Comparison of the anterior and posterior approach in treating four-level cervical spondylotic myelopathy / 中华医学杂志(英文版)

BACKGROUND@#The optimal surgical approach for four-level cervical spondylotic myelopathy remains controversial. The purpose of this study was to compare clinical and radiological outcomes and complications between the anterior and posterior approaches for four-level cervical spondylotic myelopathy.@*METHODS@#A total of 19 patients underwent anterior decompression and fusion and 25 patients underwent posterior laminoplasty and instrumentation in this study. Perioperative information, intraoperative blood loss, clinical and radiological outcomes, and complications were recorded. Japanese Orthopedic Association (JOA) score, 36-item short form survey (SF-36) score and cervical alignment were assessed.@*RESULTS@#There were no significant differences in JOA scores between the anterior and posterior group preoperatively (11.6 ± 1.6 vs. 12.1 ± 1.5), immediately postoperatively (14.4 ± 1.1 vs. 13.8 ± 1.3), or at the last follow-up (14.6 ± 1.0 vs. 14.2 ± 1.1) (P > 0.05). The JOA scores significantly improved immediately postoperatively and at the last follow-up in both groups compared with their preoperative values. The recovery rate was significantly higher in the anterior group both immediately postoperatively and at the last follow-up. The SF-36 score was significantly higher in the anterior group at the last follow-up compared with the preoperative value (69.4 vs. 61.7). Imaging revealed that there was no significant difference in the Cobb angle at C2-C7 between the two groups preoperatively (-2.0° ± 7.3° vs. -1.4° ± 7.5°). The Cobb angle significantly improved immediately postoperatively (12.3° ± 4.2° vs. 9.2° ± 3.6°) and at the last follow-up (12.4° ± 3.5° vs. 9.0° ± 2.6°) in both groups compared with their preoperative values (P = 0.00). Three patients had temporary dysphagia in the anterior group and four patients had persistent axial symptoms in the posterior group.@*CONCLUSIONS@#Both the anterior and posterior approaches were effective in treating four-level cervical spondylotic myelopathy in terms of neurological clinical outcomes and radiological features. However, the JOA score recovery rate and SF-36 score in the anterior group were significantly higher. Persistent axial pain could be a major concern when undertaking the posterior approach.

Effect of Resveratrol on Preventing Steroid-induced Osteonecrosis in a Rabbit Model / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Prevention of osteonecrosis (ON) has seldom been addressed. The purpose of this study was to evaluate the effect of resveratrol on preventing steroid-induced ON in rabbits.</p><p><b>METHODS</b>Seventy-two rabbits were divided into four groups: (1) NEC (ON) group: thirty rabbits were treated with lipopolysaccharide (LPS) once, then with methylprednisolone (MPS) daily for 3 days; (2) PRE (prevention) group: thirty rabbits were given one dose of LPS, then MPS daily for 3 days, and resveratrol on day 0 and daily for 2 weeks; (3) RES (resveratrol) group: six rabbits were given resveratrol for 2 weeks but without LPS/MPS; (4) CON (control) group: six rabbits were given alcohol for 2 weeks but without LPS/MPS. Levels of plasma tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor 1 (PAI-1), thrombomodulin (TM), vascular endothelial growth factor (VEGF), maximum enhancement (ME) by magnetic resonance imaging, and ON incidence were evaluated.</p><p><b>RESULTS</b>The PRE group had a lower ON incidence than the NEC group, but with no significant differences at 2 weeks and 12 weeks. The RES and CON groups did not develop ON. TM and VEGF were significantly higher in the NEC group compared with the PRE group at weeks 1, 2, and 4 (TM: 1 week, P = 0.029; 2 weeks, P = 0.005; and 4 weeks, P = 0.047; VEGF: 1 week, P = 0.039; 2 weeks, P = 0.021; 4 weeks, P = 0.014), but the difference disappeared at 12 weeks. The levels of t-PA and PAI-1 were not significantly different between the NEC and PRE groups. The TM, t-PA, PAI-1, and VEGF concentrations in the RES and CON groups did not change over time. Compared to the baseline, ME in the NEC group decreased significantly (P = 0.025) at week 1, increased significantly (P = 0.021) at week 2, and was decreased at week 12. The variance was insignificant in the PRE group.</p><p><b>CONCLUSIONS</b>Resveratrol may improve blood supply to bone in a rabbit model of ON of the femoral head via anti-inflammatory effects to protect the vascular endothelium and reduce thrombosis.</p>

