1.Comparative analysis of the predictive value of fried frailty phenotype, liver fraily index and short physical performance battery in the prognosis of patients with liver cirrhosis
Jia LUO ; Dai ZHANG ; Shan SHAN ; Xiaoming WANG ; Xiaojuan OU ; Yu WANG ; Jidong JIA
Journal of Clinical Hepatology 2025;41(9):1818-1828
ObjectiveTo investigate the value of Fried Frailty Phenotype (FFP), liver frailty index (LFI), and Short Physical Performance Battery (SPPB) in predicting 2-year all-cause mortality and decompensation events in patients with liver cirrhosis. MethodsA total of 277 patients with liver cirrhosis who were hospitalized in Beijing Friendship Hospital, Capital Medical University, from December 2020 to December 2021 were enrolled, and FFP, LFI, and SPPB were used to assess the state of frailty. Based on the scores of each tool, these patients were divided into frail and non-frail groups. These three tools were compared in terms of consistency and independent predictive performance. The primary endpoints were 2-year all-cause mortality rate and composite endpoints (death+decompensation events), and the Cox regression analysis, the receiver operating characteristic (ROC) curve, net reclassification index (NRI), and integrated discrimination improvement (IDI) index were used to analyze the predictive value of the three tools. Normally distributed continuous data were compared between two groups using the independent samples t-test, while non-normally distributed continuous data were compared using the Mann-Whitney U test. Categorical data were compared between groups using the chi-square test or Fisher’s exact test. The agreement among different frailty tools was evaluated using Cohen’s Kappa statistic. The Kaplan-Meier survival curve was plotted, and a survival analysis was performed using the log-rank test. ResultsThe prevalence rate of frailty assessed by FFP, LFI, and SPPB was 37.2%, 22.4%, and 20.2%, respectively, with a moderate consistency between FFP and LFI/SPPB (κ=0.57, 95% confidence interval [CI]: 0.47 — 0.67; κ=0.51, 95%CI: 0.41 — 0.62) and a relatively high consistency between LFI and SPPB (κ=0.87, 95%CI: 0.80 — 0.94). Compared with the non-frailty group, the frailty group had significantly higher all-cause mortality rate and incidence rate of composite endpoints (P0.001). After multivariate adjustment, FFP, LFI, and SPPB had a hazard ratio of 2.42(95%CI: 1.51 — 5.11), 2.21(95%CI: 1.11 — 4.42), and 2.21(95%CI: 1.14 — 4.30), respectively, in predicting all-cause mortality, as well as a hazard ratio of 2.51(95%CI: 1.61 — 3.91), 2.40(95%CI: 1.51 — 3.80), and 2.20(95%CI: 1.39 — 3.47), respectively, in predicting composite endpoints. Compared with Child-Pugh score, FFP had a significantly greater area under the ROC curve (AUC) in predicting all-cause mortality (0.79 vs 0.69, P=0.032) and composite endpoints (0.75 vs 0.68, P=0.044). Frailty assessment tools combined with Child-Pugh score significantly improved the performance in predicting all-cause mortality and composite endpoints, with an AUC of 0.81 — 0.82 and 0.77 — 0.78, respectively (P0.05). NRI and IDI analyses further confirmed the improvement of the combined model in classification (all P0.001). ConclusionFFP, LFI, and SPPB can independently predict adverse outcomes in patients with liver cirrhosis, among which FFP has the best predictive performance, and the combination of frailty assessment tools with Child-Pugh score can significantly enhance the accuracy of prognostic evaluation.
2.Comparison of side-opening and front-opening approach bone cement injectors in percutaneous kyphoplasty for thoracolumbar osteoporotic vertebral compression fractures.
Wei-Xin DONG ; Zhen-Tao CHU ; Yong HU ; Ou-Jie LAI ; Zhen-Shan YUAN ; Xiao-Yang SUN
China Journal of Orthopaedics and Traumatology 2025;38(2):128-133
OBJECTIVE:
To compare clinical efficacy between side-opening and front-opening bone cement injectors in percutaneous kyphoplasty(PKP) for the management of thoracolumbar osteoporotic vertebral compression fractures(OVCFs).
