Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 249
Filter
1.
Article in Chinese | WPRIM | ID: wpr-879401

ABSTRACT

OBJECTIVE@#To establish a three-dimensional finite element model of osteoporosis and to study the stiffness recovery of injured vertebrae and stress analysis of adjacent vertebrae after percutaneous vertebroplasty under different perfusion and distribution conditions by simulating fluid flow into the vertebral body.@*METHODS@#A male healthy volunteer was selected. CT scans were performed from T@*RESULTS@#(1) The VonMises stress of T@*CONCLUSION@#Reliable biomechanical model of lumbar vertebral fracture can be established by using CT scanning data through software simulation. Vertebral fracture and vertebroplasty will cause biomechanical changes of adjacent vertebral bodies. With the increase of bone cement injection, the influence of biomechanical changes will increase significantly. Neighbouring vertebral fractures are more likely. For this experiment, percutaneous vertebroplasty has a suitable amount of cement injection of 4 ml.


Subject(s)
Biomechanical Phenomena , Bone Cements , Finite Element Analysis , Fractures, Compression/surgery , Humans , Lumbar Vertebrae/surgery , Male , Osteoporotic Fractures/surgery , Spinal Fractures/surgery , Vertebroplasty
2.
Article in Chinese | WPRIM | ID: wpr-879014

ABSTRACT

To establish the method for determining non-volatile ingredients of neochlorogenic acid, chlorogenic acid, cryptochlorogenic acid, caffeic acid, isochlorogenic acid A, rosmarinic acid, ferulic acid, rutin, luteoloside, isoquercitrin, hesperidin, diosmin, diosmetin, luteolin, acacetin and linarin in Menthae Haplocalycis Herba formula granules and traditional herbal pieces by UPLC-MS/MS, and analyze the correlation of non-volatile ingredients in Menthae Haplocalycis Herba formula granules and traditional herbal pieces. Shim-pack GIST C_(18) column(2.1 mm×100 mm, 2 μm) was adopted with acetonitrile-0.1% formic acid aqueous solution as the mobile phase for gradient elution at the flow rate of 0.4 mL·min~(-1). The column temperature was set at 35 ℃. The quantitative analysis was performed using the electrospray ionization source and the multiple reaction monitoring. The linear relationship, resolution, repeatability and recovery of the 16 chemical components all met the requirements. The 16 non-volatile ingredients in traditional herbal pieces of Menthae Haplocalycis Herba could be tracked in formula granules. There were certain differences of the 16 chemical components among Menthae Haplocalycis Herba formula granules of different manufacturers and traditional herbal pieces of different producing areas. The UPLC-MS/MS method was simple, rapid and accurate, and could be used for the quality control of non-volatile ingredients in Menthae Haplocalycis Herba formula granules and traditional herbal pieces.


Subject(s)
Chromatography, High Pressure Liquid , Chromatography, Liquid , Correlation of Data , Drugs, Chinese Herbal , Tandem Mass Spectrometry
3.
Article in Chinese | WPRIM | ID: wpr-873628

ABSTRACT

@#Objective    To evaluate the effect of smoking and drinking status on the prognosis of patients with esophageal squamous cell carcinoma (ESCC). Methods    The clinical data of 483 patients with ESCC who underwent surgical treatment in Shannxi Provincial People's Hospital from 2007 to 2016 were retrospectively analyzed. Among them, 352 patients were male and 131 were female, with a median age of 64 (37-80) years. There were 311 smokers and 172 drinkers. The relationship between preoperative drinking or smoking status and the clinicopathological characteristics of patients with ESCC was analyzed. Log-rank method and Cox risk regression were used to conduct univariate and multivariate survival analysis, respectively. Results    The preoperative smoking status was related to the patient's tumor location (P=0.030). Drinking status was associated with tumor location (P=0.001), degree of differentiation (P=0.030), pathological T stage (P=0.024) and pathological N stage (P=0.029). Univariate survival analysis showed that smoking status did not affect the disease-free survival (DFS) (P=0.188) and overall survival (OS) (P=0.127) of patients with ESCC. However, patients who drank alcohol had worse PFS than non-drinking patients (29.37 months vs. 42.87 months, P=0.009). It was further proved that alcohol consumption was an independent risk factor affecting patients' recurrence and metastasis by using multivariate analysis (RR=1.28, P=0.040). Alcohol consumption also reduced the OS of patients by 21.47 months (P=0.014), however, multivariate analysis did not yield significant results. Conclusion    Preoperative drinking status is related to the stage and differentiation of patients with ESCC. It is an independent risk factor affecting the recurrence and metastasis of ESCC.

