【Abstract】 Objective To evaluate the surgical management of rigid post-traumatic thoracolumbar kyphosis (RPTK) by simultaneous posterio-anterior circumferential releasing, correction and anterior corpectomy with preserved posterior vertebral wall. Methods Twenty patients with RPTK were treated between October 2004 and October 2010 by posterior releasing, anterior subtotal corpectomy with preserved posterior vertebral wall, correction, strut graft, and short segmental fixation. There were 14 males and 6 females with an average age of 43.2 years (range, 23-63 years). The time between injury and operation was 4 months to 23 years (mean, 1.4 years). The affected locations were T11 in 1 case, T12 in 8 cases, L1 in 10 cases, and L2 in 1 case. The Cobb angle and the intervertebral height of the fractured vertebra body were measured before and after operations. The degrees of low back pain were assessed by Japanese Orthopaedic Association (JOA) scores. Results No incision infection, nerve injury, or cerebral spinal fluid leakage occurred. Seventeen patients were followed up 1-5 years with an average of 2.8 years. The JOA score at last follow-up (26.2 ± 3.9) was significantly improved when compared with the pre-operative score (14.0 ± 5.7) (t=4.536, P=0.001). One patient had aggravation of kyphosis at 3 months postoperatively, who was in stabilized condition after prolonging immobilizated time. The Cobb angle was corrected from (43.2 ± 11.5)° preoperatively to (9.8 ± 5.7)° at last follow-up, showing significant difference (P lt; 0.01). There was significant difference in the intervertebral height of the fractured vertebra body between preoperation and last follow-up (P lt; 0.05). The intervertebral height of fractured vertebra was restored to 87.0% ± 11.2% of adjacent disc height. Conclusion Posterio-anterior circumferential releasing and anterior corpectomy with preserved posterior vertebral wall can achieve satifactory clinical results, not only in pain relieving, kyphosis correction, vertebral height restoration, and spinal stability restoration, but also in the risk reduce of bleeding and spinal cord disturbance.
Objective To investigate the quality of life (QOL) of Beichuan cadres 1 year after Wenchuan earthquake, so as to provide references for promoting psychological intervention and improving QOL. Methods With the adoption of WHOQOL-BREF, questionnaire survey on basic conditions of cadre victims, and PCL-C scale, cross-section survey was conducted for 2 055 cadres of Beichuan public institutions in aspects of their QOL, social demographic characteristics and psychological trauma. Results a) Compared with domestic norm, although the Beichuan cadres had higher score in social relation domain (14.31 ± 2.59, Plt;0.01), their QOL scores in each dimensions (physical domain score: 14.16 ± 2.43; psychological domain score: 13.79 ± 2.59, environmental domain score: 11.20 ± 2.74) were lower with significant difference (Plt;0.01); b) The group with population under the age of 30 scored higher than other age groups in the psychological and environmental domains; men scored higher than women in the psychological domain; the widowed group scored lower than other groups in all domains; the Han nationality group scored higher than the Qiang nationality group in all domains; the primary education group scored lower than other groups in the social relation domain; the group with relatives, houses and physical loss or damage scored lower than the non-loss group in all domains; and the higher the score in PCL-C, the lower the scores in all domains (all Plt;0.05). Conclusion Beichuan cadres are severely affected in their physical, psychological and environmental domains even one year after Wenchuan earthquake, especially the female, the Qiang nationality, the old, the lost, and the psychological injured cadres are more badly affected with worse QOL, so those population should be concerned in particular with sustainable psychological service and other measures. The finding of social relation domain score being higher than general population suggests that it is important to promote the satisfaction with social relation through the timely effective support from both government and civil society, and the resettlement of sample housing area as well.