METHODS:
A retrospective cohort study was conducted, comprising 62 patients with single-segment thoracolumbar OVCFs (T11-L2), who underwent bilateral PKP at our department during the period from June 2020 to October 2021. Patients were categorized into two groups based on the specific bone cement injector employed during the surgical procedure: the side-opening group (n=29) and the front-opening group (n=33). Among them, the side-opening group consisted of 6 male and 23 female patients, with a mean age of (73.32±9.11) years. The front-opening group included 7 male and 26 female patients, with a mean age of (71.29±10.39) years. The variables encompassed essential patient characteristics were recorded, such as gender, age, bone mineral density (BMD), and fracture level (T11-L2), as well as procedural aspects, including operation duration, cement injection volume, cement distribution type (lobular or diffuse), occurrence of cement leakage, pre-and post-operative visual analogue scale (VAS) pain scores, and vertebral compression ratio.
RESULTS:
All patients underwent successful surgery, with a mean follow-up duration of (15.37±3.03) months. There were no statistically significant differences in gender, age, BMD, fracture level, preoperative vertebral compression degree, and VAS scores between the side-opening group and the front-opening group (P>0.05). The operation time, the mean cement injection volumes, the distribution of bone cement within the vertebrae has no statistically significant difference between two groups(P>0.05). Both the side-opening and front-opening groups showed significant improvements in VAS scores at 3 days and 6 months after operation (P<0.05). However, there was no significant difference in VAS scores between the two groups at both 3 days and 6 months after the operation (P>0.05).
CONCLUSION
Side-opening bone cement injectors in bilateral PKP surgery for single-segment thoracolumbar OVCF achieve similar clinical efficacy as front-opening injectors, without significant improvement in cement distribution and containment.
Humans
;
Female
;
Male
;
Kyphoplasty/instrumentation*
;
Aged
;
Bone Cements
;
Fractures, Compression/surgery*
;
Retrospective Studies
;
Spinal Fractures/surgery*
;
Thoracic Vertebrae/injuries*
;
Lumbar Vertebrae/injuries*
;
Osteoporotic Fractures/surgery*
;
Middle Aged
;
Aged, 80 and over
3.Regional adipose distribution and metabolically unhealthy phenotype in Chinese adults: evidence from China National Health Survey.
Binbin LIN ; Yaoda HU ; Huijing HE ; Xingming CHEN ; Qiong OU ; Yawen LIU ; Tan XU ; Ji TU ; Ang LI ; Qihang LIU ; Tianshu XI ; Zhiming LU ; Weihao WANG ; Haibo HUANG ; Da XU ; Zhili CHEN ; Zichao WANG ; Guangliang SHAN
Environmental Health and Preventive Medicine 2025;30():5-5
BACKGROUND:
The mechanisms distinguishing metabolically healthy from unhealthy phenotypes within the same BMI categories remain unclear. This study aimed to investigate the associations between regional fat distribution and metabolically unhealthy phenotypes in Chinese adults across different BMI categories.
METHODS:
This cross-sectional study involving 11833 Chinese adults aged 20 years and older. Covariance analysis, adjusted for age, compared the percentage of regional fat (trunk, leg, or arm fat divided by whole-body fat) between metabolically healthy and unhealthy participants. Trends in regional fat percentage with the number of metabolic abnormalities were assessed by the Jonckheere-Terpstra test. Odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated by logistic regression models. All analyses were performed separately by sex.
RESULTS:
In non-obese individuals, metabolically unhealthy participants exhibited higher percent trunk fat and lower percent leg fat compared to healthy participants. Additionally, percent trunk fat increased and percent leg fat decreased with the number of metabolic abnormalities. After adjustment for demographic and lifestyle factors, as well as BMI, higher percent trunk fat was associated with increased odds of being metabolically unhealthy [highest vs. lowest quartile: ORs (95%CI) of 1.64 (1.35, 2.00) for men and 2.00 (1.63, 2.46) for women]. Conversely, compared with the lowest quartile, the ORs (95%CI) of metabolically unhealthy phenotype in the highest quartile for percent arm and leg fat were 0.64 (0.53, 0.78) and 0.60 (0.49, 0.74) for men, and 0.72 (0.56, 0.93) and 0.46 (0.36, 0.59) for women, respectively. Significant interactions between BMI and percentage of trunk and leg fat were observed in both sexes, with stronger associations found in individuals with normal weight and overweight.
