Objective:To compare the safety and accuracy between robotic-assisted screw placement and free-hand screw placement in adolescent idiopathic scoliosis (AIS) surgery.Methods:The clinical data of 69 AIS patients underwent posterior spinal scoliosis orthomorphia from December 2021 to October 2023 in Beijing Chaoyang Hospital, Capital Medical University were retrospectively analyzed. Among them, 37 patients underwent robot-assisted screw placement (robot group), and 32 patients underwent fluoroscopy-assisted free-hand screw placement (free-hand group). The basic information of surgery (operation time, intraoperative blood loss, intraoperative radiation exposure time, postoperative hospital stay and postoperative complications), screw placement indexes (single screw placement time and accuracy of screw placement) and imaging indexes (main curve correction rate, kyphotic change and lumbar lordosis change) were compared between two groups. The ln curve regression analysis method was used to evaluate the learning curve of robot-assisted screw placement therapy for AIS.Results:A total of 716 screws were placed in 32 patients of free-hand group, and 766 screws in 37 patients of robot group. The operation time, intraoperative radiation exposure time, single screw placement time and accuracy of screw placement in robot group were significantly higher than those in free-hand group: (272.30 ± 67.98) min vs. (221.66 ± 67.32) min, (149.81 ± 57.21) s vs. (116.03 ± 63.10) s, (497.97 ± 51.74) s vs. (381.47 ± 46.58) s and 97.91% (750/766) vs. 91.48% (655/716), and there were statistical differences ( P<0.01 or <0.05); there were no statistical differences in intraoperative blood loss, postoperative hospital stay, incidence of neurological complications, incidence of incision infection and number of screw between two groups ( P>0.05). There were no statistical differences in the main curve correction rate, kyphotic change and lumbar lordosis change between two groups ( P>0.05). When the fitting degree was the highest ( R2 = 0.729, P<0.01), the fitting equation was y = - 50.93ln x + 634.7 ( x was the number of operation, and y was the single screw placement time), and the number of vertices was 12 cases. The robot group was divided into three subgroups according to the order of surgery, subgroup A consisted of 12 patients who underwent the surgery from first to twelfth, subgroup B consisted of 12 patients who underwent the surgery from thirteenth to twenty-fourth, and subgroup C consisted of 13 patients who underwent the surgery from twenty-fifth to thirty-seventh. Among them, the single screw placement time in subgroup A was significantly longer than that in subgroup B and subgroup C: (560.92 ± 35.03) s vs. (465.75 ± 21.20) and (469.62 ± 24.94) s, and there was statistical difference ( P<0.05); there was no statistical difference between subgroup B and subgroup C ( P>0.05). Conclusions:Robot-assisted screw placement for AIS can effectively improve the accuracy of screw placement without affecting deformity correction, but it can increase screw placement time, operation time and radiation exposure time. A smooth learning curve is obtained after performing 12 procedures.

Objective:To explore the effect of proxy online health information seeking based on theory of planned behavior(TPB) of rural maternal for breast feeding guidance. The aim is to provide a theoretical basis for improving the rate of exclusive breast feeding among rural mothers.Methods:Using a quasi experimental research method and convenience sampling method, the study selected postpartum women and their primary caregivers who gave birth at Maoming Dianbai Maternal and Child Health Care hospital from October 2023 to April 2024 as the research subjects. According to the admission time, 47 parturients and their primary caregiver who gave birth between October and December 2023 were designated as the control group, while 50 parturients and their primary caregiver who gave birth between January and April 2024 were designated as the observation group. The control group received routine breast feeding education, while the observation group received proxy online health information seeking based on TPB breast feeding guidance. Compared the breast feeding knowledge, self-efficacy, family support, as well as the electronic health literacy and breast feeding knowledge of the primary caregivers of two groups of postpartum women.Results:The final control group included 40 maternal and their primary caregivers, while the observation group included 47 each. The maternal age of the control group was (36.73 ± 4.36) years, while that of the observation group was (35.96 ± 3.24) years. The main caregivers for the control