Objective: To address systemic challenges in the blood system, such as supply-demand imbalance, inefficient allocation, and inappropriate clinical use, while bridging gaps in current theories regarding the integration of social mobilization, institutional practice, and policy coordination. It sought to construct a system dynamics model spanning from macro to micro levels to analyze the blood management system holistically. Methods: Key variables were identified by a systematic literature search in both Chinese and English databases. An improved Delphi method was then employed to conduct expert consultations across different fields, leading to the selection and determination of core variable sets for each sub-model. Furthermore, by defining their logical relationships, a system dynamics model was constructed to systematically analyze the operation mechanism of the blood management system. Results: Four core sub-models were developed: 1) A macro "Dynamic Balance" model quantifying regional supply-demand equilibrium and inventory control; 2) a mobilization "Three-Layer Funnel" model analyzing how socio-cultural factors, service channels, and policy incentives influence donation behavior; 3) an institutional "Dual-Cycle Regulation" model revealing hospital blood usage is driven by both disease burden (demand cycle) and management practices (regulation cycle); and 4) an individual "Three-Layer Filter" model standardizing clinical transfusion decisions based on necessity, risk-benefit, and context. These were integrated into a "Multi-Layer Linkage and Feedback" model, elucidating bidirectional interactions among five levels: policy environment, regional supply, blood station mobilization, hospital application, and clinical decision-making. Conclusion: This study constructed a system dynamics model for blood management. By defining key variables and their logical relationships, it systematically analyzes the system′s operational mechanism. The integrated framework connects multiple levels—regional supply, voluntary donation, hospital blood use, and clinical decision-making—revealing their intrinsic linkages. Future efforts should employ systems thinking to synergistically enhance supply-side mobilization, demand-side management, systemic regulation, and decision standardization to build a safe, efficient, and sustainable blood security system.

Objective:To evaluate the clinical efficacy of intervertebral disc radiofrequency(RF)ablation combined with dorsal medial branch(DMB)neurotomy in elderly patients suffering from chronic low back pain.Methods:A retrospective analysis was conducted on patients aged 60 years and older with chronic low back pain admitted to Beijing Hospital from March 2023 to September 2024.The combined treatment group underwent intervertebral disc radiofrequency ablation combined with radiofrequency treatment of the dorsal medial branch of the spinal nerve.The single treatment group underwent intervertebral disc radiofrequency ablation alone.Pain visual analogue scale(VAS)scores were assessed before treatment and on the first day, 3 months, and 6 months post-treatment.The Oswestry Disability Index(ODI)and Barthel Index were evaluated before treatment and at 3 months and 6 months post-treatment.Clinical efficacy was compared between the two groups.Results:A total of 115 elderly patients with chronic low back pain were enrolled, aged 61 to 72 years(mean 66.5 ± 5.6 years), with 44 males.The combined therapy group consisted of 71 patients, and the monotherapy group consisted of 44 patients.All patients were followed up continuously for 6 months.At all-time points post-treatment, the VAS scores in the combined therapy group were significantly lower than those in the monotherapy group( t=-4.887, -10.095, -7.687, all P<0.05); at 3 and 6 months post-treatment, the combined therapy group showed significantly greater improvements in ODI( t=-3.645, -9.451, both P<0.001)Barthel Index improvement were significantly greater than those in the monotherapy group( t=6.578, 8.530, both P<0.001); the overall good-to-excellent rate in the combined therapy group was 88.7%, higher than the 72.7% in the monotherapy group( χ2=4.85, P<0.05). Conclusions:Combined disc RF ablation and DMB neurotomy provide superior pain relief, functional recovery, and improvement in daily activities compared to single disc ablation in elderly patients with CLBP.This minimally invasive approach represents a safe and effective therapeutic strategy for managing chronic low back pain in the geriatric population.