CONCLUSIONS
Trunk fat is associated with a higher risk of metabolically unhealthy phenotype, while leg and arm fat are protective factors. Regional fat distribution assessments are crucial for identifying metabolically unhealthy phenotypes, particularly in non-obese individuals.
Adult
;
Aged
;
Female
;
Humans
;
Male
;
Middle Aged
;
Young Adult
;
Adipose Tissue
;
Body Fat Distribution
;
Body Mass Index
;
China/epidemiology*
;
Cross-Sectional Studies
;
Health Surveys
;
Phenotype
4.Mechanism of auraptene in improving acute liver injury induced by diquat poisoning in mice.
Renyang OU ; Shan HUANG ; Lihong MA ; Zhijie ZHAO ; Shengshan LIU ; Yuanliang WANG ; Yezi SUN ; Nana XU ; Lijun ZHOU ; Mei LI ; Manhong ZHOU ; Guosheng RAO
Chinese Critical Care Medicine 2025;37(6):590-594
OBJECTIVE:
To investigate whether auraptene (AUR) exerts a protective effect on acute diquat (DQ)-induced liver injury in mice and explore its underlying mechanisms.
METHODS:
Forty SPF-grade healthy male C57BL/6 mice were randomly divided into normal control group (Control group), DQ poisoning model group (DQ group), AUR treatment group (DQ+AUR group), and AUR control group (AUR group), with 10 mice in each group. The DQ poisoning model was established via a single intraperitoneal injection of 40 mg/kg DQ aqueous solution (0.5 mL); Control group and AUR group received an equal volume of pure water intraperitoneally. Four hours post-modeling, DQ+AUR group and AUR group were administered 0.5 mg/kg AUR aqueous solution (0.2 mL) by gavage once daily for 7 consecutive days, while Control group and DQ group received pure water. Blood and liver tissues were collected after anesthesia on day 7. Liver ultrastructure was observed by transmission electron microscopy. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were measured via enzyme-linked immunosorbent assay (ELISA). Hepatic glutathione (GSH), superoxide dismutase (SOD), and malondialdehyde (MDA) levels were detected using WST-1, thiobarbituric acid (TBA), and enzymatic reaction methods, respectively. Protein expression of nuclear factor-erythroid 2-related factor 2 (Nrf2), heme oxygenase-1 (HO-1), Kelch-like ECH-associated protein 1 (Keap1), and activated caspase-9 in liver tissues was analyzed by Western blotting.
RESULTS:
Transmission electron microscopy revealed that mitochondria in the Control group exhibited mild swelling, uneven distribution of matrix, and a small number of cristae fractures. In the AUR group, mitochondria showed mild swelling, with no obvious disruption of cristae structure. In the DQ group, mitochondria demonstrated marked swelling and increased volume, matrix dissolution, loss and fragmentation of cristae, and extensive vacuolization. In contrast, the DQ+AUR group showed significantly reduced mitochondrial swelling, volume increase, matrix dissolution, cristae loss and fragmentation, and vacuolization compared to the DQ group. Compared with the DQ group, the DQ+AUR group exhibited significantly lower serum AST levels (U/L: 173.45±23.60 vs. 255.33±41.51), ALT levels (U/L: 51.77±21.63 vs. 100.70±32.35), and hepatic MDA levels (μmol/g: 12.40±2.76 vs. 19.74±4.10), along with higher hepatic GSH levels (mmol/g: 37.65±14.95 vs. 20.58±8.52) and SOD levels (kU/g: 124.10±33.77 vs. 82.81±22.00), the differences were statistically significant (all P < 0.05). Western blotting showed upregulated Nrf2 expression (Nrf2/β-actin: 0.87±0.37 vs. 0.53±0.22) and HO-1 expression (HO-1/β-actin: 1.06±0.22 vs. 0.49±0.08), and downregulated Keap1 expression (Keap1/β-actin: 0.82±0.12 vs. 1.52±0.76) and activated caspase-9 expression (activated caspase-9/β-actin: 1.16±0.28 vs. 1.71±0.30) in the DQ+AUR group compared to the DQ group (all P < 0.05).
CONCLUSION
AUR attenuates DQ-induced acute liver injury in mice by activating the Keap1/Nrf2 signaling pathway.
