Objective:To evaluate the perioperative application effect of enhanced recovery after surgery (ERAS) clinical pathway in percutaneous vertebro plasty (PVP).Methods:The clinical data of 274 patients who underwent PVP treatment for osteoporotic vertebral compression fracture (OVCF) in Beijing Friendship Hospital, Capital Medical University from May 2023 to August 2024 were retrospectively analyzed. The patients were divided into two groups according to the different numbers of surgical segments: the single-segment group ( n=211) and the multisegment group ( n=63). Patients in the single-segment group underwent single-segment surgery, while patients in the multisegment group underwent surgery on ≥2 segments. The core points of the ERAS clinical pathway adopted in this study include perioperative education, pain management, early mobilization, application of "outfast", and joint guidance from the departments of nutrition and rehabilitation. Comparison was made between the two groups of patients in terms of visual analog scale (VAS) scores for low back pain at preoperative, 2 h, 6 h, 24 h postoperatively, and on the day of discharge; Oswestry disability index (ODI) scores preoperatively and on the day of discharge; time to first ambulation postoperatively, total length of hospital stay, postoperative length of stay, perioperative complications, and perioperative application of Opioid consumption. Measurement data were expressed as mean±standard deviation ( ± s), and the independent sample t-test was used for comparison between groups; count data were expressed as cases and percentage, and the Chi-square test was used for comparison between groups. The VAS pain scores at each stage of the perioperative period were evaluated using repeated measures analysis of variance or generalized estimating equations. Results:Compared with that before the operation [(6.17±0.93) points, (6.29±0.83) points], the VAS scores of low back pain of patients in the single-segment group and the multisegment group at 2 hours after surgery [(3.09±0.82) points, (3.27±0.65) points], 6 hours after surgery [(2.60±0.79) points, (2.62±0.55) points], and 24 hours after surgery [(1.89±0.77) points, (1.97±0.72) points] and on the day of discharge [(1.72±0.71) points, (1.81±0.64) points] were significantly decreased, and the differences were statistically significant ( P<0.05). At the same stage, the VAS scores of low back pain in both groups were not statistically significant ( P>0.05). The ODI scores of patients in the single-segment group and the multisegment group on the day of discharge [(24.21±2.35) points, (24.63±3.31) points] were significantly lower than those before the operation [(64.50±4.81) points, (65.52±4.08) points], and the differences were statistically significant ( P<0.05). There were no statistically significant differences in perioperative complications and the proportion of Opioid drug application between the two groups of patients ( P>0.05). Conclusion:For patients with single-segment or multisegment OVCF, PVP surgical treatment under ERAS clinical pathway management can achieve immediate pain relief, early ambulation exercise, and satisfactory perioperative efficacy.

Objective:To evaluate preoperative malnutrition risk in patients with osteoporotic vertebral compression fracture (OVCF) based on mini nutritional assessment short form (MNA-SF) and analyze the related clinical risk factors.Methods:A cross-sectional study was conducted using clinical data from 129 OVCF patients who underwent percutaneous vertebroplasty at Beijing Friendship Hospital, Capital Medical University, between May 2023 and December 2023. The cohort included 26 males and 103 females, aged (74.71±9.13) years(ranging from 48-98 years). According to MNA-SF scoring method, they were divided into three groups, the malnutrition group ( n=6), the nutritional risk group ( n=40), and the good nutrition group ( n=83). Nutritional risk and malnutrition rates were evaluated using the MNA-SF score. Measurement data with normal distribution were expressed as mean±standard deviation ( ± s) and compared using one-way ANOVA. The comparison between groups of count data was conducted using chi-square test. Univariate analysis and multivariate logistic regression were performed to identify independent risk factors for malnutrition and nutritional risk. Results:According to the MNA-SF score, among 129 patients, the malnutrition rate was 4.7%, the nutritional risk rate was 31.0%, and 64.3% exhibited adequate nutrition based on MNA-SF scores. The results of one-way ANOVA showed that gender ( P=0.023) and BMI ( P<0.001) were significantly correlated with malnutrition and nutritional risk; Logistic regression analysis suggested that the influencing factors of nutritional risk included gender ( P=0.002) and BMI ( P<0.001), while the only dangerous factor of malnutrition was BMI ( P<0.001). Conclusions:Bsed on MNA-SF, OVCF patients undergoing percutaneous vertebroplasty have a higher incidence of malnutrition and nutritional risk. The risk factors for nutritional risk in patients are gender and BMI, while the risk factor for malnutrition is only BMI.

