BACKGROUND: The puncture approach and injection method of unilateral approach should be improved to obtain mechanical distribution of bilateral approach.Preliminary studies designed three-dimensional puncture guider and utilized withdrawal injection of bone cement,which improved clinical effect.However,the mechanical distribution of unilateral approach versus bilateral approach remains unclear.OBJECTIVE: To analyze biomechanical changes during vertebroplasty with unilateral approach and withdrawal injection using a finite element analysis and compare with bilateral approach.METHODS: The primary image was from a male patient,76 years old,with L1 osteoporosis and pain.The patient was subjected to operation in the injured vertebrae by unilateral approach,and the needle entrance point was at the left center of pedicle,with an oblique angle of 24.5°.The needle was inserted into the front one third of vertebrae body and 3 mL bone cement was injected.The needle was withdrawn to the middle of the vertebrae,maintained for 3 minutes,and 2 mL bone cement was injected.The needle was withdrawn to the posterior 1/3 of the vertebrae body,followed by injection of 1 mL bone cement.Bilateral approach was simulated,and each side was injected with 3 mL bone cement.L1-2 fault image was obtained and finite element model was established.Vertebral biomechanics was compared under loads of 500,1 000,1 500,2 000,and 2 500 N on the supine surface.RESULT AND CONCLUSION: The strain and stress were increased with increasing load.The vertebral bodies showed property of elasticity,and nearly linear minor deformity.There were no differences in stress distribution and deformity between bilateral fixation point and withdrawl injection of bone cement(P > 0.05).Results show that unilateral approach withdrawl injection of bone cement displayed similar biomechanics as bilateral fixation point during vertebroplasty.

The primary imagine is from a seventy-old man and his L_1 is osteoporosisand painful. The patient is given operation in the injured vertebrae by onelateral, the needing point is in the left central of lateral mass of vertebrae, introversion angle is 24.5°, using withdraw way. First puncture the needle to the front one third, and inject 3 mL bone cement in, and withdraw the needle to the middle of the vertebrae, staying 3 minutes, and then inject 2 mL bone cement, and then withdraw the needle to the hind 1/3 of the body, injecting 1 mL in it. Contrasting with the way inject the all 6 mL bone cement one time in the front 1/3, which is the tradition way (simulate) and get L_(1-2) fault image, getting a validated finite element mordel, exerting the load of 500, 1 000, 1 500, 2 000, 2 500 N on the supine surface of the vertebra respectively and evaluate the stress distribution of the vertebro bodies. With the increasing load, the deformity and the strain increase with it. The vertebral bodies show the property of elasticcity, nearly linear minor deformity is. The way using withdrawal way injecting bone cement has more stress distribution and deformity than the way by tradition. The way using withdrawal way injecting bone cement has better stress distribution than the way by tradition.

A total of 45 patients with indication of vertebroplasty using unilateral approach were detected by CT scanning,2D and 3D reconstruction methods to measure the angle between vertebral pedicle and 1/3 of median horizontal plane,distance from skin needle entry point to spinous process at the horizontal plane as well as the declination angle between vertebral pedicle and sagittal plane.The three-dimensional anterior-posterior perspecitive images of vertebra were reduced to identify the entry point.The measurement results showed significant changes in introversion angle at T4-L5:T4-T8 was 23.75?-25.34?,T9-L1 was 25.74?-26.83?,and L2-L5 was 27.45?-41.57?;but minimal changes in declination angle at sagittal plane,from 19.17? to 25.24?;the open distance adjacent to the spinous process was increased from thoracic vertebra to lumbar vertebra:T4-T8 was 2.56?-2.87?,T9-L1 was 3.05?-3.61?,L2-L5 was 3.89?-8.23?.The best vertebral puncture point reduction was located at 9-11 points of the left,1-3 point of the right.Imaging-based measurements of introversion angle,declination angle,entry point and distance of spinous process at the horizontal plane are important data for percutaneous vertebroplasty.According to pedicle shape features at different stages,included angle,puncture point,path and depth,the vertebroplasty could be performed accurately and safely with reduced damage.Moreover,reliable data are provided for the design of a three-dimensional puncture-oriented device.

According to the anatomy characteristics of vertebral pedicle and on the basis of puncture site on the skin to the level distance of vertebral process, a three-dimension guider was designed. Eighty-three cases were received percutaneous vertebroplasty from December 2006 to December 2008, including 43 cases with three-dimension guider. Thirty-six cases of above 43 cases puncture site were guided by fluoroscopy, and then performed percutaneous vertebroplasty by three-dimension guider without fluoroscopy monitoring under guidance of preoperative CT measures. The rest 7 cases of 43 were performed percutaneous vertebroplasty by the monitored by fluoroscopy. All cases were successful, and the needle tip could reach the ideal position. Forty cases were received primary two-dimesion guider to perform the percutaneous vertebroplasty, which were monitored by fluoroscopy. The mean puncture time was 1.9 minutes in two-dimension guider while 1.5 minutes in three-dimension guider. Results demonstrated that three-dimension guider has the virtue of logical design, suit for the body anatomy and easy to perform, which can reduce the expose time of x-rays and more safety and efficiency to operators.

