Correlation between cognitive impairment and cortical atrophy in elderly patients with asymptomatic carotid artery stenosis / 中华健康管理学杂志

Objective:To analyze the correlation between cognitive impairment and cortical atrophy in elderly patients with asymptomatic carotid artery stenosis (ACAS).Methods:In this cross-sectional study, 40 consecutive elderly patients with ACAS treated in the Department of Neurology, Northern Jiangsu People′s Hospital from July 1, 2020 to June 30, 2021 (ACAS group), and 40 elderly healthy controls who accepted physical examination during the same period (control group) were included. Cognitive assessment was performed using the Mental State Examination Scale (MMSE) and the Montreal Cognitive Assessment Scale (MoCA), and brain magnetic resonance imaging scanning was performed in the ACAS group. The artificial intelligence technique was applied for brain lobe segmentation and cortical volume calculation. The χ2-test, independent sample t-test and Wilcoxon non-parametric test were used to analyze the difference of clinical data and cognitive scores between the two groups. In the ACAS group, the cortical volumes of the side with carotid stenosis was compared with that of the normal side, and Spearman′s correlation analysis was used to assess the correlation between cognitive scores and cortical atrophy. Results:Compared with the control group, the ACAS group got significantly lower scores of MMSE and MoCA, as well as lower scores of visuospatial executive function, attention and calculation, language function, abstraction ability and delayed recall [(25.60±2.49) vs (27.18±1.01), (22.05±3.59) vs (25.60±1.43), (2.73±1.04) vs (4.08±0.62), (4.53±0.93) vs (5.03±0.66), 2.00 (0.00) vs 3.00 (0.00), 1.00 (1.00) vs 2.00 (0.00), and (2.95±0.96) vs (3.35±0.62)] (all P<0.05). There was not significant differences in naming and orientation ability between the two groups (both P>0.05). The volume of cortical, temporal lobe, frontal lobe, parietal lobe and insular lobe on the side with carotid stenosis in the ACAS group were significantly smaller than those on the normal side [186.23 (177.97, 202.53) vs 194.67 (185.65, 204.82) cm 3, 54.74 (50.66, 56.95) vs 55.61 (51.24, 58.49) cm 3, 72.98 (70.76, 78.34) vs 75.27 (72.34, 80.66) cm 3, 53.66 (51.11, 57.86) vs 56.59 (52.80, 60.09) cm 3, 6.57 (6.35, 7.07) vs 6.72 (6.46, 7.34) cm 3] (all P<0.05). The MoCA score in the ACAS group was positively related to the cortical volume ratio of the two sides ( r=0.427, P<0.01). The attention ( r=0.353) and abstraction ( r=0.226) ability scores were positively correlated with the temporal lobe volume ratios of the two sides (both P<0.05). The visuospatial executive ( r=0.187) and language ( r=0.373) ability scores were positively correlated with frontal lobe volume ratios of the two sides (both P<0.05), and visuospatial executive ( r=0.386), naming ( r=0.344), language ( r=0.517), abstraction ( r=0.335) and delayed recall ( r=0.333) ability scores were positively correlated with parietal lobe volume ratios of the two sides (all P<0.05). Conclusion:In elderly patients with ACAS, the cognitive impairment and cortical atrophy on the sides with carotid stenosis are significant and a positive correlation is detected between them.

Tryptophan metabolism involved by gut microbiota and ischemic stroke / 国际脑血管病杂志

Tryptophan is one of the essential amino acids of human body. Its metabolites 5-hydroxytryptamine, kynurenine, tryptamine, and indole derivatives have the functions of immune regulation, nerve regulation, anti-inflammatory, anti-oxidation, anti-cancer, and metabolic regulation. In recent years, it has been found that dysregulation of tryptophan metabolism is closely associated with the onset and prognosis of ischemic stroke, and intestinal flora plays an important role in the regulation of tryptophan metabolism. This article reviews the research progress on the role and mechanism of tryptophan metabolism involved by intestinal flora in ischemic brain injury, and provides a new perspective for future basic and clinical research.