Animals
;
Male
;
Mice
;
Mice, Inbred C57BL
;
Liver/pathology*
;
Chemical and Drug Induced Liver Injury/drug therapy*
;
Diquat/poisoning*
;
NF-E2-Related Factor 2/metabolism*
;
Oxidative Stress
;
Apoptosis
;
Coumarins
5.Protective effects of 2-methoxyestradiol against hypoxic pulmonary hypertension in neonatal rats
Ou XIE ; Shan-Shan LI ; Yang LUO ; Le WANG
Chinese Journal of Contemporary Pediatrics 2024;26(7):757-764
Objective To investigate the protective effects of 2-methoxyestradiol(2ME)against hypoxic pulmonary hypertension(HPH)in neonatal rats.Methods Ninety-six Wistar neonatal rats were randomly divided into a normoxia group,a hypoxia group,and a hypoxia+2ME group,with each group further subdivided into 3-day,7-day,14-day,and 21-day subgroups,containing eight rats each.The hypoxia and hypoxia+2ME groups received daily subcutaneous injections of saline and 2ME(240 μg/kg),respectively,while the normoxia group was raised in a normoxic environment with daily saline injections.Right ventricular systolic pressure(RVSP)was measured using the direct pressure method.Pulmonary vascular morphology was assessed using hematoxylin and eosin staining,with metrics including the percentage of medial thickness of small pulmonary arteries relative to the external diameter(MT%)and the cross-sectional area of the media of small pulmonary arteries relative to the total cross-sectional area(MA%).Immunohistochemistry was used to detect the expression levels of hypoxia-inducible factor-1α(HIF-1α)and proliferating cell nuclear antigen(PCNA)proteins,while real-time quantitative PCR was used to to assess HIF-1α and PCNA mRNA levels.Results Compared to the normoxia group,the hypoxia and hypoxia+2ME groups showed increased RVSP and upregulated HIF-1α and PCNA protein and mRNA expression levels at 3,7,14,and 21 days after hypoxia(P<0.05).Furthermore,at 7,14,and 21 days after hypoxia,the hypoxia group showed increased MT%and MA%(P<0.05).In comparison to the hypoxia group,the hypoxia+2ME group exhibited reduced RVSP and downregulated HIF-1α and PCNA protein and mRNA expression levels,along with decreased MT%and MA%at 7,14,and 21 days after hypoxia(P<0.05).Conclusions 2ME may protect against HPH in neonatal rats by inhibiting the expression of HIF-1α and PCNA and reducing pulmonary vascular remodeling.
6.circMYO9A_006 inhibits expression of cardiac hypertrophy-related pro-teins in cardiomyocytes by translating protein MYO9A-208aa
Jiaxue JIANG ; Jinfeng SU ; Ya WANG ; Tao OU ; Hui LI ; Jindong XU ; Yupeng LIU ; Xianhong FANG ; Zhixin SHAN
Chinese Journal of Pathophysiology 2024;40(1):1-8
AIM:To investigate the effect of circular RNA MYO9A-006(circMYO9A_006)on hypertrophic phenotype of cardiomyocytes and the underlying mechanism.METHODS:The effect of adenovirus-mediated overexpres-sion of circMYO9A_006 on the expression of hypertrophy-related proteins,including β-myosin heavy chain(β-MHC),skeletal muscle actin alpha 1(ACTA1)and atrial natriuretic peptide(ANP),was evaluated in neonatal mouse ventricular cardiomyocytes(NMVCs).Moreover,a neonatal rat ventricular cardiomyocyte(NRVC)model of phenylephrine(PE)-in-duced hypertrophy was established.The effect of circMYO9A_006 overexpression on NRVC size was ascertained using Phalloidin-iFluor 647 staining method.Dual-luciferase reporter assay was employed to measure the activity of potential in-ternal ribosome entry sites(IRES)in circMYO9A_006.The translation and intracellular location of the circMYO9A_006-translated protein,MYO9A-208aa,were verified using Western blot.To investigate the role of MYO9A-208aa in the ef-fect of circMYO9A_006 on the cardiomyocyte hypertrophic phenotype,we prepared and used the following adenoviruses:the recombinant circMYO9A_006-ORF adenovirus to express MYO9A-208aa,the recombinant circMYO9A_006-ATG-mut adenovirus that does not express MYO9A-208aa,the recombinant circMYO9A_006 adenovirus,and the adenovirus vector control.These were then employed to infect NRVCs.RESULTS:Successful adenovirus-mediated overexpression of circMYO9A_006 was observed in NMVCs.The increased expression of circMYO9A_006 notably reduced the expres-sion of hypertrophy-related proteins in NMVCs(P<0.01).Concurrently,overexpression of circMYO9A_006 substantially reduced the expression of hypertrophy-associated proteins and diminished the size of PE-induced NRVCs(P<0.05).Dual-luciferase reporter assay identified the activity of 2 IRES in circMYO9A_006.Western blot results indicated that circ-MYO9A_006 could produce the MYO9A-208aa protein with an anticipated molecular weight of 28 kD in NRVCs,primari-ly found in the cytoplasm.Elevated expression of both circMYO9A_006 and MYO9A-208aa consistently reduced the ex-pression of hypertrophy-associated proteins(P<0.01),and counteracted the enlarged size of PE-induced NRVCs(P<0.05).However,increased expression of circMYO9A_006-ATG-mut did not counteract the PE-induced hypertrophic phe-notype of NRVCs.CONCLUSION:circMYO9A_006 attenuates the hypertrophic phenotype of cardiomyocytes by synthe-sizing the MYO9A-208aa protein.
