8.5±2.9)mL in each operation. The average length in hospital stay was(7.6±3.5)day. Compared with the preoper?ative VAS scores,the postoperative and last follow-up scores for lower back and leg pain decreased significantly (P<0.01). The ODI of pre-operation and last follow-up were (18.90 ± 7.78)%and (73.30 ± 18.21)%respectively with statistic differ?ence. As to the modified Macnab criteria,theexcellent and goodratio was 94.4%. One case present hyperalgesia in L4 der?matome which recovered through conservative treatment. No complications such as permanent nerve root injury ,cerebrospi?nal fluid leakage,or infection were found during or after operations. All patients are in stable conditions during follow-up pe?riod without recurrence. Conclusion PTED using target puncture and 2-stage procedures is an effective method with mini?mal trauma, less bleeding, quick recovery, high security, short hospitalization time. what′s more, it can remove protruded disc and broken nucleus from the intervertebral space. It ensure efficacy and avoid recurrence.
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Objective To investigate the effect of corpectomy decompression by subtotal vertebrectomy and fusion of adjacent segmental artificial disc replacement through anterior intervertenral spance (Hybrid Surgery) in the anteriorcervical spondylotic myelopathy treatment . Methods Hybrid Surgery were operated on 18 patients who suffered from anterior cervi?cal spondylotic myelopathy . Follow up of 1-50 months. Patient’s conditions were assessed according to the Japanese Associ?ation for Department of orthopedics assessment score (JOA score) before and after operation. Effects of Hybrid operation were assessed by the improvement of JOA score, Odom’s follow-up grade and cervical mobility . Results The JOA scores of all 18 operated patients were improved from 10.6 ± 1.7 before operation to 13.5 ± 2.4 after operation. And the difference is statistically significant (t=1.314, P 0.05). Conclusion Hybrid Surgery of anterior cervical decompression and fusion can both improve the nerve function and preserve cervical mobility.
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Objective To investigate short?term clinical outcomes of XLIF through small incision approach combined with percutaneous pedicle screw fixation for degenerative lumbar scoliosis. Methods From December 2011 to June 2013, 15 pa?tients with degenerative lumbar scoliosis were treated by XLIF combined with percutaneous pedicle screw fixation (XLIF group). There were 6 males and 9 females, with an average age of 68.27±5.70 (ranging from 58 to 75) years old and Cobb angle of scoliosis 22.20°±6.66° (ranging from 14° to 35°). Meanwhile, 23 patients were treated with posterior lumber inter?body fusion (PLIF) com?bined with pedicle screw fixation (PLIF group). There were 9 males and 14 females, with an average age of 63.26 ± 6.03 (ranging from 49 to 73) years old and Cobb angle of scoliosis 23.17°±6.95° (ranging from 13° to 36°). The efficacy was assessed through cor?rection rate of Cobb angle, VAS and lumbar JOA score at the time of the latest follow?up. Results The operation time was 224.35 ± 51.53 min in the PLIF group and 197.47 ± 31.84 min in the XLIF group. No significant differences were found, but there was significantly difference in the intraoperative blood loss (PLIF group: 576.52 ± 227.89 ml, XLIF group: 181.33 ± 47.37 ml, t=-8.054, P0.05). Conclusion Treatment of degenerative lumbar scoliosis with XLIF through small incision approach combined with percutaneous pedicle screw fixation is a kind of safe and effective minimally invasive spine surgery with small trauma and less bleeding, and the recent surgery efficacy was close to PILF.