Objective:To evaluate the clinical efficacy of intervertebral disc radiofrequency(RF)ablation combined with dorsal medial branch(DMB)neurotomy in elderly patients suffering from chronic low back pain.Methods:A retrospective analysis was conducted on patients aged 60 years and older with chronic low back pain admitted to Beijing Hospital from March 2023 to September 2024.The combined treatment group underwent intervertebral disc radiofrequency ablation combined with radiofrequency treatment of the dorsal medial branch of the spinal nerve.The single treatment group underwent intervertebral disc radiofrequency ablation alone.Pain visual analogue scale(VAS)scores were assessed before treatment and on the first day, 3 months, and 6 months post-treatment.The Oswestry Disability Index(ODI)and Barthel Index were evaluated before treatment and at 3 months and 6 months post-treatment.Clinical efficacy was compared between the two groups.Results:A total of 115 elderly patients with chronic low back pain were enrolled, aged 61 to 72 years(mean 66.5 ± 5.6 years), with 44 males.The combined therapy group consisted of 71 patients, and the monotherapy group consisted of 44 patients.All patients were followed up continuously for 6 months.At all-time points post-treatment, the VAS scores in the combined therapy group were significantly lower than those in the monotherapy group( t=-4.887, -10.095, -7.687, all P<0.05); at 3 and 6 months post-treatment, the combined therapy group showed significantly greater improvements in ODI( t=-3.645, -9.451, both P<0.001)Barthel Index improvement were significantly greater than those in the monotherapy group( t=6.578, 8.530, both P<0.001); the overall good-to-excellent rate in the combined therapy group was 88.7%, higher than the 72.7% in the monotherapy group( χ2=4.85, P<0.05). Conclusions:Combined disc RF ablation and DMB neurotomy provide superior pain relief, functional recovery, and improvement in daily activities compared to single disc ablation in elderly patients with CLBP.This minimally invasive approach represents a safe and effective therapeutic strategy for managing chronic low back pain in the geriatric population.

Objective:To explore the advantages and disadvantages of anterior versus posterior approach surgery in the treatment of cervical spinal cord injury without radiographic abnormality in elderly patients.Methods:Clinical data of 31 geriatric patients of spinal cord injuries without radiographic abnormality in our department from January 2014 to December 2018 were retrospectively analyzed for the cause of injury and the extent of injury.The patients were divided into two groups: anterior approach operation group and posterior approach operation group.The operation time, blood loss, volume of drainage, Japanese Orthopaedic Association(JOA)score before operation and 3 weeks, 3 months, 6 months, 12 months after operation, were recorded in the two groups.Results:Comparing the anterior versus posterior approach operation groups, the median operation time were 100.0(90.0, 110.0)min versus 132.5(123.7, 140.0)min, the median bleeding volume was 30.0(20.0, 35.0)ml versus 175.0(150.0, 202.5)ml, and the median postoperative drainage volume was 20.0(10.0, 20.0)ml versus 210.0(197.5, 237.5)ml, respectively, with statistically significantly differences between the two groups( U=18.00、0.00、0.00, all P<0.01). When comparing the anterior versus posterior approach operation groups, the median JOA scores at 5 time points were 4.0(3.0, 5.0), 6.0(5.5, 8.5), 9.0(8.5, 11.0), 11.0(10.0, 12.5), 12.0(11.0, 13.0)in the anterior operation group, and 4.0(3.0, 7.3), 6.5(5.7, 10.0), 10.5(8.7, 12.3), 12.5(11.0, 13.0), 13.0(11.0, 13.3)in the posterior operation group, with no significantly difference between the two groups( U=89.01, 90.03, 85.50, 74.02, 89.54, P=0.52, 0.55, 0.42, 0.20, 0.52), but there was significant difference in the median JOA scores at each of five different time points( χ2=82.46, 39.23, all P<0.01). Interestingly, the JOA score was higher at the latter time point than at the previous time point, with statistically significantly differences(all P<0.05). Conclusions:Both anterior and posterior approaches for decompression surgery have good effects on the recovery of spinal cord function in geriatric patients with cervical spinal cord injury without radiographic abnormality.Anterior approaches for decompression surgery are better than posterior approaches for the less operation time, less bleeding, less drainage and quickly recovery.

