Influential factors of the prognosis of patients with winter sports-induced traumatic cervical spinal cord injury complicated with intramedullary hemorrhage and edema after emergency surgical treatment.

Objective: To explore relevant influencing factors of the prognosis of patients with winter sports-induced traumatic cervical spinal cord injury complicated with intramedullary hemorrhage and edema after emergency surgical treatment. Methods: A retrospective analysis was performed on 73 cases of traumatic cervical spinal cord injury complicated with intramedullary hemorrhage and edema in The First Hospital Affiliated to Hebei North University from January 2020 to October 2022. The enrolled patients were divided into the good prognosis (n=17) group and poor prognosis (n=56) group according to the recovery of neurological function after six months of follow-up. The risk factors affecting the prognosis of patients with traumatic cervical spinal cord injury complicated with intramedullary hemorrhage and edema after emergency surgery were analyzed by binary Logistic regression. Results: Among the enrolled 73 patients with traumatic cervical spinal cord injury complicated with intramedullary hemorrhage and edema, 56 cases showed significant improvement in ASIA Grade-6 months after operation, with an improvement rate of 76.71%. Further Logistic regression analysis revealed that concomitant diabetes, preoperative MSCC>40.83% and recovery rate of AMS <40.13% 3d after operation were independent risk factors affecting the poor prognosis of patients with traumatic cervical spinal cord injury complicated with intramedullary hemorrhage and edema. Conclusions: Emergency surgery can improve the neurological function of patients with cervical spinal cord injury complicated with intramedullary hemorrhage and edema caused by winter sports. Concomitant diabetes, preoperative MSCC and recovery rate of AMS 3d after operation are the main factors affecting the prognosis of patients with emergency surgery.

Musculoskeletal Ultrasound Image-Based Radiomics for the Diagnosis of Achilles Tendinopathy in Skiers.

OBJECTIVES: Our study aimed to develop and validate an efficient ultrasound image-based radiomic model for determining the Achilles tendinopathy in skiers. METHODS: A total of 88 feet of skiers clinically diagnosed with unilateral chronic Achilles tendinopathy and 51 healthy feet were included in our study. According to the time order of enrollment, the data were divided into a training set (n = 89) and a test set (n = 50). The regions of interest (ROIs) were segmented manually, and 833 radiomic features were extracted from red, green, blue color channels and grayscale of ROIs using Pyradiomics, respectively. Three feature selection and three machine learning modeling algorithms were implemented respectively, for determining the optimal radiomics pipeline. Finally, the area under the receiver operating characteristic curve (AUC), consistency analysis, and decision analysis were used to evaluate the diagnostic performance. RESULTS: By comparing nine radiomics analysis strategies of three color channels and grayscale, the radiomic model under the green channel obtained the best diagnostic performance, using the Random Forest selection and Support Vector Machine modeling, which was selected as the final machine learning model. All the selected radiomic features were significantly associated with the Achilles tendinopathy (P < .05). The radiomic model had a training AUC of 0.98, a test AUC of 0.99, a sensitivity of 0.90, and a specificity of 1, which could bring sufficient clinical net benefits. CONCLUSIONS: Ultrasound image-based radiomics achieved high diagnostic performance, which could be used as an intelligent auxiliary tool for the diagnosis of Achilles tendinopathy.

The Efficacy of Anterior Cervical Corpectomy and Fusion and Posterior Total Laminectomy on Cervical Spinal Cord Injury and Quality of Life.

This study is aimed at investigating the efficacy of anterior cervical corpectomy and fusion and posterior total laminectomy in the treatment of cervical spinal cord injury and assessing the impact of the two approaches on cervical spine function and patient quality of life. Retrospectively analyze the clinical data from 180 patients with cervical spinal cord injury who were admitted to the First Affiliated Hospital of Hebei North University from June 2019 to June 2021. The patients were divided into an anterior approach group (n = 89, treated with anterior cervical corpectomy and fusion) and a posterior approach group (n = 91, treated with posterior total laminectomy). The amount of blood loss in the posterior approach group was larger compared to the anterior approach group. Patients in the posterior approach group had higher wound diameters and operation times compared to the anterior approach group, as well as the operation cost. The visual analogue scale (VAS) scores of patients in the posterior approach group were significantly higher than in the anterior approach group one month after operation. The Japanese Orthopaedic Association (JOA), neck disability index (NDI), and American Spinal Injury Association (ASIA) scores of patients in both groups at 1, 6, and 9 months after surgery were higher compared to those before surgery, yet no significant differences were observed between the two groups. Also, no significant difference was observed in the incidence of complication and the quality of life between the two groups before and after treatment. Anterior cervical corpectomy and fusion and posterior total laminectomy can effectively restore the cervical nerve function in the treatment of cervical spinal cord injury. However, anterior subtotal vertebral resection is associated with improved perioperative indicators compared to posterior total laminectomy. Clinically, surgical methods can be selected according to imaging findings, the general condition of patients, and individual economic status.

