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1.
BMC Musculoskelet Disord ; 22(1): 185, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33588805

RESUMO

BACKGROUND: The purpose of the study was to investigate whether pelvic incidence (PI) will affect the occurrence of PJK in Lenke 5 AIS patients after correction surgery and try to explore a better surgical scheme based on PI. METHODS: Lenke 5C AIS patients that underwent correction surgery with a minimum of a 2-year follow-up were identified. Demographic and radiographic data were collected preoperatively, postoperatively, and at the final follow-up. The comparison between the PJK and the Non-PJK group was conducted and the subgroup analysis was performed based on the preoperative value of PI to investigate the potential mechanism of PJK. Clinical assessments were performed using the Scoliosis Research Society (SRS)-22 questionnaire. RESULTS: The mean preoperative Cobb angle of the TL/L curve was 53.4°±8.6. At the final follow-up, the mean TL/L Cobb angle was drastically decreased to 7.3°±6.8 (P < 0.001). The incidence of PJK in Lenke 5 AIS was 18.6 %, 21.9 % (7/32) in the low PI group (PI < 45°) and 15.8 % (6/38) in the high PI group (PI ≥ 45°), and there was no statistical difference between the two groups (χ2 = 0.425, P = 0.514). For low PI patients, there is no significant difference where the UIV is located with regards to the TK apex between the PJK and Non-PJK subgroups (χ2 = 1.103, P = 0.401). For high PI patients, PJK was more likely to occur when UIV was cephalad to than caudal to the TK apex (31.25 % vs. 4.7 %, P = 0.038). There was no significant difference in the selection of LIV between the two groups. CONCLUSIONS: There is no difference in the incidence of PJK between the Lenke 5 AIS patients with low PI (< 45°) and high PI (≥45°), but the main risk factor of PJK should be different. For patients with low PI, overcorrection of LL should be strictly avoided during surgery. For patients with high PI, the selection of UIV should not be at or cephalad to the apex of thoracic kyphosis to retain more mobile thoracic segments.

2.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(1): 33-38, 2021 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-33448196

RESUMO

Objective: To compare the predictive abilities of O-C2 angle (O-C2a), O-EA angle (O-EAa), and Oc-Ax angle (Oc-Axa) for development of dysphagia in patients after occipitocervical fusion (OCF). Methods: Between April 2010 and May 2019, 114 patients who underwent OCF and met the selection criteria were selected as the research objects. Among them, 54 were males and 60 were females; they were 14-76 years old, with an average of 50.6 years old. The follow-up time was 13-122 months (median, 60.5 months). The O-C2a, O-EAa, Oc-Axa, and the narrowest oropharyngeal airway space (nPAS) were measured by the lateral X-ray films before operation and at last follow-up, and the differences before and after operation (dO-C2a, dO-EAa, dOc-Axa, and dnPAS) were calculated. Patients were divided into two groups according to whether they had developed postoperative dysphagia. The general data including age, gender, fixed segment, proportion of patients with rheumatoid arthritis (RA), atlantoaxial subluxation (AS), and combined with anterior release surgery (ARS), and imaging indicators were compared between the two groups. The correlations between dO-C2a, dO-EAa, and dOc-Axa and dnPAS in 114 patients were analyzed to further compare the predictive value of three imaging indicators for occurrence of dysphagia after OCF. Results: Dysphagia occurred after OCF in 31 cases with the incidence of 27.2%. There was significant difference in gender between the dysphagia group and the non-dysphagia group ( χ 2=7.940, P=0.005). There was no significant difference between the two groups in age, fixed segment, the proportion of patients with RA, the proportion of patients with AS, and the proportion of patients combined with ARS ( P>0.05). There was no significant difference in O-C2a and Oc-Axa of 114 patients before operation and at last follow-up ( P>0.05). The differences in O-EAa and nPAS were significant ( P<0.05). There was no significant difference in preoperative O-EAa, Oc-Axa, and nPAS between the dysphagia group and the non-dysphagia group ( P>0.05); the difference in the O-C2a was significant ( t=2.470, P=0.016). At last follow-up, the differences in the above imaging indicators were significant ( P<0.05). There were significant differences in the dO-C2a, dO-EAa, dOc-Axa, and dnPAS between the two groups ( P<0.05). Correlation analysis showed that the dO-C2a, dO-EAa, dOc-Axa were all positively correlated with dnPAS ( P<0.05). The dO-C2a≤-5°, postoperative O-EAa≤100°, postoperative Oc-Axa≤65° were all related to postoperative dysphagia ( P<0.05), and the highest risk factor suffering postoperative dysphagia was dO-C2a ≤-5° with a significant OR of 14.4. Conclusion: The dO-C2a, postoperative O-EAa, and postoperative Oc-Axa can be used as the predictive indexes of dysphagia after OCF, among which dO-C2a has the highest predictive value.


