Comparison of clinical outcome between the percutaneous pedicle screw fixation and Wiltse approach for the treatment of thoracolumbar fractures without neurological injury / 国际外科学杂志

Objective:To compare the safety and efficacy of two different minimally invasive approaches to implant pedicle screw for the treatment of single-segment thoracolumbar spine fractures without nerve injury.Methods:This was a retrospective study. Eighty patients with mono-segmental thoracolumbar fractures treated with minimally invasive pedicle screw fixation at Beijing Friendship Hospital, Capital Medical University from January 2020 to June 2022 were included. There were 46 males and 36 females, the age was (45.93±7.91) years old, and ranged from 27 to 60 years old. They were divided into two groups according to different surgical techniques: percutaneous pedicle screw fixation group ( n=44) and Wiltse approach group ( n=36). The operative time, operative visible blood loss, hidden blood loss, total blood loss, fluoroscopy times, incision length, hospital time after surgery and ambulation time were compared. Visual analogue scale (VAS), Oswestry disability index (ODI), ratio of the vertebral anterior height, angle of injured vertebral endplate were recorded and compared between two groups before surgery and at 3 days, 6 months and 1 year after surgery. The accuracy of pedicle screw position and the facet joint violation rate were evaluated by using the postoperative CT scan. Perioperative related complications were investigated. Normally distributed numerical data were presented as mean ± standard deviation, and differences between the groups were compared using t-test. The counting data were expressed as percentages or rates and compared using χ2 test. Results:All patients were followed for a minimum of 12 months. There is no significant difference between the two groups in intraoperative visible blood loss, hospital time after surgery, ambulation time, postoperative VAS and ODI, ratio of vertebral anterior height and angle of injured vertebral endplate at 3 days after surgery, pedicle screw position accuracy and perioperative complications ( P>0.05). The operative time, hidden blood loss, total blood loss, intraoperative fluoroscopy times, facet joint violation rate in the percutaneous pedicle screw fixation group were remarkably higher than in the Wiltse approach group ( P<0.05). The ratio of vertebral anterior height in the percutaneous pedicle screw fixation group was dramatically lower than in the Wiltse approach group at 6 months and 1 year after surgery ( P<0.05). The postoperative injured vertebral endplate angle was higher in the percutaneous pedicle screw fixation group than that in the Wiltse approach group at 6 months and 1 year ( P<0.05). Conclusions:Both percutaneous pedicle screw fixation and Wiltse approach were safe and effective minimally invasive surgical procedures for the treatment of thoracolumbar fractures without neurological injury. The Wiltse approach can reduce fluoroscopy times and perioperative hidden blood loss, reduce the risk of facet joint violation, and maintain a better reduction than percutaneous pedicle screw fixation.

Biomechanical characteristics of a novel interspinous distraction fusion device BacFuse for the repair of lumbar degenerative disease / 中国组织工程研究

