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The method of scoping review was used to systematically search and sort out the clinical research of oral Chinese patent medicines for ischemic stroke，to understand the scope of relevant research and the distribution of evidence. Three medical catalogs were manually searched to obtain the oral Chinese patent medicines used for ischemic stroke，and 7 databases were retrieved to obtain the clinical research including these oral Chinese patent medicines. Then the clinical evidence results were visualized by description combined with chart analysis. A total of 68 oral Chinese patent medicines were retrieved，and 1 392 articles were included，with 367 published in core journals， involving 35 oral Chinese patent medicines. The research types included randomized controlled trials，cohort studies，case series，case reports，secondary studies，adverse drug reaction reports，pharmacoeconomic evaluations，drug interactions，consensus or guidelines，non-randomized intervention studies and cross-sectional studies，of which randomized controlled trials had the largest number （283， 77.1%），followed by secondary studies and case series （25， 6.7% for each）. Among the 283 randomized controlled trials，there were 159 clinical studies in the acute phase of ischemic stroke，65 in the non-acute phase，and 59 in the unclear phase. Ten intervention control types and 20 outcome index types were summarized. Among them， the composite outcome index and surrogate outcome index were used 217 times （76.7%） and 245 times （86.6%）， respectively，followed by the degree of neurological impairment （three scales）. Future clinical research of oral Chinese patent medicines for ischemic stroke should clarify the stage of the disease，and the research design should specify the advantages of oral Chinese patent medicines intervening in ischemic stroke. Furthermore， publicly-recognized positive controls should be employed，and important clinical outcome indexes should be selected.
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Objective To summarize the clinical features of patients with Wilson's disease (WD). Methods A retrospective analysis was performed for the clinical data of 83 patients with WD who were admitted to The Third Hospital of Hebei Medical University from April 2013 to August 2021, including clinical manifestations, Imaging examinations, laboratory examinations, liver histopathological examinations, and ATP7B gene testing results. The patients were divided into groups based on different clinical types. A one-way analysis of variance was used for comparison between groups. Results The youngest age was 3 years for the 83 patients with WD, among whom 39 (46.99%) had an age of ≤18 years, with a mean age of 21.16±14.87 years for all 83 patients. Of all patients, 63.86% had liver-type WD, 31 patients (37.35%) had developed liver cirrhosis at the time of consultation, and 5 patients (6.2%) attended the hospital due to acute or acute-on-chronic liver failure. Of all patients, 62(74.69%) were positive for corneal K-F ring, and the positive rate of K-F ring was 66.04% in the patients with liver-type WD. Among the 83 patients, 79(95.18%) had a reduction in blood ceruloplasmin, and 73(87.95%) had an increase in 24-hour urine copper. The liver histopathological results of 25 patients showed varying degrees of inflammation, fibrosis, steatosis, and copper particle deposition in liver tissue. The ATP7B gene testing results of 25 patients showed that c.2333G > T/p.R778L of exon 8 was the most common mutation site. Conclusion Most patients with WD have the manifestation of liver diseases, and the examinations of corneal K-F ring, serum ceruloplasmin, and 24-h urine copper have their own limitations. Liver pathology and ATP7B gene testing can be performed when it is unable to make a confirmed diagnosis.
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Objective To investigate the clinical and pathological features of children with glycogen storage disease (GSD). Methods A retrospective analysis was performed for ten children with GSD who were admitted to the Third Hospital of Hebei Medical University and The Fifth Medical Center of Chinese PLA General Hospital from January 2002 to January 2022, based on medical history, liver biochemistry, and liver biopsy, and population characteristics, clinical manifestations, biochemical parameters, and liver histopathological characteristics were compared and analyzed. Results All ten children had developmental retardation and a short stature, with the manifestations of abnormal liver function, mild weakness, poor appetite, yellow urine, and yellow eyes, and four children had hepatosplenomegaly. Among the ten children, six had the clinical manifestations of hypoglycemia, and one had bilateral gastrocnemius hypertrophy and positive Gower sign. Two children had positive CMV IgG. Liver histopathological manifestations included diffuse enlargement of hepatocytes, light cytoplasm, and small nucleus in the middle like plant cells, with or without fibrous tissue proliferation. Conclusion Most patients with GSD have developmental retardation and abnormal aminotransferases, and liver pathological examination shows specific pathological features.
