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Objective To evaluate the reliability of the TLICS and AO-TLICS scoring system for the thoracolumbar fracture and the effectiveness of the final treatment scheme.Methods The clinical data of 56 adult patients with acute traumatic thoracolumbar fracture diagnosed in Department of Orthopedics,Chui Yang Liu Hospital Affiliated to Tsinghua University from June 2015 to June 2017 were analyzed retrospectively.There were 35 males and 21 females,aged (32.3 ± 9.8) years,with an age range of 21-53 years.Two senior deputy chief orthopaedic physicians retrospective analyzed DR plain films,CT,MRI images and clinical records of thoracolumbar spine by independent blind method.According to TLICS and AO-TLICS scoring system (include injury morphology,neurologic status,posterior ligament complex (PLC) damage or M1 modifier,the severity scores of thoracolumbar fracture were classified and calculated.The score was divided into TLICS score group and AO-TLICS score group,each group of scores was the above 56 patients.Three months later,the two physicians repeated the above analysis process and compared the consistency of the scores between the observer and the observer's own control.The consistency of the two groups was compared,and the accuracy,sensitivity and specificity of the final treatment were compared.Cohen kappa test was used for consistency comparison according to the score and the mean value was taken.Measurement data were expressed as mean ± standard deviation (Mean ± SD),and t test was used for inter-group comparison.Results In the TLICS score group,the Cohen kappa coefficients of the observer's own control in fracture type,neurological status assessment,and PLC injury were 0.810,0.966,and 0.698,respectively,and the total scores were consistent (k=0.727).Cohen kappa coefficients between the observers in fracture morphology,neurological status assessment,and PLC injury were 0.725,0.931,and 0.594,respectively,and the total scores were consistent (k =0.615).In the AO-TLICS score group,the Cohen kappa coefficients of the observer's own control in terms of fracture type,neurological status assessment,and M1 correction factor were 0.760,0.892,and 0.711,respectively,and the total scores were consistent (k =0.666).Cohen kappa coefficients of the observers in terms of fracture type,neurological status assessment and M1 correction factor were 0.707,0.836 and 0.604,respectively,and the total score was consistent (k =0.592).According to the TLICS score,the correct rate of treatment was (84.2 ± 2.8) ％,the sensitivity was (84.1 ±2.1)％,and the specificity was (85.9 ± 6.5)％.According to the AO-TLICS score,the correct rate of treatment was (89.0 ± 2.6) ％,the sensitivity was (88.3 ± 3.5) ％,and the specificity was (89.6 ± 2.4) ％.There was a statistically significant difference in the rate of correct rate (t =2.485,P =0.047).Conclusion The advantage of TLICS score is better consistency in interobservers or intraobservers,but the AO-TLICS score system is more comprehensive,and the choice of treatment plan is more instructive.
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Objective To evaluate the effect of diabetes on the effect of percutaneous transforaminal discectomy (TPED) for patients with lumbar disc herniation (LDH).Methods Retrospective analysis 69 LDH patients treated with TPED from January 2014 to June 2017 in Department of Orthopedics,Chui Yang Liu Hospital Affiliated to Tsinghua University.There were 32 males and 37 females with an age of (58.2±14.8) years and body mass mdex (BMI) (22.4 t 4.0) kg/m2.According to whether they had diabetes or not,they were divided into control group (53 cases) and diabetes mellitus (DM) group (16 cases).Agex,BMI,course of disease,operative segment,MRI grade of Pfirrmann lumbar disc herniation,operative time,blood loss,hospitalization time and perioperative complications were compared between the two groups.Outpatient follow-up was conducted for 6 months.The follow-up included Oswestry dysfunction index (ODI) and modified MacNab criteria.ODI score,modified MacNab criteria and postoperative complications were compared between the two groups.Independent sample t test was used to compare the measurement data between groups,and repeated measurement data analysis of variance was used to compare ODI scores.x2 test or Fisher exact test were used to compare the counting data between groups;Kruskal-Wallis rank sum test was used to compare the graded grouped data between groups.Results The average age,the BMI,the course of the disease,the time of follow-up,the distribution of the lumbar disc herniation and the severity of the lumbar disc were not significantly different between the two groups.The time of hospitalization in DM group was significantly longer than that in the control group (t =2.095,P =0.045).The operation time of DM group was slightly longer (t =1.369,P =0.182),and the amount of bleeding was slightly more (t=1.833,P =0.077).In DM group,the incidence of operative complications (18.8％) and the recurrence rate (6.3％) was higher,while the incidence of operative related complications (3.8％) and the recurrence probability (1.9％) was lower in the control group,but there was no statistical difference (P =0.233 and 0.393).In DM group,the improvement of ODI score after operation was not as good as that in the control group (F =10.475,P =0.003),especially in 3 months and 6 months after operation,the ODI score was higher than that in the control group (P =0.043 and 0.048).After 6 months of follow-up,the overall good rate was 92.8％ according to the modified MacNab criteria,and there were significant differences between the two groups (U =311.00,P =0.033).Conclusions TPED is a safe and effective treatment for LDH,which can significantly improve the quality of life after LDH,but has a limited effect on the postoperative effect.In the actual clinical work,in order to obtain better effect of TPED operation,we should pay attention to the control of
