The existent problems of medical insurance specialty core course system currently are tallied up on the foundation of definition of core course system. The strategy and measure for adjustment are put forward,providing a basis for this professional course reform.

Objective:To investigate the effectiveness and safety of middle-column preserved pedicle subtraction closing-opening wedge osteotomy for the treatment of stiff kyphosis.Methods:From January 2016 to April 2018, 12 patients with stiff kyphosis in our department were treated with middle-column preserved pedicle subtraction closing-opening wedge osteotomy. The patients' operative time, intraoperative blood loss, postoperative drainage, surgical complications, low back pain and leg pain visual analogue scale (VAS), Oswestry dysfunction index (ODI) score, and SF-36 were recorded.These parameters were compared at preoperative, postoperative, and at the final follow-up. Coronal parameters included lumbar scoliosis Cobb angle, C 7 vertebral body center to humeral vertical line distance (C 7PL-CSVL), whilesagittal parameters includedlumbar Lordosis (LL), sacral slope (SS), pelvic tilt (PT), and sagittalvertical axis (SVA). Results:All of 12 patients successfully completed the operation.The mean operation time was 238.20±65.95 min, the mean intraoperative blood loss was 440.50±133.60 ml.The patients’ODI score was 65.92%±6.96% at the preoperative, and 21.00%±3.19% at the final follow-up. The difference was statistically significant ( t=20.32, P<0.0001).The VAS score of back pain was 6.00±0.95 at preoperative, 2.33±0.89 at 3 months postoperatively, and 1.42±0.51 at the final follow-up. The VAS score of leg pain was 6.91±1.24 at preoperative, 2.50±1.00 at 3 months postoperatively, and1.50±0.52 at the final follow-up. There was significant difference in SF-36 at preoperative and at final follow-up ( P<0.05). The differences in LL, SS, PT and SVA at the preoperative and at final follow-up were statistically significant ( F=17.47, P<0.001; F=5.015, P=0.0125; F=14.66, P<0.001; F=81.11, P<0.001) . There was significant difference in lumbar scoliosis Cobb angle and C 7PL-CSVL at the preoperative and at final follow-up ( F=87.19, P<0.001; F=100.9, P<0.001) . Conclusion:The advantages of this surgical procedure includesimple operation, reducedsurgery time, and shorten intraoperative bleeding, which can effectively relief clinical symptoms, improve the quality of life, correctkyphosis, and maintain the patient's spinal-pelvic balance.

In this study, we compared the three-point bending test of the metaphyseal tibia versus the three-point bending test of the diaphysial tibia in rats. Twenty 6-month-old female Sprague-Dawley rats were randomly divided into the ovariectomized (OVX) group and the sham-operated (Sham) group. All rats were housed in standard environmental conditions. Five months after operation, all rats were sacrificed by depletion method. All left tibia were removed for the three-point bending test. The changes of mechanical parameters were examined by the three-point bending test of the metaphyseal tibia and by that of the diaphysial tibia. Elastic, Maximum Load, Maximum Stress, Failure Load, and Failure Stress of the metaphyseal tibia were much lower in OVX rats than in Sham rats. However, there was no statistically significant difference in all of the mechanical parameters of the diaphysial tibia between the OVX group and the Sham group. The new three-point bending test of the metaphyseal tibia is much more sensitive and useful as compared with the test of the diaphysial tibia in evaluating the changes of mechanical properties of tibia in osteoporotic rats.
Animals ; Biomechanical Phenomena ; Bone Density ; physiology ; Female ; Osteoporosis ; pathology ; physiopathology ; Ovariectomy ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Tibia ; physiology

This study was aimed at observing the effects of ovariectomy and estradiol on the microarchitecture of cancellous bone and exploring the influence of microarchitectural change on the biomechanical properties. Thirty 6-month-old unmated female SD rats were randomly divided into 3 groups (10 rat each): sham-operated control group (Sham), ovariectomized group (OVX)and Estradiol Benzoate treated group (EBT). All rats were housed in standard environmental conditions. Five months after operation, the rats were sacrificed. The biomechanical properties of the third lumbar vertebras (L3) were measured with compression testing in vitro. Micro-CT scanning was performed on the fourth lumbar vertebras (L4) in vitro. In comparison with the corresponding variables of Sham, the bone volume fraction (BV/TV) and the trabecular number (Tb. N) of OVX were reduced remarkably, and the trabecular separation (Tb. Sp) and the structural model index (SMI) of OVX were enhanced obviously. These facts implicated that the bone trabecular plate-like structure of OVX were decreased. BV/TV, Tb. N and the trabecular thickness (Tb. Th) of EBT were greater than those of OVX. Tb. Sp and SMI of EBT were much smaller than those of OVX. The results of mechanical test showed that the maximum forioe (Fmax), the maximum stress (sigmamax) and the elastic modeulus (E) of the lumbar vertebral cancellous bone of OVX were declined sharply, while the aforesaid biomechanical index of EBT was improved distinctly. The performance of three-dimensional micro-CT and the mechanical testing to assess microarchitecture of cancellous bone are useful for evaluating the state of osteoporosis and the antiosteoporotic effect of agents.
Animals ; Biomechanical Phenomena ; Estradiol ; pharmacology ; Female ; Imaging, Three-Dimensional ; Lumbar Vertebrae ; diagnostic imaging ; pathology ; Osteoporosis ; pathology ; Ovariectomy ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Tomography, X-Ray Computed

