Background Short-segment transpedicular screw fixation is a common method for the treatment of thoracolumbar burst fractures (TBFs),but this technique has many problems. Therefore,the purpose of this article is to observe and evaluate the clinical efficacy of a novel transpedicular reducer that we designed for fractured vertebral body reduction and bone grafting in the treatment of TBFs. Methods From July 2018 to November 2020, 70 cases of TBFs were included. Thirty-five patients were treated with the novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation (observation group), and 35 patients were treated with short-segment transpedicular screw fixation (control group). Before the operation, after reduction, and 3 days, 3 months,and 12 months after the operation, the two groups were assessed, and compared with respect to the anterior and middle heights of the injured vertebrae, the ratios of the anterior and middle heights of the injured vertebral body to the respective heights of the adjacent uninjured vertebral bodies (AVBHr and MVBHr, respectively), and the Cobb angle of the patients. We compared the pain VAS score and quality of life GQOL-74 score at the last follow-up. Finally,we evaluated the distribution of bone grafts and bone healing 12 months after the operation. Results The anterior height, middle height, AVBHr, MVBHr, and Cobb angle of the injured vertebral body in the observation after reduction, and 3 days, 3 months and 12 months post-operatively were compared with those of the injured vertebral body before operation. All of these parameters were improved, and the difference was statistically significant (p < 0.05). These parameters in the observation group at the above time points were significantly better than thoes in the control group at the corresponding time points (p < 0.05). The VAS scores at the last follow-up were significantly better than those of the control group (p < 0.05), but the GQOL-74 score differences were not statistically significant (p > 0.05). The observation group showed no obvious defects on CT at 12 months after the operation, and the bone healing was good. Conclusion The novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation for TBFs has good clinical efficacy.

Purpose: In this study, computed tomography (CT) radiographic measurements and common clinical scores were used to evaluate the effectiveness of percutaneous posterior full-endoscopic resection of an ossified thoracic ligamentum flavum. Methods: A prospective study was conducted on 16 patients treated with posterior endoscopy from September 2017 to November 2019. Before the operation, 3 days after the operation and 1 year after the operation, the area of ossification in the ligamentum flavum was assessed by sagittal CT scans and transected to evaluate the decompression effect of posterior endoscopic surgery. The clinical efficacy of the surgery was evaluated at the above time points by using the visual analog scale for pain, modified Japanese Orthopedic Association scale, ODI and Macnab efficacy evaluation. Results: The area of sagittal ossification in the ligamentum flavum in 16 patients was 116.62±32.72 mm2 before the operation, 15.99±12.54 mm2 3 days after the operation, and 16.78±11.49 mm2 1 year later. The sagittal canal invasive proportions were 48.10±10.04% before the operation, 6.46±4.86% 3 days after the operation, and 6.83±4.48% 1 year later. The area of transected ossification in the ligamentum flavum was 141.59±27.25 mm2 before the operation, 11.72±8.64 mm2 3 days after the operation, and 10.82±7.57 1 year later. The transected spinal canal invasive proportions were 57.58±11.37%, 4.76±3.45% and 4.40±3.01%. The mJOA score were 3.50±1.10, 6.19±0.91 and 9.19±1.38, with a n average recovery rate of 73.96±16.58%. According to the Macnab evaluation, the recovery status of the 16 patients 1 year after the operation was excellent in 9 patients, good in 5 patients, and fair in 2 patients; the excellent and good rate was 87.50%. The differences were statistically significant (P<0.05). Intraoperative dural tears occurred in 2 of 16 patients, but no complications, such as cerebrospinal fluid leakage, were observed. Conclusion：The measurements of ossification ligamentum flavum area and spinal canal invasive proportion can appropriately evaluate the degree of spinal canal stenosis in thoracic myelopathy caused by ossification of the ligamentum flavum. This method can be used together with other common clinical scores to better evaluate the efficacy of surgery.

BackgroundThis study aimed to develop an autoimmune thyroid disease (AITD) risk prediction model for patients with vitiligo based on readily available characteristics.MethodsA retrospective analysis was conducted on the clinical characteristics, demographics, skin lesions, and laboratory test results of patients with vitiligo. To develop a model to predict the risk of AITD, the Least Absolute Shrinkage and Selection Operator (LASSO) method was used to optimize feature selection, and logistic regression analysis was used to select further features. The C-index, Hosmer–Lemeshow test, and decision curve analysis were used to evaluate the calibration, discrimination ability and clinical utility of the model. Internally, the model was verified using bootstrapping; externally, two independent cohorts were used to confirm model accuracy.ResultsSex, vitiligo type, family history of AITD, family history of other autoimmune disease, thyroid nodules or tumors, negative emotions, skin involvement exceeding 5% of body surface area, and positive immune serology (IgA, IgG, IgM, C3, and C4) were predictors of AITD in the prediction nomogram. The model showed good calibration and discrimination (C-index: 0.746; 95% confidence interval: 0.701–0.792). The accuracy of this predictive model was 74.6%.In both internal validation (a C-index of 1000 times) and external validation, the C-index outperformed (0.732, 0.869, and 0.777). The decision curve showed that the AITD nomogram had a good guiding role in clinical practice.ConclusionThe novel AITD nomogram effectively evaluated the risk of AITD in patients with vitiligo.

BackgroundShort-segment transpedicular screw fixation is a common method for the treatment of thoracolumbar burst fractures (TBFs). When it is used, the anterior middle columns of the fractured vertebral body lack good support, resulting in fractured vertebral bodies decreased height and difficult to reduct.Therefore,the purpose of this study was to evaluate the clinical effect of a new type of transpedicular reducer that we designed for fractured vertebral body reduction and bone grafting in the treatment of TBFs.MethodsA total of 9 patients with TBFs who agreed to be treated with the new transpedicular reducer for fracture reduction via pedicle and bone grafting combined with pedicle screw fixation were retrospectively analysed. We measured the anterior and middlel heights of the injured vertebrae, the ratios of the anterior and middlel heights of the injured vertebral body to the respective heights of the adjacent uninjured vertebral bodies (AVBHr and MVBHr, respectively), and the Cobb angle of patients at different stages before and after surgery, and evaluated the distribution of bone grafts and bone healing 3 days and 12 months after the operation.ResultsThe anterior height of the injured vertebrae before the operation; after application of the transpedicular reducer; and 3 days, 3 months, 6 months and 12 months after the operation were 17.56±3.74 mm; 27.70±2.53 mm; and 29.08±2.52 mm, 28.36±1.93 mm, 28.12±1.42 mm, and 27.96±0.72 mm, respectively. The mid-heights of the injured vertebrae were 21.36±4.20 mm; 26.74±1.00 mm; and 27.70±2.01 mm, 27.05±2.45 mm, 26.94±1.84 mm, and 26.83 ±2.45 mm, respectively. The Cobb angles of the injured vertebrae were 3.80±1.44°; 1.26±1.00°; and 0.72±0.70°, 1.03±0.65°, 1.12±0.63°, and 1.34±0.56°, respectively. The allogeneic bones were distributed in the anterior and middle columns 3 days after the operation, and the bone had healed well 12 months after the operation.ConclusionThe new transpedicular reducer has a good reduction, allogeneic bone support, and clinical treatment effect for TBFs through pedicle fracture reduction and bone grafting combined with pedicle screw fixation.