Short-term Clinical Effects Research Articles

Outcomes of surgical hip dislocation combined with bone graft for adolescents and younger adults with osteonecrosis of the femoral head: a case series and literature review

BackgroundOsteonecrosis of the femoral head (ONFH) may occur in the adolescent and younger adults (AYAs). Total hip arthroplasty (THA) is not the best treatment option for younger patients. Surgical hip dislocation (SHD) combined with bone graft can be used in patients at different stages to reconstruct the bone structure in the head and delay the replacement time. The purpose of this study was to evaluate the effect and potential influencing factors of this surgery for ONFH in AYA patients. MethodsWe conducted a literature review and a retrospective research of our own cases. The Pubmed, Cochrane Library, EMBASE and CNKI databases were searched from 1 January 2001 to 1 October 2021, for clinical studies. A retrospective case series study of 34 patients (38 hips) treated with SHD combined with bone graft was performed.ResultsA total of 13 studies were included and the results showed that SHD combined with bone grafts had better clinical results for patients with pre- or early post-collapse. In the case series study, we retrospectively analyzed 34 patients (38 hips), and the mean follow-up time was 40.77 ± 15.87 months. One patient died and three patients were converted to THA finally. The post-collapse degree and post-lesion size were better than those before the operation (P < 0.05). The iHOT-12 at the last follow-up was significantly higher than that before the operation (P < 0.05). There were significant differences in the results of hip Harris score (HHS), visual analogue scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) before the operation, 2 years after the operation and at the last follow-up, but the difference was not related to the follow-up time (P < 0.05). There were no significant differences in the final clinical score and arthritic changes among different Japanese Investigation Committee (JIC) classification, the degree of collapse and the size of the necrotic (P > 0.05).ConclusionsIn AYA patients, SHD combined with bone grafting is a potentially good option for hip preservation in ONFH. The differences in JIC classification, collapse degree and lesion size did not affect the final clinical function and the risk of osteoarthritis. Even for very severe cases at collapsed stage, good short-term clinical effects can still be achieved by SHD combined with bone graft.Trial registrationChiCTR2100055079.retrospectively registered.

Comparison of corrective and clinical effects between SRS-Schwab grade IV osteotomy combined with the interbody fusion cage and pure grade IV osteotomy in the treatment of old thoracolumbar vertebral osteoporotic fractures with kyphosis.

To compare the corrective and clinical effects between Scoliosis Research Society (SRS)-Schwab grade IV osteotomy combined with the interbody fusion cage and pure grade IV osteotomy in the treatment of old thoracolumbar vertebral osteoporotic fractures with kyphosis. Twenty-four cases of old thoracolumbar osteoporotic fractures with kyphosis treated by grade IV osteotomy in Sichuan Provincial Orthopedic Hospital from January 2018 to December 2019 were reviewed. Eleven cases were treated with grade IV osteotomy combined with the interbody fusion cage (group A), and 13 cases were treated with grade IV osteotomy alone (group B). Operation time, blood loss, and perioperative conditions of the 2 groups were recorded. After operation and the last follow up, the kyphosis angle (Cobb angle) and sagittal vertical axis (SVA) were measured by whole-spine splicing X-ray; clinical effect was analyzed by visual analog score (VAS) and Oswestry disability index (ODI). All operations were successful. Operation time was 239.5±29.0 min in group A and 179.2±22.7 min in group B (P<0.05). Intraoperative blood loss in group A was 1,560.9±378.6 mL and 1,242.3±339.0 mL in group B (P<0.05). Cerebrospinal fluid leakage occurred in 3 cases in group A and 1 case in group B (P<0.05). There were 3 cases of transient neurological symptoms in group A and 1 case in group B (P<0.05). There was no significant difference in Cobb angle and SVA between the 2 groups (P>0.05). There was no significant difference in ODI and VAS between the 2 groups (P>0.05). There were no complications, such as spinal cord injury, internal fixation loosening and fracture, or orthopedic loss. SRS-Schwab grade IV osteotomy combined with the interbody fusion cage and pure grade IV osteotomy can achieve good short-term orthopedic and clinical effects in the treatment of old thoracolumbar osteoporotic fractures with kyphosis. Corrective and clinical effects of the two groups are equivalent, but the operation time of grade IV osteotomy combined with the interbody fusion cage is longer, the amount of intraoperative blood is greater, and the incidence of complications is higher.

Proximal gastrectomy with double-tract reconstruction versus total gastrectomy for proximal early gastric cancer: A systematic review and meta-analysis.

Background:The incidence of proximal gastric cancer in the gastric fundus, cardia, and other parts is increasing rapidly. The purpose of this study was to systematically compare the short-term and long-term clinical effects of proximal gastrectomy with double tract reconstruction (PG-DTR) to total gastrectomy (TG) for proximal early gastric cancer (EGC).Methods:A systematic review and meta-analysis was conducted through searching the literature in PubMed, Web of Science, Cochrane Library, EMBASE, CNKI, WAN FANG, and VIP databases. All clinical controlled trials and randomized controlled trials (RCTs) of PG-DTR and PG were included. Simultaneously, the relevant data were extracted, and the software RevMan version 5.1 was used for the meta-analysis.Results:Eight studies with a total of 753 patients were eligible for the meta-analysis. There were no significant differences in the operation time, intraoperative blood loss, postoperative hospital stay, early complications (anastomotic fistula and anastomotic bleeding), late complications (reflux symptoms and anastomotic stenosis), and 5-year survival rate between PG-DTR and TG. However, the levels of partial nutritional indicators (vitamin B12 supplements and vitamin B12 deficiency) were significantly higher in the PG-DTR group than in the TG group.Conclusion:This study showed ample evidence to suggest that PG-DTR improved the postoperative nutritional status without compromising patient safety while providing the same surgical characteristics and postoperative morbidity as TG.

