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Objective:To assess the effect and safety of bone-filling mesh container (BFC) and percutaneous kyphoplasty (PKP) in treatment of osteoporotic vertebral compression fractures (OVCF).Methods:PubMed, Web of Science, Cochrane Library, CNKI, VIP, CBM and Wanfang database were searched by computer from inception to September 2019, for the randomized controlled trial (RCT) or case-control trial (CCT) that compared the treatment of OVCF using BFC and PKP. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies. Then meta-analysis was performed using RevMan 5.3. The literature search results, basic characteristics of the included studies, operation time, postoperative visual analogue score (VAS), Oswestry disability index (ODI), Cobb's angle, leakage rate of the bone cement and publication bias were evaluated.Results:Only 5 RCTs and 5 CCTs involving 668 patients were included. Compared with the PKP group, the BFC group showed no significant difference in postoperative VAS ( MD=-0.06, 95% CI -0.24-0.37), ODI ( MD=-0.20, 95% CI-1.13-0.73) and Cobb's angle ( MD=0.18, 95% CI-0.05-0.91), while there were significant differences in operation time ( MD=-3.07, 95% CI-5.53--0.60) and leakage rate ( OR=0.21, 95% CI 0.12-0.36). Funnel plots showed that there was no significant asymmetry among the above indicators, suggesting that publication bias had little effect on the results. Conclusion:BFC is as effective as PKP in the postoperative efficacy of OVCF, but is superior in operation time and leakage rate of bone cement.
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Objective@#To investigate the clinical efficacy of modified tracer minimally invasive fixation in robot-assisted pedicle screw placement.@*Methods@#A prospective randomized controlled study was conducted to analyze the clinical data of 41 patients with thoracolumbar fresh fracture at the orthopaedics department of Karamay Central Hospital from July 2017 to December 2017. There were 20 males and 21 females, aged 25-55 years, with an average of 40.6 years. According to AO fracture typing, there were 28 patients with type A and 13 patients with type B. The patients underwent robot-assisted pedicle screw placement. Random number table method was used to divide the patients into the conventional group (20 patients) and modified group (21 patients). The conventional group was treated with conventional tracer fixation, and the modified group modified tracer minimally invasive fixation. A total of 92 pedicle screws were implanted in the conventional group and 96 pedicle screws were implanted in the modified group. The size of wound, wound bleeding, time of fixing the tracer, complications (spinal cord injury and nerve root injury when fixing the tracer), development of the tracer fixator and artifacts were recorded. The accuracy of nail placement was evaluated by 320-slice CT scan and Gertzbein-Robbins criteria.@*Results@#There was no significant difference in age, sex, diagnosis, transverse diameter of pedicle and e angle between the two groups (P>0.05). The wound size, wound bleeding, and time of fixing the tracer in the modified group were (6.00±1.26)mm, (1.38±0.22)ml and (1.42±0.17)minutes, respectively, while those of the conventional group were (40.16±5.71)mm, (11.61±1.15)ml, and (5.12±0.64)minutes respectively (P<0.05). No spinal cord or nerve root injury occurred in either group when the tracer was fixed. In the process of three-dimensional image acquisition and automatic registration, the tracer fixator in the modified group developed with Kirschner needle without artifacts, and the tracer in minimally invasive fixator had good fluoroscopy effect. The modified group included 94 pedicle screws of type A and two of type B according to Gertzbein-Robbins criteria. The conventional group included 89 pedicle screws of type A and three of type B according to Gertzbein-Robbins criteria. There was no significant difference in the screw placement accuracy between the two groups (P>0.05).@*Conclusion@#In the robot-assisted pedicle screw placement, the modified tracer minimally invasive fixation method is safe and less traumatic, with no side effect on the accuracy of pedicle screw placement.
