Objective To investigate the effect of Yiqi Huoxue Tongluo Decoction on microRNA-126a-5p(miR-126a-5p)and vascular endothelial growth factor(VEGF)signaling pathway in cervical spondylotic myelopathy model rats.Methods Thirty healthy male SD rats were divided into the sham operation group,the model group and the traditional Chinese medicine(TCM)group by random number table method.Cervical spondylotic myelopathy models were prepared in the model group and the TCM group.The TCM group was given intragastric administration of Yiqi Huoxue Tongluo Decoction,while the sham operation group and the model group were given intragastric administration of normal saline for 12 weeks.After intervention,the threshold of mechanical stimulation and retraction time of thermal stimulation in each group were measured by behavior tests.Rats were sacrificed to collect intervertebral disc tissue for hematoxylin-eosin(HE)staining and observe the number of vascular buds in intervertebral disc.Rat intervertebral disc annulus fibrosus cells were subjected to terminal dexynucleotidyl transferase-mediated dUTP nick end labeling(TUNEL)staining.The miR-126a-5p and VEGF mRNA of rat intervertebral disc tissue were detected by real-time fluorescence quantitative polymerase chain reaction(RT-PCR).The expression of VEGF protein of rat intervertebral disc tissue was detected by Western blot assay.Results Compared with the sham operation group,the number of vascular buds in intervertebral disc was decreased in the model group and the TCM group.The cell destruction of intervertebral disc annulus was obvious in rats,and apoptosis was high and cell density decreased.Mechanical stimulation threshold decreased,and mechanical stimulation threshold decreased.The level of miR-126a-5p was decreased,and the expression levels of VEGF mRNA and protein were increased.Compared with the model group,the number of vascular buds in intervertebral disc was increased in the TCM group.The destruction of intervertebral disc annulus cells was alleviated in rats.The apoptosis of annulus fibrosus cells in intervertebral disc decreased and cell density increased.The threshold of mechanical stimulation increased,and the retraction time of thermal stimulation was prolonged.The level of miR-126a-5p increased,and the expression levels of VEGF mRNA and protein decreased(P＜0.05).Conclusion The mechanism of Yiqi Huoxue Tongluo Decoction in the treatment of cervical spondylotic myelopathy may be related to the up-regulation of miR-126a-5p expression and the down-regulation of VEGF expression.

Objective:By comparing the clinical effect of minimally invasive hollow screw internal fixation Assisted by orthopedic robot (TiRobot) and O-arm navigation in the treatment of pelvic fractures, and practicability and security of both treatments were evaluated.Methods:Retrospective analysis of data of 42 cases of Tile C type pelvic fractures was employed during June 2017 to June 2020. Among them, 32 cases, twenty-four men, eight women, aged 34±6.2 years (range 24-68 years), were treated with percutaneous screw fixation guided by O-arm X wire instrument. According to Tile classification, there were 3 cases of C1.1 type, 8 cases of C1.2 type and 21case of C1.3 type. According to the Denis classification of sacral fractures, 17 cases were in zone I, and 8 cases in zone II. Ten patients, eight males and two females, aged 36±5.2 years (range 19-62 years) were treated by percutaneous screw fixation assisted by orthopedic robot. According to Tile classification, there were 1 case of C1.1 type, 2 cases of C1.2 type and 7 cases of C1.3 type. According to the Denis classification of sacral fractures, there were 5cases in zone I, 2 cases in zone II. For those who got obviously displaced pelvic fractures, Starr frames were used and then internal fixation was used to fix pelvic anterior ring and posterior ring injury respectively. Based on the times of needle adjustments, intraoperative fluoroscopy time, good screw position and incidence of complications two groups were statistically analysed. Matta score was employed to evaluate the quality of fracture reduction, while the Majeed score was employed to evaluate the clinical efficacy. Through the two groups of cases guide needle adjustment times, intraoperative fluoroscopy time, screw position excellent and good rate and the incidence of complications, which were statistically analyzed.Results:All screw positions were confirmed by CT scan after operation. The average time required for each screw placement of the O-arm group was 7.36±2.63 s, of the robot group was 6.80±3.20 s, so difference was not statistically significant ( P<0.05). An average of screw adjustments per one screw