OBJECTIVETo analyze the effects of three surgical operations in the treatment of Pilon fracture of Rüedi-Allgower type III, and put forward the best therapeutic method.

METHODSThe clinical data of 33 patients with Pilon fracture who received surgical operations (plaster immobilization group, 10 cases; distal tibia anatomical plate group, 11 cases; external fixation with limited internal fixation group, 12 cases) from October 2009 to January 2012 were analyzed. There were 5 males and 5 females, ranging in age from 24 to 61 years in the plaster immobilization group. There were 7 males and 4 females, ranging in age from 21 to 64 years in the distal tibia anatomical plate group. There were 7 males and 5 females, ranging in age from 23 to 67 years in the external fixation with limited internal fixation group. The Ankle X-ray of Pilon fracture after operation, ankle score, early and late complications were collected. Bourne system was used to evaluate ankle joint function.

RESULTSAfter 8 months to 3 years follow-up, it was found that three kinds of treatment had significant differences in the outcomes and complications (P < 0.05): the external fixation with limited internal fixation group got the best results. The number of anatomic reduction cases in the external fixation with limited internal fixation group (7 cases) and the distal tibia anatomical plate group (8 cases) was more than the plaster immobilization group (2 cases). According to the ankle score, 8 patients got an excellent result, 3 good and 1 poor in the limited internal fixation group ,which was better than those of distal tibia anatomical plate group (5 excellent, 4 good and 2 poor) and the plaster immobilization group (3 excellent, 4 good and 3 poor). The number of early and late complications in the external fixation with limited internal fixation group was more than those in the plaster immobilization group and the distal tibia anatomical plate group (P< 0.05).

CONCLUSIONTreatment of external fixation with limited internal fixation in the treatment of Pilon fracture of Rüedi-Allgower type III is effective and safe.

Adult ; Aged ; Case-Control Studies ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tibial Fractures ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult

OBJECTIVETo summarize experiences of serious perioperative complications management of obstructive sleep apnea hypopnea syndrome (OSAHS), and evaluate the effect of intervention in decreasing the incidence of serious complications.

METHODSRetrospective analysis of clinical data in Shenyang General Hospital of PLA and Liaoning Province Jinqiu Hospital of OSAHS surgery cases from January 1995 to December 2009 were included in this study, patients were divided into two groups according to with or without intervention. Experience and lessons were analyzed.

RESULTSPatients without and with intervention were 402 and 521 respectively, and uvulopalatopharyngoplasty (UPPP) cases in each group were 387 and 390. Five patients in the first group who accepted UPPP had breathing difficulty and were all successfully rescued, while no one in the second group had breathing difficulty. The difference was significant (P < 0.05). Sixteen patients in the first group had severe bleeding after UPPP, while only 5 patients had the severe bleeding in the second group. The difference was significant, too P < 0.05. No breathing difficulty cases in the second group, and serious bleeding cases in each group was 5 and in 1, there was no significant difference (P > 0.05).

CONCLUSIONSBreath difficulty and serious bleeding are serious perioperative complications of OSAHS surgery, and with systemic intervention the incidence of the complications can be decreased.

Adolescent ; Adult ; Aged ; Female ; Humans ; Intraoperative Complications ; prevention & control ; Male ; Middle Aged ; Palate, Soft ; surgery ; Retrospective Studies ; Sleep Apnea, Obstructive ; surgery ; Uvula ; surgery ; Young Adult

OBJECTIVETo establish a novel model of lumbar disc degeneration on the early stage in the rhesus monkey using percutaneous needle puncture guided by CT.

METHODS(1) Thirteen rhesus monkeys aged from 4 to 7 years, female 7 and male 6 were selected for establishing a model of the early stage of lumbar disc degeneration. (2)13 monkeys, 91 discs were divided into 3 groups: 64 discs from L1/2 to L5/6 were percutaneous punctured with a needle 20G as experimental group and 1 disc with a needle 15G as puncture control group and 26 discs were not be punctured from L6,7 to L7-S1 as control group. (3) Lumbar disc localization for needle puncture was guided by CT. All discs were examined by MRI, the HE, Masson's trichrome, Safranine-O and immunohistochemical staining of type II collagen before disc puncture and after puncture at 4, 8 and 12 weeks.

