Preoperative standing to prone spinal-pelvic sagittal parameter changes in old traumatic spinal fractures with kyphosis / 中国修复重建外科杂志

OBJECTIVE@#To investigate the changes in spinal-pelvic sagittal parameters from preoperative standing to prone position in old traumatic spinal fractures with kyphosis.@*METHODS@#The clinical data of 36 patients admitted between December 2016 and June 2021 for surgical treatment of old traumatic spinal fractures with kyphosis, including 7 males and 29 females, aged from 50 to 79 years (mean, 63.9 years), were retrospectively analyzed. Lesion segments included 2 cases of T 11, 12 cases of T 12, 2 cases of T 11, 12, 4 cases of T 12 and L 1, 12 cases of L 1, 2 cases of L 2, 1 case of L 2, 3, and 1 case of L 3. The disease duration ranged from 4 to 120 months, with an average of 19.6 months. Surgical procedures included Smith-Petersen osteotomy in 4 cases, Ponte osteotomy in 6 cases, pedicle subtraction osteotomy in 2 cases, and improved fourth level osteotomy in 18 cases; the remaining 6 cases were not osteotomized. The bone mineral density ranged from -3.0 to 0.5 T, with a mean of -1.62 T. The spinal-pelvic sagittal parameters from preoperative standing to prone positions were measured, including local kyphosis Cobb angle (LKCA), thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and PI and LL mismatch (PI-LL). The kyphotic flexibility=(preoperative standing LKCA-preoperative prone LKCA)/preoperative standing LKCA×100%. Spinal-pelvic sagittal parameters were compared between standing position and prone position before operation, and Pearson correlation was used to judge the correlation between the parameters of standing position and prone position before operation.@*RESULTS@#When the position changed from standing to prone, LKCA and TK decreased significantly ( P<0.05), while SS, LL, PT, and PI-LL had no significant difference ( P>0.05). Pearson correlation analysis showed that LL was significantly correlated with SS and PI-LL in both standing and prone positions ( P<0.05), and the correlation strength between LL and SS in prone position was higher than that in standing position. In the standing position, LKCA was significantly correlated with SS and PT ( P<0.05). However, when the position changed from standing to prone, the correlation between LKCA and SS and PT disappeared, while PT and PI-LL was positive correlation ( P<0.05). The kyphotic flexibility was 25.13%-78.79%, with an average of 33.85%.@*CONCLUSION@#For the patients of old traumatic spinal fractures with kyphosis, the preoperative LKCA and TK decrease significantly from standing position to prone position, and the correlation between spinal and pelvic parameters also changed, which should be taken into account in the formulation of preoperative surgical plan.

Back-forward bending CT in simulated surgical position to evaluate the remaining real angle and flexibility of thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture / 中国修复重建外科杂志

OBJECTIVE@#To introduce a scout view scanning technique of back-forward bending CT (BFB-CT) in simulated surgical position for evaluating the remaining real angle and flexibility of thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture.@*METHODS@#A total of 28 patients with thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture who met the selection criteria between June 2018 and December 2021 were included in the study. There were 6 males and 22 females with an average age of 69.5 years (range, 56-92 years). The injured vertebra were located at T 10-L 2, including 11 cases of single thoracic fracture, 11 cases of single lumbar fracture, and 6 cases of multiple thoracolumbar fractures. The disease duration ranged from 3 weeks to 36 months, with a median of 5 months. All patients received examinations of BFB-CT and standing lateral full-spine X-ray (SLFSX). The thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), local kyphosis of injured vertebra (LKIV), lumbar lordosis (LL), and the sagittal vertical axis (SVA) were measured. Referring to the calculation method of scoliosis flexibility, the kyphosis flexibility of thoracic, thoracolumbar, and injured vertebra were calculated respectively. The sagittal parameters measured by the two methods were compared, and the correlation of the parameters measured by the two methods was analyzed by Pearson correlation.@*RESULTS@#Except LL ( P>0.05), TK, TLK, LKIV, and SVA measured by BFB-CT were significantly lower than those measured by SLFSX ( P<0.05). The flexibilities of thoracic, thoracolumbar, and injured vertebra were 34.1%±18.8%, 36.2%±13.8%, and 39.3%±18.6%, respectively. Correlation analysis showed that the sagittal parameters measured by the two methods were positively correlated ( P<0.001), and the correlation coefficients of TK, TLK, LKIV, and SVA were 0.900, 0.730, 0.700, and 0.680, respectively.@*CONCLUSION@#Thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture shows an excellent flexibility and BFB-CT in simulated surgical position can obtain the remaining real angle which need to be corrected surgically.

Correlations among childhood trauma, autistic traits and dysexecutive functions in college students / 中国心理卫生杂志

Objective:To explore the relations among childhood trauma,autistic traits and dysexecutive functions in college students.Methods:Totally 2757 college students were assessed with the Childhood Trauma Questionnaire (CTQ).Sixty-three college students were randomly selected as the abused group according to the subscale cutoff point of CTQ Scale defined by Bernstein,and 93 students were randomly selected from students without history of childhood trauma as the control group.They were assessed with the Self-Rating Depression Scale (SDS),Autism Spectrum Quotient (AQ) and Dysexecutive Questionnaire (DEX) to measure depression,autistic traits and abnormality of executive functions,respectively.The individuals from the top and below 27％ of CTQ and AQ scores were defined as higher or lower-level different types of abused group and higher or lower-level autistic traits group,respectively.Results:The differences of DEX scores between higher or lower-level four types of CTQ (emotional abuse,physical abuse,sexual abuse,emotional neglect and physical neglect) and between higher or lower-level autistic traits group were significant (Ps ＜0.05).DEX scores in all higher-level groups were higher than all lower-level groups.Regression analysis showed that DEX score could be positively predicted by scores of emotional abuse,AQ and SDS (β =0.17-0.32,P ＜0.05).SDS score was a mediator between scores of emotional abuse and DEX,and between scores of autistic traits and DEX (95％ confidence interval were 0.05-0.32 and 0.07-0.55,respectively).Conclusion:Childhood trauma and autistic traits may positively predict dysexecutive function,and depression may play a mediating role between emotional abuse and dysexecutive function,and between autistic traits and dysexecutive function.

Surgical therapy for treating the fracture and dislocation of talus in 21 patients / 国际外科学杂志

Objective To evaluate the surgical therapy on dislocated fracture of talus. Methods Retrospective analysis was mode in 21 patients with dislocated fracture of talus collected from Jan. 2004 to Jan.2010, which were treated with open reduction, cannulated screw fixation, and kept neutral position plaster fixation with no weight loading, to do functional exercise depending on the Ⅹ film demonstrations. Results All the patients were followed up from 6 months to 3.8 years post-operation, and according to the evaluation standard by American Foot-Ankle Surgery Society, good rate was 61.91%. Conclusion Treating dislocated fracture of talus with emergency operation, anatomical reduction, valid internal fixation and no weight loading plaster fixation post-operation, shows good effect with low rate of complication.