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OBJECTIVE@#To summarize the research progress of anterior cutaneous nerve injury and repair in knee arthroplasty.@*METHODS@#The relevant literature at home and abroad in recent years was reviewed and summarized from the anatomy of anterior cutaneous nerve, nerve injury grade, clinical manifestations, prevention and treatment of anterior cutaneous nerve.@*RESULTS@#The anterior cutaneous nerve injury is a common complication of knee arthroplasty. Because the anterior cutaneous nerve branches are many and thin, and mainly run between the first and second layers of fascia, this level is often ignored during surgical exposure. In addition, the knee arthroplasty does not routinely perform the exploration and repair of the cutaneous nerve. So the anterior cutaneous nerve injury is difficult to avoid, and can lead to postoperative skin numbness and knee pain. At present, studies have explored the feasibility of preventing its occurrence from the aspects of improved incision and intraoperative separation of protective nerve. There is no effective prevention and treatment measures for this complication. For patients with skin numbness after knee arthroplasty, the effectiveness of drug treatment is not clear. Local nerve block or nerve excision can be used to treat patients with painful symptoms after knee arthroplasty considering cutaneous pseudoneuroma.@*CONCLUSION@#Knee arthroplasty is widely used and anterior cutaneous nerve injury is common in clinic. In the future, more high-quality clinical studies are needed to further explore the prevention and treatment measures of this complication and evaluate the clinical benefits obtained.
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Humans , Arthroplasty, Replacement, Knee/adverse effects , Hypesthesia/etiology , Skin , Pain/etiology , Knee Joint , Pain, PostoperativeABSTRACT
Objective:To investigate the efficacy of different conversion therapies for colorectal cancer with unresectable simultaneous liver metastasis.Methods:A total of 170 patients of colorectal cancer complicated with liver metastasis who were admitted to the First Affiliated Hospital of Nanchang University from Jan 2015 to Dec 2020 were included in the study. Patients were divided into an initial resectable group (42 cases) and an initial non-resectable group (128 cases).Results:There were no significant differences in OS and PFS between patients with CRLM (colorectal cancer with liver metastasis) who were resected initially and those successfully underwent transformation therapy ( P>0.05). The median OS was 36 months in the group with successful transformation, while it was 21 months in the group with simple primary tumor resection and no liver metastasis resection ( P=0.014), HR=0.48 (0.27-0.86). The median PFS was 28 months in the successful conversion group, while it was 10 months in the primary tumor resection only and no liver metastasis resection ( P=0.005), HR=0.43 (0.24-0.77). The OS difference between the group with simple primary tumor resection and no resected liver metastasis and the group with neither primary tumor nor liver metastasis resection was statistically significant: (21 months vs.13 months), HR=0.52 (0.32-0.86) ( P=0.01), while the PFS between the two groups was not statistically significant, ( P>0.05). Conclusions:Chemotherapy combined with targeted therapy has the best effect among the conversion therapies, and can improve the resection rate and survival rate of patients undergoing R 0 surgery. Resection of the primary lesion alone can also prolong the patient's survival.
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BACKGROUND:The existing bone grafting apparatus are al long tubular-shape, antegrade bone grafting; however, the bone grains within the tube were difficult to put through, along with large bone loss. OBJECTIVE:To design a new concept of minimaly invasive bone grafting apparatus, so as to achieve the minimaly invasive bone grafting in vertebral body and intervertebral space. METHODS: On Solidworks 2012 software platform, the 3D three-dimensional solid modeling technology was employed to design a new concept of gun-shape bone grafting device with the characteristics of headend reversely placing at the grafting position and antegrade pushout, against the problems such as antegrade bone grafting, long bone grafting path and difficulty in bone grafting existing in precious percutaneous or/and transpedicular bone graft apparatus. The virtual assembly and simulative bone grafting surgery were performed with the bone grafting apparatus for observation of the instrument matching degree and grafting surgical procedures. RESULTS AND CONCLUSION: A set of minimaly invasive gun-shape bone grafting apparatus was successfuly designed; its length was 20 cm in total; the length of the front semi-closed bone tube was 2.5 cm. There are two kinds of diameter specifications: inner diameter of 3.5 mm/outer diameter of 4 mm, and inner diameter of 5 mm/outer diameter of 6 mm. Virtual assembly revealed that the grafting apparatus were wel matched. Stimulative surgery displayed that the bone grain loading and launch were simple. The gun-shape bone grafting device is reasonable in design, avoiding pushing too long distance, bone pushing difficulties, bone loss and other problems in previous tubular bone grafting apparatus. Percutaneous, endoscopic vertebrae or intervertebral space minimaly invasive bone grafting can be performed with this apparatus.