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Objective To investigate the clinical efficacy of modified tracer minimally invasive fixation in robot-assisted pedicle screw placement. Methods A prospective randomized controlled study was conducted to analyze the clinical data of 41 patients with thoracolumbar fresh fracture at the orthopaedics department of Karamay Central Hospital from July 2017 to December 2017. There were 20 males and 21 females, aged 25-55 years, with an average of 40. 6 years. According to AO fracture typing, there were 28 patients with type A and 13 patients with type B. The patients underwent robot-assisted pedicle screw placement. Random number table method was used to divide the patients into the conventional group (20 patients) and modified group (21 patients). The conventional group was treated with conventional tracer fixation, and the modified group modified tracer minimally invasive fixation. A total of 92 pedicle screws were implanted in the conventional group and 96 pedicle screws were implanted in the modified group. The size of wound, wound bleeding, time of fixing the tracer, complications (spinal cord injury and nerve root injury when fixing the tracer), development of the tracer fixator and artifacts were recorded. The accuracy of nail placement was evaluated by 320-slice CT scan and Gertzbein-Robbins criteria. Results There was no significant difference in age, sex, diagnosis, transverse diameter of pedicle and e angle between the two groups (P>0. 05). The wound size, wound bleeding, and time of fixing the tracer in the modified group were (6. 00 ± 1. 26)mm,(1. 38 ± 0. 22)ml and (1.42 ±0.17)minutes, respectively, while those of the conventional group were (40. 16 ± 5. 71)mm, (11.61 ±1.15)ml, and (5.12 ±0.64)minutes respectively (P<0.05). No spinal cord or nerve root injury occurred in either group when the tracer was fixed. In the process of three-dimensional image acquisition and automatic registration, the tracer fixator in the modified group developed with Kirschner needle without artifacts, and the tracer in minimally invasive fixator had good fluoroscopy effect. The modified group included 94 pedicle screws of type A and two of type B according to Gertzbein-Robbins criteria. The conventional group included 89 pedicle screws of type A and three of type B according to Gertzbein-Robbins criteria. There was no significant difference in the screw placement accuracy between the two groups (P>0. 05). Conclusion In the robot-assisted pedicle screw placement, the modified tracer minimally invasive fixation method is safe and less traumatic, with no side effect on the accuracy of pedicle screw placement.
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Objective To investigate the clinical efficacy of anterior cervical surgery by comparative analyzing hand dysfunction using brief Michigan hand questionnaire(Brief MHQ)in Hirayama disease patients.Methods From Aug 2011 to Dec 2016,27 patients of hirayama disease who underwent surgery were enrolled in this study.The study group consisted of 27 men.The mean follow-up period was 41.1 months.The levels of surgery included 18 cases of C4-C7,6 cases of C3-C6,2 cases of C4-C6 and 1 case of C5-T1.Brief MHQ were evaluated for the 27 patients.According to the Wilcoxon analysis,the unchanged domains were analyzed with the multifactor Logistic regression analysis by preoperative duration of symptoms,age of onset,and number of affected extremities.Dynamic flexion-extension lateral X-rays were performed at baseline and at final follow-up.Results No failure of internal fixation was detected on dynamic flexion-extension lateral X-rays.Five domains of preoperative Brief MHQ had lower scores,including Function,Satisfaction,Aesthetics,Activities of daily living,Work domain.With the exception of Aesthetics and Pain domain,all the other four domains showed significant improvement after surgery.The total score was 38.44±5.83 at base-line and 43.19±4.47 at follow-up.The score of Function was 5.19±1.36 at baseline 6.37±1.15 at follow-up;The score of Satisfaction was 5.56±1.22 at baseline 6.60±1.05 at follow-up;The score of Activities of daily living was 6.33±1.84 at baseline 7.60±1.47 at follow-up;The score of Work was 6.85±1.75 at baseline 7.67±1.33 at follow-up.The risk factors of postoperative outcomes reported in the literature included duration of disease at the time of surgery,age of onset,and extremity involvement.According to the Logistic regression,pre-operation duration was the risk factor for Aesthetics domain and the cut-off time was 1.75 years.Conclusion Four domains of Brief MHQ score were improved significantly after anterior surgery for patients with hirayama disease.Brief MHQ was useful to evaluate the hand dysfunction and clinical efficacy in patients with hirayama disease.