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Objective:To investigate the efficacy of the novel bone cement bridging screw system combined with percutaneous vertebroplasty (PVP) in the treatment of symptomatic chronic osteoporotic vertebral fractures (SCOVF) with intravertebral vacuum cleft (IVC).Methods:A retrospective case series study was used to analyze the clinical data of 27 patients with SCOVF admitted to Honghui Hospital affiliated to Xi′an Jiaotong University from August 2016 to August 2018, including 6 males and 21 females; age 69-88 years [(75.2±4.9)years]. All patients were treated by the novel bone cement bridging screw combined with PVP. The operation time, amount of bone cement injected and occurrence of bone cement leakage or displacement were recorded. The vertebral body index (VBI), vertebral body angle (VBA), two-segment Cobb angle (BCA), visual analogue score (VAS) and Oswestry disability index (ODI) were compared preoperatively, at day 1 after operation and at the last follow-up. The results of the MOS 36-item short form health survey (SF-36) and Odom′s criteria were compared preoperatively and at the last follow-up to evaluate pain relief and neurological recovery.Results:All patients were followed up for 36-48 months [(40.2±3.7)months]. The operation time was 37-70 minutes [(49.6±10.8)minutes], with the amount of bone cement injected for 3-6 ml [(34.7±0.9)ml]. Intraoperative bone cement leakage occurred in 4 patients (15%), among which 3 had lateral vertebral leakage and 1 superior intervertebral disc leakage. There was no bone cement displacement during the postoperative period to the last follow-up. The VBI, VBA, BCA, VAS and ODI were (43.1±5.9)%, (21.0±2.6)°, (45.0±6.3)°, 7.6 (7.0, 8.0)points, (79.9±7.6)% preoperatively, were (78.7±2.6)%, (12.7±2.1)°, (26.1±4.7)°, 3.2 (3.0, 4.0)points, (50.0±9.3)% at day 1 after operation, and were (78.0±2.3)%, (13.2±2.4)°, (27.1±4.9)°, 2.0 (2.0, 2.0)points, (22.9±5.1)% at the last follow-up. There were significant differences in above five measures at day 1 after operation and at the final follow-up in comparison with the preoperative values (all P<0.05), and their values measured at day 1 after operation and at the final follow-up were also significantly different (all P<0.05). The SF-36 score in physical function, role physical, body pain, vitality and social function was 45.2 (40.0, 50.0)points, 28.7 (25.0, 50.0)points, 15.9 (10.0, 22.0)points, 48.3 (40.0, 60.0)points, 29.2 (25.0, 37.5)points preoperatively, significantly different from 78.0 (75.0, 85.0)points, 75.0 (75.0, 75.0)points, 68.1 (64.0, 74.0)points, 62.0 (55.0, 70.0)points, 34.7 (25.0, 37.5)points at the last follow-up (all P<0.05). However, there were no significant differences in SF-36 before operation and at the last follow-up in dimensions of general health, emotional function and mental health (all P>0.05). According to Odom′s criteria, 19 patients were graded as excellent, 7 good, 1 fair and 0 poor, with an excellent and good rate of 96%. Conclusion:For SCOVF patients with IVC, the novel bone cement bridging screw system combined with PVP has advantages of no displacement of bone cement, satisfactory fixation, significant pain relief and satisfactory functional recovery.
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Osteoporotic vertebral compression fracture (OVCF) is a kind of fragility fracture, and osteoporotic thoracolumbar fracture (OTLF) is the most common type. At present, OTLF has gradually been a common disease in the elderly, among which improper treatments may cause serious complications and even death, bringing a heavy burden to the family and society. Accordingly, in-depth researches on the prevention and treatment of this disease is significant to improve the quality of life for the elderly and reduce social burden. Accurate choices of treatments depend on fracture classifications. A variety of OTLF classifications have been proposed by domestic and foreign scholars, but each has its own defects, and to distinguish their differences may be problematic. Therefore, it is difficult to apply each classification. In this study, the authors review the research progress in different classification and scoring sytems for OTLF to provide a reference for clinical diagnosis and treatment.
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Osteoporosis is a type of chronic disease characterized by increased bone fragility caused by destruction of bone microstructure and high risk of vertebral compression fractures. Previous researches show hyperactive bone resorption caused by abnormal activity of osteoclasts is highly related to osteoporosis. Icariin, a traditional Chinese medicine monomer, has been reported to have a biological effect in regulating osteoclast signaling pathway RANK/RANKL/OPG. It also can participate in the regulation of multiple stages of osteoclast differentiation. These results suggest icariin has an important role in regulating osteoclast differentiation and bone erosion. The authors systematically review the related researches on the mechanism of icariin in regulating osteoclast differentiation, in order to provide new ideas for osteoporosis-targeted treatment for osteoporosis.
