Nailfold capillaroscopy alterations in androgenetic alopecia: A cross-sectional study

Background: Androgenetic alopecia is considered to be an independent predictor of mortality from diabetes mellitus and heart disease. However, whether androgenetic alopecia causes changes in microcirculation is unknown. Objective: The objective of the study was to investigate whether alterations in nailfold capillaries occur in androgenetic alopecia patients. Methods: The nailfold capillaroscopy images of androgenetic alopecia patients and matched controls were collected and analyzed. Results: The frequencies of avascular areas, dilated, bushy and bizarre capillaries and capillary disorganization, nailfold capillaroscopy scores of 2 or scores both 2 and 3 were significantly higher in the androgenetic alopecia group than in the healthy controls (9.0% vs. 0%, 57.7% vs. 19.2%, 3.8% vs. 0%, 2.8% vs. 1.3%, 3.8% vs. 0%, 38.5% vs. 12.8% and 39.7% vs. 12.8%, respectively). Limitations: The results of this study may be biased on account of the limited sample size or the presence of an undiagnosed disease in participants which could alter the nailfold capillaries. Conclusion: Bushy, bizarre and dilated capillaries, capillary disorganization, avascular areas and nailfold capillaroscopy scores of 2 or 2 and 3 were more common in androgenetic alopecia patients than in healthy controls. These findings indicate that abnormalities in microcirculation may be involved in androgenetic alopecia

Quality analysis of Citri Trifoliatae Fructus in different harvest time by HPLC combined with electronic eye technology / 中国中药杂志

As a local variety of medicinal material, Citri Trifoliatae Fructus is widely used in many places, whereas its harvest time remains unclear. Therefore, studying its harvest time can make more reasonable use of this medicinal material. In this study, we determined the flavonoids content and compared the color of Citri Trifoliatae Fructus harvested in different time, aiming to guide the harvest of this medicinal material. The fresh fruits of Citrus trifoliata were collected from Xinxiang city, Henan province, graded according to the diameter range, and then dried. The contents of isonaringin, naringen, and poncirin in Citri Trifoliatae Fructus were determined by HPLC, and the color values of the samples were detected by electronic eye. The correlation analysis of the obtained data was carried out to explore the relationships of color and diameter with quality. The results showed that the contents of isonaringin, naringen, and poncirin varied significantly in different harvest time, within the ranges of 0.21-1.20, 2.21-11.59, and 3.73-23.16 mg·g~(-1), respectively. With the delay of harvest time, Citri Trifoliatae Fructus showed the color changing from green to yellow, gradually increased diameter, and gradually decreased contents of isonaringin, naringen, and poncirin. The contents of isonaringin, naringen, and poncirin were negatively correlated with the degree of red and green(a~*) and positively correlated with the degree of yellow and blue(b~*). The contents of naringen and poncirin had significantly negative correlations with the diameter. This study indicates that the quality of Citri Trifoliatae Fructus can be judged by its diameter and skin color, which provides a theoretical basis for the rational harvest of this medicinal material.

Clinical epidemiological analysis of 141 brucellosis cases in Shanxi Province / 中华地方病学杂志

Objective@#To analyze the clinical epidemiological situation and trend of brucellosis in Shanxi Province in order to provide the basis for diagnosis.@*Methods@#Brucellosis cases admitted to the First Hospital of Shanxi Medical University during January 2013 to December 2015 were included in the study. A retrospective investigation was undertaken and patient files were reviewed for general situation, clinical and laboratory findings, the process of diagnosis and treatments.@*Results@#The data of 141 patients were collected, including 100 males and 41 females, the male to female ratio was 2.44 ∶ 1.00; the majority were 51-60 years old, 49 cases, accounting for 34.75%; the peak incidence was July and August each year, a total of 51 cases, accounting for 36.17%; of the 141 patients, 112 (79.43%) were professional, 29 (20.57%) were non-professional; and the clinical performance was diverse, 114 (80.85%) patients with irregular heat type, only 17 cases (12.06%) showed typical migratory joint pain; 31 cases (21.99%) were first diagnosed with only brucellosis, the shortest misdiagnosis time was 1 week, and the longest 18 month, the average misdiagnosis time was 3 months, and the total misdiagnosis rate was as high as 78.01% (110/141).@*Conclusions@#Significant changes have happened in the clinical epidemiological characteristics of brucellosis in Shanxi Province. Various forms of prevention knowledge propaganda and education should be continually carried out, so as to strengthen the awareness and attention of the clinical workers on the disease.

