Tumor volume affects the short-term efficacy of cervical cancer and brachytherapy / 中华放射肿瘤学杂志

Objective:To evaluate the effect of tumor volume on the radiation dose and efficacy of locally advanced cervical cancer patients undergoing radical radiotherapy and chemotherapy.Methods:Clinical data of 126 patients who were diagnosed with cervical cancer (stage ⅡB-ⅣA) and underwent radical concurrent chemoradiotherapy in Guangxi Medical University Cancer Hospital from November 2019 to November 2022 were retrospectively analyzed. The cut-off values of tumor volume before (pre-TV) and after (post-TV) external radiotherapy and tumor volume reduction rate (TVRR) were calculated by Jamovi software. The effects of pre-TV, post-TV and TVRR on short-term efficacy, progression-free survival (PFS), brachytherapy (BT) mode , high-risk clinical target volume (HR-CTV) and organs at risk (OAR) dose were investigated by univariate and multivariate analyses.Results:Pre-TV≥67.03 cm 3 and post-TV≥14.88 cm 3 were poor prognostic factors for 6-month PFS and objective response rate (ORR) (both P<0.05), and post-TV was an independent prognostic factor. In the TVRR≥73.0% and <73.0% groups, no statistical differences were observed in the 6-month PFS and ORR. In the pre-TV≥67.03 cm 3 group, the cases number of intracavitary brachytherapy (ICBT) and intracavitary / interstitial brachytherapy (IC/IS-BT) was 36 (50.0%), while in the pre-TV<67.03 cm 3 group, the cases number of ICBT and IC/IS-BT was 41 (76%) and 13 (24%), respectively ( P=0.003). In the post-TV≥14.88 cm3 group, the cases number of ICBT and IC/IS-BT was 28 (47%) and 32 (53%), while 49 (72%) and 17 (26%) in the post-TV<14.88 cm3 group, respectively ( P=0.002). The dose of HR-CTV D 90% in the TVRR≥73.0% group was significantly higher than that in the TVRR<73.0% group ( P=0.014), but there was no significant difference in the dose of bladder D 2 cm3, rectal D 2 cm3 and small intestine D 2 cm3 (all P>0.05). The dose of HR-CTV D 90% in the post-TV<14.88 cm 3 group was significantly higher than that in post-TV≥14.88 cm 3 group ( P<0.001), and the dose of bladder D 2 cm3 in the post-TV≥14.88 cm 3 group was higher than that in the post-TV<14.88 cm 3 group ( P<0.05). There was no significant difference in the dose of rectal D 2 cm3 and small intestinal D 2 cm3 between two groups (both P>0.05). The number of concurrent chemotherapy (≥4 times vs.<4 times) had no statistical difference for 6-month PFS and TVRR. Conclusions:Pre-TV and post-TV are the influencing factors of short-term efficacy and BT mode selection for locally advanced cervical cancer. Post-TV is an independent prognostic factor and also indirectly affects the dose of HR-CTV D 90% and bladder D 2 cm3 Increasing the number of concurrent chemotherapy (≥4 times) does not improve TVRR and short-term efficacy.

Expression of autophagy-related genes Beclin1 and LC3 in ossified tissues of posterior longitudinal ligament of cervical spine and correlation analysis with osteogenic factors / 中国脊柱脊髓杂志

Objectives:To investigate the expression levels of autophagy-related genes Beclin1 and LC3 in ossified tissues of posterior longitudinal ligament in cervical spine and their correlations with osteogenic factors.Methods:18 posterior longitudinal ligament tissue specimens from cervical ossification of posterior longitudinal ligament(OPLL)patients underwent OPLL surgical removal from October 2020 to May 2021(OPLL group)and 15 tissue specimens of the posterior longitudinal ligament of the cervical spine that were not ossified(non-OPLL group)were collected.The morphological changes of posterior longitudinal ligament tissues were observed by hematoxylin-eosin(HE)staining;the deposition of calcium salts was observed by Von Kossa staining;The mRNA and protein expression levels of Beclin1,microtubule associated protein light chain 3(LC3),and the osteogenic factors runt-related transcription factor 2(RUNX2),bone morphogenetic protein-2(BMP2),and Osterix in the specimens of the two groups were determined with immunohistochemical staining and RT-qPCR respectively;Pearson correlation analysis was used to explore the relationship between Beclin1,LC3,RUNX2,BMP2,and Osterix.Results:Compared with the non-OPLL group,the cell morphology in the OPLL group was larger and irregular in shape,and the nuclei were more obvious;Von Kossa staining showed that there was no obvious calcium salt deposition in the non-OPLL group,whereas brownish-black calcium salts could be seen in the OPLL group,which were aggregated into flakes or clusters;The expression levels of Beclin1,LC3,RUNX2,BMP2 and Osterix proteins and mRNA in the OPLL group were higher than those in the non-OPLL group(P＜0.05);Beclin1 mRNA expression level was significantly correlated with BMP2,RUNX2 and Osterix(P＜0.05,r＞0.5),while LC3 was not correlated with osteogenic factors.Conclusions:The autophagy-related genes Beclin1 and LC3 are significantly overexpressed in ossified tissues of posterior logitudinal ligament of cervical spine,and Beclin1 is closely related to posterior longitudinal ligament osteogenesis.

Difficulties and challenges of pelvic exenteration in locally advanced rectal cancer / 中华胃肠外科杂志

In recent years, with advances in pelvic oncology and surgical techniques, surgeons have redefined the boundaries of pelvic surgery. Combined pelvic exenteration is now considered the treatment of choice for some patients with locally advanced and locally recurrent rectal cancer, but it is only performed in a few hospitals in China due to the complexity of the procedure and the large extent of resection, complications, and high perioperative mortality. Although there have been great advances in oncologic drugs and surgical techniques and equipment in recent years, there are still many controversies and challenges in the preoperative assessment of combined pelvic organ resection, neoadjuvant treatment selection and perioperative treatment strategies. Adequate understanding of the anatomical features of the pelvic organs, close collaboration of the clinical multidisciplinary team, objective assessment and standardized preoperative combination therapy creates the conditions for radical surgical resection of recurrent and complex locally advanced rectal cancer, while the need for rational and standardized R0 resection still has the potential to bring new hope to patients with locally advanced and recurrent rectal cancer.