RESULTSMRI: (1) Experimental group: Pfirmann's Grade I was shown at postoperation 4, 8 and 12 weeks; (2) Puncture control group: Grade III was shown at postoperation 4 weeks and Grade IV at 8 weeks; (3) CONTROL GROUP: Grade I was shown at postoperation 4, 8 and 12 weeks. Histological examination: (1) In experimental group, there was no any change at postoperation 4 weeks, and the cell population of the nucleus was decreased at 8 weeks and more decreased at 12 weeks in HE. (2) There was no any change at postoperation 4 weeks, the clefts among the lamellae of the annulus fibrosus (AF) were shown at 8 weeks and more wider of the clefts of AF at 12 weeks in Masson's trichrome. (3) No any change was shown at postoperation 4 weeks, proteoglycan were progressively decreased at 8 and 12 weeks in Safranine-O. (4) No statistically significant difference in positive rate was observed at 4 and 8 weeks compared with control group in immunohistochemical staining of type II collagen. There was statistical difference at 12 weeks compared with control group (P<0.05). In puncture control group postoperation 8 weeks, the morphology of cell of nucleus pulposus was not clear in HE. The wider clefts of lamellae of the AF were shown in Masson's trichrome. The proteoglycan was obviously decreased in Safranine-O. Immunohistochemical staining collagen II synthesized was decreased. In normal control group, no any change was shown at 4, 8 and 12 weeks.

CONCLUSIONSThe degeneration of lumbar intervertebral disc on the early stage could be induced by the percutaneous needle puncture (20G) to the annulus fibrosus. The assessment of disc degeneration on early stage is not shown on MRI and only confirmed by histological examination.

Animals ; Disease Models, Animal ; Female ; Intervertebral Disc ; metabolism ; pathology ; surgery ; Intervertebral Disc Displacement ; etiology ; metabolism ; pathology ; Lumbar Vertebrae ; surgery ; Macaca mulatta ; Male ; Minimally Invasive Surgical Procedures ; Random Allocation

Objective To analyze the epidemic situation and characteristics of spatial autocorrelation and spatiotemporal regular of hand，foot and mouth disease( HFMD) in Yunnan Province during the period from 2014 to 2018，thus to provide theoretical basis for HFMD prevention and control． Methods Descriptive epidemiologic method was used to analyze the epidemic situation of HFMD，spatial autocorrela- tion was used to analyze the spatial cluster aggregation，and discrete Possion model in spatio－temporal in scan was used to detect HFMD＇s spatio－temporal clustering condition． Ｒesults The incidence of HFMD in Yunnan Province had been risen rapidly during the past 5 years． Cases mainly occurred among the group of male，0－4 years old group and scattered children． The predominant pathogen had changed，Other enterovir- us gradually replaced enterovirus 71( EV71) to be the predominant． HFMD cases and pathogen showed sig- nificant spatial clustering aggregation，HFMD cases hot spots mainly concentrated in the central and south－ central part of Yunnan Province． The amount of EV71 cases hot spots increased gradually，and the hot spot areas augmented and extended to the central and south－central part of Yunnan Province． There was obvious spatial－temporal aggregation of HFMD，annual scan results detected 3 first－level cluster areas and 1 second －level cluster area． Clustering time was mainly concentrated in April to October of each year． Conclusions Distribution characteristics of HFMD among people in Yunnan Province did not change significantly during the period from 2014 to 2018，while the proportion of pathogenic spectrum changed significantly． The key areas of HFMD control and prevention were still in the central and central－south part of Yunnan Province，while the aggregation and break of HFMD in these areas from April to October should be concerned．

Objective To study the anatomical features of medial wall of the glomus jugulare to provide the theoretical direction for surgery of the glomus jugulare. Methods Fifteen (30 sides)formalin-fixed adult cadaveric specimens were dissected under the operating microscope, and their structural features of the medial wall of the glomus jugulare and their anastomosis of nerves were observed; and 5 dry skull specimen were also employed to observe the bone landmark of medial wall of the glomus jugulare. Results The medial wall of the glomus jugulare is composed of endocranial opening of the jugular foramen, jugular process of the temporal bone and occipital bone, cerebral dura mater and the Ⅸ, Ⅹ and Ⅺ cranial nerves. A curve line was marked on medial wall of the glomus jugulare, finding that the cranial nerves and the cerebral dura mater are at the anteroinferior position and the posterior-up part is composed of the well of the jugular vein adhered to the petrous bone and cerebral dura mater. Cranial nerve Ⅸ travels at the anterosuperior part of its own fibrous sheath and the inferior petrosal sinus ostium separates it from cranial nerves Ⅹ and Ⅺ; cerebral dura mater separates the cranial nerves Ⅸ and Ⅹ. The cranial nerve Ⅹ and the accessory nerve are closely related. Interval of cerebral dura mater between cranial nerve Ⅸ and Ⅹ is clearly seen in 86.67％ (26/30) patients and illegible in 13.33％ (4/30). Hypoglossal canal travels of the bottom of the medial wall of the glomus jugulare. Conclusion The medial wall of the glomus jugulare is composed of endocranial opening of the jugular foramen,jugular process of the temporal bone and occipital bone, cerebral dura mater and the Ⅸ, Ⅹ and Ⅺ cranial nerves, and this information can help the clinicians during the operations of the jugulare foramen, so that the operation complications can be reduced.

