Clinical study of percutaneous coablation nucleoplasty for the treatment of discogenic low back pain / 国际外科学杂志

Objective:To evaluate the clinical effect of percutaneous coablation nucleoplasty (PCNP) in the treatment of discogenic low back pain (DLBP).Methods:From March 2015 to March 2019, the clinical data of 97 single segment DLBP patients with PCNP admitted to orthopaedic department of Beijing Chui Yang Liu hospital were analyzed retrospectively. They were divided into PCNP group ( n=43) and control group ( n=54). The sex proportion, age, medical history, length of hospital stay, follow-up time, operation time, responsibility segment, Pfirrmann classification and complications were recorded. 1 month, 3 months and 6 months after the operation, the routine outpatient reexamination and follow-up were conducted for 6-36 months. The therapeutic effect was evaluated by numeric rating scale (NRS) and Roland-Morris Disability Questionnaire (RMDQ) before, 1 month, 3 months and 6 months after the operation. Measurement data were presented by Mean± SD, t test was used for comparison between groups, and analysis of variance of repeated measurement data was used for comparison of NRS score and RMDQ score before and after treatment. The counting data were expressed by percentage, χ2 test or Fisher precision test was used for comparison between groups, and Mann-Whitney rank sum test was used for comparison between groups of follow-up time and hierarchical grouping data. Statistical software SPSS 20.0 was used to process the data, P< 0.05 was statistically significant. Results:The average operation time of PCNP patients was (36.3±13.2) min (15 to 65 min), and no complications occurred. After treatment, the NRS score and RMDQ score of the two groups decreased significantly( F组内=26.000, P=0.001; F组内=26.000, P=0.001), and the NRS score and RMDQ score of the PCNP group decreased more significantly( F组间=5.666, P=0.024; F组间=4.261, P=0.048), and the NRS score and RMDQ score of the PCNP group decreased more significantly with time ( F交互=26.000, P=0.028; F交互=26.000, P=0.010). Conclusion:PCNP with DLBP patients showed satisfied clinical results in pain relief and improve dysfunction. PCNP is a safe, minimally invasive and effective treatment method, which has a long therapeutic effect and is superior to conservative treatment.

Analysis of the clinical effect of percutaneous endoscopic lumbar discectomy in the treatment of complex lumbar disc herniation / 国际外科学杂志

Objective:To evaluate the clinical effect of percutaneous endoscopic lumbar discectomy (PELD) in the treatment of complex lumbar disc herniation (LDH).Methods:A retrospective analysis of clinical data of 122 patients with LDH who underwent PELD from October 2015 to June 2019 in department of orthopedics, Beijing Chui Yang Liu Hospital was performed. There were 71 males and 51 females. According to whether lumbar disc herniation was a simple non migrated type, the patients were divided into control group ( n=85) and complex group ( n=37). The age, length of stay, operative approach, operation time, the bleeding volume, operative segments, perioperative complications, and excellent and good rate of 3 months after operation were recorded. Follow-up visit was performed by regular outpatient visit for 3 to 36 months. Before and after surgery, 3 days, 1 month, and 3 months after surgery, the Oswestry disability index (ODI) and modified MacNab criteria were used to evaluate the effect of surgery. The measurement data were expressed as mean±standard deviation ( Mean± SD), and the comparison between groups was performed by ANOVA analysis, the count data were expressed as percentage (%), and the comparison between groups was performed by χ2 test or Fisher test, the rank grouping data were performed by Mann-Whitney U non-parametric test. Results:The age of patients in complex group [(63.0±15.9) years] was older than that in control group [(48.7±16.3 years] ( t=2.289, P=0.030), and the length of stay in complex group [(13.0±6.9) d] was longer than that in control group [(8.2±4.3) d] ( t=2.384, P=0.024). There were no significant differences of the operative approach between the two groups ( χ2=0.420, P=0.517). Compared with the control group [(59.0±25.0) min, (16.3±10.9) mL], the operation time of the complex group [(87.0±29.2) min] was longer ( t=2.737, P=0.011), and the bleeding volume [(63.5±52.5) mL] was more ( t=3.925, P=0.001). There were no significant differences of the operative segments between the two groups ( χ2=0.356, P=0.837). The incidence of operation related complications in the complex group (13.5%, 5/37) was significantly higher than that in the control group (2.4%, 2/85) ( χ2=5.937, P=0.026). There were no significant differences in the excellent and good rate between the two groups at 3 months after operation ( U = 1 398.000, P=0.106). The preoperative ODI score of the complex group [(86.6±8.8) scores] was significantly higher than that in the control group [(76.1±7.7) scores]( t=3.359, P=0.002). The ODI score of the two groups decreased significantly. There were significant differences ( t=18.683, P=0.001) between the preoperative [(76.1±7.7) scores] and 3 d postoperative [(36.6±7.5) scores] in the control group. There were significant differences ( t=7.365, P=0.001) between the 3 d postoperative [(36.6±7.5) scores] and 1 month postoperative [(15.0±10.8) scores] in the control group. There were significant differences ( t=4.524, P=0.001) between the 1 month postoperative [(15.0±10.8) scores] and 3 month postoperative [(10.4±12.7) scores] in the control group. There were significant differences ( t=9.923, P=0.001) between the preoperative [(86.6±8.8) scores] and 3d postoperative [(40.1±11.0) scores] in the complex group. There were significant differences ( t=3.619, P=0.006) between the 3d postoperative [(40.1±11.0) scores] and 1 month postoperative [(18.2±15.1) scores] in the complex group. There were significant differences ( t=5.966, P=0.001) between the 1 month postoperative [(18.2±15.1) scores] and 3 month postoperative [(12.7±14.5) scores] in the complex group. Conclusions:PELD technology can treat complex LDH. Compared with simple non migrated LDH, although the operation time is longer, the amount of intraoperative bleeding is more and the incidence of postoperative complications is higher, there is no difference in ODI scores, excellent and good rate. The clinical effect is similar to that of simple non migrated LDH.