The application of grid locator in lumbar vertebroplasty / 中华骨科杂志

Objective:To compare the optimal gridpercutaneous vertebroplasty (PVP) and conventional PVP in the treatment of osteoporotic vertebral compression fractures (OVCFs).Methods:A retrospective cohort study was conducted of 102 patients with OVCFs who had underwent PVP between May 2016 and May 2019 at department of spine surgery, General Hospital of Northern Theater Command. According to the different surgical methods, they were divided into the optimalgrid PVP group (102 cases) and conventional PVP group (94 cases). In the optimal grid PVP group, there were 38 males and 64 females with an average age of 67.3±8.5 years old, and the course of disease was 2.3±1.2 days; the injured sites were lumbar vertebra, including 59 cases of L 1 vertebra, 31 cases of L 2 vertebra, 8 cases of L 3 vertebra, 3 cases of L 4 vertebra and 1 case of L 5 vertebra. In the conventional PVP group, there were 26 males and 68 females with an average age of 71.5±5.6 years old, and the course of disease was 2.1±1.1 days; the injured sites were lumbar vertebra, including 52 cases of L 1 vertebra, 33 cases of L 2 vertebra, 7 cases of L 3 vertebra and 2 cases of L 4 vertebra. The patients were prepared before operation. Then the best puncture point was selected, and the guide wire and working channel were inserted. Finally the bone cement was pushed. The operation time, intraoperative fluoroscopy times, bone cement dosage and bone cement leakage were compared between the two groups. Visual analogue scale (VAS), anterior heights and median heights of injured vertebra were compared between the two groups at postoperative 3 days, 3 months and the final follow-up. Results:There were no significant differences in the general clinical data between the two groups before operation ( P>0.05). All patients had no complications such as wound infection,pulmonary embolism,spinal cord embolism or death. The operation time, fluoroscopy times, bone cement dosage and bone cement permeability of the two groups were statistically significant different ( P<0.05), and the optimal grid group was better than the conventional group. VAS at 3 days, 3 months and the final follow-up was statistically significantlower in the optimal grid group than the conventional group ( P<0.05). There was no significant difference in the recovery of the anterior and middle edge heights of injured vertebra in the two groups 3 days after operation ( P>0.05), but there were statistical significant difference between the two groups3 months after operation and at the last follow-up ( P<0.05), whilethe optimal grid group was better than the conventional group. Conclusion:Compared with conventional PVP, the optimal grid PVP is safer and more effective in the treatment of osteoporotic vertebral compression fractures.

Roles of gap junction proteins and pannexins in cerebral ischemia / 国际脑血管病杂志

There are a wide range of gap junction proteins and pannexins between brain cells. The neurovascular unit, which are composed of neurons, glial cells and vascular cells, integrate and process information through cell membrane channels composed of gap junction proteins and pannexins, so as to maintain the dynamic balance of the nervous system. After cerebral ischemia, cell membrane channels play an important role in ischemic brain injury by participating in excitatory toxicity, inflammatory response, blood-brain barrier injury and other pathological mechanisms. Therefore, maintaining the normal function of gap junction proteins and pannnexins is essential to protect neurons from ischemic brain injury.

CT and MR features of hepatic ischemia/necrosis after hepatosplenic surgery and upper gastrointestinal hemorrhage / 中华肝胆外科杂志