Clinical epidemiological analysis of 141 brucellosis cases in Shanxi Province / 中华地方病学杂志

Objective To analyze the clinical epidemiological situation and trend of brucellosis in Shanxi Province in order to provide the basis for diagnosis. Methods Brucellosis cases admitted to the First Hospital of Shanxi Medical University during January 2013 to December 2015 were included in the study. A retrospective investigation was undertaken and patient files were reviewed for general situation, clinical and laboratory findings, the process of diagnosis and treatments. Results The data of 141 patients were collected, including 100 males and 41 females, the male to female ratio was 2.44 : 1.00; the majority were 51 - 60 years old, 49 cases, accounting for 34.75％; the peak incidence was July and August each year, a total of 51 cases, accounting for 36.17％; of the 141 patients, 112 (79.43％) were professional, 29 (20.57％ ) were non -professional; and the clinical performance was diverse, 114 (80.85％) patients with irregular heat type, only 17 cases (12.06％) showed typical migratory joint pain; 31 cases (21.99％) were first diagnosed with only brucellosis, the shortest misdiagnosis time was 1 week, and the longest 18 month, the average misdiagnosis time was 3 months, and the total misdiagnosis rate was as high as 78.01％ (110/141). Conclusions Significant changes have happened in the clinical epidemiological characteristics of brucellosis in Shanxi Province. Various forms of prevention knowledge propaganda and education should be continually carried out, so as to strengthen the awareness and attention of the clinical workers on the disease.

Treatment of ossification of ligamentum flavum complicated with lumbar spinal stenosis / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the imaging characteristic and operation outcome of ossification of ligamentum flavum with lumbar spinal stenosis.</p><p><b>METHODS</b>January 2013 to January 2016, 9 patients with ossification of ligamentum flavum with lumbar spinal stenosis were treated, included 5 males and 4 females, aged from 51 to 63 years old with an average of 57 years old. All patients complained intermittent claudication and radiating pain at lower limb. The pathologic change regions examined by CT or MRI were as follows:2 cases in L₄,₅ and L₅S₁, 5 in L̀,̀, and 2 in L₅S₁. Four patients underwent simple laminectomy and 5 patients underwent laminectomy and discectomy, interbody fusion and internal fixation with pedicle screw. Clinical effects were evaluated according to JOA score, which items included subjective symptom, daily activity limitation, clinical sign and bladder function.</p><p><b>RESULTS</b>No complications such as infection or nerve injury were found after operation. The follow-up period was from 12 to 60 months with an average of 24 months. The low back pain and radiating pain at lower limb improved significantly and walking distance approached normal at final follow-up;and JOA scores improved obviously.</p><p><b>CONCLUSIONS</b>Ossification of ligamentum flavum has the special characteristic on CT scan, which decide the selection of operation method. The operative aim is effectively spinal decompression and rebuilding lower lumbar stability by minimally invasive surgery.</p>

One-Stage Anterolateral Debridement, Bone Grafting, and Internal Fixation for Treating Lumbosacral Tuberculosis

STUDY DESIGN: Retrospective case series. PURPOSE: To investigate the clinical efficacy and feasibility of one-stage anterolateral debridement, bone grafting, and internal fixation for treating lumbosacral tuberculosis. OVERVIEW OF LITERATURE: There has been no consensus regarding the optimal means of treating lumbosacral tuberculosis. The one-stage anterolateral extraperitoneal approach for radical debridement, bone grafting, and internal fixation for treating lumbosacral tuberculosis is rare in literature. METHODS: Twenty-one patients with lumbosacral tuberculosis were retrospectively analyzed. All patients underwent the surgery of anterolateral debridement after regularly antituberculous drugs therapy. We evaluated the erythrocyte sedimentation rate, C-reactive protein, radiography, computed tomography, magnetic resonance imaging, visual analogue score, and Oswestry disability index before and after surgery. RESULTS: All patients completed a follow-up survey 9–48 months after surgery. All patients' wounds healed well without chronic infection or sinus formation, and all patients with low-back pain reported relief after surgery. All cases had no tuberculosis recurrence. Solid bony fusion was achieved within 6–12 months. At final follow-up, evaluated the erythrocyte sedimentation rate decreased from 38.1±12.5 to 11.3±7.1 mm/hr, C-reactive protein decreased from 6.2±4.2 to 1.6±1.3 mg/dL, the visual analog scale score decreased from 4.6±1.1 to 1.4±1.0, the Oswestry disability index score decreased from 50.2%±11.9% to 13.0%±6.6%, and the lumbosacral angle increased from 20.0°±4.8° to 29.0°±3.9° (p<0.05). CONCLUSIONS: One-stage anterolateral debridement, bone grafting, and internal instrument fixation for treating lumbosacral tuberculosis is safe and effective.