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Objective To investigate whether the polylactic acid(PLA)membrane can reduce the scar size and or improve the clinical outcome of the patients after lumbar disc herniation surgery,and the association between peridural scarring and recurrent pain after lumbar disc herniation surgery.Methods Seventy-two patients treated with lumbar disc herniation surgery were collected and randomly divided into two groups, including 38 cases were treated with PLA membrane,and 34 cases as the control group.All patients underwent MRI at 12 months after surgery for grading the size,location and development of the scar.NRS was used to assess the severity of lower limb pain before and 12 months after surgery.The modified Macnab scale was used to assess the clinical outcomes of the patients.Results For 9 cases(23.7%)in the PLA membrane group,the scar tissue had an effect on the nerve root,while 16 cases(47.1%)in the control group experienced the same,the difference was statistically sigificant(χ2=4.326,P=0.038).There was significant difference in scar score between the two groups(Z=2.340,P=0.019),but there was no significant difference in leg pain degree between the two groups(t=0.687,1.014,0.426,0.000,P=0.532,0.324,0.675,1.000).There was no significant difference between the two groups in modified Macnab classification grading(χ2=1.202,P=0.273).Conclusion PLA membranes used in lumbar disc herniation surgery could reduce peridural scar formation,but it does not significantly improve the clinical results.
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Objective To evaluate the efficacy and satefy of percutaneous kyphoplasty for treating Kummel disease with severe osteoporosis.Methods The clinical data of 23 Kummell's patients with severe osteoporosis attending orthopedics in ChuiYang Liu Hospital Affiliated to Tsinghua University from March 2013 to July 2016 were retrospectively analyzed.The patients underwent percutaneous kyphoplasty,the first day after surgery was evaluated during the hospitalization period,outpatient review for 3 months and 1 year.All measurement data were expressed as ((x) ± s),repeated measures analysis of variance was used for statistical analysis of preoperative and postoperative pain visual analogue scale,Oswesay dysfunction index,mean vertebral anterior,central and posterior height,kyphotic angle and operative complications.Results Outpatients were followed up for 12 to 24 months,with an average follow-up of (18.1 ± 5.6) months.The mean preoperative visual analogue scale of the patients with percutaneous kyphoplasty was (8.4 ± 1.5) scores after operation,(2.2 ± 1.1) and (3.1 ± 1.7) scores at 1st day after operation,3 months and (4.6 ± 2.0) scores at 1 year after operation respectively,all P ＜0.001.The preoperative average Oswesay disability index score was (70.1 ± 10.5) scores,(27.4 ± 7.9) and (36.6 ± 8.1) scores at 1st day after operation,3 months,and (46.5 ± 9.3) scores at one year after operation,all P ＜0.001.Postoperative one year pain visual analogue scale and Oswesay dysfunction index score compared with 1 st day and 3 months after operation,the difference was statistically significant (P ＜ 0.05).The mean preoperative vertebral body height percentage was (44.4 ± 6.9)％,(50.1 ± 6.3)％ and (88.2 ± 4.1)％,respectively,(65.5 ± 5.0)％,(66.2 ± 5.7)％ and (89.3 ± 3.7)％ respectively at 1st day after operation,(63.8 ± 7.4)％,(64.6 ± 5.0)％ and (88.1 ± 3.9)％ respectively at 3 months after operation,(57.8 ± 6.3)％,(63.0 ± 6.7)％ and (87.1 ± 4.2)％ respectively at 1 year after operation.Postoperative vertebral anterior and central height percentage compared with the preoperative significantly improved (P ＜ 0.05).There was no significant difference in the height of vertebral trailing edge.The height of vertebral body at 1 year after operation was significantly different from that at one day and three months after operation (P ＜ 0.05).The kyphotic angle improved significantly from 25.0° ± 7.5° to 16.5° ±4.1° at 1st day after surgery (P =0.001),18.2° ±5.8° at 3 months after surgery (P =0.032),but the kyphotic angle increased to 21.3° ± 8.1° at 1 year after the procedure (P =0.051).However,asymptomatie peripheral bone cement leakage occurred in 2 patients and 5 patients sustained adjacent fractures after percutaneous kyphoplasty,the rest of the patients did not have surgical complications and adjacent vertebral fractures.Conclusion Percutaneous kyphoplasty is a safe and effective method for the treatment of Kummell's disease,though it has long-term deterioration of adjacent vertebral fractures and kyphosis,but it can provide spinal stability and relieve pain in the short term,which is conducive to the recovery of patients.