Objective@#To investigate the CT and MR imaging features of hepatic ischemia/necrosis after hepatosplenic surgery and upper gastrointestinal hemorrhage.@*Methods@#A total of 36 patients diagnosed with hepatic ischemia/necrosis by both medical imaging and clinical diagnosis shortly after hepatosplenic surgery and upper gastrointestinal hemorrhage were collected, including 9 patients with liver cancer resection, 5 patients with liver cancer ablation (microwave ablation/radiofrequency ablation, argon-helium knife, alcohol injection), 11 patients with spleen resection, and 11 patients with upper gastrointestinal bleeding. Conventional liver CT and / or MR plain and dynamic enhancement scan were performed to comprehensively analyze the morphology and density/signal performance of the lesions.@*Results@#(1) Number of lesions: All cases had multiple lesions. (2) Distribution of lesions: scattered in the liver lobes, clustered or regional distribution, mainly in the periphery of the liver. (3) Size of lesions: the boundary of the nodular lesion was clear, and the single maximum diameter was 1.0-1.5 cm. It can be fused into a wedge-shaped patch or a segmental/sub-segmental large patch with a slight mass effect. (4) CT density or MR signal characteristics: CT plain scan showed slightly low density; MR plain scan showed slightly low signal on T1WI, high signal on T2WI, slightly high signal on DWI and no lipid/fat on dual phase imaging; 24 out of 36 cases (66.7%) showed no enhancement, while some lesions showed thin ring enhancement on the edge; emboli were found in the main and/or branches of portal vein (21/36 cases, 58.3%). (5) In the short-term review (minimum 5 days), the lesions became smaller or disappeared, and the local liver volume became smaller or the surface was depressed.@*Conclusions@#Hepatic ischemia/necrosis occurs after hepatosplenic surgery and upper gastrointestinal hemorrhage. The imaging manifestations are multiple nodular or flaky hypovascular foci, and the short-term review shows a markedly improvement. It needs to be differentiated from infection and metastasis of malignant tumors after operation.

Value of diffusion?weighted imaging in the evaluation of therapeutic effect of cyber knife on hepatocellular carcinoma / 中华放射学杂志

Objective To investigate the value of DWI in the evaluation of the therapeutic effect of cyber knife in the treatment of hepatocellular carcinoma.Methods Ninety patients who were clinically diagnosed with hepatocellular carcinoma (95 lesions) in the 5th Medical Center of General Hospital of PLA from February 2011 to December 2013 were retrospectively analyzed. All 90 patients underwent pre‐treatment dynamic contrast‐enhanced MRI scans of liver. Fourty six of them underwent liver MRI scan 3 months after treatment with cyber knife, and 49 patients underwent liver MRI scans 6 months after treatment. According to the evaluation criteria of solid tumor effect, complete necrosis tumor lesions and postoperative residual active lesions were determined. The ADC values of residual active tissue lesion, necrosis lesion in tumor and normal liver were measured. Paired sample t test was used to compare the difference of ADC values of tumor necrosis lesions and normal liver tissues between 3 and 6 months after treatment and before treatment, and ROC was used to evaluate the efficacy of ADC values in predicting complete tissue necrosis after treatment. Results In the 95 lesions, 91 lesions were completely necrotic, and active tissues were found in 4 lesions after treatment. There were statistically significant differences in the ADC values of the lesions at 3 and 6 months after treatment and before treatment (P<0.05),and the ADC values of the tissues after treatment were higher than those before treatment. There was no statistically significant difference in ADC values between 3 and 6 months after treatment and before treatment in normal liver tissue (P>0.05). The area under the ROC of using ADC value to predict the complete necrosis after treatment with cyber knife was 0.767, and the ADC value was 1.23×10‐3 mm2/s as the diagnostic cutoff value. The sensitivity and specificity of the diagnosis were 76.5% and 70.6%, respectively. Conclusion ADC values can distinguish the necrotic component from the active component of hepatocellular carcinoma after treatment, and can be used to evaluate the therapeutic effect of cyber knife in hepatocellular carcinoma.

Quantitative assessment of blood-brain barrier permeability and its application in patients with acute ischemic stroke / 国际脑血管病杂志

The occurrence,development and reperfusion treatment of ischemic stroke may damage the structure and function of the blood-brain barrier,leading to increased permeability of the blood-brain barrier,and then having cerebral edema or hemorrhagic transformation,and finally resulting in poor outcome.Quantitative assessment of blood-brain barrier permeability is now available.This article reviews the assessment methods of blood-brain barrier permeability and their application in patients with ischemic stroke.