Assuntos
Transtornos de Deglutição , Luxações Articulares , Fusão Vertebral , Adolescente , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Transtornos de Deglutição/etiologia , Feminino , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Adulto Jovem
3.
BMC Musculoskelet Disord ; 22(1): 54, 2021 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-33422037

RESUMO

BACKGROUND: PIA has been proven to be a predictor for postoperative dysphagia in patients who undergo occipitospinal fusion. However, its predictive effect for postoperative dysphagia in patients who undergo OCF is unknown. The aim of this study was to evaluate the predictive ability of the pharyngeal inlet angle (PIA) for the occurrence of postoperative dysphagia in patients who undergo occipitocervical fusion (OCF). METHODS: Between 2010 and 2018, 98 patients who had undergone OCF were enrolled and reviewed. Patients were divided into two groups according to the presence of postoperative dysphagia. Radiographic parameters, including the atlas-dens interval (ADI), O-C2 angle (O-C2a), occipital and external acoustic meatus to axis angle (O-EAa), C2 tilting angle (C2Ta), C2-7 angle (C2-7a), PIA and narrowest oropharyngeal airway space (nPAS), were measured and compared. Simple linear regression and multiple regression analysis were used to evaluate the radiographic predictors for dysphagia. In addition, we used PIA = 90° as a threshold to analyze its effect on predicting dysphagia. RESULTS: Of the 98 patients, 26 exhibited postoperative dysphagia. Preoperatively, PIA in the dysphagia group was significantly higher than that in the nondysphagia group. We detected that O-C2a, O-EAa, PIA and nPAS all decreased sharply in the dysphagia group but increased slightly in the nondysphagia group. The changes were all significant. Through regression analyses, we found that PIA had a similar predictive effect as O-EAa for postoperative dysphagia and changes in nPAS. Additionally, patients with an increasing PIA exhibited no dysphagia, and the sensitivity of PIA <90° in predicting dysphagia reached 88.5%. CONCLUSIONS: PIA could be used as a predictor for postoperative dysphagia in patients undergoing OCF. Adjusting a PIA level higher than the preoperative PIA level could avoid dysphagia. For those who inevitably had decreasing PIA, preserving intraoperative PIA over 90° would help avert postoperative dysphagia. TRIAL REGISTRATION: This trial has been registered in the Medical Ethics Committee of West China Hospital, Sichuan University. The registration number is 762 and the date of registration is Sep. 9 th, 2019.

4.
Sci Adv ; 6(50)2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33310848

RESUMO

Osteoporotic fractures are prevalent in society, and their incidence appears to be increasing as the worldwide population ages. However, conventional bone repair materials hardly satisfy the requirements for the repair of pathological fractures. Here, we developed a biomimetic polyetherketoneketone scaffold with a functionalized strontium-doped nanohydroxyapatite coating for osteoporotic bone defect applications. The scaffold has a hierarchically porous architecture and mechanical strength similar to that of osteoporotic trabecular bone. In vitro and in vivo studies demonstrated that the scaffold could promote osteoporotic bone regeneration and delay adjacent bone loss via regulating both osteoblasts and osteoclasts. In addition, the correlations between multiple preimplantation and postimplantation parameters were evaluated to determine the potential predictors of in vivo performance of the material. The current work not only develops a promising candidate for osteoporotic bone repair but also provides a viable approach for designing other functional biomaterials and predicting their translational value.

5.
Spine J ; 2020 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-33049411

RESUMO

BACKGROUND CONTEXT: Tranexamic acid (TXA) is widely used in surgery for adolescent idiopathic scoliosis (AIS) and has been proved to be efficacious in reducing intraoperative blood loss (IBL) and the transfusion rate. However, the routine TXA regimen was intraoperative administration alone, in which the concentration of TXA could not cover the whole process of hyperfibrinolysis. And, its ability to control the massive postoperative blood loss (PBL) may be insufficient. Thus, we promoted a multiple-dose regimen of TXA for patients with AIS who underwent surgical correction. PURPOSE: The primary aims were (1) to determine whether the multiple-dose regimen of TXA could reduce PBL and the postoperative transfusion rate, and (2) to compare the efficacy of oral administration with intravenous administration. The secondary aims were (3) to evaluate whether this regimen could alleviate inflammatory response, and (4) to assess the occurrence of drug-related side effects. STUDY DESIGN: Prospective, double-blinded, randomized controlled trial. PATIENT SAMPLE: A total of 108 patients with AIS who underwent posterior scoliosis correction and spinal fusion (PSS) were enrolled in this study. OUTCOME MEASURES: The primary parameters were PBL and postoperative transfusion rate. Other parameters such as total blood loss (TBL), maximum hemoglobin (Hb) decrease, volume of drainage, inflammation markers (interleukin-6 [IL-6] and C-reactive protein [CRP]), and occurrence of complications were also collected and compared. Multiple regression analysis was used to examine the variables that affected PBL. METHODS: Patients were randomized into three groups. All patients received intravenous TXA 50 mg/kg loading dose and 10 mg/kg/h maintenance dose during surgery. Group A received 1 g oral TXA at 4 hours, 10 hours, and 16 hours postoperatively; group B received 0.5 g intravenous TXA at 6 hours, 12 hours, and 18 hours postoperatively; group C received placebo. RESULTS: The mean PBL and postoperative transfusion rate in group A (957.8±378.9 mL, 13.89%) and B (980.3±491.8 mL, 11.11%) were significantly lower than those in group C [1,495.9±449.6 mL, mean differences=538.1 mL, 95% confidence interval (CI), 290.1-786.1 mL, p<0.001; 515.6 mL, 95% CI, 267.6-763.6 mL, p<.001]; (36.11%, p=.029, p=.013). Meanwhile, the mean TBL, maximum Hb decrease, and volume of drainage were also significantly lower in group A and B than in group C. IL-6 and CRP in group A and B were significantly lower than in group C from postoperative days 1 to 3. All these differences were not significant between groups A and B. No drug-related complications were observed in any patient. Multiple regression showed that the application of postoperative TXA and number of screws were significant parameters affecting PBL. CONCLUSIONS: A multiple-dose regimen of TXA, either by oral or intravenous application, could be a safe and effective means of controlling PBL and decreasing the postoperative transfusion rate in patients with AIS who underwent scoliosis surgery. In addition, it could inhibit postoperative inflammatory response.

