Modified arthroscopic anterior approach for the treatment of shoulder Bankart lesion / 中国骨伤

OBJECTIVE@#To explore the effects of single anterior approach under shoulder arthroscopy in the treatment of Bankart injury, and to provide a scheme to overcome the difficulties and simplify the operation process.@*METHODS@#From July 2016 to January 2019, 62 patients with recurrent dislocation caused by Bankart leision were treated under shoulder arthroscopy, including 50 males and 12 females, ranging in age from 19 to 44 years old with an average age of (26.5±6.1) years old. There were 25 cases of left shoulder and 37 cases of right shoulder. The patients were divided into two groups according to the operation mode, 35 patients in the front modified single approach group (experimental group) and 27 patients in the traditional double approachgroup (control group). The results of the operation were evaluated by assessing the preoperative and postoperative ASES scores of the shoulder joint, and the time of the approach establishment and the overall operation process was recorded to evaluate whether the operation time of the experimental group was shortened.@*RESULTS@#Three patients were lost during the follow-up after operation, and except for one case of re-dislocation, all patients achieved satisfactory results without neurovascular injury and other complications. The patients were followed up before operation and 3, 6, 12 months after operation, and the ASES scores were significantly enhanced at the latest follow-up compared with those of before operation. The time of establishing surgical approach in the experimental group was (7.5±1.5) minutes, which was shorter than that of control group (13.7±1.2) minutes.@*CONCLUSION@#The improved technique of single-channel anterior approach has the advantages of reducing the surgical incision and shortening the operationtime while ensuring the quality of the operation, which is worthy of popularization and application.

An anthropometry study of the shoulder region in a chinese population and its correlation with shoulder disease / Estudio antropométrico de la región del hombro en una población china y su relación con enfermedad del hombro

Purpose: There is a paucity of data which reflected the relationship between morphology and incidence of shoulder disorders with respect to the ethnic Chinese population. We used anteroposterior radiographs to measure the Acromion Index (AI) and Acromioglenoid Angle (AA) of Chinese patients. The baseline was defined as the line that connected the superior and inferior osseous margins of the glenoid cavity. In order to calculate the AI, the distance from the baseline to the lateral margin of the acromion was measured and then divided by the distance from the baseline to the lateral aspect of the humeral head. The AA was defined as the angle formed by the intersecting line drawn tangent to the sclerotic line of the acromion undersurface and the baseline point. The AI and AA were determined in three groups: 165 patients (average age, 60.2 years) with chronic shoulder symptoms; in an age and gender-matched acute injury group of 61 patients (average age, 44.3 years); and in an age and gender-matched control group of 63 volunteers (average age, 37.3 years).The average AI and standard deviation was 0.72 +/- 0.06 in shoulders with subacromial impingement syndrome, 0.59 +/- 0.06 in those with acute injury, and 0.66 ± 0.06 in normal shoulders. The average AA and standard deviation was 76.8°+/-7.02 in shoulders with subacromial impingement syndrome, 84.2°+/-7.81 in those with acute injury, and 80.0°+/- 7.33 in normal shoulders. The AI and AA varied between patients with acute and chronic shoulder problems.

Hay escasez de datos que reflejen la relación entre la morfología y la incidencia de los trastornos de hombro con respecto a la población de origen chino. Se utilizó radiografías anteroposteriores para medir el índice acromial (IA) y ángulo acromioglenoido (AA) de los pacientes chinos. La línea de base se define como la que conecta los márgenes óseos superior e inferior de la cavidad glenoidea. Con el fin de calcular el IA, se midió la distancia desde la línea base hasta el margen lateral del acromion y luego se dividió por la distancia desde la línea base hasta la cara lateral de la cabeza humeral. El AA se define como el ángulo formado por la línea de intersección dibujada tangente a la línea esclerótica de la superficie inferior del acromion y el punto de línea base. El AI y AA se determinaron en tres grupos: 165 pacientes (edad media, 60,2 años) con síntomas crónicos en el hombro; en un grupo de 61 pacientes (edad media, 44,3 años) con herida aguda, y en un grupo control de 63 voluntarios (edad media, 37,3 años). La IA promedio fue de 0,72 +/- 0,06 en los hombros con el síndrome de pinzamiento subacromial, 0,59 +/- 0,06 en los pacientes con lesión aguda, y 0,66 +/- 0,06 en los hombros normales. El AA promedio fue de 76,8 ° +/- 7,02 en los hombros con el síndrome de pinzamiento subacromial, 84,2 ° +/- 7,81 en los pacientes con lesión aguda, y 80,0 ° +/- 7,33 en los hombros normales. La IA y AA variaron entre los pacientes con problemas en el hombro agudos y crónicos.