Case of Langerhans Cell Histiocytosis That Mimics Meningioma in CT and MRI

Langerhans cell histiocytosis (LCH) is a rare disorder histologically characterized by the proliferation of Langerhans cells. Here we present the case of a 13-year-old girl with LCH wherein CT and MRI results led us to an initially incorrect diagnosis of meningioma. The diagnosis was corrected to LCH based on pathology findings. An intracranial mass was found mainly in the dura mater, with thickening of the surrounding dura. It appeared to be growing downward from the calvaria, pressing on underlying brain tissue, and had infiltrated the inner skull, causing a bone defect. The lesion was calcified with the typical dural tail sign. The dural origin of the lesion was verified upon surgical dissection. There are no previous reports in the literature describing LCH of dural origin presenting in young patients with typical dural tail signs and meningioma-like imaging findings. The current case report underscores the need for thorough histological and immunocytochemical examinations in LCH differential diagnosis.

Comparison of Clinical Influence of Intramedullary versus Extramedullary Alignment Guides on Total Knee Arthroplasty / 中国医学科学院学报

<p><b>UNLABELLED</b>Objective: To compare the clinical influence of intramedullary versus extramedullary alignment guides on total knee arthroplasty (TKA) in terms of alignment of the lower limbs,intraoperative tourniquet time,and postoperative complications.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 105 patients(210 knees)undergoing bilateral TKA from February 2012 to November 2013. All patients were divided to two groups:40 [age:(66.65 ± 9.57)years] were implanted using intramedullary guides on the tibia and 65 [age:(65.29±9.27)years] were implanted using extramedullary guides on the tibia. Alignment of lower limb,tibial component angle in the sagittal plane,tourniquet time,and postoperative complications were compared.</p><p><b>RESULTS</b>The gender ratio,age,height,weight,body mass index,and preoperative alignment of lower limbs were not significantly different between these two groups (all P>0.05). The average coronal alignment of lower extremity was (179.69 ± 2.91)° in the intramedullary guides group and (178.26 ± 3.38)° in the extramedullary guides group (P=0.002). The alignment of lower limbs on neutral and valgus position were found in 68 cases(85.00%)in the intramedullary group and in 94 cases (72.31%) in extramedullary group (P=0.033) ;the tourniquet time was (79.46 ± 12.06) min in the intramedullary group and (84.68 ± 8.02) min in the extramedullary group (P=0.001); the postoperative complication rate was 6.25% in intramedullary group and 3.07% in extramedullary group (P=0.279).</p><p><b>CONCLUSION</b>Alignment and tourniquet time can be significantly improved by the intramedullary instrumentation,while the incidence of complications associated with intramedullary instrumentation is higher than extramedullary instrumentation.</p>

The microbiology and antimicrobial susceptibility of the infected knee arthroplasty / 中华外科杂志

<p><b>OBJECTIVES</b>To describe the microbiology, antimicrobial susceptibility of patients proven prosthetic joint infection (PJI) after primary total knee arthroplasty (TKA)and to provide reference for the diagnosis and treatment of this complication.</p><p><b>METHODS</b>The medical data of the patients with infected knee arthroplasty, who were managed with revision surgery between January 1995 to December 2011 were reviewed. Twenty-nine cases were identified and majority of the patients were female (23/29). Diagnosis of PJI after primary TKA was between 1 week and 10 years (average 24.3 months). The microbiology and antimicrobial susceptibility were analyzed.</p><p><b>RESULT</b>The overall positive rate of cultures was 65.5% (19/29). The most common organisms identified were Coagulase-negative Staphylococcus (CNS) (7/19) and Staphylococcus Aureus (SA) (5/19). Rare pathogens of Mycobacterium (2/19) and fungi (1/19) were also identified. Vancomycin was the most effective antibiotics with overall sensitivity rates of 100%.Resistant and rare pathogens were all in type IV infection.</p><p><b>CONCLUSIONS</b>Gram-positive bacterias are the main pathogen, resistant and rare pathogens should be payed attention to. Antibiotic treatment for infected TKA should be based on the results of drug susceptibility. Vancomycin allows infected knee arthroplasties before the result.</p>

