Reconstrução da região superior do dorso com retalho musculocutâneo do trapézio em V-Y baseado na artéria dorsal da escápula / Reconstruction of the upper region of the back with a V-Y trapezius musculocutaneous flap based on the dorsal artery of the scapula

Introdução: Defeitos na região superior do dorso geralmente são de difícil tratamento, especialmente nos casos de exposição de vértebras, meninge ou material de síntese. O fechamento primário com retalho muscular ou musculocutâneo é a melhor escolha, mas a área doadora para tratar grandes defeitos pode requerer enxertia. A preservação da artéria dorsal da escápula parece assegurar um território cutâneo maior do que o do retalho musculocutâneo do trapézio clássico baseado apenas na artéria cervical transversa. Método: Foi concebida uma ampla ilha triangular de pele sobre o músculo trapézio baseado na artéria dorsal da escápula com transferência por movimento pendular e um procedimento tipo V-Y em cinco pacientes após a extirpação de tumores malignos. Resultados: Os defeitos e as áreas doadoras foram fechados primariamente com total viabilidade dos retalhos e não foram observadas complicações além da ocorrência de seroma. Conclusão: O retalho musculocutâneo do trapézio baseado na artéria dorsal da escápula oferece segurança no tratamento de exposição óssea na região superior do dorso.

Introduction: Defects in the upper region of the back are generally difficult to treat, especially in cases of exposure of vertebrae, meninges, or synthetic material. Primary closure with a muscular or musculocutaneous flap is the best choice, but the donor area to treat large defects may require grafting. Preservation of the dorsal artery of the scapula appears to ensure a larger cutaneous territory than that of the classic trapezius musculocutaneous flap based only on the transverse cervical artery. Method: A wide triangular island of skin was designed over the trapezius muscle based on the dorsal scapular artery with pendulum transfer and a V-Y type procedure in five patients after the extirpation of malignant tumors. Results: The defects and donor areas were closed primarily with full viability of the flaps and no complications were observed other than the occurrence of seroma. Conclusion: The trapezius musculocutaneous flap based on the dorsal artery of the scapula offers safety in the treatment of bone exposure in the upper back region.

Prospective Study of the Assessment of Anxiety Symptoms after Minimally Invasive Lumbar Decompression / Estudo prospectivo da avaliação dos sintomas de ansiedade após descompressão lombar minimamente invasiva

Summary Objective To analyze associations between anxiety and postsurgical clinical outcomes in patients who underwent minimally invasive lumbar decompression surgery in addition to comparing symptoms of anxiety and depression before and after surgery. Methods This prospective cohort study of patients who underwent minimally invasive lumbar decompression surgery. Clinical outcomes were measured before and 6 months after surgery using the Visual Analog Scale (VAS), Global Perceived Effect of Change (GPE), Hospital Anxiety and Depression Scale (HADS), and Oswestry Disability Index (ODI). Based on the presurgical anxiety score, patients were categorized into anxious and non-anxious patients, and the outcomes were compared. Results The patients of both groups obtained similar results concerning the clinical outcomes evaluated. Preoperative HADS scores decreased significantly 6 months after surgery in both anxiety (8.70 ± 3.48 vs. 5.75 ± 3.91) and depression (6.95 ± 3.54 vs. 5.50 ± 2.99). The VAS scale for the back (-2.8 ± 3.64) and legs (-5.5 ± 3.5) showed a reduction in pain. Conclusion Minimally invasive lumbar decompression surgery promoted clinical and functional improvement, not being affected by preoperative anxiety symptoms. Mental health indicators showed a significant reduction in symptoms 6 months after surgery.

Resumo Objetivo Analisar associações entre ansiedade e desfecho clínico pós-cirúrgico em pacientes que realizaram a cirurgia de descompressão lombar minimamente invasiva, além de comparar sintomas de ansiedade e depressão antes e após a cirurgia. Métodos Trata-se de um estudo de coorte prospectiva de pacientes que realizaram a cirurgia de descompressão lombar minimamente invasiva. Os desfechos clínicos foram mensurados antes e 6 meses após a cirurgia, utilizando a escala visual analógica de dor (EVA); Global Perceived Effect of Change (GPE); Hospital Anxiety and Depression Scale (HADS) e o Oswestry Disability Index (ODI). A partir do escore de ansiedade précirúrgico, os pacientes foram categorizados em pacientes ansiosos e não ansiosos e os desfechos comparados. Resultados Os pacientes de ambos os grupos obtiveram resultados similares em relação aos desfechos clínicos avaliados. Os escores HADS pré-operatório diminuíram significantemente 6 meses após a cirurgia, tanto em ansiedade (8,70 ± 3,48 vs. 5,75 ± 3,91) quanto em depressão (6,95 ± 3,54 vs. 5,50 ± 2,99). Houve redução da dornaescalaEVA dascostas(-2,8 ± 3,64) e das pernas (-5,5 ± 3,5). Conclusão A cirurgia de descompressão lombar minimamente invasiva promoveu melhora clínica e funcional, não sendo afetada por sintomas pré-operatórios de ansiedade. Os indicadores de saúde mental evidenciaram redução significativa dos sintomas 6 meses após a cirurgia.

