Assessing the causal relationship between blood metabolites and low back pain: a Mendelian randomization study.

AIM: Low back pain (LBP) is one of the most common health problems worldwide. This study aimed to determine whether blood metabolites were causally linked to the risk of LBP. METHODS: Based on summary-level genome-wide association studies, we designed a Mendelian randomization (MR) study. Instrumental variables were selected for each blood metabolite with the following criteria: genome-wide significance levels of < 5e-8 and independent clumping (r2 < 0.001, distance < 10,000 kb). Inverse-variance weighting (IVW) was used as the primary statistical method. The weighted median (WM) method and MR-Egger regression were implemented to complement IVW. Subsequently, sensitivity analyses were conducted, including Cochran's Q test, MR-Egger intercept analysis, scatter plots, leave-one-out analysis, and funnel plots. RESULTS: IVW revealed that higher levels of lactate (odds ratio [OR] = 0.974, 95% confidence interval [CI] 0.953-0.995, P = 0.017), medium low-density lipoprotein triglycerides (OR = 0.990, 95% CI 0.983-0.997, P = 0.005) and albumin (OR = 0.985, 95% CI 0.973-0.998, P = 0.019) had a causal effect on decreased risk of LBP, whereas positive causality was detected between genetic predisposition to tyrosine and LBP (OR = 1.016, 95% CI 1.001-1.032, P = 0.043). Estimates from WM and MR-Egger were consistent with the direction of the IVW method. Additionally, there was no evidence of heterogeneity or pleiotropy in this study. CONCLUSION: This MR study demonstrated that four blood metabolites were causally related to LBP. It is possible to enhance the diagnosis of LBP, prognostic outcome predictions, and the personalization of therapy by analyzing novel signatures of metabolites.

Tetrahedral Framework Nuclear Acids Can Regulate Interleukin-17 Pathway to Alleviate Inflammation and Inhibit Heterotopic Ossification in Ankylosing Spondylitis.

Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease that leads to serious spinal deformity and ankylosis. Persistent inflammation and progressive ankylosis lead to loss of spinal flexibility in patients with AS. Tetrahedral framework nucleic acids (tFNAs) have emerged as a one kind of nanomaterial composed of four specially designed complementary DNA single strands with outstanding biological properties. Results from in vivo experiments demonstrated that tFNAs treatment could inhibit inflammatory responses and heterotopic ossification to halt disease progression. In vitro, tFNAs were proved to influence the biological behavior of AS primary chondrocytes and inhibit the secretion of pro-inflammatory cytokines through interleukin-17 pathway. The osteogenic process of chondrocytes was as well inhibited at the transcriptional level to regulate the expression of related proteins. Therefore, we believe tFNAs had a strong therapeutic effect and could serve as a nonsurgical remedy in the future to help patients suffering from AS.

Biomechanical Study of Horizontal Screw-screw Crosslink in C1-2 Pedicle Screw-rod Fixation.

STUDY DESIGN: This is a biomechanical study in vitro. OBJECTIVE: To investigate the biomechanical differences between horizontal rod-rod crosslink (hR-R CL) and the horizontal screw-screw crosslink (hS-S CL) implementation in C1-2 pedicle screw-rod (C1-2 PSR) fixation. SUMMARY OF BACKGROUND: To improve internal fixation stability, transverse connector (TC) is used in C1-2 PSR to increase torsional stiffness. The connection mode of horizontal connection includes hR-R CL and hS-S CL. hS-S CL adopted in C1-2 PSR was rarely reported and its biomechanics are still unclear. MATERIALS AND METHODS: Six fresh cadaveric cervical spine specimens were each tested as an Intact model, then modified and tested as an Instability model (unstable odontoid fractures), and then as 3 internal fixation models, including C1-2 PSR, C1-2 pedicle screw-rod+horizontal rod-rod crosslink (C1-2 PSR+ hR-R CL), C1-2 pedicle screw-rod+horizontal screw-screw crosslink (C1-2 PSR+ hS-S CL). The ROM of the C1-2 segments was measured by applying 1.5 nm load in 6 loading conditions, including flexion-extension (FE), left and right lateral bending (LB), and left and right axial rotation (AR). RESULTS: The C1-2 PSR+hR-R CL and C1-2 PSR+hS-S CL models, respectively, showed 60% and 75% lower ROM than the C1-2 PSR model in LB and AR conditions ( P <0.05). ROM was comparable between the C1-2 PSR+hR-R CL and the C1-2 PSR+hS-S CL models in all loading conditions ( P >0.05). CONCLUSION: Both types of crosslinks showed superior C1-2 stability under LB and AR conditions than PSR without crosslinks. The C1-2 segment stability was comparable between the 2 types of crosslinks themselves.