OBJECTIVETo compare the clinical effect between the lamina osteotomy and former vertebral plates regraft method and total laminectomy and interbody fusion method in treating single-segment lumbar degenerative disease.

METHODSThe clinical data of 167 patients with single-segment lumbar degenerative disease underwent surgical treatment from January 2010 to December 2014 were retrospectively analyzed. There were 92 males and 75 females, aged from 45 to 75 years old with an average of (59.6±12.4) years. The patients were divided into lamina osteotomy and former vertebral plates regraft group(82 cases) and total laminectomy and interbody fusion group(85 cases) according to the different surgical methods used. The general conditions and clinical effects were compared between two groups. General conditions included the operation time, intraoperative blood loss, postoperative drainage, hospitalization time and the clinical effects included the visual analogue scale (VAS), Japanese Orthopaedic Association(JOA), Oswestry Dability Index(ODI), MacNab results, epidural fibrosis (EF), the incidence of adjacent segment degeneration (ASD).

RESULTSAll the patients were followed for 18 to 36 months with an average of (24.8±5.7) months, furthermore, there was no significant difference in the follow-up time between two groups. There was no significant difference in general conditions such as operation time, intraoperative blood loss, postoperative drainage, or hospitalization time between two groups. At final follow-up, the VAS, ODI, JOA, of all patients were significantly improved (<0.05);and the three factors above in the lamina osteotomy and former vertebral plates regraft group respectively were(2.0±1.1) points, (24.0±1.8) %, (19.8±8.2) point, while the results of total laminectomy and interbody fusion group were(2.5±1.6) points, (23.3±2.0)%, and(22.5±8.5) point;there was statistical difference between two groups(<0.05). According to the standard of MacNab, 59 cases obtained excellent results, 20 good, 3 fair results in the lamina osteotomy and former vertebral plates regraft group;while 47 cases got excellent results, 26 good, and 12 fair results in the total laminectomy and interbody fusion group;there was significant difference between two groups(<0.05). Sixteen patients(19.51%) with EF and 20 patients(24.39%) with ASD were found in lamina osteotomy and former vertebral plates regraft group;and 30 patients(35.29%) with EF and 37 patients(43.53%) with ASD were found in total laminectomy and interbody fusion group; there was significant difference between two groups(<0.05).

CONCLUSIONSBoth two methods can achieve the ideal effects for the treatment of single-segment lumbar degenerative disease, but the lamina osteotomy and former vertebral plates regraft method can reserve the integrity of posterior ligamentous complex, reducing the incidence of EF and ASD, and is a better surgical method.

Adult ; Aged ; Bone Transplantation ; Female ; Humans ; Laminectomy ; Lumbar Vertebrae ; pathology ; surgery ; Lumbosacral Region ; Male ; Middle Aged ; Osteotomy ; Retrospective Studies ; Spinal Fusion ; Treatment Outcome

OBJECTIVETo explore the clinical effects of posterior debridement, bone grafting via intervertebral space combined with internal fixation for the treatment of lumbosacral tuberculosis.

METHODSThe clinical data of 32 patients with lumbosacral tuberculosis underwent the procedure of one-stage posterior intervertebral debridement, bone grafting and internal fixation from January 2007 to July 2013 were retrospectively analyzed. There were 17 males and 15 females, aged from 27 to 63 years with an average of (49.8±9.2) years. The course of disease was from 5 to 18 months with the mean of (10.7±3.2) months. There was involved the vertebral body of L₅ in 1 case, the intervertebral space of L₅S₁ in 8 cases, and the vertebral body of L₅ or S₁ combined with intervertebral space of L₅S₁ in 23 cases. VAS, ESR, CRP, the lumbosacral angle, the height of intervertebral space of L₅S₁, and ASIA grade were used to evaluate clinical effects.