group of parturients were 5 males and 35 females, aged 61.00 (59.00, 62.00) years old. There were 8 males and 39 females in the observation group, aged 62.00 (59.00, 64.00) years. After 6 months of intervention, the scores of breast feeding knowledge, self-efficacy, and family support were 14.00(12.00, 16.00), 45.67 ± 9.49, 3.00(3.00, 4.00) in the intervention group, more than those in the control group 7.00(2.00, 10.75), 37.15 ± 8.12, 2.00(2.00, 3.00) points, the differences were statistically significant between the two groups ( Z=-6.55, -5.68, t=-4.45, all P<0.05); the primary caregivers' electronic health literacy and breast feeding knowledge scores were 31.45 ± 4.92 and 14.00 (11.00, 16.00), respectively, higher than those of the control group family members 28.68 ± 4.46 and 4.50 (2.00, 9.75). The differences were statistically significant ( t=-3.38, Z=-7.19, both P<0.05). The pure breast feeding rate at 1 week, 3 months and 6 months postpartum were 70.2%(33/47), 63.8%(30/47), 59.6%(28/47) in the intervention group, more than those in the control group 47.5%(19/40), 37.5%(15/40), 27.5%(11/40), the differences were statistically significant between the two groups ( χ2=4.64, 6.00, 8.99, all P<0.05). Conclusions:Proxy online health information seeking based on TPB can effectively strengthen the health information searching ability of primary caregivers of rural maternal, and help rural maternal improve breastfeeding knowledge, self-efficacy and family support to promote exclusive breast feeding.

Objective:To compare the safety and accuracy between robotic-assisted screw placement and free-hand screw placement in adolescent idiopathic scoliosis (AIS) surgery.Methods:The clinical data of 69 AIS patients underwent posterior spinal scoliosis orthomorphia from December 2021 to October 2023 in Beijing Chaoyang Hospital, Capital Medical University were retrospectively analyzed. Among them, 37 patients underwent robot-assisted screw placement (robot group), and 32 patients underwent fluoroscopy-assisted free-hand screw placement (free-hand group). The basic information of surgery (operation time, intraoperative blood loss, intraoperative radiation exposure time, postoperative hospital stay and postoperative complications), screw placement indexes (single screw placement time and accuracy of screw placement) and imaging indexes (main curve correction rate, kyphotic change and lumbar lordosis change) were compared between two groups. The ln curve regression analysis method was used to evaluate the learning curve of robot-assisted screw placement therapy for AIS.Results:A total of 716 screws were placed in 32 patients of free-hand group, and 766 screws in 37 patients of robot group. The operation time, intraoperative radiation exposure time, single screw placement time and accuracy of screw placement in robot group were significantly higher than those in free-hand group: (272.30 ± 67.98) min vs. (221.66 ± 67.32) min, (149.81 ± 57.21) s vs. (116.03 ± 63.10) s, (497.97 ± 51.74) s vs. (381.47 ± 46.58) s and 97.91% (750/766) vs. 91.48% (655/716), and there were statistical differences ( P<0.01 or <0.05); there were no statistical differences in intraoperative blood loss, postoperative hospital stay, incidence of neurological complications, incidence of incision infection and number of screw between two groups ( P>0.05). There were no statistical differences in the main curve correction rate, kyphotic change and lumbar lordosis change between two groups ( P>0.05). When the fitting degree was the highest ( R2 = 0.729, P<0.01), the fitting equation was y = - 50.93ln x + 634.7 ( x was the number of operation, and y was the single screw placement time), and the number of vertices was 12 cases. The robot group was divided into three subgroups according to the order of surgery, subgroup A consisted of 12 patients who underwent the surgery from first to twelfth, subgroup B consisted of 12 patients who underwent the surgery from thirteenth to twenty-fourth, and subgroup C consisted of 13 patients who underwent the surgery from twenty-fifth to thirty-seventh. Among them, the single screw placement time in subgroup A was significantly longer than that in subgroup B and subgroup C: (560.92 ± 35.03) s vs. (465.75 ± 21.20) and (469.62 ± 24.94) s, and there was statistical difference ( P<0.05); there was no statistical difference between subgroup B and subgroup C ( P>0.05). Conclusions:Robot-assisted screw placement for AIS can effectively improve the accuracy of screw placement without affecting deformity correction, but it can increase screw placement time, operation time and radiation exposure time. A smooth learning curve is obtained after performing 12 procedures.