Identification of blood metabolites linked to the risk of intervertebral disc diseases: a comprehensive Mendelian randomization study.

BACKGROUND: Intervertebral disc degeneration (IVDD) has affected millions of people worldwide and dramatically affects human beings' quality of life. Observational studies hypothesize that metabolites play key roles as markers and effectors of IVDD, but their causality has not yet been illustrated. METHODS: We conducted comprehensive Mendelian randomization (MR) to determine the causal relationship between 249 plasma metabolites and IVDD. Inverse-variance weighting was used as the primary estimate, whereas MR-Egger and weighed median were used to detect robustness. A series of sensitivity analyses including Cochran Q test, leave one out, and MR-Egger intercept analysis were also conducted. RESULTS: In total, we found 13 blood metabolites significantly associated with IVDD, including phospholipids in very large high-density lipoprotein (HDL), free cholesterol to total lipids ratio in very large HDL, average diameter for HDL particles, cholesteryl esters to total lipids ratio in large HDL, free cholesterol to total lipids ratio in medium HDL, creatinine, free cholesterol to total lipids ratio in large HDL, phospholipids to total lipids ratio in very large HDL, cholesterol to total lipids ratio in very large HDL, cholesteryl esters to total lipids ratio in large HDL, phospholipids in large HDL, total lipids in very large HDL, and total lipids in large HDL. No pleiotropy was detected. Heterogeneity existed in several estimates and random-effect inverse-variance weighting was applied. CONCLUSIONS: Our study highlighted the causal association of blood metabolites with the risk of IVDD. Our results provide new insights into possible treatment protocols controlling the concentration of specific blood metabolites in IVDD patients. Key messages What is already known on this topic Low back pain is the most common symptom for patients with intervertebral disc degeneration (IVDD) and influences the quality of life of large populations. Observational studies have indicated the association between metabolites and IVDD. However, causality has not been determined yet. What this study adds We conducted a comprehensive Mendelian randomization study to reveal the causal effect from 249 blood metabolites on low back pain. A total of 13 metabolites were found to causally affect the risk of IVDD, among which 11 were negatively associated and 2 were positively asscociated. How this study might affect research, practice, or policy These 13 significant metabolites could serve as biomarkers for IVDD and our results provide new insights into possible treatment protocols for IVDD patients.

[Application of a new point contact pedicle navigation template as an auxiliary screw implant in scoliosis correction surgery].

Objective: To explore the effectiveness of a new point contact pedicle navigation template (referred to as "new navigation template" for simplicity) in assisting screw implantation in scoliosis correction surgery. Methods: Twenty-five patients with scoliosis, who met the selection criteria between February 2020 and February 2023, were selected as the trial group. During the scoliosis correction surgery, the three-dimensional printed new navigation template was used to assist in screw implantation. Fifty patients who had undergone screw implantation with traditional free-hand implantation technique between February 2019 and February 2023 were matched according to the inclusion and exclusion criteria as the control group. There was no significant difference between the two groups ( P>0.05) in terms of gender, age, disease duration, Cobb angle on the coronal plane of the main curve, Cobb angle at the Bending position of the main curve, the position of the apical vertebrae of the main curve, and the number of vertebrae with the pedicle diameter lower than 50%/75% of the national average, and the number of patients whose apical vertebrae rotation exceeded 40°. The number of fused vertebrae, the number of pedicle screws, the time of pedicle screw implantation, implant bleeding, fluoroscopy frequency, and manual diversion frequency were compared between the two groups. The occurrence of implant complications was observed. Based on the X-ray films at 2 weeks after operation, the pedicle screw grading was recorded, the accuracy of the implant and the main curvature correction rate were calculated. Results: Both groups successfully completed the surgeries. Among them, the trial group implanted 267 screws and fused 177 vertebrae; the control group implanted 523 screws and fused 358 vertebrae. There was no significant difference between the two groups ( P>0.05) in terms of the number of fused vertebrae, the number of pedicle screws, the pedicle screw grading and accuracy, and the main curvature correction rate. However, the time of pedicle screw implantation, implant bleeding, fluoroscopy frequency, and manual diversion frequency were significantly lower in trial group than in control group ( P<0.05). There was no complications related to screws implantation during or after operation in the two groups. Conclusion: The new navigation template is suitable for all kinds of deformed vertebral lamina and articular process, which not only improves the accuracy of screw implantation, but also reduces the difficulty of operation, shortens the operation time, and reduces intraoperative bleeding.