Effect of traditional Chinese medicine in attenuating chronic kidney disease and its complications by regulating gut microbiota-derived metabolite trimethylamine N-oxide: a review / 中国中药杂志

Trimethylamine N-oxide(TMAO), a metabolite of gut microbiota, is closely associated with chronic kidney disease(CKD). It can aggravate the kidney injury and promote the occurrence of complications of CKD mainly by inducing renal fibroblast activation, vascular endothelial inflammation, macrophage foaming, platelet hyperreactivity, and inhibition of reverse cholesterol transport. Thus it is of great significance for clinical treatment of CKD to regulate circulating TMAO and alleviate its induced body damage. Currently, therapeutic strategies for TMAO regulation include dietary structure adjustment, lifestyle intervention, intestinal microflora regulation, and inhibition of intestinal trimethylamine synthesis and liver trimethylamine oxidation. Chinese medicinal herbs have the clinical advantage of multi-component and multi-target effects, and application of traditional Chinese medicine(TCM) to synergistically regulating TMAO and improving CKD via multiple pathways has broad prospects. This study systematically reviewed the clinical relevance and mechanism of TMAO in aggravating CKD renal function deterioration and complication progression. In addition, the effect and mechanism of TCM in improving TMAO-induced kidney injury, cardiovascular disease, hyperlipidemia, thrombosis and osteoporosis were summarized. The results provided a theoretical basis for TCM in attenuating gut microbiota-derived metabolite TMAO and improving CKD, as well as a basis and direction for in-depth clinical development and mechanism research in the future.

Application of canal-shaped implant template in brachytherapy for cervical cancer / 中华放射肿瘤学杂志

Objective:To explore the method of developing a canal-shaped implant template using a combined automatic pre-planning and 3D printing technology, and assess its impact on dose and efficacy improvement.Methods:Retrospective analysis of 15 patients with advanced cervical cancer admitted to the Affiliated Cancer Hospital of Guangxi Medical University from September 2020 to September 2022 was performed. Patients had characteristics such as vaginal stump recurrence, tumor eccentric growth, and previous hysterotomy, etc. Three-dimensional images were obtained by CT scan after automatic pre-planning. The PMT 3D software was used to analyze digital imaging and communications in medicine (DICOM) radiotherapy data, capture the coordinates of the pre-planned stay points to establish the implant channel, and generate the size and shape of the canal-shaped implant template based on patients' physiological structure. Dosimetric parameters, such as conformity index (CI), were evaluated. The changes of tumor size before and after treatment were analyzed by paired t-test. Results:Fifteen patients were treated with the canal-shaped implant template. The CI was 0.74±0.26, the total radiation dose (HR-CTV) D 90% (EQD 2, α/β=10) was (85.5±6.8) Gy, and the D 2 cm3 (EQD 2, α/β=3)for bladder, rectum, small intestine, and colon were (72.2±4.2), (65.8±6.1), (65.2±4.4), and (69.8±3.7) Gy, respectively, meeting clinical needs. After the treatment, the tumor volume was significantly decreased. The template had a good fit with the vaginal cavity, and a small amount of air gap on the sidewall did not affect the dose. Non-parallel needle insertion increased the utilization of the cavity space and implant needles. Conclusion:The method of developing the canal-shaped implant template using automatic pre-planning and 3D printing technology is efficient and effective, meets the requirements of modern precise radiotherapy, and has practical clinical value.

Anterior cervical release and posterior fixation for the treatment of irreducible atlantoaxial dislocation with retropharyngeal internal carotid artery / 中华骨科杂志

Objective:To investigate the clinical effect of anterior cervical release and posterior fixation in the treatment of irreducible atlantoaxial dislocation with retropharyngeal internal carotid artery.Methods:Thirteen patients with irreducible atlantoaxial dislocation of retropharyngeal internal carotid artery from January 2015 to July 2019 were treated with anterior cervical release and posterior fixation. There were 8 males and 5 females, aged from 34 to 65 years with an average of 46.1±12.6 years. Positive, lateral and dynamic X-ray films, MR and CTA were performed before operation. There were 4 cases with bilateral retropharyngeal internal carotid artery and 9 cases with unilateral retropharyngeal internal pharyngeal artery. The time of operation, the amount of bleeding and intraoperative and postoperative complications were recorded. The main observations were Japanese Orthopaedic Association (JOA) score, atlantodental interval (ADI), Chamberlain line (CL), and changes in the morphology of the retropharyngeal internal carotid artery and implant fusion.Results:All the operations completed successfully. The operation time was 210-260 min, the average was 245±21 min; the blood loss was 350-600 ml, the average blood loss was 490±107 ml. There was no injury of internal carotid artery, vertebral artery, spinal cord or nerve root during the operation. All patients were followed up for 9 to 24 months, with an average of 15.1±6.2 months. Preoperative JOA score was 6.9±2.3 points, 1 month after operation was 13.5±2.5 points, and the last follow-up was 14.3±2.1 points. The difference was statistically significant ( F=30.91, P<0.001). The difference between 1 month after operation and before operation was statistically significant ( P<0.001), and the improvement rate of JOA score was 75.6%±15.2%. There was no significant difference between the last follow-up and 1 month after operation ( P>0.05). The preoperative ADI was 8.9±2.2 mm, 1 month after operation was 1.1±0.8 mm, and the last follow-up was 1.2±0.9 mm. The difference was statistically significant ( F=114.69, P<0.001). The difference between 1 month after operation and before operation was statistically significant ( P<0.001), and ADI had returned to normal level. There was no significant difference between the last follow-up and 1 month after operation ( P>0.05). The preoperative CL was 11.7±4.8 mm, 1 month after operation was 1.6±2.1 mm, and the last follow-up was 1.8±2.3 mm. The difference was statistically significant ( F=34.19, P<0.001). The difference between 1 month after operation and before operation was statistically significant ( P<0.001), and the position of odontoid process returned to normal level. There was no significant difference between the last follow-up and 1 month after operation ( P>0.05). Bone graft fusion was received at 6 to 12 months after operation, with an average of 10.2 months. Conclusion:CTA examination should be performed before anterior release of atlantoaxial dislocation to understand the position and shape of internal carotid artery. Anterior cervical release combined with posterior bone graft fusion is an effective method for the treatment of irreducible atlantoaxial dislocation with retropharyngeal internal carotid artery without increasing the risk of internal carotid artery injury.