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Objective To evaluate the clinical efficacy of hybrid surgery,which combines fusion with cervical disc replacement (CDR),compared to anterior cervical discectomy and fusion (ACDF) in patients with multi-level cervical spondylosis.Methods From January 2015 to March 2017,the clinical data of 53 patients with multi-level cervical spondylosis admitted to Department of Orthopedics,Chui Yang Liu Hospital Affiliated to Tsinghua University,were retrospectively analyzed.They were divided into anterior cervical discectomy and fusion group (ACDF) (n =29) and hybrid surgery group (n =24) according to different operative methods.The operation time and intraoperative bleeding were analysised.Visual analogue scale (VAS) score,neck disability index (NDI),Japanese orthopaedic association (JOA) scores,Odom criteria and surgical complications were evaluated when outpatient reviewed for 1,3 and 6 months postoperative.The cervical range of motion (ROM),and adjacent segments degeneration (ASD) were assessed with radiographs.The measurement data of normal distribution were expressed as ((x) ± s),the comparison between groups was conducted by independent sample t test,and the repeated measurement data were analyzed by variance analysis.Counting data were expressed as percentage (％) and intergroup comparisons were performed by x2 test or Fisher exact test,and inter-group comparisons of classified data were performed by Kruskal-Wallis H (K) rank test.Results The operation time [(81.0 ± 15.4) min] and the amount of bleeding [(69.0 ± 38.4) ml] in the hybrid surgery group were less,but there was no statistical difference (t =1.487,1.065,P =0.154,0.301).Compared with postoperative complications,dysphagia occurred in 19 patients (65.5％) in group ACDF,which was significantly higher than 5 in group hybrid surgery (20.8％),but there was no significant difference in overall complications (x2 =9.759,P =0.082).Significant improvements in VAS score,NDI score and JOA score were observed postoperation in ACDF and hybrid surgery group,but there was no significant difference between the two groups (Fintra-group =31.225,70.358,32.412,P =0.000,0.000,0.000;Finter-group =1.258,2.451,0.914,P =0.277,0.135,0.352).There was no significant difference in Odom criteria between the two groups (x2 =260.500,P =0.077).The ROM of C3-C7 in group ACDF decreased significantly,while that in group hybrid surgery was not significantly decreased (t =2.514,1.776,P =0.022,0.093).The ROM of C3-C7 was significantly different at 6 months postoperation (t =2.353,P =0.030).Although no ASD changes were found in the hybrid surgery group during the follow-up period,there was no significant statistical significance in the two groups (x2 =2.632,P =0.105).Conclusion Compared with the previous ACDF operation,there is no significant difference in the clinical results of hybrid surgery operation for multilevel cervical spondylosis,but it can effectively preserve cervical ROM,reduce adjacent segment degeneration and postoperative dysphagia.
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Objective To evaluate the effect of recombinant human erythropoietin (rhEPO) combined with methylprednisolone sodium succinate (MPSS),compared to MPSS alone,in the treatment of neurological function of patients with acute spinal cord injury (SCI).Methods Twenty-one patients presenting in hospital within less than 8 hours after acute SCI were randomly divided into two groups,the control group (10 cases) and the intervention group (11 cases).The control group was treated by MPSS combined with placebo,while the intervention group received MPSS with rhEPO.Both groups received MPSS 30 mg/kg within the first hour,and if the patient was admitted within 4 hours,MPSS would be applied in the treatment with 5.4 mg/kg per hour in the subsequent 23 hours and till 47 hours if the patient was admitted within 4-8 hours after injury.The intervention group received 500 U/kg rhEPO on admission and another 500 U/kg in the next 24 hours,compared with the control group where placebo was used.The evaluation on neurologic function recovery was made on admission,24 h,72 h,one week,2 months and 6 months later,and statistical analysis was performed.Results The change in ASIA score: in the control group,the increase was seen from admission to 6 months after injury in terms of exercise,algesia and tactile sensation ((31.2±6.6) points vs.(57.8±9.8) points,(41.4±9.5) points vs.(64.3±10.6) points, (39.2±6.8) points vs,(61.5±11.3) points),the increase also took place in the intervention group ((29.5±7.2) points vs.(77.4±10.3) points,(39.7±7.2) points vs.(82.3±12.1) points,(37.4±6.2) points vs.(78.6±12.4) points).As time went on,the increase range in the intervention group became larger,compared with the control group.The difference between the two groups in ASLA score was statistically significant (P0.05).Conclusion The application of MPSS combined with rhEPO within 8 hours after acute spinal injury may be more effective than MPSS with placebo in the neurologic dysfunction recovery.
