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Objective:To investigate the clinical effect of anterior cervical release and posterior fixation in the treatment of irreducible atlantoaxial dislocation with retropharyngeal internal carotid artery.Methods:Thirteen patients with irreducible atlantoaxial dislocation of retropharyngeal internal carotid artery from January 2015 to July 2019 were treated with anterior cervical release and posterior fixation. There were 8 males and 5 females, aged from 34 to 65 years with an average of 46.1±12.6 years. Positive, lateral and dynamic X-ray films, MR and CTA were performed before operation. There were 4 cases with bilateral retropharyngeal internal carotid artery and 9 cases with unilateral retropharyngeal internal pharyngeal artery. The time of operation, the amount of bleeding and intraoperative and postoperative complications were recorded. The main observations were Japanese Orthopaedic Association (JOA) score, atlantodental interval (ADI), Chamberlain line (CL), and changes in the morphology of the retropharyngeal internal carotid artery and implant fusion.Results:All the operations completed successfully. The operation time was 210-260 min, the average was 245±21 min; the blood loss was 350-600 ml, the average blood loss was 490±107 ml. There was no injury of internal carotid artery, vertebral artery, spinal cord or nerve root during the operation. All patients were followed up for 9 to 24 months, with an average of 15.1±6.2 months. Preoperative JOA score was 6.9±2.3 points, 1 month after operation was 13.5±2.5 points, and the last follow-up was 14.3±2.1 points. The difference was statistically significant ( F=30.91, P<0.001). The difference between 1 month after operation and before operation was statistically significant ( P<0.001), and the improvement rate of JOA score was 75.6%±15.2%. There was no significant difference between the last follow-up and 1 month after operation ( P>0.05). The preoperative ADI was 8.9±2.2 mm, 1 month after operation was 1.1±0.8 mm, and the last follow-up was 1.2±0.9 mm. The difference was statistically significant ( F=114.69, P<0.001). The difference between 1 month after operation and before operation was statistically significant ( P<0.001), and ADI had returned to normal level. There was no significant difference between the last follow-up and 1 month after operation ( P>0.05). The preoperative CL was 11.7±4.8 mm, 1 month after operation was 1.6±2.1 mm, and the last follow-up was 1.8±2.3 mm. The difference was statistically significant ( F=34.19, P<0.001). The difference between 1 month after operation and before operation was statistically significant ( P<0.001), and the position of odontoid process returned to normal level. There was no significant difference between the last follow-up and 1 month after operation ( P>0.05). Bone graft fusion was received at 6 to 12 months after operation, with an average of 10.2 months. Conclusion:CTA examination should be performed before anterior release of atlantoaxial dislocation to understand the position and shape of internal carotid artery. Anterior cervical release combined with posterior bone graft fusion is an effective method for the treatment of irreducible atlantoaxial dislocation with retropharyngeal internal carotid artery without increasing the risk of internal carotid artery injury.
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Objective:To compare the effect of O-arm assisted and free-hand pedicle screw placement in the treatment of AO type C thoracolumbar fracture.Methods:A retrospective cohort study was used to analyze the clinical data of 34 patients with type C thoracolumbar fracture admitted to Henan Provincial People′s Hospital from January 2018 to June 2021, including 23 males and 11 females; aged 42-63 years [(50.4±7.4)years]. The fracture was located at T 11 in 4 patients, T 12 in 10, L 1 in 12, L 2 in 6, T 11~12/L 1 in 1 and T 12/L 1 in 1. Posterior reduction and internal fixation was carried out for all patients, of whom 18 were treated with O-arm assisted pedicle screw placement (navigation group) and 16 with free-hand pedicle screw placement (free-hand group). The operation time, single screw placement time, intraoperative bleeding volume, operation mode and screw placement accuracy were compared between the two groups. The kyphotic Cobb angle, visual analogue score (VAS) and American Spinal Injury Association (ASIA) score were compared between the two groups before operation, at 1 week after operation, at 3 months after operation and at the last follow-up. Postoperative complications were observed. Results:All patients were followed up for 12-29 months [(16.8±6.1)months]. There was no significant difference between the two groups in the operation time, intraoperative bleeding volume and operation mode (all P>0.05). The single screw placement time was (9.4±1.6)minutes in navigation group, but was (10.8±1.5)minutes in free-hand group ( P<0.05). The screw placement accuracy was 97.4% in navigation group, but was 81.5% in free-hand group ( P<0.01). The kyphotic Cobb angle and VAS had no significant differences between the two groups before operation (all P>0.05). The kyphotic Cobb angle in navigation group and free-hand group was (4.3±1.1)° and (5.9±1.1)° at 1 week after operation, (4.4±1.2)° and (5.7±1.3)° at 3 months after operation, and (4.4±1.2)° and (6.8±0.9)° at the last follow-up, decreased significantly from that before operation [(21.8±3.1)°, (22.2±3.2)°] (all P<0.01). The kyphotic Cobb angle in navigation group was significantly lower than that in free-hand group at 1 week, 3 months after operation and at the last follow-up (all P<0.01). The VAS in navigation group and free-hand group was (3.2±0.7)points and (4.1±0.7)points at 1 week after operation, (2.4±0.6)points and (3.0±0.8)points at 3 months after operation, and (1.8±0.9)points and (2.6±0.7)points at the last follow-up, decreased significantly from that before operation [(8.4±0.8)points, (8.3±0.9)points] (all P<0.01). The VAS in navigation group was significantly lower than that in free-hand group at 1 week, 3 months after operation and at the last follow-up (all P<0.01). The ASIA score showed no significant difference within and between the two groups before operation, at 1 week, 3 months after operation and at the last follow-up (all P>0.05). Postoperative incision infection occurred in 1 patient in both groups ( P>0.05). Implant failure such as loosening or displacement was not observed in navigation group, and only occurred in 2 patients in free-hand group ( P>0.05). Conclusion:Compared with free-hand pedicle screw placement, O-arm assisted pedicle screw placement in the treatment of AO type C thoracolumbar fracture has advantages of rapid and accurate screw placement, good reduction and notable pain relief.