RESULTSAll the patients were followed up from 18 to 39 months with an average of 21.6 months. Operative time was 120 to 260 min with the mean of 175 min, and intraoperative bleeding was 700 to 1 450 ml with the mean of 1 050 ml. VAS before operation was 8.4±1.6, then descended to 3.5±0.8(<0.05) on the 3rd month after operation and redescended to the level of 1.7±0.6(<0.05) at the final follow-up. The ESR and CRP before operation were (48.8±10.2) mm and (58.6±5.6) mg/L, respectively, then decreased to (35.6±6.9) mm and (22.5±4.3) mg/L (<0.05) at the 3rd month after operation and returned to the normal level at the final follow-up. The height of intervertebral space of L₅S₁ and lumbosacral angle before operation were (7.7±0.4) mm and (19.3±1.2)°, respectively, then improved to (10.3±0.3) mm and (22.4±1.5)° on the 3rd month after operation(<0.05), and maintained such level, no obvious lost at later. According to ASIA grade, 8 cases were grade C, 19 were grade D, 5 were grade E before operation, and at final follow-up, 1 case still was grade D, others were grade E.

CONCLUSIONSThe procedure of posterior debridement, bone grafting via intervertebral space combined with internal fixation is an effective and safe method in treating lumbosacral tuberculosis, it can effectively debride tuberculose focus, maintain the spinal stability, and improve the dysfunction with less complication.

OBJECTIVE: To investigate the clinical application of two elastic pedicle internal fixation systems in single-segment lumbar disc herniation fenestration. METHODS: A retrospective analysis of 64 patients with lumbar intervertebral disc herniation treated by surgery from June 2019 to March 2021. According to the different elastic fixation systems placed during the operation, the patients were divided into ordinary pedicle screw elastic rod link group (elastic rod group) and a special elastic pedicle screw rigid rod fixed connection group (elastic screw group). There were 33 cases in the elastic rod group, including 18 males and 15 females, aged from 30 to 69 years old with an average of(49.18±10.23) years old;and 31 cases in the elastic screw group, including 16 males and 15 females, aged from 32 to 68 with an average of (49.81±9.24) years old. The operation time, intraoperative blood loss, postoperative wound drainage, and postoperative landing time of the two groups were recorded separately. The visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) score, and Oswestry Disability Index (ODI) were compared before and 3, 12 months after operation. The height of the adjacent vertebral space on the lateral DR film before and 12 months after the operation was measured. The clinical efficacy was evaluated by Macnab standard. RESULTS: All the patients successfully completed the operation, and were followed up. The operation time, intraoperative blood loss, postoperative wound drainage and postoperative landing time in the elastic rod group were(63.73±12.01) min, (89.55±16.07) ml, (81.67±16.00) ml, (3.45±0.75) d , while in the elastic nail group was (62.96±11.54) min, (88.35±17.14) ml, (82.29±15.40) ml, (3.29±0.78) d, the difference was not statistically significant. The symptoms of low back pain and lower extremity numbness were significantly improved in all patients after operation. There was no significant difference in VAS, JOA score and ODI between the two groups before and after surgery (P>0.05). At 12 months after operation, there was no significant difference in the height of the adjacent vertebral space between the upper adjacent vertebral body and the same segment before operation(P>0.05), and there was no significant difference between the groups before and after the operation. According to Macnab criteria, the elastic rod group was excellent in 30 cases, good in 2 cases, fair in 1 case, while the elastic nail group was excellent in 29 cases, good in 2 cases, fair in 0 cases, and there was no significant difference(Z=-0.42, P=0.68). CONCLUSION In fenestrated nucleus pulposus extraction for lumbar disc herniation, the two elastic pedicle internal fixation systems are equally effective and can be used. The elastic screw internal fixation system has certain advantages when the distance between the two vertebral bodies is short, and the elastic rod cannot be placed or is difficult to be placed, and it is more widely used.
Male ; Female ; Humans ; Adult ; Middle Aged ; Aged ; Intervertebral Disc Displacement/surgery* ; Lumbar Vertebrae/surgery* ; Spinal Fusion ; Nucleus Pulposus ; Retrospective Studies ; Pedicle Screws ; Treatment Outcome ; Postoperative Hemorrhage

OBJECTIVETo observe the change of behavior, pathological change of the spinal cord,and expression of brain-derived neurotrophic factor (BDNF) and brain-derived neurotrophic factor (NGF) on rats with spinal cord injury in order to explore the optimal time of BMSCs transplantation.

