Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (version 2022) / 中华创伤杂志

Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.

Occipitocervical fusion and fixation in malformation of craniocervical junction surgery / 上海交通大学学报（医学版）

Objective·To study the application of occipitocervical fusion and fixation in malformation of craniocervical junction surgery.Methods·Thirty-six consecutive patients with craniocervical junction malformation were decompressed under evoked-potential monitoring.Sixteen patients were treated with posterior occipitocervical fusion and fixation using Vertex screw-hook system,and 11 using Vertex screw-rod system,other patients using Mountaineer OCT spinal system.All patients were followed up for 2 to 12 years (mean 7 years).The recovery rate was analysed based on the scoring system of the Japanese Orthopaedic Association (JOA).Results·All the patients were followed up.A stable bony fusion according to radiological criteria was achieved in all cases.There was no implant broken and dislocation.The improvement rate according to JOA scoring system were evaluated.Twenty-four cases (66.7％) got cured;4 cases (11.1％) had remarkable effects;8 cases (22.2％) were effective;none was ineffective.Conclusion·Occipitocervical stabilizations hope to be restored through occipitocervical fusion and fixation.Good results can be obtained in most patients with complete radiological data,proper surgery indication,suitable surgical modality and internal fixation materials.

Ethical Dilemma and Countermeasure of the Vagrant Mental Patients / 中国医学伦理学

Through investigating the hospital admission and hospital discharge of vagrant mental patients in Xi-aoshan Hospital from January 2011 to December 2015 , the present study found that there existed some ethical di-lemmas including the risk ofdiagnosing mental disorder but actually not, lack of the guarantee of patients' rights and interests and supervision mechanism without guardian, long-term retention in the wards, and so on. It is sug-gested to establish right protection and supervision committee for vagrant mental patients, reduce the misdiagnosis ofdiagnosing mental disorder but actually not through the error correction mechanism, ensure proper treatment and care, create retention way, protect the basic rights of the vagrant mental patients, reduce mental disability, avoid to stray again, so as to perfect the social management system.

Unilateral pedicle screw fixation through the pedicle of fractured vertebra in combination with the short segment of pedicle screw in the treatment of thoracolumbar fracture of mild to moderate instability / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of unilateral pedicle screw fixation through the pedicle of fractured vertebra in combination with the short segment of pedicle screw in the treatment of thoracolumbar fracture of mild to moderate instability.</p><p><b>METHODS</b>Twenty-six patients with single segment thoracolumbar fracture received unilateral pedicle screw fixation through the pedicle of fractured vertebra in combination with the short segment of pedicle screw from January 2008 to December 2009. There were 16 patients were male and 10 were female with an average age of 47.3 years (range from 39 to 60 years). Fracture severity score was constructed by using the load-sharing classification (4 points for 2 cases, 5 points for 14 cases, 6 points for 10 cases). By Frankel assessment system, 2 cases were in grade C, 3 in grade D, 21 in grade E. The assessment included anterior vertebral body height, the sagittal Cobb angle, the restoration of nervous function, visual analogue score (VAS) and Oswestry disability index (ODI).</p><p><b>RESULTS</b>The follow-up after the surgery was 13 - 26 months, with an average of 18.6 months. There were no fixation failure, defined as implant failure or ≥ 10° correction loss. The neurological status of 4 patients, who had an associated neurologic deficit preoperatively, was completely recovered. The Frankel grade of another case was re-rated D from the original C. The mean anterior vertebral body height increased from 57.0% ± 6.3% before the surgery to 93.1% ± 1.7% at the last follow-up(F = 455.276, P < 0.05). The sagittal Cobb angle decreased from 15.6° ± 4.7° before the surgery to 2.6° ± 5.2° at the last follow-up (F = 34.623, P < 0.05). VAS and ODI were 1.0 ± 0.7 and 17.0 ± 5.9 at the last follow-up.</p><p><b>CONCLUSION</b>Unilateral pedicle screw fixation through the pedicle of fractured vertebra combined with the short segment of pedicle screw is effective for thoracolumbar fracture with mild to moderate instability.</p>

Short-segment transpedicular fixation combined with augmentation vertebroplasty in treatment of thoracolumbar burst fractures / 中华骨科杂志

ObjectiveTo evaluate the efficacy of short-segment transpedicular fixation combined with augmentation vertebroplasty in treatment of thoracolumbar burst fractures. MethodsFrom November 2006 to September 2009, 37 patients with thoracolumbar burst fracture were admitted and received transpedicular fixation combined with calcium sulfate cement augmentation vertebroplasty, and the clinical data including fracture types, complications and following-up results were collected for analysis. The multimethod evaluation strategies involved the anterior vertebral body height, the sagittal Cobb's angle, the restoration of nervous function, internal fixation failure, visual analogue scale (VAS) and Oswestry disability index (ODI) were retrospective analyzed. Results All patients were followed up for average 19 months (range, 14-37). There were no internal fixation failure, loss of reduction, neurological complications in all the patients. In 16 patients with partial neurologic deficits, 14 initially improved at the final follow-up, with no deterioration of neurologic functions. The mean time of calcium sulfate cement obvious absorption and union was 3 months and 5 months postoperatively, respectively. The anterior vertebral body height was 55.40％before surgery and 85.46％ after surgery on average, ended up with 82.35％. The sagittai Cobb's angle was improved from 22.45° to 6.86°, ended up with 9.66° on average. The mean VAS and ODI at the final followup were respectively 1.2 and 20.4 on average. ConclusionShort-segment transpedicular fixation combined with augmentation vertebroplasty appears to be effective in achieving stable biomechanics with high security,which seems to be a feasible option in the management of thoracolumbar burst fractures.

