[Nomograma prediction of the surgical treatment in triad of elbow].

OBJECTIVE: To establish an individualized Nomogram prediction model for predicting the postoperative recovery of patients with triad of elbow (TE) by analyzing risk factors of triad of elbow joint. METHODS: From January 2012 to December 2018, 116 patients with TE who met the criteria were collected. The independent risk factors were screened by univariate Logistic regression analysis. The statistically significant risk factors were included in the multivariate Logistic regression model. The R software was used to establish the Nomogram diagram model to predict the postoperative recovery of TE patients. C index was used to verify the discrimination, Calibration plot of the model, and the decision curve (decision curve analysis, DCA) to verify the net clinical benefit rate of the model. RESULTS: Forty-four of the 116 patients with TE developed symptoms after operation, with an incidence of 37.93%. Age (OR=1.930, 95% CI 1.418 to 2.764), work (OR=6.153, 95%CI 1.466 to 31.362), smoking(OR=4.463, 95%CI 1.041 to 2.291), the Mason of radial head(OR=1.348, 95%CI 2.309 to 9.348), the Regan-Morrey of coronal process (OR=4.424, 95%CI 1.751 to 2.426) and postoperative elbow immobilization time(OR=7.665, 95%CI 1.056 to 5.100) were independent risk factors for postoperative recovery of TE (P<0.05). The C-index of Nomogram plot was 0.716. Calibration plot showed that the predictive model was consistent, and the DCA curve showed satisfactory clinical net benefit. CONCLUSION: The Nomogram for predicting postoperative results of TE patients based on six independent risk factors:age, work, smoking, Mason classification of radial head, Regan-Morrey classification of coronal process and immobilization time of elbow joint after operation, has good distinguishing capacity and consistency. Thepredictive model could help clinicians to identify high risk population and establish appropriate intervention strategies.

Safe trajectory for an occipital condyle screw: A computer simulation study.

OBJECTIVE: The purpose of this study was to evaluate the feasibility of posterior occipital condyle screw (OCS) placement analysis of the safe trajectory area for screw insertion. METHODS: Computed tomographic angiography scans of patients (46 males and 27 females) with normal occipitocervical structures were obtained consecutively. Vertebral artery (VA)-occiput distance <4.0 mm was defined as "unfeasible" for OCS fixation, and occipital-atlas angulation was measured to assess the feasibility of screw placement. Next, the placement of 3.5 mm diameter OCS was simulated, the probability of breach of structures surrounding occipital condyles was calculated, and placement parameters were analyzed. RESULTS: OCS placement was feasible in 91.1% (133/146) of occipital condyles, and the feasible probability also presented a significant sex-related difference: The probability was higher for males than for females (95.7% vs. 83.3%, p < 0.05). The incidence of anatomical structures injured under screw placement limitation was 18.8% (VA), 81.2% (hypoglossal canal), 59.4% (occipital-atlas joint), and 40.6% (occiput bone surface). There were no significant differences between the left and right condyles in relation to the measured parameters (p > 0.05). The screw range of motion was significantly smaller in females than in males (p < 0.05). The feasibility of OCS placement and OCS range of motion were significantly greater in the kyphosis group (>5°) than in the other two groups (p < 0.05). CONCLUSION: OCS placement is a feasible technique for occipital-cervical fusion. The male group and occipitocervical region kyphosis group had a wider available space for OCS placement. Tangent angulation may be useful for the accurate and safe placement of an OCS.

[Case-control study of pedicle screw fixation combined with vertebroplasty and injured vertebra pedicle fixation in treatment of osteoporotic thoracolumbar burst fractures].

OBJECTIVE: To compare the curative effect of short-segment pedicle screw fixation combined with vertebroplasty and injured vertebra pedicle fixation in treating osteoporotic thoracolumbar burst fractures. METHODS: A retrospective study was performed for 52 patients with thoracolumbar burst fractures from August 2010 to August 2015. Among them, 27 patients(group A) were treated with short-segment pedicle screw fixation combined with vertebroplasty, including 17 males and 10 females, aged from 54 to 68 years old with an average of(61.01±5.41) years, 16 cases were type A3 and 11 cases were type A4 according the new AO typing. Other 25 patients (group B) were treated with short-segment pedicle screw fixation combined with injured vertebra pedicle fixation, including 12 males and 13 females, aged from 55 to 66 years old with an average of (59.28±6.12) years, 18 cases were type A3 and 7 cases were type A4 according the new AO typing. Operation time, intraoperative bleeding volume, complication, image data and clinical effect were compared between two groups. RESULTS: All the patients were followed up for 12 to 15 months with an average of (12.4±2.1)months. There was no significant difference in general data(including gender, age, injured site, preoperative VAS score, Cobb angle, injured vertebral anterior border height) between two groups. There was no significant differences in operation time, intraoperative bleeding volume between two groups. Preoperative, one week after operation and final follow-up, VAS scores were 5.2±0.5, 1.2±0.2, 0.8±0.1 respectively in group A and 5.0±0.6, 2.5±0.4, 1.3±0.2 in group B; injured vertebral anterior border height were (49.4±6.8)%, ( 94.5±1.2)%, ( 94.1±3.7)% respectively in group A and (48.2±7.0)%, ( 94.3±4.1)%, ( 90.0±2.3)% in group B;Cobb angles were (20.4±5.2) °, (2.5±1.8) °, (4.4±1.7)° respectively in group A and (19.8±6.8)°, (2.4±1.7)°, (7.0±1.2)° in group B. At final follow-up, VAS, Cobb angle, injured vertebral anterior border height in two groups were obviously improved(P<0.05). Postoperative at 1 week and final follow-up, VAS score of group A was lower than that of group B(P<0.05);and there was no significant difference in Cobb angle between two groups(P>0.05); there was significant difference in injured vertebral anterior border height between two groups(P<0.05). The complication of internal fixation failure had 1 case in group A and 4 cases in group B. CONCLUSIONS: For the treatment of single osteoporotic thoracolumbar burst fractures, short-segment pedicle screw fixation combined with vertebroplasty is better than combined with injured vertebra pedicle fixation in clinical effect, it can relieve pain, maintain injured vertebral height and sagittal alinement, reduce the complications associated with internal fixation, and be worth spread in clinic.