Construction of a microcavity-based microfluidic chip with simultaneous SERS quantification of dual biomarkers for early diagnosis of Alzheimer's disease.

Since there is no effective Alzheimer's disease (AD)-modifying therapy available currently, early analysis of AD core biomarkers has become one of great significance and common concern in clinical diagnosis. Herein, we designed an Au-plasmonic shell attached polystyrene (PS) microsphere in a microfluidic chip for simultaneous detection of Aß1-42 and p-Tau181 protein. The corresponding Raman reporters were identified in femto gram level by ultrasensitive surface enhanced Raman spectroscopy (SERS). Both of Raman experimental data and finite-difference time-domain modeling demonstrates the synergetic coupling between PS microcavity with the optical confinement property and the localized surface plasmon resonance (LSPR) of AuNPs, so leading to highly amplified electromagnetic fields at the 'hot spot'. Moreover, the microfluidic system is designed with multiplex testing and control channels in which the AD-related dual proteins were detected quantitatively with a lower limit of 100 fg mL-1. Thus, the proposed microcavity-based SERS strategy initiates a new way for accurately prediction of AD in human blood samples and provides the potential application for synchronous determination of multiple analytes in general disease assays.

miR-1297 inhibits osteosarcoma cell proliferation and growth by targeting CCND2.

Cyclin D2 (CCND2) is abnormally overexpressed in many tumor types and has been associated with tumor cell proliferation. Although the important role of miR-1297 is well established, the molecular mechanism between CCND2 and miR-1297 in osteosarcoma (OS) has not been determined. In the present study, we found CCND2 was highly expressed in OS cells, and its downregulation suppressed cell proliferation, resulting in G1 phase cell cycle arrest. In contrast, miR-1297 was lowly expressed in OS compared to normal tissue. Several data platforms predicted that CCND2 was a target of miR-1297, which was validated by a dual-luciferase reporter assay that revealed miR-1297 could bind with CCND2-3'UTR. miR-1297 overexpression greatly inhibited CCND2 protein expression and exerted the same phenotypic effect as CCND2 downregulation in OS cells. Furthermore, miR-1297 inhibition could also be rescued by CCND2. Nude mice injected cells stable overexpressing miR-1297 OS cells showed lower size and tumor weight. Moreover, lower fluorescence activity recorded by in vivo imaging system and bone erosion revealed by microCT in the miR-1297 group demonstrated miR-1297 inhibited OS tumor growth via CCND2. Our findings demonstrated that miR-1297 can inhibit proliferation and tumor growth in OS by directly targeting CCND2, which indicates that miR-1297 may represent a novel therapeutic target for OS.

Preoperative position and protection of radial nerve by B-ultrasound combined with MIPPO for treatment of middle-inferior humerus fractures.

BACKGROUND AND PURPOSE: Open reduction and internal fixation through the posterior approach are standard methods for treating middle-inferior humerus fractures. Given the limited operative field and difficulty in locating the radial nerve, the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique via the posterior approach to treat middle-inferior humerus fractures has rarely been reported. This study aims to evaluate the clinical effect of the preoperative study of the radial nerve position by B-ultrasound and its intraoperative protection combined with MIPPO in managing middle-inferior humerus fractures. METHODS: The data were studied retrospectively involving 64 participants who had surgery for middle-inferior humerus fractures from the start of 2017 to the end of 2020. Participants were divided into two groups, those treated with the MIPPO technique, including newly developed dual procedures and preoperative position and protection of radial nerve by B-ultrasound (group A), and those treated with open reduction and internal plating fixation (group B). RESULTS: All the cases were followed up for 12-34 months (an average of 25.6 ± 8.76 months), and there was no significant difference in the mean operative duration, surgical incision infection, range of motion (ROM) and MEPS (Mayo elbow performance score) for groups A and B. However, the occurrence of complications (radial nerve palsy, bone nonunion and flexible internal fixation or ruptures) in group B was significantly higher than the group A. A statistically significant difference was observed in the intraoperative blood loss, hospital stay and fracture nonunion time between the two groups. All the cases gained bone union within the MIPPO group. CONCLUSION: MIPPO via the posterior dual approach associated with preoperative position and protection of radial nerve by B-ultrasound does not increase radial nerve injury, however, it exhibits obvious advantages in the bone union, which is worthy of clinical application.

