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OBJECTIVE:At present,there are many reports on the related factors associated with the incidence of cervical spine instability in patients with rheumatoid arthritis,but there are problems such as small sample size and many confounding factors,and the research results of various studies on the same related factors are also different.This article analyzed the factors related to cervical spine instability in patients with rheumatoid arthritis by means of a systematic review. METHODS:Articles related to cervical spine instability in patients with rheumatoid arthritis were collected by searching both Chinese and English databases until March 2023.The outcome of cervical spine instability in patients with rheumatoid arthritis was used as the grouping criterion to abstract basic information,baseline patient characteristics,laboratory-related tests,medication use,and other relevant risk factors.Meta-analysis was done using Stata 14.0 software. RESULTS:(1)Sixteen relevant studies,all of moderate or above quality,were included,including seven studies with case-control studies and nine with cross-sectional studies.The overall incidence of cervical spine instability in patients with rheumatoid arthritis was 43.08%.(2)Meta-analysis showed:Related risk factors included female(OR=0.60,95%CI:0.44-0.82,P=0.002);age at disease onset(SMD=-0.52,95%CI:-0.86 to-0.18,P=0.003);duration of disease(SMD=0.58,95%CI:0.14-1.02,P=0.01);body mass index(OR=0.74,95%CI:0.63-0.88,P=0.001);rheumatoid factors positive univariate analysis subgroup(OR=1.33,95%CI:1.02 to 1.72,P=0.04),C-reactive protein(SMD=0.26,95%CI:0.16-0.35,P=0.00),erythrocyte sedimentation rate(SMD=0.15,95%CI:0.002-0.29,P=0.047),anti-cyclic-citrullinated peptide antibodies(OR=1.73,95%CI:1.19-2.51,P=0.004),28-joint Disease Activity Score(SMD=0.20,95%CI:0.04-0.37,P=0.02),destruction of peripheral joints(OR=2.48,95%CI:1.60-3.85,P=0.00),and corticosteroids(OR=1.91,95%CI:1.54-2.37,P=0.00)were strongly associated with the development of rheumatoid arthritis-cervical spine instability.Female and corticosteroid use were independently associated with the occurrence of rheumatoid arthritis-cervical spine instability. CONCLUSION:Based on clinical evidence from 16 observational studies,the overall incidence of rheumatoid arthritis-cervical spine instability was 43.08%.However,the incidence of cervical spine instability in rheumatoid arthritis patients varied greatly among different studies.Gender(female)and the use of corticosteroids were confirmed as independent correlation factors for the onset of cervical spine instability in patients with rheumatoid arthritis.The results of this study still provide some guidance for early clinical recognition,diagnosis,and prevention of rheumatoid arthritis-cervical spine instability.
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Ankylosing spondylitis (AS) combined with lower cervical fracture is often categorized into unstable fracture, with a high incidence of neurological injury and a high rate of disability and morbidity. As factors such as shoulder occlusion may affect the accuracy of X-ray imaging diagnosis, it is often easily misdiagnosed at the primary diagnosis. Non-operative treatment has complications such as bone nonunion and the possibility of secondary neurological damage, while the timing, access and choice of surgical treatment are still controversial. Currently, there are no clinical practice guidelines for the treatment of AS combined with lower cervical fracture with or without dislocation. To this end, the Spinal Trauma Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate Clinical guidelines for the treatment of ankylosing spondylitis combined with lower cervical fracture in adults ( version 2024) in accordance with the principles of evidence-based medicine, scientificity and practicality, in which 11 recommendations were put forward in terms of the diagnosis, imaging evaluation, typing and treatment, etc, to provide guidance for the diagnosis and treatment of AS combined with lower cervical fracture.
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Hydration status refers to the balance between the intake and discharge of water in the body. When the ingested and discharged water are roughly equal and the body is in water balance, it is the normal hydration status, and when the water intake is too little or too much, it is the "dehydration" or "overhydration status". The hydration status of the body not only affects metabolism, but also affects the functions of the urinary system, cardiovascular system, nervous system, etc. In order to further clarify the relationship between body hydration status and decompression sickness (DCS), this paper reviewed relevant studies and analyzed the interaction between hydration and decompression safety during diving. The primary causes of dehydration in diving are "hyperbaric diuresis", "immersion diuresis", breathing dry gas, heat, and cold. Dehydration not only promotes the occurrence of DCS but also reduces the aerobic work efficiency and athletic performance of divers, as well as affects cognition and mood. A study found that appropriate rehydration before and during diving can reduce the risk of DCS, which possibly associates with the increase of blood volume, plasma surface tension, and vasoconstriction. Fluid therapy is also important for those who already have DCS. This paper analyzed the amount, nature, timing, and effect of rehydration involved in the above links, comprehensively sorted out the relationship between hydration and diving safety, summarized the existing problems, and provided reference for practical application and future research.