Effect of fast acupuncture at Zusanli (ST36) on the recovery of gastrointestinal function after ;abdominal non-gastrointestinal surgery / 国际中医中药杂志

Objective To observe the effect of fast acupuncture at Zusanli(ST36) on the recovery of gastrointestinal function after abdominal non-gastrointestinal surgery. Methods In this randomised placebo-controlled single-blind clinical trial, patients received abdominal non-gastrointestinal surgery were assigned to a treatment group and a control group. The treatment group received fast acupuncture and the control group received superficial conciliative acupuncture. The acupuncture was taken at both sides of Zusanli (ST36) for 1 minute respectively during 7-8 a.m. and 7-8 p.m..We began from the first postoperative day and stopped when the patients got initial postoperative flatus or stool, or at the end of the fifth postoperative day. Results 37 controlled patients were assigned to the treatment group (18 patients) and the control group (19 patients) randomly. There were no differences on general information between the two groups. The treatment group had stronger feeling than the control group on the comparison of the acupuncture sensation level (5.7 ± 3.0 vs. 2.7 ± 2.2;t=-3.471, P=0.001). For the treatment group, the initial postoperative flatus or stool time is 19 hours earlier than the control group (65.9 ± 18.1 h vs. 85.0 ± 24.5 h; t=2.682, P=0.011). And the treatment group patients’ postoperative abdominal distension is lesser than the control group (P=0.006). Conclusion Fast acupuncture at Zusanli(ST36) can promote the recovery of gastrointestinal function after abdominal non-gastrointestinal surgery, and can also lighten the patients’ postoperative abdominal distension.

Effects of Danshensu on bone formation in ovariectomized rats / 浙江大学学报·医学版

To investigate the effects of Danshensu on bone formation in ovariectomized rats.Thirty female SD rats were randomly divided into three groups with 10 rats in each:blank control group, model control group and Danshensu group. The osteoporosis model was induced by bilateral ovariectomy and rats in Danshensu group were fed with Danshensu 12.5 mg·kg·dby gavage after ostroporosis model induced. All animals were sacrificed after 90 days. The bone mineral density (BMD) of the whole body, femur and lumbar vertebra was measured by dual energy X-ray absorptiometry. The biomechanical properties of femur were measured by AG-IS mechanical universal testing machine. Serum osteocalcin and bone alkaline phosphates (BALP) levels were measured by ELISA. The number of osteoblasts of proximal femoral metaphysis was counted with light microscopy after HE staining.Compared with blank control group, BMD, biomechanical properties of femur, serum osteocalcin and BALP levels and the number of osteoblasts were decreased in model control group (<0.05 or<0.01). While compared with model control group, BMDs of the whole body, femur and lumbar vertebra, the elastic modulus, maximum load, yield strength, breaking point load of femur, the serum levels of osteocalcin and BALP, and the number of osteoblasts were significantly improved in Danshensu group (<0.05 or<0.01).Danshensu can improve bone quality by increasing bone density, improving biomechanical properties, promoting the expression of osteogenesis-related factors, and increasing the number of osteoblasts.

Clinical observation of imaging expression and operation treatment for intramedullary schwannoma of thoracolumbar spine / 中国骨伤

<p><b>OBJECTIVE</b>To explore the imaging characteristics and operation outcomes of intramedullary schwannoma in thoracolumbar spine.</p><p><b>METHODS</b>From June 2005 to December 2012,17 patients with intramedullary schwannoma in thoracolumbar spine were operated through posterior approach, including 11 males and 6 females with an average age of 53 years old ranging from 46 to 67 years old. The courses of disease ranged from 3 to 5 years (averaged 3.3 years). Thoracic patients manifested chest and back pain,numbness and inability on lower limb gradually, unsteady gait. Lumbar patients manifested low back pain,radiating pain and numbness on lower limb, intermittent claudication. Preoperative VAS score was 5 to 8 with an average of 6.12. Eleven patients suffered from never injury, 4 cases were grade C, 5 cases were grade D and 2 cases were grade E according to Frankel classification. Three patients were injured on thoracic segments, 5 patients were on thoracolumbar segments, 3 patients on lumbar segments and 6 patients on lumbosacral segment confirmed by CT and MRI. Five patients were epidural, 12 were intradural extramedullary. Six patients underwent spinal decompression and tumor resection simply, eleven patients underwent spinal decompression, tumor resection, internal fixation and bone graft fusion.</p><p><b>RESULTS</b>No injury of blood vessel or spinal cord occurred during operation, cutting healed well. All patients were followed up from 12 to 60 months with an average of 32 months. Chest and back pain, low back pain, radiating pain and numbness on lower limb were improved significantly. VAS score at final follow-up was 0 to 3 (averaged 1.5). According to Frankel classification, 5 cases were grade D, and 6 cases were grade E at final follow-up.</p><p><b>CONCLUSION</b>MRI is an effective method in diagnosis of intramedullary schwannoma in thoracolumbar spine. Operative method is choosed by imaging expression, and the aim is effectively decompression of spine, reconstruction of stability of spine.</p>