Lumbar transforaminal epidural block for treatment of low back pain with radicular pain / 南方医科大学学报

OBJECTIVE@#To evaluate the efficacy of lumbar transforaminal epidural block (LTEB) for treatment of low back pain with radicular pain.@*METHODS@#We retrospectively analyzed the clinical data of 78 patients with low back pain and radicular pain admitted to the Department of Orthopedics of Beijing Chuiyangliu Hospital from March, 2017 to April, 2019. Thirty-three of the patients received treatment with LTEB (LTEB group), and 45 received comprehensive conservative treatment including traction, massage, acupuncture and physiotherapy (control group). The demographic and clinical data of the two groups were compared. The patients were followed up for 3 to 24 months, and numerical rating scale (NRS) and Oswestry disability index (ODI) scores of the patients were evaluated before the treatment and at 2 weeks, 1 month and 3 months after discharge to assess the efficacy of the treatment.@*RESULTS@#The mean operation time of LTEB was 25.7 7.5 min (15-45 min). After the operation, 5 patients developed weakness of the lower limbs but all recovered within 24-72 h. The patients receiving LTEB all showed significantly decreased NRS scores for low back and radicular pain and ODI scores after the operation (@*CONCLUSIONS@#As a minimally invasive approach, LTEB is effective for treatment of low back pain with radicular pain and can produce good short-term effects of pain relief and functional improvement.

Comparative study of the clinical application of TLICS and AO-TLICS scores / 国际外科学杂志

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.

Effect of diabetes on the clinical effect of lumbar disc herniation after percutaneous endoscopic lumbar discectomy / 国际外科学杂志

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

Progress of Research on Intestinal Mucosal Injury Induced by Acute Exposure to High Altitude / 胃肠病学

High altitude environment is a special ecological environmental system. The specificity of this environment is the main reason of gastrointestinal reaction caused by acute exposure to high altitude. With the development of economy, more and more people come to the plateau,and gastrointestinal reaction caused by acute exposure to high altitude has attracted wide attention by scholars. This article briefly reviewed the mechanism of intestinal mucosal injury induced by acute exposure to high altitude.

Clinical effect of polylactic acid membrane in the surgery of lumbar disc herniation / 中国综合临床

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.

A comparison of anterior cervical discectomy and fusion versus fusion combined with cervical disc replacement for treating multi-level cervical spondylotic disease / 国际外科学杂志

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.

Clinical results of percutaneous kyphoplasty for the treatment of severe osteoporotic Kummell disease / 国际外科学杂志

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.

Observation of clinical effects of recombinant human erythropoietin combined with methylprednisolone sodium succinate in the treatment of acute spinal cord injury / 中国综合临床

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.

The clinical study on prophylactic radiation therapy on sacral lymph nodes after radical resection of cervical cancer / 肿瘤

Objective:To study whether sacral lymph nodes should be included in the target volume delineation for those patients with early (stageⅠB-ⅡA) uterus cervix cancer during postoperative radiotherapy. Methods:Forty-six patients with early uterus cervix cancer were given postoperative three dimensional conformal radiation therapy (3D-CRT) in our department for one month after radical resection. The patients were randomly divided into two groups. The sacral lymph nodes were not included in the target volume delineation in the treatment group. But they were delineated in control group. All the patents had no radiotherapy-related contraindications and signed the consent agreement. The patients were followed up. The local controlling rate and the incidence and degree of radioactive proctitis were compared between the two groups. Results:The local controlling rate of the two groups had no significant difference(t=0.000, P=1.000). The doses received by the 5% and 95% volume of the rectum(V_5, V_95), the average dose, and the minimum dose had significant difference between the two groups(t_(V5)=2.169, P_(V5)=0.041; t_(V95)=4.036, P_(V95)=0.001;t_(mean)=2.236, P_(mean)=0.036; t_(min)=2.265, P_(min=0.034), but the maximum dose received by the rectum had no obvious difference (t_(max)=0.518, P_(max)=0.610). The incidence of radioactive proctitis had significant difference between the two groups(t=2.174, P=0.190). Conclusion:For the early uterus cervix cancer patients who have recurrent risk after radical surgery, sacral lymph nodes should not be included in the delineation of target volume during 3D-CRT in order to decrease the incidence of radioactive proctitis.