ABSTRACT
BACKGROUND:Application of Wiltse paraspinal sacrospinalis splitting approach can reduce paraspinal muscle injuries caused by operations, but there are stil no precise criteria to determine anatomic locations of longissimus-multifidus cleavage planes. OBJECTIVE:To have an intimate knowledge of structural characteristics of Wiltse paraspinal sacrospinalis splitting approach, to determine specific locations of longissimus-multifidus cleavage planes in different lumbar segments, and to provide experiences and references for its clinical applications by observations and measurements of autopsies and magnetic resonance images in Chinese people. METHODS:Ten embalmed adult cadavers were used for anatomical observations. The natural cleavage planes between longissimus and multifidus were noted and bluntly dissected bilateraly. Measurements were done between these planes and the midline at levels of spinous processes of L2 and L4. 400 patients’ images of lumbar spines were also used for observations. Measurements were taken bilateraly between longissimus-multifidus cleavage planes and the midline at levels of discs from L2/L3 to L5/S1. The correlations between these distances and sex or age were analyzed. RESULTS AND CONCLUSION:No important vessels or nerves were found in the longissimus-multifidus cleavage planes of al 10 cadavers. Superior facets and roots of transverse processes could be exposed at the bottom of the planes. At L2, the mean distance was (2.3±0.3) cm; at L4, (3.4±0.6) cm. Of al 400 images, the mean distances from L2/L3 to L5/S1 were respectively (19.71±1.93) mm, (23.49±2.49) mm, (27.49±2.84) mm and (31.36±3.15) mm. No strong correlation was discovered between sex or age with respect to measured distances. This study provides valuable references for clinical application of Wiltse paraspinal sacrospinalis splitting approach. We suggest routine measurements of magnetic resonance imaging before surgeries to reduce iatrogenic injuries.
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Objective To investigate the therapeutic effect of the sandwich method (medical glue +gelatin sponge+medical glue) in the repair of spinal dura mater to prevent the cerebrospinal fluid leakage.Methods From February 2007 to June 2011,54 patients with spinal subdural tumors underwent excision of tumor in our hospital.According to manner of repairing spinal dura mater,all patients were classified into two groups:routine group and sandwich group.There were 16 males and 7 females with an average age of 45.2±7.2 years in the routine group,while 19 males and 12 females with an average age of 44.2±6.4 years in sandwich group.In routine group,the spinal dura mater was repaired through running locked suture.In sandwich group,the spinal dura mater was repaired through running locked suture,painting medical glue around the dural incision,covering with gelatin sponge,and painting medical glue on the surface and margin of gelatin sponge successively.Results Compared with the routine group,the total volume of postoperative drainage in sandwich group decreased significantly on the very day,the first day,the second day,and the third day,and the incidence of cerebrospinal fluid leakage decreased significantly.Before discharge,hydrops happened in 3 cases in the routine group,and got well through aspiration,continuous pressure by sandbag,and prone position.Three months after operation,5 cases from the routine group got deep hydrops under the incision and no treatment was applied to them.There was no obvious abnormality in the sandwich group.Conclusion The sandwich method can improve the repair effect of spinal dura mater injury,reduce the volume of postoperative drainage,and decrease the incidence of cerebrospinal fluid leakage
ABSTRACT
The dislocation of acromioclavicular joint is a common type of dislocation in clinic. Non- operative therapy has usually been the main traditional method to deal with it. However, with research on its mechanism and classification going further and further, more and more scholars have been inclined to apply surgical methods in recent years. In this article, we discuss briefly the non- operative and operative methods for dislocation of acromioclavicular joint