Design and biomechanical evaluation of atlantoaxial lateral mass fusion cage / 中华骨科杂志

Objective To design an atlantoaxial lateral mass fusion cage and evaluate its biomechanical stability when it is combined with atlantoaxial vertebral pedicle screw fixation.Methods Forty-six sets of CT 3D reconstruction pieces of the normal atlantoaxial junction were chosen to measure sagittal diameter and transverse diameter of atlantoaxial lateral mass joint,sagittal diameter and transverse diameter of epistropheus lateral mass and space height of atlantoaxial lateral mass joint.An atlantoaxial lateral mass fusion cage was designed on this basis.Six fresh human cadaveric cervical spines (C0-C4) were used as samples to measure 3D motion range of C1,and 2 segments under 1.5 N · m load.3D motion range of samples under the following situations was measured at random:intact state,unstable state (ligament around odontoid process was cut off),fixation with atlantoaxial joint screw+Gallie steel wire,atlantoaxial pedicle screw,atlantoaxial lateral mass joint fusion cage+atlantoaxial vertebral pedicle screw.Results Corresponding width/length of fusion cage is 8/11,9/12,10/13 mm,respectively,and the height is designed to 3.5,4.0,and 4.5 mm,respectively.The motion range of three internal fixation methods is less than that under intact state and unstable state.The difference has statistical significance.The C1+C2+cage fixation produces the least motion range in lateral bending and axial rotation directions and generates the highest motion range in flexion/extension direction.But,the difference has no statistical significance.Conclusion The C1+C2+cage internal fixation technique has similar stability with common atlantoaxial intemal fixation method and can provide extra atlantoaxial fusion spots.Thus,it may be a feasible alternative for atlantoaxial fusion when the posterior arch of the atlas is absent.

One-stage treatment of infected nonunion of the distal tibia with reverse-flow vascular pedicle fibular grafts / 中华创伤杂志

Objective To measure the effect of one-stage transplantation of reverse-flow vascular pedicle fibular grafts in treatment of infected nonunion of the distal tibia.Methods From January 2001 to December 2012,23 patients sustaining the infected nonunion of the distal tibia were transplanted with reverse-flow vascular pedicled fibular grafts in one-stage.There were 13 males and 10 females,aged 26 to 59 years (mean,38.7 years).Tibial nounion based on the Jain-Sinha classification was rated as Type A in 6 patients and Type B in 17 patients.After the operation,the patients received 2-3 weeks of intravenous antibiotic treatment and then 4-week oral antibiotic therapy.Wound healing,limb and ankle joint fucntion and outcomes in fibular transplantation were observed.Results Duration of follow-up was 16-46 months (mean,28.6 months).There were no exudates and ulcerations of the skins.Smooth healing was achieved in all the patients except that fibular fracture was noted in one patient healed after cast immobilization.Healing time ranged from 12 to 28 weeks (mean,15.6 weeks).Limb function evaluated with Ennecking system had (87 ± 11) ％ restoration.According the Olerud-Molander scoring system,ankle function was excellent in 16 patients and good in 7 patients,with the excellent-good rate of 100％.Conclusion One-stage reverse-flow vascular pedicle fibular grafting is an optional procedure for treatment of infected nonunion of the distal tibia,due to the technique is easy and effective.

