Objective To observe the curative effect of Edaravone on intracerebral hemorrhage(ICH).Methods 122 ICH patients were randomly divided into Edaravone group(61 cases) and routine group(61 cases).On the basis of routine therapy for the two groups,the Edaravone group received Edaravone 30 mg with normal saline 100 ml intravenous drip twice a day for 14 d.The levels of serum S-100? protein(S-100?),neuron-specific enolase(NSE) were detected before and 3 d,7 d and 14 d after treatment.The score of neurologic dysfunction(NDS) was evaluated before and 7 d,14 d,28 d after treatment.The volumes of hematoma and edema were measured by skull CT scan before and 7 d,21 d after treatment.The curative effect and Barthel index(BI) were evaluated at 28 d and 90 d after treatment.Results Compared with before treatment,the levels of serum S-100? and NSE,the NDSs,the volumes of hematoma and edema were obviously improved at each time point after treatment in the two groups(all P

Objeetive To assess the study outcomes in a consecutive series of patients with thoracic disc herniation (TDH) who undergone posterior spinal canal decompression and discectomy with segmental instrumentation and fusion.Methods Between January 2005 and June 2012,the data of 17 patients (11 males and 6 females) was retrospectively reviewed and analyzed.Disc herniation was classified as central in 10 cases and paracentral in 7 cases.The average canal encroachment was 71.7％±9.6％ (range,52％ to 90％).Their mean age at surgery was 55.7 years (range,21 to 81 years).All patients underwent a transfacet decompression and segmental instrumentation with interbody fusion.The data of patients included clinical presentation,blood loss,operative time,complications,visual analogue scale (VAS),Japanese Orthopaedic Association (JOA) score,and Frankel grading system.Results The average follow-up period was 37±12 months.The average surgical time was 120±63 min.The mean blood loss was 471±198 ml.Mean preoperative VAS score was 8.01±0.21,which improved to a mean of 1.12±0.07 at final follow-up.Average pre-and post-operative at 12 months JOA scores were 3.17±0.83 and 8.78±0.94 points,respectively.The average recovery rate was 65.1％±23.4％.Overall JOA scores showed a significant postoperative improvement.All patients reported 1 or 2 grade improvement in Frankel grading compared with preoperative status except for 1 patient whose grade had not changed.There were three complications,including one patient developing postoperative wound infection,one experiencing a cerebrospinal fluid leakage,one developing further neurological deterioration.Conclusion The results suggested that the posterior approach using special shaped osteotomy is feasible for central calcified TDH.No major complications occurred for achieving adequate decompression for central calcified TDH.

Objective To evaluate the clinical efficacy of a self-designed novel n-shaped aiming device in aiding the percutaneous cannulated screwing for treatment of odontoid fractures of Anderson-D' Alonzo type Ⅱ and shallow type Ⅲ.Methods A retrospective analysis was conducted of the 17 patients who had been treated at our department for odontoid fracture of Anderson-D' Alonzo type Ⅱ and shallow type Ⅲ between January 2009 and December 2013.They were 13 males and 4 females,with an average age of 37.5 years (from 16 to 61 years).All received surgical treatment after skull traction or jaw pillow traction preoperatively for reduction.Intraoperatively,percutaneous cannulated screwing via the anterior cervical approach was performed with the help of a self-designed novel n-shaped aiming device to fix the odontoid.Postoperatively,X-ray and CT scan were used to check the screw locations and evaluate the fracture healing.Results The 17 cases were followed up for 6 to 15 months (average,10.5 months).No intraoperative injury to the esophagus,artery,spinal cord or nerve root happened.The operating time ranged from 60 to 125 min.The bleeding was from 10 to 40 mL.Intraoperative observation revealed fine locations of the screws.Bony union was achieved in 16 cases 3 months postoperatively while separation and hardening of the fracture ends was found in one ease.Conclusion Our self-designed novel n-shaped aiming device can facilitate the percutaneous cannulated screwing for treatment of odontoid fractures of Anderson-D'Alonzo type Ⅱ and shallow type Ⅲ,given that it has advantages of simple manipulation,accurate insertion,minimal invasion,quick recovery and reliable efficacy.

