Objective To explore the effect of pedicle fixation for treatment of thoracolumbar burst fractures in patients with osteoporosis,and to provide more evidence for the treatment.Methods Retrospectively analyzed the clinical data of 121 patients with osteoporotic vertebral burst fracture from June 2012 to October 2015.And these patients were divided into two groups according to different operation methods, namely the control group (n=56) who were given short segment fixation and the observation group (n=65) who were given single segment fixation.The visual analogue scale(VAS),Oswestry disability index(ODI),vertebral height,kyphotic angle and bone mineral density of the two groups were analyzed before surgery and 3 days,1 month,3 months and 12 months after surgery.Results The VAS score,ODI score,vertebral height,and Cobb angle of the injured vertebra were significantly improved in both of the two groups,and the difference was statistically significant (P<0.05).The VAS score of the observation group was better than that of the control group 3 days after surgery with statistically significant difference (P<0.05).But there was no significant difference 3 months,6 months and 12 months after surgery(P>0.05).The ODI score of the observation group was better than that of the control group 3 days and 3 months after surgery with statistically significant difference (P<0.05),and there was no significant difference between the two groups till the end of follow-up.Pedicle fixation at the injured vertebra significantly improved the vertebral height and Cobb angle with statistically significant difference (P<0.05).And the anti-osteoporosis treatment significantly increased the bone mineral density (P<0.05).Conclusion Pedicle fixation at the injured vertebra is useful in pain relief as well as function and anatomical structure restoring.And anti-osteoporosis treatment is necessary for the bone mineral density increase.

Objective To evaluate the effect of asymptomatic hyperuricemia on the postoperative functional recovery in osteoarthritis (OA)patients with knee joint replacement.Methods Among the 294 patients who recieved knee joint replacement in our hospital from Feb-ruary 2013 to September 2015,a total of 187 patients were included in this study with 79 cases in the hyperuricemia group and the other 108 cases in the control group.The WOMAC index of the two groups were analyzed before the surgery,2 weeks,3 months,and 6 months after the knee joint replacement surgery.Multivariable linear regression was performed to test the effect of impact factors on the variation of WOMAC index.Results The WOMAC index of the two groups significantly increased 2 weeks after surgery,and the difference was statistically signifi-cant(P <0.05).And the WOMAC index of the control group was higher than that in the hyperuricemia group 2 weeks and 3 months after sur-gery with statistically significant difference(P <0.05).Conclusion The uric acid level before surgery was a influence factor of WOMAC index, and high uric acid level before knee joint replacement has negatively impact for the postoperative functional recovery in the osteoarthritis patients.

OBJECTIVE: To seek a convenient and effective method through subjective psychophysical measurements and CAP/SIR assessment. To compare the discrimination of rehabilitation between post-lingual and pre-lingual deafened patients. METHOD: Thirty-one post-lingual cochlear implantees and 59 pre-lingual cochlear implantees, the warble tone and CAP/SIR were assessed. The discrimination of threshold levels, comfortable levels and dynamic range between post-lingual and pre-lingual deafened patients in same electrodes were compared. RESULT: There was no statistic difference in warble tone, T-levels, C-levels and dynamic range in same electrodes implant after 6 months implant (P>0.05). The score of CAP and SIR in post-lingual deafened patients were more prominent. CONCLUSION CAP and SIR is a kind of convenient and effective method to assess the ability of aural and oral. There was no discrimination in warble tone, T-levels, C-levels and dynamic range in same electrodes implant, but the ability of aural and oral in post-lingual deafened patients were more prominent.
Adolescent ; Adult ; Auditory Threshold ; Child ; Child, Preschool ; Cochlear Implantation ; methods ; Cochlear Implants ; Deafness ; etiology ; physiopathology ; therapy ; Humans ; Infant ; Middle Aged ; Speech Perception ; Treatment Outcome ; Young Adult