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Objective To quantitatively compare the effect of preservation or removal of atlas posterior arch on cervical posterior decompression,so as to provide a basis for reasonable selection of upper cervical spine decompression range and determination of surgical indications for atlas posterior arch resection.Methods The data of 45 patients with posterior decompression of upper cervical spine were retrospectively analyzed.According to the decompression range,the patients were divided into C2-C7 group and C1-C7 group.There were 25 cases in the C2-C7 group,19 males and 6 females,with an average age of 56.3 years (40-71 years),4 cases of cervical spondylotic myelopathy and 21 cases of ossification of the posterior longitudinal ligament of cervical spine.All of the 25 patients underwent open-door laminoplasty:20 cases with hinge side anchoring procedure and 5 cases with preservation of the unilateral posterior muscular-ligament complex procedure (titanium cable procedure).There were 20 cases in C1-C7 group,12 males and 8 females,with an average age of 58A years (44-75 years).All of the 20 cases underwent atlas posterior arch resection as well as C2-C7 open-door laminoplasty,including anchoring procedure in 1 case,titanium miniplate procedure in 4 cases,and titanium cable procedure in 15 cases.Standardized vertebral-cord distance (SVCD) at each level from atlas to level C~ was measured on T2-weighted images of MR on the mid-sagittal plane in the neutral position pedormed 3-12 months postoperatively at each individual level.As the main outcomes,the SVCD values obtained at the same level of the two groups were compared between the two groups.Shapiro-Wilk normality test was performed on the SVCD values at C1.2 and C2 levels of two groups.The area under the normal distribution curve of SVCDs was used to calculate the corresponding residual compression rate with different magnitude of compression mass to further discover the difference of the decompression effect between the two groups.Results The SVCD obtained at the level of the anterior arch of atlas (C1),the junction of odontoid process and axis (C1,2) and the middle part of axis body (C2) in the C2-C7 group was 9.91±1.34 mm,8.35±1.27 mm,and 8.22 ±1.43 mm,respectively.The SVCD at the same levels was 11.02±1.60 mm,9.72±1.24 mm,and 9.12±1.11 mm,respectively.SVCDs differed significantly in the above range between the two groups.However,from level C2,3 to C6,7,there was no significant difference in SVCDs between the two groups.The JOA score of group C2-C7 was 11.8±2.7 preoperatively and increased significantly to 14.7±1.8 at 12 months postoperatively(t=-7.006,P＜0.001) with a recovery rate of 57.0％±32.2％.The JOA score of group C1-C7 was 11.7±2.8 preoperatively and increased significantly to 14.2±2.3 at 12 months postoperatively(t=-6.177,P＜0.001) with a recovery rate of 51.9％±32.1％.Conclusion Atlas posterior arch resection can significantly increase the decompression effect of posterior cervical surgery from the anterior arch of atlas to the middle part of axis body,but it would not increase the decompression effect at level C2.3 or below.When the magnitude of the ventral compression factor exceeds the decompression limit (8.5 mm) available with C2-C7 decompression in the range from atlas to the middle of the axis body,extending the decompression range by atlas posterior arch resection is an effective means to achieve adequate decompression.
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The early dynamic 18 F?FDG PET/CT can reflect perfusion, bio?distribution, uptake and excretion of 18 F?FDG in certain organs ( or lesions) in the early phase post injection. This imaging technique could be used to evaluate the organ ( or lesion) perfusion and to serve as a supplement for conventional 18 F?FDG PET/CT in the evaluation of glucose metabolism. This review summarizes the basic principle, imaging methods and clinical application of early dynamic 18 F?FDG PET/CT.