Finite Element Analysis of Horizontal Screw-Screw Crosslink Used in C1-C2 Pedicle Screw-Rod Fixation.

BACKGROUND In the craniocervical junction, a C1-C2 pedicle screw-rod (PSR) fixation is applied to provide stability. The horizontal rod-rod crosslink (hR-R CL) is often used to enhance segmental posterior instrumentation. However, the biomechanics of the alternative horizontal screw-screw crosslink (hS-S CL) in the craniocervical junction are unclear. MATERIAL AND METHODS A nonlinear atlantoaxial instability 3-dimensional C1-C2 finite element model was constructed using computed tomography images. On this basis, 2 fixation models were established with C1-C2 PSR fixation using (1) a rod-rod crosslink (R-R CL), and (2) a screw-screw crosslink (S-S CL). Range of motion (ROM) of the atlantoaxial joint, stress distribution of the implants, and maximum stress value of the vertebral bodies were calculated and compared under 4 loading conditions, including flexion, extension, lateral bending, and axial rotation. RESULTS Atlantoaxial joint ROM was reduced by 90.19% to 98.5% with the hR-R CL, and by 90.1% to 98.7% with the hS-S CL, compared with the instability model. During axial rotation, the total stress peak of the PSR fixation was smaller with hS-S CL than with hR-R CL. The peak stress values of the vertebral bodies were comparable between the 2 fixation models. CONCLUSIONS The 2 tested crosslink models provided comparable stability. However, during axial rotation, the total stress peak of hS-S CL fixation was smaller than that of hR-R CL fixation. Since the atlantoaxial joint primarily functions as a rotational joint, our results suggested that the use of hS-S CL can provide a more stable environment for the implants.

Repair of spinal cord injury in rats via exosomes from bone mesenchymal stem cells requires sonic hedgehog.

OBJECTIVE: The loss of neural ability leading to subsequent diminishing of motor function and the impairment below the location of the injury is a result of the SCI (Spinal Cord Injury). Among the many therapeutic agents for SCI, the exosomes considered as extracellular vesicles seem to be the most promising. Sonic Hedgehog (Shh) is an exosome-carrying protein. This Study's purpose was to identify whether Shh is required for exosomes from BMSCs (mesenchymal stem cells of the bone) and plays a protective effect on SCI. METHODS: Spinal cord injection with shRNA Shh-adeno associated virus (sh-Shh-AAV) were used to silence Shh. Exosomes were extracted from BMSCs. Rats that had suffered SCI were given intravenous injections of exosomes through the veins of the tail. Immunohistochemistry was used to identify the expression of Shh glycoprotein molecule as well as the expression of Gli-1 (glioma-associated oncogene homolog 1) in the rat spinal cord tissues. Western blot was performed to measure the levels of growth associated protein-43 (GAP-43). The BBB (Basso Beattie Bresnahan) score was used to assess the motor functions of the hind legs. In the same manner, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling or TUNEL and Nissl Staining was deployed to assess the level of regeneration of neurons and assess the level of histopathological damage in the tissues of the Spinal Cord. RESULTS: In the case of the rats with SCI, the levels of display of Gli-1 and Shh showed dramatic improvement after the BMSCs exosome injections. In comparison to rats with SCI, the subjects of BMSCs exosomes group showed an improvement in their SCI, including a higher BBB score and Nissl body count, increasing GAP-43 expression, along with a much-decreased number of cells that suffered apoptosis. While the exosome effect on Spinal Cord Injury was completely ineffective in rats that had Shh silencing. CONCLUSIONS: Exosomes secreted from BMSCs showed great effectiveness in the SCI healing with a vital involvement of Shh in this repair.

