[Efficacy of polyetheretherketone rod hybrid surgery in preventing proximal junctional failure after adult spinal deformity surgery].

Objective: To investigate the clinical outcome and preventive effect of polyetheretherketone(PEEK) rod hybrid surgery on proximal junction failure(PJF) after long-segment fusion of adult spinal deformity. Methods: A retrospective study was conducted to analyze patients with degenerative scoliosis/kyphosis who underwent long-segment decompression and fusion surgery at Department of Orthopedics, Peking University First Hospital from January 2017 to December 2021. A total of 75 patients were included in the study, including 14 males and 61 females, aged (67.2±6.8)years (range:55 to 84 years). According to the operation method chosen by the patients, the patients were divided into PEEK rod hybrid group (20 cases) and traditional titanium rod group (55 cases). The general information of the patients was collected, and the coronal and sagittal parameters of the spine were measured before operation, at 1 month after operation, and at the last follow-up. The clinical effect of surgery was judged by the visual analogue scale (VAS) and Oswestry disability index (ODI). Whether proximal junctional kyphosis (PJK) and PJF occurred during the follow-up and the time of occurrence were recorded. Comparisons between groups were performed using independent sample t test, Mann-Whitney U test, χ2 test and Fisher's exact probability method. The data before and after surgery in the same group were compared using the paired sample t test and the Wilcoxon test. Results: There were no significant differences in age, gender, body mass index, bone mineral density, distal instrumented vertebrae, surgical segments, osteotomy method, operation time, and intraoperative bleeding between the two groups (all P>0.05). The follow-up time of the PEEK rod group was shorter(M(IQR)16.5(4.8) vs. 25.0(12.0),Z=-4.230,P<0.01). There were no significant differences in coronal, sagittal parameters, VAS and ODI between the two groups before operation (all P>0.05). Postoperative coronal Cobb angle, pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, thoracic kyphosis, sagittal vertical axis (SVA), VAS and ODI were significantly improved in both groups(all P<0.05). At the last follow-up, the SVA of the PEEK rod hybrid group was(3.74±2.40)cm, which was significantly lower than that of the titanium rod group (6.28±4.06)cm (t'=-3.318, P=0.002). At the last follow-up, the ODI of the PEEK rod hybrid group was 30.7±6.1, significantly better than the titanium rod group 39.3±17.2(t=-3.203, P=0.046). PJK occurred in 2 patients (10.0%) in the PEEK rod hybrid group, and no PJF phenomenon was observed. In the titanium rod group, 18 patients (32.7%) developed PJK, and 11 patients (20.0%) developed PJF. There was a statistically significant difference in the incidence of PJF between the PEEK rod hybrid group and the titanium rod group (P=0.031). Conclusions: PEEK rod hybrid surgery can achieve good clinical results in the treatment of adult spinal deformities. Compared with traditional titanium rod surgery, it can significantly reduce the incidence of postoperative PJF and improve the clinical function of patients.

[Clinical efficacy of short-term halo-pelvic traction combined with surgery in the treatment of severe spinal deformities].

OBJECTIVE: To evaluate the clinical efficacy of short-term halo-pelvic traction (HPT) combined with surgery in the treatment of severe spinal deformities. METHODS: In the study, 24 patients diagnosed as severe spinal deformity accepted the treatment of one-stage short-term HPT and two-stage surgery from January 2015 to May 2018 in our orthopedics department. 24 cases (9 males and 15 females) were retrospectively reviewed. The average age of the cohort was (28.8±10.0) years (12－48 years). The height, scoliosis angle, kyphosis angle, the height difference of shoulders, the height difference of crista iliaca, C7PL-CSVL and the perpendicular distance of S1 and the convex point of the patients were assessed at pre-traction, post-traction and post-surgery. The paired t test was used to analyze the difference among pre-traction, post-traction and post-surgery. RESULTS: The average traction time of 24 cases was (2.5±1.1) weeks (1－5 weeks). The height of pre-traction and post-traction were (141.7±11.2) cm (116-167 cm) and (154.1±9.5) cm (136－176 cm) respectively, showing significant difference (P < 0.05), and the increased height was (12.4±4.6) cm (4－20 cm). The average scoliosis angle before traction was 104.9°±35.0°(25°ï¼158°), and it was significantly decreased in post-traction[64.8°±21.0°(19°ï¼92°)] and post-surgery[39.3°±17.0° (10°-70°)] (P < 0.05). The traction's coronal correction rate was 37.2%±10.9% (11.9%－51.2%) and the total coronal correction rate was 61.9%±12.6%(26.9%-79.0%). The average kyphosis angle before traction was 106.9°±29.2°(54°ï¼163°), and it was significantly decreased in post-traction [63.1°±17.1°(32°ï¼92°)] and post-surgery [39.0°±16.8°(10°ï¼68°)](P < 0.05). The traction's sagittal correction rate was 40.0%±10.7%(16.7%－55.5%) and the total sagittal correction rate was 64.3%±10.7%(49.0%－87.5%). The average C7PL-CSVL before traction was (3.2±2.8) cm, and it was significantly decreased in post-traction [(2.5±2.5) cm] (P < 0.05). The perpendicular distance of S1 and the convex point before traction was (10.5±4.8) cm, and it was significantly decreased in post-traction[(8.4±3.5) cm] (P < 0.05). CONCLUSION: The one-stage short-term HPT combined with two-stage surgery is a safe and effective procedure for severe spinal deformities. The clinical efficacy is satisfactory and the complication is relatively less.