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AIM To prepare the microemulsions loaded with total flavonoids from Potentilla discolor Bunge and to evaluate the therapeutic effect on diabetic mice.METHODS Total flavonoids,the extract from P.discolor by 70％ ethanol,were made into microemulsions after purification with.macroporous resin.With types and amount of oil phase,emulsifier and co-emulsifier,and addition amount of total flavonoids as influencing factors,together with drug loading,encapsulation efficiency,particle size and Zeta potential as evaluation indices,the formulation was optimized by drawing pseudo-ternary phase diagram.By establishing diabetic mouse models induced by streptozotocin (STZ) and high fat diet,the obtained microemulsions' effects on fasting blood glucose,oral glucose tolerance (OGT),insulin,glycosylated serum protein (GSP),triglyceride (TG),total cholesterol (TC),low density lipoprotein (LDL),high density lipoprotein (HDL),superoxide dismutase (SOD) and malondialdehyde (MDA) in mice were investigated.RESULTS The optimal formulation was determined to be 400 mg for isopropyl myristate (oil phase) amount,400 mg for Cremophor RH 40 (emulsifier) amount,200 mg for polyethylene glycol 400 (coemulsifier) amount,and 80 mg for addition amount of total flavonoids.The spherical-like and uniformly-sized microemulsions shared average drug loading of (7.28 ± 0.12)％,encapsulation efficiency of (91.79 ± 1.02)％,particle size of (36.79 ±0.17) nm and Zeta potential of (-15.77 ±2.89) mV.They could significantly reduce fasting blood glucose level,promote insulin secretion,regulate blood lipid,increase SOD activity,and decrease MDA level in diabetic mice.CONCLUSION Once prepared into microemulsions,the total flavonoids from P.discolor demonstrate an obviously enhanced activity in reducing blood glucose.
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Purpose Synchronous multiple primary esophageal carcinomas may be undetected by gastroscopy. This study aims to assess the role of 18F-fluorodeoxyglucose (18F-FDG) PET/CT in detecting synchronous multiple primary esophageal carcinomas. Materials and Methods Thirteen patients with synchronous multiple primary esophageal carcinoma who underwent gastroscopy and 18F-FDG PET/CT within two weeks before treatment were retrospectively analyzed. Results Gastroscopy and 18F-FDG PET/CT detected 22 and 29 esophageal carcinomatous foci respectively, and the difference was statistically significant (Z=-2.333, P<0.05). All the 29 esophageal carcinomatous foci showed high 18F-FDG uptake with a SUVmax ranging from 3.1 to 20.1 (mean, 10.7±5.7). 18F-FDG PET/CT also detected surrounding organ invasion in 3 patients, lymphatic metastasis in 10 patients and distant metastasis in 3 patients. Conclusion 18F-FDG PET/CT detects more esophageal carcinomatous foci compared with gastroscopy in patients with synchronous multiple primary esophageal carcinomas and also performs the staging diagnosis, which may help in improving clinical management and prognosis.
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Objective:To retrospectively analyze the clinical data of the patients with reoperation for cervical myelopathy due to progressing ossification of the posterior longitudinal ligaments,with previous open-door expansive laminoplasty,and to evaluate the outcomes.Methods:From May 2006 to July 2012,a retrospective study was performed on a consecutive series of 17 patients with previous open-door expansive laminoplasty,who had received the reoperation for cervical myelopathy due to progressing ossi-fication of the posterior longitudinal ligaments.The reoperation was performed based on the clinical mani-festations and segments of responsibility.The anterior approaches were performed in 12 cases,and the posterior approaches in 5 cases.The correlation between the clinical factors and Japanese Orthopedic As-sociation (JOA)scores or the JOA recovery rate was evaluated by Pearson or Spearman correlation test. The pre-and post-operative JOA scores were analyzed by repeated measures ANOVA and the JOA recovery rates were compared with paired t test.Results:The mean follow-up was 137.5 months (range 60-348 months).There were no serious complications after surgical procedures.There was one case that had C5 palsy in the first operation and had recovery after one week.Another case had C5 palsy in the reoperation with posterior approach,which had recovery at the end of 6 months post-operation.Three cases had the cerebrospinal fluid leakage of the reoperation,with two cases in the anterior approaches and one case in the posterior approach.There was no significant correlation between the clinical variables and JOA scores or JOA recovery rates.The JOA scores of the patients in the first operation were improved from 9.4 ±4.1 to 12.8 ±2.8 (P<0.01),and the JOA recovery rate was 45.6%.The JOA scores of the reoperation were improved from 10.2 ±2.8 to 12.7 ±2.4 (P<0.05)at the end of 6 months and 14.3 ±1.9 (P<0.01)by the last follow-up.There were significant differences between the JOA recovery rates by the last follow-up (63 .2%)and at the end of 6 months (39 .3%)of the reoperation or 45 .6%of the first opera-tion (P<0.01).Conclusion:The reoperation for cervical myelopathy duo to progressing ossification of the posterior longitudinal ligaments can significantly promote the recovery of the spinal cord,based on the clinical manifestations combined with segments of responsibility of the imaging.
