ABSTRACT
Objective To evaluate the effect of electrical stimulation of the pelvic floor muscles combined with bladder training on urinary dysfunctionafter incomplete spinal cord injury.Methods Sixty-two incomplete spinal cord injury patients who had received an operation between November 2009 and December 2014 were enrolled and divided randomly into a control group (n=32) and a treatment group (n =30).Both groups were treated with conventional intermittent catheterization,while the treatment group was additionally given electrical stimulation of the pelvic floor muscles combined with bladder training.The residual urine volume was recorded before and after the treatment.Uurodynamic examinations were conducted,and the rate of successful catheter extraction and of urinary tract infection on the 15th and 30th day of treatment,were recorded and analyzed.Results All of the patients were followed-up for an average of 18.5 months.Significant improvement was observed in the residual urine volume,the maximum or average urinary flow rate,and the detrusor pressure at peak flow of both groups.However,at the end of follow-up the treatment group recorded significantly better results on all these measures than the control group.The successful catheter extraction rate of the treatment group (96.7％) was significantly higher than that of the control group and their average number of catheterization days was significantly fewer.The urinary tract infection rates on the 15th and 30th day of treatment were 16.7％ and 6.7％ in the treatment group,significantly lower than in the control group.Conclusions Electrical stimulation of the pelvic floor combined with bladder training significantly improves urination function after an operation for incomplete spinal cord injury,decreases the days of catheterization and lowers the rate of urinary tract infection.Such combined therapy is worth promoting in clinical practice.
ABSTRACT
Objective To evaluate the accuracy of thoracic pedicle screw placement using the "funnel technique" and investigate its consistency in experimental study and clinical application.Methods The clinical data of three human cadavers and 11 patients with the installation of at least one thoracic pedicle screw at T1 -T12 from August 2006 to July 2008 were retrospectively analyzed. One junior spine surgeon lack of experience were responsible for placing these screws with the "funnel technique".The accuracy of screw placement and the complications related to the use of thoracic pedicle screws were analyzed by assessing postoperative CT scans. Results The mean follow-up time was 23.1 months,which showed no vascular or visceral complications, or iatrogenic neurological injury. The rate of unintended cortex perforations was 14% (10/72) in cadavers and 15% (8/55) in patients, respectively.The critical perforation occurred in two screws (3%) in cadavers and one screw (2%) in patients. There was no statistical difference between the percentage of cortex perforations in cadavers and patients. Of all the 11 patients, screw violation occurred laterally in six ( 11% ), medially in one ( 2% ) and superiorly in one (2%). No violations occurred inferiorly or anteriorly. For all patients, only one screw needed revision. The perforations made by the junior spine surgeon occurred in six screws in the first cadaver, three in the second cadaver and one in the third cadaver. Conclusions The "funnel technique" is a simple,safe, accurate and cost-effective technique for pedicle screw placement. The result of the experimental study is consistent with that of the clinical application. "funnel technique" is helpful for junior spine surgeons to master the technique of thoracic pedicle screw placement.
ABSTRACT
Objective To discuss biomechanical mechanism of reconstructed joint capsule ligament stabilizing hip joint by means of three-dimensional finite element analysis.Methods A finite element model of total hip arthroplasty(THA)including ischiofemoral ligament reconstruction was construtted by using finite element analysis software Unigraphics NX 2.0 and SolidWorks 2006 to simulate seated leg crossing and obtain peak resisting moment and range of motion prior to impingement.Results The current form of finite element model was characterized by large deformation multi-body contact,large interfacial sliding and high elasticity and could clearly reflect real anatomy and biomechanical behavior of ischiofemoral ligaments.Compared with model with only metal,model of ischiofemoral ligament reconstruction could reduce the peak polyethylene stress at the impingement site and at the head egress site by typically 17%and 31%respectively,increase peak resisting moment by nearly 57%and provide 2.29-fold stability.Conclusions As a discrete structure within the posterior capsule of the hip joint,the ischiofemoral ligament may be the most important contributor to the mechanical integrity of the posterior stability structure.The joint capsule ligament must be reconstructed in hip arthroplasty.