Objective To measure the clivus-axial angle (CAA) of Chinese,provide a normal value,and explore the correlation between CAA with cervico-medullary angle (CMA).Methods The CAA was measured on the CT of cervical spine in 225 Chinese with normal cranio-vertebral junction (CVJ).Both the CAA and the CMA were measured on the MRI of cervical spine in 117 subjects.All measurements were performed under a bone window (window level,300 Hu; window width,1 000 Hu) with an accuracy of 0.01°.A regression analysis was used for analyzing the correlation between CAA and CMA.The angle between the clivus plane and the straight line parallel to that of the posterior margin of the C2 vertebral body was defined as CAA; moreover,the angle between the strajght line parallel to the ventral side of the cervical spinal cord and the straight line parallel to that of the ventral side of the medulla oblongata was defined as CMA.Two experienced spinal surgeons performed the measurements.The CAA and CMA were measured three times,and the mean value was considered as the result.Results The CAA of 225 subjects was 133.52°-172.16° (156.93°±6.53°).The 95％ confidence interval was 145.10°-170.19° in male and 142.67°-168.47° in female.If the patients were divided into five groups according to their age,a comparison of these groups showed that there were no significant differences among the groups with respect to CAA.It showed that there was consistency between the CAAs measured with MRI and CT.The CMA for 117 patients ranged from 130.38° to 168.75° with a mean value of 154.17°±6.54°,and its 95％ confidence interval ranged from 141.35° to 166.99°.If the patients were distributed according to their gender or to their age,there were no significant differences among the groups.The relationship between CAA and CMA was linearity,and the regression coefficient was as high as 0.95 (P=0.007).Conclusion The normal CAA of Chinese is from 133.52° to 172.16°.The 95％ confidence interval goes from 145.10° to 170.19° in male,and 142.67° to 168.47° in female,close to CMA.It is valuable for measuring the compression of spinal cord,which can be accessed easily during the procedure.

Objective The aims of this study were to evaluate the morbidity of osteoporosis and the relationship between bone mineral density ( BMD ) and bone metabolic markers in the patients with spine degeneration disease needing surgery, at the same time to observe the influence of type 2 diabetes mellitus on bone metabolism and BMD.Methods This retrospective analysis included 139 patients suffered by spine degeneration disease needing surgery from the October 2013 to October 2014 in Beijing Jishuitan Hospital. Lumbar BMD was measured by quantitative computed tomography ( QCT) before surgery.Serum N-terminal propeptide of type I procollagen ( PINP) , βC-terminal cross-linked telopeptide of type I collagen (β-CTX), osteocalcin (OC) , 25-hydroxyvitamin D[25(OH)D], parathyroid hormone (PTH), calcium and phosphorus were quantified simultaneously.The relationship between the results of lumbar BMD measured by QCT and bone metabolic markers was analyzed by partial correlation.The differences of bone metabolic markers among three groups classified according to BMD were performed by one-way ANOVA and analysis of covariance.The influence factors of lumbar BMD measured by QCT were analyzed by multifactor linear regression.T-test was used to analyze the differences of BMD and bone metabolic markers between two groups with and without type 2 diabetes mellitus.Results The average age of 139 patients was(62.74 ± 6.83) years old.Lumbar BMD revealed that the percentage of osteoporosis, osteopenia and normal BMD were 40.2%(56/139) , 43.8% (61/139) and 16% (22/139) separately.The percentage was 47%(66/139) in subjects with 25(OH)D below 30 nmol/L.The percentage of subjects with the concentrations of 25 ( OH ) D between 30-50 nmol/L was 40% ( 55/139 ) , while the percentage of subjects with the concentrations of 25(OH)D between 50-125 nmol/L was only 13% (18/139).Partial correlation analysis revealed that lumbar BMD measured by QCT was negatively correlated with PINP ( r=-0.352, P<0.01) ,β-CTX ( r=-0.356, P<0.01 ) and OC ( r=-0.276, P=0.001 ) with gender and type 2 diabetes mellitus as covariates.Along with the age of patients increasing and BMD reducing, the levels of PINP,β-CTX and OC increased gradually and the differences were statistically significant ( F=11.575, P<0.01;F=11.550, P<0.01; F=9.738, P<0.01).Multiple linear regression analysis revealed that age and PINP were the main factors that influenced the change of BMD in the patients with spine degeneration disease needing surgery (β=-1.863, t=-5.425, P<0.01;β=-0.393, t=-2.061, P=0.041) .Subjects were divided into diabetes group and non-diabetes group according to the clinical diagnosis and whether having abnormal serum glucose.The levels of PINP (36.56 ±14.56 versus 49.51 ±16.68μg/L) ,β-CTX (0.39 ±0.20 versus 0.52 ±0.21 μg/L) and OC (14.21 ±5.13 versus 20.74 ±6.84 μg/L) in serum between two groups had significant differences (t=3.648, P<0.01;t=2.754, P<0.01;t=4.573, P<0.01) .Conclusions There was prevalence of osteoporosis, osteopenia and vitamin D deficiency in the patients with spine degeneration disease needing surgery.The patients with high level of PINP and age were more prone to appear lower BMD which increasing the risk of osteoporosis.The patients combined with type 2 diabetes mellitus had suppressed bone markers which maybe the risk factor, independent of BMD, increasing fracture risk.