7.Effect of safflower yellow injection on the pharmacokinetics and anticoagulation of aspirin
Dandan SHEN ; Zhonghui YANG ; Ji HUANG ; Yingfei OU ; Yunlong SHAN
Journal of China Pharmaceutical University 2024;55(6):795-800
This article explores the interaction between aspirin and safflower yellow injection from the perspective of pharmacokinetics, combined with pharmacological indicators such as anticoagulation. Quantitative HPLC analysis was performed for the detection of salicylic acid in plasma samples, and the pharmacokinetic effects of aspirin in combination with safflower yellow injection on aspirin’s hydrolyzed product salicylic acid was evaluated. Thromboxane B2 (TXB2) and 6-keto prostaglandin F1 in plasma were determined using enzyme-linked immunosorbent assay and fully automated biochemical analyzer α (6-keto-PGF1) α), and the levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN), and serum creatinine (Scr) were tested to evaluate the anticoagulant effect and safety indicators after long-term combined use of the two drugs, including liver and kidney function and cardiac pathological examination. The results showed that, compared with the aspirin group, there was no significant difference (P>0.05) in the plasma pharmacokinetic parameters of rats with combined use of safflower yellow injection. In addition, the plasma TXB2 in the combination group was significantly reduced compared to the aspirin group (P<0.01), yet with no significant difference for 6-keto-PGF1 α (P>0.05). There was no statistically significant difference in the levels of serum BUN, Scr, AST, and ALT between the two groups before and after treatment (P>0.05). These results suggest that the combination of aspirin and safflower yellow injection does not cause significant change in the blood concentration of salicylic acid. It does not affect the antiplatelet effect of aspirin.
8.Protective effect and mechanism of quercetin on acute liver injury induced by diquat poisoning in mice
Shan HUANG ; Jianhong WANG ; Renyang OU ; Guosheng RAO ; Zhijie ZHAO ; Nana XU ; Manhong ZHOU
Chinese Critical Care Medicine 2024;36(6):604-608
Objective:To investigate the protective effect of quercetin (QR) on acute liver injury induced by diquat (DQ) poisoning in mice and its mechanism.Methods:Eighty healthy male C57BL/6 mice with SPF grade were randomly divided into control group, DQ model group, QR treatment group, and QR control group, with 20 mice in each group. The DQ poisoning model was established by a one-time intraperitoneal injection of DQ solution (40 mg/kg); the control and QR control groups received equivalent amounts of distilled water through intraperitoneal injection. Four hours after modeling, the QR treatment group and the QR control group received 0.5 mL QR solution (50 mg/kg) through gavage. Meanwhile, an equivalent amount of distilled water was given orally to the control group and the DQ model group. The treatments above were administered once daily for seven consecutive days. Afterwards, the mice were anesthetized, blood and liver tissues were collected for following tests: changes in the structure of mice liver tissue were observed using transmission electron microscopy; the levels of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were detected using enzyme linked immunosorbent assay (ELISA); the levels of glutathione (GSH), superoxide dismutase (SOD), and malondialdehyde (MDA) in liver tissues were measured using the water-soluble tetrazolium-1 (WST-1) method, the thiobarbituric acid (TBA) method, and enzymatic methods, respectively; the protein expressions of nuclear factor erythroid 2-related factor 2 (Nrf2), heme oxygenase-1 (HO-1), Kelch-like ECH-associated protein 1 (Keap1), and activated caspase-9 in liver tissues were detected using Western blotting.Results:Severe mitochondrial damage was observed in the liver tissues of mice in the DQ model group using transmission electron microscopy, yet mitochondrial damage in the QR treatment group showed significant alleviation. Compared to the control