ObjectiveTo observe the medium-term clinical and radiological outcomes of anterior release internal distraction in treatment of severe and rigid scoliosis. MethodsBetween March 2009 and March 2012, 26 patients with severe and rigid scoliosis were treated with anterior release, posterior internal distraction, and two stage posterior spinal fusion. There were 11 males and 15 females with an average age of 19.6 years (range, 14-25 years). The average disease duration was 13.6 years (range, 3-24 years). All cases were idiopathic scoliosis. Of 26 cases, 2 cases were rated as Lenke type I, 8 as type Ⅱ, 13 as type IV, 1 as type V, and 2 as type VI. The apical vertebrae located at T6 in 1 case, at T7 in 3 cases, at T8 in 7 cases, at T9 in 13 cases, and at T10 in 2 cases. The average 4 vertebral bodies were released by anterior approach, and average 14 vertebral bodies were fused after posterior surgery. Fourteen patients received 2 times distraction. Scoliosis Research Society-22 (SRS-22) questionnaire was used to access health-related quality of life. The radiological parameters were measured, including coronal plane Cobb angel of major curve, apical vertebral translation (AVT), C7 plumb line-center sacral vertical line (C7PL-CSVL), sagittal vertical axis (SVA), and thoracic kyphosis (TK) at pre-and post-operation. ResultsThe average total operation time was 592.7 minutes; the average total blood loss volume was 1 311.2 mL; and total hospitalization cost was (14.7±1.4)×104 yuan RMB. The coronal plane Cobb angle of major curve was (55.7±16.5)°, and the TK was (43.2±16.2)° after first distraction. The patients were followed up 2-5 years (mean, 3.8 years). Temporary dyspnea and pleural effusion occurred in 1 case respectively after distraction, and symptoms disappeared after symptomatic treatment. Screw loosening and pseudoarthrosis formation was observed in 1 case at 6 months after fusion, good recovery was achieved after revision. No infection or neurological complication was found. The coronal plane Cobb angel of major curve, TK, and AVT after fusion and at last follow-up were significantly lower than preoperative ones (P<0.05), but no significant difference was found between at post-fusion and last follow-up (P>0.05). There was no significant difference in C7PL-CSVL and SVA between at pre-and post-operation (P>0.05). At last follow-up, SRS-22 questionnaire scores were 4.32±0.42 for active degree, 4.54±0.58 for mental health, 3.97±0.76 for self-image, 4.09±0.64 for pain, and 4.03±0.83 for satisfaction degree. ConclusionAnterior release internal distraction can provide satisfactory correction results for severe and rigid scoliosis with higher safety and lower incidence of complication.
ObjectiveTo analyze the clinical characteristics of stiff left atrial syndrome (SLAS) after Mei mini maze procedure for atrial fibrillation (AF), and to explore its risk factors and treatments. Methods We retrospectively analyzed the clinical data of the patients who underwent Mei mini maze procedure in Xinhua Hospital between 2010 and 2020. According to whether SLAS occurred in the early postoperative period, patients were divided into a SLAS group and a non-SLAS group. The basic data, perioperative echocardiogram and laboratory test indexes of the two groups were compared. Results A total of 1 056 patients were collected. There were 672 (63.6%) males with an average age of 63.6±9.3 years, including 489 patients with persistent AF and 567 patients with paroxysmal AF. Fourteen (14/1 056, 1.3%) patients developed SLAS, with an average occurrence time of 2.1±1.1 days after the surgery. The average follow-up time of the whole group was 21.4±7.8 months. Two patients in the SLAS group developed SLAS again after discharge, and the occurrence time was 3 weeks and 4 weeks after the operation, respectively; while no SLAS occurred after discharge in the non-SLAS group. Diabetes and small preoperative left atrial diameter were risk factors for SLAS after surgery. Patients with SLAS had a good prognosis after adequate diuretic therapy. Conclusion The incidence of SLAS after Mei mini maze procedure for AF is low, and it mostly occurs in the early postoperative period. After adequate diuretic treatment, the prognosis is good.
