1.Trends in disease burden due to childhood asthma from 1990 to 2021 and future projections in China
Chinese Journal of School Health 2025;46(4):573-578
Objective:
To investigate the trends in disease burden due to childhood asthma in China from 1990 to 2021 and to project the disease burden from 2022 to 2035, so as to provide insights into formulation of the control interventions for childhood asthma in China.
Methods:
The prevalent case, agestandard prevalence, disability-adjusted life years (DALYs) and agestandard DALYs rate of children with asthma at ages of 0 to 14 years and their 95% uncertainty interval (UI) in China from 1990 to 2021 were extracted from the Global Burden of Disease (GBD) database. The temporal trends in the disease burden of childhood asthma were evaluated with estimated annual percentage change (EAPC) and its 95% confidence interval (CI), and the disease burden due to asthma was projected among children at ages of 0 to 14 years in China using a Bayesian age-period-cohort (BAPC) model from 2022 to 2035.
Results:
There were 9.368 3 million (95%UI=6.410 7 million to 14.026 1 million) prevalent cases of asthma among children at ages of 0 to 14 years in China in 2021, contributing to 0.387 9 million (95%UI=0.216 1 million to 0.668 8 million) DALYs loss. The prevalent cases and DALYs of asthma decreased by 37.28% and 52.55% among children at ages of 0 to 14 years in China in 2021 compared with 1990, and the agestandardized prevalence [EAPC=-0.70%, 95%CI=-1.26% to -0.13%)] and DALY rates [EAPC=-1.71%, 95%CI=-2.32% to -1.10%)] also appeared a tendency towards a decline. From 1990 to 2021, the prevalent cases, prevalence, DALYs and DALYs rate of asthma were all higher among male children than among female children, and the disease burden of asthma was higher among children at ages of 5 to 9 years than at other age groups. BAPC model predicted a decline in both prevalent cases and DALYs of asthma among children at ages of 0 to 14 years in China from 2022 to 2035, with 6.759 6 million prevalent cases and DALYs of 0.228 4 million personyears in 2035, while the prevalence and DALYs rates were projected to rise to 5 143.35/105 and 173.75/105 in 2035.
Conclusions
Despite a reduction in the disease burden of asthma among children at ages of 0 to 14 years in China from 1990 to 2021, the prevalence remained high. The disease burden due to asthma is projected to appear a decline among children at ages of 0 to 14 years in China from 2022 to 2035; however, the prevalence and DALYs rates still rise. Intensified control measures and targeted interventions are required to reduce the disease burden of childhood asthma.
2.Trends in burdens of dengue fever among children aged 0-14 years in China from 1990 to 2021:findings from the Global Burden of Disease Study 2021,and projections up to 2035
Tao LUQIU ; Zou YANZHENG ; Liu TAO ; Tan GAO ; Sun LI ; Liu XIAOLI ; Wang WEI
Global Health Journal 2025;9(2):145-152
Objective:Children below 14 years of age are highly vulnerable to dengue infection and are at a greater risk of developing severe dengue illness.This study aimed to investigate the trends in the burden of dengue fever among children below 14 years of age in China from 1990 to 2021 and to project the disease burden from 2022 to 2035.Methods:Based on the datasets derived from the Global Burden of Disease Study 2021,the following data were collected from dengue-affected children aged ≤14 years in China from 1990 to 2021:number and rate of incident dengue cases,number of prevalent dengue cases,number of deaths due to dengue,and disability-adjusted life years(DALYs)lost due to dengue.The trends in disease burden were examined based on average annual percent change(AAPC)and annual percent change,and the burdens were projected from 2022 to 2035 by using a Bayesian age-period-cohort model.Results:The incidence and prevalence of dengue fever were increased in children aged ≤14 years in China from 1990 to 2021(AAPC=5.42%and 5.44%,respectively,P<0.001),while the mortality and DALYs rates were reduced(AAPC=-8.21%and-7.55%,respectively,P<0.001).The burden was comparable between genders,with numerically lower incidence and prevalence in boys than in girls.The lowest incidence and prevalence and the highest mortality and DALYs rates were observed in children aged<5 years.The incidence and prevalence rates were projected to increase from 2022 to 2035;in contrast,the mortality and DALYs rates were projected to decrease during this period.Conclusions:Although the mortality and DALYs rates of dengue fever decreased significantly in children aged 0-14 years in China from 1990 to 2021,the incidence and prevalence increased remarkably.Enhanced surveil-lance and ample health education programs and preventive interventions are recommended for targeting this high-risk population.
