BACKGROUND:Pedicle screw is the major instrumentation of surgery in thoracic spine. However, there have been few reports about pedicle morphology relevant to screw insertion tracts, and few reports comparing the normal adolescents and adolescent idiopathic scoliosis patients. OBJECTIVE:To compare the morphologic characteristics of the thoracic pedicle with regard to safe thoracic pedicle screw placement in normal adolescents and adolescent idiopathic scoliosis patients. METHODS: Thoracic pedicles of thirty-five normal adolescents and thirty-five adolescent idiopathic scoliosis patients were measured with three-dimensional reconstruction CT images. Measured parameters include (1) critical distance: the shortest distance from an entry point to the ventral cortex of the lamina. (2) Safe distance: the distance from the entry point to the tangent of the spinal canal at the medial wal of the pedicle. (3) Pedicle screw length. (4) Pedicle width. (5) Pedicle transverse angle. The dangerous area was defined as the distance between the critical distance and the safe distance. RESULTS AND CONCLUSION: The mean critical distance was (9.2±1.0) mm for the normal adolescents, and (9.4±1.2) mm for the adolescent idiopathic scoliosis patients. Safe distances were significantly less in normal adolescents (14.7±0.8) mm than that of the adolescent idiopathic scoliosis group (15.4±1.4) mm (P < 0.001). The dangerous area was (5.4±0.7) mm for the normal adolescents, which was significantly less than that of the adolescent idiopathic scoliosis patients (6.0±1.0) mm (P < 0.001). Pedicle screw length was (36.6±4.1) mm for the normal adolescents and (37.1±5.3) mm for the adolescent idiopathic scoliosis patients. Pedicle width was (5.8±1.2) mm for the normal adolescents and (5.7±1.7) mm for the adolescent idiopathic scoliosis patients. No significant difference in critical distance, pedicle screw length and pedicle width was found between the two groups (P=0.382, 0.135, 0.293). Pedicle transverse angle decreased gradualy from T1 to T12 in both groups. These results verify that pedicle morphology of many parameters is different between normal adolescents and adolescent idiopathic scoliosis patients, especialy in the apical area of the thoracic curve.

Objective:　To explore the importance of mechanic al ventilation (MV) in treating multiple trauma mainly accompanied with cerebral injury and improve the treatment level. 　　Methods:　All 116 patients who suffered from multiple trauma acc ompanied with mainly cerebral injury were analyzed. Rank correlation and Chi-sq uare test were made between MV with GCS, ISS, and whether shock or not. 　　Results:　The MV was correlated with GCS, ISS scores, and whethe r shock or not markedly. Furthermore, when GCS≤8, the ratio of MV was about 70% . When ISS≥35, the ratio of MV was about 85%. 　　Conclusions:　During the treatment of multiple trauma accompanie d with cerebral injury, the principle of “early MV, early withdraw” and “indi vidualism” should be insisted on. For patients accompanied with shock, the opti mum PEEP is very important. Proper and active MV is of great importance and can improve the treatment level markedly.

Objective:To evaluate our self-designed guide device for Kirschner-wire placement in the surgery for paediatric fractures of supracondylar humerus.Methods:A retrospective study was conducted of the 117 children who had been treated for fractures of supracondylar humerus at Department of Orthopedics, The First People's Hospital of Huaian Affiliated to Nanjing Medical University from March 2019 to January 2023. There were 64 boys and 53 girls with an age of (5.8±1.5) years. By the Gartland classification, there were 67 fractures of type Ⅱ and 50 fractures of type Ⅲ. The time from injury to operation averaged (48.5±10.8) hours. The children were divided into 2 groups according to how their Kirschner-wires were placed. In the control group of 58 cases, external percutaneous Kirschner-wire placement was assisted using a syringe needle; in study group of 59 cases, external percutaneous Kirschner-wire placement was assisted using our self-designed guide device for Kirschner-wire placement. The operation time, rate of one-time placement of disposable K-wire, intraoperative fluoroscopy frequency, Baumann angle, carrying angle, fracture healing time, Flynn score of elbow joint function at the final follow-up, and postoperative complications were compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). The 117 pediatric patients were followed up for (15.3±3.2) months after operation. The operation time [(30.6±4.5) min] and intraoperative fluoroscopy frequency [(15.6±2.1) times] in the study group were significantly less than those in the control group [(40.6±7.3) min and (23.7±4.9) times], while the rate of one-time placement of disposable K-wire in the study group was significantly higher than that in the control group [84.2%(149/177) versus 32.2%(56/174)] ( P<0.05). There were no significant differences in Baumann angle, carrying angle, fracture healing time, or Flynn score of elbow joint function at the final follow-up between the 2 groups ( P>0.05). The incidence of complications in the study group (6.8%, 4/59) was significantly lower than that in the control group (20.7%, 12/58) ( P<0.05). Conclusions:Our self-designed guide device for Kirschner-wire placement is simple and convenient to use. In the surgery for paediatric fractures of supracondylar humerus, it can improve the rate of one-time placement of disposable K-wire, reduce intraoperative fluoroscopy, and decrease the incidence of complications.

Humans ; Parkinson Disease/diagnosis* ; Machine Learning