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Objective@#To explore the application value of virtual touch tissue imaging quantification(VTIQ) technology in initial polymyositis(PM).@*Methods@#Sixteen PM patients collected from February 2016 to March 2019 in Wenzhou People′s Hospital were selected as PM group, and 33 healthy subjects as healthy control group. After gray and color Doppler ultrasound, the shear wave velocity(SWV) values of target muscle and control muscle in the same side of affected limb were measured by VTIQ technique. Maximum velocity(Vmax) and minimum velocity(Vmin) were measured, average velocity(Vmean) and standard deviation(SD) were calculated, and compared between the two groups. SWV difference and ratio between target muscle and control muscle were calculated, and creatine kinase(CK) was detected in the same day.@*Results@#Part of PM patients had abnormal ultrasonographic manifestations of full muscle shape (31.25%), increased or decreased echo of muscle bundles (56.25%), blurred muscle texture (25.00%) and increased blood flow signals (37.50%). There were significant differences in Vmin, SD, and Vmax difference, Vmin difference, Vmean difference, and Vmax ratio, Vmin ratio, and Vmean ratio between PM group and healthy control group (all P<0.01). The ROC curve analysis showed that the diagnostic efficiency of Vmin was lower than those of Vmin difference and Vmean difference, Vmin ratio and Vmean ratio with very close diagnostic efficiencies of the latter four parameters. The correlation analysis showed that Vmin difference and Vmean difference were moderately correlated with CK value(r=0.512, 0.601; all P<0.05).@*Conclusions@#Reduced VTIQ values or relative reduction of VTIQ values compared with other non-involved muscles are the manifestations of initial PM, VTIQ have certain diagnostic efficacy for initial PM.
ABSTRACT
Objective:To explore the clinical effects of endoscopic sinuvertebral nerves neurotomy for discogenic low back pain.Methods:Based on the anatomical research of sinuvertebral nerves, a total of 40 patients, including 9 males and 21 females aged 35±10 (24-55) years, with single-segment discogenic low back pain were treated with endoscopic sinuvertebral nerves neurotomy in our hospital from July 2018 to February 2019. The operating section included 4 cases of L 3,4 (10.0%, 4/40), 31 cases of L 4, 5 (77.5%, 31/40), and 5 cases of L 5S 1 (12.5%, 5/40). The preoperative visual analogue scale (VAS) score was 4.5±0.9 with the preoperative Oswestry disability index (ODI) score 49.7%±14.0%. For diagnostic nerves block, lidocaine (0.1-0.3 ml of 0.05 g/L) was successfully injected into the intersection of the lateral edge of the bilateral pedicle projection and the upper edge of the intervertebral disc projection. The initial segment of the sinuvertebral nerves was destroyed by a radiofrequency blade or a nerve dissector after bilateral percutaneous transforaminal endoscopic. All cases were followed up at 1, 3, 6 and 12 months after surgery, observing the changes in VAS and ODI. Results:Filamentous lumbar sinuvertebral nerve was observed under endoscope with its main trunk tranversed into the spinal canal against the intervertebral disc. The deputy trunk crossed at the posterolateral edge of the intervertebral disc and entered the intervertebral disc or the posterior edge of the vertebral body. By moving along with postcentral branches of spinal artery, the main trunk of sinuvertebral nerve was with tension and was capable of moving with the nerve root. In spite of moving the working channel along the main trunk of the sinuvertebral nerve laterally, the starting point of the sinuvertebral nerve at the ventral ganglion could be observed. All 40 patients successfully completed the sinuvertebral nerve destruction. The VAS was reduced to 1.7±0.9, 1.3±0.9, 1.2±0.8, 1.3±0.7 at 1, 3, 6 and 12 months after sugery respectively, which were significantly lower than those at pre-operation ( F=116.7, P=0.00). The improvement rate of VAS in 40 cases was 68.9%± 17.1% (33.3%-100.0%) at 12 months after operation. The VAS score in 6 cases was higher at 12 months after surgery than that preoperatively ( t=4.2, P=0.48), namely 1 case of L 3, 4, 2 cases of L 4, 5, and 3 cases of L 5S 1. In all cases, the ODI was reduced to 18.3%±5.2%, 14.5%±4.3%, 13.6%±3.7%, 12.8%±3.0% points at 1, 3, 6 and 12 months after surgery respectively, which were significantly lower than those before surgery ( F=237.7, P=0.00). The improvement rate of ODI was 72.0%±11.6% (33.3%-88.9%) at 12 months after surgery in all cases. Conclusion:The destruction of sinuvertebral nerve after transforaminal endoscope could improve the pain and function in patients with discogenic low back pain at L 3,4 and L 4, 5 segments within 12 months. For patients with discogenic low back pain at L 5S 1 segment, the clinical effects could be better within 6 months.