METHODSEighty health SD rats were randomly divided into 8 groups (group A,B,C,D,E,F,G,H), 10 rats in each group. According to the modified Allen method,the rat model of spinal cord injury was built. Group A as non-injured group only exposed the spinal cord but not result in blast injury. BMSCs of vitro culture were respectively infunded the region of spinal cord injury in group C, D, E, F, G, H (as transplantation groups) at the 0 h, 6 h, 24 h,3 d,5 d,7 d after model made. Group B as single model group was infunded the equal cell culture fluid. BBB score was used to evaluate the function of spinal cord at the 1st,2nd and 4th weeks after injury. The morphological changes of the tissue of spinal cord injury were observed by HE stain and the expression of BDNF and NGF were detected by Elisa method at the 4th weeks after BMSCs transplantation.

RESULTSIn non-injured group,BBB score was highest than that of other 7 groups at the 1st, 2nd and 4th weeks after injury (P<0.01). There was no significant difference in BBB score between single model group and transplantation groups at the 1st week after BMSCs transplantation (P>0.05). BBB score in transplantation groups were higher than that of single model group at the 2nd and 4th weeks after BMSCs transplantation (P<0.05). At the 2nd week after injury, BBB score from high to low was group F,E,G,D,H,C,but there was no significant difference among the groups (P>0.05). At the 4th week after injury,there was significant differences in BBB score between group F and other transplantation groups (group C,D,E,G,H)(P0.05). The levels of BDNF and NGF in group F was highest at the 4th week after BMSCs transplantation (P<0.05). In non-injured group,HE staining showed the struction of spinal cord was clear and complete,no neutrophil was found. But in other 7 groups,HE staining showed obviously oedema at local tissue,juncture of gray and white matter was undefined,and different gliocyte proliferation and inflammatory cell infiltrate cound be found.

CONCLUSIONAllogeneic BMSCs transplantation is effective to stimulate the recovery of spinal cord function in rats with spinal cord injury,and the optimal time of BMSCs transplantation maybe at the 3 d after injury.

Animals ; Behavior, Animal ; Brain-Derived Neurotrophic Factor ; genetics ; Female ; Male ; Mesenchymal Stem Cell Transplantation ; Nerve Growth Factor ; genetics ; Rats ; Rats, Sprague-Dawley ; Spinal Cord Injuries ; metabolism ; pathology ; therapy ; Transplantation, Homologous

BACKGROUNDThere has been no external validation of survival prediction models for severe adult respiratory distress syndrome (ARDS) with extracorporeal membrane oxygenation (ECMO) therapy in China. The aim of study was to compare the performance of multiple models recently developed for patients with ARDS undergoing ECMO based on Chinese single-center data.

METHODSA retrospective case study was performed, including twenty-three severe ARDS patients who received ECMO from January 2009 to July 2015. The PRESERVE (Predicting death for severe ARDS on VV-ECMO), ECMOnet, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score, a center-specific model developed for inter-hospital transfers receiving ECMO, and the classical risk-prediction scores of Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) were calculated. In-hospital and six-month mortality were regarded as the endpoints and model performance was evaluated by comparing the area under the receiver operating characteristic curve (AUC).

RESULTSThe RESP and APACHE II scores showed excellent discriminate performance in predicting survival with AUC of 0.835 (95% confidence interval [CI], 0.659-1.010, P = 0.007) and 0.762 (95% CI, 0.558-0.965, P = 0.035), respectively. The optimal cutoff values were risk class 3.5 for RESP and 35.5 for APACHE II score, and both showed 70.0% sensitivity and 84.6% specificity. The excellent performance of these models was also evident for the pneumonia etiological subgroup, for which the SOFA score was also shown to be predictive, with an AUC of 0.790 (95% CI, 0.571-1.009, P = 0.038). However, the ECMOnet and the score developed for externally retrieved ECMO patients failed to demonstrate significant discriminate power for the overall cohort. The PRESERVE model was unable to be evaluated fully since only one patient died six months postdischarge.

CONCLUSIONSThe RESP, APCHAE II, and SOFA scorings systems show good predictive value for intra-hospital survival of ARDS patients treated with ECMO in our single-center evaluation. Future validation should include a larger study with either more patients' data at single-center or by integration of domestic multi-center data. Development of a scoring system with national characteristics might be warranted.

Adult ; Extracorporeal Membrane Oxygenation ; adverse effects ; methods ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Prognosis ; ROC Curve ; Respiratory Distress Syndrome, Adult ; mortality ; pathology ; therapy ; Retrospective Studies ; Risk Assessment