CT and MR features of hepatic ischemia/necrosis after hepatosplenic surgery and upper gastrointestinal hemorrhage / 中华肝胆外科杂志

Objective To investigate the CT and MR imaging features of hepatic ischemia/necrosis after hepatosplenic surgery and upper gastrointestinal hemorrhage.Methods A total of 36 patients diag-nosed with hepatic ischemia/necrosis by both medical imaging and clinical diagnosis shortly after hepato-splenic surgery and upper gastrointestinal hemorrhage were collected,including 9 patients with liver cancer resection,5 patients with liver cancer ablation(microwave ablation/radiofrequency ablation,argon-helium knife,alcohol injection),1 1 patients with spleen resection,and 11 patients with upper gastrointestinal bleeding.Conventional liver CT and/or MR plain and dynamic enhancement scan were performed to com-prehensively analyze the morphology and density/signal performance of the lesions.Results(1)Number of lesions:AU cases had multiple lesions.(2)Distribution of lesions:scattered in the liver lobes,clustered or regional distribution,mainly in the periphery of the liver.(3)Size of lesions:the boundary of the nodu-lar lesion was clear.and the single maximum diameter Was 1.0-1.5 ca.It can be fused into a wedge-shaped patch or a segmental/sub-segmental large patch with a slight mass effect.(4)CT density or MR sig-nal characteristics:CT plain scan showed slightly low density;MR plain scan showed slightly low signal on T1 WI,high signal on T2WI,slightly high signal on DWI and no lipid/fat on dual phase imaging;24 out of 36 cases(66.7％)showed no enhancement,while some lesions showed thin ring enhancement on the edge;emboli were found in the main and/or branches of portal vein(21/36 cases,58.3％).(5)In the short-term review(minimum 5 days),the lesions became smaller or disappeared,and the local liver volume be-came smaller or the surface was depressed.Conclusions Hepatic ischemia/necrosis OCCURS after hepato-splenic surgery and upper gastrointestinal hemorrhage.The imaging manifestations are multiple nodular or flaky hypovascular foci,and the short-term review shows a markedly improvement.It needs to be differentia-ted from infection and metastasis of malignant tumors after operation.

Roles of Toll-like receptor 4 in cerebral ischemia / 国际脑血管病杂志

In recent years,studies have shown that inflammation is an important factor in secondaryischemic injury.The exploration of the related mechanisms of the occurrence of inflammation has become ahot spot in the field of cerebral ischemia.Toll-like receptor 4 (TLR4) signaling pathway is one of theclassical inflammatory pathways.Studies have shown that TLR4 is involved in the early inflammatoryresponse after cerebral ischemic injury and the late nerve repair.This article reviews the research progress ofthis signaling pathway in cerebral ischemia injury,so as to seek a therapeutic target against inflammatoryinjury caused by cerebral ischemia through the analysis of its potential research direction.

Analysis on adverse event in acupotomy therapy based on literature research / 中国针灸

OBJECTIVE@#To explore the current domestic situation of the adverse event in acupotomy so as to promote the standardization of acupotomy and improve the clinical effect and safety of acupotomy therapy.@*METHODS@#The method of retrospective journal researching was used. The case report about the adverse event in acupotomy from CNKI, WANFANG and VIP databases was retrieved and the types, the features, the causes, the numbers of the papers and the cases were analyzed.@*RESULTS@#Fifty-eight papers were included, with total 343 cases. It was indicated that the adverse events in acupotomy were mainly postoperative local pain, hematoma, swelling, nerve damage, tendon rupture, adhesion, injury, infection, syncope, anesthesia accident, undeserved hormone use, etc. The lower level of standardization of acupotomy in the clinical use may lead to adverse events.@*CONCLUSION@#Safe acupotomy treatment for some complicated diseases and dangerous parts remains to be improved, and the standardization of the acupotomy is an important approach to improve its safety. The related work needs to be carried out.