The effect of mild hypothermia plus rutin on the treatment of spinal cord injury and inflammatory factors by repressing TGF-ß/smad pathway.

PURPOSE: To probe the mechanism of mild hypothermia combined with rutin in the treatment of spinal cord injury (SCI). METHODS: Thirty rats were randomized into the following groups: control, sham, model, mild hypothermia (MH), and mild hypothermia plus rutin (MH+Rutin). We used modified Allen's method to injure the spinal cord (T10) in rats, and then treated it with MH or/and rutin immediately. BBB scores were performed on all rats. We used HE staining for observing the injured spinal cord tissue; ELISA for assaying TNF-α, IL-1ß, IL-8, Myeloperoxidase (MPO), and Malondialdehyde (MDA) contents; Dihydroethidium (DHE) for measuring the reactive oxygen species (ROS) content; flow cytometry for detecting apoptosis; and both RT-qPCR and Western blot for determining the expression levels of TGF-ß/Smad pathway related proteins (TGF-ß, Smad2, and Smad3). RESULTS: In comparison with model group, the BBB score of MH increased to a certain extent and MH+Rutin group increased more than MH group (p < 0.05). After treatment with MH and MH+Rutin, the inflammatory infiltration diminished. MH and MH+Rutin tellingly dwindled TNF-ß, MDA and ROS contents (p < 0.01), and minified spinal cord cell apoptosis. MH and MH+Rutin could patently diminished TGF-ß1, Smad2, and Smad3 expression (p < 0.01). CONCLUSIONS: MH+Rutin can suppress the activation of TGF-ß/Smad pathway, hence repressing the cellular inflammatory response after SCI.

Exosomes secreted from sonic hedgehog-modified bone mesenchymal stem cells facilitate the repair of rat spinal cord injuries.

BACKGROUND: Spinal cord injuries (SCIs) can cause a loss of neurons and associated sensory and motor functionality below the injured site. No approaches to treating SCIs in humans have been developed to date. Exosomes are extracellular vesicles that hold promise as a potential therapeutic modality when treating such injuries. The present study was thus designed to determine whether sonic hedgehog (Shh)-overexpressing bone mesenchymal stem cell (BMSC)-derived exosomes were protective in the context of SCIs. METHODS: Exosomes were extracted from control or Shh lentivirus-transduced BMSCs, yielding respective BMSC-Exo and BMSC-Shh-Exo preparations which were intravenously injected into SCI model rats. Shh expression in spinal cord tissues in these animals was then assessed via immunohistochemical staining, while Basso-Beattie-Bresnahan (BBB) scores were utilized to measure high limb motor function. Neuronal damage and regeneration within the spinal cord were additionally evaluated via terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL), Nissl, hematoxylin and eosin, and immunofluorescent staining. RESULTS: Both BMSC-Exo and BMSC-Shh-Exo preparations significantly increased Shh expression in the spinal cord of SCI model rats and improved BBB scores in these treated animals, while also increasing the frequencies of Nissl- and NeuN-positive neurons are reducing the numbers of apoptotic and GFAP-positive neurons. While both treatments yielded some degree of benefit to treated animals relative to untreated controls, BMSC-Shh-Exos were more beneficial than were control BMSC-Exos. CONCLUSIONS: Shh-overexpressing BMSC-derived exosomes represent an effective treatment that can facilitate SCI repair in rats.

The effect of mild hypothermia plus rutin on the treatment of spinal cord injury and inflammatory factors by repressing TGF-β/smad pathway

ABSTRACT Purpose To probe the mechanism of mild hypothermia combined with rutin in the treatment of spinal cord injury (SCI). Methods Thirty rats were randomized into the following groups: control, sham, model, mild hypothermia (MH), and mild hypothermia plus rutin (MH+Rutin). We used modified Allen's method to injure the spinal cord (T10) in rats, and then treated it with MH or/and rutin immediately. BBB scores were performed on all rats. We used HE staining for observing the injured spinal cord tissue; ELISA for assaying TNF-α, IL-1β, IL-8, Myeloperoxidase (MPO), and Malondialdehyde (MDA) contents; Dihydroethidium (DHE) for measuring the reactive oxygen species (ROS) content; flow cytometry for detecting apoptosis; and both RT-qPCR and Western blot for determining the expression levels of TGF-β/Smad pathway related proteins (TGF-β, Smad2, and Smad3). Results In comparison with model group, the BBB score of MH increased to a certain extent and MH+Rutin group increased more than MH group (p < 0.05). After treatment with MH and MH+Rutin, the inflammatory infiltration diminished. MH and MH+Rutin tellingly dwindled TNF-β, MDA and ROS contents (p < 0.01), and minified spinal cord cell apoptosis. MH and MH+Rutin could patently diminished TGF-β1, Smad2, and Smad3 expression (p < 0.01). Conclusions MH+Rutin can suppress the activation of TGF-β/Smad pathway, hence repressing the cellular inflammatory response after SCI.