[Mini-open trans-spatium intermuscular versus percutaneous short-segment pedicle fixation for the treatment of thoracolumbar mono-segmental vertebral fractures].

OBJECTIVE: To compare the clinical effects and radiographic outcomes of mini-open trans-spatium intermuscular and percutaneous short-segment pedicle fixation in treating thoracolumbar mono-segmental vertebral fractures without neurological deficits. METHODS: From August 2009 and August 2012, 95 patients with thoracolumbar mono-segmental vertebral fractures without neurological deficits were treated with short-segment pedicle fixation through mini-open trans-spatium intermuscular or percutaneous approach. There were 65 males and 30 females, aged from 16 to 60 years old with an average of 42 years. The mini-open trans-spatium intermuscular approach was used in 58 cases (group A) and the percutaneous approach was used in 37 cases (group B). Total incision length, operative time, intraoperative bleeding, fluoroscopy, hospitalization cost were compared between two groups. Visual analog scale (VAS) and radiographic outcomes were compared between two groups. RESULTS: All patients were followed up from 12 to 36 months with an average of 19.6 months. No complications such as incision infection, internal fixation loosening and breakage were found. In group A, fluoroscopy time was short and hospitalization cost was lower than that of group B (P<0.05). But the total incision length in group B was smaller than that of group A (P<0.05). There was no significant differences in operative time, intraoperative bleeding, postoperative VAS and radiographic outcomes between two groups (P>0.05). Postoperative VAS and radiographic outcomes were improved than that of preoperative (P<0.05). CONCLUSION: The mini-open trans-spatium intermuscular and percutaneous short-segment pedicle fixation have similar clinical effects and radiographic outcomes in treating thoracolumbar mono-segmental vertebral fractures without neurological deficits. However, in this study, the mini-open trans-spatium intermuscular approach has a short learning curve and more advantages in hospitalization cost and intraoperative radiation exposure times, and is recommendable.

The effects of burn serum on the erythropoiesis and granulopoiesis in bone marrow in mice / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the effects of burn serum on the erythropoiesis and granulopoiesis in bone marrow in mice, and to explore the possible underlying mechanism.</p><p><b>METHODS</b>Murine bone marrow cell (BMC) strain was prepared routinely and was employed in the establishment of the culture system of colony forming units of erythrocytes, or granulocytes and monocytes. To both sets of culture system normal murine serum (N group) and burn serum, which was collected from the mice with 15% full thickness burn at 12 postburn hours (PBH) and 1, 3, 5, 7 and 10 postburn days (PBD), (burn serum group) was added. In addition, positive control and blank control groups were set accordingly. The stimulating activity of all kinds of sera on the BMCs in the two sets of culture system was determined. The changes in the burn serum concentrations of EPO and GM-CSF were detected by radioimmunoassay, and the data were analyzed by logarithmic linear fitting correlation with the former influence of burn sera on the erythrocytes and granulocytes.</p><p><b>RESULTS</b>(1) Burn sera exhibited obvious stimulation promoting activity on the erythropoiesis and granulopoiesis in BMC, and the activity peaked (384 +/- 60 and 127 +/- 16 CFU) on 1 PBD and decreased thereafter to approach the values found in normal sera group (125 +/- 14 and 34 +/- 20 CFU) on 7 PBD. (2) The EPO content in burn serum was evidently higher than the normal value (P < 0.01) during 12 PBH to 7PBD period. The GM-CSF concentration was obviously higher than the normal value (P < 0.05) at 12 PBH and on 1 PBD. (3) The EPO concentration in burn serum was significantly and logarithmically correlated with the stimulation promoting activity of burn serum on erythropoiesis (r = 0.8570, P = 0.0137). But the GM-CSF concentration in culture with burn serum was not correlated with the stimulation promoting activity of burn serum on granulopoiesis (r = 0.7049, P > 0.05).</p><p><b>CONCLUSION</b>The sera harvested from burned mice during early postburn stage exhibited strong stimulation promoting activity on the erythropoiesis and granulopoiesis in bone marrow. The increased EPO level in burn serum might be the important factor contributing strong stimulation action on erythropoiesis, while increased GM-CSF level was not.</p>