ObjectiveTo investigate the effects of gender and age on the posterior cranial fossa linear volume and cerebellar tonsil position in normal populations.MethodsA total of 180 normal adults who underwent cervical MRI examination at the physical examination center were selected, including 90 males and 90 females; the age ranged from 20 to 79 years, with an average of 50.4 years. The posterior cranial fossa linear volume and cerebellar tonsil position were measured by two spine surgeons on the mid-sagittal plane of the cervical MRI T2-weighted image. The posterior cranial fossa linear volume included the length of clivus (AB), anteroposterior diameter of foramen magnum (BC), length of supraocciput (CD), anteroposterior diameter of posterior fossa (DA), posterior fossa height (BE), and clivus angle (∠α). The index of the cerebellar tonsil position was the distance from the lower edge of the cerebellar tonsil to the baseline (MN). The differences of each indicators between males and females were compared, and the correlations between age and each indicators were analyzed.ResultsThe posterior fossa cranial linear volume AB, BC, CD, BE, and ∠α in males were significantly larger than those in females (P<0.05); DA in males was larger than that in females, but showing no significant difference (t=1.978, P=0.050). The cerebellar tonsil position (MN) in females was higher than that in males, but showing no significant difference (t=0.526, P=0.600). Correlation analysis showed that age was negatively correlated with AB, BC, CD, DA, BE, ∠α, and MN (r=−0.375, P=0.001; r=−0.417, P=0.001; r=−0.046, P=0.001; r=−0.244, P=0.001; r=−0.326, P=0.001; r=−0.320, P=0.001; r=−0.334, P=0.001).ConclusionThe posterior cranial fossa linear volume of normal adults is significantly larger in males than in females; the posterior cranial fossa linear volume and the cerebellar tonsil position may have a decreasing process of age-related degeneration.
Objective To determine the efficacy and safety of Amplatzer transcatheter closure and surgical closure for ostium secundum atrial septal defects. Methods MEDLINE (1966-July 2006), EMBASE (1966-July 2006), The Cochrane Library (Issue 2, 2006) and CBMdisc (1979-July 2006) were searched for randomized controlled trials or non-randomized controlled trials. Data were extracted by two reviewers using a specially designed extraction form. The quality of included trials was critically assessed. The Cochrane Collaboration’s RevMan 4.2 software was used for data analysis. Results Sixteen non-RCTs involving 2 043 patients were included. No deaths were reported in 14 trials. The other two trials reported one death respectively in the surgical group. Meta-analysis of 12 trials involving 1 722 patients showed that the procedure success rate for the Amplatzer group was lower than that for the surgical group [WMD:0.95, 95%CI (0.92,0.98)]. Similar results were also found in the complete closure rate in 24-hour follow-up [6 trials involving 1 106 patients, WMD:0.96, 95%CI (0.92 to 1.00)], the complication rate [16 trials involving 1 971 patients, WMD:0.27, 95%CI(0.21 to 0.35)] and the transfusion rate [14 trials involving 1 807 patients, WMD:0.03, 95%CI(0.02 to 0.06)]. Conclusions The success rate for Amplatzer device closure of ASD is lower than that of surgical repair. However, the complication rate, length of hospital stay and transfusion rate are lower or shorter for Amplatzer device closure than for surgical repair. Based on appropriate patient selection, Amplatzer closure of ASD is a safe and effective alternative to surgical repair.
ObjectivesTo investigate the occurrence and parents’ cognition of accidental injury among pre-school children in Nanchong city, and provide advice and countermeasures to reduce accidental child injuries.MethodsUsing the multi-stage cluster sampling method, a total of 945 students and parents from 3 classes in each of 4 kindergartens in three districts of Nanchong city were surveyed with questionnaire.ResultsA total of 945 questionnaires were issued and 858 valid questionnaires were returned and the effective response rate was 90.79%. The incidence of incidental injury of pre-school children in Nanchong city was 25.99%, with no difference between boys and girls, and no difference between age groups. The top three injuries were falling (35.64%), smashing/touching/squeezing (22.11%), cutting/stabbing (10.56%). The child smashing/touching/squeezing rate was higher in boys than in girls, the difference was statistically significant (χ2=5.549, P=0.018). The top three places of the occurred injury were outdoor (53.67%), home (43.58%), and playground and kindergarten (13.76%). Between parents who possess injury-related knowledge and those who didn’t, there was no difference in the incidence of accidental injuries among their children. Parents often learned from cell phone (23.88%), TV (21.76%) and computer (18.11%). Ways in which they most hoped to learn from were the school advertised education (22.67%), TV (18.80%) and cell phones (17.75%). Of all types of emergency management skills, the top three figures acquired by the largest population were post-burn emergency treatment (72.03%), emergency treatment for traumatic bleeding (52.56%) and emergency treatment of animal bites (37.53%).ConclusionsThe incidence of accident injuries is high in urban areas of Nanchong city. The safety management of home and kindergarten should be strengthened, including schools' safety education and skills training for children and parents.