4.
Chinese Journal of Orthopaedics ; (12): 611-617, 2021.
Article in Chinese | WPRIM | ID: wpr-884751

ABSTRACT

Objective:To explore the long-term clinical efficacy and complications of modified spinous process splitting laminoplasty using coralline hydroxyapatite (SLAC).Methods:The patients who underwent SLAC surgery in this hospital from 2005.5 to 2011.7 were included retrospectively. The perioperative data were collected and followed up. A total of 165 cases were included. Among them, there were 115 males and 50 females; the average age was 56.5±11.4 years (range: 26-84 years), and the average follow-up period was 136.5±23.2 months (range: 108-182 months). The modified Japanese Orthopedic Association (mJOA) score, the neck disability index (NDI) score were used to evaluate the clinical symptoms of patients, and follow-up imaging to observe the changes in cervical spine curvature and mobility.Results:In terms of functional score: mJOA score increased from 11.4±2.9 before surgery to 15.0±1.8 in the early postoperative period but dropped to 14.0±2.5 at the last follow-up ( F=77.096, P<0.001), and NDI score decreased from 19.2%±14.4% before surgery to 13.0%±15.0% in the early postoperative period, but it rose to 14.0%±14.9% at the last follow-up ( F=6.915, P<0.001). The improvement rate of mJOA was 63.5% (early postoperatively) and 50.8% (last follow-up). Regarding the curvature of the cervical spine, the C 2-C 7 Cobb angle decreased from 14.8°±9.1° before surgery to 11.1°±10.5°, and it was maintained at the last follow-up (11.0°±10.1°) ( F=1.083, P=0.342). The cervical spine range of motion decreased significantly, mainly because the Cobb angle in the flexion position decreased from -19.8°±13.6° before the operation to -3.7°±10.6° at the last follow-up ( P<0.001). Seventy-two patients (44.0%) had complications after operation. Six patients (3.6%) developed neurological symptoms aggravated during follow-up, and their mJOA decreased by more than 3 points. 62 patients (37.6%) developed axial symptoms, of which 7 cases were relieved early (within 6 months post-op), 55 patients had persisted symptom and 17 cases (10.3%) remained painful. C 5 nerve root palsy occurred in 10 cases (6.1%) after the operation, 9 cases resolved within two years and the last patient did not resolve. Conclusion:SLAC surgery can effectively alleviate the patient's neurological symptoms and maintain long-term efficacy and cervical lordosis. The occurrence of persistent axial symptoms and the loss of cervical flexion range are long-term complications after SLAC surgery.

5.
Chinese Journal of Orthopaedics ; (12): 532-540, 2021.
Article in Chinese | WPRIM | ID: wpr-884742

ABSTRACT

The cervical sagittal balance is a description of cervical spine at the standing position. The position of cervical spine is measured by the corresponding sagittal parameters. The commonly used sagittal parameters of cervical spine include cervical lordosis (CL), cervical sagittal vertical axis (cSVA), T 1 Slope (T 1S), etc. Cervical sagittal balance is closely related to the overall balance of the spine, and the imbalance of sagittal parameter is also related to the progression of cervical disease, the choice of surgical methods and the postoperative efficacy. In recent years, more and more researchers have begun to pay attention to the sagittal balance of the cervical spine, especially the variation of sagittal parameters after cervical surgery, which can predict the postoperative neurological recovery and the change of long-term efficacy or complications. However, due to the variety of cervical surgery methods and the variety of cervical sagittal balance parameters, the existing studies can only reflect the relationship between the two from a certain aspect, while lacking overall and comprehensive description. In this paper, the relationship between sagittal plane balance and cervical surgery was reviewed by systematically searching literatures and screening relevant studies. According to our review, the cervical sagittal parameters have different tendency after different cervical surgery. Generally, anterior cervical surgery can maintain or improve the sagittal plane balance of the cervical spine, among which anterior cervical discectomy and fusion (ACDF) surgery has a best effect.After posterior cervical surgery, the cervical sagittal parameters tend to be unbalanced or compensated, and patients with preoperative sagittal imbalance, advanced age, and complex OPLL are more likely to have postoperative imbalance or imbalance aggravation. Therefore, attention should be paid to preoperative evaluation and reasonable surgical design in clinical practice to prevent the occurrence of sagittal imbalance of patients after surgery.

6.
Article in Chinese | WPRIM | ID: wpr-880109

ABSTRACT

OBJECTIVE@#To assess the impact of early relapse (ER) after autologous hematopoietic stem cell transplan-tation (AHSCT) on overall survival (OS) for multiple myeloma (MM) patients.@*METHODS@#Clinical data of 37 patients with MM undergoing AHSCT in department of hematology of Shanxi Bethune Hospital from January 2012 to December 2017 were retrospectively analyzed. The effect of ER on OS of patients was analyzed. The effects of international staging system (ISS) staging, cytogenetics, pre-transplant efficacy, minimal residual disease, and age on OS of the patients were also analyzed respectively.@*RESULTS@#Among the 37 patients, 13 cases (35.1%) had ER, and 24 cases (64.9%) had non-ER. 3 patients with ER had extramedullary disease, but none with non-ER showed extramedullary disease. More than or equal to very good partial rate (VGPR) in patients with ER and without ER were 3 cases (23.1%) and 15 cases (62.5%), respectively, and the curative effect of the former was significantly lower than that of the latter (P<0.05). The median follow-up time was 31 (12-96) months, and median OS time was 93 months in all the patients. The median survival time of patients with ER was 17 months, and the median progression free survival was 7 months, both were significantly shorter than 93 months and 38 months of patients with non-ER (P<0.05). Univariate analysis showed that the OS was affected by ER, cytogenetic abnormalities (FISH), and ≥VGPR before transplantation. Multivariate analysis showed that ER was an independent prognostic factor.@*CONCLUSION@#The prognosis of patients with ER after AHSCT in newly diagnosed MM is poor. ER is an independent prognostic factor of survival.


Subject(s)
Hematopoietic Stem Cell Transplantation , Humans , Multiple Myeloma , Prognosis , Recurrence , Retrospective Studies , Transplantation, Autologous , Treatment Outcome
7.
Chinese Journal of Surgery ; (12): 1-4, 2020.
Article in Chinese | WPRIM | ID: wpr-798702

ABSTRACT

The combination of network and medical field gave birth to telemedicine.The implementation of telemedicine can improve the uneven distribution of regional medical resources, reduce the working pressure of medical staff, shorten the distance between medical staff and patients and medical staff, and improve the timeliness of monitoring, diagnosis and treatment.The continuous development of telemedicine relies on the continuous innovation of network communication technology, the latest 5th generation wireless systems (5G) is bringing significant changes to mobile communication and other related industries by virtue of its advantages of high data rate and low latency. This paper reviews the development of telemedicine, introduces the characteristics of 5G technology, combines the research results of 5G technology applied in the medical field at home and abroad, and prospects the development of this field in the future.