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<p><b>BACKGROUND</b>Limited number of studies have been reported regarding the utilization of F-18-fluoro-deoxy-glucose (F-18-FDG) positron emission tomography/computed tomography (F-18-FDG PET/CT) in Langerhans cell histiocytosis (LCH). The aim of this study was to assess the role of F-18-FDG PET/CT in the diagnosis and treatment of LCH.</p><p><b>METHODS</b>Eight newly diagnosed and seven recurrent patients with LCH received F-18-FDG PET/CT scans. The diagnosis of LCH was established by pathology, multi-modality imaging, and clinical follow-up.</p><p><b>RESULTS</b>F-18-FDG PET/CT was positive in 14 patients with 13 true positives and one false positive. All 45 LCH lesions were F-18-FDG avid including six small bone lesions <1.0 cm in diameter. The mean maximal standardized uptake value (SUVmax) was 7.13 ± 4.91. F-18-FDG uptake showed no significant difference between newly diagnosed lesions vs recurrent lesions (SUVmax: 6.50 ± 2.97 vs. 7.93 ± 6.60, t = -0.901, P = 0.376). Among 45 LCH lesions, 68.9% (31/45) were found in bones and 31.1% (14/45) in soft tissue. The most commonly involved bones were the pelvis and vertebrae. There was no significant difference in F-18-FDG uptake between bone lesions vs. non-bone lesions (SUVmax: 6.30 ± 2.87 vs. 8.97 ± 7.58, t = 1.277, P = 0.221). In two patients, changes in F-18-FDG uptake on serial PET/CT scans reflected response of lesions to treatment.</p><p><b>CONCLUSIONS</b>The present study suggests that F-18-FDG PET/CT may be useful for diagnosis and assessing the treatment response of LCH. Because of the small sample size, further research is warranted to confirm our findings.</p>
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Adolescente , Adulto , Niño , Preescolar , Humanos , Persona de Mediana Edad , Adulto Joven , Fluorodesoxiglucosa F18 , Histiocitosis de Células de Langerhans , Diagnóstico , Tomografía de Emisión de Positrones , MétodosRESUMEN
<p><b>BACKGROUND</b>Adjacent segment disease (ASD) is common after cervical fusion. The aim of this study was to evaluate the risk factors for ASD on X-ray and magnetic resonance imaging (MRI).</p><p><b>METHODS</b>Patients included in this study had received revision surgeries after developing symptomatic ASD following anterior decompression and fusion. A control group that had not developed ASD was matched 1:1 by follow-up time and fusion segments. Plate-to-disc distances (PDDs), developmental cervical canal stenosis on X-ray, cervical disc degeneration grading, and cervical disc bulge impingements on preoperative MRI were measured and compared between the ASD group and the control group.</p><p><b>RESULTS</b>Thirty-four patients with complete radiographic data were included in the ASD group. The causative segments of ASD included nine cases of C3-4, 18 cases of C4-5, three cases of C5-6, and four cases of C6-7. The ASD occurred at the upper adjacent segments in 26 patients and at the lower adjacent segments in eight patients. PDD distributions were similar between the ASD group and the control group. Developmental cervical canal stenosis was a risk factor for ASD, with an odd ratio value of 2.88. Preoperative cervical disc degenerations on MRI were similar between the ASD group and the control group. In the upper-level ASD group, the disc bulge impingement was (19.7±9.7)%, which was significantly higher than that of the control group of (11.8±4.8)%.</p><p><b>CONCLUSIONS</b>ASD was more likely to develop above the index level of fusion. Developmental cervical canal stenosis and greater disc bulge impingement may be risk factors for the development of ASD.</p>
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Humanos , Masculino , Persona de Mediana Edad , Vértebras Cervicales , Patología , Cirugía General , Descompresión Quirúrgica , Degeneración del Disco Intervertebral , Diagnóstico , Imagen por Resonancia Magnética , Radiografía , Factores de Riesgo , Fusión Vertebral , Estenosis Espinal , Diagnóstico por ImagenRESUMEN
Objective To investigate the effects and prognosis of aspirin combined with atorvastatin calcium for the treatment of acute cerebral infarction.Methods According to the digital table,80 patients with acute cerebral infarction were selected and randomly divided into the control group and observation group,each group 40 cases.The patients in control group were given aspirin enteric-coated metformin hydrochloride 100mg/d treatment,while the ob-servation group was treated in the control group taking on the basis of atorvastatin calcium 20mg/d.After the continu-ous treatment of 4 weeks,the curative effects were compared between the two groups,and the different hs-CRP levels in the body of the prognosis of patients were analyzed.Results The total effective rate of the observation group was 95%,which was higher than 75%of the control group(χ2 =3.98,P0.05).Conclusion Aspirin combination with atorvastatin calcium for the treatment of acute cerebral infarction exactly can well improve the prognosis,which is wor-thy of clinical popularization and application.