Objective To manage the preoperative, intraoperative and postoperative pain of percutaneous kyphoplasty (PKP) under the concept of enhanced recovery after surgery (ERAS) and explore the role of pain management under the ERAS concept in enhancing postoperative rehabilitation of PKP. Methods From January to December 2016, 136 patients with osteoporotic compression fractures treated with PKP of local anesthesia were selected, among which 71 patients in the ERAS group were treated between July and December 2016, who were treated with celecoxib capsule for analgesia before the operation and such local anesthetics as lidocaine and ropivacaine combined with intravenous injection of dexmedetomidine hydrochloride for multi-mode analgesia during the operation; after the operation, celecoxib capsules and tizanidine hydrochloride tablets were orally administered by the routine for analgesia; if the pain was increased, 40 mg parecoxib would be added for analgesia by intramuscular injection. While 65 patients in the conventional group were treated between January and June 2016, who were given intraoperative local anesthesia with lidocaine; if the patients suffered from severe pain after the operation, they would be given 40 mg parecoxib by intramuscular injection. The Visual Analogue Scale (VAS), mean arterial pressure (MAP), the complications after surgery, postoperative infections, bed rest time, length of hospital stay and patient satisfaction were compared between the two groups. Results There was no statistical difference in age, gender or fracture vertebral number between the two groups (P>0.05). The preoperative, intraoperative and postoperative VAS scores (4.0±1.5, 4.8±1.8, 1.6±1.1), MAP change [(22.0±4.7) mm Hg (1 mm Hg=0.133 kPa)], bed rest time [(1.5±0.7) days], and length of hospital stay [(3.8±0.8) days] in the ERAS group were significantly less than those in the conventional group [4.7±1.7, 5.7±1.5, 2.4±1.1, (31.3±6.1) mm Hg, (2.1±0.8) days, and (5.0±1.6) days, respectively] (P<0.05). The incidence of intraoperative complication of bone cement leakage (4.2%, 3/71) in the ERAS group was lower than that in the conventional group (13.8%, 9/65) (P<0.05); there was no statistical difference in postoperative pulmonary infection between the two groups (P>0.05). Patients’ satisfaction was significantly improved from 86.2% (the conventional group) to 95.8% (the ERAS group) (P<0.05). There was no incision infection, urinary tract infection or venous thrombosis in the two groups. Conclusion With the concept of ERAS, taking a management of pain can effectively alleviate the dis-comfortable pain feeling, improve the patients’ satisfaction, and enhance the recovery for the patients after PKP surgery.