8.
Frontiers of Medicine ; (4): 518-527, 2020.
Article in English | WPRIM | ID: wpr-827853

ABSTRACT

Spinal surgery is a technically demanding and challenging procedure because of the complicated anatomical structures of the spine and its proximity to several important tissues. Surgical landmarks and fluoroscopy have been used for pedicle screw insertion but are found to produce inaccuracies in placement. Improving the safety and accuracy of spinal surgery has increasingly become a clinical concern. Computerassisted navigation is an extension and application of precision medicine in orthopaedic surgery and has significantly improved the accuracy of spinal surgery. However, no clinical guidelines have been published for this relatively new and fast-growing technique, thus potentially limiting its adoption. In accordance with the consensus of consultant specialists, literature reviews, and our local experience, these guidelines include the basic concepts of the navigation system, workflow of navigation-assisted spinal surgery, some common pitfalls, and recommended solutions. This work helps to standardize navigation-assisted spinal surgery, improve its clinical efficiency and precision, and shorten the clinical learning curve.

9.
Journal of Experimental Hematology ; (6): 1245-1250, 2020.
Article in Chinese | WPRIM | ID: wpr-827132

ABSTRACT

OBJECTIVE@#To evaluate the value of serum free light chain (sFLC) κ/λ ratio (sFLCR) on the diagnosis and prognosis of patients with newly diagnosed multiple myeloma(MM), and explore the effect of sFLCR normalization on the prognosis of patients after 4 courses of induction therapy.@*METHODS@#The clinical data of 43 newly diagnosed MM patients from January 2014 to January 2019 were analyzed retrospectively. Immunoturbidimetry was used to detect the expression levels of sFLC κ and λ. According to the ratio of involved and uninvolved sFLC, using 100 as a boundary, the MM patients were divided into the high ratio group (sFLCR≥100 or ≤0.01) and the low ratio group (0.010.05).@*CONCLUSION@#Patients in the high ratio group at the initial diagnosis have worse renal function, later stage of disease, lower deep remission rate, earlier disease progression, shorter survival time, and worse clinical prognosis.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols , Humans , Immunoglobulin Light Chains , Multiple Myeloma , Drug Therapy , Prognosis , Retrospective Studies
10.
Article in Chinese | WPRIM | ID: wpr-872403

ABSTRACT

In consideration of the current policies for scientific and technological achievement translation, the paper explored the model and strategy of such translation in medical institutions by analyzing typical cases of " orthopedic surgical robot" translation. Most common translation models in medical institutions are transfer or licensing. As hospitals lack the qualifications and conditions for product manufacturing and sales, " orthopedic surgical robot" was translated by means of a combined practice of both patent transfer and joint R&D with the enterprise under a strategic cooperation agreement. This practice not only manifested the contribution and interests of stakeholders in a rational way, but also guaranteed sustainable iterative R&D. Hospitals should launch cooperation with enterprises, universities or research organizations and form strategic alliances, and choose appropriate translation models based on their specifics, value and characteristics of the achievement flexibly.

11.
Chinese Journal of Orthopaedics ; (12): 1531-1539, 2020.
Article in Chinese | WPRIM | ID: wpr-869106

ABSTRACT

Objective:To evaluate the feasibility of surgery for upper cervical spine anomaly instability achieved by readjusting the clivus-axial angle (CAA) and evaluating available screw trajectories based on preoperative virtual simulation reduction using 3D CT reconstruction.Methods:From January 2014 to September 2019, 52 patients (28 males, 24 females; mean age 46.7 years; range 18-64 years) with upper cervical spine anomalies were enrolled in a retrospective study. DICOM data of preoperative CT scanning of cervical spine were imported into Mimics 15.0 to reconstruct the 3D model of atlantoaxial joint. The target range of CAA was set with the value measured in fusing images of extension view of cervical spine as the upper bound; and 140°, the lower limit of normal CAA range, was set as the lower bound. The trajectories of screws were sought within the target range of CAA. The exact CAA value of the available trajectories was set as the target angle of intraoperative reduction . The preoperative, postoperative and simulated target CAA values were compared. The accuracy of screw placement was evaluated according to the Gertzbein-Robbins scale. The pre- and postoperative neck disability index (NDI) and Nurick scale were also compared.Results:Among 52 patients, available screw trajectories existed in 35 patients. With the validation under computer-assisted navigation as the gold standard, 37 patients underwent Magerl screws fixation (Magerl group) while the other 15 patients underwent screw-rods fixation (screw-rods group). In Magerl group, no significant difference was found between simulated target CAA values (150.1°±6.6°) and postoperative CAA values (149.0°±6.5°)( t=1.194, P=0.240); postoperative CAA values were significantly larger than preoperative CAA values (124.0°±8.9°)( t=-13.499, P< 0.001). In screw-rods group, no significant difference was found between simulated target CAA values (150.4°±5.6°) and postoperative CAA values (150.2°±6.1°) ( t=0.319, P=0.754); postoperative CAA values were also significantly larger than preoperative CAA values (121.9°±8.3°)( t=-12.431, P< 0.001). Follow-up data were obtained in all 52 patients, with a mean follow-up time of 1.7±0.9 years (range, 0.5-4 years). A total of 106 screws were placed into 52 patients, including 74 in Magerl group and 32 in screw-rods group. According to the Gertzbein-Robbins scale, 88 and 15 were classified into grade A and B respectively; and 97.1% (103/106) of screws were acceptable. No severe complications such as vertebral artery injury and low cranial nerve palsy occurred. The postoperative NDI (9.7±6.4 vs. 27.4±8.7) and Nurick scale (1.1±1.4 vs. 2.6±1.3) decreased significantly compared to preoperative ones, respectively. Conclusion:Preoperative virtual simulation can evaluate available screw trajectories and provide the target CAA values for guidance of intraoperative reduction. Based on this, readjusting the CAA under computer-assisted navigation were safe and feasible, and warranted the possibility of a single posterior reduction and fusion approach for reducible upper cervical anomaly instability.