BACKGROUND:Interspinous distraction fusion device BacFuse was used for the management of lumbar degenerative disease and obtained good clinical efficacy in recent years.However,the related biomechanical study was lacking. OBJECTIVE:To explore the related biomechanical characteristics of BacFuse,a novel interspinous distraction fusion device,which was used in lumbar degenerative disease. METHODS:After constructing the goat spinal models(L1-L6),they were grouped into four groups based on different simulated surgeries:the control group,the BacFuse group(L3/4),the screw-rod fixation group(L3/4)and the Topping-off group(L3/4 screw-rod fixation + L2/3 BacFuse fixation).The goat lumbar spine surgical model was assembled into a biomechanical testing system.A biomechanical machine was used for mechanical loading,simulating lumbar spine movement of flexion,extension,lateral flexion and rotation with a 4 Nm moment.A visual tracking system was used for positioning and capturing.Finally,mechanical and optical calibration was completed to calculate the range of motion of the L2/3,L3/4 and L4/5 segments. RESULTS AND CONCLUSION:(1)Compared with the control group,the range of motion of the L3/4 segment in the BacFuse group decreased 27.27%,70%,38.1%and 23.08%in the flexion,extension,lateral bending and rotation directions,respectively(P<0.05).The range of motion of L3/4 segment in the screw-rod fixation group decreased 72.73%,80%,71.43%and 73.08%in the flexion,extension,lateral bending and rotation directions,respectively(P<0.05).(2)Compared with the control group,the range of motion of the adjacent segment L2/3 increased by 33.33%,25%and 23.81%in the extension,lateral bending and rotation directions,respectively in the BacFuse group(P<0.05),with no significant change in flexion.In the screw-rod fixation group,there was a 50%,44.44%,50%and 58.96%increase in the adjacent segment L2/3 in the flexion,extension,lateral calibration and rotation directions,respectively(P<0.05).(3)Compared with the control group,the BacFuse group showed an increase in range of motion in proximal segment L4/5 in the extension and rotation directions by 27.3%and 17.39%(P<0.05)respectively,with no significant change in flexion or lateral bending.In the screw-rob fixation group,the proximal segment L4/5 demonstrated 38.89%,22.73%and 26.09%(P<0.05)increases in range of motion in the flexion,extension and rotation directions,respectively,with no significant change in lateral bending.(4)In the Topping-off group,the range of motion of L2/3 was reduced by 37.04%,73.08%,56.67%and 38.46%in flexion,extension,lateral flexion and rotation,respectively,compared to the screw-rob fixation group(P<0.05).Compared with the screw-rob fixation group,the Topping-off group showed a 20%reduction in the range of motion of the L4/5 in the flexion direction(P<0.05),with no significant differences seen in extension,lateral bending and rotation.(5)It is concluded that the interspinous distraction fusion device BacFuse significantly reduces the range of motion of the implanted segment and provides some stability.It still retains more mobility and reduces the impact on the adjacent segment compared to screw-rob fixation,while the Topping-off tip,which can be used for intervertebral fusion fixation,significantly reduces the range of motion of the adjacent segment and reduces the risk of adjacent segment degeneration.

Clinical study of percutaneous vertebroplasty on osteoporotic vertebral compression fractures with chronic kidney disease-mineral and bone disorder / 国际外科学杂志

Objective:To explore the clinical efficacy of percutaneous vertebroplasty(PVP) in the treatment of osteoporotic vertebral compression fractures(OVCF) patients with chronic kidney disease-mineral and bone disorder(CKD-MBD), and analyzed the efficacy of the operation in relieving pain and improving quality of life.Methods:This retrospective study selected 71 patients who underwent PVP treatment for OVCF at Beijing Friendship Hospital, Capital Medical University from December 2013 to December 2018. Among them, there were 24 males and 47 females, with an age range of 66-92 years and an average age of (73.7±8.4) years. Based on whether the patients had CKD-MBD, the patients were divided into two groups: 31 patients with CKD-MBD comprised the experimental group, and 40 patients without CKD-MBD comprised the control group. General patient information and perioperative data were collected, including surgical time, bone cement fill volume, preoperative, postoperative, and different follow-up timepoint visual analog scale (VAS) pain scores, analgesic medication usage scores, oswestry disability index (ODI) scores. Measure and record patient vertebral anterior, middle, and posterior heights and Cobb′s angle, as well as patient blood calcium, blood phosphorus, bone metabolic markers, serum 25-hydroxyvitamin D, parathyroid hormone, total hip bone density, femoral neck bone density, and bone fracture indicators. Measurement data were represented as mean±standard deviation( ± s), the comparison between groups was conducted using the t-test; and repeated measure ANOVA was used for comparison before and after operation; the comparison of count data between groups was conducted by Chi-square test. Results:The surgical duration for the patients in this group was 20-50 min, average (29.8±7.2) min, and the volume of bone cement used was 2.0-5.0 mL, average (3.0±1.0) mL. In the experimental group, VAS scores of postoperative pain, analgesic medication usage scores, and ODI showed statistically significant differences compared to preoperative values ( P<0.001). At the last follow-up, there were no statistically significant differences in analgesic medication usage scores and ODI compared to postoperative values, but VAS scores had improved to a certain extent compared to postoperative values, with statistical significance ( P<0.001). In the experimental group, vertebral anterior height increased from (2.26±0.20) cm preoperatively to (2.57±0.28) cm postoperatively, and vertebral middle height increased from (1.96±0.18) cm preoperatively to (2.21±0.16) cm postoperatively, both with statistically significant differences ( P<0.001). Three patients (9.7%) experienced recurrent fractures, including 1 case of surgical vertebral recurrent fracture (3.2%). The experimental group showed a general increasing trend in blood calcium levels, with the last follow-up blood calcium being (2.31±0.09) mmol/L, which was significantly higher than preoperative ( P=0.002). There was no statistically significant difference in the changes in blood phosphorus ( P>0.05), and parathyroid hormone levels showed a slight decrease in the last follow-up when compared to preoperative, but the difference was not statistically significant ( P>0.05). Both total hip bone mineral density(BMD) and femoral neck BMD at the last follow-up showed significant increases compared to preoperative values. The experimental group had higher levels of blood phosphorus and parathyroid hormone than the control group at both preoperative and last follow-up assessments, with statistical significance ( P<0.05). Conclusion:PVP can effectively alleviate pain and enhance the quality of life for patients with OVCF accompanied by CKD-MBD.

