【Abstract】 Objective To summarize the current development of the correction of severe and rigid scol iosis. Methods Recent l iterature concerning the correction of severe and rigid scol iosis at home and abroad was extensively reviewed, and current developments of the correction of severe and rigid scol iosis were summarized. Results The correction of severe and rigid scol iosis shows developments as follows: the application of Halo-gravity traction increase and Halo-femoral traction is applied in posterior correction surgery. Fixation and correction technique with all pedicle screws was gradually popularized. The applications of posterior vertebral column resection, one-stage anterior and posterior surgery, and posterior-only correction surgery increase. Conclusion The developments of all kinds of correction techniques improve the correction effects of severe and rigid scol iosis. Now there is no standardized treatment protocol for severe and rigid scol iosis. Greater development can be expected in the future.
ObjectiveThis study intends to analyze the changing disease burden of mood disorders in China from 1990 to 2021 and project the epidemiological trends in the next two decades. MethodsThis study uses data from the Global Burden of Disease (GBD) 2021 database on three mood disorders in China (bipolar disorder, major depressive disorder, and dysthymia) from 1990 to 2021. The indicators such as age-standardized number of diseases and disability-adjusted life years (DALYs) were used to explore the characteristics of time, gender, and age distribution of the disease burden of mental disorders. The BAPC model was used to predict the disease burden in the next two decades. ResultsIn 2021, the number of cases of dysthymia, MDD, and BD in China was 27.84 million, 26.0 million, and 2.85 million, with an increase of 73.24%, 38.33%, and 36.79% compared with 1990, respectively. In 2021, DALYs of dysthymic disorder, MDD and BD were 2.67 million, 5.2 million and 0.61 million person-years, which increased by 71.45%, 34.29% and 34.76% compared with 1990, respectively. The burden of mood disorders is heavier among women and the middle-aged and elderly population. In addition, it is expected that ASPR and ASDR of dysthymia will continue to increase after a brief decline, MDD will show a downward trend, while BD will show a slight upward trend in the next two decades. ConclusionThe disease burden of mood disorders in China remains substantial, with dysthymia and BD showing persistent upward tendency. More resources should be invested in mental health care.
摘要:目的：探讨纤支镜经口引导气管插管在慢阻肺合并重度呼吸衰竭救治中的临床应用价值。方法：237例慢阻肺合并重度呼吸衰竭患者,随机分为纤支镜经口引导气管插管组(纤支镜组)125例和喉镜经口引导气管插管组(喉镜组)112例,分别在纤支镜和喉镜引导下按常规进行气管插管术。结果：纤支镜组和喉镜组一次获得插管成功率分别为984%和920%(P＜005),平均插管时间分别为（613±391） min 和（926±415） min(P＜005)。纤支镜组有5例患者出现咽喉部少量出血,并发症发生率为40%;喉镜组共有12例发生并发症,并发症发生率为107%(P＜005),其中齿、舌、咽或喉部损伤6例,反射性呕吐致误吸2例,单侧肺通气1例,插入食管2例,心跳呼吸骤停1例。结论：纤支镜经口引导气管插管在慢阻肺合并重度呼吸衰竭救治中是一种简便快速、成功率高和并发症少的有效方法,值得临床推广应用。Abstract: Objective: To evaluate the efficacy of endotracheal intubation under fiberoptic bronchoscope through mouth in severe respiratory failure. Methods:Two hundreds and thirtyseven cases of severe respiratory failure were divided into two groups at random (fiberoptic bronchoscope group and laryngoscope group), 125 cases were intubated through mouth under fiberoptic bronchoscope, the others were intubated through mouth by laryngoscope. Results: The successful rates of endotracheal intubation were 98.4% and 92.0% in two groups respectively (P ＜005), the mean intubation timewere (613±391) min and (926±415) min respectively ( P ＜ 005), 4 cases in fiberoptic bronchoscope group appeared a little blood in throat, the complication rate was 32% 12 cases in the laryngoscope group had complications, the complication rate was 107%( P＜ 005). Among it, 6 cases had the injury of tooth, tongue, gullet and larynx.The cases of reflexvomiting were 2,pulmonary ventilation by single lung were 1, intubation in esophagus were 2, cardiopulmonary arrest were 1.Conclusions:Endotracheal intubation under fiberoptic bronchoscope through mouth was accurate, the fewer complications and effective for patients, and could be used widely in clinical applications.