Correlación entre la edad cronológica y dental con los estadios de maduración vertebral / Correlation between chronological and dental age with vertebral maturation stages

Introducción: el desarrollo esquelético y dental es una condición determinante como factor principal de mala oclusión e influye en la evaluación, diagnóstico y planificación de los tratamientos de ortodoncia. Objetivo: estimar la correlación entre la edad cronológica y dental con los estadios de maduración vertebral. Material y métodos: la edad cronológica y dental se estimó por los métodos de Baccetti y el de Demirjian, con la lectura de 400 radiografías panorámicas y laterales de cráneo de 205 mujeres y 195 varones, con edades entre 4 y 17 años. La significancia estadística se estableció con el valor p < 0.05 del coeficiente de correlación de Pearson utilizando el programa SPSS v.24. Resultados: se observó un mayor porcentaje entre el estadio D de Demirjian con el estadio I de madurez de las vértebras cervicales (CVM) de Baccetti, seguido del estadio de calcificación dentaria E con el estadio CVM II. Además, existió una correlación moderada entre el método de Baccetti y el método de Demirjian en la pieza 37 (R2 = 0.3741) para la apreciación de la edad cronológica de un individuo. Conclusión: existe una buena correlación entre la edad cronológica y dental con los estadios de la maduración vertebral cervical, sin existir diferencias significativas por el sexo del individuo (AU)

Introduction: skeletal and dental development is a determining condition as the main factor of malocclusion and influences the evaluation, diagnosis, and planning of orthodontic treatments. Objective: to estimate the correlation between chronological and dental age with vertebral maturation stages. Material and methods: chronological and dental age was estimated by the Baccetti and Demirjian methods, with the reading of 400 panoramic and lateral skull radiographs of 205 women, and 195 men, aged between 4 and 17 years. Statistical significance was established with the value p < 0.05 of the Pearson correlation coefficient using the SPSS v.24 program. Results: a higher percentage was observed between Demirjian stage D with Baccetti cervical vertebral maturation (MVC) stage I, followed by dental calcification stage E with MVC stage II. In addition, there was a moderate correlation between the Baccetti method and the Demirjian method in piece 37 (R2 = 0.3741) for the assessment of the CD of an individual. Conclusion: there is a good correlation between chronological and dental age with the stages of cervical vertebral maturation, without significant differences due to the sex of the individual (AU)

Síndrome medular completo secundario a mielitis infecciosa causada por Mycobacterium tuberculosis. Informe de caso / Central spinal cord syndrome secondary to infectious myelitis caused by Mycobacterium Tuberculosis

Introducción: La tuberculosis, un problema de salud pública a nivel mundial que afecta a la población. Causada por Mycobacterium tuberculosis, se transmite a través de gotas de saliva y la presentación extrapulmonar afecta 5­45% de la población infectada. La tuberculosis de columna vertebral es una enfermedad crónica y progresiva, secundaria a la diseminación de un foco primario, que puede pasar desapercibido. Descripción del caso: Paciente masculino con fiebre de 4 días de evolución, nocturna, con diaforesis, debilidad de fuerza de miembros superiores e inferiores bilateral; miembros inferiores con (0) fuerza y miembros superiores (1), ausencia de reflejos osteotendinosos en ambas extremidades, nivel sensitivo C4, con ausencia de control de esfínteres. El diagnóstico se estableció mediante toracocentesis diagnóstica, realizando GeneXpert y cultivo de líquido pleural, positivo para tuberculosis y negativo para micobacteria resistente; resonancia magnética con gadolinio identifica área hiperintensa cervical medular de C2 hasta C4, produciendo aumento en el diámetro de la médula espinal. Se inició tratamiento tetraconjugado: isoniazida, rifampicina, pirazinamida y etambutol. Cuatro semanas posteriores al comienzo de tratamiento paciente presenta (2) fuerza en miembros inferiores y (3) en miembros superiores, continuando con terapia física. Conclusión: la tuberculosis se presenta de maneras muy diversas y se debe tener presente en pacientes jóvenes sin antecedentes personales patológicos que presenten cuadros de fiebre como uno de los primeros síntomas. Pruebas diagnósticas serológicas, GeneXpert y de imagen como la resonancia magnética ayudan en establecer un diagnóstico. La tuberculosis debe considerarse siempre en un proceso infeccioso que se desconoce etiología...(AU)

Comparison of Vertebral Artery Ultrasound, Magnetic Resonance Angiography and Digital Subtraction Angiography in the Diagnosis of Vertebral Artery Stenosis in Patients with Posterior Circulation Ischemia

SUMMARY: The aim of this study was to compare the clinical value of vertebral artery ultrasound (VAU), Magnetic Resonance Angiography (MRA) and Digital Subtraction Angiography (DSA) on vertebral artery stenosis in patients with posterior circulation ischemia. Seventy-three patients with posterior circulation ischemia underwent vertebral artery ultrasound and magnetic resonance angiography as well as digital subtraction angiography, and the diagnosis of vertebral artery stenosis (VAS) and the degree of stenosis (normal, mild stenosis, moderate stenosis, severe stenosis, and occlusion) were recorded and compared between digital subtraction angiogram and vertebral artery ultrasound and magnetic resonance angiography. The vertebral artery stenosis rates on digital subtraction angiography and vertebral artery ultrasound were 87.30 % (55/63) and 49.20 % (31/63), respectively, and the difference was statistically significant. The rates of vertebral artery stenosis on digital subtraction angiography and, magnetic resonance angiography was 90.38 % (47/52) and 88.46 % (46/ 52), respectively, and the differences was not statistically significant. The sensitivity, accuracy, negative predictive value, and positive predictive value of vertebral artery ultrasound in diagnosing vertebral artery stenosis were 51.35 %, 54.76 %, 18.18 %, and 95.00 %, respectively, lower than those of magnetic resonance angiography, which were 91.89 %, 90.48 %, 57.14 %, and 97.14 %, respectively. Of the noninvasive imaging techniques, vertebral artery ultrasound does not accurately characterize vertebral artery stenosis and its degree of stenosis. Magnetic resonance angiography effectively screens for vertebral artery stenosis and its degree of stenosis, and can be used as a reliable tool for vertebral artery stenosis in posterior circulation cerebral infarction, and can be used in conjunction with digital subtraction angiogram in order to improve diagnostic convenience and accuracy.