Identification of Novel Potential VEGFR-2 Inhibitors Using a Combination of Computational Methods for Drug Discovery.

The vascular endothelial growth factor receptor 2 (VEGFR-2) is largely recognized as a potent therapeutic molecular target for the development of angiogenesis-related tumor treatment. Tumor growth, metastasis and multidrug resistance highly depends on the angiogenesis and drug discovery of the potential small molecules targeting VEGFR-2, with the potential anti-angiogenic activity being of high interest to anti-cancer research. Multiple small molecule inhibitors of the VEGFR-2 are approved for the treatment of different type of cancers, with one of the most recent, tivozanib, being approved by the FDA for the treatment of relapsed or refractory advanced renal cell carcinoma (RCC). However, the endogenous and acquired resistance of the protein, toxicity of compounds and wide range of side effects still remain critical issues, which lead to the short-term clinical effects and failure of antiangiogenic drugs. We applied a combination of computational methods and approaches for drug design and discovery with the goal of finding novel, potential and small molecule inhibitors of VEGFR2, as alternatives to the known inhibitors’ chemical scaffolds and components. From studying several of these compounds, the derivatives of pyrido[1,2-a]pyrimidin-4-one and isoindoline-1,3-dione in particular were identified.

Effect of fire needling on mild to moderate knee osteoarthritis and related serum inflammatory cytokines

To compare the clinical effect of fire needling and filiform needling for mild to moderate knee osteoarthritis (KOA) and observe the influence on related serum inflammatory sytokines. A total of 60 patients with mild to moderate KOA were randomly divided into an observation group (30 cases, 4 cases dropped off) and a control group (30 cases, 4 cases dropped off). Both groups were given basic health management, and the acupoints of the two groups were Liangqiu (ST 34), Xuehai (SP 10), Neixiyan (EX-LE 4), Dubi (ST 35), Yanglingquan (GB 34) and ashi point. The observation group was treated with fire needling, while the control group was treated with filiform needling. Both groups were treated once every other day, 3 times a week for 2 weeks. The Western Ontario and McMaster University osteoarthritis index (WOAMC) scores of the two groups were compared before treatment, in 1, 2 weeks of treatment and 2, 6 weeks of follow-up. ELISA method was used to detect the levels of serum interleukin 1α (IL-1α), tumor necrosis factor α (TNF-α) and matrix metalloproteinase 3 (MMP-3) before treatment and in 2 weeks of treatment. The clinical effect of the two groups was evaluated in 1, 2 weeks of treatment and 2, 6 weeks of follow-up. At each time point of treatment and follow-up, the pain, stiffness, difficulty of daily activities scores and WOMAC total scores of the two groups were lower than those before treatment (P<0.05); the stiffness score of the observation group was lower than that of the control group in 1 week of treatment (P<0.05); the various scores and total scores of the WOMAC scale of the observation group were lower than those of the control group in 1, 2 weeks of treatment and 2, 6 weeks of follow-up (P<0.05). In 2 weeks of treatment, the levels of serum MMP-3 and IL-1α in the observation group and IL-1α in the control group were higher than those before treatment (P<0.05). In 1 week of treatment and 2, 6 weeks of follow-up, the total effective rates of the observation group were higher than those in the control group (P<0.05). Fire needling can improve the pain, stiffness and joint dysfunction of patients with mild to moderate KOA, and increase serum MMP-3 and IL-1α levels. Its short and long term clinical effects are better than filiform needling.

Posterior Percutaneous Transpedicular Endoscopic Approach for Treating Single-Segment Cervical Myelopathy.

Background Standard posterior percutaneous endoscopic cervical discectomy (PECD) is considered an effective minimally invasive surgery. Although standard PECD can be used to treat radiculopathy with relatively minimal trauma, it is still a challenge to use this approach for treating myelopathy. Objective This report is aimed at first describing a posterior transpedicular approach under endoscopy for myelopathy and evaluating the feasibility and short-term clinical effects of this approach. Methods In our retrospective analysis between Feb. 2016 to Mar. 2017, 16 patients managed with PECD using the posterior transpedicular approach for symptomatic single-segment myelopathy. Surgery involved drilling 1/2 to 2/3 of the medial portion of the pedicle under endoscopy to provide sufficient space and an appropriate angle for inserting the endoscope into the spinal canal, followed by ventral decompression of the spinal cord. Computed tomography and magnetic resonance imaging were used to evaluate pedicle healing and spinal cord decompression. The primary outcomes included a visual analog scale (VAS) scores of axial neck pain and Japanese Orthopaedic Association (JOA) scores of neurological conditions. Results All patients completed a 1-year follow-up examination. The mean duration of surgery was 95.44 ± 19.44 min (52–130 min). The fluoroscopy duration was 5.88 ± 1.05 (4–7). The VAS scores of axial pain significantly improved from 6.94 ± 0.75 preoperatively to 2.88 ± 1.22 postoperatively (P < 0.05). The mean JOA scores improved from 8.50 ± 1.12 preoperatively to 14.50 ± 1.46 at the final follow-up (P < 0.05). The effects were excellent in 8 cases, good in 6 cases, and fair in 2 cases. After partial pedicle excision, the width of the remaining pedicle was 1.70 ± 0.22 mm postoperatively and significantly recovered to 3.38 ± 0.49 mm at the 1-year follow-up. There were no surgery-related complications, such as dural tearing, spinal cord injury, nerve root injury, pedicle fracture, and cervical hematocele or infection. Conclusions The posterior transpedicular approach is an effective method for the treatment of myelopathy in select patients and is a supplement to the described surgical approach for PECD.

