Objective:To compare the clinical efficacy of percutaneous endoscopic interlaminar discectomy (PEID) and posterior small incision microdiscectomy (MD) in the treatment of recurrent lumbar disc herniation.Methods:A retrospective analysis was conducted on the data of 132 patients who underwent revision surgery for recurrent lumbar disc herniation at the same segment at Qilu Hospital of Shandong University between July 2012 and August 2022. The patients were treated with either PEID or MD. The PEID group consisted of 90 patients, including 51 males and 39 females, with a mean age of 42.7±11.3 years and a mean body mass index (BMI) of 23.7±3.4 kg/m 2. The surgical segments were L 4-5 in 38 cases and L 5S 1 in 52 cases. The primary surgeries included open discectomy in 7 cases, laminectomy with bone graft in 3 cases, MD in 35 cases, and PEID in 45 cases. The MD group consisted of 42 patients, including 30 males and 12 females, with a mean age of 41.2±12.6 years and a mean BMI of 24.3±4.7 kg/m 2. The surgical segments were L 4-5 in 19 cases and L 5S 1 in 23 cases. The primary surgeries included open discectomy in 2 cases, laminectomy with bone graft in 1 case, MD in 17 cases, and PEID in 22 cases. The visual analogue scale (VAS) scores for low back pain and leg pain, Oswestry disability index (ODI), immediate postoperative VAS score for surgical wound pain, intraoperative blood loss, surgical wound length, operation duration, length of hospital stay, and various complications before and after surgery were compared between the PEID and MD groups. Results:The operation duration in the PEID group was 81.7±11.3 min, that in the MD group was 85.2±9.5 min, but the difference was not statistically significant ( t=1.740, P=0.081). The intraoperative blood loss in the PEID group was 4.4±2.9 ml, the surgical wound length was 0.9±0.2 cm, and the length of hospital stay was 3.1±1.3 d, all significantly less than those in the MD group (26.6±10.3 ml, 3.4±1.1 cm, and 8.7±1.6 d, respectively), with statistically significant differences ( P<0.05). Both groups were followed up, with a mean follow-up duration of 24.4±5.5 months in the PEID group and 24.5±4.9 months in the MD group, and there was no statistically significant difference between the two groups ( t=0.101, P=0.920). Both the PEID and MD groups showed significant improvements in postoperative VAS scores for leg pain, VAS scores for low back pain, and ODI compared with preoperative values ( P<0.05). Additionally, the VAS score for surgical wound pain on the first postoperative day in the PEID group was 1.2±0.4, which was lower than that in the MD group (2.9±0.6), with a statistically significant difference ( t=19.261, P<0.001). The incidence rates of muscle weakness, postoperative sensory abnormalities, and dural tears in the PEID group were 12%(11/90), 27%(24/90), and 6%(5/90), respectively, significantly lower than those in the MD group [31%(13/42), 40%(17/42), and 33%(14/42), respectively], with statistically significant differences ( P<0.05). However, there were no statistically significant differences between the two groups in the incidence rates of recurrence, residual nucleus pulposus, spinal cord-like hypertension syndrome, subcutaneous wound infection, or intervertebral space infection ( P>0.05). No patients in either group developed retroperitoneal hematoma postoperatively. Conclusion:For patients with recurrent lumbar disc herniation after primary posterior surgery, PEID demonstrates equally excellent clinical efficacy compared with MD, with smaller surgical trauma and a lower incidence of complications.