El objetivo de este estudio fue comparar el valor clínico de la ecografía de la arteria vertebral (VAU), la angiografía por resonancia magnética (ARM) y la angiografía por sustracción digital (DSA) en la estenosis de la arteria vertebral en pacientes con isquemia de la circulación posterior. A 73 pacientes con isquemia de la circulación posterior se les realizó una ecografía de la arteria vertebral y una angiografía por resonancia magnética, así como una angiografía por sustracción digital, y se les diagnosticó estenosis de la arteria vertebral (EVA) y el grado de estenosis (normal, estenosis leve, estenosis moderada, estenosis grave, y oclusión) se registraron y compararon la angiografía por sustracción digital y la ecografía de la arteria vertebral y la angiografía por resonancia magnética. Las tasas de estenosis de la arteria vertebral en la angiografía por sustracción digital y la ecografía de la arteria vertebral fueron del 87,30 % (55/63) y del 49,20 % (31/63), respectivamente, y la diferencia fue estadísticamente significativa. Las tasas de estenosis de la arteria vertebral en la angiografía por sustracción digital y la angiografía por resonancia magnética fueron del 90,38 % (47/52) y del 88,46 % (46/52), respectivamente, y las diferencias no fueron estadísticamente significativas. La sensibilidad, precisión, valor predictivo negativo y valor predictivo positivo de la ecografía de la arteria vertebral en el diagnóstico de estenosis de la arteria vertebral fueron 51,35 %, 54,76 %, 18,18 % y 95,00 %, respectivamente, inferiores a los de la angiografía por resonancia magnética, que fueron 91,89 %, 90,48 %, 57,14 % y 97,14 %, respectivamente. De las técnicas de imagen no invasivas, la ecografía de la arteria vertebral no caracteriza con precisión la estenosis de la arteria vertebral y su grado de estenosis. La angiografía por resonancia magnética detecta eficazmente la estenosis de la arteria vertebral y su grado de estenosis, y puede usarse como una herramienta confiable para la estenosis de la arteria vertebral en el infarto cerebral de circulación posterior, y puede ser utilizada junto con la angiografía por sustracción digital para mejorar el diagnóstico y la exactitud.

Quiste óseo aneurismático del atlas: Tratamiento con denosumab y reporte de caso / Aneurysmal bone cyst of the atlas: treatment with denosumab and case report

Presentamos un caso de quiste óseo aneurismático (QOA) de ubicación infrecuente y comportamiento agresivo en un paciente masculino de 28 años, en que la resección quirúrgica es controversial por el riesgo de iatrogenia y eventual recurrencia. El tratamiento con denosumab ha sido recientemente propuesto como una alternativa para el manejo de QOAs irresecables o recurrentes; sin embargo, la literatura disponible es escasa. Reportamos nuestra experiencia en un caso y analizamos la bibliografía disponible

We present a case of aneurysmal bone cyst (ABC) of infrequent location and aggressive behavior in a 28-year-old male patient, in which surgical resection is controversial due to the risk of iatrogenicity and eventual recurrence. Treatment with denosumab has been recently proposed as an alternative for the management of unresectable or recurrent ABCs; however, the available literature is sparse. We report our experience with one case and analyze the available literature

Clinical outcomes of 3D-printing stand-alone artificial vertebral body in anterior cer-vical surgeries / 北京大学学报(医学版)

Objective:To explore the short-term outcomes of 3D-printing stand-alone artificial vertebral body(AVB)in the surgical procedure of anterior cervical corpectomy and fusion(ACCF).Methods:Following the proposal of IDEAL(idea,development,exploration,assessment,and long-term follow-up)framework,we designed and conducted this single-armed,retrospective cohort study.The patients with cervical spondylotic myelopathy were recruited,and these patients exclusively received the surgical procedure of single-level ACCF in our single center.After the process of corpectomy,the size was tailored using different trials and the most suitable stand-alone AVB was then implanted.This AVB was manufactured by the fashion of 3D-printing.Two pairs of screws were inserted in an inclined way into the adjacent vertebral bodies,to stabilize the AVB.The participants were regularly followed-up after the operation.Their clinical data were thoroughly reviewed.We assessed the neurological status according to Japanese Orthopedic Association(JOA)scale.We determined the fusion based on imaging examination six months after the operation.The recorded clinical data were analyzed using specific software and they presented in suitable styles.Paired t test was employed in comparison analysis.Results:In total,there were eleven patients being recruited eventually.The patients were all followed up over six months after the operation.The mean age of the cohort was(57.2±10.2)years.The mean operation time was(76.1±23.1)min and the median bleeding volume was 150(100,200)mL.The postoperative course was uneventful for all the cases.Dysphagia,emergent hematoma,and deterioration of neurological func-tion did not occur.Mean JOA scores were 13.2±2.2 before the operation and 16.3±0.8 at the final follow-up,which were significantly different(P＜0.001).The mean recovery rate of neurological func-tion was 85.9％.By comparing the imaging examinations postoperatively and six months after the opera-tion,we found that the average subsidence length was(1.2±1.1)mm,and that there was only one ca-ses(9.1％)of the severe subsidence(＞3 mm).We observed significant improvement of cervical lor-dosis after the operation(P=0.013).All the cases obtained solid fusion.Conclusion:3D-printing stand-alone AVB presented favorable short-term outcome in one-level ACCF in this study.The fusion rate of this zero-profile prosthesis was satisfactory and the complication rate was relatively low.

