Effectiveness and postoperative rehabilitation of one-stage combined anterior-posterior surgery for severe thoracolumbar fractures with spinal cord injury.

BACKGROUND: Thoracolumbar fractures are generally combined with spinal cord injury to varying degrees, which may cause deterioration of the patients' condition and increase the difficulty of clinical treatment. At present, anterior or combined anterior-posterior surgery is preferred for severe thoracolumbar fractures. AIM: To investigate the effectiveness and postoperative rehabilitation of one-stage combined anterior-posterior surgery for severe thoracolumbar fractures with spinal cord injury. METHODS: One-hundred-and-twenty patients who received surgery for severe thoracolumbar fractures with spinal cord injury at our hospital from February 2018 to February 2020 were randomly enrolled. They were randomly divided into group 1 (one-stage combined anterior-posterior surgery, n = 60) and group 2 (one-stage anterior-approach surgery, n = 60). Treatment efficacy was compared between the two groups. RESULTS: Blood loss was greater and the operation time was longer in group 1 than in group 2, and the differences were statistically significant (P < 0.05). Incision length, intraoperative X-rays, and length of hospital stay were not significantly different between the two groups (P > 0.05). Preoperative function of the affected vertebrae was not significantly different between the two groups (P > 0.05). In each group, the patients showed significant improvement after surgery. The anterior vertebral height ratio and the posterior vertebral height ratio in group 1 after surgery were significantly higher than those in group 2. The Cobb angle after surgery was significantly lower in group 1 than in group 2 (P < 0.05). The canal-occupying ratio of the affected vertebrae was not significantly different between the two groups (P > 0.05). Before surgery, there was no significant difference in the quality of life scores between the two groups (P > 0.05). The above indicators were significantly improved after surgery compared with before surgery in each group. In addition, these indicators were markedly better in group 1 than in group 2 after surgery (P < 0.05 for each). CONCLUSION: One-stage combined anterior-posterior surgery effectively improves the function of the affected vertebrae and the life quality of patients with severe thoracolumbar fractures and spinal cord injury. This surgical approach is worthy of popularization in clinical use.

Outcomes of cervical degenerative disc disease treated by anterior cervical discectomy and fusion with self-locking fusion cage.

BACKGROUND: Cervical degenerative disc (CDD) disease is a common type of spondylosis. Although anterior cervical discectomy and fusion (ACDF) is the preferred treatment for CDD disease, internal fixation with a titanium plate may cause various complications. The invention of the ACDF with a self-locking fusion cage (ROI-C) has effectively decreased the incidence of postoperative complications. AIM: To observe the outcomes of CDD disease treated by ACDF with a ROI-C. METHODS: Ninety patients with CDD disease treated at our hospital from March 2019 to March 2021 were included. They were divided into two groups (control group and observation group, n = 45 in each) using a random number table. Patients in the control group received ACDF plus internal fixation with a titanium plate. Those in the observation group received ACDF + ROI-C placement. The two groups of patients were compared in terms of surgical parameters, pain, cervical spine function, range of motion, and complications. RESULTS: The two groups of patients showed no significant differences in surgical time, blood loss, drainage volume, and length of hospital stay (P > 0.05). No significant differences in the visual analogue scale (VAS), Japanese Orthopedic Association (JOA), and neck disability index (NDI) scores were observed between the two groups before surgery (P > 0.05). The VAS and NDI scores in the observation group were considerably lower than those in the control group after surgery; however, the JOA scores in the observation group were significantly higher than those in the control group (P < 0.05). No significant differences were observed in cervical disc height and the range of motion of the superior or inferior adjacent vertebrae between the two groups before surgery (P > 0.05). The disc height in the observation group was larger than that in the control group after surgery. The range of motion of both the superior and inferior adjacent vertebrae was significantly smaller in the observation group than in the control group (P < 0.05). The incidence of complications was only 2.22% in the observation group compared to 15.56% in the control group, and the difference was statistically significant (P < 0.05). CONCLUSION: Cervical spine function restoration was better with ROI-C with internal fixation in ACDF than with conventional titanium plates in ACDF for CDD disease.

Long-Term Follow-Up of Multilevel Thoracic Ossification of the Posterior Longitudinal Ligament Following Circumferential Decompression via Posterior Approach: A Retrospective Study.

OBJECTIVE: To examine the postoperative progression of multilevel thoracic posterior longitudinal ligament (OPLL) at circumferential decompression (CD) levels and evaluate the long-term results after CD via the posterior approach. METHODS: Clinical data from 16 patients with thoracic myelopathy secondary to OPLL who underwent CD at a single center were evaluated retrospectively from 2007 to 2014 and were followed up for more than 60 months. Patients of all sexes and ages were included in the study. Thin-slice computed tomography scans obtained at the time of surgery and the most recent follow-up were analyzed. The ossified area was measured on the axial reconstructed scan of the most obvious protrusion of ossification at the CD level. The neurological outcomes were evaluated using modified Japanese Orthopaedic Association (JOA) scores and Hirabayashi recovery rates (HRRs). Continuous variables were presented as the mean ± standard deviation and were analyzed using the Student's t-test, while categorical variables were tested using Fisher's exact test. RESULTS: Among all patients, the most predominant type was the mixed type (9/16, 56.3%), while the circumscribed type was only found in two patients (12.5%), and the continuous type was found in five patients (31.2%). Six cases were associated with ossification of the ligamentum flavum, and two cases were combined with cervical OPLL. The OPLL area at the CD level increased in all patients. The mean follow-up period was 5.5 ± 0.92 years (range 5-8 years). The mean area of ossification increased from 35.63 ± 39.23 mm2 at the time of surgery to 99.94 ± 65.39 mm2 at the last follow-up visit (P < 0.01). There was no internal fixation disorder on any computed tomography scan after the operation. The average JOA score of all patients improved from 4.2 ± 2.2 points before surgery to 8.4 ± 2.6 points at the final follow-up (P < 0.01). The overall HRR was 61.8%. None of the patients exhibited any neurological deterioration due to OPLL progression. One patient developed a severe gait disturbance due to worsening lumbar canal stenosis, an unrelated cause, but the other 15 experienced gait disturbance improvements. CONCLUSIONS: According to the long-term follow-up results, although OPLL progression did not decrease or stop after removing the OPLL mass, CD is a safe and effective procedure that can provide adequate reserve ventral space to cope with postoperative OPLL progression.