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Objective To investigate the efficacy of combined monitoring of motor evoked potentials with transcranial electrical stimulation (TES-MEP),somatosensory evoked potentials (SEP) and spontaneous electromyo-graphy (s-EMG) in tuberculosis surgery involving the thoracic,lumbar and sacral vertebrae.Methods Twenty-seven patients with tuberculosis of the thoracic vertebrae (T2-L2) received intra-operative SEP and TES-MEP monito-ring.Combined SEP,TES-MEP and spontaneous EMG monitoring were employed in 11 patients with tuberculosis of the lumbar or/and sacral vertebrae (L3-S1).SEP and TES-MEP were used to precisely observe the status of the sen-sory and motor pathways; s-EMG responses were used to more accurately localize nerve root irritation.ResuIts (1) SEP monitoring was successful in all of the operations.TES-MEPs were successfully monitored in 35 of them (92.1％).Combined motor and sensory monitoring was successfully achieved in 35 cases (92.1％).Abnormal SEPs were observed in 3 cases (7.9％),while abnormal MEPs were observed in 11 cases (28.9％).Abnormality in both the SEP and TES-MEP occurred in 2 cases (5.3％).There were 9 cases (23.7％) where the SEPs were nor-mal and the TES-MEPs were abnormal.In only 1 case (2.6％) was the SEP normal and the MEP abnormal.The false negative rate was 0％ with combined SEP and TES-MEP monitoring,while the false positive rate was 5.3％.There were 2 cases complicated by post-operative neurological deficits.(2) Spontaneous EMG monitoring can accu-rately determine the functioning of lumbar nerve roots during lumbar or lumbosacral tuberculosis surgery.Among 5 cases where EMG responses were observed,4 cases occurred during the spinal canal and nerve root decompression,1 case occurred in the orthopedic reset phase.Conclusions (1) During tuberculosis surgery involving thoracic,lumbar or sacral vertebrae,combined monitoring of SEPs and TES-MEPs can reflect the physiological and pathological condition of the spinal cord after ruling out interfering factors.This can improve monitoring and help assure the safety of lumbar surgery.(2) Intra-operative s-EMG monitoring can accurately reveal nerve root function in real time,help-ing to avert nerve root injury in lumbar and lumbosacral tuberculosis surgery.
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Objective To discuss perioperative features, operative approach and surgical effects of spinal tuberculosis in older patients. Methods Retrospective analysis was conducted to analyze the clinical data of 45 patients with spinal tuberculosis ranging in age from 61 to 78 years (average, 67 years). The lesion was located in thoracic vertebrae in 9 patients, thoracolumbar vertebrae in 14, lumbar in 16, and lumbosacral in 6. Preoperative Frankel grades were B in 7 cases, C in 21, D in 11 and E in 6. Among them, 21 had cardio-cerebrovascular disease, 10 had diabetes mellitus. With preoperative medicine and chemotherapy for 2-3 weeks, all patients were treated surgically. The surgical procedures included: 1) Posterior focus debridement, bone grafting and one-stage posterior transpedicular screw system fixation in thoracic vertebrae (T2-T7). 2) Anterior debridement, bone grafting and one-stage posterior transpedicular instrumental fixation in lumbosacral vertebrae (L5-S1). 3) Anterior focus elimination, bone grafting and one-stage anterior plate fixation in the other vertebrae. Results Forty-five patients were followed up for 24 to 40 months, with the average of 28.5 months. No severe complication occurred during and after operation. Forty-four cases had recovered and 1 recurred. Spinal fusion occurred 12-18 months after operation. Frankel neurological grades improved significantly. Conclusion With the effective management of comorbidities in perioperative period,the elderly could tolerate surgical treatment. The appropriate approaches, thorough debridement and reasonable bone grafting with internal fixation are key to therapeutic success.
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Objective Collecting the loosening periprosthetic interface-membrane, to discuss the mechanism of hip arthroplasty loosening. Methods The periprosthetic interface tissues of 29 hip arthroplasty revision cases from February 1995 to December 2003 were collected. The retrieved periprosthetic interface tissues were detected by immunohistochemistry. Some of them were studied by electronic microscope. Results (1)Transmission electronic microscope examination: the mitochondria swell. There were some substantia like lipid in the plasm of macrophages. Wear particles could be seen under scaning electronic microscope.(2)Immunohistochemistry: there were 22 IL-1? positive cases in cells of interface membrane. There were 29 IL-6 positive cases in cells of interface membrane. There were no positive results in TNF-? test. Conclusion (1)The wear particles of arthroplasty are important factors which cause biological reaction.(2)The interface membranes contain cytokine IL-1? and IL-6, which may play an important role in periprosthetic osteolysis and arthroplasty loosening.
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Objective Examinating the efficacy and safety on prophylaxis of deep venous thrombosis(DVT) following arthroplasty using low-molecular-weight heparin (LMWH) in combination with intermittent pneumatic compression(IPC) starting with different time. Methods 156 patients undergoing primary arthroplasty from July 2003 to June 2005 were divided into four groups randomly. In the first group, 38 patients used LMWH preoperatively and IPC starting since anesthesia. In the second group, 42 patients did LMWH postoperatively and IPC starting since anesthesia. In the third group, 36 patients did preoperative LMWH and post-operative IPC. In the fourth group, 40 patients did post-operative LMWH and IPC. All patients were examined by colour duplex ultrasonography, valued the clinical symptom of DVT, recorded the volume of blood loss in perioperation and observed complication of hemorrhage. Results In the first group, two cases of DVT (5.26%) were found and the average perioperative volume of blood loss was (1030.8?282.0) ml. In the second group, two cases of DVT (4.76%) were found and the average volume of blood loss was (900.7?246.9) ml. In the third group, one case (2.78%) of DVT was found and the average volume of blood loss was (1040.3?288.5) ml. In the fourth group, nine cases of DVT (22.5%) were found and the average volume of blood loss was (852.2?295.4) ml. Comparing the incidence of DVT between each group, group 1, 2, 3 were lower than group 4(P﹤0.05). Comparing the volume of blood loss in perioperation, group 2 , 4 were less than group 1,3(P﹤0.05). Conclusion On the basis of this study, it is more effective and safer using LMWH staring with post-operative 10 h in combination with IPC starting with anesthesia on prophylaxis of DVT following arthroplasty.