Objective:To summarize the CT features of ankle fracture and to analyze the relationship between the CT images and the most commonly used ankle fracture classification.Methods: With 369 cases of adult ankle fractures analyzed retrospectively,the CT images 1 cm above the ankle joint and its characteristics,the Danis-Weber classification of ankle fracture were studied,and so was the relationship between CT images and the fracture classification.Results: There were 8 forms of CT images.With a,b,and c referred to the fibular fracture,posterior malleolar fracture and interosseous tibiofibular ligament (IOL) rupture respectively.369 CT imges had 40 cases of 0 degree injury (fibula,posterior malleolus,IOL all intact);60 cases of Ⅰa degree injury (fibular fracture,posterior malleolus and IOL intact),3 cases of Ⅰb degree injury (fibula intact,posterior malleolus fracture,IOL intact),26 cases of Ⅰc degree injury (fibula and posterior malleolus intact,IOL rupture);163 cases of Ⅱab degree injury (fibula and posterior malleolus fractures,IOL intact),6 cases of Ⅱac degree injury (fibular fracture,posterior malleolus intact,IOL rupture),61 cases of Ⅱbc degree injury (fibula intact,posterior malleollar fracture,IOL rupture);10 cases of Ⅲ degree injury (fibular fracture,posterior malleollar fracture and IOL rupture).According to the Danis-Weber classification,there were 18 cases of type A,238 cases of type B,94 cases of type C,and 19 cases without fibular fracture.The prevalence of IOL rupture were 0,5.9％,and 88.3％ in types A,B,and C respectively.There was a correlation between the CT image and Danis-Weber classification,the incidence of IOL rupture was changed with the severity of Danis-Weber classification,and the difference was statistically significant after the rank correlation test (Spearman R=0.781,P<0.001).IOL rupture not determined by the fracture classification was found with the CT images and the incidence was 5.9％.Conclusion: Cross-sectional CT images 1 cm above the ankle joint can clearly determine the IOL injury pre-operatively with a good correlation with the Danis-Weber fracture classification,IOL rupture unrecognized with the fracture classification can also be noticed with the CT image.