Repair of high energy injury-induced soft tissue wound of the heel / 中华创伤杂志

Objective To investigate the methods and effects of different flaps for repair of high energy injury-induced soft tissue wound of the heel.Methods From January 2002 to June 2012,the patients including 12 males and 9 females aged 18-57 years (mean,32 years) underwent heel soft tissue defect reconstruction.Causes of injury were traffic injury in 11 case and mechanical injury in 10 cases.Dimension of soft tissue defect ranged from 5 cm × 3 cm to 8 cm × 6 cm.Soft-tissue defect was repaired with sural neurovascular flaps at the posterolateral heel in 9 cases (Group A),with posterior tibial artery flaps at the posterolateral heel in 5 cases (Group B),and with medial plantar flaps at the loading area of heel in 7 cases (Group C).Sensory recovery and two point discrimination motion of the ankle joint were observed and compared among groups 12 month after operation.Heel pain was observed during weight bearing and joint activity was evaluated using the visual analogue scale (VAS).Results All the flaps survived,except for one with epidermal necrosis over the distal part,which healed after partial changing medication.Duration of follow-up was 12-24 months.There were no differences in the appearance,texture and contour between the flaps and recipient sites.Flaps showed no ulcer in the weight-bearing area and recovered their protective sense.Patients could walk normally after surgery.At postoperative 1 year,sensory recovery rate of the flaps in Groups A,B and C was 0,20％ and 100％ respectively (P ＜0.01).Appearance of the heel in all groups recovered to almost normal.Cases that could start nil weight-bearing exercise without pain accounted for 8 (89％) in Group A,4 (80％) in Group B,and 6 (86％) in Group C (P ＞ 0.05).While heel pain existed in weight-bearing exercise.Difference in VAS was significant among the three groups (P ＜ 0.05),but ankle range of motion was not (P ＞0.05).Conclusion Medial plantar flaps are suitable for tissue defect of 5-8 cm in length but sural neurovascular flaps and posterior tibial artery flaps should be considered for over 8 cm defect in order to elevate survival rate of the flaps and reconstruct limb function.

Endoplasmic reticulum stress promotes the apoptosis of testicular germ cells in hyperlipidemic rats / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the role of endoplasmic reticulum stress in the apoptosis of testicular germ cells in hyperlipidemic rats.</p><p><b>METHODS</b>We randomly assigned 42 four-week-old male Wistar rats into a normal control group (n = 12) and a high-fat group (n = 30) to be fed on a normal diet and a high-fat diet, respectively, for 10 weeks. Then we measured the concentrations of triglyceride (TG) and total cholesterol (TC) in the serum using an automatic biochemistry analyzer, detected the apoptosis of testicular germ cells by TUNEL staining, and determined the protein and mRNA expressions of GRP78 and. caspase-12 in the testis tissue by immunohistochemistry and RT-PCR, respectively.</p><p><b>RESULTS</b>The concentrations of TG and TC were significantly increased in the animals of the high-fat group ([3.00 ± 0.92] and [3.04 ± 0.39] mmol/L) as compared with the control rats ([1.43 ± 0.41] and [1.55 ± 0.23] mmol/L) (P < 0.01), and so was the apoptosis index of the testicular germ cells ([37.17 ± 2.74]% vs [5.16 ± 0.81]%, P < 0.01). The high-fat group, in comparison with the control, also showed remarkably upregulated protein and mRNA expressions of GRP78 (0.32 ± 0.03 and 0.86 ± 0.05 vs 0.19 ± 0.01 and 0.37 ± 0.03, P < 0.01) and caspase-12 (0.34 ± 0.02 and 0.87 ± 0.01 vs 0.12 ± 0.01 and 0.34 ± 0.03, P < 0.01) in the testis tissue.</p><p><b>CONCLUSION</b>The apoptosis of testicular germ cells is increased in hyperlipidemic rats, which may be attributed to endoplasmic reticulum stress.</p>

Retention force attenuation of 2 kinds of clasps and surface abrasion of the Cr-Co crowns / 实用口腔医学杂志

Objective:To investigate the the retention force changes of 2 kinds of T bar clasps on Cr-Co crowns and the surface ab-rasion of the crowns.Methods:Standard Cr-Co crowns were made,and standard T bar clasps were made of Cr-Co alloy and Vitalli-um2000 with 0.25 mm and 0.5 mm undercut depth respectively.1 800 times repeated placement and removal(fatigue test)were car-ried out on instron testing machine in or without saliva soak condition.The attenuation curves of the maximum retention force was an-alysed.The surface abrasion of the crowns was observed before and after the fatigue test by SEM.Results:The retention force attenu-ation of the clasps in every group was accord with the logarithm attenuation law.SEMexamination showed that in the same condition, there was less surface abrasion in Vitallium2000 group than that in Cr-Co group.Vitallium2000 clasp was superior to Cr-Co clasp in maintaining the retention force.Conclusion:Vitallium2000 T bar clasp may provide better retention force with less furface abrasion on Cr-Co crown than Cr-Co clasp.