[Anterior cervical discectomy and fusion to treat cervical spondylosis with sympathetic symptoms].

OBJECTIVE: To investigate the clinical effectiveness of polytheretherketone (PEEK) cages assisted anterior cervical discetomy and fusion (ACDF) to treat cervical spondylosis with sympathetic symptoms. METHODS: Retrospective analysis was undertaken for 39 patients who were diagnosed as cervical spondylosis with sympathetic symptoms and underwent ACDF with PEEK cages. Radiographs obtained before surgery, after surgery, and at the final follow-up were assessed for quality of fusion. The following criteria were used for assessing radiographic success of fusion: (1) endplate obliterated with no lucent lines; (2) obliteration of disc space by bony trabeculae; (3) less than 2°of intervertebral motion or 2 mm of motion between the spinous processes at the operated segment on flexion-extension lateral radiographs. The sympathetic symptoms including vertigo, headache, tinnitus, nausea and vomiting, heart throb, hypomnesia and gastroenterological discomfort were scored by 20-point system preoperatively, 2 months postoperatively and at the final follow-up. The recovery rate and clinical satisfaction rate were also evaluated. Surgical complications were also assessed. RESULTS: They were followed up for at least one year. The mean follow-up was 15.6 months. Radiographs of the cervical spine at the last follow-up revealed a solid fusion with no signs of a pseudoarthrosis in 36 cases. In two patients delayed union and bony fusion were achieved at the end of 9 and 11 months. Pseudoarthosis was found in 1 case but the patient had no symptoms. The score of sympathetic symptoms before surgery, 2 months after surgery and at the final follow-up were 8.4±1.0,2.2±0.3,and 2.4±0.3, respectively. There were 22 excellent cases, 15 good cases, 1 fair case and 1 bad case in terms of RR. Good to excellent results were attained in 95% of theses patients. The sympathetic symptoms improved in all the patients and the score was significantly improved after surgery. There was one patient who had cerebral spinal fluid leakage but he recovered one week after surgery. Two patients felt a mild swallowing discomfort, but it disappeared within one month after surgery. Subcutaneous hematoma occurred in one patient due to obstructed drainage. It was cleared two days after surgery. CONCLUSION: Cervical spondylosis patients with sympathetic symptoms may be managed successfully with ACDF using PEEK cages. Successful clinical results regarding symptom improvement and general satisfaction with the surgical procedure depend not only on obtaining successful decompression and radiographic fusion but also on patient selection.

[Efficacy of transforaminal endoscopic nerve root decompression in the treatment of degenerative lumbar spinal stenosis].

OBJECTIVE: To evaluate the feasibility of transforaminal endoscopic nerve root decompression for degenerative lumbar spinal stenosis (DLSS). METHODS: From July 2011 to April 2016, 96 cases of single segment DLSS were involved. All the patients had unilateral lower extremity neurological symptoms, signs, neurogenic intermittent claudication of less than 500 m. Imaging examinations (CT or MRI) or diagnostic nerve root block confirmed single segment degeneration. The mean age was (71.6±5.4) years, male: 55 cases, female: 41 cases. Their intraoperative blood loss, operation time, complications, ambulation time and discharge time were recorded. Leg pain VAS, ODI were used to evaluate the pain and lumbar function of the patients. The clinical efficacy was evaluated by Nakai evaluation. RESULTS: All the patients were performed endoscopic decompression of the lateral recess and nerve root by removing the ventral part of the superior facet joint, the ligamentum flavum and the intervertebral disc. The decompression range was from the inferior edge of the upper pedicle to the superior edge of the lower pedicle. The nerve root was detected to have no compression and the pulse of nerve root returned to normal. The patient got ambulant on the operation day and discharged if he had no discomfort symptom. In the study, 68 cases got follow up. The mean follow-up time was 12.1 months (6-63 months). The VAS at different follow-up time points was improved relative to the baseline, and the difference was statistically significant (F=491.60, P<0.001). The ODI at different follow-up time points was improved relative to the baseline, and the difference was statistically significant (F=189.91, P<0.001). The excellent and good rates of Nakai evaluation were 79.4% (excellent in 42 cases, good in 12 cases, fair in 10 cases and poor in 4 cases). The mean intraoperative blood loss was (49.29±11.86) mL. The mean operation time was (92.46±21.34) min. The mean ambulation time was 1.8 h. The mean discharge time was 2.3 days. Postoperative epidural hematoma was found in 1 case. Foot drop was found in 1 case. Second stage open surgery was performed in 6 cases. CONCLUSION: We can apply transforaminal endoscopic decompression for the patients of lumbar spinal stenosis who have unilateral nerve root irritation. Patients with transforaminal endoscopic decompression can get less surgical trauma, quick recovery and obtain good short-term outcome.

