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Objective@#To explore the clinical effect of reduction and reconstruction of the removed bony structure after one-stage posterior resection of high cervical tumors.@*Methods@#From October 2009 to March 2018, 17 patients including 10 males and 7 females of high cervical tumors who underwent one-stage posterior resection with an average age of 57 years (26~84 years) were reviewed. There were 11 shwannomas, 3 meningiomas and 3 concurrent shwannoma and meningioma arising in the same level, respectively. Reduction with (14 cases) or without internal fixation (3 cases) were performed for the removed C1 posterior arch or C2 laminar and spinous process. The clinical effects were compared with Visual analogue score (VAS), Japanese Orthopaedic Association scores (JOA) and American Spinal Injury Association (ASIA) grade. The cervical lordosis and range of motion were measured with the X-ray before the operation and at the last follow-up.@*Results@#There were no vertebral artery injury or massive hemorrhage during the surgeries. The operation time was 184±43 min, blood loss was 203±223 ml, and mean follow-up period was 29.1±28.2 months. No recurrence was found during the follow-up, and the motor and sensory were significant recovered in all patients after surgery. VAS score and JOA score were significantly improved at the last follow-up. ASIA grade was C for 1 case, D for 11 cases and E for 5 cases before surgery. After surgeries, C improved to D, 8 cases of D improved to E and 3 cases of D failed improved to E. Although the cervical lordosis and range of motion was decreased significantly in the last follow-up in X-ray, no patients complained stiffness and discomfort in rotation or flexion and extension of the neck. Cardiac arrest during operation was occurred in 1 case, and heartbeat recovered after stopping the manipulation. CSF leakage was found in 9 cases and no surgical site infection was occurred.@*Conclusion@#Resection of high cervical dumbbell-shape tumors is a demanding surgery with high incidence of complications. The reduction and reconstruction of removed bony structure without fusion could rebuild the stability of high cervical spine and preserve the cervical range of motion as much as possible which improves clinical effect.
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Objective To explore the clinical effect of reduction and reconstruction of the removed bony structure after one?stage posterior resection of high cervical tumors. Methods From October 2009 to March 2018,17 patients including 10 males and 7 females of high cervical tumors who underwent one?stage posterior resection with an average age of 57 years (26~84 years) were reviewed. There were 11 shwannomas, 3 meningiomas and 3 concurrent shwannoma and meningioma arising in the same level, respectively. Reduction with (14 cases) or without internal fixation (3 cases) were performed for the removed C1 posteri?or arch or C2 laminar and spinous process. The clinical effects were compared with Visual analogue score (VAS), Japanese Ortho?paedic Association scores (JOA) and American Spinal Injury Association (ASIA) grade. The cervical lordosis and range of motion were measured with the X?ray before the operation and at the last follow?up. Results There were no vertebral artery injury or massive hemorrhage during the surgeries. The operation time was 184±43 min, blood loss was 203±223 ml, and mean follow?up pe?riod was 29.1±28.2 months. No recurrence was found during the follow?up, and the motor and sensory were significant recovered in all patients after surgery. VAS score and JOA score were significantly improved at the last follow?up. ASIA grade was C for 1 case, D for 11 cases and E for 5 cases before surgery. After surgeries, C improved to D, 8 cases of D improved to E and 3 cases of D failed improved to E. Although the cervical lordosis and range of motion was decreased significantly in the last follow?up in X?ray, no patients complained stiffness and discomfort in rotation or flexion and extension of the neck. Cardiac arrest during operation was occurred in 1 case, and heartbeat recovered after stopping the manipulation. CSF leakage was found in 9 cases and no surgical site infection was occurred. Conclusion Resection of high cervical dumbbell?shape tumors is a demanding surgery with high in?cidence of complications. The reduction and reconstruction of removed bony structure without fusion could rebuild the stability of high cervical spine and preserve the cervical range of motion as much as possible which improves clinical effect.
