Endoscopic anterior cervical decompression and fusion based on the use of a working tube / 中国矫形外科杂志

[Objective]To investigate feasibility and efficacy of clinical application of endoscopic anterior cervical decompression and fusion.[Method]With Metrx MED system and modified working tube and decompression instruments,endoscopic anterior cervical decompression and fusion were performed on 15 patients with cervical spondylotic myelopathy.A paramidline right transverse incision of 2 cm long was made.A channel between the neurovascular and visceral sheath was created through finger dissection.The dilators were inserted sequentially.An original one arm working tube or a modified,shortened working tube with double arms was inserted over the dilators.Then decompression and fusion with autologus graft was performed under endoscope.[Result]Once the tubular retractor was stably fixed throughout the operation,releasing of the discomfort was observed.All the compression tissue such as soft disc tissue or hard osteophyte and anterior longitudinal ligament or dura sac were clearly visualized under the endoscope.Shortened working tube provided improved visual field and increased manipulation space for the decompression instrument.The double arms enhanced stability of the working tube but could not eliminate moving of it during operation.Intraoperative blood loss was 200 ml to 800 ml.The operation lasted 80 to 210 minutes.The incision healed in one week.Postoperative discomfort in laryngeal region was light.All of the cases showed thorough decompression on postoperative MRI films and gained better spinal cord function at postoperative follow-up.No surgery-related complication were encountered.[Conclusion]Endoscopic anterior cervical decompression and fusion based on the use of a working tube is technically feasible.Compared with conventional method,this technique has the advantages of improved intraoperative visualization,thorough decompression,minimal trauma,quicker recovery and improved cosmetic result.Disadvantages waiting for further improving include:limited manipulation space,discomfort and potential hazards to the surrounding structure resulted from moving of the working tube.

Setting up a management operating mechanism that combines responsibilities, powers and interests / 中华医院管理杂志

Reform in personnel matters and the distribution system began to be implemented from October 2001 in line with the guiding principle of putting quality at the core of medical practice, taking doctors as the axis, putting emphasis on profits, and using distribution by merit as a lever. A series of reform measures was adopted: the employment of the entire staff on the basis of a contract system and transformation of identity management into post management; division of medical service units based on medical groups, with the attending doctors being in charge; and intra hospital distribution by the principle of more pay for more and better work. As a result, a management operating mechanism that specifies clear cut job responsibilities and combines responsibilities, powers and interests has been set up, bringing about good results.