Objective To employ intraoperative discography to determine the injured intervertebral disc segments that can not be identified on the preoperative MRI in patients with cervical spinal cord injury without fracture and dislocation for confirming the responsible segments needing surgical decompression and fusion.Methods The study involved 85 patients with cervical spinal cord injury without fracture and dislocation treated from January 2007 to December 2011,among which sixteen patients had not been identified with the responsible segments by preoperative MRI.The average preoperative Japanese Orthopedic Association (JOA) score was (9.1 ± 1.8) points.There was no obvious fracture or dislocation of the cervical spine on preoperative X-ray film,CT and MRI,but all patients displayed high intense signal in cervical spinal cord on MRI T2 weighted imaging.Besides,MRI revealed hemorrhagic swelling of anterior cervical soft tissue in nine patients and cervical intervertebral disk hernia in all patients.Annulus fibrosus rupture of cervical intervertebral disc with contrast leakage in intraoperative discography of suspected injury segments in all patients under direction of C-arm X-ray machine was set as the injury criterion.The patients with pure ruptured discs received cervical discectomy,interbody fusion and titanium plate fixation.The patients associated with multilevel cervical intervertebral disc hernia or ossification of posterior longitudinal ligament underwent anterior cervical corpectomy,bone graft with titanium cageand titanium plate fixation of ruptured discs.Results Nineteen injured discs were identified eventually by discography,including 2 discs at C3/4,4 at C4/5,8 at C5/6 and 5 at C6/7.Moreover,anterior annulus fibrosus rupture with intact anterior longitudinal ligament was found in 11 patients.The follow-up lasted for (24.4 ± 10.0) months.JOA scores were (13.3 ± 1.5) points and (14.5 ± 1.6) points at two weeks and three months after operation,and (15.1 ± 1.5) points at the last follow-up,indicating a relevant improvement rate of 53％,68％ and 76％ respectively.Mean operation time was 110 minutes and blood loss was 120 ml.Three patients had pain on shoulder and back and one patient had hoarse voice,but all the patients were relieved in two weeks after conservative treatments.No serious complications,such as deep infection,deterioration of neurological dysfunction,vertebral artery injury or internal fixation failure were noticed intra-or post-operatively.Conclusion For the intradiscal rupture that is hard to be determined by the conventional imaging methods,intraoperative discography can be used as an auxiliary method of imaging diagnosis in early surgical determination of responsible segments for cervical spinal cord injury without fracture and dislocation.

Objective To explore the influence of Chinese Qigong--Baduanjin on mild cognitive impairment (MCI) in elderly diabetic patients.Methods A total of 78 elderly type 2 diabetic patients complicated with MCI were divided into intervention group and control group by random digits table method.The control group with 41 patients was received routine treatment and discharged guidance after discharging from hospital.The intervention group with 37 patients was received Baduanjin exercise for 12 months based on the routine treatment in control group.Montreal Cognitive Assessment (MoCA) and Activity of Daily Living (ADL) scores in two groups were compared before intervention and 1,3,6,9 and 12 months after intervention.Results In intervention group,MoCA scores were significantly increased at different times after intervention compared with those before intervention,F=72.782,the differences were statistically significant,P＜0.05.At the same time,MoCA scores were all significantly higher in intervention group than those in control group,F=2.231,2.972,4.362,5.085,5.373,the differences were statistically significant,P＜ 0.05.In intervention group,ADL scores had significantly improved since 6 months after intervention compared with those before intervention,F=93.126,the differences were statistically significant,P＜0.05,and compared with those in control group,the scores were significantly higher since 6 months after intervention,F=3.853,4.561,7.162,the differences were statistically significant,P＜0.05.Conclusion Chinese Qigong--Baduanjin in treatment of elderly diabetic patients complicated with MCI can delay the MCI progress and improve ADL of the patients.

Acupuncture analgesia is involved in various functions of the whole nervous system. The spinal cord is the first station for processing and translating the acupuncture analgesia; the brain stem is the relay station for systematization, differentiation and analysis, excitation, synthesis of acupuncture analgesic message, playing an important role in acupuncture analgesia; the thalamus functions complicated analysis and comprehensive regulation on various messeges with many kinds of neurohumoral factors involved and it is a coordinate center for strengthening and controlling acupuncture analgesia; the limbic system and its nuclear groups with many neurotransmitters involved, play coordinate action on acupuncture analgesia; the cerebral cortex is the high center and functions not only excitation and inhibition processes, but also is a center for complicated regulation and command, strengthening acupuncture analgesia and inhibiting the excess, so as to exerts interaction of dynamic balance.
Acupuncture Analgesia ; Brain Stem ; physiology ; Cerebral Cortex ; physiology ; Humans ; Limbic System ; physiology ; Pain ; physiopathology ; Spinal Cord ; physiology ; Thalamus ; physiology

With the growing awearness of Big data and its application in economic,social and scientific fields,this paper analyzed the impact and challenges big data has brought to the field of biomedical research,and put forward suggestion of improving applications of big data in biomedical research.