[Association of peripheral and central systolic blood pressure with urinary albumin-to-creatinine ratio in a community-based population in Beijing].

Objective: The aim of this study was to investigate the association of both peripheral and central systolic blood pressure (pSBP and cSBP) with urinary albumin-to-creatinine ratio (UACR) in a community-based population in Beijing. Methods: A total of 3 479 Chinese subjects with questionnaire, UACR, pSBP, and cSBP data available were included from an atherosclerosis cohort of Peking University First Hospital in Shijingshan District, Beijing followed up from April to July in 2014. Multivariate linear regression analyses were used to examine the effect of pSBP and cSBP on lnUACR, and further tests for interactions were performed according to associated covariates. Results: Subjects were (59.0±8.6) years old, 36.2% (n=1 260) were male, 46.0% (n=1 595) had hypertension, and 20.2% (n=700) had diabetes. The pSBP and cSBP was (126.9 ± 16.4) mmHg (1 mmHg=0.133 kPa), and (136.3 ± 16.7) mmHg, respectively. P(50) (P(25)-P(75)) of UACR was 6.2 (4.2-11.1) mg/g. Both pSBP and cSBP were linearly associated with lnUACR adjusted for age, sex, body mass index, smoking status, drinking status, triglyceride, HDL-C, LDL-C, fasting glucose, creatinine, history of cardiovascular disease, antihypertensive and hypoglycemic agents (every 10 mmHg increase for pSBP: ß=0.12, 95%CI: 0.10-0.15, P<0.001; for cSBP: ß=0.11, 95%CI: 0.09-0.14, P< 0.001). The relationships were remained in subgroups such as non-hypertension group, non-diabetes group, normal UACR group, and 3-combination group (every 10 mmHg increase for pSBP: ß=0.09, 95%CI: 0.05-0.13; ß=0.12, 95%CI: 0.10-0.15; ß=0.07, 95%CI: 0.06-0.09; ß=0.08, 95%CI: 0.05-0.12. for cSBP: ß=0.07, 95%CI: 0.04-0.11; ß=0.11, 95%CI: 0.08-0.13; ß=0.07, 95%CI: 0.05-0.08; ß=0.06, 95%CI: 0.03-0.09, all P<0.001). Furthermore, analyses for interaction found that both pSBP and cSBP were more strongly associated with lnUACR in males, current smokers and subjects with high serum creatinine level (≥87 µmol/L) when compared with females, non-current smokers and subjects with low serum creatinine level (<87 µmol/L), respectively (all P for interaction<0.05). Conclusion: The results showed that both pSBP and cSBP were independently associated with UACR in this Chinese community-based population even in low risk population suggesting well-controlled both peripheral and central blood pressure may reduce urinary albumin. Males, current smokers and subjects with higher serum creatinine should pay more attention to the impacts of pSBP and cSBP on UACR.

[Distribution and influencing factors of lipoprotein (a) levels in non-arteriosclerotic cardiovascular disease population in China].