Objective To investigate the safety, reliability and effectiveness of supra - aortic artery stenting angioplasty via transradial access in treating supra-aortic artery occlusion or stenosis. Methods The clinical data of 325 consecutive patients with supra-aortic artery occlusion or stenosis, who were admitted to authors' hospital during the period from January 2012 to January 2016 to receive stenting angioplasty, were retrospectively analyzed. According to patient's own will, the 325 patients were divided into transradial access group (n=52) and transfemoral access group (n=273). The results of the puncturing, the operative results, the duration of operation, the amount of intraoperative blood loss, the postoperative complications, the time of postoperative rest in bed, the average time of hospitalization of both groups were recorded. Results No statistically significant differences in the success rate of puncturing, the success rate of operation and the amount of intraoperative blood loss existed between the two groups (P＞0. 05). In 73. 1％ of patients (38/52) of the transradial access group the duration of operation was ≤30 min, while only in 43. 2％ of patients (118/ 273) of the transfemoral access group the duration of operation was ≤30 min, the difference between the two groups was statistically significant (P＜0. 000 1). After the operation, in transradial access group puncture point bleeding was seen in 8 patients and hematoma at the puncture site in one patient, the complication rate was 17. 3％ (9/52), while in transfemoral access group puncture point bleeding was observed in 23 patients, hematoma at the puncture site in 7 patients, pain of puncture site in one patient, and cerebral hemorrhage in one patient, the total complication rate was 11. 7％ (32/273); but the difference between the two groups was not statistically significant (χ2=1. 236, P=0. 266). Patients in the transradial access group could get out of bed immediately after the operation. No statistically significant difference in the average time of hospitalization existed between the two groups (P＞0. 05). Conclusion In performing endovascular stenting angioplasty for supra-aortic artery occlusion or stenosis, both transradial access and transfemoral access are safe, reliable and effective. Transradial access can be used as a replacement of transfemoral access. (J Intervent Radiol, 2018, 27:207-210)

Objective:To explore the effect of decalcified bone matrix (DBM) rich in biological activity on surgical-grade medical calcium sulfate, and to observe the change of different content of DBM on the physical and chemical properties of calcium sulfate, which provide theoretical basis for the preparation of calcium sulfate bone cement with osteogenic and injectable properties.Methods:DBM with weight content of 0, 5%, 10%, 20%, 30%, 40% was fully mixed with CSH. Dissolve 0.3 g of methyl cellulose in 10 ml of deionized water to prepare a 3% methyl cellulose solution. Methylcellulose solution was added according to the liquid-solid ratio of 0.4. The mixture was evenly stirred to form slurry, then the degradation rate, compressive strength, setting time and and pH value of calcium sulfate in vitrowas measured.Results:The initial setting time and final setting time of calcium sulfate were 4.96±0.20 and 5.83±0.12 min respectively. With the increase of DBM content, the initial setting time and final setting time increased significantly ( F=49.275, P<0.05; F=124.859, P<0.05). The compressive strength of pure calcium sulfate is 23.33±6.35 MPa; when the content is 40%, the compressive strength is only 3.33 MPa. With the increase of DBM content, the compressive strength first increased and then decreased; the content of 5%, 10%, 20% DBM had little effect on the compressive strength ( P>0.05), while the compressive strength of 30% and 40% groups decreased significantly ( t=3.259, P<0.05). DBM with different contents can significantly change the degradation rate of calcium sulfate complex. When the content of DBM is 30% and 40%, the complete degradation time in vivo is only 10 d, while the degradation rate of calcium sulfate is 63% in 30 d. At any time point in vitro degradation, DBM had no significant effect on the pH value of calcium sulfate complex culture medium, and the change law was consistent with that of pure calcium sulfate. Conclusion:With the increase of DBM content, the degradation rate is gradually accelerated, the compressive strength is reduced, and the setting time is prolonged, which is not conducive to the preparation of injectable calcium sulfate cement.

Objective:To observe the epidemiological characteristics of spinal metastases by retrospectively analyzing the medical records of multicenter spinal metastases in China.Methods:Patients with spinal metastases were identified from several clinical centers between January 2007 and July 2019. A total of 1 976 patients were included in this study, including 1 129 males (57.14%) and 847 females (42.86%). The mean age was 58.6±11.6 years (range 13-92 years). The demographic characteristics, primary tumor types, spinal involvement of each patient were summarized and their clinical indicators were obtained by consulting medical records, including: Frankel grade, visual analog scale (VAS), metastatic spinal cord compression (MSCC), Tokuhashi revised score, the spinal instability neoplastic score (SINS), Karnofsky performance status (KPS), and history of malignant tumors. Finally, the intervention influencing factors of patients undergoing surgical treatment were statistically analyzed.Results:The ratio of male to female in 1 976 spinal metastases was 1.33∶1. The median age was 59.0, and most patients (63.71%) were in the ages range of 50-69. The average age of female was younger than male, and the difference was statistically significant. The proportion of male patients over 60 years old was higher than females, and the difference was statistically significant. The most common primary tumor was lung cancer (n=730, 36.94%), followed by unknown origin (n=326, 16.50%), breast cancer (n=159, 8.05%), kidney cancer (n=120, 6.07%), gastrointestinal cancer (n=109, 5.52%), etc. The most common primary tumor was lung cancer in both males and females, followed by unknown origin in males and breast cancer in females. In the past 10 years, the proportion of unknown origin has decreased, and the proportion of breast cancer has increased. According to the Tomita score, 1 284 patients (64.98%) were rapid growth tumors, 211 patients (10.68%) were moderate growth tumors, and 481 patients (24.34%) were slow growth tumors. There were 730 patients (57.14%) in the subgroup of the number<3, the most level of which was lumbar vertebrae, with 368 patients (32.60%). The remaining 847 patients (42.86%) were included in the subgroup of the number≥3, the most level of which was multiple-level of spine, with 617 patients (72.85%). Among the 1 976 patients, spinal cord injury occurred in 50.76% of patients, in which 77.18% of patients developed moderate and above pain, 14.02% of patients appeared metastatic spinal cord compression, and only 28.95% of patients had a clear history of primary tumor. In terms of treatment, 34.92% of patients underwent surgery, 5.97% underwent radiotherapy on spinal metastases, 6.02% underwent chemotherapy, and 1.77% underwent targeted therapy. Preoperative Frankel grade, SINS, and Tokuhashi revised score were important factors affecting the surgical treatment of patients.Conclusion:This study describes the epidemiological characteristics of multicenter spinal metastases in detail, which could assist orthopedic surgeons to understand the clinical characteristics of spinal metastases and was of great significance on guiding the clinical diagnoses and scientific researches.