3.Safety study of navigation-assisted medial “in-out-in” technique in C 2 screw fixation
Jia SHAO ; Yanzheng GAO ; Kun GAO ; Kezheng MAO ; Xiuru ZHANG
Chinese Journal of Surgery 2025;63(12):1146-1155
Objective:To evaluate the safety and clinical efficacy of the navigation-assisted medial “in-out-in” technique in C 2 pedicle screw fixation. Methods:This study is a retrospective cohort study. The clinical data of 68 patients with high-riding vertebral arteries of the axis who underwent C 2 pedicle screw implantation using the medial “in-out-in” technique in the Department of Spinal Surgery, Henan Provincial People′s Hospital from August 2020 to July 2023 were retrospectively analyzed. There were 32 males and 36 females, with an age of (56.9±10.2) years (range: 35 to 78 years). Among them, 36 patients underwent navigation-assisted medial “in-out-in” technique for C 2 pedicle screw implantation and were included in the navigation group; 32 patients received freehand screw placement and were included in the freehand group. The operative time, intraoperative blood loss, postoperative maximum pedicle-screw distance (PSD max), bone graft fusion time, fusion rate, and occurrence of internal fixation-related complications were recorded and compared between the two groups. The spinal cord cross-sectional area (SSC) was measured before surgery and at 1 week after surgery. The atlanto-dental interval (ADI), clivus-canal angle (CCA), and Japanese Orthopaedic Association (JOA) score were evaluated before surgery, at 1 week, 3 months, 1 year after surgery, and at the final follow-up. Independent sample t-test, repeated measures analysis of variance, paired t-test, χ2 test, or Fisher′s exact test were used for data comparison. Results:Six patients with reduction blocked by atlanto-dental osteophytes first underwent anterior cervical atlanto-dental arthroplasty, followed by posterior surgery in the prone position, while the remaining 62 patients underwent posterior reduction and internal fixation. All 36 patients in the navigation group successfully completed C 2 medial “in-out-in” screw implantation, including 34 cases with unilateral medial ”in-out-in” screw implantation and 2 cases with bilateral implantation. In the freehand group, 28 cases completed medial “in-out-in” screw implantation, with 4 cases (12.5%) of implantation failure; the implantation failure rate in the navigation group was lower than that in the freehand group ( χ 2=5.027, P=0.025). The posterior surgical time in the navigation group was shorter than that in the freehand group ((158.1±25.7) minutes vs. (176.4±27.6) minutes, t=2.829, P=0.006), while there was no statistically significant difference in intraoperative blood loss during posterior surgery between the two groups ((217.5±62.2) ml vs. (212.7±53.2) ml, t=0.340, P=0.735). There was no significant change in SSC before and after surgery in both groups (all P>0.05). The postoperative JOA scores, ADI, and CCA in both the navigation group and the freehand group were significantly improved compared with those before surgery (all P<0.01), and there were no differences between the two groups (all P>0.05). The postoperative PSD max was (4.7±0.9) mm and the bone graft fusion time was (4.9±1.3) months in the navigation group, compared with (4.8±0.5) mm and (4.9±1.7) months in the freehand group, respectively; there were no statistically significant differences between the two groups (all P>0.05). During pedicle preparation, 1 case (2.8%) in the navigation group and 3 cases (9.4%) in the freehand group developed cerebrospinal fluid leakage due to dural puncture by the hand drill. One patient in the freehand group developed symptomatic cerebral infarction postoperatively, presenting with dysarthria, which recovered after medical treatment. There was no significant difference in the incidence of cerebrospinal fluid leakage or vertebral artery injury between the two groups. Conclusion:The navigation-assisted medial “in-out-in” technique enables safe and rapid implantation of three-column fixation screws in patients with high-riding vertebral arteries of the axis, with high accuracy in screw placement and satisfactory clinical outcomes.