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Objective To explore the relationship between non-high density lipoprotein cholesterol(non-HDL-C)level and leptomeningeal collateral circulation in patients with acute middle cerebral artery occlusion.Methods A total of 85 patients with first-onset acute cerebral infarction with middle cerebral artery M1 segment occlusion were enrolled.According to the results of DSA,LMC circulation was assessed by American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology Collateral Circulation Assess-ment System.All patients were assigned to better LMC circulation group(score 2～4,n = 30)and worse LMC circulation group(score 0～1,n = 55),and the levels of non-HDL-C were compared between the two groups.Results The levels of LDL-C and non-HDL-C in worse LMC circulation group were significantly higher than those of the better LMC circulation group(P = 0.026,P = 0.010).non-HDL-C was an independent risk factor for the worse LMC circulation(OR = 3.019,95%CI:1.053～8.658,P = 0.04).LMC circulatory score of patients was negatively correlated with the levels of non-HDL-C level(r =-0.228,P = 0.036).The AUC of non-HDL-C predicted for the worse LMC circulation was 0.638(95%CI:0.521～0.755,P = 0.036).Conclusions non-HDL-C in patients with acute cerebral infarction was significantly related to worse LMC circulation,and was a risk factor for worse LMC circulation.It is suggested that the higher expression of non-HDL-C could be used to predict worse LMC circulation as a serological indicator.
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In this study, we designed a core competency-oriented formative assessment system for standardized residency training. A formative assessment information platform was established according to this formative assessment system. We described the business process design in detail and how to use information technology for assessment data application. The corresponding data were fed back to residents, instructors, rotation departments, specialty bases, and residency training management departments to promote continuous quality improvement. Meanwhile, we demonstrated the difficulties, deficiencies, and future direction of the construction of formative assessment information platform.
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Odontoid fracture is the most common type of upper cervical vertebral fractures.Because the blood supply of odontoid is poor and the healing rate of part fractures is low,surgical treatment can increase the chance of fracture healing.Compared with traditional open surgery,minimally invasive treatment has obvious advantages,such as less trauma and faster recovery.Different types of odontoid fracture should be treated with different surgical methods.Only by accurately classifying odontoid fractures and choosing accurate minimally invasive treatment methods can we achieve safe and effective expected results.The author introduces the classification of odontoid fracture and the selection strategies of minimally invasive treatment methods,and puts forward the existing problems and development prospects,so as to provide help for the treatment and research of odontoid fracture.
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Objective To compare the clinical efficacy of simulated optimal reduction combined with percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of senile osteoporotic vertebral compression fractures (OVCF).Methods A retrospective case series study was conducted to analyze the clinical data of 136 patients with osteoporotic vertebral compression fractures admitted to the spine surgery department of Luoyang Orthopedic Hospital of Henan Province from January 2014 to January 2015.There were 54 males and 82 females,aged 55 to 83 years old,with an average age of 68.3 years.All the enrolled patients had single segment vertebral compression fractures,whose compression degree was ≥ 1/3 of adjacent normal vertebral bodies and ≤2/3 of adjacent normal vertebral bodies.Among them,59 patients were treated with simulated optimal reduction combined with PVP (PVP group),and 77 patients were treated with PKP (PKP group).The operation time,intraoperative fluoroscopy time,incidence of bone cement leakage,hospitalization cost and length of stay were compared between the two groups.Postoperative X-ray and CT examination were performed to observe bone cement diffusion.Before surgery and after surgery (1 day,1 week,1 month,6 months,1 year,2 years and 3 years),Visual analogue scale (VAS) score,Oswestry disability index (ODI) scores,Cobb's angle,ratio of anterior and middle height of the affected vertebrae,and the incidence of vertebral refractures within 3 years were compared between the two groups.Results All the patients were followed up for 29-43 months,averaging 36 months.One patient in the PVP group was lost to follow-up after one year.In the PKP group,two patients were lost to follow-up after one year and one patient was lost to follow-up after two years.In the PVP group,single vertebral body operation time [(28.9 ± 5.7) seconds] and intraoperative fluoroscopy time [(54.0 ± 13.4)seconds] were significantly less than those in the PKP group,with statistically significant differences (P ＜ 0.01).The incidence of bone cement leakage in the two groups was 8.5％ and 7.8％,respectively,with no significant difference (P ＞ 0.05).The hospitalization cost in the PVP group [(9.7 t3.2) thousand yuan] was lower than that in the PKP group [(22.35 ± 16.2) thousand yuan] (P ＜ 0.01).The diffusion coefficient in PVP group (2.40 ± 0.27) was higher than that in the PKP group (2.29 ± 0.19) (P ＜ 0.01).In both groups,the fractured vertebral anterior height ratio,fractured vertebral middle height ratio and Cobb's angle were significantly improved after operation (P ＜ 0.01),while there were no significant differences between the two groups (P ＞0.05).In both groups,the VAS and ODI were significant decreased after operation (P ＜ 0.01).Better results were obtained in PVP group than the PKP group concerning the VAS [(2.5 ± 0.8) points vs.