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Objective:To investigate the efficiency and safety of traditional growing rod in the treatment of early onset dystrophic scoliosis secondary to type 1 neurofibromatosis (NF1-DS) with intraspinal rib head in children.Methods:From September 2006 to May 2020, this study recruited 20 children with intraspinal rib head with early onset NF1-DS who had received traditional growing rods. There were 13 boys and 7 girls and the age of the initial operation was 7.0±1.6 years (range, 4.1-9.8 years). There were 7 cases of simple left chest bend, 9 cases of simple right chest bend, and 4 cases of double chest bend; 13 patients had varying degrees of kyphosis deformity. Two children had neurological symptoms before surgery, American Spinal Injury Association Impairment Scale (AIS) were grade D. The proportion of the intraspinal rib head (IRP), the Cobb angle of the main chest bend, apical vertebra rotation (AVR), apical vertebral translation (AVT), trunk shift (TS) and sagittal TK, lumbar lordosis (LL), sagittal balance and T 1-S 1 height were measured before and after first time internal fixation and at last follow-up, and the complications were also evaluated. Results:All 20 patients were followed up and the average follow-up time was 41.6±23.8 months (range, 24-99 months). A total of 85 operations was conducted including 63 protrude operations. After operation, the IRP was significantly lower than that before operation (preoperative 33.1%±17.5% vs. postoperative 22.2%±11.3%, P<0.001) and no significant correction loss was found at last follow-up 23.7%±12.4% ( P>0.05). The mean Cobb angle decreased from 75.9°±26.7° preoperatively to 45.0°±18.5° postoperatively ( P<0.001) and there was still significant improvement at the last follow-up (41.0°±17.2°) compared with postoperatively ( P<0.05). The AVR was significantly reduced after surgery compared with preoperatively (33.0°±10.1° vs. 39.3°±13.3°, P<0.001), and the last follow-up (40.1°±11.4°) was significantly improved compared with postoperative ( P=0.005). The T 1-S 1 height increased from 259.8±70.7 mm preoperatively to 296.9±78.4 mm postoperatively ( P=0.001), and at the last follow-up 296.9±78.4 mm was still significantly higher than after operation ( P<0.001), with an average annual increase of 12.4±3.2 mm. Significant correction of AVT, TK, LL and sagittal balance were noted after initial surgery ( P<0.05), and no significant correction loss was found at last follow-up ( P>0.05). There were 10 complications in 7 cases. There were 5 complications of pedicle screw loosening, 1 complication of bolt droping, 2 complications of broken rod, 1 complication of distal junctional kyphosis and 1 complication of adding-on phenomenon. 2 cases with nerve injury were recover after operation (AIS grading E). None of the children had new neurological complications during growth rod insertion and multiple stretching during follow-up. Conclusion:For children with early onset NF1-DS with intraspinal rib head, if the preoperative AIS grade is D or E, traditional growing rod technique is relatively safe and effective and can make the intraspinal rib head remove from the spinal canal partly.
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Objective@#To investigate the role of body fat ratio in the evaluation of obstructive sleep apnea(OSA).@*Methods@#A retrospective analysis was made on 174 cases (between November, 2017 and April, 2018 showed that) of sleep monitoring in the Department of Otorhinolaryngology in Peking University Third Hospital. The data included the gender, age, body fat rate, body mass index (BMI), neck circumference, and apnea-hypopnea index (AHI). The above data were analyzed by non parametric correlation analysis, receiver operating characterristic (ROC) curve analysis and multiple factor Logistic regression analysis to study the relationship between the gender,age,body fat rate,BMI,neck circumference and other indexes of the patients with AHI.@*Results@#Nonparametric correlation analysis showed that the correlation from strong to weak to AHI among women was BMI (r=0.621, P<0.001),body fat rate (r=0.602, P<0.001), age (r=0.570, P<0.001), neck circumference (r=0.402, P=0.014), respectively. BMI (r=0.599, P<0.001), neck circumference (r=0.493, P<0.001), body fat rate (r=0.318, P<0.001), and age (r=0.256, P=0.003) among men. ROC curve analysis showed that the strong to weak index (area under curve,AUC) of the AHI>15/h among women was the body fat rate (AUC=0.884, P=0.001), BMI(AUC=0.810, P=0.008), neck circumference (AUC=0.759, P=0.027), age (AUC=0.750, P=0.033), and the male was BMI (AUC=0.765,P<0.001), neck circumference (AUC=0.720, P<0.001), age (AUC=0.634, P=0.008), and body fat rate (AUC=0.632, P=0.010), respectively. Multifactor Logistic regression analysis showed that the body fat rate (OR=1.704,95%CI=1.012-2.870) in women was an independent risk factor for AHI greater than 15/h; the age of male (OR=1. 044, 95%CI=1.005-1.085) and BMI (OR=1.285, 95%CI=1.056-1.562) were independent risk factors for AHI greater than 15/h.@*Conclusion@#Body fat rate can be used as a new indicator for predicting the severity of OSA,especially in adult female population. In adult female moderate to severe OSA patients (AHI>15/h), compared with BMI,neck circumference and age,the body fat rate has the greatest correlation with AHI. Compared with BMI,neck circumference and age,the body fat rate has a decisive role in predicting moderate to severe OSA (AHI>15/h).