Objective:To compare the outcomes of ranibizumab and conbercept adjunct for pars plana vitrectomy (PPV) in the treatment of proliferative diabetic retinopathy (PDR).Methods:A prospective randomized case-control study. From June 2022 to December 2023, 90 cases (90 eyes) of PDR patients diagnosed through ophthalmic examination at Department of Ophthalmology of Gansu Provincial Hospital were included in the study. All patients underwent the best corrected visual acuity (BCVA), intraocular pressure, B-mode ultrasound, and optical coherence tomography (OCT) examinations. The central macular thickness (CMT) was measured using an OCT instrument. The patients were randomly divided into a intravitreal injection of ranibizumab group (monoclonal-antibody group) and a intravitreal injection of conbercept group (fusion-protein group) using a random number table method, with 45 cases (45 eyes) in each group. Two groups of patients were intravitreal injected with 10 mg/ml ranibizumab or conbercept 0.05 ml, respectively. A standard 23G PPV was performed through the flat part of the ciliary body 3-7 days after intravitreal injection. Relevant examinations were performed using the same equipments and methods as before surgery at postoperative 1 week, 1, 3, 6, and 12 months. The PPV time, intraoperative use of intraocular electrocoagulation, incidence of iatrogenic retinal breaks, and sterile air or silicone oil tamponade rate in the vitreous cavity, the postoperative changes of BCVA and CMT, and incidence of complications were compared between two groups. Independent sample t test was used for inter group comparison. Results:The intraoperative utilization rate of intraocular electrocoagulation in the monoclonal-antibody group was higher than that in the fusion-protein group, and the difference was statistically significant ( χ2=3.876, P<0.05). There were no statistically significant differences in the PPV time ( t=0.152), intraoperative bleeding rate ( χ2=0.800), incidence of iatrogenic retinal breaks ( χ2=1.975), and sterile air and silicone oil tamponade rate in the vitreous cavity ( χ2=1.607, 1.553) between the two groups ( P>0.05). There were no statistically significant differences in early and late postoperative vitreous hemorrhage ( χ2=1.235, 2.355), and re-PPV ( χ2=2.355) between two groups ( P>0.05). The BCVA of the fusion-protein group was significantly better than that of the monoclonal-antibody group at postoperative 3 months, and the difference was statistically significant ( t=2.428, P<0.05). The CMT of the fusion-protein group was lower than that in the monoclonal-antibody group at postoperative 1 week, and the difference was statistically significant ( t=2.739, P<0.05). None of the patients experienced endophthalmitis, retinal artery occlusion, or severe cardiovascular events after surgery. Conclusion:Compared with intravitreal injection of ranibizumab before PPV, intravitreal injection of conbercept before PPV in PDR patients can shorten the surgical time, reduce intraoperative bleeding rate, lower the rate of electrocoagulation and intraocular tamponade, and incidence of iatrogenic retinal breaks, and improve the visual acuity.

Objective:To compare the clinical efficacy of percutaneous endoscopic interlaminar discectomy (PEID) and posterior small incision microdiscectomy (MD) in the treatment of recurrent lumbar disc herniation.Methods:A retrospective analysis was conducted on the data of 132 patients who underwent revision surgery for recurrent lumbar disc herniation at the same segment at Qilu Hospital of Shandong University between July 2012 and August 2022. The patients were treated with either PEID or MD. The PEID group consisted of 90 patients, including 51 males and 39 females, with a mean age of 42.7±11.3 years and a mean body mass index (BMI) of 23.7±3.4 kg/m 2. The surgical segments were L 4-5 in 38 cases and L 5S 1 in 52 cases. The primary surgeries included open discectomy in 7 cases, laminectomy with bone graft in 3 cases, MD in 35 cases, and PEID in 45 cases. The MD group consisted of 42 patients, including 30 males and 12 females, with a mean age of 41.2±12.6 years and a mean BMI of 24.3±4.7 kg/m 2. The surgical segments were L 4-5 in 19 cases and L 5S 1 in 23 cases. The primary surgeries included open discectomy in 2 cases, laminectomy with bone graft in 1 case, MD in 17 cases, and PEID in 22 cases. The visual analogue scale (VAS) scores for low back pain and leg pain, Oswestry disability index (ODI), immediate postoperative VAS score for surgical wound pain, intraoperative blood loss, surgical wound length, operation duration, length of hospital stay, and various complications before and after surgery were compared between the PEID and MD