Bone-filling mesh container plasty for spinal metastases with damaged posterior wall of vertebra / 中华骨科杂志

Objective:To study the efficacy and safety of bone-filling mesh container plasty in the treatment of posterior wall fracture of vertebra caused by spinal metastases.Methods:This study is a retrospective analysis of 65 patients with pathological fractures of the vertebra caused by vertebral metastases treated with bone-filling mesh container plasty from January 2015 to December 2019. There were 21 males and 44 females, 70.3±10.8 (46-90) (years). According to primary tumor, there were 25 cases of lung cancer, 14 cases of breast cancer, 11 cases of digestive system cancer, 13 cases of urinary system cancer, 1 case of lymphoma and 1 case of ovarian cancer. In the segment of vertebral metastases, there were 2 cases of T 2 vertebra, 1 case of T 5 vertebra, 1 case of T 6 vertebra, 2 cases of T 8 vertebra, 1 case of T 9 vertebra, 5 cases of T 10 vertebra, 4 cases of T 11 vertebra, 15 cases of T 12 vertebra, 12 cases of L 1 vertebra, 8 cases of L 2 vertebra, 8 cases of L 3 vertebra, 4 cases of L 4 vertebra, and 2 cases of L 5 vertebra. According to the CT images of the patient's vertebra before operation, the area of the damaged posterior wall of the vertebra is measured as s, and the area of the posterior wall of the intact vertebra is measured as S. The ratio of posterior wall damage is calculated as R= s/ S, and the value of R represents the degree of damage to the posterior wall of the vertebra. According to the size of the R value, the patients were divided into four groups, typeⅠ( R≤25%, 21 cases), typeⅡ(25%< R≤50%, 22 cases), typeⅢ (50%< R≤75%, 14 cases), typeⅣ( R>75%, 8 cases). The visual analog scale (VAS), Oswestry disability index (ODI) and activity of daily living (ADL) before and 1 day after surgery, 1 month after surgery, and 3 months after surgery were analyzed and compared to evaluate the efficacy of bone-filling mesh container plasty. Pairwise comparisons were performed to verify whether there is a difference in efficacy, bone cement leakage and postoperative complications. Results:All 65 patients were followed up for 3-6 months, with an average of 3.8 months. The VAS scores before surgery, postoperative day 1, postoperative 1, 3 months were 7.32±0.99, 4.14±1.06, 4.11±0.97, and 4.34±1.11, respectively, with a statistically significant difference ( F=149.20, P<0.001). ODI of preoperative, postoperative day 1, postoperative 1, and 3 months were 69.45%±4.15%, 36.65%±3.72%, 36.84%± 3.38%, 37.78%±3.45%, respectively, with a statistically significant difference ( F=840.88, P<0.001). ADL score of preoperative, postoperative day 1, postoperative 1, and 3 months were 71.31±12.81, 79.85±9.14, 78.92±8.95, and 78.31±8.67, respectively, with a statistically significant difference ( F=149.20, P<0.001). There was no significant difference in VAS, ODI and ADL scores between types I and IV (all P>0.05), but with the increase of R value, the leakage rate of intraspinal bone cement would increase correspondingly. Eleven cases occurred bone cement leakage with the rate of 17%. The leakage rate of type I and II was 0, type III was 7.1% (1/14), and type IV was 37.5% (3/8). All patients did not have systemic complications such as allergies, shock, decreased oxygen saturation, etc., and there were no bleeding, infection, nerve root symptoms or cement insertion syndrome after surgery. Conclusion:Bone-filling mesh container plasty can significantly improve the pain symptoms of patients with spinal metastases and recovery functions. The degree of damage to the posterior vertebra has no effect on the efficacy of the surgery. As the degree of damage to the posterior wall of the vertebra increases, the risk of complications of bone cement leakage in the spinal canal will increase.