Objective:To compare the clinical effect of miniplates plus reconstruction plate fixation assisted by preoperative digital design and conventional miniplates plus reconstruction plate fixation in the treatment of comminuted posterior acetabular wall fracture.Methods:A retrospective cohort study was used to analyze the clinical data of 35 patients with comminuted posterior acetabular wall fracture admitted to General Hospital of Central Theater Command of PLA from January 2012 to June 2019, including 26 males and 9 females, aged 25-63 years [(45.5±9.8)years]. A total of 16 patients received miniplates plus reconstruction plate fixation assisted by preoperative digital design (digital design group) and 19 patients received conventional miniplates plus reconstruction plate fixation (conventional group). The operation time, intraoperative blood loss, hospitalization time and fracture healing time were compared in the two groups. Matta radiological standard score was performed to assess the quality of fracture reduction at postoperative 2 days. Modified Merle d′Aubign-Postel score was used to evaluate hip function at postoperative 3 months, 6 months and final follow-up. Postoperative complications were observed.Results:All patients were followed up for 12-48 months [(30.1±8.9)months]. The operation time and intraoperative blood loss were (114.7±16.1)minutes and (323.4±26.1)ml in digital design group, significantly less than (179.8±67.3)minutes and (392.6±87.8)ml in conventional group (all P<0.01). There were no significant differences in hospitalization time, fracture healing time, excellent and good rate of quality of fracture reduction between the two groups (all P>0.05). The modified Merle d′Aubign-Postel score was higher in digital design group [(14.1±2.3)points, (15.4±2.3)points and (17.1±1.8)points] than those in conventional group [(13.7±2.2)points, (15.0±2.5)points and (16.8±2.1)points] at 3 months, 6 months and last follow-up, but there were no significant differences (all P>0.05). The modified Merle d′Aubign-Postel score showed significant differences within each group at each time point (all P<0.01). In digital design group, one patient was found with heterotopic ossification and one with traumatic arthritis. In conventional group, two patients were found with heterotopic ossification, one with traumatic arthritis and one with avascular necrosis of the femoral head. The rate of postoperative complications was 12.5% (2/16) in digital design group and was 21.1% (4/19) in conventional group ( P>0.05). Neither of the two groups had complications such as penetration of screws into the articular cavity, failure of internal fixation or iatrogenic sciatic nerve injury. Conclusion:Both miniplates plus reconstruction plate fixation assisted by preoperative digital design and conventional miniplates plus reconstruction plate fixation can achieve satisfactory clinical efficacy in the treatment of comminuted posterior acetabular wall fracture, but the former can significantly reduce operation time and intraoperative blood loss.

Objective:To evaluate the clinical results of miniplates combined with reconstruction plate in treating comminuted posterior wall acetabular fractures.Methods:A retrospective case series study was conducted for 27 patients with comminuted posterior wall acetabular fractures treated in General Hospital of Central Theatre Command of PLA from October 2015 to June 2019. There were 18 males and 9 females, at age of 23-61 years［（45.9±10.9）years］. All patients were treated by using miniplates combined with the reconstruction plate. The operation time, intraoperative blood loss, intraoperative blood transfusion, length of hospital stay and time of fracture healing were recorded. The reduction quality was evaluated according to Matta radiographic standard at 2 days postoperatively. The modified Merle D'Aubigné-Postel score was adopted to evaluate the hip function at 3, 6 months postoperatively and the final follow-up. Postoperative complications were observed, and heterotopic ossification was assessed by Brooker grading standard.Results:All patients were followed up for 12-48 months［36（24, 36）months］. The operation time was 123-242 minutes［（165.4±29.8）minutes］; the intraoperative blood loss was 170-550 ml［（358.3±111.3）ml］; nine patients required intraoperative blood transfusion of 300-500 ml［（377.8±66.7）ml］. The length of hospital stay was 12-29 days［（21.4±4.7）days］. The fracture healing time was 12-24 weeks［（16.3±3.0）weeks］. According to Matta radiographic standard, the reduction quality was excellent in 21 patients, good in 3 and poor in 3 at 2 days postoperatively, with the excellent rate of 89%. The modified Merle D'Aubigné-Postel score was 9-16 points［（13.1±1.9）points］at 3 months postoperatively, was 10-18 points［（15.4±2.0）points］at 6 months postoperatively, and was 12-18 points［（16.9±1.8）points］at last follow-up（ P<0.01）. The modified Merle D'Aubigné-Postel score between 3 months and 6 months was significantly different（ P<0.01）, and the difference between 6 months and the follow-up was statistically significant（ P<0.01）. The modified Merle D'Aubigné-Postel score was graded as excellent in 0 patient, good in 7, fair in 11 and poor in 9 at 3 months postoperatively, with the excellent rate of 26%; graded as excellent in 3 patients, good in 19, fair in 2 and poor in 3 at 6 months postoperatively, with the excellent rate of 81%; graded as excellent in 18 patients, good in 5, fair in 3 and poor in 1 at the last follow-up, with the excellent rate of 85%（ P<0.01）. No iatrogenic sciatic nerve injury, deep vein thrombosis or wound infection occurred after operation. No hardware loosening or loss of reduction occurred during the follow-up. The post-traumatic arthritis was identified in 2 patients. The avascular necrosis of femoral head was observed in 1 patient and thereafter underwent total hip replacement. The heterotopic ossification occurred in 3 patients, among which 2 patients were graded as Brooker class I and 1 as class II, but there was no adverse effect on hip function. Conclusions:Miniplates combined with reconstruction plate in the treatment of comminuted posterior wall acetabular fractures have reliable fixation effect and attain good reduction, high fracture healing rate, less complications and satisfactory functional recovery.

