Cervical Angina: A Literature Review on Its Diagnosis, Mechanism, and Management

Cervical angina has been defined as chest pain that resembles true cardiac angina but originates from the disorders of the cervical spine. Thus, physicians and spine surgeons alike should raise awareness of this unusual condition for diagnosis and treatment. Particularly when neurologic signs and symptoms are present, there should be a strong suspicion for cervical angina in any patient with inadequately explained noncardiac chest pain. Cervical angina can be diagnosed according to negative cardiac workups, positive neurologic examination, and cervical radiographic findings (herniated disk, spinal cord compression, or foraminal encroachment). However, the mechanisms of pain production in cervical angina remain unclear. Previous studies attributed the pain to cervical nerve root compression, cervical sympathetic afferent fibers, referred pain, or lesions of the posterior horn of the spinal cord. Conservative treatments, which include neck collar fixation, head traction, and nonsteroidal anti-inflammatory drugs, have been determined to be successful in most patients with cervical angina. But when conservative treatment fails, anterior cervical surgery with complete decompression of the spinal cord and/or nerve root has been identified to effectively relieve cervical angina symptoms.

Cervical Angina: A Literature Review on Its Diagnosis, Mechanism, and Management

Cervical angina has been defined as chest pain that resembles true cardiac angina but originates from the disorders of the cervical spine. Thus, physicians and spine surgeons alike should raise awareness of this unusual condition for diagnosis and treatment. Particularly when neurologic signs and symptoms are present, there should be a strong suspicion for cervical angina in any patient with inadequately explained noncardiac chest pain. Cervical angina can be diagnosed according to negative cardiac workups, positive neurologic examination, and cervical radiographic findings (herniated disk, spinal cord compression, or foraminal encroachment). However, the mechanisms of pain production in cervical angina remain unclear. Previous studies attributed the pain to cervical nerve root compression, cervical sympathetic afferent fibers, referred pain, or lesions of the posterior horn of the spinal cord. Conservative treatments, which include neck collar fixation, head traction, and nonsteroidal anti-inflammatory drugs, have been determined to be successful in most patients with cervical angina. But when conservative treatment fails, anterior cervical surgery with complete decompression of the spinal cord and/or nerve root has been identified to effectively relieve cervical angina symptoms.

Practice and investigation of clinical teaching mode of standardized treatment in colorectal cancer for fellows in training / 中华胃肠外科杂志

A new clinical teaching mode of standardized treatment in colorectal cancer for fellows in training is reported here with good results. This one-year program included medical ethics education, humanistic management, pre job training, clinical thinking mode, surgery teaching, and computerized teaching. This new clinical teaching mode with distinct features is effective and introduced in this article.

A cadaveric study on establishing an individualized navigation template for the placement of occipital condyle screws using a three-dimensional printing technique / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the feasibility of establishing an individualized navigation template for occipital condyle screws insertion using a fused deposition modeling based three-dimensional printing forming technique, and to evaluate the accuracy and safety of template-assisted condyle screw insertion.</p><p><b>METHODS</b>Thirty adult occipitocervical specimens were selected to take a CT-scan. After original Dicom data imported into the Mimics software, the craniocervical junction models were created, which were used to evaluate anatomic structures and define the screw-related parameters. Design and generate the cavity models of the occipital condyle based on a three-dimensional printing forming technique. After using a free-hand procedure to create a navigation template with a well-established screw path, finish bilateral condyle screws insertion assisted by the navigation template. Anatomy study and CT-scan were taken postoperatively to access the position of the screws.</p><p><b>RESULTS</b>Sixty condyle screws were implanted assisted by 30 individualized navigation templates with an average time cost of (91.4 ± 8.2) s. The axial medial angle, sagittal cranial angle and distance between the entry point to atlantooccipital joint surface were (33.2 ± 6.4)°, (8.9 ± 3.4)°, (3.9 ± 0.9) mm, respectively. The variations due to different sex and sides resulted in a statistically insignificant difference of the parameters. Anatomy study and CT-scan indicated no intrusion of the vertebral artery, hypoglossal canal, condyle emissary vein canal or atlantooccipital joint. Fifty-nine condyle screws were completely contained within the condyle, while only 1 screw perforated lateral condyle wall.</p><p><b>CONCLUSIONS</b>Using the Mimics software for establishing the occipital condyle and related cavity model based on CT-scan images proves to be a feasible and precise method.Occipital condyle screws insertion assisted by a three-dimensional printing model is highly accurate and simple, which could be a new alternative to conventional technique.</p>

Rehabilitative exercise prescription for osteoarthritic patients at different stages after needle knife therapy / 中国组织工程研究

0.05). In the rehabilitation group, all the symptoms and functions were improved significantly after 3 courses of treatment (P

Management of acetabular comminuted fractures combined with compressive defects / 中华创伤骨科杂志