Objective To explore the effectiveness of arthroscopic release of elbow joint assisted by medial small incision ulnar nerve release in the treatment of non-traumatic elbow stiffness. MethodsThe clinical data of 15 patients with non-traumatic elbow stiffness treated with arthroscopic release of elbow joint assisted by medial small incision ulnar nerve release between April 2019 and September 2023 were retrospectively analyzed. There were 6 males and 9 females with an average age of 46 years ranging from 34 to 56 years. The causes included rheumatoid arthritis in 3 cases, gouty arthritis in 2 cases, loose bodies in 3 cases, and elbow osteoarthritis in 7 cases. There were 4 cases with ulnar neuritis and 3 cases with synovial osteochondromatosis. The duration of elbow stiffness ranged from 6 to 18 months, with an average of 10 months. The operation time and intraoperative blood loss were recorded. The effectiveness was evaluated by visual analogue scale (VAS) score, range of elbow motion (maximum flexion, maximum extension, and total flexion and extension), Mayo score, and Hospital for Special Surgery (HSS) elbow score. ResultsThe operation time was 60-90 minutes, with an average of 65 minutes, and the intraoperative blood loss was 40-100 mL, with an average of 62 mL. All patients were followed up 13-18 months, with an average of 14 months. There was no complication such as vascular and nerve injury, poor wound healing, collateral ligament injury, elbow joint space narrowing, osteophyte proliferation, or loose body formation around the joint. At last follow-up, the elbow range of motion (maximum flexion, maximum extension, and total flexion and extension), VAS score, and Mayo score significantly improved when compared with those before operation (P<0.05). The HSS elbow score was 85-95, with an average of 92; 12 cases were excellent, 3 cases were good, and the excellent and good rate was 100%. ConclusionArthroscopic release of elbow joint assisted by medial small incision ulnar nerve release is an effective way to treat non-traumatic elbow stiffness, which has the advantages of small trauma, short operation time, and good effectiveness. It can carry out early elbow rehabilitation training and significantly improve elbow function.
目的 研究长期持续性心房颤动患者静息心率控制与脉搏波传导速度（PWV）的关系。 方法 序贯收集于2011年12月－2012年3月在四川大学华西医院心脏内科门诊就诊的长期持续性心房颤动患者84例，将人群按静息心率是否低于80次/min，分为标准组（心率＜80次/min）和对照组（心率≥80次/min），采用Pearson相关及多元线性回归分析方法，研究静息心率控制与PWV的关系。 结果 ①标准组人群的PWV显著低于对照组，而饮酒率显著高于对照组，差异皆有统计学意义（P＜0.05）。②Pearson相关分析显示静息心率与PWV存在线性相关关系（r=0.355，P=0.001）；多元线性回归分析显示，在调整了年龄、性别、BMI、收缩压、舒张压、吸烟、饮酒、空腹血糖、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白等混杂因素影响后，心率与PWV仍独立相关。 结论 长期持续性心房颤动患者的静息心率控制不良与PWV升高关系密切。
ObjectiveTo investigate the relationship between the level of stromal cell-derived factor-1 (SDF-1), internal carotid artery stiffness index, and non-arteritic anterior ischemic optic neuropathy (NAION) with macular edema (ME). MethodsA retrospective study. A total of 202 patients with NAION diagnosed by ophthalmic examination in Department of Ophthalmology, The Second Affiliated Hospital of Jiamusi University from January 2023 to January 2025 were included in the study. Based on the presence or absence of ME, the patients were divided into the NAION+ME group and the NAION group, with 94 and 108 cases respectively. A prediction model was constructed based on the influencing factors. To comprehensively evaluate the predictive value of SDF-1 level and carotid artery stiffness index for NAION with ME, a multidimensional analytical approach was employed. The diagnostic performance of individual and combined markers was assessed by constructing receiver operating characteristic (ROC) curves and calculating the area under the curve (AUC). Multivariate logistic regression analysis was performed to determine their independent predictive value. Stratified subgroup analyses were conducted to explore predictive differences across various populations. Cox proportional hazards regression models were established to evaluate long-term predictive value. Restricted cubic spline (RCS) analysis was applied to reveal potential nonlinear dose-response relationships. Mediation effect models were constructed to analyze the mediating role of carotid artery stiffness index in the association between SDF-1 level and NAION with ME. ResultsIn the NAION+ME group, systolic blood pressure (t=6.066), body mass index (t=2.804), disease duration (t=2.552), intraocular pressure (t=2.574), high-density lipoprotein (t=2.729), fasting blood glucose (t=2.022), glycosylated hemoglobin (t=7.235), SDF-1 level (t=14.319), and internal carotid artery stiffness index (t=2.633) were higher than those in the NAION group, while diastolic blood pressure was lower (P＜0.05). ROC curve analysis showed that the AUC of SDF-1 level combined with internal carotid artery stiffness index in predicting the risk of adverse prognosis was 0.894 [95% confidence interval (CI) 0.803-0.945], with a sensitivity of 87.98% and a specificity of 95.69%. Logistic regression analysis demonstrated significant independent correlations between SDF-1 level (OR=1.682, 95%CI 1.156-1.986), internal carotid artery stiffness index (OR=1.826, 95%CI 1.369-2.648), and the risk of ME in NAION patients (P＜0.05). Subgroup analysis revealed that elevated SDF-1 level and internal carotid artery stiffness index were associated with a higher risk of NAION with ME (Pfor trend＜0.05). RCS analysis demonstrated a nonlinear dose-response relationship between the continuous changes in SDF-1 level and internal carotid artery stiffness index and the risk of NAION with ME (P＜0.05). Mediation effect model analysis showed that internal carotid artery stiffness index played a mediating role between SDF-1 level and the risk of NAION with ME. ConclusionsSDF-1 level and internal carotid artery stiffness index are independent risk factors for ME in NAION patients. The combined detection of these two indicators holds significant value in predicting disease progression.