Evaluation of Visual Acuity Outcomes and Corneal Alterations of New Generation Hybrid Contact Lenses in Patients With Advanced Keratoconus.

To evaluate the visual and corneal outcomes of new generation hybrid contact lenses (HCL) in patients with advanced keratoconus. This was a retrospective study undertaken at a single academic center. The study cohort consisted of subjects with advanced keratoconus who had elected not to undergo keratoplasty and were fitted with HCLs. Patients were fitted either with EyeBrid (LCS, Cane, France) or Airflex (SwissLens, Prilly, Switzerland) HCLs. Primary outcome measures included contact lens (CL) drop-out rate, best corrected visual acuity, and corneal endothelial cell density (ECD) measurements at the end of a 6-month HCL wear. ECD was measured using in vivo confocal microscopy (ConfoScan4; Nidek, Tokyo, Japan). One eye per patient was included for statistical purposes. Paired t tests and Wilcoxon signed-rank tests were used for comparative analyses. Thirty-two keratoconic eyes of 32 patients (14M/18F) with a mean age of 25.9 ± 11.5 years were included in the study. All patients were able to continue CL wear for a duration of 6 months. There was a significant improvement in the mean best corrected visual acuity from 0.5 ± 0.2 logarithm of minimal angle of resolution to 0.1 ± 0.1 logarithm of minimal angle of resolution after daily CL wear with HCL at the 6-month follow-up visit (P < 0.001). No vision-threatening CL-related corneal adverse effects were observed. There was no significant reduction in the ECD noted at the 6-month visit [2625.8 ± 300.3 cells/mm (baseline) vs. 2566.4 ± 309.8 cells/mm (6-month); P = 0.623]. Hybrid contact lenses can provide improved visual function without inducing any short-term clinical or microscopic adverse effects on corneal endothelial cells in patients with advanced keratoconus.

The influence of adipose-derived stromal vascular fraction cells on the treatment of knee osteoarthritis

BackgroundAdipose-derived stromal vascular fraction (SVF) cells are a mixed cell population that includes cells with multilineage potential, similar to bone marrow-derived mesenchymal stem cells. Our purpose is to investigate the influence of SVF cells in patients with knee osteoarthritis (OA) and the short-term treatment effects.MethodsFifty-seven patients were enrolled and treated with intra-articular injection of 2.5 × 107 SVF cells into the knee joint between September 2017 and March 2018. All patients were followed up for 12 months or longer. Mean age at treatment and follow-up period were 69.4 ± 6.9 years and 13.7 ± 2.0 months, respectively. The mean preoperative hip-knee-ankle angle was 6.7 ± 3.6°. SVF cells were prepared using the Celution®800/CRS system from the patients’ abdominal or breech subcutaneous fat. The mean SVF cell viability was 90.6 ± 2.7%. Clinical evaluations were performed for range of motion, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale (VAS) for pain, and the Knee injury and Osteoarthritis Score (KOOS). Imaging evaluations, which included the hip-knee-ankle angle assessed via radiography, and T2 mapping value using a 1.5-T magnetic resonance imaging unit were also assessed. Both clinical and imaging evaluations were performed preoperatively, 1, 3, 6, and 12 months postoperatively, and compared among all timepoints (p < 0.05).ResultsKnee extension angle at 6 and 12 months postoperatively was significantly better than the preoperative angle. Total WOMAC, VAS, and KOOS scores at 1, 3, 6 and 12 months postoperatively were significantly better than preoperative scores. There was no significant difference in hip-knee-ankle angle among the five time periods. T2 mapping values of lateral femur and tibia were significantly higher 12 months postoperatively than preoperatively.ConclusionsThe short-term clinical effects of intra-articular SVF cell injection on knee OA were excellent. Intra-articular SVF cell injection is a novel and innovative approach for treating patients with knee OA.

Anabolic androgenic steroid abuse in young males.