Efficacy of NHP66 Bioactive Cage on Patients with Cervical Spine Injury in Short-Track Speed Skating.

BACKGROUND: Short-track speed skating (STSS) is an extreme sport in pursuit of extreme speed and explosive force. In such a sport, once athletes fall down, they are susceptible to serious cervical spine injury (CSI) under the inertia of high-velocity movement. Nanohydroxyapatite/polyamide 66 (NHP66) bioactive cage is a high-tech product of nanotechnology in the medical field in recent years. With a structure similar to that of human cortical bone, NHP66 bioactive cage has extremely high toughness and strength, which tailors to the needs of STSS. OBJECTIVE: This study mainly analyzed the therapeutic effect of NHP66 on patients with CSI in STSS, aiming to provide new opportunities for the treatment of this patient population. METHODS: A total of 51 patients with CSI treated in our hospital were enrolled, including 19 cases of short-track speed skaters (observation group) and 32 cases of car accidents, falls from heights, or collision injuries (control group). The relevant surgical indicators (operation time, intraoperative blood loss, etc.), the incidence of adverse reactions, the Cobb angle of cervical lordosis before and after surgery, and the fusion segment height of the cage were observed and compared between the two groups. Postoperative pain was evaluated by the visual analog scale (VAS), improvement of spinal cord injury was assessed by the American Spinal Cord Injury Association (ASIA) Impairment Scale, and bone fusion, bone subsidence, and other motor functions were assessed by the Japanese Orthopaedic Association (JOA) score rating system. RESULTS: The operation time, intraoperative blood loss, and incidence of adverse reactions in the observation group were significantly lower than those in the control group. The Cobb angle of cervical lordosis and the fusion segment height of cage increased significantly higher in both groups after surgery. In addition, the VAS scores of the observation group 2 h and 3 d after operation were significantly lower than those of the control group. In terms of improvement of spinal cord injury, ASIA and JOA scores in the observation group were significantly higher than those before treatment and in the control group. There was no significant difference in bone fusion activity between the two groups. CONCLUSIONS: In this study, it is found through experiments that NHP66 has higher safety and application value than autogenous iliac bone, confirming that NHP66 can achieve significant results as a cage for anterior cervical decompression and iliac bone graft fusion and internal fixation in short-track speed skaters after CSI.

Clinical Effect of Doxycycline Combined with Compound Sulfamethoxazole and Rifampicin in the Treatment of Brucellosis Spondylitis.

OBJECTIVE: The purpose of this study was to determine the clinical value of triple antibiotic therapy consisting of doxycycline, compound sulfamethoxazole and rifampicin in the treatment of brucellosis spondylitis. METHODS: A retrospective analysis was performed on 100 patients with brucellosis spondylitis admitted to the First Affiliated Hospital of Hebei North University from March 2016 to June 2019. Patients were divided into the following two groups: the control group (n = 50) treated with dual antibiotic therapy (rifampicin + compound sulfamethoxazole), and the observation group (n = 50) treated with triple antibiotic therapy (rifampicin + doxycycline + compound sulfamethoxazole). The treatment effect, low back pain relief, levels of erythrocyte sedimentation rate (ESR), procalcitonin (PCT) and C-reactive protein (CRP), as well as the adverse reactions were compared between the two groups. RESULTS: The response rate of the observation group was significantly higher than that of the control group (P < 0.05). Before treatment, there was no significant difference in the low back pain assessed by the visual analogue scale (VAS), or levels of ESR, PCT and CRP between the two groups (P > 0.05). But after treatment, the VAS score and the levels of ESR, PCT and CRP in observation group were lower than those in the control group (P < 0.05). No significant difference was found in the incidence of adverse reactions (P > 0.05). CONCLUSION: The triple antibiotic therapy of doxycycline, compound sulfamethoxazole and rifampicin is effective in the treatment of brucellosis spondylitis. It can significantly alleviate patients' back pain and inflammation with a high safety profile, which is worthy of clinical application.

