Exploratory development of titanium mesh with bone allograft in treatment of cervical spinal tuberculosis / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the exploratory development of bone graft by titanium mesh with bone allograft in treatment of cervical spinal tuberculosis.</p><p><b>METHODS</b>Thirty two cases of cervical spinal tuberculosis treated with anterior radical debridement, decompression and inter fixation from January 2002 to January 2007 were included (at least two years follow-up). 18 male and 14 female, age from 18 to 72, mean 41.3 years old. 0.5 - 15.0 months before visit, mean 6.9 months. There were 13 cases in initial treatment group and 19 cases in retreatment group. All cases were divided into two groups (group A and group B) by resource of bone graft. Group A, titanium mesh with bone allograft, 17 cases. Group B, autograft with ilium, 15 cases. Operation time, blood loss, curing conditions, cervical curvature (absolute rotation angle, ARA), function of spinal cord and the rate for bone graft fusions in two groups were compared. The mean follow-up was 3.5 years (range 2 - 5 years).</p><p><b>RESULTS</b>The primary healing rate of incisions was 93.8% (30/32), and total healing rate was 96.9% (31/32). There were no significant differences in operation time or in blood loss between two groups (P > 0.05). Operation time and blood loss, 72 min/121 ml in group A and 90 min/198 ml in group B, there were significant differences between two groups (P < 0.05). In each group, there were significant differences in the function of spinal cord between preoperative and immediately post operative, between preoperative and follow-up, and between immediately post operative and follow-up (P < 0.05), and there were significant differences in ARA between preoperative and immediately post operative, and between preoperative and follow-up (P < 0.05), and there were no significant differences between immediately post operative and follow-up (P > 0.05). On preoperative, immediately post operative and follow-up, there were no significant differences in the function of spinal cord or in ARA between two groups (P > 0.05).</p><p><b>CONCLUSION</b>For cervical spinal tuberculosis followed by effective individual chemotherapy, a good effect can be obtained by treated with radical debridement and bone allograft with titanium mesh.</p>

A preliminary clinical study on the treatment of primary hepatic carcinoma by transcatheter arterial perfusion of batroxobin combined with TACE / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the therapeutic efficacy and safety of batroxobin in patients with primary hepatic carcinoma (PHC) and the advantages of transcatheter arterial perfusion of batroxobin combined with transcatheter arterial chemoembolization (TACE).</p><p><b>METHODS</b>40 patients with PHC were randomized into experimental group (transcatheter arterial perfusion of batroxobin combined with TACE treatment, 20 patients) and control group (TACE alone group, 20 patients). The patients were followed up and the data were recorded, compared and analyzed.</p><p><b>RESULTS</b>(1) Compared with the control group, the FIB level in the experimental group was significantly decreased at the first month after treatment (P < 0.05). (2) The baseline of the tumor was shortened in both groups after the treatment. There was a significant difference between the two groups at different time intervals (P < 0.05). (3) After the treatment, there was a significant difference of PFS levels between the two groups (t = 2.877, P < 0.05).(4) The incidence of metastasis were 5.0% (1/20) in both groups at 6 months after treatment, and that after one year was 10.0% (2/20) in the experimental group and 25.0% (5/20) in the control group. However, the difference was not significant (chi(2) = 0.693, P > 0.05).</p><p><b>CONCLUSION</b>Batroxobin can rapidly and effectively decrease the FIB level. Therefore it may be used as an effective and safe adjuvant drug for the the treatment of primary hepatic carcinoma. Transcatheter arterial perfusion of batroxobin combined with TACE therapy has advantages in comparison with TACE alone. It could be taken as a new therapeutic regimen in the PHC treatment.</p>

Prevention and management of the neurological complications during the treatment of severe scoliosis / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the prevention and management of the neurological complications during treatment for severe scoliosis.</p><p><b>METHODS</b>Seventy-one patients with the coronal Cobb angle more than 80 degrees underwent operation. The average coronal Cobb angle was 96.6 degrees (80 degrees - 135 degrees ), and 31 patients combined with kyphotic deformity with average sagittal Cobb angle 83.0 degrees (52 degrees - 145 degrees ). Fourteen patients were treated with posterior pedicle screw fixation alone, 21 combined with posterior wedge resection, 34 with staged operation, and 2 with combined anterior and posterior approach. Intraoperative somatosensory evoked potentials (SEP) monitoring and wake up test were used in 61 cases, and wake up test was used alone in 10 cases.</p><p><b>RESULTS</b>The average coronal curve correction was 59.2% (average 39.6 degrees ) and sagittal curve correction was 61.6% (average 31.9 degrees ). Thirty-nine patients were followed up with average 51 months (5 - 81 months). Among them, 33 patients achieved solid spinal fusion and the rate of correction loss was 2.1%. Two patients underwent reoperation because of the breakages of the internal fixation. Among 8 patients with neurological dysfunction pre-operatively, 3 patients obtained complete recovery, 1 patient incomplete recovery, and the rest had not recovered because of post-poliomyelitis syndrome. Four of 5 patients developed neurological dysfunction post-operatively obtained complete recovery and 1 partial recovery.</p><p><b>CONCLUSIONS</b>Halo-pelvic distraction and apical vertebra osteotomy are useful for increasing the correction rate and decreasing the neurological dysfunction. Intraoperative SEP monitoring combined with wake up test can call attention to early nerve injury. Early using of glucocorticoids and dehydration therapy promptly post-operatively is benefit to prevent neurological complications.</p>