Objective To compare the clinical effect of the two surgical methods of posterior pedicle screw fixation decompression in treatment of thoracolumbar burst fractures,and in order to provide the basis for choosing the rational treatment.Methods Retrospectively analyzed the clinical data of 98 patients with thoracolumbar burst fractures underwent surgery of posterior pedicle screw fixation decompression from January 2007 to January 2011.Fifty-six patients were given posterior fixed indirect decompression surgery (indirect decompression group) and 42 patients were given posterior fixed direct decompression (direct decompression group).The patients were followed up for (1.03 ± 0.36) years after surgery,the image,recovery of neurological function,postoperative complications and capacity for independent living of the two groups were compared and evaluated.Results After surgery,the vertebral height ratio,Cobb angle,canal compromise rate in indirect decompression group were (91.67 ± 26.19)％,(10.10 ± 2.89)°,(18.61 ±5.32)％,in direct decompression group were(86.23 ± 24.64)％,(11.98 ± 3.42)°,(22.37 ± 6.39)％.There was significant difference compared with before surgery (P ＜ 0.05) and no significant difference between two groups (P ＞0.05).After surgery,the neurological function of the two groups were improved,and the improvement in indirect decompression group was better than that in direct decompression group (P ＜ 0.05).The postoperative complications ratio in indirect decompression group was 23.2％ (13/56),significantly lower than that in direct decompression group[83.3％(35/42)](x2 =10.370,P＜ 0.01).There was 60.7％(34/56)patients with capacity for independent living in indirect decompression group,significantly higher than that in direct decompression group [40.5％ (17/42)] (x2 =4.329,P ＜ 0.05).Conclusion The posterior pedicle screw fixation indirect decompression in treatment of thoracolumbar burst fractures is a feasible operation method,and is worth to utilize in clinic.

Objective:To evaluate the relationship between intraoperative concentration of C-X-C motif chemokine 13 (CXCL13) in peripheral blood and postoperative delirium (POD) in elderly patients under general anesthesia.Methods:Ninety-three patients of both sexes, aged 65-85 yr, of American Society of Anesthesiologists physical statusⅠor Ⅱ, scheduled for elective hip replacement under general anesthesia, were selected.Peripheral venous blood samples were collected to determine the concentrations of CXCL13 and interleukin-6 (IL-6) before anesthesia and during surgery (30 min after skin incision). The Confusion Assessment Method Scale in Chinese was used to detect the development of POD every day within 7 days after surgery in 2 groups.The patients were divided into POD group and non-POD group.Logistic regression analysis was used to identify the risk factors for POD.Results:Seventeen patients developed POD (19%). There was significant difference in ages, preoperative mini-mental state examination (MMSE) scores before surgery, hospital stay time and intraoperative concentrations of CXCL13 and IL-6 in peripheral blood between group non-POD and group POD ( P<0.05). The results of logistic regression analysis showed that preoperative MMSE scores, intraoperative concentrations of CXCL13 and IL-6 in peripheral blood and advanced ages were independent risk factors for the development of POD ( P<0.05). Conclusion:Preoperative MMES scores, intraoperative concentrations of CXCL13 and IL-6 in peripheral blood and advanced ages are independent risk factors for the development of POD.

Objective To discuss the MSCT imaging characteristics of metastatic lymph nodes in pancreatic cancer.Methods The MSCT images of 30 pancreatic cancer patients with metastatic lymph node confirmed by pathology were selected and all the patients underwent enhanced MSCT before surgery.The location, maximum short axis diameter ( MSAD) , sizes, density, enhancement, necrosis and fusion of the metastatic lymph nodes were analyzed using the 5th edition of TNM stage of Japan Pancreatic Society in 2002 as the standard.Results Sixty-three metastatic lymph nodes was pathologically diagnosed , while 53were diagnosed by MSCT.The metastatic lymph nodes most commonly occurred in group 13 and 17in pancreatic head cancer, while group 18 lymph node metastasis was more common in pancreatic body and tail cancer.The MSAD of metastatic lymph nodes was 2~17 mm with the average of (7.2 ±4.0)mm.All of metastatic lymph nodes were divided into MSAD <5 mm group, 5 mm~<10 mm group and ≥10 mm group based on their size.The number of metastatic lymph nodes of the three groups were 10, 18 and 25, respectively.The number of enhanced metastatic lymph nodes was decreased as the size increased, while the number of necrotic and fused lymph nodes was increased, which were statistically different (all P<0.05).Comparison between the two groups showed that the number of enhancement metastatic lymph nodes in MSAD <5 mm group and 5 mm~<10 mm group were more than that in ≥10 mm group ( 7/10 and 11/18 vs 2/25 ) .The number of fused lymph nodes in MSAD <5 mm group and 5 mm~<10 mm group were less than that in≥10 mm group (0 and 2/18 vs 22/25 ) .Clear edge metastatic lymph nodes were more in MSAD <5 mm group than that in≥10 mm group (6/10 vs 5/25).The number of necrotic metastatic lymph nodes in MSAD <5 mm group was less than that in ≥10 mm group(2 /10 vs 18/25).All the differences above were statistically significant ( all P<0.05), but no other significant differences were found between two groups.Conclusions The main imaging findings of metastatic lymph nodes in pancreatic cancer were unobvious enhancement, intratumoral necrosis and fusion.Heterogeneous density and unclear edge could benefit the diagnosis of metastatic lymph node.