Full-Endoscopic Foraminotomy with a Novel Large Endoscopic Trephine for Severe Degenerative Lumbar Foraminal Stenosis at L5 S1 Level: An Advanced Surgical Technique.

To (i) introduce the technical notes of a novel full-endoscopic foraminotomy with a large endoscopic trephine for the treatment of severe degenerative lumbar foraminal stenosis at L5 S1 level; (ii) assess the primary clinical outcomes of this technique; (iii) compare the effectiveness of this full-endoscopic foraminotomy technique and other previous techniques for lumbar foraminal stenosis. From January 2019 to August 2019, a retrospective study of L5 S1 severe degenerative lumbar foraminal stenosis was performed in our center. All patients who were diagnosed with severe foraminal stenosis at L5 S1 level and failed conservative treatment for at least 6 weeks were identified. Patients with segmental instability or other coexisting contraindications were excluded. A total of 21 patients were enrolled in the study. All patients were treated by full-endoscopic foraminotomy using large endoscopic trephine. The visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated preoperatively and at 1, 3, 6 months, and 1 year after the surgery, and the modified MacNab criteria were used to evaluate clinical outcomes at the last follow-up. There were 10 males and 11 females with a mean age of 66.38 ± 9.51 years. Five patients had a history of lumbar surgery. The mean operative time was 63.57 ± 25.74 min. The mean follow-up time was 13.29 ± 1.38 months. The mean postoperative hospital stay time was 1.29 ± 0.56 days. The mean preoperative VAS score significantly decreased from 7.38 ± 1.02 to 2.76 ± 1.09 (t = 19.759, P < 0.01), 2.25 ± 1.02 (t = 21.508, P < 0.01), 1.60 ± 1.05 (t = 31.812, P < 0.01), and 1.45 ± 1.10 (t = 25.156, P < 0.01) at 1 month, 3 months, 6 months, and 1 year after the operation. The mean preoperative ODI score significantly decreased from 64.66% ± 4.91% to 30.69% ± 4.59% (t = 33.724, P < 0.01), 29.44% ± 4.50% (t = 32.117, P < 0.01), 24.22% ± 4.14% (t = 33.951, P < 0.01), and 22.44% ± 4.94% (t = 30.241, P < 0.01) at 1 month, 3 months, 6 months, and 1 year after the operation. At the last follow-up, 19 patients (90.48%) got excellent or good outcomes. One patient suffered postoperative dysesthesia, and the symptoms were controlled by conversion treatment. One patient took revision surgery due to the incomplete decompression. There were no other major complications. Percutaneous endoscopic decompression is minimally invasive spine surgery. However, the application of endoscopic decompression for L5 S1 foraminal stenosis is relatively difficult due to the high iliac crest and narrow foramen. Full-endoscopic foraminotomy with the large endoscopic trephine is an effective and safe technique for the treatment of degenerative lumbar foraminal stenosis.

Efficacy and safety evaluation on 10 μg Hansenula recombinant hepatitis B vaccine booster for school-age children / 上海预防医学

Objective] To assess the safety and immunogenicity of booster vaccination 10 μg of recombinant Hansenula hepatitis B vaccine in school-age children , and to provide scientific basis for the development of hepatitis B immunization strategies . [ Methods] A total of 2 101 children were selected as the safety study object and were inoculated with three injections of 10 μg Hansenula hepatitis B vaccine for observation of the incidence of abnormal reaction .Among them 404 schoolchildren were observed for immune effects.And comparison was made in the difference of antibody titers and antibody positive rate before and after immunization . [ Results] Of the 2 101 children, 85 cases of adverse reactions occurred and the incidence rate was 4.05%.Of the 85 cases, 84 had slight reactions , one with moderate reactions and none with severe reactions .After vaccination , the positive rate of protective antibodies increased to 100.00%, and antibody titers rose from 2.55 IU/L to 5 051.90 IU/L, the difference being statistically significant (Z =12.51, P =0.00). [Conclusion] Hansenula hepatitis B vaccine used for booster immunization in schoolchildren is of good security and fine immune effect .

Spectroscopic parameter and molecular constant investigations on low-lying states of BeF radical.

The potential energy curves (PECs) of X(2)∑(+), A(2)Π(r) and B(2)∑(+) states of BeF radical have been investigated using the complete active space self-consistent-field (CASSCF) method, followed by the highly accurate valence internally contracted multireference configuration interaction (MRCI) approach at the correlation-consistent basis sets, cc-pV5Z for Be and aug-cc-pV6Z for F. Based on the PECs of X(2)∑(+), A(2)Π(r) and B(2)∑(+) states, the spectroscopic parameters (D(e), R(e), ω(e), ω(e)χ(e), α(e) and B(e)) have also been determined in the present work. With the PECs determined at the present level of theory, vibrational states have been predicted for each state when the rotational quantum number J equals zero (J = 0). The vibrational levels, inertial rotation and centrifugal distortion constants are determined for the three states, and the classical turning points are also calculated for the X(2)∑(+) state. Compared with the available experiments and other theories, it can be seen that the present spectroscopic parameter and molecular constant results are more fully in agreement with the experimental findings.