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Objective To study the influences of Yang-warming, Blood-activating, and Toxin-removing Recipe(YBTR)-containing serum sampled under different conditions on the proliferation of human umbilical vein endothelial cells(HUVECs). Methods HUVECs were cultured in vitro for the experiment. Pharmacological serum for the experiment was prepared as follows: Thirty-two SD rats (male in half) were randomly divided into 4 groups, namely normal saline group and low-, middle-, and high-dose YBTR groups (at the intragastric dosage of 10.35, 31.05, 93.15 g·kg-1 respectively, twice a day). The pharmacological serum was taken from one female rat and one male rat in various groups at 4 time points, i.e. at hour 1, 2 after first intragastric administration on the fourth feeding day, and at hour 1, 2 after first intragastric administration on the sixth feeding day(abbreviated as D3H1, D3H2, D5H1, D5H2 respectively). The effects of YBTR-containing serum on the proliferation of HUVECs were observed by CCK-8 assay method. Results The difference of proliferation-inhibition rate of HUVECs was statistically significant after treated with YBTR-containing serum prepared from rats of different genders at different time(Pgender=0.000<0.01, Ptime=0.000<0.01). The difference of interaction of time and gender was also significant (Ptime × gender=0.001<0.01), and the effect at D3H1 and D5H1 varied with the gender (PD3H2×gender = 0.000 < 0.01, PD5H1×gender = 0.002 < 0.01). The inhibitory action of YBTR-containing serum became stronger with the increase of the dosage of serum of female rat at D3H2, and the inter-group difference was statistically significant (P < 0.05), the effect showing concentration-dependent tendency. The inhibition of HUVECs proliferation reached the peak after treated by various doses of YBTR-containing serum from the female rat at D3H2, while the inhibition arrived to the peak after treated by low- and middle-dose YBTR-containing serum from the male rat at D5H1, and the inhibition arrived to the peak in the group of high-dose YBTR-containing serum from the male rat at D3H1. Conclusion The inhibitory action of YBTR-containing serum on the proliferation of HUVECs was stronger when the serum was taken from the female rat at D3H2.
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Objective To investigate the effectiveness and safety of middle-column preserved pedicle subtraction closingopening wedge osteotomy for the treatment of ankylosing spondylitis (AS)-related thoracolumbar kyphosis.Methods From January 2010 to December 2016,eleven patients (9 males and 2 females) who underwent one-level middle-column preserved pedicle subtraction osteotomy with an average age of 40.8 years (21-68 years) were reviewed.The average thoracolumbar kyphosis angle (TLK) was 50.5°±9.6° and the average lumbar lordosis angle was-2.5°±24.1°.The thoracolumbar kyphosis,sagittal vertical axis (SVA),lumbar lordosis,pelvic tilt,sacral slope,thoracic kyphosis,Scoliosis Research Society (SIRS) 22,Oswestry disability index (ODI) score,the length of anterior column and posterior column at the pre-and post-operation,operation time,perioperative blood loss and complications were recorded.Results The osteotomy sites of 11 cases included 7 in L2,2 in L3 and 2 in T12.Theaverage operation time was 156.8 min (120-220 min).The average blood loss was 604.5 ml (350-900 ml).The average time of followup was 24 months (12-42 months).Complications were encountered in 2 patients.There were 1 casewith transient neurological deficits,another case with incision infection.No serious neurological or vascular complications occurred in all cases.The thoracolumbar kyphosis (TLK),lumbar lordosis,pelvic tilt,sacral slope,thoracic kyphosis,SRS 22 and ODI score were improved significantly.The preoperative TLK cobb was 50.5° (36°-66°),which improved to 5.1 ° (1 °-11°) at the final follow-up with a mean correction rate of 89.9％.Sagittal migrationwas improved from 184.6 mm preoperatively to 79.2 mm atthe final follow-up with an average correctionrate of 49.3％.The differences of the length of posterior column of osteotomy site after operation showed no statistical significance.All patients had solid fusion at osteotomy site and no instrumentational failure and loosening were found over the follow up.Conclusion Middle-column preserved pedicle subtraction closing-openingwedge osteotomy is safe and effective for correction of the thoracolumbar kyphosis deformity occurring in ankylosing spondylitis,resulting in satisfactory out comes with acceptable complications.