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Objective:Based on the Delphi method, the electronic intelligent kanban system for general ward nursing was constructed, and its clinical application was studied.Methods:This study was the quasi experimental research, 39 nursing staff working in the experimental ward of electronic intelligent kanban in general surgery of Zhongshan Hospital Fudan University in November 2021 and November 2022 were selected, Delphi expert consultation was used to develop the menus and detailed contents of general ward nursing electronic intelligent kanban system, and it was used in clinical practice. We used the Chinese version of the Nursing Assessment of Shift Report to evaluate the effect of nursing staff before and after the application.Results:The authority coefficients of the two rounds of expert consultation were 0.868 and 0.886 respectively, and the Kendall coordination coefficients of expert consultation were 0.068 and 0.076 respectively (all P<0.01). Finally, the electronic intelligent kanban consisted of 4 first-level menus, 8 second-level menus and 13 third-level menus. After the application of electronic intelligent kanban, the score of Nursing Assessment of Shift Report increased from (79.62 ± 7.64) to (83.51 ± 2.47), with a statistically significant difference ( t=-3.03, P<0.05). Conclusions:The constructed nursing electronic intelligent kanban system was scientific and reliable, which will be beneficial to improve the the effect of nurse shift handover.
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Objective:To observe the effect of insertion of in-out-in axis pedicle screws on the vertebral artery in the posterior occipitocervical surgery for atlantoaxial subluxation or instability.Methods:The data of 52 patients with atlantoaxial dislocation or instability were analyzed who had been treated by internal fixation with in-out-in pedicle screws in the posterior occipitocervical surgery from January 2015 to February 2021 at Department of Spine and Spinal Cord Surgery, Henan Provincial People's Hospital. There were 30 males and 22 females, aged from 17 to 65 years (mean, 41.2 years). There were 26 cases of unilateral vertebral artery high-riding, 3 cases of bilateral high-riding, 19 cases of unilateral narrow pedicle due to C2 and C3 fusion, and 4 cases of bilateral narrow pedicles. X-ray, CTA and MRI were performed before and 3 days after surgery. The patients' clinical symptoms were recorded. CTA was used to measure the diameter of the vertebral artery at the transverse foramina of C 2 and C 3 and to observe the effect of in-out-in screws on the morphology of the vertebral artery. X-ray and CT examinations were performed at 6 months after surgery to observe the bone fusion. Results:The surgery went on uneventfully in all the patients. In the 9 cases undergoing anterior and posterior surgery, the operation time averaged 271.2 min (from 213 to 352 min) and the bleeding volume 471.5 mL (from 230 to 830 mL). In the 43 cases undergoing posterior surgery, the operation time averaged 171.6 min (from 131 to 226 min) and the bleeding volume 395.9 mL (from 170 to 660 mL). There was no such complication as spinal or vascular injury. The CTA reexamination 3 days after surgery showed that the diameter of the vertebral artery was (2.92±0.55) mm and (3.04±0.54) mm, respectively at the cervical 2 and 3 transverse foramina, showing no significant change compared with the preoperative values [(2.91±0.68) mm and (3.11±0.50) mm] ( P>0.05) and that the vertebral artery was displaced externally and inferiorly in 21 cases. Follow-ups for all patients ranged from 7 to 24 months (mean, 11 months). At 6 months after surgery, bone fusion was observed by imaging and no breakage or displacement of the internal fixation was observed. Conclusion:The in-out-in pedicle screws in the posterior occipitocervical surgery may have little impact on the vertebral artery, leading to reliable clinical outcomes.
