Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic ...Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic spinal cord injury in China have mostly been regional in scope;national-level studies have been rare.To the best of our knowledge,no national-level study of treatment status and economic burden has been performed.This retrospective study aimed to examine the epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China at the national level.We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China.Patient epidemiological and clinical features,treatment status,and total and daily costs were recorded.Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program.The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall(annual percentage change,-0.5%and 2.1%,respectively).A total of 10,053(74.7%)patients underwent surgery.Only 2.8%of patients who underwent surgery did so within 24 hours of injury.A total of 2005(14.9%)patients were treated with high-dose(≥500 mg)methylprednisolone sodium succinate/methylprednisolone(MPSS/MP);615(4.6%)received it within 8 hours.The total cost for acute traumatic spinal cord injury decreased over the study period(-4.7%),while daily cost did not significantly change(1.0%increase).Our findings indicate that public health initiatives should aim at improving hospitals’ability to complete early surgery within 24 hours,which is associated with improved sensorimotor recovery,increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.展开更多
Objective： The aim of this study was to investigate the biomechanical property of lumbosacral reconstruction after subtotal sacrectomy. Methods： Three three-dimensional finite element models of lumbosacral region we...Objective： The aim of this study was to investigate the biomechanical property of lumbosacral reconstruction after subtotal sacrectomy. Methods： Three three-dimensional finite element models of lumbosacral region were established： （1） An intact model （INT）; （2） A defective model （DEF） on which subtotal sacrectomy was performed cephalad to the $1 foramina; （3） A reconstructed model （REC）. These models were validated by compared with literature. Upright posture was stimulated under a compression load of 925N. A finite element analysis was performed to account for the displacement and stress on the models. The REC model was calculated twice, with the material property of reconstruction instrument set as titanium and stainless steel, respectively. Results： The displacements of anchor point on the L3 vertebrae in INT, DEF and REC model were 6.63 mm, 10.62 mm, 4.29 mm （titanium） and 3.86 mm （stainless steel）, respectively. The stress distribution of the instrument in REC model showed excessively concentration on caudal spinal rod, which may cause rod failure between spine and ilia. The maximum von Mise stress of stainless steel instrument was higher than that of titanium instruments （992 MPa vs 655 MPa）, and the value of stress of anchor point around sacroiliac joint in REC model were 26.4 MPa with titanium instruments and 23.9 MPa with stainless steel instruments. Conclusion： Lumbosacral reconstruction can significantly increase the stiffness of spino-pelvis of the patient who underwent subtotal sacrectomy. However, the rod between L5 and ilia is the weakest region of all the instruments. It is suggested that the bending of rod should be conducted carefully and smoothly to avoid significant stress concentration so as to reduce the risk of rod failure. And stainless steel instrument has higher maximum stress and significantly greater stress shielding effect than titanium instrument, which means stainless steel instruments are of higher risk of rod failure and less favorable for lumboiliac arthrodesis than titanium instruments.展开更多
基金supported by the National Key Research and Development Project,No.2019YFA0112100(to SF).
文摘Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic spinal cord injury in China have mostly been regional in scope;national-level studies have been rare.To the best of our knowledge,no national-level study of treatment status and economic burden has been performed.This retrospective study aimed to examine the epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China at the national level.We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China.Patient epidemiological and clinical features,treatment status,and total and daily costs were recorded.Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program.The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall(annual percentage change,-0.5%and 2.1%,respectively).A total of 10,053(74.7%)patients underwent surgery.Only 2.8%of patients who underwent surgery did so within 24 hours of injury.A total of 2005(14.9%)patients were treated with high-dose(≥500 mg)methylprednisolone sodium succinate/methylprednisolone(MPSS/MP);615(4.6%)received it within 8 hours.The total cost for acute traumatic spinal cord injury decreased over the study period(-4.7%),while daily cost did not significantly change(1.0%increase).Our findings indicate that public health initiatives should aim at improving hospitals’ability to complete early surgery within 24 hours,which is associated with improved sensorimotor recovery,increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.
文摘Objective： The aim of this study was to investigate the biomechanical property of lumbosacral reconstruction after subtotal sacrectomy. Methods： Three three-dimensional finite element models of lumbosacral region were established： （1） An intact model （INT）; （2） A defective model （DEF） on which subtotal sacrectomy was performed cephalad to the $1 foramina; （3） A reconstructed model （REC）. These models were validated by compared with literature. Upright posture was stimulated under a compression load of 925N. A finite element analysis was performed to account for the displacement and stress on the models. The REC model was calculated twice, with the material property of reconstruction instrument set as titanium and stainless steel, respectively. Results： The displacements of anchor point on the L3 vertebrae in INT, DEF and REC model were 6.63 mm, 10.62 mm, 4.29 mm （titanium） and 3.86 mm （stainless steel）, respectively. The stress distribution of the instrument in REC model showed excessively concentration on caudal spinal rod, which may cause rod failure between spine and ilia. The maximum von Mise stress of stainless steel instrument was higher than that of titanium instruments （992 MPa vs 655 MPa）, and the value of stress of anchor point around sacroiliac joint in REC model were 26.4 MPa with titanium instruments and 23.9 MPa with stainless steel instruments. Conclusion： Lumbosacral reconstruction can significantly increase the stiffness of spino-pelvis of the patient who underwent subtotal sacrectomy. However, the rod between L5 and ilia is the weakest region of all the instruments. It is suggested that the bending of rod should be conducted carefully and smoothly to avoid significant stress concentration so as to reduce the risk of rod failure. And stainless steel instrument has higher maximum stress and significantly greater stress shielding effect than titanium instrument, which means stainless steel instruments are of higher risk of rod failure and less favorable for lumboiliac arthrodesis than titanium instruments.