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Objective To explore the early clinical efficacy of posteromedial approach for treatment of posterior bicondylar tibial plateau fractures.Methods From October 2010 to December 2013,data of 13 patients of posterior bicondylar tibial plateau fracture who were treated with plate and screw fixation through posteromedial approach were retrospectively analyzed.There were8 males and 5 females,in which 7 cases located in the left knee and 6 cases located in the right knee,with an average age of 41.5±6.6 years.An inverted L shaped posteromedial incision was made in the operation.If the fracture line was involving the posteromedial condyle,a locking anatomical plate or L shaped compression plate was used.A 3.5 mm T shaped plate was used to support the posterolateral condyle.Allogeneic bone was used to support the articular surface in the cases with obvious bone defect.Rasmussen score was used for radiological assessment,and HSS knee score was used for efficacy assessment 12 months postoperative.An anteroposterior view and lateral view of the knee were obtained 2,4,12 weeks,6 months and 12 months postoperation.The fracture healing time was judged by X-ray and clinical examinations,additionally,the complications and corresponding outcomes were also recorded.Results All 13 patients had obtained an average of 20.8±9.4 months follow-up (range,8-34 months),and all fractures were healed.The healing time in terms of X-ray was 12 to 24 weeks (mean,15.6±5.2 weeks).After surgery,the Rasmussen score was 1-18 points (mean 15.8 points).7 cases achieved excellent results,4 good,and 2 fair.The excellent and good rate was 84.6％.HSS knee score improved significantly from 38.2±7.8 points (range,26-48 points) to 85.2±7.8 points (range,56-92 points) 12 months postoperation,and the results was excellent in 9 cases,good in 2,fair in 1 and poor in 1,with total excellence and good result of 84.6％.The range of knee activity was 95°-130°.None of the skin and soft tissue complications such as infection,breakage of screw loosening occurred at the time of the latest follow-up,but two cases got chronic pain in the knee postoperation.In the follow-up period,a mild knee gap narrows had been observed in one patient and traumatic arthritis was diagnosed.The pain was partial relieved by oral non-steroidal drugs and intra-articular injection of Sodium Hyaluronate.The other one's pain was significantly relieved by oral non-steroidal drugs,and X ray film shows the knee joint gap has no obvious narrow.Conclusion Posteromedial approach for treatment of posterior bicondylar tibial plateau fractures can obtain a satisfactory therapeutic effect.
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Objective To explore the effect of airway humidification on lung injury as a result of mechanical ventilation with different tidal volume(VT). Methods Twenty-four male Japanese white rabbits were randomly divided into four groups:low VT with airway humidification group,high VT with airway humidification group,low VT and high VT group without humidification,with 6 rabbits in each group. Mechanical ventilation was started after intubation and lasted for 6 hours. Low VT denoted 8 mL/kg,while high VT was 16 mL/kg,fraction of inspired oxygen (FiO2)denoted 0.40,positive end-expiratory pressure(PEEP)was 0. Temperature at Y piece of circuit in airway humidification groups was monitored and controlled at 40℃. Arterial blood gas analysis,including pH value,arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2),lung mechanics indexes, including peak airway pressure(Ppeak)and airway resistance(Raw),and lung compliance was measured at 0,2,4, 6 hours of mechanical ventilation. The levels of tumor necrosis factor-α(TNF-α)and interleukin-8(IL-8)in plasma and bronchoalveolar lavage fluid(BALF)were determined by enzyme linked immunosorbent assay(ELISA). The animals were sacrificed at the end of mechanical ventilation. The wet to dry(W/D)ratio of lung tissues was calculated. Histopathologic changes in the lung tissueies were observed with microscope,and lung injury score was calculated. Scanning and transmission electron microscopies were used to examine the integrity of the airway cilia and the tracheal epithelium. Results Compared with low VT group,pH value in high VT group was significantly increased,PaCO2 was significantly lowered,and