Objective To explore optimal puncture route and method for advance pierce accuracy when perform percutaneous vertebroplasty. Methods 248 cases (365 vertebrae )with osteoporotic vertebral body fractures in thoracic vertebral and lumbar vertebral were treated by percutaneous vertebroplasty. Total injured vertebraes were examined and measured puncture routes under CT before operation. Then according to measure route pierce and perform percutaneous vertebroplasty, when the pricker arrived preconceive place, take some radiographs obverse and side, after operation,scan injured vertebraes with CT again. Pierce accuracy was evaluated. Results 365 vertebrae were pierced successfully,the pierce successful rate was 100%. 324 vertebra piercing route were coincident with CT measure routes,coincident rate 88.8%. 41 vertebra piercing route weren' t coincident with CT measure routes, deflective rate was 11.2%. Conclusion CT measure puncture route and directing pierce was effective means when percutaneous vertebroplasty.

[Objective]To determine the efficacy and characteristics of percutaneous vertebroplasty in treating patients with vertebral osteoporosis fractures combined with intraosseous cyst.[Method]Thirteen cases of vertebral osteoporosis fractures combined with intraosseous cyst were performed with percutaneous vertebroplasty.Bone cement containing appropriate proportion allograft bone powder were injected to vertebral body according to the sererity of osteoporosis and the size of intraosseous cyst.[Result]According to standard of World Health Organization about pain,complete pain relief was in 10,partial in 2,and slight in 1 patient.One case developed bone cement leakage into the paravertebral soft tissues during operation,but there were no clinical signs and symptoms.The next vertebral body fracture was found at sixteen days after percutaneous vertebroplasty in 1 case,and percutaneous vertebroplasty was repeated to relieve his pain.This patient was followed-up for 1 year,and no refracture was observed.[Conclusion]Vertebral osteoporosis fractures combined with intraosseous cyst is a special disease in elderly population.Percutaneous vertebroplasty is effective and it shouled be the first option for treatment of patients with vertebral osteoporosis fractures combined with intraosseous cyst.The complications could be reduced by local treatment combined with anti-osteoporosis drugs and correct rehabilitation.

BACKGROUND: Osteolysis has always occurred in pelvis. Percutaneous injection of bone cement stabilized bone fracture, relieved pain or even treated tumor. However, leakage of bone cement might cause severe complications. OBJECTIVE: To explore the therapeutic effect of peroutaneous injection of bone cement on treating osteolysis pelvic disease in 9 cases by the CT guidance. METHODS: By the CT guidance, needing degree was determined firstly. Focal size and scanning layers were used to calculate focal volume and estimate injected dose of bone cement. Three-dimensional targeting device was used to introduce the puncturation. The bone cement which was 0.2-0.5 mL less than the calculated volume was injected into osteolysis site. The accuracy, injected dose, clinical efficacy, and complications were investigated. RESULTS AND CONCLUSION: The following-up ranged from 5 months to 4 years, with mean duration of 1.5 years. At 1-48 hours after operation, symptoms were recovered, including complete recovery (n=6), partial recovery (n=2), and light recovery (n=1). Leakage of bone cement was not detected out around focal region. This suggested that percutaneous injection of bone cement into the erosion site is an effective method to treat pelvic osteolysis disease, characterizing by security, effective, and less invasive.