Vertebral fractures combined with prolonged activated partial prothrombin time:A case report / 北京大学学报(医学版)

With the development of modern medical standards,autoimmune diseases and their associ-ated successive osteoporosis have received increasing attention in recent years.Patients with autoimmune diseases,due to the characteristics of the disease and the prolonged use of glucocorticoid hormone thera-py,may affect the bone formation and bone absorption of the patient,followed by severe successive osteo-porosis,thereby increasing the risk of osteoporotic vertebral fractures.Vertebral compression fractures of the spine are common fracture types in patients with osteoporotic fractures.Osteoporosis is a common complication after glucocorticoid therapy in patients with autoimmune diseases.Percutaneous vertebro-plasty(PVP)and percutaneous kyphoplasty(PKP)are minimally invasive operation and are commonly used surgical methods for the treatment of osteoporotic vertebral compression fractures.However,due to the operation of spinal puncture during the operation,there are serious surgical risks such as bone cement leakage,spinal epidural hemorrhage,subdural hemorrhage,and subarachnoid hemorrhage in both PVP and PKP.As a result,it is necessary to evaluate the patient's body before surgery carefully,especially in the case of blood coagulation.This article reports a case of autoimmune disease patient admitted to Peking University People's Hospital due to lumbar 4 vertebral compression fracture combined with Sj?gren's syn-drome.The patient's preoperative examination showed that the activated partial thromboplastin time(APTT)was significantly prolonged.After completing the APTT extended screening experiment and lu-pus anticoagulant factor testing,the multi-disciplinary team(MDT)of Peking University People's Hospi-tal jointly discussed the conclusion that the patient's test results were caused by an abnormal self-immuni-ty anti-copulant lupus(LAC).Based on the results of the laboratory examination,the patient was con-sidered to be diagnosed with combined antiphospholipid syndrome(APS).For such patients,compared with the patient's tendency to bleed,we should pay more attention to the risk of high blood clotting in the lower limbs of the patient,pulmonary clots and so on.With timely anti-coagulation treatment,the patient safely passed the peripheral period and was successfully discharged from the hospital.Therefore,for pa-tients with autoimmune diseases with prolonged APTT in the perioperative period,doctors need to careful-ly identify the actual cause and carry out targeted treatment in order to minimize the risk of surgical and perioperative complications and bring satisfactory treatment results to the patients.

Feasibility study of low tube voltage and low contrast medium combined with IMR technology in 3DCTA of vertebral artery V3 segment / 重庆医学

Objective To investigate the feasibility of low-voltage,automatic tube current adjustment(ATCM)and low contrast agent concentration,dose and injection rate combined with full-model iterative re-construction(IMR)in vertebral artery V3-segment three-dimensional CT angiography(3DCTA).Methods A total of 60 patients with suspected upper cervical spine,craniocervical junction lesions undergoing cervical vertebral artery V3 segment 3DCTA in this hospital from November 2019 to May 2020 were selected and divided into the group A and B by adopting the random number table method,30 cases in each group.The group A adopted the ATCM technology of 80 kV,average tube current of 50 mAs,25 mL of contrast agent io-hexol(iodine content 300 mg/mL)combined IMR technology with an injection rate of 3 mL/s,while the group B adopted 120 kV,150 mAs fixed tube current,50 mL injection rate of 5 mL/s contrast agent iopamidol(iodine content 370 mg/mL)combined filter back projection(FBP)reconstruction technology.CT value,noise,signal-to-noise ratio(SNR),contrast noise ratio(CNR)and image sensitivity(FOM)were measured and compared between the two groups and the quality of the resulting images was evaluated.The CT volumet-ric dose index(CTDIvol)and dose-length product(DLP)were recorded,and the effective dose(ED)was cal-culated.Results There was no statistically significant difference in the vertebral arterial CT value between the two groups(P＞0.05),but the noise of the group A was lower than that of the group B(P＜0.05),SNR,CNR and FOM of the group A were greater than those of the group B(P＜0.05).The image quality of the two groups met the requirements of clinical diagnosis[(4.78±0.41)points vs.(4.85±0.35)points],and there was no statistically significant difference in the subjective evaluation of image quality(P＞0.05).The CTDIvol,DLP and ED levels in the group A were lower than those in the group B(P＜0.05).The iodine in-takes of contrast medium in the group A and group B were 7.5 g and 18.5 g,respectively,and the iodine flow rates of contrast agent were 0.9 and 1.85 mg/s,respectively,and compared with group B,the iodine intake and iodine flow rate of the group A were decreased by 59.5％and 51.4％,respectively.Conclusion Low tube voltage ATCM and low contrast concentration,dose and injection rate combined with IMR technology can not only ensure the 3DCTA image quality of vertebral artery V3 segment,but also reduce the radiation dose re-ceived by the patients,and reduce the iodine intake and iodine flow rate of contrast agent.

Clinical Study on Dingxuan Decoction Combined with Vestibular Function Rehabilitation Training in the Treatment of Meniere's Disease / 广州中医药大学学报

Objective To investigate the efficacy of Dingxuan Decoction combined with vestibular function rehabilitation training in the treatment of Meniere's disease and to observe its effect on clinical symptoms and blood flow of vertebral artery.Methods A total of 100 patients with Meniere's disease of liver-kidney yin deficiency complicated with wind-water upward stirring type were randomly divided into an observation group and a control group,with 50 patients in each group.The control group was given conventional treatment and vestibular function rehabilitation training,and the observation group was treated with Dingxuan Decoction on the basis of treatment for the control group.The two groups were treated for 4 weeks and then were followed up for 6 months.The changes of traditional Chinese medicine(TCM)syndrome score,Dizziness Handicap Inventory(DHI)score,Tinnitus Handicap Inventory(THI)score,hearing visual analogue scale(VAS)score and vertebral artery blood flow in the two groups were observed before and after the treatment.After treatment,the TCM syndrome efficacy,hearing improvement and follow-up results were compared between the two groups.Results(1)After 4 weeks of treatment,the total effective rate for TCM syndrome efficacy of the observation group was 86.00%(43/50),and that of the control group was 62.00%(31/50),and the intergroup comparison showed that the TCM syndrome efficacy in the observation group was significantly superior to that in the control group(P＜0.01).(2)After 4 weeks of treatment,the hearing of patients in both groups was improved,and the total effective rate for the efficacy of hearing improvement in the observation group was 76.00%(38/50),while that in the control group was 46.00%(23/50).The intergroup comparison showed that the efficacy of hearing improvement in the observation group was significantly superior to that in the control group(P＜0.01).(3)After treatment,the TCM syndrome scores,DHI score,THI score and hearing VAS scores in the two groups were all decreased compared with those before treatment(P＜0.05 or P＜0.01),and the decrease in the observation group was significantly superior to that in the control group(P＜0.01).(4)After treatment,the average blood flow velocity of the left vertebral artery(LVA)and the right vertebral artery(RVA)in the two groups were both increased compared with those before treatment(P＜0.05),and the increase in the observation group was significantly superior to that in the control group(P＜0.05 or P＜0.01).(5)The results of 6-month follow-up after treatment showed that the incidence of Meniere's disease and the frequency of attack in the observation group were significantly reduced compared with those in the control group,and the episode duration in the observation group was significantly shorter than that in the control group,the differences being all statistically significant(P＜0.05 or P＜0.01).Conclusion Dingxuan Decoction combined with vestibular function rehabilitation training exert certain effect in treating patients with Meniere's disease of liver-kidney yin deficiency complicated with wind-water upward stirring type,and the therapy is effective on improving patients'clinical symptoms and vertebral artery blood flow,reducing the risk of recurrence and improving the quality of life of the patients.