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Objective To investigate the influence of preoperative training of pushing trachea and esophagus or not on cervical operation by anterior approach.Methods All patients were randomly divided into two groups:experimental group and control group (56 cases,respectively).Patients in the former group had no training of pushing trachea and esophagus,while patients in the latter group had,recording the data of surgery duration,operator's degree of satisfaction,blood loss,blood pressure,heart rate,and oxygen saturation during operation,hospital stay and cost.Meanwhile,we observed and compared the VAS scores and the complication rate etc.between two groups.Results There were no differences between two groups in surgery duration,operator's degree of satisfaction,blood loss,blood pressure,heart rate,and oxygen saturation during operation,hospital stay and cost,nor in the VAS scores and the throat-related complications rate.The hospital stay and cost of patients in experimental group were longer and higher than that of patients in control group,(7.3±1.6) d vs (5.8±1.4) d,(48 468.3±4 313.8) vs (45 228.4±4 124.6) yuan,t=5.280,4.062,P＜0.05.Conclusions Training of pushing trachea and esophagus has no influence in the throat-related complications rate,VAS scores and operator's degree of satisfaction.Instead,training of pushing trachea and esophagus increases hospital stay and cost and amount of nurse's work.So,it's not necessary to undertake the preoperative training before cervical operation by anterior.
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Objective To investigate the perioperative complications and risk factors of one-stage posterior vertebral column resection (VCR) for severe spinal deformity.Methods From September 2004 to July 2012,39 patients with severe and fixed spinal deformity underwent one-stage posterior VCR,including 15 males and 24 females,aged from 3 to 53 years (average,16.9 years).There were 24 cases of kyphoscoliosis (mean coronal Cobb angle:85.1°,mean sagittal Cobb angle:92.9°),7 cases of scoliosis (mean coronal Cobb angle:81.1°),and 8 cases of kyphosis (mean sagittal Cobb angle:94.4°).Eleven patients had neurological compromise.The perioperative complications and related risk factors of 39 patients were retrospectively analyzed.Results All patients were followed up for 3 to 72 months (average,29.4 months).There were 15cases (13 patients) of perioperative complications.Neurological complications occurred in 6 patients (15.4％),among whom one patient presented complete paraplegia after surgery and 5 patients presented transient paresthesia or muscle weakness.Adults had a significantly higher incidence of neurological complications than teenagers.The incidence rate of neurological complications was 36.4％ in patients with preoperative neurological compromise,while 7.1％ in patients without preoperative neurological compromise.All patients with postoperative neurological complications had kyphosis before operation,and the incidence of neurological complications increased significantly in patients with severe kyphosis (Cobb angle ≥90°).Prolonged respiratory support was conducted in 4 cases.Rupture of the parietal pleura occurred in 3 cases (7.7％),cerebrospinal fluid leak in 1 case (2.6％),and pulmonary infection in 1 case (2.6％).Conclusion One-stage posterior VCR is effective in the treatment of severe and rigid spinal deformity.However,the perioperative complications,especially the neurological complications are common.The risk factors of neurological complications include preoperative neurological compromise,degree of kyphosis and the age of patients.