Objective:To investigate the epidemiological data of maternal sepsis in intensive care unit (ICU), analyze the common causes, outcomes of maternal sepsis, and the risk factors of multi-drug resistant (MDR) bacteria.Methods:A retrospective cohort study. Maternal sepsis cases admitted to ICUs of Peking University Third Hospital, Beijing Chao-Yang Hospital Affiliated to Capital Medical University, and Beijing Friendship Hospital Affiliated to Capital Medical University from January 2008 to September 2022 were enrolled. The following data were recorded: demographic characteristics, sequential organ failure assessment (SOFA) during infection, infection time, infection sites, invasive intervention measures before infection, microbial culture results, blood routine test during infection, body temperature, and clinical outcomes caused by infection. According to the time of sepsis occurrence, the patients were divided into pre-ICU sepsis group and ICU sepsis group, and the causes of sepsis in the two groups were analyzed. According to whether MDR occurred, the patients were divided into MDR group and non-MDR group, and clinical outcomes were analyzed. Multivariate Logistic regression was used to analyze the risk factors of MDR bacteria infection in obstetrics with sepsis.Results:160 patients were enrolled, among which 104 cases of sepsis happened before ICU and 56 cases of sepsis happened during ICU, 53 cases were with MDR bacteria and 107 cases were without MDR bacteria. The median age of the patients was 30.5 (28.0, 34.0) years old, the median temperature was 38.8 (38.2, 39.5) ℃, and the median white blood cell count (WBC) was 17.2 (13.2, 21.3)×10 9/L, the median SOFA score was 5.0 (3.0, 8.0), and 130 cases (81.2%) were referred from other hospitals. The main infection sites were uterine cavity in 64 cases (40.0%), lung in 48 cases (30.0%), abdominal and pelvic cavity in 30 cases (18.8%), urinary system in 27 cases (16.9%). Sepsis led to hysterectomy in 6 cases (3.8%), stillbirth in 8 cases (5.0%), and neonatal death in 2 cases (1.3%). The main surgical intervention measures were cesarean section (44 cases, accounting for 27.5%), followed by exploratory laparotomy (19 cases, 11.9%). The median length of ICU stay was 5.0 (3.0, 10.0) days, and the median hospital length was 14.0 (10.0, 20.8) days. Intrauterine infection was the primary cause of sepsis happened during ICU, accounting for 50.0% (28/56), of which postpartum hemorrhage accounted for 85.7% (24/28). The proportion of diabetes [28.3% (15/53) vs. 14.0% (15/107)], intrauterine operation [41.5% (22/53) vs. 23.4% (25/107)], intrauterine infection [50.9% (27/53) vs. 34.6% (37/107)] and bacteremia [18.9% (10/53) vs. 2.8% (3/107)] in the MDR group were significantly higher than those in the non-MDR group (all P < 0.05). Multivariate Logistic regression analysis showed that diabetes [odds ratio ( OR) = 2.348, 95% confidence interval (95% CI) was 1.006-5.480, P = 0.048] and intrauterine operation ( OR = 2.541, 95% CI was 1.137-5.678, P = 0.023) were independent risk factors for MDR bacterial infection in obstetrics with sepsis. Conclusions:Intrauterine infection is the common cause of maternal sepsis in ICU, and postpartum hemorrhage is the common cause of secondary intrauterine infection in ICU. MDR bacteria can lead to serious clinical outcomes. Diabetes and intrauterine operation are independent risk factors for MDR bacteria' infection.