Radiofrequency ablation versus laparoscopic hepatectomy for treatment of hepatocellular carcinoma: a systematic review and meta-analysis.

BACKGROUND: Several randomized controlled trials (RCTs) compared the effects of laparoscopic hepatectomy (LH) and radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC), but the results have remained inconsistent. Hence, a meta-analysis and a systematic review of these treatment modalities are necessary to evaluate their efficacy and safety for HCC treatment. METHODS: From the inception of this meta-analysis and review until August 31, 2019, we searched Medline, PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, and China Biomedical Literature Database for RCTs involving LH and RFA treatments of patients with HCC. The studies were screened and the data from these articles were extracted independently by two authors. Summary odd ratios (OR) or mean differences (MD) with 95% confidence intervals (CI) were calculated for each outcome with a fixed- or random-effect model. The outcomes for effectiveness evaluations included duration of surgery, estimated bleeding volume, incidence of blood transfusion during surgery, duration of hospital stay, and the outcome for safety included the incidence of cancer recurrence. RESULTS: Seven RCTs with a total of 615 patients were identified, 312 and 303 of which underwent RFA and LH treatments, respectively. The duration of surgery (MD = -99.04; 95% CI: -131.26--66.82), estimated bleeding volume (MD = -241.97; 95% CI: -386.93--97.02), incidence of blood transfusion during surgery (OR = 0.08; 95% CI: 0.02-0.37), and duration of hospital stay (MD = -3.4; 95% CI: -5.22--1.57) in RFA treatment were significantly lower than those of LH treatment. However, the incidence of cancer recurrence was significantly higher for RFA treatment compared with LH treatment (OR = 2.68; 95% CI: 1.72-4.18). CONCLUSIONS: LH treatment is preferred over RFA treatment with a better radical effect, but RFA treatment is more beneficial with smaller trauma, development of less complications, and shorter operating time when compared with HCC treatment.

[Comparison of radiological changes after Halo-pelvic traction with posterior spinal osteotomy versus simple posterior spinal osteotomy for severe rigid spinal deformity].

OBJECTIVE: To compare the changes of scoliosis and kyphosis angles after Halo-pelvic traction with posterior spinal osteotomy versus simple posterior spinal osteotomy for severe rigid spinal deformity. METHODS: A clinical data of 28 patients with severe rigid spinal deformity between January 2015 and November 2017 was retrospectively analyzed. Sixteen patients were treated by Halo-pelvic traction with posterior spinal osteotomy (group A) and 12 patients were treated with posterior spinal osteotomy only (group B). There was no significant difference between the two groups ( P>0.05) in gender, age, body mass index, and preoperative pulmonary function, coronal and sagittal Cobb angles, and flexibility. The operation time, intraoperative blood loss, and complications were recorded. The coronal and sagittal Cobb angles were measured on X-ray films before operation (before traction in group A), at 10 days after operation, at last follow-up in the two groups and after traction in group A. The improvement rate of deformity after traction in group A, the correction rate of deformity after operation, and the loss rate of correction at last follow-up were calculated. RESULTS: All patients were followed up 24-30 months (mean, 26.5 months). The operation time and intraoperative blood loss were significantly less in group A than in group B ( t=7.629, P=0.000; t=8.773, P=0.000). In group A, 1 patient occurred transient numbness of both legs during continuous traction and 2 patients needed ventilator support for more than 12 hours. In group B, 7 patients needed ventilator support for more than 12 hours, including 1 patient with deep incision infection. The incidence of complications was 18.75% (3/16) in group A and 58.33% (7/12) in group B, and the difference between the two groups was significant ( χ 2=4.680, P=0.031). The coronal and sagittal improvement rates of deformity after traction in group A were 40.47%±3.60% and 40.70%±4.20%, respectively. There was no significant difference between the two groups ( P>0.05) in the coronal and sagittal Cobb angles at 10 days after operation and at last follow-up, in the correction rate of deformity after operation, and in the loss rate of correction at last follow-up. CONCLUSION: For the severe rigid spinal deformity, Halo-pelvic traction with posterior spinal osteotomy and simple posterior spinal osteotomy can obtain the same orthopedic effect and postoperative deformity correction. However, the Halo-pelvic traction can shorten operation time, reduce blood loss and incidence of perioperative complications.