4.Efficacy of occipitocervical fusion with the occipital screw-rod-multiaxial screw internal fixation system in the treatment of"sandwich"deformity with atlantoaxial dislocation
Yunpeng HAN ; Jia SHAO ; Yanzheng GAO
Chinese Journal of Spine and Spinal Cord 2025;35(5):449-458
Objectives:To investigate the clinical efficacy of occipitocervical fusion with the occipital screw-rod-multiaxial screw internal fixation system in treating"sandwich"deformity with atlantoaxial disloca tion.Methods:A retrospective analysis was conducted on 62 patients who underwent posterior reduction,bone graft fusion,and occipitocervical internal fixation for"sandwich"deformity with atlantoaxial dislocation from January 2017 to January 2023.There were 19 males and 43 females,aged 51.1±23.5 years(29-72 years).The patients were divided into two groups based on the different fixation methods of the occipital screws used in the two types of occipitocervical internal fixation systems:group A of 38 patients utilized the occipital screw-rod-multiaxial screw system,consisting of 12 males and 26 females,aged 50.9±24.8 years(29-72 years),and the imaging findings revealed brainstem or cervical spinal cord compression in 30 cases,syringomyelia in 6 cases,and Chiari malformation in 2 cases;And group B of 24 cases utilized the occipital plate-rod-multiaxial screw system,consisting of 7 males and 17 females,aged 51.4±22.4 years(32-69 years),and the imaging findings revealed brainstem or cervical spinal cord compression in 16 cases,syringomyelia in 6 cases,and Chiari malformation in 2 cases.Group A was followed up for 36.5±11.8 months and Group B was followed up for 36.1±9.8 months.No statistically significant differences were observed between the two groups in terms of age,sex,imaging findings,or surgery style(P>0.05).A comparison was performed between the groups regarding intraoperative blood loss,operative time,follow-up period,and complication rates.Clini-cal outcomes were evaluated preoperatively and at the final follow-up using the neck pain visual analog scale(VAS)score,neck disability index(NDI),and Japanese Orthopaedic Association(JOA)score.The cross-sectional and sagittal bone fusion area of the graft site,atlantodental interval(ADI),space available for cord(SAC),clivus canal angle(CCA),and cervico-medullary angle(CMA)were measured preoperatively,1 week postoperatively,and at the final follow-up in both groups.Results:Group A and group B weren't significantly different in intraoperative blood loss(362.4±89.1mL vs 345.1±93.8mL,P>0.05)and operative time(144.8±35.6min vs 143.7±36.2min,P>0.05).In group B,rod fractures occurred in 2 cases and loss of reduction was observed in 3 cases,whereas the remaining patients maintained stable screw-rod fixation.Neither group experienced severe complications such as spinal cord injury or cerebrospinal fluid leakage.Both groups demonstrated statistically significant differences between preoperative NDI,VAS,JOA scores and those measured at the final follow-up(P<0.05),while no statistically significant differences existed between the two groups at the same time points(P>0.05).Statistically significant differences were observed between preoperative and postoperative(1-week and final follow-up)measurements for ADI,SAC,CCA and CMA in both groups(P<0.05),while no significant in-tergroup differences were found at corresponding time points(P>0.05).In group A,the cross-sectional area and the sagittal area of the graft site were 385.44±84.51mm2 and 290.28±1 10.41mm2 in postoperative 1 week,and 267.06±66.13mm2 and 204.54±83.85mm2 at the final follow-up;which in group B were 442.61±76.85mm2 and 267.21±104.63mm2 in postoperative 1 week,and 172.43±37.37mm2 and 124.87±48.10mm2 at final follow-up.Comparisons between groups revealed no statistically significant differences in either cross-sectional or sagittal graft areas at 1 week postoperatively(P>0.05),however,significant differences were observed at the final fol-low-up(P<0.05)for both parameters between the two groups.Conclusions:The occipital screw-rod-multiaxial screw internal fixation system presents comparable restoration effects to the occipital plate-rod-multiaxial screw system in treating"sandwich"deformity with atlantoaxial dislocation.It exhibits satisfactory implant fusion postoperatively and achieves reliable occipitocervical fixation.