Objective To evaluate the psychological trauma incurred by the hospitalization survivor of Zhouqu district after the Zhouqu debris flow so as to provide relevant information for psychological and medical interventions. Methods The psychological state of 67 hospitalized survivors of the disaster and other 47 inpatients with similar complaints but not coming from the disaster area was investigated through a mental health self-assessment questionnaire, self-rating anxiety scale (SAS), self-rating depression scale (SDS) and PTSD-SS scale. Results The post-disaster survivors had different levels of psychological problems and post-traumatic stress disorder, and there were significant differences compared to the control group (Plt;0.01, Plt;0.01). The SDS score and the SAS score of the survivor were 48.44+15.648 and 52.92+11.672, respectively, which were all much higher than those of the control group (Plt;0.01, Plt;0.05). Conclusion The debris flow disaster bring serious psychological trauma to the victims. It is necessary to pertinently carry out post-disaster psychological relief including psychological intervention and regulation for the hospitalized survivors, so as to alleviate and reduce their psychological suffering.
Objective To evaluate the psychological trauma incurred by the people in wenxian after the Wenchuan earthquake so as to provide relevant information for psychological and medical interventions. Methods Thepsychological state of the people after the earthquake was investigated using a mental health self-assessment questionnaire, self-rating anxiety scale, and self-rating depression scale. Results We found: 56.0% of the respondents were not happy, 39.6% often cried bitterly, 56.7% felt pain, 40.7% lost interest, 69.2% felt uneasy, nervous, or worried, and 27.0% would like to end their lives; the SDS scores (56.48±110.43) and SAS scores (39.88±11.38) of the people were significantly higher than those of the national norms (Plt;0.001). The following symptons appeared: 59.3% had headache, 50.5% poor appetite, poor sleeping 56.0%, 58.2% were easily frightened, tremors 29.7%, 50.5% dyspepsia, 42.9% thoughts fuzzy, 60.4% stomach discomfort, fatigue 85.7%. Conclusion The earthquake disaster brought about serious psychological harm to people. It is necessary to strengthen post-earthquake psychological relief and strengthen interventions in order to reduce the psychological suffering of victims.
Objective To observe the effect of mental nursing for operation patients with earthquake trauma on their rehabilitation. Methods Eighty operation patients with earthquake trauma were randomly divided into two groups: mental nursing group and conventional nursing group. Psychological consult was used in the mental nursing group. Results were recorded by psychologic test, investigation questionnaire and nursing statistics. The measuring scales included SCL-90, HAMD and HAMA. Results The degree of satisfaction in the mental nursing group was obviously higher than that in the conventional nursing group. The scores of depression and anxiety in the mental nursing group were lower than these in the conventional nursing group. The length of hospital stay in the mental nursing group was also shorter (Plt;0.05). Conclusion Mental nursing could reduce dysphrenia in operation patients with earthquake trauma and facilitate their rehabilitation.
Objective To identify evidence-based treatment choices for a patient with increased intracranial pressure after acute traumatic brain injury. Methods We searched The Cochrane Library (Issue 2, 2006), MEDLNE (1981 to August 2006) and CBMdisc (1978 to August 2006) to identity systematic reviews (SRs), randomized controlled trials (RCTs), controlled clinical trials (CCTs) and prospective cohort studies involving the efficacy and safety of pharmacotherapy and non-pharmacotherapy for increased intracranial pressure after acute traumatic brain injury. Results We found 2 SRs and 8 RCTs on pharmacotherapy, and 6 SRs and 2 RCTs on non-pharmacotherapy. Conventional-dose mannitol was no better than hypertonic saline, but was better than other intracranial pressure lowering agents. High-dose mannitol can reduce mortality and the incidence of severe disability compared with conventional-dose mannitol. There were no studies comparing high-dose mannitol and hypertonic saline. Non-pharmacotherapy was not recommended for routine use due to the lack of good quality evidence. Conclusion For patients with increased intracranial pressure after acute traumatic brain injury, mannitol is effective in reducing the mortality and the incidence of severe disability. However, more large-scale RCTs are required to compare high-dose mannitol versus other drugs. Non-pharmacotherapy is not recommended as an adjunct therapy at present.