This review summarizes 10 years experience with male abusers of anabolic androgenic steroids (AAS). The typical user of AAS is male, aged between 20 and 40 and lifting weights. Illegal AAS are cheap and easily obtained via internet or local suppliers. AAS are mostly used in cycles with a duration between 6 and 18 weeks. Most AAS cycles contain multiple agents, used simultaneously in a dose vastly exceeding a substitution dose. A variety of other performance and image-enhancing drugs are commonly used, including human growth hormone, thyroid hormone, tamoxifen, clomiphene citrate and human chorionic gonadotrophin. Short-term clinical and biochemical side effects are well established. Long-term side effects are uncertain, but may include heart failure, mood-and anxiety disorders, hypogonadism and subfertility. We share our views on the management of common health problems associated with AAS abuse.

Fibular osteotomy and distal tibiofibular joint fusion for treatment of chronic valgus Pilon fracture malunion

To explore clinical effects of fibular osteotomy and distal tibiofibular joint fusion for chronic valgus Pilon fracture malunion. From January 2014 to January 2017, 8 patients with chronic valgus Pilon fracture malunion were treated, including 7 males and 1 female, aged from 20 to 47 years old, 6 patients on the left side and 2 patients on the right side; according to Rüedi-Allgöwer classification, 1 case was typeⅠ, 3 cases were typeⅡand 4 cases were type Ⅲ; the time from injury to admission ranged from 7 to 21 months. All deformities were evaluated individually based on pre-operatively weight bearing X-ray and 3D CT scan, and 3D printing model was also used for preliminary surgery. Weight-bearing X-ray showed posterior subluxation of ankle joint in 5 cases. There were 5 cases of fibular fracture at primary injury, and 2 cases of fibular fracture malunion. Fibular osteotomy and distal tibiofibular syndesmosis fusion strategy was performed to reduce articular surface congruency and correct lower limb alignment. Postoperative complication, fracture healing time and reduction were regularly recorded. Clinical function was evaluated according to American Orthopedic Foot and Ankle Society (AOFAS) at 1 year after operation. All patients were followed up from 12 to 30 months. All incisions were primarily healed. No infection, neurovascular injuries or implant failure, lost of reduction occurred. Fracture healing time ranged from 13 to 19 weeks with good lower limb alignment. AOFAS score at 1 year after operation was 63 to 90 points, 1 patient got excellent result, 4 good and 3 fair. Seven patients returned to work at 6 to 14 months after opertaion. For chronic valgus Pilon fractures malunion, fibular osteotomy and distal tibiofibular syndesmosis fusion could effectively restore congruency and alignment, correct lower limb alignment, improve ankle joint function, reduce occurrence of complication, and receive short term clinical effects.

Safety and Efficacy Evaluation of Traditional Chinese Medicine (Qingre-Lishi-Yishen Formula) Based on Treatment of Regular Glucocorticoid Combined with Cyclophosphamide Pulse in Children Suffered from Moderately Severe Henoch-Schonlein Purpura Nephritis with Nephrotic Proteinuria.

Objective At present, the most appropriate management of Henoch–Schonlein purpura nephritis (HSPN) with nephrotic-range proteinuria still remains controversial; thus, the purpose of this study is to evaluate safety and efficacy of traditional Chinese medicine (TCM), Qingre-Lishi-Yishen Formula (QLYF), integrated with regular oral glucocorticoid and cyclophosphamide intravenous pulse therapeutic regimen in children suffered from moderately severe HSPN with nephrotic proteinuria. Methods From 1 January 2012, to 1 January 2016, totally 150 hospitalized children suffered from HSPN with nephrotic proteinuria were included. All were treated with glucocorticoid and cyclophosphamide, and 100 of them were treated with integrative traditional Chinese decoction QLYF. Patients were followed up for 2 years. Rate of adverse event occurrence, short-term clinical effects, long-term clinical effects, and TCM therapeutic evaluation were all compared. Results Total adverse event rate was lower in the QLYF group (χ2 = 5.357, p = 0.022); rates of respiratory infection, urinary infection, poor appetite, hepatotoxity, cardiotoxicity, and neutropenia were all decreased in patients who received QLYF (p = 0.022); rates of respiratory infection, urinary infection, poor appetite, hepatotoxity, cardiotoxicity, and neutropenia were all decreased in patients who received QLYF (p = 0.022); rates of respiratory infection, urinary infection, poor appetite, hepatotoxity, cardiotoxicity, and neutropenia were all decreased in patients who received QLYF (p = 0.022); rates of respiratory infection, urinary infection, poor appetite, hepatotoxity, cardiotoxicity, and neutropenia were all decreased in patients who received QLYF (p = 0.022); rates of respiratory infection, urinary infection, poor appetite, hepatotoxity, cardiotoxicity, and neutropenia were all decreased in patients who received QLYF (p = 0.022); rates of respiratory infection, urinary infection, poor appetite, hepatotoxity, cardiotoxicity, and neutropenia were all decreased in patients who received QLYF (Conclusion Compared with merely using regular oral glucocorticoid plus cyclophosphamide pulse therapeutic regimen, the therapeutic regimen that integrates QLYF with the abovementioned western medicine might be a safe means to decrease the occurrence rate of adverse events and improve short-term and long-term clinical effects in children who suffered from moderately severe HSPN with nephrotic proteinuria.