Objective: To describe the distribution of lipoprotein (a) [Lp(a)] levels in non-arteriosclerotic cardiovascular disease (ASCVD) population in China and explore its influencing factors. Methods: This study was based on a nested case-control study in the CKB study measured plasma biomarkers. Lp(a) levels was measured using a polyclonal antibody-based turbidimetric assay certified by the reference laboratory and ≥75.0 nmol/L defined as high Lp(a). Multiple logistic regression model was used to examine the factors related to Lp(a) levels. Results: Among the 5 870 non-ASCVD population included in the analysis, Lp(a) levels showed a right-skewed distribution, with a M (Q1, Q3) of 17.5 (8.8, 43.5) nmol/L. The multiple logistic regression analysis found that female was associated with high Lp(a) (OR=1.23, 95%CI: 1.05-1.43). The risk of increased Lp(a) levels in subjects with abdominal obesity was significantly reduced (OR=0.68, 95%CI: 0.52-0.89). As TC, LDL-C, apolipoprotein A1(Apo A1), and apolipoprotein B(Apo B) levels increased, the risk of high Lp(a) increased, with OR (95%CI) for each elevated group was 2.40 (1.76-3.24), 2.68 (1.36-4.93), 1.29 (1.03-1.61), and 1.65 (1.27-2.13), respectively. The risk of high Lp(a) was reduced in the HDL-C lowering group with an OR (95%CI) of 0.76 (0.61-0.94). In contrast, an increase in TG levels and the ratio of Apo A1/Apo B(Apo A1/B) was negatively correlated with the risk of high Lp(a), with OR (95%CI) of 0.73 (0.60-0.89) for elevated triglyceride group, and OR (95%CI) of 0.60 (0.50-0.72) for the Apo A1/B ratio increase group (linear trend test P≤0.001 except for Apo A1). However, no correlation was found between Lp(a) levels and lifestyle factors such as diet, smoking, and physical activity. Conclusions: Lp(a) levels were associated with sex and abdominal obesity, but less with lifestyle behaviors.

The clinical significance of carotid intima-media thickness in cardiovascular diseases: a survey in Beijing.

This study is to investigate the relationships between prevalent cardiovascular events (myocardial infarction, stroke and peripheral arterial disease) and carotid intima-media thickness (CIMT) in middle-aged and older adults; to assess which of the indexes, IMT in the common carotid artery (CCA), internal carotid artery (ICA) and carotid bifurcation (CB) separately or in combination, is a better correlate. IMT of the CCA, ICA and CB were measured with duplex ultrasound in 1058 individuals (aged between 37 and 86 years old) in a suburban community of Beijing. Histories of cardiovascular events as well as prevalent risk factors were obtained. CIMT were compared between groups with and without cardiovascular events. Associations of cardiovascular events with IMT measurements in CCA, CB and ICA were ascertained. The group with cardiovascular events had higher mean CIMT (0.74 (0.60-0.98) mm vs 0.65 (0.54-0.80) mm, P=0.000) and higher abnormal CIMT proportion (77.20 vs 64.45%, P=0.000). The odds ratio (OR) for myocardial infarction was 1.74 (P=0.010), for stroke 1.98 (P=0.001) and for peripheral arterial disease 1.80 (P=0.072) in abnormal CIMT. However, after adjustment of traditional risk factors, the correlations disappeared, implying that CIMT may act via other risk factors. After adjustment of age, mean CIMT correlated best with total cardiovascular events (OR: 4.39 (2.39-8.04), P=0.000) and stroke (OR: 4.98 (2.55-9.71), P=0.000) separately; mean posterior CIMT correlated with myocardial infarction best (OR: 2.97 (1.68-5.24), P=0.000). CIMT may act as an intermediate point for cardiovascular diseases. Combined CIMT might be the best index associated with cardiovascular diseases.

Association of Carotid Intima-media Thickness and Atherosclerotic Plaque with Periodontal Status.

Studies have suggested an association between clinical/subclinical atherosclerosis and periodontal status. The purpose of this study was to investigate the association among maximal carotid intima-media thickness (cIMT), atherosclerotic plaque, and periodontal status in Chinese elderly patients. A cross-sectional study was conducted of 847 participants (age, 70.64 ± 9.03 yr) with ≥10 teeth. A questionnaire survey, routine biochemical tests, a periodontal examination, and maximal cIMT measurement were performed for each. Traditional risk factors for atherogenesis were considered in the statistical analysis. Mean plaque index, which reflects oral hygiene, was correlated with maximal cIMT and atherosclerotic plaque in the study sample overall (ß = 0.068, p < .001; OR = 2.051, p < .001) and in euglycemic participants (ß = 0.066, p = .008; odds ratio = 2.122, p = .009). In hyperglycemic participants, multiple linear regression analysis (p = .006) and multivariate logistic regression analysis (p = .025) revealed a linear and dose-dependent association between mean clinical attachment loss and maximal cIMT after adjustment for traditional risk factors. Each 1-mm increase in mean clinical attachment loss corresponded to a 0.018-mm increase in maximal cIMT. The risk of atherosclerotic plaque increased by 18.3% with each 1-mm increase in mean clinical attachment loss. Other indicators of periodontal exposure, including percentage of sites with attachment loss ≥ 3 to 5 mm (3%-5%), were also correlated with cIMT and atherosclerotic plaque in hyperglycemic patients. In this elderly population, a linear and dose-dependent association among mean clinical attachment loss, attachment loss 3% to 5%, maximal cIMT, and atherosclerotic plaque was verified in those with hyperglycemia. Poor oral hygiene was correlated with maximal cIMT and atherosclerotic plaque in all participants, including those with normal blood glucose.