Objective:To explore the effect of proxy online health information seeking based on theory of planned behavior(TPB) of rural maternal for breast feeding guidance. The aim is to provide a theoretical basis for improving the rate of exclusive breast feeding among rural mothers.Methods:Using a quasi experimental research method and convenience sampling method, the study selected postpartum women and their primary caregivers who gave birth at Maoming Dianbai Maternal and Child Health Care hospital from October 2023 to April 2024 as the research subjects. According to the admission time, 47 parturients and their primary caregiver who gave birth between October and December 2023 were designated as the control group, while 50 parturients and their primary caregiver who gave birth between January and April 2024 were designated as the observation group. The control group received routine breast feeding education, while the observation group received proxy online health information seeking based on TPB breast feeding guidance. Compared the breast feeding knowledge, self-efficacy, family support, as well as the electronic health literacy and breast feeding knowledge of the primary caregivers of two groups of postpartum women.Results:The final control group included 40 maternal and their primary caregivers, while the observation group included 47 each. The maternal age of the control group was (36.73 ± 4.36) years, while that of the observation group was (35.96 ± 3.24) years. The main caregivers for the control group of parturients were 5 males and 35 females, aged 61.00 (59.00, 62.00) years old. There were 8 males and 39 females in the observation group, aged 62.00 (59.00, 64.00) years. After 6 months of intervention, the scores of breast feeding knowledge, self-efficacy, and family support were 14.00(12.00, 16.00), 45.67 ± 9.49, 3.00(3.00, 4.00) in the intervention group, more than those in the control group 7.00(2.00, 10.75), 37.15 ± 8.12, 2.00(2.00, 3.00) points, the differences were statistically significant between the two groups ( Z=-6.55, -5.68, t=-4.45, all P<0.05); the primary caregivers' electronic health literacy and breast feeding knowledge scores were 31.45 ± 4.92 and 14.00 (11.00, 16.00), respectively, higher than those of the control group family members 28.68 ± 4.46 and 4.50 (2.00, 9.75). The differences were statistically significant ( t=-3.38, Z=-7.19, both P<0.05). The pure breast feeding rate at 1 week, 3 months and 6 months postpartum were 70.2%(33/47), 63.8%(30/47), 59.6%(28/47) in the intervention group, more than those in the control group 47.5%(19/40), 37.5%(15/40), 27.5%(11/40), the differences were statistically significant between the two groups ( χ2=4.64, 6.00, 8.99, all P<0.05). Conclusions:Proxy online health information seeking based on TPB can effectively strengthen the health information searching ability of primary caregivers of rural maternal, and help rural maternal improve breastfeeding knowledge, self-efficacy and family support to promote exclusive breast feeding.

Objectives:To investigate the clinical efficacy of unilateral biportal endoscopy (UBE) in the treatment of degenerative lumbar disease (DLD) and its impact on postoperative lumbar stability.Methods:This is a retrospective case series study. A total of 109 cases of DLD treated with UBE in the Department of Orthopaedic, Beijing Chaoyang Hospital Affiliated to Capital Medical University from July 2020 to June 2022 were analyzed retrospectively. There were 47 males and 62 females, aged (53.3±8.2) years (range: 21 to 80 years). The surgical segments were single segment in 80 cases, two segments in 25 cases, and three segments in 4 cases. The low back pain and leg pain of visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI) were evaluated before and after operation. The modified MacNab criteria were used for evaluation of the clinical consequences. Postoperative three-dimensional lumbar CT was performed to observe the preservation of the facet joints and the angle of the medial surface of the facetectomy(β angle). At 12 months after surgery, X ray of the flexion and extension lumbar spine were reviewed. The comparison and analysis of the data were conducted using paired sample t tests or generalized estimation equations. Results:All 109 patients underwent operative procedures successfully. The operation time was (94.5±37.1) minutes (range:56 to 245 minutes), the times of X ray was 6.8±4.0 (range:4 to 16 times), and the days of hospitalization was (5.3±3.7) days (range:4 to 14 days). Complications included dural tears in 4 cases, transient lower limb numbness in 4 cases, epidural hematoma in 2 case. The follow-up time was (19.6±7.2) months (range:12 to 36 months). The postoperative low back pain VAS, leg pain VAS, JOA score and ODI were significantly improved(all P<0.05). According to the modified MacNab criteria, the excellent and good rate was 88.99%(97/109) at 12 months after surgery. One case underwent revision surgery because of recurrent lumbar disc herniation. In term of radiographic evaluation, the area of the surgical side facet joints after UBE surgery was reserved more than 60%. The β angle was less than 90° in all patients. After 12 months of surgery, there was no surgical segment instability or spondylolisthesis by the X-ray of the flexion and extension lumbar spine. Conclusion:UBE can achieve satisfactory clinical efficacy in the treatment of DLD, and maintain the stability of the lumbar spine.