Axial instrument strategy for atlantoaxial dislocation with complex artery variation / 中华骨科杂志

Objective:To evaluate the axial instrument strategy for atlantoaxial dislocation with complex vertebral artery variation.Methods:A total of 55 patients with atlantoaxial dislocation who underwent surgical treatment from January 2019 to December 2021 were retrospectively analyzed, including 14 males and 41 females, aged 54.0±12.8 years (range, 22-78 years). Among these patients, 10 patients with unilateral vertebral artery high ride with contralateral vertebral artery occlusion, 30 patients with bilateral vertebral artery high ride with single dominant vertebral artery, 15 patients with bilateral vertebral artery high ride. All patients underwent posterior reduction and internal fixation. Visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score were used to evaluate the postoperative efficacy.Results:All patients completed the surgery successfully with a follow-up time of 14.6±5.5 months (range, 6-24 months). C 2 pedicle screw fixation was performed on the non-dominant side of unilateral vertebral artery high ride and the non-dominant side of bilateral vertebral artery high ride with one dominant vertebral artery (40 vertebraes). The dominant side of unilateral high vertebral artery and bilateral high vertebral artery with one dominant vertebral artery was fixed with C 2 medial "in-out-in" screw (10 vertebraes), C 2 isthmus screw (21 vertebraes), C 2 without screw (9 vertebraes) only extended the fixed segment. For bilateral vertebral artery high ride patients, one side was used C 2 "in-out-in" pedicle screws (right 10 vertebraes, left 5 vertebraes), and the other side was fixed with C 2 medial "in-out-in" screw (8 vertebraes), C 2 isthmus screw (5 vertebraes), C 2 without screw only extended the fixed segment (2 vertebraes). The JOA scores were 8.5±1.8, 13.9±1.3, and 14.4±1.1 preoperatively, 6 months postoperatively, and at the final follow-up, respectively, with statistically significant differences ( F=279.40, P<0.001). JOA at 6 months postoperatively and at the final follow-up was greater than preoperatively, and the differences were statistically significant ( P<0.05), whereas the differences in JOA scores at 6 months postoperatively and at the final follow-up was not statistically significant ( P>0.05). Preoperative, 6 months postoperatively and final follow-up cervical VAS scores were 3.7±1.9, 2.1±0.9 and 1.6±1.0, respectively, with statistically significant differences ( F=39.53, P<0.001). The cervical VAS at 6 months postoperatively and at the last follow-up was less than that before surgery, and the differences were statistically significant ( P<0.05). Cervical VAS scores at 6 months postoperatively were greater than at the last follow-up, with a statistically significant difference ( P<0.05). Conclusion:For patients with atlantoaxial dislocation with complex vertebral artery variation, C 2 lateral "in-out-in" screw, C 2 medial "in-out-in" screw, isthmus screw fixation or C 2 without screw only extended the fixed segment can obtain good clinical efficacy.

Operative strategies for atlanto-axial dislocation revision surgery / 中国脊柱脊髓杂志

Objectives:To explore the operative strategies of revision surgery after atlanto-axial dislocation(AAD)surgery.Methods:12 patients undergone AAD revision surgery in our hospital between January 2016 and August 2019 were analyzed in this retrospective study,including 3 males and 9 females,aged 7-62 years[45.5(34.25,52.50)years].The interval of initial operation and revision operation was 3-360 months[30(5,93)months].Internal fixation and bone graft were removed before revision surgery.The patients were assessed to receive anterior release according to the conditions of 1/6 body weight dose skull traction.According to preoperative imaging and intraoperative exploration,larger diameter and longer screws,new screw track,and extended fixed segments were performed optionally to increase the overall internal fixation strength,and the lateral atlantoaxial joint release and grafting were performed to increase bone graft fusion.The follow-up peri-od ranged 12-50 months[24.0(17.25,34.00)months].The atlanto-dental interval(ADI),clivus-axial angle(CAA),cervico-medullary angle(CMA)and Japanese Orthopaedic Association(JOA)score were assessed at 3 days after surgery and final follow-up,the CT examination was performed at 3 days,3 months,6 months,12months and final follow-up after surgery to evaluate the bone graft fusion.Results:There were 8 patients receiving inter-nal fixation and bone graft removing before revision surgery.Among the patients,4 received anterior releasing combined with posterior reduction and internal fixation and fusion,the other 8 patients underwent posterior reduction and internal fixation and fusion.Of all the patients,occipital screw revision was performed in 4 with new screw track;C1 screw revision was performed in 4,of which 2 patients were fixed with larger di-ameter and longer screws,and 2 patients were fixed with new screw track;C2 screw revision was performed in 8,of which 5 patients were fixed with larger diameter and longer screws,and 3 patients were fixed with new screw track;extended fixed segments were preformed in 3 patients;the lateral atlantoaxial bone grafting was performed in all 12 patients.Anatomical reduction was obtained in all the patients.The postoperative 3d and final follow-up ADI were significantly reduced compared with pre-operative ADI,and the CCA and CMA were significantly increased than those at pre-operation(P＜0.05).The JOA at 3 days after surgery and final follow-up were significantly improved than that at pre-operation.Bony fusion was achieved in all the patients,with a bone fusion rate of 100％,and the bone fusion time ranged 3-7 months[3.5(3.0,6.0)months].Con-clusions:Anterior release is suitable for the patients with un-reduced atlantoaxial dislocation after removal of primary internal fixation under heavy traction.During posterior revision surgery,occipital screws need to change trajectory to maintain firm internal fixation,and larger diameter and longer screw is suitable for C1,and C2 screws,while extended fixed segments are suitable for patients whose C1 or C2 screws cannot be in-serted.The lateral atlantoaxial joint bone grafting is suitable for all AAD revision.