Objective To understand the real experience of the lateral decubitus position in the postoperative patients with lumbar degenerative disease during the period of staying in bed and explore the best nursing scheme of the decubitus position for the improvement of the patients' rehabilitation.Methods With the purposive sampling method, 12 postoperative patients with lumbar degenerative disease who were hospitalized in some Beijing class Ⅲ grade A hospital from December 2016 to January 2017 were interviewed deeply. The interview data were analyzed by Colaizzi data analysis method, and the subjects were extracted. Results Through sorting, analyzing and refining, 4 themes were summed up: lateral decubitus need experience, decubitus experience of spine neutral position, needs for professional care and relatives' companionship, lateral decubitus position comfort experience.Conclusions The patients with lumbar degenerative disease after surgery have higher needs for the lateral decubitus position. The experience of their lateral decubitus position varies. Nurses need to grasp the decubitus position demand of the patients and make the personalized decubitus nursing program for them, in order to improve their postoperative comfort degree.

Objective:To study the effects of naringenin on pancreatic fibrosis in the mouse model of chronic pancreatitis (CP) and its effects on the activation, proliferation and apoptosis of pancreatic stellate cells (PSCs).Methods:Eighteen C57BL/6 mice were randomly divided into control group, CP group and naringenin group, with 6 mice in each group. The CP mouse model was established by intraperitoneal injections of caerulein. Naringenin group was given naringenin (200 mg/kg/day) by gavage once a day from the first day of the fourth week of modeling process to the day before the killing; the control group and CP group were treated by gavage with an equivalent amount of drug solvent containing 0.5% sodium carboxymethyl cellulose (CMC-Na). Mice were killed 5 days after the last caerulein injection, and their pancreatic tissues were collected for hematoxylin-eosin staining and Sirius Red staining, pathological scoring and collagen sedimentation detection. Naringenin with different concentrations (0, 5, 10, 20, 50, 100, 150, 200 μmol/L) were used to intervene HPSC for 24 hours, and CCK-8 method was used to detect the cell activity. TGF-β1 recombinant protein (2 ng/ml) was used to induce PSCs for 1 hour (TGF-β1 stimulation group), and naringenin with low (50 μmol/L), middle (100 μmol/L) and high (150 μmol/L) concentration was used to intervene for 36 hours after TGF-β1 stimulation, respectively. Western Blotting was used to detect the expression of PSC activation related proteins FN and COL1A1, cell proliferation marker p21, anti-apoptotic protein Bcl-xL, pro-apoptotic protein Bax and Bid.Results:The pathological scores of pancreatic tissue [(7.33±1.15), (4.67±1.15)] and the percentage of collagen positive areas [(46±4), (28±2)%] in CP group and naringenin group were higher than those in the control group [0, (4±2)%]. However, these indexes in the naringenin group were lower than those in CP group, and the differences were all statistically significant (all P value <0.05). The relative expression of FN in control group, TGF-β1 stimulation group and low, medium and high naringenin group was 0.02, 0.76, 0.67, 0.34 and 0.07, respectively; the expression of COL1A1 in these groups was 0.51, 1.71, 1.34, 0.84 and 0.11. The expression of FN and COL1A1 in TGF-β1 stimulation group was significantly higher than that in control group, and the expression of FN and COL1A1 in low, medium and high naringenin group was significantly lower than that in TGF-β1 stimulation group, and the differences were all statistically significant (all P value <0.05). The expression of p21 in the above five groups was 0.87, 1.18, 1.27, 1.22 and 1.00. The expression of p21 in TGF-β1 stimulation group was higher than that in control group, and the expression of p21 in high naringenin group was obviously lower than that in TGF-β1 stimulation group, and the differences were all statistically significant (all P value <0.05). In addition, the expression of Bcl-xL in these groups was 2.09, 2.21, 2.38, 2.50 and 2.12; the expression of Bax was 0.98, 0.88, 0.98, 1.00 and 0.88; the expression of Bid was 1.15, 1.09, 1.14, 1.18 and 1.18. There was no statistically significant difference among these groups (all P value >0.05). Conclusions:Naringenin could significantly alleviate the inflammation, atrophy and fibrosis in the CP mouse model, and inhibit the activation and proliferation of PSCs. However, naringenin had no significant effect on the apoptosis of PSCs, indicating that naringenin may be potentially used to treat pancreatic fibrosis in CP.