ObjiectiveTo obtain reliable evidence of diagnosis and treatment through evaluating the validity of pneumonia severity index (PSI), CURB-65 and acute physiology and chronic health evaluationⅡ(APACHEⅡ) scores in predicting risk stratification, severity evaluation and prognosis in elderly community-acquired pneumonia (CAP) patients.MethodsClinical and demographic data were collected and retrospectively analyzed in 125 in-hospital patients with CAP admitted in Shanghai Dahua Hospital from January 2012 to April 2015. The severity of pneumonia was calculated with PSI, CURB-65 and APACHEⅡgroups during 1 to 3 days after admission. Mortality and intensive care unit (ICU) admission rates were evaluated among patients in each scores and was categorized into three classes, namely mild, moderate and severe groups during 1 to 3 days after admission. Mortality and ICU admission rates were evaluated among patients in each severity level. Through evaluating the sensitivity, specificity, the predicting values and the area under receiver operating characteristic (ROC) curve (AUC) among PSI, CURB-65 and APACHEⅡ, the validity and consistency of these three scoring systems were assessed.ResultsUsing PSI, CURB-65 and APACHEⅡ scoring systems, the patients were categorized into mild severity (48.8%, 64.0% and 52.8%, respectively), moderate severity (37.6%, 23.2% and 32.0%, respectively) and severe severity (13.6%, 12.8% and 15.2%, respectively). In PSI, CURB-65 and APACHEⅡ systems, the mortality in high risk groups was 41.3%, 62.5% and 47.4%, respectively; The ICU-admission rate in high risk groups was 88.3%, 100.0% and 94.7%, respectively. The sensitivity of PSI, CURB-65 and APACHEⅡ was 50.0%, 71.4% and 64.3% in predicting mortality, and was 46.8%, 50.0% and 59.3% in predicting ICU-admission, respectively. PSI, CURB-65 and APACHEⅡ showed similar specificity (approximately 90%) in predicting mortality and ICU admission. ROC was conducted to evaluate the sensitivity of PSI, APACHEⅡ and CURB-65 in predicting mortality and ICU admission. The AUC had no significant difference among these three scoring systems. The AUC of PSI, CURB-65 and APACHEⅡwas 0.893, 0.871, 0.880, respectively for predicting mortality, and was 0.949, 0.837, 0.949, respectively for predicting ICU admission. There was no significant difference among these three scoring in predicting mortality and ICU admission (all P>0.05).ConclusionsPSI, CURB-65 and APACHEⅡ performed similarly and achieved high predictive values in elderly patients with CAP. The three scoring systems are consistent in predicting mortality risk in elderly CAP patients. The CURB-65 is more sensitive in predicting the risk of death, and more early in identifing patients with high risk of death. The APACHEⅡ is more sensitive in predicting the risk of ICU admission, and has good value in identifying severe patients and choosing the right treatment sites.
