Objective:To explore the characteristics of Traditional Chinese Medicine (TCM) syndromes in sepsis patients with different blood urea nitrogen (BUN) levels.Methods:From January 2017 to December 2018, 252 sepsis patients, who were admitted in the Department of Intensive Care Unit of the Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine) and met the inclusion criteria, were divided into lower level group (BUN<9.25 mmol/L) and higher level group (BUN≥9.25 mmol/L) according to BUN levels. The baseline data, complications, infection sites and other data were collected. TCM syndromes were judged according to the four diagnostic information of TCM and BUN levels. Variables with P<0.2 in univariate analysis were introduced as candidate variables, and the correlation between TCM syndrome elements and BUN was analyzed by multivariate logistic regression. Results:The comparison of TCM syndromes showed that the proportion of blood stasis syndrome in higher level group was significantly higher than that of the lower level group [74.60% (94/126) vs. 53.17% (67/126), P<0.01)], and the proportion of toxic heat syndrome in the higher level group was significantly lower than that of the lower level group [52.38% (66/126) vs. 65.87% (83/126), P=0.029]. The comparison of TCM deficiency syndromes showed that the proportion of qi deficiency syndrome and yang deficiency syndrome in the higher level group was significantly higher than that of the lower level group [67.46% (85/126) vs. 45.24% (57/126), P<0.01; 11.90% (15/126) vs. 3.97% (5/126), P=0.032, respectively]. Logistic regression analysis showed that the higher blood urea nitrogen level was correlated with the increased incidence of qi deficiency syndrome ( OR=3.425, 95% CI: 1.934-6.068, P<0.01), yang deficiency syndrome ( OR=3.460, 95% CI: 1.160-10.325, P=0.026) and kidney deficiency syndrome ( OR=2.212, 95% CI: 1.173-4.173, P=0.014) in sepsis patients. Conclusion:Sepsis patients with higher blood urea nitrogen level have a higher proportion of blood stasis syndrome, qi deficiency syndrome and yang deficiency syndrome and may be related to the increased incidence of qi deficiency syndrome, yang deficiency syndrome and kidney deficiency syndrome.

Spinal tuberculosis is one of the common causes of severe kyphosis. The formation of spinal tuberculosis kyphosis is multi-factors, including age at the time of infection, the cumulative number of segments, the height of vertebral body loss before treatment, and "spine danger signs" . Although the use of anti-tuberculosis drugs has achieved good results, for patients with spinal tuberculosis cured by drug treatment, the kyphosis will continue to progress and gradually develop into a severe kyphosis. Then there are a series of problems such as appearance, psychology, rib-pelvic impingement, cardiopulmonary dysfunction, and nerve and spinal cord compression. The X-ray signs of the height of the vertebral body loss and "spine danger signs" before treatment can help predict the severity of future deformities. Therefore, a comprehensive understanding of the formation of kyphosis of spinal tuberculosis and individualized selection of surgical methods according to the specific conditions of the disease as soon as possible can effectively prevent the formation of kyphosis and reduce the incidence of neurological damage and delayed paralysis.

With the large use of vertebral augmentation in the treatment of osteoporotic thoracolumbar fracture (OTLF), the complication of cement leakage has become an increasing concern. Although most cement leakage has no obvious clinical symptoms, some patients still sustain serious complications such as vertebral fracture, pulmonary embolism and spinal nerve compression. Cement leakage is closely related to patients′ own factors, cement factors and perioperative related factors. To clarify the risk factors of cement leakage with implementation of preventive measures accordingly is of great guiding significance to improve the clinical efficacy and surgical safety. Therefore, the authors discuss bone cement leakage in aspects of the risk factors and preventive measures so as to provide a reference for reducing the incidence of cement leakage.

Re-fracture of the injured vertebrae is a serious complication after vertebral augmentation for osteoporotic thoracolumbar fractures (OTLF), manifested by recurrent lower back pain, limitation of spinal motion and increased retroflexion deformity. The clinical treatment of re-fracture of the injured vertebrae is difficult, and some patients even need spinal function reconstruction to stabilize the fractured vertebrae, which has a serious impact on their postoperative rehabilitation, quality of life and economic burdens. Re-fracture of the injured vertebrae after vertebral augmentation for OTLF is closely related to patient factors, bone cement factors and perioperative factors. To this end, the authors discuss the risk factors for re-fracture of the injured vertebrae after vertebral augmentation for OTLF and propose corresponding management methods to provide a reference for understanding the risk of re-fracture of the injured vertebrae and improving the clinical treatment.