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Objective:To compare the efficacy of posterior atlas uniaxial and polyaxial screw instrumentation and fusion with bone graft for Gehweiler type IIIb atlas fracture.Methods:A retrospective cohort study was performed to analyze the clinical data of 36 patients with Gehweiler type IIIb atlas fracture admitted to Henan Provincial People′s Hospital from January 2015 to October 2020. There were 29 males and 7 females, with age range of 23-82 years [(48.8±15.5)years]. All patients were treated with posterior atlas screw-rod internal fixation and fusion with bone graft, of which 14 received atlas uniaxial screw internal fixation (uniaxial screw group) and 22 received atlas polyaxial screw internal fixation (polyaxial screw group). The operation time and intraoperative blood loss were compared between the two groups. The atlas fracture union rate and atlantoaxial posterior arch bone fusion rate were compared between the two groups at 3 months and 6 months after operation. The anterior atlantodental interval (ADI), basion-dens interval (BDI) and lateral mass displacement (LMD) were compared between the two groups to evaluate the reduction of fracture fragments before operation, at 1, 3, 6 months after operation and at the last follow-up. At the same time, the visual analogue scale (VAS) and neck dysfunction index (NDI) were compared between the two groups to evaluate neck pain and functional recovery. The postoperative complications were observed.Results:All patients were followed up for 12-44 months [(27.2±9.9)months]. There was no significant difference in operation time or intraoperative blood loss between the two groups (all P>0.05). The atlas fracture union rate and atlantoaxial posterior arch bone fusion rate were 85.7% (12/14) and 78.6% (11/14) in uniaxial screw group at 3 months after operation, insignificantly different from those in polyaxial screw group [72.7% (16/22) and 77.3% (17/22)] (all P>0.05). All patients in the two groups achieved bone union and fusion at 6 months after operation. There was no significant difference in ADI between the two groups before and after operation (all P>0.05). The BDI in the two groups did not differ significantly before operation ( P>0.05), but a significantly higher value was found in uniaxial screw group at 1, 3, and 6 months after operation and at the last follow-up [(5.9±1.3)mm, (5.8±1.3)mm, (5.9±1.2)mm and (5.8±1.2)mm] than in polyaxial screw group [(3.1±0.6)mm, (3.1±0.6)mm, (3.1±0.6)mm and (3.1±0.6)mm] (all P<0.01). The two groups did not differ significantly before operation ( P>0.05), but LMD at 1, 3, and 6 months after operation and at the last follow-up was (1.6±0.8)mm, (1.5±0.8)mm, (1.5±0.7)mm and (1.5±0.9)mm in uniaxial screw group, significantly lower than that in polyaxial screw group [(4.8±1.6)mm, (4.6±1.6)mm, (4.9±1.6)mm and (4.9±1.6)mm] (all P<0.01). There was no significant difference in VAS between the two groups before operation ( P>0.05). The VAS at 1, 3, and 6 months after operation and at the last follow-up was 3.0(3.0, 4.0)points, 2.0(1.0, 2.0)points, 1.0(0.8, 2.0)points and 1.0(0.0, 1.3)points in uniaxial screw group and was 3.5(3.0, 4.0)points, 2.0(2.0, 3.0)points, 2.0(1.0, 2.0)points and 2.0(1.0, 3.0)points in polyaxial screw group. In comparison, the VAS scored much lower in uniaxial screw group than in polyaxial screw group at 6 months after operation and at the last follow-up (all P<0.01). There was no significant difference in NDI between the two groups before operation ( P>0.05). The NDI at 1, 3, and 6 months after operation and at the last follow-up was 34.9±6.3, 23.4±6.2, 13.9±2.7 and 9.4±2.8 in uniaxial screw group and was 33.2±6.1, 24.4±6.3, 18.1±4.1 and 12.7±3.2 in polyaxial screw group, showing a significantly lower NDI in uniaxial screw group than in polyaxial screw group at 6 months after operation and at the last follow-up (all P<0.01). The complication rate was 21.4% (3/14) in uniaxial screw group when compared to 22.7% (5/22) in polyaxial screw group ( P>0.05). Conclusion:For Gehweiler type IIIb atlas fracture, both techniques can attain atlas fracture union and atlantoaxial posterior arch bone fusion, but the posterior atlas uniaxial screw instrumentation and fusion is superior in reduction of atlas fracture displacement and lateral mass separation, neck pain relief and functional improvement.
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TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.
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Objective:To compare the application value of prefabricated path with an awl for guiding pin and traditional screw placement during anterior odontoid screw fixation.Methods:A retrospective case-control study was conducted to analyze 35 patients with fresh odontoid fractures treated from January 2010 to August 2017 in Henan Provincial People's Hospital, including 25 males and 10 females with age range of 19-55 years (mean, 36.9 years). The preoperative odontoid fractures were classified into type IIA in 15 patients, type IIB in 20 patients according to Anderson and D'Alonzo classification. Among them, 16 patients in Group A were treated with prefabricated path by an awl for guiding pin during anterior odontoid screw fixation, and 19 patients in Group B were implanted screws according to traditional experience in anterior odontoid screw fixation. Operation time, intraoperative fluoroscopy time, success rate of first-time guiding pin implantation, intraoperative blood loss, fracture healing outcomes and American Spinal Injury Association (ASIA) grade at the latest follow-up were collected and compared between the two groups.Results:All patients were followed up for 13-20 months [(16.8±1.5)months]. Two groups had significant differences in operation time [Group A: (73.5±12.9)minutes; Group B: (82.6±13.6)minutes], intraoperative fluoroscopy time [Group A: (3.1±0.6)minutes, Group B: (7.0±0.9)minutes], and success rate of first-time guiding pin implantation (Group A: 94%, Group B: 58%) ( P<0.05), but not in intraoperative blood loss [Group A: (129.4±40.6)ml; Group B: (135.8±38.4)ml] and fracture healing rate (Group A: 94%, Group B: 95%) and ASIA grade at the latest follow-up (Group A: grade C in 1 patient, grade D in 3, grade E in 12; Group B: grade C in 2 patients, grade D in 2, grade E in 15) ( P>0.05). All patients were successfully operated without occurrence of cerebrospinal fluid leakage, neurovascular injury or incision infection. Conclusions:Prefabricated path with an awl for guiding pin during anterior odontoid screw fixation is superior to traditional experience, which can reduce operation time, intraoperative fluoroscopy time and improve the success rate of first-time guiding pin implantation. Meanwhile, there is no effect on intraoperative blood loss or fracture healing outcomes.
