Jiawei shentong zhuyu decoction prevented the occurrence of failed back surgery syndrome and its effect on serum TNF-alpha a clinical study / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To explore the clinical roles of Jiawei Shentong Zhuyu Decoction (JSZD) in preventing the occurrence of failed back surgery syndrome (FBSS), and to observe its effect on serum tumor necrosis factor-alpha (TNF-alpha).</p><p><b>METHODS</b>Totally 100 patients prepared for surgical operation due to lumbar intervertebral disc herniation were randomly assigned to the treatment group and the control group according to random number table, 50 cases in each group. Patients in the treatment group additionally took JSZD, one dose per day, taken in two portions, once in the morning and once in the evening. Those in the control group took Celecoxib Capsule (200 mg each time, once per day) and Mecobalamin Tablet (0.5 mg each time, 3 times per day). They only took Mecobalamin Tablet from the 11th day. All patients were treated for 30 days. Japanese Orthopaedic Association (JOA) score was performed before treatment, at week 1, after treatment, at 6 months of followed-ups, and at 12 months of followed-ups. And the levels of TNF-alpha in the peripheral blood were observed before treatment and at one month after treatment.</p><p><b>RESULTS</b>Totally 93 patients completed the followed-up study. The JOA scores were improved after treatment, at 6 and 12 months of followed-ups (P < 0.05, P < 0.01). The JOA score at 6 months of followed-ups was superior in the treatment group to that of the control group (P < 0.05). Five patients (accounting for 10.6%) suffered from FBSS in the treatment group, while 9 (accounting for 19.6%) suffered from FBSS in the control group. The treatment group was superior to the control group (P < 0.05). The TNFalpha level was improved after treatment in the two groups. Of them, the improvement of TNF-alpha in the treatment group was better than that of the control group (P < 0.05).</p><p><b>CONCLUSION</b>The application of JSZD was effective for preventing the occurrence of FBSS, and improved the serum TNF-alpha level.</p>

Clinical study of transforaminal instrumented lumbar interbody fusion / 中国骨伤

<p><b>OBJECTIVE</b>To study the effect and complications of transforaminal lumbar interbody fusion technique.</p><p><b>METHODS</b>The medical records and radiographs of 40 patients undergone transforaminal lumbar interbody fusion between 2005 and 2007 were retrospectively reviewed. There were 49 segments with fusion. Preoperative and 1 year postoperative functional evaluation were graded with ODI and VAS scoring system. The height and angle of the intervertebral space and the fusion status were measured as well.</p><p><b>RESULTS</b>All patients were followed-up for 12 to 24 months with the average of 18 mouths. There were no severity postoperative complications. The operation time averaged 160 min and average blood loss 510 ml. The effect results were excellent in 28 cases, good in 7 and fair in 5. The fusion rate was 100%. One year after operation, the pain relief in the VAS and the reduction of the ODI were significant (P < 0.01), the height and angle of the intervertebral space increased obviously (P < 0.05). Fifteen patients complained low back pain to some extent untill the last follow-up.</p><p><b>CONCLUSION</b>Transforaminal lumbar interbody fusion can achieve satisfactory clinical and radiographic results especially for the failed back surgery syndrome.</p>

The synthetic typing and its clinical application in atlantoaxial dislocation / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the synthetic typing and the treatment strategy for atlantoaxial dislocation.</p><p><b>METHODS</b>The synthetic typing of atlantoaxial dislocation was worked out on the base of pathogenesis typing, Fielding imaging typing, and clinical typing, named PIR typing system (Pathogenesis, Imaging, and Reduction). Ninety-three patients with atlantoaxial dislocation were treated according to this typing system.</p><p><b>RESULTS</b>Nine cases of type-II dens fracture were treated with hollow screw fixation. Bone union was accomplished at the follow-up of three months in all the patients, only with slight limitation of cervical motion. Un-retrieved Fielding I -degree dislocation was found in one case. Among the thirty-four patients treated with trans-oropharyngeal atlantoaxial reduction plate system (TARP), 32 obtained complete atlantoaxial reduction and fusion three months after operation. Atlantoaxial dislocation recurred in the other two cases because of screw loosening and the problem was solved through revision operations. Four patients in non-reducible type underwent anterior and/or posterior decompression. T heir neurological improved after operation but their atlantoaxial joints remained dislocated, and one case complicated with intracranial infection.</p><p><b>CONCLUSIONS</b>Via the synthetic PIR typing system, atlantoaxial dislocation can be better classified according to its pathogenesis, imaging manifestation and mechanic stability. This system can also be served as a guide for clinical treatment. Anterior TARP operation and posterior atlantoaxial trans-pedicle screw-rod fixation are the main methods for the treatment of atlantoaxial dislocation.</p>

The reason and prevention of upper cervical reoperations / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the reasons for the operation performed on 13 patients with upper cervical disease and to explore the management and prevention of upper cervical disease.</p><p><b>METHODS</b>Thirteen patients with upper cervical disease were retrospectively reviewed. The reason for of reoperations on these patients were analyzed. The measures to reduce upper cervical operational complication and bad prognosis were discussed to avoid reoperations.</p><p><b>RESULTS</b>The reasons for reoperations included 9 cases with unstable or re-dislocated atlantoaxial joint, 10 cases with residual spinal cord compression, 1 case with malposition of odontoid screw, 1 case with adjacent cervical spine regression, 1 case with occipital-cervical fusion failure, 1 case with spinal cord injury during operation, 1 case with bone-plant slipped into canales spinalis, and 1 case with demand to take out internal fixation for aggravated symptom.</p><p><b>CONCLUSIONS</b>The common reasons for upper cervical reoperations were due to instability or redislocation of atlantoaxial joint and residual of spinal cord compression. Some measures such as reducing operate miss, using firm internal fixation and decompressing were advisable to decrease the incidence of reoperations.</p>