Objectives:To investigate clinical characteristics, outcomes and antimicrobial resistance of community-acquired Pseudomonas aeruginosa (CAPA) infections in Chinese pediatric patients. Methods:This retrospective study was conducted at 6 tertiary hospitals in China during January 2016 to December 2018. The clinical and microbiological data of CAPA infected hospitalized children in Hainan and in other regions were collected and compared, and the antimicrobial resistance patterns, clinical characteristics and antibiotic therapy were analyzed. Between different groups were compared using the Chi-square test and Mann-Whitney U test. Results:Among 91 patients, 63 cases were males, 28 cases were females, and 74 cases were from Hainan province, 17 cases were from other regians. The age of consultation was 22.5 (5.4, 44.0) months. Twenty-four cases (26%) had underlying diseases. Fever (79 cases (87%)) and cough (64 cases (70%)) were common initial symptoms. Other concomitant symptoms included wheezing 8 cases (9%), diarrhea 3 cases (3%) and vomiting 4 cases (4%). Twenty-eight cases (31%) had organ infections, including pneumonia 22 cases (24%), skin infection 5 cases (5%), meningitis, intra-abdominal infection and upper urinary tract infection each 1 case (1%). The resistance rate of CAPA isolates to cefepime (4% (4/90)), amikacin (1% (1/90)), ciprofloxacin (2% (2/90)) and levofloxacin (1% (1/89)) was low, and to ceftazidime, piperacillin, piperacillin-azobactam, carbapenem was 12% (11/90), 3/16, 18% (10/56) and 6% (5/90), respectively. Antimicrobial combination therapy accounted for 52% (47/91) of empirical therapy and 59% (52/88) of definite therapy. Two cases (2%) were hopeless discharged, and 3 cases (3%) died during hospitalization. The worse prognosis of CAPA infection is significantly different among children in other regions and in Hainan (4/17 vs. 1% (1/74), χ2=9.74, P<0.05). Conclusions:The invasive CAPA-infection has regional difference in incidence and prognosis in China. Clinical symptoms and signs are non-specific. CAPA strains isolated from pediatric patients display low level of resistance to most of the common antipseudomonal antibiotics. The proportion of poor prognostic outcome is lower in Hainan than in other regions.

OBJECTIVE: To investigate the surgical technique of the pericanal electrode insertion technique for ies cochlear implantation. METHOD: Forty cases of sensorineural deafness were subjected to the ies cochlear implants. Cochleostomy was performed through the external auditory canal with a microdrill anterior to the round window. The electrode impedance and electrically auditory brainstem responses(EABR) were tested during the operation. The X-ray photographs were taken after the operation. The cochlear implant was activated in all 40 cases 4 weeks following surgery. RESULT: All of the electrodes were inserted and all of the implants worked well. No electrode extrusions or serious surgical complications happened during postoperative observation for 6 months. CONCLUSION The pericanal electrode insertion technique is a safe approach for ies cochlear implantation.
Child, Preschool ; Cochlear Implantation ; methods ; Cochlear Implants ; Ear Canal ; surgery ; Female ; Hearing Loss, Sensorineural ; surgery ; Humans ; Infant ; Male ; Otologic Surgical Procedures ; methods ; Subcutaneous Tissue ; surgery

Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.