Objectives:To investigate the clinical efficacy of unilateral biportal endoscopy (UBE) in the treatment of degenerative lumbar disease (DLD) and its impact on postoperative lumbar stability.Methods:This is a retrospective case series study. A total of 109 cases of DLD treated with UBE in the Department of Orthopaedic, Beijing Chaoyang Hospital Affiliated to Capital Medical University from July 2020 to June 2022 were analyzed retrospectively. There were 47 males and 62 females, aged (53.3±8.2) years (range: 21 to 80 years). The surgical segments were single segment in 80 cases, two segments in 25 cases, and three segments in 4 cases. The low back pain and leg pain of visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI) were evaluated before and after operation. The modified MacNab criteria were used for evaluation of the clinical consequences. Postoperative three-dimensional lumbar CT was performed to observe the preservation of the facet joints and the angle of the medial surface of the facetectomy(β angle). At 12 months after surgery, X ray of the flexion and extension lumbar spine were reviewed. The comparison and analysis of the data were conducted using paired sample t tests or generalized estimation equations. Results:All 109 patients underwent operative procedures successfully. The operation time was (94.5±37.1) minutes (range:56 to 245 minutes), the times of X ray was 6.8±4.0 (range:4 to 16 times), and the days of hospitalization was (5.3±3.7) days (range:4 to 14 days). Complications included dural tears in 4 cases, transient lower limb numbness in 4 cases, epidural hematoma in 2 case. The follow-up time was (19.6±7.2) months (range:12 to 36 months). The postoperative low back pain VAS, leg pain VAS, JOA score and ODI were significantly improved(all P<0.05). According to the modified MacNab criteria, the excellent and good rate was 88.99%(97/109) at 12 months after surgery. One case underwent revision surgery because of recurrent lumbar disc herniation. In term of radiographic evaluation, the area of the surgical side facet joints after UBE surgery was reserved more than 60%. The β angle was less than 90° in all patients. After 12 months of surgery, there was no surgical segment instability or spondylolisthesis by the X-ray of the flexion and extension lumbar spine. Conclusion:UBE can achieve satisfactory clinical efficacy in the treatment of DLD, and maintain the stability of the lumbar spine.

Objective:To investigate the risk factors for proximal junctional kyphosis (PJK) in adult spinal deformity patients with concomitant osteoporosis undergoing long-segment spinal fusion surgery.Methods:A retrospective analysis was conducted on 76 adults spinal deformity patients with osteoporosis who underwent long-segment spinal fusion surgery at the Department of Orthopaedics, Beijing Chaoyang Hospital, between June 2013 and December 2019. The cohort included 19 males and 57 females, with a mean age of 66.26±6.10 years (range, 54-78 years). Patients were categorized into two groups based on the occurrence of PJK within a 2-year postoperative follow-up: the PJK group (21 cases) and the non-PJK group (55 cases). Comparative analyses were performed on baseline characteristics, surgical details, preoperative and postoperative spinal-pelvic parameters, Hounsfield Units (HU) of the vertebral bodies, and paraspinal muscle morphology between the groups. Spinal-pelvic parameters included the main Cobb angle, lumbar lordosis (LL), lumbosacral lordosis (LSL), sagittal vertical axis (SVA), T 1 pelvic angle (TPA), pelvic tilt (PT), sacral slope (SS), and pelvic incidence (PI). Preoperative CT was used to measure HU values at the upper instrumented vertebra (UIV), UIV+1, and UIV+2. Paraspinal muscle morphology, including the relative functional cross-sectional area (rFCSA) and functional muscle-fat index (FMFI) at the L 4 lower endplate level, was assessed using preoperative MRI. Optimal cutoff values for HU and paraspinal muscle parameters were determined using receiver operating characteristic curve analysis. Multivariable logistic regression was employed to identify independent risk factors for PJK. Results:Significant differences were observed between the PJK and non-PJK groups in preoperative PT (17.60°±8.39° vs. 24.12°±9.37°), postoperative LL (35.61°±10.62° vs. 42.22°±13.11°), LSL (30.24°±10.10° vs. 35.87°±11.12°), and SVA (37.82°±20.46° vs. 21.37°±17.35°). The differences were statistically significant ( P<0.05). The HU values of UIV (113.62±17.25 vs. 133.94±16.61), UIV+1 (123.14±16.03 vs. 138.27±13.69), and UIV+2 (121.00±15.91 vs. 134.47±15.53) were significantly lower in the PJK group ( P<0.05). Optimal cutoff values for HU at UIV, UIV+1, and UIV+2 were identified as 120.72, 127.51, and 121.50, respectively. Significant differences were also found in rFCSA (156.87±48.06 vs. 204.87±50.16) and FMFI (0.31±0.10 vs. 0.23±0.09). The differences were statistically significant( P<0.05), with optimal cutoff values of 175.43 for rFCSA and 0.24 for FMFI. Multivariable logistic regression analysis indicated that postoperative SVA [ OR=1.049, 95% CI (1.003, 1.097), P=0.037], HU of UIV [ OR=0.938, 95% CI (0.887, 0.991), P=0.024], and rFCSA of paraspinal muscles [ OR=0.883, 95% CI (0.792, 0.983), P=0.023] were independent risk factors for PJK. Conclusion:Reduced HU values of the UIV, decreased rFCSA of lumbar paraspinal muscles, and inadequate sagittal alignment correction are independent risk factors for PJK in adult spinal deformity patients with osteoporosis undergoing long-segment spinal fusion surgery.

OBJECTIVE: To review the application status, clinical advantages, and complications of unilateral biportal endoscopy (UBE) technique and explore its future development direction. METHODS: By reviewing recent domestic and international literature, the evolution history of UBE technique, its surgical advantages, and its application effectiveness in various spinal diseases were analyzed, providing a comprehensive review. RESULTS: UBE technique, with its unique dual-channel design, provides a clearer surgical field and more flexible operating space, significantly reduces surgical trauma and postoperative recovery time. UBE technique has demonstrated high safety and effectiveness in the treatment of lumbar disc herniation, spinal stenosis, lumbar instability, and cervical spondylosis. Additionally, the complication incidence of UBE surgery is lower than that of traditional open surgery. CONCLUSION In recent years, UBE technique has shown good clinical application prospects and efficacy, but further technical optimization and large-scale clinical research are still needed to ensure the safety and effectiveness. In the future, the combination of UBE technique and intelligent medical and surgical robotics technology is expected to promote the further development of spinal surgery.
Humans ; Endoscopy/methods* ; Spinal Stenosis/surgery* ; Intervertebral Disc Displacement/surgery* ; Spinal Diseases/surgery* ; Postoperative Complications/prevention & control* ; Lumbar Vertebrae/surgery* ; Treatment Outcome ; Spondylosis/surgery* ; Laparoscopy/methods*

Objective To explore the relationship between positive rate of de novo donor specific antibody (dnDSA ) and human leukocyte antigen (HLA ) mismatch after kidney transplantation and explore the impact of dnDSA upon long-term graft survival and rejection .Methods Retrospective analysis was conducted for clinical data of 101 kidney transplant recipients .Based upon HLA antibody and dnDSA ,they were divided into three groups of HLA-(n=70) ,dnDSA- (n=23) and dnDSA+(n=8) .Rejection and graft survival were recorded for evaluating the impact of dnDSA on rejection and graft survival and observing the differences among all groups .Results The mismatchs of HLA-A/B and HLA-DR were more frequent than HLA-and dnDSA-groups(P=0 .047 , P=0 .010)and graft survival was lower in dnDSA+ group than HLA-and dnDSA-groups (P=0 .001) .The rejection rate was higher in dnDSA+ group (62 .5％ ) than HLA- group (8 .57％ ) and dnDSA-group (8 .69％ ) . The difference was statistically significant (P=0 .013) . Pathological examination indicated microcirculatory inflammation (glomerulonephritis & trichodangiitis ) and damage (multilayer change of capillary basement membrane) occurred frequently in dnDSA + group and C4d remained positive . However ,scar ,arterial fibrosis or tubulointerstitial inflammation was not correlated with dnDSA . Conclusions HLA mismatch is correlated with dnDSA positivity . And dnDSA may reduce graft survival and enhance rejection rate . Rejection mediated by dnDSA is often accompanied by microcirculatory inflammation and C4d positivity .