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Objective To investigate the awareness rate of knowledge related with vascular cognitive impairment (VCI) in community residents in Shuangjing District,Beijing.Methods 5 communities were randomly selected from 12 communities in Shuangjing District.According to roster,512 residents were selected randomly.Among them,there were 197 males and 315 females with an average age of (64.71±8.22) years.87.9％ of subjects had junior high school culture and over.The awareness rate of knowledge related with VCI was investigated by questionnaires from January 2013 to March 2013.Results Although the awareness rate of knowledge related with vascular dementia was only 36.9％,the awareness rates of symptoms of impairment in memory,orientation,language,execution,calculation,visuospatial and judgement were 43.8％-89.3％.The awareness rates of four outpatient clinics among dementia patients were 21.5％-38.9％,however,the awareness rate of dementia which was not curable was 47.5％.The awareness rates of 5 risk factors for stroke were 54.5％-83.4％,but the awareness rate of cognition impairment caused by hypotension and hypoglycemia was 42.8％ and 43.2％,respectively.About VCI-related preventive knowledge,the awareness rates of VCI population with high risk factors,cognitive abilities screening,and primary prevention were 35.5％-95.5 ％.The main routes taking healthy knowledge were the television and newspapers with the awareness rate of 86.9％ and 60.2％,respectively.85.9％ of subjects agreed that healthy education was helpful to their life qualities.Multiple linear regression analysis showed a significant relationship of accumulated points of VCI-related knowledge with gender and education degree (P＜0.05).Conclusions The awareness rates of risk factors,diagnosis and therapy and primary prevention for VCI are lower in Shuangjing community,and the health education about VCI should be strengthened.
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Objective To survey the awareness rate of knowledge about vascular cognitive impairment (VCI) in community physicians.Methods A questionnaire survey on the awareness of knowledge about VCI was conducted in 87 community physicians from 4 community hospitals in Beijing Chaoyang District from October to December 2012.Among all participants there were 27 males and 60 females with an average age of (39 ± 11) years,85％ (74/87)had college or university degrees,90％ (78/87) held primary or middle-level professional titles,41％ (36/87),of them were internists.Results All participants completed the questionnaire.The awareness rate about minor and major neurocognitive disorder was 39％ (60/87) ; the rates of various causes of dementia were 51％ (44/87)-100％ (87/87) and various symptoms of cognitive impairment were 79％ (69/87)-99 ％ (86/87),respectively.The awareness rate of cognitive impairment as initial symptom displayed in stroke was 54 ％ (47/87).The awareness rates of knowledge related to diagnosis and treatment of dementia were 57％ (50/87)-97％ (84/87) and 80％ (70/87)-100％ (87/87),respectively.The awareness rates about that Alzheimer's disease and dementia with Lewy bodies were not reversed by early treatment were 46％ (40/87)and 37％ (32/87),respectively.The awareness rates of vascular risk factors were 20％ (17/87)-100％ (87/87)and those about the mode of health education were 52％ (45/87)-95 ％ (83/87).There was 36％ (31/87) community physicians who thought that they possessed VCI-related knowledge.Conclusions The results of survey suggest that community physicians shall upgrade their knowledge of diagnosis and treatment for vascular cognitive impairment.
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Objective To analyze the causes of the complications in the treatment of limb deformities with the Ilizarov technique and to discuss the management and prevention of these complications.Methods From January 2000 to October 2010,846 patients with limb deformities (16 upper limbs and 830 lower limbs) who had been treated with Ilizarov technique were retrospectively analyzed,including 508 males and 338 females with an average age of 25.7 years (range,1.2-72).Statistical analysis was used to compare the type,severity,treatment methods and results of complications.Results Postoperative follow-up lasted for 6 to 30 months,with an average of 18 months.There were 81 cases of pin tract infections,36 cases of restricted joint movements,6 cases of skin thermal damage,7 cases of nerves and vessels injury,8 cases of bone delayed union,2 cases of osteofascial compartment syndrome,7 cases of dislocation,5 cases of fixed needle breakage,8 cases of secondary joint deformities,5 cases of serious osteoporosis,6 cases of skin eruption,4 cases of femoral fractures near to proximal external fixator,3 cases of subsequent fracture after external fixator dismantled,11 cases of deformity recurrence and 1 case of the others.Combining with anti-infection,functional training,physiotherapy,and the second operation therapy and so on,a permanent disability was finally left in 13 patients.Conclusion If the Ilizarov technique was used improperly,there would be multiple complications during the preoperative preparation,surgical procedures and postoperative management.Effective preventive measures should be taken,such as following the principle of the Ilizarov technique,standardizing operation procedures,strictly postoperative observation,correcting postoperative rehabilitation exercise guidance,regular follow-up radiography and postoperative adaptability dynamic adjustment of the external technique.