group, the DQ model group had significantly increased levels of MDA in liver tissue, serum AST, and ALT, yet had significantly decreased levels of GSH and SOD in liver tissue. In comparison to the DQ model group, the QR treatment group exhibited significant reductions in serum levels of ALT and AST, as well as MDA levels in liver tissue [ALT (U/L): 52.60±6.44 vs. 95.70±8.00, AST (U/L): 170.45±19.33 vs. 251.10±13.09, MDA (nmol/mg): 12.63±3.41 vs. 18.04±3.72], and notable increases in GSH and SOD levels in liver tissue [GSH (μmol/mg): 39.49±6.33 vs. 20.26±3.96, SOD (U/mg): 121.40±11.75 vs. 81.67±10.01], all the differences were statistically significant (all P < 0.01). Western blotting results indicated that the protein expressions of Nrf2 and HO-1 in liver tissues of the DQ model group were significantly decreased compared to the control group. On the other hand, the protein expressions of Keap1 and activated caspase-9 were conspicuously higher when compared to the control group. In comparison to the DQ model group, the QR treatment group showed a significant increase in the protein expressions of Nrf2 and HO-1 in liver tissues (Nrf2/β-actin: 1.17±0.08 vs. 0.92±0.45, HO-1/β-actin: 1.53±0.17 vs. 0.84±0.09). By contrast, there was a notable decrease in the protein expressions of Keap1 and activated caspase-9 (Keap1/β-actin: 0.48±0.06 vs. 1.22±0.09, activated caspase-9/β-actin: 1.17±0.12 vs. 1.59±0.30), the differences were statistically significant (all P < 0.01). Conclusion:QR may reduce acute liver injury induced by DQ poisoning in mice via activating Keap1/Nrf2 signaling pathway.
9.3D printing navigation template assisted pedicle screw placement for the treatment of type Ⅱ old odontoid fractures
Wei-Xin DONG ; Zhen-Tao CHU ; Yong HU ; Ou-Jie LAI ; Zhen-Shan YUAN
China Journal of Orthopaedics and Traumatology 2024;37(8):779-785
Objective To compare the safety and clinical efficacy of freehand and 3D printing navigation template assisted screw placement in patients with old odontoid fractures of type Ⅱ.Methods Total of 38 patients with old odontoid fractures of type Ⅱ were treated from November 2018 to December 2022,all of which presented as chronic neck pain.According to the dif-ferent methods of screw insertion into the pedicle,the patients were divided into a navigation template group and a freehand group.In the navigation template group,there were 17 patients including 9 males and 8 females with an average age of(51.30±13.20)years old,disease duration was(22.18±7.59)months.In the freehand group,there 21 patients including 7 males and 14 females with an average age of(49.46±11.92)years old,disease duration was(19.52±9.17)months.The intraoperative blood loss,operation time,and postoperative drainage output were recorded and compared between two groups.The accuracy of screw placement was evaluated by CT scan.Before operation and 1 year after operation,cervical pain was assessed by visual analogue scale(VAS),neurological changes were evaluated by the Japanese Orthopaedic Association(JOA)score,and the de-gree of spinal cord injury was assessed by the American Spinal Injury Association(ASIA)injury scale.Results All patients were followed up for(25.31±1.21)months.The operation time of template group(112.00±20.48)min had significantly shorter than that of the freehand group(124.29±15.24)min(P<0.05),while there were no significant differences between two groups in terms of intraoperative blood loss,postoperative drainage,and hospital stay(P>0.05).At 1 year after operation,in template group and freehand group,the VAS[(2.88±0.86),(2.90±0.83)]and JOA[(14.94±1.82),(14.62±2.19)]improved with pre-operative[VAS(4.71±0.92),(4.86±0.79)and JOA(12.18±2.30),(11.95±2.31)](P<0.05),with no significant difference between two groups(P>0.05).No significant improvement was observed in ASIA grading in either group at 1 year after opera-tion(P>0.05),and there was no significant difference between two groups(P>0.05).The template group had significantly better accuracy of screw placement in the pedicle of the axis than the freehand group(P<0.05),while no significant difference was observed between two groups in the accuracy of screw placement in the pedicle of the atlas(P>0.05).Conclusion In the treat-ment of type Ⅱ old odontoid fractures with posterior pedicle screw fixation,3D printing navigation template screw placement can significantly shorten the operation time,achieve similar clinical efficacy as free-hand screw placement,and significantly im-prove the accuracy of screw placement in the pedicle of the axis.
