Objectives:To evaluate the clinical efficacies of robot-assisted versus C-arm fluoroscopy-guided percutaneous pedicle screw fixation for thoracolumbar burst fractures.Methods:A retrospective analysis was conducted on 46 patients(26 males,20 females;age 27-69 years)with thoracolumbar burst fractures treated between January 2022 and December 2023.The patients were divided into the observation group of 21 cases(12 males,9 females;52.1±8.8 years)receiving robot-assisted navigation,and the control group of 25 cases(14 males,11 females;50.9±13.2 years)undergoing conventional C-arm fluoroscopy guidance.No significant differences were observed in baseline characteristics(case number,sex ratio,BMI;P＞0.05).Both groups of patients underwent percutaneous pedicle screw internal fixation of the injured vertebra.Intraoperative parameters(fluoroscopy frequency,operative time,blood loss),postoperative CT scans on 3d(assessed by Gertzbein-Robbins scale for screw placement accuracy),pre-and postoperative pain VAS scores(thoracolumbar back pain before surgery and at 1d,3d,and 1 month after surgery),and radiographic parameters(Cobb angle,anterior vertebral body height ratio at preoperation,and postoperative 3d,1 month,and 6 months)were recorded and compared using t-tests and Mann-Whitney U tests.Results:The observation group demonstrated significantly shorter operative time(90.71±9.52min vs 117.62±16.63min,P＜0.05),reduced blood loss(67.14±18.75mL vs 139.52±28.01mL,P＜0.05),and fewer fluoroscopy exposures(9.14±2.27 vs 18.86±2.86,P＜0.05)than the control group.No complications occurred during follow-up in both groups.The observation group exhibited superior screw placement accuracy(98.4％vs 90.7％,P＜0.05)with 124/126 screws graded as excellent/good versus 136/150 in controls.Postoperative pain VAS scores were lower in the observation group on 1d(2.67±0.57 vs 4.00±0.70,P＜0.05)and 3d(1.19±0.68 vs 1.95±0.59,P＜0.05),but comparable at 1 month(0.76±0.43 vs 1.10±0.53,P＞0.05).The postoperative 3d,1 month and 6 months'Cobb angles(6.08°±1.49° vs 6.09°±1.05°,6.26°±1.46° vs 6.28°±1.14°,6.78°±1.38° vs 6.91°±1.31°)and anterior vertebral height ratios[(90.14±1.56)％vs(90.06±1.69)％,(89.62±1.56)％vs(89.44±2.12)％,(88.87±1.72)％vs(88.92±1.88)％]showed no significant in-tergroup differences at different time points(P＞0.05).Conclusions:Robot-assisted percutaneous pedicle screw fixation for the treatment of thoracolumbar burst fractures has significant advantages in improving surgical ac-curacy,reducing intraoperative blood loss,shortening operative time,and decreasing the number of fluoroscopic exposures.

Objectives:To evaluate the clinical efficacies of robot-assisted versus C-arm fluoroscopy-guided percutaneous pedicle screw fixation for thoracolumbar burst fractures.Methods:A retrospective analysis was conducted on 46 patients(26 males,20 females;age 27-69 years)with thoracolumbar burst fractures treated between January 2022 and December 2023.The patients were divided into the observation group of 21 cases(12 males,9 females;52.1±8.8 years)receiving robot-assisted navigation,and the control group of 25 cases(14 males,11 females;50.9±13.2 years)undergoing conventional C-arm fluoroscopy guidance.No significant differences were observed in baseline characteristics(case number,sex ratio,BMI;P＞0.05).Both groups of patients underwent percutaneous pedicle screw internal fixation of the injured vertebra.Intraoperative parameters(fluoroscopy frequency,operative time,blood loss),postoperative CT scans on 3d(assessed by Gertzbein-Robbins scale for screw placement accuracy),pre-and postoperative pain VAS scores(thoracolumbar back pain before surgery and at 1d,3d,and 1 month after surgery),and radiographic parameters(Cobb angle,anterior vertebral body height ratio at preoperation,and postoperative 3d,1 month,and 6 months)were recorded and compared using t-tests and Mann-Whitney U tests.Results:The observation group demonstrated significantly shorter operative time(90.71±9.52min vs 117.62±16.63min,P＜0.05),reduced blood loss(67.14±18.75mL vs 139.52±28.01mL,P＜0.05),and fewer fluoroscopy exposures(9.14±2.27 vs 18.86±2.86,P＜0.05)than the control group.No complications occurred during follow-up in both groups.The observation group exhibited superior screw placement accuracy(98.4％vs 90.7％,P＜0.05)with 124/126 screws graded as excellent/good versus 136/150 in controls.Postoperative pain VAS scores were lower in the observation group on 1d(2.67±0.57 vs 4.00±0.70,P＜0.05)and 3d(1.19±0.68 vs 1.95±0.59,P＜0.05),but comparable at 1 month(0.76±0.43 vs 1.10±0.53,P＞0.05).The postoperative 3d,1 month and 6 months'Cobb angles(6.08°±1.49° vs 6.09°±1.05°,6.26°±1.46° vs 6.28°±1.14°,6.78°±1.38° vs 6.91°±1.31°)and anterior vertebral height ratios[(90.14±1.56)％vs(90.06±1.69)％,(89.62±1.56)％vs(89.44±2.12)％,(88.87±1.72)％vs(88.92±1.88)％]showed no significant in-tergroup differences at different time points(P＞0.05).Conclusions:Robot-assisted percutaneous pedicle screw fixation for the treatment of thoracolumbar burst fractures has significant advantages in improving surgical ac-curacy,reducing intraoperative blood loss,shortening operative time,and decreasing the number of fluoroscopic exposures.