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Objective:To discuss the curative effect between direct decompression and indirect decompression plus lumbo-iliac fixation for treatment of Denis type II sacrum fracture combined with sacral foraminal bone space-occupying lesion and sacral nerve injury.Methods:A retrospective case-control study was performed on clinical data of 47 patients with Denis type II sacrum fracture combined with sacral foraminal bone space-occupying lesion and sacral nerve injury admitted to Honghui Hospital Affiliated to Xi'an Jiaotong University School of Medicine from March 2012 to March 2017. All patients underwent lumbo-iliac internal fixation. The operation time ranged from 3 to 14 days after injury, with an average of 6 days. In direct decompression group ( n=26), the sacral foramina mass was removed during the operation and direct decompression was performed. There were 16 males and 10 females, with age of (36.2±8.4)years. In indirect decompression group ( n=21), indirect decompression through traction and distraction was performed. There were 11 males and 10 females, with the age of (38.7±9.8)years. Operation time, intraoperative blood loss, bone union, Mears imaging evaluation, Gibbons score, and Majeed function score were compared between the two groups. Postoperative complications were observed as well. Results:All patients were followed up for 1233 months, with an average of 16.7 months. The operation time and intraoperative blood loss in direct decompression group were (112.3±26.3)minutes and (512.1±29.4)ml, which had no significant differences in comparison with that in indirect decompression group [(129.3±25.1)minutes and (529.7±22.1)ml] ( P>0.05). Bone union was observed in all patients. According to the Mears imaging evaluation, the direct decompression group had anatomical reduction in 17 patients, and satisfactory reduction in 9, and the indirect decompression group had anatomical reduction in 15 patients and satisfactory reduction in 6 ( P>0.05). At the last follow-up, Gibbons score in direct decompression group was lower than that in the indirect decompression group [(1.2±0.3)points vs. (2.2±0.5)points] ( P<0.01); Majeed function score in direct decompression group was higher than that in indirect decompression group [(87.3±11.4)points vs. (68.5±16.7)points] ( P<0.01). In direct decompression group, 1 patient had deep wound infection, while in indirect decompression group, 1 patient had pressure sore due to the protrusion of the tail of the iliac screws on the skin. Conclusion:For Denis type II sacrum fracture combined with sacral foraminal bone space-occupying lesion and sacral nerve injury, direct decompression with lumbo-iliac fixation can obtain better neural functional recovery and functional recovery of life compared with the indirect decompression.
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Vertebral body augmentation for spine-related diseases has the advantages of minimally invasive surgery,obvious postoperative pain relief,and quick postoperative recovery compared with open surgery.It can quickly reconstruct spinal stability,relieve pain,and improve patients' quality of life.Intraoperative injection of bone cement into the diseased vertebral body carries the risk of bone cement leakage during the process.Knowing well the complications is helpful to the timely clinical treatment so as to avoid delays,and understanding the risk factors can facilitate targeted measures to prevent leakage during surgery.Therefore,to understand the consequences of bone cement leakage,leakage incidence rate,related risks factors and preventative measures is conducive to clinical treatment and surgery safety.The authors discuss the complications and risk factors related to bone cement leakage after vertebral body augmentation,in order to deepen the understanding of bone cement leakage,provide reference for clinical work,and improve the safety of surgery.
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Objective To evaluate the feasibility of using gelatin sponge to reduce bone cement leakage in percutaneous vertebroplasty (PVP).Methods A retrospective case control study was conducted to analyze the 191 patients (191 vertebrae) with lumbar osteoporosis vertebrae compression fractures (OVCF) who were treated by PVP from October 2014 to October 2017 in Xi'an Honghui Hospital.There were 52 males and 139 females,aged 65-91 years,with an average of 75.1 years.A total of 48 patients were treated with routine PVP,and bone cement was injected directly after puncture (Group A).A total of 47 patients,49 patients and 47 patients were injected with 1/4,1/3 and 1/2 gelatin sponge before bone cement injection respectively (Group B,Group C and Group D).Postoperative routine X-ray and CT scans were used to compare the amount of bone cement injection,the leakage of bone cement,the visual analogue score (VAS),neurological symptoms and complications before and after operation.Results All patients were followed up for 1-12 months,with an average of 3.6 months.There were no significant differences in the amount of bone cement injection after operation between groups (P ＞ 0.05).There was a significant difference in the cement leakage rate among the groups after operation [Group A:42％ (20/48);Group B:40％ (19/47);Group C:14％ (7/49);Group D:13％ (6/47)] (P ＜ 0.05).The results of pairwise comparison of bone cement leakage rate were as follows:significant differences were found between Group A and Group C as well as between Group A and Group D (P ＜ 0.008 3),but no significant difference was found between Group A and Group B (P ＞ 0.008 3);significant differences were found between Group B and Group C as well as between Group B and Group D (P ＜ 0.008 3),but no significant difference was found between Group C and Group D (P ＞ 0.05).There were no significant differences in VAS among the groups (P ＞ 0.05);VAS was significantly improved after operation within each group (P ＜ 0.05).After operation,two patients had persistent lower back pain and one patient had intraspinal leakage.Wound healing was found in all patients,with no neurological symptoms.Conclusion For OVCF,use of 1/3 or 1/2 gelatin sponge in PVP can reduce bone cement leakage.
