ObjectiveTo investigate the effectiveness of cervical pedicle screw implantation technique under regional method.MethodsThe clinical data of 85 patients who met the selection criteria between April 2010 and May 2018 were retrospectively analyzed. There were 57 males and 28 females, aged 35-68 years, with an average of 57.6 years. Among them, there were 10 cases of ossification of posterior longitudinal ligament, 68 cases of cervical spondylosis with multilevel stenosis, 3 cases of cervical tumor, 1 case of congenital malformation, and 3 cases of cervical trauma; the lower cervical spine lesions involved C3-C7. Preoperative Frankel spinal cord injury grading: 2 cases of grade C, 51 cases of grade D, and 32 cases of grade E. Cervical pedicle screw implantation technique under regional method was performed with a total of 618 pedicle screws. Postoperative changes in neurological symptoms were observed; cervical mouth opening anteroposterior and lateral X-ray films and cervical CT examinations were performed to evaluate the pedicle screws position.ResultsThe operation time was 2.5-4.0 hours, with an average of 3.0 hours. The intraoperative blood loss was 180-550 mL, with an average of 345 mL. No intraoperative vascular or nerve injury occurred. The patients with neurological symptoms were relieved to varying degrees. There were 2 cases of superficial incision infection after operation, the wound healed after enhanced dressing change. The postoperative hospital stay was 5-14 days, with an average of 8.4 days. At discharge, Frankel neurological grading was grade D in 26 patients and grade E in 59 patients. All the patients were followed up 6-24 months, with an average of 13 months. At last follow-up, cervical X-ray films showed the good pedicle screw fixation without loosening. Cervical CT evaluated the position of pedicle screws: 523 pedicle screws (84.7%) in grade Ⅰ, 80 (12.9%) in grade Ⅱ, and 15 (2.4%) in grade Ⅲ; the accuracy rate of the screw position was 97.6%.ConclusionCervical pedicle screw implantation technique under regional method can significantly improve the success rate of screw implantation. It is easy to operate, does not destroy the bone cortex, and has stable fixation.
ObjectiveTo explore the risk factors affecting occurrence of arteriosclerosis obliterans (ASO) for patients with type 2 diabetes mellitus (T2DM) and to develop a nomogram predictive model for these risk factors. MethodsA case-control study was conducted. The patients with T2DM accompanied with ASO and those with T2DM alone, admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2017 to December 2022, were retrospectively collected according to the inclusion and exclusion criteria. The basic characteristics and relevant laboratory test indicators of two groups were compared. The multivariate logistic regression analysis was used to identify the risk factors for the occurrence of ASO in the patients with T2DM, and then a nomogram predictive model was developed. ResultsThe study included 119 patients with T2DM alone and 114 patients with T2DM accompanied with lower extremity ASO. The significant differences were observed between the two groups in terms of smoking history, white blood cell count, neutrophil count, lymphocyte count, platelet count, systemic immune-inflammation index, systemic inflammatory response index (SIRI), high-density lipoprotein cholesterol, apolipoprotein A1 (ApoA1), apolipoprotein α (Apoα), serum cystatin C, free-triiodothyronine (FT3), total triiodothyronine, free triiodothyronine / total triiodothyronine ratio, fibrinogen (Fib), fibrinogen degradation products, and plasma D-dimer (P<0.05). Further the results of the multivariate logistic regression analysis revealed that the history of smoking, increased levels of Fib and SIRI value increased the probability of occurrence of ASO in the patients with T2DM [OR (95%CI) = 2.921 (1.023, 4.227), P=0.003; OR (95%CI) =2.641 (1.810, 4.327), P<0.001; OR (95%CI) = 1.020 (1.004, 1.044), P=0.018], whereas higher levels of ApoA1 and FT3 were associated with a reduced probability of occurrence of ASO in the patients with T2DM [OR (95%CI) = 0.231 (0.054, 0.782), P=0.018; OR (95% CI) = 0.503 (0.352, 0.809), P=0.003]. The nomogram predictive model based on these factors demonstrated a good discrimination for predicting the ASO in the T2DM patients [area under the receiver operating characteristic curve (95%CI) =0.788 (0.730, 0.846)]. The predicted curve closely matched the ideal curve (Hosmer-Lemeshow goodness-of-fit test, χ2= 5.952, P= 0.653). The decision curve analysis showed that the clinical net benefit of intervention based on the nomogram model was higher within a threshold probability range of 0.18 to 0.80 compared to no intervention or universal intervention. ConclusionThe analysis indicates that T2DM patients with a smoking history, elevated Fib level, and reduced levels of ApoA1 and FT3 should be closely monitored for ASO risk. The nomogram predictive model based on these features has a good discriminatory power for predicting ASO in T2DM patients, though its value warrants further investigation.