A new insights of mesorectum / 中华胃肠外科杂志

Total mesorectal excision (TME) represents the gold standard for radical resection in rectal cancer. The development in radiology and laparoscopic surgical equipment and the advancement in technology have led to a deepened understanding of the mesorectum and its surrounding structures. Both the accuracy of preoperative staging and the preciseness of the planes of TME surgical dissection have been enhanced. The postoperative local recurrence rate is reduced and the long-term survival of rectal cancer patients is improved. The preservation of the pelvic autonomic nervous system maintains the patient's urinary and sexual functions to the greatest extent possible, which in turn improves the patient's postoperative quality of life. A thorough understanding of the anatomy of the mesorectum and its surrounding structures is a prerequisite for successful TME. Herein, we review the basic concepts and the anatomy of the mesorectum in the current literature. Some important clinical issues are also discussed systematically in terms of imaging, surgery, and pathology.

Efficacy comparison of posterior atlas uniaxial and polyaxial screw instrumentation and fusion with bone graft for Gehweiler type IIIb atlas fracture / 中华创伤杂志

Objective:To compare the efficacy of posterior atlas uniaxial and polyaxial screw instrumentation and fusion with bone graft for Gehweiler type IIIb atlas fracture.Methods:A retrospective cohort study was performed to analyze the clinical data of 36 patients with Gehweiler type IIIb atlas fracture admitted to Henan Provincial People′s Hospital from January 2015 to October 2020. There were 29 males and 7 females, with age range of 23-82 years [(48.8±15.5)years]. All patients were treated with posterior atlas screw-rod internal fixation and fusion with bone graft, of which 14 received atlas uniaxial screw internal fixation (uniaxial screw group) and 22 received atlas polyaxial screw internal fixation (polyaxial screw group). The operation time and intraoperative blood loss were compared between the two groups. The atlas fracture union rate and atlantoaxial posterior arch bone fusion rate were compared between the two groups at 3 months and 6 months after operation. The anterior atlantodental interval (ADI), basion-dens interval (BDI) and lateral mass displacement (LMD) were compared between the two groups to evaluate the reduction of fracture fragments before operation, at 1, 3, 6 months after operation and at the last follow-up. At the same time, the visual analogue scale (VAS) and neck dysfunction index (NDI) were compared between the two groups to evaluate neck pain and functional recovery. The postoperative complications were observed.Results:All patients were followed up for 12-44 months [(27.2±9.9)months]. There was no significant difference in operation time or intraoperative blood loss between the two groups (all P>0.05). The atlas fracture union rate and atlantoaxial posterior arch bone fusion rate were 85.7% (12/14) and 78.6% (11/14) in uniaxial screw group at 3 months after operation, insignificantly different from those in polyaxial screw group [72.7% (16/22) and 77.3% (17/22)] (all P>0.05). All patients in the two groups achieved bone union and fusion at 6 months after operation. There was no significant difference in ADI between the two groups before and after operation (all P>0.05). The BDI in the two groups did not differ significantly before operation ( P>0.05), but a significantly higher value was found in uniaxial screw group at 1, 3, and 6 months after operation and at the last follow-up [(5.9±1.3)mm, (5.8±1.3)mm, (5.9±1.2)mm and (5.8±1.2)mm] than in polyaxial screw group [(3.1±0.6)mm, (3.1±0.6)mm, (3.1±0.6)mm and (3.1±0.6)mm] (all P<0.01). The two groups did not differ significantly before operation ( P>0.05), but LMD at 1, 3, and 6 months after operation and at the last follow-up was (1.6±0.8)mm, (1.5±0.8)mm, (1.5±0.7)mm and (1.5±0.9)mm in uniaxial screw group, significantly lower than that in polyaxial screw group [(4.8±1.6)mm, (4.6±1.6)mm, (4.9±1.6)mm and (4.9±1.6)mm] (all P<0.01). There was no significant difference in VAS between the two groups before operation ( P>0.05). The VAS at 1, 3, and 6 months after operation and at the last follow-up was 3.0(3.0, 4.0)points, 2.0(1.0, 2.0)points, 1.0(0.8, 2.0)points and 1.0(0.0, 1.3)points in uniaxial screw group and was 3.5(3.0, 4.0)points, 2.0(2.0, 3.0)points, 2.0(1.0, 2.0)points and 2.0(1.0, 3.0)points in polyaxial screw group. In comparison, the VAS scored much lower in uniaxial screw group than in polyaxial screw group at 6 months after operation and at the last follow-up (all P<0.01). There was no significant difference in NDI between the two groups before operation ( P>0.05). The NDI at 1, 3, and 6 months after operation and at the last follow-up was 34.9±6.3, 23.4±6.2, 13.9±2.7 and 9.4±2.8 in uniaxial screw group and was 33.2±6.1, 24.4±6.3, 18.1±4.1 and 12.7±3.2 in polyaxial screw group, showing a significantly lower NDI in uniaxial screw group than in polyaxial screw group at 6 months after operation and at the last follow-up (all P<0.01). The complication rate was 21.4% (3/14) in uniaxial screw group when compared to 22.7% (5/22) in polyaxial screw group ( P>0.05). Conclusion:For Gehweiler type IIIb atlas fracture, both techniques can attain atlas fracture union and atlantoaxial posterior arch bone fusion, but the posterior atlas uniaxial screw instrumentation and fusion is superior in reduction of atlas fracture displacement and lateral mass separation, neck pain relief and functional improvement.