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Objective To develop a new type of lumbar prosthesis,movable artificial lumbar vertebral body (MALV) and evaluate the stability and activity of the prosthesis by in vitro biomechanical test.Methods Fifteen adult fresh lumbar spine specimens were randomly divided into three groups:intact group,fusion group and non-fusion group.The anatomical parameters of L2 vertebral body and adjacent intervertebral discs were collected by software (Mimics 16.0,Materialise Company,USA) and the new prosthesis was personalized by 3D printing and mechanical processing.All specimens in fusion group and in non-fusion group were implanted with titanium cage,titanium plate and MALV respectively after partial resection of L2 vertebra and adjacent intervertebral disc.No other intervention was conducted on physiological specimens.All specimens were examined by imaging to determine the position of the prosthesis and the condition of the spinal cord.Specimens in all groups were subjected to a 7.5 N · m load biomechanical test in flexion,extension,left and right lateral bending,left and right rotation aiming to evaluate the mobility of operative site and adjacent discs.Results The new prosthesis consists of three parts,vertebral body,intervertebral disc and composite material ball.All 15 cadavers were free of spinal deformity,fracture and osteoporosis.Postoperative radiographic examination indicated no prosthesis displacement and spinal compression without adverse phenomena.The results in vitro mechanical test were as followed.There was no statistical difference in ROM of the T12L1 intervertebral in non-fusion group (3.68°±0.86°,3.52°± 0.86°,2.64°±0.93°,2.58°±0.76° respectively) and in intact group (3.98°±0.90°,3.74°±0.91°,2.94°±1.10°,2.96°±0.86° respectively) in flexion,extension,left and right lateral bending (P＞0.05).The ROM of the T12L1 intervertebral in fusion group (5.28°±0.83°,5.32°±0.42°,4.72°±1.10°,4.94°±1.17° respectively) was significantly larger than that in intact group and non-fusion group (P＜0.05).There was no statistically significant difference between the ROM of L1.2 and L2.3 intervertebral in flexion,extension and left and rightlateral bending in the non-fusion group (ROM of L1.2 were 4.62°±0.51 °,4.34°±0.67°,3.16°±0.55°,3.28°±0.41 ° respectively;ROM of L2.3 were 4.54°±0.58°,4.36°±0.65°,3.26°±0.21°,3.42°±0.37° respectively) and the intact group (ROM of L1.2 were 4.10°±0.53°,3.72°±0.42°,2.74°±0.50°,3.04°±0.40° respectively;ROM of L2.3 were 4.26°±0.72°,4.08°±0.77°,3.00°±0.36°,3.20°±0.31° respectively) (P＞0.05).The ROM of L1.2 and L2.3 in intact group and in non-fusion group were significantly greater than those in the fusion group (ROM of L1.2 were 1.10°± 0.35°,1.28°±0.31°,0.84°±0.34°,0.80°± 0.43° respectively;ROM of L2.3 were 1.14°±0.30°,1.18°±0.28°,0.94°± 0.36°,1.06°±0.32°) (P＜0.05).There was no statistically significant difference in the ROM of the T12-L3 full segment in the left and right rotation of the three groups (Intact group:4.47°± 0.99°,4.40°±0.70°;Non-fusion group:4.60°±0.90°,4.50°±0.77°;Fusion group:3.85°±0.50°,3.72°±0.70°)(P＞0.05).Conclusion The MALV can retain the mobility of the operative site in flexion,extension,lateral bending and rotation.Furthermore,it can effectively avoid the increased mobility of adjacent segment intervertebral.After implantation,the prosthesis can obtain satisfied immediate stability.
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Objective To investigate the clinical efficacy of non-fusion and fusion internal fixation with posterior pedicle screw for odontoid fractures. Methods A retrospective case control study was conducted to analyze the clinical data of 46 patients with odontoid fractures admitted to Henan Provincial People's Hospital from January 2013 to June 2015. There were 35 males and 11 females, aged 19-62 years [(36. 9 ± 1. 6)years]. The preoperative odontoid fractures were classified as type IIA in five patients, type IIB in eight, type IIC in 22, shallow type III in six according to Anderson and D'Alonzo typing. The fractures of five patients were not classified. According to the ASIA grading, the preoperative spinal cord function was graded as D or E in the 46 patients. Among the patients, 15 underwent posterior pedicle screw non-fusion internal fixation ( Group A) , with 60 pedicle screws removed 12-29 months after operation. A total of 31 patients were treated with fusion internal fixation with posterior pedicle screw ( Group B) , with 124 pedicle screws free from removal after operation. The follow-up time, operation time, intraoperative fluoroscopy time, intraoperative blood loss as well as visual analog scale (VAS), cervical rotation degree, and neck disability index ( NDI) before operation, 1 year after surgery ( when no internal fixation was removed ) and at the last follow-up were compared between the two groups. Results There were no significant differences between the two groups in the follow-up time, operation time, intraoperative fluoroscopy time, intraoperative blood loss, VAS score, neck rotation degree, NDI score before operation and at 1 year after operation (P >0. 05). There were significant differences between two groups in VAS scores, neck rotation degree, NDI scores indicating driving and walking and recreational activities at the last follow-up ( P <0. 05 ) . There were no significant differences between two groups in other NDI scores items, including neck discomfort, personal care, lifting heavy objects, reading & watching TV, headache situation, attention, working status, and sleep disorder at the last follow-up ( P> 0. 05 ) . Conclusions Posterior pedicle screw internal fixation for odontoid process fracture has good curative effect. Non-fusion internal fixation with posterior pedicle screw is more conducive to the recovery of cervical spine rotation function, the relief of neck and back pain, and the improvement of patients' driving, walking and entertainment activities.