5.Discussion on the implementation effect of the integrated traditional Chinese and western medicine DRG payment model in traditional Chinese medicine hospitals
Xiuling GAO ; Zhitao LIU ; Xiaomin JIANG ; Shantao ZHANG ; Jihu ZHONG ; Ruwei ZHANG ; Jiyuan SHI ; Peng QI ; Yanzheng QU
Modern Hospital 2025;25(6):910-912,916
Objective To explore and analyze the implementation effect of the combined traditional Chinese medicine(TCM)and Western medicine DRG payment model in TCM hospitals,aiming to provide a reference for the reform of medical in-surance payment methods in such hospitals.Methods R language was utilized to statistically analyze the costs and other indica-tors of the sample hospitals before and after the implementation of the combined TCM and Western medicine DRG payment within 1-2 years.Results Following the implementation of the combined TCM and Western medicine DRG payment,there was a de-crease in average hospitalization costs and average length of stay,accompanied by an increase in CMI(average weight).The cost structure underwent changes:the proportions of western medicine fees and auxiliary examination fees decreased,whereas the pro-portion of TCM treatment fees increased.Significant statistical differences were observed in each group of data(p<2.2e-16).Conclusion The combined TCM and Western medicine DRG payment reform model can facilitate TCM hospitals in reducing medical costs,controlling medical expenses,optimizing the cost structure,and promoting the development of TCM diagnosis and treatment characteristics.
6.Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture-dislocation in adults (version 2025)
Qingde WANG ; Tongwei CHU ; Jian DONG ; Liangjie DU ; Haoyu FENG ; Shunwu FAN ; Shiqing FENG ; Yanzheng GAO ; Yong HAI ; Da HE ; Dianming JIANG ; Jianyuan JIANG ; Bin LIN ; Bin LIU ; Baoge LIU ; Fang LI ; Feng LI ; Li LI ; Weishi LI ; Fangcai LI ; Xiaoguang LIU ; Hongjian LIU ; Yong LIU ; Zhongjun LIU ; Shibao LU ; Xuhua LU ; Keya MAO ; Xuexiao MA ; Yong QIU ; Limin RONG ; Jun SHU ; Yueming SONG ; Tiansheng SUN ; Yan WANG ; Zhe WANG ; Zheng WANG ; Bing WANG ; Linfeng WANG ; Yu WANG ; Qinghe WANG ; Jigong WU ; Hong XIA ; Guoyong YIN ; Jinglong YAN ; Wen YUAN ; Yong YANG ; Qiang YANG ; Cao YANG ; Jie ZHAO ; Jianguo ZHANG ; Yue ZHU ; Zezhang ZHU ; Yingjie ZHOU ; Zhongmin ZHANG ; Yan ZENG ; Dingjun HAO ; Baorong HE ; Wei MEI
Chinese Journal of Trauma 2025;41(3):243-252
Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.