no difference in PaO2 was found. Ppeak,Raw,and lung compliance were significantly increased during mechanical ventilation. There were no significant differences in blood gas analysis and lung mechanics indexes between low VT with airway humidification group and low VT group. Compared with high VT group,PaCO2 in high VT with airway humidification group was significantly decreased,Ppeak raised obviously,and no difference in pH value,PaO2,Raw and pulmonary compliance was found. Compared with low VT with airway humidification group,no difference in blood gas analysis(PaCO2,mmHg,1 mmHg=0.133 kPa)was found,but Ppeak(cmH2O,1 cmH2O=0.098 kPa),Raw(cmH2O),and lung compliance(mL/cmH2O)were increased significantly in high VT with airway humidification group(PaCO2 at 2 hours:27.96±4.64 vs. 36.08±2.11,4 hours:28.62±2.93 vs. 34.55±5.50, 6 hours:29.33±2.14 vs. 35.01±5.53;Ppeak at 0 hour:14.34±1.97 vs. 8.84±1.32,2 hours:17.33±0.52 vs. 11.17±2.14,4 hours:17.83±0.98 vs. 12.67±2.06,6 hours:18.67±1.22 vs. 13.50±2.16;Raw at 0 hour:37.36±5.14 vs. 27.05±2.93,2 hours:43.94±6.58 vs. 31.95±3.56,4 hours:48.04±6.07 vs. 35.24±3.50, 6 hours:50.33±6.34 vs. 36.66±3.64;pulmonary compliance at 6 hours:2.28±0.18 vs. 1.86±0.37,all P0.05). Microscopic observation showed that cilia were partially detached,adhered and sparse in low VT group,while cilia in high VT group showed serious detachment and lodging. Remaining cilia were sparse,with lodging,and cellular structure was damaged. Lung tissue pathological injury score in the high VT group was significantly higher than that of low VT group(6.17±2.14 vs. 3.50±1.52,P0.05). Cilia were severely detached,adhered and lodging,and cellularity were not obvious in high VT with airway humidification group,and lung tissue pathological injury score was elevated significantly than that of the low VT with airway humidification group but without statistically significant difference(5.17±2.14 vs. 3.00±1.10,P>0.05). TNF-α and IL-8 concentrations showed no change in plasma and BALF in all groups during ventilation,and no significant difference was found among the groups. Conclusions Airway humidification can alleviate pathological lung injury,damage of cilia and cellular structure in trachea caused by mechanical ventilation with low and high VT. High VT with humidification can result in serious pulmonary edema.
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[Objective]To evaluate clinical results of videoassisted thoracoscopic anterior spine release combined with anterior or posterior correction of adolescent idiopathic scoliosis(AIS).[Method]Eleven cases of received video-assisted thoracoscopic anterior spine release followed by anterior or posterior instrumentation from July 2003 to December 2005 were reviewed.The average age at surgery was 14.6 years(ranged from 12 to 16 years).There were nine cases of Lenke type Ⅰ with average preoperative Cobb's angle of 59.7?(ranged from 54? to 68?),and two cases of Lenke type Ⅲ,with average preoperative Cobb's angle of 64.5?(ranged from 58?to 71?).The correction rate of thoracic curves in bending film averaged 26.4%(ranged from 21.8% to 32.4%).All 11 patients underwent release via endoscopic anterior resection of intervertebra disc through radiofrequency,and anterior or posterior correction.The coronal and sagittal Cobb's angle after surgery,and at follow-up were measured.The operative time,intraoperational blood loss,peri-operative complications and loss of carrection were analyzed.[Result]The average operation time was 4 hours and 50 min.The blood loss during surgery averaged 171 ml.The average number of released levels was 4.4(ranged from 5 to 7).The average postoperative Cobb's angle of 9 cases of Lenke type Ⅰ was 20.4? with curve correction rate of 65.5%.Postoperative Cobb's angles of 2 cases of Lenke type Ⅲ were 20? and 25?,the correction rate of thoracic curve averaged 65.1%.One patient developed thoracic effusion.The average follow-up period was 18.6 months,only one of them with loss correction of 14?.No neurologic or vascular complication occurred.[Conclusion]Compared to the open anterior surgery,video-assisted thoracoscopic anterior spinal release is a safe and effective treatment for idiopathic scoliosis.It can avoid complications incurred by traditional thoracic surgery.It has satisfactory clinical results compared to conventional thoracotomic release for AlS.