Objective:To investigate the surgical efficacy and safety of vertebroplasty as a day surgery procedure for osteoporotic vertebral fracture(OVF).Methods:A total of 159 patients with OVF undergoing vertebroplasty in Department of Orthopaedics, Beijing Hospital were enrolled and the clinical data were analyzed in this retrospective cohort study.They were grouped as the day-surgery group(n=81, the hospitalization, operation, briefly observation, recovered and discharged after treatment were completed during 1 working day)and as the hospitalized surgery group(n=78, patients stayed overnight in hospital or were hospitalized more than 24 hours). The mean follow-up time was 12.3 months(12-14 months). Pain score, analgesic drug use and activity ability were compared between the two groups before operation, 1 week after operation and at the last follow-up.Clinical effect, intra-operative and post-operative complications in the two groups were observed.Results:In intra-group comparison in the day-surgery group, the pain score, analgesic drug use and activity ability showed statistically significant differences at 1 week after surgery and at last follow-up as compared with those before treatment( P<0.01). No significant differences in pain score, analgesic drug use and activity ability were found between the day-surgery group and the hospitalized surgery group at 1 week after operation and at the last follow-up(2.3±1.2 vs.2.4±1.2, 1.7±0.9 vs.1.6±0.8; 1.5±0.3 vs.1.3±0.7, 1.8±0.4 vs.1.6±0.6; 1.3±0.7 vs.1.3±0.9, 1.3±0.6 vs.1.4±0.5; all P>0.05). The blood loss during surgery, postoperative complications including cerebrospinal fluid leakage, bone cement leakage, hematoma or infection at the puncture site, nerve root stimulation symptoms and re-fracture had no statistical difference between the two group(all P>0.05). Conclusions:The vertebroplasty as a day-surgery mode for osteoporotic vertebral fracture can improve the postoperative VAS score and activity ability, and decrease pain medication use.Efficacy and safety of a day-surgery for OVF are comparable to those of the hospitalized operation.

Objective To investigate the effectiveness of open-door laminoplasty with lateral mass screw fusion in the treatment of multisegmental cervical spondylotic myelopathy (CSM)with segmental instability.Methods Forty-one patients with multisegmental cervical spondylotic myelopathy combined with instability underwent open-door laminoplasty with lateral mass screw fusion.The JOA(Japanese Orthopaedic Association)scoring system and Neck Disability Index(NDI) were applied to evaluate neurological function and axial neck/shoulder pain before and after surgery,respectively.In addition,the Ishihara method was used to measure the cervical curvature index(CCI),and spinal cord expansion was calculated with MRI.Results After 43 months of postoperative follow-up,there were significant differences in JOA scores[(7.12±0.91) vs.(14.73± 1.12),t =35.28,P＜0.001],areas of the dural sac at the level of maximum stenosis in MRI[(0.22±0.05)]cm2 vs.(0.62±0.09)cm2,t=14.15,P＜0.001],and NDI scores[(24.46±6.61) vs.(12.90±3.46),t=15.59,P ＜ 0.001],compared with those before treatment.However,there were no significant differences in pre-and post-operation CCI[(10.36±1.69) vs.(10.87±2.05),t=1.11,P＞0.05].Conclusions Open-door laminoplasty with lateral mass screw fusion can improve neurological function and maintain the normal cervical curvature.Therefore,it is effective in the treatment of multisegmental cervical spondylotic myelopathy with segmental instability.

Objective To investigate the effect of pedicle screw augmentation with bone cement perfusion on the long segment fixation and fusion in the elderly patients with spinal deformity treated by osteotomy.Methods The cohort data of the older patients aged ≥70 years with spinal kyphosis were retrospectively analyzed in Beijing Hospital,Department of Orthopedic Surgery,Division of Spine Surgery from January 2012 to June 2014.32 cases with complete clinical date were included in this study.The kyphosis of all patients was secondary to thoracolumbar osteoporotic compression fracture.All patients were treated by posterior thoracolumbar spinal osteotomy with long segment fixation and fusion.The patients with fusions including sacral vertebral body fusion or the T score of BMD were less than-5 were excluded.Some patients with neurological compression symptoms also underwent selective decompression in spinal canal and nerve root foramen.All patients were divided into two groups:with (n=14)versus without(n=18)screw augmentation with bone cement perfusion(augmentation vs.non-augmentation/control group).The follow-up time was no less than 12 months.The data of age,gender,operative time,blood loss volume and preoperative bone mineral density were compared between two groups.Cobb angle of postoperative spinal surgery region,lordosis angle of postoperative lumbar,VAS and ODI improvement were analyzed.Data of surgical fixation and fusion segments were recorded.Pedicle screw loosening was compared between two groups.Results In the augmentation group,the pedicle screw loosening didn't occur.But control group showed screw loosening in 7 cases,a euphoric zone around screw in 4 cases,pedicle screw pullout in 2 cases,and vertebral cutting phenomenon with euphotic zone around screw in 1 case.There were no significant differences in ODI improvement rate and surgical satisfaction between the two groups.Conclusions When operative procedures of surgeon are in precision and skillful,bone cement augmentation technique for pedicle screw can reduce the occurrence of pedicle screw loosening in older patients during osteotomy and long segment fixation and fusion operation for spinal kyphosis.