The incidence of osteoporotic vertebral compression fractures (OVCF) is increasing year by year. OVCF is manifested by thoracolumbar back pain, kyphosis and limitation of motion, which severely reduces the quality of life and life expectancy of the patients. It is often caused by minor violence with an insidious onset, and has a high rate of missed diagnoses on routine examination. Currently, percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are effective treatments for OVCF, but postoperative complications such as cement leakage and vertebral re-fracture occur often. Digital orthopedic technology is an emerging interdisciplinary discipline that combines computer digital technology with orthopedic clinics. As a new orthopedic clinical technology, digital orthopedic technology is pushing the boundaries of spinal surgery research and clinical application due to its advantages in individualization, precision, and minimally invasiveness, and is currently at a rapid development stage with high endurance and high throughput. To this end, the authors outlined the current application of digital orthopedic technology in OVCF, so as to provide a reference for achieving rapid and accurate diagnosis of OVCF and formulating reasonable treatment plans.

Objective:To compare the clinical efficacy of femoral neck system (FNS) and cannulated screw fixation in the treatment of femoral neck fracture in the young and middle-aged patients.Methods:A retrospective cohort study was conducted to analyze the clinical data of 76 young and middle-aged patients with femoral neck fracture admitted to Honghui Hospital Affiliated to Xi′an Jiaotong University from March 2018 to September 2020, including 45 males and 31 females, aged 23-63 years [(49.5±8.2)years]. Garden classification of the fracture was 25 patients with type II, 34 with type III and 17 with type IV. Pauwels classification of the fracture was 16 patients with type I, 31 with type II and 29 with type III. A total of 40 patients were treated with cannulated screw fixation (cannulated screw group) and 36 patients with FNS fixation (FNS group). Operation time, frequency of fluoroscopy, length of hospital stay, weight-bearing time and bone union time were compared between the two groups. Hip function was assessed by Harris hip score at 6, 12 months after operation. The incidence of postoperative complications was observed.Results:All patients were followed up for 12-20 months [(15.2±1.7)months]. The frequency of fluoroscopy [(13.4±1.9)times], weight-bearing time [(11.1±1.9)weeks] and bone union time [(13.8±1.6)weeks] in FNS group were lower or shorter than those in cannulated screw group [(18.2±2.6)times, (15.7±1.6)weeks, (14.6±1.6)weeks] (all P<0.05 or 0.01). There were no significant differences in operation time, length of hospital stay and Harris hip score at 6, 12 months after operation between the two groups (all P>0.05). No postoperative infection occurred in both groups. In cannulated screw group, there were 4 patients with femoral neck shortening, 3 with deep venous thrombosis, 2 with internal fixation loosening, 2 with nail withdrawal and 1 with fracture non-union, showing the incidence of complications of 30% (12/40). In FNS group, there was 2 patients with femoral neck shortening, 1 with deep vein thrombosis and 1 with internal fixation loosening, showing the incidence of complications of 11% (4/36) ( P<0.05). Conclusion:For femoral neck fracture in the young and middle-aged patients, both FNS and cannulated screw fixation can obtain satisfactory efficacy, but FNS has the advantages of decreased frequency of intraoperative fluoroscopy, early weight bearing, reduced time to bone union and low incidence of complications.

Objective:To investigate the risk factors associated with the occurrence of proximal junctional kyphosis (PJK) after posterior long-segment internal fixation for type IV chronic symptomatic osteoporotic thoracolumbar fracture (CSOTLF) in the elderly.Methods:A case-control study was used to analyze the clinical data of 95 elderly patients with type IV CSOTLF treated in Honghui Hospital affiliated to Xi′an Jiaotong University from January 2013 to June 2018, including 32 males and 63 females, aged from 60 to 85 years［(67.4±6.5) years］. Injured segments were T 11 in 17 patients, T 12 in 37, L 1 in 30 and L 2 in 11. All patients were treated with posterior long-segment internal fixation and divided into PJK group ( n=30) and non-PJK group ( n=65) according to whether PJK occurred after surgery. Univariate analysis was performed for the correlation of the following indices with the incidence of postoperative PJK, including general information such as gender, age, body mass index (BMI), bone mineral density (BMD), history of smoking, cause of injury, comorbidities, injury segments, American Spinal Injury Association (ASIA) classification and time from injury to surgery, preoperative imaging data such as posterior junctional angle (PJA), sagittal vertical axis (SVA), pelvic incidence-lumbar lordosis difference (PI-LL), pelvic tilt (PT) and sacral slope (SS), basic surgical data such as posterior ligament complex (PLC) injury, location of upper instrumented vertebrae (UIV), location of lower instrumented vertebrae (LIV) and number of fixed segments. Multifactorial Logistic regression analysis was used to measure the independent risk factors associated with the occurrence of postoperative PJK. Results:Univariate analysis showed that the incidence of postoperative PJK was correlated with age, BMI, BMD, preoperative PJA, preoperative SVA, preoperative PI-LL, PLC injury, location of UIV, location of LIV and number of fixed segments (all P<0.05), rather than gender, history of smoking, cause of injury, comorbidities, injury segments, ASIA classification, time from injury to surgery, preoperative PT and preoperative SS (all P>0.05). Multifactorial Logistic regression analysis showed that age ≥70 years ( OR=32.28, 95% CI 3.83-272.29, P<0.01), BMI>28.0 kg/m 2 ( OR=7.88, 95% CI 1.63-37.99, P<0.01), BMD T value<-3.5 SD ( OR=20.84, 95% CI 2.36-183.93, P<0.01), preoperative PI-LL>20° ( OR=13.30, 95% CI 1.54-113.87, P<0.05) and PLC injury ( OR=13.98, 95% CI 1.37-142.34, P<0.05) were significantly associated with the occurrence of postoperative PJK. Conclusions:Age≥70 years, BMI>28 kg/m 2, BMD T value<-3.5 SD, preoperative PI-LL>20° and PLC injury are independent risk factors for the incidence of PJK after posterior long-segment internal fixation in elderly patients with type IV CSOTLF. Attention should be paid to soft tissue protection and sagittal balance restoration of the spine intraoperatively and weight control and anti-osteoporosis treatment postoperatively.

