BACKGROUND:The methods to treat intertrochanteric fracture are controversial. A large number of clinical studies concern the therapeutic effects of several popular methods to repair intertrochanteric fracture, but these results lack of independence, and may have bias that cannot be measured in the variable and observational studies. Thus, relevant studies have been limited. OBJECTIVE:To compare the repair effects of proximal femoral nail anti-rotation, dynamic hip screw and total hip arthroplasty on intertrochanteric fracture in aged patients by meta-analysis. METHODS: Four electronic databases were searched, including Cochrane library, PubMed, Web of Science and Chinese BioMedical Literature Database, to colect al randomized controled trials concerning the treatment of intertrochanteric fractures in the elderly with proximal femoral nail anti-rotation, dynamic hip screw and total hip arthroplasty. Using meta-analysis of evidence-based medicine, X-ray exposure time, postoperative complication rate, postoperative bed time, postoperative wound infection rate, Harris hip scores, mean operation time, intraoperative blood loss, length of hospital stays and length of the incision were compared and evaluated. Standard and methodology quality of the trials were criticaly assessed and relative data were extracted. This study used the Review Manager 5.0 software provided by Cochrane colaboration network. RESULTS AND CONCLUSION:Twelve randomized controled trials with 1 454 patients were included. Significant differences in mean operation time, intraoperative blood loss, X-ray exposure time, postoperative complication rate, and postoperative bed time were detected between the proximal femoral nail anti-rotation and dynamic hip screw groups (P < 0.05). Significant differences in length of hospital stays, postoperative complication rate, and postoperative bed time were observed between the proximal femoral nail anti-rotation and total hip arthroplasty groups (P < 0.05). Significant differences in postoperative complication rate, postoperative bed time, and Harris hip scores were detectable between the dynamic hip screw and total hip arthroplasty groups (P < 0.05). These data confirm that proximal femoral nail anti-rotation was apparently better than dynamic hip screw and total hip arthroplasty in operation time, intraoperative blood loss, length of hospital stays, postoperative complication rate, and postoperative bed time. Dynamic hip screw was better than proximal femoral nail anti-rotation in X-ray exposure time. Total hip arthroplasty was better than dynamic hip screw and proximal femoral nail anti-rotation in length of hospital stays, postoperative complication rate and postoperative bed time.

Objective:To evaluate the effect and safety of monoclonal antibodies to calcitonin gene-related peptide and its receptor (CGRP-mAbs) on migraine.Methods:Database of PubMed, Embase, Cochrane, CNKI, Wangfang digital journals were searched for randomized controlled trials (RCTs) of CGRP-mAbs in treatment of migraine. Quality of enrolled literature was assessed by the software of Review Manager 5.3 and software of StataMP14 was employed to conduct meta analysis.Results:A total of 13 RCTs were included, including 6 218 adult migraine patients (experimental group: 2 679 patients, placebo group: 3 539 patients). Meta analysis suggested that CGRP-mAbs for preventive treatment of migraine significantly reduced the monthly migraine days from baseline (standardized mean difference (SMD)=-0.35, 95% CI-0.4--0.3) and monthly acute migraine-specific medication consumption from baseline (SMD=-0.38, 95% CI-0.43--0.32), as compared with placebo group. CGRP-mAbs for preventive treatment of migraine significantly increased the ≥50% reduction from baseline in migraine days per month ( RR=1.65, 95% CI 1.54-1.76). The adverse events were similar between the CGRP-mAbs group and placebo group ( RR=1.06, 95% CI 1.01-1.10). Conclusion:CGRP-mAbs are effective and safe for preventive treatment of migraine.