Objective To investigate the clinical effect of Zero-profile anterior cervical interbody fusion on single-segment cervical spondylosis in the elderly, and to compare with the effect of traditional anterior cervical decompression and fusion (ACDF) with titanium plate.Methods Clinical data of elderly patients who underwent anterior cervical discectomy and fusion operation (one-or two-level) in our department from June 2009 to March 2014 were retrospectively analyzed.The 49 patients who took anterior cervical interbody fusion with the Zero-profile cage were considered as the Zero-P group, and the other 60 patients who received ACDF with titanium plate as control (ACDFP group).The operation time, blood loss, Neck Disability Index (NDI) score before and after operation, Cobb angle of the cervical spine and Cobb angle of the operated segment before and after operation, the fusion rate 1 year after operation, the dysphagia rate after operation according to Bazaz index were recorded and assessed.Results The operation time and blood loss had no statistical difference between the two group (P＞0.05 for both).The NDI scores were declined in the two group after operation as compared with before treatment (P＜0.05 for both), while there were no statistical difference in NDI score between the two groups (P＞0.05).The Cobb angle of cervical spine had little improvement 1 day after operation as compared with before operation, and improved significantly 3 month after operation in the two group.The Cobb angle of operated segment (Cobb S) was reduced 3 months in the two group after operation as compared with before treatment, and the Cobb S was declined much more in Zero-P group than in control group (P＜0.01).There was no statistical difference in the number of patients with successful fusion between the two group (46 cases vs.56 cases, x2 =0.08, P＞ 0.05).Conclusions The clinical effect of Zero-profile anterior cervical interbody fusion is equivalent as the traditional ACDFP.Zero-profile anterior cervical interbody fusion has less exposure and blood loss, which is more suitable for the elderly patients with cervical degenerative disease.

Objective To investigate the surgical curative effect of long-segment fixation and fusion on the degenerative scoliosis (DS) in the elderly.Methods The clinical data of 27 patients with DS undergoing surgical treatment from January 2011 to December 2013 in our department in Beijing Hospital were retrospectively analyzed.All patients suffered from degenerative scoliosis accompanied with lumbar canal stenosis, lumbar spondylolisthesis, lumbar vertebrae lateral slip in coronal surface, spinal vertebral rotation deformity and kyphosis.The decompression osteotomy and fixed segment, blood loss volume and operation time were recorded.The differences in scoliosis angle (Cobb angle), lumbar lordotic angle, top vertebral rotation degree (Nash-Moe vertebral rotation grade), apical vertebral offset distance, visual analogue scale (VAS) score and Oswestry disability index (ODI) score were compared between pretreatment versus the last follow-up.Results The selective 1-5 segment decompression and 5-10 segment fusion were selected in a total of 27 patients.Some patients were treated with Smith-Petersen osteotomy (SPO).All of 27 cases were treated with a lamina and inter-transverse fusion, among which 25 cases took inter-vertebral fusion additionally.The time of postoperative follow-up was more than 1 year.The Cobb angle, lumbar lordotic angle, apical vertebral offset distance, VAS and ODI scores were improved after treatment as compared with pretreatment [(11 6) vs.35 6 , (32±10) vs.(17±9) , (16.3±8.2) mm vs.(32.2±9.8) mm, (3.3±1.6) vs.(7.3±2.1), (18±14) vs.(33±14), t=2.469, 2.313, 2.331, 2.362, 2.395, P=0.021, 0.030, 0.029, 0.026, 0.023 respectively].The satisfaction survey result was excellent in 19cases, good in 5 cases, fair in 3 cases.Complications were found in 9 patients, among whom 2 cases had screw loosening in the internal fixation, 2 cases had adjacent segment degeneration, 1 case had pulmonary infection, 1 case had urinary tract infection, 2 eases had spinal fluid leakage, 1 case had epidural hematoma.No serious complications and deaths were observed.Conclusions Under strictly controlling the therapeutic indications, the limited decompression and long-segmental fixation and fusion have good therapeutic efficacy on degenerative scoliosis in elderly patients.