目的探讨轮椅技能训练的简单化、实用化和规范化。方法将 216例脊髓损伤住院患者按性别、年龄和损伤平面分为4组进行轮椅技能训练,项目包括绕障碍物行走计时、100m竞速、400m竞速、2柱×10折返跑、上下台和上下坡道,将各项目按成绩分为10个级别,制定出不同组别患者应该达到的水平,评定患者的训练效果。结果训练后,患者的100m、400m竞速、2柱×10跑折返、绕障碍计时成绩和上台(坡)的能力明显提高(P<0.01);训练效果明显75人、有效141人。结论轮椅技能训练可使脊髓损伤患者真正达到生活自理、自立,但应根据患者的损伤平面制定规范化的训练方案。

Objective To study the onset,treatment,prognosis and possible causes of transient quadriplegia shortly after anterior cervical compression and fixation (within four hours postoperatively) in three patients with cervical spondylotic myelopathy who could function well for limbs after anesthesia awakening from the operation. Methods A retrospective study was carried out on medical data of three patients including two males and one females,at age of 41-61 years.Anterior cervical corpectomy,titanium mesh bone fusion and titanic plate fixation were performed under general anesthesia.The decompression segment was C5 in one patient,C6 in one and C5 plus C6/7intervertebral disc in one respectively.Paralysis occurred between 30 minutes and 4 hours postoperatively.Two patients were with complete paralysis and one with incomplete. All the patients received dehydration,neurotrophic drugs and high-dose methylprednisolone therapy immediately after paralysis. Meanwhile,emergent cervical MRI was performed,which showed spinal cord swelling,without obvious spinal cord compression by hematoma.Results The paralysis was alleviated completely in two patients within two hours after early medication without additional surgical compression.The other one patient was recovered incompletely at 24 hours after medicationand then underwent posterior cervical laminoplasty,when tremendous pressure was released from cervical spinal cord.But the spinal function had significant recovery after surgical compression and won complete recovery one week later. Conclusions Besides spinal cord ischemia-reperfusion injury,the transient paralysis after anterior cervical surgery may be associated with cervical spinal cord swelling and limited anterior decompression space.Early diagnosis and early intervention of paralysis may save the spinal cord function and attain a satisfactory prognosis.

Objective To evaluate the effect of en bloc open-door laminectomy and pedicle screw fixation for extremely severe cervical ossification of posterior longitudinal ligament (OPLL).Methods From January 2007 to December 2011,16 cases of serious cervical OPLL were treated,in which there were 13 males and 3 females,aged from 45 to 74 years (average,56.5 years).Spinal cord functional deterioration was related to minor activities of the neck,such as sneeze,cough or hyperextension of the neck,in 15 cases.One case suffered from aggravating neurological symptoms without a definite precipitating factor.The average preoperative Japanese Orthopaedic Score (JOA) was 7.1 ±1.8.Preoperative CT scans displayed the average stenotic rate (thickness of OPLL/sagittal diameter of the spinal canal) was 83.7％.All the patients received en bloc laminectomy and pedicle screw fixation of the cervical spine.Results All the patients were followed up for 3 months to 4 years (average,24.4±10 months).The JOA scores at 2 weeks,3 months,and the last follow-up postoperatively were 13.2±1.7,13.5 ±1.6 and 14.1 ±1.5,respectively; the improvement rates were 61.6％,64.6％ and 70.7％,respectively.The operative time ranged from 80 to 150 minutes (average,130 minutes),and blood loss ranged from 150 to 600 ml (range,300 ml).One case of postoperative wound hematoma,1 case of cerebrospinal fluid leakage and 3 cases of trapezius muscle pain occurred in this group.No serious complications,such as deep infection,deterioration of neurological dysfunction,vertebral artery injury and internal fixation failure,were noticed.Conclusion Owing to the minimum interference to the cervical spinal cord,stabilization of the decompressed segments and maintenance of cervical lordosis,en bloc open-door laminectomy and pedicle screw fixation is suitable for extremely severe cervical OPLL.