7.Robot system-assisted versus freehand screw revision for ankylosing spondylitis with lower cervical fractures: a multicenter retrospective study
Shuai LI ; Jiaojiao BAI ; Baorong HE ; Yanzheng GAO ; Wei MEI ; Xinyu LIU ; Yue ZHU ; Qingda LI ; Yukuan LEI ; Lei ZHU ; Zhigang ZHAO ; Yunfei HUANG ; Jinpeng DU ; Mingzhe FENG ; Ningbo CHEN ; Yansheng HUANG ; Xuefang ZHANG ; Zhen CHANG
Chinese Journal of Trauma 2025;41(5):440-448
Objective:To compare the efficacy of robot system-assisted versus freehand screw revision for ankylosing spondylitis (AS) with lower cervical fractures.Methods:A multicenter retrospective cohort study was conducted to analyze the clinical data of 57 patients with AS combined with lower cervical fractures admitted to Honghui Hospital Affiliated to Xi'an Jiaotong University School of Medicine, Henan Provincial People's Hospital, Zhengzhou Orthopedic Hospital, and Qilu Hospital of Shandong University, including 46 males and 11 females, aged 38-77 years [(65.4±9.5)years]. Injury segments involved C 3 in 7 patients, C 4 in 13, C 5 in 25, C 6 in 10, and C 7 in 2. All the patients underwent revision surgery, among whom, 22 patients were treated with robot system-assisted cervical pedicle screw placement (robot nailing group, with 190 screws), and 35 with freehand cervical pedicle screw placement (freehand nailing group, with 300 screws). The operative duration, intraoperative bleeding volume, frequency of intraoperative fluoroscopy, incision length, and length of hospital stay of the two groups were compared; the time of single nscrew insertion, the number of single nail revisions, the distance between screws and the anterior cortex, the accuracy of screw placement of grade 0 and grade 0+1 were recorded in the two groups. The visual analogue scale (VAS), Japanese Orthopedic Society (JOA) score, neck dysfunction index (NDI), American Spine Injury Association (ASIA) classification before operation, at 3 days, 3 months after operation and at the last follow-up were compared between the two groups. The complication rate was also noted. Results:All the patients were followed up for 12-16 months [(14.3±2.1)months]. The operative duration, intraoperative bleeding volume, and frequency of intraoperative fluoroscopy were (186.4±12.9)minutes, (486.1±68.6)ml, and (3.4±1.3)times in the robot nailing group, which were shorter or less than (206.7±14.4)minutes, (660.3±45.2)ml, and (13.5±3.6)times in the freehand nailing group ( P<0.01). The incision length was (9.4±2.4)cm in the robot nailing group, longer than (5.6±1.2)cm in the freehand nailing group ( P<0.01), and the length of hospital stay was (3.7±0.4)days, shorter than (4.4±1.4)days in the freehand nailing group ( P<0.01). The length of single nail insertion, the number of single nail revision, and the distance between the screws and the front cortex were (6.5±0.4)minutes, (1.1±0.1)times, and (3.5±1.3)mm in the robot nailing group, which were shorter or less than (11.6±0.2)minutes, (1.5±0.2)times, and (12.4±4.7)mm in the freehand nailing group ( P<0.01). The accuracy of the screw placement in the robot nailing group was 90.0% (171/190) and 95.8% (182/190) with level 0 and 0+1 screws, better than 80.0% (240/300) and 89.0% (267/300) in the freehand nailing group ( P<0.05). There was no significant difference in VAS, JOA score, NDI, or ASIA grading between the two groups before operation ( P>0.05). The VAS, JOA, and NDI scores at 3 days after operation were (3.1±0.6)points, (12.1±1.2)points, and (15.6±2.9)points, respectively in the robot nailing group, which were better than (5.0±1.4)points, (11.3±1.1)points and (22.5±3.7)points, respectively in the freehand nailing group ( P<0.05). No statistically significant difference was observed in the ASIA grade between the two groups at 3 days after operation ( P>0.05). There were no significant differences in VAS, JOA, NDI scores, or ASIA grading between the two groups at 3 months after operation and at the last follow-up ( P>0.05). Compared with those before operation, the VAS, JOA, NDI scores, and ASIA grading were significantly improved at 3 days, 3 months after operation and at the last follow-up in the two groups, which were further improved with the passage of time. Two patients in the robot nailing group had pneumonia, with a complication rate of 9% (2/22), while 2 patients in the freehand nailing group had dural sac rupture and cerebrospinal fluid leakage and 3 had lung infection after operation, with a complication rate of 14% (5/35) ( P<0.05). Conclusion:Compared with freehand nailing, the robot system-assisted nailing revision for AS with lower cervical fracture has more advantages in terms of the operative duration, length of hospital stay, intraoperative bleeding volume, frequency of intraoperative fluoroscopy nailing speed and accuracy, screw holding force, early pain relief, function restoration, and complication rate, despite longer surgical incision.