Percutaneous S2-alar-iliac screw fixation for lower lumbar spondylodiscitis with no neurological symptoms in elderly patients: analysis of short-term curative effect / 介入放射学杂志

Objective To evaluate the short-term efficacy of percutaneous S2-alar-iliac screw (S2AIS) fixation for the treatment of lower lumbar spondylodiscitis with no neurological symptoms in elderly patients.Methods The clinical data of 28 patients of lower lumbar spondylodiscitis with no neurological symptoms,who were admitted to the Ward of Spine,Department of Orthopaedics,General Hospital of Shenyang Military Region,China,to receive percutaneous S2AIS fixation,were retrospectively analyzed.The operation was performed by the same surgeon for all patients.A total of 56 S2AIS fixation procedures were accomplished.The patients' age varied from 71 to 79 years old.The spondylodiscitis was located at IAL5 or L5-S1.After the treatment,the patients were followed up for a mean of 6.67 months.The mean operative time,the amount of intraoperative blood loss,the postoperative bed time,the average hospitalization days and the postoperative wound healing were documented and analyzed.The Oswestry score,visual analogue score,erythrocyte sedimentation rate,C reactive protein level were determined before operation as well as at one week and 6 months after operation,and postoperative CT was performed to check the loosening of internal screw fixation.The results were compared and analyzed.Results The mean operative time was (158.12±4.32) min,the average amount of intraoperative blood loss was (25.34±3.23) ml,the average postoperative bed time was (1.34±0.35) d,and the average hospitalization time was (7.29±1.34) d.Poor surgical incision healing was seen in only one patient,and the postoperative wound healing rate was up to 96.42％.Loosening of right S2AIS was detected in one patient,with the screw loosening rate being 1.79％.The Oswestry scores determined at one week and 6 months after treatment were 32.21 and 23.20 respectively,which were significantly different from the preoperative score (P＜0.05).The visual analogue scores determined at one week and 6 months after treatment were 2.17 and 1.25 respectively,which were significantly different from the preoperative score (P＜0.05).At one week and 6 months after treatment,the erythrocyte sedimentation rates were 15.32 mm/h and 14.56 mm/h respectively,and the C reactive protein levels were 7.89 mg/L and 8.90 mg/L respectively,both of which were significantly different from the preoperative ones (both P＜0.05).Conclusion For the treatment of lower lumbar spondylodiscitis with no neurological symptoms in elderly patients,percutaneous S2AIS fixation has certain advantages,such as less trauma,less blood loss,early postoperative ambulation,remarkable improvement of clinical symptoms,etc.with satisfactory short-term clinical efficacy.

Risk factors for progressive cardiogenic stroke / 中华老年心脑血管病杂志

Objective To study the risk factors for progressive cardiogenic stroke (CS).Methods Seventy-one acute ischemic stroke patients admitted to our hospital from 2008-08-01 to 2014-12-31 were divided into progressive CS group (n=14) and non-progressive CS group (n=57).The NIHSS was used to assess the neurologic deficit when the patients were admitted and 30 days after the stroke onset.Their clinical data were retrospectively analyzed.The risk factors for progressive CS were analyzed by univariate logistic regression analysis and multivariate logistic regression analysis respectively,their critical thresholds were analyzed according to the ROC curve.Results The NIHSS improvent of the progressive CS group was significantly less than that of the non-progressive CS group (P＜0.01).The age was significantly older,the incidence of right-side infarction and the serum level of D-dimer were significantly higher while the serum level of glutamic pyruvic transaminase was significantly lower in progressive CS group than in non-progressive CS group (77.29±8.87 years vs 71.44±9.51 years,P=0.041;71.4％ vs 33.3％,P=0.009;2.82 mg/L vs 0.91 mg/L,P=0.048;13.79±4.44 U/L vs 21.98±17.34 U/L,P=0.002).Lo gistic regression analysis showed a significant difference in age,right-side infarction and serum D-dimer level between the two groups (P=0.030,P=0.007,P=0.025).The area under the ROC curve revealed that age ＞ 70.75 years and serum D-dimer level ＞1.23 mg/L were the risk factors for progressive CS.Conclusion Age,right-side infarction and serum D-dimer level are the risk factors for progressive CS and can thus be used as predictors of progressive CS.