Objective To explore the CT and pathologic manifestations of the pulmonary chondroma,to improve the diagnostic accuracy and reduce the misdiagnosis.Methods The CT data of 6 patients with pulmonary chondroma proved by pathology were analyzed retrospectively.Results All 6 cases were solitary,3 cases occurred in the right lung and the other 3 cases occurred in the left lung.The diameter of the lesions ranged from 1.0 cm to 5.1 cm.2 cases showed lobulated shape,4 cases showed round shape.4 cases showed circumscribed margin,2 cases showed blurrmed margin.Furthermore,calcification was detected in 1 case.Conclusion Pulmonary chondroma has some characteristic CT features,including vascular border sign and begonia sign.However,it should be differentiated from pulmonary hamartoma,peripheral lung cancer and sclerosing pneumocytoma.

Objective:To investigate the clinical and electrophysiological characteristics of patients with sudden unexpected death of epilepsy (SUDEP).Methods:Using "epilepsy" as the keyword, the relevant cases entered from October 2011 to March 2012 were searched in the database of the Electroencephalogram (EEG) Monitoring Center, Xijing Hospital, the Air Force Military Medical University. Telephone follow-up was conducted for all confirmed epilepsy patients, and for the death cases confirmed by telephone follow-up, the patients identified as consistent with SUDEP diagnosis were included in this study based on their past medical history, clinical data, death details, etc, and their clinical and neuroelectrophysiological characteristics were summarized and analyzed.Results:Among the 1 232 patients who underwent 24-hour video-EEG monitoring during the study period, 354 patients were successfully followed up by telephone interview, of whom 17 patients were died (4.8%), 12 individuals met the diagnosis of SUDEP (7 men, 5 women). The duration of the disease in 9 patients exceeded 10 years. Eight cases presented with focal-bilateral tonic clonic seizures. Nine patients were treated with anti-seizure drug monotherapy. All the 24-hour video EEG of 12 patients were abnormal. There were 8 occasions when the EEG occipital α background rhythm slowed down compared with the standard frequency of peers or was dominated by slow waves. Interictal epileptic discharge (IED) located in temporal lobe were found in 12 EEG records, of which 9 EEG records were found with frontal IED. One of the 12 cases received 24-hour video EEG twice within 6 years, and his EEG background rhythm was significantly slower and the IED region was expanded compared with the first EEG record. At the third year after reexamination of EEG, SUDEP developed in this patient.Conclusions:SUDEP patients have a long course of disease and bilateral tonic-clonic seizure. The interictal EEG shows occipital slow α activity and temporofrontal epileptiform discharges, which may increase the risk of SUDEP.

Objective To discuss the feasibility,the advantages and disadvantages,the clinical efficacy and the indications of minimally invasive transforaminal endoscopic debridement combined with allograft and posterial percutaneous internal fixation for thoracolumbar spinal tuberculosis.Methods All of 22 patients with thoracolumbar tuberculosis treated in our department from January 2012 to December 2013 were retrospectively reviewed.There are 11 male and female cases separately,with an average age of 54.1 ±10.2 years and with an average disease duration of 5.3 ± 1.9 months.Endoscopic lesion removal and allograft bone grafting combined with posterial percutaneous immobilization were performed on all these cases.The data of these patients were complete,and all patients had been followed up for more than 36 months.The clinical and radiographic results were recorded and analyzed.Results In this group,22 patients were followed-up for 41.9±2.5 months(36-48 months).The spinal kyphosis was not improved 3 months after surgery (t=0.3546,P=0.7029),but the amount of blood loss (30.5±7.9 ml) was less in the operation,the amount of postoperative analgesics(0.3±0.1 g) was low and the bed time(1.5±0.3 days) was short.No recurrence and no internal fixation failure was found after long term follow-up.Good clinical outcomes were achieved with the fusion rate reached above grade 2 in all patients(95.5％) except one.The neuralgia was relieved,and the spinal cord injury was recovered to ASIA E.The VAS score and SF-36 score which were recorded 1 month and 3 months after operative were all improved significantly compared with those before operation,and patients' life quality in the early period after operation was excellent.The incidence of complications was low(9.0％),and the patients were satisfied with the treatment process.Conclusion It may be a potential way to treat spinal tuberculosis with minimally invasive transforaminal endoscopic debridement combined with allograft and percutaneous internal fixation,which could be a powerful supplement to other therapeutic measures,and is worthy of further research and development.