In the early stages of type 2 diabetes,inducing remission of hyperglycemia has become a global hotspot in the field of diabetes management.In recent years,scholars from both domestic and international commu-nities have established several remission intervention methods,including short-term intensive insulin therapy,life-style intervention,and metabolic surgery.They have also proposed theories such as beta-cell dedifferentiation and liver-pancreas"twin cycle"hypothesis,which have accelerated the growth of clinical and research information in this field.This review summarizes the clinical evidence,basic mechanisms,applicable populations,and exacutive principle points in the field of diabetes remission,with the aim of deepening the understanding of clinical practitio-ners about diabetes remission and laying the foundation for better practice and research in related fields.

Objectives:To assess the midterm clinical outcomes after decompression and dynamic stabiliza-tion(Dynesys system)in multi-segmental lumbar spinal stenosis.Methods:The clinical data of 59 patients with lumbar spinal stenosis treatedwith decompression and 3 or more segments dynamic stabilization in our hospital from March 2010 to June 2015 were retrospectively reviewed.There were 28 males and 31 females,with an average age of 67.6±8.9 years(49-80 years).The operative time,blood loss and complications of the patients were collected.Before operation,at 3 months after surgery and final follow-up,visual analog scale(VAS)was used to assess the pain status of low back and leg,and Oswestry disability index(ODD was adopt-ed for functional evaluation,and also lumbar lordosis,range of motions(ROMs)of fixed segments and the first upper adjacent segment were evaluated with X-ray examination in the mean time,and the retention of ROM of the fixed segments was also calculated.Results:3 segmental Dynesys dynamic stabilizations were per-formed in 44 patients,4 segmental dynamic stabilizations were in 13 paticnts,5 segmental stabilizations were in 2 patients.The operative time was 259±58min,and the average blood loss was 593±296mL.The mean follow-up period was 7.2±1.3 years(range 5-9 years).The VAS scores and ODI at 3 months after operation improved significantly compared with those preoperatively(P＜0.05).At final follow-up,loosening was observed in 6 screws in 4 patients,who were asymptomatic;Wound infection developed in 1 patient at 34 months after surgery,which was cured by puncture pumping pus,irrigation and antibiotics for 4 weeks;None of the patients underwent revision surgery.At final follow-up,the ROM of the fixed segments was 13.1°±4.7°,which on average retained 43.8％of the preoperative ROM(28.9°±8.1°),and the ROM of the adjacent upper segement,and lumbar lordosis were preserved compared with before operation with no statistical difference(P＞0.05).Conclusions:Decompression and dynamic stabilization with Dynesys system was a safe and effective treatment in patients with multi-segmental lumbar spinal stenosis,which preserves lumbar activities with minor injury.

The pelvic and acetabular fracture accounts for 3%-8% of all fractures, and is often accompanied with injuries to the bladder, rectum, important nerves and blood vessels. The fatality rate and disability rate are as high as 18%. The treatment of pelvic and acetabular fracture has experienced conservative treatment, surgical treatment and minimally invasive treatment. In recent years, minimally invasive surgery has been widely used in internal fixation of pelvic fracture. The anterior pelvic ring is an important tension bow of the pelvis. For unstable pelvic fracture, the anterior pelvic ring fracture accounts for almost 3/4. The authors review several minimally invasive surgical techniques for anterior pelvic ring fracture, including internal fixation (INFIX), anterior column channel screw internal fixation, pubic symphysis channel screw internal fixation and anterior ring bridge plate osteosynthesis, so as to provide a reference for choice of clinical treatment methods.