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Objective To identify barriers of evidence-based practice in venous blood specimen collection. Methods Totally 12 nurses from Zhongshan Hospital Fudan University participated in the non-structure interviews. Data were analyzed by category analysis. Results There were 8 barriers, including standard operation procedure of blood specimen collection was not updated in time, lacking of education and professional support for evidence-based nursing, lacking of effective superintendence, rising economic cost, deficiency of technology and equipment, sufficient nurses, deficiency of evidence-based practice environment. Conclusions Establishing and implementing an evidence- based standard operation procedure, strengthening personnel education, looking for professional support, developing link management, reasonable allocation of human resources and flexible scheduling, creating an evidence-based practice environment, seeking technical and equipment support and evaluating evidence to control costs are benefit to promote the best evidence of venous blood collection to achieve clinical transformation.
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Objective To investigate the clinical efficacy of percutaneous fixation assisted by O-arm-based navigation for thoracolumbar fractures without neurologic deficits.Methods A retrospective case control study was conducted analyze the clinical data of 35 thoracolumbar fracture patients without neurologic deficits admitted to Henan Provincial People's Hospital from January 2018 10 December 2018.There were 26 males and 9 females,aged 17-51 years,with an average age of 30.4 years.The injured segments were distributed at T11 in 10 patients,T12 in 15,L1 in 11,and L2 in 4 patients.A total of 19 patients(22 vertebrae,98 pedicle screws)were treated with O-arm guided navigation assisted percutaneous internal fixation(Group A),and 16 patients(18 vertebrae,82 pedicle screws)were treated with C-arm guided percutaneous internal fixation(Group B).The operation time,accuracy rate of nail placement,complications,Cobb angle of fracture vertebral body,visual analogue score(VAS)and Japanese Orthopaedic Association(JOA)score were recorded and compared before operation,7 days after operation and at the last follow-up.Results The patients were followed up for 2-12 months [(7.2 ±2.9)months] in Group A and 3-13 months [(7.1±3.3)months] in Group B.The operation time was(70.5±11.2)minutes in Group A and(81.3±10.9)minutes in Group B(P＜0.01).A total of 93 screws were completely placed in the pedicle in Group A(accuracy rate of 95％),and 74 screws in Group B(accuracy rate of 90％)(P＜0.01).There were no complications such as infection,pulmonary embolism,spinal cord,nerve injury or lower extremity deep vein thrombosis in either group.The Cobb angle of the fractured vertebral body at day 7 after operation in Group A and Group B was(9.4±2.1)° and(10.4±2.5)° respectively,while the Cobb angle of the fractured vertebral body at the final follow-up in Group A and Group B was(9.7±2.3)°and(11.4±2.9)° respectively.The postoperative Cobb angle was significantly increased compared with the preoperative Cobb angle(P＜0.05),but there was no significant difference between the two groups(P＞0.05).The V AS at day 7 after operation was(2.3±1.1)points and(2.8±1.0)points in Group A and Group B,respectively,while the VAS at the final follow-up was(0.7±0.7)points and(0.8±0.7)points in Group A and Group B respectively.The postoperative VAS was significantly decreased compared with the preoperative VAS(P＜0.05),but there was no significant difference between the two groups(P ＞0.05).The JOA at day 7 after operation was(21.1±2.2)points and(21.8±2.5)points in Group A and Group B respectively,while the JOA at the final follow-up was(24.9±2.2)points and(23.8±1.9)points in Group A and Group B respectively.The postoperative JOA was significantly increased compared with the preoperative JOA(P＜0.05),but there was no significant difference between the two groups(P＞0.05).Conclusion For thoracolumbar fractures without neurologic deficits,percutaneous fixation assisted by O-arm-based navigation can shorten the operation time and deliver a higher accuracy rate in the placement of pedicle screws,in addition to the similar effects with percutaneous fixation assisted by C-arm in pain relief,function improvement and correction of fracture vertebral kyphosis.