was 1.56±0.02 times by O-arm, and by the robot group was 0.34±0.06 times, so differences between the two groups were statistically significant ( P>0.05). The average operating time of O-arm group was 53.86±15.06 min, while the robot group was 52.52±15.14 min, so differences between the two groups were not statistically significant ( P>0.05). Position distribution of screw placement in two groups, all screws in O-arm group of position evaluations were excellent, excellent rate was 100%, all screw position evaluations by robot were excellent, excellent rate was 100%, so difference in screw distribution between the two groups was not statistically significant ( P>0.05). All cases were followed up for 6-12 months. Fracture healing time: 34.6±8.6 weeks for O-arm group, 33.4±9.4 weeks for robot group. Comparison between the two groups was not statistically significant ( P>0.05). Majeed score of O-arm group was 55-87, including Excellence of 17 cases, goodness of 9, fairness of 6. The rate of excellence and goodness was 81.2%, while robot group was 76-95, and that were excellent 7 cases,1 good, and the excellent and good rate was 80%, there was no significant difference between Matta and Majeed score between the two groups ( P>0.05). The incidence of complications between the two groups were no statistically significant ( P>0.05). Conclusion:Orthopedic robot system and O-arm navigation system assisted by percutaneous hollow screw fixation treatment of pelvic anterior and posterior ring injury, which are accurate, safe, minimally invasive, can reduce radiation damage to patients and surgeons. The efficacy were satisfactory. Both treatments are ideal for minimally invasive treatment of pelvic fractures, and the orthopedic robot have advantages of being programmed, standardized, stable and it’s learning curve is shorter.

Objective:To investigate the feasibility and clinical efficacy of percutaneous screw fixation for acetabular anterior column fracture with laser-assisted axial fluoroscopy.Methods:Data of 20 patients (22 sided) with acetabular anterior column fracture treated by percutaneous screw fixation with laser-assisted axial fluoroscopy from January 2017 to December 2018 were retrospectively analyzed. There were 11 males and 9 females with an average of 42.1±3.2 years (range, 24-68 years). There were 7 cases of unilateral acetabular anterior column fracture, 2 cases of bilateral acetabular anterior column fracture (4 sides), 7 cases of anterior column with ipsilateral sacral fracture, and 4 cases of anterior column with sacroiliac joint injury. There were 3 hips of Area I, 6 Area II, 13 Area III of acetabular anterior column fractures according to Nakatani partition. The time from injury to surgery was 5 days (range, 3-11 days). All patients with acetabular anterior column fractures were fixed by percutaneous screw fixation with laser-assisted axial fluoroscopy, and patients with sacral fracture or sacroiliac joint injury were fixed by percutaneous sacroiliac screws with Starr frame-assisted reduction. The time of operation, the number of intraoperative fluoroscopy and the amount of intraoperative bleeding were recorded. Matta scoring criteria were used to assess fracture reduction quality, and hip function was assessed at the last follow-up according to the modified Merle D' Aubigné and Postel scoring system.Results:The average operative time was 22±10 min (range, 20-40 min) with an average times of intraoperative fluoroscopy of 30±8 times (range, 21-45 times), and the amount of intraoperative blood loss was 20±5 ml (range, 10-40 ml). 20 patients were followed up after operation for a period of 14±3.1 months (range, 12-18 months). The quality of postoperative fracture reduction was assessed according to the Matta acetabular fracture reduction criteria: anatomical reduction in 18 hips, satisfactory reduction in 2 hips, unsatisfactory reduction in 2 hips, with an excellent and good rate of 91% (20/22). The fracture healing time was 13±2.2 weeks (range, 11-16 weeks). At the lastest follow-up, hip function was assessed according to the modified Merle D' Aubigné and Postel scoring system: excellent 18, good 3, fair 1, and the satisfactory rate was 95%(21/22). No major neurological, vascular injury, wound infection and ectopic ossification were found during follow-up.Conclusion:Using laser-assisted axial fluoroscopy percutaneous screw to treat acetabular anterior column fracture, the operation is simple. And there is low risk to damage important blood vessels and nerves. This method can shorten the operation time of acetabular anterior column fracture, reduce the amount of blood loss during the operation, and the outcome is satisfactory.