6.
World Neurosurg ; 144: e916-e925, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32987173

RESUMO

BACKGROUND: Previous studies have reported the progression of deformity in patients with adolescent idiopathic scoliosis after implant removal. However, for patients with congenital scoliosis, few studies have investigated the prognosis after implant removal. METHODS: We observed 24 patients with congenital scoliosis, who underwent implant removal, for at least 3 years. Radiographic parameters and demographic data were compared to evaluate whether implant removal would lead to deformity progression. RESULTS: Four of the 24 patients (16.7%) suffered correction loss and underwent revision surgery (RS). All correction losses occurred within 12 months of implant removal. The average curve of fixed segments (9.84° ± 7.22° to 16.42° ± 16.79°; P = 0.017) and kyphosis of fixed segments (10.46° ± 13.42° to 18.98° ± 25.99°; P = 0.03) increased significantly throughout the follow-up. After excluding patients who underwent RS, the changes in curve of fixed segments (9.10°-11.58°) and kyphosis of fixed segments (8.50°-9.24°) were all within the measurement error. The coronal and sagittal balance maintained during the follow-up. Through comparison, we thought that the younger age and lower Risser's grade with larger scoliosis might be risk factors for correction loss. CONCLUSIONS: Implant removal after fusion surgery for congenital scoliosis may present loss of correction and require RS, thus preserving implants is recommended. When removal of instrumentation is inevitable, parents and patients should be counseled for potential loss of correction and RS, and patients should be monitored for the progression of deformity.

7.
Spine J ; 20(11): 1761-1769, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32615327

RESUMO

BACKGROUND CONTEXT: Titanium mini-plate has been used in unilateral open-door laminoplasty to maintain the open angle of laminae. Previously, both all-level fixation (C3-C7) and alternative-level (C3, C5, C7) unilateral open-door laminoplasty have been proven to have satisfactory clinical outcomes. However, whether they could achieve similar long-term clinical and radiographic efficacy is still questionable. PURPOSE: To compare the long-term clinical and radiological outcomes between alternative-level and all-level fixation unilateral open-door laminoplasty with a mini-plate fixation system. STUDY DESIGN/SETTING: Retrospective comparative study. PATIENT SAMPLE: Ninety-one patients who underwent unilateral open-door laminoplasty. OUTCOME MEASURES: Clinical results including Japanese Orthopedic Association score, Visual Analogue Score, Neck Dysfunction Index score. Radiographic results including cervical curvature index, cervical range of motion, and the spinal canal expansive parameters, including anteroposterior diameter, Pavlov's ratio, and open angle. METHODS: Between April 2007 and June 2011, 91 patients with minimum 7-year postoperative follow-up were included. Thirty-eight underwent alternative-level fixation (group A) and 53 underwent all-level fixation (group B). Demographic data, including age, gender, operative time, blood loss, and cost, were collected and compared between the two groups. Clinical and radiographic data were obtained preoperatively, at 3 and 6 months and 1 and 3 years postoperatively, as well as at final follow-up. The difference between the two groups and between different time points within one group was compared. RESULTS: Both groups obtained satisfactory clinical outcomes till the final follow-up. No statistic difference was found in Japanese Orthopedic Association, Visual Analogue Score, and Neck Dysfunction Index between the two groups throughout the whole follow-up. Both groups maintained APD and Pavlov's ratio well till follow-up. However, statistic difference was found in the open angle between two groups at final follow-up (34.17±2.75° vs. 36.19±1.80°, p<.05). When we subdivided the cervical segments in group A, we found the mini-plate segments showed maintenance in open angle but a 4.52° decrease in suture segments. The mean cost in group B (17,669.82±1,157.65 $) was significantly higher than in group A (11,452.19±871.07 $; p<.05). CONCLUSIONS: Despite a difference in the maintenance of open angle, both fixation methods achieved satisfactory clinical outcomes. We believe alternative-level fixation is also a safe, effective, and economical fixation method.