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Objective@#To compare the efficacy of unilateral and bilateral percutaneous kyphoplasty (PKP) for thoracolumbar osteoporotic vertebral compression fractures (OVCFs).@*Methods@#A retrospective case control study was conducted to analyze the clinical data of 234 OVCFs patients admitted to Honghui Hospital affiliated to Xi'an Jiaotong University Medical College from June 2014 to January 2016. There were 95 males and 139 females, aged 60-89 years, with an average age of 68.3 years. The fractured segments included T11 in 45 patients, T12 in 65 patients, L1 in 72 patients, and L2 in 52 patients. A total of 116 patients were treated with PKP through unilateral puncture of transverse process and superior articular process (unilateral group), and 118 patients were treated with PKP through bilateral puncture of Magerl (bilateral group). The operation time, radiation exposure, bone cement injection and leakage were compared between the two groups. Visual analogue scale (VAS) and Oswestry dysfunction index (ODI) were used to evaluate the clinical efficacy and life quality improvement. The distribution of bone cement was observed by CT. The complications were recorded.@*Results@#All patients were followed up for 25-36 months, with an average of 27 months. The operation time of unilateral group [(19.6±5.3)minutes] was significantly shorter than that of bilateral group [(35.6±8.9)minutes]; the radiation exposure [(0.65±0.22)mSv] was lower than that of bilateral group [(1.69±0.58)mSv]; the bone cement injection [(5.3±0.8)ml] was less than that of bilateral group [(6.5±1.3)ml] (P<0.05). The postoperative X-ray showed that 10 patients (8.6%) in the unilateral group and 22 patients (18.6%) in the bilateral group (P<0.05) were found with bone segment leakage, although without clinical symptoms. The postoperative VAS and ODI of the two groups were significantly improved than before operation (P<0.01), and there was no significant difference between the two groups (P>0.05). Bone cement was mainly distributed in the front and middle of the vertebral body (A2, B1, C2, D1) in the unilateral group and in the front 2/3 of the vertebral body (A, B, C, D) in the bilateral group. There were in total 10 patients with cerebrospinal fluid during intraoperative puncture, including two patients in the unilateral group and eight patients in the bilateral group (P>0.05). The puncture direction was adjusted during the operation, and there was no neurological damage after the operation. There were 16 patients with local pain caused by small joint injury, including two patients in unilateral group and 14 patients in bilateral group (P<0.05). The pain was relieved one month after physical treatment. A total of 30 patients had vertebral fracture again, including 18 in unilateral group and 12 in bilateral group (P>0.05), all of whom were treated with PKP again.@*Conclusion@#Compared with Magerl bilateral approach, PKP for OVCFs has the advantages of shorter operation time, less radiation exposure, low leakage rate of bone cement and good distribution of bone cement.
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Objective To evaluate the precise percutaneous sacroplasty (PSP) assisted by a Renaissance robot for sacral insufficiency fractures (SIF).Methods The clinical data of 12 SIF patients were retrospectively analyzed who had been treated from March 2016 to March 2018 at Department of Spinal Surgery,Honghui Hospital.They were 5 males and 7 females,aged from 55 to 76 years (average,67.5 years).They all received PSP assisted by a Renaissance robot.Their operation time,hospital stay and intraoperative radiation were recorded.The clinical efficacy was evaluated by comparing their visual analogue scale (VAS) and Oswestry disability index (ODI) before surgery,1 day,3 and 12 months after surgery.Results All the 12 patients underwent surgery successfully with no complications like cement leakage.Their operation time ranged from 32 to 47 minutes (mean,36.8 minutes),their hospital stay from 12 to 25 hours (mean 17.5 hours) and their intraoperative exposure to radiation from 0.87 to 1.53 mSv (mean,1.27 mSv).All the patients were followed up for 12 to 18 months (mean,15.8 months).Their VAS (1.7 ± 0.7) and ODI (22.8 ± 4.1) one day after surgery were significantly decreased than the preoperative values (7.6 ±0.9 and 43.7 ±4.6) (P ＜ 0.05).At 3 and 12 months after surgery,their VAS scores were 2.0 ± 0.8 and 2.4 ±0.8 and their ODI scores 21.5 ±4.3 and 23.0 ±4.6,respectively,showing no significant differences from the values at 1 day after surgery (P ＞ 0.05).Conclusion The PSP assisted by a Renaissance robot is safe and leads to satisfactory clinical efficacy for SIF as bone cement can be accurately injected into the target area of the fracture.