Reconstruction of the medial patellofemoral ligament using hamstring tendon graft with different methods: a biomechanical study / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To measure the tensile strength of the normal medial patellofemoral ligament (MPFL), and evaluate the biomechanics of different fixation methods of the hamstring tendon graft on the patella.</p><p><b>METHODS</b>Eight fresh cadaver knees were prepared by isolating the patella, leaving only the MPFL as its attachment to the medial condyle of femur. The MPFL was reconstructed by three different methods: four-suture fixation, anchors-single suture fixation, and anchors-double suture fixation. The tensile strength and the elongation of the normal MPFL and the tendon grafts were measured.</p><p><b>RESULTS</b>The tensile strength of the four-suture fixation group (234.86±49.02 N) was stronger than that of the normal MPFL (146.91±25.30 N, P=0.0014) and the anchors-single suture group (159.17±49.07 N, P=0.0077), while weaker than that of the anchors-double suture group (314.74±78.46 N, P=0.0052) CONCLUSIONS: With regard to the tensile strength, the four-suture fixation method is reliable for clinical use. Compared with the anchor-suture method, the four-suture fixation method which has no specific implants is more economical, convenient and efficient.</p>

Distinguish reasons for the variety of intraoperative transcranial magnetic motor evoked potential: the anaesthesia or the operative injury / 中华外科杂志

<p><b>OBJECTIVE</b>To find a way to discriminate operative reason from anaesthesia reason for the changes of intraoperative transcranial magnetic motor evoked potentials (MEPs).</p><p><b>METHODS</b>In 26 patients under Etomidate/Fentanyl anesthesia from February 2001 to June 2004, MEPs elicited by transcranial magnetic stimulation were recorded from tibialis anterior muscles, simultaneously bispectral index (BIS) and train-of-four stimulation (TOF) were used to monitor the anesthesia depth and neuromuscular blockade respectively. MEP, BIS and measurements of TOF at different anesthesia depth and muscular relaxation were recorded synchronously, statistical analysis of this data set was done in order to find the inherent relationship between these variables.</p><p><b>RESULTS</b>Under anesthesia, MEP amplitude was always positively correlated with the corresponding BIS and TOF value. A regression equation could be built, with which the MEP amplitude could be reckoned based on realtime BIS and T(1)/T(c). In case of spinal cord injury, the measured amplitude value would significantly deviate from predicted one, which suggested that the change of MEP was because of the operation, but not the anaesthesia or neuromuscular blockade. Each patient had his or her own regression equation, which was different from each other.</p><p><b>CONCLUSIONS</b>The establishment of regression equation from MEPs, BIS and TOF is very useful to distinguish reasons of the changes of transcranial magnetic MEPs during surgery, and with this technique, the intraoperative MEP monitoring should be more reliable and practicable.</p>

Prostate cancer with five different histological features: a case report and review of the literature / 中华男科学杂志

<p><b>OBJECTIVE</b>To study the clinical manifestations, pathological characteristics and treatment methods of prostate cancer with five different histological features.</p><p><b>METHODS</b>We reported 1 case of prostate cancer with five different histological features and further analyzed the diagnosis, pathology and treatment of the disease by reviewing the relevant literature.</p><p><b>RESULTS</b>The patient was an 84-year-old male, admitted due to difficult urination and dribbling urine for 1 year, hematuria for 8 months and deterioration for 2 weeks. Prostate cancer was indicated by rectal examination, ultrasonography, CT, MRI and PSA, and confirmed by biopsy. Considering the general condition of the patient, we performed electrotransurethral resection under epidural anesthesia to alleviate his urinary symptoms and remove suspected tumor tissues. Postoperative pathology showed the case to be prostate adenocarcinoma, histologically characterized by cribriform carcinoma, acinar carcinoma, diffuse invasive carcinoma, ductal carcinoma, and mucinous adenocarcinoma, with a Gleason score of 9. Bicalutamide and goserelin were administered postoperatively. Systemic metastasis occurred 10 months later, and the patient died 1 year after the operation.</p><p><b>CONCLUSION</b>Prostate cancer with five different histological features is extremely rare. Its early diagnosis is difficult and mainly depends on pathological and immunohistochemical examinations, and radical prostatectomy can be considered for its treatment.</p>

Expressions of integrinalpha2beta1 and CD133 in benign prostatic hyperplasia complicated by prostatitis and their significance / 中华男科学杂志