groups. Results:The operation duration in the PEID group was 81.7±11.3 min, that in the MD group was 85.2±9.5 min, but the difference was not statistically significant ( t=1.740, P=0.081). The intraoperative blood loss in the PEID group was 4.4±2.9 ml, the surgical wound length was 0.9±0.2 cm, and the length of hospital stay was 3.1±1.3 d, all significantly less than those in the MD group (26.6±10.3 ml, 3.4±1.1 cm, and 8.7±1.6 d, respectively), with statistically significant differences ( P<0.05). Both groups were followed up, with a mean follow-up duration of 24.4±5.5 months in the PEID group and 24.5±4.9 months in the MD group, and there was no statistically significant difference between the two groups ( t=0.101, P=0.920). Both the PEID and MD groups showed significant improvements in postoperative VAS scores for leg pain, VAS scores for low back pain, and ODI compared with preoperative values ( P<0.05). Additionally, the VAS score for surgical wound pain on the first postoperative day in the PEID group was 1.2±0.4, which was lower than that in the MD group (2.9±0.6), with a statistically significant difference ( t=19.261, P<0.001). The incidence rates of muscle weakness, postoperative sensory abnormalities, and dural tears in the PEID group were 12%(11/90), 27%(24/90), and 6%(5/90), respectively, significantly lower than those in the MD group [31%(13/42), 40%(17/42), and 33%(14/42), respectively], with statistically significant differences ( P<0.05). However, there were no statistically significant differences between the two groups in the incidence rates of recurrence, residual nucleus pulposus, spinal cord-like hypertension syndrome, subcutaneous wound infection, or intervertebral space infection ( P>0.05). No patients in either group developed retroperitoneal hematoma postoperatively. Conclusion:For patients with recurrent lumbar disc herniation after primary posterior surgery, PEID demonstrates equally excellent clinical efficacy compared with MD, with smaller surgical trauma and a lower incidence of complications.

OBJECTIVE: To investigate the surgical technique and effectiveness of tension band-assisted plate fixation combined with external fixator for volar marginal fractures of the distal radius. METHODS: A retrospective analysis was performed on the clinical data of 12 patients with volar marginal fractures of the distal radius treated by Kirschner wire tension band-assisted anatomical plate fixation combined with external fixator between October 2018 and July 2023. The cohort included 9 males and 3 females, aged from 20 to 52 years (mean, 35.5 years). The injury causes included traffic accidents in 6 cases, falls from height in 3 cases, and fall in 3 cases. According to AO/Orthopaedic Trauma Association (AO/OTA), there were 1 case of type B2, 4 cases of type B3, 2 cases of type C1, 3 cases of type C2, and 2 cases of type C3. According to Fernandez classification, there were 2 cases of type Ⅲ, 5 cases of type Ⅳ, and 5 cases of type Ⅴ. Associated injuries included radiocarpal joint dislocation or subluxation in 7 cases and median nerve injury in 2 cases. The time from injury to operation was 2-7 days (mean, 3.2 days). Postoperatively, functional outcomes were evaluated using the modified Mayo wrist score and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Grip strength was measured as the ratio to the unaffected side, and wrist range of motion (ROM) including dorsiflexion, palmar flexion, ulnar deviation, and radial deviation was assessed. RESULTS: All procedures were successfully completed, with an operation time of 55-110 minutes (mean, 65 minutes). All patients were followed up 6-36 months (mean, 13.7 months). Surgical incisions healed by first intention, without complications such as vascular-nerve injury or infection. Bony union and articular congruency were attained in all patients, with a healing time of 3-5 months (mean, 3.8 months). During follow-up, 1 case of Kirschner wire migration occurred with no instances of infections, radiocarpal dislocations, internal fixation failures, or extensor pollicis longus tendon ruptures. At last follow-up, the modified Mayo wrist score ranged from 65 to 92 (mean, 80.8), the DASH score ranged from 7 to 15 (mean, 11.6), the grip strength was 65%-90% (mean, 78.2%) of the unaffected side; and wrist ROM was palmar flexion 60°-85° (mean, 77.4°), dorsiflexion 55°-80° (mean, 74.8°), radial deviation 10°-25° (mean, 18.8°), and ulnar deviation 15°-30° (mean, 24.5°). CONCLUSION Kirschner wire tension band-assisted anatomical plate fixation combined with external fixator for volar marginal fractures of the distal radius is a simple method with reliable fixation, which can achieve satisfactory effectiveness.