Clinical efficacy of rapamycin-eluting vertebral artery stents in the treatment of severe ostial vertebral artery stenosis / 介入放射学杂志

Objective To investigate the clinical effect of rapamycin-eluting vertebral artery stent in the treatment of severe ostial vertebral artery stenosis(OV AS),and to analyze the incidence of postoperative in-stent restenosis(ISR).Methods A total of 96 patients with severe OVAS,who received stenting angioplasty at authors'hospital between November 2020 and May 2022,were retrospectively collected.The patients were divided into the observation group(n=48)and the control group(n=48).For the patients of the observation group implantation of rapamycin-eluting vertebral artery stent was carried out,while for the patients of the control group implantation of peripheral balloon dilatation bare metal stent(BMS)was performed.The perioperative basic data,the incidence of complications during follow-up period,and the postoperative incidence of ISR were compared between the two groups.Results Successful stent implantation was achieved in all patients of both groups.During perioperative period no complications such as transient ischemia attack(TIA),dropping-off or fracture of the stent,vertebral artery or stent-related stroke occurred.No statistically significant differences in the length and the diameter of the implanted stents,in the preoperative vertebral artery stenosis ratio,and in the postoperative residual stenosis ratio existed between the two groups(all P＞0.05).In both groups,the postoperative residual stenosis ratio was＜20％.The patients were followed up for a mean period of(12.33±5.82)months(range of 6-18 months),the incidence of postoperative vertebral artery or stent-related stroke in the observation group and the control group was 0％and 4.17％respectively,the difference between the two groups was not statistically significant(P＞0.05).The improvement of clinical symptoms such as dizziness,vertigo,etc.was observed in 47 patients of the observation group and in 45 patients of the control group,and no recurrent posterior circulation TIA or stent-related thrombotic event occurred.The incidence of postoperative restenosis in the observation group was 10.42％,which was significantly lower than 29.17％in the control group(P＜0.05).Conclusion Rapamycin-eluting vertebral artery stent can safely and effectively treat severe OVAS and reduce the incidence of postoperative ISR.(J Intervent Radiol,2024,33:275-279)

The quadrant method was used to assess the relationship between the type of cement distribution after vertebroplasty and new fractures of osteoporotic vertebral bodies / 临床外科杂志

Objective To evaluate the diffusion distribution of bone cement in the vertebral body by quadrant method,and to analyze and evaluate the correlation between the diffusion distribution type of bone cement and new vertebral fractures after vertebral augmentation.Methods A total of 170 subjects who met the conditions from January 2020 to December 2021 were collected.According to the anteroposterior and lateral view of the spine,the injured vertebra was divided into four quadrants,and divided into homogeneous diffusion group and uneven diffusion group according to the postoperative diffusion distribution of bone cement in the injured vertebra.The incidence and types of refracture were followed up,and the VAS score and Cobb angle were compared between the two groups.Results 170 patients were followed up for at least 12 months,including 90 patients in homogeneous diffusion group and 80 patients in heterogeneous diffusion group.There were 33 cases of refracture(19.41％),12 cases of refracture(13.33％)in the diffuse homogeneous group,and 21 cases of refracture(26.25％)in the diffuse heterogeneous group,and the difference between the groups was statistically significant(P＜0.05).The site of refracture in the diffuse homogeneous group was mainly the clinical vertebral fracture,while the probability of refracture in the diffuse heterogeneous clinical vertebra and the operated vertebra was similar.The incidence of postoperative bone cement leakage in the diffuse homogeneous group was significantly lower than that in diffuse heterogeneous group(P＜0.05).The VAS score and Cobb angle were significantly improved in both groups after surgery and at the last follow-up compared with those before surgery,but there was no significant difference between groups.Conclusion The incidence of new vertebral fractures after vertebroplasty is closely related to the type of cement diffusion,and the risk of refracture defined as uneven cement diffusion by quadrant method is high.

Evaluation of high-resolution MRI in patients with posterior circulation ischemic stroke caused by vertebral artery dissection / 实用放射学杂志

Objective To evaluate the imaging features of posterior circulation ischemic stroke caused by vertebral artery dissection(VAD)by high-resolution magnetic resonance imaging(HR-MRI).Methods A total of 56 patients with highly suspected VAD were selected.According to HR-MRI characteristics,these patients were divided into ischemic stroke group(n=23)and control group(n=33).The correlation between imaging features and risk factors in the two groups was analyzed.Results The proportions of intramural hematoma,tumor-like dilatation,and degree of vessel wall enhancement in the ischemic stroke group were significantly higher than those in the control group,and the difference was statistically significant(P<0.05).However,there was no statistical significance in the double-chamber sign and intimal valve sign(P=0.075).Correlation analysis showed that the effective lumen index was significantly negatively correlated with the incidence of posterior circulation ischemic stroke in patients with VAD(r=-0.721,P<0.05),and the area under the curve(AUC)of the effective lumen index reached 0.935.Conclusion The effective features of HR-MRI in the diagnosis of posterior circulation ischemic stroke caused by VAD include intramural hematoma,tumor-like dilatation,degree of vessel wall enhancement,and reduction of effective lumen index,which are helpful for the management and prediction of patients with VAD.