Preserving hip treatment of steroid-induced osteonecrosis of the femoral head

Objective To investigate the early diagnosis and treatment options for steroid-induced osteonecrosis of the femoral head (SONFH). Methods Retrospective analysis was conducted in 73 patients with unilateral SONFH from January 2010 to June 2017. There were 27 males and 46 females, aged 34.26±10.35 years (range, 20-45 years). The following type of cases were included, 21 cases of ARCO I, 24 cases of IIa, 8 cases of IIb, 18 cases of IIc and 2 cases of IIIa. Patients with ARCO I were limited in weight and were treated with low molecular weight heparin sodium and ginkgo dharma drugs after excluding bleeding risk. Core decompression was performed in patients with ARCO IIa and IIb vascularized greater trochanter bone transfer was conducted in patients with IIc and IIIa. During the follow-up duration, when the ARCO I progressed to ARCO IIa and IIb, the core decompression was performed. When the ARCO IIa and IIb progressed to the ARCO IIc or IIIa, the vascularized greater trochanter bone transfer was conducted. Vascularized greater trochanter bone combined with the tantalum rod was implanted in ARCO IIIb. The femoral head reconstruction with the larger trochanter bone flap or joint replacement was performed in ARCO IIIc and above. The Harris hip score was used to evaluate the clinical outcomes. The femoral head survival curve of SONFH was drawn with the end of joint replacement. Results All 73 patients were followed up for an average of 29 months (range, 18 to 48 months). After treatment of 21 patients with ARCO I, a total of 14 (67%) patients had no ARCO staging progress. After 6 months, three patients progressed to ARCO IIb and 4 patients progressed to ARCO IIc. All 32 patients with ARCO IIa and IIb were treated, of which 25 (78%) did not progress but 4 patients progressed to ARCO IIIa at 6 months. Only one patient progressed to ARCO IIIb at 6 months, and 2 patient progressed to ARCO IIIc at 12 months. There were 18 patients with ARCO IIc underwent treatment, of which 14 patients (78%) did not progress but 2 patients progressed to ARCO IIIa at 6 months and 2 patients progressed to ARCO IIIc at 24 months and to ARCO IV at 42 months, respectively. Two patients of ARCO IIIa, 1 patient did not progress and the other one progressed to ARCO IV at 36 months. The Harris hip score was 90.48±5.36 before treatment and 91.76±8.19 at the last follow-up. The difference was not statistically significant (t=1.231, P=0.402). The Harris hip score of patients with ARCO IIa and IIb in creased from 75.22±8.30 to 84.47±16.77 with statistically significant difference (t=5.624, P<0.001). The Harris hip score of patients with ARCO IIc and IIIa increased from 59.80±9.24 to 77.75±20.75 with statistically significant difference (t=12.033, P<0.001). Four patients eventually underwent arthroplasty. The femoral head survival rate was 98.6% at 2 years and 94.5% at 4 years. Conclusion The SONFH can be diagnosed early by screening, and is treated by different reserving hip methods according to severe stages. The short-term clinical effects are satisfied. Key words: Glucocorticoids; Femur head necrosis; Free tissue flaps; Decompression, surgical

To analyse the clinical and radiological outcome of proximal fibular osteotomy in osteoarthritis knee

Principal Objectives: Knee OA accounts for more than 80% of the joint disorder and as per an estimate in US population, it affects at least 19% of adults aged 45 years and older. In patients of Osteoarthritis knee there is pain and limitations in joint mobility. The pathological features of Knee Osteoarthritis (KOA) include the articular cartilage degeneration, remodelling of subchondral bone, osteophyte formation, ligamentous laxity, and weakening of periarticular muscles. Materials and Methods: The present study was conducted in the Department of Orthopaedics, Rohilkhand Medical College, Bareilly to assess the effect of Proximal Fibular Osteotomy in osteoarthritis of the knee from May 2018 to May 2019. Results: The operation time, blood loss during operation and post op rehabilitation period are significantly shortened in the observation Group. The VAS score (Post-Operatively) is remarkably lessens with notably decreased rate of post-operative complications such as injury to common peroneal nerve, infection, deep vein thrombosis, and deformity recurrence. Conclusion: The short-term clinical and functional effects of proximal fibular osteotomy on varus KOA are excellent.

Analysis of the clinical effects of different pedicle screw fixation methods for the treatment of thoracolumbar fractures