Synchronized and integrated prehospital treatment for acute cervical spinal cord injury.

OBJECTIVE: To explore the effect of synchronized and integrated prehospital treatment strategies for on-site first aid, rescue transport and prehospital first aid in patients with acute cervical spinal cord injury. METHODS: A prospective non-randomized controlled study was designed to include patients with acute cervical spinal cord injury. A total of 50 patients were included in a Control group (before the implementation of synchronized and integrated prehospital treatment), and 50 patients were included in an Observation Group (after the implementation of synchronized and integrated prehospital treatment). We compared the timeliness of prehospital treatment, the proportion of patients received methylprednisolone treatment within 3 h after injury, the changes in Japanese Orthopaedic Association (JOA) score during transport, the incidence of adverse events, the clinical outcomes, the number of prehospital deaths, the case number of paralysis and the recovery of postoperative neural function between the two groups. RESULTS: Compared with the Control group, the Observation group showed significantly shorter time from injury to admission, from injury to receiving methylprednisolone pulse therapy, as well as from injury to receiving dehydrating agents and diuretics (all P<0.001). The proportion of patients received methylprednisolone treatment within 3 h after injury was significantly higher in the Observation group than that in the Control group (P<0.05). There was no significant change in the JOA score in the Observation group before and after the transport, while the score was significantly lower in the Control group after the transport (P<0.001). The JOA score was higher in the Observation group than that in the Control group at admission (P<0.001). The Observation group also showed decreased incidences of adverse events, mortality, and paralysis rate (all P<0.05) as well as better recovery of postoperative neural function (P<0.001) when compared with the Control group. CONCLUSION: Synchronized and integrated prehospital treatment has a significant effect in patients with acute cervical spinal cord injury through shortening the admission time, reducing the risk of adverse events, and improving the rescue effect and the prognosis of neural function.

Effects of multidisciplinary model of damage control on acute cervical spinal cord injury in winter Olympic sports.

PURPOSE: To investigate the feasibility of multidisciplinary model of damage control (MMDC) in patients with acute cervical spinal cord injury (ACSCI) in winter Olympic sports. METHODS: A total of 110 patients with ACSCI who participated in winter Olympic sports were selected as the study subjects, and were divided into the study group (SG, n=60, MMDC) and the control group (CG, n=50, conventional intervention) according to the intervention mode. The clinical effects of intervention, changes in neurological function and muscle tone before and after intervention, the changes in motor function and activity of daily living during intervention, and patient satisfaction towards intervention were compared between the two groups. RESULTS: The effective rate of intervention in the SG was 98.33%, higher than 88.00% in the CG (P < 0.05), and the percentage of patients with Grade E injuries in the SG after intervention was 30.00%, significantly higher than 12.00% in the CG (P < 0.05). The scores of all dimensions of Ashworth scale in the SG were lower than those in the CG (P < 0.05). The patients in the SG exhibited higher FMA scale and modified Barthel index (MBI) scores than the CG from 1 to 6 months of intervention (P < 0.05). CONCLUSION: MMDC showed better efficacy, the patients' neurological function, muscle tone and motor function could be better restored, and patients' abilities of daily activities were improved after intervention.

Effect of Crosslinks on the Stability of the Spine and the Pedicle Screw Fixation.

OBJECTIVE: To evaluate the effect of crosslinks on the stability of the spine and pedicle screws. METHODS: Compression fracture of the L1 vertebra was produced in 30 fresh thoracic and lumbar vertebrae samples obtained from adult sheep, which were divided into 3 groups (n=10)with lot-drawing method. Four screws were fixed onto the superior and inferior pedicles of vertebral arch close to the fractured vertebrae, with different number of crosslinks (0 in Group A,1 in Group B, and 2 in Group C) on the rods. After fixation, the samples were subject to 10 000 times of fatigue test with 1.5 Hz load on the HY-3080 computer-control electronic universal test machine and HY-1000NM computer-control torsion test machine. The axial compressive stiffness, maximum pullout strength,and range of motion (ROM) of 6 directions, i.e., flexion, extension, left and right lateral bending, and left and right axial rotation of the 3 groups were measured and compared. RESULTS: There were no statistically significant differences in axial compressive stiffness as well as the ROM of flexion, extension, and left and right lateral bending (all P>0.05). The maximum pullout strength was significantly smaller in Group A and Group B than in Group C [(129.56±29.63)N vs.(294.67±23.25) N,P=0.000;(254.02±36.29)vs.(294.67±23.25)N, P=0.006]. The ROM of left axial rotation was the highest in Group A(13.35°±1.06°), followed by Group B(12.23°±1.06°)and Group C (11.04°±0.74°)(F=13.44, P=0.000; Group B vs. Group A, P=0.000; Group B vs. Group C, P=0.001; Group C vs. Group A,P=0.000). The ROM of right axial rotation was also the highest in Group A(13.56°±1.15°), lower in Group B (12.39°±1.01°) and the lowest in Group C (10.81°±0.51°) (F=21.91, P=0.000; Group B vs. Group A,P=0.002; Group B vs. Group C, P=0.001; Group C vs. Group A, P=0.000). CONCLUSION: Crosslinks may reinforce the pullout strength of the screws and improve the axial stability of the spine.