Objective:To investigate the efficacy of intramedullary plus extramedullary fixation in the treatment of fractures of distal radial diametaphyseal transition zone in children.Methods:The data were retrospectively analyzed of the 49 children who had been admitted to Pediatric Orthopedic Hospital, Honghui Hospital Affiliated to Xi'an Jiaotong University from July 2018 to April 2020 for fractures of distal radial diametaphyseal transition zone. There were 30 males and 19 females; 21 left sides, 27 right sides, and one case of bilateral sides. In the operation, an elastic intramedullary nail or Kirschner wire was used for intramedullary fixation while another Kirschner wire was used to fix the cortex at the distal and proximal ends of the fracture. The ranges of wrist motion and Disabilities of the Arm, Shoulder and Hand (DASH) scores at 1 and 9 months after operation were recorded and compared; the incidence of postoperative complications was also recorded.Results:The operation time for the 49 children averaged 45.0 min (from 39 to 51 min). The patients were followed up for 6 to 36 months (mean, 18.6 months). The fracture union time averaged 8.6 weeks (from 6.8 to 10.4 weeks). Needle tract infection developed in one case but the wound was healed after removal of the K-wire after callus formation and oral use of antibiotics for 3 days. Another case reported skin irritation the symptoms of which disappeared after the child reduced activities. The ranges of pronation, supination, flexion and extension of the wrist and DASH score were 47.9°±2.5°, 45.5°±3.0°, 51.2°±1.6°, 53.4°±1.7° and (36.7±4.5) points at one month after operation while they were 85.6°±3.1°, 87.6°±2.1°, 88.8°±2.0°, 88.0°±1.2° and (23.2±8.6) points at 9 months after operation. There were statistically significant differences in the above indexes between one and 9 months after operation ( P<0.05). Conclusion:In the treatment of fractures of distal radial diametaphyseal transition zone in children, intramedullary plus extramedullary fixation is simple in surgical techniques, easily repeatable, slightly invasive, and reliable in fixation.