Objective To investigate the effect of anterior percutaneous endoscopic discectomy (APECD) and open-door laminoplasty (ODLP) through hybrid surgery in the treatment of multisegmental cervical stenosis and giant disc herniation. Methods This study involved 3 patients with multisegmental cervical stenosis and giant disc herniation confirmed by MRI. Among them, there were 2 males and 1 female, with ages from 56-61. All patients showed significant paresthesia or weakness, and were treated between September and November 2016. The surgery was performed by first the ODLP that made spinal cord back shift, and then APECD for the second step. The visual analog scale (VAS) and neck disability index (NDI) were assessed before and after operation. Results The VAS and NDI scores were improved two weeks after operation. No adverse events like spinal cord injury and vascular injury were found during the operation. After operation, no patients were found incision infection, hematoma formation, cerebrospinal fluid leakage, dysphagia, trachyphonia and so on. Conclusion The hybrid surgery of APECD and ODLP for the treatment of the multisegmental cervical stenosis and giant disc herniation can not only decompress the nerve safely and improve the function, but also preserve cervical intervertebral disc and motion segments, therefore delaying the degeneration of adjacent segments with clinical significance.

BACKGROUND:Hip arthroplasty and internal fixation are presently effective therapeutic methods in treatment of femoral neck fracture in the elderly. However, which method can reduce the incidence of postoperative complications remains controversial.
OBJECTIVE:To systematical y review the reoperation, postoperative complications and 1-year and 2-year mortality after hip arthroplasty and internal fixation in the elderly with femoral neck fracture.
METHODS:Pubmed/Medline, EMBASE, and Cochrane CENTRAL databases were retrieved by computer for articles published before May 2013. Systematic review on randomized control ed trials of hip arthroplasty versus internal fixation for femoral neck fractures in the elderly was conducted using the Cochrane Col aboration’s RevMan 5.2 software. Outcome measures included reoperation, main complications related to the surgery and mortality.
RESULTS AND CONCLUSION:Six published randomized control ed trials of nine literatures containing 1 496 cases were involved in this review. Meta-analysis results indicated that reoperation rate was greater in the internal fixation group within and more than 2 years after the surgery compared with the hip arthroplasty group (P<0.000 01). Compared with hip arthroplasty group, internal fixation significantly increased the main complications related to the surgery [OR=8.79, 95%CI(6.50-11.88), P<0.000 01]. No significant difference in 1-year and 2-year mortality after surgery was detected between the internal fixation and hip arthroplasty groups [OR=0.85, 95%CI(0.66-1.11), P=0.23;OR=0.88, 95%CI(0.70-1.10), P=0.27]. These data suggested that the long-term reoperation rate and incidence of main complications were obviously higher in internal fixation compared with hip arthroplasty for femoral neck fracture in the elderly, and no significant difference in 1-year and 2-year mortality after the surgery was detectable between the two methods. Clinical recommended hip arthroplasty in the repair of femoral neck fracture in the elderly.

BACKGROUND:Gait deviations are the important diagnosis criteria and surgical indications of cervical myelopathy. Conventional three-dimensional gait laboratory failed to apply in clinics due to complex operations and time consuming. In recent years, a portable gait analyzer based on the micro-sensors is emerging and developing, it has been verified by clinical practice, al owing gait analysis in the ward.
OBJECTIVE:To quantitatively analyze gait characteristics of patients with cervical spondylotic myelopathy (CSM) by a portable gait analyzer.
METHODS:From March 2013 to November 2013, 15 CSM patients and 30 healthy subjects were enrol ed in the study. The involved patients were accompanied by gait abnormalities. A portable gait analyzer was used for gait analysis. Subjects walked on a 30-meter corridor back and forth for 120 meters. Total y 12 gait parameters were involved in this study, including seven common parameters (single limb support, double limb support, gait cycle, speed, cadence, step length and stride length) and five new parameters (pul ing acceleration, swing power, ground impact, foot fal , and pre-swing angle). Three patients underwent cervical decompression surgery. The gait characteristics were re-evaluated one week later, carrying neck support.
RESULTS AND CONCLUSION:The double limb support and gait cycle duration of CSM group were significantly longer than control group (P<0.05). Speed, cadence, step length, stride length, swing power, ground impact, foot fal , and pre-swing angle of CSM patients were significantly smal er than healthy subjects (P<0.05). No differences were found in single limb support and pul ing acceleration (P>0.05). after cervical decompression surgery, the mean remission rate of Japanese Orthopedics Association scores was 32.5%and lower limb acceleration was improved obviously in the graph one week after surgery. Varying degree of correlation was seen between Japanese Orthopedics Association scores and the detected 12 gait parameters in CSM patients. The portable gait analyzer can effective measure the pathological gait deviation in CSM patients with abnormal gaits, and assists to evaluate the lower limb functions.