Construction of artificial intelligence-based prediction models for non-recognizable thoracolumbar compression fractures by X-ray inspection / 实用放射学杂志

Objective To evaluate the potency of applying an artificial intelligence(AI)based model for classifying vertebral fractures in lumbar X-ray images.Methods Patients who underwent lateral lumbar X-ray and MRI were retrospectively selected.Based on MRI results,the vertebrae were categorized as fresh fractures,old fractures,and normal vertebrae.A ResNet-18 classification model was constructed using delineated region of interest(ROI)on the X-ray images,and the model's performance was evaluated.Results A total of 272 patients(662 vertebrae)were included in this study.The vertebrae were randomly divided into training(n=529)and validation(n=133)sets.The model's performance in discerning normal vertebrae,fresh fractures,and old fractures revealed accuracy of 0.91,0.42,and 0.75,and the sensitivity were 0.91,0.408,and 0.72,while the specificity were 0.796,0.892,and 0.796,respectively.Conclusion The X-ray-based ResNet-18 AI model has significant accuracy for distinguishing old fractures and normal vertebrae;However,the model's accuracy needs further improvement for distinguishing fresh fractures.

Meta-analysis of efficacy and safety of terlipatide and bisphosphate in the treatment of postmenopausal osteoporosis fractures / 中国组织工程研究

OBJECTIVE:To compare the efficacy and safety of terlipatide and bisphosphate in the treatment of postmenopausal osteoporosis fractures through a Meta-analysis. METHODS:By searching PubMed,Cochrane Library,EMbase,CNKI,WanFang and VIP databases,18 randomized controlled studies on terlipatide and bisphosphate in the treatment of postmenopausal osteoporosis fractures were included according to inclusion and exclusion criteria.Endnote X9 software was used to manage the literature and Revman 5.3 software was used to perform a Meta-analysis on the extracted data.The incidences of vertebral fracture,non-vertebral fracture and adverse reaction in postmenopausal osteoporosis patients treated with terlipatide and bisphosphate were analyzed. RESULTS:A total of 18 randomized controlled studies were included,of which 10 were of medium and high quality and 8 were of low quality.Meta-analysis results showed that the fracture incidence in the teriparatide group[risk ratio(RR)=0.56,95%confidence interval(CI):0.48-0.66,P＜0.000 01]was lower than that in the bisphosphonate group,and teriparatide was superior to alendronate in preventing fractures in postmenopausal women with osteoporosis(RR=0.50,95%CI:0.35-0.69,P＜0.000 1)and other bisphosphonates(RR=0.58,95%CI:0.49-0.70,P＜0.000 01).During the follow-up over 18 months,teriparatide was superior to bisphosphonates in preventing fractures in postmenopausal women with osteoporosis(RR=0.56,95%CI:0.48-0.69,P＜0.000 01).In addition,we found that teriparatide was superior to bisphosphonates in preventing vertebral fractures(RR=0.48,95%CI:0.37-0.62,P＜0.000 01)and non-vertebral fractures(RR=0.63,95%CI:0.51-0.78,P＜0.000 1)in postmenopausal women with osteoporosis.Teriparatide was superior to bisphosphonates in increasing lumbar bone density[odds ratio=4.16,95%CI:2.96-5.36,P＜0.000 1)and femoral neck bone density(odds ratio=1.02,95%CI:0.04-2.01,P=0.04).There was no significant difference in adverse reactions between teriparatide and bisphosphonates(RR=0.95,95%CI:0.85,1.06,P=0.37). CONCLUSION:Teriparatide is superior to bisphosphonates in preventing vertebral and non-vertebral fractures in postmenopausal women with osteoporosis,but the safety and adverse drug reactions of teriparatide and bisphosphonates are basically similar.Teriparatide is superior to bisphosphonate in preventing fracture and improving lumbar and femoral neck bone density regardless of short-term(＜18 months)or long-term(≥18 months)use.

Correlation between coronal pressure variation and coronal imbalance in adolescent idiopathic scoliosis patients / 中国组织工程研究

BACKGROUND:The distribution of horizontal pressure in adolescent idiopathic scoliosis can be used to evaluate the coronal imbalance.Currently,there are no reports on the characteristics of coronal pressure distribution and its correlation with coronal imbalance. OBJECTIVE:To explore the correlation between coronal pressure variation and coronal imbalance in adolescent idiopathic scoliosis patients. METHODS:A total of 39 adolescent idiopathic scoliosis patients who met the inclusion and exclusion criteria in Lianyungang First People's Hospital from March 2021 to June 2022 were selected as the adolescent idiopathic scoliosis group,and 30 matched healthy volunteers were recruited from the outpatient department as the control group.The horizontal position pressure,folding position pressure,coefficient of variation,and global and trunk pressure variation were measured by the TBED Postural Couch evaluation system.In the adolescent idiopathic scoliosis group,full-length spine radiographs were taken to measure Cobb angle,coronal balance,apical vertebral deviation and Nash-Moe rotation.The characteristics of coronal pressure variation and its correlation with coronal imbalance were analyzed. RESULTS AND CONCLUSION:(1)Compared with the control group,there was no statistically significant difference in the horizontal position pressure and folding position pressure in the adolescent idiopathic scoliosis group(P>0.05),but the global pressure variation and coefficient of variation were significantly increased(all P<0.05).(2)There were differences in both sides of the trunk of the adolescent idiopathic scoliosis group and the control group(P<0.05),and the convex side pressure variation in the adolescent idiopathic scoliosis group was higher than the concave side pressure variation in the left and right side pressure variation in the control group(all P<0.05).(3)The variation of the convex side pressure of the trunk in adolescent idiopathic scoliosis patients was positively correlated with coronal balance intensity(r=0.692,P<0.05),moderately positively correlated with Cobb angle and apical vertebral deviation(r=0.499,0.595,all P<0.05),and weakly correlated with Nash-Moe grade(r=0.377,P<0.05).The variation of the concave side pressure of the trunk was moderately positively correlated with coronal balance(r=0.410,P<0.05),and the rest was weakly correlated or not correlated(P>0.05).(4)These findings indicate that pressure variation may be used as an adjoint assessment tool in patients with mild to moderate scoliosis.