Objective To assess the efficacy of internal fixation assisted with Halo-vest in the treatment of Anderson-D'Alonzo type Ⅱ and superficial type Ⅲ odontoid fractures.Methods A retrospective case series study was made on 15 patients clinically diagnosed as Anderson-D'Alonzo type Ⅱ and type Ⅲ odontoid fractures with a fracture gap over 2 mm,displacement over 5 mm and broken end angel over 11° from January 2007 to January 2015.There were nine males and six females,aged 27-61 years [(44.5 ± 10.9)years].The patients were treated in "three phases" with the assistance of Halo-vest external fixation system and a novel guide pin aiming device.The three phases were as follows:phase Ⅰ:cervical traction reduction and halo-vest external fixation;phase Ⅱ:Halo-vest assisted internal fixation using the novel aiming device;phase Ⅲ:the Halo-vest fixation removal and cervical collar fixation.Operation duration,intraoperative bleeding,and postoperative visual analogue scale (VAS) pain score one month after the operation were recorded.The cervical lateral and open mouth X-ray or atlantoaxial CT scan with sagittal and coronal two-dimensional reconstruction were regularly reviewed,and the location of screws,reduction and fracture healing were evaluated.Results Operation duration ranged from 54 to 96 minutes [(71.3-± 11.9) min].The intraoperative blood loss was 5-60 ml [(32.6 ± 16.8) ml].There was no spinal cord or nerve root injury,cerebrospinal fluid leakage,wound infection or other complications.All patients were followed up for 12-36 months (mean,28 months).Fourteen patients were seen bony union 6 months after the surgery and one patient was seen a false joint.At the last follow-up,the patient with false joint was seen bone sclerosis,and other patients with sound bone healing.The preoperative VAS and that of one month after the operation was (7.3 ± 0.6) points and (1.6 ± 0.7) points,respectively (P ＜ 0.05).Conclusion For Anderson-D'Alonzo type Ⅱ and type Ⅲ odontoid fractures,which have a fracture gap greater than 2 mm,displacement more than 5 mm,broken end angle above 11 degrees,the three-phase Halo-vest assisted internal fixation can provide good stability before operation and promote bone healing and pain relief after operation.

Objective To identify prognostic factors ofmotorfunctionafter surgery of metastatic spinal cord compression (MSCC).Methods The clinical data of 681 patients with spinal metastases from January 2008 to December 2017 were retrospectively analyzed.According to inclusion and exclusion criteria,a total of 206 patients with spinal metastatic were included.Postoperative neurological function was assessed using Frankel classification.The influence of age,gender,preoperative status,number of spine metastases,location of spinal metastases,visceral metastases,bone metastases,primary tumor type,interval from symptom to surgery,time of developing motor deficits,interval from primary tumor diagnosis to MSCC,preoperativethe Eastern Cooperative Oncology Group performance status (ECOG-PS),Karnofsky Performance score (KPS) and surgical procedures on postoperative function outcomes were explored.Results 140 (68.0％) patients were able to walk postoperatively compared with 88 (42.7％) patients preoperatively.Moreover,in 89.8％ of all patients,79 ambulatory patients maintained ambulation after treatment.The univariate analysis according to Ordered-logit model showed thatnumber of spine metastases,location of spinal metastases,preoperative ECOG-PS,preoperative KPS,interval from symptom to surgery and time of developing motor deficits were related with posttreatment motor functions.The multivariable analysis showed that number of spine metastases (OR=2.03;95％CI:1.12-3.33;P=0.04),preoperative ECOG-PS (OR=4.84;95％CI:2.42-8.15;P=0.038),interval from symptom to surgery (OR=3.78;95％CI:3.12-9.15;P=0.024),time of developing motor deficits(OR=2.75;95％CI:1.22-3.89;P=0.01) were independent prognostic factors for function outcomes.Conclusion 1-2 levels of metastasis,Interval from symptom to treatment ≥ 48 h,time of developing motor deficits ≥7 d,and ECOG-PS 1-2 can be considered as the most significant positive prognosticfactors for post-treatment ambulatory status.Spinal metastasis should have a higher priority,and immediate intervention should be started before the development of irreversible neurologic deficits.Increasing awareness of early symptoms and earlier screeningwith regular outpatient review might make a difference for patients with MSCC.Consequently,the identified prognostic factors can be considered as apreoperative assessment tool to predict the neurologic outcomeand guide clinical treatment for individual patients with MSCC.