8.Comparative efficacy of laminoplasty via intermuscular approach or posterior midline approach for cervical spinal cord injury without radiographic abnormality: a multi-center retrospective study
Yunfei HUANG ; Shuai LI ; Jinpeng DU ; Baorong HE ; Yanzheng GAO ; Wei MEI ; Shibao LU ; Zhigan ZHAO ; Liang YAN ; Xiaobin YANG ; Yuan HE ; Zhen CHANG
Chinese Journal of Trauma 2025;41(7):635-644
Objective:To compare the efficacy of laminoplasty via the intermuscular approach or posterior midline approach for treating spinal cord injury without radiographic abnormality (SCIWORA).Methods:A multi-center retrospective cohort study was conducted to analyze the clinical data of 135 patients with SCIWORA admitted to Honghui Hospital Affiliated to Xi'an Jiaotong University School of Medicine, Xi'an No.5 Hospital, Henan Provincial People's Hospital, Zhengzhou Orthopedic Hospital, Xuanwu Hospital of Capital Medical University from February 2021 to June 2023, including 75 males and 60 females, aged 35-78 years [(55.3±8.1)years]. The injury segments involved C 3-C 6. All the patients underwent posterior cervical open-door laminoplasty, among whom 70 patients were treated via the intermuscular approach (intermuscular group) and 65 via the posterior midline approach (posterior midline group). The operation duration, intraoperative blood loss, postoperative drainage volume, and length of hospital stay were recorded. The visual analogue scale (VAS) score, Japanese Orthopedic Association (JOA) score, neck disability index (NDI), Barthel index, cervical Cobb angle, and cervical range of motion (ROM) were measured preoperatively, at 3, 6, 12 months postoperatively and at the final follow-up. The American Spinal Injury Association (ASIA) scale was evaluated preoperatively, at 3, 12 months postoperatively and at the final follow-up. The postoperative complication rate was recorded as well. Results:All the patients were followed up for 15-19 months [(16.3±1.6)months]. The operation duration, intraoperative blood loss, postoperative drainage and length of hospital stay were (125.0±23.0)minutes, (210.4±34.8)ml, and (165.3±23.7)ml, and (5.3±0.1)days in the intermuscular group, which were significantly shorter or less than (168.0±27.6)minutes, (260.2±45.3)ml, (196.4±31.6)ml, and (6.4±0.2)days in the posterior midline group ( P<0.01). The preoperative VAS score, JOA score, NDI and Barthel index showed no significant differences between the two groups ( P>0.05). The VAS score and JOA score also showed no significant differences between the two groups at 3, 6, 12 months postoperatively or at the final follow-up ( P>0.05). The NDI and Barthel index also showed no significant differences between the two groups at 3 months postoperatively ( P>0.05). At 6, 12 months postoperatively and at the final follow-up, the NDI were (15.4±2.5)points, (11.8±2.1)points and (8.6±1.5)points in the intermuscular group, significantly lower than (19.1±3.4)points, (14.3±2.4)points and (11.9±1.4)points in the posterior midline group ( P<0.01). At 6, 12 months postoperatively and at the final follow-up, the Barthel index were (71.4±6.2)points, (83.4±5.8)points and (89.2±7.1)points in the intermuscular group, significantly higher than (59.6±4.7)points, (74.2±3.9)points and (78.8±6.2)points in the posterior midline group ( P<0.01). Both groups showed significant improvements in VAS score, JOA score, NDI and Barthel index at 