ObjectiveTo systematically review the prevalence of enuresis in Chinese children and adolescents. MethodsA computer search was conducted for epidemiological research on the prevalence of enuresis among Chinese children and adolescents in databases including CNKI, WanFang Data, VIP, SinoMed, PubMed, Embase, and Web of Science. Two researchers independently carried out literature screening, data extraction, and quality evaluation. Meta-analysis was executed using R language, with baujat plots and subgroup analysis to investigate heterogeneity sources, and leave-one-out for sensitivity analysis. ResultsA total of 38 papers were included, encompassing 327 065 participants, with 18 392 children suffering from enuresis. The aggregate prevalence rate was 5.59% (95%CI 4.58% to 6.81%). The prevalence rate showed a significant decreasing trend with increasing age, with rates at ages 5, 12, and 18 being 12.30% (95%CI 9.96% to 15.11%), 2.07% (95%CI 1.68% to 2.56%), and 1.95% (95%CI 0.90% to 4.20%), respectively. The incidence rate in male children was higher at 6.36% (95%CI 5.49% to 7.36%) than that in female children at 4.30% (95%CI 3.57% to 5.16%). Using DSM-IV as the diagnostic criteria, the prevalence rate was 3.78% (95%CI 2.58% to 5.52%), while it was 5.99% (95%CI 4.75% to 7.52%) using ICCS as the criteria. ConclusionThe prevalence of enuresis among Chinese children and adolescents is affected by factors such as region, age, gender, and diagnostic standards. The prevalence is higher in South China, decreases with age, and is significantly higher in males than in females.
ObjectiveTo compare the effects of robot-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open freehand TLIF for the treatment of single-level degenerative lumbar spondylolisthesis (DSL) on adjacent segmental degeneration (ASD). Methods The clinical data of 116 patients with L4、5 DLS who were admitted between November 2019 and October 2021 and met the selection criteria were retrospectively analyzed. According to the surgical methods, they were divided into the robotic group (45 cases, who underwent robot-assisted MIS-TLIF) and the open group (71 cases, who underwent open freehand TLIF). There was no significant difference in baseline data such as gender, age, body mass index, DLS Meyerding grading, and preoperative Pfirrmann grading, Weishaupt grading, L3, 4 intervertebral disc height (DH), L3, 4 intervertebral mobility, sagittal parameters [including pelvic incidence (PI), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT)], and Cage height (P>0.05). The grade of facet joint violation (FJV) by pedicle screws on the superior articular process was assessed postoperatively. Sagittal parameters, L3, 4 DH, L3, 4 DH loss, and L3, 4 intervertebral mobility were measured preoperatively and at last follow-up in order to determine whether ASD occurred. The influencing factors for the occurrence of ASD after TLIF were analyzed by using a univariate analysis, and further analyzed by using a logistic regression to analyze the risk factors for the occurrence of ASD after TLIF. Results Patients in both groups were followed up 21-47 months, with a mean of 36.1 months; there was no significant difference in the follow-up time between the two groups (P>0.05). The occurrence of postoperative FJV was significantly better in the robotic group than in the open group (P<0.05). At last follow-up, the difference in the change values of sagittal parameters PI, PT, SS, and LL was not significant when comparing the two groups of patients (P>0.05); the change values of L3, 4 DH and L3, 4 DH loss in the robotic group were smaller than those in the open group, and the change values of L3, 4 intervertebral mobility were larger than those in the open group, and the differences were significant (P<0.05). At last follow-up, ASD occurred in 8 patients (17.8%) in the robotic group and 35 patients (49.3%) in the open group, and the difference in ASD incidence between the two groups was significant (P<0.05). Univariate analysis showed that patients’ age, preoperative Pfirrmann grading, preoperative Weishaupt grading, change values of L3, 4 intervertebral mobility at last follow-up, treatment method, and postoperative FJV grading were the influencing factors for the occurrence of ASD after TLIF (P<0.05). Further logistic regression analysis showed that open surgery, preoperative Pfirrmann grading IV-V, preoperative Weishaupt grading ≥2, and postoperative FJV grading ≥1 were risk factors for the development of ASD after TLIF (P<0.05). Conclusion Preoperative disc and synovial joint degeneration in adjacent segments, nonrobotic-assisted minimally invasive therapy, and FJV are risk factors for ASD after TLIF. Compared with traditional open surgery, orthopedic robot-assisted MIS-TLIF in the treatment of single-level DLS can more accurately insert pedicle screws, reduce the loss of DH and the occurrence of FJV, and effectively reduce the incidence of mid-postoperative ASD.