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Objective:To compare the clinical efficacy of robot-assisted percutaneous screw implantation and free-hand open screw implantation by Wiltse approach in the treatment of thoracolumbar fracture.Methods:A retrospective cohort study was performed to analyze the clinical data of 71 patients with thoracolumbar fracture admitted to Second Affiliated Hospital of Soochow University from May 2018 to May 2020. There were 52 males and 19 females, with age range of 22-54 years［(41.0±7.8)years］. Of all, 33 patients were treated with robot-assisted percutaneous screw implantation (Group A) and 38 patients were treated with free-hand open screw implantation by Wiltse approach (Group B). Following parameters were measured, including frequency of radiation exposure, operation time, intraoperative blood loss, length of hospital stay, incidence of complications, rate of fracture healing at 3 months and 6 months postoperatively, visual analogue scale (VAS) and Oswestry dysfunction index (ODI) at 3 days, 3 months, 6 months postoperatively and at the last follow-up, anterior vertebral body height ratio and sagittal Cobb angle preoperatively, at 3 days postoperatively and at the last follow-up, and rate of screw implantation of grade A and B and rate of facet joint violation at 3 days postoperatively.Results:All patients were followed up for 10-24 months［(15.2±4.4)months］. Frequency of radiation exposure and operation time showed no statistical differences between the two groups (both P>0.05). Intraoperative blood loss was 100(100, 135)ml in Group A, less than 160(120, 200)ml in Group B ( P<0.01). Length of hospital stay was 8(7, 11) days in Group A, shorter than 12(10, 16)days in Group B ( P<0.01). There were no complications such as infection, spinal nerve injury or cerebrospinal fluid leakage in both group. There were no significant differences between the two groups in the rate of fracture healing at 3 and 6 months postoperatively (all P>0.05). VAS and ODI in Group A was 3(2, 4)points and 21(18, 23)points at 3 days postoperatively, lower than 4 (3, 5)points and 27(20, 32)points in Group B ( P<0.05 or 0.01), and the two groups showed no significant differences in VAS and ODI at other time points (all P>0.05). There were no significant difference in the anterior vertebral body height ratio or sagittal Cobb angle between the two groups at 3 days postoperatively and at the last follow-up (all P>0.05). Rate of screw implantation of grade A and B was 96.5% (191/198) in Group A, higher than 90.4% (206/228) in Group B ( P<0.05). Rate of facet joint violation was 4.0%(8/198) in Group A, lower than 11.8% (27/228) in Group B ( P<0.01). Conclusion:For thoracolumbar fracture, robot-assisted percutaneous screw implantation is superior to free-hand open screw implantation by Wiltse approach in terms of less bleeding, shorter hospitalization, earlier pain alleviation, higher accuracy of screw implantation and lower risk of facet joint violation.
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This article aims to study the factors affecting the flexibility of the tip of an epidural anesthesia catheter. The flexibility of the tip of the epidural anesthesia catheter was tested with a softness tester from four aspects:raw materials, tip structure, tip processing technology, and the outer diameter of the catheter. Highly flexible and malleable polymer material with a smooth tip, the tip softening process and the proper outer diameter can effectively improve the tip flexibility of the epidural anesthesia catheter.
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Anesthesia, Epidural , Catheterization , Catheters , Epidural SpaceABSTRACT
Objective:To evaluate the effect of zoledronic acid administration for osteoporotic vertebral compression fracture (OVCF) after treatment with percutaneous kyphoplasty (PKP).Methods:A retrospective case-control study was performed on 430 elderly patients with OVCF admitted to the Second Affiliated Hospital of Soochow University from January 2012 to December 2016. There were 31 males and 399 females, with age of 52-92 years[(72.8±8.3)years]. Fracture segments were at T 5-T 10 (82 vertebrae), T 11-L 2 (389 vertebrae) and L 3-L 5 (173 vertebrae). In zoledronic acid group ( n=178), patients were given zoledronic acid 3 days after PKP surgery. In basic treatment group ( n=252), patients were only given basic treatment after PKP surgery. Bone mineral density was measured before operation and one year after operation. Visual analogue scale (VAS) and Oswestry disability index (ODI) were assessed before operation, 3 days and one year after operation. Incidence rate of refracture, mortality and complication rate were recorded after operation. Results:All patients were followed up for 12-60 months (mean, 27 months). Before operation and at postoperative 1 year, the vertebral bone mineral density in zoledronic acid group was (-2.3±1.5)SD and (-1.2±2.3)SD ( P<0.05), and that in basic treatment group was (-2.2±1.2)SD and (-2.1±1.1)SD ( P>0.05). At postoperative 1 year, the bone mineral density in zoledronic acid group was significantly better than that in basic treatment group ( P<0.05). At preoperative 3 days, postoperative 3 days and postoperative 1 year, the VAS was (8.6±0.8)points, (2.8±0.8)points, (2.1±0.8)points in zoledronic acid group, and was (8.5±1.1)points, (2.9±0.9)points, (3.0±2.3)points in basal treatment group; ODI was 48.7±5.3, 24.0±2.9, 22.3±3.3 in zoledronic acid group, and was 48.3±6.1, 24.5±3.8, 27.6±4.0 respectively in basal treatment group. The VAS and ODI were significantly reduced in two groups at postoperative 3 days and 1 year compared to those before operation ( P<0.05). Moreover, the VAS and ODI in zoledronic acid group were significantly lower than those in basal treatment group at postoperative 1 year ( P<0.05). At postoperative 2 years, the incidence rate of refracture in zoledronic acid group was 10.1%(18/178), significantly lower than 16.7%(43/252) in basic treatment group ( P<0.05). Mortality rate in zoledronic acid group was 5.1%(9/178), and that in basic treatment group was 6.3%(16/252) ( P>0.05). No serious complications were observed in both groups such as nerve injury or pulmonary embolism. Conclusion:For OVCF patients, zoledronic acid given after PKP can improve the bone mineral density, reduce pain, fasten function recovery, and effectively decrease the refracture rate.
