Objective to investigate the clinical efficacy of decompression and pedicle screw fixation through posterior approach for complete thoracic spine fracture dislocation.Methods The clinical data of six patients with complete thoracic spine fracture and dislocation treated from September 2002 to June 2016 were analyzed retrospectively by case series study.There were five males and one female,aged 21-67 years old (mean,47.2 years).The injury segments were T3～4 dislocation in one case,T5～6 dislocation in two cases,T6 ～7 dislocation in two cases and T8 ～9 dislocation in one case.There was one case of ASIA grade E and five cases of Grade A,and all of six cases were associated with multiple rib fractures and hemopneumothorax.The companied status was one case of sternal fracture,one case of atlantoaxial complex fractures and three cases of pulmonary contusion.The posterior median incision decompression and pedicle screw system fixation were performed,and the intervertebral bone grafting was conducted after restoration.The surgery time,bleeding volume during surgery,fracture restoration,bone grafting fusion,failure of internal fixation and other complications were recorded.The Visual Analogue Scale (VAS) and American Spinal Injury Association (ASIA) classification were used to assess the pain and neurological function improvement between the preoperative visit and final follow-up visit.Results The surgery time was 150-240 minutes (mean,205 minutes).The bleeding volume during the surgery was 700-2 100 ml (mean,1167 ml).One case was died of pulmonary infection at one week after surgery,the others were followed up for 3-14 months (mean,7.4 months).After operation,five patients were satisfied with the reduction,and the lateral displacement was partially restored in one cases.Five cases of intervertebral bone grafting all had bone fusion.There was no fixation failure.The VAS was (7.4 ± 0.6) points before surgery,(4.5 ± 1.6) points at one week after surgery and (1.8 ± 0.3) points at final visit of follow-up,which had significant difference from the preoperative status (P ＜ 0.05).One case of ASIA grade E had no postoperative aggravation and four cases of grade A had no improvement.Conclusion Posterior decompression and pedicle screw fixation system is optimal choice of treatment for complete thoracic fractures and dislocations for it can attain reduction of fracture and dislocation as well as bone fusion,provide stability for spine and relieve pain.

Objective:To analyze the role of patient support system in multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) treatment adherence and outcome, and provide evidence for deepening the patient-centered support system.Methods:Based on the stakeholder analysis, definite stakeholders (administrators from the Department of Medical Insurance, and those from the provincial CDC), expectant stakeholders (administrators from regional CDC, health workers from primary CDCs, medical workers from designated MDR/RR-TB hospitals and MDR/RR-TB patients), and latent stakeholders (MDR/RR-TB patient families and their neighbors or colleagues) were selected using a purposive sampling. These stakeholders were subject to a semi-structured interview on patient support. The inclusion of participants ceased after reaching code or thematic saturation and meaning saturation, while thematic framework analysis was applied in interview data.Results:The 25 interviewees included could be categorized into three groups of stakeholders, i. e., 4 definite stakeholders, 19 expectant stakeholders and 2 latent stakeholders. Three themes summarized in this regard were definite stakeholders providing policy support to advance these patients′ access to standardized diagnosis and treatment services; diagnosis and treatment and management support of expectant stakeholders of these patients to encourage their compliance to treatment and enable their access to high quality medical care; and support from latent stakeholders as a critical guarantee for the patients to welcome a desirable treatment outcome. Psychological support provided under MDR/RR-TB basic care program in some provinces contributed positively to raising patients′ compliance. Economic support, treatment support from family menmbers ccould help the patients to welcome desirable outcomes.Conclusions:MDR/RR-TB patient-centered support system operating in the Yangtze River delta provide the patients with MDR/RR-TB diagnostic and treatment services of some accessibility. Given the progress, there are still shortcomings for the respective stakeholders to enhance their attention and collaboration to improve the access and equity to medical service.