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Objective To investigate the efficacy of posterior atlantoaxial joint axial release,bone grafting and internal fixation for the treatment of irreducible atlantoaxial dislocation (IAAD) with partial reduction.Methods A retrospective case-control study was conducted to analyze the clinical data of 42 patients with IAAD admitted to Henan Provincial People's Hospital from January 2014 to October 2017.There were 17 males and 25 females,aged from 12 to 72 years [(47.2 ± 11.3) years].After more than 50％ reduction by high weight skull traction,18 patients underwent posterior atlantoaxial joint axial release,reduction,bone grafting and fusion with internal fixation (Group A),and 24 patients underwent anterior transoral or retropharyngeal release,reduction,posterior bone grafting and fusion with internal fixation (Group B).The operation time,intraoperative blood loss,preoperative and postoperative anterior atlantodental interval (ADI),clivus-canal angle (CCA),cervicomedullary angle (CMA),and Japanese Orthopaedic Association (JOA) scores between the two groups were compared.The improvement rate of JOA scores at the last follow-up of the two groups and the atlantoaxial joint fusion rate at 3 months and 6 months after surgery were calculated and compared.The complications were recorded.Results All patients were followed up for 12 to 40 months with an average of 24.6 months.Group A had significant decreases in operation time [(138.1 ±25.6) minutes ∶ (242.8 ± 38.1) minutes] and intraoperative blood loss [(179.3 ± 48.7) ml ∶ (218.2 ± 42.6) ml] compared with Group B (P ＜0.05).There were significant differences between the ADI,CCA,CMA and JOA scores before operation and during the last follow-up in both Group A and Group B (P ＜ 0.05),but there was no significant difference between the two groups in terms of these scores (P ＞ 0.05).The JOA scores in Group A were excdlent in eight patients,good in eight patients,and fair in two patients,with the improvement rate of 89％.The JOA scores in Group B were excellent in 13 patients,good in eight patients,and fair in three patients,with the improvement rate of 87％ (P ＞0.05).In Group A,the atlanto-axial joint fusion rate was 83％ at 3 months and 100％ at 6 months postoperatively;in Group B,the fusion rate was 79％ at 3 months and 100％ at 6 months postoperatively (P ＞ 0.05).There was no failure of internal fixation or loss of reduction in both groups.Conclusion Posterior atlantoaxial joint axial release,bone grafting and fusion with intemal fixation can be used to treat the partially reducible IAAD through a single approach.The reduction effect was comparable to that of anterior transoral or retropharyngeal release,bone grafting and fusion,with less operation time and intraoperative blood loss.
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Objective To investigate the effect of oral nutritional supplements (ONS) on body weight loss and life quality in post-discharge patients with gastric and colorectal cancer. Methods All the enrolled post-operative gastric or colorectal cancer patients were randomly divided into ONS group and control group. Body weight loss, middle arm circumference, triceps skinfold thickness and right-hand grip strength were measured and the Karnofsky score, ECOG score and QOL score were calculated 3 months after the discharge. ResultsThe body weight loss of gastric cancer patients was lower in ONS group than in control group since 2 months after discharge. (2 months after discharge: 1. 65±2. 11vs. 2. 70±1. 90 kg, t = -2. 3853, P = 0. 0193; 3 months after discharge: 1. 95±2. 75vs. 3. 67±2. 29 kg, t = -3. 1347, P = 0. 0024), There was no difference of body weight loss between two groups in colorectal cancer patients. The middle arm circumference, triceps skinfold thicknessand right-hand grip strength showed no statistic difference between two groups both in gastric and colorectal cancer patients. The Karnofsky score (56. 82±13. 65％vs. 51. 71± 9. 72％, t = 2. 0148, P = 0. 0472) and QOL score (41. 91±6. 92 vs. 38. 39±8. 77, t = 2. 0597, P = 0. 0426) were higher in ONS group than in control group in gastric cancer patients. While all 3 types of scores had no difference between two groups in colorectal cancer patients. Conclusion ONS can efficiently reduce the body weight loss and improve the performance status and life qualityin post-discharge gastric cancer patients, but not in colorectal cancer patients.
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Objective@#To identify barriers of evidence-based practice in venous blood specimen collection.@*Methods@#Totally 12 nurses from Zhongshan Hospital Fudan University participated in the non-structure interviews. Data were analyzed by category analysis.@*Results@#There were 8 barriers, including standard operation procedure of blood specimen collection was not updated in time, lacking of education and professional support for evidence-based nursing, lacking of effective superintendence, rising economic cost, deficiency of technology and equipment, sufficient nurses, deficiency of evidence-based practice environment.@*Conclusions@#Establishing and implementing an evidence-based standard operation procedure, strengthening personnel education, looking for professional support, developing link management, reasonable allocation of human resources and flexible scheduling, creating an evidence-based practice environment, seeking technical and equipment support and evaluating evidence to control costs are benefit to promote the best evidence of venous blood collection to achieve clinical transformation.
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Objective@#To investigate the efficacy of posterior atlantoaxial joint axial release, bone grafting and internal fixation for the treatment of irreducible atlantoaxial dislocation (IAAD) with partial reduction.@*Methods@#A retrospective case-control study was conducted to analyze the clinical data of 42 patients with IAAD admitted to Henan Provincial People's Hospital from January 2014 to October 2017. There were 17 males and 25 females, aged from 12 to 72 years [(47.2±11.3) years]. After more than 50% reduction by high weight skull traction, 18 patients underwent posterior atlantoaxial joint axial release, reduction, bone grafting and fusion with internal fixation (Group A), and 24 patients underwent anterior transoral or retropharyngeal release, reduction, posterior bone grafting and fusion with internal fixation (Group B). The operation time, intraoperative blood loss, preoperative and postoperative anterior atlantodental interval (ADI), clivus-canal angle (CCA), cervicomedullary angle (CMA), and Japanese Orthopaedic Association (JOA) scores between the two groups were compared. The improvement rate of JOA scores at the last follow-up of the two groups and the atlantoaxial joint fusion rate at 3 months and 6 months after surgery were calculated and compared. The complications were recorded.@*Results@#All patients were followed up for 12 to 40 months with an average of 24.6 months. Group A had significant decreases in operation time [(138.1±25.6) minutes ∶(242.8±38.1) minutes] and intraoperative blood loss [(179.3±48.7)ml ∶(218.2±42.6)ml] compared with Group B (P<0.05). There were significant differences between the ADI, CCA, CMA and JOA scores before operation and during the last follow-up in both Group A and Group B (P<0.05), but there was no significant difference between the two groups in terms of these scores (P>0.05). The JOA scores in Group A were excellent in eight patients, good in eight patients, and fair in two patients, with the improvement rate of 89%. The JOA scores in Group B were excellent in 13 patients, good in eight patients, and fair in three patients, with the improvement rate of 87% (P>0.05). In Group A, the atlanto-axial joint fusion rate was 83% at 3 months and 100% at 6 months postoperatively; in Group B, the fusion rate was 79% at 3 months and 100% at 6 months postoperatively (P > 0.05). There was no failure of internal fixation or loss of reduction in both groups.@*Conclusion@#Posterior atlantoaxial joint axial release, bone grafting and fusion with internal fixation can be used to treat the partially reducible IAAD through a single approach. The reduction effect was comparable to that of anterior transoral or retropharyngeal release, bone grafting and fusion, with less operation time and intraoperative blood loss.