Unilateral short-segment pedicle screw fixation for treatment of thoracolumbar fractures / 局解手术学杂志

Objective To assess the operation results of unilateral and bilateral short-segment pedicle screw fixation combined with in-termediate screws in thoracolumbar fractures .Methods A total of 73 patients with thoracolumbar fracture were included in our study .Among the 73 patients, 48 cases were treated by bilateral short-segment pedicle screw fixation and the other 25 cases were treated by unilateral short-segment pedicle screw fixation,with a mean follow-up of 24.6 months.Surgical time,surgical blood loss,surgical draining loss,hospital stays, hospitalization cost,Cobb’s angle,kyphosis of the vertebral body ,anterior height of the fracture vertebral body ,VAS and ODI scores between the two groups were compared .Results There were significant differences in the surgical time and hospitalization cost between two groups (P0.05).Conclusion Unilateral short-segment pedicle screw fixation combined with intermediate screws can significantly correct the kyphosis and achieve the clinical effect of bilateral short -segment pedicle screw fixation technique .Meanwhile , the unilateral short-segment pedicle screw fixation technique can significantly reduce the surgical time and hospitalization cost ,which is an ef-fective method for thoracolumbar fracture .

Study on Preparation Technology and in vitro Drug Release Behavior of Baicalin Monolithic Osmotic Pump Tablets / 中国药房

OBJECTIVE:To prepare Baicalin monolithic osmotic pump tablets and investigate its in vitro drug release behavior. METHODS:Using accumulative release rate as evaluation index,baicalin solid dispersion was prepared to improve solubility,sin-gle factor test and orthogonal test were used to optimize preparation technology(the amount of penetrating agent and pore-forming agent,weight gaining of coating film) of monolithic osmotic pump tablets using baicalin solid dispersion as intermediate. Release rate and mechanism of samples prepared by optimized technology were investigated in 3 kinds of release medium (water,0.1 mol/L HCl,simulated gastric fluid). RESULTS:The optimal preparation technology was that penetrating agent sodium chloride was 30 mg;pore-forming agent polyethylene glycol 400 was 20% amount of excipient cellulose acetate;weight gaining of coating film was 2%. RSD of 12 h accumulative release rate was 1.06%(n=3)for 3 batches of Baicalin monolithic osmotic pump tablets pre-pared by optimized technology. 12 h accumulative release rate of them in 3 kinds of medium were similar to each other,being all more than 80%. Release equation was in line with zero-order drug release model (r=0.9985). CONCLUSIONS:Prepared Ba-icalin monolithic osmotic pump tablets after optimization can release drug at controlled rate.

A novel guide wire used in percutaneous pedicle screw insertion : evaluation of its efficacy and safety / 介入放射学杂志

Objective To compare the biomechanical characteristics of a novel guide wire with that of the conventional guide wire by using cadaver specimen test,and to evaluate the safety and effectiveness of this new guide wire through clinical experiment.Methods By using cadaver specimen test,the average push-out force on the guide wire and the extra-force required to penetrate the anterior wall of the vertebral bodies,from L1 to L5,were determined,and the results were compared between the novel guide wire and the conventional guide wire.Results The definition of push-out force was a force that caused the tip of the guide wire to bend or disperse within the vertebral body and then the further moving of the wire to the front of the vertebral body was impeded.The average push-out forces for the novel guide wire and the conventional guide wire were (15.5±1.9) and (5.7±0.8) newton respectively (P＜0.001).The mean force required to penetrate the anterior wall of the vertebral body for the novel guide wire and the conventional guide wire were (69.1±4.2) and (37.1±4.8) newton respectively (P＜0.000 5).A total of 222 novel guide wires were used in clinical trial,and no penetration of vertebral anterior wall by the guide wire occurred.Conclusion The average push-out force within the vertebral body and the mean force required to penetrate the anterior wall of the vertebral body for the novel guide wire are about 2 times and 3 times greater than those for the conventional guide wire respectively.The use of this novel guide wire can effectively prevent the wire from moving forward in the vertebral body as well as from penetrating the vertebral anterior wall.Therefore,the use of this novel guide wire can reliably improve the safety for patients with osteoporosis receiving percutaneous pedicle screw insertion procedure.