The radiographic classification and presentations of atypical spinal tuberculosis / 中华骨科杂志

Objective To investigate the radiographic classification and presentation of atypical spinal tuberculosis in adults.Methods Data of 45 consecutive patients who had suffered from atypical spinal tuberculosis confirmed by surgical interventions and pathologic examinations at our department from February 2000 to August 2012 were retrospectively analyzed.There were 29 males and 16 females,aged from 20 to 71 years (mean,46.2 years).Twenty-five patients presented with low-grade fever,lassitude and loss of weight,and the other 20 patients denied the constitutional symptoms of tuberculosis.An increased erythrocyte sedimentation rate (range,25-107 mm/1 h) was found in 37 patients.All patients were investigated by the following imaging resources:plain X-rays,CT scan and MRI.3D reconstruction CT was performed in 12 patients and PET-CT was performed in 2 patients.All patients were treated surgically and confirmed by pathologic examinations and 3 patients had undergone CT-guided biopsy.Results Atypical spinal tuberculosis presented in different radiographic presentation forms.Nine patients had involvement of a single vertebral body,which was depicted with nonuniformly increased signal intensity on T2-weighted MR images.CT scan showed irregular bony destruction in old patients and solitary osteolytic lesion with well-defined margins in young adults.There were 2 cases of isolated affection in the posterior elements (vertebral appendages type),and the involved vertebral appendages demonstrated hyperintense signal on T2-weighted MR images and bony destruction on CT scan.There were 8 cases of simultaneous affection in the anterior and posterior element of one vertebra (circumferential vertebral involvement type),and CT scan showed multiple bony destruction in vertebral body and neural arch.There were 5 cases of affection in disc (intervertebral disc involvement type),which presented decreased signal in MRI and protruding disc pressing the dural sac could be found.There were 14 cases of multiple vertebral tuberculosis in continuity (contiguous spinal tuberculosis),which presented multiple tuberculosis lesions on 3D-CT.There were 7 cases of multiple vertebral tuberculosis in noncontinuity (noncontiguous spinal tuberculosis),which presented destructive tubercular lesions affected different levels in different regions of the spine on MRI.Conclusion Atypical spinal tuberculosis had multiply radiographic presentation forms and atypical radiographic features.Worm-eaten destruction of bone or vertebral endplate,marrow edema and increased signal intensity of paraspinal ligament are features of radiographic presentation in diagnosis of atypical spinal tuberculosis.

Curative effect evaluation and complication analysis of Bryan artificial cervical disc replacement / 中国骨伤

<p><b>OBJECTIVE</b>To observe the curative effects and complications of Bryan cervical disc replacement for cervical disc herniation.</p><p><b>METHODS</b>From Jannary 2005 to December 2008,39 patients with cervical disc herniation were treated with Bryan cervical disc replacement. There were 20 males and 19 females,with an average age of 47 years old (ranged, 35 to 59). Spinal compression symptom (20 cases) and nerve root symptom (19 cases) were main clinical symptoms. Single level disc was replaced in 35 cases and two-level replaced in 4 cases. Offset and activity of prosthesis,cervical physiological curvature, heterotopic ossification, prosthetic fusion were observed by dynamic X-ray. According to Odom's standard and JOA score,nerve function were evaluated; and depending on NDI standard,clinical symptom and daily function status were recorded.</p><p><b>RESULTS</b>All the patients were followed up from 16 to 36 months with an average of 24 months. Nerve function obviously improved and radiating pain of upper limb completely relieved. No patient with prosthetic anterior-posterior offset more than 2 mm was found. Prosthetic flexion and extention angle was (8.5+-1.8)degrees,left and right flexion range respectively were (3.5+/-1.2)degrees and (3.3+/-1.5)degrees. Cervical physiological curvature improved obviously or recovered normally. Three cases occurred in heterotopic ossification and 2 cases occurred in prosthetic fusion. According to Odom's standard,25 cases got an excellent results,9 good, 5 fair, the rate of excellent and good was 87.2%. JOA score increased from preoperative (8.26+/-1.32) to (15.71+/-1.89) at final follow-up and NDI decreased from preoperative (43.7+/-3.8) to (20.1+/-2.9) at final follow-up.</p><p><b>CONCLUSION</b>Treatment of cervical disc herniation with Bryan cervical disc replacement can get the good curative effects,which can obtain good nerve functional recovery,cervical stability and activity. Nevertheless,the operation has typical complication such as heterotopic ossification and prosthetic fusion. Thus,it is important in chosing indication and operative procedure.</p>