Objective To investigate the efficacy of the enhancement treatment on osteoporotic vertebral compression fracture and its complications in the elderly.Methods From September 2007 to February 2012,183 patients with osteoporotic vertebral compression fracture underwent percutaneous kyphoplasty (PKP) or percutaneous vertebroplasty (PVP) in our department.157 of them were completely followed up (PKP group,n=96; PVP group,n=61) and totally 182 vertebral bodies were fractured (PKP group,n=107; PVP group,n=75).Visual analogue scale (VAS) score and Oswestry disability index (ODI) score were evaluated before and 3 days and 3 months after the surgery.Plain film radiography was taken to evaluate the vertebral body height.ODI score was evaluated at the end of the follow-up.The leakage of polymethylmethacrylate (PMMA) during the operation and the refracture were recorded.Results The mean height of the vertebral body before operation had no difference between PVP and PKP group [(1.31±0.18) cm vs.(1.32±0.16) cm,t =0.72,P＞0.05].After the operation,the mean height of the vertebral body was lower in PVP group than in PKP group [(1.50±0.20) cm vs.(1.66±0.17) cm,t=2.28,P＜0.05].The mean amount of the PMMA injected into the vertebral bodies was less in PVP group than in PKP group [(2.93±0.34) ml vs.(3.34±0.49) ml,t=2.39,P＜0.05].In the PVP group,the VAS scores were (7.5±0.79),(3.0±0.6) and (1.9±0.9) before,3 days and 3 months after operation respectively,and there was a significant difference in VAS score before versus 3 days after operation (t =15.59,P＜0.05).In thePKPgroup,the VAS scores were (7.3±1.0),(3.0±0.8) and (2.2± 0.9)before,3 days and 3 months after operation respectively,and there was a significant difference in VAS score before versus 3 days after operation (t=10.69,P＜0.05).In the PVP group,the ODI scores were (78.9±7.3),(30.0±3.7) and (25.5±3.5) before and 3 months after operation and at the end of follow-up respectively,and there were significant differences in ODI score before operation versus 3 months after operation (t=20.83,P＜0.01) and 3 months after operation versus at the end of follow-up (t=4.03,P＜0.05).In the PKP group,the ODI scores were (78.8±6.8),(29.8±4.43) and (23.8 ± 2.7) before operation,3 months after operation and at the end of follow-up respectively,and there were significant differences in ODI score before operation versus 3 months after operation (t=21.52,P＜0.01) and 3 months after operation versus at the end of follow-up (t=3.14,P＜0.05).There were no significant differences in VAS and ODI scores between the two groups before versus after operation (t=0.34,P＞0.05).The incidence of refracture was 8.2％ in PVP group and 9.4％ in PKP group,which had no statistical difference between the two groups(x2 =0.06,P＞0.05).All the leakage was asymptomatic.The incidence of PMMA leakage was 20.0％ (15 cases) in PVP group and 9.3％ (10 cases) in PKP group,which had a statistical difference between the two groups (x2 =4.22,P ＜ 0.05).Conclusions Enhancement treatment for osteoporotic vertebral compression fracture can quickly relieve the pain and improve the quality of life.PKP and PVP show no differences in the effect of analgesia and the improvement of life quality,but PKP has the advantages in recovering vertebral height and reducing PMMA leakage.