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<p><b>OBJECTIVES</b>To investigate the effect of C(2-7) laminoplasty on postoperative anterior cord space (ACS) compared with C(3-7) laminoplasty, and to provide evidence for reasonable enlargement of decompression range cephalad.</p><p><b>METHODS</b>Fifty-seven Patients underwent cervical laminoplasty from February 2008 to October 2011 were studied retrospectively, which were divided into two groups by decompression range: Group C(3-7) and Group C(2-7). The pre-and post operative JOA scores,VAS scores of neek and shoulder pain, and cervical alignment were compared in each group. The postoperative ACS at each level from C(2-3) to C(7)-T(1) measured on MRI were compared between the two groups.</p><p><b>RESULTS</b>The postoperative JOA scores increased significantly in both groups. VAS scores and cervical alignment showed no significant difference. ACS at C(2-3) and C(3-4) was 6.13 mm (95%CI: 5.71-6.55) and 6.60 mm (95%CI: 6.10-7.11) respectively in Group C(3-7), which increased 2.5 mm and 2.1 mm respectively in Group C2-7 at the same segment, there was significant difference (P < 0.01). However, there was no significant difference of ACS at C(4-5) and any other caudal levels between the two groups.</p><p><b>CONCLUSIONS</b>Compared with conventional C(3-7) laminoplasty, the extensive decompression cephalad to C(2) leads to larger ACS at C(2-3) and C(3-4). When the mid-sagittal diameter of anterior compression is more than 6.10 mm at C(3-4), C(3-7) laminoplasty may cause insufficient decompression, and enlargement of decompression range cephalad should be considered.</p>
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Humanos , Vértebras Cervicales , Cirugía General , Descompresión Quirúrgica , Laminoplastia , Imagen por Resonancia Magnética , Periodo Posoperatorio , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Objectives To investigate influencing factors and pattern of posterior shifting of the spinal cord after cervical laminoplasty.Methods Forty three patients with compressive cervical myelopathy,including 32 males and 11 females,aged from 33 to 78 years (average,57.9 years),treated with open-door laminoplasty from C3 to C7 between February 2008 and October 2010,were enrolled in this study.There were 30 cases of cervical spondylotic myelopathy with developmental cervical stenosis and 13 cases of ossification of the posterior longitudinal ligament.Twenty one cases underwent modified open-door laminoplasty using anchor method,and the other 22 cases underwent laminoplasty with preservation of the unilateral muscular ligament complex.According to midsagittal T2-weighted MRI in the neutral position,several parameters indicating shift distance of the spinal cord and dural sac were measured at each level before operation and at 3 months after operation:shift of anterior margin of the spinal cord (SAMSC),shift of posterior margin of the spinal cord (SPMSC),shift of anterior margin of the dural sac (SAMDS) and shift of posterior margin of the dural sac (SPMDS).The line connecting the top of dens and posterior inferior angle of T1 was defined as E line and the length was E.The length of perpendicular line from each base point to E line was Px (x =1-6).The parameter (100×Px/E) was used to represent local curvature at each level,and the curvature index (CI)was used to represent the global curvature of the cervical spine.Then correlation analyses of the parameters above were performed.Results There was no significant change in SAMDS at different level after surgery,however SAMSC,SPMSC and SPMDS changed significantly and synchronously.At the level of C5 and C6,SPMSC was maximum,but not correlated to CI.Actually,SPMSC was correlated to the local curvature and highly correlated to SPMDS at the same level.Conclusion After cervical laminoplasty,posterior shifting of the spinal cord was highly correlated to posterior shifting of the dural sac at the same level,weakly correlated to local curvature and not correlated to the global curvature of the cervical spine.