<p><b>OBJECTIVE</b>To study the expressions of Integrinalpha2beta1 and CD133 in benign prostatic hyperplasia (BPH) complicated by prostatitis and their significance.</p><p><b>METHODS</b>Specimens were obtained from 56 BPH patients undergoing transvesical prostatectomy. Paraffin sections of the specimens were subjected to HE staining for pathological examination of inflammatory changes under the light microscope. Twenty-four patients with simple BPH were included in Group A, and the other 32 with BPH complicated with prostatitis in Group B. The expressions of Integrinalpha2beta1 and CD133 in the prostatic tissues of the two groups were determined by immunohistochemistry, Western blotting and IPP6.0 image analysis software.</p><p><b>RESULTS</b>The expressions of Integrinalpha2beta1 and CD133 were significantly higher in Group B than in A (P < 0.05), and so were the mean relative value of the optical density of Integrinalpha2beta1 (0.29 +/- 0.18 vs 0.04 +/- 0.03) and that of CD133 (0.08 +/- 0.07 vs 0.0020 +/- 0.0018) (P < 0.05).</p><p><b>CONCLUSION</b>Inflammation can up-regulate the expressions of Integrinalpha2beta1 and CD133 in BPH tissue.</p>

Undifferentiated prostate sarcoma with cartilage metaplasia: a case report and review of the literature / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the clinical presentations and pathologic features of undifferentiated sarcoma of the prostate with cartilage metaplasia, and to clarify its category.</p><p><b>METHODS</b>We analyzed the clinical data of a case of undifferentiated sarcoma of the prostate with cartilage metaplasia treated by surgical resection. The tumor tissue was subjected to routine HE and immunohistochemical staining, its histological structure and immunohistochemical expression were observed under the light microscope, and relevant literature on its manifestations was reviewed.</p><p><b>RESULTS</b>The case was pathologically diagnosed as gray prostate tumor, with chondrosarcomatous and undifferentiated malignant mesenchymal components under the light microscope. Immunohistochemical staining revealed vimentin (+), local CD117 (+/-), SMA (-), Des (-), myoglobin (-), CD34 (-), CK7 (-), and CK8 (-). Tumor metastasis was found 2 months after the operation, and the patient died 4 months later.</p><p><b>CONCLUSION</b>Undifferentiated sarcoma of the prostate with cartilage metaplasia is a very rare and highly malignant aggressive tumor, which can be diagnosed by biopsy and immunohistochemistry.</p>

The utility of neuronavigation in the microsurgery for cerebral cavernous malformations / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the utility of neuronavigation in the microsurgery for cerebral cavernous malformations.</p><p><b>METHODS</b>In a retrospective study, 47 patients with cavernous malformations were involved from January 1995 to December 2010. Fourteen cases admitted into hospital from January 1995 to December 2002 were treated without neuronavigation (conventional group), the focus localization was based on magnetic resonance imaging (MRI) images, anatomic landmarks, and the experiences of the neurosurgeon. In the other 33 cases admitted after February 2002 to December 2010, surgeries were performed with neuronavigation using the Medtronic Stealth Station TREON or TRIA system (neuronavigation group). Excision of the cavernomas were all performed microsurgically, surrounding gliotic rim and hemosiderin stained tissue were resected in the case of epilepsy, and a few patients underwent extended hippocampal resection or multiple subpial transection.</p><p><b>RESULTS</b>With the use of neuronavigation, the extent of craniotomy reduced from 5.2 cm to 3.6 cm (P < 0.01), and deeper cavernoma focuses could be treated surgically. There were no changes with regard to the mean size of the cavernomas, the mean time of surgery and hospital stay (P > 0.05), but the mean time of anaesthesia was prolonged from 164 min to 197 min (P < 0.01). Cavernomas were resected completely in all 47 cases, which was confirmed by postoperative MRI recheck. The conditions of all patients were improved or remain unchanged, and no significant differences in the clinical outcome could be evaluated between the two groups.</p><p><b>CONCLUSIONS</b>Application of neuronavigation-assisted microsurgery of intracranial cavernous malformations surgery, helps reduce the surgical trauma, and has security and reliability.</p>