In the electroencephalography (EEG) monitoring of patients with hypoxic-ischemic encephalopathy, generalized periodic discharges are often monitored abnormal waveforms. When there are some features of generalized periodic discharges (e.g., frequency≥1.5 Hz or plus), it indicates that the patient is at high risk for seizures or has a poor prognosis. Compared with conventional EEG, the time of continuous EEG monitoring is longer, so the detection rate of these waveforms is higher. At present, scholars at home and abroad have studied these waveforms, but there is controversy about the significance of these waveforms. In this paper, the definition and characteristics of these waveforms and their significance in determining prognosis and guiding treatment in patients with hypoxic-ischemic encephalopathy are reviewed.

Objective To investigate the effect of intravenous tranexamic acid (TXA) on perioperative hidden blood loss in percutaneous pedicle screw fixation for thoracolumbar fractures.Methods A prospective study was conducted in the 113 patients who would be subjected to percutaneous pedicle screw fixation for thoracolumbar fracture from January 2017 to December 2017.They were randomly assigned into an observation group (n =58) receiving intravenous drip of 15 mg/kg TXA 30 minutes preoperation or a control group (n =55) receiving intravenous drip of normal saline solution 30 minutes preoperation.The total blood loss and hidden blood loss 24 hours postoperation,D-dimer volume,incidences of deep vein thrombosis and other complications were recorded and compared between the 2 groups.Results There were 54 patients in the observation group and 50 patients in the control group for statistic analysis.The observation group had significantly less total blood loss (319.0 ± 140.5 mL) and hidden blood loss (242.0 ± 143.4 mL) 24 hours postoperation than the control group (418.7 ± 188.1 mL and 354.7 ± 181.9 mL,respectively) (P ＜ 0.05).There were no significant differences between the 2 groups in operation time or intraoperative blood loss (P ＞ 0.05).The volume of postoperative D-dimer was significantly higher than the preoperative value in both groups (P ＜ 0.05).No thromboembolic events occurred in either group.Conclusion Intravenous TXA may significantly reduce intraoperative hidden blood loss with no increased rik of thromboembolic events in percutaneous pedicle screw fixation for thoracolumbar fractures.

Objective To compare minimally invasive percutaneous pedicle screw fixation and open pedicle screw fixation for neurologically intact thoracolumbar fractures.Methods A retrospective study was conducted in the 180 patients who had been treated for thoracolumbar fractures without neurological deficits from January 2016 to December 2016.Of them,93 were treated by minimally invasive percutaneous pedicle screw fixation and 87 by open pedicle screw fixation.The 2 groups were compared in terms of blood loss,radiological parameters,visual analogue scale (VAS) and Oswestry disability index (ODI).Results Compared with the open surgery group,the minimally invasive surgery group had significantly shorter operating time (95.8 ±33.4 min versus 106.3 ±30.9 min),significantly less intraoperative blood loss (65.8 ±40.3 mL versus 183.1 ± 77.5 mL),significantly less total blood loss in theory 24 hours after surgery (374.7 ± 160.6 mL versus 614.8 ± 242.6 mL) and significantly shorter hospital stay (5.2 ± 2.0 d versus 6.7 ± 2.7 d),but significantly longer C-arm exposure time (23.6 ±4.2 min versus 12.4 ±4.1 min) and significantly more hidden blood loss 24 hours after surgery (308.9 ± 159.0 mL versus 243.5 ± 195.5 mL) (P ＜ 0.05).Compared with preoperation,significant improvements were observed at one week postoperation and the last follow-up in the 2 groups regarding the percentage of anterior height of the fractured vertebral body and cobb angle (P ＜ 0.05),but there were no significant differences in the percentage of anterior height of the fractured vertebral body or cobb angle between the 2 groups at one week postoperation or at the last follow-up (P ＞ 0.05).At 3 days postoperation,significant better pain relief was observed in the minimally invasive surgery group than in the open surgery group (P ＜ 0.01),but at the last follow-up no obvious pain was reported in either group.At the last follow-up,there was no significant difference between the 2 groups in ODI (6.2 ± 1.1 versus 6.0 ± 1.4) (P =0.320).Conclusions In the treatment of neurologically intact thoracolumbar fractures,minimally invasive percutaneous pedicle screw fixation may lead to shorter operating time,less blood loss and shorter hospital stay but no poorer radiological outcomes or long-term patient-reported outcomes than the open pedicle screw fixation.However,it should be noted that the former may lead to a higher volume of hidden blood loss.