Objective:To compare the clinical effects of discectomy combined with transpedicular dynamic stabilization and transforaminal lumbar interbody fusion (TLIF) in treating single-level lumbar disc herniation.Methods:From November 2012 to November 2015, a total of 96 patients with single-level lumbar disc herniation (disc height decreased more than 1/3, the width of the basilar part of the herniated disc >6 mm, massive disc herniation or Modic type I endplate changes) treated by discectomy combined with Dynesys dynamic stabilization (Dynesys group, n=48) or TLIF (fusion group, n=48) were enrolled. Clinical assessments included operation duration, intraoperative blood loss, MacNab score, visual analogue scale (VAS), Oswestry disability index (ODI) and rate of complications. Radiographs were evaluated for lumbar mobility, intervertebral height, etc. Results:A total of 86 patients were included in the final analysis (44 in Dynesys group and 42 in fusion group) and were evaluated after 5 years follow-up. The operation duration of Dynesys group (159.61±37.29 min) was less than that of the fusion group (177.42±39.90 min) significantly ( t=2.140, P=0.035). Intraoperative blood loss in Dynesys group (151.78±50.88 ml) was less than that in fusion group (197.74±76.55 ml) with significant difference ( t=3.293, P=0.001). At 5 years follow-up, there were 2 cases with screw loosening and 5 cases with adjacent segmental degeneration in Dynesys group without symptom. In fusion group, there were 12 cases with adjacent segmental degeneration and two of them with symptom. There were significant differences in the incidence of adjacent segment degeneration between the two groups ( χ2=4.012, P=0.045). According to the MacNab criteria, excellent or good cases accounted for 95% in Dynesys group and 93% in fusion group without significant differences ( Z=0.425, P=0.671). VAS back, VAS leg and ODI scores were improved significantly in both groups after 2 years and 5 years ( P<0.05). However, there were no significant differences between the two groups ( P<0.05). The activity of the surgical segment was 4.59°±0.48° in Dynesys group and 1.00°±0.42° in fusion group at 5 years after surgery. The height of intervertebral space in Dynesys group decreased from 11.19±2.07 mm before surgery to 9.98±2.02 mm at 2 years after surgery and to 9.86±1.64 mm at 5 years after surgery ( F=6.462, P=0.002). However, there was no statistically significant difference between the 2 and 5 years follow-up ( q=0.415, P>0.05). At 5 years after surgery, the activity of the first proximal segment in the two groups was 9.74°±3.29° and 11.69°±3.89°, respectively ( t=2.514, P=0.014). Conclusion:Both discectomy combined with dynamic stabilization and TLIF can achieve satisfied clinical effects in treating single-level lumbar disc herniation. Dynamic stabilization preserves the intervertebral activity of surgical segments and results in a lower incidence of adjacent segment degeneration compared with that in fusion surgery. Furthermore, discectomy combined with dynamic stabilization is a less invasive intervention with shorter operation duration and less blood loss compared with TLIF.

