Severe kyphosis in thoracolumbar fracture patients with injured intervertebral disc after posterior fixation / 中国组织工程研究

BACKGROUND:Thoracolumbar fracture often accompanies with the injury of adjacent intervertebral disc. Traditional posterior short-segment fixation does not deal with the injured intervertebral disc, which may be the main reason for kyphosis in patients after surgery. OBJECTIVE:To investigate the effect of injured intervertebral disc on kyphosis angle in patients with single vertebral thoracolumbar fracture after treated with posterior short-segment fixation alone. METHODS:From January 2009 to June 2014, 40 cases of thoracolumbar fractures were treated in Jinan Central Hospital. They were folowed-up at preoperation, 2 and 12 months after operation and 6 months after internal fixation removal. Data were obtained from X-ray and MRI scanning. According to the preoperative MRI images, cases were assigned to observation group (17 cases) and control group (23 cases) according to injury and non-injury intervertebral disc. Data of vertebral wedge angle, sagittal plane kyphosis, proximal intervertebral disc angle, sagittal index and degeneration classification of proximal intervertebral disc angle from two different groups were analyzed at each folow-up time point (18-30 months, averagely 23.6 months). RESULTS AND CONCLUSION:(1) Imaging parameters: sagittal plane kyphosis was significantly severer at 6 months than that at 2 months in both groups (P < 0.05). Sagittal plane kyphosis, proximal intervertebral disc angle and sagittal index were greater in the observation group than in the control group at 12 months after surgery and 6 months after fixator removal (P < 0.05). (2) Degeneration classification of proximal intervertebral disc angle: Pearce degeneration grade of proximal intervertebral disc was significantly higher in the observation group than in the control group at 2 months after surgery and 6 months after internal fixation removal (P < 0.05). (3) Results suggested that kyphosis may appear in the patients with thoracolumbar fracture after a posterior short-segment fixation alone, and the injured disc may lead to more severe kyphosis.

Computer-assisted percutaneous pelvic and acetabulum lag screw placement / 中华创伤杂志

Objective To simulate the process of lag screw insertion on intact pelvises under guidance of conventional fluoroscopes or 2D and Iso-C3D computer-assisted navigations and evaluate the accuracy and practicability of the computer-assisted navigation. Methods Six dried intact adult pelvic specimens were selected and divided into three groups randomly. A total of 54 hollow screws were placed in bilateral pedicles of S1 and S2, anterior column of bilateral acetabulum, anterior column of bilateral acetabulum and pubic symphysis of intact adult dried pelvic specimens of three groups under guidance of conventional fluoroscopy, 2D and Iso-C3Dcomputer assisted navigations, respectively. The accuracy of the screw positions, the average operating time of each screw insertion and the average time of radiation exposure during the insertion of each screw were compared among three groups. Results There were significant differences in the accuracy of the screw positions, the average operating time and the average time of radiation exposure among three groups (P＜0.01). The navigation with Iso-C3D appeared to provide the highest accuracy and the shortest operating time of all guidance techniques. The mean operating time and the average time of radiation exposure of the conventional fluoroscope were the longest among three groups. The average time of radiation exposure of the 2D computer-assisted navigation was the shortest.Conclusions Iso-C3D computer-assisted navigation is the most accurate and expeditious means of all guidance techniques. The time of radiation exposure can be significantly reduced by both 2D and Iso-C3D computer-assisted navigations.

Treatment of meniscal cyst by arthroscopic partial meniscectomy and decompression of the cyst / 中国矫形外科杂志