Hygienic economic evaluation of inter-spinal distraction fusion and fixation for lumbar disc herniation / 国际外科学杂志

Objective:To analyze the clinical efficacy of inter-spinal distraction fusion and fixation and Posterior lumbar interbody fusion in the treatment of lumbar disc herniation with stenosis, and to evaluate the health economics of the two surgical methods.Methods:Retrospectivly analyzed the clinical data of 400 patients with lumbar disc herniation with stenosis, who were enrolled in Beijing Friendship Hospital, Capital Medical University from Jan. 2015 to Jan. 2019, including 190 male cases and 210 female cases, aged from 50 to 87 years old, with the average age of 67.97. All patients were divided into two groups according to different surgical methods. Among them, 200 patients used interspinous process fusion and distraction fixation (ISDFF group), the other 200 cases used posterior lumbar decompression and pedicle internal fixation (PLIF group). All patients completed the follow-up time of more than 1 year after operation. The basic information of patients′ age, gender, total number of days in hospital, intraoperative bleeding, operation time, surgical incision length and other basic information were observed. The Oswestry dysfunction index (ODI), the Japanese Orthopaedic Association Score (JOA) and the visual analog scale (VAS) were used to evaluate the relief of symptoms before and after the two groups of patients. Total medical expenses, anesthesia expenses, surgical expenses and other expenses were analysed. The software of SPSS 20.0 were conducted to analyze data.Results:The patients in the ISDFF group were (70.84±8.93) years old, and the PLIF group was (65.10±10.23) years old ( t=5.98, P=0.008). The operation time in the ISDFF group was (59.21±16.22) min, and the operation time in the PLIF group was (81.31±17.24) min( t=13.20, P<0.001). The bleeding volume of the ISDFF group was (33.24±11.31) mL, and the bleeding volume of the PLIF group was (67.30±17.61) mL ( t=23.02, P<0.001). The length of the surgical incision in the ISDFF group was (8.27±2.53) cm, and the length of the surgical incision in the PLIF group was (11.15±1.91) cm ( t=11.848, P<0.001). The total hospitalization time in the ISDFF group was (15.15±0.54) days, and the total hospitalization time in the PLIF group was (19.86±0.97) days( t=4.26, P<0.001). There was no significant difference in preoperative ODI, JOA and VAS between the two groups ( P>0.05). Symptoms of postoperative patients were significantly improved compared with preoperative. There were statistical differences in ODI, JOA and VAS between the two groups before and after operation ( P<0.05). However, ODI, JOA and VAS were no statistical difference between the two groups after operation. Complications occurred in 5 cases of the two groups of patients, including two cases of superficial infection in the PLIF group, two cases of dural tear in the PLIF group, one case of spinous process fracture in the ISDFF group. The total hospitalization fee for ISDFF was (57 450±8 670) (yuan), and the total hospitalization fee for PLIF was (75 770±1 640) (yuan), with statistical differences ( t=9.92, P<0.001). The cost of ISDFF operation was 1864±38.19 (yuan), and the cost of PLIF operation was 2352±41.39 (yuan) ( t=8.65, P<0.001). ISDFF antibacterial drug usage fee was 635.5±64.69 (yuan), PLIF antibacterial drug usage fee was 1449±307.1 (yuan) ( t=2.59, P<0.001). The one-time medical material cost during the ISDFF operation was (38 990±300) (yuan), and the one-time medical material cost during the PLIF operation was (52 110±150) (yuan) ( t=5.88, P<0.001). The excellent and good rate of ISDFF group was 92%, and that of PLIF group was 86%. In this study, the total cost of hospitalization was used as an indicator to measure the cost, and further cost-effectiveness evaluation was made. For every good patient, the cost of the ISDFF group was 62 450 yuan, and the cost of the PLIF group was 88, 100 yuan. Conclusions:ISDFF is beneficial to reduce the cost of medical insurance in China, which is in line with the direction of national reform to reduce medical expenditure. It is a surgical method worthy of wide promotion and has a good application prospect.