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Objective To investigate the effect of graded surgical treatment according to injury classification on old thoracolumbar vertebral compression fractures ( OVCFs) . Methods A retrospective case series study was conducted to analyze the clinical data of 238 patients with old thoracolumbar OVCFs admitted to the Honghui Hospital affiliated to the College of Medicine, Xi'an Jiaotong University from February 2013 to November 2016. There were 49 males and 189 females, aged 63-78 years, with an average age of 66. 8 years. The bone density T value was ( -3. 8 ± 0. 3)SD. The injured segments were located at T7-T9 in 35 patients, T10-L2 in 171, and L3-L4 in 32. A total of 16 patients had neurological injury, including 14 with grade C and two with grade D according to the American Spinal Injury Association ( ASIA) neurological function classification. According to the patient's clinical manifestations and imaging complexity, the patients were assigned with I to V grades for individualized surgical treatment. Among them, 86 patients with grade I were treated with vertebral augmentation; 60 patients with grade II received posterior reduction and internal fixation combined with vertebral augmentation when necessary;44 patients with grade III were treated with posterior decompression and reduction and internal fixation;30 patients with grade IV received posterior osteotomy and orthopedic fusion; 18 patients with grade V were treated based on the major symptoms. The visual analogue score ( VAS ) , Oswestry dysfunction index ( ODI) , vertebral sagittal index, and the American Spinal Injury Association ( ASIA) grading before operation and at the last follow-up as well as the postoperative complications were recorded. Results All patients were followed up for 12-38 months with an average of 18. 5 months. The VAS of patients with grade I to V improved from preoperative (8. 0 ± 0. 7)points, (8. 1 ± 0. 7)points, (8. 3 ± 0.89)points,(8.1±0.7)points,(8.2±0.2)pointsto(2.1±0.8)points,(2.0±0.8)points,(2.2± 0. 8)points, (2. 3 ± 0. 8)points, (2. 2 ± 0. 8)points at the last follow-up (P<0. 05);ODI was improved from preoperative 69. 5 ± 3. 0, 70. 1 ± 2. 0, 70. 3 ± 2. 1, 69. 9 ± 1. 9, 70. 0 ± 2. 2 to 39. 8 ± 2. 2, 39. 1 ± 2. 4, 40. 1 ± 2. 1, 39. 0 ± 2. 3, 39. 5 ± 2. 3 at the last follow-up (P<0. 05);the vertebral sagittal index improved from (89. 7 ± 2. 1)％, (74. 4 ± 8. 3)％, (75. 0 ± 6. 7)％, (72. 3 ± 5. 2)％, (71. 1 ± 2. 1)％to (85.2 ±7.4)％, (84.2 ±5.5)％, (85.1 ±4.4)％, (86.2 ±3.5)％, (83.4 ±1.7)％ (P<0.05). For 16 patients with nerve injury, the ASIA grading was improved from preoperative grade C in 14 patients and grade D in two patients to grade D in four patients and grade E in 12 patients at the last follow-up. A total of 11 patients ( seven patients with grade I, one with grade II, two with grade IV, and one patient with grade V) had vertebral height loss in the later stage, but only two patients underwent secondary surgery for severe low back pain. Conclusions For obsolete thoracolumbar OVCFs, the concept of graded surgery can effectively guide the treatment strategies of these patients. Different surgical schemes for patients with different conditions can effectively alleviate the pain, restore spinal stability, correct kyphosis deformity, relieve nerve compression and promote functional recovery.