Treatment of cervical spondylotic radiculopathy with posterior percutaneous endoscopic cervical discectomy: Short-term outcomes of 24 cases.

To determine the short-term clinical outcomes of single-segment cervical spondylotic radiculopathy treated with posterior percutaneous endoscopic cervical discectomy (PPECD).Data of a total of 24 patients who underwent PPECD and local anesthesia for single-level segmental cervical spondylotic radiculopathy between March 2016 and December 2017 were reviewed. The Japanese Orthopaedic Association, visual analog scale (VAS), and neck disability index scores at preoperative 1 day, postoperative 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year were recorded. The modified MacNab criteria at the last follow-up were re-recorded for the evaluation of clinical effectiveness.All operations were successfully completed under endoscopic guidance. No patient showed spinal cord, nerve root, vascular injuries, dural tears or other complications. The postoperative VAS scores of the arm and neck were significantly reduced compared with the preoperative VAS scores (P < .05), while postoperative the Japanese Orthopaedic Association scores were significantly increased (P < .05). The postoperative neck disability index scores were significantly reduced compared with preoperative scores (P < .05). The modified MacNab criteria at the last follow-up showed 16 excellent cases, 8 good cases, 0 fine cases, and 0 poor cases. Postoperative magnetic resonance imaging and cervical 3-dimensional computed tomography reconstruction showed that the intervertebral disc was adequately resected and the nerve root was not under compression.PPECD is safe and effective for the treatment of single-segment cervical spondylotic radiculopathy.

Clinical analysis of an anchor nail combined with a titanium cable in the treatment of lower patella fractures.

OBJECTIVE: This study was performed to evaluate the clinical effect of an anchor nail and titanium cable for lower patella fractures and identify an effective treatment. METHODS: Thirty-five patients with lower patella fractures were treated using anchor nail and titanium cable technology. The anchor was fixed to the main part of the patella; the lower patella was then fixed. A bone tunnel was created, and the titanium cable was fixed. The fracture was allowed to heal without tension. Postoperative radiographs were obtained at regular follow-up evaluations. The Böstman function scores were used to assess postoperative complications. RESULTS: All patients were followed for an average of 15 months. The fracture healing time ranged from 12 to 24 weeks. The postoperative Böstman function scores were as follows: average, 28.6 points; excellent and good scores in 28 and 7 patients, respectively (100% rate of excellent and good scores). At 6 and 12 months postoperatively, the maximum degree of active extension of the affected knee joint was comparable with that of the healthy contralateral joint. CONCLUSION: The combination of an anchor nail and titanium cable for lower patella fractures is simple and clinically satisfactory, restores knee function well, and is a worthy orthopedic method.

Clinical Application of Atlantoaxial Pedicle Screw Placement Assisted by a Modified 3D-Printed Navigation Template.

