ObjectiveTo explore the safety and preliminary effectiveness of transintervertebral release, bone impaction grafting, and posterior column compressed-closing in the treatment of osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis.MethodsThe clinical data of 21 elderly patients with osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis were retrospectively analyzed between March 2016 and November 2017. There were 1 male and 20 females, aged 55-75 years, with an average of 64.8 years. The disease duration was 8-24 months, with an average of 13.1 months. The bone density T value ranged from −3.4 to −2.1, with an average of −2.3. Lesion segments: T11 in 2 cases, T12 in 6 cases, L1 in 8 cases, L2 in 1 case, T11, 12 in 1 case, T12, L1 in 2 cases, and T12, L2 in 1 case. Preoperative neurological function was classified according to the American Spinal Injury Association (ASIA): 5 cases of grade D and 16 cases of grade E. All patients underwent transintervertebral release, bone impaction grafting, and posterior column compressed-closing. The effectiveness was evaluated by visual analogue scale (VAS) score and Oswestry dysfunction index (ODI) score before operation, at 3 months after operation, and at last follow-up. The neurological function was assessed by ASIA at last follow-up. Local kyphosis Cobb angle (LKCA), thoracic kyphosis (TK), lumbar lordosis (LL), and sagittal vertebral axis (SVA) were measured on the X-ray films of the full-length lateral spine of the patient before operation, at 1 week after operation, and at last follow-up.ResultsNo complication such as fracture of internal fixator or nerve injury occurred. LKCA, TK, and SVA were significantly improved at 1 week after operation and at last follow-up (P<0.05). There was no significant difference between at 1 week after operation and at last follow-up (P>0.05). There was no significant difference in LL before and after operation (F=3.013, P=0.057). The VAS and ODI scores were significantly improved at 3 months after operation and at last follow-up, and further improved at last follow-up when compared with the scores at 3 months after operation, showing significant differences between time points (P<0.05). Five patients with ASIA grade D neurological function recovered to grade E at 6 months after operation.ConclusionTransintervertebral release, bone impaction grafting, and posterior column compressed-closing for treating osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis has definite effectiveness, strong orthopaedic ability, and minimal trauma, which can effectively restore the sagittal balance of the spine, alleviate pain, and improve the patients’ quality of life.
Objective To study the characteristics of pulmonary impact injury under closure and open states of glottis. Methods One hundred and eight rabbits were randomly divided into two groups (54 each group). Open state of glottis group(open group): impact injuries with opened glottis; closure state of glottis group (closed group): impact injuries with closed glottis. Parameters were set up with various combinations of driven pressures and compress percentage and the model of rabbit blunt chest trauma were established. Pathological changes were examined and abbreviated injury scale (AIS), water containing and mortality were recorded. Results Two and four rabbits died in open group and closed group respectively under the condition of 30% for compress percentage and 8 250 mmHg for driven pressures. In most cases, AIS values of closed group were significantly higher than that of open group (Plt;0.05). AIS values were positively related to driven pressures and compress percentage (r=0.9313, 0.7847; Plt;0.01, 0.01). Quantities of contained water in lung of closed group were significantly higher than that of open group(t=2.28,Plt;0.01). Conclusion The severity of injury, the increased mortality and earlier occurrence of traumatic acute lung injury were the characteristics of pulmonary impact injury under the closure states of glottis.
ObjectiveTo investigate the effectiveness of open reduction and internal fixation with locking anatomical plate for treating valgus impacted proximal humerus fracture. MethodsA retrospective analysis was made on the clinical data of 38 patients with valgus impacted proximal humerus fracture who underwent open reduction and internal fixation with locking anatomical plate between January 2009 and January 2014. There were 25 males and 13 females, aged from 47 to 63 years (mean, 52.3 years); the left and the right sides were involved in 18 and 20 cases, respectively. The causes of fracture included high falling injury in 10 cases, traffic accident injury in 15 cases, and falling injury in 13 cases. The time between injury and operation was 5-10 days (mean, 7.5 days). The collodiaphyseal angle was 160-200° (mean, 176°) on X-ray films. ResultsAll incisions healed by first intention, and there was no early complication related to operation. All these patients were followed up 12-30 months (mean, 18 months). X-ray film showed that clinical healing time of fracture was 10-16 weeks after operation (mean, 12 weeks); at 12 months after operation, the collodiaphyseal angle recovered to 120-145° (mean, 135°). During follow-up, no loss of fracture reduction and no loosening of internal fixation were observed. At 10-12 months, osteonecrosis of the humeral head occurred in 3 cases (7.9%), including 2 cases of Cruess stageⅢand 1 case of Cruess stageⅣ. At last follow-up, the Constant shoulder joint scores were 56-95 (mean, 82.6); the results were excellent in 10 cases, good in 15 cases, fair in 9 cases, and poor in 4 cases, with an excellent and good rate of 66%. Visual analogue scale (VAS) scores were 0-6 (mean, 0.9). ConclusionIt can achieve a comparatively satisfactory clinical result to use open reduction and internal fixation with locking anatomical plate for treating valgus impacted proximal humerus fracture.