Humans ; Male ; Adult ; Female ; Radius Fractures/diagnostic imaging* ; Retrospective Studies ; Middle Aged ; Bone Plates ; Bone Wires ; External Fixators ; Young Adult ; Fracture Fixation, Internal/instrumentation* ; Treatment Outcome ; Range of Motion, Articular ; Hand Strength ; Wrist Injuries/surgery*

OBJECTIVE: To investigate the feasibility and effectiveness of precise-guided temporary fixation assistive devices in assisting the main nail guide pin placement and precise temporary fixation in proximal femoral nail antirotation (PFNA) internal fixation of femoral intertrochanteric fractures. METHODS: A prospective randomized controlled study was conducted to analyze the clinical data of 60 patients with femoral intertrochanteric fractures over 65 years old who met the selection criteria between January 2020 and June 2022 and were treated with PFNA internal fixation. The patients were randomly divided into the trial group (auxiliary device guided main nail guide pin placement and temporary fixation) and the control group (conventional treatment), with 30 cases in each group. There was no significant difference in baseline data such as gender, age, cause of injury, time from injury to operation, fracture side, AO/Orthopaedic Trauma Association (AO/OTA) classification, and combined medical diseases between the two groups ( P>0.05). The operation time, times of main nail guide pin placement, intraoperative fluoroscopy frequency, intraoperative blood loss, and perioperative blood transfusion were recorded and compared between the two groups. The quality of fracture reduction was evaluated by CHANG Shimin et al criteria. Harris score was used to evaluate the hip function at 1 year after operation. RESULTS: In the trial group, 2 temporary fixation needles were successfully placed 2-5 times, including 2 times in 13 cases (43.3%), 3 times in 8 cases (26.7%), 4 times in 7 cases (23.3%), and 5 times in 2 cases (6.7%). The operation time, times of main nail guide pin placement, intraoperative fluoroscopy frequency, and intraoperative blood loss in the trial group were significantly less than those in the control group, and the reduction quality score was significantly better than that in the control group ( P<0.05). There was no significant difference in perioperative blood transfusion between the two groups ( P>0.05). All patients were followed up 12-19 months (mean, 15 months). There was no complication such as incision infection, deep vein thrombosis, or internal fixation loosening. At 1 year after operation, the Harris score of the affected hip joint in the trial group was significantly higher than that in the control group ( P<0.05). CONCLUSION The technique of main nail guide pin placement and temporary fixation under the guidance of auxiliary devices in PFNA internal fixation can achieve faster insertion of the main nail guide pin, accurate temporary fixation to maintain reduction, and avoid the subsequent operation space, so as to improve the effectiveness.
Humans ; Bone Nails ; Male ; Female ; Hip Fractures/surgery* ; Fracture Fixation, Intramedullary/instrumentation* ; Aged ; Prospective Studies ; Operative Time ; Treatment Outcome ; Fracture Fixation, Internal/instrumentation* ; Aged, 80 and over

Objective:To compare the outcomes of ranibizumab and conbercept adjunct for pars plana vitrectomy (PPV) in the treatment of proliferative diabetic retinopathy (PDR).Methods:A prospective randomized case-control study. From June 2022 to December 2023, 90 cases (90 eyes) of PDR patients diagnosed through ophthalmic examination at Department of Ophthalmology of Gansu Provincial Hospital were included in the study. All patients underwent the best corrected visual acuity (BCVA), intraocular pressure, B-mode ultrasound, and optical coherence tomography (OCT) examinations. The central macular thickness (CMT) was measured using an OCT instrument. The patients were randomly divided into a intravitreal injection of ranibizumab group (monoclonal-antibody group) and a intravitreal injection of conbercept group (fusion-protein group) using a random number table method, with 45 cases (45 eyes) in each group. Two groups of patients were intravitreal injected with 10 mg/ml ranibizumab or conbercept 0.05 ml, respectively. A standard 23G PPV was performed through the flat part of the ciliary body 3-7 days after intravitreal injection. Relevant examinations were performed using the same equipments and methods as before surgery at postoperative 1 week, 1, 3, 6, and 12 months. The PPV time, intraoperative use of intraocular electrocoagulation, incidence of iatrogenic retinal breaks, and sterile air or silicone oil tamponade rate in the vitreous cavity, the postoperative changes of BCVA and CMT, and incidence of complications were compared between two groups. Independent sample t test was used for inter group comparison. Results:The intraoperative utilization rate of intraocular electrocoagulation in the monoclonal-antibody group was higher than that in the fusion-protein group, and the difference was statistically significant ( χ2=3.876, P<0.05). There were no statistically significant differences in the PPV time ( t=0.152), intraoperative bleeding rate ( χ2=0.800), incidence of iatrogenic retinal breaks ( χ2=1.975), and sterile air and silicone oil tamponade rate in the vitreous cavity ( χ2=1.607, 1.553) between the two groups ( P>0.05). There were no statistically significant differences in early and late postoperative vitreous hemorrhage ( χ2=1.235, 2.355), and re-PPV ( χ2=2.355) between two groups ( P>0.05). The BCVA of the fusion-protein group was significantly better than that of the monoclonal-antibody group at postoperative 3 months, and the difference was statistically significant ( t=2.428, P<0.05). The CMT of the fusion-protein group was lower than that in the monoclonal-antibody group at postoperative 1 week, and the difference was statistically significant ( t=2.739, P<0.05). None of the patients experienced endophthalmitis, retinal artery occlusion, or severe cardiovascular events after surgery. Conclusion:Compared with intravitreal injection of ranibizumab before PPV, intravitreal injection of conbercept before PPV in PDR patients can shorten the surgical time, reduce intraoperative bleeding rate, lower the rate of electrocoagulation and intraocular tamponade, and incidence of iatrogenic retinal breaks, and improve the visual acuity.