Surgical timing for acute traumatic central cord syndrome / 中华创伤骨科杂志

Objective:To investigate the effects of different surgical time points on the treatment efficacy of acute traumatic central cord syndrome (ATCCS).Methods:Retrospectively analyzed were the 84 ATCCS patients who had been treated at Department of Spinal Surgery, Henan Provincial People's Hospital from January 2013 to February 2021. According to the surgical timing, the patients were divided into 3 groups. In group A (surgery < 48 hours) of 16 cases, there were 11 males and 5 females, aged from 43 to 76 years; in group B (surgery within 3 to 7 days) of 41 cases, there were 31 males and 10 females, aged from 41 to 78 years; in group C (surgery within 8 to 14 days) of 27 cases, there were 15 males and 12 females, aged from 46 to 83 years. Anterior, posterior or combined anterior and posterior approaches were used according to their specific condition. The American Spinal Injury Association (ASIA) motor scores and Japanese Orthopaedic Association (JOA) scores at admission, 7 days and 12 months after operation, postoperative ICU duration, and complications were compared among the 3 groups.Results:There were no significant differences in the preoperative general information or surgical approaches among the 3 groups, showing they were comparable ( P> 0.05). In all patients, the ASIA motor scores and JOA scores at 7 days and 12 months after operation were significantly better than those at admission, and the ASIA motor scores and JOA scores at 12 months after operation were significantly better than those at 7 days after operation ( P<0.01). There was no significant difference in the ASIA motor score or JOA score between the 3 groups at 7 days or 12 months after operation ( P>0.05). The postoperative ICU duration in group A was 42 (26, 61) h, significantly longer than 23 (16, 35) h in group B and 24 (14, 38) h in group C ( P<0.05). There were no deaths in the 84 patients; there was no significant difference in the overall incidence of serious complications or in that of general complications among the 3 groups ( P>0.05). Conclusions:Surgery is safe and effective for ATCCS. However, decompression surgery within 2 weeks may achieve better outcomes.

Postoperative paravertebral muscle degeneration and its correlations with health related quality of life in patients undergoing minimally invasive surgery-transforaminal lumbar interbody fusion / 中华创伤骨科杂志

Objective:To analyze the postoperative paravertebral muscle degeneration and its correlations with health related quality of life (HRQL) in patients undergoing minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF).Methods:The clinical data of the 50 patients were retrospectively analyzed who had undergone single-segmental MIS-TLIF at Department of Spinal Cord Surgery, The People's Hospital of Henan Province from January 2019 to December 2021. The relative volumes of lumbar posterior muscle (LM), the relative volumes of the psoas major (PM), and the rates of fatty degeneration (FD) of the fused segment and its adjacent segments were compared respectively between preoperation, 6 and 12 months postoperation. The correlations were analyzed between the HRQL scores [visual analog scale (VAS) for pain and Oswestry disability index (ODI)] and the relative LM volumes, the relative PM volumes, and the FD rates of the fused segment and its adjacent segments at 12 months postoperation.Results:Compared with the preoperative values, the relative LM volumes and the relative PM volumes of the fused segment and its adjacent segments at 6 and 12 months postoperation were significantly reduced while the FD rates significantly increased. However, the FD rate of the fused segment at 12 months postoperation (20.6% ± 6.1%) was significantly lower than that at 6 months postoperation (29.7% ± 8.2%) ( P < 0.05). The VAS score was strongly negatively or positively correlated with the relative LM volume ( r = -0.819, P < 0.001) and the FD rate ( r = 0.86, P < 0.001) of the fused segment, and moderately negatively correlated with the relative PM volume ( r = -0.435, P = 0.016). The ODI index was moderately negatively correlated with the relative LM volume ( r = -0.512, P = 0.004) and the relative PM volume ( r = -0.402, P = 0.020) of the fused segment, but moderately positively correlated with the FD rate of the fused segment ( r = 0.565, P = 0.001). There was a moderate negative correlation between the ODI index and the relative LM volume of the adjacent segments ( r = -0.478, P = 0.012). Conclusions:After MIS-TLIF, the volume of the paravertebral muscles decreases and the dorsal muscles develop fatty degeneration. The improvement of LM fatty degeneration may be observed by 12-month follow-up in the fused segment, but not in the adjacent segments. The LM volume and the FD rate of the fused segment are the most closely related to the postoperative HRQL.

The effect of in-out-in axis pedicle screws on the vertebral artery in the posterior occipitocervical surgery / 中华创伤骨科杂志

Objective:To observe the effect of insertion of in-out-in axis pedicle screws on the vertebral artery in the posterior occipitocervical surgery for atlantoaxial subluxation or instability.Methods:The data of 52 patients with atlantoaxial dislocation or instability were analyzed who had been treated by internal fixation with in-out-in pedicle screws in the posterior occipitocervical surgery from January 2015 to February 2021 at Department of Spine and Spinal Cord Surgery, Henan Provincial People's Hospital. There were 30 males and 22 females, aged from 17 to 65 years (mean, 41.2 years). There were 26 cases of unilateral vertebral artery high-riding, 3 cases of bilateral high-riding, 19 cases of unilateral narrow pedicle due to C2 and C3 fusion, and 4 cases of bilateral narrow pedicles. X-ray, CTA and MRI were performed before and 3 days after surgery. The patients' clinical symptoms were recorded. CTA was used to measure the diameter of the vertebral artery at the transverse foramina of C 2 and C 3 and to observe the effect of in-out-in screws on the morphology of the vertebral artery. X-ray and CT examinations were performed at 6 months after surgery to observe the bone fusion. Results:The surgery went on uneventfully in all the patients. In the 9 cases undergoing anterior and posterior surgery, the operation time averaged 271.2 min (from 213 to 352 min) and the bleeding volume 471.5 mL (from 230 to 830 mL). In the 43 cases undergoing posterior surgery, the operation time averaged 171.6 min (from 131 to 226 min) and the bleeding volume 395.9 mL (from 170 to 660 mL). There was no such complication as spinal or vascular injury. The CTA reexamination 3 days after surgery showed that the diameter of the vertebral artery was (2.92±0.55) mm and (3.04±0.54) mm, respectively at the cervical 2 and 3 transverse foramina, showing no significant change compared with the preoperative values [(2.91±0.68) mm and (3.11±0.50) mm] ( P>0.05) and that the vertebral artery was displaced externally and inferiorly in 21 cases. Follow-ups for all patients ranged from 7 to 24 months (mean, 11 months). At 6 months after surgery, bone fusion was observed by imaging and no breakage or displacement of the internal fixation was observed. Conclusion:The in-out-in pedicle screws in the posterior occipitocervical surgery may have little impact on the vertebral artery, leading to reliable clinical outcomes.