12.
Chinese Journal of Orthopaedics ; (12): 515-525, 2020.
Article in Chinese | WPRIM | ID: wpr-868997

ABSTRACT

Objective:To compare the clinical effects of oblique lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar degenerative scoliosis.Methods:A retrospective study was performed in 116 patients with lumbar degenerative scoliosis and spinal stenosis, who were admitted to Beijing Jishuitan Hospital from January 2015 to May 2018. The patients were divided into two groups according to the surgical method. Among them, 56 patients underwent the OLIF approach (OLIF group), consisting of 21 men and 35 women, with an average age of 65.2±8.7 years. According to Lenke-Silva classification, there were 41 cases of type II and 15 cases of type III in OLIF group. 60 cases underwent the TLIF approach (TLIF group), consisting of 19 men and 41 women, with an average age of 61.3±11.6 years. There were 43 cases of type II and 17 cases of type III in TLIF group. The preoperative and last follow up visual analogue scale (VAS) and Oswestry disability index (ODI) were compared between the two groups. The coronal and sagittal Cobb angle changing and the offset distance for apical midline of the lumbar vertebrae between pre-operation and last follow-up were measured. The respective complications of the two groups were collected.Results:For OLIF group, VAS decreased from 7.7±1.6 at pre-operation to 1.9±1.5 at the last follow up; for TLIF group, VAS decreased from 8.1±1.2 at pre-operation to 2.2±0.9 at the last follow up. Although there were obvious improve for both group compared pre-operation to last follow-up, there was no significant difference between the two groups. For OLIF group, ODI decreased from preoperative 47.5%±9.1% to last follow up 22.4%±6.7%; for TLIF group, ODI decreased from preoperative 52.6%±5.8% to last follow up 25.1%±8.4%. Obvious changes were foundin both group between pre-operation and last follow up, but there was no significant difference between the two groups. For sagittal lumbar cobb angle, OLIF group changed from preoperative 8.6°±5.7° to last follow-up 23.6°±4.3°. TLIF group changed from pre-operation 9.2°±4.2° to last follow-up 21.3°±4.8°. Obvious changes were found in both group between pre-operation and last follow up, while OLIF group had better improvement than TLIF group ( P=0.01). For lumbar coronal Cobb angle, OLIF group changed from preoperative 16.4°±9.6° to last follow-up 2.8°±2.1°, and TLIF group from preoperative 15.2°±7.8° to last follow-up 6.4°±2.7°. Obvious changes were found in both group comparing pre-operation to last follow up, while OLIF group had better improvement. The offset distance for apical midline of the lumbar vertebrae in OLIF group improved from preoperative 26.3±9.4 mm to 4.3±1.9 mm; TLIF group improved from preoperative 23.4±5.5 mm to 7.5±4.2 mm. Obvious changes were found between pre-operation and last follow up for both group, while OLIF group has better improvement compared to TLIF group ( t=-5.26, P=0.03). The fusion rate was 97.7% (127/130) in OLIF group, and 91.1% (164/180) in TLIF group. There was no statistically significant difference between the two groups ( χ2=1.15, P=0.097). The neural complication rate was 16.1% (9/56) in OLIF groupand 8.3% (5/60) in TLIF group. There was no statistical difference between the two groups ( χ2=1.63, P=0.201). The cage subsidence was 12.3% (16/130) in OLIF group and 21.9% (35/180) in TLIF group. There was statistically significant difference between the two groups ( χ2=4.53, P=0.03). Conclusion:OLIF can be considered as an effectivesurgical option for the treatment of lumbar degenerative scoliosis with spinal stenosis, since it can achieve similar clinical effects and better correction of coronal and sagittal imbalances compared to TLIF.