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Objective To evaluate the effect of modified Ilizarov device combined with minimally invasive osteotomy in the treatment of genu varum deformity.Methods From February 2002 to May 2010,a total of 31 patients with genu varum deformity who had underwent corrections by using modified Ilizarov device combined with minimally invasive osteotomy were retrospectively analyzed,including 8 males and 23 females with an average age of 35.6 years (range,18-69 years).Fifty-six knees were involved in the 31 patients.Preoperative angle of genu varum was 17.0° ±8.8°.According to the American knee society score (KSS),preoperative score was about 34-100 point with an average of 86.2±18.5.After determining the center of rotation angulation,osteotomy was performed in the site of tibial deformity and below the fibular head with minimally invasive device respectively.Prepared modified Ilizarov device was assembled and fixed with kirschner wire.Then genu varum deformity was progressively corrected by adjusting the length of bilateral bolts.X-ray film,KSS score,subjective sensation,and occurrence of complication were used to evaluate the therapeutic effects.Results Modified Ilizarov devices were used in 56 knees for 9-20 weeks,all patients were followed up for 14-50.4 months,with an average of 30.5 months.The angle of genu varum deformity was 1.7°±0.9°,the KSS was 96.1±7.7.According to KSS,the results were excellent in 49 knees,good in 6,fair in 1,with the excellent and good rate was 98.2％ (55/56).The complications included pin site infection in 11 patients and pin loosening in 3 ones; they were healed through routine dressing change and replacing pin site respectively.Conclusion Modified Iilizarov device combined with minimally invasive osteotomy for the treatment of genu varum deformity can achieve a satisfactory therapeutic effect.
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ObjectiveTo observe the 2-8 years' follow-up results of percutaneous laser disc decompression(PLDD) on cervical spondylotic radiculopathy,and to identify factors affecting the outcome of PLDD.MethodsEighty-seven patients with cervical spondylotic radiculopathy were treated consecutively by PLDD in our hospital from December 2002 to June 2009,who were followed up for 2-8 years.There were 32males and 26 females,with the mean age of 51.8 years (range,26-74).The results were evaluated according to the Japanese Orthopedic Association's score of cervical spondylotic radiculopathy(JOA 20 score) and numeric rating scales (NRS) after surgery.Two years after the operation,the excellent and good rate of JOA score of patients with different genders,ages and duration of each subgroup will be compared.ResultsThe excellent and good rate were 37.9％,51.7％,65.5％,81.0％,82.8％,80.9％,72.4％ and 72.7％ at 1,3,6months and 1,2,4,6,8 years after operation respectively.Significant difference was found between the time points of 6 months to eight years after operation and that of one month after operation.The NRS score of the pain symptoms at the final follow-up was significantly reduced(P＜0.05).The excellent and good rate of patients whose course of disease (93.3％) was less than 18 months was significantly higher than that of those whose course of disease was over than 18 months(71.4％) two years after operation (P＜0.05).Conclusion The intermediate-term curative effect of PLDD for the treatment of cervical spondylotic radiculopathy is reliable and stable,and the postoperative curative effect may be influenced by patients' duration of disease.
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[Objective]To study the accuracy of Helfet test in the diagnosis of the knee meniscus tear.[Method]From Apr.2007 to Oct.2007,52 cases of the lateral meniscus tear and 23 cases of the medial meniscus tear were checked-up with Helfet test,McMurray test ,KS test,and arthroscope comparatively.[Result]The Helfet Test was positive in most of the lateral meniscus tear cases.The consistency with McMurray test and arthroscope was lateral meniscus tear,especially to bucket-handle and Horizontal tear high respectively.The rate of accuracy to lateral menicus was 81.4%.The rate of accuracy to bucket-handle and Horizontal tear were 89.6% and 87.2% respectively.[Conclusion]The "Helfet" test is sensitive to the knee lateral meniscus tear.It is fast,simple,reliable,reproducible,positive for diagnose of lateral meniscus tear,and is worth of being used widely.