8.
Spine J ; 20(5): 745-753, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31778822

RESUMO

BACKGROUND CONTEXT: Dysphagia is a common postoperative complication in patients undergoing occipitocervical fusion (OCF). Previous studies had proposed the use of two measures-the occipital to C2 angle (O-C2a) and the occipital and external acoustic meatus to axis angle (O-EAa)-to predict postoperative dysphagia after OCF. However, these studies had small sample sizes and the predictive abilities of both measures are still not clear. PURPOSE: To evaluate the predictive ability of O-EAa and O-C2a for dysphagia after OCF. STUDY DESIGN: A retrospective clinical study. PATIENT SAMPLE: A total of 109 consecutive patients who had undergone OCF. OUTCOME MEASURES: Presence of postoperative dysphagia, O-C2a, C2 tilting angle (C2Ta), O-EAa, and the narrowest oropharyngeal airway space (nPAS). METHODS: Between April 2010 and June 2018, 109 consecutive patients who had undergone OCF were reviewed. Patients were divided into two groups according to the presence of postoperative dysphagia. Radiographic measurements, including O-C2a, C2Ta, O-EAa, and nPAS, were evaluated at preoperative and 1 month postoperative and the findings were compared. Simple linear regression was used to measure the correlations between the parameters and the presence of dysphagia, and the correlations within the parameters. Multiple regression analysis was used to examine the variables that affected the change of nPAS (dnPAS%). Sensitivity and specificity analyses were used to evaluate the effectiveness of the previously proposed measures ("O-C2a change≤-5°" and "postoperative O-EAa<100°") for prediction of post-OCF dysphagia. RESULTS: The incidence of dysphagia after OCF was 26.6% (29/109). Preoperative values for the radiographic parameters were similar between patients with and without dysphagia. In the dysphagia group, both O-C2a and O-EAa values showed a dramatic decrease after surgery, which was accompanied by a decrease in nPAS. Postoperative O-C2a, O-EAa, and nPAS in the dysphagia group were significantly smaller than those in the nondysphagia group (p<.05). The changes in O-EAa, O-C2a, and nPAS showed a linear correlation with the presence of dysphagia (p<.05). In addition, linear correlations were found between two of the three parameters. Multiple regression showed the change of O-C2a and O-EAa were significant predictors for dnPAS% (ß=0.200, p=.022 and ß=0.549, p=.000). The sensitivity and specificity of "O-C2a change≤-5°" in predicting dysphagia were 75.9% and 80.0% respectively, and those of "postoperative O-EAa<100°" were 75.9% and 62.5%, respectively. However, the sensitivity of the combination of these two values in predicting postoperative dysphagia was as high as 96.6%. CONCLUSION: Both O-EAa and O-C2a could be critical predictors for postoperative dysphagia. During surgery, ensuring that the O-EAa exceeds 100° and simultaneously avoiding an O-C2a reduction greater than 5° could effectively avert postoperative dysphagia.

9.
J Biomed Mater Res B Appl Biomater ; 107(8): 2629-2637, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-30861641

RESUMO

Epidural adhesion is a great clinical challenge after laminectomy. In the present study, two types of hydroxyapatite (HA) laminas with distinct surface microstructures were prepared by cold isostatic pressing (CIP) and slip casting (SC) techniques, and investigated to their anti-fibrosis/adhesion effects by in vitro and in vivo evaluations. In contrast with the dense HA-CIP, HA-SC had a large number of micropores on the surface. After cultured on both HA ceramics, human skin fibroblasts presented the obvious senescent feature, and CCN1 gene expression was significantly up-regulated. HA-SC induced higher CCN1 gene expression than HA-CIP. After used for closing the lost vertebral after laminectomy in rabbits, both HA laminas promoted the recovery of the bony structure as well as prevented the hyperplastic fibrous tissue from penetration into the spinal canal area and inhibited the formation of scar-like tissue in laminectomy sites to some extent. Besides, thinner layer of fibrous tissue and smaller gap between the implant surface and paravertebral muscles were found in HA-CIP than HA-SC. Therefore, HA ceramics could have good anti-fibrosis/adhesion effect when used in spinal repair, and the dense HA-CIP could be an ideal choice. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B:2629-2637, 2019.


Assuntos
Cerâmica/farmacologia , Durapatita/farmacologia , Laminectomia/efeitos adversos , Coluna Vertebral , Aderências Teciduais , Animais , Humanos , Coelhos , Coluna Vertebral/metabolismo , Coluna Vertebral/patologia , Coluna Vertebral/cirurgia , Aderências Teciduais/etiologia , Aderências Teciduais/metabolismo , Aderências Teciduais/patologia , Aderências Teciduais/prevenção & controle
10.
World Neurosurg ; 121: e827-e835, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30312815