Objective:To investigate the clinical features and treatment strategies of infection after lumbar transpedicular dynamic stabilization.Methods:A total of 1 623 cases with lumbar transpedicular dynamic stabilization conducted from January 2010 to June 2020 were retrospectively analyzed, including 854 males and 769 females and aged 47.56±12.76 years old. There were 1 150 cases with Dynesys fixation, 235 cases with K-Rod, 181 cases with Isobar, 52 cases with Fule and 5 cases with Waveflex. The primary diseases were as following, 984 cases (60.63%) with lumbar disc herniation, 280 cases (17.25%) with lumbar spinal stenosis, 174 cases (10.72%) with lumbar spondylolisthesis, 98 cases (6.04%) with lumbar degenerative scoliosis and 87 cases (5.36%) with discogenic low back pain. Some baseline indicators, such as the overall incidence of infection, the age, gender, smoking, drinking, diagnosis, previous operation history, concomitant disease, the number of fenestration, the number of discectomy, the number of fixed segments, operation duration, blood loss, blood transfusion, the number of the dura mater rupture, postoperative infection duration from primary operation, inflammation indicators (leukocytes, neutrophils, C-reactive protein, erythrocyte sedimentation rate and procalcitonin) of the infected patients, were recorded. According to the time when the infection occurred, the cases were divided into the early infection group (within 3 months after surgery) and the late infection group (more than 3 months after surgery). The clinical indicators and treatment strategies were compared between the two groups.Results:The overall infection rate was 1.66% (27/1 623), including 2.17% (25/1 150) in Dynesys fixation, 1.92% (1/52) in Fule fixation and 0.55% (1/181) in Isobar fixation. The follow-up duration was 51.89±32.55 months. The number of fenestrations was 1(1, 2). The number of discectomy was 1(1, 2), and that of fixed segments was 2(1, 3). The operation duration was 186.30±81.33 minutes, with the blood loss 200 (200, 500) ml and the blood transfusion volume 0(0, 345) ml. There was 1 case of cerebrospinal fluid leakage in early infection group. Thirteen cases of pathogenic bacteria were identified, included 5 cases of Staphylococcus epidermidis, 2 cases of Staphylococcus aureus and 1 case each of Salmonella, Escherichia coli, Pseudomonas aeruginosa, Enterobacter aerogenes, Acinetobacter baumannii, and Streptococcus lactis. A total of 21 patients underwent secondary surgery, including 10 cases of debridement and suturing, 2 cases of internal fixation replacement and 9 cases of internal fixation removal. The other 4 cases underwent puncture and irrigation, while 2 cases received only antibiotic treatment. There were 16 cases with early infection and 11 cases with late infection. There were no significant differences between the two groups in the number of fenestrations, discectomy, operation duration, blood loss, and blood transfusion ( P>0.05). The inflammation indexes of early infection group were higher than those of late infection group with significant difference ( P<0.05), except for procalcitonin. The detection rates of pathogenic bacteria in early and late infection group were 62.5% (10/16) and 27.3% (3/11), respectively. The main infection sites in early infection group were the incision (50.0%, 8/16) and around the internal fixation (18.8%, 3/16). However, the main infection sites in late infection group were around the internal fixation (90.9%, 10/11). In the early infection group, the main treatments including debridement and suturing were conducted in 9 cases, puncturing in 2 cases and internal fixation replacement in 2 cases. In the late infection group, internal fixation removal was performed in 8 cases and puncturing in 2 cases. Conclusion:The overall infection rate after lumbar transpedicular dynamic stabilization was 1.66%. The incidence of early infection was 0.99%, while that of late infection was 0.68%. The incidence of Dynesys fixation was 2.17%. In early infection, the internal fixation could be retained through some treatments as debridement and internal fixation replacement. In most late infection cases, removal of the internal fixation could be helpful to control the infection.

A 22-year-old female patient presented with skin flushing in the bilateral legs for 4 years, which gradually spread throughout the whole lower limbs and forearms 6 months ago. Skin examination showed diffuse flushing and dilated capillaries in the lower limbs and both forearms, and the flushing faded after a press. Histopathological examination of the skin lesion on the leg showed hyperkeratosis in a basket-like shape, increased pigmentation in the basal layer, infiltration of the superficial dermis with scattered lymphocytes, with no obvious red blood cell overflow; periodic acid-Schiff staining showed thickened and homogeneous deposits around the blood vessels; immunohistochemical staining showed thickened blood vessel walls and positive staining for type Ⅳ collagen. Diagnosis: cutaneous collagenous vasculopathy.

Acute traumatic cervical spinal cord injury (TCSCI) is one of the most common severe injuries, and is often accompanied by complications like respiratory infection due to different degrees of paralysis of respiratory muscles, decreased cough function, increased bronchial secretions and bronchial spasm, which seriously affects the respiratory function recovery and enhances mortality rate. The authors review the respiratory management in patients with TCSCI from mechanical ventilation, tracheotomy, oxygen therapy, aerosolized inhalation, assisted sputum extraction, and respiratory function training, in order to provide a reference for clinical nursing work and improve the treatment effect.

Objective To introduce extrapedicular infiltration anesthesia as an improved method of local anesthesia which applied to unipedicular percutaneous vertebroplasty or percutaneous kyphoplasty.Methods From March 2015 to March 2016,20 patients in our hospital received percutaneous vertebroplasty or percutaneous kyphoplasty with 1％ lidocaine local infiltration anesthesia and extrapedicular infiltration anesthesia.The visual analogue score of patients during the operation and whether they needed additional sedative anesthesia were evaluated.The anaesthetic effect of nerve root block was observed.Results The visual analogue score of all the patients ranged from 1 point to 3 point,averagely (2.5 ± 0.7) point.Among the 20 patients,there were 2 cases of 1 point,7 cases of 2 point and 11 cases of 3 point.No patients required additional sedative anesthesia,and no nerve root block effects were observed.Conclusion Extrapedicular infiltration anesthesia provides good local anesthetic effects without significant complications,which deserved further use in unipedicular percutaneous vertebroplasty and percutaneous kyphoplasty.