(2.6 ± 0.9) points,(2.7 ± 0.3) points vs.(2.8 ± 0.5) points,(2.8 ± 0.6) points vs.(2.9 ±0.7)points] and ODI [(25.3 ±4.0 vs.25.5 ±3.9,25.8 ±4.1 vs.27.5 ±4.0,26.0 ±2.9 vs.28.6 ±3.9)] at postoperative 1,2 and 3 years,and there were no significant difference between the two groups at postoperative 1 day,1 week,1 month and 6 months (P ＞ 0.05).The three-year follow-up showed that the re-fracture rate of adjacent vertebral body in the PVP group was significantly lower than that in thePKP group (0 vs.1.3％) (P ＜ 0.01).Conclusion For OVCF,the simulated manual reduction combined with PVP is easy for operation and has no significant difference in short-term analgesic effect compared with PKP,but the recovery of height of diseased vertebra and correction of kyphosis are better,with lower re-fracture rate of adjacent vertebra in the later stage.
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Odontoid fracture is the most common type of upper cervical vertebral fractures. Because the blood supply of odontoid is poor and the healing rate of part fractures is low, surgical treatment can increase the chance of fracture healing. Compared with traditional open surgery, minimally invasive treatment has obvious advantages, such as less trauma and faster recovery. Different types of odontoid fracture should be treated with different surgical methods. Only by accurately classifying odontoid fractures and choosing accurate minimally invasive treatment methods can we achieve safe and effective expected results. The author introduces the classification of odontoid fracture and the selection strategies of minimally invasive treatment methods, and puts forward the existing problems and development prospects, so as to provide help for the treatment and research of odontoid fracture.
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Objective@#To compare the clinical efficacy of simulated optimal reduction combined with percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of senile osteoporotic vertebral compression fractures (OVCF).@*Methods@#A retrospective case series study was conducted to analyze the clinical data of 136 patients with osteoporotic vertebral compression fractures admitted to the spine surgery department of Luoyang Orthopedic Hospital of Henan Province from January 2014 to January 2015. There were 54 males and 82 females, aged 55 to 83 years old, with an average age of 68.3 years. All the enrolled patients had single segment vertebral compression fractures, whose compression degree was ≥1/3 of adjacent normal vertebral bodies and ≤2/3 of adjacent normal vertebral bodies. Among them, 59 patients were treated with simulated optimal reduction combined with PVP (PVP group), and 77 patients were treated with PKP (PKP group). The operation time, intraoperative fluoroscopy time, incidence of bone cement leakage, hospitalization cost and length of stay were compared between the two groups. Postoperative X-ray and CT examination were performed to observe bone cement diffusion. Before surgery and after surgery (1 day, 1 week, 1 month, 6 months, 1 year, 2 years and 3 years), Visual analogue scale (VAS) score, Oswestry disability index (ODI) scores, Cobb's angle, ratio of anterior and middle height of the affected vertebrae, and the incidence of vertebral refractures within 3 years were compared between the two groups.@*Results@#All the patients were followed up for 29-43 months, averaging 36 months. One patient in the PVP group was lost to follow-up after one year. In the PKP group, two patients were lost to follow-up after one year and one patient was lost to follow-up after two years. In the PVP group, single vertebral body operation time [(28.9±5.7)seconds] and intraoperative fluoroscopy time [(54.0±13.4)seconds] were significantly less than those in the PKP group, with statistically significant differences (P<0.01). The incidence of bone cement leakage in the two groups was 8.5% and 7.8%, respectively, with no significant difference (P>0.05). The hospitalization cost in the PVP group [(9.7±3.2)thousand yuan] was lower than that in the PKP group [(22.35±16.2)thousand yuan](P<0.01). The diffusion coefficient in PVP group (2.40±0.27) was higher than that in the PKP group (2.29±0.19) (P<0.01). In both groups, the fractured vertebral anterior height ratio, fractured vertebral middle height ratio and Cobb's angle were significantly improved after operation (P<0.01), while there were no significant differences between the two groups (P>0.05). In both groups, the VAS and ODI were significant decreased after operation (P<0.01). Better results were obtained in PVP group than the PKP group concerning the VAS [(2.5±0.8)points vs. (2.6±0.9)points, (2.7±0.3) points vs. (2.8±0.5)points, (2.8±0.6) points vs. (2.9±0.7)points] and ODI [(25.3±4.0 vs. 25.5±3.9, 25.8±4.1 vs. 27.5±4.0, 26.0±2.9 vs. 28.6±3.9)] at postoperative 1, 2 and 3 years, and there were no significant difference between the two groups at postoperative 1 day, 1 week, 1 month and 6 months (P>0.05). The three-year follow-up showed that the re-fracture rate of adjacent vertebral body in the PVP group was significantly lower than that in the PKP group (0 vs. 1.3%)(P<0.01).@*Conclusion@#For OVCF, the simulated manual reduction combined with PVP is easy for operation and has no significant difference in short-term analgesic effect compared with PKP, but the recovery of height of diseased vertebra and correction of kyphosis are better, with lower re-fracture rate of adjacent vertebra in the later stage.