RESUMO

BACKGROUND: Extended fusion can be performed in patients with Lenke 5C adolescent idiopathic scoliosis (AIS) with a large and relatively rigid thoracic curve. Progression of the thoracic curve is related to coronal imbalance. We aimed to determine the correlation between the upper instrumented vertebra choice and coronal balance in patients with Lenke 5C AIS. METHODS: A total of 61 patients with Lenke 5C AIS underwent posterior fusion from 2009 to 2015 in a single institution with ≥2 years of follow-up data available. The extended fusion group (n = 32) and thoracolumbar/lumbar (TL/L) fusion group (n = 29) were compared for the correction rates for the main TL/L and thoracic curves, coronal balance, upper end vertebra (UEV) tilt, and Scoliosis Research Society-22 questionnaire score. RESULTS: Both groups had excellent correction of the main TL/L curve, and the extended fusion group had a significantly greater correction rate of the thoracic curve than the TL/L fusion group (70.2% vs. 57.3%). The incidence of coronal imbalance was similar in both groups. The spontaneous change in UEV tilt was associated with the change in coronal balance from the first to the final follow-up examination. In the TL/L fusion group, the increase in UEV tilt from the first to final follow-up visit resulted in improved coronal balance at the final follow-up examination. Both groups had similar Scoliosis Research Society-22 questionnaire scores at 2 years postoperatively. CONCLUSIONS: In patients with Lenke 5C AIS, thoracic curve fusion results in better correction of the thoracic curve but no improvement in coronal balance. With TL/L fusion, a postoperative UEV tilt >5° leads to better coronal balance.


Assuntos
Vértebras Lombares/cirurgia , Escoliose/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Adolescente , Criança , Feminino , Seguimentos , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Radiografia , Estudos Retrospectivos , Escoliose/complicações , Escoliose/diagnóstico por imagem , Estatísticas não Paramétricas , Inquéritos e Questionários , Vértebras Torácicas/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
11.
Clin Neurol Neurosurg ; 176: 25-29, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30481654

RESUMO

OBJECTIVES: The nanohydroxyapatite/polyamide-66 (n-HA/PA66) cage is a novel biomimetic nonmetal cage device that is now used in some medical centers, while the titanium mesh cage (TMC) is a typical metal cage device that has been widely used for decades. This study was performed to compare the long-term outcomes of these two different cages in patients undergoing anterior cervical corpectomy. PATIENTS AND METHODS: This retrospective study involved 107 patients who underwent single-level anterior corpectomy using either a TMC (n = 52) or an n-HA/PA66 cage (n = 55) for treatment of cervical degenerative disease with a minimum follow-up of 8 years. Their radiographic data (cage subsidence, fusion status, segmental sagittal alignment, and cervical spine degeneration) and clinical data [visual analog scale (VAS) and Japanese Orthopedic Association (JOA) scores] were evaluated preoperatively, postoperatively, and at the final follow-up. RESULTS: The mean duration of follow-up was 103.6 ± 6.3 months in the n-HA/PA66 group and 102.4 ± 4.6 months in the TMC group. The n-HA/PA66 group and the TMC group had similar final fusion rates (97% vs. 94%, respectively). The final n-HA/PA66 cage subsidence was 2.4 ± 1.0 mm with 18.2% subsidence of >3 mm, which was significantly lower than the respective 3.0 ± 0.7 mm and 40.4% for the TMC (p < 0.01). The n-HA/PA66 group also had better JOA scores than the TMC group (p < 0.01). No significant difference in the segmental sagittal alignment, cervical lordosis, or VAS score was observed between the two groups (p = 0.18, 0.42, and 0.17, respectively). CONCLUSIONS: The n-HA/PA66 cage is associated with excellent radiographic fusion, lower subsidence and better clinical outcomes than the TMC within 8 years after single-level anterior cervical corpectomy. With the addtional benefit of radiolucency, the n-HA/PA66 cage could be superior to the TMC in anterior cervical construction.


Assuntos
Nylons , Espondilose/cirurgia , Telas Cirúrgicas , Titânio , Adulto , Idoso , Vértebras Cervicais/cirurgia , Feminino , Seguimentos , Humanos , Lordose/cirurgia , Masculino , Pessoa de Meia-Idade , Nylons/efeitos adversos , Próteses e Implantes , Procedimentos Cirúrgicos Reconstrutivos/métodos , Doenças da Medula Espinal/cirurgia , Fusão Vertebral/instrumentação , Telas Cirúrgicas/efeitos adversos , Titânio/efeitos adversos , Resultado do Tratamento
12.
Acta Orthop Belg ; 84(1): 108-115, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30457509

RESUMO

To evaluate and compare the clinical and radiographic results between temporary C1-C2 pedicle screw fixation and cable-dragged reduction and cantilever beam internal fixation. Between 2010 and 2013, temporary C1-C2 pedicle screw fixation (Group P, 28 patients) and cable-dragged reduction following cantilever beam internal fixation (Group C, 33 patients) were performed on type II odontoid fracture cases. Implants were removed after fracture union. All of the 61 surgeries were performed successfully with no iatrogenic neurological worsen. One patient in Group P detected intra-operative vertebral artery injury. All patients gained fracture union. Among the observed indexes, only blood loss in Group P (128.9 ± 73.9ml) is statistically higher than in Group C (97.3 ± 5 4.2ml). Pedicle screw fixation carries the risk of vertebral artery injury, especially in patients with high-riding vertebral artery. Cable-dragged reduction following cantilever beam internal fixation could avoid the potential risk of vertebral injury, but it prolonged the fixed segments. We thought cable-dragged reduction following cantilever beam internal fixation could be an alternative method for treating type II odontoid fracture.