Objective To investigate the effectiveness and safety of middle-column preserved pedicle subtraction closingopening wedge osteotomy for the treatment of ankylosing spondylitis (AS)-related thoracolumbar kyphosis.Methods From January 2010 to December 2016,eleven patients (9 males and 2 females) who underwent one-level middle-column preserved pedicle subtraction osteotomy with an average age of 40.8 years (21-68 years) were reviewed.The average thoracolumbar kyphosis angle (TLK) was 50.5°±9.6° and the average lumbar lordosis angle was-2.5°±24.1°.The thoracolumbar kyphosis,sagittal vertical axis (SVA),lumbar lordosis,pelvic tilt,sacral slope,thoracic kyphosis,Scoliosis Research Society (SIRS) 22,Oswestry disability index (ODI) score,the length of anterior column and posterior column at the pre-and post-operation,operation time,perioperative blood loss and complications were recorded.Results The osteotomy sites of 11 cases included 7 in L2,2 in L3 and 2 in T12.Theaverage operation time was 156.8 min (120-220 min).The average blood loss was 604.5 ml (350-900 ml).The average time of followup was 24 months (12-42 months).Complications were encountered in 2 patients.There were 1 casewith transient neurological deficits,another case with incision infection.No serious neurological or vascular complications occurred in all cases.The thoracolumbar kyphosis (TLK),lumbar lordosis,pelvic tilt,sacral slope,thoracic kyphosis,SRS 22 and ODI score were improved significantly.The preoperative TLK cobb was 50.5° (36°-66°),which improved to 5.1 ° (1 °-11°) at the final follow-up with a mean correction rate of 89.9％.Sagittal migrationwas improved from 184.6 mm preoperatively to 79.2 mm atthe final follow-up with an average correctionrate of 49.3％.The differences of the length of posterior column of osteotomy site after operation showed no statistical significance.All patients had solid fusion at osteotomy site and no instrumentational failure and loosening were found over the follow up.Conclusion Middle-column preserved pedicle subtraction closing-openingwedge osteotomy is safe and effective for correction of the thoracolumbar kyphosis deformity occurring in ankylosing spondylitis,resulting in satisfactory out comes with acceptable complications.

Objective:To investigate the effect of middle-column preserved pedicle subtraction closing-opening wedge osteotomy for the treatment of old thoracolumbar compression fractures combined with kyphosis deformity.Methods:A retrospective case series study was performed to analyze data of 27 patients with old thoracolumbar compression fractures combined with kyphosis deformity admitted in Taizhou Hospital from January 2010 to January 2017. There were 10 males and 17 females, with age range of 45-75 years (mean, 61.7 years). The injured segments and osteotomy segments included T 11 in 5 patients, T 12 in 10, L 1in 8 and L 2 in 4. Time from initial fracture to surgery was 9-120 months (mean, 23.2 months). According to the American Spinal Injury Association (ASIA) classification, neurological impairment symptoms were detected in 9 patients, including grade C in 1 and grade D in 8. All patients underwent one-level middle-column preserved pedicle subtraction osteotomy. Operation time, blood loss, and perioperative complications were recorded. Before operation, at 3 months after operation and at latest follow-up, kyphosis Cobb angle, sagittal vertical axis (SVA) and height of anterior column (AC) as well as posterior column (PC) were measured. Visual analogue scale (VAS) and Oswestry disability index (ODI) score were used to evaluate the clinical efficacy. American Spinal Injury Association (ASIA) score was used to assess neurological function. Results:All patients were followed up for average 18.1 months (range, 12-34 months). Operation time was (155.2±35.4)minutes (range, 130-250 minutes). Blood loss was (338.1±101.4)ml (range, 150-550 ml). No serious neurological or vascular complications occurred during perioperative period. Kyphosis Cobb angle was (6.0±3.1)° at postoperative 3 months compared to preoperative (46.5±8.5)°( P<0.05), and showed no significant loss at latest follow-up [(7.9±3.8)°] ( P>0.05). SVA was improved significantly from preoperative [42.7(25.5, 78.2)]mm to [5.5(1.2, 7.3)]mm at postoperative 3 months ( P<0.05). AC height was increased by average 16.3 mm at postoperative 3 months compared to the preoperative level ( P<0.05), with no significant change in PC height ( P>0.05). There was no significant difference in SVA, AC height and PC height at postoperative 3 months and latest follow-up ( P>0.05). There were significant differences in VAS [(1.7±0.8)points, (2.3±1.4)points] and ODI (17.3±7.5, 19.4±4.3) at postoperative 3 months and at latest follow-up compared to these before operation [(7.7±1.3)points, 61.4±6.2] ( P<0.05), with no significant differences in VAS and ODI at postoperative 3 months and latest follow-up ( P>0.05). No implant failure was noted during follow-up. The osteotomy surface was fused in all patients at postoperative 6 months. At latest follow-up, ASIA grade was improved from grade C to grade D in 1 patient and from grade D to grade E in 8 patients. Conclusion:Middle-column preserved pedicle subtraction closing-opening wedge osteotomy can effectively correct old thoracolumbar fractures with kyphosis, relieve pain and improve nerve function.