Objective To investigate the relationship between the red blood cell distribution width (RDW) and the severity of community-acquired pneumonia (CAP). Methods The clinical data of 285 adult patients with CAP admitted from November 2014 to August of 2017 were analyzed retrospectively. The severity of CAP was evaluated by pneumonia severity index (PSI) score. Meanwhile, 60 cases with qualified medical examination were collected as a healthy control group. The distributions of PSI score, RDW, procalcitonin (PCT), C-reactive protein (CRP) and neutrophil percentage (NEU%) were described in the patients with different risk degree. The correlation analysis of various indicators were analyzed by Spearman correlation. The threshold of RDW(%) was calculated through the construction of the general linear regression equation. The risk factors of PSI score were analyzed with multiple linear regression. Results The higher the risk stratification, the higher the distribution of PSI scores, RDW, PCT, CRP and NEU% were. RDW was positively correlated with PCT, CRP, and NEU% (r values were 0.417, 0.252, 0.318, respectively, P<0.05). PSI score was positively correlated with RDW, PCT, CRP, and NEU% (r values were 0.537,0.598, 0.557, 0.482, respectively, P<0.05). RDW was positively correlated with PSI score (r=0.537, P<0.05). The thresholds of RDW(%) were 14.514 and 19.041. Multiple linear regression showed that RDW, PCT, CRP and NEU% were all influential factors of PSI scores and explained 46.9% of the total mutation rate. Conclusion RDW is correlated with the severity of CAP, and can predict the severity of CAP.
ObjectiveTo analyze the methods of offside reconstruction in total hip arthroplasty (THA) for severe osteoarthritis. MethodsBetween July 2009 and June 2011,18 cases (18 hips) of severe osteoarthritis of the hip were treated by THA,including 14 males and 4 females with a mean age of 55.4 years (range,47-72 years).The disease duration was 11-74 months (mean,33.6 months).The left hip was involved in 11 cases and the right hip in 7 cases.The hip Harris score was 34.6±5.3.The lower limb discrepency was observed in 15 cases.Thomas sign,Patrick sign,and Trendelenburg sign were positive in all cases.All patients received THA; during operation,standard femoral neck osteotomy was performed and the correct rotation center was chosen to reconstruct offside. ResultsAll the incisions healed primarily.Common peroneal nerve injury occurred in 1 case and was cured after symptomatic treatment for 3 months,and the other patients had no complication.The mean follow-up period was 43.5 months (range,30-53 months).All patients achieved pain relief,and returned to normal gait.The X-ray films showed no dislocation of the hip or prosthetic loosening.Lower limb discrepency was observed in 6 cases.The mean offside difference between normal and ipsilateral side was 0.4 mm (range,0.1-0.7 mm).At last follow-up,the hip Harris score was 83.0±7.1,showing significant difference when compared with preoperative score (t=-22.96,P=0.01); the hip range of motion was significantly increased when compared with preoperative one (P<0.05). ConclusionThe offside reconstruction can accurately be carried out by making precise template and vernier caliper measurement,selecting suitable prosthesis preoperatively,maintaining the proper femoral calcar length,adjusting the length of the neck and neck-shaft angle,releasing the soft tissue reasonably during THA for severe osteoarthritis,and the short-term effectiveness is satisfactory.
Objective To investigate the technique of reduction by posterior approach for severe spondylolisthesis, and to discuss the method to prevent nerve stretch injury. Methods Between July 2007 and April 2011, 17 patients with severe spondylolisthesis underwent reduction, fixation, and fusion by posterior approach. There were 2 males and 15 females with a median age of 15 years (range, 8-67 years) and a median disease duration of 18 months (range, 5 months-16 years and 4 months). The level of spondylolisthesis was at L4 in 1 case and L5 in 16 cases; the spondylolisthesis was at degree III in 12 cases and degree IV in 5 cases according to Meyerding classification. There were 16 cases of developmental spondylolisthesis (high- dysplastic and low-dysplasia spondylolisthesis in 9 and 7 cases, respectively) and 1 case of traumatic spondylolisthesis; 16 cases of developmental spondylolisthesis at L5 level included 6 cases of type 4, 9 case of type 5, and 1 case of type 6 according to Spinal Deformity Study Group (SDSG) classification. All cases underwent posterior spinal decompression, Schanz screw fixation for the slipped vertebrae, the intervertebral and posterolateral fusion and reduction of the slipped vertebrae, and