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<p><b>OBJECTIVE</b>To investigate the clincial effects and feasibility of anterior thoracoscopically assisted surgery (TAS) with posterior one-stage total en block spondylectomy(TES) for thoracic spinal tumour.</p><p><b>METHODS</b>From October 2014 to January 2016, 4 patients with thoracic spinal tumour were treated by anterior thoracoscopically assisted surgery with posterior one-stage total en block spondylectomy. There were 2 males and 2 females, aged 16, 35, 46, 60 years. Courses of disease were 1, 4, 6, 9 months. The tumor occurred at T₄, T₆, T₁₃₀ segment in 1 case respectively, at double T7/T8 segments in 1 case. Preoperative visual analogue scores(VAS) were 4, 5, 6, 8 points. Frankel grade of neurologic function was grade B in 2, D in 1, and E in 1. SF-36 quality of life scores were 38, 65, 35, 29 points, including 2 cases of primary spinal tumors, 2 cases of metastatic spinal tumors. According to the classification of Tomita, 1 case was type III, 2 cases were type IV, 1 case was type VI. And according to the WBB staging, 4-9/ABCD was in 2 cases, 5-8/ABC compliated with 1-3 was in 1 case, 6-7/ABC was in 1 case. Surgical procedure: With lateral position, the thoracoscope channel was inserted. The involved intervertebral vessels and corresponding intercostal vessels were ligated, while the prevertebral large vessels were completely separated and protected. The front halves of superior and inferior involved vertebral discs were removed. Then the patients were changed to prone position, posterior one-stage total en block spondylectomy, titanium cage bone graft (allograft bone), pedicle screw fixation were performed.</p><p><b>RESULTS</b>All of the operations were successful and the patients were followed up for 34, 10, 11, 12 months. Pleural effusion occurred in 1 case after operation, and pleural closed drainage was done. All incisions got primary healing; and all patients showed significant pain relief (<0.005), with the VAS score decreasing to 2(2 cases) and 3(2 cases) scores, 2 months after surgery. No nerve functional injury aggravated. SF-36 quality of life score obviously improved with postoperative scores for 88, 92, 71, 80 at 3 months after operation. No recurrent vertebral tumor, internal fixation lossening or breakage was found at follow-up points of 3, 6, 12 months. One patient with lung cancer died of multiple organ failure at 11 months after operation.</p><p><b>CONCLUSIONS</b>With anterior TAS, vertebral anterior vessels, intervertebral blood vessels, intercostal vessels were successfully separated or ligated, intraoperative bleeding was effectively controlled, lung and esophagus were effectively protected, and the tumor received wide excision. Anterior TAS and one-stage posterior TES could significantly reduce the surgical trauma and the risk of surgery.</p>
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<p><b>OBJECTIVE</b>To investigate the diagnostic and therapeutic procedures of intraosseous lipoma.</p><p><b>METHODS</b>From June 1986 to January 2016, 19 patients with intraosseous lipoma were treated including 12 males and 7 females, aged from 24 to 76 years, a predilection aged was from 40 to 50 years in 13 cases. Symptoms presented with pain or swelling in 15 patients, the lesions were found incidentally in 3 patients, another case was bone defect lipoma replacement after curettage of bone cyst for 4 years. On plain X-ray flims of all bones showed a well-circumscribed radiolucent area. Diagnosis was established with CT or MRI. Among them, 16 cases were treated by surgical operation, 3 cases were treated by concervative treatment. All patients' clinical data, histologic findings and X-ray, CT and MRI were analysed.</p><p><b>RESULTS</b>Total 19 patients were followed up from 9 to 42 months with an average of 15 months. There was no local tumor recurrence in 16 patients after excising the tumors, the remaining 3 patients showed no enlargement of the lesion.</p><p><b>CONCLUSIONS</b>Surgical intervention is considered as an unnecessary in the patients diagnosied intraosseous lipoma by MRI or CT. Patients with symptomatic should adopt surgical treatment with curettage and bone grafting.</p>
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<p><b>OBJECTIVE</b>To investigate the clinical effects of close reduction and proximal femoral locking plate fixation for the treatment of femoral neck fractures in young adults.</p><p><b>METHODS</b>From August 2010 to 2014 August, 54 patients with displaced femoral neck fracture were treated with closed reduction and proximal cannulated screw locking plate fixation. There were 34 males and 20 females, aged from 18 to 55 years with an average of 39.8 years. The informations of fracture healing and complications were recorded after operation. According to Harris criteria, the function of hip joint was evaluated.</p><p><b>RESULTS</b>All patients were followed up from 4 to 24 months with an average of 11.3 months. Three cases occurred fracture nonunion, fracture union rate was 94.4%(51/54), union time was from 3 to 6 months with an average of 4.1 months. Among the healed 51 cases, the median of femoral neck shorten was 0.8 mm with the mean of (0.48±0.46) mm. No complications such as infection, internal fixation displacement were found during follow up. According to Harris criteria, 40 cases obtained excellent results, 9 good, 2 fair, 3 poor.</p><p><b>CONCLUSIONS</b>Close reduction and proximal femoral locking plate fixation is an effective method in treating femoral neck fracture in young adults, it has advantages of avoiding the femoral neck crispation, reliable fixation, high rate of fracture union and good functional recovery.</p>
ABSTRACT
<p><b>OBJECTIVE</b>In order to sum up the experience of diagnosis and treatment, the clinical information, diagnostic approach and treatment strategies from 23 patients with hematogenous pyogenic discitis and vertebral osteomyelitis (PDVO) in adults were reviewed.</p><p><b>METHODS</b>A retrospective record review was conducted of all cases of hematogenous PDVO from July 1999 to October 2006, the diagnostic approach and the treatment strategies were discussed.</p><p><b>RESULTS</b>The average age was 55.4 years. The average delayed diagnosis time was 4.4 months (range, 4 weeks to 11 months). Of these, 17 had underlying diseases such as diabetes mellitus, chronic alcoholism, liver cirrhosis, rheumatic disease, and the use of corticosteroids. All percent had elevated erythrocyte sedimentation rates and C-reactive proteins, while white blood cell counts were less reliably elevated. Imaging studies included radiographs and MRI. Seven patients were treated with immobilization and intravenous antibiotic drugs. Because of a delay in diagnosis, 16 patients underwent operative treatment for hematogenous PDVO using staged anterior debridement and Bone grafting with iliac crest or rib strut, anterior spinal instrumentation in 3 patients, posterior instrumentation was placed in 7 patients at a second procedure 10 days to 2 weeks following initial operation. Twenty-three patients were followed-up for an average period of 27 months, with a minimum of 6 months and the longest for 7 years. The patients return to their preoperative everyday activity. No patient had a recurrence of osteomyelitis. All their symptoms improved after surgery, bony fusion occurred in 87.5% of cases.</p><p><b>CONCLUSIONS</b>Adult hematogenous PDVO is a disease that affects mainly older patients suffering underlying medical illnesses. Positive blood cultures is valuable for the diagnosis. Hematogenous PDVO may require surgery in case of a development of biomechanical instability and/or a vertebral collapse with progressive deformity. In experienced hands, surgical debridement, interbody fusion, and anterior or posterior instrumentation is a safe and effective treatment.</p>