Application of medial "in-out-in" axis pedicle screw in upper cervical spine surgery / 中华神经医学杂志

Objective:To investigate the clinical efficacy of medial "in-out-in" axial pedicle screw in the treatment of atlantoaxial dislocation or instability during upper cervical spine surgery.Methods:Thirty-one patients with atlantoaxial dislocation or instability, admitted to our hospital from January 2017 to January 2020, were chosen in our study; 17 patients were with unilateral stenosis at the pedicle of vertebral arch, including 15 with dominant vertebral artery and 2 with unilateral vertebral artery, and medial "in-out-in" axis pedicle screw was placed on this side and conventionally axis pedicle screw was implanted on the other side; 14 patients were with bilateral stenosis at the pedicle of vertebral arch, including 13 with dominant vertebral artery and one with unilateral vertebral artery, and the medial "in-out-in" axial pedicle screw weas placed on the side of the dominant or unilateral vertebral artery and the medial or lateral "in-out-in" axial pedicle screw was inserted on the other side. X-ray, CT, and MRI were performed before, and 5 d and 3, 6, and 12 months after surgery to observe the fusion of bone grafts. Scores of visual analogue scale (VAS) and Japanese Orthopedic Association (JOA) were compared before surgery, and 7 d, and 3 and 6 months after surgery, and during the last follow-up to evaluate the clinical efficacy of these patients.Results:The surgical time was (164.2±28.3) min (136-224 min); the intraoperative blood loss was (283.6±74.5) mL (180-560 mL), and there was no spinal cord vascular injury or other serious complications. Two patients had cerebrospinal fluid leakage after surgery, the drainage tube was pulled out after a delay of 8 d, and the wounds healed at one stage. The distal end of the screw did not enter the vertebral body of one patient during the surgery, and the screw was inserted again after the distal end was tapped to enter the vertebral body. Follow up for 9-25 months was performed in all patients, with an average of 13 months. The imaging examination showed no loosening of internal fixation, fracture, or fusion of bone grafts at 6 months after surgery. Seven d, and 3 and 6 months after surgery and during the last follow-up, the VAS scores were 1.56±0.98, 1.13±1.01, 1.11±0.86 and 1.09±0.91, respectively, which were significantly lower than those before surgery (3.52±1.97, P<0.05); the JOA scores were 11.8±2.1, 12.3±1.9, 12.5±2.2, and 12.6±1.8, respectively, which were significantly improved as compared with those before surgery (8.2±1.7, P<0.05). Conclusion:The use of medial "in-out-in" axial pedicle screw posterior fusion and internal fixation has a positive clinical effect in treatment of atlantoaxial dislocation or instability during upper cervical spine surgery.

Cervical anterior approach atlantodentoplasty for the treatment of irreducible atlantoaxial dislocation complicated with bony abnormality of atlanto-dental joint / 中华骨科杂志

Objective:To evaluate the clinical efficacy of cervical anterior approach atlantodentoplasty for the treatment of irreducible atlantoaxial dislocation complicated with bony abnormality of atlanto-dental joint.Methods:Retrospective analysis was conducted to study the clinical data of 31 patients with irreducible atlantoaxial dislocation complicated with bony abnormality of atlanto-dental joint, including 7 males and 24 females; age ranged from 23 to 74 years, with an average of 49.0±12.0 years. All patients underwent cervical anterior approach soft tissue release, atlantodentoplasty and one-stage posterior occipito-cervical fixation and fusion. Twenty-one patients with atlantodental osteoarthritis underwent simplex atlantodental osteophyte resection, 5 patients with anterior tubercle hypertrophy of atlas and 5 patients with anterior tubercle hypertrophy of atlas and atlantodental osteoarthritis underwent atlantodental osteophyte resection and partial anterior tubercle resection. The operation time and blood loss of anterior procedure and total procedure were recorded. The anterior tubercle thickness (ATT), the atlantodental interval (ADI)were recorded before and 1 week after the operation. The available space of the cord (SAC), clivus-canal angle (CCA), cervicomedullaryangle (CMA), and the Japanese Orthopaedic Association (JOA) scores were recorded before the operation, 1 week, 3 months and 12 months after the operation, and at the last follow-up. The JOA improvement rate at the last follow-up was calculated, the time of postoperative bone graft fusion was recorded, and the complications were observed.Results:All patients were followed up for 12-60 months, with an average of 34.5±13.8 months. The operation time of anterior cervical atlantodentoplasty was 120.9±15.9 min, and the overall operation time was 315.1±31.4 min; The blood loss of anterior procedure was 101.2±31.2 ml, and that of overall procedure was 372.7±56.0 ml. The one week postoperative ATT (7.4±1.6 mm) of patients with anterior tubercle partial resection of atlas was lower than that before operation 10.8±1.5 mm ( t=4.94, P=0.001). The one week postoperative ADI 0.9±1.2 mm decreased compared with the preoperative ADI 8.3±2.2 mm ( t=17.91, P<0.001). The preoperative SAC was 10.4±2.8 mm, which increased to 19.2±3.6 mm one week after operation and 19.4±3.7 mm ( F=41.31, P<0.001) at last follow-up. The preoperative CCA was 119.4°±17.9°, which increased to 142.6°±13.0° one week after operation and 141.6°±12.2° ( F=35.86, P<0.001) at last follow-up. The preoperative CMA was 121.7°±14.1°, which increased to 148.9°±9.4° one week after operation and 149.4°±9.0° ( F=52.07, P<0.001) at last follow-up. The preoperative JOA score was 12.0±2.6, which was 14.3±1.3 one week after operation and 15.9±1.0 ( F=23.81, P<0.001) at last follow-up. JOA improvement rate was 78.9%±17.1%, while 23 cases were excellent (74.2%), 8 cases were good (25.8%), and the excellent and good rate was 100%; Thd fusion time of grafted bone was 5.7±1.5 months with the fusion rate of 100%; There were 12 patients with dysphagia after operation, all of which relieved spontaneously 5-10 days after operation; There were 3 cases of irritating choking after drinking or eating, and 2 cases were gradually alleviated 3-5 days after operation. One case was complicated with aspiration pneumonia due to stubborn choking, which gradually alleviated after 1 month of nasal feeding. No hardware failure or reduction loss, no serious complications such as esophageal injury, cerebrospinal fluid leakage, incision infection or vertebral artery injury occurred. Conclusion:Cervical anterior approach atlantodentoplasty for the treatment of irreducible atlantoaxial dislocation complicated with bony abnormality of atlanto-dental joint can anatomically reduce the atlantoaxial joint, and the clinical effect is satisfactory.