Objective:To establish the acute symptomatic osteoporotic thoracolumbar fracture (ASOTLF) classification system, and to examine the reliability and evaluate the effect of clinical application.Methods:A retrospective case series study was conducted to analyze the clinical data of 1 293 patients with osteoporotic thoracolumbar fracture(OTLF) admitted to Honghui Hospital from January 2016 to December 2018. There were 514 males and 779 females, aged 57-90 years [(71.4±6.3)years]. The T value of bone mass density was -5.0--2.5 SD [(-3.1±-0.4)SD]. According to the clinical symptoms a and fracture morphology, OTLF was divided into 4 types, namely type I(I occult fracture), type II(compressed fracture), type III (burst fracture) and type IV(unstable fracture). The type II was subdivided into three subtypes (type IIA, IIB, IIC), and the Type III into two subtypes (type IIIA, IIIB). of all patients, 75 patients (5.8%) were with type I, 500 (38.7%) with type II A, 134 (10.4%) with type IIB, 97 (7.5%) with type IIC, 442 (34.2%) with type IIIA, 27(2.1%) with type IIIB and 18 (1.4%) with type IV. After testing the validity of the classification, different treatment methods were utilized according to the classification, including percutaneous vertebroplasty (PVP) for Type I, PVP after postural reduction for Type II, percutaneous kyphoplasty (PKP) for Type IIIA, posterior reduction and decompression, bone graft fusion and bone cement-augmented screw fixation for Type IIIB, and posterior reduction, bone graft fusion and bone cement-augmented screw fixation for Type IV. The visual analog score (VAS), Oswestry disability index (ODI), Frankel grade of spinal cord injury, local Cobb Angle, and vertebral body angle (vertebral body angle) were recorded in all patients and in each type of patients before surgery, at 1 month after surgery and at the last follow-up. The neurological function recovery and complications were also recorded.Results:The patients were followed up for 24-43 months [(29.9±5.1)months]. A total of 3 000 assessments in two rounds were conducted by three observers. The overall κ value of inter-observer credibility was 0.83, and the overall κ value of intra-observer credibility was 0.88. The VAS and ODI of all patients were (5.8±0.7)points and 72.5±6.6 before surgery, (1.8±0.6)points and 25.0±6.3 at 1 month after surgery, and (1.5±0.6)points and 19.5±6.2 at the last follow-up, respectively (all P<0.05). The Cobb angle and vertebral body angle of all patients were (13.0±9.1)° and (8.0±4.6)° before surgery, (7.9±5.2)° and (4.6±2.9)° at 1 month after surgery, and (9.1±6.0)° and (5.8±3.0)° at the last follow-up, respectively (all P<0.05). At the last follow-up, VAS, ODI, Cobb Angle and VBA of each type of patients were significantly improved compared with those before surgery (all P<0.05). The spinal cord compression symptoms were found 1 patient with type IV and 5 patients with type IIIB preoperatively. At the last follow-up, neurological function improved from grade C to grade E in 1 patient and from grade D to grade E in 5 patients ( P<0.05). The lower limb radiation pain or numbness in 3 patients with type IV and 22 patients with type III preoperatively were fully recovered after surgical treatment at the last follow-up except for three patients. Conclusions:The ASOTLF classification is established and has high consistency and reliability. The classification-oriented treatment strategy has achieved a relatively satisfactory effect, indicating that the classification has a certain guiding significance for treatment of OTLF.