13.
Chinese Journal of Orthopaedics ; (12): 317-324, 2020.
Article in Chinese | WPRIM | ID: wpr-868974

ABSTRACT

Objective:To explore the efficacy of posterior iliac screw rod for unilateral unstable Denis I and II sacral fractures.Methods:Data of 50 patients with unilateral unstable Denis I, II sacral fractures treated from March 2016 to October 2018 were retrospectively analyzed. According to fixation methods, the patients were divided into posterior iliac screw rod group (Iliac screw rod group) and robot-assisted iliosacral screw group (Iliosacral screw group). There were 20 patients in the Iliac screw rod group, 13 males and 7 females, with an average age of 41.10±14.07 years (range, 22-76 years), and there were 5 cases of Denis type I and 15 cases of type II sacral fractures. All of them had anterior pelvic ring injuries, and according to pelvic Tile classification, there were 2 B1 type, 12 B2 type, 6 C1 type, and 3 cases of Gibbons grade II sacral nerve injuries. There were 30 patients in the Iliosacral screw group, 18 males and 12 females, with an average age of 44.70±13.35 years (range,16-78 years), and there were 6 cases of type I and 24 cases of type II sacral fractures. There were 2 cases of type B1, 20 cases of B2, 8 cases of C1 pelvic fractures, 4 cases combined with sacral nerve injuries including 3 cases of Gibbons grade II and 1 case of grade III. The patients’ age, operation time, amount of bleeding, times of fluoroscopy, postoperative Majeed score were compared by the independent t test. The quality of fracture reduction was compared by Chi-square test, and the postoperative Gibbons grade was compared by the rank sum test.Results:All patients were followed up for 22.8 months (range, 12-40 months). In the Iliac screw rod group, the operation time was 41.40±7.30 min, intraoperative blood loss 105.00±61.94 ml, intraoperative times of fluoroscopy 19.10±7.33, and according to Mears and Velyvis valuation criterion, there were 9 cases of anatomical reduction, 10 cases of satisfactory reduction, and 1 case of unsatisfactory reduction, with the Majeed score of 84.25±8.29. There were 3 cases with Gibbons grade II sacral nerve injury, and 2 of them recovered to grade I. In the Iliosacral screw group, the operation time was 18.27±5.89 min, intraoperative blood loss 33.00±17.54 ml, intraoperative times of fluoroscopy 14.93±4.49, and according to Mears and Velyvis valuation criterion, there were 15 cases of anatomical reduction, 13 cases of satisfactory reduction and 2 cases of unsatisfactory reduction, with the Majeed score of 86.43±7.43. There were 3 cases with Gibbons grade II sacral nerve injury, and 2 of them recovered to grade I, and 1 case with grade III recovered to grade II postoperation. Compared to Iliosacral screw group, the Iliac screw rod group has longer operation time ( t=-12.36, P<0.001), more blood loss ( t=-6.04, P<0.001) and more intraoperative times of fluoroscopy ( t=-2.50, P=0.016). There were no statistical differences for quality of fracture reduction ( χ2=0.23, P=0.89), Majeed score ( t=0.97, P=0.34), and the Gibbons grade ( Z=-0.224, P=0.82) between the two groups. In the Iliac screw rod group, 1 patient had a unilateral superficial wound infection and 1 patient complained of discomfort because of the nail. In the Iliosacral screw group 1 patient had iatrogenic S 1 neurological injury. Conclusion:For the unstable sacral fractures, who are not suitable for iliosacral screw fixation, posterior iliac screw rod fixation is an effective alternative with similar clinical effect as robot assisted iliosacral screw fixation.

14.
Chinese Journal of Orthopaedics ; (12): 277-284, 2020.
Article in Chinese | WPRIM | ID: wpr-868970

ABSTRACT

Objective:To compare the clinical outcomes between minimal-invasive triangular fixation with orthopedic robot and traditional open fixation method for unilateral unstable sacral fracture patients.Methods:Data of 24 consecutive patients with unilateral unstable sacral fracture who were treated from August 2014 to February 2018 were retrospectively analyzed. All patients were associated with anterior ring injuries of pelvis and received magnetic resonance of nerve (MRN) preoperatively to exclude the compression of sacral nerve by bone. All patients received surgical treatment of sacral fractures with triangular fixation and the fixation of pelvic anterior ring injuries simultaneously and two groups were divided according to the different surgical methods of sacral fractures. There were 10 males and 2 females with an average age of 36.3±1.2 years in the orthopaedic robot group. According to Dennis classification, there were 4 type I and 8 type II fractures. Two patients were associated with nerve injuries (Gibbons II 1 case, III 1 case). In traditional posterior-midline open fixation group, there were 11 males and 1 female with an average age of 38.2±1.6 years. According to Dennis classification, there were 3 type I and 9 type II fractures. Three patients were associated with nerve injuries (Gibbons II 2 cases, III 1 case). The clinical data of two group patients were collected and compared statistically. T test was used to compare the operation time, intraoperative bleeding, intraoperative fluoroscopy times, Majeed function assessment which was to evaluate the patients' clinical prognosis and healing time of fracture. χ2 test was used to compare the healing rate of fracture, accuracy assessment of fixation insertion, and Mears radiological assessment which was applied to evaluate the reduction quality of fractures. The rank sum test was used to compare Gibbons score which was applied as the index of neurological deficiency recovery. The Fisher exact test was used to compare the infection rate. Results:All patients were followed up continuously for an average time of 21.2±3.2 months. The average operation time of robot group was 100.3±14.5 minutes, meanwhile the open fixation group was 202.0±18.5 min. The average intraoperative bleeding of robot group was 180.0±17.4 ml, meanwhile the open fixation group was 850.0±15.2 ml. The average intraoperative fluoroscopy time of robot group was 23.3±4.5 s, meanwhile the open fixation group was 90.0±7.7 s. All fractures were healed and no loss of reduction or fail of fixation occurred in both groups. The healing time of fracture of robot group was 8.5±1.9 months, meanwhile the open fixation group was 12.8±2.4 months. The satisfaction rates of reduction which was based on Mears-Velyvis radiological criterion of both groups were 91.7%. The accuracy rate of fixation insertion of robot group was 100% meanwhile the open fixation group was 77.78%. Majeed function assessment score of robot group was 86.2±3.4, meanwhile the open fixation group was 84.2±2.7. There was no infection occurred in robot group, meanwhile 3 patients infected in open fixation group. The Gibbons score of one patient changed from II preoperative to I postoperative and one case changed from III preoperative to II postoperative in robot group, meanwhile two patients changed from II preoperative to I postoperative and one case changed from III preoperative to II postoperative in open fixation group. The healing rate of fracture, infection rate, Majeed function assessment, Mears-Velyvis radiological evaluation criterion and Gibbons score of two groups had no significant statistical difference ( P >0.05), meanwhile the operation time ( t=14.99), intraoperative bleeding ( t=100.46), intraoperative fluoroscopy time ( t=32.13), healing time of fracture ( t=4.87) and accuracy rate of fixation insertion ( χ2=9.00) of orthopedic robot group were better than traditional open group and had the significant difference ( P< 0.05). Conclusion:The minimal-invasive triangular fixation with orthopedic robot for unilateral unstable sacral fracture had the advantages of less operation time, less intraoperative bleeding and less times of fluoroscopy, more accurate of fixation insertion and less healing time of sacral fractures compared to traditional open fixation method and should be recommended as an effective and advanced choice.