One-stage debridement and bone grafting with internal fixation via posterior approach for treatment of children thoracic spine tuberculosis / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the outcome of the children with thoracic spine tuberculosis who underwent radical debridement, reconstruction with bone autograft or allograft and internal fixation via posterior approach.</p><p><b>METHODS</b>From June 2005 to December 2010,9 children with thoracic spine tuberculosis underwent radical debridement, reconstruction with bone autograft or allograft and internal fixation via posterior approach including 7 males and 2 females with an average age of 7 years old ranging from 3 to 12 years. The course of the disease ranged from 3 months to 1 year (averaged 6 months). All the patients had continuous thoracic and back pain,intercostal nerve pain and kyphosis deformity, accompanied with low fever,night sweat and pathologic leanness. The predilection sites examined by X-ray, CT or MRI were in T4 to T9 segment. The kyphosis angle ranged from 35 degrees to 72 degrees (averaged 48.2 degrees) before surgery. The ASIA classification was as follows: 2 cases at grade B, 5 at grade C, 2 at grade D. All the patients underwent a standard one-stage operation via posterior approach. Radical debridement was performed, then iliac crest bone autograft or allograft was placed and transpedicular screw system internal fixation was done to reconstruct the spinal column. The change of kyphosis angle and fusion of bone grafting were reexamined by X-ray regularly. The neurological function were evaluated according to ASIA classification.</p><p><b>RESULTS</b>There was no injury of blood vessel or spinal cord during the surgery. Nine children were followed-up for 16 to 38 months (averaged 24 months). The tuberculosis symptoms disappeared after surgery and there was no tuberculosis recurrence,incision infection, sinus formation and internal fixation failure in any of these chiildren. ESR reexamination recovered normally. Bony fusion was obtained in all patients and internal fixation position was normal 4 to 8 month postoperatively. The kyphosis angle ranged from 12 degrees to 30 degrees (averaged 19.50) at final followed-up. The function of spinal cord improved postoperatively, the function of spinal cord recovered at different degrees: 2 cases at grade C, 2 at grade D, and 5 at grade E.</p><p><b>CONCLUSION</b>The one-stage posterior approach can provide direct and safe access to the lesion. The effect of vertebral canal decompression and kyphosis deformity correction were significantly. The structural iliac crest autograft or allograft and posterior transpedicular screw system could work effectively to stabilize the thoracic junction.</p>

Analysis of postoperative recurrence reason and observation of reoperation outcome for spinal tuberculosis / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the reason of postoperative recurrence of spinal tuberculosis and observe the clinical outcome of these patients in reoperation.</p><p><b>METHODS</b>From January 2002 to May 2010,27 patients with postoperative recrudescent spinal tuberculosis were treated. There were 15 males and 12 females with an average age of 36.5 years old (ranged, 21 to 65). The risk factors and effect strength associated with postoperative recrudescent spinal tuberculosis were compared by Logistic regression analysis. Individual operation was performed according to the major reason. Re-operative methods including debridment in 5 cases, debridment and sinuses resection in 7 cases, one stage debridement and bone grafting via anterior approach and internal fixation via posterior approach in 8 cases, one stage bone grafting and internal fixation via posterior approach combined with CT-guided percutaneous catheter drainage and local chemotherapy in 2 cases, CT-guided percutaneous catheter drainage and local chemotherapy in 5 cases. Antituberculosis drugs were regularly used in all patients after operation. The ESR, X-ray and 3D-CT were regularly performed to estimate the progress of tuberculosis and condition of bony fusion.</p><p><b>RESULTS</b>The risk factors associated with postoperative recrudescent spinal tuberculosis were complicated, including no regularly used antituberculosis drugs before and after operation, no early diagnosis and treatment of the postoperative fluidify, malnutrition, no thoroughly debridement during operation and poor spinal stability after operation, according to effect strength to arrange. There was no injury of blood vessel,spinal cord or ureter during reoperation. The follow-up period was from 12 to 36 months with an average of 24 months. Tuberculosis symptoms disappeared after reoperation and no complications such as tuberculosis recurrence, infection of incision, sinuses formation and internal fixation failure were found in the patients. ESR recovered normal in follow-up and bone graft obtained fusion at 8 to 12 months after operation and internal fixation position was normal.</p><p><b>CONCLUSION</b>The reoperative reasons of spinal tuberculosis are complicated and multifactorial. The diagnosis and treatment are difficult. It is important to analyze the recrudescent reasons thoroughly before operation,emphasize the application of regularly antituberculosis drugs and individual operation, meanwhile, reinforce nourishment and supportive treatment.</p>