目的 探讨“5.12”地震后北川羌族人群中类风湿关节炎（RA）患者外周血 T细胞亚群的表达情况并分析创伤后应激障碍（PTSD）对RA患者细胞免疫之间的影响。 方法 2009年3月－2010年3月，对98例北川羌族RA患者、112例健康对照，以及同期绵阳郊区84例RA患者、120例健康对照进行分析。用流式细胞仪分别检测CD3+、CD3+CD4+、CD3+ CD8+ T淋巴细胞数及CD4/+CD8+比值， RA疾病活动性采用DAS28测定，应用美国精神障碍诊断与统计手册第4版（DSM-Ⅳ）诊断标准调查RA人群中的PTSD患者，应用PTSD检查表平时版（PCL-C）检查对PTSD患者进行分析。 结果 北川羌族与绵阳郊区RA活动组患者（分别为58例、39例）与健康对照组比较，CD8+ T淋巴细胞数降低，CD+4/CD8+比值增高，差异有统计学意义（P＜0.05）；北川羌族RA活动组与绵阳郊区RA活动组比较，CD3+ T淋巴细胞数降低，差异有统计学意义（P＜0.05）。北川RA患者中PTSD者（38例）与非PTSD者（60例）比较，PTSD组CD3+ T淋巴细胞数和CD4+/CD+8比值均明显低于PTSD组，差异有统计学意义（P＜0.05）；PCL-C对北川RA患者中PTSD的测定发现，PCL高分组CD3+ T淋巴细胞数显著低于PCL低分组（P＜0.05）。 结论 “5.12”地震后一部分RA患者出现T细胞免疫功能异常，且免疫功能异常与PTSD有关，对合并有PTSD的进行RA患者早期心理干预及药物治疗，改善患者生存质量。
目的 调查极重灾区某中学学生的创伤后应激障碍（PTSD）症状检出率及影响因素，为进一步开展灾后心理卫生服务提供依据。 方法 2008年9月下旬，对汶川地震的极重灾区都江堰某镇中学1 500名同学进行调查，获有效问卷1 498份。采用一般情况调查问卷、儿童事件影响量表（CRIES-13）中文版进行集体施测。 结果 某镇中学学生灾后4个月PTSD症状检出率29.71%（445/1 498）。经非条件逐步logistic回归筛选PTSD症状的影响因素有：地震时是否受伤（OR=1.995，P=0.000）、性别（OR=1.785，P=0.000）、绝望感（OR=1.597，P=0.000）、是否目睹死亡（OR=1.344，P=0.000）、年龄（OR=1.308，P=0.000）、是否目睹受伤（OR=1.262，P=0.000）、地震时是否被困（OR=1.209，P=0.011）、震后居住地点（OR=1.182，P=0.000）、是否目睹垮塌（OR=1.176，P=0.000）、家人情况（OR=1.104，P=0.000）、地震后是否住院（OR=0.828，P=0.041）12个因素。 结论 在灾后重建过程中，该中学的学生PTSD症状检出率较高，其与地震时是否受伤、性别、绝望感、是否目睹死亡、年龄、是否目睹受伤、地震时是否被困、震后居住地点、是否目睹垮塌、家人情况、地震后是否住院呈显著相关。
目的 利用局部一致性（ReHo）方法探测创伤后应激障碍（PTSD）患者在静息状态下是否存在着大脑功能异常。 方法 2010年5月－7月对18例未经治疗的地震PTSD患者和19例同样经历地震但未患PTSD的对照者进行了静息态功能磁共振成像（Rs-fMRI） 扫描。应用ReHo方法处理Rs-fMRI数据，得出PTSD患者的异常脑区，并将患者存在组间差异的脑区ReHo值与临床用PTSD诊断量表（CAPS）、汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）分别进行相关分析。 结果 ① PTSD组ReHo显著增加的脑区包括右侧颞下回、楔前叶、顶下叶、中扣带回，左侧枕中回以及左/右侧后扣带回；ReHo显著降低的脑区包括左侧海马和左/右侧腹侧前扣带回。② 异常脑区中后扣带回和右侧中扣带回ReHo与HAMD呈负相关（中扣带回r=?0.575，P=0.012；右侧后扣带回：r=?0.507，P=0.032），其余脑区ReHo与临床指标无明显相关性（P＞0.05），左侧海马与CAPS的相关性相对其他脑区较大（r=?0.430，P=0.075）。 结论 PTSD患者在静息状态下即存在着局部脑功能活动的降低和增加，ReHo方法可能有助于研究PTSD患者静息状态脑活动。