Objective To compare the effectiveness of posterior lumbar interbody fusion (PLIF) by unilateral fenestration and bilateral decompression with ultrasounic osteotome and traditional tool total laminectomy decompression PLIF in the treatment of degenerative lumbar spinal stenosis. Methods The clinical data of 48 patients with single-stage degenerative lumbar spinal stenosis between January 2017 and June 2017 were retrospectively analyzed. Among them, 27 patients were treated with unilateral fenestration and bilateral decompression PLIF with ultrasonic osteotome (group A), and 21 patients were treated with total laminectomy and decompression PLIF with traditional tools (group B). There was no significant difference in gender, age, stenosis segment, degree of spinal canal stenosis, and disease duration between the two groups (P>0.05), which was comparable. The time of laminectomy decompression, intraoperative blood loss, postoperative drainage volume, and the occurrence of operation-related complications were recorded and compared between the two groups. Bridwell bone graft fusion standard was applied to evaluate bone graft fusion at last follow-up. Visual analogue scale (VAS) score was used to evaluate the patients’ lumbar and back pain at 3 days, 3 months, and 6 months after operation. Oswestry disability index (ODI) score was used to evaluate the patients’ lumbar and back function improvement before operation and at 6 months after operation. Results The time of laminectomy decompression in group A was significantly longer than that in group B, and the intraoperative blood loss and postoperative drainage volume were significantly less than those in group B (P<0.05). There was no nerve root injury, dural tear, cerebrospinal fluid leakage, and hematoma formation during and after operation in the two groups. All patients were followed up after operation, the follow-up time in group A was 6-18 months (mean, 10.5 months) and in group B was 6-20 months (mean, 9.3 months). There was no complication such as internal fixation fracture, loosening and nail pulling occurred during the follow-up period of the two groups. There was no significant difference in VAS scores between the two groups at 3 days after operation (t=1.448, P=0.154); the VAS score of group A was significantly lower than that of group B at 3 and 6 months after operation (P<0.05). The ODI scores of the two groups were significantly improved at 6 months after operation (P<0.05), and there was no significant difference in ODI scores between the two groups before operation and at 6 months after operation (P>0.05). At last follow-up, according to Bridwell criteria, there was no significant difference in bone graft fusion between the two groups (Z=–0.065, P=0.949); the fusion rates of groups A and B were 96.3% (26/27) and 95.2% (20/21) respectively, with no significant difference (χ2=0.001, P=0.979 ). Conclusion The treatment of lumbar spinal stenosis with unilateral fenestration and bilateral decompression PLIF with ultrasonic osteotome can achieve similar effectiveness as traditional tool total laminectomy and decompression PLIF, reduce intraoperative blood loss and postoperative drainage, and reduce lumbar back pain during short-term follow-up. It is a safe and effective operation method.
ObjectiveTo analyze and compare the clinical efficacy and safety between one-stage operation and staged operation in the treatment of tandem spinal stenosis (TSS).MethodsThe data of 39 patients with TSS were retrospectively analyzed, who were definitely diagnosed and treated surgically between February 2011 and March 2016 in the Affiliated Hospital of Southwest Medical University. According to whether one-stage decompression was performed, the patients were divided into group A (cervical and lumbar vertebral canal decompression procedures were performed in one stage, n=21) and group B (cervical and lumbar spinal canal decompression procedures were performed in two stages with a time interval of 3-6 months, n=18). Both one-stage and staged operations were performed by the same surgical team. The Nurick scores, Japanese Orthopedic Association (JOA) scores of cervical spine and lumbar spine, and Oswestry Disability Index (ODI) before operation and in postoperative follow-up, postoperative JOA improvement rate, and perioperative indicators were recorded and compared.ResultsAll patients completed the operations successfully, and the lengths of follow-up were all longer than 12 months. There was no significant difference in gender, age, body mass index, preoperative duration of symptoms, preoperative Kang grade, preoperative Schizas grade, preoperative underlying diseases, preoperative cervical or lumbar spine JOA score, preoperative ODI, preoperative Nurick score, decompression segment or distribution, or length of follow-up between the two groups (P>0.05). The Nurick score, JOA score of cervical and lumbar spine, and ODI at one year after operation and the last follow-up were significantly improved compared with those before operation. The one-year after operation improvement rates of JOA of cervical and lumbar spine in group A were significantly higher than those in group B [cervical spine: (70.55±9.28)% vs. (55.29±7.82)%, P<0.05; lumbar spine: (69.50±4.95)% vs. (51.58±7.62)%, P<0.05], but there was no significant difference in the improvement rate of JOA between the two groups at the last follow-up (P>0.05). There was no significant difference in Nurick score or ODI between the two groups at one year after operation or the last follow-up (P>0.05). There was no significant difference in the average length of hospital stay between the two groups [(15.67±3.40) vs. (15.72±1.57) d, P>0.05]. The operation time [(293.10±43.83) vs. (244.44±22.29) min] and intraoperative bleeding [(533.33±180.51) vs. (380.56±38.88) mL] in group A were significantly higher than those in group B (P<0.05). The incidence of postoperative complications of group A was higher than that of group B (57.1% vs. 16.7%, P<0.05).ConclusionsCompared with staged surgery, one-stage operation in the treatment of TSS has a significant improvement in neurological function and clinical efficacy in short-term follow-up, but there is no significant difference in long-term follow-up. Staged surgery has the advantages of shorter operation time, less intraoperative blood loss, lower postoperative complication rate, and higher safety.