Clinical manifestations and management of infectious spondylitis following vertebroplasty or kyphoplasty / 中华创伤骨科杂志

Objective:To report the clinical manifestations and management of infectious spondylitis following vertebroplasty or kyphoplasty.Methods:Six cases of infectious spondylitis following vertebroplasty or kyphoplasty were analyzed retrospectively which had been treated at Department of Spinal Surgery, Henan Provincial People's Hospital between January 2014 and June 2019. They were 2 males and 4 females, aged from 64 to 81 years. Their visual analogue scale (VAS) scores ranged from 6 to 8 points; their spinal cord function was graded as C in 2 cases and E in 4 according to the American Spinal Cord Injury Association (ASIA) grading. All the patients were treated by sub-total resection of the infected vertebra, long segmental pedicle screw fixation and corresponding antibiotics therapy. The therapeutic efficacy was assessed by the inflammation indexes, imaging examinations and clinical manifestations.Results:The 6 patients were followed up for 12 to 42 months(mean 20.4 months). Their operation time ranged from 295 to 455 min (mean 370.8 min) and blood loss from 760 to 2, 250 mL (mean 1 536.7 mL). There were no such serious complications as dural tear, worsening of neurological symptoms or death. The last follow-up revealed normal body temperature and fine incision healing in all patients. Their inflammatory indexes returned to normal. Imaging examinations at the last follow-up showed no displacement of internal implants, no screw loosening or breakage of screws or rods, good bony fusion at the grafting site, and no inflammatory signals from the infected vertebra. At the last follow-up, their VAS for back pain ranged from 2 to 4 points, the ASIA grading was improved from C to D in 2 patients and maintained E in 4. Eventually, 4 patients recovered independent normal walking but 2 required a walker.Conclusions:Infectious spondylitis following vertebroplasty or kyphoplasty can lead to back pain and neurological dysfunction. Sub-total resection of the infected vertebra, long segmental pedicle screw fixation and corresponding antibiotics therapy can result in fine therapeutic outcomes.

Value of 3D printing combined with intraoperative electrophysiological monitoring in excision of cerebellopontine angle tumor / 中华神经医学杂志

Objective:To investigate the value of 3D printing combined with intraoperative electrophysiological monitoring in excision of cerebellopontine angle (CPA) tumor.Methods:The clinical data of 43 patients with CPA tumor, admitted to our hospital from October 2016 to October 2019, were collected and analyzed. These patients were voluntarily divided into ordinary group ( n=27) and optimized group ( n=16). Patients in the ordinary group were operated microscopically, and those in the optimized group were operated microscopically with 3D printing combined with intraoperative electrophysiological monitoring. The degrees of tumor resection and neurological functions (facial and auditory nerve function, swallowing function, limb activity) improvements were compared between the two groups. Results:The degrees of tumor resection of the optimized group were significantly higher than those of the ordinary group ( P<0.05), and the improvement of facial and auditory nerve function in the optimized group was significantly better than that in the ordinary group ( P<0.05). There was no significant difference in improvements of swallowing function and limb activity between the two groups ( P>0.05). Conclusion:The 3D printing combined with intraoperative electrophysiological monitoring can improve the resection rate of CPA tumor, protect the facial auditory nerve, and improve the quality of life of patients after surgery.

Comparison of prefabricated path with an awl for guiding pin and traditional screw placement in anterior odontoid screw fixation / 中华创伤杂志

Objective:To compare the application value of prefabricated path with an awl for guiding pin and traditional screw placement during anterior odontoid screw fixation.Methods:A retrospective case-control study was conducted to analyze 35 patients with fresh odontoid fractures treated from January 2010 to August 2017 in Henan Provincial People's Hospital, including 25 males and 10 females with age range of 19-55 years (mean, 36.9 years). The preoperative odontoid fractures were classified into type IIA in 15 patients, type IIB in 20 patients according to Anderson and D'Alonzo classification. Among them, 16 patients in Group A were treated with prefabricated path by an awl for guiding pin during anterior odontoid screw fixation, and 19 patients in Group B were implanted screws according to traditional experience in anterior odontoid screw fixation. Operation time, intraoperative fluoroscopy time, success rate of first-time guiding pin implantation, intraoperative blood loss, fracture healing outcomes and American Spinal Injury Association (ASIA) grade at the latest follow-up were collected and compared between the two groups.Results:All patients were followed up for 13-20 months [(16.8±1.5)months]. Two groups had significant differences in operation time [Group A: (73.5±12.9)minutes; Group B: (82.6±13.6)minutes], intraoperative fluoroscopy time [Group A: (3.1±0.6)minutes, Group B: (7.0±0.9)minutes], and success rate of first-time guiding pin implantation (Group A: 94%, Group B: 58%) ( P<0.05), but not in intraoperative blood loss [Group A: (129.4±40.6)ml; Group B: (135.8±38.4)ml] and fracture healing rate (Group A: 94%, Group B: 95%) and ASIA grade at the latest follow-up (Group A: grade C in 1 patient, grade D in 3, grade E in 12; Group B: grade C in 2 patients, grade D in 2, grade E in 15) ( P>0.05). All patients were successfully operated without occurrence of cerebrospinal fluid leakage, neurovascular injury or incision infection. Conclusions:Prefabricated path with an awl for guiding pin during anterior odontoid screw fixation is superior to traditional experience, which can reduce operation time, intraoperative fluoroscopy time and improve the success rate of first-time guiding pin implantation. Meanwhile, there is no effect on intraoperative blood loss or fracture healing outcomes.