The application of field comprehensive operation rescue shelter in performing emergency percutaneous kyphoplasy at the disaster site / 介入放射学杂志

Objective To analyze the short-term clinical efficacy of percutaneous kyphoplasy in treating aged patients with osteoporotic vertebral compression fractures in a field comprehensive operation rescue shelter at the disaster site.Methods The clinical data of 43 aged patients with osteoporotic vertebral compression fractures (51 diseased vertebrae in total),who received treatment during the period from April 2013 to August 2016 in a field comprehensive operation rescue shelter at the disaster site,were retrospectively analyzed.After injury,the patients were immediately sent to the field comprehensive operation rescue shelter,which was developed by authors' institute,to receive percutaneous kyphoplasy.The average operation time,preoperative and postoperative pain visual analogue scale (VAS) scores,the manifestations of Cobb'angle of the corresponding segment that was determined on lateral radiography,and the changes in anterior,middle and posterior height of the vertebrae were documented.Results The average operation time was (52.34±14.76) min.The postoperative VAS scores were significantly decreased when compared to the preoperative ones (P＜0.01).After percutaneous kyphoplasy,the Cobb'angle of the coresponding segment of injured vertebrae was obviously improved (P＜0.01),moreover,the anterior,middle and posterior height of the injured vertebrae was remarkably restored (P＜0.01).Conclusion In treating osteoporotic vertebral compression fractures in aged patients,percutaneous kyphoplasy,that is used as an emergency treatment and is carried out in a field comprehensive operation rescue shelter,is quite effective.This treatment can reliably relieve the severe pain caused by compression fracture and improve the prognosis as well.

Comparison of clinical complications of iliac screw fixation versus S2 alar-iliac screw / 局解手术学杂志

Objective To compare the clinical complications between S2 alar-iliac(S2AI) screw and iliac screw(IS) fixation technique.Methods The data of 65 patients who were diagnosed as degenerative scoliosis and underwent spinopelvic fixation in our hospital from August 2010 to July 2012 were retrospectively reviewed.These patients were divided into the iliac screw fixation group (IS group) with 43 patients and the S2 alar iliac fixation group (S2AI group) with 22 patients according to different methods.The complications included screw loosening,screw breakage,acute infections,delayed wound infection and persistent pain over the gluteal region occurring longer than 3 months postoperatively were recorded.Results There were 8cases with screw loosening and 13 cases with gluteal pain in IS group,while there were no screw loosening and only 2 cases with gluteal pain in S2AI group.The average onset of gluteal pain were 11.8 months postoperatively in the IS group and 18 months postoperatively in the S2AI group.It showed that the absolute risk reduction(ARR) of screw loosening and late pain in the S2AI group was 18.6%,which was lower than 21.1% in the IS group. In the IS group, there were a total of 5 cases of delayed wound infection. Finally,3 caes of them were cured by irrigation and debridement only.and the other 2 cases were cured by irrigation and debridement with implant removal.There were no cases of delayed wound infection in the S2AI group.Conclusion The S2AI technique is associated with significantly less clinical and radiographic complications when compared with the iliac screws technique,it is a kind of internal fixation of spine and pelvis,which is worthy of being popularized by spine surgeons.