Objective To discuss the therapy for acetabular comminuted fractur e combined with compressive defects. Methods From July 1997 to February 2005, 43 cases of comminuted acetabular fracture combined with compressive defect were t reated. 25 cases were obsolete, 16 fresh, and 2 malformed (90 days after injury) . 34 cases were complicated fractures with defects, and 9 simple fractures with defects. The defect volumes ranged from 3 to 9 cm3, averaging 4.5 cm3. They were treated with ATMFS (acetabular tridimensional memory fixation system) to fixate the comminuted bone fragments tridimensionally. The modified acetabular approac h, reduction of acetabular comminuted articular face, anatomical reconstruction of posterior wall of acetabulum with autogenous ilium, autogenous and artificial bone implantation and bone wax isolation were used. The follow-ups lasted from 5 to 86 months, averaging 15.7 months. Results 31 cases achieved anatomical red uction by filling up the compressive defects. 12 cases were treated by anatomica l reconstruction of posterior wall. On average, 5.3 months after operation, the injured hip joint was as good as the healthy one in 40 cases. Ischemia necrosis of femoral head occurred in 1 case, and 2 cases experienced heterotopic ossifica tion with ischemia necrosis of femoral head which led to osseous fusion of hip j oint. Conclusion The new methods for treatment of acetabular fractures with comp ressive defects elevate the reduction rate of acetabulum and femoral head, and a re effective for the functional recovery of hip joint.

Causes of and strategies for postoperative reduction loss in tibial plateau fracture patients / 中华创伤骨科杂志

Objective To analyze the causes of postoperative step off of the tibial plateau fracture and to suggest strategies to cope with them. Methods 57 cases of tibial plateau fracture who had been treated operatively in our department from January 2001 to June 2003 with satisfactory reduction of the articular surface were reviewed. Their radiograms were analyzed. Results The follow ups lasted 6 to 30 months (average 15 months). Postoperative step off rate was 28.1%in all the cases according to radiological step off criteria. (A depression of the articular surface more than 3 millimeters or malalignment of the extremity more than 5 degrees is considered as step off.). Six causes of loss of reduction were: 1) more than sixty years of age, 2) severe osteoporosis, 3) preoperative displacement and fracture fragmentation, 4) poor anti shearing strength of screw and plate, 5) loose bonegraft, and 6) premature weight bearing. Conclusions The key points to enhance the outcome include precise judgment of the type of fracture, sufficient amount of bonegraft, rigid internal fixation after anatomic reduction and an appropriate plan for performing early, loadless, functional exercise. The traumatic osteoarthritis may be avoided or deferred if the above mentioned six causes can be taken into full consideration or preventive measures can be taken.

Treatment of tibial plateau fracture associated with ligament injuries / 中华创伤骨科杂志

Objective To explore the incidence of tibial plateau fracture with ligament injuries and the early diagnosis and management of the condition. Methods Fifty seven cases of tibial plateau fractures which had been treated operatively from Jan. 2001 to Jun.2003 and had satisfactory reduction of the articular surface were reviewed. The stability of their knee joints was analyzed. Results The follow up lasted 6 to 30 months with an average of 15 months. The incidence of knee unstability was low. The four potential reasons for the postoperative knee stability were found to be: 1) the low prevalence of ligament injury with displaced fractures of tibial plateau; 2) incomplete ligament disruption or mild ligament injury; 3) anatomic reduction and rigid internal fixation; 4) fine and detailed plan for immobilization and functional exercise. Conclusion The prevalence of complete ligament disruption is low, and nonoperative management can result in satisfactory outcomes for tibial plateau fracture with incomplete ligament injury.

Diagnosis and treatment of lumbar disc herniation in teenagers: a clinical analysis of 40 cases / 第二军医大学学报

Objective:To investigate the pathogenesis, clinical feature and alternative approach of lumbar disc herniation in teenagers. Methods: The clinical data of 40 inpatients (age ≤21 years, admitted in Changhai Hospital from 1993 to 2001) with lumbar disc herniation were retrospectively reviewed. Of them, 7 patients received conservative treatment and the remaining underwent operation, including interlaminar partial laminotomy on one side (16 patients), hemilaminar laminotomy (14 patients) and interlaminar partial laminotomy on both sides (3 patients). All patients were followed up for 3 to 10 (4.2?0.6) years. Follow-up evalutions were performed via clinical visits. The Japanese Orthopaedic Association's evaluation system for lower back pain syndrome (JOA score) was used to evaluate the outcomes. Results: The lumbar and leg pain was released in all 40 patients after therapy. There was no deterioration of symptoms in the operative groups. During the follow-up, 8 patients had occasional low back pain but it did not affect their lives, 2 patients in the non-operative group had numbness, and no patients had lumbar degeneration in the operative groups. The improvement of JOA score was more significant in operative groups than in the non-operative group. There were significant differences in JOA scores before and after treatment in all groups (P

Alteration of bone matrix components in degenerative vertebra metabolism of cervical spondylosis / 第二军医大学学报

Objective:To investigate the biological mechanism of the degeneration of cervical spine in cervical spondylosis(CS) by analyzing the alteration of bone matrix components.Methods:Twenty five degenerative cervical vertebra and 8 blood samples from CS cases were collected.The contents of hyaluronic acid(HA),laminin(LN),pro collagen Ⅲ,collagen Ⅳ were detected by radioimmunoassay.Calcium,phosphate and total protein levels were detected by automatic biochemical analyzer.Results:Ruling out the inference of blood, the contents of HA, LN, pro collagen Ⅲ and collagen Ⅳ were significantly lower in degenerated CS vertebra than in the control, so as the levels of calcium and phosphate. Conclusion:Bone matrix components are obviously decreased during the degeneration of cervical vertebra, resulting in the alleviation of bone tenacity and hardness. This may be one of the biological mechanisms of cervical vertebra degeneration and deterioration of cervical spine biomechanics.