目的 了解老年2型糖尿病动脉僵硬度与踝臂指数（ABI）对评价外周动脉硬化的价值。 方法 2010年1月－3月，应用超声、回声跟踪技术和动脉硬化检测仪检测80例老年2型糖尿病患者（观察组）和40例正常老年人（对照组）的颈总动脉内中膜厚度（IMT）、僵硬系数（β）、脉搏波传导速度（PWVβ）、ABI及动脉斑块情况。 结果 与对照组比较，观察组患者的IMT增厚、β增高、PWVβ增快、ABI降低及动脉斑块发生率增多，差异均具有统计学意义（P＜0.001）。 结论 老年2型糖尿病可导致IMT增厚、动脉僵硬度增高、PWVβ增快、ABI降低及更易发生动脉粥样硬化斑块，这些参数可以预测外周动脉粥样硬化的程度，利用彩色多普勒超声诊断仪和动脉硬化检测仪可以较容易得到这些参数，是评价外周动脉粥样硬化病变一种简便、易行，有临床实际意义的方法和手段。
ObjectiveTo 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.MethodsA 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.ResultsAll 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 (χ2=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.ConclusionFor 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.
Objective To explore the effectiveness of computer-aided technology in the treatment of primary elbow osteoarthritis combined with stiffness under arthroscopy. Methods The clinical data of 32 patients with primary elbow osteoarthritis combined with stiffness between June 2018 and December 2020 were retrospectively analyzed. There were 22 males and 10 females with an average age of 53.4 years (range, 31-71 years). X-ray film and three-dimensional CT examinations showed osteophytes of varying degrees in the elbow joint. Loose bodies existed in 16 cases, and there were 7 cases combined with ulnar nerve entrapment syndrome. The median symptom duration was 2.5 years (range, 3 months to 22.5 years). The location of bone impingement from 0° extension to 140° flexion of the elbow joint was simulated by computer-aided technology before operation and a three-dimensional printed model was used to visualize the amount and scope of impinging osteophytes removal from the anterior and posterior elbow joint to accurately guide the operation. Meanwhile, the effect of elbow joint release and impinging osteophytes removal was examined visually under arthroscopy. The visual analogue scale (VAS) score, Mayo elbow performance score (MEPS), and elbow range of motion (extension, flexion, extension and flexion) were compared between before and after operation to evaluate elbow function. Results The mean operation time was 108 minutes (range, 50-160 minutes). All 32 patients were followed up 9-18 months with an average of 12.5 months. There was no other complication such as infection, nervous system injury, joint cavity effusion, and heterotopic ossification, except 2 cases with postoperative joint contracture at 3 weeks after operation due to the failure to persist in regular functional exercises. Loose bodies of elbow and impinging osteophytes were removed completely for all patients, and functional recovery was satisfactory. At last follow-up, VAS score, MEPS score, extension, flexion, flexion and extension range of motion significantly improved when compared with preoperative ones (P<0.05). Conclusion Arthroscopic treatment of primary elbow osteoarthritis combined with stiffness using computer-aided technology can significantly reduce pain, achieve satisfactory functional recovery and reliable effectiveness.