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Objective To investigate whether cerebral microbleeds (CMBs) can predict hematoma expansion in hypertensive cerebral hemorrhage bleeding.Methods One hundred and forty-four patients with hypertensive cerebral hemorrhage bleeding in 6 hours after the onset of symptom were included.Gradient echo pulse sequence-T2 WI (GRE-T2 WI) and computed tomography (CT) were performed to detect the size of hematoma in half an hour after hospital admission.Based on the performance of GRE-T2 WI,patients were divided into microbleeds group and no microbleeds group.CT was performed 24 and 72 hours later to check whether hematoma was enlarged,the ratio of hematoma enlargement and the increased hematoma volume were compared between 2 groups.Results A variable number of CMBs were found in 74 cases by GRE-T2WI on admission.The hematoma volume was increased in 12.5％ (18/144) of patients by CT 24 hours later,and in 13.9％ (20/144) by CT 72 hours later.The ratio of CMBs in microbleeds group was higher than no microbleeds group significantly (70.0％ (14/20) vs 48.4％ (60/124),x2 =4.221,P ＜0.01).Besides,the ratio of the patients with the increased hematoma volume in microbleeds group was significantly higher than no microbleeds group(17.6％ (13/74) vs 10.0％ (7/70),x2 =3.172,P ＜ 0.05).Logistic multiple regression showed that CMBs was the only risk factor which could enter regression equation (OR=2.213,95％CI 1.320-2.972,P＜0.01).Conclusion CMBs patients with hypertensive cerebral hemorrhage bleeding in GRE-T2WI can predict the high risk of hematoma expansion.
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Objective To investigate cause,diagnosis,treatment and prevention of vertebral artery injury in cervical spine surgery.Methods Data of 7 patients with vertebral artery injury caused by cervical spine surgery from October 2002 to April 2012 were retrospectively analyzed.There were 6 males and 1 female,aged from 23 to 65 years (average,48.9 years).The reasons of cervical spine surgery were as follows:cervical spondylotic myelopathy (5 cases),traumatic subluxation of C4 and C5 (1 case),and cervical spinal stenosis due to skeletal fluorosis (1 case).All cases had unilateral vertebral artery injury,including 4 cases in the left side and 3 cases in the right side.The cause,treatment and prognosis of vertebral artery injury in 7 patients were analyzed.Results Four patients suffered from vertebral artery injury during anterior cervical spine surgery; 2 cases were caused by excessive lateral trepanation,1 by excessive lateral discectomy using a curette,and 1 by Kerrison punch during decompression in a patient with anomalous vertebral artery due to traumatic subluxation of C4 and C5.Three patients suffered from vertebral artery injury during posterior surgery; 2 cases were caused by a drill bit during drilling lateral mass of C4 and 1 by a rongeur during removing posterior C1 arch in a patient with cervical spinal stenosis due to skeletal fluorosis.After vertebral artery injury,all patients were immediately treated by hemostatic tamponade,and then the incisions were closed.However,1 patient occurred delayed cervical hemorrhage 4 weeks after operation.Then he underwent vertebral artery angiography,balloon embolization and evacuation of hematoma.All cases had no cerebral infarction.However,two of them had postoperative temporary dizziness.Conclusion Vertebral artery injury in cervical spine surgery is a rare but serious complication,which is associated with surgical mistakes and anatomical variations.Hemostatic tamponade and embolization are effective for this complication.