Analysis of the effect of inter-spinal distraction fusion and fixation combined with limited decompression on the treatment of lumbar spinal stenosis in elderly patients / 国际外科学杂志

Objective:To analyze the effect of inter-spinal distraction fusion and fixation (ISDFF) combined with limited decompression on the treatment of lumbar spinal stenosis in elderly patients.Methods:A total of 32 elderly patients with lumbar spinal stenosis, aged from 80 to 87 years old (mean age: 82.0±2.0 years) including 10 males and 22 females, in the Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University from January 2016 to January 2020 were enrolled in this retrospective study. Clinical evaluation and imaging measurement were performed before operation, after operation, 6 months and 24 months after operation. SPSS software was used for statistical analysis. Measured data of normal distribution were expressed as means±standard deviation. One way analysis of variance was used for comparison between groups. Paired t-test was used to compare between preoperative and postoperative as well as between preoperative and 24 months′ follow-up. Results:All of the 32 patients had one or more common accompanying diseases, such as hypertension, diabetes, coronary heart disease, and so on. All patients were successfully completed the operation with a total of 32 segments. VAS score was decreased from (6.22±0.91) before operation to (1.94±0.76) at 24 months( t=16.52, P<0.001). ODI score was also demonstrated the similar trend, from (54.17±10.65) preoperatively to (19.91±4.20) at 24 months follow-up( t=15.89, P<0.001). JOA score was significantly increased from (11.69±3.36) before surgery to (23.44±1.66) at the last follow-up ( t=-19.90, P<0.001). In the change of imaging, the intervertebral angle was decreased from preoperation (9.12±4.65) to (6.77±2.70) at 24 months( t=3.53, P=0.001). The posterior disk height was increased from (0.68±0.19) cm to (0.76±0.19) cm at the last follow-up( t=-2.45, P=0.020). Conclusions:As a new type of minimally invasive internal fixator, the ISDFF combined with limited decompression can relieve the pain of elderly patients with lumbar spinal stenosis and improve the quality of life. It is suitable for the treatment of elderly patients with lumbar spinal stenosis.

Analysis of XRCC1 and TYMS gene polymorphism test results of resected non-small cell lung cancer / 国际外科学杂志

Objective To discusses the clinical significance of XRCC1 399 and TYMS 5'-translation section enhancement subsequence polymorphism in guidance the postoperative individual chemotherapy for patients with resected non-small cell lung cancer.Methods Retrospectively analyze the results of 150 cases from February 2010to June 2014.Statistical analysis with SPSS 21.0.Results Three of the most common gene type of XRCC1 399 is Arg/Arg(58.7％),Arg/Gln(36.7％) and Gln/Gln(4.6％),respectively.Three of the most common gene type of TYMS is 3R/3R (70.7％),2R/3R (25.3％) and 2R/2R (4.0％),respectively.Conclusion In resected non-small cell lung cancer,XRCC1 399 Arg/Arg genotype is the most common,followed by Arg/Gln type.At the sarne time,TYMS gene type 3R/3R accounted for more than 70％,especially higher percentage of in adenocarcinoma.Neither of these two gene polymorphism is recommended as marker to guide the postoperative individual chemotherapy.