To discuss the clinical effects of the different pedicle screw fixation methods for the treatment of thoracolumbar fractures. The clinical data of 55 patients with single thoracolumbar fractures treated between January 2013 and December 2016 were retrospectively analyzed. There were 32 males and 23 females, aged from 20 to 55 years with an average of 35.6 years old. All the fractures were located on a single segment, 8 cases of T₁₁, 18 cases of T₁₂, 19 cases of L₁, 10 cases of L₂. According to the classification of AO, 10 cases were type A1, 17 cases were type A2, 18 cases were type A3, 7 cases were type B2, 2 cases were type B3, 1 case was type C1. The patients were divided into three groups according to the different fixation methods, among them, 20 cases treated by traditional short-segment 4 pedicle screws fixation were control group, 22 cases treated by intermediate bilateral pedicle screws fixation (6 pedicle screws fixation) were bilateral group, 13 cases treated by intermediate unilateral pedicle screw fixation (5 pedicle screws fixation) were unilateral group. The three groups were compared by operation time, intraoperative blood loss, hospitalization cost, VAS and ODI scores, the correction of the fractured vertebrae height and kyphosis angle postoperatively and the losing rate of the fractured vertebrae height and kyphosis angle at the final follow-up and so on. All the patients were followed up from 12 to 20 months with an average of 15.2 months. No complications such as loosening of internal fixation and breakage were found after operation. There was no significant difference in operation time and intraoperative blood loss among three groups(P>0.05). In terms of hospitalization cost, the control group[(20 932.4±298.3)yuan] was significantly lower than the unilateral group[(22 428.2±321.5)yuan] and the bilateral group [(23 630.5±310.5)yuan] (P<0.05), and the unilateral group was lower than the bilateral group (P<0.05). There was no significant difference in VAS and ODI scores at preoperative, postoperative 1 week and final follow-up among the groups(P>0.05). And there was no significant difference in the correction of the injuried vertebrae height and kyphosis angle immediately after operation among three groups(P>0.05). However, for the losing rate of the injuried vertebrae height at the final follow-up, the unilateral group[(6.3±2.1)%] and bilateral group [(5.6±2.8)%] were significantly better than the control group[(9.2±1.8)%] (P<0.05), there was no significant difference between unilateral group and bilateral group; for the losing rate of kyphosis angle at the final follow-up, the unilateral group[(15.2±6.5)%] and bilateral group[(13.9±7.2)%] were significantly better than the control group[(23.6±7.5)%] (P<0.05), but there was no statistical difference between the unilateral and bilateral group(P>0.05). All the three different pedicle screw fixation methods are suitable for the treatment of thoracolumbar fractures and the short-term clinical effects are consistent. Compared with traditional short-segment 4 pedicle screws fixation, intermediate bilateral or unilateral pedicle screw fixation were more effective in maintaining the height of the injuried vertebrae and preventing the occurrence of kyphosis. The intermediate unilateral pedicle screw fixation was comparable to that of bilateral fixation at clinical outcomes, but the unilateral fixed hospitalization cost was lower, which was worthy of clinical promotion.

Modified internal fixator for anterior pelvic ring fractures versus conventional two-screw fixation.

The present study aims to evaluate the short-term clinical effects and complications of modified three-screw fixation and conventional two-screw fixation for treating anterior pelvic ring fractures. A retrospective study of 51 patients with type B fractures was performed. 25 patients (modified group) were treated with modified three-screw fixation and the other 26 patients (conventional group) with conventional two-screw fixation. Outcome measures included operation time, intraoperative blood loss, hospital stays, postoperative complications and the Majeed score at postoperatively 2months, 3months, 1year and the time of implant removal. The mean operative times and mean blood loss for modified three-screw fixation versus conventional two-screw fixation bilateral were 54.8 ± 10.7min versus 32.3 ± 9.9min, and 153.3mL versus 550.0mL (p < 0.001), respectively. However, the Majeed score was better in modified group at postoperatively 2months (75.6 ± 9.5 vs. 69.7 ± 8.3, p = 0.008) and 3months (80.3 ± 10.7 vs. 75.1 ± 11.9, p = 0.014). There was no statistical difference between two groups at the time of implant removal (82.1 ± 9.3 vs. 80.9 ± 8.8, p = 0.272) and postoperatively 1year (83.5 ± 7.8 vs 82.6 ± 8.2, p = 0.723). No patients experienced surgical wound infection, deep vein thrombosis, delayed union or nonunion, implant loosening or rupture. One patient complained of tardive unilateral thigh pain at postoperatively 4months in conventional group. Both modified three-screw fixation and conventional two-screw fixation could ultimately afford satisfactory clinical and radiological outcomes with less complication for anterior pelvic ring fractures. The modified three-screw fixation might have better biomechanical strength and faster pelvic rehabilitation.

A Prospective Comparison of CT-Epidurogram Between Th1-Transforaminal Epidural Injection and Th1/2-Parasagittal Interlaminar Epidural Injection for Cervical Upper Limb Pain