Objective: To analyze the risk factors of implant-related complications in adult patients with adult degenerative scoliosis (ADS) who underwent long-level internal fixation. Methods: This was a retrospective study that analyzed 99 cases of adult degeneration scoliosis patients who underwent long level posterior pedicle screw fixation in our hospital between June 2013 and January 2016. The internal fixation and related complications were evaluated by measuring and analyzing the radiographic data of the postoperative X-ray films. The timepoints of measurement were pre-operation, before discharge, half a year, 1 year, when complications occur and the final follow-up after operation. Implant-related complications included proximal junctional kyphosis (PJK), proximal junctional failure (PJF), distal junctional kyphosis/failure (DJK/DJF), rod breakage in addition to other radiographic implant-related complications (that were not related to PJF) such as screw loosening, breakage or pullout, or interbody graft and hook or set screw dislodgements seen on follow-up radiographs. The incidence of postoperative implant-related complications was counted. All the cases included in the study were divided into the complication group and the non-complication group. Statistical difference between groups at different follow-up time point was analyzed. Potential risk factors were identified using univariate testing. Multivariate Logistics regression was used to analyze the independent risk factors for implant-related complications. The postoperative functional scores were assessed using the Oswestry Disability Index (ODI), Japanese Orthopaedic Association Scores (JOA), Visual Analogue Scale (VAS), and Lumbar Stiffness Disability Index (LSDI). Functional scores were tested using group t tests. Patients were divided into groups according to PI-LL <10 °, 10°-20 ° and > 20 °. The preoperative and postoperative radiographical parameters and clinical function score among each groupwere compared.The best PI-LL matching value was verified by analyzing the effect of long-segment fusion orthopedics on ADS. Results: Ninety-nine ADS patients who underwent long level posterior fixation were included. The incidence of patients with mechanical complications was 30.3%. Univariate analysis showed that chronic risk factors of postoperative implant-related complications after surgery of ASD included diabetes (OR=3.52, P=0.001) and blood transfusion (OR=2.61, P=0.030); surgical risk factor isosteotomy (OR=4.33, P=0.000); preoperative imaging risk factor was preoperative SVA (OR=1.03, P=0.000); the risk factors for increased risk of the implant-related complications included anemia (OR=1.17, P=0.810), cardiac complications (OR=1.80, P=0.290) and hospital stay (OR=1.11, P=0.110). Independent predictors identified on multivariate Logistics regression modeling included osteotomy (OR=3.05, P=0.032), and preoperative SVA (OR=1.03, P=0.007). The radiographical parameters and clinical function scores of the PI-LL 10°-20° group were better than or partially superior to those of the PI-LL<10° group and the PI-LL>20° group. The postoperative SVA of the PI-LL 10°-20° group was significantly lower than that of the PI-LL<10° group (t=2.399, P=0.020) and the PI-LL>20° group (t=-3.074, P=0.005). The incidence of implant-related complications in the PI-LL 10°-20° group was significantly lower than that in the PI-LL<10° group (t=1.584, P=0.003). Survival analysis showed that the PI-LL 10°-20° group was significantly better than the PI-LL<10° group (χ²=7.782, P=0.005), while the PI-LL 10°-20° group had better survival than PI-LL>20° group, althoughthatwas not statistically significant (χ²=2.542, P=0.111). Conclusion Risk factors of postoperative implant-related complications after surgery of ASD included osteotomy and preoperative SVA. Patients with one or more of these risk factors should be informed of the risk increase with informed consent. Patients with PI-LL between 10 ° and 20 ° had better postoperative radiographical parameters and clinical functional scores. They should be optimized preoperatively and followed up closely during the postoperative period.