The utility of transcranial magnetic motor evoked potential monitoring during spinal surgery / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the practicability and validity of transcranial magnetic motor evoked potential monitoring (TMS-MEP) during spinal surgery.</p><p><b>METHODS</b>From February 2001 to June 2004, 37 patients undergoing spinal surgery were involved, anaesthesia was maintained with volatile anesthetics in 11 operations and etomidate in 26. Analgesia was provided with fentanyl, and non-depolarizing muscle relaxant was given intermittently. MEPs elicited with transcranial magnetic stimulations were recorded from tibialis anterior muscles, simultaneously bispectral index (BIS) and train-of-four stimulation (TOF) were used to monitor the anesthesia depth and neuromuscular blockade respectively. The variety of MEP and its effect on surgical operation at different anesthesia depth and muscular relaxation were observed, and the muscle strength of the patients before and after operation were compared.</p><p><b>RESULTS</b>The 11 cases anesthetized with isoflurane or enflurane gave no response to TMS, the other 26 cases in which anaesthesia was maintained with etomidate and fentanyl gave satisfactory TMS-MEPs, but with significantly attenuated amplitudes and prolonged latencies (P < 0.05). Intraoperative MEP showed a grossly unchanged waveform, and its amplitude and latency had little fluctuation when anaesthesia and neuromuscular blockade maintained stable. When T(1) value of TOF at 40% - 60%, a steady MEP could be acquired and the muscular contraction after TMS should not interfere the operation.Seven of 26 cases had a MEP amplitude drop up to 50% or more during the operation, the surgical team was notified to avoid further spinal injury, at last only 1 case had a worsen muscle power after operation.</p><p><b>CONCLUSIONS</b>Myogenic TMS-MEP is a valid and practicable technique for intraoperative monitoring, and the etomidate + fentanyl technique is adequate for its anesthesia. BIS and TOF monitoring are helpful to maintain the steadiness of the anesthesia and MEPs, which is very important for monitoring the changes of the MEPs.</p>

Treatment of multisegmental intramedullary cervical spinal cord ependymomas / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the possibility of microneurosurgery techniques in the treatment of multisegmental intramedullary cervical spinal cord ependymomas.</p><p><b>METHODS</b>The clinical data of 26 cases of multisegmental intramedullary cervical spinal cord ependymomas patients was reviewed and analyzed.</p><p><b>RESULTS</b>There were 14 cases of cervical spinal cord ependymomas, 12 cases of cervical and thoracic spinal cord ependymomas. 4.5 spinal cord segments were involved in average. Incompletely inferior paraplegia was in 18 cases, incompletely high paraplegia in 8 cases, dyspnea in 6 cases, sphincter dysfunction in 10 cases. MRI detected syringomyelia formation in 24 cases. Vertebral lamina reposition were done in 20 cases. Muscle strength recovered in 21 cases, no change in 4 cases, aggravated in 1 case. All cases had total resection and 1 cases vertebral had instability in MRI.</p><p><b>CONCLUSIONS</b>Total resection of intramedullary cervical spinal cord ependymomas can be achieved by microneurosurgery. Most of the symptoms can be released after microsurgical treatment. After multisegmental laminotomy, the vertebral plate reposition should be done to ensure the stability.</p>

Experimental research of myogenic motor evoked potentials to transcranial magnetic stimulation for spinal cord monitoring / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the validity of intraoperative magnetic MEP (motor evoked potentials) monitoring in a spinal-cord-menaced surgery.</p><p><b>METHODS</b>32 rabbits were employed in weight-drop spinal cord contusion model. After anesthetized with a combination of Ketamine and Droperidol the spinal cords were surgically exposed with the dura intact, and the contusion injuries were delivered except the rabbits in control group. The MEPs were recorded and the relationship between the variation of the MEPs and the residual locomotor capacity after spinal cord injury was analyzed.</p><p><b>RESULTS</b>The 6 rabbits in mild-spinal-cord-injury group experienced transient attenuation of their TMS-MEPs, and the locomotor capacity remained intact (scores of 5) in almost all rabbits (5 of 6) when assessed 24 hours later; In the moderate-spinal-cord-injury group the 8 rabbits lost their TMS-MEP immediately after the weight-drop contusion, but they regained them partly in 1 hour one after another and scored 4 or 5 in the assessment of muscle power next day except for one score of 2; 8 rabbits had their spinal cords impaired severely in the contusion procedure and lost their TMS-MEP too but without recovery, their locomotor capacity outcomes were very poor, 5 of them had no response to transcranial magnetic stimulation next day, and in the other 3 rabbits we only found some polyphase waves with variant latency and lower amplitude which did not resemble common compound muscle action potential (CMAPs) evoked by TMS.</p><p><b>CONCLUSIONS</b>Myogenic TMS-MEPs was very sensitive to the spinal cord injury and should be a valid technique for intraoperative monitoring, and a slight change of them, even if a transient lose, should be unnecessarily related to a severe movement disorder. The warning threshold for a given patient should depend on the malady itself.</p>

Development of the new measuring & training device for eustachian tube opening function / 中国医疗器械杂志

This paper presents to you the principles, composition, features and applications of ET-100 measuring-training device for eustachian tube opening function.