Objective:To explore the risk factors of cement leakage into the spinal canal in percutaneous vertebroplasty (PVP) for spinal metastases.Methods:A retrospective analysis was conducted on the case data of 211 patients with spinal metastases who underwent PVP in the Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University from January 2016 to June 2024. According to the presence or absence of intraspinal bone cement leakage after surgery, the patients were divided into the leakage group ( n=45) and the non-leakage group ( n=166). The clinical data of the two groups, including gender, age, bone mineral density T-score, American Society of Anesthesiologists (ASA) classification, operation time, and bone cement injection volume, were collected and statistically analyzed. Measurement data were expressed as mean±standard deviation ( ± s), and the independent samples t-test was used for comparison between groups; count data were expressed as the number of cases and percentage, and the Chi-square test was used for comparison between groups. Univariate analysis was used to explore the possible risk factors for intraspinal bone cement leakage after PVP, and then the indicators with statistically significant differences in the univariate analysis were included in the multivariate Logistic regression analysis to identify the independent risk factors. Results:A total of 45 patients out of 211 patients with PVP surgery had cement leakage into the spinal canal after surgery, with an incidence rate of 21.3%. There were statistically significant differences between the leakage group and the non-leakage group in terms of whether the posterior wall of the vertebral body was broken, operation time, the injection volume of bone cement, distribution of injured vertebrae, and viscosity of bone cement ( P<0.05). The results of multivariate Logistic regression analysis showed that the broken posterior wall of the vertebral body, large injection volume of bone cement, and low viscosity of bone cement were the independent risk factors for the occurrence of cement leakage into the spinal canal in PVP for spinal metastases ( P<0.05). Conclusion:When PVP surgery is used to treat spinal metastases, broken posterior wall of the vertebral body, large injection volume of bone cement, and low viscosity of bone cement can increase the incidence of postoperative intravertebral cement leakage, and the operation should be performed with caution.

Objective:To explore the impact of different preoperative fluid supplementation methods (oral multidimensional carbohydrates and conventional fluid supplementation) on early postoperative recovery and pain management in patients undergoing unilateral biportal endoscopic (UBE) spine surgery.Methods:A retrospective cohort study was conducted to analyze the data of 386 patients who underwent UBE lumbar spine surgery under general anesthesia in the two courtyards of Beijing Friendship Hospital Affiliated to Capital Medical University from May 2023 to April 2024. All patients were divided into oral multidimensional carbohydrates ( "Outfast" supplementation, composed mainly of water, sugars, salts, and vitamins) group (referred to as oral "Outfast" group, 189 patients) and conventional fluid supplementation group (197 patients) according to the type of fluid replenishment. Patients in the oral "Outfast" group were given one oral dose in the morning of the first surgery, and another oral infusion before 10∶00 in the morning of the next surgery or afternoon surgery. Patients in the conventional fluid supplementation group received intravenous infusion in the morning of the first surgery, and were given intravenous infusion of glucose and sodium chloride injection in the morning of the next surgery or afternoon surgery. The two groups were compared for the proportion of patients receiving preoperative intravenous fluids on the day of surgery, intraoperative and postoperative fluid volumes, average daily fluid volumes over the first three postoperative days, time to first postoperative ambulation, time to first bowel movement, post-anesthesia care unit (PACU) stay duration, 4-hour and 24-hour postoperative visual analog scale (VAS) pain scores, incidence of anesthesia-related adverse reactions, and incidence of severe gastrointestinal adverse reactions. The measurement data of normal distribution were expressed as mean±standard deviation ( ± s), and t-test was used for inter-group comparison. The measurement data of skewed distribution were expressed as M ( Q1, Q3) and rank sum test was used for inter-group comparison. Count data was presented in terms of examples and percentages, and a chi-square test was used for comparison between two groups. Results:In the oral "Outfast" group, 8 patients (4.2%) received preoperative intravenous fluids on the day of surgery, compared to 136 patients (69.0%) in the conventional fluid supplementation group, showing a significant difference ( P<0.001). The postoperative fluid volumes, average daily fluid volumes over the first three postoperative days, and shorter time to first ambulation in the oral multidimensional carbohydrates group were 700.0(600.0, 1 100.0) mL, 200.0(200.0, 300.0) mL, and 6.0(6.0, 11.0) h, respectively. The conventional fluid supplementation group was 1 100.0(700.0, 1 200.0) mL, 600.0(500.0, 700.0) mL, and 12.0(6.0, 19.0) h, respectively. The oral "Outfast" group was lower than the conventional fluid supplementation group ( P<0.001).There were no significant differences between the two groups in intraoperative fluid volumes, time to first bowel movement, PACU stay duration, 4-hour and 24-hour VAS pain scores, incidence of anesthesia-related adverse reactions, or incidence of severe gastrointestinal adverse reactions ( P>0.05). Conclusions:Preoperative oral multidimensional carbohydrates supplementation effectively reduces the amount of preoperative and postoperative intravenous fluid required, shortens the time to first ambulation. Preoperative oral multidimensional carbohydrates is safe and does not adversely impact gastrointestinal reactions or pain management in the postoperative period.