Research progress of minimally invasive transforaminal lumbar interbody fusion / 中国矫形外科杂志

Lumbar fusion is currently the major treatment of lumbar degenerative disease, spinal instability and discogenic disease etc. Transforaminal lumbar interbody fusion (TLIF) is a novel lumbar fusion technique in recent years, and with the progress of minimally invasive spinal surgery, minimally invasive TLIF (mini-TLIF) technique has also got access to rapid development, which has more advantages compared with traditional open TLIF. The authors review the indications and contraindications, surgical method, development and advantages and minimally invasive surgical assistant instruments of mini -TLIF.

Chronic mild stress stimulates nitric oxide production in rat brain cortex and hippocampus / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To evaluate the nitric oxide (NO) levels in rat brain cortex and hippocampus after chronic mild stress.</p><p><b>METHODS</b>Sixteen male Sprague-Dawley rats were allocated into control group and model group randomly. Model rats were induced by consecutive chronic mild stress; weight gain, open field test and sucrose solution consumption were investigated before and after procedure. Nitric oxide contents in prefrontal cortex and hippocampus were determined by spectrophotometric assays.</p><p><b>RESULT</b>Decreased locomotion, loss of interest and anhedonia were observed in chronic mild stress rat model group. Nitric oxide contents in prefrontal cortex and hippocampus were significantly higher in chronic mild stress group [(31.00 +/-2.55)nmol/mg.pro and (38.11 +/-1.73)nmol/mg.pro, respectively] than those in control group [(26.97 +/-1.38)nmol/mg.pro and (36.06 +/-0.87)nmol/mg.pro, respectively] (P <0.05).</p><p><b>CONCLUSION</b>Chronic stress can stimulate NO release, and dysfunction of nitric oxide pathway may be involved in development of depression.</p>

Clinical analysis of residual low back pain and recurrent herniation after standard discectomy for lumbar disc herniation / 中国矫形外科杂志

[Objective]To investigate residual low back pain and recurrent herniation after standard discectomy for lumbar disc herniation.[Method]The long-term follow-up was analyzed in 84 patients who were selected randomly from 200 patients during a minimum of 5 years after standard discectomy,which was based on the rating of JOA and image methodology on both before and after the operations.[Result](1)Residual low back pain was found in 79.8% of the patients,of which 14.3% had severe low back pain(JOA 1).The majority of the patients with severe low back pain were under age of 35 at time of operation.(2)Twelve patients had operations again because of herniation and 1 patient had operation again because of the unstable of lumbar,who were mainly male adults under age of 50.[Conclusion]It is easier for young man to have severe low back pain and herniation recurrence.When conducting the operation for those young patients for the first time,we can consider fusion of spine properly according to their condition.

Revised Tongxie Yaofang Treat 57 Cases Diarrhea-type Intestinal Irritable Syndrome / 浙江中医药大学学报

ObjectiveTo explore the effective method of intestinal irritable syndrome(IBS). Method Randomly divide 57 cases into 2 groups, Chinese drug group 28 cases were treated with Tongxie Yaofang; the combination group 29 with revised Tongxie Yaofang and chlorimipramine, for 4 weeks.Result The gastro-intestinal symptoms were relieved markedly for both groups; after treated for 14 and 28 days, there’s no statistical difference between the both groups on reduction rate of patients’ SDS; at the 28~ th day, there’s no obvious difference on the symptoms of abdomen pain and diarrhea in both groups. Conclusion Tongxie Yaofang can effectively treat IBS. The relieving of depression may not be related with chlorimipramine.

Key points about atlanto-axial internal-fixation and fusion using Gallie's technique / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical problems about posterior atlanto-axial internal-fixation and fusion for atlanto-axial instability or dislocation.</p><p><b>METHODS</b>Surgical treatments of 138 cases with atlanto-axial instability or dislocation were reviewed. There were 62 cases of odentoid malformation, 54 cases of odentoid fracture or rupture of transverse ligament, 22 cases of subluxation and rotation. All cases were treated using Gallie's technique. Six cases were also fixed with transarticular screws, and protected with Philadelphia collar. Other patients were fixed with plaster paris brackets. The followed-up period was 1 to 12 years with an average of 3 year and 5 months.</p><p><b>RESULTS</b>According to Sumi's criteria, excellent 70 cases (50.7%), good 40 cases (29.0%), fair 15 cases (10.9%), poor 13 cases (9.4%). 9 cases with bone graft postponed fusion were cured by enhance external-fixation. 2 cases with nonunion were treated with revision surgery. Complication of cord injury happened in 1 case.</p><p><b>CONCLUSION</b>Gallie's fusion technique is an effective method to manage the atlanto-axial instability or dislocation. Skull distraction before operation and reliable external-fixation post operative are important assistant measures. Key points for successful operation are careful wiring or cable traversing, decortication of posterior arc of C1, and maintaining the physiological height between C1 and C2 posterior arc. Indications and objectives should be conformed before revision surgery for failure cases.</p>