Application of the tension skin flap with different shapes in the pedicle of the reverse neurocutaneous island flap / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the effects of the tension skin flap with different shapes on the transplantation of the reverse neurocutaneous island flap.</p><p><b>METHODS</b>From January 2006 to January 2012,there were 21 patients in the study (including 15 males and 6 females), and aged from 14 to 58 years old (35 years old on average). Tension skin flaps with different shapes (triangle ,round and ellipse) were used to improve the blood supply of the reverse neurocutaneous island flap. The tension skin flaps in the pedicle were designed triangularly (10 patients), spherically (8 patients) or elliptically (3 patients). There were 5 patients with defects in the hand (the size from 5.0 cm x 2.0 cm to 8.0 cm x 5.0 cm), and 16 patients with defects in the foot and inferior segment of leg, or around the ankle (the size from 6.0 cm x 4.0 cm to 13.0 cm x 7.0 cm). And all the patients were with the tendon and bone exposed. All the flaps were reversal transplanted, including 5 dorsal neurocutaneous flaps of foot, 4 superficial peroneal neurocutaneous flaps, 4 saphenous neurocutaneous flaps, 3 sural neurocutaneous flaps, 2 superficial radial neurocutaneous flaps, 3 lateral neurocutaneous flaps of forearm. And the survival rate, appearance and sensory recovery of the flaps were analyzed.</p><p><b>RESULTS</b>The distant part of the reversed sural neurocutaneous island flap in 1 case necrosized and healed after dressing change. The other flaps survived entirely, and the donor site all healed primarily. The follow-up time was from 3 months to 2 years (averaged 7 months), and all the flaps had recovered pain and warm sensation with perfect appearance.</p><p><b>CONCLUSION</b>The tension skin flap in the pedicle can enhance the blood supply and promote survival rate of the reverse neurocutaneous island flap, and can also improve its appearance.</p>

Different surgical approaches for treatment of fracture and dislocation of the lower cervical spine / 中华创伤杂志

Objective To investigate outcomes of different surgical approaches for treating cases of fracture and dislocation of the lower cervical spine.Methods The study involved 26 cases of fracture and dislocation of the lower cervical spine treated surgically from December 2002 to January 2012,including 19 males and 7 females with age ranging from 27 to 62 years (average 39 years).According to the AO classification,there were 12 cases of type B3.1,three of type B3.2,two of type C2.1,three of type C3.1,and six of type C3.2.Preoperative spinal cord function graded by Frankel criteria was six cases of grade A,five of grade B,seven of grade C,six of grade D,and two of grade E.Conventional skull traction was done for all patients before operation.Vertebral cannal decompression and interbody fusion through anterior,posterior or anterior-posterior approaches were determined according to type of fracture dislocation and severity of spinal cord injury.Radiography was performed regularly after operation to review the correction of dislocation,restoration of vertebral height,and interbody fusion.Spinal cord function was also evaluated postoperatively.Results No large blood vessel injury or aggravation of spinal cord injury occurred intraoperatively.There were no complications of incision infection,leakage of cerebrospinal fluid,herniation of bone graft or implant breakage postoperatively.All cases obtained successful correction of fracture and dislocation of the lower cervical spine as well as the recovery of cervical sequence,physiological curvature,and vertebral height in the 12 to 24 months of follow-up (average 16 months).Bony fusion was obtained for all cases at postoperative 3-6 months (average 3.5 months).Spinal function evaluated by Frankel criteria at the latest follow-up showed was grade A in six cases,grade B in three,grade C in five,grade D in five and grade E in seven,with different degree of improvement for all cases.Conclusions Operative approaches should be selected according to the specific status of fracture and dislocation of the lower cervical spine.Anterior approach can be performed for vertebral or intervertebral disc injury straightly and the procedure handles cervical instability immediately.Posterior surgical approach can be used to settle dislocation and interlocking of the articular process directly,but the intervertebral disc injury should be ruled out simultaneously in order to avoid further injury of spinal cord during the reduction process.Combined anterior and posterior surgical approach can be applied to treat fracture and dislocation of lower cervical spine and intervertebral disc injury concurrently but has high risk and large operation wound.