correction of the lumbosacral kyphosis. The reductive degree of slipped vertebrae was modulated according to the strain of exiting spinal root. The slip degree should be reduced within Meyerding degree II. The anteroposterior and lateral radiographs of whole spine were taken in a standardized standing position to observe the correction of displacement severity and lumbosacral angle. The nerve function and pain score of lower extremity were evaluated by neurological Frankel grade and visual analogue scale (VAS). Bony fusion was assessed by followed-up CT three-dimentional reconstruction. Results Exiting nerve root paralysis occurred in 1 case after operation, and released at 4 weeks after operation; no aggravation of nerve damage was observed in the other patients. The incisions primarily healed. All the patients were followed up 12-48 months (mean, 25 months). The slip percentage, the lumbosacral angle, and VAS score of lower extremity were improved from 72% ± 10%, (18.2 ± 3.5)°, and 7.0 ± 1.5 at preoperation to 12% ± 6%, ( — 7.3 ± 2.9)°, and 1.5 ± 1.3 at 12 months after operation respectively, all showing significant differences (P lt; 0.05). Osteosynthesis was seen at the bone grafting area by CT three-dimentional reconstruction at 12 months after operation. No breakage of screw and rod or reduction loss occurred. Conclusion It can obtain satisfactory clinical result to use spinal canal decompression by posterior approach, the Schanz screw fixation of the slipped vertebrae, the intervertebral and posterolateral fusion for severe spondylolisthesis. The risk of nerve stretch injury can be prevented by choosing the lowest height of intervertebral cage, modulating the reductive degree of slipped vertebrae according to the strain of exiting spinal root, and correcting lumbosacral kyphosis.
Objective To review the research progress in the treatment of high-grade spondylolisthesis (HS), in order to provide a reference for clinical treatment decision-making. Methods The literature related to the treatment of HS at home and abroad in recent years was widely reviewed. The methods of conservative treatment, in situ fusion, and spondylolisthesis reduction were analyzed and summarized. Results Surgical treatment is the main treatment of HS, but which method is the best is still controversial. The advantages, disadvantages, and applicability of various operations are also different, so individualized analysis is needed in clinic. Conclusion The treatment plan of HS needs to be considered comprehensively according to the individual condition of the patient. It will be an important research direction to further compare the existing treatment methods and develop more safe and effective new technology.
Objective To summarize the short-term efficacy， surgery complications， and relative experiences in the management of severe functional constipation （SFC） under laparoscopy-assisted subtotal colectomy combined modified Duhamel procedure. Methods All the data of 15 patients underwent laparoscopy-assisted subtotal colectomy combined modified Duhamel procedure from March 2010 to August 2011 were collected retrospectively， all the patients were diagnosed as SFC and failed to conservative therapy. The postoperative short-term efficacy， complications of surgery， score of gastrointestinal living condition， and improvement degree of defecation were analyzed. Results All 15 procedures achieved success， the operation time was （247.33±55.10） min， the intraoperative blood loss volume was （107.33±45.59） ml， the incision length was （8.40±2.41） cm， the postoperative out of bed activity time was （2.27±1.28） d，the postoperative passage of gas by anus time was （2.60±1.89） d， the postoperative defecation time was （2.87±2.50） d，the postoperative foods taken per oral time was （3.07±1.16） d， the hospital stay was （12.64±2.37） d. Approximately on day 3-4 after operation， 10 patients presented with postoperative diarrhea but were all under control with antidiarrheals efficiently. One patient presented with incomplete bowel obstruction on day 8 after operation and one patient with stomal leakage complicated with deep infection on day 9 after operation， who both recovered under conservative therapy. The scoreof gastrointestinal living quality on month 1 after operation was significantly higher than that on day 1 before operation （121.80±4.72 versus 90.80±7.24， P=0.000）， and the improvement degree of defecation was （0.81±0.56）%. Conclusions From the limited case informations， the laparoscopy-assisted subtotal colectomy combined modified Duhamel procedure has a certain short-term curative effect in treatment for SFC with the advantages of faster recovery， less bleeding， shorter hospital stay， and fewer complications.