15.
Chinese Journal of Endemiology ; (12): 801-804, 2020.
Article in Chinese | WPRIM | ID: wpr-866224

ABSTRACT

Objective:To understand the current situation of children's fluorosis in the coal-burning-borne endemic fluorosis areas (abbreviated as coal-burning fluorosis) in Suojia Miao, Yi and Hui Township (Suojia Township for short) in Liuzhi Tequ, Guizhou Province, and to provide scientific basis for formulating prevention and control strategies and measures.Methods:In 2019, the cluster sampling method was adopted to select children aged 8-12 years old from 6 primary schools in Suojia Township, Liuzhi Tequ, Guizhou Province to conduct a questionnaire survey to collect basic information, and perform dental fluorosis examination and indexing in accordance with the "Diagnosis of Dental Fluorosis" standards. Immediate urine samples were collected from children in April and October, and urinary fluoride content was determined by ion selective electrode method.Results:A total of 1 381 children aged 8-12 years old were investigated, aged (9.84 ± 1.38) years old, including 679 boys and 702 girls. A total of 625 children with dental fluorosis were detected, and the detection rate was 45.26%; the dental fluorosis index was 1.00, and the prevalence intensity was moderate; the main score of dental fluorosis was extremely mild, accounting for 37.00% (511/1 381). The detection rates of dental fluorosis in children aged 8 to 12 years old were 35.10% (106/302), 35.83% (115/321), 47.96% (129/269), 55.23% (153/277), and 57.55% (122/212), respectively; the difference between different ages was statistically significant (χ 2 = 48.949, P < 0.01), and the detection rate of dental fluorosis in children increased with age(χ 2trend = 45.254, P < 0.01).The detection rates of dental fluorosis in boys and girls were 43.59% (296/679) and 46.87% (329/702), respectively, and there was no significant difference between different genders (χ 2 = 1.492, P > 0.05). In April and October, 123 and 107 urine samples of children aged 8-12 years old were tested. The geometric mean of urinary fluoride was 1.55 and 0.47 mg/L, respectively. The urinary fluoride level in April was higher than the normal range (< 1.40 mg/L). Conclusions:Suojia Township in Liuzhi Tequ of Guizhou Province is still a fluorosis area, and there is a big difference in urinary fluorine level in different months, which indicates that the residents in this area may have intermittent high fluorine intake, and prevention and control of endemic fluorosis should be further strengthened.

16.
Chinese Journal of Endemiology ; (12): 641-646, 2020.
Article in Chinese | WPRIM | ID: wpr-866180

ABSTRACT

Objective:To investigate the relationship between gene polymorphism of osteoprotegerin (OPG) and coal-burning endemic fluorosis in Guizhou Province.Methods:In 2018 and 2019, a case-control study was conducted in Bijie City, a typical coal-burning endemic fluorosis area in Guizhou Province, and 260 cases of coal-burning endemic fluorosis patients were selected as case group. According to the "Diagnostic Criteria for Endemic Skeletal Fluorosis" (WS 192-2008), the case group was divided into severe group (130 cases) and mild group (130 cases). At the same time, 130 cases without dental fluorosis and skeletal fluorosis symptoms were chosen as control group in Changshun County, a non-coal-burning endemic fluorosis area in Guizhou Province. Whole blood genomic DNA was extracted, and real-time fluorescence quantitative PCR with TaqMan-MGB probe was utilized to type the OPG gene rs2460985, rs2073618, rs6469804 and rs6993813 four single nucleotide polymorphism (SNP) loci of all samples, and genetic model analysis was performed to compare the frequency distribution of its alleles, genotypes and constructed haplotypes in control, mild and severe groups. Results:By Hardy-Weinberg equilibrium test, the genotype frequencies of the four SNP loci all reached genetic balance in control, mild and severe groups ( P > 0.05). There was a statistically significant difference in the genotype frequency of OPG gene rs6469804 locus among the three groups (χ 2 = 10.615, P < 0.05), and the difference in the genotype frequency of this locus between the control group and the severe group was statistically significant (χ 2 = 6.784, P < 0.05). The results of genetic model analysis showed that in comparison between the control group and the severe group, the optimal genetic model of rs6469804 locus was the overdominant genetic model, the frequency distribution of genotypes AA + GG and AG in the control group and the severe group was statistically significant [odds ratio ( OR) = 1.94, 95% confidence interval ( CI): 1.16 - 3.23, P < 0.05], genotype AG was a risk factor for coal-burning endemic fluorosis. In comparison between the control group and the mild group, the optimal genetic model of rs2073618 locus was the recessive genetic model, the frequency distribution of genotypes GG + GC and CC in the control group and the mild group was statistically significant ( OR = 3.17, 95% CI: 1.08 - 9.30, P < 0.05), genotype CC was a risk factor for coal-burning endemic fluorosis. In comparison between the control group and the mild group, haplotypes C-C-G-T and T-G-A-C were risk factors for coal-burning endemic fluorosis (adjusted OR = 2.41, 1.98, 95% CI: 1.29 - 4.50, 1.22 - 3.23, P < 0.05); in comparison between the control group and the severe group, haplotype T-G-A-C was a risk factor for coal-burning endemic fluorosis (adjusted OR = 1.87, 95% CI: 1.14 - 3.07, P < 0.05). Conclusion:OPG gene rs6469804 locus genotype AG and rs2073618 locus genotype CC may be risk factors for coal-burning endemic fluorosis.