Assuntos
Fixação Interna de Fraturas/métodos , Processo Odontoide/lesões , Fraturas da Coluna Vertebral/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Processo Odontoide/cirurgia , Parafusos Pediculares , Resultado do Tratamento
13.
World Neurosurg ; 117: e522-e529, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29929029

RESUMO

BACKGROUND: Choosing the fusion level for posterior fusion in patients with Lenke 5C adolescent idiopathic scoliosis (AIS) is highly associated with coronal balance. Previous studies indicated that in patients with lowest end vertebra tilt >25°, surgeons could extend distal fusion to avoid coronal imbalance (CIB). This study aimed to assess the risk factors for CIB in Lenke 5C scoliosis and to discuss how to select fusion level. METHODS: We reviewed 59 patients with Lenke 5C AIS in 1 institution with at least 2 years follow-up from 2010 to 2015. Preoperative and 3-month and 2-year postoperative follow-up radiographs were measured using several specific measurements related to coronal balance. Patients were categorized into an LEV (lower end vertebra) group and an LEV+1 group. RESULTS: CIB was found in 6/31 patients in the LEV+1 group at final follow-up and not found in the LEV group at the first or final follow-up. The C7 plumb line shifted to the convex side of the central sacral vertical line in 47/59 patients, including all of the 19 patients with CIB after surgery. Patients who underwent fusion at LEV+1 with >25° LEV tilt also showed poor results regarding CIB. Statistically, coronal balance at the final follow-up was correlated with preoperative bending lumbosacral hemicurve (P = 0.002) and all 6 patients with CIB had bending lumbosacral hemicurve >15°. No significant difference was found in Scoliosis Research Society-22 questionnaire scores between the 2 groups at 2-year-follow-up. CONCLUSIONS: Distal fusion extension at LEV+1 is more likely to result in CIB at the first and final follow-up, especially when the bending lumbosacral hemicurve is >15°. Fusion at LEV+1 should not be chosen when LEV is at L4.


Assuntos
Escoliose/cirurgia , Fusão Vertebral/métodos , Coluna Vertebral/cirurgia , Adolescente , Feminino , Seguimentos , Humanos , Masculino , Dor/etiologia , Dor/cirurgia , Satisfação do Paciente , Estudos Retrospectivos , Escoliose/complicações , Escoliose/diagnóstico por imagem , Escoliose/psicologia , Autoimagem , Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
14.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 32(4): 420-427, 2018 04 15.
Artigo em Chinês | MEDLINE | ID: mdl-29806299

RESUMO

Objective: To explore the feasibility of co-transduction and co-expression of Nogo extracellular peptide residues 1-40 (NEP1-40) gene and neurotrophin 3 (NT-3) gene into neural stem cells (NSCs). Methods: NSCs were derived from the cortex tissue of Sprague Dawley rat embryo. The experiment included 5 groups: no-load lentiviral vector transducted NSCs (group A), NEP1-40 transducted NSCs (group B), NT-3 transducted NSCs (group C), NEP1-40 and NT-3 corporately transducted NSCs (group D), and blank control (group E). Target genes were transducted into NSCs by lentiviral vectors of different multiplicity of infection (MOI; 5, 10, 15) for different time (24, 48, 72 hours). Fluorescent microscope was used to observe the expression of fluorescence protein and acquire the optimum MOI and optimum collection time. Real-time fluorescence quantitative PCR and Western blot tests were utilized to evaluate the gene expressions of NEP1-40 and NT-3 in NSCs and protein expressions of NEP1-40 and NT-3 in NSCs and in culture medium. Results: The optimum MOI for both target gene was 10 and the optimum collection time was 48 hours. The real-time fluorescence quantitative PCR and Western blot results showed that the mRNA and protein relative expressions of NEP1-40 in groups B and D were significantly higher than those in groups A and C ( P<0.05), but no significant difference was found between groups B and D, and between groups A and C ( P>0.05). The mRNA and protein relative expressions of NT-3 in groups C and D were significantly higher than those in groups A and B ( P<0.05), but no significant difference was found between groups A and B, and between groups C and D ( P>0.05). Conclusion: NEP1-40 and NT-3 gene can be successfully co-transducted into NSCs by the mediation of lentiviral vector. The expressions of the two target genes are stable and have no auxo-action or antagonism between each other.