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Objective To explore the safety and effectiveness of a novel percutaneous self-expanding forceful reduction screw system in the treatment of thoracolumbar fracture with severe vertebral height loss.Methods Thirty-eight patients of thoracolumbar fracture with more than 50％vertebral height loss were treated with the novel percutaneous self-expanding forceful reduction screw between March 2014 and June 2015.The screw system is a single plane screw with a reduction angle of 0,3,6,9 degrees.During the operation,the fracture vertebral body was automatically restored during the locking process of the top cap.All the patients were single vertebral fractures.Percutaneous screw fixation and reduction was used in the operation.Two groups of screws were used to fix the two adjacent vertebrae of the injured vertebra and to restore the injured vertebral body,without fusion treatment.The vertebral body index (VBI),height of the anterior margin of fractured vertebra (HAMFV),vertebral body angle (VBA),bisegmental Cobb angle (BCA),visual analog scale (VAS) and Oswestry disability index (ODI) of the patients before and after operation,6 months after operation,and at the end of the follow-up were compared.The scoring results were compared using a t test.Results The operation was completed successfully in 38 cases.A total of 152 screws were placed.The accuracy rate of CT evaluation was 98.7％.The average operation time was 90.7±21.9 min,and the average intraoperative bleeding amount was 89.2±31.9 ml.The patients' preoperative VBI,HAMFV,VBA,BCA,VAS and ODI scores were 0.38±0.07,0.38±0.06,25.45°±4.54°,18.66°± 8.57°,7.76± 1.02,and 44.58％±2.33％,respectively.The postoperative measurements were 0.93±0.03,0.95±0.02,3.71°± 1.35°,5.84°±6.80 °,4.29± 1.16 and 24.37％± 1.88％.At the last follow-up,the measurements were 0.92±0.03,0.94±0.02,3.89° ± 1.31 °,6.05°±7.00°,1.71 ±0.65 and 5.95％±2.67％.There was significant difference between the preoperative and postoperative data,as well as the preoperative and the last follow-up data (P＜0.05).Conclusion In the treatment of thoracolumbar fractures with severe loss of vertebral height,the novel percutaneous self-expanding forceful reduction screw system has achieved satisfactory vertebral height restoration and kyphosis correction.
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Object To compare the efficacy of unilateral and bilateral percutaneous kyphoplasty(PKP)for thoracolumbar osteoporotic vertebral compression fractures(OVCFs).Methods A retrospective case control study was conducted to analyze the clinical data of 234 OVCFs patients admitted to Honghui Hospital affiliated to Xi'an Jiaotong University Medical College from June 2014 to January 2016.There were 95 males and 139 females,aged 60-89 years,with an average age of 68.3 years.The fractured segments included T11 in 45 patients,T12 in 65 patients,L1 in 72 patients,and L2 in 52 patients.A total of 116 patients were treated with PKP through unilateral puncture of transverse process and superior articular process(unilateral group),and 118 patients were treated with PKP through bilateral puncture of Magerl(bilaleral group).The operation time,radiation exposure,bone cement injection and leakage were compared between the two groups.Visual analogue scale(VAS)and Oswestry dysfunction index(ODI)were used to evaluate the clinical efficacy and life quality improvement.The distribution of bone cement was observed by CT.The complications were recorded.Results All patients were followed up for 25-36 months,with an average of 27 months.The operation time of unilateral group [(19.6±5.3)minutes] was significantly shorter than that of bilateral group [(35.6± 8.9)minutes] ; the radiation exposure [(0.65±0.22)mSv] was lower than of that of bilateral group[(1.69±0.58)mSv] ; the bone cement injecition[(5.3±0.8)ml] was less that of bilateral group[(6.5±1.3)ml](P＜0.05)The postoperative X-ray showed that 10 patients(8.6％)in the unilateral group and 22 patients(18.6％)in the bilateral group(P＜0.05)were found with bone segment leakage,although without clinical symptoms.The postoperative VAS and ODI of the two groups were significantly improved than before operation(P＜0.01),and there was no significant difference between the two groups(P＞0.05).Bone cement was mainly distributed in the front and middle of the vertebral body(A2,B1,C2,D1)in the unilateral group and in the front 2/3 of the vertebral body(A,B,C,D)in the bilateral group.There were in total 10 patients with cerebrospinal fluid during intraoperative puncture,including two patients in the unilateral group and eight patients in the bilateral group(P＞0.05).The puncture direction was adjusted during the operation,and there was no neurological damage after the operation There were 16 patients with local pain caused by small joint injury,including two patients in unilateral group and 14 patients in bilateral group(P＜0.05).The pain was relieved one month after physical treatment.A total of 30 patients had vertebral fracture again,including 18 in unilateral group and 12 in bilateral group(P＞0.05),all of whom were treated with PKP again.Conclusion Compared with Magerl bilateral approach,PKP for OVCFs has the advantages of shorter operation time,less radiation exposure,low leakage rate of bone cement and good distribution of bone cement.