OBJECTIVES: To investigate the primary clinical value of atlantoaxial pedicle screw placement assisted by a modified 3D-printed navigation template. METHODS: We retrospectively analyzed the cases of 17 patients treated from June 2015 to September 2016 with atlantoaxial pedicle screw placement assisted by a modified 3D-printed navigation template. All procedures were performed prior to surgery, including thin-slice CT scanning, medical image sampling and computerized 3D modeling of the atlantoaxial joint, optimal pedicle screw trajectory determination, and anatomical trait acquisition for the atlantoaxial pedicle, spinous process of the axis, vertebral lamina and posterior lateral mass, and design of a reverse template. During surgery, a navigation template was tightly attached to the atlantoaxial joint to assist in pedicle screw placement. Surgeons subsequently used an electric drill to remove the template through a guide channel and then placed the atlantoaxial pedicle screw. Observed indexes included the VAS score, JOA improvement rate, surgery duration, and blood loss. RESULTS: Surgery was successful in all 17 patients, with an average operation duration of 106±25 min and an average blood loss of 220±125 ml. Three days postoperatively, the VAS score decreased from 6.42±2.21 to 3.15±1.26. Six months postoperatively, the score decreased to 2.05±1.56. The postoperative JOA score increased significantly from 7.68±2.51 to 11.65±2.72 3 d after surgery and to 13.65±2.57 after 6 months. Sixty-eight pedicle screws were inserted successfully, with 34 in the atlas and 34 in the axis. According to the Kawaguchi standard, 66 screws were in grade 0 (97.06%), and 2 were in grade 1 (2.94%). The pre- and postoperative transverse and sagittal screw angles showed no significant differences. CONCLUSIONS: Atlantoaxial pedicle screw placement assisted by a modified 3D-printed navigation template is worth recommending due to the improved accuracy in screw placement, improved patient safety and beneficial clinical effects.

Effects of C5/C6 Intervertebral Space Distraction Height on Pressure on the Adjacent Intervertebral Disks and Articular Processes and Cervical Vertebrae Range of Motion.

BACKGROUND This study aimed to investigate the association between range of motion of the cervical vertebrae and various C5/C6 intervertebral space distraction heights. MATERIAL AND METHODS The cervical vertebrae from 6 fresh adult human cadavers were used to prepare the models. Changes in C4/C5 and C6/C7 intervertebral disk pressures, articular process pressure, and range of motion of the cervical vertebrae before and after the distraction of the C5/C6 intervertebral space at benchmark heights of 100%, 120%, 140%, and 160% were tested under different exercise loads. RESULTS The pressure on the adjacent intervertebral disks was highest with the standing upright position before distraction, varied with different positions of the specimens and distraction heights after distraction, and was closest to that before distraction at a distraction height of 120% (P<0.05). The pressure of the adjacent articular processes was highest with left and right rotations before distraction, varied with different positions of the specimens and distraction heights after distraction, and was lowest under the same exercise load with different positions at a distraction height of 120% (P<0.05). The ranges of motion of the cervical vertebrae and intervertebral disks were largest without distraction and at a distraction height of 120% after distraction, respectively (P<0.05). CONCLUSIONS When removing the C5/C6 intervertebral disk and implanting an intervertebral bone graft, a benchmark height of 120% had little influence on the pressure of the adjacent intervertebral disks and articular processes and range of motion of the cervical vertebrae and is therefore an appropriate intervertebral space distraction height.

Design and Application of a Novel Patient-Specific Three-Dimensional Printed Drill Navigational Guiding in Atlantoaxial Pedicle Screw Placement.

PURPOSE: To explore accuracy and clinical efficacy of a novel patient-specific three-dimensional (3D) printed drill navigational guiding template in atlantoaxial pedicle screw placement. METHODS: A retrospective analysis of 49 patients with atlantoaxial vertebral fractures and dislocations was performed. Patients were divided into a 3D printed navigational guiding template group (n = 25) and traditional group (n = 14). Safety of screw position was assessed, and accuracy of 2 screw placement methods was compared. Accuracy of screw placement was assessed by comparing differences between preoperative designed channel transverse angle and postoperative actual screw placement angle. Two groups were compared to find differences between operative time, intraoperative blood loss, screw placement time, number of fluoroscopy examinations, visual analog scale score, and Japanese Orthopaedic Association score. RESULTS: There were statistically significant differences between the guiding template group and traditional group in operative time, intraoperative blood loss, screw placement time, and number of fluoroscopy examinations. No statistically significant differences were found between groups in transverse and sagittal angles with ideal values. There were statistically significant differences between preoperative and 1-week, 1-month, 3-month, 6-month, and 1-year postoperative visual analog scale and Japanese Orthopaedic Association scores in the same group, whereas there were no statistically significant differences between the groups. CONCLUSIONS: Use of the novel patient-specific 3D printed drill navigational guiding template in surgical treatment of atlantoaxial fracture and dislocation can improve accuracy of pedicle screw placement and safety of the surgery, can reduce surgical risks, and can obtain satisfactory clinical curative effects.