Safety and efficacy of balloon pulmonary angioplasty in the treatment of chronic thromboembolic pulmonary hypertension / 中华放射学杂志

Objective:To evaluate the safety and efficacy of balloon pulmonary angioplasty (BPA) in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH).Methods:A study was conducted on 25 patients consisting of 10 males and 15 females with CTEPH who received BPA treatment from February 2017 to May 2018 in Beijing Chaoyang Hospital, Capital Medical University. The changes of brain natriuretic peptide (BNP), mean pulmonary artery pressure (mPAP), tricuspid annulus systolic plane excursion (TAPSE), six-minute walking test (6WMD), right ventricular basement diameter and WHO cardiac function grading were compared before and after treatment with BPA using paired t test. Results:Twenty-five patients received a total of 50 BPA treatments, and among them, 12 patients received two or more times. The mPAP decreased from (50.4±9.9) mmHg (1 mmHg=0.133 kPa) to (39.9±10.6) mmHg before and after operation, and the difference was statistically significant ( t=9.7, P<0.001); BNP decreased from (513.5±357.3) pg/ml to (106.3±137.53) pg/ml, and the difference was significant ( t=3.2, P=0.006); TAPSE increased from (16.2±2.8) mm to (18.0±2.4) mm, and the difference was statistically significant ( t=-5.7, P=0.002); the right ventricular base diameter decreased from (45.9±6.9) mm to (41.2±7.3) mm, and the difference was statistically significant ( t=5.6, P<0.001); 6WMD increased from (371.1±86.8) m to (467.7±76.1) m, with statistical significance ( t=-6.4, P<0.001); WHO cardiac function grading was improved from (2.4±0.7) to (1.2±0.4) after surgery, and the difference was statistically significant ( t=2.8, P=0.021). Pulmonary artery injury occurred in 3 patients and 2 patients had hemoptysis.The hemoptysis was stopped after arterial embolization. No other complications such as pulmonary edema occurred. Conclusion:BPA may improve clinical status and hemodynamics of patients with CTEPH, which offers an alternative approach of treatment in patients with inoperable CTEPH.

Finite element analysis of the influence of new anterior cervical spine memory compression fixator on adjacent segments / 中华骨科杂志

Objective:To compare the effect of the new anterior cervical spine memory compression fixation device (GYZ memory alloy plate) and traditional titanium plate on the range of motion (ROM) and stress of the adjacent segment after anterior cervical discectomy and fusion.Methods:An adult male volunteer was recruited for a fee. After excluding cervical malformations, fractures, infections and other diseases, C 3-C 7 thin-layer CT scans were performed. Import the scanned data into the finite element modeling software to establish the finite element model of the physiological group and verify itseffectiveness. After C 5,6 discectomy, the intervertebral fusion device was inserted, and the anterior fixation was assisted by a conventional titanium plate or a new type of fixator. Thus, the finite element model of the traditional titanium plate group and the new fixer group was established. The three models were imported into the finite element analysis software ANSYS 16.0, and a vertical downward axial load of 73.6 N was loaded to simulate the head weight and the torque of 1.0 N·m to simulate the cervical spine flexion, extension, left lateral bending, right lateral bending, left rotation and right rotation.Compare the changes of intervertebral disc ROM and stress in adjacent segments of physiological group, traditional titanium plate group and new type fixator group. Results:The intervertebral disc ROM under six conditions was basically similar to the results of previous studies, and the model was effective. In the adjacent segment C 4,5, the three groups of activities in the flexion, extension, left lateral bending, right lateral bending, left rotation and right rotation conditions were: physiological group 3.9°, 4.2°, 3.7°, 3.7°, 2.2° and 2.2°, traditional titanium plate group 4.6°, 4.7°, 4.3°, 4.4°, 3.3° and 3.1°, and new fixture group 4.4°, 4.3°, 4.0°, 4.2°, 2.8° and 2.7°. The maximum stresses of the intervertebral discs under three different working conditions were: physiological group 1.81, 1.60, 3.99, 2.06, 3.63 and 3.41 MPa, traditional titanium plate group 1.86, 1.67, 4.21, 2.16, 3.82 and 3.63 MPa, and new fixture group 1.84, 1.64, 4.17, 2.14, 3.78 and 3.58 MPa. In the adjacent segment C 6,7, the activities of the three groups in six working conditions were: physiological group 3.1°, 3.2°, 2.5°, 2.5°, 1.2° and 1.3°, traditional titanium plate group 4.2°, 3.7°, 3.4°, 3.0°, 2.1° and 2.2°, and new fixture group 3.5°, 3.3°, 2.5°, 2.7°, 1.8° and 1.9°.The maximum stress of the intervertebral disc under three different working conditions was: physiological group 0.45, 0.66, 1.12, 0.85, 0.84 and 0.82 MPa, traditional titanium plate group 0.62, 0.93, 1.55, 1.24, 1.44 and 1.27 MPa, and new fixture group 0.61, 0.92, 1.54, 1.22, 1.07 and 1.24 MPa. The ROM and disc pressure of adjacent segments in the conventional titanium plate group were higher than those of the new fixator group. Conclusion:Compared with the traditional titanium plate, the new type of anterior cervical memory compression fixator has less effect on the ROM and stress of adjacent segments, which may slow down the process of adjacent segments degeneration to a certain extent.