Objective To assess the variations in different thyroid stimulating hormone(TSH) and free thyroxine (FT4) detection kits for evaluating thyroid function during pregnancy and to establish the corresponding normal reference ranges.Methods This study was based at the International Peace Maternity and Child Health Hospital affiliated to Shanghai Jiaotong University School of Medicine.A total of 200 pregnant women who visited the hospital between June,2011 and September,2012 were recruited in this study according to the National Academy of Clinical Biochemistry (NACB) criteria.Blood samples were sequentially collected from the women at the first (T1,9-12 weeks),second (T2,16-24 weeks) and third (T3,32-36 weeks) trimesters to determine the serum TSH and FT4 levels using four different detection kits (Siemens-C,Siemens-Ⅰ,Abott and Roche).A linear trend test was used to analyze serum TSH and FT4 levels with four different kits.A percentile range of P2.5 to P97.5 was used to establish the normal trimester-dependent reference ranges of TSH and FT4 levels for different detection kits.The Bootstrap method was used to compare the differences in the four reference ranges.Results Similar dynamic changes in TSH and FT4 levels during pregnancy were detected among the different kits (F=0.950,P=0.595; F=11.640,P=0.081,respectively).Among the four reference ranges of TSH,the Roche kit showed the most remarkable fluctuation during pregnancy,while Roche kit in the first trimester and Siemens C kit in the second and third trimesters showed larger fluctuations in reference ranges of FT4.More importantly,the reference ranges of TSH and FT4 showed significant variations among the four different kits in each trimester (TSH:T1:F=2 945.390,P ＜ 0.01; T2:F=2 826.260,P ＜ 0.01; T3:F=1 698.360,P ＜ 0.01.FT4:Tl:F=1 145.440,P ＜ 0.01; T2:F=2 260.240,P ＜ 0.01; T3:F=1 439.920,P ＜ 0.01).Conclusions TSH and FT4 measurement using four different commercial kits showed similar trimester-dependent dynamic changes.However,it is necessary to establish trimester-dependent and detection kit dependent normal reference ranges of TSH and FT4 for thyroid function evaluation for pregnant women.

Objective: To investigate the molecular characteristics and tracing of the hemagglutinin (HA) gene, and to analyze the risk of human infection with influenza virus A (H7N9) in Guizhou Province, so that to provide evidence for the prevention and control of highly pathogenic avian influenza A (H7N9). Methods: Nucleic acids of 5 strains of H7N9 including 1 sample of the patient′s nasopharyngeal swab and 4 samples of the live poultry market (LPM) environment were extracted and HA genes were amplified and sequenced. Then the homology, genetic evolution and the pivotal sites related to receptor binding regions, pathogenicity and potential glycosylation of the avian influenza A (H7N9) viruses were analyzed by a series of bioinformatics softwares. Results: Homology analysis revealed that the homologies of nucleotide and amino-acid of the HA gene of H7N9 strains from the patient and LPM in Weining County, Guizhou Province were 99.8% and 99.6%, respectively, while those of 4 strains from LPM were both 100%. The homologies of nucleotide and amino-acid of the HA gene of H7N9 strains were the highest with the strain of A/Guangxi/5/2017 isolated from a Guangxi infected patient (99.7%-99.9% and 99.4%-99.8%, respectively), while those with the strain isolated from LPMs environment at the end of 2016 (A/Environment/Guangdong/C16283222/2016) were 99.0%-99.2% and 98.9%-99.2%, respectively. However, the homologies of nucleotide and amino-acid of the HA gene of H7N9 strains with A/Shanghai/2/2013 recommended by world health organization and the candidate vaccine strain A/Anhui/1/2013 were 96.8%-97.0% and 95.8%-96.2%, respectively. Phylogenetic analysis showed that the 5 strains had the nearest genetic distance to the strain A/Guangxi/5/2017. All the 5 strains cleavage site sequences of HA protein showed mutation of PEVPKRKRTAR↓GLF, and they were highly pathogenic avian influenza viruses mutant strains, which all had mutation of G186V at the receptor binding sites of HA gene, while no Q226L mutation was found. All 5 strains had new mutation of A363S, and new mutations of R56K and I297V were only found in the strain isolated from the patient. Among the five potential glycosylation motifs in the HA, only 421NWT and 493NNT had variation of the position post shift. Conclusions All the 5 H7N9 strains isolated in Weining County, Guizhou Province are highly pathogenic avian influenza mutative viruses. The current candidate vaccine may not provide a very good protection. The mutations of cleavage site of HA protein, G186V as well as other new mutation sites of HA may enhance the susceptibility and pathogenicity to human beings.

Hip fracture is considered as the most severe osteoporotic fracture characterized by high disability and mortality in the elderly. Improved surgical techniques and multidisciplinary team play an active role in alleviating prognosis, which places higher demands on perioperative nursing. Dysfunction, complications, and secondary impact of anaesthesia and surgery add more difficulties to clinical nursing. Besides, there still lack clinical practices in perioperative nursing for elderly patients with hip fracture in China. In this context, led by the Orthopedic Nursing Committee of Chinese Nursing Association, the Expert consensus on clinical practice in perioperative nursing for elderly patients with hip fracture ( version 2023) is developed based on the evidence-based medicine. This consensus provides 11 recommendations on elderly patients with hip fracture from aspects of perioperative health education, condition monitoring and inspection, complication risk assessment and prevention, and rehabilitation, in order to provide guiding advices for clinical practice, improve the quality of nursing and ameliorate the prognosis of elderly patients with hip fracture.