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Objective To study the impacts of white matter ischemic lesions in various regions on the different cognitive domains of the patients. Methods 120 patients with white matter ischemic lesions were divided into subcortex,semi oval center,peri-ventricle,mixed regions according to MRI imaging (n=30 cases for each group). The 30 healthy control subjects were enrolled.Cognitive functions were evaluated by mini mental status scale (MMSE), montreal cognitive assessment (MOCA),object memory test (FOM),rapid verbal retrieve (RVR),block design (BD)and digit span (DS). Results The score of language in subcortical group (0.36±0.49) was lower than in control group (1.00±0.00) (P=0.011).There was no significant difference in RVR scores between mixed regions group and peri- ventricle group [(27.00 ± 9.22) vs. (32.30 ± 7.78) P =0.067],while RVR scores in mixed regions group (27.00± 9.22) were increased as compared with subcortex,semi oval center and control groups [(38.21±11.93),(35.94=9.53) and (37.00±3.16),respectively] (F=3.462,P=0.013).There was no difference,in BD scores between mixed regions group and semi- oval center group [(21.20± 9.21) vs.(25.63±12.10).P 0.070] but the mixed group scores were decreased as compared with subcortex, peri-ventricle, control groups [(37.14±10.43),(36.80± 14.27),(40.30±6.29),F=7.795,P=0.000].The scores of immediate verbal memory,calculation,short-term memory,visual spatial ability and executive were reduced in mixed regions group than in other groups (P=0.034,0.030,0.016,0.000).There was no difference in orientation score in MOCA and MMSE among the groups (P=0.256 and P=0.325).Conclusions Ischemic white matter lesions may lead to cognitive impairments depending on different region lesions. The obvious impact of peri-ventricle lesion is on memory, subcortex lesion on language,semi-oval center lesion on recognition and construction of images,while wide range of cognitive impairment may be attributed to the lesion in mixed regions.The scale of the MOCA is helpful and sensitive for identifying the presence of early cognitive impairment.
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Objective To study the value of echoeardiography for diagnosis of juxtaposition of atrial appendage(JAA) and to discuss its features. Methods Eehocardiographic characteristics of JAA in nine cases were compared with results of cardiac catheterization and operation. The diagnostic features of echocardiography were summarized. Results Seven cases had juxtaposition of left atrial appendage and two had juxtaposition of right atrial appendage. The nine cases were all associated with severe congenital heart disease and the most frequent malformations observed with JAA were double outlet right ventricle, transposition of great artery, single ventricle and so on. Direct visualization of the JAA in the parasternal short-axis view at the base of the heart and visualization of an unusual transverse orientation of the atrial septum were the most features of JAA. Echocardiographie characteristics of JAA cases were correspondent to the results of cardiac catheterization and operation. Conclusions There is high accuracy by echocardiography to diagnosis JAA. JAA should be alerted in severe congenital heart disease.
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malities should be alerted in TOF.
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Objective To study the mortality and risk factors of death of critical patients treated in emergency department for initial stabilization and life support. Method The clinical data of 1240 critical patients from January 2005 to December 2006 were retrospectively analyzed. The patients were divided into death group and survival group. The differences of demographics, symptoms, physical signs and laboratory findings of patients between two groups were analyzed by using univariate and multivariate logistic regression analysis, sex, age, visiting time after attack, the history of chronic diseases, temperature, respiratory rate, heart rate, mean arterial pressure, respiratory dysfunction, circulatory dysfunction, hepatic dysfunction, gastrointestinal dysfunction, renal dysfunction, coagulation disorders, acid base and electrolyte disturbances, lencocyte count,platelet count, Glasgow coma scale (GCS) score and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ). Results There were higher mortality and morbidities of patients with diseases of respiratory, digestive, circulatory and nervous systems. The mortality of patients with the history of chronic diseases was higher (P < 0.01) ,and there were more patients with chronic obstructive pulmonary disease(COPD), chronic cardiac insufficiency, diabetes mellitus or cirrhosis of liver in death group (P < 0.05). The mortality of patients with 3 dysfunctional organs was 32.81%, and the mortality of lity of those with five dysfunctional organs was 76.67% . Logistic regression analysis indicated that male gender, age between 46 and 65, respiratory dysfunction, circulatory dysfunction, gastrointestinal dysfunction, hepatic dysfunction, low Glasgow coma scale (GCS) score and high APACHE II score were risk factors of the death of critical patients. Conclusions The mortality of patients with the history of critical diseases is higher. The more dysfunctional organs, the higher mortality is. Age between 46 and 65, male gender, and dysfunction of lung, circulation, gastrointestinal tract,and liver,and low CCS score and high APACHE II score are risk factors of the death of emergency and critical disease.