[Clinical evaluation of one-stage radical debridement combined with posterior pedicle internal fixation for brucellar spondylitis of the thoracic and lumbar vertebrae].

OBJECTIVE: To discuss the surgical treatment method and effectiveness of brucellar spondylitis. METHODS: Between January 2002 and October 2010, 78 patients underwent one-stage radical debridement and posterior pedicle internal fixation, who were definitely diagnosed as having brucellar spondylitis of the thoracic and lumbar vertebrae. There were 42 males and 36 females, aged 24 to 65 years (mean, 45 years). The disease duration was 8-29 months (mean, 12 months). Two vertebrae were involved in 70 cases and three vertebrae were involved in 8 cases. All of the cases complicated by nerve function damage in different extent before operation. The patients were followed up regularly after operation. The pain score (visual analogue score, VAS), nerve function Frankel classification, effectiveness evaluation, and the blind test evaluation of X-ray and MRI were performed. RESULTS: All 78 cases were followed up 12 to 30 months (mean, 26 months). No sinus tract and recurrence occurred. The VAS scores were significantly improved at 1 month (2.4 +/- 0.3), 3 months (1.0 +/- 0.2), 6 months (0.5 +/- 0.4), and 12 months (0) when compared with preoperative score (9.2 +/- 0.6) (P < 0.05). The nerve function Frankel classification after operation was significantly improved when compared with preoperative one (P < 0.05); the patients in grade C and grade D had the most obvious improvement. The effectiveness evaluation indicated no aggravated cases. As time went on, the improved and unchanged patients were cured gradually and the improvement rate and the curative rate were 100% and 91.03%, respectively at 12 months after operation. The imaging scores were significantly improved at 1 month (4.11 +/- 0.09), 3 months (4.68 +/- 0.04), 6 months (4.92 +/- 0.08), and 12 months (5) when compared with the preoperative score (0.17 +/- 0.03) (P < 0.05). CONCLUSION: One-stage radical debridement combined with posterior pedicle internal fixation is an ideal therapeutic method for brucellar spondylitis of the thoracic and lumbar vertebrae, which has obvious superiority in pain relief, the spine stability, the nerve function recovery, and early rehabilitation.

The application of the axial view projection of the S1 pedicel for sacroiliac screw.

BACKGROUND: The objective of this study was to position the iliosacral screws speedily, easily, and safely, we sought to delineate readily reproducible radiographic anatomic clues of the pedicel of S1 for the iliosacral screw placement. METHODS: We used eight normal adult pelvic specimens lying on the operation table in the prone position. First, the C-arm fluoroscope unit is positioned for the lateral view of the body of S1. We gradually changed the angle of the C-arm to ventral and cephalad. When a clear oval track image appears, we fix the angle of the C-arm. With the assistance of the C-arm projection, the starting point for the guide pin is centered on the oval track, and the orientation is adjusted. When the projection of the guide pin became a point inside of the oval track, the guide pin is inserted using battery-powered equipment. The accuracy and angle of pin placement is assessed using computed tomography scans in all cases. RESULTS: In all the pelves, the oval track has been successfully found, and the guide pins are accurately inserted using the sacral pedicel axial view. In the angular orientations by the computed tomography scan, the transverse plane inclination to the ventral of the guide pin is approximately 38.3 degrees +/- 1.9 degrees, and the frontal plane inclination to the cephalad is approximately 29.6 degrees +/- 2.0 degrees. CONCLUSION: The sacral pedicel axial view projection is a optimal radiographic technique for percutaneous placement of iliosacral screws in clinical practice. We can get the limpid axial view of pedicel of S1 to applicate this project method, which provides a speedier method with less radiation exposure for percutaneous placement of iliosacral screws.