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Objective:To explore the application value of virtual touch tissue imaging quantification(VTIQ) technology in initial polymyositis(PM).Methods:Sixteen PM patients collected from February 2016 to March 2019 in Wenzhou People′s Hospital were selected as PM group, and 33 healthy subjects as healthy control group. After gray and color Doppler ultrasound, the shear wave velocity(SWV) values of target muscle and control muscle in the same side of affected limb were measured by VTIQ technique. Maximum velocity(Vmax) and minimum velocity(Vmin) were measured, average velocity(Vmean) and standard deviation(SD) were calculated, and compared between the two groups. SWV difference and ratio between target muscle and control muscle were calculated, and creatine kinase(CK) was detected in the same day.Results:Part of PM patients had abnormal ultrasonographic manifestations of full muscle shape (31.25%), increased or decreased echo of muscle bundles (56.25%), blurred muscle texture (25.00%) and increased blood flow signals (37.50%). There were significant differences in Vmin, SD, and Vmax difference, Vmin difference, Vmean difference, and Vmax ratio, Vmin ratio, and Vmean ratio between PM group and healthy control group (all P<0.01). The ROC curve analysis showed that the diagnostic efficiency of Vmin was lower than those of Vmin difference and Vmean difference, Vmin ratio and Vmean ratio with very close diagnostic efficiencies of the latter four parameters. The correlation analysis showed that Vmin difference and Vmean difference were moderately correlated with CK value( r=0.512, 0.601; all P<0.05). Conclusions:Reduced VTIQ values or relative reduction of VTIQ values compared with other non-involved muscles are the manifestations of initial PM, VTIQ have certain diagnostic efficacy for initial PM.
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BACKGROUND:Studies have shown that limited lumbar discectomy can harvest better clinical efficacy, but also face a higher risk of recurrence. In clinic, how to guarantee access to good effect, and meanwhile to reduce the probability of recurrent disc herniation? The annulus repair technology may be an effective way, but it is rarely reported. OBJECTIVE:To investigate the early clinical effects of endoscopic lumbar discectomy associated with annulus repair in the treatment of lumbar disc herniation. METHODS: Totaly 224 patients with lumbar disc herniation who accepted discectomy surgery were selected from the Department of Spinal Surgery, the Third Affiliated Hospital of Southern Medical University from January 2011 to January 2013, including 56 cases of microendoscopic discectomy associated with annulus repair (repair group) and 168 cases of microendoscopic discectomy (control group). Oswestry disability index and visual analog scale scores for lumbago and lower limb pain were recorded before and at 10 days, 3 months, 6 months, 12 months and 18 months after operation. Simultaneously, operative time, blood loss, surgical complications, and postoperative recurrence of lumbar disc herniation were recorded. RESULTS AND CONCLUSION:In the repair group, only 51 patients completed the folow-up, while al the patients in the control group completed the folow-up. There was no difference between the repair and control groups before and after surgery in the Oswestry disability index and visual analog scale scores for lumbago and lower limb pain (P > 0.05), but at 10 days after surgery, the Oswestry disability index and visual analog scale scores for lumbago and lower limb pain were significantly decreased in the repair group (P < 0.05), and this trend continued until the 18th month after surgery. There were no dural tears, disc space infection, hematoma formation in the spinal canal and other serious complications. The recurrence rate was 9.5% in the control group and 3.9% in the repair group. 31.2% of relapsed patients in the control group received the second operation, while on patient in the repair group received reoperation. These findings indicate that microendoscopic discectomy associated with annulus repair can obtain remarkable early clinical results, and effectively reduce the recurrent rate and risk of secondary lumbar disc surgery, which is safe and reliable.