Comparison of blood loss during total knee arthroplasty between haemophilic arthropathy and osteoarthritis / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the amount of blood loss and the efficacy of clotting factor in controlling blood loss during total knee arthroplasty.</p><p><b>METHODS</b>The medical documents of 18 patients with haemophilic arthritis (HA) secondary to haemophilia A and 19 patients with osteoarthritis (OA) were retrospectively reviewed. Demographic data,functional and hematological test results,the amount of blood loss and transfusion,and complications were analyzed.</p><p><b>RESULTS</b>The median amounts of total and external blood loss were 2240 ml(1892-3415 ml) and 1326 ml(934-2256 ml)in the HA group, which were significant higher than those in the OA group [1746 ml(1259-2246 ml)and 846 ml (504-1217 ml), respectively]. The median amounts of external blood loss in the two groups were 680 ml(370-1330 ml)and 730 ml(200-1190 ml)and there was no significant difference(p=0.620). Moreover, more patients in the HA group required blood transfusion (84.2% vs. 47.4%), and more red cells were transfused per patient in the HA group (2.3 U vs. 0 U).</p><p><b>CONCLUSIONS</b>The total blood loss and hidden blood loss are higher in the HA patients than in OA patients during total knee arthroplasty, although the external blood loss is basically the same. Management with more clotting factor may decrease the blood loss in HA patients.</p>

Treatment of severe bone deficiency in acetabular revision surgery using a reinforcement device and bone grafting / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Severe acetabular bone deficiency is a major challenge in acetabular revision surgery. Most cases require reconstruction of the acetabulum with bone grafting and a reinforcement device. The purpose of this study was to evaluate the results of this procedure for severe acetabular bone deficiency in acetabular revision surgery.</p><p><b>METHODS</b>This study involved 12 patients (2 males and 10 females) with severe acetabular bone defects who underwent implantation of a reinforcement device (ring or cage) and bone grafting between February 2003 and October 2008. Using the Paprosky classification, 2 cases were Paprosky IIC, 6 were IIIA, and 4 were IIIB. The mean age at the time of surgery was 63.0 years (range, 46 - 78 years). During revision surgery, a reinforcement ring was implanted in 6 patients, and a cage in 6 patients. The clinical and radiographic results were evaluated retrospectively. The mean duration of follow-up was 37 months (range, 9 - 71 months).</p><p><b>RESULTS</b>The average Harris Hip Score improved from 35.2 preoperatively to 82.9 at the time of the final follow-up visit. The results were excellent in 8 hips (66.7%), good in 2 (16.7%), and fair in 2 (16.7%). Osteolysis was found in 1 case, but did not worsen. Three patients had yellow wound effusion, with healing after administration of dressing changes, debridement, and antibiotics. Dislocation occurred in a 62-year-old woman. Closed reduction was performed, and dislocation did not recur. There was no evidence of intraoperative acetabular fracture, nerve injury, ectopic ossification, aseptic loosening, or infection.</p><p><b>CONCLUSION</b>Reconstruction with a reinforcement device and bone grafting is an effective approach to the treatment of acetabular bone deficiency in acetabular revision surgery, given proper indications and technique.</p>

Acetabular revision arthroplasty using antiprotrusio cage / 中华外科杂志

<p><b>OBJECTIVE</b>To study the efficacy of acetabular antiprotrusio cage for the reconstruction of acetabular bone defect in revision hip arthroplasty.</p><p><b>METHODS</b>Twelve cases of severe acetabular bone defect after total hip arthroplasty were revised with antiprotrusio cage and bone grafting from February 2003 to October 2008. Clinical and radiological data before and after revision surgery were collected and compared for assessment.</p><p><b>RESULTS</b>The classification of acetabular bone defect of this group of patients according to Paprosky classification was: 2 cases of type IIB, 6 cases of type IIIA and 4 cases of type IIIB. The average postoperative follow-up period was 37 months (9 - 71 months). Mean Harris score of all cases was 35.2 before revision surgery, 80.9 at the first time follow-up and 84.6 at latest follow-up. There were no prosthesis loosening and breakage. There was mild radiolucent line in Delee & Charnley III zone of the acetabulum in one patient 6 month after revision, but no deterioration was found during further follow-up. No further revision was needed in this group of patients during the follow-up.</p><p><b>CONCLUSIONS</b>Reconstruction of acetabular bone defect using antiprotrusio cage and bone grafting is a useful method to restore the bone defect and stability of the acetabulum. The outcome via short to middle term follow-up is encouraging.</p>