3, 6, 12 months postoperatively and at the final follow-up when compared to those preoperatively ( P<0.05). Among them, the VAS score, NDI and Barthel index were further improved over time ( P<0.05). Simultaneously, the JOA score was significantly improved at 6, 12 months postoperatively and at the last follow-up when compared to that at 3 months postoperatively ( P<0.05), with no significant difference at later time points between the two groups ( P>0.05). The preoperative cervical Cobb angle and ROM showed no significant differences between the two groups ( P>0.05). There was no significant difference in the Cobb angle between the two groups at 3, 6 or 12 months postoperatively ( P>0.05), while it was (13.6±2.4)° in the intermuscular group at the final follow-up, significantly larger than (10.4±2.8)° in the posterior midline group ( P<0.01). At 3, 6, 12 months postoperatively and at the final follow-up, the cervical ROM were (34.1±6.4)°, (32.6±7.3)°, (31.8±9.1)° and (29.6±8.7)° in the intermuscular group, significantly larger than (23.7±8.3)°, (22.3±7.8)°, (22.5±8.1)° and (20.6±9.3)° in the posterior midline group ( P<0.01). In the intermuscular group, the cervical Cobb angle showed no significant changes at 3, 6, 12 months postoperatively and at the final follow-up when compared to those preoperatively ( P>0.05). In the posterior midline group, the Cobb angles were significantly reduced at 3, 6, 12 months postoperatively and at the final follow-up when compared to those preoperatively ( P<0.05), showing significant decrease at 12 months postoperatively and at the final follow-up from those at 3, 6 months postoperatively ( P<0.05), no significant difference at 6 months postoperatively from that at 3 months postoperatively ( P>0.05), and significant decrease at the final follow-up from that at 12 months postoperatively ( P>0.05). In the intermuscular group, the cervical ROM were significantly improved at 3, 6, 12 months postoperatively and at the final follow-up when compared to those preoperatively and showed further improvement over time ( P<0.05). In the posterior midline group, the cervical ROM were significantly improved at 3, 6, 12 months postoperatively and at the final follow-up when compared to those preoperatively ( P<0.05), showing significant decreases at 6, 12 months postoperatively and at the final follow-up from that at 3 months postoperatively ( P<0.05), significant decreases at the final follow-up from those at 6, 12 months postoperatively ( P<0.05), and no significant difference at 12 months postoperatively from that at 6 months postoperatively ( P>0.05). The ASIA grades showed no significant difference between the two groups preoperatively, at 3, 12 months postoperatively and at the final follow-up ( P>0.05) , but were gradually improved over time in both groups ( P<0.05). The postoperative complication rate was 9%(6/70) in the intermuscular group, significantly lower than 48%(31/65) in the posterior midline group ( P<0.01). Conclusion:Compared to the posterior midline approach, the intermuscular approach for laminoplasty in patients with SCIWORA possesses advantages, including shorter operative time and length of hospital stay, reduced intraoperative blood loss and postoperative drainage, less postoperative neck disability, higher daily life quality, better long-term preservation of cervical lordosis and motion, and a lower complication rate.
