Comparison of pedicle subtraction osteotomy or vertebroplasty combined with long segment fixation in treating nonunion of osteoporotic vertebral fractures with kyphosis / 中华创伤杂志

Objective:To compare the clinical efficacy of pedicle subtraction osteotomy (PSO) versus vertebroplasty (VP) combined with long segment fixation for nonunion of osteoporotic vertebral fractures with kyphosis.Methods:A retrospective cohort study was conducted to analyze the clinical data of 72 patients with nonunion of osteoporotic vertebral fractures with kyphosis admitted to Jiangnan Hospital affiliated to Zhejiang University of Traditional Chinese Medicine from January 2010 to December 2017. There were 16 males and 56 females, aged 55-84 years [(68.2±5.2)years]. Level of injury was located at T 11 in 3 patients, at T 12 in 19, at L 1 in 31, and at L 2 in 19. According to the American Spinal Injury Association (ASIA) classification, 31 patients were scaled as grade D and 41 grade E. Overall, 51 patients were treated with PSO combined with long segment fixation (PSO group) and 21 patients treated with VP combined with long segment fixation (VP group). The operation time and bleeding volume were compared between the two groups. Before operation, at postoperative 2 weeks and at the last follow-up, the kyphotic Cobb angle, sagittal vertical axis (SVA), thoracic kyphosis (TK) and lumbar kyphosis (LL) were used to evaluate the osteotomy effect, and the visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the degree of pain and lumbar function recovery. The improvement of ASIA grade was observed at the last follow-up. The complications were observed as well. Results:All patients were followed up for 24-46 months [(33.2±5.9)months].The operation time and bleeding volume were more in PSO group than in VP group (all P<0.01). Before operation, the kyphotic Cobb angle, SVA, TK and LL were not significantly different between the two groups (all P>0.05). At postoperative 2 weeks, TK was not significantly different between the two groups ( P>0.05), while PSO group showed significantly decrease of kyphotic Cobb angle and SVA and increase of LL when compared with VP group ( P<0.05 or 0.01). At the last follow-up, the kyphotic Cobb angle, SVA and TK in PSO group were (8.5±1.1)°, (2.6±0.5)cm and (28.8±6.2)°, respectively, significant lower than those in VP group [(14.2±1.5)°, (4.4±0.9)cm and (32.6±5.9)°] (all P<0.05); while the LL was significantly larger in PSO group [(43.1±3.9)°] than in VP group [(36.9±5.3)°] ( P<0.01). Before operation, the VAS and ODI were not significantly different between the two groups (all P>0.05). At postoperative 2 weeks, the VAS and ODI in the two groups were also not significantly different (all P>0.05), but both were greatly decreased from the preoperative level (all P<0.05). At the last follow-up, the VAS and ODI in PSO group were (1.4±0.5)points and 22.5±2.5, significant higher than (1.8±0.6)points and 25.5±5.1 in VP group (all P<0.01). At the last follow-up, the ASIA classification was grade E in all patients. There were 1 patient suffering from dural matter tear and 1 from proximal junctional kyphosis in PSO group. Whereas 3 patients had bone cement leaking and 1 pedicle screw loosening in PVP group. The complication rate was 3.9% (2/51) in PSO group, significant lower than 19.0%(4/21) in VP group ( P<0.05). Conclusion:Compared with VP group in the treatment of osteoporotic vertebral fractures with kyphosis, PSO combined with long segment fixation is much effective in improving kyphosis angle and spinal axial imbalance correction, maintaining vertebral height and spinal axial stability in middle- to long-term, improving pain and dysfunction and minimizing complications, regardless of more operation time and bleeding volume.

Short-term efficacy of pedicle subtraction osteotomy plus long segment fixation for kyphosis in ankylosing spondylitis combined with thoracolumbar fractures / 中华创伤杂志