Objective:To compare the efficacy of forceful reduction percutaneous pedicle screw and ordinary percutaneous pedicle screw in the treatment of osteoporotic thoracolumbar burst fracture with kyphosis.Methods:A retrospective cohort study was conducted to analyze the clinical data of 566 patients with osteoporotic thoracolumbar burst fracture with kyphosis admitted to Honghui Hospital, Xi ′an Jiaotong University from January 2015 to December 2018, including 191 males and 375 females, with age range of 48-79 years [(61.7±10.7)years]. Fracture segments were located at T 11 in 134 patients, T 12 in 154, L 1 in 160, and L 2 in 118. All fractures were type IIIA according to the acute symptomatic osteoporotic thoracolumbar fracture classification (ASOTLF). The thoracolumbar osteoporotic fracture severity score assessment system (TLOFSAS) score was ≥5 points. A total of 275 patients underwent forceful reduction and percutaneous pedicle screw internal fixation (forceful reduction screw group), and 291 patients underwent common percutaneous pedicle screw internal fixation (common screw group). The operation time, intraoperative blood loss, times of X-ray exposure on patients and measures documented before operation, at 3 days after operation and at 2 years after operation including anterior height ratio of the injured vertebrae, sagittal Cobb angle of the injured vertebrae, Japanese Orthopaedic Association (JOA) score and visual analog scale (VAS) were compared between the two groups. Moreover, degree of correction of Cobb angle at 3 days after operation, loss of correction of Cobb angle at 2 years after operation and postoperative complications were observed. Results:All patients were followed up for 25-34 months [(29.9±3.4)months]. The operation time, intraoperative blood loss and times of X-ray exposure on patients in forceful reduction screw group were (69.4±10.2)minutes, (60.3±13.1)ml and (26.8±3.7)times, less than (80.6±11.9)minutes, (80.7±15.4)ml and (30.4±3.4)times in common screw group (all P<0.01). There was no significant difference in anterior height ratio of the injured vertebrae between the two groups before operation and at 3 days after operation (all P>0.05). The anterior height ratio of the injured vertebrae in forceful reduction screw group was (95.5±2.3)% at 2 years after operation, significantly higher than (85.4±1.7)% in common screw group ( P<0.01). There was no significant difference in sagittal Cobb angle of the injured vertebrae between the two groups before operation ( P>0.05). The sagittal Cobb of the injured vertebrae in forceful reduction screw group at 3 days and 2 years after operation were (7.9±1.6)° and (8.8±1.5)°, lower than (10.6±1.1)° and (12.3±1.2)° in common screw group ( P<0.05 or 0.01). There were no significant difference in JOA score and VAS between the two groups before operation, at 3 days and at 2 years after operation (all P>0.05). The degree of correction of Cobb angle in forceful reduction screw group was (19.4±2.5)°, higher than (17.3±2.6)° in common screw group ( P<0.05). The loss of correction of Cobb angle in forceful reduction group was less than that in common screw group at 2 years after operation, but the difference was not statistically significant ( P>0.05). The incidence of postoperative complications in forceful reduction screw group was 12.4% (34/275), compared to 14.1% (41/291) in common screw group ( P>0.05). There were no complications such as iatrogenic nerve injury, fracture or loosening of internal fixator or leakage of bone cement in the spinal canal in both groups. Conclusions:For osteoporotic thoracolumbar burst fracture with kyphosis, forceful reduction and percutaneous pedicle screw internal fixation can significantly shorten operation time, reduce intraoperative blood loss and times of X-ray exposure on patients, restore height of the injured vertebrae, correct kyphosis and maintain reduction height of the injured vertebrae in contrast with conventional percutaneous pedicle screw internal fixation.