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Objective@#To explore the safety and effectiveness of a novel percutaneous self-expanding forceful reduction screw system in the treatment of thoracolumbar fracture with severe vertebral height loss.@*Methods@#Thirty-eight patients of thoracolumbar fracture with more than 50%vertebral height loss were treated with the novel percutaneous self-expanding forceful reduction screw between March 2014 and June 2015. The screw system is a single plane screw with a reduction angle of 0,3,6,9 degrees. During the operation, the fracture vertebral body was automatically restored during the locking process of the top cap. All the patients were single vertebral fractures. Percutaneous screw fixation and reduction was used in the operation. Two groups of screws were used to fix the two adjacent vertebrae of the injured vertebra and to restore the injured vertebral body, without fusion treatment. The vertebral body index (VBI), height of the anterior margin of fractured vertebra (HAMFV), vertebral body angle (VBA), bisegmental Cobb angle (BCA), visual analog scale (VAS) and Oswestry disability index (ODI) of the patients before and after operation, 6 months after operation, and at the end of the follow-up were compared. The scoring results were compared using a t test.@*Results@#The operation was completed successfully in 38 cases. A total of 152 screws were placed. The accuracy rate of CT evaluation was 98.7%. The average operation time was 90.7±21.9 min, and the average intraoperative bleeding amount was 89.2±31.9 ml. The patients' preoperative VBI, HAMFV, VBA, BCA, VAS and ODI scores were 0.38±0.07, 0.38±0.06, 25.45°±4.54°, 18.66°±8.57°, 7.76±1.02, and 44.58%±2.33%, respectively. The postoperative measurements were 0.93±0.03, 0.95±0.02, 3.71°± 1.35°, 5.84°±6.80 °, 4.29±1.16 and 24.37%±1.88%. At the last follow-up, the measurements were 0.92±0.03, 0.94±0.02, 3.89° ±1.31°,6.05°±7.00°, 1.71±0.65 and 5.95%±2.67%. There was significant difference between the preoperative and postoperative data, as well as the preoperative and the last follow-up data (P<0.05).@*Conclusion@#In the treatment of thoracolumbar fractures with severe loss of vertebral height, the novel percutaneous self-expanding forceful reduction screw system has achieved satisfactory vertebral height restoration and kyphosis correction.
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Chronic hepatitis C in children has an insidious onset and has few available treatment options.Pegylated interferon alpha (Peg-IFNα) combined with ribavirin (RBV),known as the PR regimen for short,used to be the standard regimen;however,treatment response is often affected by various factors including hepatitis C virus genotype,viral load,and host gene polymorphisms,and some children cannot tolerate the adverse reactions of PR regimen.HCV Guidance:Recommendations for Testing,Managing,and Treating Hepatitis C developed by the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America (AASLD/IDSA) in September,2017 recommended that direct-acting antiviral agents (DAAs) can be used for children with hepatitis C who are aged above 12 years or have a body weight of ≥35 kg.Sofosbuvir combined with ledipasvir is the recommended regimen for children with genotype 1,4,5,or 6 infection,and sofosbuvir combined with RBV is recommended for children with genotype 2 or 3 infection.The course of disease is 12 weeks for previously untreated children with genotype 1 infection,children with genotype 1 infection who were treated by IFNα and do not have liver cirrhosis,or children with genotype 2,4,5,or 6 infection,and 24 weeks for children with genotype 1 infection who were treated by IFNα and have liver cirrhosis or children with genotype 3 infection.Further studies are needed to investigate the type of DAAs used in children with chronic hepatitis C aged ＜ 12 years,related regimens,and their safety.As for special populations including children with chronic hepatitis C complicated by HIV infection and those treated by liver transplantation,individualized treatment regimens should be developed with reference to the status of HIV infection and complications of liver transplantation.
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Liver cirrhosis is a chronic progressive liver disease. A non-invasive diagnostic technique for hepatic fibrosis combined with liver biochemistry, molecular biology, and immunology, imaging study, liver histopathological assessment, and traditional Chinese medicine (TCM) syndrome differentiation can accurately diagnose the cause, severity of disease, and determine the prognosis. In clinical practice of Western medicine, there are five-stages of cirrhosis classification, with periods 1 and 2 being compensated stage, and periods 3 to 5 being decompensated stage. Etiological treatment and anti-hepatic fibrosis treatment are the basic measures for different disease severity and complications. Comprehensive application of modern medical technology and traditional Chinese medicine differentiation therapy can improve the treatment effect and survival rate.