Background: Cervical epidural injections for treating neck and upper limb pain are performed by 2 methods: transforaminal and interlaminar. Many serious complications caused by inadvertent intravascular injection have been reported with the use of cervical transforaminal epidural steroid injection through the anterior-lateral approach. Despite international practical guidelines that have been proposed, cervical transforaminal epidural injection is still less recommended than cervical interlaminar epidural injection. Objectives: The objective of this study is to introduce Th1-transforaminal epidural injection (Th1- TFEI) through the posterior-lateral approach, compare the injectate spread in Th1-TFEI with that of Th1/2-parasaggital interlaminar epidural injection (Th1/2-pILEI), and clarify the clinical characteristics of Th1-TFEI. Study Design: This research involved a prospective study of 30 patients receiving both Th1-TFEI and Th1/2-pILEI. Methods: Thirty patients with unilateral upper limb pain were enrolled for this prospective study. Th1-TFEI and Th1/2-pILEI were administered on each case in random order under fluoroscopy, and computed tomographic (CT) epidurograms were compared. Changes in circulatory dynamics, presence of Horner’s syndrome, changes in the Numerical Rating Scale (NRS-11), and adverse events were investigated. Results: Patients included 15 men and 15 women and included 24 cases of cervical spine disease and 6 cases with other upper limb pain. The Th1-TFEI group had significantly higher rates of “Th1 root filling” (100%), “ventral spread” (70.0%), and “lateral limitation” (26.7%) compared to the Th1/2-pILEI group. In the Th1-TFEI group, cephalad spread averaged 2.97 vertebral bodies, reaching approximately up to C6. The Th1/2-pILEI group had an average of 4.76 vertebral bodies, approximately up to C4. The 2 groups showed significant differences in cephalad spread. Horner’s syndrome appeared in the Th1-TFEI group at a rate of 56.7%, significantly higher than that in the Th1/2-pILEI group at 17.2%. The presence of Horner’s syndrome showed significant correlations with “ventral spread” and “spread up to C6.” There were no significant differences in NRS-11 improvement and changes in circulatory dynamics between the groups. There were no major complications. Limitations: The components of injectate were standardized; however, the needle gauge numbers were varied. In addition, interpretation of the CT-epidurogram was not blinded. The sample size was small; therefore, multivariate analysis was not possible. Conclusions: CT-epidurogram comparison revealed that Th1/2-pILEI was not localized on the injection side, and there was better dorsal spread – although ventral spread was small. Contrarily, Th1-TFEI was localized on the injection side, and better ventral spread was shown while cephalad spread was limited. We expected the addition of a sympathetic block effect suggested by the Horner’s syndrome as well as the merits of the ventral spread. However, short-term clinical effects were equal to those of Th1/2 pILEI. In future research, we need to standardize the diseases to include and to increase the number of cases to enable evaluation of clinical effectiveness.Key words: Epidural, cervical, transforaminal, interlaminar, fluoroscopy, CT-epidurogram, dorsal, ventral, cephalad, Horner’s syndrome

Effect of otopoint pellet-pressing combined with medication on clinical symptoms of migraine patients and changes of plasma 5-HT and CGRP contents

To investigate the short-term and long-term clinical effects of otopoint pellet-pressing combined with medication in the treatment of patients with migraine without aura and its impact on plasma 5-hydroxytryptamine(5-HT) and calcitonin gene-related peptide(CGRP) contents. Patients with migraine without aura were randomly divided into medication(control) group(n=48) and otopoint pellet-pressing plus medication (treatment) group(n=49). Patients of the control group were given oral Flunarizine capsules(10 mg/time) twice a day, and those of the treatment group received same dosage of Flunarizine and pellet-pressing of otopoints Nao(Brain), Nie (Temporal), Shenmen(Shenmen), Jiaogan(Sympathy) and Pizhixia(Subcortex), 2 min/point, 3 times a day, simultaneously. The treatment was conducted for 1 month. The short-term and long-term clinical effects were evaluated according to Yang and colleagues' methods, and "Guiding principles for clinical research of new TCM drugs (trial)". The contents of plasma 5-HT and CGRP were detected by ELISA. After one month's treatment, of the 48 and 49 patients in the control and treatment groups, 10(20.83%)and 17(34.69%) were under control, 19(39.59%)and 23(46.94%) experienced marked improvement, 10(20.83%)and 7(14.29%)were effective, 9(18.75%) and 2(4.08%) failed, with the total effective rates being 81.25% and 95.92%, respectively. Six months' follow-up survey showed that of the 48 and 49 patients in the control and treatment groups, 4(8.33%)and 11(22.45%) were under control, 20(41.67%)and 24(48.98%)experienced marked improvement, 11(22.92%)and 9(18.37%)were effective, and 13(27.08%) and 5(10.20%)failed, with the total effective rates being 72.92% and 89.80%, respectively. The number of headache attacks, duration of each attack and the degree of headache were significantly decreased after 1 and 6 months' treatment in both groups in comparison with their own pre-treatment (P<0.05). The contents of plasma 5-HT at the time-points of 1 and 6 months were markedly increased (P<0.05), and those of plasma CGRP at the two time points markedly decreased in both groups in comparison with their own pre-treatment (P<0.05). The therapeutic effects of the treatment group were obviously superior to those of the control group in lowering the number of headache attacks, duration of each attack and the degree of headache and plasma CGRP content, as well as in increasing plasma 5-HT levels after 1 and 6 months' treatment (P<0.05). Otopoint pellet-pressing combined with oral administration of Flunarizine can significantly improve the clinical symptoms in patients with migraine without aura, and possess a stable long-term clinical effect, which may be associated with its effect in increasing plasma 5-HT and decreasing CGRP levels.

Bone and soft tissue combined with surgery for the treatment soft flatfoot combined with painful navicular bone