[Objective]To investigate the treatment and result of the meniscal cyst treatment by arthroscopic partial meniscectomy and decompression of the cyst.[Method]Nine patients who had suffered from meniscal cysts were treated by arthroscopic partial meniscectomy and decompression of the cyst in General Hospital of Yanzhou Coal Mine Group during the period from January 2002 to December 2005.There were 3 males and 6 females.The age ranged from 16 years to 54 years,with an average of(32.5?14.1) years.The duration was between 2 months and 2 years with an average of(13.4?6.8) months.One patient had medial meniscal cyst and eight patients had lateral meniscal cysts.There were 5 cysts in meniscal anterior horn,3 cysts in meniscal body and 1 cyst in meniscal posterior horn.Meniscal lesions adhering to cysts included 6 horizontal cleavages and 3 complex cleavages.Arthroscopy was performed to identify the hole through the meniscus to cyst,then the meniscal tear was partially resected taking great care to preserve the meniscal rim.The planer was used to decompress the cyst and excise the wall of the cyst and broaden the passage between the cyst and the main knee compartment.After operation,all patients were instructed to perform quadriceps exercises.The patients were followed up from 6 to 38 months with an average of(17.2?9.8) months.A conclusion was deduced from the pre-and post-operative Lysholm score of the patients.[Result]None of the 9 patients reoccored during follow-up.After operation,the symptoms of the knee pain and swelling disappeared,the range of the knee motion restored,poping and locking didn't reoccur,the fullness at the site of the cyst died away.The complication of the operation didn't occur such as infection,damage of the vascular and nerve and restriction of the knee motion.Lysholm score of the 9 patients showed a significant improvement from(70.2?7.8) pre-operation to(96.7?3.3) post-operation(t=9.3868,P=0.000).[Conclusion]Arthroscopic partial meniscectomy and cyst decompression has obvious advantages of preserving the function of the meniscus and decreasing the incidence of the knee osteoarthritis.It should be the primary treatment of the meniscal cyst owing to its low morbidity and satisfying results.

Repair of defects of distal ulnar artery and nerve of forearm with grafting of vascular sural nerve / 中华创伤骨科杂志

Objective To investigate clinical effects of g rafting of vascular sural nerve.Methods From1998to 2003,97cases of the defects o f the distal ulnar artery and nerve we re repaired by grafting of sural nerv e with anastomosis of short saphenous vein.Results All the cases were followed up for 6to24months.They were e-valuated according to the modified S eddon rating system.The total excellent and good rate was 80.41%.The ex-cellent and good rate of the emergency cases was 89.74%,while the excelle nt and good rate of second operation was74.14%.Conclusions Grafting of sural nerve with anastom osis of short saphenous vein is an effective method to repair the defects of distal ulnar artery and nerve of the forearm,because the procedure is easy,the nerve and vein are widely available,and the nerve is th ick enough to be foldable.The artery can be repaired after reverse vascul ar anastomosis so as to improve the bloo d circulation of limbs and prevent nerve necrosis.[

BFGF improves the viability of subdermal vascular network flap / 中国现代普通外科进展

Objective:To investigate the application valve of bFGF to improve the viability of subdermal vascular network flap.Methods:Four white healthy pigs were used,each pig had 6 SVNF on back,16cm?4cm,totally 24 flaps were divided randomly into 2 groups:The bFGF groups and the control groups.On postoperative day 6,we observed the appearance of the flaps.The survival area of each flap was measured and the flap was harvested for histological analysis and the density of angiogenesis was also examined.Results:On postoperative day 6,the survival rates of the bFGF group and the control group were (81.2?1.7)% and (66.2?1.8)% respectively,the angiogenesis density of the middle and the distal segment in the bFGF group was (16.7?6.0)/mm2,(29.7?5.5)/mm2,(14.9?6.0)/mm2 respectively,while (16.6?4.0)/mm2,(21.4?5.2)/mm2,(3.5?5.1)/mm2 respectively in the control group.The bFGF group was superior to the control group in the appearance and histological analysis of the flaps.Conclusion:The results suggest that the injection of bFGF locally can promote the survival rate by accelerating the blood circulation of the SVNF’ bottom and edge,shorten the division time of SVNF and broaden the ratio of length and width.

Microendoscopic versus open discectomy in the treatment of lumbar spinal stenosis / 中国微创外科杂志

Objective To compare curative effects between posterior approach microendoscopic discectomy (MED) and traditional open discectomyin the treatment of lumbar spinal stenosis (LSS). Methods A total of 70 cases of lumbar spinal stenosis from October 2000 to December 2002 were divided into two groups: the MED Group ( n =30) and the Open Group ( n =40). Curative outcomes were compared between the two groups. Results The rate of excellent or good results was 93.3% in the MED Group (28/30) and 90.0% in the Open Group (36/40), without statistically significant difference ( ? 2 =0.819, P =0.664). The operation time was significantly shorter in the MED Group than in the Open Group ( t =2.295, P =0.025). The intraoperative blood loss was significantly less in the MED Group than in the Open Group ( t =-42.344, P =0.000). The time to normal activities in the MED Group was significantly shorter than that in the Open Group ( t =-30.123, P =0.000). Conclusions Curative effects of MED are identical with those of traditional surgery in the treatment of lumbar spinal stenosis, but shorter operation time, less blood loss and quicker postoperative recovery are achieved in MED.