Influencing factors of adjacent vertebral re-fracture in patients with osteoporotic vertebral fractures after percutaneous vertebroplasty / 中国组织工程研究

BACKGROUND:Osteoporotic vertebral compression fractures have a high rate of recurrent fractures in adjacent vertebrae after percutaneous vertebroplasty,but the cause of their occurrence is still controversial. OBJECTIVE:To explore the influencing factors of adjacent vertebral re-fractures after percutaneous vertebroplasty in patients with single-segment osteoporotic vertebral compression fractures. METHODS:A retrospective analysis was performed in 210 patients admitted to the Fifth Hospital of Wuhan City,Second Affiliated Hospital of Jianghan University from June 2016 to June 2020,who had been diagnosed with new single-segment osteoporotic vertebral compression fractures by X-ray and MRI examinations,and received percutaneous vertebroplasty.The patients were followed up for more than 18 months.The general preoperative data and postoperative indicators were collected.The general preoperative data included age,sex,body mass index,fracture segment location,fracture days,fracture cause,whether accompanied by diabetes mellitus,whether accompanied by renal and thyroid dysfunction,and visual analogue scale score on admission.The postoperative indicators included recovery rate of anterior edge of the vertebral body after operation,degree of dispersion of bone cement,leakage of bone cement,use of bone material,single or bilateral injection of bone cement,recovery rate of the injured vertebral mid-column after operation,local Cobb angle of the injured vertebra after operation.According to their real conditions,the patients were divided into a group without adjacent vertebral re-fractures(n=190)and a group with adjacent vertebral re-fractures(n=20).The presence or absence of postoperative re-fracture of the adjacent vertebrae of the injured spine was used as the dependent variable and the categorical variables such as preoperative general data and postoperative indicators were used as independent variables for statistical analysis. RESULTS AND CONCLUSION:After percutaneous vertebroplasty,patients with adjacent vertebral re-fractures showed significant differences in age,body mass index,postoperative vertebral body anterior edge recovery rate,degree of cement dispersion,and cement leakage from those without adjacent vertebral re-fractures(P<0.05).However,sex,time of fracture,cause of fracture,presence of diabetes or kidney disease or thyroid disease,location of the initial vertebral fracture segment,mode of cement injection,local Cobb angle of the injured vertebra,recovery rate of the injured vertebral mid-column,and use of bone tissue were not statistically significant in relation to re-fracture of the adjacent vertebra after percutaneous vertebroplasty(P>0.05).Multivariate Logistic regression analysis showed that age,vertebral body anterior edge recovery rate and cement leakage were independent risk factors for re-fractures of the adjacent vertebra after percutaneous vertebroplasty.To conclude,age,vertebral body anterior edge recovery rate and leakage of bone cement are the influencing factors of adjacent vertebral re-fractures after percutaneous vertebroplasty.However,factors such as the degree of bone cement dispersion and the local Cobb angle of the injured vertebra were not correlated with adjacent vertebral re-fractures after percutaneous vertebroplasty.

Cone-beam CT evaluation of bone mass in the external oblique line of the mandible in adolescents with different cervical vertebral bone ages / 中国组织工程研究

BACKGROUND:The application of miniscrew in adolescents is increasing day by day,but at present,there are few studies on bone mass in the external oblique line of the mandible in adolescents at home and abroad,and there is no systematic study on bone mass in the external oblique line of the mandible in adolescents in different growth and development periods. OBJECTIVE:To measure the bone mass in the external oblique line of the mandible in adolescents with different cervical vertebral bone ages using a cone-beam CT and to investigate the difference of bone mass in the external oblique line of the mandible in adolescents with different cervical vertebral bone ages and the correlation between bone mass in this area and the cervical vertebral bone age. METHODS:The cone-beam CT data of 105 adolescent patients before orthodontic treatment were collected and divided into CS3 group(n=24),CS4 group(n=26),CS5 group(n=29)and CS6 group(n=26)using the cervical vertebral maturation method.The adolescent mandibular buccal shelf was reconstructed by Mimics Medical 21.0 software.The width of buccal bone at 6 and 11 mm under the cemento-enamel junction and the bone height at 4 and 5 mm buccal to the cemento-enamel junction of right mandibular first and second molars were measured.The measured data were statistically analyzed.The measurement was made on four planes:plane 1 is the plane where the proximal mesial root of the mandibular right first molar is located;plane 2 is the plane where the distal mesial root of the mandibular right first molar is located;plane 3 is the plane where the proximal mesial root of the mandibular right second molar is located;and plane 4 is the plane where the distal mesial root of the mandibular right second molar is located. RESULTS AND CONCLUSION:In each group,the bone width on the buccal side of the external oblique line increased gradually from the first molar proximally to the second molar distally in adolescents,and the width of buccal bone at 6 and 11 mm under the cemento-enamel junction showed significant difference among different layers(P<0.05).The bone width of buccal bone at 11 mm under the cemento-enamel junction was greater than that at 6 mm.The bone height on the buccal side of the external oblique line increased gradually from the first molar proximally to the second molar distally in all four groups,and the bone height at 4 and 5 mm buccal to the cemento-enamel junction showed significant differences at different layers(P<0.05).The bone height at 4 mm buccal to the cemento-enamel junction was greater than that at 5 mm.On the fourth plane,the bone width at 11 mm buccal to the cemento-enamel junction was smaller in the CS3,CS4,and CS5 groups than in the CS6 group(P<0.05).On the third plane,the bone heights at 4 mm and 5 mm buccal to the cemento-enamel junction were smaller in the CS3 and CS4 groups than in the CS6 group(P<0.05).On the fourth plane,the bone height at 5 mm buccal to the cemento-enamel junction was smaller in the CS3 and CS4 groups than in the CS6 group(P<0.05).On the fourth plane,the bone height at 4 mm buccal to the cemento-enamel junction was smaller in the CS3 group than in the CS6 group(P<0.05).Spearman correlation analysis showed that there was no correlation between bone mass and the cervical vertebral bone age,except that there was a weak correlation between bone mass at some measurement sites and cervical vertebral bone age.To conclude,the bone mass in the external oblique area of the mandible in adolescents does not change significantly with the increase of cervical vertebral bone age.The buccal side of the mesial root and distal root of the mandibular second molar in the external oblique area of CS3-CS6 adolescents meets the requirement of bone mass for miniscrew implantation,which is a site available for miniscrew implantation.