Objective To explore the microsurgical treatment strategies for patients with carotid artery stenosis complicated by tortuosity.Methods A retrospective study was conducted on 9 patients with carotid artery stenosis and tortuosity who underwent microsurgical treatment in the Department of Neurosurgery,the Second People's Hospital of Liaocheng,from June 2019 to August 2023.Patient demographics and clinical data,including sex,age,initial admission diagnosis,clinical symptoms,risk factors for carotid artery stenosis(hypertension,diabetes,hyperlipidemia,smoking,drinking),pre-operative and contralateral vascular imaging were collected.According to the type of vascular tortuosity,three surgical methods were employed:(1)For"C"-shaped tortuosity of the internal carotid artery(ICA),the ICA was divided obliquely at the carotid bifurcation,and eversion carotid endarterectomy was performed.Then ICA was opened longitudinally along its medial side,the common carotid artery(CCA)was extended proximally along its lateral border.The ICA was end-to-side anastomosis anastomosed to the CCA.(2)For coiling of the ICA,the ICA was divided obliquely at the carotid bifurcation and eversion carotid endarterectomy was completed.The redundant segment of the ICA origin was resected,and an end-to-side anastomosis between the ICA and CCA was performed.(3)For cases of kinking of both the ICA and external carotid artery(ECA),or kinking of the CCA,the technique was performed by transection of the CCA,and then eversion carotid endarterectomy was performed,and part of the CCA was resected.After downward mobilization of the ICA and ECA,an end-to-end anastomosis of the CCA was carried out.Postoperatively,all patients underwent neck CT angiography(CTA)and duplex ultrasound examination within 1-3d to assess carotid patency,tortuosity improvement,and hemodynamic changes.Surgical success was defined as residual stenosis ≤30％,improved tortuosity,and no occurrence of stroke within 1-3d after surgery.Postoperative complications,including stroke,myocardial infarction,hoarseness,surgical site bleeding,swelling,and poor wound healing,were also observed.Follow-up carotid ultrasound was performed at 1,6,and 12 months to monitor for restenosis(peak systolic velocity＞220 cm/s or＞70％reduction in vessel diameter).Results Among the 9 patients,4 were males and 5 were females;the age ranged from 61 to 74 years,with an average of(67±4)years.3 cases had asymptomatic severe stenosis,3 cases had symptomatic moderate stenosis,and 3 cases had symptomatic severe stenosis.There were 9 cases of previous hypertension,5 cases of diabetes,6 cases of hyperlipidemia,4 cases of coronary heart disease,5 cases of smoking,and 4 cases of drinking.There were 5 cases of ICA"C"-shaped tortuosity,2 cases of coiling of the ICA,1 case of both ICA and ECA tortuosity,and 1 case CCA tortuosity.All 9 patients successfully underwent surgery.Postoperative neck CTA within 1-3 d demonstrated patency of the operated carotid artery and improvement in vascular tortuosity in all cases,with duplex ultrasound showing favorable hemodynamic status.No postoperative complications were observed.Follow-up at 1,6,and 12 months revealed no restenosis in any of the patients.Conclusions Microsurgical surgery is an effective method for treating carotid artery stenosis complicated by tortuosity.Detailed preoperative evaluation and selection of appropriate surgical techniques are essential.This study is a single-center study with a small sample size,and the findings require further validation through multi-center,large-scale research.