10.Zero-profile intervertebral fusion with cage-titanium plate for the treatment of multilevel cervical spondylotic myelopathy.
Jian-Bin ZHONG ; Yong HU ; Zhen-Tao CHU ; Wei-Xin DONG ; Zhen-Shan YUAN ; Xiao-Yang SUN ; Bing-Ke ZHU ; Ou-Jie LAI
China Journal of Orthopaedics and Traumatology 2024;37(12):1188-1195
OBJECTIVE:
To explore clinical effect of Zero-profile intervertebral fusion with cage-titanium plate in treating multilevel cervical spondylotic myelopathy.
METHODS:
From January 2016 to January 2020, 107 patients with multisegmental cervical spondylotic myelopathy treated by surgery were retrospectively analyzed and divided into Hybrid group and control group according to different surgical methods. There were 54 patients in Hybrid group, including 42 males and 12 females, aged from 33 to 77 years old with an average of (57.3±9.5) years old;20 patients with C3-C6, 27 patients with C4-C7 and 7 patients with C3-C7;Zero-profile intervertebral fusion with cage-titanium plate internal fixation was performed. There were 53 patients in control group, including 34 males and 19 females;aged from 36 to 79 years old with an average of (57.8±8.9) years old;17 patients with C3-C6, 27 patients with C4-C7, and 9 patients with C3-C7;titanium plate interbody fusion fixation was performed. Operation time, blood loss and complications between two groups were compared, visual analogue scale (VAS), Japanese Orthopedic Association (JOA) scores and neck disability index (NDI) were used to assess recovery of clinical symptoms;cervical lordosis (CL), cervical sagittal vertical axis (C-SVA), and T1 slope (T1S) were measured and compared to evaluate cervical sagittal plane parameters.
RESULTS:
All patients were followed up, Hybrid group was followed up for 24 to 64 months with an average of (31.7±18.4) months, and control group was followed up for 24 to 65 months with an average of (32.6±15.8) months. There was no significant difference in follow-up time between two groups (P>0.05). Operation time and blood loss in Hybrid group were less than those in control group (P<0.05). VAS, JOA score and NDI were significantly improved between two groups at the lastest follow-up (P<0.05). There were no significant difference in VAS, JOA and NDI scores between two groups before and after operation (P>0.05). CL in both two groups at 3 months and the latest follow-up after operation were significantly improved than those before operation (P<0.05), there were no significant difference between two groups in T1S and C-SVA before and after operation (P>0.05). Postoperative dysphagia occurred in 2 patients in Hybrid group and 9 patients in control group, and had statistically difference in the incidence of dysphagia between two groups (χ2=5.112, P=0.024). During the follow-up, there were no complications such as loosening, displacement or fracture of internal fixation between two groups.
CONCLUSION
Compared with titanium plate interbody fusion, Zero-profile intervertebral fusion combined with cage-titanium plate for the treatment of multilevel cervical spondylotic myelopathy could shorten surgical time and blood loss, reduce surgical trauma and postoperative swallowing difficulties, and is conducive to early and rapid recovery.
Humans
;
Male
;
Female
;
Middle Aged
;
Spinal Fusion/instrumentation*
;
Bone Plates
;
Titanium
;
Aged
;
Spondylosis/surgery*
;
Adult
;
Cervical Vertebrae/surgery*
;
Retrospective Studies
;
Spinal Cord Diseases/surgery*

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