In recent years, it has become a new direction in the field of neuroscience to explore the mode characteristics, functional significance and interaction mechanism of resting spontaneous electroencephalography (EEG) and task-evoked EEG. This paper introduced the basic characteristics of spontaneous EEG and task-evoked EEG, and summarized the core role of spontaneous EEG in shaping the adaptability of the nervous system. It focused on how the spontaneous EEG interacted with the task-evoked EEG in the process of task processing, and emphasized that the spontaneous EEG could significantly affect the performance of tasks such as perception, cognition and movement by regulating neural activities and predicting external stimuli. These studies provide an important theoretical basis for in-depth understanding of the principle and mechanism of brain information processing in resting and task states, and point out the direction for further exploring the complex relationship between them in the future.
ObjectiveTo investigate the short- and mid-term effectiveness of revision hip arthroplasty by using impaction bone allograft and acetabular components in treatment of severe acetabular defects.MethodsA clinical data of 42 patients (44 hips) with severe acetabular defects between February 2011 and May 2018 were retrospectively analyzed. All patients underwent revision hip arthroplasty by using impaction bone allograft and acetabular components. Cemented cup (24 cases, 24 hips) and non-cemented cup (18 cases, 20 hips) were used in the revision surgery. There were 17 males and 25 females with an average age of 62.8 years (range, 22-84 years). The interval between the first total hip arthroplasty and revision was 2.5-12.0 years (mean, 8.3 years). The patients were accepted revision surgery for prosthesis aseptic loosening in 32 hips (31 cases) and the periprosthetic infection in 12 hips (11 cases). Twenty-nine hips (28 cases) were Paprosky type ⅢA and 15 hips (14 cases) were type ⅢB. The preoperative Harris score was 22.25±10.31 and the height of hip rotation center was (3.67±0.63) cm and the length difference of lower limbs was (3.41±0.64) cm.ResultsThe operation time was 130-245 minutes (mean, 186 minutes) and the intraoperative blood loss was 600-2 400 mL (mean, 840 mL). The postoperative drainage volume was 250-1 450 mL (mean, 556 mL). Superficial infection of the incision occurred in 1 case, and the incisions healed by first intention in the other patients. All patients were followed up 6-87 months, with an average of 48.6 months. At last follow-up, the Harris score was 85.85±9.31, which was significantly different from the preoperative score (t=18.563, P=0.000). Imaging examination revealed that the allogeneic bone gradually fused with the host bone, and no obvious bone resorption was observed. At last follow-up, the height of the hip rotation center was (1.01±0.21) cm, which was significantly different from the preoperative level (t=17.549, P=0.000); the length difference of lower limbs was (0.62±0.51) cm, which was significantly different from the preoperative level (t=14.211, P=0.000). The Harris score in the cemented group and non-cemented group increased significantly at last follow-up. The height of the hip rotation center decreased, and the hip rotation centers of both groups were within the Ranawat triangle zone. The length difference of the lower limbs also decreased, and the differences in all indexes were significant between pre- and post-operation (P<0.05). There was significant difference in the height of the hip rotation center between groups (t=2.095, P=0.042), but there was no significant difference in the Harris score and the length difference of lower limbs between groups (P>0.05).ConclusionFor severe acetabular defect (Paprosky type Ⅲ), the hip can be reconstructed with the impaction bone allograft and cemented or non-cemented components in revision hip arthroplsty. The short- and mid-term effectiveness are satisfactory.
ObjectiveTo compare the effectiveness of sequestrum clearance and impacting bone graft via surgical hip dislocation approach and core decompression and bone graft for avascular necrosis of the femoral head (ANFH) at Association Research Circulation Osseous (ARCO) stage Ⅲ.MethodsA clinical data of 60 patients (69 hips) of non-traumatic ANFH at ARCO stage Ⅲ, which met the inclusion criteria between October 2013 and April 2016, was retrospectively analyzed. Among them, 24 patients (28 hips) were treated with sequestrum clearance and impacting bone graft via surgical hip dislocation approach (group A); and 36 patients (41 hips) were treated with core decompression, sequestrum clearance, impacting bone graft, and nonvascular fibular allograft supporting (group B). There was no significant difference in gender, age, disease duration, affected side, type and stage of the ANFH, and preoperative Harris hip score and visual analogue scale (VAS) score between the two groups (P>0.05). After operation, the function of the hip was evaluated by Harris hip score, imaging examination was performed to observe the femoral head shape and evaluate whether the hip preserving success.ResultsThe incisions of two groups healed by first intention. All patients were followed up. The follow-up time was 12-48 month (mean, 25.8 months) in group A and 12-54 months (mean, 26.4 months) in group B. At last follow-up, 5 hips in group A were classified as clinical failure, femoral head survival rate was 82.1%, the median survival time was 43 months. While 19 hips in group B were classified as clinical failure, femoral head survival rate was 53.7%, the median survival time was 42 months. There was significant difference in survival curve distribution between the two groups (χ2= 4.123, P=0.042), and the surgical procedures of group A was superior to group B. In the two groups, the Harris hip scores at last follow-up were significantly higher than preoperative ones (P<0.05), and VAS scores were significantly lower than preoperative ones (P<0.05). There was no significant difference in Harris hip score and VAS score at last follow-up between the two groups (P>0.05). All grafted bones got fusion according to the X-ray films, and there was no significant difference in the fusion time between the two groups (t=0.752, P=0.456). In group A, greater trochanter bone cutting were healed well; and the heterotopic ossification around the hip joint occurred in 1 case.ConclusionThe surgery of impacting bone graft via surgical hip dislocation approach and core decompression and bone graft can be applied to treat ANFH at ARCO stage ⅢA which was mild collapse and satisfactory effectiveness can be obtained. While for the patients of ANFH at ARCO stage Ⅲ B with severe collapse, the hip survival rate of the former is better than that of the latter.