To explore short-term clinical effects of bone and soft tissue combined with surgery for the treatment of soft flatfoot accompanied with painful navicular bone. From May 2015 to August 2017, 16 patients (16 feet) with navicular bone soft flatfoot accompanied with painful navicular bone were treated with bone and soft tissues operation (gastrocnemius release, medial displacement calcaneal osteotomy, and excision of accessory navicular with reconstruction of posterior tibial tendon). Among them, there were 9 males (9 feet) and 7 females (7 feet), aged from 22 to 48 years old with an average of (32.0±3.4) years old. The duration of diseases ranged from 6 months to 5 years with an average of (2.4±1.7) years. The postoperative complications were observed, talocalcaneal angle, the first metatarsal horn of the talus, arch height, angle of inclination and calcaneal valgus before and after operation at 12 months were compared. VAS score and AOFAS score after operation at 12 months were applied to evaluate pain relief and function. All patients were followed up for an average of (18.4±3.5) months(13~25 months). The incisions of patients were healed at grade A without wound infection, nonunion or delayed union, internal fixation fracture or loosening and other complications. Medial pain of foot was disappeared and motor ability was restored at 12 months after operation. Arch height, angle of inclination and the first metatarsal horn of the talus of lateral X-ray before operation and after operation at 12 months on weight-bearing foot were(21.51±1.20)°vs(31.01±1.62)°, (10.71±1.52)°vs(22.12±2.11)°, (15.61±1.41)°vs(5.10±1.20)°; talocalcaneal angle, the first metatarsal horn of the talus of AP X-ray before operation and after operation at 12 months on weight-bearing foot were (36.12±2.21) ° vs (22.12±2.61)°, (13.41±1.51)°vs(4.30±0.91)°; calcaneal valgus of axial X-ray before operation and after operation at 12 months on weight-bearing foot were (10.80±1.21)°vs(3.92±1.81)°; there were statistical difference in imaging indicators between preoperation and 12 months after operation. VAS score was significantly decreased from (6.21±2.31) before operation to (1.82±0.56) at 12 months after operation (t=2.64, P<0.05). AOFAS score was obviously increased from (51.2±5.6)before operation to (87.1±4.7)at 12 months after operation (t=3.43, P<0.05). Bone and soft tissue operation (namely, gastrocnemius release, medial displacement calcaneal osteotomy, and excision of accessory navicular with reconstruction of posterior tibial tendon) could obviously relieve foot pain, improve foot appearance and function in patients with navicular bone soft flatfoot complicated with painful navicular bone, and has certain clinical efficacy.

Effect of Massage on Clinical and Physiological Variables During Muscle Fatigue Task in Participants With Chronic Low Back Pain: A Crossover Study

ObjectiveThe purpose of this study was to determine if a reduction of short-term physiological and clinical effects of muscle fatigue can be seen after a session of massage in nonspecific chronic low back pain (cLBP) individuals and to study the possible association between physiological and clinical changes induced by massage. MethodsThirty-six cLBP individuals participated in 2 experimental sessions. In one session, the Sorenson protocol was preceded by a 30-minute massage, but in the other session, only the Sorenson test was performed by participants. Lumbar paraspinal muscle activity was recorded using surface electromyography, and maximal voluntary contraction force was measured using a load cell. Participants rated their lumbar pain intensity before and after massage and after the Sorensen protocol. A 2-way repeated-measures analysis of variance was conducted to test the effect of massage on both variables for both conditions. Pearson correlation analyses were conducted to determine the linear association between physiological and clinical responses to massage. ResultsResults showed that pain perception was significantly reduced after massage (P = .004) but did not seem to influence pain score increases occurring after the Sorensen protocol. Individuals with a high score of low back pain–related disability showed lower back muscle endurance time (r = -.35). Massage yielded no significant effect on fatigue-related physiological variables. ConclusionThe perception of pain in cLBP individuals was reduced after massage. Although massage yielded some positives clinical effects, they were not explained by a reduction in physiological effect of muscle fatigue.

Zoledronate and ibandronate treatments provide a significant improvement in BMD values in osteoporosis patients

Objective: In this study, we aimed to make a comparative analysis of short term clinical effectivity and side effects of intravenous zoledronate administration as single dose yearly and intravenous ibandronate administration as four doses per year. Methods: The patients whom were included in our study had osteoporosis according to WHO criteria and were treated with either parenteral zoledronate or ibandronate. 43 patients were treated with single dose of 5mg intravenous zolendronat which was applied once in a year; whereas in 39 patients were treated with 3 mg intravenous ibandronate which was applied four times in a year in three months intervals. Biochemical tests were performed in all patients before intravenous drug infusion. Side effects during drug administration and also in the first three months of the treatment were noted for all patients. Clinical effectivity was analyzed according to changes in bone mineral density (BMD) at the end of two year after treatment. Results: Eighty-two patients who were followed-up and evaluated for the effectivity and side effects of the treatment were included in our study. The compliance of patients were 100% in both groups. Mean age was 75.23±6.9 years and mean body mass index (BMI) was 26.94±7.2. In zoledronate group in which there were 23 females and 20 males. Mean age was 73.64±8.7 years and mean BMI was 27.34±4.4. In ibandronate group in which there were 39 females. There were no statistically significant differences between the groups in terms of gender (p=0.000) Mean age, BMI and rate of diagnosed side effects were not statistically significant in between the groups. According to a one-year follow-up in both groups comparison with before application had a statistically significant increase in BMD (p&lt;0.01). However, a one-year follow-up between the two groups in terms of mean values of bone mineral density did not differ significantly (p&gt;0.05). Conclusion: Choice of medical treatment is decided according to bone mineral density and personal risk factors in osteoporosis. Parenteral agents in the treatment of osteoporosis may be the preferred choice for the patients with comorbid diseases, using multiple drug therapies, or having trouble in using oral drug therapy. However, it should always be kept in mind that drug related side effects may be seen more commonly with parenteral agents. Clinicians should be aware of the probable side effects during and after application.