Objective To evaluate the efficacy of pedicle subtraction osteotomy (PSO) plus long-segment pedicle nail bar system in treating kyphosis in ankylosing spondylitis (AS) combined with thoracolumbar fractures.Methods A retrospective case series study was made on the clinical data of 13 patients with kyphosis in AS combined with thoracolumbar fractures admitted to Xiaoshan Hospital of Traditional Chinese Medicine from January 2012 to May 2016.There were 11 males and two females,aged 32-64 years [(44.3 ± 10.6) years].Two fractures occurred at T11,five at T12,three at L1,and three at L2.According to the American Spinal Injury Association (ASIA) classification,the spinal injuries were rated as grade B in one patient,grade C in four,grade D in five and grade E in three.All patients underwent PSO plus long-segment pedicle nail bar system.The operation duration,intraoperative blood loss,fixation segments,and complications were recorded.Thoracolumbar kyphosis angle (TL) and sagittal vertical axis (SVA) were measured to evalute the correction effect.Visual analogue scale (VAS),Oswestry disability index (ODI),ASIA grade were compared before and after operation to assess the efficacy.Results All patients were followed up for 12-18 months [(15.2 ± 1.2) months].The operation time ranged from 120 to 256 minutes [(175.2 ±40.3)minutes].The intraoperative blood loss ranged from 660 to 3 300 ml [(1 011 ±681)ml].Number of fixed seqments was 12-16 (12.2 ±0.8).Anemia occurred in one patient after operation,and the patient recovered after blood transfusion.Incision infection occurred in one patient after operation,which was improved after antibiotic treatment through osmotic culture.Compared with the detection before operation,postoperative TL was improved significantly [(52.6 ± 6.2) ° vs.(17.1 ± 3.1) °],with an average correction rate of 67.5％;final follow-up showed decreased VAS [(7.5 ± 0.7) points vs.(1.9 ± 0.6) points] and decreased ODI [(75.2 ±5.3) points vs.(22.9 ± 4.4) points] (P ＜ 0.05);SVA was improved significantly [(11.5 ± 2.1) cm vs.(3.5 ± 0.9) cm],with an average correction rate of 69.6％ (P ＜ 0.05).ASIA grade was significantly improved at the final follow-up,including grade D in three patients and grade E in ten patients (P ＜0.05).There was no case of epidural hematoma or infection after operation,and no loosening of internal fixator or pseudarthrosis formation occurred during follow-up.Conclusion For kyphosis in AS combined with thoracolumbar fractures,PSO osteotomy plus long segment pedicle nail bar system treatment can significantly reduce lower back pain and promote functional recovery.

The study of near and long term changes of bone cement and cancellous bone after percutaneous vertebroplasty / 中华骨科杂志

Objective To observe the research of the biologically performance,interface micro-structure and nano-indentation situation when polymethyl methacrylate bone cement-PMMA injected into rabbit in the near future and far future individually.Methods New Zealand white rabbits were used ovariectomy plus dcxamethasone intramuscular injection to establish osteoporosis animal model.All animal models were divided into 3 groups with 35 in each osteoporosis group,testing group,and normal group.Execute the lumbar centrum of New Zealand rabbit as osteoporosis bone defect model,injected bone cement,with the help of material dynamo experiment machine to do the axial compression tests,three point bending test,and torsion test in order to observe the biological dynamic changes.Optical microscope,fluorescence microscope and scanning electron microscope were used to observe the changes of micro bone cement and the changes of bone looseness.Nano-indentation testing was applied by the triboindenter to study the critical load.Results PMMA can rapidly establish the strong support with stable function in the near future.Biomechanical experiments showed that biomechanical properties of bone cement group was significantly higher than those in the other two groups.Biomechanical properties of bone cement group may decline with the time,but which were still better than those of OP in the control group.Histo-morphological observation result shows that under osteoporosis state the bone grows slower,bone's rebuilding time also extended.And in the later period,main bone's continuous osteoporosis had some impact on the interface.Nano-indentation testing showed that the young modulus and stiffness of the interface among bone,material and interface were significantly differences.Bone cement had showen the best nano indentation hardness,then was interface and bone tissue.Conclusion The polymethyl methacrylate bone cement llⅢ has a good effect in filling,on account of it has great plasticity and liquidity and can penetrate into the minuteness aperture between trabecula,then after solidifying,it will combine firmly with the host bone.PMMA can rapidly establish the strong support with stable function after operation.The performance is decreasing in the far future but still with satisfaction.

The Level Change of Plasma Motilin and Serum Gastrin in Patients with Craniocerebral Trauma / 中国医师杂志

0.05)in the mild group compared with at the first day, but an obvious rise(P0.05), while continued to increase in the severe group(P

Guiding principles in developing community health service in the new century / 中华医院管理杂志

Community health service in the new century has entered a new stage of development. To ensure the healthy advancement of community health service in the course of system building, the following guiding principles must be adhered to: spurring on system innovation with concept innovation and giving full play to the staying power of community health service; taking the introduction of the competition mechanism as the soul and unremitting impetus of innovation; persisting in the solution of problems accompanying advance and development with methods promoting development; taking the strategic readjustment of health resources as the main line of development; taking the attainment of a favorable external environment as the impetus of development; and sticking to a path of coordinated growth that stresses both quality and speed.

Vigorously promoting reform of the medical health system and accelerating development of community health services / 中华医院管理杂志

A nationwide pilot project concerning community health sendees, the major part and chief link of the reform in the urban medical health system, has basically come to an end. The author expounds against the background of reform in the health system in China the motives and orientation of reform in the medical health system and the current situation of and problems in the development of community health services. It is pointed out that advancing community health services entails all of the following:①genuinely transforming concepts and seeking unity of thinking; ②adopting the mechanism of competition and enhancing the sense of innovation; ③persisting in keeping abreast of the times and laying emphasis on reform and development;④accelerating the readjustment of resources and optimizing resource allocation; ⑤ceating a sound environment and seeking common development; ⑥giving priority to the improvement of quality and avoiding superficial transformation.