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Objective to investigate the clinical efficacy of decompression and pedicle screw fixation through posterior approach for complete thoracic spine fracture dislocation.Methods The clinical data of six patients with complete thoracic spine fracture and dislocation treated from September 2002 to June 2016 were analyzed retrospectively by case series study.There were five males and one female,aged 21-67 years old (mean,47.2 years).The injury segments were T3～4 dislocation in one case,T5～6 dislocation in two cases,T6 ～7 dislocation in two cases and T8 ～9 dislocation in one case.There was one case of ASIA grade E and five cases of Grade A,and all of six cases were associated with multiple rib fractures and hemopneumothorax.The companied status was one case of sternal fracture,one case of atlantoaxial complex fractures and three cases of pulmonary contusion.The posterior median incision decompression and pedicle screw system fixation were performed,and the intervertebral bone grafting was conducted after restoration.The surgery time,bleeding volume during surgery,fracture restoration,bone grafting fusion,failure of internal fixation and other complications were recorded.The Visual Analogue Scale (VAS) and American Spinal Injury Association (ASIA) classification were used to assess the pain and neurological function improvement between the preoperative visit and final follow-up visit.Results The surgery time was 150-240 minutes (mean,205 minutes).The bleeding volume during the surgery was 700-2 100 ml (mean,1167 ml).One case was died of pulmonary infection at one week after surgery,the others were followed up for 3-14 months (mean,7.4 months).After operation,five patients were satisfied with the reduction,and the lateral displacement was partially restored in one cases.Five cases of intervertebral bone grafting all had bone fusion.There was no fixation failure.The VAS was (7.4 ± 0.6) points before surgery,(4.5 ± 1.6) points at one week after surgery and (1.8 ± 0.3) points at final visit of follow-up,which had significant difference from the preoperative status (P ＜ 0.05).One case of ASIA grade E had no postoperative aggravation and four cases of grade A had no improvement.Conclusion Posterior decompression and pedicle screw fixation system is optimal choice of treatment for complete thoracic fractures and dislocations for it can attain reduction of fracture and dislocation as well as bone fusion,provide stability for spine and relieve pain.
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BACKGROUND:In recent years, with the development of minimaly invasive techniques, the application of percutaneous pedicle screw fixation techniques gradualy become widespread, but in the percutaneous pedicle screw fixation for thoracolumbar fractures, due to lack of reduction apparatus or power defect, the reduction of the injured vertebra is poor. In order to improve this deficiency, we design a percutaneous pedicle screwsystem in order to achieve the desired effect of reduction. OBJECTIVE:To investigate the two different effects for treating unstable thoracolumbar fractures by fixing RTS (rotation softened trauma fixation system) or SEXTANT screws under minimaly invasive technology. METHODS:From October 2011 to June 2013, 50 patients who suffered from single-segment thoracolumbar fractures without any nerve-injured symptoms were treated by using percutaneous pedicle screws. Among them, 25 cases used Sextant screws; the others used RTS screws. Data were compared between the two groups, including the height of injured vertebrae, Cobb’s angle, visual analogue scale scores and Oswestry disability index 1 week, 3 and 6 months postoperatively, and during final folow-up. RESULTS AND CONCLUSION:(1) Al patients were folowed upfor8-18 months. (2) The height of injured vertebrae and Cobb’s angle were restored in both groups, showing significant differences (P<0.01). The restoration of the height of injured vertebrae and Cobb’s angle was better in the RTS group than in the SEXTANT group after treatment (P< 0.05-0.01). (3) The visual analogue scale scores and Oswestry disability index were significantly better in the RTS group than in the SEXTANT group 6 months postoperatively and during final folow-up (P< 0.05). (4) These results suggest that both RTS and SEXTANT systems can effectively repair single-segment thoracolumbar fractures without any nerve-injured symptoms. However, it is clear that the recovery of the height ofthe vertebral body is more satisfied and the postoperative pain and dysfunctionweremore minor in the RTS group.