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To introduce a case of nasal sound after alar base reduction. The patient was an 78-year-old female who came to the Hangzhou’s First Hospital(Nanjing Medical University Affiliated Hangzhou Hospital)because of the conscious feeling of nasal fat hypertrophy. The diagnosis was nasal atrophy, and nasal sounds were produced after the alarization was reduced while the wound heals good. The symptoms were not significantly improved after 6 months of follow-up, suggesting that there is a possibility of nasal noise after nasal augmentation. Therefore, when performing the alar reduction, attention should be paid not only to the nasal shape, but also to the nasal function.
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Objectives To investigate the efficiency and safety of ultrasound-guided microwave ablation (MWA) for hepatocellular carcinoma (HCC) adjacent to danger areas.Methods The 106 patients with HCC treated by ultrasound-guided MWA were retrospectively included in our study.There were 149 lesions in total,including 8 lesions adjacent to gallbladder,33 lesions adjacent to grade Ⅰ-Ⅱ bile duct,39 lesions adjacent to diaphragm,28 lesions adjacent to gastrointestinal tract and 41 lesions adjacent to hepatic capsule.The mean diameter of the tumors was (2.04 ±0.92)cm.Individualized treament strategies for different sites of the tumors were conducted.The early complete ablation rate of the tumors was assessed by enhanced computed tomography (CT) or magnetic resonance imaging (MRI) one month later and followed up regularly.Results The total inactivation rate was 89.9％.The early complete ablation rates of adjacent gallbladder,adjacent grade Ⅰ-Ⅱ bile duct,adjacent diaphragm,adjacent gastrointestinal tract and adjacent hepatic capsule were 100％,84.8％,89.7％,92.9％,90.2％ respectively.The local progression rates were 0,15.2％,10.3％,7.1％,9.8％,respectively.The 1-,2-and 3-year survival rates were 91.6％,85.8％ and 74.5％.Total cases were ablated 149 times.Serious complications accounted for 6.6％,including diaphragm injury,needle implantation,abdominal hemorrhage,severe infection,bile tumors.Conclusions Our study presented a novel individualized treament strategies using MWA in HCC patients.The individualized scheme effectively boosted the complete ablation rate of tumors and significantly improve the clinical outcome of HCC patients.
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Objective: To describe the applications and effects of electromagnetic navigation [EN] technology in distal locking for the treatment of long diaphyseal fracture [LDF] with interlocking intramedullary nailing [IIN]
Study Design: An interventional study
Place and Duration of Study: The Second Affiliated Hospital of Soochow University, China, from March 2013 to July 2014
Methodology: Patients who underwent IIN-LDF were selected. Twenty-four [50%] of whom were operated under EN guidance [group A] and the other 24 [50%] under conventional targeting guidance [group B]. The distal locking time and X-ray irradiation time of the two groups were compared
Results: Each group included 16 [33.3%] cases of femoral fracture and 8 [16.7%] cases of tibial fracture. The success rate of distal locking in group A was higher than that in group B [95.8% vs. 83.3%, p=0.045]. There were statistically significant differences in the distal locking time and X-ray irradiation time of femoral intramedullary nailing between the two groups [p=0.027 and p=0.001, respectively]. There were no statistically significant differences in the distal locking time and X-ray irradiation time of tibial intramedullary nailing between the two groups [p=0.347 and p=0.056, respectively]
Conclusion: EN-IN was advantageous as it enabled easy targeting, significantly reduced intraoperative fluoroscopy and operation time and small trauma and had other advantages when used for treating LDFs, especially femoral diaphyseal fractures