Objective:To explore the impact of weekend hospitalization on total hospitalization expenses for elderly patients with hip fracture under the geriatric orthopedic co-management.Methods:A retrospective analysis was conducted to analyze the clinical data of elderly patients with hip fracture who had been hospitalized for surgical treatment at Beijing Jishuitan Hospital from May 2015 to December 2020. They were divided into 2 groups based on their admission date. Group A was admitted from Monday to Thursday while Group B from Friday to Sunday. The general demographic data, diagnostic information, comorbidities, hospitalization expenses of the patients were collected. The differences in total hospitalization expenses, hospitalization time, rate of surgery within 48 hours and rate of hospital mortality between the 2 groups were analyzed by rank sum test, chi square test, correlation analysis, and multiple linear regression.Results:A total of 6,075 patients with hip fracture were included in this study, including 1,675 males and 4,400 females with a median age of 80 (74, 85) years. There were 3,935 ones in group A and 2,140 ones in group B. The total hospitalization expenses for group A was 58,160.52 (49,215.45, 72,748.94) yuan, insignificantly lower than those for Group B [58,412.90 (49,163.58, 72,712.61) yuan] ( P>0.05). The rate of surgery within 48 hours for group A was 75.8% (2,984/3,935), significantly higher than that for group B [49.3% (1,054/2,140)]. The hospitalization time for group A was 5 (4, 7) days, significantly less than that for group B [5 (4, 7) days] ( P<0.05). There was no significant difference in the rate of hospital mortality between the 2 groups ( P>0.05). Multiple linear regression analysis showed that total hospitalization expenses were significantly higher for patients admitted on weekends, hospitalization time was positively correlated with total hospitalization expenses, and total hospitalization expenses were significantly lower for the patients undergoing surgery within 48 hours ( P<0.05). Conclusion:Admission on weekends can increase total hospitalization expenses, prolong hospitalization time, and reduce rate of surgery within 48 hours for elderly patients with hip fracture.

BACKGROUNDPercutaneous pedicle screw use has a high rate of cranial facet joint violations (FVs) because of the facet joint being indirectly visualized. Computer-assisted navigation shows the anatomic structures clearly, and may help to lower the rate of FVs during pedicle screw insertion. This study used computed tomography (CT) to evaluate and compare the incidence of FVs between percutaneous and open surgeries employing computer-assisted navigation for the implantation of pedicle screw instrumentation during lumbar fusions.

METHODSA prospective study, including 142 patients having lumbar and lumbosacral fusion, was conducted between January 2013 and April 2014. All patients had bilateral posterior pedicle screw-rod instrumentation (top-loading screws) implanted by the same group of surgeons; intraoperative 3-dimensional computer navigation was used during the procedures. All patients underwent CT examinations within 6 months postoperation. The CT scans were independently reviewed by three reviewers blinded to the technique used.

RESULTSThe cohort comprised 68 percutaneous and 74 open cases (136 and 148 superior-level pedicle screw placements, respectively). Overall, superior-level FVs occurred in 20 patients (20/142, 14.1%), involving 27 top screws (27/284, 9.5%). The percutaneous technique (7.4% of patients, 3.7% of top screws) had a significantly lower violation rate than the open procedure (20.3% of patients, 14.9% of top screws). The open group also had significantly more serious violations than did the percutaneous group. Both groups had a higher violation rate when the cranial fixation involved the L5. A 1-level open procedure had a higher violation rate than did the 2- and 3-level surgeries.

CONCLUSIONSWith computer-assisted navigation, the placement of top-loading percutaneous screws carries a lower risk of adjacent-FVs than does the open technique; when FVs occur, they tend to be less serious. Performing a single-level open lumbar fusion, or the fusion of the L5-S1 segment, requires caution to avoid cranial adjacent FVs.

Aged ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Pedicle Screws ; Prospective Studies ; Zygapophyseal Joint ; surgery