ABSTRACT
Objective To compare the surgical outcomes between microsurgery lumbar discectomy and microendoscopic discectomy for lumbar disc herniation. Methods A prospective study was conducted on the surgical procedures for lumbar disc herniation.The target of our study was a group of 33 patients who underwent surgery by microsurgery lumbar discectomy(MSLD group)and 36 patients who underwent surgery by microendoscopic discectomy(MED group).The items investigated were the operation time,amount of bleeding,duration of hospitalization,pre-and postoperative scores based on judgment criteria for treatment of lumbar spine disorders established by the Japanese Orthopaedic Association score,visual analog scales (VAS,0 to 10) for lumbago and sciatica before surgery and at discharge,perioperative complications.Results The mean duration of follow-up was 2 years and 2 months (11 months to 4 years).There were no significant differences between the 2 surgical procedures in the frequency of the pre-and postoperative Japanese Orthopaedic Association scores or postoperative VAS for lumbar pain and sciatica,operation time and duration of hospitalization. Statistically significant differences were observed in amount of bleeding and operation time,but the differences were not large, and may not have been clinically significant.Conclusion Both microsurgery lumbar discectomy and microendoscopic discectomy are appropriate for lumbar disc herniation.
ABSTRACT
BACKGROUND: The effect of the treatment of long tubular bone defect by free vascularized fibular graft, especially when combined with monitoring island skin flap is definitely reliable. However, there is still the possibility of broken fibular graft with single fibular graft for repairing the long loading tubular bone.OBJECTIVE: To investigate the clinical effect on the treatment of long femoral bone defect by combinatorial fibular graft with monitoring island skin flap.DESIGN: Before and after self-controlled observation.SETTING: Department of Orthopaedic Spine Surgery, Guangzhou People's HospitalPARTICIPANTS: Totally 14 patients who wer treated for long femoral bone defect in the Department of Orthopaedic Spine Surgery were recruited between July 1995 and November 2003. Locus: distal part of the femur,5cases; middle part of the femur, 9cases.The length of bone defect was 6 to 28 cm.INTERVENTIONS: There were 7 cases of free vascularized bi-fibular graft transplantation with monitoring island skin flap. There were 7 cases of free vascularized fibular graft centralized with large segmental allograft.Monitoring island skin flap was 3 cm×5 cm, sectioned fibular was 16 to 32cm. Dry frozen bone of allograft was 12 to 28 cm. The wound and island skin were detected postoperatively.MAIN OUTCOME MEASURES: The living condition of bi-fibular graft or binding composite allograft with skin flap, morphology change of transplanted bone and loaded walking ability in patients with bone defect after operation.RESULTS: Totally 14 patients entered the result analysis. Seven cases in bi- fibular group were followed up for 3 years and 7 patients in the centralized graft group were followed up for 1 year. Fourteen cases detected by monitoring island skin flap all survived. One case in the centralized graft group presented yellow exudates 3 months after operation, and then the graft bone was taken out. Follow-up of the rest 6 patients showed that transplanted fibular bone was closely connected with allograft. The thickness of the transplanted bone was increased, shaped and similar with the diameter of the femur at the receptor. Patients in the two groups could walk with loading without walking stick. Transplanted bone has no fracture.CONCLUSION: Transplantation of free vascularized bi-fibular graft transplant or free vascularized fibular graft monitoring island skin flap binding to large segmental allograft can increase its structural strength through hypertrophy, decrease or avoid fracture of the transplanted graft fibula.
ABSTRACT
Objective To evaluate the effectiveness of Moss Miami pedicle sc re w system in the treatment of thoracolumbar burst fractures. Methods A total of 2 7 cases of thoracolumbar burst fractures were operated on with Moss Miami pedicl e screw system through posterior approach to provide spreading, reduction and fi xation. The bilateral posterolateral bone-graft spinal fusion was also done at the same time. Results The 27 patie nts were followed up for 6 to 30 months. The heights of compressed vertebral bod y and the cross spinal canal were significantly increased after treatment (P
ABSTRACT
Objective To evaluate 18F-FDG hPET/CT in the diagnosis of postoperative recurrence and metastasis of colorectal cancer. Methods GE HAWKEYE coincidence SPECT was carried out in 81 colorectal cancer patients with suspected recurrence or metastasis after intravenous injection of 259 ~ 298 MBq (7-8 mCi) 18F-FDG. The acquired data were reconstructed using iterative algorithm and attenuation-corrected X-ray. The results were compared with the final diagnosis established by histological examination of resected specimens、and clinical follow-up. Results The sensitivity, specificity, positive predictive value (PPV)and negative predictive value(NPV)was 93% (57/61)、80% (16/20)、93% (57/61)、80% (16/20) for 18F-FDG hPET/CT respectively. For conventional CT the sensitivity, specificity, PPV and NPV was 67% (37/55)、73% (19/26)、84% (37/44)、51% (19/37) respectively; 18F-FDG hPET/CT detected 91 recurrent or metastatic lesions whereas only 46 lesions were detected by conventional CT in 65 patients. Conclusions 18 F-FDG hPET/CT has unique value in the diagnosis of recurrence and metastasis in postoperative colorectal cancer patients which was superior to conventional CT. Combined 18 F-FDG coincidence imaging with localizing CT improves the detection and localization of postoperative recurrence and/or metastasis in colorectal cancer patients.
ABSTRACT
Objective In order to find the best methods for treatment of lumbar intervertebral disc herniation through posterior approach microendoscopic discectomy. Methods The approach of operation by lamina arcus vertebrae space was used to remove ligamentum flavum not to removed lamina arcus vertebrae and other tissue in lateral recumbent position. Extraction of lumbar interverebral disc herniation was used in 113 cases. Results A follow-up study was performed after operation, ranged from 6 to 24 months with a mean duration of 12 months. According to Nakai standard, there were 107 cases scored "excellent" and 6 scored "good". Conclusion Microendoscopic discectomy by the approach of lamina arcus vertebrae space caused less injury and bleeding, and was safe for both surgery and anesthesia. It achieved successfully without affecting the spinal stability.