As an important auxiliary means of pharmacoeconomics evaluation, budget impact analysis can effectively measure the affordability of medical insurance fund, and plays a significant role in the process of medical insurance access negotiation, adjustment of medical insurance reimbursement directory and establishment of payment price. The quality of budget impact analysis data has a great impact on the analysis results and the scientific decision-making. When the existing data cannot meet the requirements of the paper, relevant software is needed to carry out Delphi method to ensure the data accuracy. Infopoll is a powerful, easy-to-use application that designs consultation questionnaires by providing multiple question choices and multiple forms of answer settings, as well as detailed statistical charts for results analysis. This paper introduces how to obtain the data of budget impact analysis based on Delphi method using Infopoll software, and analyzes the main results in detail.
Objective To assess the quality of budget impact analysis in China and Canada. Methods We searched databases including PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP from inception to 1st November, 2016, to collect studies about budget impact analysis. Two reviewers independently screened literatures, extracted data and assessed the quality of included studies. Results 27 literatures were included. The mean grades of Chinese and Canadian literatures were 3.8 and 5.5, respectively. Some Chinese studies did not explicitly clarify the research perspective. Few studies in China were conducted according to budget holders’ perspective and with a short time horizon, or examined the results using sensitivity analyses responsive to the uncertainty surrounding future market developments, or compared between current and comparator scenarios. These deficiencies were not conducive to scientific and rational decision-making. Conclusion The quality of budget impact analysis is relatively low in China. It is needed to establish uniform budget impact analysis guideline to improve quality to guide decision making.
Objective To investigate the effectiveness of ulnar shortening osteotomy combined with elastic suspension fixation for ulnar impaction syndrome caused by relatively long ulna. Methods Between October 2015 and August 2016, 3 cases of ulnar impaction syndrome were treated. One patient was male and 2 patients were females. The age was 32, 29, and 59 years, respectively. One patient was dislocation and impaction of distal radioulnar joint for more than 1 year after internal fixation due to ulnar and radial open fractures. Other patients had no trauma and surgery, but long-term manual history. The visual analogue scale (VAS) scores were 7, 5, and 5, respectively. Cooney wrist function scores were rated as poor. Preoperative X-ray measurements of the ulnar variance was 12.7, 9.0, and 8.7 mm, respectively. The ulna was transversely osteotomy and fixed with plate and screws. The distal radioulnar joint was elastic suspension fixed with mini plate. Results Postoperative X-ray film showed that the matching of the distal radioulnar joint had no significant difference compared with the contralateral side. All the incisions healed by first intention without complication such as neurovascular injury, infection, and dislocation of the distal radioulnar joint. The patients were followed up 27, 17, and 23 months, respectively. At last follow-up, X-ray film showed that all osteotomy segments achieved bony union without internal fixation failure. The VAS scores were 2, 0, and 1, respectively, and the Cooney wrist function scores were rated as excellent. Conclusion The ulnar shortening osteotomy combined with elastic suspension fixation can correct the ulna variation, avoid the instability of the distal radioulnar joint caused by the extensive dissection of the tissue around the ulnar, and avoid stiffness of the joints caused by rigid fixation. It is an ideal treatment for ulna impaction syndrome.
ObjectiveTo discuss the diagnostic value of multi-slice spiral CT for bronchial mucoid impaction in early central-type carcinoma of lung. MethodsWe used multi-planar reformat, maximum intensity projection and minimum intensity projection to observe the characteristics of 15 patients with bronchial mucoid impaction in early central-type carcinoma of lung treated between March 2010 and October 2013. The characteristics included location, shape and enhanced performance of the tumor and the bronchial mucoid impaction. All the cases were confi rmed by operation or pathology. ResultsAmong the 15 cases, 12 were squamous cell carcinoma and 3 adenocarcinoma; 8 occurred on the right and 7 on the left. All the tumors showed equal density and were enhanced moderately. Bronchial mucoid impaction showed low density, no enhancement, accompanied bronchiectasis and occurred in bronchi which were far from the tumor, and there were 9 cases of strip, 5 of fabrication, and 1 of nodositas or cystic carcinoma. ConclusionThe location and shape of tumor and bronchial mucoid impaction are displayed clearly by multi-slice spiral CT and enhancement scanning can differentiate tumor from bronchial mucoid impaction. Multi-slice spiral CT has important diagnostic value in bronchial mucoid impaction of primary lung cancer in its early stage.