Objective:To investigate the efficacy and safety of ropivacaine combined with betamethasone in the treatment of early neurogenicin pain after unilateral biportal endoscopy (UBE) surgery.Methods:A retrospective case-control study was conducted on a total of 179 patients with lumbar degenerative diseases who underwent unilateral biportal endoscopic spine surgery in the orthopedic department of Beijing Friendship Hospital Affiliated to Capital Medical University from March 2020 to January 2024. The observation group ( n=82) and the control group ( n=97) were divided according to whether or not drugs were injected locally into the nerve root during the operation; the injected drug in the observation group was a mixture of ropivacaine and betamethasone, and no drugs were injected locally in the control group.General information such as gender, age, and body mass index of patients in both groups were recorded. Additionally, VAS scores for lower extremity pain at various time points after surgery (12 h, 24 h, 48 h post-operation), clinical efficacy, and related complications were documented. Peripheral blood leukocytes and fasting blood glucose levels were monitored during the perioperative period.Normally distributed measures were expressed as mean±standard deviation( ± s), and t-test was used for comparison between groups, while non-normally distributed measures were expressed as M( Q1, Q3), and rank sum test was used for comparison between groups. The chi-square test was used to compare the count data between groups. Results:All patients underwent surgical procedures without any complications. In comparison to their preoperative condition, patients were monitored at various intervals post-surgery, revealing a notable decline in VAS scores for lower extremity pain in both patient groups ( P<0.05). The VAS scores for lower limb pain at 12 and 24 hours after surgery in the observation group were(2.57±1.19)scores and(1.83±0.86)scores, respectively, compared with (3.43±1.68) scores and (3.14±1.49) scores in the control group, which were significantly lower in the observation group compared with the control group, and the difference was statistically significant in the comparison between the two groups ( P<0.05). Nevertheless, by 48 hours after surgery, the VAS scores for lower extremity pain were comparable between the two groups, showing no significant variation ( P>0.05). Following three months after surgery, we conducted a thorough assessment of surgical outcomes utilizing the Fischgrund evaluation criteria. The findings indicated that the observation group achieved a commendable rate of 90.2%, whereas the control group attained a good rate of 88.7%. Despite the disparity between the two groups, further statistical examination disclosed that this difference lacked statistical significance ( P>0.05). Additionally, there were no noteworthy statistical disparities in the occurrence of complications, including nerve damage, dural tears, or epidural hematomas, between the two groups ( P>0.05). The peripheral blood leukocyte count in the observation group was (10.58±2.68)×10 9/L and fasting blood glucose was (9.51±1.93) mmol/L, compared with (6.97±2.19)×10 9/L and (6.87±1.76) mmol/L in the preoperative period and (6.89±2.24)×10 9/L and (6.68±1.84) mmol/L in the control group, respectively. The observation group was significantly higher compared to the preoperative and control groups, and the difference was statistically significant ( P<0.05). Conclusion:Local injection of a mixture of ropivacaine and betamethasone during lumbar UBE surgery is clinically effective in relieving neurogenic pain in the early postoperative period, and did not increase perioperative complications, but had some effect on peripheral blood leukocyte counts and blood glucose.

OBJECTIVE To establish the correlation evaluation and quality evaluation method of HPLC fingerprint grade of color sorting Lonicerae Japonicae Flos, and provide technical basis for the grade standard of color sorting Lonicerae Japonicae Flos. METHODS The chromatographic column was SVEA C18(250 mm×4.6 mm, 5 μm); mobile phase was acetonitrile(A)- 0.2% formic acid aqueous solution(B); gradient elution; injection volume was 10 μL; detection wave length was 245 nm; volume flow rate was 0.5 mL·min-1; column temperature was 38 ℃. The common peak determination and similarity evaluation of HPLC chromatogram data were carried out by using the Similarity Evaluation System of Traditional Chinese Medicine Chromatographic Fingerprints(Version 2012); the color sorting grade evaluation was carried out by CA, PCA and PLS-DA. The first part of Chinese Pharmacopoeia 2020 Edition was used to measure the quality control indicators, and the data were analyzed comprehensively. RESULTS A total of 28 common peaks were identified in the fingerprints, and 7 components were identified. The similarity of 24 batches of color sorting grade samples was 0.936-0.968. CA and PCA divided 28 batches of Lonicerae Japonicae Flos samples into 4 categories, which were basically consistent with the classification of color sorting, and PLS-DA achieved a discrimination result that was very consistent with the classification of color sorting. The color sorting grade was negatively correlated with the diameter, flowering rate, damage rate, and luteolin content of Lonicerae Japonicae Flos. The color sorting grade was positively correlated with chlorogenic acid, 3,5-di-O-caffeoyl quinic acid and 4,5-di-O-caffeoyl quinic acid. There was a clear correlation between the color sorting of Lonicerae Japonicae Flos and established fingerprint overall. There were differences in the quality of Lonicerae Japonicae Flos in the color sorting grade. Based on the sensory indicators of diameter, flowering rate, and damage rate, the content, diameter, flowering rate, and damage rate of luteolin showed a trend from high to low, ranging from third grade>second grade>first grade>special grade. The content of three phenolic acids showed a trend from high to low, ranging from special grade>first grade>second grade>third grade. Among the special grade, the content of three phenolic acids was the highest. CONCLUSION Combining the content of luteolin and phenolic acids as evaluation and control indicators for color selection grade is feasible and scientific, which can achieve intelligent color sorting grade production of Lonicerae Japonicae Flos grade.