17.
Chinese Journal of Orthopaedics ; (12): 1311-1319, 2019.
Article in Chinese | WPRIM | ID: wpr-803178

ABSTRACT

Objective@#To evaluate the accuracy of transarticular screw fixation using intraoperative three-dimensional fluoroscopy-based navigation (ITFN) and to evaluate the clinical outcomes of this treatment method.@*Methods@#Data of 56 patients(26 males and 30 females) with atlantoaxial instability who were treated by C1, 2 transarticular screw fixation using ITFN from November 2005 to October 2015 were retrospectively analyzed. The mean age of the patients was 44.5 years (range, 9-68 years). There were 44 cases with congenital malformation, 4 with old odontoid fracture, 7 with spontaneous dislocation, and 1 with rheumatoid arthritis. C2 isthmus width and height were measured on preoperatively obtained CT scans, and screw positioning was evaluated on postoperatively obtained CT scans, and classified into three types: ideal position (type I), acceptable position (type II) and unacceptable position (type III). A novel grading system is proposed based on previous study and grading system, and the difficulty of placing C1, 2 transarticular screw using ITFN was classified into three types: easy (total score 0), median (total score 1) and hard (total score 2, 3). Pain scores were assessed using the visual analogue scale. Myelopathy was assessed using the Nurick scale and Odom’s criteria.@*Results@#The isthmus width was 5.46±1.86 mm on the right side and 5.38±1.36 mm on the left side. The isthmus height was 4.89±1.33 mm on the right side and 4.97±1.17 mm on the left side. According to the grading system, 78, 11, and 23 of the sides were classified into easy, median and hard groups respectively. One hundred and seven transarticular screws were placed in 56 patients, and 71.03% of which were ideal screws, and 28.97% were acceptable screws. Five patients had unilateral screws placed. There was no significant difference in screw positioning among the three groups (χ2=0.46, 0.54, 1.18; P=0.50, 0.46,0.28). The mean follow-up period was 44.7 months (range, 6-120 months). At the latest follow-up, according to Nurick score, there are 30 patients scoring 0, 25 patients scoring 1, and 1 patient scoring 2. According to Odom’s criteria, outcomes were as follows: excellent, 66.1%; good, 26.8%; fair, 7.1%; and poor, 0%. All patients with preoperative neck pain had symptom relief or improvement, with more than 89.33% improvement in visual analogue scale scores. No dural laceration, injury to the vertebral artery, spinal cord, or hypoglossal nerve were noted.@*Conclusion@#ITFN is a safe, accurate, and effective tool for transarticular screw placement in patients with atlantoaxial instability.

18.
Chinese Journal of Orthopaedics ; (12): 1285-1292, 2019.
Article in Chinese | WPRIM | ID: wpr-803107

ABSTRACT

Objective@#To develop a calculation model for normal sagittal diameter (SD) of bulbo-medullary junction with the change of distance above the measurement baseline(the line connecting the anterior lower margin of the C2 vertebral body and the posterior upper margin of the C3 vertebral body), and to investigate its calculation error.@*Methods@#All of 164 patients with cervical disc herniation or cervical spinal stenosis who underwent cervical MRI between April 2018 and August 2018 in Beijing Jishuitan Hospital were included in this study. The normal bulbo-medullary junction was divided into two parts from top to bottom, and the dividing line was defined factitiously (the line parallel to the measurement baseline and through the lower margin of cancellous bone of the anterior arch of atlas). On the middle sagittal MRI images of 100 cases of normal bulbo-medullary junction, the change rate of the SD along the distance above the measurement baseline was counted on the upper and lower segments separately. The calculation model for SD of bulbo-medullary junction was established, with the SD of spinal cord at level of the lower margin of axis and the distance above the measurement baseline as independent variables. After setting-up of the calculation model, the actual SD at the lower margin of the C1 anterior arch and 10 mm above and below it was measured on other 64 cases of normal bulbo-medullary junction. The actual SD and calculation value were compared for calculating the error and error rate. The SD at the dividing line was estimated using the substituted estimation (the actual SD at level of the lower margin of axis) and mean-value estimation (the mean SD of the first 100 cases). Calculation value, substituted estimation and mean-value estimation were compared, and their calculation error and the occurrence rate of significant error (no less than 1 mm) were also compared.@*Results@#Calculation formula for SD of bulbo-medullary junction: (below the dividing line) SD=sagittal diameter at level of the lower margin of axis (SDA)+0.0472×height above the measurement baseline (HAB), (above the dividing line) SD=SDA+0.0472×height of dividing line above the measurement baseline (HDL)+0.298×(HAB-HDL). The error of calculation model increased with the distance above the measurement baseline. The error at the topmost level was 1.06±0.72 mm, and the error rate was 10.52%± 8.26%. Compared with the estimation method using the mean value, the calculation model was accompanied with a significantly lower ratio of significant error (Z=-3.527, P<0.001). Compared with the estimation method using a substitute, the error of the calculation model was significantly smaller (Z=-4.88, P<0.001) and the ratio of significant errors was significantly lower (Chi-Square= 6.015, P=0.024).@*Conclusion@#The SD calculation model could accurately estimate the SD of a normal bulbo-medullary junction, and has great significance for the quantitative imaging assessment and decompression strategy in patients with atlantoaxial instability.

