Short shaft ratio: A novel predictor for dural ossification in patients with ossification of the ligamentum flavum.

Background: Dural ossification (DO) is strongly correlated with an increased incidence of complications during the surgery for the patients with thoracic ossification of the ligamentum flavum (OLF). Some methods for predicting DO have emerged, but the accuracy remains to be improved. We aimed to find a more accurate way to predict the appearance of DO. Methods: Retrospective study was adopted in this study. According to the intraoperative findings, ninety-one patients with thoracic OLF were ultimately included and divided into two groups based on the presence or absence of DO. Patient characteristics and radiographic data were recorded. The residual area ratio (RAR, residual area/cross-section area of normal spinal canal × 100%) and the short shaft ratio (SSR, the length of short shaft of the ellipse-like shape/the length of the spinal canal × 100%) were measured and calculated by 2 independent observers, followed by statistical analysis. The receiver operating characteristic curve was used to evaluate the accuracy of the SSR and RAR in predicting DO. Results: No significant differences were found in sex, age and BMI between the DO group and the non-DO group. The mean RAR (and standard deviation) in the Non-DO group (62.6% ± 10.2%) was significantly higher (p < 0.001) than that in the DO group (46.1% ± 10.5%). The mean SSR (and standard deviation) in the Non-DO group (61.6% ± 6.0%) was significantly higher (p < 0.001) than that in the DO group (43.6% ± 9.2%). The receiver operating characteristic curve indicated that the SSR and RAR can be used as the efficient indicators to identify DO, and the SSR has a higher accuracy in indicating the presence of DO, with a cutoff value of ＜48.71% (sensitivity of 100% and specificity of 85.0%). Conclusion: The SSR can be used as a supplement parameter to traditional methods to predict DO, and it could be a better predictor. And, compared with bilateral and bridged type, unilateral type of OLF was more likely to develop DO with a larger SSR.

Effects of different exercise methods of calf muscles on the hemodynamics of lower extremity vein.

OBJECTIVE: To compare the effects of active and passive calf muscle contraction on the hemodynamics of the lower extremity vein. METHODS: 30 females were selected by convenient sampling. The hemodynamic indexes of the common femoral vein were measured by Duplex ultrasound during the active ankle pump exercise, active circular exercise, passive ankle pump exercise, passive circular exercise, and massage the calf muscles. RESULTS: There was no significant difference in the velocity of common femoral vein when the subjects do active ankle pump exercise, active circular exercise, and massage the calf muscles (p > .05), but the velocity of common femoral vein was faster than that of passive ankle pump exercise and passive circular exercise (p < .01). CONCLUSION: The effects of active ankle exercise and massage on promoting venous blood return of lower extremity are better than that of passive ankle exercise.

Epidemiological status and risk factors of deep vein thrombosis in patients with femoral neck fracture.

OBJECTIVES: The purpose of this study was to investigate the incidence of deep vein thrombosis (DVT) and clarify the risk factors of DVT in patients with femoral neck fracture. METHODS: A self-designed questionnaire was used to collect the clinical data of 1209 patients with femoral neck fracture in our hospital from January 2019 to December 2019. The content of the questionnaire mainly includes general information, past medical history, history of present illness, operation related information, occurrence of DVT. The collected data were entered into Excel to analyze the incidence and risk factors of DVT in patients with femoral neck fracture. Chi square test and binary logistic regression model was used to screen the risk factors of DVT. RESULTS: 1209 cases of femoral neck fracture were included in this study. The incidence of DVT was 28.0% (339 patients). Among them, 71.7% (243 patients) were preoperative DVT and 28.3% (96 patients) were postoperative DVT. For the risk-factor analysis, gender, age, time from injury to hospitalization, operative method, anesthesia method and intraoperative blood loss were independent risk factors for DVT. CONCLUSION: The incidence of DVT in patients with femoral neck fracture is relatively high, and there are many related risk factors.

Comparison of Anterior Cervical Discectomy and Fusion with Cervical Laminectomy and Fusion in the Treatment of 4-Level Cervical Spondylotic Myelopathy.

OBJECTIVE: To assess and compare the therapeutic effects of Anterior Cervical Discectomy and Fusion (ACDF) and Cervical Laminectomy and Fusion (CLF) in the treatment of 4-level cervical. METHODS: We performed a retrospective review on 39 patients with 4-level CSM who underwent ACDF or CLF in the Third Hospital of Hebei Medical University from January 2010 to December 2018. The patients were divided into ACDF group and CLF group according to the treatment. The operative index was evaluated based on intraoperative blood loss and operation time. The functional outcomes including Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS) of axial pain were compared. The Cobb angle, Cobb angle improvement rate, range of motion (ROM) and ROM loss ratio were measured for radiographic evaluation. RESULTS: No major complications or deaths occurred. The average age at baseline was 55 years. There was no significant difference between the ACDF and CLF group in follow-up time (26.29 months, 25.39 months, P > 0.05). The intraoperative blood loss was higher in the CLF group than in the ACDF group (692.67 ± 38.68 vs 392.14 ± 128.06, P < 0.05). The operation time was longer in the CLF group than in the ACDF group (206.60 ± 49.37 vs 172.64 ± 31.96, P < 0.05). Significant improvements in the VAS and JOA scores were observed in both groups (P < 0.05). No significant difference in VAS was found between the ACDF and CLF groups (P < 0.05). There was a significantly larger improvement rate of JOA score in the ACDF group than in the CLF group (60.9% ± 9.57% vs 31.5% ± 15.70%, P < 0.05). There were two (9.6%) cases with complications In the ACDF group, including one (4.8%) case of dysphagia and one (4.8%) case of pharyngodynia. In the CLF group, two patients (11.1%) developed C5 palsy. No significant difference in the incidence of complications, ROM loss ratio and Cobb angle improvement rate was found between group ACDF and group CLF (all P < 0.05). CONCLUSION: Both ACDF and CLF were effective in the treatment of multi-level cervical spondylosis and ACDF is more suitable for patients with 4-level CSM.

Challenges in Subtrochanteric Femur Fracture Management.

Subtrochanteric femur fractures present significant treatment challenges. The deforming muscle forces make fracture reduction difficult. Treatment options include cephalomedullary nailing and various types of plate fixation. There is a high rate of treatment complications, including malunion, delayed union, nonunion, and implant failure.