Assuntos
Córtex Cerebral , Lentivirus/genética , Células-Tronco Neurais/citologia , Neurotrofina 3/genética , Fragmentos de Peptídeos/genética , Animais , Células Cultivadas , Lentivirus/metabolismo , Neurotrofina 3/metabolismo , Ratos , Ratos Sprague-Dawley
15.
BMC Musculoskelet Disord ; 19(1): 101, 2018 04 04.
Artigo em Inglês | MEDLINE | ID: mdl-29615017

RESUMO

BACKGROUND: To evaluate the mid- to long-term clinical and radiographic outcomes of anterior cervical discectomy and dynamic cervical implant (DCI) arthroplasty for degenerative cervical disc disease. METHODS: From April 2010 to October 2010, 38 patients with single- or double-level cervical disc herniation underwent anterior cervical discectomy and DCI arthroplasty. The clinical results and radiographic outcomes of these 38 patients (42 levels) were retrospectively evaluated. The clinical results included the visual analogue scale, Japanese Orthopaedic Association score, Neck Disability Index score, 36-item short form health survey questionnaire, and incidences of complications and neurological deterioration. Radiographic results including cervical alignment, intervertebral height, cervical range of motion (ROM), ROM of the functional spinal unit, adjacent intervertebral ROM, migration, subsidence, and heterotopic ossification (HO) were assessed on plain radiography, three-dimensional computed tomography, and magnetic resonance imaging. RESULTS: The mean follow-up period was 72.3 months (range 68-78 months). During follow-up, all patients showed significant improvements in the visual analogue scale score, Japanese Orthopaedic Association score, Neck Disability Index score, 36-item short form health survey physical component summary score and mental component summary score. The ROM of the functional spinal unit was partly reduced. The DCI migrated forward in 10 of 42 (23.8%) cases, and HO was detected in 24 of the 42 (57.1%) DCI segments. Subsidence was observed in 14 of 42 (33.3%) DCI segments. Two patients experienced symptom recurrence, and were treated conservatively. CONCLUSIONS: The clinical efficacy of DCI arthroplasty was maintained during mid- to long-term follow-up. HO formation is a common phenomenon, leading to a substantial decrease in ROM at the index level and recurrence of neurological symptoms. The incidence of implant subsidence and migration is relatively high, leaving a potential risk of symptoms at the index level and adjacent segment degeneration. We consider that the first choice for patients with degenerative cervical disc disease should still be total disc replacement or anterior cervical discectomy and fusion, rather than DCI arthroplasty.


Assuntos
Vértebras Cervicais/cirurgia , Degeneração do Disco Intervertebral/cirurgia , Substituição Total de Disco , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos
16.
Acta Haematol ; 139(1): 19-27, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29320771

RESUMO

In this study, we aimed to investigate the incidence, risk factors, and clinical outcomes of perianal infections during the pre-engraftment phase after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Consecutive patients who underwent non-T-cell-depleted allo-HSCT at the Peking University Institute of Hematology from January 1 to December 31, 2016 were enrolled (n = 646). Ninety-nine patients were found to have perianal infections during the pre-engraftment phase, and 80 were found to have neutropenia on perianal infection diagnosis. The cumulative incidence of perianal infection during the pre-engraftment phase after allo-HSCT was 15.3%. A history of perianal infection (hazard ratio [HR] = 15.28, p < 0.001) or hemorrhoids before allo-HSCT (HR = 3.09, p = 0.001) was significantly associated with the new occurrence of perianal infection after allo-HSCT. All patients received empirical broad-spectrum antimicrobial therapies, and 97 were cured after treatment. The clinical outcomes at 100 days after allo-HSCT were comparable in patients with and without perianal infections. In summary, patients who had perianal infection or hemorrhoids before allo-HSCT had a higher risk of new occurrence of perianal infection after allo-HSCT. With appropriate treatment, perianal infection during the pre-engraftment phase did not influence the clinical outcomes.


Assuntos
Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Infecções/epidemiologia , Infecções/etiologia , Proctite/epidemiologia , Proctite/etiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Infecções/diagnóstico , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Proctite/diagnóstico , Fatores de Risco , Taxa de Sobrevida , Condicionamento Pré-Transplante , Transplante Homólogo , Adulto Jovem
17.
Clin Neurol Neurosurg ; 164: 103-107, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29220729

RESUMO

OBJECTIVE: To compare clinical and radiographic outcomes of dynamic cervical implant(DCI) with anterior cervical discectomy and fusion(ACDF) in the treatment of single-level cervical degenerative disc disease (CDDD) 5 years after surgery. PATIENTS AND METHODS: Forty-three patients with DCI were matched one-to-one with patients with ACDF based on age, gender, and operative segment in this retrospective study. All patients had been followed up for more than 5 years. Radiological assessments included heterotopic ossification(HO), adjacent segment degeneration (ASD), intervertebral height (IH), range of motion (ROM) at C2-7, the implanted level and adjacent levels. Clinical parameters included Visual Analogue Scale (VAS), Japanese Orthopedic Association (JOA) scores, Neck Disability Index (NDI) and Short Form-36 scores(SF-36). Patients were also asked to rate their postoperative satisfaction at final follow-up. RESULTS: The postoperative ROM of C2-7 and ROM at the implanted level in the DCI group were higher than those in the ACDF group. The ROM at the implanted level in the DCI group was maintained at 2 years postoperatively but decreased at final follow-up (10.7° vs 4.5°). The rate of HO in the DCI group was 46.5% (20/43). The rate of ASD was comparable between the two groups (16.3% vs 20.9%). The JOA, VAS, NDI, and SF-36 scores were comparable between two groups and improved postoperatively. However, the proportion of patients who reported their level of satisfaction as being very satisfied, or somewhat satisfied was larger in the ACDF group than that in the DCI group (95.3% vs 79.1%). CONCLUSIONS: DCI resulted in better ROM of C2-7 and the implanted level than ACDF did. The clinical outcomes were similar between two groups. However, the ROM at the implanted level decreased at final follow-up in the DCI group, which may contribute to patient dissatisfaction. The long-term outcomes were not that satisfactory especially due to the deviation from its original intention as a non-fusion technique. As such, we have not used DCI in the past 2 years.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/cirurgia , Fusão Vertebral/instrumentação , Fusão Vertebral/tendências , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Próteses e Implantes/tendências , Estudos Retrospectivos , Resultado do Tratamento
18.
BMC Musculoskelet Disord ; 18(1): 538, 2017 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-29258494