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Objective To investigate outcomes of posterior instrumentation and fusion in treating ankylosing spondylitis (AS) combined with lower cervical fractures.Methods A retrospective case series study was made on 53 AS patients combined with cervical fractures or cervical thoracic fractures treated by posterior instrumentation and fusion from January 2006 to January 2013.There were 51 male and 2 female patients.The mean age of patients was 55 years old (range,34-69 years old).All the patients showed significant kyphosis on the thoracolumbar and cervicothoracic junction.A total of 20 patients had neurological dysfunction at different extents.According to the American spinal injury association (ASIA) classification,neurological status was scored as Grade A in 4 cases,Grade B in 5,Grade C in 4 and Grade D in 7.The operation time,total bleeding and decompression status were recorded during the surgery.Reduction,decompression condition and complications were evaluated.The neurological status and bone fusion were recorded at the follow-up.Results All surgeries were well accomplished.Mean surgical time was 3.7 h (range,2.9-5.3 h).Mean total bleeding was 690 ml (range,470-1 600 ml).Two patients died within 1 year follow-up because of internal diseases (1 case caused by respiratory system disease in 13 months postoperatively and 1 case caused by acute myocardial infarction in 15 months postoperatively).The mean follow-up time of other patients was 25 months (range,18-48 months).The CT scan manifested all patients achieved satisfactory fusion,and the mean time span of the fusion was 3.5 months (range,3-6 months) postoperatively.Among the 20 patients with various levels of neurological deficits before operation,the postoperative ASIA score was Grade A in 4 cases,Grade C in 2,Grade D in 4,and Grade E in 10.No instrumentation failure occurred during follow-up.Conclusion The posterior instrumentation and fusion for treating AS combined with cervical fractures can obtain satisfactory neurological results,spinal stabilization and clinical results,and hence an effective clinical problem-solving algorithm for such kind of patients.
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Objective To evaluate the clinical outcomes of sacral decompression and lumbopelvic fixation for neurologically impaired patients with sacral fracture-dislocation.Methods From January 2009 to December 2013,32 patients with sacral fracture and spino-pelvic dissociation of Roy-Camille types Ⅱand Ⅲ were treated at our department.They were 21 men and 11 women,with a mean age of 34.3 years.According to Roy-Camille classification,9 patients belonged to type Ⅱand 23 to type Ⅲ;25 patients had S1 fracture-dislocation and 7 S2 fracture-dislocation.After their overall conditions were stabilized,all were treated with open reduction,sacral decompression and lumbopelvic fixation.Pre-and post-operative neurological functions were recorded by Gibbons criteria.We analyzed the correlations between the neurological recovery and (i) the extent of cauda equina deficit and (ii) the continuity of sacral roots,as well as the correlations between the functional recovery of the bladder and bowels and the above two.The reduction and fusion status were evaluated by the Mears and Velyvis radiological criteria;clinical effectiveness was evaluated by Majeed scoring system.Intra-and post-operative complications were all recorded.Results The mean follow-up time for this series was 35 months (from 25 to 47 months).The average Gibbons score improved from 4.0 to 2.7 at the follow-ups.The patients with mild cauda equina deficit or with continuity of sacral roots achieved significantly better neurological recovery than those with severe cauda equina deficit or with discontinuity of sacral roots (P ＜ 0.001).However,the functional recovery of the bladder or bowels was not significantly correlated with the extent of cauda equina deficit or with the continuity of sacral roots.Anatomical reduction was achieved in 26 patients,satisfactory reduction in 5 and unsatisfactory reduction in one,yielding a satisfaction rate of 96.9％.Bony fusion was obtained in 29 patients at 3 months,but not until at 9 months in 2 patients,and still not at 9 months in one who showed no symptoms.The Majeed scoring showed 22 excellent,6 good and 4 moderate cases,giving an excellent to good rate of 87.5％.Two patients developed deep wound infection,3 complained of the pain related to hardware prominence,and one had unilateral rod breakage.Conclusions In treatment of sacral fracture with spino-pelvic dissociation,sacral decompression and lumbopelvic fixation can lead to effective neurological recovery,restoration of lumboscacral stability and alignment,early ambulation and prevention of deformity.Complete neurological recovery is more likely in patients with incomplete cauda equina deficit or with continuity of all sacral roots.
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Objective To explore the clinical outcome with anterior debridement,bone graft and posterior internal fixation with short nail of treating intervertebral infection.Methods Ninteen cases (11 male and 8 female,aged from 34 to 63,46 on average) of lumbar intervertebral space infection treated in our hospital from June 2008 to June 2013 were retrospectively analyzed.These infections occurred at L2-L3 in 2 cases,L3-L4 in 5 cases,L4-L5 in 8 cases and L5-S1 in 4 cases.All patients had history of disc surgery or puncture.The clinical outcome after operation was analyzed according to the low back paine after operation which analyzed by visual analog scale (VAS),and the bone fusion.Erythrocyte sedimentation rata and C-reactionprotein were aslo recorded before and after surgery.Results All cases were followed up,average 24 months.The lower back pain was improved obviously between preoperation and postoperation (P ＜0.05).Also erythrocyte sedimentation rata and C-reactionprotein returned to normal after the operation and all cases had complete bone union at the end of follow-up with no instrument failure noted.Conclusion Anterior debridement,bone graft and posterior internal fixation with short nail in of treating intervertebral infection not only can effectively reconstruct the stability of the spine,but also retain range of motion segment of spine.