ObjectiveTo explore the common syndrome elements of cerebral ischemic stroke （CIS） complicated with obstructive sleep apnea-hypopnea syndrome （OSAHS）， reveal the characteristics of traditional Chinese medicine （TCM） syndromes of the disease， clarify the syndrome differentiation and syndrome types， provide evidence for clinical syndrome differentiation， and provide reference for establishing the TCM syndrome type standards of CIS complicated with OSAHS. MethodThe clinical information form of CIS complicated with OSAHS formulated by the research group was used for syndrome survey， and the four-examination information of 300 patients with CIS complicated with OSAHS was collected. The four-examination information of patients was analyzed by latent structure method and comprehensive cluster analysis， and the common syndrome elements of CIS complicated with OSAHS were extracted by combining the TCM basic theory and clinical experience. On this basis， the characteristics of TCM syndromes and the syndrome types in line with reality were summarized. ResultThe top five syndrome elements in patients with CIS and OSAHS are sleep snoring， open mouth breathing， physical obesity， night awakening and dizziness. The top five tongue and pulse manifestations are enlarged tongue， slippery pulse， slippery coating， thick and white coating and purple tongue. The disease locations are the lung， spleen， stomach， kidney， liver and brain. The nature of disease includes deficiency， depression， blood stasis， phlegm， dampness and fire. The clinical syndrome types include the syndrome of stagnation of phlegm and dampness， syndrome of phlegm-dampness blocking the mind， syndrome of spleen deficiency with dampness， syndrome of Yin deficiency leading to fire hyperactivity， syndrome of Qi depression blocking collaterals， syndrome of liver depression and blood stasis， syndrome of Qi deficiency with dampness， and syndrome of Yang deficiency induced water retention. ConclusionIn addition to the common phlegm-， dampness- and blood stasis-related syndromes in patients with CIS and OSAHS， there are also depression- and deficiency-related syndromes. The main etiology and pathogenesis is the disturbance of Qi movement. In clinical practice， attention should be paid to the specific situation of individual patients to differentiate between deficiency and excess， and the treatment should be performed by the method of soothing and reinforcing， or unblocking and clearing， or both.

The core of diagnosing and treating diseases in traditional Chinese medicine lies in syndrome differentiation. The eight principles of syndrome differentiation serve as guidance for syndrome differentiation. As one of the eight principles of syndrome differentiation， the differentiation of deficiency and excess is the basic and critical method. Ischemic stroke is currently the leading cause harming the health of Chinese residents. Although the hypotheses about the cause of ischemic stroke have evolved from external wind to the later internal wind and to the modern theory of toxin damaging the brain collaterals， they all believe that this disease is rooted in internal deficiency and external excess. According to available studies， although stroke is characterized by complex pathogenesis and rapid progression of syndromes， the key cause evolution has a regularity， that is， from excess to deficiency. This article analyzes the historical evolution of the etiology， pathogenesis， and syndrome differentiation schemes of stroke. There are diverse schemes for the syndrome differentiation of stroke， which make it difficult to choose in clinical practice. In view of this problem， this paper puts forward a new approach of staging sequential treatment of ischemic stroke based on the differentiation of deficiency and excess according to the evolution law of the key cause of stroke. Furthermore， we conducted a randomized controlled study on 100 patients with ischemic stroke to evaluate this new approach. The results showed that the staging sequential treatment of ischemic stroke based on the differentiation of deficiency and excess demonstrated definite clinical efficacy. In addition， this article reviews the previous research results of our team and the research achievements of other teams to preliminarily explore the relationship between stroke syndromes and biomarkers， aiming to provide an objective basis for unveiling the pathogenesis of stroke. In summary， according to the key cause evolution （from excess to deficiency）， the treatment of ischemic stroke by stages based on differentiation of deficiency and excess can facilitate the rapid intervention and improve the clinical efficacy on ischemic stroke.