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Objective@#To investigate the clinical efficacy of percutaneous fixation assisted by O-arm-based navigation for thoracolumbar fractures without neurologic deficits.@*Methods@#A retrospective case control study was conducted to analyze the clinical data of 35 thoracolumbar fracture patients without neurologic deficits admitted to Henan Provincial People's Hospital from January 2018 to December 2018. There were 26 males and 9 females, aged 17-51 years, with an average age of 30.4 years. The injured segments were distributed at T11 in 10 patients, T12 in 15, L1 in 11, and L2 in 4 patients. A total of 19 patients (22 vertebrae, 98 pedicle screws) were treated with O-arm guided navigation assisted percutaneous internal fixation (Group A), and 16 patients (18 vertebrae, 82 pedicle screws) were treated with C-arm guided percutaneous internal fixation (Group B). The operation time, accuracy rate of nail placement, complications, Cobb angle of fracture vertebral body, visual analogue score (VAS) and Japanese Orthopaedic Association (JOA) score were recorded and compared before operation, 7 days after operation and at the last follow-up.@*Results@#The patients were followed up for 2-12 months [(7.2±2.9)months] in Group A and 3-13 months [(7.1±3.3)months] in Group B. The operation time was (70.5±11.2)minutes in Group A and (81.3±10.9)minutes in Group B (P<0.01). A total of 93 screws were completely placed in the pedicle in Group A (accuracy rate of 95%), and 74 screws in Group B (accuracy rate of 90%) (P<0.01). There were no complications such as infection, pulmonary embolism, spinal cord, nerve injury or lower extremity deep vein thrombosis in either group. The Cobb angle of the fractured vertebral body at day 7 after operation in Group A and Group B was (9.4±2.1)° and (10.4±2.5)° respectively, while the Cobb angle of the fractured vertebral body at the final follow-up in Group A and Group B was (9.7±2.3)° and (11.4±2.9)° respectively. The postoperative Cobb angle was significantly increased compared with the preoperative Cobb angle (P<0.05), but there was no significant difference between the two groups (P>0.05). The VAS at day 7 after operation was (2.3±1.1)points and (2.8±1.0)points in Group A and Group B, respectively, while the VAS at the final follow-up was (0.7±0.7)points and (0.8±0.7)points in Group A and Group B respectively. The postoperative VAS was significantly decreased compared with the preoperative VAS (P<0.05), but there was no significant difference between the two groups (P>0.05). The JOA at day 7 after operation was (21.1±2.2)points and (21.8±2.5)points in Group A and Group B respectively, while the JOA at the final follow-up was (24.9±2.2)points and (23.8±1.9)points in Group A and Group B respectively. The postoperative JOA was significantly increased compared with the preoperative JOA (P<0.05), but there was no significant difference between the two groups (P>0.05).@*Conclusion@#For thoracolumbar fractures without neurologic deficits, percutaneous fixation assisted by O-arm-based navigation can shorten the operation time and deliver a higher accuracy rate in the placement of pedicle screws, in addition to the similar effects with percutaneous fixation assisted by C-arm in pain relief, function improvement and correction of fracture vertebral kyphosis.
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Objective@#To investigate the effect of oral nutritional supplements(ONS) on body weight loss and life quality in post-discharge patients with gastric and colorectal cancer.@*Methods@#All the enrolled post-operative gastric or colorectal cancer patients were randomly divided into ONS group and control group. Body weight loss, middle arm circumference, triceps skinfold thickness and right-hand grip strength were measured and the Karnofsky score, ECOG score and QOL score were calculated 3 months after the discharge.@*Results@#The body weight loss of gastric cancer patients was lower in ONS group than in control group since 2 months after discharge.(2 months after discharge: 1.65±2.11vs. 2.70±1.90 kg, t=-2.385 3, P=0.019 3; 3 months after discharge: 1.95±2.75vs. 3.67±2.29 kg, t=-3.134 7, P=0.002 4), There was no difference of body weight loss between two groups in colorectal cancer patients. The middle arm circumference, triceps skinfold thicknessand right-hand grip strength showed no statistic difference between two groups both in gastric and colorectal cancer patients. The Karnofsky score(56.82±13.65%vs. 51.71±9.72%, t=2.014 8, P=0.047 2) and QOL score(41.91±6.92 vs. 38.39±8.77, t=2.059 7, P=0.042 6) were higher in ONS group than in control group in gastric cancer patients. While all 3 types of scores had no difference between two groups in colorectal cancer patients.@*Conclusion@#ONS can efficiently reduce the body weight loss and improve the performance status and life qualityin post-discharge gastric cancer patients, but not in colorectal cancer patients.