19.
Chinese Journal of Orthopaedics ; (12): 1180-1185, 2019.
Article in Chinese | WPRIM | ID: wpr-803027

ABSTRACT

Objective@#To analyze the relationship between cervical alignment and the development of dysphagia after anterior and posterior cervical spine surgery (AC and PC).@*Methods@#A total of 354 patients were reviewed in the present study, including 172 patients who underwent the AC procedure and 182 patients who had the PC procedure between June 2007 and May 2010. The presence and duration of postoperative dysphagia were recorded via face-to-face questioning or telephone interview performed at least 1 year after the procedure. The preoperative and postoperative neutral lateral cervical spine radiographs were evaluated. The C2-C7 angles were measured twice by the same researcher, independently, using the same methods. The change in C2-C7 angle (dC2-C7 angle) was equal to the difference between postoperative and preoperative.@*Results@#There were 12.8% AC (22/172) and 9.3% PC (17/182) patients reported dysphagia after cervical surgery. Of them, 12 patients could be graded as "mild", 8 patients as "moderate", and 2 patients as "severe" dysphagia in AC group, following the dysphagia grading system defined by Bazaz. There were 11 patients graded as "mild", 5 patients as "moderate", and 1 patient as "severe" dysphagia in PC group. No statistical significance was found between AC and PC group (χ2=0.513, P=0.545). Logistic regression analysis revealed that the dC2-C7 angle had considerable impact on postoperative dysphagia (OR=1.141, P=0.001). The chance of developing postoperative dysphagia in patients with dC2-C7 angle larger than 5 degree (64.1%) was significantly greater than that with lower than 5 degree (34.9%, χ2=10.831, P=0.001). Age, gender, BMI, operative time, blood loss, procedure type, revision surgery, most cephalic operative level and number of operative levels did not significantly influence the incidence of postoperative dysphagia (P>0.05). No relationship was found between the dC2-C7 angle and the degree of dysphagia (RR=-0.012, P=0.516).@*Conclusion@#Postoperative dysphagia is a common complication after cervical surgery. The dC2-C7 angle may play an important role in development of dysphagia in both AC and PC surgery. Over-enlargement of cervical lordosis should be avoided in order to reduce the rate of development of postoperative dysphagia.

20.
Chinese Journal of Orthopaedics ; (12): 1053-1060, 2019.
Article in Chinese | WPRIM | ID: wpr-802877

ABSTRACT

Objective@#To provide the normal value of atlas (C1) inner sagittal diameter in adults thus defining the diagnostic value of developmental canal stenosis at C1 and to establish the Jishuitan (JST) morphological classification for C1 developmental canal stenosis in craniovertebral junction (CVJ) anomalies.@*Methods@#From December 2010 to November 2018, 101 patients with various CVJ anomalies (50 males, 51 females; mean age 48.8±12.9 years, range 15-78 years; the anomaly group) and 857 patients with normal CVJ (461 males, 396 females; mean age 50.2±8.3 years, range 21-79 years; the normal group) were enrolled in a retrospective study. In the anomaly group, 92 cases of atlantoaxial dislocation were furtherly divided into three subgroups according to Wadia classification: atlantoaxial dislocation with os odontoideum (OO subgroup, n=33), atlantoaxial dislocation with occipitalization of the atlas (OA subgroup, n=24), atlantoaxial dislocation without both OO and OA (AAD subgroup, n=35); the rest of the anomaly group was combined with Chiari malformation (CM subgroup, n=9). The range of C1 inner sagittal diameter in each group was measured via CT scan images. The normality of C1 inner sagittal diameter of each group was tested via Shapiro-Wilk method. T test was performed on C1 inner sagittal diameter of each group. The diagnostic value of C1 developmental canal stenosis was defined as the lower bound of 95% confidence interval (CI) for the mean of the normal group. The C1 morphology of developmental canal stenosis cases in anomaly group were analyzed via CT scan images thus establishing the JST morphological classification for C1 developmental canal stenosis in CVJ anomalies.@*Results@#The mean C1 inner sagittal diameter was 29.05±1.60 mm (range, 24.05-33.50, 95%CI: 25.91-32.19). C1 developmental canal stenosis was defined as C1 inner diameter ≤ 25.91 mm. The mean C1 inner sagittal diameter of the whole anomaly group was 26.84±2.04 mm (95%CI: 22.84-30.84), which differed significantly from that in the the normal group (t=10.504, P< 0.01). A total of 33 cases meeting the criteria of C1 inner diameter ≤ 25.91 mm were diagnosed as C1 developmental canal stenosis, including 14 cases of the OO subgroup, 4 cases of the OA subgroup, 15 cases of the AAD subgroup and none of the CM subgroup. Based on the C1 morphological characteristics of 33 cases, the JST classification of C1 developmental canal stenosis in CVJ anomalies was established, which could be divided into type I-III. Type I: little atlas type, 84.9% (28/33), normal C1 posterior arch morphology without C1 occipitalization; Type II: atlas posterior arch incurving type, 3.0%(1/33), C1 posterior arch incurves towards spinal canal, without C1 occipitalization; Type III atlas occipitalization type, 12.1% (4/33), furtherly divided into: type IIIa with normal C1 posterior arch morphology; type IIIb with incurving C1 posterior arch.@*Conclusion@#The normal value of C1 inner sagittal diameter in adults was from 24.05 to 33.50 mm. The criteria of C1 inner sagittal diameter ≤ 25.91 mm can be used as the radiographic diagnostic value of C1 developmental canal stenosis. C1 developmental canal stenosis in CVJ anomalies can be classified according to the JST classification system.

SELECTION OF CITATIONS
SEARCH DETAIL