Application of Sextant system fixation for patients with thoracolumbar fractures in field comprehensive operation rescue shelter / 局解手术学杂志

Objective To discuss the short-term effect of Sextant system fixation for thoracolumbar fractures without neurological deficit in the field comprehensive operation rescue shelter.Methods There were 32 patients with thoracolumbar fractures without neurological deficit which rescued by our hospital.Those patients included 18 males and 14 females, with average age of (25.54±2.86) years old.All patients were undergoing internal fixation with Sextant system in the field comprehensive operation rescue shelter.Clinical and surgical evaluation including surgery time,intraoperative blood loss,postoperative ambulation time and wound healing time were observed.Functional outcomes of pre-operation and postoperation 3-days were evaluated by visual analog scale(VAS) and Oswestry disability index(ODI).Cobb angle and front height of fracture vertebral body were compared between pre-operation and postoperation 3-days.Results The operation time was (96.55±14.15)minutes, intraoperative blood loss was (45.25±3.55)mL, postoperative ambulation time was (1.20±0.61)days.There were statistical differences in terms of Cobb angle,front height of fracture vertebral body,VAS and ODI between pre-operation and postoperation 3 days.Conclusion The Sextant system fixation in the field comprehensive operation rescue shelter is a timely,safe and effective method for thoracolumbar fractures without neurological deficit,which is deserved to utilize at the scene when war or disaster urgency treatment.

Effect of preventing infection for a continuous pulsing water ball in lumbar surgery / 局解手术学杂志

Objective To study the effect of the continuous pulsing water ball in preventing infection in the multi-level posterior lumbar interbody fusion(PLIF).Methods From June 2016 to December 2016,thirty patients who were treated with multi-level posterior lumbar interbody fusion in our hospital were randomly divided into two groups.The 15 patients in the observation group were given continuous pulsing water ball,and the other 15 patients in the control group were given conventional dumping.The items including the time of intraoperative washing,the C-reactive protein(CRP),the time of suture clearing,postoperative fever cases and postoperative incision healing were oberved and compared between the two groups.Results The time of intraoperative washing was (2.13±0.15)min in the observation group and (5.59±1.24)min in the conrtrol group,and the difference was statistically significant (P<0.05).The postoperative CRP of 1st,3rd, and 5th day in the observation group was declining,whileas the control group was increasing.The time of suture clearing in the oberation group was 11.57 d, which was significantly less than 14.29 d the control group.The temperature of 3rd and 5th day after opreation in the obervation group was (37.1±2.26)℃ and (37.0±0.12)℃ respectively, which were significantly lower than (38.2±3.34)℃ and (37.5±0.25)℃ respectively the control group,and the difference was statistically significant(P<0.05).Conclusion Compared to the the conventional dumping,the continuous pulsing water ball has the some advantages in the multi-level posterior lumbar interbody fusion (PLIF),such as decreasing the washing time and reducing the local inflammatory reponse.

Application of preoperatively vertebral artery CTA in screw setting of upper cervical spine / 局解手术学杂志

Objective To study the application of cervical vertebral artery CT angiography(CTA) preoperatively in the screw setting of upper cervical spine.Methods The data of 170 patients who underwent upper cervical spine surgery from January 2014 to December 2015 in our hospital were retrospectively analyzed,of whom 80 cases with typeⅡodontoid fractures,90 cases with atlantoaxial dislocation;20 cases were operated with occipitocervical fusion,150 cases treated with atlantoaxial fusion.Seventy-eight cases were examinated by cervical vertebral artery CTA before sugery(observation group) but the other 92 cases(control group).The rate of the vertebral arterial lesion between the two groups were compared.Results Six cases with vertebral artery injury in control group,the incidence of arterial injury was 7％;unilateral vertebral artery was found in 3 cases,small congenital development of left cervical vertebral artery in 5 case,abnormal branch in 5 cases.The rate of dysplasia was 17％,and the rate of vertebral artery injury was 0.The rate of vertebral artery injury in control group was higher than observation group,the difference was significant(P<0.05).Conclusion Vertebral artery CTA examination preoperatively may become a routine examination,in order to make the operator carefully evaluate the relationship between the vertebral artery with atlantoaxial vertebral,choose the accurate screw-setting and avoid the vertebral artery injury in the upper cervical spine surgery.