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Postoperative epidural adhesion is one of the most common causes of failed back surgery syndrome (FBSS), which can lead to back and leg pain or neurological deficit. Prevention of epidural adhesion after laminectomy is critical for improving the outcomes of lumbar surgery. The main origins of epidural fibrosis are raw surface of erector muscles and rupture fibers of intervertebral disc. The main current preventive methods for epidural adhesion include the usage of implants, chemicals and low dose radiation. However, most of them are still in experiment period. There are still controversies on the clinic usage of autograft free fat, ADCON-L, and Mitomycin C (MMC). The optimal implants are characteristics of better biocompatibility, degradable absorption and capability of existing for a certain period in body. The optimal medicine should have good effect on anti-desmoplasia, less side effects and long half-life. Besides, the combination of biodegradable medical film and drug and the mixture of two or more medical films are also the research frontlines of epidural adhesion. Further researches are required to explore new materials and drugs with stable and most favorable effect in preventing epidural adhesion.
Subject(s)
Humans , Biocompatible Materials , Epidural Space , Pathology , Laminectomy , Lumbar Vertebrae , General Surgery , Tissue AdhesionsABSTRACT
<p><b>OBJECTIVE</b>To observe the effect of Wendan Xiezhuo method (WXM) on carotid arteriosclerosis and vascular endothelial diastolic function in essential hypertension (EH) patients with turbid-phlegm syndrome (TPS).</p><p><b>METHODS</b>Forty-three EH patients of medium and low risk with TPS were randomly assigned to two groups, the Wendan Tablet (WT) group (23 cases) and the placebo group (20 cases), they were treated with WT and placebo respectively on the base of amlodipine treatment to control the blood pressure. Carotid intimamedia thickness (IMT), atherosclerotic plaque score of carotid artery, endothelium-dependent dilation (EDD) and flow-mediated vasodilation (FMD) of brachial artery after taking nitroglycerin were detected with ultrasonography before and after 6 months of treatment.</p><p><b>RESULTS</b>As compared with those in the placebo group, in the WT group after treatment, scores of TPS and carotid plaque were better, area of carotid plaque was lesser and IMT was lower significantly (P<0.05 or P<0.01). There was a negative correlation between brachial artery EDD and carotid IMT in EH patients with TPS (r = - 0.596, P < 0.05). After treatment EDD was improved more significantly in the WT group than that in the placebo group, however, no significant difference was found in non-endothelium-dependent dilation between the two groups.</p><p><b>CONCLUSION</b>A negative correlation exists between brachial artery EDD and carotid IMT, and the latter could be aggravated by TPS in EH patients. WXM shows favorable effects in improving carotid plaque and EDD.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Atherosclerosis , Pathology , Carotid Arteries , Diagnostic Imaging , Carotid Artery Diseases , Diagnostic Imaging , Pathology , Drugs, Chinese Herbal , Therapeutic Uses , Endothelium, Vascular , Pathology , Hypertension , Drug Therapy , Pathology , Phytotherapy , Syndrome , Treatment Outcome , UltrasonographyABSTRACT
<p><b>OBJECTIVE</b>To study the effects of Shexiang Baoxin Pill (SBP) in treating carotid atherosclerosis (CAS).</p><p><b>METHODS</b>Forty-one CAS patients were randomly assigned to 2 groups, the SBP group (31 cases) treated with SBP plus routine treatment and the control group (10 cases) with routine treatment only. Both were treated for 6 months. The changes of carotid atheromatous plaque (CAP), C reactive protein (CRP), fibrinogen (FIB), D-dimer and blood lipids, etc. were observed.</p><p><b>RESULTS</b>After treatment, average number, total scores and area of plaque, as well as levels of CRP, FIB and D-dimer decreased significantly in the SBP group (P < 0.05 or P < 0.01), and were lower than those in the control group after treatment respectively (P < 0.05). No severe adverse reaction occurred in both groups.</p><p><b>CONCLUSION</b>SBP is a safe and effective remedy for treatment of CAS.</p>