Relationship between degeneration of paraspinal muscle and refractures in postmenopausal women treated by percutaneous vertebroplasty / 中国组织工程研究

BACKGROUND:There are few studies on the effect of degeneration of paraspinal muscle on osteoporotic vertebral compression refractures treated by percutaneous vertebroplasty in postmenopausal women.This paper intends to reveal the relationship between them. OBJECTIVE:To investigate the relationship between degeneration of paraspinal muscle and osteoporotic vertebral compression refractures in postmenopausal women treated by percutaneous vertebroplasty. METHODS:The medical records of 81 postmenopausal female patients who were admitted to the First Affiliated Hospital of Guangzhou University of Chinese Medicine from May 2018 to March 2021 for osteoporotic vertebral compression fracture and received percutaneous vertebroplasty were retrospectively analyzed.The patients were divided into an osteoporotic vertebral compression refracture group(n=39)and a control group(n=42)according to whether they had osteoporotic vertebral compression refracture after percutaneous vertebroplasty.General data,vertebral bone mineral density,paravertebral cross-sectional area and mean CT value(Hu)of the two groups were analyzed. RESULTS AND CONCLUSION:(1)Univariate analysis showed that there was no significant difference in age and mean CT value of psoas major between the two groups(P>0.05).The body mass index,vertebral bone mineral density,paravertebral cross-sectional area and the mean CT value of the posterior vertebral muscle group in the control group were significantly higher than those in the osteoporotic vertebral compression refracture group(P<0.05).(2)Multivariate logistic regression analysis showed that low vertebral bone mineral density(OR=0.004,95%CI:0.000-0.555,P<0.05)and low mean CT value of posterior vertebral muscle group(OR=0.940,95%CI:0.894-0.988,P<0.05)were independent risk factors for postmenopausal osteoporotic vertebral compression refracture.(3)It is indicated that degeneration of paraspinal muscle will increase the risk of osteoporotic vertebral compression refractures in patients treated by percutaneous vertebroplasty,especially in postmenopausal women with a low mean CT value of low posterior vertebral muscle group.

Influence of bone cement volume and distribution on surgical and adjacent vertebral refractures after percutaneous vertebroplasty / 中国组织工程研究

BACKGROUND:Studies have exhibited that symmetrical distribution and effective dose of bone cement can reduce postoperative vertebral refractures and help improve outcomes,but obtaining better distribution and dose of bone cement during percutaneous vertebroplasty remains an issue for surgeons. OBJECTIVE:To investigate the risk factors of percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture,and to analyze the correlation between these factors and recurrent fractures of the operative vertebral body and adjacent vertebral bodies after percutaneous vertebroplasty. METHODS:111 patients who underwent unilateral approach percutaneous vertebroplasty in Sixth Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2021 were screened and divided into fracture group(n=17)and non-fracture group(n=94)according to whether refracture was observed during follow-up.The following variables were reviewed in both groups:Gender,age,body mass index,operation time,menopause age,bone cement distribution index,bone density T value,bone cement dose,location of bone cement distribution,percutaneous vertebroplasty stage,past history,adverse reactions and disc cement leakage of patients.These variables were analyzed by univariate analysis.The statistically significant factors were replaced by a binary Logistic regression model to analyze the correlation with vertebral refracture after percutaneous vertebroplasty. RESULTS AND CONCLUSION:(1)Univariate analysis demonstrated that after percutaneous vertebroplasty,vertebral refracture was associated with disc cement leakage(P=0.000),cement dose(P=0.049),and cement distribution location(P=0.017).(2)Binary Logistic regression revealed that bone cement leakage(P=0.000),cement dose(P=0.031),and location of cement distribution(P=0.015)were risk factors for recurrent fracture of the operative vertebral body and adjacent vertebral body after percutaneous vertebroplasty.Compared with cement distribution types I,II,and III,the risk of recurrent fracture in the operative and adjacent vertebrae was higher in cement distribution types IV and V(OR=36.340,P=0.016;OR=27.755,P=0.017).(3)It is concluded that recurrent fractures of the surgically operated vertebral body and adjacent vertebral bodies are caused by the interaction of multiple risk factors.Bone cement distribution and bone cement leakage were independent risk factors.Recurrent fractures of the operative vertebra and adjacent vertebrae are more likely when the cement is distributed in type IV and type V.Surgeons should fully assess these risk factors before surgery and develop targeted prevention and treatment strategies to help reduce the risk of future refractures.