9.Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures (version 2025)
Yong YANG ; Xiaoguang ZHOU ; Qixin CHEN ; Jian CHEN ; Jian DONG ; Liangjie DU ; Shunwu FAN ; Jin FAN ; Zhong FANG ; Haoyu FENG ; Shiqing FENG ; Haishan GUAN ; Aiguo GAO ; Yanzheng GAO ; Yong HAI ; Da HE ; Dengwei HE ; Haiyi HE ; Dianming JIANG ; Xuewen KANG ; Bin LIN ; Baoge LIU ; Changqing LI ; Fang LI ; Li LI ; Fangcai LI ; Weishi LI ; Xiaoguang LIU ; Hongjian LIU ; Xinyu LIU ; Yong LIU ; Zhongjun LIU ; Shibao LU ; Xuhua LU ; Fei LUO ; Yuhai MA ; Keya MAO ; Xuexiao MA ; Bin MENG ; Xu NING ; Limin RONG ; Hongxun SANG ; Jun SHU ; Tiansheng SUN ; Dasheng TIAN ; Zheng WANG ; Bing WANG ; Linfeng WANG ; Qingde WANG ; Qinghe WANG ; Lan WEI ; Jigong WU ; Baoshan XU ; Youjia XU ; Guoyong YIN ; Jinglong YAN ; Feng YAN ; Cao YANG ; Huilin YANG ; Qiang YANG ; Bin ZHAO ; Jie ZHAO ; Yue ZHU ; Jianguo ZHANG ; Wenzhi ZHANG ; Zhongmin ZHANG ; Zhaomin ZHENG ; Yan ZENG ; Baorong HE ; Wei MEI
Chinese Journal of Trauma 2025;41(7):613-626
Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.
10.Evidence-based guidelines for rehabilitation treatment after internal fixation of thoracolumbar spine fracture in adults (version 2025)
Zhengwei XU ; Liming CHENG ; Qixin CHEN ; Jian DONG ; Shunwu FAN ; Zhong FANG ; Shiqing FENG ; Haoyu FENG ; Haishan GUAN ; Weimin JIANG ; Dianming JIANG ; Yong HAI ; Lijun HE ; Yuan HE ; Bo LI ; Jianjun LI ; Feng LI ; Li LI ; Weishi LI ; Chunde LI ; Qi LIAO ; Baoge LIU ; Xiaoguang LIU ; Yong LIU ; Xuhua LU ; Shibao LU ; Bin LIN ; Wei MEI ; Chao MA ; Renfu QUAN ; Limin RONG ; Jiacan SU ; Honghui SUN ; Yuemin SONG ; Hongxun SANG ; Jun SHU ; Tiansheng SUN ; Jiwei TIAN ; Qiang WANG ; Xinwei WANG ; Zhe WANG ; Zheng WANG ; Liang YAN ; Guoyong YIN ; Jie ZHAO ; Yue ZHU ; Xiaobo ZHANG ; Xuesong ZHANG ; Zhongmin ZHANG ; Rongqiang ZHANG ; Dingjun HAO ; Yanzheng GAO ; Baorong HE
Chinese Journal of Trauma 2025;41(1):19-32
Thoracolumbar spine fracture often leads to severe pain, functional impairments, and neurological deficits, for which open reduction and internal fixation can effectively restore the spinal structural stability. Open decompression and reduction with internal fixation can help relieve spinal cord compression and improve spinal function in cases of concomitant cord injury. Although spinal stability can be restored through surgery, patients often face chronic pain and functional impairments postoperatively. A postoperative rehabilitation program is critical in optimizing therapeutic outcomes, reducing complications, and minimizing the risk of secondary injuries. However, current rehabilitation methods, such as physical therapy, functional training, and pain management, are confronted with problems in clinical practice, including significant variation in efficacy, poor patient adherence, and prolonged rehabilitation period. There is an urgent need for a unified rehabilitation strategy to address these problems. To this end, the Spinal Trauma Group of the Orthopedic Physicians Branch of the Chinese Medical Association and the Spine Health Professional Committee of the Chinese Human Health Technology Promotion Association organized experts from relevant fields to formulate Evidence-based guidelines for rehabilitation treatment after internal fixation of thoracolumbar spine fracture in adults ( version 2025) by integrating evidences from clinical researches and advanced rehabilitation concepts at home and abroad. A total number of 14 recommendations concerning the rehabilitation treatment with multimodal analgesia, psychological intervention, deep vein thrombosis prevention, core muscle and extremity exercise, appropriate use of braces, early weight-bearing, device-aided rehabilitation exercise, neuroregulatory therapy, rehabilitation team were put forward, aiming to standardize the post-operative rehabilitation process following internal fixation, promote the functional recovery, and enhance patients′ quality of life.


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