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Objective To evaluate the efficacy and safety of therapeutic drug monitoring (TDM ) based vancomycin dose adjustment in patients with gram‐positive infections .Methods A cohort study was designed with 128 inpatients undergoing TDM in Huashan Hospital from January 2005 to September 2014 .The clinical data of these patients were used to analyze the efficacy and safety of vancomycin therapy by Cox model and survival analysis .Results The patients undergoing TDM‐based dose adjustment had a higher daily dose and blood trough concentration ,which may lead to better bacteriological efficacy and overall efficacy .Cox proportional hazards model analysis showed that TDM‐based dose adjustment is a protective factor .No safety‐related risk factor was found .Conclusions TDM‐based vancomycin dose adjustment is important for patients to achieve better outcomes in fighting gram‐positive infections .
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BACKGROUND:Now the filling material which is used for the treatment of osteoporotic compression fractures is mainly polymethacrylic acid (PMMA),but the PMMA as a permanent foreign body cannot promote bone regeneration,and has a downward extension of the possibility of mechanical properties with time prolonging,so a new type of filling material used to substitute PMMA is looking.OBJECTIVE:To investigate the effect and image characteristics of different filling materials on percutaneous vertebroplasty performing on a goat model of osteoporotic compression fracture.METHODS:Three vertebral fracture models were established on osteoporosis goats by using an appropriate mechanical stress.Under the G-arm X-ray machine,the fractured vertebrae was performed with percutaneous vertebroplasty and then filled with polymethyl methacrylate (PMMA),self-setting calcium phosphate cement (CPC) and recombinant human bone morphogenetic protein-2(rhBMP-2)/self-calcium phosphate cement.RESULTS AND CONCLUSION:① A total of 36 vertebral bodies of 12 goats were successfully performed with percutaneous vertebroplasty,and there was no significant difference in filling quantity among three materials (3.5±1.8) mL (P>0.05).Bolus resistance of PMMA was strong,but operative time was short,and the image was great;the bolus resistance of self-CPC and rhBMP-2/self-CPC was weak,operative time was long,but there was no leakage placeholde.②CT scanning results on the 2~(nd) day after surgery demonstrated that the three materials were disorderly distributed in the vertebral body,showing high-density patching shaping.Six out of 36 vertebral bodies were leakage,which was induced by PMMA (n=4),self-CPC (n=1),and rhBMP-2/self-CPC (n=1).③ Scanning electron microscope indicated that all materials in the PMMA group were not able to closely bind with host bone,but self-CPC and rhBMP-2/self-CPC were able to closely bind with host bone.The results suggested that rhBMP-2/self-CPC is characterized by long-term operation,short time of bone substitute,and stabilization of reconstructed spine.
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Objective To investigate the clinical effect and Practical value of percutaneous vertebroplasty using China-made bone cement. Methods Under CT or C-arm X-ray machine guided, 22 cases with vertebral osteoporotic compression fracture, hemangeoma orosteolytic carcinoma were treated by perfusion of China-made bone cement through percutaneous puncture. Results Thirty vertebraes in 22 cases were operated by percutaneous vertebroplasty and the successful rate was 100%. The symptoms in 21 cases were remarkably released, the clinical effective rate was 95.5%. During the operation, bone cement leakage occurred in 23.3% of the treated vertebrae, but no serious untoward effect appeared. Conclusion The application of China-made bone cement in percutaneous vertebroplasty is of the features of minimal invasion, safty and remarkable curative effect. It can release pain and consolidate the vertebrae.
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Objective To evaluate the methods and predictive values of obstetric conjugata measured by ultrasound.Methods A total of 200 women at 37～42 week's gestation,delivering a singleton infant and having an ultrasound examination within three days before delivery were studied.The obstetric conjugata,fetal biparietal diameter(BPD),fetal clavicula were measured by ultrasound,and compared with the obstetric conjugata measured in operation,newborn BPD,and newborn clavicula.Results The parameters such as obstetric conjugata,BPD and clavicula had no significant difference between ultrasonic measurement and actual measurement.When the obstetric conjugata and BPD difference