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Objective To evaluate the indications and clinical efficacy of the different surgical methods for lumbosacral tuberculosis.Methods 112 patients suffering from lumbosacral tuberculosis from January 1998 to October 2011 were reviewed retrospectively.Based on American Spinal Injury Association (ASIA) grading system,31 case was classified as grade C,32 as grade D and 49 as grade E.The affected locations were L5,S1 in 66 cases,L4-S1 in 32,and L5-S2in 14 cases.41 cases (posterior group) underwent posterior pedicle screw instrumentation,debridement and allograft; and 38 cases (anterior group) underwent one-stage anterolateral debridement plus allograft and internal fixation.33 (posterior-anterior group) cases experienced posterior pedicle screw instrumentation and anterior debridement and allograft.All cases underwent routine support and anti-tuberculosis treatment before and after operation.The change of erythrocyte sedimentation rate (ESR),signs of tuberculosis activity,graft fusion,neurological recovery and correction of deformity were evaluated in follow-up and compared among three groups.Results The average operating time in posterior,anterior and posterior-anterior group was (150±22) m in,(140± 18) min,(180± 1 8) min respectively.ESR and C-reactive protein (CRP) were recovered to normal 3 months post surgery.The quality of life total score of lumbosacral tuberculosis patients was very low (55.54 ± 9.23).After surgery and drug treatment,the total score and each dimension scores of the SF-36 were significantly improved.Postoperative ASIA classification and 1umbosacral angle were significantly improved.Tuberculosis recurrence occurred in three cases,fixation loosening in two cases,fixation fracture in one case,and all above cases were cured after revision surgery.The others all were cured and bone graft fusion was determined.Conclusion The quality of life of lumbosacral tuberculosis patients were impacted seriously,and which could be significantly improved with surgical intervention.According to the patient MRI,CT characteristics,surgical approach selection was based on lesion location.Effective internal fixation was based on the extent of damage in bone structure and anatomical characteristics.Following above principles,satisfactory clinical results could be achieved.
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ObjectiveTo investigate the safety and early clinical efficiency of dynamic cervical implant (DCI) internal fixation to treat cervical disc herniation.Methods From September 2009 to December 2010,31 patients with herniation of cervical disc underwent DCI implantation.The operation time and blood loss were recorded and analyzed.Neck disability index (NDI),Japanese Orthopaedic Association (JOA) score,and visual analogue scale(VAS) score were used to evaluate neurofunctional recovery pre- and post-operation.Routinely,the patients accepted X-ray examination preoperatively and postoperatively.We used White's measurement to measure the range of motion(ROM) and height ratio of implant segment and the superior vertebra pre- and post-operation.ResultsThe average operation time and amount of bleeding were 45 (30-60) min and (100±30) ml respectively.The average postoperative follow-up was 14 months (range,6-20).The average NDI (50.5±16.2 vs.19.6±4.3,P＜0.05),JOA score (12.3±1.6 vs.13.9±1.8,P＜0.05) and VAS score (6.3±2.6 vs.3.1±2.2,P＜0.05) changed significantly at the last follow-up compared with those pre-operation.There were no significant differences in the average ROM of implant segment (9.6°±4.2° vs.6.9°±5.3°,P＞0.05),the height ratio of implant segment and the superior vertebra(2.6±0.1 vs.2.5±0.1,P＞0.05) and the angle of functional spine unit(2.6°±5.2° vs.1.7°±2.9°,P＞0.05) at last follow-up compared with those preoperation.ConclusionUsing DCI to treat cervical disc herniation had shorter operation time and less bleeding advantages,and the early clinical effect was satisfactory.It may retain the cervical biomechanical movement in some degree,maintain the cervical stability.
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BACKGROUND: Bone joint immobilization is often used to prevent the injured tissue from secondary injury.OBJECTIVE: To investigate the effects of knee immobilization on biomechanical changes in rabbit patellar tendon and ultrastructure morphology. METHODS: Twenty adult rabbits were assigned into two groups. The left hindlimbs of rabbits in the immobilized group (n = 10) were immobilized by plaster of paris and two adjustable aluminium splints for 6 weeks, while those left hindlimbs in the control group (n = 10) served as controls. Rabbit knees were immobilized in extension and the ankle was immobilized at 90°flexion for 6 weeks. Then the patellar tendon-bone complex was harvested to observe the biomechanical properties and ultrastructure changes of patellar tendon. RESULTS AND CONCLUSION: After 6-week immobilization, the tensile strength and tangent modulus of patellar tendon-bone complex were decreased to 64.44% and 53.08% of the control values (P < 0.01). However, there was no significant difference in the elongation at failure and the maximum load between the immobilized and control groups. The curves of stress and strain of patellar tendon based on the average material constant were greatly different. The cross-sectional area of patellar tendon was significantly larger in the immobilized group than in the control group (P < 0.01). Smaller collagen fibrils took the predominance in the immobilized group. These results showed that immobilization of knee joint could result in biomechanical changes of patellar tendon and produce influence on patellar tendon.