Objective:To explore the treatment options for patients with osteoporotic thoracolumbar injury classification and severity score (OTLICS) of 4 points following acute symptomatic osteoporotic vertebral compression fracture (OVCF) .Methods:A retrospective case-control study was conducted to analyze the clinical data of 108 patients with acute symptomatic OVCF admitted to Honghui Hospital, Xi'an Jiaotong University Faculty of Medicine from February 2016 to February 2018. There were 21 males and 87 females, aged 55-92 years [(71.6±5.3)years]. All patients had OTLICS score of 4 points. Of all, 76 patients were treated operatively (surgery group) and 32 patients were treated non-operatively (non-surgery group). The visual analogue scale (VAS), Oswestry disability index (ODI) and quality of life score (SF-36) were compared between the two groups before treatment, at 1 week, 3 months, 6 months after treatment, and at the last follow-up. The recovery of the injured vertebrae before and after treatment (Cobb angle of the injured vertebra, relative height of the anterior edge of the injured vertebrae), adjacent vertebral body fractures, and complications were compared between the two groups.Results:All patients were followed up for 12-18 months [(13.4±4.2)months]. At 1 week, 3 months and 6 months after treatment, the VAS in surgery group [(3.5±1.0)points, (2.1±0.6)points, (2.0±0.4)points] was better than that in non-surgery group [(6.4±1.7)points, (5.3±1.5)points, (3.3±0.6)points] ( P<0.05), the ODI in surgery group [(45.8±10.3)points, (35.3±8.6)points, (26.5±7.1)points] was better than that in non-surgery group [(65.7±12.1)points, (58.3±10.7)points, (45.6±9.3)points] ( P<0.05), the SF-36 in surgery group [(82.8±1.4)points, (85.0±1.5)points, (88.0±1.3)points] was better than that in non-surgery group [(80.4±1.3)points, (81.5±1.4)points, (85.6±1.1)points] ( P<0.05). At the last follow-up, there were no significant differences in VAS, ODI and SF-36 between the two groups ( P>0.05). At 3 months, 6 months and the last follow-up, the Cobb angle in surgery group [(18.3±3.9)°, (17.5±3.0)°, (17.8±1.6)°] was better than that in non-surgery group [(22.4±2.2)°, (22.5±1.7)°, (22.1±1.3)°] ( P<0.05), and the relative height of the anterior edge of the injured vertebra in surgery group [(75.4±8.6)%, (76.6±8.6)%, (75.2±8.3)%] was better than that in non-surgery group [(63.5±7.6)%, (65.2±7.4)%, (62.8±7.2)%] ( P<0.05). The adjacent vertebral fractures occurred in 6 patients (8%) in surgery group, and in 2 patients (6%)in non-surgey group ( P>0.05). Postoperative complications occurred in 8 patients (11%) in surgery group, and occurred in 6 patients (19%) in non-surgery group ( P>0.05). Conclusion:When applying the OTLICS scoring system to treat acute symptomatic OVCF, patients with OTLICS score of 4 points should be promptly treated with operatively, which can quick relieve pain, correct deformities promote functional recovery, and improve quality of life.

Objective:To explore the clinical effect of percutaneous vertebroplasty (PVP) at stage I in treatment of acute multi-segment osteoporotic vertebral compression fracture (OVCF) in the elderly with over 3 vertebrae operated.Methods:A retrospective case-control study was conducted to analyze the clinical data of 105 aged patients with acute multi-segment OVCF admitted to Honghui Hospital, Xi'an Jiaotong University from October 2015 to February 2019. There were 27 males and 78 females, aged 65-92 years [(73.0±14.5)years]. All patients received stage I multi-segmental PVP and standard anti-osteoporosis treatment. There were more than 3 operative vertebral segments in 30 patients (observation group) and less than or equal to 3 operative vertebral segments in 75 patients (control group). The operation time, intraoperative fluoroscopy frequency, cement injection volume, cement leakage rate and incidence of recurrent vertebral fractures were compared between the two groups. The visual analogue scale (VAS), Oswestry disability index (ODI) and activity of daily living (ADL) score were compared before operation, 1 day, 1 month after operation and at the last follow-up.Results:All patients were followed up for 11-13 months [(12.5±1.8)months]. The observation group showed operation time of (71.2±12.2)minutes, intraoperative fluoroscopy frequency of (38.8±6.4)times and cement injection volume of (20.2±4.6)ml, more than those in control group [(52.3±10.6)minutes, (25.4±5.3)times, (12.3±4.3)ml] ( P<0.05). There was no significant difference in cement leakage rate and incidence of recurrent vertebral fractures between the two groups ( P>0.05). No complications such as infection, nerve damage or cement implantation syndrome occurred. Before operation, 1 day after operation, 1 month after operation and at the last follow-up, the VAS in observation group [(7.6±0.7)points, (3.0±0.8)points, (2.3±0.7)points, (2.2±0.6)points] showed no significant difference from those in control group [(7.4±0.5)points, (2.9±0.4)points, (2.1±0.5)points, (2.0±0.5)points], the ODI in observation group [(74.6±3.3)%, (36.8±4.6)%, (29.7±4.0)%, (24.0±3.6)%] did not differ from those in control group [(73.8±1.0)%, (35.1±0.9)%, (28.4±2.2)%, (22.8±0.9)%], the ADL score in observation group [(34.5±5.0)points, (54.5±3.8)points, (73.7±3.9)points] were similar with those in control group [(36.2±3.4)points, (56.8±4.7)points, (75.3±5.3)points, (81.3±4.5)points] (all P>0.05). The postoperative VAS, ODI and ADL score in both groups were significantly improved in comparison with preoperation ( P<0.05). Conclusion:For acute multi-segment OVCF in the elderly with over 3 or not more than 3 the vertebrae operated, PVP at stage I has the same advantages in early pain relief and improvement of motor function and quality of life.