RESUMO

BACKGROUND: Osteoblastoma is a rare and benign tumor which requires early diagnosis and surgical excision. Scoliosis is a common presentation following osteoblastoma. It is considered due to pain-provoked muscle spasm on the side of the lesion. Few researches about osteoblastoma combined with severe scoliosis have been reported. CASE PRESENTATION: A 14-year-old girl presents with progressive scoliosis deformity for 3 years, with gradually appeared low back pain and numbness of left leg. Radiographic results showed osteoblastic mass at the left side of L3-L4 with severe scoliosis deformity, pelvic obliquity and spinal imbalance. The patient underwent posterior tumor excision, spinal decompression, scoliosis correction, spinal fusion with auto-graft and instrumentation from T8-S1. The mass was found to be osteoblastoma. The patient had a full neurological recovery with no aggravate of scoliosis or spinal imbalance during the follow-up. CONCLUSIONS: This case emphasizes the importance of early diagnosis and surgical treatment of osteoblastoma. Early surgical excision will not only prevent neurological deficit but also the progression of scoliosis. Atypical scoliosis presence without pain requires carefully examination of whether a tumor exists.


Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/cirurgia , Osteoblastoma/diagnóstico por imagem , Osteoblastoma/cirurgia , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Adolescente , Neoplasias Ósseas/complicações , Feminino , Seguimentos , Humanos , Osteoblastoma/complicações , Escoliose/complicações
19.
Neural Netw ; 93: 219-229, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28668660

RESUMO

Stochastic Gradient Descent (SGD) updates Convolutional Neural Network (CNN) with a noisy gradient computed from a random batch, and each batch evenly updates the network once in an epoch. This model applies the same training effort to each batch, but it overlooks the fact that the gradient variance, induced by Sampling Bias and Intrinsic Image Difference, renders different training dynamics on batches. In this paper, we develop a new training strategy for SGD, referred to as Inconsistent Stochastic Gradient Descent (ISGD) to address this problem. The core concept of ISGD is the inconsistent training, which dynamically adjusts the training effort w.r.t the loss. ISGD models the training as a stochastic process that gradually reduces down the mean of batch's loss, and it utilizes a dynamic upper control limit to identify a large loss batch on the fly. ISGD stays on the identified batch to accelerate the training with additional gradient updates, and it also has a constraint to penalize drastic parameter changes. ISGD is straightforward, computationally efficient and without requiring auxiliary memories. A series of empirical evaluations on real world datasets and networks demonstrate the promising performance of inconsistent training.


Assuntos
Redes Neurais de Computação , Processos Estocásticos
20.
Medicine (Baltimore) ; 96(14): e6559, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28383432

RESUMO

In its typical form, spinal tuberculosis (TB) presents as destroyed contiguous vertebral bodies with involvement of intervertebral discs and paravertebral or psoas abscesses. Atypical forms are uncommonly reported. Here, we describe 8 patients with noncontiguous multisegmental spinal TB with no intervertebral disc involvement. From 2013 to 2014, we surgically treated 384 patients with spinal TB to relieve spinal cord compression, re-establish spinal stability, confirm the diagnosis, and debride the TB foci. Eight of these patients had noncontiguous multisegmental TB without intervertebral disc involvement. Seven of the 8 patients underwent short-segmental fixation and fusion at a single focus. Appropriate combinations of anti-TB medication were continued until final follow-up. They were followed at established intervals using plain radiography, 3-dimensional computed tomography, and magnetic resonance imaging of the surgical region to evaluate fusion and the condition of the foci. Mean follow-up was 26.6 months (range, 24-32 months), during which time all patients were prescribed the appropriate anti-TB medications. Satisfactory clinical and radiological results were obtained in all patients, without complications. Presentation of noncontiguous multisegmental spinal TB without the involvement of intervertebral disc resembles that of a neoplasm or other spinal infection. Differentiation requires the presence of a combination of general symptoms, laboratory test results, appropriate radiological results, and the physician's experience. For patients in whom surgery is indicated, the patient's general condition should be taken into consideration. Surgical intervention only focus on the responsible level is less invasive and can achieve satisfactory clinical and radiographic outcomes.


Assuntos
Tuberculose da Coluna Vertebral/diagnóstico por imagem , Adolescente , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Coluna Vertebral/patologia , Tomografia Computadorizada por Raios X , Tuberculose da Coluna Vertebral/patologia , Tuberculose da Coluna Vertebral/terapia , Adulto Jovem
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